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There is still a serious challenge of the measurement of critical quality attributes (CQAs) related to clinical efficacy for Chinese materia medica manufacturing. To overcome this challenge, an integrated strategy of biosensor and ultra-performance liquid chromatography/tandem mass spectrometry (UPLC-MS/MS) was proposed using Tongren niuhuang qingxin pills as a trial. Firstly, an original biosensor was created using a semiconductor chip material high electron mobility transistor (HEMT) as the transducer and the macrophage migration inhibitory factor (MIF) as the identification element. By this MIF-HEMT biosensor, the efficacy on stoke of different components from Tongren niuhuang qingxin pills was measured. It was clear that all three components of Tongren niuhuang qingxin pills had strong therapeutic effects on stroke, especially the section A, the KD of which reached to 8.722×10-10 g·mL-1. Furthermore, MIF-HEMT biosensor integrated UPLC-MS/MS was introduced to identify the efficacy CQAs of different components of Tongren niuhuang qingxin pills. As a result, 19 potential CQAs, such as albiforin, paeoniflorin, and prim-O-glucosylcimifugin, were measured as the efficacy CQAs of Tongren niuhuang qingxin pills on stroke treatment by MIF. These results provided vital measurement techniques and methodological guidance for the CQAs study of Tongren niuhuang qingxin pills intervention in MIF-induced stroke treatment. This also provided an essential guideline for the efficient utilization and quality control measurement of high-quality classical recipes.
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This study primarily concentrated on scientific problems of poor taste caused by unclear critical quality attributes of oral preparations manufactured by Chinese materia medica, successfully established an identification method for taste critical quality attribute and a taste improvement method combining electronic tongue with human senses, and determined the optimal taste formula, to improve patients' oral medication compliance. The study received ethical approval from the Review Committee of the Beijing University of Chinese Medicine. The results showed that the proportion of bitterness of Xiaoer Qingrening Granule was 61.8%, and its bitterness grade was 3.70, it was determined that bitterness is the critical quality attribute that caused the poor taste of Xiaoer Qingrening Granule. Additionally, the optimal taste formula per milliliter of Xiaoer Qingrening sugar-free intermediate was determined with allowable daily intake, solubility, and sweetness as the limiting conditions, which was 40 mg hydroxypropyl β-cyclodextrin, 180 mg trehalose, and 1.5 mg acesulfame potassium. Compared with the Xiaoer Qingrening Granule, the sensory evaluation score of the optimal taste formula was increased by 37.5 points. In conclusion, this study achieved the taste improvement of Xiaoer Qingrening Granule and formed a set of taste improvement strategies including the identification of taste critical quality attribute, the selection of the type and dosage of corrigent, and the optimization of taste formula, which provided a thought reference for the taste improvement of other oral preparations and a new perspective for quality control of intelligent manufacturing of traditional Chinese medicines.
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With in-depth research and development of dermoscopy, the dermoscopic features including perifollicular pigments, perilesional pigments, pigment network structure, satellite phenomenon and "tapioca sago" appearance, micro-Koebner phenomenon and comet tail-like phenomenon have provided a basis for the evaluation of vitiligo activity. This review summarizes progress in the evaluation of vitiligo activity with dermoscopy in recent years, aiming to promote the application of dermoscopy in the assessment of vitiligo activity.
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How to quickly predict an individual's behavioral choices is an important issue in the field of human behavior research. Using noninvasive electroencephalography, we aimed to identify neural markers in the prior outcome-evaluation stage and the current option-assessment stage of the chicken game that predict an individual's behavioral choices in the subsequent decision-output stage. Hierarchical linear modeling-based brain-behavior association analyses revealed that midfrontal theta oscillation in the prior outcome-evaluation stage positively predicted subsequent aggressive choices; also, beta oscillation in the current option-assessment stage positively predicted subsequent cooperative choices. These findings provide electrophysiological evidence for the three-stage theory of decision-making and strengthen the feasibility of predicting an individual's behavioral choices using neural oscillations.
