Many plasma cell diseases can affect the kidneys，leading to varing degrees of impairment in renal function.Such diseases in this paper will be referred to as kidney involved plasma cell diseases （KiPCD）.How to distinguish these diseases continuously puzzled many physicians.Although kidney biopsy can provide a clear diagnosis most of the time，it is an invasive procedure that greatly increases the diagnosis and treatment risks for patients.So non-invasive testing is more needed in clinical practice to assist the differential diagnosis.Urinary protein electrophoresis （uPEP） is a non-invasive and simple examination.It is essential in the diagnosis and treatment of plasma cell diseases.Many physicians focus solely on the presence and amount of M protein while neglecting its value in the diagnosis and differential diagnosis of KiPCD.In order to further improve the clinical ability to distinguish KiPCD and let more patients receive optimal diagnosis and treatment，this article will systematically introduce uPEP and its distinct characteristics in different KiPCD.
Rapid and accurate diagnosis is a crucial link in the trauma treatment system.As the main examination technique，the standardized construction of CT is an important guarantee for the quality of trauma treatment.Abdominal and pelvic injuries are often highly concealed and strictly rely on the accurate diagnosis of CT examinations.For this reason，the expert group of this guideline has discussed the emergency CT protocol for abdominal and pelvic trauma，including the selection of indications for emergency CT techniques in abdominal and pelvic trauma，the specifications of examination techniques，and the requirements for diagnostic reports.All the standards in this guideline are based on published literatures with such evidence.In the case of absence of clear evidence，the agreed standards are derived from the recommended suggestions of the guideline development group.
In the 1970s，the American doctor George L.Engel challenged the dominant biomedical model in clinical medicine and put forward the "bio-psycho-social medical model"，from which the concept of "psychosomatic disease" caught people′s attention.In this concept，mental illness is the "cause" and physical symptoms are the "effect"，although the physical symptoms of patients with psychosomatic diseases do not have clear biological abnormalities，their clinical symptoms are real，such diseases are called"functional diseases".Until now，it is still believed that in psychosomatic diseases，psychological disorders as a cause of illness，like somatic diseases，do not have obvious biological abnormalities.The author believes that psychological disorders，as a kind of disease，may have biological abnormalities，which are related to the changes in the limbic system of the human brain，especially the hippocampus.At the same time，it is further believed that the changes in the limbic system and hippocampus are not only related to the functional diseases of the body，but also related to some organic diseases of the body.The purpose of this paper is to show that the relationship between physical functional diseases and psychological disorders is not a causal relationship，but both may be the result of changes in the hippocampus，and the persistence of these diseases may in turn promote the deterioration of hippocampal lesions，forming a vicious circle.
To investigate the clinical diagnostic features of a case of Kennedy disease（KD） with serum antibody-negative myasthenia gravis （SNMG）.
Methods
The clinical data of a patient with KD combined with SNMG admitted to the Department of Neurology，Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University on June 25，2024 was retrospectively analyzed.The clinical diagnostic characteristics of KD with SNMG were summarized，and the literature was reviewed.
Results
The patient was male，52 years old，and had intermittent limb weakness for 2 years.The symptoms were chronic，progressive and fluctuating，gradually progressing from the proximal end to the distal end，with mild symptoms in the morning and severe symptoms in the evening，accompanied by muscle spasm at the onset of the disease，and tremor was obvious when the upper limbs were raised horizontally.Physical examination showed mild development of the male breast，perioral muscle atrophy，tongue muscle fibrillation，double palmar thenar muscle atrophy，double upper limb deltoid muscle atrophy，double lower limb slender，bilateral limb muscle strength grade 4，postural tremor when both upper limbs were raised horizontally.Serum creatine kinase increased.Electromyography indicated chronic neurogenic injury，with damage to the anterior horn cells of the spinal cord，involving the muscles of the upper and lower limbs，the rectus abdominis and the trapezius.Neostigmine test was positive.The number of CAG repeats in exon 1 region of androgen receptor gene was abnormally amplified.All 5 myasthenia gravis antibodies were negative.KD combined with SNMG was considered.Treatment with the cholinesterase inhibitor pyridostigmine bromide and coenzyme Q10 resulted in significant remission of the patient′s symptoms.
Conclusion
The early misdiagnosis rate of KD combined with SNMG is very high，and clinicians should pay more attention to muscle fatigue as the first symptom of KD.Gene detection is important for the diagnosis of KD.
