Objective To evaluate the effect of irregular follow-up during normalized prevention and control of novel coronavirus pneumonia (COVID-19) epidemic on BK virus (BKV) reactivation and clinical prognosis of kidney transplant recipients. Methods Clinical data of 363 kidney transplant recipients were retrospectively analyzed, and they were divided into the pre-epidemic follow-up group and during-epidemic follow-up group according to the follow-up time. All patients were followed up for 1 year. The follow-up interval was compared between two groups. The infection of BKV and the correlation between the infection process of BKV and renal graft function were analyzed in two groups. Results A total of 1 790 preson-times were followed up before COVID-19 epidemic and 2 680 during COVID-19 epidemic. Compared with the during-epidemic follow-up group, the follow-up intervals within 3, 3-6 and 7-12 months after kidney transplantation were shorter in the pre-epidemic follow-up group, and the differences were statistically significant (all P<0.05). Within 1 year after kidney transplantation, 35 cases（32%） were diagnosed with BKV viruria, 3 cases（3%） of BKV viremia and 1 case（1%） of BKV-associated nephropathy (BKVAN) in the pre-epidemic follow-up group, and 53（25%）, 3（1%） and 1（1%） in the during-epidemic follow-up group, with no statistical significance (all P>0.05). In the pre-epidemic follow-up group, the time for the initial diagnosis of BKV viruria was longer and the viral load of the first urinary BKV reactivation was smaller than those in the during-epidemic follow-up group, with statistical significance (both P<0.05). The load of the first urinary BKV reactivation was positively correlated with the peak load of urinary BKV, and the differences between the baseline and serum creatinine levels at 1 and 3 months after BKV reactivation (all P<0.05). Conclusions Irregular follow-up after kidney transplantation may lead to early BKV reactivation and higher detection value of the first viral load of urinary BKV, delay diagnosis and interventions, and lead to poor prognosis. It is urgent to establish a remote follow-up system to meet the follow-up requirements of kidney transplant recipients when public health incidents occur.

Objective:To investigate the clinical features and prognosis of male with anti-melanoma differentiation-associated gene 5 (MDA5) autoantibody.Methods:The clinical data of 246 patients with DM and anti-MDA5 autoantibodies hospitalized by Jiangsu Myositis Cooperation Group from 2017 to 2020 were collected and retrospectively analyzed. Chi-square test was performed to compared between counting data groups; Quantitative data were expressed by M ( Q1, Q3), and rank sum test was used for comparison between groups; Single factor survival analysis was performed by Kaplan-Meier method and Log rank test; Cox regression analysis were used for multivariate survival analysis. Results:①The male group had a higher proportion of rash at the sun exposure area [67.1%(47/70) vs 52.8%(93/176), χ2=4.18, P=0.041] and V-sign [50.0%(35/70) vs 30.7%(54/176), χ2=8.09, P=0.004] than the female group. The male group had higher levels of creatine kinase [112(18, 981)U/L vs 57 (13.6, 1 433)U/L, Z=-3.50, P<0.001] and ferritin [1 500 (166, 32 716)ng/ml vs 569 (18, 14 839)ng/ml, Z=-5.85, P<0.001] than the female group. The proportion of ILD [40.0%(28/70) vs 59.7%(105/176), χ2=7.82, P=0.020] patients and the red blood cell sedimentation rate[31.0(4.0, 101.5)mm/1 h vs 43.4(5.0, 126.5)mm/1 h, Z=-2.22, P=0.026] in the male group was lower than that of the female group, but the proportion of rapidly progressive interstitial lung disease (PR-ILD) [47.1%(33/70) vs 31.3%(55/176), χ2=5.51, P=0.019] was higher than that of the female group. ②In male patients with positive anti-MDA5 antibodies,the death group had a shorter course of disease[1.0(1.0, 3.0) month vs 2.5(0.5,84) month, Z=-3.07, P=0.002], the incidence of arthritis [16.7%(4/24) vs 42.2%(19/45), χ2=4.60, P=0.032] were low than those in survival group,while aspartate aminotransferase (AST)[64(22.1, 565)U/L vs 51(14,601)U/L, Z=-2.42, P=0.016], lactate dehydrogenase (LDH) [485(24,1 464)U/L vs 352(170, 1 213)U/L, Z=-3.38, P=0.001], C-reactive protein (CRP) [11.6(2.9, 61.7) mg/L vs 4.95(0.6, 86.4) mg/L, Z=-1.96, P=0.050], and ferritin levels [2 000(681, 7 676) vs 1 125 (166, 32 716)ng/ml, Z=-3.18, P=0.001] were higher than those in the survival group, and RP-ILD [95.8%(23/24) vs 22.2%(10/45), χ2=33.99, P<0.001] occurred at a significantly higher rate. ③Cox regression analysis indicated that the course of disease LDH level, and RP-ILD were related factors for the prognosis of male anti-MDA5 antibodies [ HR (95% CI)=0.203(0.077, 0.534), P=0.001; HR (95% CI)=1.002(1.001, 1.004), P=0.003; HR (95% CI)=95.674 (10.872, 841.904), P<0.001]. Conclusion:The clinical manifestations of male anti-MDA5 antibody-positive patients are different from those of female. The incidence of ILD is low, but the proportion of PR-ILD is high. The course of disease, serum LDH level, and RP-ILD are prognostic factors of male anti-MDA5 antibody-positive patients.

