1.Efficacy comparison of different intraocular lens fixation in the treatment of aphakic patients lacking capsule support
Hua WU ; Lei YAO ; Yayuan YANG ; Chenxi YANG ; Lixin CHEN
International Eye Science 2025;25(8):1313-1316
AIM: To compare the efficacy of different intraocular lens(IOL)fixation in aphakic patients lacking capsule support.METHODS:Retrospective study. Totally 120 cases(120 eyes)of aphakia patients who lacked capsule support admitted to our hospital from June 2019 to June 2024 were selected as the study subjects and randomly assigned into group A and group B, with 60 cases in each group. Group A underwent subcapsular IOL deep scleral fixation, while group B underwent IOL suture suspension fixation in the ciliary groove. The surgery time, uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), intraocular pressure(IOP), corneal endothelial cell density(CECD), corneal endothelial cell loss rate, and postoperative complications were compared between the two groups before and at 1, 3, 6 mo after surgery.RESULTS:The operation time of the group A was lower than that of the group B(24.69±2.69 vs. 32.75±3.75 min, t=11.937, P<0.05). The UCVA and BCVA in both groups were better than those before operation, and the group A was better than the group B(all P<0.05). The loss rates of corneal endothelial cells in the group A were lower than those in the group B at 1, 3 and 6 mo after surgery, the IOP in the group A was lower than that in the group B at 1 mo after surgery, and the CECD in the group A was higher than the group B(all P<0.05). The 3 eyes(5.0%)of the postoperative IOL ectopic in the group A were less than 11 eyes in the group B(18.3%, P=0.023).CONCLUSION:Subcapsular IOL deep scleral fixation has prominent curative effects on aphakic patients who lack capsule support. It helps improve vision, with less operation time, and fewer postoperative complications.
2.Analysis of factors influencing postoperative pathological upgrading in prostate cancer with target biopsy Gleason score 3 + 3 and development of a predictive model
Rongjie SHI ; Lai DONG ; Zhiyi SHEN ; Kaiyu ZHANG ; Chenglong ZHANG ; Yamin WANG ; Ruizhe ZHAO ; Shangqian WANG ; Gong CHENG ; Lixin HUA
Chinese Journal of Urology 2025;46(9):684-690
Objective:To explore the influencing factors for pathological upgrading in prostate cancer patients with a Gleason score of 3 + 3 undergoing targeted biopsy,and to establish a nomogram prediction model.Methods:A retrospective analysis was conducted on 191 patients with localized prostate cancer diagnosed with a Gleason score of 3 + 3 through targeted biopsies at the First Affiliated Hospital of Nanjing Medical University from January 2020 to June 2024. The age of the patients was 67(61,73)years,with prostate-specific antigen(PSA)level of 7.44(5.53,10.19)ng/ml,prostate volume of 35.64(26.59,48.97)ml,and PSA density(PSAD)of 0.20(0.14,0.31)ng/ml 2. Among them,61 cases(31.94%)had a Prostate Imaging Reporting and Data System(PI-RADS)score of 3,104 cases(54.45%)had a score of 4,and 26 cases(13.61%)had a score of 5. The diameter of the main lesion was 10.75(7.86,14.00)mm. The lesions were located in the peripheral zone in 78 cases(40.84%),the transition zone in 99 cases(51.83%),and the anterior fibromuscular stroma in 14 cases(7.33%). The lesions were found at the apex in 56 cases(29.32%),in the body in 120 cases(62.83%),and at the base in 15 cases(7.85%). MRI revealed only one lesion with a PI-RADS score ≥ 3 in 131 cases,two suspected lesions in 43 cases,three suspected lesions in 12 cases,and four suspected lesions in 5 cases. Systematic biopsy was positive in 121 cases(63.4%)and negative in 70 cases(36.6%). The lesions were confined to the left lobe in 63 cases(32.98%),right lobe in 68 cases(35.60%),and involved both lobes in 60 cases(31.41%). The interval between biopsy and surgery was 9.0(7.0,14.0)days. Univariate analyses were performed using Mann-Whitney U tests or χ2 tests,and multivariate logistic regression was used to identify independent predictors of pathological upgrading. A nomogram model was constructed based on these independent predictors. The model’s discriminative ability was assessed using the area under the receiver