Objective:To explore the predictive value of the difference in average CT attenuation values between renal pelvis urine and bladder urine on the risk of pyonephrosis, and to establish a nomogram model in combination with other parameters and to verify its predictive ability.Methods:The clinical data of patients with obstructive hydronephrosis who came to our hospital for emergency percutaneous nephrostomy (PCN) between January 2020 and December 2022 were retrospectively analyzed. There were 16 men and 33 women, with the age of (57.59, 14.67) years. Body mass index was (23.34, 3.11) kg/m 2. Urine nitrite was positive in 14 cases. Urine culture was positive in 21 cases. In the routine blood test, the median white blood cell count was 10.96 (7.21, 15.15) ×10 9/L, haemoglobin (115.08, 22.71) g/L and platelets (263.00, 97.20)×10 9/L. The difference in average CT attenuation values between renal pelvis urine and bladder urine (mean CT value of pyelonephritis-mean CT value of cysturia) was -2.19 (-7.04, 4.05) HU. Patients were divided into pyonephrosis group and hydronephrosis group according to whether the drainage fluid after PCN was pus. Single-factor and multi-factor logistic regression models were used to analyze the independent predictors of pyonephrosis and to construct nomograms. The discrimination of the model was assessed by the area under the curve (AUC) of the receiver operating characteristics (ROC), the accuracy by the calibration curve and the clinical efficacy by the decision curve analysis (DCA). Results:There were 49 cases in this study, 31 cases in the hydronephrosis group and 18 cases in the pyonephrosis group. The average CT attenuation values of renal pelvis urine were 3.35(0.56, 8.96) HU and 7.78 (3.75, 18.38) HU, respectively, and the difference between the two groups was statistically significant ( P=0.023). The average CT attenuation values of bladder urine were (7.81±6.15)HU and (7.22±7.50)HU, respectively, and there was no significant difference between the two groups ( P=0.780). The difference in average CT attenuation values between renal pelvis urine and bladder urine were -3.98(-7.54, 0.60)HU and 2.13 (-5.15, 9.36)HU, respectively, and the difference between the two groups was not statistically significant ( P=0.059); the white blood cells were 9.82(7.04, 12.46) ×10 9/L and 13.99(9.75, 18.44) ×10 9/L, respectively, and the difference between the two groups was statistically significant ( P=0.048). Platelet counts were (248.06±87.87)×10 9/L and (288.72±109.29)×10 9/L, respectively, and there was no statistical difference between the two groups ( P=0.189). The proportion of urine protein positive was higher in the pyonephrosis group (17 vs. 20, P=0.048). Between the two groups, sex, age, body mass index, clinical symptoms (with or without low back pain), surgical history of upper urinary tract stones, underlying diseases (including hypertension, diabetes, coronary heart disease, etc.), location of hydronephrosis (left, right, and both sides), reasons of obstruction [upper urinary tract stones, other factors (such as tumor, ureteral stricture, etc.)], haemoglobin, were not statistical different. There were no significant difference in blood glucose, blood potassium, blood sodium, urine leukocytes, urine erythrocytes, urine nitrite and urine culture ( P>0.05). Multivariate logistic regression analysis showed that the difference in average CT attenuation values between renal pelvis urine and bladder urine ( OR=1.196, 95% CI 1.055-1.437, P=0.018), white blood cells ( OR=1.252, 95% CI 1.036-1.615, P=0.038), and platelets ( OR=1.014, 95% CI 1.003-1.030, P=0.025) were independent predictors of pyonephrosis. According to the above indicators, the nomogram model was established and the AUC value of the model was 0.767 (95% CI 0.616-0.918), the sensitivity was 0.611 and the specificity was 0.935. The calibration curve showed that there is a good fit between the observed value and the predicted value. The DCA analysis showed that the nomogram model has a net gain in a wide threshold range, demonstrating its predictive accuracy and clinical practicality in predicting the risk of pyonephrosis. When the cut-off value of the difference between the average CT values of pyelonephritis and cystourethrosis was 6.54 HU, the AUC value of the independent prediction of pyonephrosis was 0.690(95% CI 0.564-0.816), the sensitivity was 0.444 and the specificity was 0.935. Conclusions:The difference in average CT attenuation values between renal pelvis urine and bladder urine is an independent risk factor for predicting pyonephrosis, and the nomogram constructed by combining it with white blood cells and platelets has a good predictive effect for predicting the risk of pyonephrosis. If the difference in average CT attenuation values between renal pelvis urine and bladder urine is greater than 6.54HU, it should be alert to the occurrence of pyonephrosis.

