Abstract:Objective：To investigate the ability of the histological expression of the key protein cytoskeleton -associated protein 4 （CKAP4）in urine extracellular vesicles as a biomarker for the progression of diabetic kidney disease（DKD）. Methods：A total of 143 type 2 diabetic patients with biopsy -proven DKD and 10 patients with renal malignant tumors were enrolled from the First Affiliated Hospital of Nanjing Medical University. The expression of CKAP4 in renal tissue was detected by immunohistochemistry. Spearman’s correlation analysis was used to analyze the correlation between CKAP4 expression level and clinical indicators. The area under the receiver operating characteristic（ROC）curve（AUC）was calculated to assess whether CKAP4 expression could effectively distinguish patients with poor renal prognosis. ROC curve analysis was used to determine the best cut-off value of CKAP4 score for renal events （highest Youden’s index）. Time - dependent AUC analyses were also performed to characterize the predictive accuracy of CKAP4 beyond 6 months after renal biopsy. In addition，hazard ratios between CKAP4 and DKD progression were calculated using by Cox proportional hazards models. The clinicopathological factors with statistical significance（P ＜ 0.05）in univariate analysis were included as covariates in multivariate Cox proportional hazards model analysis. Kaplan -Meier analysis was used to evaluate the difference in survival beyond 6 months after renal biopsy between CKAP4 high-expression and CKAP4 low-expression groups. Results：Compared with the adjacent normal kidney tissues of tumor patients，the expression of CKAP4 in the kidneys of DKD patients was significantly increased（P ＜ 0.05）. The expression of CKAP4 in renal tissues of DKD patients was different in different stages，and the differences between stage Ⅱ and stage Ⅲ ，stage Ⅱ and stage Ⅳ ，and stage Ⅲ and stage Ⅳ were statistically significant（P ＜ 0.05）. The expression level of CKAP4 in DKD patients was positively correlated with serum creatinine，urea nitrogen and 24 h urine protein，while negatively correlated with estimated glomerular filtration rate and hemoglobin. During a median follow-up period of 2.22 years， 63 patients（44.06% ）had DKD progression. Pearson correlation analysis showed that CKAP4 increased with the increase of pathological grade of DKD（r=0.808，P ＜ 0.001）. Of note，multivariate Cox regression analysis showed that elevated CKAP4 was associated with an increased risk of DKD progression（HR：4.120，95% CI：1.730- 9.811，P=0.001）. In addition，in Kaplan - Meier survival analysis，patients with high CKAP4 expression had a significantly higher incidence of renal endpoint events than those with low CKAP4 expression（P ＜ 0.001）. At the same time，a nomogram was developed including CKAP4 classification to predict the risk of DKD progression（C - index：0.689）. Conclusion：Our findings suggest that expression of CKAP4，derived from urine extracellular vesicles，is an independent risk factor for disease progression over 6 months after renal biopsy in DKD patients.

Abstract:Objective：Construction and identification of a chronic antibody - mediated rejection（cABMR）model of renal graft in mice. Methods：Male 6-8 weeks old BALB/cH2d and C57BL/6H2b mice were randomly divided into the syngeneic control group，cell - mediated rejection group，acute antibody - mediated rejection（aABMR）group，cABMR group 1，cABMR group 2，cABMR group 3. Pathological staining and Banff score were performed to diagnose the transplanted kidneys，survival curves were plotted，the levels of complement fragment C3d deposition，peripheral blood IgG class donor-specific antibody（DSA），serum creatinine（Cr）and serum urea nitrogen（BUN）were detected in transplanted kidney tissues，the expression of CD3 + T cells，CD19 + B cells，F4/80 labelled macrophages，Ly6G labelled myeloid cells were detected. Results：cABMR group 1 met ABMR diagnostic criteria with 80% postoperative survival rate and negligible CD3+ T cell expression，thus selected for subsequent studies. Compared to the control group，the C3d - positive exoression regions were significantly increased in the cABMR group and the average fluorescence intensity of IgG DSA in peripheral blood was notably enhanced. Serum Cr and BUN levels in peripheral blood were significantly higher. Compared to aABMR，the cABMR model of transplanted kidneys showed more extensive peritubular capillary haemorrhage and dilatation，single nucleus infiltration in the glomeruli，and more typical tubular damage and brush border detachment in the tubules，higher Banff scores， significantly more positive areas of C3d expression，significantly higher mean fluorescence intensity of peripheral blood IgG DSA， significantly higher peripheral blood serum Cr and BUN levels. Incontrast to aABMR，cABMR group showed no siginificant infiltration of CD19+ B cells or CD3+ T cells in the renal interstitial or peritubular capillaries，but there was a more significant infiltration of renal interstitial F4/80 labelled macrophage and Ly6G labelled myeloid cell. Foxp3 and IL-10 expression were significantly reduced in the cABMR model，while the infiltration of IL-1β，IL-6，TNF-α and CCL2 inflammatory cytokines was significantly increased in cABMR model. Conclusion：A cABMR model with an extended survival period was successfully constructed and identified. This model can be used to assess the mechanisms and intervention strategies of cABMR，with high clinical application value.