operating characteristic(ROC)curve(AUC),and internal validation of the model’s consistency was conducted using the bootstrap resampling method. Decision curve analysis(DCA)was performed to assess clinical utility. Results:Among the 191 cases,60(31.4%)had no pathological upgrading after surgery,while 131(68.6%)showed upgrading. Univariate analysis showed that the maximum diameter of the main lesion[9.0(6.0,13.2)mm vs. 11.0(8.4,14.0)mm],number of suspicious lesions on MRI[1.0(1.0,1.0)vs. 1.0(1.0,2.0)],number of positive systematic biopsy cores[1.0(0,2.0)vs. 1.0(0,3.0)],percentage of positive systematic biopsy cores[0.08(0,0.17)vs. 0.12(0,0.25)],number of positive targeted biopsy cores[2.0(1.0,3.0)vs. 3.0(1.0,4.0)],percentage of positive targeted biopsy cores[0.37(0.24,0.75)vs. 0.50(0.38,0.85)],level of the index lesion,location of the index lesion,and PI-RADS score were associated with pathological upgrading( P < 0.05). Multivariate logistic regression analysis showed that PI-RADS score 4( OR = 5.88,95% CI 2.41 - 14.35),number of suspicious lesions on MRI( OR = 4.15,95% CI 1.88 - 9.17),location of the index lesion in the transition zone( OR = 6.86,95% CI 2.81 - 16.73),and percentage of positive targeted biopsy cores( OR = 4.37,95% CI 1.38 - 14.90)were independent risk factors for pathological upgrading( P < 0.05). The nomogram model constructed using these predictors had an AUC of 0.845. Internal validation using the Bootstrap method yielded an AUC value of 0.812,indicating high predictive accuracy of the model. The calibration curve indicated good calibration. Decision curve analysis showed that the threshold range for net benefit in the model was between 12% - 100%. Conclusions:The PI-RADS score 4,the number of lesions with PI-RADS ≥ 3,the location of the main lesion in the transition zone,and the percentage of positive needles in targeted biopsy are independent risk factors for pathological upgrading from Gleason score 3 + 3. The nomogram model constructed from these factors demonstrates good predictive performance and provides a reference for clinical decision-making.
3.Transcranial magnetic stimulation combined with human umbilical cord mesenchymal stem cells promotes spinal cord injury repair through inhibiting ferroptosis
Zuoyu HUA ; Yashi WANG ; Shi SUN ; Lixin ZHANG
Journal of China Medical University 2025;54(7):577-582
Objective To investigate the effects of transcranial magnetic stimulation(TMS)combined with human umbilical cord mesen-chymal stem cells(hUC-MSCs)on ferroptosis following spinal cord injury(SCI)in rats.Methods Allen percussion was used to estab-lish the SCI model.A total of 60 SD rats were randomly divided into sham,SCI,TMS,hUC-MSC,and TMS+hUC-MSC groups,with 12 rats in each group.Motor function was evaluated using the Basso-Beattie-Bresnahan(BBB)score.Spinal cord tissues were sampled and stained with hematoxylin and eosin(HE)as well as Nissl to observe tissue damage as well as the changes in neurons and Nissl bodies,respectively.The colorimetric method was used to detect the contents of ferrous ions(Fe2+)and reduced glutathione(GSH).Transmission electron microscopy was applied to observe the ultrastructure of the mitochondria.Western blotting was performed to detect the expres-sion levels of SLC7A11,GPX4,and ACSL4.Results The SCI group had lower BBB scores,higher Fe2+and ACSL4 protein expression levels,and lower GSH,SLC7A11,and GPX4 protein expression levels than the sham group(P<0.05).The mitochondrial cristae reduced with membrane shrinkage,neuronal damage was severe,and Nissl bodies were absent in the SCI group.The TMS,hUC-MSC,and TMS+hUC-MSC groups had higher BBB scores,lower Fe2+and ACSL4 protein expression levels,and higher GSH,SLC7A11,and GPX4 protein expression levels than the SCI group(P<0.05).The mitochondrial cristae increased with an intact membrane structure,the pathological damage was attenuated,neuronal morphology was restored,and Nissl bodies were clearly visible in TMS,hUC-MSC,and TMS+hUC-MSC groups.Conclusion TMS combined with hUC-MSC inhibits ferroptosis through activating the SLC7A11/GSH/GPX4 pathway,alleviates secondary injury after SCI,and promotes functional recovery and neural remodeling in rats.
