Objective:To establish an automated labeling method of 18F-AlF-1, 4, 7-triazocyclohexane-1, 4, 7-triacetic acid- D-Phe1-Tyr3-Thr8-octreotide (NOTATATE) and perform neuroendocrine tumor (NET) imaging. Methods:Based on the GE-FASTLab2 synthesis module, 18F-AlF-NOTATATE was automatically prepared by one-step chelation labeling with aluminum fluoride, and its labeling conditions were optimized. The product quality was analyzed. One patient (male, 47 years old) with lower rectal segment NET and one patient (female, 52 years old) with pancreatic NET underwent 18F-AlF-NOTATATE PET/CT imaging. Results:18F-AlF-NOTATATE was successfully prepared with a total synthesis time of 35 min. The optimized radiochemical yield was (23.8±3.1)% (without decay correction, n=3), the radioactivity was (4.63±0.68) GBq, and the radiochemical purity was >95%. The stability was good, and the product quality met the requirements. 18F-AlF-NOTATATE showed clear imaging in the patient with rectal segment NET, with SUV max of 13.3 and tumor/liver ratio of 3.3. Metastatic lesions in the liver, lymph nodes, and ribs showed high SUV max and tumor/liver ratios. The imaging of the pancreatic NET patient showed an abnormal increase in local radioactive uptake at the uncinate process of the pancreatic head, with SUV max of 5.6 and SUV max of 6.3 and the tumor/liver ratio of 2.3 after 2-hours imaging. Conclusions:Using the GE-FASTLab2 synthesis module, 18F-AlF-NOTATATE can be prepared with high activity. The preparation is simple, the method is stable, and the product has high radiochemical purity. 18F-AlF-NOTATATE exhibits good imaging performance in NET patients, providing valuable information for diagnosis, treatment, and prognosis evaluation.

OBJECTIVES: Multiple myeloma (MM) is a plasma cell malignancy occurring in middle and old age. MM is still an incurable disease due to its frequent recurrence and drug resistance. However, its pathogenesis is still unclear. Abnormal amino acid metabolism is one of the important characteristics of MM, and the important metabolic pathway of amino acids participates in protein synthesis as basic raw materials. Aminoacyl transfer ribonucleic acid synthetase (ARS) gene is a key regulatory gene in protein synthesis. This study aims to explore the molecular mechanism for ARS, a key factor of amino acid metabolism, in regulating amino acid metabolism in MM and affecting MM growth. METHODS: The corresponding gene number was combined with the gene expression profile GSE5900 dataset and GSE2658 dataset in Gene Expression Omnibus (GEO) database to standardize the gene expression data of ARS. GSEA_4.2.0 software was used to analyze the difference of gene enrichment between healthy donors (HD) and MM patients in GEO database. GraphPad Prism 7 was used to draw heat maps and perform data analysis. Kaplan-Meier and Cox regression model were used to analyze the expression of ARS gene and the prognosis of MM patients, respectively. Bone marrow samples from 7 newly diagnosed MM patients were collected, CD138⁺ and CD138^- cells were obtained by using CD138 antibody magnetic beads, and the expression of ARS in MM clinical samples was analyzed by real-time RT-PCR. Human B lymphocyte GM12878 cells and human MM cell lines ARP1, NCI-H929, OCI-MY5, U266, RPMI 8266, OPM-2, JJN-3, KMS11, MM1.s cells were selected as the study objects. The expression of ARS in MM cell lines was analyzed by real-time RT-PCR and Western blotting. Short hairpin RNA (shRNA) lentiviruses were used to construct gene knock-out plasmids (VARS-sh group). No-load plasmids (scramble group) and gene knock-out plasmids (VARS-sh group) were transfected into HEK 293T cells with for virus packaging, respectively. Stable expression cell lines were established by infecting ARP1 and OCI-MY5 cells, and the effects of knockout valyl-tRNA synthetase (VARS) gene on proliferation and apoptosis of MM cells were detected by cell counting and flow cytometry, respectively. GEO data were divided into a high expression group and a low expression group according to the expression of VARS. Bioinformatics analysis was performed to explore the downstream pathways affected by VARS. Gas chromatography time-of-flight mass spectrometry (GC-TOF/MS) and high performance liquid chromatography (HPLC) were used to detect the valine content in CD138⁺ cells and ARP1, OCI-MY5 cells and supernatant of knockdown VARS gene in bone marrow samples from patients, respectively. RESULTS: Gene enrichment analysis showed that tRNA processing related genes were significantly enriched in MM compared with HD (P<0.0001). Further screening of tRNA processing-pathway related subsets revealed that cytoplasmic aminoacyl tRNA synthetase family genes were significantly enriched in MM (P<0.0001). The results of gene expression heat map showed that the ARS family genes except alanyl-tRNA synthetase (AARS), arginyl-tRNA synthetase (RARS), seryl-tRNA synthetase (SARS) in GEO data were highly expressed in MM (all P<0.01). With the development of monoclonal gammopathy of undetermined significance (MGUS) to MM, the gene expression level was increased gradually. Kaplan-Meier univariate analysis of survival results showed that there were significant differences in the prognosis of MM patients in methionyl-tRNA synthetase (MARS), asparaginyl-tRNA synthetase (NARS) and VARS between the high expression group and the low expression group (all P<0.05). Cox regression model multivariate analysis showed that the high expression of VARS was associated with abnormal overall survival time of MM (HR=1.83, 95% CI 1.10 to 3.06, P=0.021). The high expression of NARS (HR=0.90, 95% CI 0.34 to 2.38) and MARS (HR=1.59, 95% CI 0.73 to 3.50) had no effect on the overall survival time of MM patients (both P>0.05). Real-time RT-PCR and Western blotting showed that VARS, MARS and NARS were highly expressed in CD138⁺ MM cells and MM cell lines of clinical patients (all P<0.05). Cell counting and flow cytometry results showed that the proliferation of MM cells by knockout VARS was significantly inhibited (P<0.01), the proportion of apoptosis was significantly increased (P<0.05). Bioinformatics analysis showed that in addition to several pathways including the cell cycle regulated by VARS, the valine, leucine and isoleucine catabolic pathways were upregulated. Non-targeted metabolomics data showed reduced valine content in CD138⁺ tumor cells in MM patients compared to HD (P<0.05). HPLC results showed that compared with the scramble group, the intracellular and medium supernatant content of ARP1 cells and the medium supernatant of OCI-MY5 in the VARS-shRNA group was increased (all P<0.05). CONCLUSIONS MM patients with abnormal high expression of VARS have a poor prognosis. VARS promotes the malignant growth of MM cells by affecting the regulation of valine metabolism.
Humans ; Valine-tRNA Ligase ; Multiple Myeloma/genetics* ; Metabolomics ; Amino Acids ; RNA, Transfer

