Objective To investigate the diagnostic value of biparametric magnetic resonance imaging(bpMRI)radiomics combined with prostate-specific antigen density(PSAD)in predicting low-grade and high-grade prostate carcinoma(PCa).Methods The clinical and imaging data of patients with PCa confirmed by pathology in Taizhou Central Hospital from June 2018 to October 2022 were retrospectively analyzed.According to Gleason grade group(GGG),GGG≤2 was defined as low-grade PCa,and GGG＞2 was defined as high-grade PCa.PCa patients with different grades were randomly divided into training group and test group according to a ratio of 7∶3.Radiomics features were extracted based on T2 weighted imaging(T2WI)and apparent diffusion coefficient(ADC)sequences.Feature selection and dimensionality reduction were carried out using maximum relevance minimum redundancy,least absolute shrinkage and selection operator,and 5-fold cross validation was performed to retain the best radiomics features.Receiver operating characteristic(ROC)curve and Delong's test were used to evaluate the performance of each model.Decision curve analysis(DCA)was used to evaluate the clinical utility of the model.Results Among all the models,T2WI-ADC-PSAD combined model had the best diagnostic efficiency,the area under the curve(AUC)in training group and test group were 0.882,0.772,respectively.Delong's test showed that in training group,there was no significant difference in AUC between T2WI-ADC-PSAD model and T2WI model(P＞0.05),but there were significant differences between T2WI-ADC-PSAD model and other models(P＜0.05).In test group there were no significant differences in AUC between T2WI-ADC-PSAD model and other models(P＞0.05).The DCA showed that the T2WI-ADC-PSAD model provided a higher net benefit for clinical decision-making when the threshold probability was less than 97％.Conclusion BpMRI radiomics combined with PSAD can improve the diagnostic efficiency of low-grade and high-grade PCa,and guide the treatment decision of patients.

Objective:To establish and verify a nomogram model based on MRI liver imaging reporting and data system (LI-RADS) features for predicting microvascular invasion (MVI) in hepatocellular carcinoma (HCC) following the Milan criteria.Methods:A retrospective analysis was conducted on data from 118 HCC patients (121 lesions) confirmed by pathology from June 2016 to June 2022 at the Third Affiliated Hospital of Soochow University. Forty-seven HCCs were diagnosed as MVI-positive and 74 HCCs as MVI-negative. The data was randomly divided into the training set (83 patients with 84 HCCs, including 31 MVI-positive and 53 MVI-negative HCCs) and the test set (35 patients with 37 HCCs, including 16 MVI-positive and 21 MVI-negative HCCs) using cross-validation method. HCC imaging features were evaluated based on LI-RADS (version 2018). In the training set, the χ 2 test was used to compare the differences in LI-RADS features between the MVI-positive group and the MVI-negative group. The logistic regression analysis was conducted to identify independent risk factors for predicting MVI-positive and to construct the nomogram model. The receiver operating characteristic (ROC) curves and decision curve analysis (DCA) were used to evaluate the performance and clinical benefits of the nomogram model in predicting MVI tumors. Results:There were statistically significant differences between the MVI-positive group and the MVI-negative group in terms of tumor size, tumor margin, mosaic architecture, and corona enhancement ( P<0.05). Multivariate logistic analysis results showed that HCC maximum diameter>3 cm (OR=1.427, 95%CI 1.314-12.227, P=0.009), nonsmooth tumor margin (OR=3.167, 95%CI 1.227-461.232, P=0.041), mosaic architecture (OR=1.769, 95%CI 1.812-61.434, P=0.022), and corona enhancement (OR=4.015, 95%CI 3.327-836.384, P=0.011) were independent risk factors for predicting MVI-positive tumors. Based on the independent predictors, the constructed nomogram model demonstrated an area under the ROC curve of 0.863 (95%CI 0.768-0.947) and 0.887 (95%CI 0.804-0.987) in the training and test sets for predicting MVI tumors, respectively. DCA showed that the curve of the nomogram model was consistently above the treat-all and treat-none strategies across all reasonable threshold probabilities in the training set, indicating that patients could obtain clinical benefits from the model. Conclusions:The preoperative nomogram model based on MRI LI-RADS features can effectively predict MVI in HCC following the Milan criteria, which could benefit the patients.

