Volume 105 · Issue 04 · 2025

Plasma cell disorders represent a spectrum of complex diseases, ranging from benign conditions to malignancies. The monoclonal immunoglobulins produced in these disorders can result in various renal pathologies, which may present as differing degrees of renal insufficiency. In severe instances, patients may necessitate dialysis or kidney transplantation. The recovery of kidney damage is relatively delayed after treatment. Some patients achieved hematological complete response, but kidney impairment may progressively worsen. Clinicians need to be more vigilant and pay more attention to PCD related kidney impairment. Early diagnosis and treatment are of great significance for reversing renal dysfunction and improving survival.

T-cell immune response is an important component of antiviral immunity, it is of great significance to determine their absolute counts, relative frequencies and functionalities for evaluating protective immunity in individuals and population. However, there is a lack of guidelines or a consensus on assays for antigen-specific T cells. It is necessary to evaluate the SARS-CoV-2-specific T cells in population during and after COVID-19 epidemic. To standardize the detection method for SARS-CoV-2-specific T cells, the Chinese Society for Immunology organized experts and reached a consensus on the detection method, biomarker combination scheme, technical points of SOP, quality control, data analysis and interpretation of results, personnel training, etc. The consensus is of guiding significance to establish standard detection methods and operating procedures for SARS-CoV-2-specific T cells, which is beneficial for the consistency and comparability of results from different laboratories, and also provides reference for antigen-specific T cell standard detection methods for other pathogens (such as influenza) infection.

To develop and validate a predictive model for assessing the risk of early postoperative high intraocular pressure (HIOP) following posterior chamber intraocular lens implantation.

The clinical data of patients who underwent posterior chamber intraocular lens implantation at the Second Affiliated Hospital of Zhejiang University School of Medicine between May 2023 and April 2024 were retrospectively reviewed. Patients were divided into a modeling group and a validation group with a 7∶3 ratio using computerized random allocation. The modeling group was further categorized into normal intraocular pressure and HIOP groups based on the occurrence of early postoperative HIOP. Multivariate logistic regression analysis was employed to establish a risk prediction model. Receiver operating characteristic (ROC) curve analysis was conducted using R software to assess the predictive ability and accuracy of the model, along with calibration and decision curve analysis (DCA) curve plotting.

A total of 239 patients (478 eyes) were enrolled. The modeling group consisted of 168 patients (82 males and 86 females) (336 eyes), with an average age of (25.5±5.1) years. The validation group consisted of 71 patients (36 males and 35 females) (142 eyes), with an average age of (24.7±5.7) years. The early postoperative HIOP incidence rate after posterior chamber intraocular lens implantation was 32.4% (109/336), while it was 26.8% (38/142) in the validation group. The multivariate logistic regression analysis indicated that preoperative refractive diopter (OR=0.873, 95%CI: 0.782-0.976, P=0.017), corneal endothelial cell count (OR=0.996, 95%CI: 0.995-0.997, P<0.001), corneal thickness (OR=1.015, 95%CI: 1.006-1.024, P=0.001), and preoperative intraocular pressure (OR=1.470, 95%CI: 1.283-1.686, P<0.001) were associated factors for early HIOP. The Hosmer-Lemeshow test showed that the χ² value was 8.444 (P=0.391), and the area under the ROC curve (AUC) was 0.888 (95%CI: 0.852-0.925). The Youden index reached its maximum value of 0.646, with a sensitivity of 0.862 and specificity of 0.784. AUC of validation group was 0.921 (95%CI: 0.870-0.972), with a maximum Youden index of 0.765, sensitivity of 0.842 and specificity of 0.923.

The risk prediction model constructed based on preoperative refractive diopter, corneal endothelial cell count, corneal thickness, and preoperative intraocular pressure demonstrates good predictive performance for early postoperative HIOP following posterior chamber intraocular lens implantation.

To simplify the Chinese version of the Visually Induced Motion Sickness Susceptibility Questionnaire (VIMSSQ), develop the simplified Chinese version of VIMSSQ, and evaluate its performance.

