Objective To evaluate the impact of dynamic changes in proteinuria on the deterio-ration of renal function in patients with IgA nephropathy(IgAN).Methods A total of 105 patients with IgAN were selected as the study subjects,and they had complete 3-year follow-up data.Based on the initial 24 h proteinuria levels,the patients were categorized into mild proteinuria(group A,＜1.0 g),moderate proteinuria(group B,1.0 to 3.0g)and severe proteinuria(group C,＞3.0 g).The primary endpoint of this study was the incidence of an annual decline rate of ≥30％in the esti-mated glomerular filtration rate(eGFR),while the secondary endpoint was the occurrence of end-stage renal disease events.Survival analysis was conducted using the Kaplan-Meier method.Cox pro-portional hazards regression model was employed to assess the impact of different clinical variables on renal function decline.Receiver operating characteristic(ROC)curves were plotted to analyze the predictive efficacy of changes in proteinuria levels on disease progression.Results Statistically sig-nificant differences were observed among the three groups in terms of the proportion of patients with eGFR decline rate of ≥30％and hormone therapy(P＜0.05).The mean survival time was 35.686 months in the group A,34.644 months in the group B,and 29.760 months in the group C.Both the initial proteinuria level(OR=4.068,P＜0.001)and the change in proteinuria level(OR=3.914,P＜0.001)were significant predictors of renal function decline.The initial proteinuria level[area under the curve(AUC)=0.825,P＜0.001]demonstrated higher predictive efficacy for the deterioration of IgAN compared to the change in proteinuria level(AUC=0.643,P＜0.05).Con-clusion The initial proteinuria level and its dynamic changes are important predictors of renal func-tion progression in patients with IgAN.Monitoring the dynamic changes in proteinuria can facilitate early intervention in renal function deterioration.

Objective:To explore the influencing factors for pathological upgrading in prostate cancer patients with a Gleason score of 3 + 3 undergoing targeted biopsy，and to establish a nomogram prediction model.Methods:A retrospective analysis was conducted on 191 patients with localized prostate cancer diagnosed with a Gleason score of 3 + 3 through targeted biopsies at the First Affiliated Hospital of Nanjing Medical University from January 2020 to June 2024. The age of the patients was 67（61，73）years，with prostate-specific antigen（PSA）level of 7.44（5.53，10.19）ng/ml，prostate volume of 35.64（26.59，48.97）ml，and PSA density（PSAD）of 0.20（0.14，0.31）ng/ml 2. Among them，61 cases（31.94%）had a Prostate Imaging Reporting and Data System（PI-RADS）score of 3，104 cases（54.45%）had a score of 4，and 26 cases（13.61%）had a score of 5. The diameter of the main lesion was 10.75（7.86，14.00）mm. The lesions were located in the peripheral zone in 78 cases（40.84%），the transition zone in 99 cases（51.83%），and the anterior fibromuscular stroma in 14 cases（7.33%）. The lesions were found at the apex in 56 cases（29.32%），in the body in 120 cases（62.83%），and at the base in 15 cases（7.85%）. MRI revealed only one lesion with a PI-RADS score ≥ 3 in 131 cases，two suspected lesions in 43 cases，three suspected lesions in 12 cases，and four suspected lesions in 5 cases. Systematic biopsy was positive in 121 cases（63.4%）and negative in 70 cases（36.6%）. The lesions were confined to the left lobe in 63 cases（32.98%），right lobe in 68 cases（35.60%），and involved both lobes in 60 cases（31.41%）. The interval between biopsy and surgery was 9.0（7.0，14.0）days. Univariate analyses were performed using Mann-Whitney U tests or χ2 tests，and multivariate logistic regression was used to identify independent predictors of pathological upgrading. A nomogram model was constructed based on these independent predictors. The model’s discriminative ability was assessed using the area under the receiver operating characteristic（ROC）curve（AUC），and