Objective To investigate the independent risk factors affecting the prognosis of chronic active antibody-mediated rejection (caAMR) after kidney transplantation. Methods A retrospective analysis was conducted on 61 patients who underwent renal biopsy and were diagnosed with caAMR. The patients were divided into caAMR group (n=41) and caAMR+TCMR group (n=20) based on the presence or absence of concurrent acute T cell-mediated rejection (TCMR). The patients were followed up for 3 years. The value of 24-hour urinary protein and estimated glomerular filtration rate (eGFR) at the time of biopsy in predicting graft loss was assessed using receiver operating characteristic (ROC) curves. The independent risk factors affecting caAMR prognosis were analyzed using the LASSO-Cox regression model. The correlation between grouping, outcomes, and Banff scores was compared using Spearman rank correlation matrix analysis. Kaplan-Meier analysis was used to evaluate the renal allograft survival rates of each subgroup. Results The 3-year renal allograft survival rates for the caAMR group and the caAMR+TCMR group were 83% and 79%, respectively. The area under the ROC curve (AUC) for predicting 3-year renal allograft loss was 0.83 ［95% confidence interval (CI) 0.70-0.97］ for eGFR and 0.78 (95% CI 0.61-0.96) for 24-hour urinary protein at the time of biopsy. LASSO-Cox regression analysis and Kaplan-Meier analysis showed that eGFR≤25.23 mL/(min·1.73 m²) and the presence of donor-specific antibody (DSA) against human leukocyte antigen (HLA) class I might be independent risk factors affecting renal allograft prognosis, with hazard ratios of 7.67 (95% CI 2.18-27.02) and 5.13 (95% CI 1.33-19.80), respectively. A strong correlation was found between the Banff chronic lesion indicators of renal interstitial fibrosis and tubular atrophy (P<0.05). Conclusions The presence of HLA class I DSA and eGFR≤25.23 mL/(min·1.73 m²) at the time of biopsy may be independent risk factors affecting the prognosis of caAMR.

With the rapid development of radiotherapy technology, the therapeutic outcomes of tumor patients have improved significantly, enabling effective disease control. However, during radiotherapy, the skin as the first barrier of the human body is inevitably exposed to radiation, leading to superficial skin injury. This injury often manifests as blistering, cracking, bleeding, and ulceration, resulting in wounds that are difficult to heal and potentially affecting the effectiveness of the treatment. At present, the therapeutic effect of drugs on radiation-induced skin injury remains limited, and the development of new drugs depends on the elucidation of the mechanisms. Therefore, it is crucial to investigate the mechanisms of radiation-induced skin injury. This article reviews these mechanisms, including DNA damage, oxidative stress, inflammatory response, and vascular damage and fibrosis, and summarizes the therapeutic drugs and targeted proteins in recent years, aiming to provide a reference for the further development and clinical application of drugs for radiation-induced skin injury.

Fibromyalgia syndrome （FMS） is a refractory， chronic non-articular rheumatic disease characterized by widespread pain throughout the body， for which there are no satisfactory therapeutic drugs or options. There are rich Chinese medical therapies， and some non-drug therapies， such as acupuncture， Tai Chi， and Ba-Duan-Jin， have shown satisfactory efficacy and safety and definite advantages of simultaneously adjusting mind and body. FMS is taken as a disease responding specifically to traditional Chinese medicine （TCM） by the National Administration of Traditional Chinese Medicine in 2018. In order to clarify the research progress in FMS and the clinical advantages of TCM/integrated Chinese and Western medicine， the China Academy of Chinese Medicine organized a seminar for nearly 20 experts in Chinese and Western medicine， including rheumatology， psychology， acupuncture and moxibustion， and encephalopathy， with the topic of difficulties in clinical diagnosis and treatment of FMS and advantages of TCM and Western medicine. The recommendations were reached on the difficulties in early diagnosis and solutions of FMS， mitigation of common non-specific symptoms， preferential analgesic therapy， TCM pathogenesis and treatment advantages， and direction of treatment with integrated Chinese and Western medicine. FMS is currently facing the triple dilemma of low early correct diagnosis， poor patient participation， and unsatisfactory benefit from pure Western medicine treatment. To solve the above problems， this paper suggests that rheumatologists should serve as the main diagnostic force of this disease， and they should improve patient participation in treatment decision-making， implement exercise therapy， and fully utilize the holistic and multidimensional features of TCM， which is effective in alleviating pain， improving mood， and decreasing adverse events. In addition， it is suggested that FMS treatment should rely on both TCM and Western medicine and adopt multidisciplinary joint treatment， which is expected to improve the standard of diagnosis and treatment of FMS in China.

