To summarize the clinical characteristics, antibody spectrum and neuroelectrophysiological features of autoimmune nodopathy(AN), and to explore the phenotypic differences among different antibody-positive subgroups.

Objective To explore the risk factors of the stone-free rate after flexible ureteroscopy for lower pole calculi,develop a predictive model based on these identified factors,with subsequent validation and evalua-tion of the established model.Methods A retrospective analysis was conducted on 154 patients with lower pole renal calculi who underwent flexible ureteroscopy(FURS)at Guangdong Provincial Hospital of Traditional Chinese Medicine from 2020 to 2024.Based on postoperative stone clearance status,patients were categorized into a stone-free group and a residual stone group.Univariate analysis was performed to screen potential risk factors,while Pear-son correlation coefficients and variance inflation factor(VIF)were employed to assess multicollinearity,retaining the indicator with the highest area under the curve(AUC).Independent predictors were identified through multi-variate logistic regression analysis,and a nomogram model was constructed.Internal validation was conducd using the bootstrap resampling method.The predictive performance and clinical utility of the model were evaluated using receiver operating characteristic(ROC)curves and decision curve analysis(DCA).Results Univariate analysis demonstrated that largest stone diameter(LSD),cumulative stone diameter(CSD),stone volume(SV),stone surface area(SA),mean stone density(MSDE),and infundibular pelvic angle(IPA)were significantly associated with stone-free rate(SFR)following flexible ureteroscopy(FURS)for lower pole calculi(all P<0.05).After collinearity diagnostics,LSD(area under the curve[AUC]=0.724)was retained as the optimal stone burden parameter.Multivariate logistic regression analysis confirmed LSD,MSDE,and IPA as independent predictors of postoperative SFR.The nomogram model exhibited robust predictive performance with an AUC of 0.786(sensitivity:79.6%,specificity:71.0%).Internal validation via 1000 bootstrap resamples yielded an AUC of 0.792,and deci-sion curve analysis(DCA)confirmed clinical utility with net benefit across threshold probabilities of 4%—75%.Conclusions The nomogram model developed in this study,which incorporates both stone characteristics and renal anatomical parameters,demonstrates effective prediction of stone-free rate(SFR)following flexible ureteros-copy for lower pole calyceal stones.With stable predictive performance and high clinical applicability,this model provides a reliable tool for preoperative personalized decision-making in endourological management.

Objective:To investigate the related factors of kidney injury in patients with masked hypertension (MHT).Methods:This study was a cross-sectional study. A total of 311 MHT patients who visited Dongguan Liaobu Community Health Service from June 1,2022 to June 1, 2023 were enrolled in the study. The complete blood biochemistry, urinary microalbumin and 24-hour urinary protein tests were conducted, and the risk factors of renal injury in MHT patients were analyzed with multivariate logistic regression.Results:The age of the 311 enrolled patients was(48.8±9.2)years, with 192 males(61.7%) There were 73 cases with microalbuminuria (MAU), accounting for 23.47% (73/311); and 28 cases of positive 24-hour urine total protein (24-hour UTP), accounted for 9.00% (28/311). Multivariate logistic regression analysis showed that fasting blood glucose level and mean nocturnal systolic blood pressure were independent risk factors of positive MAU in MHT patients ( OR=1.577, 95% CI: 1.049-2.370, P=0.030; OR=1.024, 95% CI: 1.001-1.047, P=0.038), while older age was a protective factor of MAU ( OR=0.965, 95% CI: 0.935-0.997, P=0.030); mean nocturnal systolic pressure, 24-hour mean systolic pressure and mean diurnal systolic pressure were independent risk factors of positive 24-hour UTP in MHT patients ( OR=1.031,95% CI: 1.000-1.064, P=0.049; OR=1.048,95% CI: 1.008-1.091, P=0.020; OR=1.042,95% CI: 1.003-1.083, P=0.035). Conclusion:Older age, fasting blood glucose, mean nocturnal systolic pressure, 24-hour mean systolic pressure and mean diurnal systolic pressure are associated with the renal injury in MHT patients.

