Objective The application of 18F-PSMA-1007 PET/CT in the precise diagnosis and treatment of prostate cancer(PCa)is gradually increasing.This study aimed to explore the predictive value of 18F-PSMA-1007 PET/CT for positive surgical margins after radical prostatectomy(RP).Methods A total of 173 PCa patients who were pathologically confirmed and underwent RP in our hospital from July 2020 to August 2023 were retrospectively recruited.All patients underwent 18F-PSMA-1007 PET/CT whole-body imaging before surgery.According to the postoperative pathological results,they were divided into a negative surgical margin group with 83 cases and a positive surgical margin group with 90 cases.The differences in age,SUVmax,SUVmean,preoperative total prostate specific antigen(tPSA),prostate specific antigen density(PSAD),prostate volume,Gleason score,and clinical T staging between the groups were compared,and the risk factors were further analyzed by Logistic regression.Results The preoperative tPSA(Z=-3.252,P=0.001),SUVmax(Z=2.531,P=0.011),and clinical T staging(P=0.018)were all lower in the negative surgical margin group than in the positive surgical margin group.PSAD(OR=3.492,95％CI:1.095-11.133,P=0.035),SUVmax(OR=1.036,95％CI:1.003-1.070,P=0.034),and clinical T staging(OR=3.364,95％CI:1.117-10.133,P=0.045)were independent risk factors for positive surgical margins.Conclusion 18F-PSMA-1007 PET/CT has certain predictive value for positive surgical margins after RP in PCa patients.High PSAD,high SUVmax and high clinical T stage were independent risk factors for predicting positive margin after PR surgery,thus providing some reference for the clinical treatment strategy of PCa patients.

Objective:To investigate the correlation between serum growth differentiation factor 15 (GDF15) and the clinicopathological characteristics of patients with IgA nephropathy (IgAN), and further explore the relationship of GDF15 with the cardiac and renal prognosis of IgAN patients.Methods:It was a single-center retrospective cohort study. From January 2018 to December 2022, the relevant data were collected from patients who were diagnosed with primary IgAN at the Department of Nephrology, Beijing Anzhen Hospital Affiliated to Capital Medical University, and regularly followed up for at least 1 year. Serum samples were collected at admission and the baseline level of serum GDF15 was measured. Based on the median GDF15 level, IgAN patients were categorized into high-level GDF15 group and low-level GDF15 group, and their clinicopathological characteristics were compared. A multiple linear regression model was then constructed to identify independent factors associated with serum GDF15 level based on these comparisons. Subsequently, Kaplan-Meier survival analysis was performed to investigate the association between serum GDF15 level and the cardiorenal prognosis of IgAN patients.Results:A total of 104 IgAN patients were included in this study. The serum GDF15 level in these IgAN patients was 825.60 (556.84, 1 428.15) ng/L. Serum GDF15 level was positively correlated with 24 h urinary protein ( r=0.405, P<0.001), negatively correlated with estimated glomerular filtration rate (eGFR)( r=-0.606, P<0.001). The serum levels of GDF15 in patients with tubular atrophy or interstitial fibrosis (overall comparison among T0, T1, and T2, H=21.866, P<0.001), crescentic lesions (overall comparison among C0, C1, and C2, H=13.787, P=0.001), or intrarenal arteriolar lesions (overall comparison among none, mild, and moderate-to-severe, H=9.856, P=0.007) were significantly different. Compared with IgAN patients without tubular atrophy or interstitial fibrosis, those with Oxford classification T1 ( Z=-17.326, P=0.042) or T2 ( Z=-42.933, P<0.001) had higher serum GDF15 levels. Compared with IgAN patients without crescentic lesions, those with Oxford classification C2 had higher serum GDF15 levels ( Z=-45.929, P=0.001). Compared with IgAN patients without intrarenal arteriolar lesions, those with moderate-to-severe arteriolar sclerosis had higher serum GDF15 levels ( Z=-26.686, P=0.005). The median GDF15 was used as the cut-off value to divide IgAN patients into a high-level GDF15 group (≥825.60 ng/L, n=52) and a low-level GDF15 group (<825.60 ng/L, n=52). Compared to low-level GDF15 group, IgAN patients in high-level GDF15 group presented with a higher proportion of diabetes mellitus ( χ 2=9.420, P=0.002) and cardiovascular disease ( χ 2=7.792, P=0.005), a higher level of systolic blood pressure ( Z=-2.266, P=0.023), body mass index ( Z=-2.183, P=0.031), 24 h urinary protein ( Z=-3.485, P<0.001), blood total cholesterol ( Z=-2.002, P=0.045) and left ventricular mass index ( Z=-2.649, P=0.008), and a lower level of blood albumin ( Z=-3.053, P=0.002) and eGFR ( Z=6.480, P<0.001). Multiple linear regression analysis showed that serum GDF15 level was independently associated with systolic blood pressure (regression coefficient B=29.453, 95% CI 14.139–44.767, P<0.001), blood albumin ( B=-81.412, 95% CI -113.084–-49.740, P<0.001) and eGFR ( B=-9.797, 95% CI -17.554–-2.040, P=0.014). Moreover, IgAN patients in high-level GDF15 group exhibited significantly poorer cardiac and renal prognosis compared to low-level GDF15 group ( χ 2=9.955, P=0.002). Conclusion:High serum GDF15 level correlates with disease severity in IgAN, and high serum GDF15 level may suggest a poorer cardiorenal prognosis in IgAN patients.