To explore the mechanism of stent thrombosis after percutaneous coronary intervention （PCI） in a patient with coronary heart disease and rheumatoid arthritis （RA），and to explore the indications and timing of PCI.
Methods
The clinical data of a patient with coronary heart disease complicated with RA who died after PCI in the Department of Cardiology of the Affiliated Hospital of Jining Medical University on March 5，2021 were selected，and the relevant literature was reviewed.
Results
The patient had a 30-year history of RA，which was poorly controlled by long-term use of hormone drugs，and the pain worsened in the past 10 days.The patient had a 10-year history of coronary heart disease and underwent PCI.The anti-cyclic citrulline peptide antibody was 85.33 U/mL，rheumatoid factor 66.61 U/mL，erythrocyte sedimentation rate 42 mm/h，C-reactive protein 17.4 mg/L，and D-dimer 0.66 mg/L.On March 14，2021，preoperative coronary angiography showed acute stent thrombosis.On March 16，2021，coronary angiography showed 90% stenosis in the proximal segment of left anterior descending （LAD） and 95% stenosis in the opening of D1 branch.The patient underwent PCI and a stent was implanted in the proximal segment of the LAD.Thirty minutes after the operation，the patient felt severe pain in the precordial area.Emergency coronary angiography showed thrombosis in the LAD stent，and the thrombolysis in myocardial infarction flow grade was 0.After active treatment，the patient died.
Conclusions
Coronary heart disease patients with RA in the acute phase are prone to stent thrombosis after PCI.It is necessary to fully evaluate the indications and choose the appropriate time before PCI.
To explore the clinical features，diagnosis and treatment of seroma after Morel-Lavallée injury.
Methods
The clinical data of a patient with seroma after Morel-Lavallée injury treated in the Department of Traumatology，Daping Hospital on August 19，2024 were analyzed retrospectively，and the literature was reviewed.
Results
The patient，a 48-year-old male，was injured on July 22，2024 by a heavy object crushing his chest and abdomen.On August 13，2024，the patient found swelling in the left inguinal area and gradually extended to the left thigh.Pelvic magnetic resonance imaging and CT examination in the outside hospital showed multiple injuries and effusion，suggesting lymphatic leakage，with rhabdomyolysis to be excreted.Lymphography showed lymphatic effusion from the left upper thigh to the left inguinal region，with minor gas and lymphatic leakage observed around the soft tissue，considering lymphatic vessels injury in the left inguinal region with reflux obstruction and leakage.Following the necessary examinations upon admission，the abdominal drainage tube and the left inner thigh drainage tube were retained，and the left thigh was bandaged with pressure.After 7 days，the drainage tube was removed and bandaged under continuous pressure.There was no effusion in ultrasonic examination，and the patient's symptoms were obviously improved without surgical treatment.
Conclusions
Morel-Lavallée seroma is often misdiagnosed or diagnosed late.Therefore，a thorough understanding of the diagnosis and treatment of Morel-Lavallée seroma is crucial.
To explore the diagnostic efficacy of diffusion weighted imaging （DWI） and high resolution CT （HRCT） in differentiating benign and malignant pulmonary lesions.
Methods
From July 2014 to February 2015，a retrospective analysis was conducted on 114 patients with pulmonary lesions who were treated in the Department of Thoracic Surgery of the First Affiliated Hospital of Guangzhou Medical University.All patients underwent chest HRCT scanning and MR-DWI examination.Based on the initial HRCT report results，the pulmonary lesions were divided into HRCT definitive diagnosis group and indistinguishable group.The postoperative pathological results were used as the "gold standard"，and the diagnostic efficacy was evaluated using the receiver operating characteristic （ROC） curve.
Results
Among the 114 patients，97 cases （85.09%，97/114） were in the definitive diagnosis group，the areas under the ROC curve （AUC） of DWI and HRCT were 0.832 （95%CI：0.742-0.900） and 0.869 （95%CI：0.785-0.969），respectively，and the difference was not statistically significant （Z=0.511，P=0.609）.There were 17 cases （14.91%，17/114） in the indistinguishable group，with AUCs of 0.829 （95%CI：0.571-0.964） and 0.500（95%CI：0.254-0.746），respectively，and the difference was statistically significant（Z=3.077，P=0.002）.
