Objective To compare the value of multimodal ultrasound and ultrasound-guided fine-needle aspiration biopsy(US-FNAB)for distinguishing benign and malignant thyroid nodules of Chinese thyroid imaging reporting and data system(C-TIRADS)grade 4.Methods Data of 247 thyroid nodules in 201 patients were retrospectively analyzed,including 193 malignant and 54 benign noes.Taken postoperative pathology as the gold standards,the value of multimodal ultrasound,i.e.the combination of conventional ultrasound,shear wave elastography(SWE)and contrast-enhanced ultrasound(CEUS)and US-FNAB for distinguishing benign and malignant thyroid nodules were compared.Results The sensitivity,specificity,accuracy,misdiagnosis rate and rate of missed diagnosis of conventional ultrasound for diagnosing malignant thyroid nodules was 86.53％,59.26％,80.57％,40.74％and 13.47％,respectively,of SWE was 78.76％,74.07％,77.73％,25.93％and 21.24％,respectively,of CEUS was 90.16％,77.78％,87.45％,22.22％and 9.84％,respectively,while of multimodal ultrasound was 97.93％,88.89％,95.95％,11.11％and 2.07％,respectively,and of US-FNAB was 89.64％,96.30％,91.09％,3.70％and 10.36％,respectively.The sensitivity,specificity and accuracy of multimodal ultrasound for distinguishing benign and malignant thyroid nodules were higher,while the misdiagnosis rate and missed diagnosis rate were lower than those of conventional ultrasound,SWE and CEUS alone.The sensitivity,accuracy and misdiagnosis rate of multimodal ultrasound were higher,while its specificity and missed diagnosis rate were both lower than those of US-FNAB(all P＜0.05).Conclusion For distinguishing benign and malignant thyroid nodules of C-TIRADS grade 4,multimodal ultrasound had higher sensitivity and accuracy but higher misdiagnosis rate,while US-FNAB had higher specificity but also higher missed diagnosis rate.

Background::Pulmonary embolism (PE) is a severe and acute cardiovascular syndrome with high mortality among patients with autoimmune inflammatory rheumatic diseases (AIIRDs). Accurate prediction and timely intervention play a pivotal role in enhancing survival rates. However, there is a notable scarcity of practical early prediction and risk assessment systems of PE in patients with AIIRD.Methods::In the training cohort, 60 AIIRD with PE cases and 180 age-, gender-, and disease-matched AIIRD non-PE cases were identified from 7254 AIIRD cases in Tongji Hospital from 2014 to 2022. Univariable logistic regression (LR) and least absolute shrinkage and selection operator (LASSO) were used to select the clinical features for further training with machine learning (ML) methods, including random forest (RF), support vector machines (SVM), neural network (NN), logistic regression (LR), gradient boosted decision tree (GBDT), classification and regression trees (CART), and C5.0 models. The performances of these models were subsequently validated using a multicenter validation cohort.Results::In the training cohort, 24 and 13 clinical features were selected by univariable LR and LASSO strategies, respectively. The five ML models (RF, SVM, NN, LR, and GBDT) showed promising performances, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.962-1.000 in the training cohort and 0.969-0.999 in the validation cohort. CART and C5.0 models achieved AUCs of 0.850 and 0.932, respectively, in the training cohort. Using D-dimer as a pre-screening index, the refined C5.0 model achieved an AUC exceeding 0.948 in the training cohort and an AUC above 0.925 in the validation cohort. These results markedly outperformed the use of D-dimer levels alone.Conclusion::ML-based models are proven to be precise for predicting the onset of PE in patients with AIIRD exhibiting clinical suspicion of PE.Trial Registration::Chictr.org.cn: ChiCTR2200059599.