Objective:To evaluate the clinical application potential of a novel prostate specific membrane antigen (PSMA) targeted PET tracer 68Ga-PSMA-NYM032 in patients diagnosed initially with prostate cancer. Methods:A total of 63 patients (age (68.7±8.7) years) with suspected prostate cancers who received 68Ga-PSMA-NYM032 PET/CT imaging in Affiliated Hospital of Jiangnan University between March 2022 and January 2023 were enrolled prospectively. The diagnostic efficiency of 68Ga-PSMA-NYM032 PET/CT imaging was evaluated in a patient-centered manner. The ROI was drawn to obtain SUV max by semi-quantitative analysis with visual analysis, and the diagnostic threshold of SUV max was obtained by ROC curve analysis. The correlations of SUV max in primary foci with total prostate specific antigen (tPSA) and Gleason score (GS) were analyzed by Spearman rank correlation analysis. Based on the D′Amico risk stratification (prostate specific antigen (PSA)>20 μg/L and ≤20 μg/L, GS>7 and ≤7), the detection rates of metastases by 68Ga-PSMA-NYM032 PET/CT imaging in different stratifications were analyzed by Fisher exact test, and the differences between SUV max of metastases in different stratifications were determined by Mann-Whitney U test. Results:The accuracy of 68Ga-PSMA-NYM032 PET/CT imaging was 92.06%(58/63), the sensitivity was 96.55%(28/29), the specificity was 88.24%(30/34), the positive predictive value was 87.50%(28/32), the negative predictive value was 96.77%(30/31), and the optimal SUV max threshold was 6.9. 68Ga-PSMA-NYM032 showed varying degrees of high uptake in the primary foci of prostate cancer, and SUV max were positively correlated with tPSA and GS ( rs values: 0.657, 0.592, P values: <0.001, 0.001). Stratified analysis showed a statistically significant difference in the detection rate of bone metastases by 68Ga-PSMA-NYM032 PET/CT between the GS>7 and GS≤7 subgroups (9/17 vs 1/12; P=0.019), while no statistical significances were observed in the detection rates of bone metastases or lymph node metastases of another subgroups (all P>0.05). In addition, none of the differences in SUV max of metastases in patients with different stratifications were statistically significant ( z value: from -1.57 to -0.50, all P>0.05). Conclusions:68Ga-PSMA-NYM032 PET/CT imaging has good diagnostic efficacy for prostate cancer, and it may provide a new strategy for the precise diagnosis and treatment of prostate cancer. Besides, GS stratification may affect the detection rate of bone metastases by 68Ga-PSMA-NYM032 PET/CT imaging.