Abstract:Among all renal diseases，chronic renal disease and renal cancer are significant threats to global health，with their core pathological mechanisms closely related to renal fibrosis and dysregulation of the tumor microenvironment. In recent years，the tripartite motif（TRIM）protein family has emerged as a new focus in renal disease research due to its critical roles in ubiquitination， immune regulation，and epigenetics. Studies have shown that TRIM proteins are involved in the pathological processes of renal diseases through multiple mechanisms，including the ubiquitin -proteasome system，oxidative stress，related signaling pathways，inflammatory immune regulation，and epigenetics. In terms of therapeutic strategies，gene silencing technologies，small molecule inhibitors，and recombinant proteins targeting TRIM proteins have shown potential. However，challenges such as the functional redundancy of TRIM family proteins，tissue-specific expression differences，and potential immunogenicity have made their clinical application difficult. This article provides a review of the molecular mechanisms of TRIM proteins in renal diseases and their therapeutic potential.

Abstract:Objective：The current study aims to assess the efficacy of total saponins of Panax notoginseng（PNS）supplementation on platelet hyperreactivity in hyperlipidemic mice as well as to clarify the underlying mechanisms in vivo. Methods：Healthy male C57BL/6J mice（aged 8 weeks）were randomly divided into four groups and fed either a low-fat diet（LFD group），a LFD supplemented with PNS（200 mg/kg diet，LFD+PNS group），a high-fat diet（HFD group），or a HFD supplemented with PNS（200 mg/kg diet，HFD+ PNS group）for 12 weeks. After that all mice were killed，and the plasma and purified platelets were prepared，followed by measurement levels of plasma lipid profile using commercial assay kits. A platelet aggregometer was used to measure maximal aggregation ratio. Platelet activation was determined by flow cytometry and enzyme - linked immunosorbent assays. Real - time PCR technique was used to detect CD36 mRNA expression，and Western blot was used to measure protein expression levels of CD36 and phosphorylation of Src and p47phox. Results：When compared with those in LFD group，the plasma levels of total cholesterol，triglyceride and low density lipoprotein cholesterol were significantly increased in HFD group，which were greatly decreased by PNS supplementation. Moreover，PNS supplementation favorably attenuated HFD-induced platelet aggregation and activation in response to an agonist thrombin，including inhibiting platelet surface CD62P expression，and platelet factor 4（PF4）and chemokine ligand 5 （CCL5）release，indicating a potent inhibitory effect of PNS on HFD-induced platelet hyperreactivity. Mechanistically，CD36 mRNA and protein expression increased by HFD were significantly down-regulated by PNS supplementation. Moreover，PNS supplementation also greatly attenuated HFD-induced activation of downstream signalling pathways mediated by CD36，including down-regulating Src and p47phox phosphorylation. Furthermore，it is found that platelet surface CD62P expression isolated from LFD mice in response to adenosine diphosphate were increased by adding hyperlipidemic plasma from HFD mice，which was greatly decreased in LFD+PNS group. This significant difference was abolished when pretreated with an anti-CD36 monoclonal antibody FA6-152. Conclusions：PNS supplementation attenuates platelet hyperreactivity in mice fed a high - fat diet possibly through down - regulating CD36 signalling pathway. The current study may provide potential value for PNS to improve thrombosis in hyperlipemia and the related chronic metabolic diseases.