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Aggression/physiology , Brain , Electroencephalography , Interpersonal RelationsABSTRACT
Objective: To investigate the utility of albumin RNAscope in situ hybridization in the diagnosis and differential diagnosis of hepatocellular carcinoma and its mimics. Methods: One hundred and fifty-two cases of hepatocellular carcinoma and its mimics and 33 cases of normal tissue were selected from the pathology database of the Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2013 to December 2019. Tissue microarrays were constructed and RNAscope in situ hybridization was performed to detect the expression of albumin mRNA. Results: No albumin mRNA expression was detected in normal tissues except for the liver. All hepatocellular carcinoma regardless of its degree of differentiation and primary or metastatic nature had detectable albumin mRNA, with strong and diffuse staining in 90.7% (49/54) of cases. While the positive rate of HepPar-1, Arg-1 or one of them by immunohistochemistry was 87.0% (47/54), 85.2% (46/54) and 92.6% (50/54) respectively. The positive rates of albumin mRNA in intrahepatic cholangiocarcinoma and biphenotypic hepatocellular carcinoma were 7/15 and 9/10, respectively. The former showed focal or heterogeneous staining, while the latter showed strong and diffuse staining. The positive rate of hepatoid adenocarcinoma was 8/19, and the albumin expression could be diffuse or focal. Sporadic cases of poorly differentiated gastric adenocarcinoma and metastatic colon adenocarcinoma showed focal staining of albumin mRNA. Conclusions: Detection of albumin mRNA by RNAscope in situ hybridization is of great value for the diagnosis and differential diagnosis of HCC, and the sensitivity may be improved by combining with HepPar-1 and Arg-1. It also offers different diagnostic clues according to different expression patterns.
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Humans , Adenocarcinoma/diagnosis , Albumins/genetics , Bile Duct Neoplasms/pathology , Bile Ducts, Intrahepatic/pathology , Biomarkers, Tumor/genetics , Carcinoma, Hepatocellular/genetics , China , Colonic Neoplasms , Diagnosis, Differential , In Situ Hybridization , Liver Neoplasms/pathology , RNA, MessengerABSTRACT
In order to make up for the innovation deficiency in the traditional residency training model and the shortcomings of active learning and lifelong learning, evidence-based medicine is introduced into the residency training of dental general practitioners. Theoretical knowledge training of evidence-based medicine is conducted through online course learning. PICO mode is used to conduct evidence-based analysis of clinical cases under the guidance of the instructor, so that trainees can get familiar with the process of evidence-based analysis. Students can finally design and complete the application cases of evidence-based medicine, and teachers give evaluation guidance. Through this process, students can learn and master the knowledge of evidence-based medicine step by step, thus obtaining better teaching results.
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The physical properties of powder and granules are the critical quality attributes for the process control of Suhuang Zhike Capsules, a big brand traditional Chinese medicine. This paper took the production of 25 batches of real-world Suhuang Zhike Capsules dry extract powder and granules intermediates as the research object. Firstly, a method for testing the physical properties of Suhuang Zhike Capsules powder and granules with 19 physical indicators was established. The results showed that the granules of dry extract powder after granulation had a smaller particle size, wider particle size distribution range and poor fluidity, which easily caused the problem of over-limit capsule loading. Secondly, correlation analysis, principal component analysis and cluster analysis were used for mathematical statistics. The correlation analysis showed that the density of dry extract powder could affect the chroma and fluidity. At the same time, the particle size in the granules had a stronger effect on the chroma and fluidity than the density. The study also found that the particle size and hygroscopicity of dry extract powder were potentially key physical properties that affected the physical properties of granules. Furthermore, the results of principal component analysis and cluster analysis showed that the consistency of the physical properties between the dry extract powder and intermediate granules was relatively poor. To this end, similarity analysis was carried out, and the quality control method of powder and granules based on physical fingerprint was established. The results showed that the physical fingerprint similarity of 25 batches of dry extract powder was 0.639-0.976, and the physical fingerprint similarity of the gra-nules was 0.716-0.983. With the similarity of 0.85 as the threshold, the batches with abnormal physical properties could be identified. In this study, the process quality control method of Suhuang Zhike Capsules based on the physical properties of powder and granules was established finally, which realized the identification of abnormal batches, and provided a reference for the process quality control of Suhuang Zhike Capsules.
