【Objective】 To explore the application value of ¹⁸F-PSMA PET/CT on the detection of metastatic lesions of prostate cancer with serum total prostate specific antigen (tPSA) ≤20 ng/mL and the predictive variables affecting the imaging results, and to establish a predictive nomogram for the metastasis of prostate cancer. 【Methods】 The imaging, pathological, serum and clinical data of 175 pathologically confirmed prostate cancer patients who underwent ¹⁸F-PSMA PET/CT examination during Jan.2020 and Oct.2021 were retrospectively collected.The patients were divided into metastatic group and non-metastatic group according to PET/CT imaging results, and the positive detection rate of metastatic lesions was calculated.The independent influencing factors of ¹⁸F-PSMA PET/CT in the positive detection of metastatic lesions were determined with univariate and multivariate logistic regression analyses.The predictive nomogram was established. 【Results】 Of the 175 patients, metastatic lesions were detected in 78 cases and not detected in 97 cases, with a detection rate of 44.6% (78/175).There were statistically significant differences between the metastatic group and the non-metastatic group in urinary tract symptoms, androgen deprivation treatment (ADT) at the time of PET/CT examination and the risk level of Gleason score (GS) (P<0.05).Univariate logistic regression showed that urinary tract symptoms(OR=3.64, P<0.001), GS risk (OR=3.96, P<0.001) and concurrent ADT treatment (OR=3.71, P<0.001) were associated with the positive detection rate of metastatic lesions.Multivariate Logistic regression showed that urinary tract symptoms (OR=3.19, P=0.002), GS high-risk group (OR=2.95, P=0.005) and concurrent ADT treatment (OR=3.27, P=0.001) were independent predictors of positive detection rate. 【Conclusion】 The probability of metastasis in newly diagnosed prostate cancer patients with tPSA≤20 ng/mL is high.¹⁸F-PSMA PET/CT is of high value for the early detection of metastasis.Urinary tract symptoms, GS high-risk group and concurrent ADT treatment are independent predictors of metastatic lesions.The predictive nomogram can help assist clinical optimization of imaging examination path.

Objective To explore the safety and efficacy of neoadjuvant chemotherapy(NAC)combined with immunotherapy before radical cystectomy plus pelvic lymph nodes dissection(RC-PLND)for muscle-invasive bladder cancer(MIBC).Methods The clinical data of 101 patients with MIBC who underwent neoadjuvant therapy followed by RC-PLND in the Department of Urology,the First Affiliated Hospital of Xi'an Jiaotong University during Jan.2019 and Dec.2023 were retrospectively analyzed,including 71 patients(70.3％)who received NAC(NAC group)and 30(29.7％)who received NAC combined with immunotherapy(NAC combine immunotherapy group).The clinical and pathological data and adverse events during neoadjuvant therapy were compared.Logistic regression analysis was used to explore the independent predictors of pathological complete response(pCR)and pathological partial response(pPR).Results There were no significant differences in the baseline data between the two groups(P＞0.05).However,the proportion of multiple tumors in patients receiving NAC before surgery was significantly higher than that in the NAC combined immunotherapy group(69.0％vs.46.7％,P=0.034).Compared with NAC group,NAC combined with immunotherapy group had significantly improved rate of pathological downstaging and pPR(60.6％vs.83.3％,P=0.026;45.1％vs.70.0％,P=0.022).Furthermore,the rate of pCR in patients undergoing NAC combined immunotherapy was higher than those undergoing NAC,but the difference was not significant(53.3％vs.33.8％,P=0.067).Logistic regression analysis revealed that clinical T-stage and tumor diameter were independent predictors of pCR and pPR(P＜0.05).In addition,the most common adverse events during neoadjuvant therapy were anemia,decreased white blood cells,nausea,and vomiting,but most of them were grade 1-2 and could be relieved through symptomatic treatment.Conclusion NAC combined with immunotherapy is safe and effective,which can improve the rate of pathological downstaging,pPR and pCR,without increasing the incidence of adverse reactions.