This article aimed to summarise the clinical experience of Professor XIONG Jibai in treating henoch-schonlein purpura （HSP） from the perspective of "simultaneous treatment of wind and blood". HSP was devided into acute phase and transitional phase in clinic. It was considered that the wind pathogen exists throughout the disease course， and the treatment is guided by the "four methods of treating blood" in TANG Rongchuan's Treatise on Blood Syndromes - Blood Vomiting （《血证论·吐血》）， which are stanching bleeding， expelling stasis， tranquilising blood， and tonifying blood. In the acute phase， wind-heat damaging collateral symdrome and blood-heat frenetic flow syndrome are common， which could be treated by the method of cooling blood to dispel wind， and eliminating stasis to stop bleeding， with self-prescribed modified Ziping Xiaofeng Powder （紫萍消风散）； in the transitional phase， syndrome of effulgent fire due to yin deficiency and syndrome of qi deficiency failing to control are common， which could be treated by the method of tranquilising blood and tonifying deficiency， with modified Zhibai Dihuang Decoction （知柏地黄汤） and Guipi Decoction （归脾汤）. At the same time， it is believed that wind-related medicinal has the function of eliminating stasis， stanching bleeding， and cooling blood， and the wind-related medicinal should be used throughout the treatment.

Objective To measure the air-absorbed dose rate of gamma radiation in public areas for the situation of the local radiation environment. Methods Using a large-volume γ spectrometer system with a NaI(Tl) detector mounted on a UAV, we conducted large-scale airborne radiation monitoring in public areas in southwestern China, to measure the air-absorbed dose rate at a height of 1 m from the earth’s surface. Results The airborne radiation monitoring data were used to analyze the local radiation environment. The mean air-absorbed dose rate at a height of 1 m was 43.6 ± 12.9 nGy/h. Seven abnormal radiation points were detected, and two of them were located where construction was ongoing. At one of the abnormal radiation points, FH40G meter measurements showed that the air-absorbed dose rate at a height of 1 m was up to 22.0 μGy/h. Field soil samples were collected for HPGe γ spectrometer analysis: the ²³²Th radionuclide activity concentration was 96.0 kBq/kg, and the ²²⁶Ra radionuclide activity concentration was 9.9 kBq/kg. Conclusion Using the UAV-mounted large-volume γ spectrometer system with NaI(Tl) detectors for large-scale airborne monitoring is a fast and effective method for dragnet monitoring of the level of radiation in public areas.