4.Transcranial magnetic stimulation combined with human umbilical cord mesenchymal stem cells promotes spinal cord injury repair through inhibiting ferroptosis
Zuoyu HUA ; Yashi WANG ; Shi SUN ; Lixin ZHANG
Journal of China Medical University 2025;54(7):577-582
Objective To investigate the effects of transcranial magnetic stimulation(TMS)combined with human umbilical cord mesen-chymal stem cells(hUC-MSCs)on ferroptosis following spinal cord injury(SCI)in rats.Methods Allen percussion was used to estab-lish the SCI model.A total of 60 SD rats were randomly divided into sham,SCI,TMS,hUC-MSC,and TMS+hUC-MSC groups,with 12 rats in each group.Motor function was evaluated using the Basso-Beattie-Bresnahan(BBB)score.Spinal cord tissues were sampled and stained with hematoxylin and eosin(HE)as well as Nissl to observe tissue damage as well as the changes in neurons and Nissl bodies,respectively.The colorimetric method was used to detect the contents of ferrous ions(Fe2+)and reduced glutathione(GSH).Transmission electron microscopy was applied to observe the ultrastructure of the mitochondria.Western blotting was performed to detect the expres-sion levels of SLC7A11,GPX4,and ACSL4.Results The SCI group had lower BBB scores,higher Fe2+and ACSL4 protein expression levels,and lower GSH,SLC7A11,and GPX4 protein expression levels than the sham group(P<0.05).The mitochondrial cristae reduced with membrane shrinkage,neuronal damage was severe,and Nissl bodies were absent in the SCI group.The TMS,hUC-MSC,and TMS+hUC-MSC groups had higher BBB scores,lower Fe2+and ACSL4 protein expression levels,and higher GSH,SLC7A11,and GPX4 protein expression levels than the SCI group(P<0.05).The mitochondrial cristae increased with an intact membrane structure,the pathological damage was attenuated,neuronal morphology was restored,and Nissl bodies were clearly visible in TMS,hUC-MSC,and TMS+hUC-MSC groups.Conclusion TMS combined with hUC-MSC inhibits ferroptosis through activating the SLC7A11/GSH/GPX4 pathway,alleviates secondary injury after SCI,and promotes functional recovery and neural remodeling in rats.
5.Analysis of factors influencing postoperative pathological upgrading in prostate cancer with target biopsy Gleason score 3 + 3 and development of a predictive model
Rongjie SHI ; Lai DONG ; Zhiyi SHEN ; Kaiyu ZHANG ; Chenglong ZHANG ; Yamin WANG ; Ruizhe ZHAO ; Shangqian WANG ; Gong CHENG ; Lixin HUA
Chinese Journal of Urology 2025;46(9):684-690
Objective:To explore the influencing factors for pathological upgrading in prostate cancer patients with a Gleason score of 3 + 3 undergoing targeted biopsy,and to establish a nomogram prediction model.Methods:A retrospective analysis was conducted on 191 patients with localized prostate cancer diagnosed with a Gleason score of 3 + 3 through targeted biopsies at the First Affiliated Hospital of Nanjing Medical University from January 2020 to June 2024. The age of the patients was 67(61,73)years,with prostate-specific antigen(PSA)level of 7.44(5.53,10.19)ng/ml,prostate volume of 35.64(26.59,48.97)ml,and PSA density(PSAD)of 0.20(0.14,0.31)ng/ml 2. Among them,61 cases(31.94%)had a Prostate Imaging Reporting and Data System(PI-RADS)score of 3,104 cases(54.45%)had a score of 4,and 26 cases(13.61%)had a score of 5. The diameter of the main lesion was 10.75(7.86,14.00)mm. The lesions were located in the peripheral zone in 78 cases(40.84%),the transition zone in 99 cases(51.83%),and the anterior fibromuscular stroma in 14 cases(7.33%). The lesions were found at the apex in 56 cases(29.32%),in the body in 120 cases(62.83%),and at the base in 15 cases(7.85%). MRI revealed only one lesion with a PI-RADS score ≥ 3 in 131 cases,two suspected lesions in 43 cases,three suspected lesions in 12 cases,and four suspected lesions in 5 cases. Systematic biopsy was positive in 121 cases(63.4%)and negative in 70 cases(36.6%). The lesions were confined to the left lobe in 63 cases(32.98%),right lobe in 68 cases(35.60%),and involved both lobes in 60 cases(31.41%). The interval between biopsy and surgery was 9.0(7.0,14.0)days. Univariate analyses were performed using Mann-Whitney U tests or χ2 tests,and multivariate logistic regression was used to identify independent predictors of pathological upgrading. A nomogram model was constructed based on these independent predictors. The model’s discriminative ability was assessed using the area under the receiver operating characteristic(ROC)curve(AUC),and internal validation of the model’s consistency was conducted using the bootstrap