[Objective] To analyze the clinicopathological characteristics of treatment-naive patients with highly suspected prostate cancer (PCa) with prostate-specific antigen (PSA) level ≥20 ng/mL, to provide reference for promoting early screening of PCa. [Methods] A retrospective analysis was conducted on the clinical data of treatment-naive patients with PSA level ≥20 ng/mL, undergoing prostate biopsy for highly suspected PCa at the Department of Urology, Tianjin Medical University Second Hospital during Jan.2013 and Jun.2023. The correlation between patients' age, body mass index (BMI), PSA, prostate volume (PV), prostate cancer-specific antigen density (PSAD), prostate imaging reporting and data system (PI-RADS) score, and International Society of Urological Pathology (ISUP) grade with highly suspected PCa metastasis and PSA stratification were analyzed. [Results] A total of 1778 suspected patients were enrolled. Pathological findings confirmed PCa in 1465 cases (82.4%), with 487(33.2%) diagnosed as metastatic PCa. Over the past decade, the number of patients undergoing prostate biopsy for highly suspected PCa and being confirmed has been increasing annually, with the proportion of metastatic cases remaining at around 30%. Compared with those with PSA level being 20-50 ng/mL, patients with PSA level >50 ng/mL had older age, lower BMI, higher PSAD, higher PI-RADS, higher ISUP, more diverse pathological types, and a higher incidence of metastasis (P<0.05) with lower proportion of urban residents. Additionally, analysis of metastatic PCa cases showed that 46.8%(228/487) had oligometastasis (≤5 metastatic lesions), including 99.0% bone metastasis, 4.1% extraregional lymph node metastasis, and 4.3% other organ metastasis. [Conclusion] Over the past 10 years, there has been a continuous increase in the number of treatment-naive biopsied cases and newly diagnosed cases of highly suspicious PCa with PSA level ≥20 ng/mL, while the proportion of metastatic cases remains high. Therefore, proactive efforts should be made to promote early screening of high-risk suspected cases.

Autoimmune encephalitis（AE）is a group of inflammatory disorders within the central nervous system（CNS）triggered by autoimmune mechanisms. Most AE patients show good responses to first-line immunotherapies such as corticosteroids and intravenously injected immunoglobulin. Nevertheless，the adverse effects associated with extensive immunosuppression have become a difficult issue in treatment，and some patients with severe conditions or recurrence still require further intensive therapy. Therefore，it is urgently needed to search for novel treatment strategies with high efficiency，precision，and safety. In recent years，targeted immunotherapy and chimeric antigen receptor T-cell immunotherapy that specifically target immune cells or cytokines involved in the pathogenesis of AE have gradually become research hotspots，with good tolerability and safety，which provides new options for the clinical management of AE.

Objective To investigate the effect of 5-Aza-CdR on Notch1 pathway and neural regeneration and to explore the effects of 5-Aza-CdR on learning memory ability in mice by exploring active avoidance behavior.Methods Sixty 6～8-week-old SPF-grade ICR male mice were divided into two groups.5-Aza-CdR was administered to one group of mice via lateral ventricular injection,while the control group was injected with bovine serum albumin.Notch1 and HES1 mRNA and protein expression levels were detected by Real-time PCR and Western blot 24 hours after injection;5-bromo-2'-deoxyuridine-positive cells were observed by laser confocal microscopy,and Notch1 expression in hippocampal dentate gyrus was viewed with laser confocal microscopy.Notch1 methylation changes were detected by ethylation-specific PCR,and learning and memory behaviors of mice were assessed by passive avoidance tests and shuttle avoidance assays.Results Injection of 5-Aza-CdR increased hippocampal Notch1 pathway activity,promoted neuronal regeneration in the DG region,decreased methylation levels in the Notch1 promoter region,and enhanced the ability of mice to perform active avoidance behavior.Conclusions The effect of 5-Aza-CdR on active avoidance behavior may be related to the influence of hippocampal neural regeneration through the Notch 1 pathway.