OBJECTIVE To investigate the predictive value of prognostic nutritional index(PNI) and lymphocyte-monocyte ratio(LMR) in severe radiotherapy-induced oral mucositis(RIOM) during treatment of patients with head and neck cancer,and to construct a risk prediction model and test the prediction effect. METHODS A total of 502 patients with head and neck cancer who underwent radiotherapy were recruited from September 2021 to October 2023 in Xiangya Hospital Central South University. The participants were randomly divided into training group and validation group at a ratio of 7:3. According to whether severe RIOM occurred,they were divided into severe RIOM group and non-severe RIOM group. Univariate analysis and logistic regression analysis were used to screen the risk factors of severe RIOM. The receiver operating characteristic(ROC) curve was used to evaluate its prediction effect and R4.3.2 software was used to draw nomograms and decision curve. RESULTS The risk prediction model for patients with head and neck cancer during treatment had five factors,including the number of comorbidities(OR=2.221,95％CI=1.185-4.165),surgical history(OR=2.938,95％CI=1.393-6.198),the degree of tumor differentiation(OR=1.511,95％CI=1.090-2.094),PNI(OR=0.892,95％CI=0.852-0.934),LMR(OR=0.512,95％CI=0.254-1.030). Model formula:Y=2.102+0.413×degree of differentiation+0.798×number of comorbidities+1.078×surgical history-0.114×PNI-0.669×LMR. The validation results of the prediction model showed that the area under the ROC curve of the training group was 0.847(P<0.001),the area under the curve of the validation group was 0.808(P<0.001),and the P values of the Hosmer-Lemeshow test of the modeling group and the validation group were both greater than 0.05. The decision curve was above the reference line within most of the high-risk thresholds. CONCLUSION The risk prediction model constructed in this study has good effect,which can predict the risk of severe RIOM during radiotherapy in patients with head and neck cancer,providing the reference for taking preventive intervention measures for high-risk patients.

A 50-year-old hypertension male without high-risk factors related to acute kidney injury(AKI),took 90 mL oral sodium phosphates(OSP)solution for intestinal cleansing before the colonoscopy.After medication,severe diarrhea and vomiting appeared,with decreased blood pressure,anuria for 24 h,and serum creatinine increased from 87 μmol·L-1 to 398 μmol·L-1.Renal biopsy showed blue-purple calcium phosphate crystals were deposited in the renal tubules,the brush border disappeared and epithelial cell necrosis was necrotic or shed.The patient was diagnosed with AKI.According to Naranjo's Assessment Scale for adverse reactions,AKI was"probably"associated with the oral sodium phosphate.Subsequently,the patient was treated with prednisone acetate tablets,and serum creatinine was decreased significantly to 158 μmol·L-1 2 months later.This case suggests that sodium phosphate preparation should be used with caution in hypertensive patients to avoid AKI.