Objective:To investigate the prognostic risk factors of young patients with upper gastrointestinal bleeding (UGIB) in emergency department (ED), so as to improve the efficiency of emergency treatment and diversion of these patients.Methods:A retrospective analysis was performed on the clinical data of young patients with UGIB in the ED of Hainan Provincial People's Hospital from January 1, 2019 to December 30, 2020. In-hospital mortality was the primary endpoint of the study, and admission to the Intensive Care Unit (ICU) and length of hospital stay were the secondary endpoints. Inclusion criteria: (1) patients met the diagnostic criteria of acute UGIB; (2) age ranged from 18 to 40 years old; and (3) complete clinical data. Exclusion criteria: (1) bleeding and hemoptysis from the mouth, nose and throat; (2) gastrointestinal bleeding occurred in hospital; (3) lower gastrointestinal bleeding; (4) incomplete clinical data.Results:Among the 383 patients, 268 (70.0%) underwent upper gastrointestinal endoscopy, and the most frequent endoscopic diagnoses were duodenal ulcer (64.6%) and esophageal-gastric varices bleeding (16.8%). Seventy-one (18.5%) patients required endoscopic treatment, 5 (1.3%) patients required surgical treatment, and 7 (1.8%) patients required intervention treatment. The mortality rate was 2.1%, the ICU admission rate was 2.3%, and the length of hospital stay was 5 (3, 6) d. The ICU admission rate and mortality rate were significantly higher in patients with liver disease and in patients with syncope/coma (all P<0.05). Patients with thrombocyte levels (<120×10 9/L) had a significantly longer length of hospital stay than that of patients with normal platelets [8 (5, 11) d vs. 4 (3, 6) d, P<0.001]. The dead patients had significantly higher white blood cell count, urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase and activated partial thrombin time levels (all P<0.05), and significantly lower hemoglobin, albumin, SpO 2 and Glasgow coma score (GCS) levels (all P<0.05). Low GCS was an independent risk factor of ICU admission ( OR=33.973, 95% CI: 1.582~729.417, P=0.024) and mortality ( OR=20.583, 95% CI: 1.368~309.758, P=0.029). Conclusions:The poor prognostic factors of young patients with UGIB in ED are concomitant liver disease, syncope/coma, co-infection, hyperazotemia, impaired kidney function, liver dysfunction, coagulopathy, anemia, and low SpO 2, low GCS, and low hypoproteinemia on admission.

Objective:To explore the value of MR elastography (MRE) and shear wave elastography (SWE) for staging liver fibrosis in a rabbit model.Methods:From March to November 2020, 200 healthy New Zealand white rabbits were randomly divided into control group ( n=40) and liver fibrosis group ( n=160) by random number table method. The volume ratio of CCl 4 and olive oil was 1∶1 to prepare 50% CCl 4 oil solution, and the experimental rabbits in the liver fibrosis group were subcutaneously injected with 50% CCl 4 olive oil solution. It was injected once a week at the dose of 0.1 ml/kg in the first to third weeks, once a week at the dose of 0.2 ml/kg in the 4th to 6th weeks. The dose of 0.1 ml/kg was injected twice a week from week 7 to 16. The control group were subcutaneously injected with an equal dose of normal saline. At the end of the 4th, 8th, 12th, and 16th week, 40 and 10 animals in the liver fibrosis group and the control group were randomly selected by random number table method for MRE and SWE, respectively, to obtain the liver elastic stiffness (LS), which were recorded as LS MRE and LS SWE. After the examination, the experimental rabbits were sacrificed and liver tissue of rabbits were taken for histopathological Scheuer staging, and they were divided into F0-F4 groups. One-way ANOVA was used to evaluate the differences of LS MRE and LS SWE in different stages of liver fibrosis. Spearman correlation was used to analyze the correlation between LS and pathological stages. The receiver operating characteristic curve was used to evaluate the efficacy of LS MRE and LS SWE in diagnosing liver fibrosis staging, and the area under the curve (AUC) was compared using the Z test. Results:Totally 162 rabbits were included, which covered F0 ( n=38), F1 ( n=33), F2 ( n=35), F3 ( n=31) and F4 ( n=25). Significant differences of LS MRE and LS SWE values were found among different stages of liver fibrosis ( F=295.29, 102.40, both P<0.001). LS MRE, LS SWE were both positively correlated with liver fibrosis stage ( r=0.93, 0.81, both P<0.001). The AUC of LS MRE for diagnosing liver fibrosis stages ≥F1, ≥F2, ≥F3, and ≥F4 were 0.955, 0.967, 0.996, and 0.980, respectively; the AUC of LS SWE were 0.856, 0.880, 0.974, and 0.953, respectively. The AUC of liver fibrosis stage ≥ F1, ≥ F2 for LS MRE value were greater than LS SWE value ( Z=2.93, 3.29, P=0.003, 0.001), and the AUC of ≥F3, ≥F4 had no significant differences ( Z=1.58, 1.68, P=0.115, 0.093). Conclusion:Both MRE and SWE can accurately predict the stage of liver fibrosis in experimental rabbits, and MRE is better than SWE in diagnosing early liver fibrosis.