internal validation of the model’s consistency was conducted using the bootstrap resampling method. Decision curve analysis（DCA）was performed to assess clinical utility. Results:Among the 191 cases，60（31.4%）had no pathological upgrading after surgery，while 131（68.6%）showed upgrading. Univariate analysis showed that the maximum diameter of the main lesion［9.0（6.0，13.2）mm vs. 11.0（8.4，14.0）mm］，number of suspicious lesions on MRI［1.0（1.0，1.0）vs. 1.0（1.0，2.0）］，number of positive systematic biopsy cores［1.0（0，2.0）vs. 1.0（0，3.0）］，percentage of positive systematic biopsy cores［0.08（0，0.17）vs. 0.12（0，0.25）］，number of positive targeted biopsy cores［2.0（1.0，3.0）vs. 3.0（1.0，4.0）］，percentage of positive targeted biopsy cores［0.37（0.24，0.75）vs. 0.50（0.38，0.85）］，level of the index lesion，location of the index lesion，and PI-RADS score were associated with pathological upgrading（ P < 0.05）. Multivariate logistic regression analysis showed that PI-RADS score 4（ OR = 5.88，95% CI 2.41 - 14.35），number of suspicious lesions on MRI（ OR = 4.15，95% CI 1.88 - 9.17），location of the index lesion in the transition zone（ OR = 6.86，95% CI 2.81 - 16.73），and percentage of positive targeted biopsy cores（ OR = 4.37，95% CI 1.38 - 14.90）were independent risk factors for pathological upgrading（ P < 0.05）. The nomogram model constructed using these predictors had an AUC of 0.845. Internal validation using the Bootstrap method yielded an AUC value of 0.812，indicating high predictive accuracy of the model. The calibration curve indicated good calibration. Decision curve analysis showed that the threshold range for net benefit in the model was between 12% - 100%. Conclusions:The PI-RADS score 4，the number of lesions with PI-RADS ≥ 3，the location of the main lesion in the transition zone，and the percentage of positive needles in targeted biopsy are independent risk factors for pathological upgrading from Gleason score 3 + 3. The nomogram model constructed from these factors demonstrates good predictive performance and provides a reference for clinical decision-making.

Objective:To investigate the correlation between whether the left colonic artery(LCA) is preserved intraoperatively and the incidence of severe low anterior resection syndrome(LARS) in patients with rectal cancer.Methods:Clinical data of 255 rectal cancer patients undergoing low anterior resection from Jan 2020 to Jan 2022 at the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively analysed, and the occurrence of LARS in patients with or without preserving the LCA was compared.Results:The LARS scores and severity in patients with intact LCA were better than those without preserved LCA at 12 months postoperatively ( P=0.017, 0.002). Bowel function at 6 months versus 12 months postoperatively in both groups was mainly reflected in a reduction in the number of bowel movements per day ( P=0.003, 0.001) as well as a reduction in re-voiding of the bowel within 1 hour after defecation ( P<0.001, P=0.001). Univariate and multivariate analyses showed that the distance of the lower edge of the tumour from the anal verge was ≤6 cm ( OR=2.530, 95% CI:1.307-4.900, P=0.006), preoperative neoadjuvant therapy ( OR=13.968, 95% CI: 4.969-39.260, P<0.001), prophylactic stoma ( OR=4.051, 95% CI: 2.042-8.040, P<0.001) were also independent risk factors for severe LARS after anterior resection of rectal cancer, and preservation of the left colonic artery ( OR=0.283, 95% CI: 0.142-0.563, P<0.001) was a protective factor against severe LARS after low anterior resection in rectal cancer patients. Conclusions:Intraoperative preservation of the LCA reduces the incidence and severity of postoperative LARS in patients with rectal cancer undergoing anterior resection. The distance of the lower edge of thetumour from the anal verge and prophylactic stoma are independent risk factors affecting the occurrence of severe LARS after anterior resection of rectal cancer.