Objective:To investigate the value of quantitative ultrashort-echo-time (UTE) adiabatic T 1ρ (AdiabT 1ρ) in the diagnosis of articular cartilage degeneration of knee. Methods:A prospective case-control study was used. From March 2023 to September 2024, 30 healthy volunteers and 50 patients with osteoarthritis (OA) were recruited in the Second Affiliated Hospital, South China University of Technology and the Fifth Affiliated Hospital of Sun Yat-sen University. The unilateral knee joints were scanned by using three-dimensional (3D) UTE-Cones-AdiabT 1ρ sequence. The articular cartilages of knee were divided into 13 subregions slice by slice, with a total of 3 837 subregions. The whole-organ magnetic resonance-imaging score (WORMS) was evaluated in each subregion. According to the extent of lesions, the subregions cartilages were divided into normal group (WORMS 0, 2 589 subregions), localized lesion group (WORMS 1, 2, 2.5, 911 subregions) and diffuse lesion group (WORMS 3, 4, 5, 337 subregions). According to the depth of lesions, they were divided into normal group (WORMS 0, 2 589 subregions), partial cartilage layer lesions group (WORMS 1, 2, 3, 4, 1 108 subregions) and full-thickness lesion group (WORMS 2.5, 5, 140 subregions). WORMS 1 was early cartilage degeneration. The Kellgren-Lawrence (KL) grade of the knee joints was assessed and divided into normal group (KL grade 0, 1 323 subregions), suspicious or mild OA group (KL grades 1 and 2, 1 738 subregions), and moderate or severe OA group (KL grades 3 and 4, 776 subregions). The UTE-Cones-AdiabT 1ρ values and curves for each subregion were obtained by Matlab 2017b software. The ANOVA was used to compare the differences in UTE-Cones-AdiabT 1ρ between different WORMS groups and KL groups. Spearman correlation analysis was used to evaluate the correlation between UTE-Cones-AdiabT 1ρ and WORMS and KL groups. The receiver operating characteristic curve and area under the curve (AUC) were used to determine the efficacy of UTE-Cones-AdiabT 1ρ in diagnosing early cartilage degeneration and suspicious or mild OA. Results:Both normal volunteers and OA patients were able to obtain good cartilage images and well-fitting UTE-Cones-AdiabT 1ρ curves. There were 2 589, 569, 277, 65, 199, 63 and 75 cartilage subregions with WORMS scores of 0, 1, 2, 2.5, 3, 4 and 5, respectively, and the UTE-Cones-AdiabT 1ρ values were (36.1±5.1), (41.5±5.2), (42.3±5.3), (45.2±6.3), (43.0±5.2), (44.1±5.4) and (47.5±5.7) ms, respectively. The difference was statistically significant ( F=161.63, P<0.001). There was a statistically significant difference in UTE-Cones-AdiabT 1ρ among normal group, localized lesion group and diffuse lesion group ( F=450.92, P<0.001), and there was a significant difference in UTE-Cones-AdiabT 1ρ value among normal group, partial cartilage lesion group and full-thickness lesion group ( F=479.13, P<0.001). There was a statistically significant difference in UTE-Cones-AdiabT 1ρ among the normal group, the suspected or mild OA group, and the moderate or severe OA group ( F=36.91, P<0.001). The UTE-Cones-AdiabT 1ρ values in all subregions were positively correlated with WORMS and KL grades ( r=0.55, P<0.001; r=0.26, P<0.001). The AUC of UTE-Cones-AdiabT 1ρ in the diagnosis of early cartilage degeneration was 0.773 (95% CI 0.750-0.796), and the AUC in the diagnosis of suspicious or mild OA was 0.580 (95% CI 0.560-0.601). Conclusion:3D UTE-Cones-AdiabT 1ρ is positively correlated with the degree of cartilage degeneration, which can quantitatively evaluate cartilage degeneration and has the value of early diagnosis of articular cartilage degeneration.

Objective To investigate the prevalence and severity of symptoms and to construct symptom networks in head and neck cancer patients during treatment to identify core symptoms and symptom clusters.Methods 366 patients who were hospitalized in 3 tertiary hospitals in Changsha were selected using convenience sampling from March to October 2022 and asked to complete the M.D.Anderson Symptom Inventory-Head & Neck.Exploratory factors analysis was used to extract the symptom clusters,and R packages were used to construct the symptom severity network and symptom clusters network.The centrality indexes of the networks,including strength,closeness,and betweenness,were analyzed to identify core symptoms and core symptom cluster.Results The most common symptoms in head and neck cancer patients during treatment were dry mouth(93.44％),fatigue(89.07％),loss of appetite(86.34％),and difficulty swallowing or chewing(85.79％),and the most severe symptoms were dry mouth,loss of appetite,oral or pharyngeal mucus,and difficulty swallowing or chewing.4 symptom clusters were extracted,namely oral-pharyngeal,gastrointestinal,emotional-sleep,and sickness-sensing behavioral,which could explain 67.415％of the total variance.In the symptom severity network,oral or pharyngeal mucus(rs=9.60)was a symptom with the highest strength.In the symptom clusters network,oral or pharyngeal mucus(rs=1.20),nausea(rs=1.00),fatigue(rs=1.10),and drowsiness(rs=0.97)were the symptoms with the highest strength across 4 symptom clusters.Conclusion Oral or pharyngeal mucus,nausea,fatigue,and drowsiness are the core symptoms of symptom clusters in head and neck cancer patients during treatment.Oral-pharyngeal symptom cluster is the core symptom cluster.It is recommended that clinical staff should develop interventions based on the core symptoms and symptom cluster to implement precise symptom management and improve symptom management efficiency.