Objective:To evaluate the efficacy and safety in the treatment of the visceral artery aneurysms (VAAs) by Viabahn stent graft and the detachable coils combined with Onyx embolization.Methods:A retrospective study on clinical and follow up results of 46 patients in the treatment of visceral aneurysms (VAAs) from Jun 2012 to Jun 2018 was carried out.Result:In 18 patients of VAAs treated with Vabahn endovascular stent grafting, the aneurysm cavity was completely isolated after injection of contrast and the technical success rate was 100% (18/18). In 28 patients of VAAs treated with the detachable coils combined with Onyx embolization, the aneurysm cavities of 26 patients among the 28 cases were filled tightly. In 2 patients the aneurysm neck was still visible. The average follow-up period was (36.5±2.3) months by CTA. After treating VAAs with the Viabahn stent graft, the complete isolation rate and the patency of aneurysm bearing artery were respectively 100% (18/18) and 94.4% (17/18). When VAAs was treated with the detachable coils combined with Onyx embolization, the complete isolation rate and the patency of aneurysm bearing artery were respectively 85.7% (24/28) and 92.9% (26/28) (χ 2=3.915, P=0.048), the difference of the patency of aneurysm bearing artery between the two groups was no significant difference (χ 2=0.074, P=0.786). Conclusion:VAAs treated with Viabahn endovascular stent grafting or detachable coils combined with Onyx embolization are both safe and effective.

OBJECTIVETo explore the relationship between the time after thrombosis and the efficacy of combined ultrasound and microbubble treatment for rescuing the ischemic tissues.

METHODSRat models of thrombosis in the right common iliac artery were established and received combined ultrasound and microbubble treatment at 3, 6 and 12 h after thrombosis. The recanalization rate of the right common iliac artery was assessed using both 2-dimensional and Doppler ultrasound. The plateau acoustic intensity (AI) was quantified for estimating the skeletal microvascular blood volume, and skeletal muscle injury markers including myoglobin (Mb) and creatinine kinase (CK) were measured using ELISA. Postmortem TUNEL staining was used to detect the apoptotic rate of skeletal muscle cells in the hind limb of the rats.

RESULTSCompared with those in 3 h group, the recanalization rate and AI were significantly lower, and the levels of Mb and CK and the apoptotic rate of the skeletal muscle cells were significantly higher in both 6 h group and 12 h group ( < 0.05). Compared with those in 6 h group, the rats receiving treatment at 12 h after thrombosis showed significantly lowered AI and increased Mb, CK and apoptotic rate of the skeletal muscle cells ( < 0.05).

CONCLUSIONSThe efficacy of combined ultrasound and microbubble treatment for rescuing ischemic tissues tends to be attenuated as the time after thrombosis prolongs in rats.

Objective To explore the association between BMI and the risk of developing cardiac surgery associated acute kidney injury (CS-AKI),mortality of AKI and AKI requiring renal replacement therapy (AKI-RRT) after cardiac surgery.Methods Clinical data of patients undergoing cardiac surgery from January 2011 to December 2015 in Zhongshan Hospital of Fudan University were prospectively collected.Patients were divided into four groups according to BMI classification of Chinese population.Adjustment for selection bias was further assessed using propensity score method (PSM) to evaluate the role of BMI in the development of AKI.Results A total of 8442 patients were enrolled,among which 1092 patients successfully matched through PSM.The AKI incidences were respectively 30.3％,33.3％,38.6％ and 46.8％ in four BMI groups (P ＜ 0.01) before PSM.The AKI incidences were respectively 31.9％,35.2％,42.5％ and 42.9％ in four BMI groups (P=0.016) after PSM.The risk of developing AKI increased by 19.9％ as the BMI increased per 5 kg/m2 (95％ CI:1.070-1.344,P=0.002).The hospital mortality of patient (overall,AKI,AKI-RRT) in four groups was not statistically different after PSM (P ＞ 0.05),but overweight group always had the lowest mortality.Conclusions BMI is a risk factor for AKI after cardiac surgery,and the AKI incidence increases with increasing BMI in a certain range.