Objective:To explore the influencing factors for pathological upgrading in prostate cancer patients with a Gleason score of 3 + 3 undergoing targeted biopsy，and to establish a nomogram prediction model.Methods:A retrospective analysis was conducted on 191 patients with localized prostate cancer diagnosed with a Gleason score of 3 + 3 through targeted biopsies at the First Affiliated Hospital of Nanjing Medical University from January 2020 to June 2024. The age of the patients was 67（61，73）years，with prostate-specific antigen（PSA）level of 7.44（5.53，10.19）ng/ml，prostate volume of 35.64（26.59，48.97）ml，and PSA density（PSAD）of 0.20（0.14，0.31）ng/ml 2. Among them，61 cases（31.94%）had a Prostate Imaging Reporting and Data System（PI-RADS）score of 3，104 cases（54.45%）had a score of 4，and 26 cases（13.61%）had a score of 5. The diameter of the main lesion was 10.75（7.86，14.00）mm. The lesions were located in the peripheral zone in 78 cases（40.84%），the transition zone in 99 cases（51.83%），and the anterior fibromuscular stroma in 14 cases（7.33%）. The lesions were found at the apex in 56 cases（29.32%），in the body in 120 cases（62.83%），and at the base in 15 cases（7.85%）. MRI revealed only one lesion with a PI-RADS score ≥ 3 in 131 cases，two suspected lesions in 43 cases，three suspected lesions in 12 cases，and four suspected lesions in 5 cases. Systematic biopsy was positive in 121 cases（63.4%）and negative in 70 cases（36.6%）. The lesions were confined to the left lobe in 63 cases（32.98%），right lobe in 68 cases（35.60%），and involved both lobes in 60 cases（31.41%）. The interval between biopsy and surgery was 9.0（7.0，14.0）days. Univariate analyses were performed using Mann-Whitney U tests or χ2 tests，and multivariate logistic regression was used to identify independent predictors of pathological upgrading. A nomogram model was constructed based on these independent predictors. The model’s discriminative ability was assessed using the area under the receiver operating characteristic（ROC）curve（AUC），and internal validation of the model’s consistency was conducted using the bootstrap resampling method. Decision curve analysis（DCA）was performed to assess clinical utility. Results:Among the 191 cases，60（31.4%）had no pathological upgrading after surgery，while 131（68.6%）showed upgrading. Univariate analysis showed that the maximum diameter of the main lesion［9.0（6.0，13.2）mm vs. 11.0（8.4，14.0）mm］，number of suspicious lesions on MRI［1.0（1.0，1.0）vs. 1.0（1.0，2.0）］，number of positive systematic biopsy cores［1.0（0，2.0）vs. 1.0（0，3.0）］，percentage of positive systematic biopsy cores［0.08（0，0.17）vs. 0.12（0，0.25）］，number of positive targeted biopsy cores［2.0（1.0，3.0）vs. 3.0（1.0，4.0）］，percentage of positive targeted biopsy cores［0.37（0.24，0.75）vs. 0.50（0.38，0.85）］，level of the index lesion，location of the index lesion，and PI-RADS score were associated with pathological upgrading（ P < 0.05）. Multivariate logistic regression analysis showed that PI-RADS score 4（ OR = 5.88，95% CI 2.41 - 14.35），number of suspicious lesions on MRI（ OR = 4.15，95% CI 1.88 - 9.17），location of the index lesion in the transition zone（ OR = 6.86，95% CI 2.81 - 16.73），and percentage of positive targeted biopsy cores（ OR = 4.37，95% CI 1.38 - 14.90）were independent risk factors for pathological upgrading（ P < 0.05）. The nomogram model constructed using these predictors had an AUC of 0.845. Internal validation using the Bootstrap method yielded an AUC value of 0.812，indicating high predictive accuracy of the model. The calibration curve indicated good calibration. Decision curve analysis showed that the threshold range for net benefit in the model was between 12% - 100%. Conclusions:The PI-RADS score 4，the number of lesions with PI-RADS ≥ 3，the location of the main lesion in the transition zone，and the percentage of positive needles in targeted biopsy are independent risk factors for pathological upgrading from Gleason score 3 + 3. The nomogram model constructed from these factors demonstrates good predictive performance and provides a reference for clinical decision-making.