Objective:To evaluate the relationship between systemic immune-inflammatory index (SII) and prognosis of acute respiratory distress syndrome (ARDS).Methods:ARDS patients from the I Medical Information Mart for Intensive CareⅢ were selected as the study objects. Patients were followed up for one year. The primary endpoint was the 30-day mortality rate, and secondary endpoints were the 90-day and one-year mortality rates. Cox proportional hazard regression analysis was used to assess SII as an independent risk factor for ARDS patients, with propensity score matching to control for confounding factors.Results:A total of 723 ARDS patients were included in this study. Patients with SII≥ 3655 had older age, lower SpO 2 levels, and higher simplified acute physiology scoreⅡ (SAPSⅡ) and sequential organ failure assessment (SOFA) scores compared to those with SII <3655. Additionally, the 30-day, 90-day, and one-year mortality rates were higher in patients with SII ≥3655. Cox proportional hazard regression analysis showed that high SII level was an independent risk factor for the prognosis of ARDS at 30 days ( HR=1.68, 95% CI: 1.19-2.36, P=0.0028), 90 days ( HR=1.46, 95% CI: 1.07-1.99, P=0.0170), and one year ( HR=1.34, 95% CI: 1.01-1.77, P=0.0425). Propensity score matching analysis further confirmed the relationship between SII and the prognosis of ARDS patients. Conclusions:SII, as a simple and easily measurable index, is an independent risk factor for the prognosis of ARDS patients.

The high incidence of unplanned readmission of postoperative patients with gynecologic malignancies not only seriously affects the quality of life of patients, but also increases the medical burden. This paper reviews the current situation, common causes, relevant factors and insights of unplanned readmission of postoperative gynecologic malignancy patients, and further explores the unplanned readmission of postoperative gynecologic malignancy patients in China by drawing on existing foreign studies and combining them with the actual situation in China, with the aim of providing a basis for clinical health care professionals to develop targeted intervention plans, so as to effectively reduce the unplanned readmission of postoperative gynecologic malignancy patients.

This article explains the concept, emotional recovery process, and coping strategies of the second victim after the occurrence of medical adverse events, in order to effectively identify and manage the second victim and obtain effective support. This article aims at providing a theoretical reference for constructing a positive patient safety culture and organizational support system under China's national conditions to reduce the second victim's injury.

BACKGROUND AND PURPOSE: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most common type of autoimmune encephalitis. This study aimed to explore the possible factors affecting the response to first-line treatments in patients with anti-NMDAR encephalitis. METHODS: We enrolled 29 patients who were diagnosed as anti-NMDAR encephalitis between January 1, 2015, and June 30, 2018. They were divided into the remission and nonremission groups according to their response to first-line treatments. The demographics, clinical manifestations, main ancillary examinations, follow-up treatments, and prognosis of patients were recorded. The symptoms reported on in this study occurred before treatments or during the course of first-line treatments. RESULTS: There were 18 patients (62.07%) in the remission group and 11 patients (37.93%) in the nonremission group. Compared to the remission group, a higher proportion of the patients in the nonremission group exhibited involuntary movements, decreased consciousness, central hypoventilation, lung infection, and hypoalbuminemia. The nonremission group had a high incidence of increased intracranial pressure and significant elevations of the neutrophil-to-lymphocyte ratio in peripheral blood (NLR), aspartate aminotransferase, and fibrinogen. Six patients (54.55%) in the nonremission group received second-line immunotherapy. Only one patient (3.45%) died, which was due to multiple-organ failure. CONCLUSIONS: Anti-NMDAR-encephalitis patients with more symptoms—especially involuntary movements, disturbance of consciousness, central hypoventilation, and accompanying hypoalbuminemia and pulmonary infection—may respond poorly to first-line treatments. Positive second-line immunotherapy therefore needs to be considered. Admission to an intensive-care unit, increased cerebrospinal fluid pressure, and increased NLR might be the significant factors affecting the response to first-line treatments.
Anti-N-Methyl-D-Aspartate Receptor Encephalitis ; Aspartate Aminotransferases ; Cerebrospinal Fluid Pressure ; Consciousness ; Demography ; Dyskinesias ; Encephalitis ; Fibrinogen ; Follow-Up Studies ; Humans ; Hypoalbuminemia ; Hypoventilation ; Immunotherapy ; Incidence ; Intracranial Pressure ; Lung ; Prognosis