Objective:To explore the predictive value of the difference in average CT attenuation values between renal pelvis urine and bladder urine on the risk of pyonephrosis, and to establish a nomogram model in combination with other parameters and to verify its predictive ability.Methods:The clinical data of patients with obstructive hydronephrosis who came to our hospital for emergency percutaneous nephrostomy (PCN) between January 2020 and December 2022 were retrospectively analyzed. There were 16 men and 33 women, with the age of (57.59, 14.67) years. Body mass index was (23.34, 3.11) kg/m 2. Urine nitrite was positive in 14 cases. Urine culture was positive in 21 cases. In the routine blood test, the median white blood cell count was 10.96 (7.21, 15.15) ×10 9/L, haemoglobin (115.08, 22.71) g/L and platelets (263.00, 97.20)×10 9/L. The difference in average CT attenuation values between renal pelvis urine and bladder urine (mean CT value of pyelonephritis-mean CT value of cysturia) was -2.19 (-7.04, 4.05) HU. Patients were divided into pyonephrosis group and hydronephrosis group according to whether the drainage fluid after PCN was pus. Single-factor and multi-factor logistic regression models were used to analyze the independent predictors of pyonephrosis and to construct nomograms. The discrimination of the model was assessed by the area under the curve (AUC) of the receiver operating characteristics (ROC), the accuracy by the calibration curve and the clinical efficacy by the decision curve analysis (DCA). Results:There were 49 cases in this study, 31 cases in the hydronephrosis group and 18 cases in the pyonephrosis group. The average CT attenuation values of renal pelvis urine were 3.35(0.56, 8.96) HU and 7.78 (3.75, 18.38) HU, respectively, and the difference between the two groups was statistically significant ( P=0.023). The average CT attenuation values of bladder urine were (7.81±6.15)HU and (7.22±7.50)HU, respectively, and there was no significant difference between the two groups ( P=0.780). The difference in average CT attenuation values between renal pelvis urine and bladder urine were -3.98(-7.54, 0.60)HU and 2.13 (-5.15, 9.36)HU, respectively, and the difference between the two groups was not statistically significant ( P=0.059); the white blood cells were 9.82(7.04, 12.46) ×10 9/L and 13.99(9.75, 18.44) ×10 9/L, respectively, and the difference between the two groups was statistically significant ( P=0.048). Platelet counts were (248.06±87.87)×10 9/L and (288.72±109.29)×10 9/L, respectively, and there was no statistical difference between the two groups ( P=0.189). The proportion of urine protein positive was higher in the pyonephrosis group (17 vs. 20, P=0.048). Between the two groups, sex, age, body mass index, clinical symptoms (with or without low back pain), surgical history of upper urinary tract stones, underlying diseases (including hypertension, diabetes, coronary heart disease, etc.), location of hydronephrosis (left, right, and both sides), reasons of obstruction [upper urinary tract stones, other factors (such as tumor, ureteral stricture, etc.)], haemoglobin, were not statistical different. There were no significant difference in blood glucose, blood potassium, blood sodium, urine leukocytes, urine erythrocytes, urine nitrite and urine culture ( P>0.05). Multivariate logistic regression analysis showed that the difference in average CT attenuation values between renal pelvis urine and bladder urine ( OR=1.196, 95% CI 1.055-1.437, P=0.018), white blood cells ( OR=1.252, 95% CI 1.036-1.615, P=0.038), and platelets ( OR=1.014, 95% CI 1.003-1.030, P=0.025) were independent predictors of pyonephrosis. According to the above indicators, the nomogram model was established and the AUC value of the model was 0.767 (95% CI 0.616-0.918), the sensitivity was 0.611 and the specificity was 0.935. The calibration curve showed that there is a good fit between the observed value and the predicted value. The DCA analysis showed that the nomogram model has a net gain in a wide threshold range, demonstrating its predictive accuracy and clinical practicality in predicting the risk of pyonephrosis. When the cut-off value of the difference between the average CT values of pyelonephritis and cystourethrosis was 6.54 HU, the AUC value of the independent prediction of pyonephrosis was 0.690(95% CI 0.564-0.816), the sensitivity was 0.444 and the specificity was 0.935. Conclusions:The difference in average CT attenuation values between renal pelvis urine and bladder urine is an independent risk factor for predicting pyonephrosis, and the nomogram constructed by combining it with white blood cells and platelets has a good predictive effect for predicting the risk of pyonephrosis. If the difference in average CT attenuation values between renal pelvis urine and bladder urine is greater than 6.54HU, it should be alert to the occurrence of pyonephrosis.