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Capsules , Drugs, Chinese Herbal , Medicine, Chinese Traditional , Powders , Quality ControlABSTRACT
Spatial distribution uniformity is the critical quality attribute(CQA) of Ginkgo Leaves Tablets, a variety of big brand traditional Chinese medicine. The evaluation of the spatial distribution uniformity of active pharmaceutical ingredients(APIs) in Ginkgo Leaves Tablets is important in ensuring their stable and controllable quality. In this study, hyperspectral imaging technology was used to construct the spatial distribution map of API concentration based on three prediction models, further to realize the visualization research on the spatial distribution uniformity of Ginkgo Leaves Tablets. The region of interest(ROI) was selected from each Ginkgo Leaves Tablet, with length and width of 50 pixels, and a total of 2 500 pixels. Each pixel had 288 spectral channels, and the number of content prediction data could reach 1×10~5 for a single sample. The results of the three models showed that the Partial Least Squares(PLS) model had the highest prediction accuracy, with calibration set determination coefficient R_(pre)~2 of 0.987, prediction set determination coefficient R_(pre)~2 of 0.942, root mean square error of calibration(RMSEC) of 0.160%, and root mean square error of prediction(RMSEP) of 0.588%. The classical least-squares(CLS) model had a greater prediction error, with the RMSEP of 0.867%. Multivariate Curve Resolution-Alternating Least Square(MCR-ALS) model showed the worst predictive ability among the three models, and it couldn't realize content prediction. Based on the prediction results of PLS and CLS models, the spatial distribution map of APIs concentration was obtained through three-dimensional data reconstruction. Furthermore, histogram method was used to evaluate the spatial distribution uniformity of API. The data showed that the spatial distribution of APIs in Ginkgo Leaves Tablets was relatively uniform. The study explored the feasibility of visualization of spatial distribution of Ginkgo Leaves Tablets based on three models. The results showed that PLS model had the highest prediction accuracy, and MCR-ALS model had the lowest prediction accuracy. The research results could provide a new strategy for the visualization method of quality control of Ginkgo Leaves Tablets.
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Calibration , Ginkgo biloba , Least-Squares Analysis , Medicine, Chinese Traditional , Plant Leaves , Quality Control , Spectroscopy, Near-Infrared , TabletsABSTRACT
@#Objective To explore the early outcomes of the surgical treatment for patent ductus arteriosus (PDA) combined with intracardiac abnormities via right vertical infra-axillary thoracotomy (RVIAT). Methods A total of 7 children with PDA combined with intracardiac defects underwent surgery through RVIAT at the Second Affiliated Hospital of Nanjing Medical University from 2016 to 2018. There were 4 males and 3 females, with an average age of 5.3±4.5 years and weight of 18.0±11.2 kg. Results In all patients, PDA was ligated before the repair of intracardiac abnormities. No patient died in hospital. All patients were followed up, with a mean follow-up time of 18.0±8.0 months. No other complications such as residual shunts, arrhythmias, hemorrhaging or wound infection occurred after operations or during the follow-up period. Conclusion RVIAT is an emerging technique used for the surgical repair of PDA combined with intracardiac defects. It yields satisfying cosmetic results, without increasing postoperative complications or mortality.
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ObjectiveAt present, there are few reports on the therapeutic effect of probiotic supplements in patients with dietary-controlled gestational diabetes mellitus (GDM). This study aims to evaluate the effect of probiotic supplements on insulin resistance in patients with dietary-controlled GDM.Methods122 pregnant women with dietary-controlled GDM who could control blood glucose less than 92 mg/dL through diet and exercise were selected from the Obstetrics Department in Bayannur Hospital from February to December 2018. The patients were randomly divided into two groups: Probiotics Group (probiotic supplements containing bifidobacterium and lactobacillus) and Placebo Group (placebo capsules). 61 patients in each group were treated continuously for 4 weeks. The main evaluation index was the mean difference of fasting blood glucose, fasting plasma insulin and insulin resistance index (HOMA-IR) between the two groups, and the secondary evaluation index was the change of maternal weight after intervention.ResultsThe increase of fasting blood glucose [(0.59±6.42)mg/dL], fasting plasma insulin [(1.14±1.95)mIU/mL] and HOMA-IR (0.27±0.45) in the Probiotics Group after intervention were significantly lower than those in the Placebo Group [(4.78±7.47 mg/dL), (3.86±1.82) mIU/mL, (0.86±0.59)], and the difference was statistically significant (P 0.05).ConclusionDuring pregnancy, probiotic supplements for four weeks in patients with dietary-controlled GDM can reduce fasting blood glucose and increase insulin sensitivity. Therefore, probiotic supplements can be used as adjunctive therapy for blood glucose control in patients with dietary-controlled GDM.