resampling method. Decision curve analysis(DCA)was performed to assess clinical utility. Results:Among the 191 cases,60(31.4%)had no pathological upgrading after surgery,while 131(68.6%)showed upgrading. Univariate analysis showed that the maximum diameter of the main lesion[9.0(6.0,13.2)mm vs. 11.0(8.4,14.0)mm],number of suspicious lesions on MRI[1.0(1.0,1.0)vs. 1.0(1.0,2.0)],number of positive systematic biopsy cores[1.0(0,2.0)vs. 1.0(0,3.0)],percentage of positive systematic biopsy cores[0.08(0,0.17)vs. 0.12(0,0.25)],number of positive targeted biopsy cores[2.0(1.0,3.0)vs. 3.0(1.0,4.0)],percentage of positive targeted biopsy cores[0.37(0.24,0.75)vs. 0.50(0.38,0.85)],level of the index lesion,location of the index lesion,and PI-RADS score were associated with pathological upgrading( P < 0.05). Multivariate logistic regression analysis showed that PI-RADS score 4( OR = 5.88,95% CI 2.41 - 14.35),number of suspicious lesions on MRI( OR = 4.15,95% CI 1.88 - 9.17),location of the index lesion in the transition zone( OR = 6.86,95% CI 2.81 - 16.73),and percentage of positive targeted biopsy cores( OR = 4.37,95% CI 1.38 - 14.90)were independent risk factors for pathological upgrading( P < 0.05). The nomogram model constructed using these predictors had an AUC of 0.845. Internal validation using the Bootstrap method yielded an AUC value of 0.812,indicating high predictive accuracy of the model. The calibration curve indicated good calibration. Decision curve analysis showed that the threshold range for net benefit in the model was between 12% - 100%. Conclusions:The PI-RADS score 4,the number of lesions with PI-RADS ≥ 3,the location of the main lesion in the transition zone,and the percentage of positive needles in targeted biopsy are independent risk factors for pathological upgrading from Gleason score 3 + 3. The nomogram model constructed from these factors demonstrates good predictive performance and provides a reference for clinical decision-making.
6.Effects of MYD88 overexpression on proliferation and apoptosis of diffuse large B cell lymphoma cells and its mechanism
Piaopiao HU ; Chengrui XUAN ; Hua DU ; Shirong LI ; Lixin WENG ; Ling HAI ; Yunga WU ; Xiaoyan XU
Chinese Journal of Clinical and Experimental Pathology 2024;40(1):44-50
Purpose To investigate the effect of MYD88 gene overexpression on the proliferation and apoptosis of human diffuse large B cell lymphoma(DLBCL)cells,and to prelimi-narily explore the mechanism of MYD88 gene action.Methods PEGFP-C2-MYD88 overexpressing MYD88 L265P gene was transfected into DLBCL cells by plasmid transfection.The exper-iment was divided into blank control group,negative control group and MYD88 L265P overexpression group.The fluores-cence expression of MYD88 L265P after overexpression was ob-served under inverted fluorescence microscope.RT-PCR and Western blot were used to detect the mRNA and protein expres-sion of MYD88 L265P,IRAK4,NF-κB and BCL2 in DLBCL cells before and after overexpression of MYD88 L265.CCK8 method was used to detect DLBCL cells proliferation and Ho-echst staining was used to detect DLBCL cells apoptosis.Re-sults After overexpression of MYD88 L265P,compared with the blank control group(0.670 4±0.017 5)and the negative control group(0.715 3±0.019 6),the MYD88L265P overex-pression group(1.157 2±0.010 2)increased significantly,with statistical significance(all P<0.05).After overexpression of MYD88 L265P,compared with the blank control group(0.69 ±0.04)and the negative control group(0.81±0.07),the MYD88L265P overexpression group(0.48±0.05)was signifi-cantly decreased,with statistical significance(all P<0.05).After overexpression of MYD88 L265P,compared with the blank control group(mRNA:1.0158±0.0115,0.987 3±0.010 2,1.007 6±0.015 3,protein:0.183 4±0.058 9,0.096 8± 0.015 7,0.147 5±0.0418)and negative control group(mR-NA:0.9132±0.0098,1.0032±0.0156,0.9327± 0.011 2,protein:0.187 9±0.042 3,0.088 9±0.0513,0.134 8±0.050 1),the mRNA(3.243 2±0.013 6,2.976 6 ±0.0213,1.585 9±0.019 8)and protein expressions(0.452 7±0.052 4,0.218 9±0.047 5,0.301 4±0.059 8)of IRAK4,NF-κB and anti-apoptosis protein BCL2 in MYD88L265P overexpression group were significantly increased,which was statistically significant(all P<0.05).Conclusion After overexpression of MYD88 L265P,the apoptosis rate of DLBCL cells decreased and the cell proliferation rate increased.The mechanism may be related to the mutation of MYD88 L265P gene,activation and amplification of NF-κB pathway,and pro-motion of the overexpression of antiapoptotic protein BCL2.