Objective:To explore the value of proton density fat fraction(PDFF) based on histogram analysis for quantification hepatic steatosis and fibrosis in rabbit model and the interference of hepatic fibrosis to the evaluation of hepatic steatosis with PDFF.Methods:From March to November 2020, 135 New Zealand white rabbits were randomly divided into control group ( n=30) and experimental group ( n=105) using a random number table. The volume ratio of CCl 4 and olive oil was 1∶1 to prepare 50% CCl 4 oil solution, and experimental rabbits were subcutaneously injected with the oil solution. An equal dose of normal saline was subcutaneously injected for control group rabbits. At the end of the 4 th, 8 th, and 12 th week, 35 in the experimental group and 10 rabbits in the control group were randomly selected to conduct the mDixon-Quant scanning, and histogram analysis of PDFF was analyzed including volume, mean, median, standard deviation, 25 th, 50 th, 75 th, 90 th quantile, skewness, kurtosis, entropy and inhomogeneity. After the examination, the rabbits were sacrificed and the liver percentage of steatosis (PSH) and fibrosis (POF) were recorded by semi-quantitative analysis. Spearman correlation analysis was used to correlate PDFF with PSH and POF. Multiple linear regression analysis was used to determine independent PDFF histogram parameters for evaluating PSH and POF. A receiver operator characteristic (ROC) curve was used to assess the diagnostic accuracy of PDFF for discriminating mild from moderate-severe hepatic steatosis and mild from moderate-severe hepatic fibrosis with median of PSH or POF for dichotomy, and DeLong test was used to compare the area under the curve (AUC). With the correction of hepatic fibrosis, correlation coefficient and AUC were compared of PDFF for discrimination mild from moderate-severe hepatic steatosis. Results:The PDFF mean, median, standard deviation, 75 th, 90 th showed correlation with PSH ( r=0.558, 0.522, 0.319, 0.723, 0.646, -0.589, all P<0.05). The entropy and 75 th were independent parameters for evaluating PSH (β=2.347, -5.960, P=0.018, 0.001). The PDFF 75 th was the optimal parameter for discriminating mild from moderate-severe hepatic steatosis with AUC=0.915 ( P=0.001). The PDFF volume, mean, median, standard deviation, 75 th, 90 th, entropy showed correlation with POF ( r=0.355, 0.393, 0.376, 0.298, 0.485, 0.426, -0.681, all P<0.05). The entropy, standard deviation and volume (β=-11.041, 1.356, 0.190, P=0.001, 0.026, 0.016) were independent parameters for evaluation of hepatic fibrosis, and the entropy was the optimal parameter for hepatic fibrosis (AUC=0.771, P=0.001). The correlation between PSH and PDFF 75 th was less pronounced when fibrosis was present ( r=0.512, P=0.001) than when fibrosis was absent ( r=0.751, P=0.002). The PDFF 75 th showed a significant difference in discriminating mild hepatic steatosis from moderate-severe hepatic steatosis after correction of POF (AUC=0.895, 0.950, Z=2.970, P=0.025). Conclusions:PDFF based on histogram analysis provided a noninvasive, accurate estimation of quantification for hepatic steatosis and fibrosis. Hepatic fibrosis reduced the correlation between hepatic steatosis and PDFF and the presence of hepatic fibrosis can confound the quantification of hepatic steatosis with PDFF.