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ObjectiveAt present, there are few reports on the therapeutic effect of probiotic supplements in patients with dietary-controlled gestational diabetes mellitus (GDM). This study aims to evaluate the effect of probiotic supplements on insulin resistance in patients with dietary-controlled GDM.Methods122 pregnant women with dietary-controlled GDM who could control blood glucose less than 92 mg/dL through diet and exercise were selected from the Obstetrics Department in Bayannur Hospital from February to December 2018. The patients were randomly divided into two groups: Probiotics Group (probiotic supplements containing bifidobacterium and lactobacillus) and Placebo Group (placebo capsules). 61 patients in each group were treated continuously for 4 weeks. The main evaluation index was the mean difference of fasting blood glucose, fasting plasma insulin and insulin resistance index (HOMA-IR) between the two groups, and the secondary evaluation index was the change of maternal weight after intervention.ResultsThe increase of fasting blood glucose [(0.59±6.42)mg/dL], fasting plasma insulin [(1.14±1.95)mIU/mL] and HOMA-IR (0.27±0.45) in the Probiotics Group after intervention were significantly lower than those in the Placebo Group [(4.78±7.47 mg/dL), (3.86±1.82) mIU/mL, (0.86±0.59)], and the difference was statistically significant (P 0.05).ConclusionDuring pregnancy, probiotic supplements for four weeks in patients with dietary-controlled GDM can reduce fasting blood glucose and increase insulin sensitivity. Therefore, probiotic supplements can be used as adjunctive therapy for blood glucose control in patients with dietary-controlled GDM.
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Objective To evaluate the effect of dexmedetomidine pretreatment on Toll-like receptor 4 (TLR4)/nuclear factor kappa B (NF-κB) signaling pathway during intestinal ischemia-reperfusion (I/R) in rats.Methods Twenty-four male Spragne-Dawley rats,weighing 180-220 g,were divided into 3 groups (n =8 each) using a random number table method:sham operation group (S group),intestinal I/R group (I group) and dexmedetomidine pretreatment group (DP group).Intestinal I/R model was established by occlusion of the superior mesenteric artery for 1 h followed by 2-h reperfusion in anesthetized rats.Dexmedetomidine 100 μg/kg was intraperitoneally injected at 30 min before ischemia in DP group.Blood samples were collected from hearts at the end of reperfusion for determination of the serum intestinal fatty acid binding protein (I-FABP) level by enzyme-linked immunosorbent assay.The intestinal tissues were obtained at the end of reperfusion for examination of pathologic changes and for determination of tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β) contents (by enzyme-linked immunosorbent assay) and expression of TLR4,MyD88,phosphorylated NF-κB p65 (p-NF-κB p65) in total protein and NF-κB p65 in nucleoprotein (by Western blot).The degree of intestinal tissue damage was graded using Chiu's scoring system.Results Compared with S group,the Chiu's score and concentrations of IFABP in serum and contents of TNF-α and IL-1β in intestinal tissues were significantly increased,and the expression of TLR4,MyD88 and p-NF-κB p65 in total protein and NF-κB p65 in nucleoprotein was up-regulated in I/R group,and the Chiu's score was significantly increased,the expression of MyD88 and p-NF-κB p65 was up-regulated (P＜0.05),and no significant change was found in serum I-FABP concentration,contents of TNF-α and IL-1β,or expression of TLR4 in total protein and NF-κB p65 in nucleoprotein in DP group (P＞0.05).Compared with I/R group,the Chiu's score,serum I-FABP concentration,and contents of TNF-α and IL-1β were significantly decreased,and the expression of TLR4,MyD88 and p-NF-κB p65 in total protein and NF-κB p65 in nucleoprotein was down-regulated in DP group (P＜0.05).Conclusion The mechanism by which dexmedetomidine pretreatement mitigates intestinal I/R injury may be related to inhibiting activation of TLR4/NF-κB signaling pathway in rats.