Objective:To investigate the correlation between whether the left colonic artery(LCA) is preserved intraoperatively and the incidence of severe low anterior resection syndrome(LARS) in patients with rectal cancer.Methods:Clinical data of 255 rectal cancer patients undergoing low anterior resection from Jan 2020 to Jan 2022 at the First Affiliated Hospital of Xi'an Jiaotong University were retrospectively analysed, and the occurrence of LARS in patients with or without preserving the LCA was compared.Results:The LARS scores and severity in patients with intact LCA were better than those without preserved LCA at 12 months postoperatively ( P=0.017, 0.002). Bowel function at 6 months versus 12 months postoperatively in both groups was mainly reflected in a reduction in the number of bowel movements per day ( P=0.003, 0.001) as well as a reduction in re-voiding of the bowel within 1 hour after defecation ( P<0.001, P=0.001). Univariate and multivariate analyses showed that the distance of the lower edge of the tumour from the anal verge was ≤6 cm ( OR=2.530, 95% CI:1.307-4.900, P=0.006), preoperative neoadjuvant therapy ( OR=13.968, 95% CI: 4.969-39.260, P<0.001), prophylactic stoma ( OR=4.051, 95% CI: 2.042-8.040, P<0.001) were also independent risk factors for severe LARS after anterior resection of rectal cancer, and preservation of the left colonic artery ( OR=0.283, 95% CI: 0.142-0.563, P<0.001) was a protective factor against severe LARS after low anterior resection in rectal cancer patients. Conclusions:Intraoperative preservation of the LCA reduces the incidence and severity of postoperative LARS in patients with rectal cancer undergoing anterior resection. The distance of the lower edge of thetumour from the anal verge and prophylactic stoma are independent risk factors affecting the occurrence of severe LARS after anterior resection of rectal cancer.

A retrospective analysis was conducted on 5 516 patients diagnosed with prostate cancer(PCa) at our hospital. Among these, 52 patients aged ≤ 50 years were defined as the early-onset group.For the control group, 228 patients aged >50 years were randomly selected at a ratio of 1∶4.4. The early-onset group predominantly presented with elevated PSA levels at diagnosis and had a lower positive rate of digital rectal examination. There were no significant differences in clinical and pathological characteristics between the early-onset group and the control group. Young PCa patients in the low to intermediate risk categories had similar survival prognosis to older patients. However, young patients with high-risk prostate cancer had 5-year progression-free survival rate of 38.4% compared to 55.6% for older patients, and 5-year cancer-specific survival rate of 70.1% compared to 84.1% for older patients, indicating that high-risk young patients exhibited poorer oncological outcomes.

Objective To investigate the effects of Zhoufei Pingchuan Capsules on the balance of peripheral blood helper T lymphocyte 17 cell/regulatory T lymphocyte cell(Th17/Treg)and related inflammatory factors in peripheral blood of patients with stable chronic obstructive pulmonary disease(COPD)with lung-kidney qi deficiency syndrome.Methods Totally 40 COPD patients were randomly divided into the study group and the control group,with 20 cases in each group.Another 20 cases were in the healthy group.The control group was given tiotropium bromide powder inhalation,18 μg/time,1 time/d,inhalation;on the basis of the control group,the study group was given Zhoufei Pingchuan Capsules,3 pills/time,3 times/d,orally.All patients were treated for 8 weeks.The healthy group was not given any intervention.Forced expiratory volume in one second(FEV1),FEV1/forced vital capacity(FEV1/FVC),maximum mid-expiratory flow(MMEF),carbon monoxide diffusing capacity/alveolar ventilation(DLCO/VA),arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),COPD assessment test(CAT)score,Th17/Treg ratio,cytokines interleukin(IL)-17,IL-22,IL-10,and transforming growth factor-β1(TGF-β1)were compared before and after treatment.Results Compared with before treatment,the lung function indexes(FEV1,FEV1/FVC,MMEF,DLCO/VA),blood gas indexes(PaO2,PaCO2)and CAT score in the study group after treatment were significantly improved(P<0.05).After treatment,the mean values of MMEF,DLCO/VA,PaCO2 and CAT score in the study group were better than those in the control group(P<0.05).Compared with before treatment,the levels of Th17,IL-17 and IL-22 in the study group were significantly lower,and the levels of Treg,IL-10 and TGF-β1 were significantly higher(P<0.05).After treatment,there were significant differences in Th17,Treg,IL-17,IL-22,IL-10 and TGF-β1 among the three groups(P<0.01).Further pairwise comparison showed that Th17 ranked in the order of high and low was control group>study group>healthy group,Treg in the order of high and low was healthy group>study group>control group,the levels of IL-17 and IL-22 in the order of high and low were control group>study group>healthy group,and the levels of IL-10 and TGF-β1 in the order of high and low were healthy group>study group>control group,with statistical significance(P<0.05).Conclusion Zhoufei Pingchuan Capsules can improve the lung function,arterial blood gas and symptom score of patients with lung-kidney qi deficiency syndrome in stable stage of COPD.Its mechanism may be related to regulating the balance of Th17/Treg,down-regulating the levels of Th17,IL-17 and IL-22,and up-regulating the levels of Treg,IL-10 and TGF-β1,in order to reduce airway inflammation and regulate immune homeostasis.

