Objective:To investigate the value of serum IgG4 detection in diagnosis,treatment,evaluation and outcome of IgG4-associated diseases(IgG4-RD).Methods:By integrating the clinical data of patients,retrospectively and systematically analyze the results of common laboratory examinations,imaging examinations,pathological examinations,etc.26 patients who were diagnosed with IgG4-RD in Huaian First Hospital Affiliated to Nanjing Medical University from March 2013 to October 2023.Results:The median age of onset was 65(31～90)years old,and the male to female ratio was 3.33∶1.The first three symptoms were abdominal discomfort,skin scleral yellow stain and fever.Patients mainly involved multiple organs,the most commonly involved organs were lung,pancreas,liver,kidney,bile duct.Compared with the control group,NLR,PLR,ESR,CRP,TBIL,DBIL,ALT,AST,GGT,IgG,IgA and IgM were all abnormally elevated in the first hematological,biochemical and immune tests of the patients,the difference was statisti-cally significant,while C3 and C4 were all decreased,but there was no statistical difference.The first IgG4 level of IgG4-RD patients was correlated with the length of hospitalization,the length of return visit,and the dynamic changes of IgG4 level after return visit.Conclusion:Serum IgG4 detection plays an important role in the diagnosis and treatment of IgG4-RD.In patients with abnormally high level of IgG4,those who are sensitive to high-dose glucocorticoid therapy have a faster decline in IgG4 levels and a longer duration of symptom remission.

Objective To development and validate a predictive model for distinguishing between malignant pleural effusion(MPE)and benign pleural effusion(BPE).Methods A total of 428 patients diagnosed with pleural effusion(PE)and hospitalized at the First Hospital of Huai'an Affiliated to Nanjing Medical University from July 2020 to May 2022 were selected.The patients were divided into BPE group(211 cases)and MPE group(217 cases)according to diagnostic criteria.The basic information and clinical data of these patients were collected.Boruta method was used for univariate screening,followed by multivariate Logistic regression to construct a basic nomogram model.Bootstrap method was used for internal validation to evaluate the performance of the nomogram,including dis-crimination,accuracy,and clinical applicability.Results The model included 8 key variables:dyspnea,chest pain,general symp-toms,X-ray/CT with malignant tumor features,serum carcinoembryonic antigen,serum neuron-specific enolase,pleural lactate dehy-drogenase,and pleural carcinoembryonic antigen.Internal validation showed that the area under the receiver operating characteristic curve(AUCROC)of the model was 0.933(95%confidence interval:0.912-0.954),with good accuracy(P＞0.05).Decision curve a-nalysis(DCA)indicated that this predictive model for predicting MPE risk had a significant net benefit when the probability threshold exceeded 1%.Conclusion The constructed prediction model could effectively distinguish between MPE and BPE.

Objective To development and validate a predictive model for distinguishing between malignant pleural effusion(MPE)and benign pleural effusion(BPE).Methods A total of 428 patients diagnosed with pleural effusion(PE)and hospitalized at the First Hospital of Huai'an Affiliated to Nanjing Medical University from July 2020 to May 2022 were selected.The patients were divided into BPE group(211 cases)and MPE group(217 cases)according to diagnostic criteria.The basic information and clinical data of these patients were collected.Boruta method was used for univariate screening,followed by multivariate Logistic regression to construct a basic nomogram model.Bootstrap method was used for internal validation to evaluate the performance of the nomogram,including dis-crimination,accuracy,and clinical applicability.Results The model included 8 key variables:dyspnea,chest pain,general symp-toms,X-ray/CT with malignant tumor features,serum carcinoembryonic antigen,serum neuron-specific enolase,pleural lactate dehy-drogenase,and pleural carcinoembryonic antigen.Internal validation showed that the area under the receiver operating characteristic curve(AUCROC)of the model was 0.933(95%confidence interval:0.912-0.954),with good accuracy(P＞0.05).Decision curve a-nalysis(DCA)indicated that this predictive model for predicting MPE risk had a significant net benefit when the probability threshold exceeded 1%.Conclusion The constructed prediction model could effectively distinguish between MPE and BPE.