Objective:To evaluate the efficacy and safety of rituximab (RTX) in the treatment of idiopathic membranous nephropathy (IMN), explore the influencing factors of the therapeutic effect and construct a nomogram model for predicting the therapeutic effect.Methods:A single retrospective study was conducted in IMN patients in the First Affiliated Hospital of Zhejiang University School of Medicine from January 2017 to December 2022. All patients received monotherapy with RTX and were followed up for at least 12 months. RTX regimen adopted a B-cell guided regimen to achieve 0 cells/μl of peripheral blood CD19+ B cells through multiple administrations, followed by monitoring every 2?3 months and adding doses as needed to maintain this state. The complete response rate, partial response rate, and composite response rate at 6 months, 12 months and the end of follow up were analyzed. Logistic stepwise regression and R language were applied to construct a nomogram model for efficacy prediction. The receiver operating characteristic (ROC) curve, calibration curve and Hosmer-Lemeshow test were used to internally validate the nomogram model.Results:A total of 147 IMN patients were included in the study, with age of 56 (47, 65) years, 99 (67.4%) males. There were 69 (46.9%) newly treated patients, 78 (53.1%) retreatment patients. The follow-up time was 14.4 (12.0, 15.0) months. The total RTX dose was 1 800 (1 200, 2 400) mg. The composite response rates at 6 months, 12 months and the end of the follow-up were 36.7% (54/147), 59.9% (88/147) and 63.3% (93/147), respectively. The complete remission rates at 6 months, 12 months and the end of the follow-up were 6.1% (9/147), 13.6% (20/147) and 19.7% (29/147), respectively. Logistic stepwise regression analysis showed that age ≥ 65 years ( OR=0.335, 95% CI 0.135?0.833), retreatment ( OR=0.333, 95% CI 0.144?0.771), high cholesterol ( OR=0.716, 95% CI 0.577?0.888), high serum creatinine ( OR=0.978, 95% CI 0.963?0.993) and B-cell reconstruction within 6 months ( OR=0.273, 95% CI 0.115?0.645) were independent correlated factors affecting composite remission. Based on these factors, a nomogram model for predicting the therapeutic effect of RTX in IMN patients was constructed. The ROC curve indicated that the accuracy of this model in predicting composite remission was good ( AUC=0.814, 95% CI 0.744-0.883). The calibration curve showed that the predicted composite response rate had a good fit with the actual response rate (Hosmer-Lemeshow test χ2=11.917, P=0.155). Conclusions:RTX has good efficacy and safety as a monotherapy for IMN patients. The constructed nomogram prediction model has high discrimination and accuracy to predict the efficacy of RTX treatment for IMN.