A cross-sectional study was conducted between May and July 2023. The Chinese version of the VIMSSQ was distributed to 783 university students at North China University of Science and Technology. Items were selected on the basis of their coverage rates, item-total correlation coefficients, Cronbach′s alpha coefficients, and factor loadings, resulting in the simplified Chinese VIMSSQ. Eighty participants from the initial cohort were recruited to complete a virtual reality (VR) black-and-white checkerboard visual stimulation test, the simplified Chinese VIMSSQ, and the Simulator Sickness Questionnaire (SSQ). The internal consistency, test-retest reliability, criterion validity, and discriminative ability of the simplified Chinese VIMSSQ were evaluated.

A total of 757 valid questionnaires were collected, with an effective response rate of 96.68% (757/783). Among the 757 participants, 205 were male and 552 were female, with a median age (Q₁, Q₃) of 19 (18, 20) years. Smartphone usage showed the highest coverage rate [99.60% (754/757)]. The simplified Chinese VIMSSQ included three items, with the Cronbach′s alpha coefficient of 0.909, the test-retest reliability of 0.908, and the criterion validity of 0.899. SSQ symptom scores were lower in mildly susceptible participants compared to moderately susceptible participants [30 (15, 63) vs 77 (53, 105), P=0.012], and significantly lower in moderately susceptible participants compared to severely susceptible participants [77 (53, 105) vs 137 (94, 164), P<0.001].

The simplified Chinese VIMSSQ demonstrates good reliability, validity, and discriminative ability.

To establish and validate a nomogram based on clinical characteristics and metabolic parameters derived from ¹⁸F-fluorodeoxyglucose positron emission tomography and computed tomography (¹⁸F-FDG PET/CT) for prediction of high-grade patterns (HGP) in invasive lung adenocarcinoma.

The clinical and PET/CT image data of 311 patients who were confirmed invasive lung adenocarcinoma and underwent pre-treatment ¹⁸F-FDG PET/CT scan in Beijing Hospital between October 2017 and March 2022 were retrospectively collected. The enrolled patients were divided into HGP group (196 patients) and non-HGP group (115 patients) according to the presence and absence of HGP. The data were divided into training set and validation set at 7∶3 ratio using R statistical software and simple random allocation. A nomogram prediction model was constructed in training set. The area under the curve (AUC) of receiver operating characteristic (ROC) was depicted in the training and validation set respectively for assessing the prediction efficacy. The goodness of fit, consistency between predicted and observed probability and clinical usefulness of the model were evaluated by Hosmer-Lemeshow test, calibration curve and decision curve analysis (DCA).

The age of 311 patients were (65.6±10.9) years and included 148 males (47.6%). In training set of 217 patients, 141 (65.0%) contained HGP while in validation set of 94 patients, 55 (58.5%) contained HGP. Gender in training set, serum carcino-embryonic antigen (CEA) in validation set, smoking history, clinical stage, cytokeratin fragments (CYFRA21-1), maximum standardized uptake value (SUV_max), mean standardized uptake value (SUV_mean), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and maximum diameter (D_max) in both sets showed significant differences between HGP and non-HGP groups (all P<0.05). The variables integrated in the model were gender, clinical stage, CYFRA21-1, SUV_mean and TLG. The AUC (95%CI) of the ROC curve in training and validation set were 0.888 (0.844-0.932) and 0.925 (0.872-0.977), the sensitivity and specificity were 85.1%, 79.0% and 83.6%, 89.7%, respectively. The model showed good goodness of fit (training set: χ²=8.247, P=0.410, validation set: χ²=1.636, P=0.990). Calibration curve and DCA also indicated good consistency and clinical net benefit of the nomogram model.

The nomogram model based on clinical features and metabolic parameters derived from ¹⁸F-FDG PET/CT could effectively predict the presence of HGP in invasive lung adenocarcinoma and be beneficial to treatment planning.

To compare the diagnostic value of fluorine 18-labelled prostate-specific membrane antigen (PSMA) PET/CT PRIMARY score and PSMA expression score for clinically significant prostate cancer (csPCa).

