ObjectiveTo investigate the application of the novel inflammatory factor adsorption column CA280 combined with low-dose plasma exchange （LPE） in patients with acute-on-chronic liver failure （ACLF）. MethodsA prospective cohort study was designed， and a total of 93 ACLF patients who were admitted to The Ninth Hospital of Nanchang from June 2023 to January 2025 were enrolled and randomly divided into DPMAS+LPE group with 50 patients and CA280+LPE group with 43 patients. In addition to comprehensive medical treatment， the patients in the DPMAS+LPE group received DPMAS and LPE treatment， and those in the CA280+LPE group received CA280 and LPE treatment. The two groups were observed in terms of routine blood test results， liver function parameters， renal function markers， electrolytes， coagulation function parameters， cytokines， adverse events， and 28-day prognosis before surgery （baseline）， during surgery （DPMAS or CA280）， and after surgery （after sequential LPE treatment）. The paired t-test was used for comparison of normally distributed continuous data before and after treatment within each group， and the independent-samples t test was used for comparison between groups； the Wilcoxon signed-rank test was used for comparison of non-normally distributed continuous data before and after treatment within each group， and the Mann-Whitney U test was used for comparison between groups. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups， and the Spearman test was used for correlation analysis. ResultsAfter CA280 treatment， the ACLF patients had significant reductions in the levels of cytokines （IL-6， IL-8， IL-10， TNF-α， and IFN-γ）， liver function parameters （ALT， AST， ALP， TBil， DBil， Alb， and glutathione reductase）， and the renal function marker urea nitrogen （all P<0.05）， and in terms of coagulation function parameters， there were significant increases in prothrombin time， activated partial thromboplastin time （APTT）， thrombin time， and international normalized ratio （INR） and significant reductions in prothrombin activity （PTA） and fibrinogen （FIB） （all P<0.05）. Compared with the DPMAS+LPE group， the CA280+LPE group showed better improvements in the serum cytokines IL-8 （Z=-2.63， P=0.009）， IL-10 （Z=-3.94， P<0.001）， and TNF-α （Z=-1.53， P=0.023）， and the two artificial liver support systems had a similar effect in improving liver function （ALT， AST， GGT， GR， TBil， and DBil） （all P >0.05）， but the CA280+LPE group showed a significantly greater reduction in Alb （Z=-2.08， P=0.037）. CA280+LPE was more effective in reducing uric acid （Z=-2.97， P=0.003）. Compared with DPMAS+LPE， CA280+LPE treatment resulted in a significant reduction in INR （Z=-4.01， P<0.001）， a significant increase in APTT （Z=-2.53， P=0.011）， and significant greater increases in PTA （Z=-6.28， P<0.001） and FIB （Z=-3.93， P<0.001）. There were no significant differences in the incidence rates of adverse reactions and the rate of improvement at discharge between the two groups （all P>0.05）. The Spearman correlation analysis showed that IL-6 was significantly correlated with WBC （r=0.22， P=0.042）， TBil （r=0.29， P=0.005）， and FIB （r=-0.33， P=0.003）； IL-8 was positively correlated with APTT （r=0.37， P<0.001） and INR （r=0.25， P=0.013）； TNF-α was significantly correlated with WBC （r=0.40， P<0.001） and TBil （r=0.34， P<0.001）. ConclusionCompared with DPMAS， CA280 combined with LPE can effectively clear proinflammatory cytokines and improve liver function in ACLF patients， but it has a certain impact on Alb and coagulation function. This regimen provides a new option for the individualized treatment of ACLF and can improve the short-term prognosis of patients， but further studies are needed to verify its long-term efficacy.

