Objective:To compare the efficacy of body posture combined with pharmacotherapy and pharmacotherapy alone in the treatment of chronic subdural hematoma(CSDH).Methods:Firstly, retrospective case series study was conducted. Thirty cases of CSDH that had received body posture combined with pharmacotherapy at Department of Neurosurgery, Huashan Hospital Affiliated to Fudan University from December 2016 to October 2020 were studied retrospectively. Twenty-seven patients were male, and 3 patients were female. The age of patients ( M(IQR)) was 66(16) years (range:28 to 84). Nineteen patients had unilateral hematoma, and 11 patients had bilateral hematoma. All patients received pharmacotherapy and body posture therapy that was to raise their lower limbs 20 to 30 cm with leg lift pad and get abdominal compressed with customized abdominal belt in supine position. Patients were required to maintain the body posture as much as possible, with the maximum to 16 to 18 hours per day. Patients with unilateral hematoma should tilt the head to the affected side and avoid tilting it to the opposite side. For patients with bilateral hematoma, there was no need for head lateralization. Patient were treated with oral dexamethasone and atorvastatin simultaneously. The preliminary efficacy of body posture combined with pharmacotherapy was determined by hematoma improvement rate which was analyzed by Clopper-Pearson method. Then, the multi-center, prospective, randomized controlled trial had carried out in 9 medical centers from August 2020 to November 2021. The stratified block randomization method was adopted. Patients were randomized in a ratio of 1∶1 to either receive pharmacotherapy alone(the control group) or body posture combined with pharmacotherapy(the experiment group) for 3 months and followed up for 6 months. Effective treatment was defined as complete absorption of hematoma, or the hematoma volume decreased by more than 10 ml and Markwalder grading scale score had improved by more than 1 point compared to the baseline. The efficacy rate and surgery conversion rate at 3 months and recurrence at 6 months were observed. Comparison between groups was performed with paired sample t test, Mann-Whitney U test, χ2 test, corrected χ2 test, or Fisher exact probability method. Logistic regression was used to compare the effective rate and operation rate between the two groups. Results:In the respective study, 30 patients completed follow-up 13 to 353 days after treatment. At the last follow-up, the incidence of almost complete absorption or significantly absorption of hematoma (hematoma volume was significantly reduced accompanied by symptom improvement) was 93.3%. The 95% CI for the incidence that analyzed by the Clopper-Pearson method was 77.9% to 99.2%. One hundred and six patients were enrolled in the multicenter study. Fifty-five patients underwent body posture combined with pharmacotherapy. The age was 74(17) years (range:26 to 92). Thirty-nine patients were males and 16 were females. Fifty-one patients underwent pharmacotherapy alone. The age was 69(12) years (range:48 to 84). Thirty-seven patients were males and 14 were females. The length of body posture recorded in diary card was (15.7±2.3) hours(range:7.6 to 19.3 hours). The efficacy rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 83.6% (46/55) and 56.9% (29/51), respectively at 3 months. The result of the logistic regression analysis showed that the efficacy of body posture combined with pharmacotherapy group was better than that of pharmacotherapy alone group ( OR=3.88,95% CI:1.57 to 9.58, P=0.003). Surgery rate in the body posture combined with pharmacotherapy group and pharmacotherapy alone group were 5.5% (3/55) and 21.6% (11/51) respectively. The result of Logistic regression showed that the pharmacotherapy alone group was more likely to be converted to surgery ( OR=0.21,95% CI:0.05 to 0.80, P=0.023). At the 6 months, no recurrence of cases was found in the body posture combined with pharmacotherapy group. However, the recurrence rate of pharmacotherapy alone group was 6.3% (3/48), there was no significant difference between the two groups ( P>0.05). Conclusion:The effect of body posture combined with pharmacotherapy for chronic subdural hematoma is better than that of pharmacotherapy alone.