With the rapid development of radiotherapy technology, the therapeutic outcomes of tumor patients have improved significantly, enabling effective disease control. However, during radiotherapy, the skin as the first barrier of the human body is inevitably exposed to radiation, leading to superficial skin injury. This injury often manifests as blistering, cracking, bleeding, and ulceration, resulting in wounds that are difficult to heal and potentially affecting the effectiveness of the treatment. At present, the therapeutic effect of drugs on radiation-induced skin injury remains limited, and the development of new drugs depends on the elucidation of the mechanisms. Therefore, it is crucial to investigate the mechanisms of radiation-induced skin injury. This article reviews these mechanisms, including DNA damage, oxidative stress, inflammatory response, and vascular damage and fibrosis, and summarizes the therapeutic drugs and targeted proteins in recent years, aiming to provide a reference for the further development and clinical application of drugs for radiation-induced skin injury.

Objective To examine the clinical distribution of primary intracranial tumors and analyze the risk factors for postoperative complications.Methods From January 2018 to December 2022,the clinical data of 961 patients with primary intracranial tumor in the Department of Neurosurgery of Tiantan Hospital in Beijing were collected and analyzed retrospectively.To examine the clinical distribution of patients with primary intracranial tumor and present the incidence of postoperative complications.To compare the basic data of patients with and without postoperative complications,and analyze the risk factors leading to postoperative complications.Results There were 363 cases of glioma,231 cases of meningioma,158 cases of sellar tumors,142 cases of neurilemmoma and 67 cases of other types of tumors.There were 679 cases of supratentorial tumors and 282 cases of infratentorial tumors.Postoperative complications occurred in 279 patients,and the incidence of postoperative complications was 29.03％.The incidences of intracranial infection,pulmonary infection,hyponatremia,lower extremity venous thrombosis and central nervous system infection were 9.37％,5.41％,4.99％,4.47％and 4.27％,respectively.After surgery,D-dimer(D-D),fibrin degradation products(FPD),prothrombin time(PT)in patients with primary intracranial tumors were significantly higher than those in patients without primary intracranial tumors(P<0.05).Activation of partial thromboplastin time(APTT),and thrombin time(TT)levels were significantly higher than those before surgery(P<0.05).Fibrinogen(FIB)was significantly lower than that before surgery(P<0.05).There were significant differences in tumor location,intraoperative blood loss,operation time,anesthesia recovery time and postoperative coagulation function between patients with and without postoperative complications(P<0.05).Conclusions The common types of primary intracranial tumors include gliomas,meningiomas,sellar tumors and neurilemmoma,etc.Surgical treatment has a high risk of postoperative complications.Common postoperative complications include intracranial infection,pulmonary infection,hyponatremia,lower extremity venous thrombosis,and central nervous system infection.Tumor location,operation duration,intraoperative blood loss,anesthesia recovery time and postoperative coagulation dysfunction are all risk factors for postoperative complications.

Purpose/Significance The paper retrospectively analyzes the research progress on risk prediction models for prostate cancer,and provides references for the construction of prostate cancer intelligent diagnosis and treatment system.Method/Process Through literature mining and analysis,the significance of molecular,imaging,individual,population and other omics level evaluation indexes in the diagnosis of prostate cancer is discussed,and the key characteristic variables and clinical application value of different cal-culation models are compared.Result/Conclusion The existing models have advantages of easy calculation and strong feasibility,but they also have limitations such as limited prediction accuracy and insufficient generalization ability.The integration of multi-omics data and artificial intelligence models is of great significance for medical informatics research and smart medical system construction of prostate cancer.