BACKGROUND: LY01005 (Goserelin acetate sustained-release microsphere injection) is a modified gonadotropin-releasing hormone (GnRH) agonist injected monthly. This phase III trial study aimed to evaluated the efficacy and safety of LY01005 in Chinese patients with prostate cancer. METHODS: We conducted a randomized controlled, open-label, non-inferiority trial across 49 sites in China. This study included 290 patients with prostate cancer who received either LY01005 or goserelin implants every 28 days for three injections. The primary efficacy endpoints were the percentage of patients with testosterone suppression ≤50 ng/dL at day 29 and the cumulative probability of testosterone ≤50 ng/dL from day 29 to 85. Non-inferiority was prespecified at a margin of -10%. Secondary endpoints included significant castration (≤20 ng/dL), testosterone surge within 72 h following repeated dosing, and changes in luteinizing hormone, follicle-stimulating hormone, and prostate specific antigen levels. RESULTS: On day 29, in the LY01005 and goserelin implant groups, testosterone concentrations fell below medical-castration levels in 99.3% (142/143) and 100% (140/140) of patients, respectively, with a difference of -0.7% (95% confidence interval [CI], -3.9% to 2.0%) between the two groups. The cumulative probabilities of maintaining castration from days 29 to 85 were 99.3% and 97.8%, respectively, with a between-group difference of 1.5% (95% CI, -1.3% to 4.4%). Both results met the criterion for non-inferiority. Secondary endpoints were similar between groups. Both treatments were well-tolerated. LY01005 was associated with fewer injection-site reactions than the goserelin implant (0% vs . 1.4% [2/145]). CONCLUSION: LY01005 is as effective as goserelin implants in reducing testosterone to castration levels, with a similar safety profile. TRIAL REGISTRATION ClinicalTrials.gov, NCT04563936.
Humans ; Male ; Antineoplastic Agents, Hormonal/therapeutic use* ; East Asian People ; Gonadotropin-Releasing Hormone/agonists* ; Goserelin/therapeutic use* ; Prostate-Specific Antigen ; Prostatic Neoplasms/drug therapy* ; Testosterone

【Objective】 To compare the efficacy and safety of blue laser en bloc enucleation and traditional plasmakinetic electrocautery in the treatment of non-muscle invasive bladder cancer (NMIBC). 【Methods】 A total of 50 NMIBC patients treated in our hospital during Oct.2018 and Dec.2019 were enrolled. A randomized, incomplete blinding, parallel control design and non-inferior test method was adopted. The control group (electrocautery group) used plasmakinetic electrocautery for transurethral resection, and the experimental group (blue laser group) used semiconductor blue laser for transurethral en bloc enucleation. The effective resection rate, operation time, postoperative catheter indwelling time, length of hospital stay, perioperative hemoglobin changes and obturator nerve reflex were compared. 【Results】 There were 24 patients in the blue laser group and 26 in the electrocautery group. The effective dissection rate and hemostasis rate in both groups reached 100%. The blue laser group had slightly longer operation time than the electrocautery group (55 min vs.42 min, P=0.009), but lesser hemoglobin decrease (5.7 g/L vs. 10.4 g/L, P=0.007). There were no significant differences in urinary catheter indwelling time, length of hospital stay and reoperation rate between the two groups. The electrocautery group had 3 cases of obturator nerve reflex, while the blue laser group had none. 【Conclusion】 Compared with the traditional electrocautery, blue laser has good vaporization cutting and coagulation hemostatic effects on bladder tumor tissue, and can completely enucleate tumors in a front-firing model with less bleeding and no obturator nerve reflex, which can be used as a new, efficient, safe and easy-to-learn method for NMIBC surgery. However, its effects on postoperative recurrence rate and progression rate still need further studies.

【Objective】 To investigate the feasibility and safety of semiconductor blue laser in the treatment of non-muscle invasive bladder cancer (NMIBC) in the day surgery model. 【Methods】 The clinical data of 22 NMIBC patients (average age 55.8 years and tumor size 1.4 cm) who underwent outpatient screening and accepted blue laser ambulatory surgery in our hospital during Jun.2022 and Sep.2022 were retrospectively analyzed. On the day of admission, transurethral resection of cancer was performed using blue laser en bloc enucleation. On the day of surgery or in the morning of next day, bladder irrigation was stopped, the catheter was removed, and patients were discharged. The baseline data, pre-hospital waiting time, operation time, length of hospital stay, hemoglobin decrease, complications and management, follow-up, medical costs, and patients’ satisfaction rate were recorded. 【Results】 The pre-hospital waiting time was 2 to 7 days, average (4.1±1.3)days. The operation time was 29 to 50 minutes, average (40.8±5.5)minutes. The length of hospital stay was 0.6 to 1.2 days, average (0.9±0.2)days. Hemoglobin decrease was 1 g/L to 8 g/L, average (3.8±1.8)g/L. The catheter was indwelt for 0.5 to 1 day, average (0.7±0.1)day. The medical costs were 13 790 to 16 811 Yuan, average (14 941.5±690.2) Yuan. Patients’ satisfaction rate was 100.0%. Mild intraoperative and postoperative complications occurred in 2 cases. One patient developed symptoms of cystitis which disappeared after 2 days of oral antibiotic cefixime, and another patient developed bladder spasm which was relieved after oral solifenacin succinate tablets. No adverse events such as obturator nerve reflex or bladder perforation occurred. After removal of the catheter, no urinary retention was observed. 【Conclusion】 This study was the first to apply blue laser ambulatory surgery in the treatment of bladder cancer, confirming that it is a safe, feasible, economical and efficient model for selected patients, which can be promoted in suitable hospitals.