Conclusions
DWI and HRCT have comparable diagnostic efficacy.In pulmonary lesions that are difficult to distinguish by HRCT，DWI can provide additional diagnostic value.
To investigate the imaging features in patients with aggressive angiomyxoma（AAM）.
Methods
The ultrasonography，CT and magnetic resonance imaging （MRI） data of 5 patients with AAM confirmed by postoperative pathology were retrospectively analyzed from January 2016 to November 2023 in the Department of Abdominal Ultrasound of Affiliated Hospital of Qingdao University，and the literature was reviewed.
Results
All the 5 patients with AAM were female，and the masses were located in the perineum or pelvic cavity，with the maximum diameter of 7-32 cm.MRI enhancement showed characteristic layered enhancement of perineal mass in 1 patient.After CT enhancement，2 cases showed uneven mild or light-moderate enhancement，and the envelope was significantly enhanced，and the internal septa and envelope were significantly enhanced in 1 case.The ultrasonography of 3 cases showed uneven internal echoes，and color Doppler ultrasonography indicated multiple streaks of blood flow signals within the masses，of which 2 cases were hypoechoic masses，with layered distribution high echoes，irregular in shape，and extending to surrounding tissues in a "finger" like or "tongue" like shape.CT angiography （CTA） and CT venography （CTV） showed radial distribution of blood-supply arteries and veins in the mass in 1 case.
Conclusion
The diagnosis of AAM should be considered when imaging findings reveals a mass with characteristic internal laminar shape within the perineum or pelvis，or an uneven internal echo that extends to both sides of the pelvis in a "finger like" or "tongue like" shape.
To investigate the lung injury and its influencing factors in elderly patients after hip fracture.
Methods
Three hundred and eighty-one elderly patients with hip fracture received in Emergency Truma Surgery Department of Jining NO.1 People′s Hospital from March 2022 to March 2024 were selected.The patients were divided into lung injury group （n=41） and non-injury group （n=340）after operations according to their general data.Univariate analysis was used to compare the differences in general data between the two groups.Subsequently，Logistic regression analysis was conducted to identify the risk factors of lung injury after hip fracture in elderly patients.
Results
Among the 381 patients，the total incidence of pulmonary complications was 10.76%（41/381）.The types of lung injuries in 41 cases included pulmonary infection （19 cases），pleural effusion （7 cases），respiratory failure （6 cases），aspiration pneumonia （3 cases） and atelectasis （6 cases）.Body mass index（BMI）＞30 kg/m2，American Society of Anesthesiologists（ASA） grade ≥Ⅲ，operation time ≥2 h，bed time ≥2 d before surgery，mechanical ventilation and ICU admission were all influential factors for postoperative lung injury （OR=1.048，1.176，1.022，1.227，1.081，all P＜0.05）.
Conclusion
Obesity，higher ASA grade，prolonged preoperative bed rest time，need for mechanical ventilation and admission to the ICU are closely associated with the occurrence of postoperative lung injury in elderly patients with hip fractures，which should be paid attention in clinical practice to reduce the incidence of postoperative lung injury.
To investigate the application value of serum Irisin，thyroid-stimulating hormone （TSH） and homocysteine （Hcy） in diagnosing gestational hypothyroidism.
Methods
From September 2021 to September 2023，one hundred cases of hypothyroidism during pregnancy admitted to the First Affiliated Hospital of Xi′an Jiaotong University Yulin Hospital were classified into hypothyroidism group.During the same period，normal physical examinees （100 cases） were classified into control group.Clinical data of the 2 groups were collected，and serum Irisin，TSH and Hcy levels were detected.The correlations among serum Irisin，TSH，Hcy levels and thyroid function indexes were analyzed by Pearson correlation analysis.The diagnostic value of the 3 biomarkers on hypothyroidism in pregnancy was analyzed by receiver operating characteristic （ROC） curve.