The data of 70 patients with prostate cancer who underwent radical prostatectomy at Beijing Hospital from February 1, 2019 to February 29, 2024 were retrospectively analyzed. All patients underwent whole body ¹⁸F-PSMA PET/CT examination before surgery and pathological large sections of prostate specimens were made after surgery. According to the pathological section results, the lesions were divided into csPCa group (Gleason scores≥7) and non-csPCa group (Gleason scores=6 or benign). The PRIMARY score and PSMA expression score were used to evaluate prostatic lesions on PSMA PET/CT images, respectively. The differences in PRIMARY score, PSMA expression score, maximum standardized uptake value (SUV_max), lesion-to-background ratios (LBR), PSMA uptake characteristics, and location distribution were compared between csPCa group and non-csPCa group. Multivariate logistic regression analysis was performed to determine the correlation factors for the incidence of csPCa. By plotting the receiver operator characteristic (ROC) curve and calculating the area under the curve (AUC), the optimal diagnostic threshold for csPCa of each factor was determined. The differences in AUC were compared using the Delong test. Quantitative data was represented as M (Q₁, Q₃).

The 70 patients aged 70 (64, 75) years with a total of 108 lesions, including 83 lesions (76.9%) in the csPCa group and 25 lesions (23.1%) in the non-csPCa group. There were differences between csPCa group and non-csPCa group in PRIMARY score [4 (3, 5) vs 2 (1, 4)], PSMA expression score [2 (2, 2) vs 1 (1, 2)], SUV_max [9.10 (5.70, 15.80) vs 5.40 (3.35, 6.90)], LBR [2.86 (2.09, 4.53) vs 1.96 (1.42, 2.58)], and proportion of focal uptake patterns [74.7% (62/83) vs 32.0% (8/25)] (all P<0.05). There was no statistically significant difference in the location distribution between the two groups (P>0.05). Multivariate logistic regression analysis indicated the higher the PRIMARY score, the higher the risk of developing csPCa (OR=1.863, 95%CI: 1.360-2.552). ROC curves revealed that the AUCs of the PRIMARY score and PSMA expression score for csPCa were 0.751 (95%CI: 0.659-0.829) and 0.697 (95%CI: 0.601-0.781), respectively, without statistically difference (Z=1.438, P>0.05). The cut-off values for diagnosing csPCa were 3 score for PRIMARY score and 2 score for PSMA expression score, respectively.

The higher the ¹⁸F-PSMA PET/CT PRIMARY score, the higher the risk of developing csPCa. The PRIMARY score has good diagnostic efficacy for csPCa.

To develop a predictive model for improvement of ejection fraction 1 year after heart failure with reduced ejection fraction (HFrEF) following acute ST-segment elevation myocardial infarction (STEMI).

This nested case-control study included STEMI patients diagnosed with HFrEF from a prospective multicenter multimodality imaging cohort between August 2014 and March 2021. Based on the improvement of left ventricular ejection fraction (LVEF) at baseline and 1-year follow-up, the patients were classified into the heart failure with improved ejection fraction (HFimpEF) group and the persistent HFrEF group. The clinical data were collected, and cardiac histological changes were assessed using cardiac magnetic resonance imaging. Multivariate logistic regression analysis was performed to identify factors associated with ejection fraction improvement at one year, and a predictive model was developed and internally validated. The performance and clinical applicability of the model were evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis.

A total of 117 STEMI patients (102 males and 15 females) aged (61.6±11.6) years were included in the study. At the 1-year follow-up, there were 61 patients (52.1%)in the HFimpEF group,and 56 patients (47.9%) in the HFrEF group . Compared with persistent HFrEF group, patients in HFimpEF group had smaller baseline left ventricular end-systolic diameter (LVESD) [33.0 (30.0, 36.0) mm vs 35.5 (32.0, 39.0) mm], smaller infarct size [26.1% (20.3%, 36.0)% vs 40.6% (33.0%, 45.4)%], lower peak B-type natriuretic peptide (BNP) level [340.0 (190.5, 692.5) ng/L vs 636.0 (318.5, 1 188.8) ng/L], lower peak level of soluble suppression of tumorigenicity 2 (sST2) [36.7 (25.8, 60.5) μg/L vs 62.4 (30.6, 120.7) μg/L], and higher hematocrit [(43.5%±3.5%) vs (40.8%±5.6%)] (all P<0.05). Multivariate logistic regression analysis revealed that smaller baseline LVESD (OR=0.825, 95%CI: 0.745-0.914), smaller infarct size (OR=0.967, 95%CI: 0.939-0.995), peak BNP level≤400 ng/L (OR=3.062, 95%CI: 1.283-7.306), peak sST2 level≤35 μg/L (OR=2.600, 95%CI: 1.040-6.501), and higher hematocrit (OR=1.109, 95%CI: 1.030-1.193) were predictors of LVEF improvement in STEMI patients with HFrEF. The predictive model formula: logit (P)=2.619-0.034×infarcted myocardium percentage (%)+1.119×(peak BNP level≤400 ng/L)+0.956×(peak sST2 level≤35 μg/L)+0.103×hematocrit (%)-0.192×LVESC (mm) (where peak BNP level≤400 ng/L and peak sST2 level≤35 μg/L are binary variables: Yes=1, No=0). The area under the ROC curve (AUC) was 0.805 (95%CI: 0.723-0.887), indicating good predictive ability. Calibration curves and decision curve analysis indicated good model consistency and clinical utility.