Objective To analyze the impact of digital conversion of screen-film chest radiographs on image quality in patients with pneumoconiosis. Methods Ten high-kilovoltage screen-film chest radiographs from pneumoconiosis patients were digitally converted using three devices, including a digital single-lens reflex camera, a smartphone, and a medical film scanner. The image quality and optical density values before and after image adjustment were compared across different image formats. Results Before adjustment, among the 30 JPEG images, 24 had diagnostic defect areas and 26 had unqualified optical density values. In RAW format, optical density values were not qualified in 18 out of 30 images. In DICOM format, optical density values were not qualified in nine of ten images. After adjustment, optical density values were not qualified in 13 JPEG images, 12 RAW images, and one DICOM image. Comparisons of chest radiograph quality grade distributions before and after adjustment showed significant differences for all three image formats (all P<0.05). Conclusion After being digitally converted by taking images in RAW format with digital photographic equipment and undergoing post-processing adjustment, the quality of screen-film chest radiographs for pneumoconiosis can meet the diagnostic requirements.

Objective:To explore the effect of combining ultrasound stimulation with continuous passive movement (CPM) on triceps crus spasms and the motor functioning of children with spastic cerebral palsy.Methods:Sixty children with spastic cerebral palsy were randomly divided into a control group, a CPM group, and a combined treatment group, each of 20. All received routine rehabilitation treatment (including exercise therapy, electrical stimulation and massage), while the CPM and combined groups were additionally provided with CPM and CPM + ultrasound stimulation, respectively. All of the children were treated once a day, 6 times a week, for 4 consecutive weeks. Before and after the treatment, the Tardieu scale (MTS) was used to assess the degree of triceps spasm, and the Berg Balance Scale (BBS), the Gross Motor Function Test (GMFM-88), and 10m walking speed (10MWT) were employed to assess motor function.Results:After the treatment, the average MTS scores, BBS scores and GMFM-88 scale scores in the D and E areas of all 3 groups had improved significantly compared with before the treatment, with those of the observation and CPM groups significantly better than among the control group. With the knee flexed and extended, the Tardiu scale R1, R2 and X values of the combined treatment group were significantly better than those of the CPM group, on average. The combined group′s average BBS score and its average score in the D-zone of the GMFM-88 were also significantly better than the CPM group′s averages.Conclusions:Ultrasound combined with continuous passive movement can effectively relieve triceps spasm in children with cerebral palsy, and improve their static posture control during squatting, sitting and standing.

OBJECTIVE:The quality of systematic reviews/meta-analyses directly affects the reliability of clinical decision-making basis.Currently,there is no literature quality research on the systematic reviews/meta-analyses of platelet rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis both domestically and internationally.This article will comprehensively evaluate the methodological quality,reporting quality,and evidence quality of the systematic reviews/meta-analyses of platelet rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis.METHODS:Computer searches were conducted on CNKI,WanFang Data,VIP,CBM,PubMed,Embase,and The Cochrane Library.From the establishment of the database until January 24,2024,all systematic reviews/meta-analyses treated with platelet rich plasma versus hyaluronic acid for knee osteoarthritis were collected.Two evaluators independently conducted literature screening and data extraction,and used the AMSTAR 2,PRISMA 2020,and GRADE systems to evaluate and summarize the methodological,reporting,and evidence quality of the included systematic reviews/meta-analyses.RESULTS:A total of 18 qualified systematic reviews/meta-analyses were included,and the results showed that the efficacy and safety of platelet rich plasma might be better than that of hyaluronic acid.The methodological quality of all 18 studies was extremely low;4 reports had poor quality and relatively serious information defects,while 14 reports had moderate quality and some information defects.Among the 275 outcome measures of 16 systematic reviews/meta-analyses,there were 9 medium quality evidence,90 low-quality evidence,and 176 extremely low-quality evidence,with no high-quality evidence.CONCLUSION:At present,the quality of systematic reviews/meta-analyses literature on the treatment of knee osteoarthritis with platelet rich plasma versus hyaluronic acid is relatively low.In the future,the authors of the systematic reviews need to strictly follow the entries of quality evaluation tools such as AMSTAR 2 and PRISMA 2020 in terms of plan registration,research type explanation,retrieval strategy,exclusion list,research site and funding source,bias risk analysis,publication bias evaluation,and public information acquisition,and conduct evidence quality evaluation on the combined results of the systematic reviews/meta-analyses to provide more reliable and rigorous evidence-based basis for clinical practice.