Objective:To investigate the clinical, genetic, and clonality related aspects of individuals with Richter transformation (RT) .Methods:From January 2019 to December 2021, 18 RT patients with diagnoses at the First Affiliated Hospital of Nanjing Medical University (Pukou CLL center) were retrospectively examined. The immunoglobin heavy variable (IGHV) gene usage and IGHV-D-J rearrangement pattern of diagnosed CLL/SLL and transformed diffuse large B-cell lymphoma (DLBCL) were compared to determine the clonality relatedness. To investigate the risk factors of RT, Clinical and laboratory data from patients with newly diagnosed CLL/SLL and transformed DLBCL were gathered.Results:The median age of RT was 56.5 (41-75) years old. 17 patients transformed to DLBCL and 1 transformed to Hodgkin lymphoma (HL) . Of 17 individuals who had DLBCL transformation, 15 had CLL/SLL-related clonality and 2 had unrelated clonality. Next-generation sequencing (NGS) analysis of 11 paired initially diagnosed treatment-naive CLL/SLL and RT DLBCL found that EGR2、TP53 and NOTCH1 were among the most frequently mutated genes both in treatment-naive CLL/SLL and in RT DLBCL. In several cases, specific mutations were gained or lost throughout RT, indicating clonal evolution. Among 10 patients before exposure to BTK inhibitors before RT, four patients acquired BTK mutation. The aforementioned mutations should be considered high-risk variables for transformation; in addition, TP53 and EGR2 mutations could be linked to a poor prognosis following RT in patients receiving a cocktail of new medicines.Conclusion:Most RT DLBCL patients in our center are clonality related (15/17, 88.2% ) and we recommend all qualified centers to evaluate clonality relatedness of RT DLBCL patients. There was some variability in the mutational landscape between DLBCL that had undergone a transformation and initially diagnosed, treatment-naive CLL/SLL. The underlying molecular mechanism of RT needs more research.

Renal subcapsular abscess(RSA) is a rare disease with unknown etiology and pathogenesis. CT is an important assistant examination for the diagnosis. In this study, we reported 2 cases of RSA. One case achieved good therapeutic effect by timely debridement and surgery drainage, and the other case refused to perform debridement and drainage, which lead to the death. This kind of disease develops quickly and progresses rapidly. The adequate debridement and surgery drainage are important in treating this disease.

Spontaneous renal artery dissection is a rare disease with unknown etiology, confounded clinical manifestations, and easy to be misdiagnosed as urinary tract infection. The diagnosis mainly depends on imaging examinations. Intravascular interventional therapy is a safe and effective treatment. This study reported a case of spontaneous renal artery dissection , which treated by intravascular interventional therapy of renal artery , and had achieved good therapeutic effect.

