Objective:To explore the optimal cut-off value of aldosterone-to-renin ratio (ARR) for primary aldosteronism screening in hypertensive populations stratified by sex and age.Methods:This study was a cross-sectional study. Patients who were diagnosed with hypertension from November 2016 to December 2023 at the First Affiliated Hospital of Dalian Medical University were included. Upright direct renin concentration (DRC) and plasma aldosterone concentration (PAC) were measured using chemiluminescence, and the ARR was calculated as PAC/DRC. Patients were divided into primary aldosteronism and primary hypertension groups based on the results of comprehensive screening tests and confirmatory tests (saline infusion test and/or captopril challenge test). Spearman correlation analysis was used to explore the correlation between ARR and age. Patients were stratified by age (≤40, >40 to 50, >50 to 60, and >60 years) and sex. The efficacy of ARR for primary aldosteronism screening was assessed by drawing the receiver operating characteristic curve and calculating the area under curve ( AUC), and to explore the optimal cut-off values for different ages and sexes. Results:A total of 1 282 hypertensive patients were enrolled, aged 46.0 (37.0, 56.0) years with 746 males. ARR showed a positive correlation with age in both primary aldosteronism ( r=0.168, P=0.007) and primary hypertension patients ( r=0.327, P<0.001). In the general population, male patients, and female patients, the AUC values of ARR screening for primary aldosteronism were 0.975 (95% CI 0.967-0.982), 0.989 (95% CI 0.983-0.995), 0.957 (95% CI 0.942-0.972), respectively. In the four groups of patients ≤40, >40 to 50, >50 to 60, and >60 years, the AUC values of ARR screening for primary aldosteronism were 0.990 (95% CI 0.983-0.997), 0.973 (95% CI 0.958-0.988), 0.965 (95% CI 0.947-0.982), 0.958 (95% CI 0.933-0.984), respectively. In the four groups of patients aged ≤40, >40 to 50, >50 to 60, and >60 years, the optimal ARR cut-off values for primary aldosteronism screening were 2.31, 2.67, 2.94, and 3.68 (ng·dl -1)/(mU·L -1)(1 ng/dl=27.7 pmol/L), respectively. The optimal ARR cut-off values for primary aldosteronism screening were 2.37 and 2.94 (ng·dl -1)/(mU·L -1) in male and female patients, respectively. Conclusion:The optimal cut-off value of ARR in the screening of primary aldosteronism increases with age, and the optimal cut-off value of ARR in female patients is higher than that in male patients. The ARR cut-off value should be selected individually based on the patient′s characteristics in clinical practice.

Objective:To assess the predictive value of the percentage of Gleason pattern 4 (G4%) in prostate biopsy for adverse pathology and biochemical recurrence.Methods:We retrospectively analyzed consecutive patients who underwent radical prostatectomy in our institution between January 2019 and December 2023, and included those who were diagnosed with ISUP 2-3 cancer at biopsy. A total of 109 patients were included in this study. The average age of patients was (67.40±6.11) years, and the average BMI of patients was (25.36±2.97) kg/m 2. 49 Cases (45.0%) had a PI-RADS score of 5, and the median prostate volume was 32.60 (24.57, 45.63) ml. The median of most recent tPSA before biopsy was 9.76 (6.89, 12.95) ng/ml, the median PSAD was 0.28 (0.17, 0.44) ng/ml 2, and the median f/tPSA was 0.11 (0.08, 0.16). Clinical T 2b or higher stage was found in 84 cases (77.1%). The total biopsy core length was (22.91±5.18) cm, with a median of 24 (20, 24) biopsy cores and a median of 6 (4, 9) positive cores. Gleason score 3+ 4 was found in 52 cases (47.7%), and Gleason score 4+ 3 in 57 cases (52.3%). Cribriform was present in 30 cases (27.5%). G4% was calculated based on the proportion of Gleason grade 4 tumor relative to total tumor, tumor proportion relative to total tissue, and tissue length. Patients were divided into high-G4% (≥2.45%) and low-G4% (<2.45%) groups based on the median G4% value, with 55 and 54 cases, respectively. No significant differences were observed in baseline characteristics between the two groups ( P>0.05). The main risk factor of adverse pathology was analyzed by logistic regression, and receiver operating characteristic (ROC) curve and area under curve (AUC) were performed. Patients were further stratified by the G4% cutoff value from ROC, and Kaplan-Meier survival curves were plotted to