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Purpose To study the clinicopathological characteristics of blastic Plasmacytoid dendritic cell neoplasms, and improve the acknowledgement and diagnostic level. Methods The clinicopathological features, immunohistochemistry and EBV test results of 10 cases with BPDCN were analyzed retrospectively, with review of literature. Results Skin lesions were the first symptom in 10 patients, tumor cells expression of CD43, CD56, CD4 was positive in 8 cases, CD123 were positive in 5 cases, the T and B cell specific markers is not expression. EB virus encoded small RNA(EBER ) in situ hybridization is negative;no clonal rearrangement of B cell receptor(BCR) or T cell receptor(TCR) gene. Conclusion BPDCN is a rare malignant tumor of the skin, easy to involve the skin. It is necessary to combine clinical with pathological for definite diagnosis.
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Objective To investigate the relationship between eating habits and childhood obesity by the method of cross-sectional survey in order to provide scientific basis for the prevention and intervention of childhood obesity.Methods We enrolled first-year students in Minhang District of Shanghai who participated in physical examination in 2014.Information was obtained from standardized face to face interviews of their parents or guardians with detailed questions on demographic characteristics,dietary habit,food preference,physical activity,sleep time and so on.Odds ratio (OR) and 95％ CI were calculated by unconditional Logistic regression models.Results Finally,5 752 students were enrolled in the study.The rate of obesity was 15.16％ (boys:18.35％;girls:11.83％) and the rate of over weight was 14.31％ (boys.:15.15％;girls:13.43％).Meat-based diet (OR=1.58,95％ CI:1.32-1.91),skipping breakfast (OR =1.87,95％ CI:1.01-3.46),eating too much caffeine-containing food (OR =1.66,95％ CI:1.09-2.51) and eating fast (OR:3.32-14.95) were associated with an increased risk of childhood obesity.Plant-based diet (OR =0.51,95％ CI:0.35-0.74) and choosy in food (OR:0.38-0.64) were associated with a decreased risk of childhood obesity.Besides,we found that children who preferred meat (OR =2.11,95％CI:1.42-3.14) and cured food (OR =1.42,95％ CI:1.05-1.92) had a higher risk of obesity.Conclusions Our results support the association between eating habits and childhood obesity.
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Objective To develop an instrument for automatic testing of airtightness of the equipment and facilities in biosafety laboratory using pressure decay method with an aim at improving testing efficiency.Methods On the basis of the characteristics of the pressure decay method and the equipment performance in the biosafety laboratory,the PLC and touch screen and etc,industrial control instrument was employed for designing the structure and components.By programming PLC and touch screen the intended functions were achieved.Results This developed instrument could be used for automatic and multi-channel air tightness testing in parallel,as well as for monitoring and recording the pressure and temperature data of the equipment in real time.Conclusion By using the developed instrument,the testing cycle,and the manpower and material resources input can greatly be reduced.It is presumed that the instrument can be used for testing the airtightness of facilities and equipment in biosafety laboratory.
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Objective To investigate the relationship between eating habits and childhood obesity by the method of cross-sectional survey in order to provide scientific basis for the prevention and intervention of childhood obesity.Methods We enrolled first-year students in Minhang District of Shanghai who participated in physical examination in 2014.Information was obtained from standardized face to face interviews of their parents or guardians with detailed questions on demographic characteristics,dietary habit,food preference,physical activity,sleep time and so on.Odds ratio (OR) and 95％ CI were calculated by unconditional Logistic regression models.Results Finally,5 752 students were enrolled in the study.The rate of obesity was 15.16％ (boys:18.35％;girls:11.83％) and the rate of over weight was 14.31％ (boys.:15.15％;girls:13.43％).Meat-based diet (OR=1.58,95％ CI:1.32-1.91),skipping breakfast (OR =1.87,95％ CI:1.01-3.46),eating too much caffeine-containing food (OR =1.66,95％ CI:1.09-2.51) and eating fast (OR:3.32-14.95) were associated with an increased risk of childhood obesity.Plant-based diet (OR =0.51,95％ CI:0.35-0.74) and choosy in food (OR:0.38-0.64) were associated with a decreased risk of childhood obesity.Besides,we found that children who preferred meat (OR =2.11,95％CI:1.42-3.14) and cured food (OR =1.42,95％ CI:1.05-1.92) had a higher risk of obesity.Conclusions Our results support the association between eating habits and childhood obesity.