Objective:To explore the value of non-invasive habitat imaging (HI) multi-parametric MRI (mpMRI) in predicting the risk of prostate cancer (PCa).Methods:In this cross-sectional study, 220 patients with PCa confirmed by radical prostatectomy (RP) who underwent multi-parametric MRI (mpMRI) scanning at Xijing Hospital, Air Force Military Medical University from January 2018 to May 2024 were retrospectively collected. Patients were divided into a training set (154 cases) and a test set (66 cases) by simple random sampling in a 7∶3 ratio. Based on mpMRI imaging, the apparent diffusion coefficient (ADC), perfusion fraction (f), and mean kurtosis (MK) of each voxel were integrated. The K-means clustering algorithm was used to divide the PCa target lesions into habitat subregions, generate habitat maps, and calculate the proportion of each habitat subregion in the entire lesion. According to the 2019 International Society of Urological Pathology (ISUP) guidelines, patients were categorized into a low-risk group (ISUP≤2, 65 cases) and a high-risk group (ISUP≥3, 155 cases). The RP specimens were matched with the habitat map to identify corresponding habitat subregions, and the ISUP grade of each subregion was individually evaluated to calculate the detection rate of high-risk PCa patients. The logistic regression analysis was applied to identify the independent risk factors associated with PCa risk, and the HI-clinical imaging model and clinical imaging model were constructed. The efficacy of the models was assessed using receiver operating characteristic curve.Results:Based on the optimal cluster number, the habitat was divided into three subregions. Habitat 1 had lower ADC and f values and higher MK values, while habitat 2 had the opposite characteristics, and habitat 3 was intermediate. The proportion of habitat 1 in the high-risk group was 28.8%, in the low-risk group was 8.9%. In the training set, the comparison of habitat subregions with pathological results showed that the detection rate of high-risk lesions was 66.9% (103/154) in habitat 1, 25.3% (39/154) in habitat 2, and 47.4% (73/154) in habitat 3. The logistic regression analysis indicated that the proportion of habitat 1 ( OR=3.03, 95% CI 1.77-5.18, P<0.001), prostate-specific antigen ( OR=1.66, 95% CI 1.04-2.66, P=0.034), and the prostate imaging reporting and data system score ( OR=1.65, 95% CI 1.00-2.70, P=0.048) as independent risk factors for high-risk PCa. In the training set, the area under the curve (AUC) for predicting PCa risk was 0.854 (95% CI 0.789-0.920) for the HI-clinical imaging model and 0.779 (95% CI 0.701-0.856) for the clinical imaging model. In the test set, the AUC values were 0.809 (95% CI 0.693-0.895) and 0.738 (95% CI 0.619-0.856), respectively. Conclusion:HI based on mpMRI can effectively predict the risk of PCa.

BACKGROUND: The primary limitation to kidney transplantation is organ shortage. Recent progress in gene editing and immunosuppressive regimens has made xenotransplantation with porcine organs a possibility. However, evidence in pig-to-human xenotransplantation remains scarce, and antibody-mediated rejection (AMR) is a major obstacle to clinical applications of xenotransplantation. METHODS: We conducted a kidney xenotransplantation in a brain-dead human recipient using a porcine kidney with five gene edits (5GE) on March 25, 2024 at Xijing Hospital, China. Clinical-grade immunosuppressive regimens were employed, and the observation period lasted 22 days. We collected and analyzed the xenograft function, ultrasound findings, sequential protocol biopsies, and immune surveillance of the recipient during the observation. RESULTS: The combination of 5GE in the porcine kidney and clinical-grade immunosuppressive regimens prevented hyperacute rejection. The xenograft kidney underwent delayed graft function in the first week, but urine output increased later and the single xenograft kidney maintained electrolyte and pH homeostasis from postoperative day (POD) 12 to 19. We observed AMR at 24 h post-transplantation, due to the presence of pre-existing anti-porcine antibodies and cytotoxicity before transplantation; this AMR persisted throughout the observation period. Plasma exchange and intravenous immunoglobulin treatment mitigated the AMR. We observed activation of latent porcine cytomegalovirus toward the end of the study, which might have contributed to coagulation disorder in the recipient. CONCLUSIONS 5GE and clinical-grade immunosuppressive regimens were sufficient to prevent hyperacute rejection during pig-to-human kidney xenotransplantation. Pre-existing anti-porcine antibodies predisposed the xenograft to AMR. Plasma exchange and intravenous immunoglobulin were safe and effective in the treatment of AMR after kidney xenotransplantation.
Transplantation, Heterologous/methods* ; Kidney Transplantation/methods* ; Heterografts/pathology* ; Immunoglobulins, Intravenous/administration & dosage* ; Graft Survival/immunology* ; Humans ; Animals ; Sus scrofa ; Graft Rejection/prevention & control* ; Kidney/pathology* ; Gene Editing ; Species Specificity ; Immunosuppression Therapy/methods* ; Plasma Exchange ; Brain Death ; Biopsy ; Male ; Aged