Objective To explore the patterns of the immunocyte infiltration in ovarian cancer,and their influence on clinical out-come and chemotherapy response.Methods The clinical information and gene expression profiles of 2206 ovarian cancer patients were downloaded from TCGA and GEO publicly databases.The CIBERSORT was used to evaluate the distribution of 22 immune cells and their effects on survival,and chemotherapy response.Unsupervised clustering was used to classify cases and analyze differences in clinical out-comes between subgroups.Immunofluorescence staining was performed to illustrate the macrophages infiltration in ovarian cancer samples collected from the First Affiliated Hospital,Sun Yat-sen University.Results Naive B cells,M2 macrophages,and resting memory CD4+T cells were significantly associated with poor prognosis,while follicular helper T cells were significantly associated with good prog-nosis.Plasma cells,M1 macrophages,and activated memory CD4+T cells were associated with chemotherapy sensitivity,and M2 macro-phages were associated with chemotherapy resistant.Furthermore,three subgroups were identified by unsupervised clustering which showed different distribution ratios of macrophages and T cells,and significant differences in overall survival among subgroups.The infil-tration of macrophages in metastasis tissue of ovarian cancer was more than that in primary tumor.Conclusion The immunocyte infiltra-tion in ovarian cancer is associated with clinical prognosis and chemotherapy resistance.Immune cell targeting therapy or combination chemotherapy may be the potential treatment choices for ovarian cancer.

Objective To propose SHA.LIN nephrolithometry scoring system for assessing and predicting the stone-free rate of percutaneous nephrolithotomy ( PCNL) and to investigate the clinical value of SHA.LIN scoring system for nephrolithiasis in patients undergoing PCNL .Methods A literature review from 1976 to 2014 was performed to identify clinically relevant and reproducible variables that could affect the outcomes of PCNL. Six reproducible variables available from preoperative noncontrast-enhanced computed tomography were measured , including stone size ( S) , hydronephrosis ( H) , anatomic distribution (A), length of tract(L), indicator of CT(I), number of involved calices(N) and was named as SHA.LIN nephrolithometry scoring system .A retrospective analysis was conducted of clinical data of 116 patients with nephrolithiasis undergoing PCNL from June 2011 to March 2015. The general conditions , preoperative information , stone characteristics and perioperative variables were collected . The correlation of nephrolithometry scores based on SHA.LIN scoring system with stone-free status, operation time, blood loss, length of hospital stay and postoperative complications were analyzed . Receiver operating characteristic ( ROC) curves was drawn to detect sensitivity and specificity of SHA .LIN score in predicting the stone-free rates of PCNL.Results The SHA.LIN score was 9.13 ±2.24 in this cohort.The stone free rate was 75.9%(88/116).Postoperative complications occurred in 32 (27.6%) cases.In those patients with stone
free, the SHA.LIN score was 8.27 ±1.62, significantly lower than that in those patients with residual stones 11.86 ±1.72 ( t =-10.069, P=0.000) .The SHA.LIN score showed significant correlation with the postoperative stone free status, operation time, estimated blood loss (P<0.01).But, it did not correlate with postoperative complications and length of hospital stay (P>0.05).The area under curve of ROC curves for the SHA.LIN scoring system was 0.923 ( 95%CI 0.870 -0.975 ) . Conclusions The SHA.LIN nephrolithometry scoring system can predict postoperative stone-free status of PCNL and can be used for disease related assessment.Further research is required to evaluate its performance in predicting peri-operative variables and postoperative complications .