Objective To investigate the relationship between Hepatitis B patients with different viral loads and immunoglob-ulin A,G,M and complement C3,C4.Methods Firstly,followed by real-time fluorescence quantitative PCR detection 210 cases of hepatitis B patients with HBV-DNA levels,according to 10n copies/ml different viral load detection results,it was divided into 102 ~108 copies/ml of the experimental groups.Then the experimental groups and control group were simulta-neously detected in immunoglobulin A,G,M and complement C3,C4.Analysed the correlation between HBV loads and im-munoglobulin A,G,M and complement C3,C4.Results When the viral loads of hepatitis B patients were 105 ~108 copies/ml,the testing results of IgA,IgG and IgM were both increasing (U =12.43,10.96,6.42,P <0.01),while C3 and C4 were both decreasing (U =8.37,6.0,P <0.01).When the viral loads of hepatitis B patients were 102 ~ 104 copies/ml,only IgA and IgM were increasing (U =2.36,2.04,P <0.05),the other testing results had no statistical significance.Between the test of 7 experimental groups compared with each other,only 104 group and 105 group had significantly changed (IgA and IgM were increasing,C4 was decreasing,U =2.39,2.46,2.09,P <0.05,IgG was increasing,U = 3.25,P <0.01),but between other low viral loads or high viral loads were not significantly differences.Conclusion The different viral loads of hepatitis B patients could cause the different changes of immunoglobulin A,G,M and complement C3,C4,especially in the 4 groups from 105 to 108 copies/ml.Followed by increasing in viral loads,there were immunoglobulin A,G,M increasing and comple-ment C3,C4 decreasing,and also serious impaction on the immune function of organism.There was a positive correlation be-tween viral loads in vivo and immune damages,correlation coefficient (γ =0.967,P <0.01).When the viral loads from 104 to 105 copies/ml,the testing results had changed significantly.It suggest that should control viral loads under 104 copies/ml in the hepatitis B antiviral treatment,so the effect of immune function damage will be the minimum.

Objective To investigate the roles of microRNA-382 (miR-382) in the pathogenesis of renal tubulointerstitial fibrosis (TIF).Methods Human kidney epithelial cells (HK2)transfected with miR-382 inhibitor (antagomiR-382) were used to examine the effect of miR-382 abundance on cell polarity,as well as to test the complementary relationship between miR-382 and its predicted target gene heat shock protein 60 (HSPD1),which was further verified by 3'-untranslated region luciferase assay and site-directed mutagenesis.The role of miR-382 played in the development of renal interstitial fibrosis and redox regulation was examined in a mouse unilateral ureteral obstruction (UUO) model.Locked nucleic acid (LAN)-modified anti-miR-382 was intravenous delivered via tail vein 30 min prior to UUO,and repeated the dosage 24 h after the surgery.For clinical verification,renal biopsy specimens from 12 IgA nephropathy (IgAN) patients were collected,6 patients with moderate to severe TIF and 6 patients without TIF.The relative abundance of miR-382 and HSPD1 protein was analyzed by using in situ hybridization and immunohistochemistry.Results HSPD1 was confirmed to be a new,direct target gene of miR-382 by in vitro 3'-untranslated region luciferase assay and sitedirected mutagenesis.The development of epithelial transition in HK2 cells was accompanied with upregulation of miR-382 [(6.54±0.96) vs (1.12±0.26),P ＜ 0.05].Blocking the expression of miR-382 could reversed the progression of epithelial transition partially.In UUO mice the abundance of miR-382 was up-regulated [(6.89 ± 2.47) vs (1.00±0.42),P ＜ 0.01] while HSPD1 and Trx were downregulated compared with the sham group.Down-regulation of miR-382 was associated with significant decrease in TIF,but increase in HSPD1 and thioredoxin protein compared with UUO group [HSPD1:(0.34±0.10) vs (0.14±0.05);Trx:(0.79±0.18) vs (0.36±0.16);all P ＜ 0.05].The expression of miR-382 was up-regulated and HSPD1 was significantly down-regulated in IgAN patients with TIF.Conclusions miR-382 play an important role in renal tubulointerstitial fibrosis in human and mice.HSPD1 is one of the target genes of miR-382.The down-regulation of HSPD1 and the decrease ability of anti-oxidative stress may be the important mechanism of miR-382 involved in renal tubulointerstitial fibrosis.

