Objective To investigate the effect of blood glucose control parameters on the prognosis of severe pneumonia patients based on continuous glucose monitoring(CGM)system.Methods A retrospective analysis was conducted on 51 severe pneumonia patients monitored by CGM at the Fourth Affiliated Hospital of Soochow University from November 2021 to August 2023.Assessed parameters included baseline clinical characteristics,glycosylated hemoglobin(HbA1c),mean glucose,standard deviation(SD),coefficient of variability(CV),mean amplitude of glycemic excursions(MAGE),maximum glucose level,minimum glucose level,and time in range(TIR)of glucose within the target range(3.9-10.0 mmol/L)as a proportion and levels of inflammatory indicators before and after treatment.Based on the 28-day follow-up results,the patients were divided into the survival group(39 cases)and the death group(12 cases).The blood glucose parameters of the two groups were compared.Multivariate Logistic regression model was used to analyze the influence of blood glucose parameters and infection indexes on the prognosis of patients with severe pneumonia.The efficacy of blood glucose parameters in the diagnosis of 28-day mortality was further evaluated by receiver operator characteristic curve(ROC curve).Results The acute physiology and chronic health evaluationⅡ(APACHEⅡ),SD and CV of blood glucose in death group were higher than those in survival group[APACHEⅡscore:20.5(14.0)vs.15.0(7.0),SD(mmol/L):2.6±0.7 vs.2.1±0.5,CV:(27.7±5.8)%vs.(23.7±4.3)%].However,the TIR(3.9-10.0 mmol/L)proportion was statistically lower than that of survival group[59.0%(17.0%)vs.68.0%(35.0%)],the differences were all statistically significant(all P<0.05).After using CGM,the white blood cell count(WBC)and hypersensitive C-reactive protein(hs-CRP)were significantly decreased[WBC(×109/L):9.2(6.5)vs.11.1(9.2),hs-CRP(mg/L):39.4(59.0)vs.56.2(133.8),both P<0.05].Multivariate Logistic regression showed that TIR(3.9-10.0 mmol/L)proportion was an independent risk factor for 28-day mortality in patients with severe pneumonia[odds ratio(OR)=0.923,95%confidence interval(95%CI)was 0.852-0.999,P=0.046].The ROC curve showed that TIR proportion was valuable in predicting the clinical outcomes of patients with severe pneumonia.Area under the curve(AUC)=0.720,95%CI was 0.563-0.878,P=0.022;when the cut-off value was 63.5%,the sensitivity and the specificity were 59.0%and 83.3%respectively.Conclusion Increase of TIR(3.9-10.0 mmol/L)proportion in patients with severe pneumonia could improve clinical outcomes,especially when TIR proportion≥63.5%.

Objective To investigate the effect of blood glucose control parameters on the prognosis of severe pneumonia patients based on continuous glucose monitoring(CGM)system.Methods A retrospective analysis was conducted on 51 severe pneumonia patients monitored by CGM at the Fourth Affiliated Hospital of Soochow University from November 2021 to August 2023.Assessed parameters included baseline clinical characteristics,glycosylated hemoglobin(HbA1c),mean glucose,standard deviation(SD),coefficient of variability(CV),mean amplitude of glycemic excursions(MAGE),maximum glucose level,minimum glucose level,and time in range(TIR)of glucose within the target range(3.9-10.0 mmol/L)as a proportion and levels of inflammatory indicators before and after treatment.Based on the 28-day follow-up results,the patients were divided into the survival group(39 cases)and the death group(12 cases).The blood glucose parameters of the two groups were compared.Multivariate Logistic regression model was used to analyze the influence of blood glucose parameters and infection indexes on the prognosis of patients with severe pneumonia.The efficacy of blood glucose parameters in the diagnosis of 28-day mortality was further evaluated by receiver operator characteristic curve(ROC curve).Results The acute physiology and chronic health evaluationⅡ(APACHEⅡ),SD and CV of blood glucose in death group were higher than those in survival group[APACHEⅡscore:20.5(14.0)vs.15.0(7.0),SD(mmol/L):2.6±0.7 vs.2.1±0.5,CV:(27.7±5.8)%vs.(23.7±4.3)%].However,the TIR(3.9-10.0 mmol/L)proportion was statistically lower than that of survival group[59.0%(17.0%)vs.68.0%(35.0%)],the differences were all statistically significant(all P<0.05).After using CGM,the white blood cell count(WBC)and hypersensitive C-reactive protein(hs-CRP)were significantly decreased[WBC(×109/L):9.2(6.5)vs.11.1(9.2),hs-CRP(mg/L):39.4(59.0)vs.56.2(133.8),both P<0.05].Multivariate Logistic regression showed that TIR(3.9-10.0 mmol/L)proportion was an independent risk factor for 28-day mortality in patients with severe pneumonia[odds ratio(OR)=0.923,95%confidence interval(95%CI)was 0.852-0.999,P=0.046].The ROC curve showed that TIR proportion was valuable in predicting the clinical outcomes of patients with severe pneumonia.Area under the curve(AUC)=0.720,95%CI was 0.563-0.878,P=0.022;when the cut-off value was 63.5%,the sensitivity and the specificity were 59.0%and 83.3%respectively.Conclusion Increase of TIR(3.9-10.0 mmol/L)proportion in patients with severe pneumonia could improve clinical outcomes,especially when TIR proportion≥63.5%.