Objective To investigate the effect of enteral microecopharmaceutics nutrition supplement (EMN) on incidence of ventilator associated pneumonia complications,inflammatory responses,and prognoses in patients with severe traumatic brain injury (sTBI) undergoing ventilator therapy.Methods From January 2016 to September 2017,70 patients with sTBI were randomly divided into an experimental group (EMN supplement,n=35) and a control group (n=35).Early enteral nutrition was given to patients from both groups,and bifidobacterium viable capsule was given to patients from the experimental group.Glasgow Coma Scale (GCS) scores,acute physiological and chronic health evaluation (APACHE) II scores,number of white blood cells (WBC),proportion of neutrophil (N),and serum levels of procalcitonin (PCT) and C-reactive protein (CRP) were compared between the two groups on admission and 14 d after treatment.The incidence of VAP and clinical pulmonary infection scale (CPIS) scores,pulmonary function,mechanical ventilation time and hospital stays were compared 14 d after treatment.Results The incidence of VAP in the experimental group (n=17,51％) 14 d after EMN supplement was significantly lower as compared with that in the control group (n=22,63％,P＜0.05).Meanwhile,VAP patients from the experimental group had significantly lower CPIS scores as compared with patients from control group (P＜0.05).Ventilator weaning was achieved in 29 patients from experimental group (83％) and 24 patients from control group (69％),with significant difference (P＜0.05);ventilator weaning patients from the experimental group had significantly improved lung function as compared with ventilator weaning patients from control group (P＜0.05).WBC number,N proportion,and serum PCT and CRP levels in the experimental group were significantly smaller/decreased as compared with those in the control group (P＜0.05).As compared with patients from control group,patients from the experimental group had significantly higher GCS scores (8.35±0.51 vs.9.48±0.48,P＜0.05) and significantly lower APACHE II scores (12.58±0.78 vs.14.68±0.97,P＜0.05).Conclusion EMN supplement can effectively reduce the VAP incidence,alleviate the degree of infection and inflammatory response in patients with sTBI undergoing ventilator therapy,therefore,improve the prognosis;this method is worth of promotion.

OBJECTIVETo investigate the microsurgical tchniques and effects for the resection of anterior clinoid meningioma (ACM).

METHODSBetween January 2003 and March 2013, a total of 46 ACM patients were operated on via the pterion approach or lateral subfrontal approach. There were 16 male patients and 30 female patients, their mean age was 48.5 (16-69) years. Symptoms lasted from 1 month to 9 years(average 24.7 months). Preoperative CT and MRI examination showed that the tumors were located in the anterior clinoid process (25 cases on the right side, 21 cases on the left side). The average maximal tumor diameter was 4.4 cm (1.9-7.4 cm). The patients were peroidly followed-up on outpatient on 3 months to 6 months, then every year postoperativelly. The clinical data, radiological findings, surgical records and outcome of patients were retrospectively analyzed, and the prognostic factors were ananlyzed by using of the unpaired data χ(2) test with continuity correction.

RESULTSOf fourty-six patients operated on, apparently complete removal was achieved in 36 patients (78.3%), 10 patients (21.7%) had minimal residual tumors, 5 of which had gamma knife radiosurgery. Preexisting visual deficit improved in 21 of 41 patients (51.2%), unchanged in 16(35.6%), and worsened in 9(20.0%). At 3-6 months after discharge, 37(80.4%) patients had a good recovery, 7(15.6%) patients were moderately disabled, 1(2.2%) presented with severe disability, and 1 (2.2%) patient died of surgery-related causes. The tumor wrapping blood vessels (χ(2) = 4.676, P = 0.031) and violating cavernous sinus(χ(2) = 4.973, P = 0.026) were causes of unfavorable prognosis. During the mean follow-up of 35.1 months (range, 4-107 months) for 40 patients, the average Karnofsky score was 83.2. Tumor recurred in 4 cases: 2 of which required reoperation, and 2 had gamma knife radiosurgery.

CONCLUSIONSTumor wrapped vessels and invasion of the cavernous sinus are important unfavorable prognostic factors for ACM resection. By using appropriate surgical strategies and techniques, ACM can be removed safely via the pterion approach or lateral subfrontal approach with relatively low morbidity and mortality.

Adolescent ; Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Meningeal Neoplasms ; surgery ; Meningioma ; surgery ; Microsurgery ; Middle Aged ; Neurosurgical Procedures ; methods ; Retrospective Studies ; Treatment Outcome ; Young Adult