Objective:To investigate the clinical efficacy of total laparoscopic technique in the treatment of pelvic and acetabular fractures.Methods:A total of 7 patients with pelvic and acetabular fractures admitted to the First Affiliated Hospital of Nanjing Medical University from April 2017 to August 2023 were retrospectively analyzed. There were 5 males and 2 females, aged 43.9±9.9 years (range, 27-56 years). There was 1 pelvic fracture (Tile B3) and 6 acetabular fractures, Letournel typing transverse in 2 cases, double column in 1 case, transverse combined anterior column in 1 case, anterior column in 1 case, and "T" shape in 1 case. The causes of injury included traffic accident in 4 cases, falling from height in 1 case, falling in 1 case, and heavy object injury in 1 case. The operation time, intraoperative blood loss, iatrogenic injuries of blood vessels, nerves, bladder and rectum, and incidence of postoperative complications were recorded. Matta imaging criteria was used to evaluate the quality of fracture reduction, and the hip function was evaluated by modified Merle d'Aubigné-Postel score.Results:All 7 patients were successfully operated and followed up for 12.0 (7.0, 72.0) months (range, 7-77 months). The operation time was 251.1±80.2 min (range, 150.0-370.0 min), and the intraoperative blood loss was 100.0 (50.0, 300.0) ml (range, 50-350 ml). There was no nerve, blood vessel, bladder or rectum injury during operation. Postoperative pelvic X-ray and CT showed no internal fixation into the joint. Anatomic reduction was achieved in 5 cases and satisfactory reduction in 2 cases. One patient with a transverse acetabular fracture had a slight separation and displacement of the posterior column, but the acetabular articular surface was flat as a whole without obvious steps and was not fixed. One patient with pelvic fracture had a comminuted anterior pelvic ring with severe displacement and did not achieve anatomical repositioning intraoperatively, but the anterior pelvic ring was a non-intra-articular fracture, and the fracture ends were immobilized with bilateral plates, and the morphology and stability of the anterior pelvic ring recovered well after the operation. The Merle d'Aubigné - Postel score at the final follow-up was 18.0 (17.0, 18.0) points (range, 17.0-18.0 points), with 4 excellent and 3 good cases. All 7 patients achieved clinical healing with a healing time of 2.5 (2.5, 3.0) months (range, 1.0-3.0 months). No delayed union or nonunion occurred. At the last follow-up, there were no complications such as internal fixation fracture, incision and internal fixation infection, and deep vein thrombosis.Conclusion:Total laparoscopic technique for the treatment of pelvic and acetabular fractures has less intraoperative blood loss, less surgical trauma, and satisfactory clinical efficacy. It can be used as a new choice of minimally invasive treatment of pelvic and acetabular fractures.