【Objective】 To investigate the effects of 450 nm diode blue laser on the morphological changes and thermal damage of renal pelvis under different conditions. 【Methods】 An ex vivo study was conducted on a fresh porcine pelvis model (7 cm×5 cm×3 cm). The laser fiber was fixed on the mechanical arm perpendicular to the renal pelvis tissue, and the distance between them was 1-2 mm. The renal pelvis tissue was incised at a speed of 1-2 mm/s and power of 5-30 W. After the incised tissue was fixed in formalin (4%), the morphology, depth, width and coagulation thickness were observed with naked eyes and a microscope. 【Results】 The different powers had different vaporization and incision effects. When the operating distance was 2 mm, the speed was 2 mm/s and power was 5 W, the vaporization depth, width and coagulation thickness were approximately 0 9 mm, 0.25 mm and 0.35 mm, respectively. With the increase of power, the vaporization width and depth increased, and the coagulation thickness was 0.35-0.50 mm. When the power was more than 10 W, the renal pelvis tissue was easily penetrated. When the laser power was 20 W, the section of the renal pelvis showed an irregular shape of vaporization. When the operating distance was 1 mm, the whole renal pelvis tissue was easily vaporized. When it was 2 mm, a wide and safe energy treatment window was produced. 【Conclusion】 The 450 nm diode blue laser can vaporize and incise renal pelvis tissue safely and effectively, with high precision and little thermal damage. It is expected to be a new surgical tool in the treatment of renal pelvis lesions.

Objective To investigate the effects of epidermal growth factor receptor(EGFR)interference on activation of astrocytes after intra-cerebral hemorrhage and its mechanism.Methods Rat model of intra-cerebral hemorrhage was induced by injection of Ⅶ collagenase.Sham operation group was set as control.After 7 d,the neurological function score was used to judge whether the model was successful or not.The expression of EGFR and GFAP in brain tissue of rats in intra-cerebral hemorrhage group and sham operation group were detected by SP immunohistochemical method.Astrocytes were isolated from newborn rats' cerebral cortex and cultured in vivo.Effects of EGFR interference on activation of astrocytes were observed.The experimental rats were divided into 4 groups: ① control group was not handled.② CNTF group was added with 20 μg/L CNTF.③ Negative group was added with 20 μg/L CNTF,and EGFR siRNA negative control was transfected.④ EGFR group was added with 20 μg/L CNTF,and EGFR siRNA was transfected.The expressions of EGFR,GFAP,p-JAK1,p-STAT3 were detected by real-time PCR and Western blot.Results The modeling success rate was 89.5％(17/19).The expressions of EGFR and GFAP in brain tissue of rats with intra-cerebral hemorrhage were significantly higher than those in sham operation group(P<0.05).The relative expressions of EGFR mRNA and protein in EGFR group were significantly lower than those in control group,CNTF group and negative group(P<0.05).The relative expressions of GFAP mRNA and protein in the CNTF group and the negative group were significantly higher than those in the controlgroup and the EGFR group(P<0.05),but there was no significant difference between the control group and the EGFR group(P>0.05).The relative expressions of p-JAK1 and p-STAT3 protein in the CNTF group and the negative group were significantly higher than those in the control group and the EGFR group(P<0.05),but there was no significant difference between the control group and the EGFR group(P>0.05).Conclusion The expressions of EGFR and GFAP significantly increase in the rats with intra-cerebral hemorrhage.Interference of EGFR expression can inhibit the activation of astrocytes in rats,which may be related with the inhibition of JAK1 and STAT3 phosphorylation.