compare biochemical recurrence free survival (BCRFS) between groups. The main risk factor affecting BCRFS was analyzed by Cox regression. Adverse pathology was defined as postoperative Gleason score ≥4+ 3 or pathological stage ≥T 3a. Results:Adverse pathology occurred in 44 (80.0%) high-G4% and 16 (29.6%) low-G4% patients ( P<0.01). Multivariate analysis identified G4% as an independent risk factor for adverse pathology ( OR=1.23, 95% CI 1.02-1.50, P=0.033). The highest ROC AUC value was seen for G4% (0.799), significantly outperforming Gleason score (0.799 vs. 0.641, P=0.003), tPSA (0.799 vs. 0.615, P=0.003), PSAD (0.799 vs. 0.679, P=0.038), positive cores (0.799 vs. 0.677, P=0.009), clinical T stage (0.799 vs. 0.607, P=0.001) and cribriform (0.799 vs. 0.639, P=0.001). The G4% cutoff value for predicting biochemical recurrence was 10.97%. The median BCRFS was significantly higher in the low G4% (<10.97%) group than that in the high G4% (≥10.97%) group (55 vs. 28 months, P=0.002). Cumulative recurrence free survival rates at 1 and 3 years were 94.6% vs. 74.1% and 78.0% vs. 47.6%, respectively. Multivariate Cox regression analysis indicates that G4% was an independent risk factor affecting BCRFS ( HR=1.11, 95% CI 1.00-1.23, P=0.041). Conclusions:For patients with ISUP 2-3 nmPCa, a higher G4% in biopsy specimens demonstrates strong predictive ability for adverse pathology and biochemical recurrence, outperforming traditional clinical indicators such as Gleason score and PSA.

OBJECTIVE To observe the detection and drug resistance of carbapenem-resistant Klebsiella pneumoni-ae(CRKP)strains causing hospital-acquired infections(HAI)and community-acquired infections(CAI)in recent years so as to provide bases for prevention and control of CRKP infection and reasonable clinical use of antibiotics.METHODS A total of 3444 patients who were diagnosed with Klebsiella pneumonia infection and were hospitalized in the 2nd Affiliated Hospital of Fujian Medical University from Jan.1,2017 to Dec.31,2023 were recruited as the research subjects.Totally 230 patients with CRKP infection were chosen based on the result of drug susceptibility testing,73 of whom had HAI,and 157 had CAI.The isolation rate of CRKP strains,popula-tion distribution,specimens sources and drug resistance rates were observed and compared between the patients with HAI and the patients with CAI.RESULTS The total isolation rate of CRKP strains was 6.68％(230/3444).There was no difference in the sex of the patients with CRKP infection between the HAI patients and the CAI patients,however,the isolation rate of the CRKP strains from the patients aged between 18 and 45 years old was higher in the HAI group than in the CAI group(P＜0.05).The isolation rates of CRKP strains causing the two types of infections increased year by year,showing a remarkable increasing amplitude in 2022-2023,with the HAI increasing from 9.33％to 20.67％,the CAI increasing from 5.54％to 15.03％.The lower respiratory tract,urinary tract and bacteremia were the most common infection sites,the detection rate of soft tissue infec-tions was higher among the patients with HAI than among the patients with CAI(P=0.047).CRKP strains cau-sing HAI showed the highest isolation rate(33.33％)in catheter specimens,and the isolation rate of CRKP strains in pus specimens was higher among the HAI patients than among the CAI patients(P=0.011).The isola-tion rate of CRKP strains in sputum specimens of the CAI patients raised four times in 2023 as compared with that in 2022.The drug resistance rates of the CRKP strains to 25 types of antibiotics were relatively high and showed upward trends;the drug resistance rate of the HAI-KPN strains to imipenem was 48.78％,higher than 7.09％of the CAI-KPN strains(P＜0.001),and there were no significant differences in the drug resistance rates to other carbapenems between the CAI-KPN strains and the HAI-KPN strains.CONCLUSIONS The isolation rates of the CRKP strains causing the HAI and CAI are increasing year by year.The clinical invasive procedures and community-acquired respiratory tract infections are the key points for prevention and control.It is necessary to in-tensify the hospital-community cooperative prevention and control system based on the isolation rates and drug re-sistance rates of the CRKP strains,and take comprehensive prevention and control measures so as to curb the transmission of the drug-resistant strains.