Results
The levels of serum Irisin ［（7.71±0.84）μg/L，（4.01±0.92）μg/L］，TSH［（8.01±1.23）mU/L，（2.81±0.45）mU/L］，Hcy［（9.89±2.44）μmol/L，（6.82±2.04）μmol/L］ and thyroid peroxidase antibody （TPO-Ab） ［（388.45±33.71）U/mL，（18.56±4.01）U/mL］ in hypothyroidism group were higher than those in the control group （t= 29.70，39.70，9.65，108.96，all P ＜0.01）.While the levels of free triiodothyronine （FT3） ［（3.31±0.34）pmol/L，（3.92±0.28）pmol/L］ and free thyroid hormone （FT4） ［（9.89±1.88）pmol/L，（13.04±0.65）pmol/L］were lower than those in the control group （t=13.85，15.84，all P ＜0.01）.Pearson correlation analysis showed that serum Irisin was positively correlated with TSH （r=0.411，P ＜0.01），and negatively correlated with FT3 and FT4 （r=-0.368，-0.391，all P ＜0.01），but had no significant correlation with TPO-Ab （r=0.201，P ＞0.05）.Serum Hcy was positively correlated with TSH and TPO-Ab （r=0.432，0.359，all P ＜0.01），and negatively correlated with FT3 and FT4 （r=-0.387，-0.374，all P ＜0.01）.ROC results showed that the areas under the curve （AUC） of serum Irisin，TSH and Hcy in diagnosing gestational hypothyroidism were 0.755，0.675 and 0.664，and the sensitivity and specificity were 76.00%，64.00%，60.00%，and 76.00%，66.00%，68.00%，respectively.The AUC for the combined diagnosis was 0.761，and the sensitivity and specificity were 71.00% and 76.00%，respectively.
Conclusions
Serum Irisin，TSH and Hcy of patients with hypothyroidism during pregnancy are at high levels，and serum Irisin and Hcy are positively correlated with TSH，and negatively correlated with FT3 and FT4.Serum Irisin exhibits high diagnostic efficiency，and the combined use of the 3 biomarkers can enhance the accuracy of diagnosis.
Cerebral creatine deficiency syndromes are inherited metabolic errors in creatine synthesis and transport，which are divided into creatine transporter deficiency，guanidinoacetate methyltransferase（GAMT） deficiency，and L-arginine-glycine amidinotransferase deficiency.Patients with cerebral creatine deficiency syndromes present a wide range of symptoms，including developmental delay，movement disorder，behavioral problems and early-onset epilepsy in childhood.The typical imaging feature of this disease is the deficiency of creatine peaks in brain proton magnetic resonance spectroscopy.The molecular genetic detection is important for the definitive diagnosis.Biallelic pathogenic variants in GAMT or GATM，as well as hemizygous pathogenic variants in males and heterozygous pathogenic variants in a few females in SLC6A8 can result in cerebral creatine deficiency syndrome.While all 3 types of disorders are currently treated with creatine supplementation，creatine transporter deficiency is also treated with arginine and glycine supplementation and GAMT deficiency is treated with ornithine supplementation and arginine-restricted diet.
Alzheimer disease （AD） is a currently incurable neurodegenerative disease with a high incidence rate，which seriously threatens the life quality and lifespan of the eldly.According to statistics，the worldwide incidence of AD worldwide is increasing year by year，and the pathogenesis of AD is complex，with no effective treatment method available to date.Recent studies have shown that bioactive peptides have neuroprotective effects on AD.Apelin-13 is an endogenous neuropeptide，which is widely distributed in neurons and oligodendrocytes of the central nervous system，participating in the processes of memory and learning as well as the prevention of neuronal damage.Studies have shown that apelin-13 can directly or indirectly prevent the production of amyloid-β，inhibit the accumulation of phosphorylated Tau protein，exhibit anti-inflammatory and anti-apoptotic effects，as well s modulate autophagy proless，to slow down the progression of AD.The review mainly focuses on the latest research progress on the protective mechanism of apelin-13 in AD，providing new ideas for the prevention and treatment of AD.
Esophageal cancer is one of the most common malignant tumors of the digestive system，and esophageal squamous intraepithelial neoplasia （ESIN） is widely recognized as a precancerous lesion of esophageal squamous cell carcinoma.Consequently，the diagnosis and treatment of these precancerous conditions are pivotal in the prevention of esophageal cancer.At present，endoscopic examination and treatment are the main means to detect，diagnose and treat ESIN.However，to date，specific biomarkers have not been widely promoted for clinical application，and there is a lack of effective medication for the treatment of ESIN.In recent years，research on the above issues has been continuously carried out and advanced，and some biomarkers and non-endoscopic treatment methods have shown potential value in the diagnosis and treatment of ESIN.The purpose of this paper is to comprehensively review and summarize these research advancements，with the aim of providing valuable references for the early prevention and treatment of esophageal cancer.