Objective:To investigate the value of serum IgG4 detection in diagnosis,treatment,evaluation and outcome of IgG4-associated diseases(IgG4-RD).Methods:By integrating the clinical data of patients,retrospectively and systematically analyze the results of common laboratory examinations,imaging examinations,pathological examinations,etc.26 patients who were diagnosed with IgG4-RD in Huaian First Hospital Affiliated to Nanjing Medical University from March 2013 to October 2023.Results:The median age of onset was 65(31～90)years old,and the male to female ratio was 3.33∶1.The first three symptoms were abdominal discomfort,skin scleral yellow stain and fever.Patients mainly involved multiple organs,the most commonly involved organs were lung,pancreas,liver,kidney,bile duct.Compared with the control group,NLR,PLR,ESR,CRP,TBIL,DBIL,ALT,AST,GGT,IgG,IgA and IgM were all abnormally elevated in the first hematological,biochemical and immune tests of the patients,the difference was statisti-cally significant,while C3 and C4 were all decreased,but there was no statistical difference.The first IgG4 level of IgG4-RD patients was correlated with the length of hospitalization,the length of return visit,and the dynamic changes of IgG4 level after return visit.Conclusion:Serum IgG4 detection plays an important role in the diagnosis and treatment of IgG4-RD.In patients with abnormally high level of IgG4,those who are sensitive to high-dose glucocorticoid therapy have a faster decline in IgG4 levels and a longer duration of symptom remission.

Tumors of the digestive system are one of the most important factors affecting people′s quality of life and have become a serious public health problem globally.Early screening and intervention of tumor markers in high-risk groups for tumors is the key to tumor prevention. Follistatin-related proteins (FRP) are important members of the follistatin family and such proteins are involved in the pathological process of tumors of the reproductive system and respiratory system, among others. In recent years, FRP has attracted extensive attention in the study of digestive system tumors, suggesting that FRP may play a significant role in the development of digestive system tumors, and is a potential marker for clinical diagnosis and treatment. The article reviews the biological function, expression and potential mechanism of action of FRP associated with digestive system tumors, with a view to providing reference for the diagnosis and prevention of digestive system tumors, prognosis assessment and drug development.

Tumors of the digestive system are one of the most important factors affecting people′s quality of life and have become a serious public health problem globally.Early screening and intervention of tumor markers in high-risk groups for tumors is the key to tumor prevention. Follistatin-related proteins (FRP) are important members of the follistatin family and such proteins are involved in the pathological process of tumors of the reproductive system and respiratory system, among others. In recent years, FRP has attracted extensive attention in the study of digestive system tumors, suggesting that FRP may play a significant role in the development of digestive system tumors, and is a potential marker for clinical diagnosis and treatment. The article reviews the biological function, expression and potential mechanism of action of FRP associated with digestive system tumors, with a view to providing reference for the diagnosis and prevention of digestive system tumors, prognosis assessment and drug development.