Objective:To explore the potential serum biomarkers of patients with lupus nephritis(LN)by using two-dimensional electrophoresis combined with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry(MALDI-TOF/TOF MS),so as to lay the foundation for illuminating pathogenesis.Methods:A total of 40 LN patients were divided into two groups,the active LN group and the inactive LN group,with 20 in each.In addition,20 IgA nephritis patients and 20 healthy volunteers were enrolled as IgAN group and healthy control group.Two-dimensional gel electrophoresis was used to separate and analyze the serum proteins,and MALDI-TOF/TOF MS was applied to the identification of the differentially expressed pro-teins.Results:A total of fifty differentially expressed proteins were identified.Compared with that in healthy control group,23 differentially expressed proteins were discovered in active LN group and inactive LN group,among which,8 proteins were up-regulated and 1 5 proteins were down-regulated.And 1 8 differentially expressed proteins,compared with IgA nephritis group, were found in active LN group and inactive LN group,including 13 up-regulated proteins and 5 down-regulated proteins.Fur-thermore,the number of up-regulated and down-regulated proteins in active LN group,compared with those in inactive LN group,were 4 and 5,respectively.Among the 50 identified differentially expressed proteins,the expression of serum amyloid protein A(SAA )in active LN group was higher than that in the other groups while the expression of complement component C4A in active LN group was lower than that in the other groups.And the expression of chain B (solution structure of double super helix model)in the inactive LN group was higher than that in the other groups.Compared with that in healthy control group,the expression of vitamin D-binding protein isoform 1 precursor,chain A(crystal structure of uncomplexed vitamin D-binding protein)and chain B (a covalent dimer of transthyretin that affects the amyloid pathway)was up-regulated in both ac-tive LN group and inactive LN group,while the expression of the vitronectin precursor,ficolin-2 isoform a precursor and chain A (crystal structure of the catalytic domain of human complement C1 s protease)was down-regulated.Compared with that in IgA nephritis group,the expression of lipoprotein CIII and vitronectin precursor was up-regulated in both active LN group and inactive LN group.Conclusions:Combination of two-dimensional gel electrophoresis and MALDI-TOF/TOF MS is effective for screening and identification of differentially expressed proteins in serum from LN patients.These differentially expressed pro-teins could be used as biomarkers for noninvasive diagnosis and evaluation of LN.Further study on these proteins would be conducive to understanding the pathogenesis of LN.

Objective To identify the prevalence and etiology of kidney disease and the related risk factors in type 2 diabetic patients in rural Shanghai.Methods A cross-sectional study in type 2 diabetic patients was conducted in a community of Shanghai.Questionnaire,clinical examination and laboratory tests were completed to collect the information about sociodemographic and healthcare characteristics.Results A total of 1421 eligible patients with complete information were screened from 1487 type 2 diabetic patients between November 2008 and March 2009.Of them,40.75％ were men,59.25％ were women,aged 37-86 (61.33 ± 9.65 ) years old,with diabetic duration of 0.25-43.92 (7.85 ± 6.34) years.Among them,43.42％ had diabetic retinopathy,21.18％ had neuropathy; 69.95％ met the screening definition for hypertension,76.07％ for hyperlipidemia,15.55％ for hyperuricemia and 23.65％ for cardiovascular disease.The control rates of fasting blood glucose,glycosylated hemoglobin,blood pressure and serum cholesterol were 57.71％,33.99％,14.22％ and 2.46％,respectively.The prevalence of kidney disease,diabetic nephropathy and non-diabetic renal disease was 41.31％,18.51％ and 13.44％,respectively; and 9.36％ were diagnosed as renal insufficiency of unknown reasons.Age,diabetic duration,hyperuricemia,diabetic retinopathy and poor control of blood pressure were independently associated with kidney disease;age and poor control of blood pressure were independently associated with diabetic nephropathy; age and hyperuricemia were independent risk factors of renal insufficiency in patients with diabetic nephropathy.Conclusions Although the diabetic duration of these subjects is relatively short,the prevalence of complications including diabetic nephropathy is high.The high prevalence of non-diabetic renal disease shows the importance of further screening and diagnoses for prevention.Strict control of blood glucose,blood pressure,serum cholesterol and serum uric acid are key points of cutting down the prevalence of diabetic nephropathy and chronic kidney disease.