Abstract:Objective：This study aims to investigate whether the addition of niacin（NA）to in vitro maturation（IVM）cultures can improve the quality of oocytes derived from aged mice and its mechanism. Methods：C57BL/6J mice at 8 weeks of age were used as the young control group，and mice at 40 weeks of age were used as the old group. Oocytes at the germinal vesicle（GV）stage were taken and supplemented with 100，200，and 300 μmol/L NA，respectively，and the rates of 2-cell and blastocyst formation were observed to determine the optimal concentration. Oocyte quality was assessed by the first polar body extrusion（PBE）rate，cortical granule（CG） distribution，spindle morphology abnormality rate and chromosomal abnormality rate. Mitochondrial function was assessed by mitochondrial membrane potential and adenosine triphosphate（ATP）levels. Oxidative stress levels were assessed by detecting the levels of reactive oxygen species（ROS）in oocytes and mitochondria. The levels of oxidative stress-related proteins：silent information regulator 3（SIRT3），superoxide dismutase（SOD2），and acetylated superoxide dismutase（Ac-SOD2）were detected by Western blot. Results：Under the concentration of 200 μmol/L NA culture medium，the blastocyst formation rate of oocytes in the old +NA group reached its highest level（P ＜ 0.05），therefore this concentration was selected as the optimal concentration. NA supplementation significantly improved the PBE rate and CG distribution in oocytes，while reducing abnormal spindle rates and chromosomal aberration rates，compared with that of the aged mice. NA supplementation also increased mitochondrial membrane potential，enhanced ATP production，and reduced ROS levels in both oocytes and mitochondria（all P ＜ 0.05）. Western blot analysis demonstrated that NA supplementation significantly increased SIRT3 and SOD2 protein expression（all P ＜ 0.05），while markedly decreasing Ac - SOD2 protein expression（P ＜ 0.05）. Conclusion：Addition of 200 μmol/L NA to IVM culture medium improves oocyte quality in aged mice by ameliorating mitochondrial oxidative stress and may act by affecting the SIRT3-SOD2 signaling pathway.

Abstract:Objective：To explore the regulatory effect of the enhancer of Zeste homolog 2（EZH2）on the focal adhesion kinase （FAK）/filamentous actin（F-actin）/reactive oxygen species（ROS）pathway，and to analyze its effect on the proliferation，invasion，and metastasis of colorectal cancer（CRC）cells. Methods：Tissue samples from 50 patients undergoing CRC resection at the First Affiliated Hospital of Hebei North University were collected，including both cancer tissues and adjacent normal tissues. Immunohistochemistry was used to detect EZH2 expression，and clinical data were analyzed to determine the correlation between EZH2 expression and clinicopathological parameters as well as survival prognosis. A subcutaneous xenograft model using CRC nude mice was established， dividing the mice into the negative control（EZH2 NC）group，EZH2 overexpression（EZH2 mimic）group，EZH2 NC+cytochalasin D group，and EZH2 mimic+cytochalasin D group. After 14 days of cultivation，the tumor growth was observed. Human CRC cell lines SW480 and SW620 cells were cultured in vitro and divided into the same four groups using lipofection. Western blot was used to detect the expression of FAK，F-actin，and ROS pathway-related proteins. Immunofluorescence staining was used to observe F-actin expression and distribution. Wound healing，transwell，and CCK -8 assays were used to assess cell migration，invasion，and viability. ChIP -qPCR was used to detect the enrichment of FAK，NADPH oxidase（NOX）-2，and NOX4 on EZH2. Results：Immunohistochemistry analysis showed the expression levels of EZH2 were significantly higher in CRC tissues than in adjacent normal tissues（P ＜ 0.05）. EZH2 expression levels were closely associated with lymph node metastasis and distant transfer events（all P ＜ 0.05）. The analysis of follow-up data showed that the 5 - year overall survival rate of CRC patients with low EZH2 expression was significantly higher than that of patients with high EZH2 expression，with a statistically significant difference（P ＜ 0.05）. The subcutaneous CRC xenograft model was successfully established，with the EZH2 mimic group showing significantly larger tumor volumes than that of the EZH2 NC group（P ＜ 0.05）. Post cytochalasin D intervention，both EZH2 NC+cytochalasin D and EZH2 mimic+cytochalasin D groups showed significantly reduced tumor volumes compared with the untreated groups（P ＜ 0.05），though no significant difference was noted between the two intervention groups（P ＞ 0.05）. The expression levels of EZH2，p-FAK，p-Paxillin，NOX2，NOX4，and p-JNK proteins in the EZH2 mimic group were significantly higher than those in the EZH2 NC group（P ＜ 0.05），while the expression levels of RUNX family transcription factor 3（RUNX3）protein were slightly lower than that in the EZH2 NC group（P ＜ 0.05）. The number of F - actin distribution，migration ability，and cell viability increased in the EZH2 mimic group than in the EZH2 NC group. After the intervention of cytochalasin D，there was no significant difference in the expression levels of EZH2，p-FAK，and p-Paxillin proteins compared with the untreated group（P ＞ 0.05），while the expression levels of NOX2，NOX4，and p - JNK proteins were significantly decreased（P ＜ 0.05），and the expression levels of RUNX3 protein were significantly increased compared with the untreated group（P ＜ 0.05）. There was no significant difference between the two intervention groups（P ＞ 0.05）. In addition，the number of F-actin distribution，migration ability，and cell viability were significantly decreased in the intervention groups，with no significant difference between the two groups （P ＞ 0.05）. The results of the ChIP-qPCR assay showed that after using the EZH2 antibody，the promoter contents enriched by FAK， NOX2，and NOX4 were significantly increased，respectively（P ＜ 0.05）. Conclusion：EZH2 promotes the proliferation，invasion，and metastasis of CRC cells by upregulating the activity of the FAK/F-actin/ROS pathway.

