Objective To investigate the safety of transrectal ultrasound guided prostate biopsy (TUPB)and its role in early diagnosis of prostate cancer(PCa) by analyzing the large sample data of a single center. Methods Between June 2005 and August 2014, 3256 consecutive patients with an age range from 50 to 80 years (average 69 years),underwent TUPB at Changhai hospital. Prostate specific antigen (PSA) and prostate volume was evaluated; and 12 cores biopsy was undertaken with separate Gleason score evaluation for each core.Student’s t test was used for statistically analysis. Results The positive predictive value (PPV) of cancer was 34.2%, and the median PSA and Gleason score of PCa patients were 22.8 ng/ml and 7. When the PSA value ranged less than 4.0, 4.1-10.0, 10.1-20.0, 20.1-50.0 ng/ml and 50.0ng/ml or more, PPV was 10.1%, 17.3%, 23.8%, 54.6%, and 90.7%, respectively. Of all the patients with PCa, 43.5% had PSA less than 20ng/ml.A total of 6 patients had infection and of them 2 patient had severe sepsis; 45 patients had rectal bleeding but only 2 patients needed treatment; the other minor complications were acute urine retention,haematouria and vasovagal syncope. All the patients convalesced without sequela. Conclusions TUPB is safe and effective and combination with PSA screen is still the standard for early diagnosis of PCa in China so far, regardless of continuous challenging from upto-date biopsy technique.

Objective To investigate the feasibility and safety of Sandwich Balloon Dilation for totally ultrasound guided percutaneous nephrolithotomy (PCNL) . Methods An 18G needle with length marker was used to puncture the target calyx under the guidance of ultrasound and the depth of percutaneous tract was defined. Then the length of balloon similar to tract depth was marked by marker pen. Sandwich Balloon Dilation: Balloon was indwelled along the zebra guidewire until the marker, and inflated with 20atm for 5 minutes; 20.8F renoscope combined with EMS lithotripsy were used for fragmentation; finally before the end of surgery balloon was used again to tamponade the percutaneous tract. Results Between June 2014 and October 2014, a total of 56 patients (32 males and 21 females) with the average age of 53y underwent PCNL. The average stone size was 2.4±0.4cm; BMI23.1±2.8 and hospitalization 7 days. The average hemoglobin and hematocrit before and after operation was 14.1±2.1 vs 13.3±2.1g/dl and 40.7±5.3% vs 38.1±5.1%, respectively. No patient needed transfusion or embolization. No other severe complications happened. Conclusion Balloon dilation makes totally ultrasound PCNL easy and safe; while Sandwich Balloon Dilation further decreases haemorrhage complication.

Objective To study the short-time outcome and adverse effect of cyberknife in treatment of peripheral non-small cell lung cancer, so as to evaluate the safety and efficacy of cyberknife in treatment of peripheral lung cancer. Methods A total of 66 patients with peripheral non-small cell lung cancer completed their cyberknife radiosurgery, with real-time target tracking through fiducial marker implantation in 25 cases, X-sight lung synchrony in 35 cases, and X-sight spine tracking in 6 cases. Total prescribed dosage ranged from 42 to 60 Gy, with 4 to 6 fractions prescribed to the 65%-75% isodose lines for planning target volume. The biological effective dose (BED) was 71.4-150.0 Gy. The follow-up time was 11-29 months and the median time was 18 months. Results A total of 31 patients had complete radiographic responses, 28 had partial response, 5 patients had stable disease and 2 had progressive disease. The response rate was 89.4%. Tumor size and BED were the significant factors affecting the result of treatment (P=0.019, P=0.007). Conclusion Cyberknife radiosurgery treatment is effective and safe for peripheral non-small cell lung cancer. It can achieve satisfactory tumor control rate, while the long term outcome needs further follow-up.