Objective:To analyze the application of PDCA mode in the management of blood transfusion waiting time.Methods:Using random block design, 98 patients received blood transfusion during January to December 2018 were included into the before improvement; 32 patients received blood transfusion during January to June 2019 were included into the after improvement. Standard process of blood taking and transfusion was applied to the before improvement, while based on standard process, found out the deficiencies in the previous clinical practice, continuously improved the details of the process for the after improvement. Then blood transfusion waiting times were compared between the two groups.Results:The blood transfusion waiting time was (26.95±9.20) min before improvement and (25.59±4.16) min after improvement, with a significantly lower disqualification rate 6.25% (2/32) comparing with 26.53% (26/98) before improvement. The differences were statistically significant ( t value was 3.75, P<0.01; χ2 value was 5.87, P<0.05). Conclusions:The application of PDCA circulation management mode can shorten the blood transfusion waiting time and transfusion can be made within 30 minutes after blood taking so that nursing quality of transfusion in the ward can be improved.

Helicobacter pylori ( HP ) is the most common infectious pathogen of the digestive tract , since being identified in 1880s, its critical roles in many gastrointestinal and extra -gastrointestinal diseases have been confirmed.HP is involved in disease processes by different mechanisms ,one of which significantly important is the local or systemic inflammatory response and immune damage .HP could colonize in the gastric mucosa ,resulting in the elevation of many inflammatory mediators in stomach and serum .Many kidney diseases ,like glomerulonephritis ,renal failure and diabetic nephropathy have been confirmed to be related to inflammatory responses ,and HP could partici-pate in different kinds of kidney diseases by enhancing inflammatory responses to influence humoral or cellular immune response.This manuscript reviewed the research progress on the relationship between Hp and renal disease .

Objective To observe the changes in the expression of RANK/RANKL in rat kidney treated by tripterygium wilfordii polyglucosides (TWP) in STZ induced type 2 diabetic kidney disease (DKD) and to explore its possible renoprotective mechanism.Methods T2DM animal model was established by high glucose and high fat diet plus intraperitoneal injection of STZ.The modeled rats were randomly divided into DKD group(DKD,n=8) and TWP treatment group(DT,n=8).Normal rats were taken as control group(NC,n=8).DT rats were lavaged with TWP in a dose of 50 mg/kg · d,while the NC group and DKD group were lavaged with equal volume of normal saline every day.The indicators of FPG,FIns,UAlb,BUN,Scr,and Ucr were measured before and after 12-week intervention.PAS staining was used to evaluate the pathological change of the kidney.Immunohistochemistry and Western-blot were used to observe the protein expressions of RANK,RANKL,and nephrin.Results Compared with NC group,kidney pathological changes of DN group were aggravated with higher levels of FPG,UAlb,Ccr and BUN at 12th week.The expressions of RANK[(0.27±0.05) vs (0.68±0.11)] and RANKL[(0.23± 0.07) vs (0.62±0.08)] were prominently increased in kidney in DN group than those in NC group,while the expressions of nephrin were decreased(P＜0.01).Compared with DKD group,the above indexes and renal pathological changes were improved in DT group.The expressions of RANK[(0.45 ± 0.09) vs (0.68±0.11)],and RANKL[(0.39±0.06) vs(0.62±0.08)],were markedly inhibited in DT group,while nephrin expressions were increased(P＜0.01).Conclusion TWP can protect the kidney in rats with DKD by inhibiting the expression of RANK/RANKL.