Objective To investigate the clinicalmanifestations,imaging features,diagnosis and differential diagnosis,treatment and prognosis of renal malignant solitary fibrous tumor(SFT).Methods The clinical data in 1 case of rare renal malignant SFT were retrospectively analyzed.Referring to related literatures,the histological origin,pathological features,differential diagnosis,treatment and follow-up of renal malignant SFT were analyzed.Results The patient was preoperatively diagnosed as right renal clear cell carcinoma.Postoperative pathological examination diagnosed as low grade malignant SFT of right kidney.And immunohistochemistry indicated CD34+,BCL-2 +,CD68+,CD99+,vimentin,Ki-67 5％ +,SMA focal weakly positive.No recurrence or metastasis occurred after 4-month follow-up period.Conclusion Malignant SFT of the kidney is very rare,its diagnosis and differential diagnosis depend on postoperative pathological and immunohistochemical examination.Radical nephrectomy is the main option for malignant SFT of the kidney with good prognosis.

Objective To summary the experience of laparoscopic cystectomy ileal conduit (Bricker) and orthotopic ileal neo‐bladder (Hautmann) and compare the short‐term efficacy of the two types of urinary diversion for invasive bladder cancer . Methods Retorspective analysis of the patients in our hospital who accepted laparoscopic radical cystectomy from 2010 to 2014 was performed ,74 of them accepted ileal conduit ,and 30 of them accepted orthotopic ileal neobladder .The general clinical data ,postop‐erative recovery ,postoperative complications and Oncology feature were analyzed and compared between the two groups .Results There was no demonstrable difference was found in operation time ,blood loss ,intraoperative blood transfusion rate ,the number of removed lymph node ,average hospital stay ,specimens positive margin rate and postoperative pathology results between the two groups (P>0 .05) .But there were significant difference in postoperative intestinal function recovery time[(4 .2 ± 1 .4)d ,(5 .3 ± 2 .2)d] ,(P=0 .002) ,and the complication rates 31 .9% (23 cases)vs .53 .3% (16 case) ,P=0 .043 .After 6 months ,the daytime and nighttime urinary control were 76 .9% ,57 .7% ,after 12 months ,the daytime and nighttime urinary control increased to 90 .9% , 81 .8% .2 cases(7 .7% ) were diagnosed with recurrence or metastasis during follow‐up in Hautmann group ,while 9 cases(14 .1% ) were diagnosed with recurrence or metastasis in Bricker group .Conclusion Two kinds of surgical procedures both have the similar therapeutic effect ,but the postoperative quality of life is better for Hautmann orthotopic neobladder patients .

Objective To explore the feasibility of detecting the cytokeratin 20 (CK-20) mRNA in exfoliated urothelial cells for the diagnosis of bladder carcinoma. Methods Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to detect the expression of CK-20 mRNA in cells collected from the urine of 45 cases of bladder cancer, 15 cases of cystitis accompanied by hematuria, 10 healthy volunteers, and 7 different cell lines, including bladder cancer cell line T24, kidney cancer 786-0 and GRC-1, breast cancer MCF-7 and MDA-MB-435, and ovary cancer SKOV 3 and 3AO. Results CK-20 mRNA expression was detected in 36 of 41 cases of bladder transitional cell carcinoma (87.80%), in 18 of the 21 GⅠ patients (85.71%), in 11 of the 13 GⅡ patients (84.62%), in 7 of the 7 GⅢ patients (100%), in 20 of the 22 T a-1 patients (90.91%), and in 16 of the 19T 2-4 patients (84.21%). Sensitivity of the method was found to be 87.80%, whereas specificity was 73.33%. In 15 patients with hematuria, there were 4 cases of false positive: 1 case of BPH, 1 case of atypical hyperplasia, 1 case of chronic inflammation, and 1 case undergoing TURP previously. CK-20 amplification band was also obtained in all of 19 cases of bladder transitional cell tumor tissues and bladder cancer cell line T24, but not in 4 patients with non-transitional cell carcinoma and 6 other tumor cell lines. No false positive cases were found in the healthy control group. Conclusion These results suggest that CK-20 might be a useful tumor marker for early noninvasive diagnosis and follow-up of bladder cancer by detecting CK-20 mRNA expression of uroepithelial cells from the voided urine specimen by RT-PCR.