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Objective To develop an instrument for automatic testing of airtightness of the equipment and facilities in biosafety laboratory using pressure decay method with an aim at improving testing efficiency.Methods On the basis of the characteristics of the pressure decay method and the equipment performance in the biosafety laboratory,the PLC and touch screen and etc,industrial control instrument was employed for designing the structure and components.By programming PLC and touch screen the intended functions were achieved.Results This developed instrument could be used for automatic and multi-channel air tightness testing in parallel,as well as for monitoring and recording the pressure and temperature data of the equipment in real time.Conclusion By using the developed instrument,the testing cycle,and the manpower and material resources input can greatly be reduced.It is presumed that the instrument can be used for testing the airtightness of facilities and equipment in biosafety laboratory.
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Objective:To determine the content of dracorhodin and curcumin in Dieda pills by UPLC .Methods:A UPLC method was adopted.The determination was performed on a Waters Acquity UPLC BEH C 18 column(100 mm ×2.1 mm,1.7 μm) with the mobile phase consisting of acetonitrile-0.05 mol· L-1 NaH2PO4(50 ∶50).The detection wavelength was 440 nm for dracorhodin and 431 nm for curcumin, the column temperature was 30℃and the flow rate was 0.1 ml· min-1 .Results:There was a good linear range of 0.001 8-0.036 4 μg(r=0.999 9)for dracorhodin and 0.000 8-0.015 6 μg(r=0.999 9) for curcumin.The average recovery for dracorhodin was 97.94%(RSD=0.89%) and that for curcumin was 98.45%(RSD=0.91%).Conclusion:The method is simple, rapid and reproducible ,which can be used for the determination of dracorhodin and curcumin in Dieda pills .
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Objective:To simultaneously determine six components ( paeoniflorin, rosmarinic acid, salvianolic acid B, ligustilide, clyptotanshinone and tanshinone ⅡA ) in refined coronary tablets by UHPLC-DAD. Methods: A Dikma Endevaorsil C18 column (2. 1 mm × 100 mm,1. 8 μm) was used to perform the determination, which was maintained at 30℃ during the analysis. The mobile phase was composed of acetonitrile and 0. 05% phosphoric acid at a flow rate of 0. 3 ml·min-1 with gradient elution. The detection wavelength was respectively set at 230,270,288 and 321 nm. Results:Paeoniflorin, rosmarinic acid, salvianolic acid B, ligustilide, clyptotanshinone and tanshinone ⅡA showed good linearity within the range of 0. 001 0-0. 010 2 μg ( r = 0. 999 8 ), 0. 005 7-0.056 9 μg(r =1.000 0), 0.005 3-0.052 7 μg(r = 1.000 0),0.002 1-0.020 6 μg(r = 1.000 0),0.001 1-0.011 2 μg(r =1. 000 0) and 0. 001 4-0. 014 4 μg(r=0. 999 8),respectively. The average recovery was 98. 78%(RSD=0. 50%), 97. 99%(RSD=0. 76%),98. 44%(RSD=0. 85%),99. 12%(RSD=0. 66%), 98. 82%(RSD=0. 81%) and 97. 80%(RSD=0. 80%), respec-tively. Conclusion:The method is simple, rapid and accurate, which can be used for the quality control of refined coronary tablets.
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Although several models have been developed to predict the probability of Gleason sum upgrading between biopsy and radical prostatectomy specimens, most of these models are restricted to prostate-specific antigen screening-detected prostate cancer. This study aimed to build a nomogram for the prediction of Gleason sum upgrading in clinically diagnosed prostate cancer. The study cohort comprised 269 Chinese prostate cancer patients who underwent prostate biopsy with a minimum of 10 cores and were subsequently treated with radical prostatectomy. Of all included patients, 220 (81.8%) were referred with clinical symptoms. The prostate-specific antigen level, primary and secondary biopsy Gleason scores, and clinical T category were used in a multivariate logistic regression model to predict the probability of Gleason sum upgrading. The developed nomogram was validated internally. Gleason sum upgrading was observed in 90 (33.5%) patients. Our nomogram showed a bootstrap-corrected concordance index of 0.789 and good calibration using 4 readily available variables. The nomogram also demonstrated satisfactory statistical performance for predicting significant upgrading. External validation of the nomogram published by Chun et al. in our cohort showed a marked discordance between the observed and predicted probabilities of Gleason sum upgrading. In summary, a new nomogram to predict Gleason sum upgrading in clinically diagnosed prostate cancer was developed, and it demonstrated good statistical performance upon internal validation.