Objective:To investigate the risk factors of infection with polymyxin resistant and carbapenemase-resistant Klebsiella pneumoniae（PR-CRKP）. Methods:A total of 170 patients with CRKP infection admitted in the Third Affiliated Hospital of Soochow University from July 2020 to October 2023 were enrolled，including 123 cases of CRKP infection and 47 cases of PR-CRKP infection. The general conditions，exposure of antibacterial drugs 6 months before admission，laboratory test indicators at admission，antibacterial drug use when target bacteria were detected，length of hospital stay and time of invasive procedures in two groups were retrospectively analyzed. The risk factors of PR-CRKP infection were analyzed with univariate and multivariate logistic regression. SPSS 26.0 software was used to analyze the data.Results:Univariate analysis showed that compared with the CRKP group，the average age of patients in PR-CRKP group was older（ Z = -2.186， P = 0.029），the proportion of patients with exposure history to semisynthetic penicillins，carbapenems，polymyxins，and quinolones 6 months before admission was higher（ χ 2= 3.930，5.414，11.939，8.478，all P < 0.05），the proportion of infections diagnosed at admission and blood urea nitrogen levels（ χ 2= 7.268， Z = -2.406， P = 0.007 and 0.016）was higher，the hemoglobin level（ t = 2.641， P = 0.009）was lower，the length of hospital stay was longer，the rates of tracheal intubation，urinary catheter，and deep vein catheterization were higher（ Z = -4.243，-4.660，-5.341，-4.583，all P < 0.001），the duration of carbapenem and polymyxin B use was longer（ Z = -4.757，-7.554，both P < 0.001），the proportion of combined quinolone-resistant Escherichia coli（QREC）and carbapenem-resistant organism（CRO）infections and bloodstream infections，and the rate of admission to intensive care units was higher（ χ 2 = 33.737，42.041，5.426，12.991， P < 0.05 or < 0.01）. Multivariate analysis showed that time to polymyxin B use（ OR = 1.179， 95%CI 1.059-1.312， P = 0.003），combined QREC infection（ OR = 5.357， 95%CI 2.100-13.669， P < 0.001）and combined CRO infection（ OR = 3.302， 95%CI 1.146-9.514， P= 0.027）were independent risk factors for PR-CRKP. Conclusion:Prolonged use of polymyxin B is an independent risk factor for PR-CRKP，and mixed QREC and CRO infection can increase the risk of PR-CRKP.