Objective To evaluate the efficacy of non-ablative vaginal erbium-doped yttrium aluminum garnet(Er:YAG)laser therapy in improving symptoms in women with mild-to-moderate stress urinary incontinence(SUI).Methods A prospective,multicenter,randomized controlled trial was conducted.A total of 126 female SUI patients were enrolled and randomized in a 2∶1 ratio to the treatment group(n=84,receiving Er:YAG laser therapy)and the sham control group(n=42,undergoing non-energized laser device with shielded beam).Efficacy outcomes were compared between the two groups,including the International Consultation on Incontinence Questionnaire-Short Form(ICI-Q-SF)scores at baseline and 1,3,6 months after treatment,response rate 3 month after treatment,urine leakage volume,daily incontinence episodes and visual analog scale(VAS).Results One month and 3 months after treatment,the ICI-Q-SF scores in the treatment group(8.07±3.33 and 7.04±3.04,respectively)were significantly lower than those in the control group(9.57±4.03 and 9.65±3.27,respectively;both P＜0.05).The 3-month response rate was significantly higher in the treatment group(71.43％)compared to the control group(35.71％,P＜0.05).Improvements in urine leakage volume 1 and 3 months after treatment were significantly greater in the treatment group versus the control group(both P＜0.05).A statistically significant reduction in daily incontinence episodes was observed in the treatment group 1 month after treatment compared to the control group[2(0,5)times vs.4(2,8)times,P＜0.05].VAS score in the treatment group markedly decreased 1 month after treatment,comparable to the level observed in the control group[0(0,2.45)vs.0(0,0),P＜0.05].Conclusion Non-ablative vaginal Er:YAG laser therapy significantly alleviates symptoms in women with mild-to-moderate SUI and represents a viable treatment option for this condition.

Objective:To investigate the combined application of cytology, cell block histology and immunohistochemistry to improve the diagnostic accuracy of solid pancreatic lesions in endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) samples.Methods:The pathological data of EUS-FNA in 311 cases of solid pancreatic lesions submitted to the Second Hospital of Hebei Medical University, Shijiazhuang, China from May 2019 to September 2023 were retrospectively analyzed. The cases included pancreatic ductal adenocarcinoma (PDAC, 172 cases), solid pseudopapillary neoplasm (SPN, 12 cases), neuroendocrine tumors (PNET, 14 cases) and chronic pancreatitis (113 cases). The cytological features of smears, the histology of cell block sections and the diagnostic markers in PDAC, SPN and PNET were analyzed. The diagnostic accuracies of cytology, cell block histology/immunohistochemistry and combination of the two methods for classifying these pancreatic solid lesions were evaluated.Results:Irregular arrangement of atypical (cancer) cells, anisonucleosis and nuclear atypia were the typical cytological features of PDAC, while presence of pseudopapillae with a myxoid/hyalinized fibrovascular core and low adhesion/salt-and-pepper chromatin were diagnostic features of SPN and NET, respectively. Immunohistochemical results showed that CK7 and CK19 were the most sensitive markers of pancreatic ductal epithelia, and the diffuse strong expression of S-100P (102/111, 91.9%) and aberrant expression of p53 (80/111, 72.1%) were important immunophenotypic markers of PDAC. Various degrees of CDX2 expression could be found in 66.4% PDAC. The expression of CD10, PR, vimentin, CD99 and cyclinD1 and the aberrant expression of β-catenin were the immunophenotypic features of SPN, while the expression of CgA, Syn and CD56 were indispensable immunemarkers for the diagnosis of PNET. Overall, cytology had higher sensitivity than cell block histology (93.9% versus 82.8%) and lower specificity (92.9% versus 99.1%), while the combination of the two methods significantly improved the sensitivity to 96.9% in solid pancreatic lesions. The combination of cytology and cell block histology could significantly improve the diagnostic efficacy of EUS-FNA in PDAC.Conclusions:Integrated diagnosis based on cytology (including rapid on-site evaluation), cell block histology and immunohistochemical findings could significantly improve the diagnostic yield of EUS-FNA in classifying solid pancreatic lesions.