Purpose Chemical exchange saturation transfer(CEST)imaging is used to study the changes of glutamate metabolism in the hippocampus of rats with chronic unpredictable mild stress(CUMS)model,so as to evaluate the clinical reference value of glutamate acid CEST(GluCEST)imaging results.Materials and Methods Twenty-two male SD rats were enrolled,and were divided into CUMS and healthy groups.Rats in CUMS group were further divided into the non-treatment group(n=7)and the ketamine treatment group(n=8).Seven healthy rats were randomly selected as control group.CEST imaging scans were performed using 7T small animal magnetic resonance and glutamate concentrations were measured in both hippocampi.The difference of hippocampal GluCEST value and glutamate concentration between control group and CUMS non-treatment group,CUMS ketamine treatment group and CUMS non-treatment group was analyzed,respectively.Results Compared with the control group,the hippocampal GluCEST value in CUMS non-treatment group was increased(left:t=2.8,P=0.015;right:t=3.0,P=0.011),while the hippocampal GluCEST value of rats in CUMS ketamine treatment group was decreased compared with CUMS non-treatment group(left:t=2.3,P=0.037;right:t=2.5,P=0.028).Conclusion GluCEST imaging can provide high spatial resolution images and accurately evaluate the changes of glutamate metabolism in hippocampus of rats with depression,which is conducive to monitoring the abnormal signals of hippocampal neurons caused by depression.

Objective To explore the injury process of retinal ganglion cells(RGCs)after glucocorticoid(GC)-in-duced ocular hypertension(OHT),as well as the protective effect and mechanism of estradiol(E2)in RGC injury in rats with OHT.Methods Atotalof36(36 eyes)12-week-old male Sprague-Dawley(SD)rats were randomly divided into the blank control group,the GC-OHT group,and the OHT-E2 group,with 12 rats in each group.Rats in the GC-OHT group and the OHT-E2 group were subconjunctivally injected with GC,while those in the blank control group were subconjuncti-vally injected with an equal volume of normal saline.Two weeks after modeling,in addition to being injected with GC,rats in the OHT-E2 group were also provided with E2 eye drops.Before modeling and 1,2,3,and 4 weeks after modeling,the intraocular pressure of rats in each group was measured.The visual acuity changes of rats in each group were detected by pattern electroretinogram(P-ERG)and flash visual evoked potential(F-VEP)4 weeks after modeling.After the eyeballs were removed,the distribution and number of RGCs in rats of each group were observed by immunofluorescence staining.Immunohistochemistry,Western blot,and real-time fluorescence-based quantitative polymerase chain reaction were used to detect the relative protein and mRNA expression levels of NOD-like receptor protein 3(NLRP3),cysteine aspartate prote-ase-1(Caspase-1),and gasdermin-D(GSDMD)in rats in each group.Results There was no statistically significant difference in the intraocular pressure of rats in each group before modeling(P＞0.05).Compared with the blank control group,the intraocular pressure of rats in the GC-OHT group increased 1,2,3,and 4 weeks after modeling,and the differ-ences were all statistically significant(all P＜0.01).Compared with the GC-OHT group,the intraocular pressure of rats in the OHT-E2 group decreased 3 and 4 weeks after modeling,and the differences were all statistically significant(all P＜0.01).The P-ERG and F-VEP results showed that compared with the blank control group,the amplitudes of P50 and P1 waves of rats in the GC-OHT group decreased,and the differences were both statistically significant(both P＜0.05).Com-pared with the GC-OHT group,the amplitudes of P50 and Pl waves of rats in the OHT-E2 group increased,and the differ-ences were both statistically significant(both P＜0.05).The immunofluorescence staining results showed that compared with the blank control group,the number of RGCs of rats in the GC-OHT group decreased,and the difference was statisti-cally significant(P＜0.001).Compared with the GC-OHT group,the number of RGCs of rats in the OHT-E2 group in-creased,and the difference was statistically significant(P＜0.001).The results of immunohistochemistry,Western blot,and real-time fluorescence-based quantitative polymerase chain reaction showed that compared with the blank control group,the relative protein and mRNA expression levels of NLRP3,Caspase-1,and GSDMD in the retina of rats in the GC-OHT group all increased,and the differences were all statistically significant(all P＜0.05).Compared with the GC-OHT group,the relative protein and mRNA expression levels of NLRP3,Caspase-1,and GSDMD in the retina of rats in the OHT-E2 group all decreased,and the differences were all statistically significant(all P＜0.01).Conclusion GC-induced OHT can cause pyroptosis of RGCs,and E2 may alleviate the injury of RGCs in rats with OHT by inhibiting the pyroptosis-related NLRP3/Caspase-1/GSDMD signaling pathway.