Objective To investigate the prevalence of Helicobacter pylori infection and the incidence of gastric mucosal lesions in type 2 diabetes mellitus(DM)and diabetic kidney disease(DKD)patients with dyspepsia symptoms.Methods A total of 241 type 2 diabetic patients and 69 non -diabetic subjects with dyspeptic symptoms were enrolled in the study.Gastroduodenal lesions were observed by gastrointestinal endoscopy and the presence of Helicobacter pylori infection was identified by rapid urease test and serum IgG antibodies to Helicobacter pylori.Urine albumin excretion rate(UAE)at 24 hours was measured in all subjects.According to the urinary albumin excretion rate,patients were classified into diabetes mellitus group(DMgroup,with UAE <30mg/24h),diabetic kidney disease group 1(DKD group 1,with UAE 30mg/24h to <300mg/24h)and diabetic kidney disease group 2(DKD group 2 >300mg/24h).Estimated glomerular filtration rate were above 60mL·min -1 ·(1.73m2 )-1 in the three groups of patients.The 69 cases of non -diabetic subjects were used as the control group.Results The prevalence of H pylori infection in the DKD group[145 /72(62.5%)]and the DKD group 2[34 /53(64.15%)]were significantly higher than those in the control group[28 /65(43.1%)](χ2 =3.901,P =0.04;χ2 =4.223,P =0.03)and the DM group [27 /63 (42.9%)](χ2 =4.104,P =0.04;χ2 =5.116,P =0.03).No significant differences of H.pylori prevalence were detected between the DKD groups(χ2 =1.304,P =0.29)as well as the DMgroup and the control group (χ2 =0.723,P =0.40).Gastroscopy results showed that the incidence of normal endoscopic performance in the DMgroup was higher than that of the control group(57.1% vs.38.5%,χ2 =4.612,P =0.03).There were no significant differences between the control group and DM group,DKD1 group and DKD2 group in the incidence of gastric mucosal lesions (Superficial gastritis:χ2 =1.206,0.912,0.707;erosive gastritis:χ2 =1.422,1.836 0.870;duodenal ulcer:χ2 =243.1, 1.716,2.233;gastric ulcer:χ2 =1.440,0.971,1.322 and esophagitis:χ2 =2.116,2.318,2.488,all P >0.05). Conclusion Diabetic nephropathy patients are more susceptible to Helicobacter pylori infection.There is no significant difference in the infection rate of Helicobacter pylori between type 2 diabetic nephropathy with microalbuminuria and with macroalbuminuria.There are no significant differences in the type of gastric mucosal lesion between Type 2 diabetes mellitus,diabetic nephropathy patients and non diabetic patients.

Objective To explore the clinical characteristics of IgG4-related disease (IgG4-RD) in Chinese by detailed clinicopathological and laboratory assessments.Methods The baseline features of 36 patients with biopsy-proven disease were reviewed.The diagnosis was confirmed by pathology review according to consensus diagnostic criteria and clinicopathologic correlation.Disease activity and damage were assessed by the IgG4-RD responder index (RI).Results Thirty (83.3％) of the patients were male,while six were female,and the average age of onset was 65.1 years.All of the 36 patients had active disease,in which submandibular gland,lymph nodes,retroperitoneal tissue were the most common affected organs in this group of patients.Among 36 patients,77.7％ had elevated serum IgG4 concentrations and 44.4％ had hypocomplementemia.Patients with elevated serum IgG4 had a higher RI,a greater number of organs involved (P ＜ 0.01 for all comparisons).The correlation between serum IgG4 level and RI (r=0.737,P ＜ 0.01) was stronger than IgG,ESR,CRP and serum complement levels.The incidence of hypocomplementemia in IgG4-RD patients with renal involvement was higher than that in IgG4-RD patients with other organs involvement (P ＜ 0.01).Twenty-eight patients received glucocorticoids therapy,and had lower RI and serum IgG4 concentration after therapy (P ＜ 0.05).Conclusions Both IgG4-RD RI and IgG4 concentration may be regarded as assessment markers of disease activity and therapeutic effect of IgG4-RD.The diagnosis of IgG4-RD should be supported by histopathology and clinical features.