Objective To investigate the types of diseases examined by ultrasonography in a certain island clinic,and to summarize the experience of ultrasound medical support in island area.Methods The ultrasound examination results of patients who were admitted to a certain island clinic from January 2017 to August 2022 were reviewed,and the types and characteristics of diseases examined by ultrasound were analyzed.Results A total of 2 043 patients underwent ultrasound examination.There were 76 disease categories and 1 579 diseases.The top five diseases were fatty liver(13.24%),kidney crystals(12.10%),kidney stones(10.70%),gallbladder polyps(6.33%)and ureteral stones with hydronephrosis(6.02%).Ultrasound could predict the pathological types of appendicitis and guide the clinical decision by observing the width of the appendiceal lumen and the layers of the appendiceal wall.Doppler-assessed ureteric jet could be used to determine the renal function of the affected side of ureteral calculi.Conclusion There are wide and varied disease categories in islands.Sonographers should have comprehensive abilities and qualities.This study can provide reference for the follow-up medical support on island area.

Purpose To explore the value of contrast-enhanced CT habitat imaging(HI)in preoperative non-invasive visualization for predicting pathological grading of clear cell renal carcinoma(ccRCC).Materials and Methods A retrospective analysis was conducted on enhanced CT images and clinical data from 240 patients with pathologically confirmed ccRCC at Xijing Hospital,the Fourth Military Medical University from January 2020 to December 2023.All patients were randomly divided into training and test sets at a 7:3 ratio and classified into low-grade group(International Society of Urological Pathology Ⅰ-Ⅱ)and high-grade group(International Society of Urological Pathology Ⅲ-Ⅳ)based on postoperative pathology.Using wash-in and wash-out parametric maps,the tumors were segmented into three perfusion-based habitat subregions(low,medium and high)via K-means clustering,and the volume fraction of each subregion was calculated.Predictive factors were selected from habitat features and clinical variables(including sex,age,tumor size,etc.)using Logistic regression.Three models were constructed:a clinical model,a habitat imaging model and a combined clinical-habitat model.Model performance was evaluated using receiver operating characteristic curve,calibration curve and decision curve analysis.Results Habitat 3 exhibited higher wash-in and wash-out gradients compared to Habitats 1 and 2,indicating hyper perfusion.Its proportion was significantly higher in the low-grade group than in the high-grade group(Z=-7.71,-5.11,both P<0.01).Multivariate Logistic regression identified hypertension,maximum tumor diameter and platelet-to-lymphocyte ratio as independent risk factors for high-grade ccRCC,while the proportion of Habitat 3 was a protective factor(OR=0.297,95％CI 0.184-0.479).The combined clinical-habitat model demonstrated the highest predictive performance[area under the curve(AUC)=0.938],significantly outperforming the clinical model(AUC=0.801,Z=-3.832,P<0.01)and the habitat imaging model(AUC=0.895,Z=-2.157,P=0.031).Conclusion The clinical-habitat imaging model achieves the highest predictive performance for ccRCC pathological grading.Contrast-enhanced CT habitat imaging provides significant incremental value in predicting ccRCC pathological grading,showing potential to guide precision medicine in clinical practice.