Objective To investigate the effect of silencing osteopontin (OPN) expression by short-hairpin RNA (shRNA) interference on chemotherapy sensitivity of cervical cancer HeLa cells and the possible mechanism. Methods HeLa cells were transfected with eukaryotic expression vector pGCsi3. 0 carrying OPN shRNA via liposome (shOPN group). Untransfected HeLa cells (Con group) and those transfected with empty plasmids (shNon group) served as controls. HeLa cells in all the groupswere treated with different concentrations of cisplatin (0, 0. 5, 1, and 2 (μg/mL) and paclitaxel (0, 50, 100, and 500 nmol/L) for 24 h, respectively; the apoptosis in Hela cells was analyzed by flow cytometry. The expressions of apoptosis related protein cleaved caspase-3, Bct-xL, Bct-2, and Bax were examined by Western blotting analysis. Results The apoptotic rate in shOPN group ([44. 53±2. 78]%) was significantly higher than those in shNon group ([15. 34±2. 18]%) and Con group ([15. 37± 1. 03]%) after treatment with 2 jug/mL cisplatin (P<0. 05); and significant difference was also found between the apoptotic rates after treatment with 500 nmol/L paclitaxd (shOPN group: [51. 46±1. 49]%, shNon group: [19. 16 ± 1. 87] %, Congroup: [17. 03±2. 37]%; P<0. 05). Down-regulating OPN expression significantly enhanced the cisplatin-induced activation of cleaved caspase-3 (P<0. 01), and it also resulted in inhibition of Bd^/Bd-xL. expression and up- regulation of Bax expression. Conclusion OPN silencing can sensitize cervical cancerHeLa cells to chemotherapeutic agents by promoting HeLa cells apoptosis. RNA interference mediated depletion of OPN may be a promising strategy for the new adjuvant chemotherapy treatment of cervical cancer.

Objective To study the value of magnetic resonance spectroscopic imaging (MRSD with only surface coils in diagnosing prostate cancer. Methods A total of 48 elderly patients with surgery or biopsy-confirmed benign prostatic hyperplasia or prostate cancer were preoperatively examined by surface coils for three-dimensional simple multi-voxel magnetic resonance spectroscopy scans, and the voxel (choline[Cho] + creatine[Cr])/citrate(Cit) values were calculated. According to the pathological findings, the voxels were divided into prostate cancer and non-cancer. The voxel (Cho + Cr)/Cit values of prostate central zone and prostate peripheral zone were analyzed. The voxel nature of (Cho+Cr)/Cit value was used as the gold standard receiver to plot characteristic curve (ROC curve) and to calculate the area under the curve; the maximal Youden index was used as the standard to obtain the cut-off value and the corresponding sensitivity and specificity. Results The voxel (Cho + Cr)/Cit values of different natures were significantly different (P<0. 001). When the area under the ROC curve of (Cho + Cr)/ Cit value was used for diagnosis of prostate cancer, the central zone was 0. 652, and the peripheral zone was 0. 821. For the cutoff value, the central zone was (Cho + Cr)/Cit = 0. 645, with the corresponding sensitivity and specificity being 0. 512 and 0. 71, respectively; the peripheral zone was (Cho + Cr)/Cit = 0. 815, with the corresponding sensitivity and specificity being 0. 72 and 0. 84, respectively. Conclusion Surface coil alone can successfully complete the three-dimensional proton spectroscopic imaging of prostate, and (Cho + Cr)/Cit = 0. 815 for the cut-off value has a high diagnostic value for peripheral zone prostate cancer.

Objective To analyze the expression of molecular biological markers in patients with early stage adenocarcinoma of lung and to determine the correlation between combined expression and prognosis. Methods Pathologic specimens were collected from 68 patients of early stage adenocarcinoma of lung in our hospital between 2000 to 2002. A panel of molecular markers, including Ki-67, Her-2, P16, P53, VEGF, MMP-9 and CD44v6, were chosen for immunohistochemical analysis of the tumor. Cox proportional hazards regression analysis was used to ana-lyze the relationship between expression of these factors and prognosis. Results Muhivariable analysis demonstrated significantly elevated risk for the following molecular markers: P53 (RR=3.228,95.0% CI 1.331-7.828, P=0.010),MMP-9(RR=2.071,95.0% CI 1.062-4.036,P=0.033),VEGF (RR=2.577,95.0% CI 1.124-5.908, P=0.025). The survival period in the patients with combined expression was remarkably shortened. Conclusions Combined evaluation of P53, VEGF and MMP-9 has clinical significance to the prognosis of early stage adenocarcino-ma of lung.