Smaller LVESD, smaller infarct size, peak BNP level≤400 ng/L, peak sST2 level≤35 μg/L and higher hematocrit are predictive factors for LVEF improvement after STEMI. The predictive model has good performance for predicting HFimpEF.

To investigate the impact of SMARCA4 mutations on the outcomes of patients with advanced lung adenocarcinoma with epidermal growth factor receptor (EGFR) mutations.

In the Memorial Sloan Kettering Cancer Center (MSK) MetTropism study, 960 patients with advanced EGFR-mutated lung adenocarcinoma were screened and included in the MSK cohort, composing of 313 males and 647 females, with a median [M(Q₁, Q₃)] age of 64 (56, 72) years. A retrospective analysis was conducted on the data of 178 patients with advanced EGFR-mutated lung adenocarcinoma who received EGFR tyrosine kinase inhibitors (TKIs) treatment in the Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, from January 2018 to December 2022. Among these patients, 69 were males and 109 were females, with a median age of 63 (54, 69) years. The follow-up of patients from the First Affiliated Hospital of Nanjing Medical University was conducted up to December 31, 2023, with a median follow-up time of 26.6 (95%CI: 24.6-28.6) months for the entire cohort, and 29 patients were lost to follow-up. Survival curves were plotted using the Kaplan-Meier method, and the log-rank test was used to compare the relationship between SMARCA4 gene alternations and prognosis.

In the 960 patients of the MSK cohort with advanced EGFR-mutated lung adenocarcinoma, the SMARCA4 gene alternations rate was 4.2% (40/960). The median overall survival (OS) for patients without SMARCA4 gene alternations was 41.5 (95%CI: 35.6-47.3) months, which was superior to that of patients with SMARCA4 gene alternations [15.6 (95%CI: 7.9-23.4) months, P<0.001]. Patients with SMARCA4 gene alternations had a higher risk of mortality, with an HR (95%CI) of 1.97 (1.35 to 2.88). Among the 178 patients with advanced EGFR-mutated lung adenocarcinoma from the First Affiliated Hospital of Nanjing Medical University, the SMARCA4 gene alternations rate was 4.5% (8/178). The median progression-free survival (PFS) for patients without SMARCA4 gene alternations was 16.1 (95%CI: 12.2-20.0) months, which was superior to the median PFS of patients with SMARCA4 gene alternations [6.0 (95%CI: 1.3-10.7) months, P<0.001]. The median OS for patients without SMARCA4 gene alternations was 50.1 (95%CI: 28.1-72.1) months, which was also superior to the median OS of patients with SMARCA4 gene alternations [17.6 (95%CI: 15.4-19.8) months, P=0.001].

SMARCA4 alternation is an important factor associated with poor prognosis in patients with advanced EGFR-mutant lung adenocarcinoma.