Objective To compare the clinical efficacy of laparoscopic radical nephrectomy for large renal cell carcinoma (＞7 cm) between retroperitoneal approach and transperitoneal approach.Methods From Jan 2008 to Dec 2013,the data of 68 patients who underwent laparoscopic radical nephrectomy for large renal tumor(＞7 cm) in our hospital were reviewed.There were 41 male patients and 27 female patients,whose age ranged from 43 to 73 (mean 58.4t6.9) years old.The size of tumor was between 7.0 to 12.5 cm (mean 8.9± 1.1 cm).Left renal tumor was found in 37 patients and right renal tumor in 31 patients.Clinical stages of the tumors were T2 to T3.All patients were undergone the laparoscopic radical nephrectomy,including retroperitoneal approach in 42 cases (observation group)and transperitoneal approach in 26 cases (control group).The exclusive criteria included inferior vena cava tumor thrombus,lymphatic or distant metastasis,previous operation history in the same region,multiple tumors.There were no significant differences in the age,gender,tumor size and location within two groups (P＞0.05).The perioperative indexes and oncological outcomes,such as operation time,blood loss,incidence of blood transfusion,incidence of SIRS,postoperative hospital stay,complications and follow-up results,were collected and compared between two groups.Results Conversion occurred in two cases from observation group and one case from control group.Operative time in observation group was significantly shorter than that in control group (114.9±24.4 min vs.131.2±29.9 min,P＜0.05).Bowel function recovered more rapidly in observation group than in control group (1.7±0.6 d vs.2.2±0.6 d,P＜0.05).However,the estimated blood loss,the incidence of blood transfusion,the postoperative hospital stay,the incidence of SIRS and perioperative complications showed similar results in the 2 groups (P＞0.05).The histopathological examination confirmed renal cell carcinoma in all cases.Observation group included 35 pT2 stage and 7 pT3a stage cases,while control group consisted of 21 pT2 stageand 5 pT3a stage cases.The follow-up duration ranged from 4 to 38 months (mean 17 months).Mean overall survival were 17.1 months in observation group and 18.7 months in control group.Progression free survival time was 15.7 months in observation group and 17.1 months in control group.Cox survival analysis showed that only pre-operative stage of the tumor were independent risk factor for the survival time (P=0.018) and progression free survival time (P=0.020),while the operative approach was not the independent risk factor (P=0.298,0.314).Conclusions For large renal tumors (＞7 cm),laparoscopic radical nephrectomy was safe and feasible.Compared to the transperitoneal approach,retroperitoneal approach cost less operative time and faster bowel recovery.But the operation approach is not an independent risk factor for the survival time and progression free survival time.

OBJECTIVETo compare clinical outcomes of three dimensional (3D) and traditional two dimentional (2D) laparoscopic pyeloplasty for ureteropelvic junction obstruction (UPJO).

METHODSClinical data on 31 patients who underwent retroperitoneoscopic pyeloplasty for UPJO in Peking Union Medical Hospital from January 2013 to March 2014 were retrospectively analyzed. There were 16 male and 15 female patients, and the age ranged from 21 to 42 years, mean (30 ± 6) years. The lesions of 20 cases were located on the left side and 11 cases on the right side. All cases were diagnosed as UPJO by B ultrasound and computed tomography urography (CTU). According to 3D or 2D laparoscopy, these patients were divided into two groups. The 3D laparoscopy group included 16 cases, who received 3D retroperitoneoscopic pyeloplasty. The 2D laparoscopy group included 15 cases, who received traditional 2D retroperitoneoscopic pyeloplasty. Demographic data (gender, age, laterality, body mass index), perioperative indexes and clinical outcomes (operative time, estimated blood loss , postoperative hospital stay, total hospitalization charge) were collected and compared between two groups.Numerical demographic and perioperative data were analyzed by using Student's t-test. Categorical data were compared using Pearson's Chi-square test.

RESULTSAll operations were completed successfully without open convertion.In the 3D laparoscopy group operative time was significantly shorter than 2D laparoscopy group ((106 ± 16) minutes vs. (124 ± 24) minutes, t = 5.993, P = 0.021) . There were no significant difference between two groups on the estimated blood loss ((54 ± 14) ml vs. (57 ± 16) ml, t = 0.285, P = 0.598), postoperative hospital stay ((7.3 ± 0.7) days vs. (7.5 ± 0.6) days, t = 1.415, P = 0.244), incidence of postoperative complications (0/16 vs. 1/15, χ(2) = 1.102, P = 0.484) and total hospitalization charge ((25 687 ± 3 032) RMB vs. (25 426 ± 2 626) RMB, t = 0.065, P = 0.800) . All patients were followed up from 3 to 12 months (mean 6 months).Ureteropelvic junction stricture recurred in 2 cases respectively from 3D laparoscopic group and traditional laparoscopic group. Both were cured.

CONCLUSIONS3D laparoscopic pyeloplasty is safe and feasible. Compared with the traditional 2D laparoscopic technology, 3D laparoscopy technology reduces the operation difficulty and shortens the operative time.