Objective:To explore the value of ultrasound imaging characteristics combined with clinical indicators in assessing the prognosis of patients with pancreatic ductal adenocarcinoma (PDAC).Methods:A retrospective analysis was conducted for patients who underwent pancreatic contrast-enhanced ultrasound (CEUS) from September 2017 to October 2023 at Peking Union Medical College Hospital and were diagnosed with PDAC based on pathological findings. Various parameters were recorded, including CA19-9 levels, tumor size, location, morphologic features, echogenicity, presence of internal cystic components, dilatation of the main pancreatic duct, peripheral vascular invasion, CEUS characteristics, presence or absence of liver metastasis, and treatment methods. In April 2024, patient survival information was obtained through telephone follow-up or review of medical records. Based on the results of the cox regression model analysis, a nomogram model of the risk of death was developed. The receiver operating characteristic (ROC) curves were applied to evaluate the predictive efficacy of the model. The calibration curves were plotted to evaluate the accuracy of the model, and clinical decision curves were used to evaluate the clinical benefit of the model.Results:This study included a total of 207 patients with PDAC. As of April 2024, 71 patients were alive and 136 died, with a median survival time of 14 months (95% CI: 12 -17). Multivariate analysis confirmed that the elevated CA19-9 ( HR=1.689, 95% CI: 1.102-2.588), tumor size >4 cm ( HR=1.641, 95% CI: 1.159-2.322), taller-than-wide shapes ( HR=1.450, 95% CI: 1.019-2.065), incomplete hypo-enhancement ( HR=1.618, 95% CI: 1.100-2.380), and liver metastasis ( HR=1.687, 95% CI: 1.175-2.423) were independent risk factors for survival in patients with PDAC. A nomogram model was further constructed for 6-month, 12-month and 3-year survival of patients with PDAC. The areas under the ROC curve were 0.679, 0.705 and 0.815, respectively. The calibration curves suggested that the model was more accurate, and the clinical decision curves showed that the model had a better clinical benefit. Conclusion:The combined use of ultrasound imaging characteristics and clinical indicators could effectively predict the prognosis of PDAC patients. Specifically, tumor size >4 cm, taller-than-wide shapes, incomplete hypo-enhancement, elevated CA19-9, and the presence of liver metastasis are correlated with poorer survival outcomes. The nomogram model constructed on the basis of these factors can be used to assess the survival of patients with PDAC.

Objective To construct a radiomics model to improve the discriminatory ability of 18 F-PSMA-1007 PET/CT for focal prostate cancer.Methods We retrospectively collected data from 74 patients diagnosed with prostate cancer by biopsy at The First Affiliated Hospital of Xi'an Jiaotong University between July 2020 and April 2024.These patients had focal radionuclide accumulation observed on 18F-PSMA-1007 PET/CT,with the median age of 71 years.Among them,42 patients had a Gleason score＜8 and 32 patients had a Gleason score ≥8.An external validation set was randomly selected based on the timing of examination,while the remaining patients were randomly divided into training and test sets at a 7∶3 ratio.Region of interest(ROI)were semi-automatically drawn on registered images,manually adjusted,and symmetrically shifted to contralateral non-tumor tissue.We made variance and correlation analyses to choose features,and built models with Logistic regression and compared the results with those of visual evaluation.Receiver operating characteristics(ROC)curves were drawn to compare model performance,and subgroup analysis was performed to identify optimal features for distinguishing tumor tissue,based on Gleason score,serum total prostate specific antigen(tPSA)levels,and lesion location.Results A total of eight features were selected.The area under the curve(AUC)for visual evaluation,testing set,and external validation set were 0.858,0.933,and 0.891,respectively.The sensitivity was 0.757,0.800 and 0.917;the specificity was 0.960,0.800 and 0.792,respectively.Subgroup analysis showed that the radiomic features 10percentile and skewness had a high value in tumor differentiation.In tumor tissues,the 10percentile values were higher than in non-tumor tissues across all groups(P-values were 0.012,0.002,＜0.001,＜0.001,＜0.001,and＜0.001).When tPSA≤10 ng/mL and Gleason score ≥8,there was no statistically significant difference in skewness between tumor and non-tumor tissues(P=0.08).When tPSA ≥20 ng/mL,the skewness of non-tumor tissue was slightly higher than that of tumor tissue,but the difference was not statistically significant(P-values were 0.285 and 0.791).When the tumor was located in the posterior part of the prostate(left posterior and right posterior),the skewness was significantly higher in tumor tissue than in non-tumor tissue(P-values＜0.001 for both).Conclusion The radiomics model had better sensitivity and accuracy than visual evaluation in distinguishing focal prostate cancer tumors from non-tumor tissues,but visual evaluation had higher specificity.Skewness and 10percentile had a high value in differential diagnosis.