OBJECTIVE To observe the detection and drug resistance of carbapenem-resistant Klebsiella pneumoni-ae(CRKP)strains causing hospital-acquired infections(HAI)and community-acquired infections(CAI)in recent years so as to provide bases for prevention and control of CRKP infection and reasonable clinical use of antibiotics.METHODS A total of 3444 patients who were diagnosed with Klebsiella pneumonia infection and were hospitalized in the 2nd Affiliated Hospital of Fujian Medical University from Jan.1,2017 to Dec.31,2023 were recruited as the research subjects.Totally 230 patients with CRKP infection were chosen based on the result of drug susceptibility testing,73 of whom had HAI,and 157 had CAI.The isolation rate of CRKP strains,popula-tion distribution,specimens sources and drug resistance rates were observed and compared between the patients with HAI and the patients with CAI.RESULTS The total isolation rate of CRKP strains was 6.68％(230/3444).There was no difference in the sex of the patients with CRKP infection between the HAI patients and the CAI patients,however,the isolation rate of the CRKP strains from the patients aged between 18 and 45 years old was higher in the HAI group than in the CAI group(P＜0.05).The isolation rates of CRKP strains causing the two types of infections increased year by year,showing a remarkable increasing amplitude in 2022-2023,with the HAI increasing from 9.33％to 20.67％,the CAI increasing from 5.54％to 15.03％.The lower respiratory tract,urinary tract and bacteremia were the most common infection sites,the detection rate of soft tissue infec-tions was higher among the patients with HAI than among the patients with CAI(P=0.047).CRKP strains cau-sing HAI showed the highest isolation rate(33.33％)in catheter specimens,and the isolation rate of CRKP strains in pus specimens was higher among the HAI patients than among the CAI patients(P=0.011).The isola-tion rate of CRKP strains in sputum specimens of the CAI patients raised four times in 2023 as compared with that in 2022.The drug resistance rates of the CRKP strains to 25 types of antibiotics were relatively high and showed upward trends;the drug resistance rate of the HAI-KPN strains to imipenem was 48.78％,higher than 7.09％of the CAI-KPN strains(P＜0.001),and there were no significant differences in the drug resistance rates to other carbapenems between the CAI-KPN strains and the HAI-KPN strains.CONCLUSIONS The isolation rates of the CRKP strains causing the HAI and CAI are increasing year by year.The clinical invasive procedures and community-acquired respiratory tract infections are the key points for prevention and control.It is necessary to in-tensify the hospital-community cooperative prevention and control system based on the isolation rates and drug re-sistance rates of the CRKP strains,and take comprehensive prevention and control measures so as to curb the transmission of the drug-resistant strains.