Abstract:Objective：To investigate the role of Tyro3 protein tyrosine kinase（Tyro3）in the pathogenesis of endotoxemia and its underlying molecular mechanisms. Methods：The expression profile of Tyro3 in peripheral blood from septic patients was analyzed using the GEO database（GSE54514）. An endotoxemia mouse model was established by intraperitoneal injection of lipopolysaccharide （LPS，10 mg/kg）. Disease severity -including clinical scores，96-hour survival rates，plasma inflammatory cytokine levels，and acute hepatic inflammatory pathology -was evaluated and compared between systemic Tyro3 knockout（Tyro3-/-）and wild -type（Tyro3 +/+） mice. Additionally，bone marrow-derived macrophages（BMDMs）were isolated from Tyro3+/+ and Tyro3-/- mice and stimulated with LPS （100 ng/mL）to establish an in vitro acute inflammation model. Activation of the nuclear factor kappa -B（NF-κB）signaling pathway was assessed. Results：Clinical data analysis revealed a significant downregulation of Tyro3 expression in the peripheral blood of septic patients. In vivo experiments demonstrated that Tyro3-/- mice exhibited exacerbated endotoxemia compared to Tyro3 +/+ mice，as evidenced by significantly worsened clinical scores，reduced survival rates，elevated plasma inflammatory cytokine levels，more severe acute liver injury，and increased inflammatory cell infiltration. In vitro studies showed that Tyro3 deficiency led to hyperactivation of the NF-κB pathway in macrophages，characterized by enhanced phosphorylation of inhibitor of kappa B kinase（IKK）and the p65 subunit of NF-κB，along with accelerated degradation of NF-kappa-B inhibitor alpha（IB-α）. Pharmacological activation of Tyro3 using protein S（Pros1）effectively suppresses NF - κB pathway activation. Conclusion：Tyro3 attenuates endotoxemia - induced inflammatory responses and hepatic injury by negatively regulating the NF - κB signaling pathway in macrophages，suggesting that pharmacological targeting of the Tyro3-NF-κB axis may represent a novel therapeutic strategy for endotoxemia management