Objective To analyze ancient prescriptions for knee osteoarthritis(KOA),and explore their application patterns,for providing clinical reference value.Methods Prescriptions were collected from ancient documents,and a database was created by using Excel 2016 for frequency analysis.Association rules and hidden structures were analyzed by using SPSS Modeler 18.0 and Lantern 5.0.Results A total of 373 prescriptions and 421 herbs were collected,with 3894 times of frequency of medication.Danggui was the most frequently used herb.Herbs primarily tonified deficiencies,relieved exterior symptoms,and expelled wind-dampness,with warm properties and pungent,sweet,or bitter tastes,mainly targeting the spleen and kidney meridians.Thirteen strong association rules were identified,including Chuanxiong+Niuxi-Danggui,and Bixie-Niuxi.Hidden structure analysis revealed 10 variables,leading to 4 clusters and 4 core prescriptions.Common syndromes included wind-damp,wind-cold-damp,wind-damp-heat,and qi-blood deficiency.Conclusion The treatment of KOA in ancient literature focuses on dispelling wind and removing dampness,taking into account both positive deficiency and evil excess,flexible use of tonifying spleen and kidney,clearing dampness-heat,tonifying Qi and blood and other drugs.

Objective To explore the basis of PERMA on the overall well-being and social support of elderly patients with maintenance hemodialysis(MHD).Methods A total of 60 elderly patients with MHD were selected from the blood purification center of a tertiary A hospital in Zhejiang Province from January to December 2022 as the study subjects.According to the different disease areas of the patients,they were randomly divided into an experimental group or a control group.Finally,30 patients were included in each group.The control group received routine care,and the experimental group received another 4-week bidirectional social support intervention based on the PERMA model.General well-being scale,social support rating scale,sleep duration,activity duration were used to evaluate the effect before intervention,4 weeks after intervention and 1 month after intervention.Results The results of repeated measurement ANOVA showed that there were statistically significant differences in general happiness score,social support score,sleep duration and activity duration in terms of time effect(P＜0.05),while there were statistically significant differences in general happiness score,social support score and sleep duration in terms of inter-group effect(P＜0.05).Social support score and sleep duration had statistically significant interac-tion effects(P＜0.05).Conclusion The bidirectional social support intervention based on well-being PERMA model can enhance the general well-being and social support level of elderly patients with MHD,and improve the sleep and activity status of elderly patients with MHD.

Objective:To investigate the relationship between social interaction and emotional experience in older adults,and the moderating effects of social interaction objects and personality traits on their relationship.M-ethod:Totally 208 elderly individuals were selected and assessed with a self-designed demographic information questionnaire and the NEO Personality Inventory(NEOPI).The Rochester Interaction Record(RIR)was used to record 14 days of social activity,and the Positive-Negative Affect Scale(PANAS)was used to evaluate emotions after each interaction.Using Mplus Multilevel Model(MLM)for model construction.Results:Through model con-struction,it was found that the interaction between openness and communication quality was statistically significant(β=0.45,P＜0.05).When the dependent variable was positive emotion,the higher the openness of elderly people,the stronger the connection between communication quality and positive emotion.When interacting with non-family members,the interaction between openness and social quality was statistically significant(β=0.52,P＜0.05).The higher the openness of older adults,the stronger the connection between social quality and positive emotions.Conclusion:It suggests that older adults with moderate or higher levels of openness have a stronger con-nection between social interaction quality and positive emotions when interacting with non-family members.That is,the higher the quality of interaction,the more positive emotions could be promoted,but negative emotions could not be reduced.