Objective:To assess the predictive value of the percentage of Gleason pattern 4 (G4%) in prostate biopsy for adverse pathology and biochemical recurrence.Methods:We retrospectively analyzed consecutive patients who underwent radical prostatectomy in our institution between January 2019 and December 2023, and included those who were diagnosed with ISUP 2-3 cancer at biopsy. A total of 109 patients were included in this study. The average age of patients was (67.40±6.11) years, and the average BMI of patients was (25.36±2.97) kg/m 2. 49 Cases (45.0%) had a PI-RADS score of 5, and the median prostate volume was 32.60 (24.57, 45.63) ml. The median of most recent tPSA before biopsy was 9.76 (6.89, 12.95) ng/ml, the median PSAD was 0.28 (0.17, 0.44) ng/ml 2, and the median f/tPSA was 0.11 (0.08, 0.16). Clinical T 2b or higher stage was found in 84 cases (77.1%). The total biopsy core length was (22.91±5.18) cm, with a median of 24 (20, 24) biopsy cores and a median of 6 (4, 9) positive cores. Gleason score 3+ 4 was found in 52 cases (47.7%), and Gleason score 4+ 3 in 57 cases (52.3%). Cribriform was present in 30 cases (27.5%). G4% was calculated based on the proportion of Gleason grade 4 tumor relative to total tumor, tumor proportion relative to total tissue, and tissue length. Patients were divided into high-G4% (≥2.45%) and low-G4% (<2.45%) groups based on the median G4% value, with 55 and 54 cases, respectively. No significant differences were observed in baseline characteristics between the two groups ( P>0.05). The main risk factor of adverse pathology was analyzed by logistic regression, and receiver operating characteristic (ROC) curve and area under curve (AUC) were performed. Patients were further stratified by the G4% cutoff value from ROC, and Kaplan-Meier survival curves were plotted to compare biochemical recurrence free survival (BCRFS) between groups. The main risk factor affecting BCRFS was analyzed by Cox regression. Adverse pathology was defined as postoperative Gleason score ≥4+ 3 or pathological stage ≥T 3a. Results:Adverse pathology occurred in 44 (80.0%) high-G4% and 16 (29.6%) low-G4% patients ( P<0.01). Multivariate analysis identified G4% as an independent risk factor for adverse pathology ( OR=1.23, 95% CI 1.02-1.50, P=0.033). The highest ROC AUC value was seen for G4% (0.799), significantly outperforming Gleason score (0.799 vs. 0.641, P=0.003), tPSA (0.799 vs. 0.615, P=0.003), PSAD (0.799 vs. 0.679, P=0.038), positive cores (0.799 vs. 0.677, P=0.009), clinical T stage (0.799 vs. 0.607, P=0.001) and cribriform (0.799 vs. 0.639, P=0.001). The G4% cutoff value for predicting biochemical recurrence was 10.97%. The median BCRFS was significantly higher in the low G4% (<10.97%) group than that in the high G4% (≥10.97%) group (55 vs. 28 months, P=0.002). Cumulative recurrence free survival rates at 1 and 3 years were 94.6% vs. 74.1% and 78.0% vs. 47.6%, respectively. Multivariate Cox regression analysis indicates that G4% was an independent risk factor affecting BCRFS ( HR=1.11, 95% CI 1.00-1.23, P=0.041). Conclusions:For patients with ISUP 2-3 nmPCa, a higher G4% in biopsy specimens demonstrates strong predictive ability for adverse pathology and biochemical recurrence, outperforming traditional clinical indicators such as Gleason score and PSA.

Objective:To explore the optimal cut-off value of aldosterone-to-renin ratio (ARR) for primary aldosteronism screening in hypertensive populations stratified by sex and age.Methods:This study was a cross-sectional study. Patients who were diagnosed with hypertension from November 2016 to December 2023 at the First Affiliated Hospital of Dalian Medical University were included. Upright direct renin concentration (DRC) and plasma aldosterone concentration (PAC) were measured using chemiluminescence, and the ARR was calculated as PAC/DRC. Patients were divided into primary aldosteronism and primary hypertension groups based on the results of comprehensive screening tests and confirmatory tests (saline infusion test and/or captopril challenge test). Spearman correlation analysis was used to explore