Abstract:Objective：This study aims to establish individual cerebral metabolic networks in Parkinson’s disease（PD）using integrated 18F - FDG - PET/MR imaging and Jensen - Shannon similarity estimation（JSSE）and investigate topological alterations in metabolic networks and their associations with functional networks. Methods：Twenty-eight patients with clinically confirmed PD（16 males and 12 females）who underwent 18F-FDG-PET/MR imaging at the Affiliated Nanjing Hospital of Nanjing Medical University from August 2022 to May 2024 were retrospectively analyzed，and 20 age-and sex-matched normal controls（NC）were included（10 males and 10 females）. Individual brain metabolic networks were constructed using the JSSE method，and Matlab2013b was used to analyze changes between network topological properties and metabolic connectivity in brain regions using Gretna. Data were analyzed using two independent samples t-test and Mann -Whitney U-test，and the Mantel test analyzed correlations between metabolic and functional network matrices in the PD group and the NC group. Results：Compared with the NC group，the PD group showed higher assortativity in terms of global attributes（t=-2.06，P=0.045）；in terms of nodal attributes，the centrality of nodal degree in the right fusiform gyrus was significantly reduced（t=3.32，P ＜ 0.001）；15 key metabolic connectivity parameters were reduced（P ＜ 0.001），with the reduction in metabolic connectivity between the left caudate nucleus and the left inferotemporal gyrus being the most pronounced. There was a significant positive correlation between the PD metabolic and functional network matrices（r=0.242，P ＜ 0.05），and the correlation was greater than that in the NC group（r=0.197，P ＜ 0.05）. Conclusion：The integrated PET/MR and JSSE framework demonstrates clinical efficacy in detecting cerebral topological reorganization and metabolic connectivity aberrations in PD. 18F - FDG - PET/MR imaging is useful for the early diagnosis of PD and for exploring changes in the mechanisms of intrinsic remodeling of the brain in PD patients from the perspective of brain metabolism and function.

Abstract:Objective：To investigate the relationship between serum programmed cell death factor 4（PDCD4）levels and neurological deficits as well as prognosis in patients with acute ischemic stroke（AIS）. Methods：A retrospective analysis was conducted on 110 AIS patients admitted to the Department of Neurology，the Second Affiliated Hospital of Nantong University between June 2023 and March 2024. Based on the National Institutes of Health Stroke Scale（NIHSS）scores，patients were divided into a mild group（n=70）and a moderate to severe group（n=40）. According to the modified Rankin Scale（mRS），patients were further divided into a good prognosis group（n=69）and a poor prognosis group（n=41）. The demographic data（age，sex，diabetes history，etc.）and clinical data（neutrophil count，lymphocyte count，neutrophil-to-lymphocyte ratio，etc.）of each group of patients were collected. Serum PDCD4 levels were measured using an enzyme-linked immunosorbent assay（ELISA），and their correlations with NIHSS scores，mRS scores， and other inflammatory markers were analyzed. Logistic regression was employed to identify risk factors for moderate - to - severeneurological deficits and poor prognosis in AIS patients. Receiver operating characteristic（ROC）curves were used to evaluate the effectiveness of serum PDCD4 levels in predicting the degree of neurological deficit and prognosis of AIS patients. Results：Serum PDCD4 levels were significantly higher in AIS patients with moderate -to - severe neurological deficits or poor prognosis compared to those with mild deficits or good prognosis. PDCD4 levels showed positive correlations with NIHSS scores，mRSscores，procalcitonin， high - sensitivity C - reactive protein（Hs -CRP），and neutrophil -to -lymphocyte ratio. After adjusting for confounding factors，PDCD4 remained an independent risk factor for AIS. ROC analysis demonstrated that serum PDCD4 had high predictive value for both neurological deficit severity and prognosis. Conclusions：Elevated serum PDCD4 levels are strongly associated with moderate - to - severe neurological deficits and poor prognosis in AIS patients，serving as an independent predictive biomarker for clinical outcomes.