Objective To investigate the computed tomography (CT) features of the coronavirus disease 2019 (COVID-19) and the clinical significance, so as to improve our understanding of CT imaging of this disease. Methods The chest CT features of seven COVID-19 patients, who were diagnosed by virus nucleic acid test from Jan. 25 to Feb. 15, 2020 in Changhai Hospital of Naval Medical University (Second Military Medical University), were analyzed retrospectively. There were six males and one female, aged (51.1±18.8) years (range 29-75 years). All the seven patients received chest CT plain scan examimation. The CT images were interpreted by two experienced senior radiologists, and the distribution, location and density of lesions, number of involved lobes, air bronchogram, mediastinal lymphadenopathy and pleural effusion were analyzed. Results The average time from onset of symptoms to CT examination was 3.6 d (range 1-9 d) in the seven COVID-19 patients. The lesions were distributed in single lung in one case and bilateral lungs in six cases. The lesions involved middle and lateral fields of lungs in five cases and the whole field of lungs in two cases. The lesions showed ground-glass opacity in four cases and mixed shadow in three cases. The lesions involved two or less lobes in four cases and five lobes in three cases. One case had air bronchogram. No mediastinal lymphadenopathy or pleural effusion were found. Conclusion COVID-19 patients have characteristic CT findings, which has important clinical significance for the diagnosis and treatment of COVID-19. However, the diagnosis should be confirmed based on the patient's epidemic history, clinical symptoms and laboratory indicators.

Objective To investigate the clinical characteristics of stroke warning syndrome (SWS) and to explore the effectiveness of intravenous thrombolysis with alteplase. Methods Eleven patients with SWS, who received intravenous thrombolysis with alteplase in Stroke Center of our hospital between Sep. 2013 and Jan. 2018, were selected. The clinical features, imaging findings and therapeutic effects were analyzed. Results There were risk factors of cerebrovascular diseases in the 11 patients with SWS, in which 7 had hypertension, 4 had diabetes mellitus, 2 had hyperlipoidemia, and 1 had gout. In the classification of symptoms, 7 patients were pure motor type and 4 were motor-sense type. Magnetic resonance diffusion weighted imaging showed that 10 patients developed ischemic stroke. The infarction located in the posterior limb of internal capsule, putamen, globus pallidus, corona and pons. Head and neck computed tomography angiography examination found no large vascular stenosis in the patients. The modified Rankin scale scored 0-1 in 9 patients, 2 in 1 patient, and 3 in 1 patient. Conclusion Perforating artery disease is the main pathogenesis of SWS. Intravenous thrombolysis does not prevent SWS to ischemic stroke, but it improves the prognosis of the patients.