Objective:To explore the strategy of prostate biopsy in patients with prostate specific antigen(PSA)gray zone based on prostate imaging reporting and data system (PI-RADS).Methods:The clinical data of 427 patients who underwent transperineal prostate biopsy in the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2022 were retrospectively analyzed. The median age was 66 (61, 72) years old. The median PSA was 6.62 (5.46, 8.19) ng/ml. The median PSA density (PSAD) was 0.15 (0.11, 0.21) ng/ml 2. The median prostate volume (PV) was 43.68 (31.12, 56.82) ml. PSA velocity (PSAV) data were available in 65 patients with negative MRI examination(PI-RADS <3), and the median PSAV was 1.40 (0.69, 2.89) ng/(ml· year). Among the patients with positive MRI(PI-RADS≥3), there were 174 patients with only 1 lesion and 83 patients with ≥2 lesions. A total of 170 patients with negative MRI underwent systematic biopsy, and 257 patients with positive MRI underwent systematic combined targeted biopsy. The PI-RADS score, regions of interest(ROI), PSAD, f/tPSA and PSAV were analyzed to explore the biopsy strategy for patients with PSA gray area based on bpMRI imaging. Results:Of the 427 patients included in the study, 194 were positive and 233 were negative. Among the patients with positive biopsy pathology, 140 cases were clinically significant prostate cancer (CsPCa). Among the MRI-negative patients, there were 33 cases with PSAV ≥1.4 ng/(ml·year), and 10 cases of prostate cancer and 6 cases of CsPCa were detected by systematic biopsy.In 32 cases with PSAV <1.4 ng/(ml·year), 3 cases of prostate cancer and 0 case of CsPCa were detected by systematic biopsy. The sensitivity of systematic biopsy for the diagnosis of prostate cancer and CsPCa in patients with PSAV≥1.4 ng/(ml·year) were 76.9% (10/13) and 100.0% (6/6) respectively, the specificity were 55.8% (29/52) and 54.2% (32/59) respectively, the negative predictive value were 90.6% (29/32) and 100.0% (32/32) respectively, and the positive predictive value were 30.3% (10/33) and 18.2% (6/33) respectively. In MRI-positive patients with PI-RADS 3, the prostate cancer detection rates of targeted biopsy combined with systematic biopsy, systematic biopsy and targeted biopsy were 41.7% (45/108), 32.4% (35/108) and 35.2% (38/108), respectively ( P=0.349). The detection rates of CsPCa were 27.8% (30/108), 21.3% (23/108) and 25.0% (27/108), respectively ( P=0.541). In patients with PI-RADS 4-5 and PSAD > 0.15 ng/ml 2, the detection rates of CsPCa in targeted biopsy combined with systematic biopsy, systematic biopsy and targeted biopsy were 67.8% (61/90), 58.9% (53/90) and 67.8% (61/90), respectively ( P=0.354). Conclusions:For MRI-negative patients, all CsPCa could be detected by perineal systematic biopsy when PSAV ≥1.4 ng/(ml·year), and active observation could be performed when PSAV <1.4 ng/(ml·year). For MRI-positive patients, targeted combined systemic biopsy was required when PI-RADS score was 3, and targeted biopsy only could be performed when PI-RADS score ≥4 and PSAD >0.15 ng/ml 2, otherwise targeted combined systemic biopsy was required.

A retrospective analysis was conducted on 5 516 patients diagnosed with prostate cancer(PCa) at our hospital. Among these, 52 patients aged ≤ 50 years were defined as the early-onset group.For the control group, 228 patients aged >50 years were randomly selected at a ratio of 1∶4.4. The early-onset group predominantly presented with elevated PSA levels at diagnosis and had a lower positive rate of digital rectal examination. There were no significant differences in clinical and pathological characteristics between the early-onset group and the control group. Young PCa patients in the low to intermediate risk categories had similar survival prognosis to older patients. However, young patients with high-risk prostate cancer had 5-year progression-free survival rate of 38.4% compared to 55.6% for older patients, and 5-year cancer-specific survival rate of 70.1% compared to 84.1% for older patients, indicating that high-risk young patients exhibited poorer oncological outcomes.