Objective To examine the association between residual renal function at initiation of dialysis and prognosis in maintenance dialysis patients.Methods Incident patients with end-stage renal diseases initiating dialysis between 1 January 2005 and 30 September 2009,followed up to 31 March 2010 were enrolled in this study.Residual renal function was evaluated using eGFR estimated by the abbreviated MDRD equation.Patients were classified into four groups according to eGFR of ≥10.5,8 to ＜10.5,6 to ＜8,＜6 ml·min-1·(1.73 m2)-1.The outcome was all-cause and cardiocerebral vascular mortality.Results (1) A total of 562 patients were included.The median eGFR at initiation of dialysis was 5.60 (2.26-12.62) ml·min-1·(1.73 m2)-1.The median follow-up time was 17 (0-58) months from initiation of dialysis and 141 patients died within this period.The median survival time was 45.48 (43.05-47.90) months.With eGFR declined,Scr,BUN,serum uric acid,serum prealbumin,phosphorus,calcium and phosphate product,iPTH,mean arterial pressure (MAP) at initiation of dialysis increased (P＜0.05),and hemoglobin,proportion of male,proportion of diabetes comorbidity,proportion of the Charlson comorbidity index ≥5 decreased (P＜0.05).Though there was no significant difference among the four groups,the proportion of left ventricular hypertrophy comorbidity increased when eGFR declined.(2) There was no significant difference of all-cause mortality among four groups using Kaplan-Meire survival curve.Cox regression model indicated no significant difference of all-cause mortality in levels of eGFR (HR=1.012,95％CI 0.961-1.065,P=0.654).Without patients died in the first 3 months,the multivariate Cox regression model indicated eGFR at initiation of dialysis was the protective factor to 1 year survival (HR=0.791,95％CI 0.669-0.935,P＜0.01).(3) The multivariate Cox regression model indicated the risk of overall and 1 year cardiocerebral vascular death decreased with eGFR at initiation of dialysis increased (HR=0.868,95％CI 0.777-0.971,P＜0.05; HR=0.937,95％CI 0.851-0.992,P＜0.05,respectively).(4) The multivariate Cox regression model indicated eGFR at initiation of dialysis was benefit to survival of patients treated by peritoneal dialysis,with all-cause death risk decreased by 10％ when eGFR increased by 1 ml·min-1·(1.73 m2)-1 (HR=0.90,95％CI 0.81-0.99,P＜0.05).In hemodialysis patients,Kaplan-Meire survival curve was significantly different among the four groups (Log-rank test,P=0.047); the survival of the group of 8 to ＜10.5 ml·min-1·(1.73 m2)-1 was lower as compared to the groups of 6 to ＜8 (Log-rank test,P=0.033) and ＜6 ml·min-1(1.73 m2)-1 (Log-rank test,P=0.005); but the multivariate Cox regression model indicated no relationship between survival and eGFR.In the subgroup of chronic glomerulonephritis as primary renal disease,the eGFR at initiation of dialysis was the benefit factor,with all-cause death risk decreased by 16.6％ (HR=0.834,95％CI 0.736-0.946,P＜0.01) and cardiocerebral vascular death risk decreased by 18.2％ (HR=0.818,95％CI 0.669-0.999,P＜0.05) when eGFR increased by 1 ml ·min-1 ·(1.73 m2)-1.In the subgroup of chronic glomerulonephritis treated by peritoneal dialysis,the all-cause death risk decreased by 32.1％ with eGFR increased by 1 ml·min 1·(1.73 m2)-1 (HR=0.679,95％CI 0.535-0.862,P＜0.01).Conclusions Early initiation of dialysis may not be associated with improved overall survival,but may reduce cardiocerebral vascular and 1 year all-cause mortality,improve the survival of chronic glomerulonephritis patients and peritoneal dialysis patients.