the correlation between ARR and age. Patients were stratified by age (≤40, >40 to 50, >50 to 60, and >60 years) and sex. The efficacy of ARR for primary aldosteronism screening was assessed by drawing the receiver operating characteristic curve and calculating the area under curve ( AUC), and to explore the optimal cut-off values for different ages and sexes. Results:A total of 1 282 hypertensive patients were enrolled, aged 46.0 (37.0, 56.0) years with 746 males. ARR showed a positive correlation with age in both primary aldosteronism ( r=0.168, P=0.007) and primary hypertension patients ( r=0.327, P<0.001). In the general population, male patients, and female patients, the AUC values of ARR screening for primary aldosteronism were 0.975 (95% CI 0.967-0.982), 0.989 (95% CI 0.983-0.995), 0.957 (95% CI 0.942-0.972), respectively. In the four groups of patients ≤40, >40 to 50, >50 to 60, and >60 years, the AUC values of ARR screening for primary aldosteronism were 0.990 (95% CI 0.983-0.997), 0.973 (95% CI 0.958-0.988), 0.965 (95% CI 0.947-0.982), 0.958 (95% CI 0.933-0.984), respectively. In the four groups of patients aged ≤40, >40 to 50, >50 to 60, and >60 years, the optimal ARR cut-off values for primary aldosteronism screening were 2.31, 2.67, 2.94, and 3.68 (ng·dl -1)/(mU·L -1)(1 ng/dl=27.7 pmol/L), respectively. The optimal ARR cut-off values for primary aldosteronism screening were 2.37 and 2.94 (ng·dl -1)/(mU·L -1) in male and female patients, respectively. Conclusion:The optimal cut-off value of ARR in the screening of primary aldosteronism increases with age, and the optimal cut-off value of ARR in female patients is higher than that in male patients. The ARR cut-off value should be selected individually based on the patient′s characteristics in clinical practice.

Endoscopy ; Health Services Needs and Demand

Objective:To analyze the anatomical characteristics of the adrenal veins through adrenal venography to improve the success rate of adrenal venography (AVS).Methods:This study was a cross-sectional study. Patients who were diagnosed with primary aldosteronism and underwent AVS from January 2019 to October 2023 at the First Affiliated Hospital of Dalian Medical University were included. Adrenal vein imaging was collected from the enrolled patients. We performed statistical analysis on the adrenal vein orifice position, inflow angle, and adrenal venography morphology. The adrenal venous orifice was defined as the location where the catheter was placed at the end of the calm inhalation. Spearman correlation analysis was used to explore the relationship between the positions of bilateral adrenal vein orifices and body mass index (BMI).Results:A total of 282 patients with successful bilateral AVS and complete bilateral adrenal vein imaging were enrolled, of whom 57.1% (161/282) were male and the age was (53.3±10.7) years old. The orifice of the left adrenal vein was located between the middle segment of the 11 th thoracic vertebra and the upper segment of the 2 nd lumbar vertebra. The inflow angle relative to the position of the orifice was all leftward and upward. The orifice of the right adrenal vein was located between the upper segment of the 11 th thoracic vertebra and the lower segment of the 1 st lumbar vertebra, and 91.1% (257/282) had a rightward and downward angle of inflow relative to the position of the orifice. The position of the adrenal vein orifices on both the left ( r=0.211, P<0.001) and right ( r=0.196, P=0.001) showed positive correlation with BMI. The position of the right adrenal vein orifice also increased with the position of the left adrenal orifice ( r=0.530, P<0.001). The most common adrenal venography morphology on the right side was triangular (36.5%, 103/282), while the most common venography morphology on the left side was glandular (66.3%, 187/282). Conclusions:The anatomical morphology of adrenal veins are diverse. Being familiar with the morphological characteristics of the adrenal vein and identifying the adrenal vein accurately during surgery has important clinical value in improving the success rate of AVS.