Adult ; Chi-Square Distribution ; Female ; Humans ; Hydronephrosis ; congenital ; surgery ; Imaging, Three-Dimensional ; Kidney Pelvis ; Laparoscopy ; methods ; Length of Stay ; Male ; Multicystic Dysplastic Kidney ; surgery ; Operative Time ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Treatment Outcome ; Ureteral Obstruction ; surgery ; Urologic Surgical Procedures ; methods ; Young Adult

Objective To analyze the clinical and pathological features of the adrenal primitive neuroectodermal tumors(PNET). Methods Four cases of PNET were analyzed.Of them,2 were males and 2 females,aged from 21 to 30 years old with a mean age of 24.No significant abnormal data was found in routine laboratory and endocrine examinations.The CT scan showed a soft tissue mass with unclear boundary and cystic changes in adrenal area.The tumor diameter was 8-17 cm. Results One patient refused treatment alter diagnosed by biopsy and died 6 months later.Another one received palliative operationand died after 8 months.The third patient was found distant metastasis 1 month after operation and had radiotherapy and chemotherapy.The fourth patient was found local tumor recurrence 1 month after operation,and started chemotherapy.All patients were diagnosed by pathology.At HE staining,tumor was consisted of even,uniform small round cells;the cells distributed diffusively or formed lobulated structures (Homer-Wright rosette).Immunohistochemical staining showed CD99 positive in all 4 patients. Canclusion The adrenal PNET is a rare disease originated from primitive neuroectodermal,mostly occurs between 20 and 30 years old,and has non-specific clinical and imaging findings.Histopathologieal examination is the key point for diagnosis.Rapid progression,highly malignant,poor prognosis are the characteristics of this disease.

Objective To explore the influence of mononuclear cells (MNC), CD34+ cells, CD3+ , CD3+ CD4+ , CD3+ CD8+ , CD4+ CD25+ T cells, CD3- CD16+ CD56+ natural killer cells (NKs), and dendritic cells (DCs) doses in graft on acute graft-versus-host disease (aGVHD) following HLA-identical sibling allogeneic peripheral blood hematopoietic stem cell transplantation (allo-PBSCT).Methods Sixty-five patients receiving HLA-identical sibling allo-PBSCT were studied.The number of CD34+, CD3+, CD3+ CD4+, and CD3+ CD8+ T cells in the graft was counted by fluorescence-activated cell sorting (FACS).The number of CD4+ CD25+ T cells, CD3 CD16+ CD56+ NKs, and DCs in the graft was also measured by FACS in 31 patients among above-mentioned 65 patients.The doses of each kind of cells in the graft were calculated according to per kilogram of recipients body weight.The patients were divided into high or low dose groups according to whether or not more than or equal to median of MNC, CD34+, CD3+, CD3+ CD4+, CD3+CD8+, CD4+ CD25+, CD3 CD16+ CD56+ or DC cell doses, respectively.Acute GVHD was analyzed between two groups.Results The frequency of the cumulative incidence of grade Ⅱ～Ⅳ aGVHD was increased in CD3+ CD4+ and CD3+ CD8+ T cells high dose groups as compared with correspondingly low dose groups, but the difference had no statistically significant difference (P = 0.089 and 0.098, respectively).Recipients in CD4 + CD25 + T cells high dose group had significantly reduced cumulative incidence of grade Ⅲ～Ⅳ aGVHD as compared with those in correspondingly low dose group (P< 0.05).The cumulative incidence of total aGVHD was significantly higher in DC1 high dose group than in correspondingly low dose group (P<0.05) and the cumulative incidence of grade Ⅱ～Ⅳ aGVHD was also higher in high dose group, but the difference had no statistically significant difference (P = 0.069).There was no significant difference in cumulative incidence of total and grade Ⅱ～Ⅳ aGVHD between MNC, CD34+ , CD3+, NK or DC2 high dose groups and correspondingly low dose groups (P>0.05, respectively).Conclusion Recipients in DC1 high dose group have significantly increased cumulative incidence of total aGVHD, but those in CD4+ CD25+ T cells high dose group have significantly reduced cumulative incidence of grade Ⅲ～Ⅳ aGVHD.