An 85-year-old male patient received immunotherapy with toripalimab (240 mg by intravenous infusion on day 1, 21 days as one treatment cycle). After one week of the first medication, the patient experienced fatigue, poor appetite, weight loss, gradually developed mild ptosis of the right eyelid, shortness of breath and palpitations after activity, which were progressively aggravated. The patient also developed unclear speech, choking on water, and difficulty breathing. Laboratory tests showed alanine aminotransferase (ALT) 93 U/L, aspartate aminotransferase (AST) 171 U/L, creatine kinase (CK) 2 982 U/L, creatine kinase isoenzyme (CK-MB) 110 U/L, lactate dehydrogenase (LDH) 603 U/L, and high-sensitivity troponin T (hs-cTnT) 243 ng/L. All indicators of thyroid function were abnormal. Based on results of the laboratory tests, neurophysiological examination, and electrocardiogram examination, combined with the patient′s clinical symptoms, immune-mediated hepatitis of grade 2, immune-mediated myocarditis of grade 3, myasthenia gravis of grade 3, immune-mediated myositis of grade 2, and thyroid dysfunction of grade 1 were diagnosed, which was considered to be induced by toripalimab. Toripalimab was stopped. After treatments with glucocorticoids, liver-protective drugs, and symptomatic treatments, above-mentioned indicators showed a downward trend. After 27 days of treatments, the patient′s clinical symptoms were improved significantly. Laboratory tests showed ALT 123 U/L, AST 68 U/L, CK 116 U/L, CK-MB 42 U/L, LDH 305 U/L. The thyroid function indicators were all normal. After 57 days of treatments, above symptoms in the patient basically disappeared, and laboratory indicators tended to be normal.

Objective:To investigate the relationship between serum levels of soluble advanced glycation end-product receptor (sRAGE) and programmed cell death factor 4 (PDCD4) and pathological features and local recurrence of breast cancer patients after breast-preserving surgery.Methods:A total of 150 patients with breast cancer admitted to the Department of Oncology of Yantaishan Hospital from Jun. 2019 to Jun. 2022 were selected to analyze the relationship between serum sRAGE, PDCD4 levels and pathological features of breast cancer patients. Logistic regression was used to analyze the risk factors for local recurrence of breast cancer patients after breast conserving surgery, and receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic value of serum sRAGE and PDCD4 levels for local recurrence of breast cancer patients after breast conserving surgery.Results:The regression results show that lymph node metastasis ( OR=1.802, 95%CI=1.092-3.377) , tumor diameter > 5 cm ( OR=1.902, 95%CI= 1.116-3.578) , clinical stage III to IV ( OR=2.034, 9 5%CI=1.167-4.858) , low level of PDCD4 ( OR=1.996, 95%CI=1.101-4.027) and sRAGE ( OR=1.910, 95%CI=1.086-3.943) were risk factors for local recurrence of breast cancer patients after breast conserving surgery ( P<0.05) . ROC results showed that the sensitivity of serum PDCD4, sRAGE and their combined detection of local recurrence after breast cancer preservation were 82.14%, 71.43% and 92.86%, the specificity was 72.13%, 81.97% and 90.98%, and the AUC was 0.812, 0.843 and 0.965, respectively. Conclusions:Serum sRAGE and PDCD4 levels in breast cancer patients are significantly correlated with lymph node metastasis, tumor diameter, clinical stage, and differentiation degree. The local recurrence of breast cancer patients after breast cancer preservation is affected by low levels of sRAGE and PDCD4, and the combined serum sRAGE and PDCD4 levels have a high value in predicting local recurrence of breast cancer patients after breast cancer preservation.

This study investigated the infectious status and pathogen characteristics of Leptospira in rodents and the environment in Fujian province to provide data for the prevention and control of leptospirosis.A total of 723 rodents and 31 water samples were col-lected from 19 regions in Fujian Province during 2020-2023.The prevalent rodent species was Rattus losea(35.82%,259/723),which was followed by Rattus norvegicus(20.06%,145/723),Rattus tanezumi(19.64%,142/723),and Niviventer fulvescens(13.97%,101/723).A total of 144 positive samples of Leptospira spp.were detected in rodent kidney samples,accounting for 19.92%(144/723).The positivity rate of Leptospira spp.in wild rodents was higher than that in domestic rodents(χ2=8.48,P<0.05),and the positivity rate in adult rodents was higher than that in juvenile rodents(χ2=14.19,P<0.05).The positivity rates varied among rodent species(χ2=46.11,P<0.05),and differences in the positivity rates of Leptospira spp.were observed among regions(χ2=32.113,P<0.05).Ten strains were isolated from 440 rodent samples,and the isolation rate was 2.27%(10/440).Genospecies identification indi-cated that Leptospira borgpetersenii accounted for seven of the ten isolates,and L.interrogans accounted for three.MLST typing divided 10 isolates into three ST types:ST1,ST16,and ST143.5 isolates were isolated from 31 water samples,with an isolation rate of 16.13%,all of which were nonpathogenic L.tsangambouensis.Although pathogenic Leptospira spp.were not isolated from the water samples,the rodents in Fujian Province were generally infected with pathogenic Leptospira spp.Surveillance of the environment and ro-dents infected with Leptospira spp.should be strengthened.