Objective To analyze the correlation between internal iliac artery calcification and delayed graft function (DGF) and short-term prognosis of kidney transplant recipients. Methods Clinical data of 222 kidney transplant recipients were retrospectively analyzed. According to the recovery of renal function, all recipients were divided into the DGF group (n=50) and immediate graft function (IGF) group (n=172). According to whether the recipients were complicated with severe internal iliac artery calcification, DGF and IGF groups were further divided into the high-risk DGF (n=22), low-risk DGF (n=28), high-risk IGF (n=41) and low-risk IGF(n=131) subgroups, respectively. Clinical data of donors and recipients were statistically compared between two groups. The incidences of postoperative DGF and internal iliac artery calcification were recorded. The risk factors of DGF after kidney transplantation, and the correlation between internal iliac artery calcification and clinical parameters were analyzed. Short-term prognosis of recipients with DGF complicated with severe internal iliac artery calcification was evaluated. Results The incidence of DGF was 22.5% (50/222). Among all recipients, 28.4% (63/222) were complicated with severe internal iliac artery calcification. In the DGF group, 44% (22/50) of the recipients were complicated with severe internal iliac artery calcification, higher than 23.8% (41/172) in the IGF group (P < 0.05). Univariate analysis showed that high serum creatinine (Scr) level of donors, male donor, high triglyceride level and severe internal iliac artery calcification of recipients were the risk factors for DGF after kidney transplantation (all P < 0.05). Multivariate logistic regression analysis revealed that Scr≥143 μmol/L of donors and severe internal iliac artery calcification of recipients were the independent risk factors for DGF after kidney transplantation (both P < 0.05). Correlation analysis indicated that internal iliac artery calcification was weakly correlated with the age of recipients and renal artery anastomosis (both P < 0.05). In the DGF group, the Scr level at postoperative 1 month was significantly higher, whereas the estimated glomerular filtration rate (eGFR) was significantly lower than those in the IGF group (both P < 0.05). The eGFR at postoperative 12 months in the high-risk DGF subgroup was significantly lower than those in the low-risk DGF, high-risk IGF and low-risk IGF subgroups (all P < 0.05). Conclusions Internal iliac artery calcification is not only a risk factor for recovery of renal allograft function, but also negatively affects short-term prognosis of renal allograft function.

【Objective】 To explore the effects of early application of erythropoietin (EPO) in patients with anemia after renal transplantation. 【Methods】 Patients who underwent renal transplantation in the First Affiliated Hospital of Soochow University were retrospectively analyzed. According to whether EPO was applied after operation, the patients were divided into EPO group and routine group. Patients with delayed renal function recovery were excluded, and the remaining patients were further analyzed. The general, laboratory and follow-up data of the two groups were compared, and adverse drug reactions were observed. 【Results】 The hemoglobin (P=0.026), red blood cell count (P=0.038) and hematocrit (P=0.011) in EPO group were higher than those in the routine group 2 weeks after operation, while the postoperative serum creatinine level was lower (P=0.001). Since the first week after operation, the reticulocyte count in EPO group was significantly higher than that in routine group (P<0.01). There was a negative correlation between hemoglobin and serum creatinine in EPO group at week 1 (r=-0.375, P=0.010) and week 2 (r=-0.386, P=0.008). During the treatment, 6 patients showed transient elevation of serum potassium, which returned to normal after symptomatic treatment, and no obvious adverse drug reactions were observed. 【Conclusion】 Continuous application of erythropoietin in the early stage after renal transplantation can significantly improve anemia in renal transplant patients and promote the recovery of renal function.

Objective:To explore independent risk factors and risk stratification for diagnosis of clinically significant prostate cancer (CsPCa) in biopsy-naive patients with nonsuspicious multiparametric magnetic resonance imaging (mpMRI).Methods:The data of 549 patients who underwent initial systematic biopsy (SB) in the First Affiliated Hospital of Soochow University, the Second Affiliated Hospital of Soochow University and Traditional Chinese Medicine Hospital of Kunshan between October 2015 and January 2021 were retrospectively reviewed. Nonsuspicious mpMRI was defined as Prostate Imaging-Reporting and Data System (PI-RADS)≤2. All patients received systematic 12 core prostate biopsy, 278 of them by transperineal and 271 by transrectal biopsies. The median age of the patients was 67 (62, 73) years, the median prostate specific antigen (PSA) was 9.01 (6.15, 13.64) ng/ml, the median prostate volume was 48.41 (35.85, 64.28) ml, and 54 patients were positive in digital rectal examination (DRE). Taking CsPCa as the outcome index, receiver operating characteristic (ROC) analysis was performed on age, tPSA, f/tPSA and PSA density (PSAD) to obtain the optimal cut-off value, and logistics regression was used to explore the independent risk factor of CsPCa in mpMRI negative patients. The optimal cut-off value when the negative predictive value (NPV) of mpMRI diagnosis of CsPCa was 100%, was taken as the protective factor, and the risk stratification model was finally proposed.Results:Of all 549 cases, 44 were CsPCa, 35 were clinically insignificant prostate cancer and 470 were non-prostate cancer. There were significant differences in age (71 vs. 67 years old), tPSA (11.95 vs. 8.75 ng/ml), PSAD [0.31 vs. 0.18 ng/(ml·cm 3)], f/tPSA (0.12 vs. 0.16) and DRE positive rate (38.6% vs. 7.3%) between CsPCa group and non-CsPCa group ( P<0.01). Cut-off values were taken in ROC analysis when the Youden index was at its maximum. The optimal cut-off values of each continuous variable were: age=65 years, tPSA=10ng/ml, f/tPSA=0.2 and PSAD=0.15 ng/(ml·cm 3). Multivariate analysis showed that ages over 65 years ( OR=3.43, 95% CI 1.55-7.58, P=0.002), f/t PSA ratio<0.2 ( OR=3.84, 95% CI 1.28-11.56, P=0.016), PSAD>0.15 ng/(ml·cm 3) ( OR=3.60, 95% CI 1.13-11.51, P=0.03) and positive DRE ( OR=5.20, 95% CI 2.39-11.32, P<0.001) were independent risk factors of CsPCa. When NPV was 100%, the cut-off values were taken as the protective factors: age≤55 years, f/tPSA≥0.3, PSAD≤0.1 ng/(ml·cm 3). Combined with independent risk factors, preliminary risk stratification was conducted: those with ≥2 high risk factors were considered as high risk group, those with ≥2 protective factors were considered as low risk group, and the middle region was considered as medium risk group. Conclusions:Patients with age>65 years, f/tPSA<0.2, PSAD > 0.15 ng/(ml·cm 3) and DRE positive are independent risk factors of CsPCa in mpMRI negative patients. Patients in the high-risk group were recommended to undergo prostate biopsy, while patients in the low-risk group could be considered to avoid biopsy.