Abstract:Objective：Comparison of the predictive performance of MELD 3.0，MELD -Na，and MELD scores in assessing the 3- month and 1 - year survival prognosis of patients with decompensated cirrhosis. Methods：We conducted a retrospective analysis of clinical data from 438 patients diagnosed with decompensated cirrhosis who received either outpatient or inpatient care from January 2013 to December 2022. Based on their survival status at 3 months and 1 year，the patients were categorized into survival and death groups. The predictive value of MELD 3.0，MELD-Na，and MELD scores for 3-month and 1-year mortality was compared using receiver operating characteristic（ROC）curves，the area under the curve（AUC），calibration curves，net reclassification improvement（NRI）， integrated discrimination improvement（IDI），and decision curve analysis（DCA）. Results：At the 3-month and 1-year follow-up points， 15.53% and 26.26% of patients had died，respectively. The area under the curve（AUC）for predicting 3-month and 1-year mortality for the MELD 3.0，MELD-Na，and MELD scores were 0.859（0.805-0.913），0.857（0.802-0.912），0.856（0.800-0.911）and 0.841（0.796- 0.886），0.832（0.785-0.880），0.830（0.782-0.878），respectively. However，the differences were not statistically significant（P ＞ 0.05）. In the distribution analysis across all patients，MELD 3.0 score can increase the score range for 18.0% of patients with MELD -Na scores，and 21.5% of patients with MELD scores are reclassified into a higher score category. On the calibration curve，all three models showed similar trends between predicted and actual probabilities at both time points. In terms of predicting 3-month mortality，the NRI for MELD 3.0 compared to MELD was 0.240（0.009-0.401），with a statistically significant difference（P=0.032）. For predicting 1-year mortality，the NRI and IDI for MELD 3.0 compared to MELD were 0.201（0.079-0.401）and 0.032（0.006-0.057），respectively，both of which were statistically significant（P ＜ 0.05）. In subgroup analyses，including male and female patients，viral and non-viral causes， and Child - Pugh class B and C patients，no significant statistical differences were observed among the three models（P ＞ 0.05）. Conclusion：MELD 3.0 showed significant improvement over conventional models in terms of NRI and IDI，demonstrating enhanced risk stratification capacity for clinical decision-making in decompensated cirrhosis.

Abstract:Objective：To investigate the correlation between frailty status and disease severity in elderly patients with coronary artery syndrome（CAS），and to analyze risk factors in this population. Methods：This analytical cross - sectional study included 187 elderly patients diagnosed with CAS at the First Affiliated Hospital of Nanjing Medical University from September 2023 to September 2024，who underwent coronary angiography and intervention. Participants were divided into non-frailty（n=74），pre-frailty（n=72），and frailty groups（n=41）using the FRAIL scale. Coronary lesion severity was assessed by Gensini score. All patients underwent echocardiography to evaluate cardiac structure and function. High Gensini score was defined as ＞43 points using the tertile method， followed by univariate screening and multivariate regression modeling to identify risk factors. Restricted cubic splines were applied to test nonlinear relationships. Results：The pre -frailty and frailty groups had higher mean age and increased proportion of New York Heart Association（NYHA）class Ⅲ heart function（P ＜ 0.05）. Atrial fibrillation and low glomerular filtration rates were more prevalent in frailty and pre -frailty groups compared to non -frailty group（P ＜ 0.05）. High Gensini scores occurred more frequently in frailty （36.6%）and pre - frailty（33.3%）groups than in non - frailty group（20.3%），without statistical significance（P ＞ 0.05）. Left atrial diameter progressively increased across non -frailty，pre -frailty，and frailty groups（P ＜ 0.05）. Left ventricular end -diastolic diameter was larger in pre-frailty than non-frailty（P ＜ 0.05）. Segmental wall motion abnormalities were higher in frailty（24.4%）and pre-frailty （38.9%）groups than in non-frailty group（17.6%，P ＜ 0.05）. Logistic regression identified hypertension，diabetes，fasting glucose，and segmental wall motion abnormalities as positively correlated with high Gensini scores（all P ＜ 0.05），while body mass index（BMI） showed negative correlation（OR=0.872，95% CI：0.775- 0.980，P=0.021）. Spearman analysis revealed weak negative correlation between BMI and Gensini scores（rs=- 0.161，P=0.028）. Restricted cubic splines indicated no significant nonlinear relationships between BMI and Gensini scores overall or within frailty subgroups（P ＞ 0.05）. Conclusion：Frailty status was not significantly associated with coronary lesion severity in elderly patients with CAS. However，frailty and pre -frailty status predisposed to cardiac structural abnormalities and impaired contractile function.