BACKGROUND: LY01005 (Goserelin acetate sustained-release microsphere injection) is a modified gonadotropin-releasing hormone (GnRH) agonist injected monthly. This phase III trial study aimed to evaluated the efficacy and safety of LY01005 in Chinese patients with prostate cancer. METHODS: We conducted a randomized controlled, open-label, non-inferiority trial across 49 sites in China. This study included 290 patients with prostate cancer who received either LY01005 or goserelin implants every 28 days for three injections. The primary efficacy endpoints were the percentage of patients with testosterone suppression ≤50 ng/dL at day 29 and the cumulative probability of testosterone ≤50 ng/dL from day 29 to 85. Non-inferiority was prespecified at a margin of -10%. Secondary endpoints included significant castration (≤20 ng/dL), testosterone surge within 72 h following repeated dosing, and changes in luteinizing hormone, follicle-stimulating hormone, and prostate specific antigen levels. RESULTS: On day 29, in the LY01005 and goserelin implant groups, testosterone concentrations fell below medical-castration levels in 99.3% (142/143) and 100% (140/140) of patients, respectively, with a difference of -0.7% (95% confidence interval [CI], -3.9% to 2.0%) between the two groups. The cumulative probabilities of maintaining castration from days 29 to 85 were 99.3% and 97.8%, respectively, with a between-group difference of 1.5% (95% CI, -1.3% to 4.4%). Both results met the criterion for non-inferiority. Secondary endpoints were similar between groups. Both treatments were well-tolerated. LY01005 was associated with fewer injection-site reactions than the goserelin implant (0% vs . 1.4% [2/145]). CONCLUSION: LY01005 is as effective as goserelin implants in reducing testosterone to castration levels, with a similar safety profile. TRIAL REGISTRATION ClinicalTrials.gov, NCT04563936.
Humans ; Male ; Antineoplastic Agents, Hormonal/therapeutic use* ; East Asian People ; Gonadotropin-Releasing Hormone/agonists* ; Goserelin/therapeutic use* ; Prostate-Specific Antigen ; Prostatic Neoplasms/drug therapy* ; Testosterone

Objective:To develop a deep learning model which can automatically and accurately detect osteoporotic vertebral compression fractures (OVCF) based on artificial intelligence.Methods:MRI images of 500 patients diagnosed with OVCF at The First People＇s Hospital of Guangzhou from January 2019 to October 2021 were collected retrospectively. There were 396 males and 204 females, with an age of (74.5±6.0) years. The T value of bone mineral density was -2.9±0.8. The fracture segments were L1 in 128 cases, L2 in 113 cases, L3 in 109 cases, L4 in 115 cases, and L5 in 108 cases. The multimodal layered converged network was used to train, test, and verify the robustness and generalization ability of a deep learning model based on MRI images of OVCF. The grad-cam was applied to visualize the results. The diagnostic value of the model for OVCF was assessed by comparing the diagnoses between the artificial intelligence model and 2 senior spinal surgeons on the MRI images of 30 OVCF patients randomized from the 500 ones.Results:Of the precise auxiliary diagnosis model for OVCF based on MRI images, the diagnostic accuracy was 96.7%, the sensitivity 93.5%, the specificity 88.9%, the positive predictive value 100.0%, and the negative predictive value 86.6%, all significantly higher than those of the 2 senior spinal surgeons (70.0%, 72.7%, 28.6%, 82.1%, and 28.6%) ( P<0.05). Conclusion:The present study has successfully established a deep learning model which can automatically and accurately diagnose OVCF based on MRI images, showing a high diagnostic efficiency than human spinal surgeons.