Objective:To explore the effect of enhanced recovery after surgery (ERAS) protocols in patients undergoing laparoscopic radical cystectomy (LRC) and intracorporeal urinary diversion (ICUD).Methods:A total of 83 patients who received LRC+ ICUD in Beijing Chaoyang Hospital from March 2014 to September 2020, were divided into 2 groups based on different perioperative management, including 29 ERAS cases and 54 conventional recovery after surgery (CRAS) cases. The ERAS group included 26 males and 3 females , with an average age of (62.07 ± 9.26) years. There were 26 patients with ASA class Ⅰ-Ⅱ, 3 patients with ASA class Ⅲ, 4 patients received neoadjuvant chemotherapy, and 7 patients had a history of abdominal surgery in ERAS group. The CRAS group included 44 males and 10 females , with an average age of (61.59 ± 10.16) years. There were 50 patients with ASA class Ⅰ-Ⅱ, 4 patients with ASA class Ⅲ, 9 patients received neoadjuvant chemotherapy, and 10 patients had a history of abdominal surgery in CRAS group. There were no statistically significant differences in the baseline characteristics between the two groups. The patients in both groups underwent LRC+ ICUD procedures. The perioperative results and complications between the two groups were compared.Results:In the ERAS group, there were 20 patients who underwent Bricker ileal conduit surgery and 9 patients who underwent Studer orthotopic ileal neobladder surgery. Pathological staging included 3, 3, 7, 7, 5 and 4 cases in stage T a, T is, T 1, T 2, T 3 and T 4a, respectively. There were 23, 2, 3 and 1 patient with pathological stage N 0, N 1, N 2 and N 3, respectively. Pathological diagnosis included 3 cases of low-grade urothelial carcinoma, 24 cases of high-grade urothelial carcinoma, and 2 cases of other histological subtypes. In the CRAS group, there were 31 patients who underwent Bricker ileal conduit surgery and 23 patients who underwent Studer orthotopic ileal neobladder surgery. Pathological staging included 5, 3, 12, 9, 15 and 10 patients in stage T a, T is, T 1, T 2, T 3 and T 4a, respectively. There were 35, 6, 7 and 6 patients with pathological stage N 0, N 1, N 2, and N 3, respectively. Pathological diagnoses included 6 cases of low-grade urothelial carcinoma, 45 cases of high-grade urothelial carcinoma, and 3 cases of other histological subtypes. There were no statistically significant differences ( P>0.05) in surgical methods, pathological staging, or pathological types between the ERAS and CRAS groups. ERAS group presented less albumin loss [(25.73±8.63)% vs. (32.63±9.05)%, P=0.001], shorter hospital stay [9(7, 13)d vs. 12(9, 16)d, P=0.006], less 30-day overall complications [55.2% (16/29) vs. 83.3% (45/54), P=0.009]. In multivariable analysis, maximum albumin loss≥20% was independently associated with 30-day minor complications ( P=0.049), and maximum albumin loss ≥25% was independently associated with hospital of stay≥10 days ( P=0.038), respectively. Conclusions:For patients who received LRC+ ICUD, ERAS was associated with reduced perioperative albumin loss, shorter length of stay, less 30-day complications, accelerated recovery time, improved clinical outcome and less albumin injection.

【Objective】 To investigate the effects of diabetes and/or obesity on the incidence of acute kidney injury (AKI) and long-term renal function recovery in patients undergoing laparoscopic partial nephrectomy. 【Methods】 A retrospective analysis was performed on 221 patients who underwent laparoscopic partial nephrectomy in Beijing Chaoyang Hospital during Jan.2018 and Dec.2019. Baseline data, incidence of AKI, and renal function recovery after 12 months were analyzed in the diabetic, non-diabetic, diabetic + obese and diabetic + non-obese groups, with estimated glomerular filtration rate (eGFR) reaching 90% of the preoperative level as the standard. Risk factors of AKI were analyzed with univariate and multivariate regression analyses. 【Results】 Compared with the non-diabetic group, the diabetic group had lower preoperative eGFR [ (79.1±12.1)mL/ (min·1.73 m² )vs. (85.3±10.7)mL/ (min·1.73 m² ), P=0.01] , higher incidence of AKI (14.0% vs. 11.8%), and lower proportion of patients whose renal function recovered to at least 90% of the preoperative level (73.1% vs.83.5%). Patients with diabetes and obesity were more likely to develop AKI (31.3% vs.3.7%, P=0.039), and diabetic patients without obesity had better renal function recovery (81.3% vs. 60.0%). Multivariate analysis showed gender and operation time were the independent risk factors of AKI. 【Conclusion】 There were no significant differences between diabetic and non-diabetic patients in the incidence of postoperative AKI, or rate of renal function recovery 12 months after surgery. The incidence of AKI significantly increased in diabetic patients with obesity, and the renal function recovery rate decreased one year after surgery. Gender and operation time were the independent risk factors of AKI.