Abstract:Objective：To evaluate the clinical value of CT - guided percutaneous nitrogen cryoablation for elderly patients with pulmonary malignancies. Methods：Clinical data of 56 elderly patients（49 in the radical group，7 in the palliative group）who underwent CT-guided percutaneous cryoablation from January to December 2023 were retrospectively analyzed. Treatment efficacy was assessed by modified response evaluation criteria in solid tumors（mRECIST），with complications，visual analogue scale（VAS），C - reactive protein（CRP）and Eastern Cooperative Oncology Group Score（ECOG）scores recorded. Results：All 56 procedures were successfully completed，with a pneumothorax incidence of 28.57%（16/56），all recovering well after treatment. The complete response rates in the radical group at 1，3，and 6 months postoperatively were 100.00%，91.83%，and 83.67%，respectively，whereas the partial response rates in the palliative group were 100.00%，85.71%，and 57.14%. The ECOG score decreased from a preoperative value of 3.2±0.6 to 1.3±0.4 at 6 months postoperatively（P ＜ 0.01）. Conclusion：This technique is safe and effective，particularly suitable for elderly patients ineligible for surgery. Radical ablation demonstrates significant short-term efficacy，while palliative treatment improves quality of life.

Abstract:Objective：To develop a predictive model based on clinical and ultrasound characteristics for differentiating between benign from malignant small breast masses with non-parallel growth and classified by the Breast Imaging Reporting and Data System（BI -RADS）as BI-RADS 4A and 4B，and to evaluate its application value. Methods：For this retrospective study，327 patients with breast masses were recruited in the First Affiliated Hospital of Nanjing Medical University from June 2020 to May 2024. These patients were screened and diagnosed with BI-RADS 4A and 4B classifications by ultrasound，with non-parallel growth and a diameter of ≤10 mm. They were randomly divided into a training set（n=229）and a validation set（n=98）at the ratio of 7∶3. Logistic regression analysis was used to identify risk factors for differentiating benign from malignant breast lesions and to construct a diagnostic predictive model. The effectiveness of the model was evaluated by the receiver operating characteristic（ROC）curve and the decision curve analysis（DCA）. Results：Among the 327 cases，36.1%（118/327）were malignant. Univariate and multivariate logistic regression analyses identified age，margin，elasticity assessment，and US - BI - RADS classification as independent risk factors for malignant masses. A diagnostic model incorporating these four variables was established and presented as a nomogram. The area under curve（AUC）of the ROC was 0.846 and 0.798 for the training and validation sets，respectively. DCA confirmed that the model’s prediction of the risk of benign and malignant masses could benefit patients. Moreover，risk stratification based on nomogram-calculated risk scores for all patients showed that those with risk scores ≥0.7（top 20%）were classified as high-risk，while those with scores ≤0.1（bottom 20%）were classified as low - risk，with malignant rates of 8.8% and 82.1%，respectively. Conclusion：The predictive model constructed based on clinical and ultrasound characteristics effectively differentiates benign from malignant small breast masses of BI-RADS 4A and 4B categories with non-parallel growth. Risk stratification based on nomogram-calculated risk scores indicates a malignant rate of only 8.8% in the low- risk group and 82.1% in the high-risk group，demonstrating significant clinical value.

Abstract:Objective：To optimize the current strategy of prostate puncture biopsy by analysing the clinical data of high - risk prostate cancer patients，establishing a model to predict the pathological nature of their prostate lesions，and identifying patients who can be exempted from systematic biopsy and undergo targeted puncture alone. Methods：Clinical data of patients who underwent prostate puncture at the First Affiliated Hospital of Nanjing Medical University from January 2022 to June 2024 were retrospectively analyzed，and eligible patients were screened and divided into a training set and a validation set. Univariate and multivariate logistic regression analyses were used to screen the significant factors of the pathology of prostate targeted biopsy. A predictive model was constructed based on the data from the training set，and the model effectiveness was verified in the validation set. Receiver operating characteristic（ROC）curves were used to assess the diagnostic performance of the model in both data sets. Results：Age（X1），number of lesions（X2），histological region in which the lesions are located（X3），prostate imaging reporting and data system（PI-RADS）score （X4），and prostate-specific antigen density（X5）were the variables associated with the patient’s prostate targeted biopsy pathology. The mathematical expression of the predictive model was：P=1[/ 1+e^（-15.770+0.067×X1-0.658×X2+0.381×X3+2.271×X4+5.742×X5）]. The area under the curve（AUC）of the prediction model was 0.856（95%CI：0.812-0.900）in the training set and 0.886（95%CI：0.776- 0.995）in the validation set. Conclusion：The constructed prediction model for targeted biopsy pathology in high-risk prostate cancer patients can guide the clinical strategy of prostate puncture to maintain a good diagnostic performance while reducing the number of puncture needles，thus reducing the occurrence of complications and saving medical resources.