OBJECTIVES: There is less clinical data on multiple myeloma (MM) in China, and the aim of this study was to collect and analyze the clinical data of newly diagnosed multiple myeloma (NDMM) patients in Hunan Province during 1 year, to understand the real clinical features and treatment outcome for Hunan Province patients with MM, and to strengthen the understanding of the standardized diagnosis process and treatment plan of MM. METHODS: The clinical data of 529 patients with NDMM in 12 large-scale general hospitals in Hunan Province from January 1 to December 31, 2019 were collected and analyzed, including baseline data, treatment regimens, duration of treatment, and adverse reactions. The clinical characteristics, treatment, and safety of patients were analyzed by SPSS 21.0. RESULTS: Among the 529 NDMM patients, the age was 33-90 (median 64) years and the male-female ratio was 1.38꞉1. The clinical features ranged from high to low were as follows: Bone pain (77.7%), anemia (66.8%), renal insufficiency (40.6%), hypercalcemia (15.1%). Typing: IgG 46.5%, IgA 24.6%, IgD 2.6%, IgM 0.8%, light chain 15.7%, double clone 3.0%, no secretion 0.6%, absence 6.2%. Staging: Durie-Salmon stage I, II, and III were 4.5%, 10.6%, 77.3%, respectively, and 40 cases (7.6%) missed this data. International Staging System (ISS) stage I, II, and III were 10.4%, 24.4%, and 47.6%, respectively, and 93 cases (17.6%) were missing. Revised International Staging System (R-ISS) stage I, II, and III were 5.5%, 27.0%, 23.1%, respectively, and 235 cases (44.4%) missed this data. Among the 98 NDMM patients in the Third Xiangya Hospital, Central South University, Durie-Salmon (DS) stage missing 2.0%, ISS stage missing 12.3%, and R-ISS stage missing 12.3%.Treatment: Among the 529 patients,475 received treatment, the rate of treatment was 89.8%; 67.4% of the patients were able to complete four courses of chemotherapy at induction phase, 90.3% of the patients received proteasome inhibitor based combination chemotherapy regimen more than once, 67.2% received immunomodulator based regimen more than once, and 59.8% of the patients received proteasome inhibitor and immunomodulator based combination chemotherapy regimen more than once. Curative: Overall response rate (ORR) and high quality response rate (HQR) of the 4-course group were better than those of the 2-course group (ORR: 85% vs 65%, P=0.006; HQR: 68.3% vs 24.0%, P<0.001). The HQR of the standard chemotherapy group was better than that of the non-standard chemotherapy group (65.1% vs 48.2%, P=0.035). Adverse reactions during treatment included hematologic toxicity (17.5%), peripheral neuropathy (24.8%), gastrointestinal adverse events (23.8%), pulmonary infection (25.9%), herpes zoster (4.6%), and venous thrombotic events (1.7%). CONCLUSIONS In 2019, the missed diagnosis rate of MM patients was high, the medium age of diagnosis was older, and the accuracy of patient diagnosis was not high. There is a great difference among medical centers, especially in the stage and risk stratified, nearly half of NDMM patients are not diagnosed with R-ISS stage; the lack of cytogenetic data needs to be supplemented by follow-up studies. A high proportion of patients with NDMM present with bone pain and anemia.Patients received treatment have higher use of chemotherapy regimens containing proteasome inhibitors and/or immunomodulators, but there is a significant gap among different medical centers, and standardized treatment needs to be strengthened. The safety during chemotherapy is controllable.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Female ; Humans ; Immunologic Factors/therapeutic use* ; Male ; Middle Aged ; Multiple Myeloma/therapy* ; Neoplasm Staging ; Pain ; Prognosis ; Proteasome Inhibitors/therapeutic use*

Isopentenyl flavonoids are a class of characteristic components in Sophora flavescens Ait. (S. flavescens). They have biological activities such as anti-tumor, anti-bacteria, anti-inflammol/ Lation and anti-oxidation. In this paper, the structural types, toxicology and pharmacological effects of isopentenyl flavonoids from S. flavescens were briefly reviewed. Furthermore, the worth of further study on pharmacokinetics, pharmacodynamics, toxicology, action targets, molecular mechanisms and structure-function relationships of isopentenyl flavonoids were proposed. The deep exploration on functional characterastics of isopentenyl flavonoids of S. flavescens and their application on development of innovative drugs are of great significance to further improve the added value of isopentenyl flavonoids and expand their application fields.

Objective:To observe the clinical characteristics of pressure regulation frequency of shunt pump in patients with hydrocephalus after ventriculoperitoneal shunt, and explore the correlation between frequencies of shunt pump and prognoses of these patients.Methods:One hundred and one patients underwent ventriculoperitoneal shunt in our hospital from January 2018 to December 2018 were selected. According to the frequencies of postoperative pressure regulation of these patients, they were divided into non-pressure regulation group, low-frequency pressure regulation group (1-2 times) and high-frequency pressure regulation group (2 times or more). The relations of high-pressure hydrocephalus/normal pressure hydrocephalus with pressure regulation frequency, and relation between causes of pressure regulation and pressure regulation frequency were compared, and the prognoses of patients with different pressure regulation frequencies were analyzed.Results:Among the 101 patients with implanted adjustable pressure shunt, 34 had no pressure regulation after surgery, 52 had low-frequency pressure regulation, and 15 had high-frequency pressure regulation. The percentages of patients accepted low-frequency pressure regulation and high-frequency pressure regulation in patients with high-pressure hydrocephalus were significantly higher than those with normal pressure hydrocephalus ( P<0.05). The proportions of patients with insufficient shunt, excessive shunt or magnetic field interference in the low-frequency pressure regulation group were significantly higher than those in the high-frequency pressure regulation group ( P<0.05), while the proportions of patients with abnormal shunt (stagger of insufficient shunt, excessive shunt) in the low-frequency pressure regulation group were significantly lower than those in the high-frequency pressure regulation group ( P<0.05). There were 7 patients with poor curative effect, including 4 patients from the low-frequency pressure regulation group and 3 from the high-frequency pressure regulation group. The prognoses of patients with different pressure regulation frequencies were statistically different( P<0.05), the good prognosis rate of patients in the non-pressure regulation group, low-frequency pressure regulation group and high-frequency pressure regulation group decreased successively. Conclusion:About 66.3% patients need pressure regulation treatment again after hydrocephalus-ventriculoperitoneal shunt; the rate of poor efficacy in patients accepted high-frequency pressure regulation is obviously higher than that in patients accepted low-frequency pressure regulation, which needs clinical attention.