OBJECTIVE: The biomechanical characteristics of three internal fixation modes for femoral subtrochanteric spiral fracture in osteoporotic patients were compared and analyzed by finite element technology, so as to provide the basis for the optimization of fixation methods for femoral subtrochanteric spiral fracture. METHODS: Ten female patients with osteoporosis and femoral subtrochanteric spiral fractures caused by trauma, aged 65-75 years old, with a height of 160-170 cm and a body weight mass of 60-70 kg, were selected as the study subjects. The femur was scanned by spiral CT and a three-dimensional model of the femur was established by digital technology. The computer aided design models of proximal intramedullary nail (PFN), proximal femoral locking plate (PFLP), and the combination of the two (PFLP+PFN) were constructed under the condition of subtrochanteric fracture. Then the same load of 500 N was applied to the femoral head, and the stress distribution of the internal fixators, the stress distribution of the femur, and the displacement of femur after fracture fixation were compared and analyzed under the three finite element internal fixation modes, so as to evaluate the fixation effect. RESULTS: In the PFLP fixation mode, the stress of the plate was mainly concentrated in the main screw channel, the stresses of the different part of the plate were not equal, and gradually decreased from the head to the tail. In the PFN fixation mode, the stress was concentrated in the upper part of the lateral middle segment. In the PFLP+PFN fixation mode, the maximum stress appeared between the first and the second screws in the lower segment, and the maximum stress appeared in the lateral part of the middle segment of the PFN. The maximum stress of PFLP+PFN fixation mode was significantly higher than that of PFLP fixation mode, but significantly lower than that of PFN fixation mode ( P<0.05). In PFLP and PFN fixation modes, the maximum stress of femur appeared in the medial and lateral cortical bone of the middle femur and the lower side of the lowest screw. In PFLP+PFN fixation mode, the stress of femur concentrated in the medial and lateral of the middle femur. There was no significant difference in the maximum stress of femur among the three finite element fixation modes ( P>0.05). The maximum displacement occurred at the femoral head after three finite element fixation modes were used to fix subtrochanteric femoral fractures. The maximum displacement of femur in PFLP fixation mode was the largest, followed by PFN, and PFLP+PFN was the minimum, with significant differences ( P<0.05). CONCLUSION Under static loading conditions, the PFLP+PFN fixation mode produces the smallest maximum displacement when compared with the single PFN and PFLP fixation modes, but its maximum plate stress is greater than the single PFN and PFLP fixation mode, suggesting that the combination mode has higher stability, but the plate load is greater, and the possibility of fixation failure is higher.
Humans ; Female ; Aged ; Finite Element Analysis ; Biomechanical Phenomena ; Fracture Fixation, Internal/methods* ; Hip Fractures/surgery* ; Bone Plates ; Femur Head ; Femoral Fractures/surgery*

Objective To investigate the value of serum IgG4 level in the differential diagnosis of IgG4-related pancreatic and hepatobiliary disease (IgG4-PHD) and non-IgG4-related disease (non-IgG4-RD). Methods Clinical data were collected from 491 patients who were hospitalized and 50 individuals who underwent physical examination in Huaian No. 1 People's Hospital Affiliated to Nanjing Medical University, Subei People's Hospital, and The First Affiliated Hospital of Xuzhou Medical University from August 2014 to April 2021. The 491 patients were divided into IgG4-PHD group with 20 patients, non-IgG4-RD autoimmune disease group with 431 patients (104 patients with systemic lupus erythematosus, 79 with rheumatoid arthritis, 174 with Sjogren's syndrome, 16 with ankylosing spondylitis, 11 with scleroderma, 4 with adult-onset Still's disease, 30 with myositis, 3 with psoriasis, and 10 with primary sclerosing cholangitis), and malignant pancreatic/hepatobiliary tumor group with 40 patients, and the 50 individuals undergoing physical examination were enrolled as healthy control group. Scattering immunoturbidimetric assay was used to measure serum IgG4 concentration. The two-sample Mann-Whitney U test was used for comparison of normally distributed continuous data between groups, and the Fisher's exact test was used for comparison of categorical data between groups. The receiver operating characteristic (ROC) curve was plotted to determine the optimal cut-off value of serum IgG4 in the diagnosis of IgG4-PHD. Results The IgG4-PHD group had a significantly higher serum IgG4 level than the non-IgG4-RD autoimmune disease groups, the malignant pancreatic/hepatobiliary tumor group, and the healthy control group (all P < 0.05), and the Sjogren's syndrome group had a significantly lower serum IgG4 level than the healthy control group ( Z =2.958, P < 0.05). With serum IgG4 ≥1.35 g/L and IgG4 ≥2.01 g/L as the cut-off values, the IgG4-PHD group had a significantly higher positive rate than the non-IgG4-RD autoimmune disease group and the healthy control group (all P < 0.05). The ROC curve analysis showed that IgG4 had an area under the ROC curve of 0.980 in the differential diagnosis of IgG4-PHD and non-IgG4-RD autoimmune diseases, with a sensitivity of 100.00% and a specificity of 94.00% at the optimal cut-off value of 2.21 g/L. Conclusion Serum IgG4 level may also increase in non-IgG4-RD autoimmune diseases, while the cut-off value of 2.21 g/L can improve the differential diagnosis of IgG4-PHD and non-IgG4-RD autoimmune diseases, which requires further verification in clinical practice.