Purpose Chemical exchange saturation transfer(CEST)imaging is used to study the changes of glutamate metabolism in the hippocampus of rats with chronic unpredictable mild stress(CUMS)model,so as to evaluate the clinical reference value of glutamate acid CEST(GluCEST)imaging results.Materials and Methods Twenty-two male SD rats were enrolled,and were divided into CUMS and healthy groups.Rats in CUMS group were further divided into the non-treatment group(n=7)and the ketamine treatment group(n=8).Seven healthy rats were randomly selected as control group.CEST imaging scans were performed using 7T small animal magnetic resonance and glutamate concentrations were measured in both hippocampi.The difference of hippocampal GluCEST value and glutamate concentration between control group and CUMS non-treatment group,CUMS ketamine treatment group and CUMS non-treatment group was analyzed,respectively.Results Compared with the control group,the hippocampal GluCEST value in CUMS non-treatment group was increased(left:t=2.8,P=0.015;right:t=3.0,P=0.011),while the hippocampal GluCEST value of rats in CUMS ketamine treatment group was decreased compared with CUMS non-treatment group(left:t=2.3,P=0.037;right:t=2.5,P=0.028).Conclusion GluCEST imaging can provide high spatial resolution images and accurately evaluate the changes of glutamate metabolism in hippocampus of rats with depression,which is conducive to monitoring the abnormal signals of hippocampal neurons caused by depression.

Objective·To preliminarily investigate the value of high-order functional magnetic resonance imaging in the evaluation of benign and malignant bone and soft tissue tumors and the changes after chemotherapy.Methods·Patients clinically diagnosed with bone and soft tissue tumors at the Department of Orthopaedics,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,from October 2014 to December 2024 were enrolled.The patients were divided into a control group and an amide proton transfer-weighted imaging(APTw)group according to the imaging method.All patients underwent conventional magnetic resonance imaging(MRI),diffusion-weighted imaging(DWI),and dynamic contrast-enhanced imaging(DCE)before surgery.Patients in the APTw group received additional APTw imaging.Both groups were divided into non-malignant and malignant lesion subgroups according to pathological results.According to whether the patients received chemotherapy before enrollment,the patients with malignant lesions in the APTw group were further divided into malignant group without chemotherapy and malignant group with chemotherapy.Clinical and imaging data,including APT values,apparent diffusion coefficient(ADC),and time-intensity curves(TICs)from the largest tumor section,were collected and analyzed to assess the diagnostic performance of APTw,DWI,and DCE,and to evaluate changes after chemotherapy.Results·Eighty-five patients were enrolled,including 51 males and 34 females,with ages ranging from 10 to 84 years,and a mean age of(43.05±17.62)years.There were 51 patients in the control group(16 with non-malignant lesions and 35 with malignant lesions)and 34 patients in the APTw group(5 with non-malignant lesions and 29 with malignant lesions;23 malignant lesions without chemotherapy and 6 malignant lesions with chemotherapy).The clinical and imaging data showed that only the tumor margin of the control group and the maximum tumor diameter of the APTw group had statistically significant differences in their malignant and non-malignant lesion groups(P<0.05).In the APTw group,there was a statistically significant difference in APT values between the malignant lesion group and the non-malignant lesion group(P<0.001).Further analysis showed that the APT values in the malignant group without chemotherapy were significantly lower than that in the malignant group with chemotherapy(P<0.001).However,there were no statistically significant differences in APT values between the malignant group with chemotherapy and the non-malignant lesion group(P>0.05).There were no significant differences in ADC values and TIC types between malignant and non-malignant lesion groups in the control group and the APTw group(P>0.05).The area under the curve(AUC)of the diagnostic model in the APTw group(MRI+DWI+DCE+APTw)for distinguishing malignant from benign tumors was significantly higher than that of the control group(MRI+DWI+DCE)(P<0.05).The Youden index and specificity of the diagnostic model in the APTw group were higher than those in the control group.Conclusion·As a high-order functional MRI technique,APTw imaging is capable of evaluating the nature(benign or malignant)of bone and soft tissue tumors and detecting changes after chemotherapy.It serves as a valuable supplement to conventional MRI,DWI,and DCE imaging,providing a novel noninvasive tool for the diagnosis and treatment evaluation of bone and soft tissue tumors.