Objective:To evaluate the predictive value of the quick sequential organ failure assessment(qSOFA) score in septic shock after percutaneous nephrolithotomy(PCNL).Methods:309 patients who underwent PCNL at the First Affiliated Hospital of Soochow University between May 2018 and October 2019 were retrospectively reviewed. Among them, there were 192 men and 117 women, whose mean age was (51.4±12.8)years (range from 20 to 79 years). There were 82 cases(26.5%) of hypertension and 23 cases(7.4%) of diabetes. There were 88 patients(28.5%) with positive preoperative urine culture.102 patients(33.0%) were diagnosed with staghorn calculi by abdominal CT and urinary tract abdominal plain film(KUB).78 patients(25.2%) had a history of urinary surgery. The qSOFA and SIRS were evaluated to all patients within 24 h after PCNL and the best diagnostic criteria was considered as qSOFA≥2 and SIRS≥2. Receiver operating characteristic(ROC) curves were constructed and the areas under the curve(AUC) were calculated to compare the discriminatory ability of qSOFA and SIRS with the post-PCNL septic shock. A univariate logistic regression analysis was used to identify the covariates associated with post-PCNL sepsis. Then adjusted multivariate analysis was used to identify the predictive value of positive qSOFA and SIRS for the postoperative clinical outcomes including postoperative hospitalization days, postoperative blood transfusion, postoperative re-intervention, residual stone, planned readmission within 30 days and unplanned readmission within 30 days.Results:Among the 309 patients who underwent PCNL, 23 patients(7.4%) met the positive qSOFA criterion while 84 patients(27.2%) developed to SIRS. 7 patients(2.3%) were admitted to ICU after operation and were eventually diagnosed as septic shock, among which 6 patients met the criteria of qSOFA and SIRS. 8 patients(2.6%) underwent multi-channel operation. The median operative time of 309 patients was 85(56, 115) min. Postoperative calculus composition analysis showed that 64 patients(20.7%) were infectious calculi. Postoperative KUB showed residual calculi in 179 patients (57.9%). The median postoperative hospital stay was 7(6, 9) days. 10 patients(3.2%) received blood transfusion. 9 patients(2.9%) received re-intervention after surgery. There were 41 patients (13.3%) of planned readmissions and 16 cases (5.2%) of unplanned readmissions within 30 days. The AUC of qSOFA and SIRS was 0.900 and 0.799 respectively. The qSOFA had a higher specificity, positive likelihood ratio and positive predictive value(94.4%, 15.23, 26.1%)than that of SIRS(74.2%, 3.32, 7.1%)for septic shock. In univariate logistic regression analysis significant associations were observed between positive urine culture, stone size, staghorn stones, struvite stones, surgery history, operation time and sepsis after PCNL. Multivariate logistic regression analysis revealed that postoperative length of stay( OR=1.237, 95% CI 1.048-1.459, P=0.012) and postoperative transfusion( OR=8.265, 95% CI 1.409-48.481, P=0.019) were closely associated with qSOFA after adjusting for covariates shown to be related to post-PCNL sepsis mentioned above. Conclusions:The qSOFA could be superior to SIRS in predicting septic shock after PCNL.