This study aimed to investigate the efficacy of inverted door flap (IDF) combined with transcanal approach to the tympanic antrum (TCAA) technique under the endoscope for treatment of middle ear cholesteatoma. Outcomes of patients treated with combined techniques at the First People′s Hospital of Foshan City between March 2021 and March 2023 were evaluated. A total of 31 patients (33 ears, 16 males and 15 females) aged (42.9±15.9) years were included. The patients were divided into three groups based on the extent of cholesteatoma involvement: the lateral ossicular chain (LOC) group (8 ears), the internal ossicular chain (IOC) group (11 ears), and the mastoid antrum and mastoid process (MA/MP) group (14 ears). No complications occurred postoperatively, such as cholesteatoma recurrence, facial paralysis and infection. The median (Q₁, Q₃) follow-up duration was 12 (7, 18) months. The results showed a median (Q₁, Q₃) dry ear duration of 1.5 (1.5, 2.0) months, and a dry ear rate of 97.0% (32/33) at six months postoperatively. Specifically, 7 out of 8 patients in the LOC group had dry ears, while all patients in the IOC group and the MA/MP group had dry ears 6 months after surgery. The current study demonstrates that IDF combined with TCAA techniques are safe and effective in the treatment of middle ear cholesteatoma, with rapid achievement of dry ear.

To comprehensively evaluate the structure and function of the bladder wall in children using multi-modal ultrasound (MMU). A total of 110 children without urinary symptoms admitted to the First Affiliated Hospital of Zhengzhou University from January 2022 to June 2023 were included prospectively. MMU was performed and the vesical volume (VV), bladder wall thickness (BWT), shear wave velocity (SWV) of the anterior wall, resistance index (RI) and vascularization index (VI) were measured in the filled and emptied bladder respectively, and the ultrasound bladder compliance (UBC) was also calculated. The differences in MMU parameters in children among different bladder states, age groups and sexes and the correlation between age and different MMU parameters were analyzed. The age of 110 children was (6.4±3.5) years, of which 60 were boys (54.5%). The VV [127.00 (79.00, 219.50) vs 6.65 (5.10, 9.60) ml, P<0.001] and SWV [(2.25±0.36) vs (1.54±0.20) m/s, P<0.001] of filling condition were higher than that of emptying condition, while BWT [(2.52±0.25) vs (6.72±0.74) mm, P<0.001] and VI [(4.36±0.52)% vs (8.15±1.75) %, P<0.001] were lower than that of emptying condition. There were no significant differences in VV, BWT, SWV, RI, VI and UBC between boys and girls under either bladder emptying or filling conditions (all P>0.05). BWT in emptying condition, VV and BWT in filling condition all increased with age (r was 0.706, 0.891 and 0.298, respectively, and all P<0.05). MMU in children contributes to the comprehensive evaluation of bladder wall, and the influence of age and bladder filling state should be considered when evaluating MMU parameters.

This article reports the clinical diagnosis and treatment of a patient with cholangitis who suffered from recurrent fever for more than 1 year after pancreaticoduodenectomy for 5 years. Combined with the medical history and auxiliary examination, the pancreatic duct stent was displaced to the left hepatic duct after pancreaticoduodenectomy, but the biliary duct stent did not fall off, and stones formed in the biliary system. The patient was cured and discharged after the operation. Among the long-term complications after pancreaticoduodenal surgery, the complications related to pancreatic duct and bile duct stents are rare, and they are easy to be misdiagnosed and delay surgical treatment, which should be paid attention to.

In May 2024, the health industry standard WS/T 489-2024 "Operational Guidelines for Clinical Microbiology Laboratory Testing of Urine Specimens" was officially released. This standard mainly considers the shortcomings of domestic clinical microbiology laboratories in the laboratory diagnosis process and results report of urinary tract infections. Combined with the actual operating specifications of domestic and foreign medical institutions, the current situation of laboratories is investigated, and the operating specifications that are more in line with the actual situation in China are formulated. The standard updates the standard operating procedure of urine culture laboratory testing, and improves the testing and reporting process. In order to promote the popularization and application of the standard, this paper mainly interprets the above key changes in detail, so as to help relevant staff better grasp and apply this new standard.

DNA methylation is an important modification mode in epigenetics. It can play an important role in the occurrence and development of auditory system diseases by regulating gene expression, and connect the dual effects of genetics and environment on diseases. This paper introduces the process, physiological effects and detection methods of DNA methylation, emphatically summarizes the important achievements of DNA methylation research in various auditory diseases, analyzes the application prospects and limitations of DNA methylation in the diagnosis and treatment of auditory diseases, in order to provide a new perspective for the research of auditory diseases.