Objective:To investigate the relationship between serum levels of soluble advanced glycation end-product receptor (sRAGE) and programmed cell death factor 4 (PDCD4) and pathological features and local recurrence of breast cancer patients after breast-preserving surgery.Methods:A total of 150 patients with breast cancer admitted to the Department of Oncology of Yantaishan Hospital from Jun. 2019 to Jun. 2022 were selected to analyze the relationship between serum sRAGE, PDCD4 levels and pathological features of breast cancer patients. Logistic regression was used to analyze the risk factors for local recurrence of breast cancer patients after breast conserving surgery, and receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic value of serum sRAGE and PDCD4 levels for local recurrence of breast cancer patients after breast conserving surgery.Results:The regression results show that lymph node metastasis ( OR=1.802, 95%CI=1.092-3.377) , tumor diameter > 5 cm ( OR=1.902, 95%CI= 1.116-3.578) , clinical stage III to IV ( OR=2.034, 9 5%CI=1.167-4.858) , low level of PDCD4 ( OR=1.996, 95%CI=1.101-4.027) and sRAGE ( OR=1.910, 95%CI=1.086-3.943) were risk factors for local recurrence of breast cancer patients after breast conserving surgery ( P<0.05) . ROC results showed that the sensitivity of serum PDCD4, sRAGE and their combined detection of local recurrence after breast cancer preservation were 82.14%, 71.43% and 92.86%, the specificity was 72.13%, 81.97% and 90.98%, and the AUC was 0.812, 0.843 and 0.965, respectively. Conclusions:Serum sRAGE and PDCD4 levels in breast cancer patients are significantly correlated with lymph node metastasis, tumor diameter, clinical stage, and differentiation degree. The local recurrence of breast cancer patients after breast cancer preservation is affected by low levels of sRAGE and PDCD4, and the combined serum sRAGE and PDCD4 levels have a high value in predicting local recurrence of breast cancer patients after breast cancer preservation.

This study investigated the infectious status and pathogen characteristics of Leptospira in rodents and the environment in Fujian province to provide data for the prevention and control of leptospirosis.A total of 723 rodents and 31 water samples were col-lected from 19 regions in Fujian Province during 2020-2023.The prevalent rodent species was Rattus losea(35.82%,259/723),which was followed by Rattus norvegicus(20.06%,145/723),Rattus tanezumi(19.64%,142/723),and Niviventer fulvescens(13.97%,101/723).A total of 144 positive samples of Leptospira spp.were detected in rodent kidney samples,accounting for 19.92%(144/723).The positivity rate of Leptospira spp.in wild rodents was higher than that in domestic rodents(χ2=8.48,P<0.05),and the positivity rate in adult rodents was higher than that in juvenile rodents(χ2=14.19,P<0.05).The positivity rates varied among rodent species(χ2=46.11,P<0.05),and differences in the positivity rates of Leptospira spp.were observed among regions(χ2=32.113,P<0.05).Ten strains were isolated from 440 rodent samples,and the isolation rate was 2.27%(10/440).Genospecies identification indi-cated that Leptospira borgpetersenii accounted for seven of the ten isolates,and L.interrogans accounted for three.MLST typing divided 10 isolates into three ST types:ST1,ST16,and ST143.5 isolates were isolated from 31 water samples,with an isolation rate of 16.13%,all of which were nonpathogenic L.tsangambouensis.Although pathogenic Leptospira spp.were not isolated from the water samples,the rodents in Fujian Province were generally infected with pathogenic Leptospira spp.Surveillance of the environment and ro-dents infected with Leptospira spp.should be strengthened.