Abstract:Objective：To investigate the distribution，drug resistance of pathogens and prognostic risk factors in patients with positive catheter culture，and to provide pathogenic basis and preventive measures for clinical catheter-related infection. Methods：The etiological data of patients with positive catheter culture in the First Affiliated Hospital of Nanjing Medical University from 2018 to 2023 were retrospectively analyzed，and the clinical data of the patients with the top three pathogens were collected to analyze the risk factors affecting the prognosis. Results：The overall positive rate of catheter culture was 14.7%（1 240/8 407）. After removing the same pathogens isolated from the same patient，a total of 1 096 strains of pathogens were isolated from 916 patients，48.7% of which were gram-negative bacteria，mainly Klebsiella pneumoniae，Acinetobacter baumannii，and Escherichia coli. Gram-positive bacteria accounted for 39.2%，mainly Staphylococcus aureus，Staphylococcus epidermidis，and Enterococcus. The resistance rate of Klebsiella pneumoniae to most antibiotics was higher than that of Escherichia coli. The resistance rate of Acinetobacter baumannii to most cephalosporins and carbapenems was higher（＞85.0%）. The detection rates of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis were 35.6% and 92.2% ，respectively. No vancomycin and linezolid resistant Staphylococcus and Enterococcus were detected. Multivariate analysis showed that male，≥65 years old，history of dialysis，combined catheter - associated bloodstream infection and tracheal intubation were independent risk factors for prognosis in patients with catheter-associated infection（P ＜ 0.05）. Conclusion： The incidence of catheter-associated infection is high，which needs clinical attention. Continuous monitoring and analysis of etiological characteristics in the local area can provide theoretical basis for clinical empirical anti-infection treatment.

Abstract:The global incidence and mortality rates of gastric cancer remain high. China bears a significantly higher disease burden from gastric cancer than the global average，with its mortality ranking third among all malignant tumors in the country. Alpha - fetoprotein-producing gastric cancer（AFPGC）is a special subtype of gastric cancer characterized by abnormally elevated serum alpha- fetoprotein（AFP）levels or positive AFP expression in tumor tissues detected by immunohistochemistry. The incidence of AFPGC in China accounts for approximately 2.3% - 4.6% of gastric cancer cases. Compared with conventional gastric cancer，AFPGC is more prone to distant metastasis，particularly liver metastasis，and has a poorer prognosis. Currently，there are no standardized treatment guidelines for AFPGC，and its management primarily relies on conventional gastric cancer treatment strategies. Research is ongoing to explore the differences between the occurrence and development of this tumor and general gastric cancer，as well as the related clinical features and efficacy of therapy. This article mainly reviews the biological features，clinicopathological characteristics and current treatment explorations of AFPGC in domestic and foreign research.

Abstract:Triple-negative breast cancer（TNBC）is a subtype of breast cancer with negative expression of estrogen receptor（ER）， progesterone receptor（PR）and human epidermal growth factor receptor 2（HER 2），which has extensive tumor heterogeneity at the pathological and molecular levels，and strong invasive and metastatic abilities. Currently，the treatment regimens for TNBC are not satisfactory，and there is a high possibility of recurrence and metastasis after treatment. Sonodynamic therapy（SDT），due to its non - invasiveness and high tissue penetration ability，has been gradually introduced into the research on the treatment of various cancers. This article briefly introduces the basic principle of SDT and the current research progress on the treatment of TNBC based on SDT.