Objective: To investigate the clinical features and pathogenic genes of a family with osteosclerosis. Methods: Six patients and six family members from a family in Jiangsu were tested for biochemical parameters, bone metabolic markers, bone mineral density, thoracolumbar anterior lateral slices, skull positive lateral radiographs, and pelvic plain films. Meanwhile, Sanger sequencing was performed to detect gene mutations of the proband and five other family members with high bone mass. The conformation of the mutational low-density lipoprotein receptor-related protein 5 (LRP5) protein was predicted by SWISS-MODEL. Results: Four adult patients (one male and three females) were tall, with mandibular enlargement and kyphosis in the center of the lower jaw, and none of the four had fractures. Their X ray examination revealed that the skull and long bone cortex was thickened, while the sella and mandible was enlarged. In addition, the absolute values of bone mineral density at each site of all patients were significantly higher as compared with the standard age- and sex-matched adults or adolescent mean reference values, with Z scores of L2-4, femoral neck and total hip being (6.31±4.03) SD, (6.56±2.36) SD, and (7.19±2.03) SD, respectively. The results of genetic sequencing revealed that all six patients carried a heterozygous mutation (c.331G>T; D111Y) in exon 2 of LRP5 gene, while other family members showed wild type (c.331G>G; D111D). Functional prediction indicated that this mutation was located at the amino acid terminal of exon 2 of LRP5 gene, which encodes the first β-helix-generating region of LRP5 protein. Conclusion The D111Y mutation in LRP5 gene leads to a clinical phenotype characterized by benign increased bone mineral density without increasing the risk of fracture. This mutation may further affect the downstream Wnt signaling pathway by altering the spatial structure of LRP5 protein, thereby promoting maturation and differentiation of osteoblasts and resulting in osteosclerosis.

Objective To investigate the influence of sputum specimens pre-processing on the detection result and its clinical sig-nificance .Methods The sputum samples of 124 inpatients in this hospital from February 2016 to April 2016 were selected .The sputum color ,character ,Gram staining microcopic examinationof sputum smear were observed by adopting the naked-eye observa-tion .Its influence on the sputum specimen isolation results was analyzed .Results Among 124 sputum specimens ,90 cases were qualified ,while 34cases were unqualified ;the qualification rate of colorlesssputum specimens was 30% ,which was lower than 94 .7% of yellow sputum specimens ,100% of rusty sputum specimens ,100% of red sputum specimens and 87 .5% of white sputum specimens ;the qualification rate of frothy or watery sputum specimens was 22 .2% ,which was lower than that of other character sputum specimens ,such as purulent sputum specimens (96 .2% ) ,bloody sputum specimens (100% )and mucous sputum specimens (83 .3% );the cultured results of 34 unqualified specimens were the oral and throat normal flora ,which all had the contaminating bacterial growth ;among 90 qualified specimens ,58 specimens showed pure culture or advantage growth ,and 32 specimens showed contaminating bacterial growth .Conclusion The pre-processing of sputum specimens is an efficient solution for improving the accu-racy of sputum specimens detection results ,and has the important clinical significance .