Objective To explore the prognostic influencing factors of acute cardiogenic ischemic stroke patients treated with alteplase intravenous thrombolysis. Methods Ninety-one patients with acute cardiogenic ischemic stroke, who received intravenous thrombolysis with alteplase in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) between Sep. 2013 and Sep. 2017, were included in this study. The modified Rankin scale (mRS) score at 3 months after thrombolysis was used as an prognostic indicator, and the patients with mRS score≤2 were good prognosis group (n＝54) and those with mRS score 3-6 were poor prognosis group (n＝37). The age, gender, medical history, baseline National Institutes of Health stroke scale (NIHSS) score, baseline Glasgow coma scale (GCS) score and Alberta stroke program early computed tomograghy score (ASPECTS) before thrombolysis were analyzed in each group. Multivariate logistic regression analysis was used to analyze the prognostic influencing factors. Results The good prognosis rate was 59.3% (54/91) at 3 months after thrombolysis. There were significant differences in age ([66.57±13.46] years vs [75.95±6.06] years), incidence of patent foramen ovale (11.1% [6/54] vs 0.0% [0/37]), baseline NIHSS score (7.5 [3.5, 13.0] vs 18.0 [13.0, 22.0]), baseline GCS score (14.5 [12.0, 15.0] vs 10.0 [8.0, 14.0]), ASPECTS before thrombolysis (10.0 [9.0, 10.0] vs 9.0 [8.0, 10.0]) and incidence of symptomatic intracranial hemorrhage (SICH, 1.9% [1/54] vs 32.4% [12/37]) between the good and poor prognosis groups (t＝3.964, χ2＝4.401, Z＝5.235, Z＝4.079, Z＝2.519, χ2＝16.768; all P0.05). Multivariate logistic regression analysis showed that age (odds ratio [OR]＝3.236, 95% confidence interval [CI] 1.077-9.709, P＝0.036), baseline NIHSS score (OR＝2.874, 95% CI 1.074-6.329, P＝0.034) and SICH (OR＝9.346, 95% CI 1.017-83.333, P＝0.048) were influencing factors for poor prognosis of acute cardiogenic ischemic stroke patients treated with intravenous thrombolysis. Conclusion The age, baseline NIHSS score and SICH are independent factors for poor prognosis of patients with acute cardiogenic ischemic stroke. The patients with elder age, more serious stroke or SICH may have a worse prognosis.

Objective To explore the role of dexmedetomidine (DEX) in the inflammatory response of alveolar epithelial cells in sepsis mice. Methods Male C57BL/6 mice were randomly divided into cecal ligation and puncture (CLP) group and CLP＋DEX group (n＝36). The mice in the CLP group were intraperitoneally treated with 1 mL sterile normal saline and the mice in the CLP＋DEX group were intraperitoneally injected with DEX (50 μg/kg) at 15 min before CLP. The survival rate of mice was recorded within 24 h after CLP. The serum and bronchoalveolar lavage fluid (BALF) were collected on 0, 6, 12, 24 h after CLP, and the levels of interleukin (IL)-6, IL-1β and tumor necrosis factor α (TNF-α) were detected by enzyme-linked immunosorbent assay (ELISA). The mouse alveolar epithelial cell lines MLE12 were cultured in vitro, and were divided into lipopolysaccharide (LPS) group (1 μg/mL LPS) and LPS＋DEX group (1 μg/mL LPS＋0.2 μg/mL DEX). The levels of IL-6, IL-1β and TNF-α in the cell supernatants were measured by ELISA, and the phosphorylation levels of extracellular signal-regulated kinase (ERK) 1/2 and c-Jun N-terminal kinase (JNK) were determined by Western blotting on 6, 12 and 24 h of cell culture. Results Compared with the CLP group, the survival rate of mice was significantly higher in the CLP＋DEX group within 24 h after CLP (P0.05). The IL-6, IL-1β, and TNF-α levels of serum and BALF were significantly lower in the CLP＋DEX group than those in the CLP group (P0.05, P0.01). Compared with the LPS group, the levels of IL-6, IL-1β and TNF-α were significantly lower in the MLE12 cell supernatant of the LPS＋DEX group on 6, 12 and 24 h of cell culture (P0.05, P0.01). Western blotting results showed that the phosphorylation levels of ERK1/2 on 6, 12 and 24 h of cell culture and the phosphorylation levels of JNK on 6 and 12 h of cell culture were significantly lower in the LPS＋DEX group than those in the LPS group (P0.05, P0.01). Conclusion DEX can reduce the production of inflammatory cytokines in the serum and BALF of sepsis mice and increase the survival rate in sepsis mice, which may be related to the inhibition effect of DEX against activation of ERK1/2 and JNK signal pathways.