Transient central nervous system symptoms and reversible white matter lesions have been rarely reported in X-linked Charcot-Marie-Tooth disease type 1.We reported two cases of X-linked CharcotMarie-Tooth disease type 1 associated with reversible white matter lesions.Patient 1 is a 15-year old boy who presented with paroxysmal speech disorders and limb weakness at the beginning of the illness.He still walked unsteadily after discharge.Patient 2 is a 13-year old girl with transient numbness and weakness in her left extremities and slurred speech.She completely recovered.Both of them presented pes cavus without obvious family history or personal history.Both of them showed primary symptom of central nervous system with MRI abnormal findings in corpus callosum and periventricular areas.The electrophysiological studies showed a mixed demyelinating and axonal sensorimotor neuropathy in patient 1 but no significant abnormalities in patient 2.The genetic analysis of both patients showed a pathogenic mutation in GJB1 gene.Clinicians should improve the recognition of X-linked Charcot-Marie-Tooth disease type 1.This type of disorders can behave as symptoms of nervous system firstly even if there is no other typical characteristics,such as peripheral nervous system involvement.

The severe fever with thrombocytopenia syndrome virus (SFTSV),a new RNA virus,was discovered in recent years,which can lead to fever,thrombocytopenia and multiple organ dysfunction.Picks is the main media A case of a SFTSV-related encephalitis diagnosed by second-generation gene sequencing was reported here.The patient had fever,disturbance of consciousness,convulsions,with thrombocytopenia and enzymatic indicators increased significantly.After active anti-virus and supportive treatment,the prognosis was good.It is our aim to suggest that,in the epidemic season,when you meet thesimilar patients like this,you should consider the possibility of SFTSV-related encephalitis.Virus nucleic acid detection and second-generation gene sequencing technology are helpful for timely diagnosis and treatment and reducing mortality of the disease.

Objective To evaluate the effect of methylprednisolone on endoplasmic reticulum stress in rats with ventilator-induced lung injury ( VILI ) and the relationship with phosphatidylinositol 3-kinase∕serine-threonine protein kinase ( PI3K∕Akt) signaling pathway. Methods One hundred clean-grade male Sprague-Dawley rats, aged 4-5 months, weighing 270-320 g, were divided into 5 groups ( n=20 each) using a random number table method: control group ( C group) , VILI group ( V group) and different doses of methylprednisolone groups ( M1-3 groups) . Group C received no mechanical ventilation and kept spontane-ous breathing for 4 h. Rats were mechanically ventilated ( tidal volume 40 ml∕kg, respiratory rate 15-17 breaths∕min, inspiratory∕expiratory ratio 1 : 1, positive end-expiratory pressure 0, fraction of inspired oxy-gen 21％ during OLV) in group V. Methylprednisolone 2, 10 and 30 mg∕kg were intravenously injected at 20 min before mechanical ventilation in M1-3 groups, respectively, and the equal volume of normal saline was given in group V. Blood samples and lung tissues were taken at 4 h of ventilation for measurement of the lung permeability index ( LPI) and wet∕dry lung weight ratio ( W∕D ratio) , for examination of pathological changes, and for determination of apoptosis index ( AI) in lung tissues ( by TUNEL) , expression of Akt, phosphorylated Akt (p-Akt), glucose-regulated protein 78 (GRP78), CCAAT∕enhancer-binding protein homologous protein (CHOP) and caspase-12 in lung tissues (by Western blot). Injured alveoli rate (IAR) was calculated. Results Compared with group C, the W∕D ratio, LPI, IAR and AI were significantly in-creased, the expression of p-Akt was down-regulated, and the expression of GRP78, CHOP and caspase-12 was up-regulated in V and M1 groups ( P<0. 05) , and no significant change was found in the indexes mentioned above in M2 and M3 groups ( P>0. 05) . Compared with group V, the W∕D ratio, LPI, IAR and AI were significantly decreased, p-Akt expression was up-regulated, and the expression of GRP78, CHOP and caspase-12 was down-regulated in M2 and M3 groups ( P<0. 05) . Conclusion Methylprednisolone in-hibits endoplasmic reticulum stress, thus inhibiting cell apoptosis, and the mechanism is related to activa-ting PI3K∕Akt signaling pathway in rats with VILI.