Objective To investigate the effects of epidermal growth factor receptor(EGFR)interference on activation of astrocytes after intra-cerebral hemorrhage and its mechanism.Methods Rat model of intra-cerebral hemorrhage was induced by injection of Ⅶ collagenase.Sham operation group was set as control.After 7 d,the neurological function score was used to judge whether the model was successful or not.The expression of EGFR and GFAP in brain tissue of rats in intra-cerebral hemorrhage group and sham operation group were detected by SP immunohistochemical method.Astrocytes were isolated from newborn rats' cerebral cortex and cultured in vivo.Effects of EGFR interference on activation of astrocytes were observed.The experimental rats were divided into 4 groups: ① control group was not handled.② CNTF group was added with 20 μg/L CNTF.③ Negative group was added with 20 μg/L CNTF,and EGFR siRNA negative control was transfected.④ EGFR group was added with 20 μg/L CNTF,and EGFR siRNA was transfected.The expressions of EGFR,GFAP,p-JAK1,p-STAT3 were detected by real-time PCR and Western blot.Results The modeling success rate was 89.5％(17/19).The expressions of EGFR and GFAP in brain tissue of rats with intra-cerebral hemorrhage were significantly higher than those in sham operation group(P<0.05).The relative expressions of EGFR mRNA and protein in EGFR group were significantly lower than those in control group,CNTF group and negative group(P<0.05).The relative expressions of GFAP mRNA and protein in the CNTF group and the negative group were significantly higher than those in the controlgroup and the EGFR group(P<0.05),but there was no significant difference between the control group and the EGFR group(P>0.05).The relative expressions of p-JAK1 and p-STAT3 protein in the CNTF group and the negative group were significantly higher than those in the control group and the EGFR group(P<0.05),but there was no significant difference between the control group and the EGFR group(P>0.05).Conclusion The expressions of EGFR and GFAP significantly increase in the rats with intra-cerebral hemorrhage.Interference of EGFR expression can inhibit the activation of astrocytes in rats,which may be related with the inhibition of JAK1 and STAT3 phosphorylation.

Objective:To study protective effect of nitrates pharmacological postconditioning (PI‐PostC) on ischemia‐reperfusion (I/R) injured myocardium in rats .Methods :A total of 32 Wistar rats were randomly and equally divided into sham operation group ,I/R group ,ischemia postconditioning group (IPostC group) and PI‐PostC group .Myo‐cardial ischemic area ,infract size ,plasma level of cardiac troponin I (cTnI) and cell apoptotic index were measured and compared among all groups .Results:Compare with sham operation group ,there was significant rise in plasma cTnI level [ (6.39 ± 2.35)μg/L vs .(70.33 ± 6.94)μg/L vs .(41.19 ± 4.50)μg/L ,(37.47 ± 4.20)μg/L ,P<0.01 all] in I/R group ,IPostC group and PI‐PostC group ,and those of IPostC group and PI‐PostC group were significant‐ly lower than that of I/R group , P<0.01 both .Compared with I/R group ,there were significant reductions in my‐ocardial ischemic area [ (53.31 ± 3.87)% vs .(46.46 ± 2.13)% vs .(42.08 ± 4.84)% ] ,infarct size [ (52.19 ± 3.44)% vs .(41.02 ± 2.93 )% , (38.13 ± 2.05 )% ] and cell apoptotic index [ (26.92 ± 1.91 )% vs . (20.54 ± 3.05)% ,(19.49 ± 2.41)% ] in IPostC group and PI‐PostC group ,P<0.01 all .Compared with IPostC group ,ische‐mic area significantly reduced (P<0.05) in IP‐PostC group ,but there were no significant changes in infarct size , cTnI level and cell apoptotic index between IPostC group and IP‐PostC group , P>0.05. Conclusion:Nitrates phar‐macological postconditioning possesses the same protective effect on myocardial I/R injury as ischemia postcondition‐ing ,and it can reduce myocardial ischemic area more effectively .

Objective To evaluate the clinical and pathological characteristics and risk factors of the prognosis of Cardia cancer.Methods Clinical data of 52 cases of cardiac cancer patients who were treated by surgery and follow-up data were collected from June 2009 to August 2011.Factors influencing the prognosis of the patients were analyzed by univariate and multivariate analysis.Results The survival rates in 1,2,3years were 73％,54％,46％.Single factor analysis showed that there was a significant correlation between T stage,N stage,TNM stage,classification Siewert,MSLN and venous invasion.Stepwise Cox proportional hazard model showed that T stage,N stage and MSLN were independent risk factors.Peritoneal and liver were the main way of recurrence and metastasis.Peritoneal metastasis was related to T stage and lymph node invasion,while the liver metastasis was related to MSLN.The survival curves of patients with Kaplan-Meier showed that the survival period of patients with liver metastasis and peritoneal metastasis was significantly shortened.Conclusion Standardization of lymph node cleaning is a key factor affecting prognosis,D2 surgery should be an operation standard in cardia cancer.