Objective To observe the trend of temperature changes after ventriculoperitoneal shunt and its relation with postoperative infection.Methods A retrospective cohort study was conducted on 272 patients underwent ventriculoperitoneal shunt in our hospital from January 2015 to December 2018.Patients were divided into infected group and non-infected group according to whether intracranial infection occurred after surgery.According to the occurring time of postoperative intracranial infection,patients were divided into early infection group and delayed infection group.Temperature levels of all patients were monitored on the surgery day,and on the first,yd,5th and 7th d of surgery,and the temperature changes and fever rate of the two groups were compared.Results Among 272 patients,intracranial infection occurred in 25 (9.19％),including 21 with early infection and 4 with delayed infection,and un-infection in 247 (90.81％).As compared with those in the non-infected group,the fever rate and body temperature of the infected group were significantly higher on the 3rd,5th and 7th d after surgery (P＜0.05).There was no significant difference in fever rate and body temperature changes between the early infection group and the delayed infection group on the surgery day and on the first,3rd,5th and 7th d of surgery (P＞0.05).Conclusions The fever rate is higher and the body temperature decreases faster after ventriculoperitoneal shunt.The fever since the third d of surgery is closely related to postoperative intracranial infection,which has a certain predictive significance for postoperative infection,so we should consider anti-infection treatment in time.

Objective To perform the ligand-based computer-aided drug design and construct the pharmacophore model of(1,3)-β-D-Glucan Synthase(GS)small molecule inhibitors.Method Six small molecules with diverse structures and good inhibitory activity were selected to construct the training set.The HipHop algorithm in Catalyst pharmacophore generation module was utilized to construct the pharmacophore models.The pharmacophore models were evaluated by constructed Decoy-set 3D database.Results Pharmacophore 02 has a good enrichment factor,sensitivity and specificity parameters.Pharmacoph-ore model validation with Decoyset 3D database proved that the model has good distinguishing capability.Conclusion The pharmacophore model of GS small molecule inhibitors was constructed and tested.It will provide valuable information for de-sign and discovery of novel small molecule GS inhibitors.

Objective To investigate the effects of autologous blood transfusion and allogeneic blood transfusion on postoperative complications and outcome of patients underwent craniotomy with traumatic brain injury.Methods All transfusional cases underwent emergency craniotomy with trau-matic brain injury from January,2012 to June,201 6,1 61 males and 38 females,ASA physical statusⅠ-Ⅳ,were respectively analyzed and divided into autologous blood group (n = 108)and allogeneic blood group (n =91)based on whether or not using cell salvage.The restrictive transfusion strategy was applied in the two groups and the red blood cells were infused to maintain the hemoglobin concen-tration at 70-100 g/L.The incidence of postoperative complications and adverse transfusion reaction were analyzed and the clinical outcome was judged by Glasgow outcome score (GOS).Results The incidence of postoperative complications (33% vs.56%,P <0.01 )and adverse transfusion reaction (5% vs.14%,P <0.05)of the autologous blood group were lower than that in the allogeneic blood group,and the clinical outcome was better (P <0.01).Logistic regression analysis showed that allo-genetic transfusion (OR =1.953,95%CI 1.381-2.529)was an independent risk factor of postopera-tive complications.Conclusion The use of autologous blood transfusion in patients with traumatic brain injury can reduce the incidence of postoperative complications and the risk of blood transfusion and improve clinical outcome.