7.Progress in ferroptosis and its inhibitors in central nervous system diseases
Yashi WANG ; Zuoyu HUA ; Lixin ZHANG
Journal of China Medical University 2024;53(3):276-281
The etiology of central nervous system(CNS)diseases is complex and mostly unknown,and patients are often left with sequelae and poor prognosis.Recently,ferroptosis has emerged as a unique oxidative stress-induced cell death pathway and is important in various CNS diseases.It is an important mode of neuronal cell death.This article summarizes the molecular mechanism of ferroptosis,research progress of ferroptosis in CNS diseases,and application of ferroptosis inhibitors in CNS diseases to provide new targets and clini-cal references for CNS disease treatment.
8.Explore the mechanism of Huangqi Jiedu decoction in the treatment of breast cancer syndrome of Zheng-deficiency and toxic-incandescence based on network pharmacology and molecular docking technology
Lingjia TIAN ; Zihao YIN ; Liang ZHOU ; Qin ZHANG ; Lixin LIANG ; Yongjie CAO ; Hua WANG ; Lifang LIU
Journal of Chinese Physician 2024;26(3):360-365
Objective:To explore the mechanism of Huangqi Jiedu Decoction (HQJD) in the treatment of breast cancer with the syndrome of Zheng deficiency and toxic incandescence by network pharmacology and molecular docking technology.Methods:The main active ingredients and targets of HQJD were screened through the traditional Chinese medicine (TCM) systematic pharmacology database and analysis platform. The relevant targets of breast cancer with the syndrome of Zheng-deficiency, toxic-incandescence were obtained using OMIM, GeneGards and Drugbank databases, and the relevant targets of HQJD for the treatment of breast cancer with the syndrome of Zheng-deficiency and toxic incandescence were obtained by intersection; The Cytoscape 3.9.1 software was used to build the protein protein interaction (PPI) network and the " drug active component target disease" network on the basis of String 11.0 database, and the core active components and core targets of HQJD in treating breast cancer with the syndrome of Zheng-deficiency and toxic-incandescence were inferred according to the topological parameters. gene ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were performed on core targets using R language; and molecular docking verification on the main active ingredients and core targets were conducted.Results:230 effective targets of active ingredients of HQJD were screened, and 15 467 active ingredients of breast cancer with syndrome of Zheng-deficiency/toxic-incandescence were obtained; 217 intersection targets; GO function enrichment analysis showed that the treatment of HQJD for breast cancer with the syndrome of Zheng-deficiency and toxic-incandescence mainly involved oxidative stress and cytochemical stress; The enrichment analysis of KEGG pathway showed that HQJD treatment of breast cancer with the syndrome of Zheng-deficiency and toxic-incandescence was mainly related to phosphatidylinositol 3-protein kinase B (PI3K-Akt), interleukin-17 (IL-17) and other signal pathways. The molecular docking results showed that the main active ingredients such as β-sitosterol, stigmasterol, luteolin had good binding ability with core targets.Conclusions:HQJD has the characteristics of multi-component, multi target and multi pathway in the treatment of breast cancer with syndrome of Zheng-deficiency and toxic-incandescence, and its main mechanism may be related to PI3K-Akt, IL-17, P53 and other signal pathways.
9.PSA value gray area (4-10 ng/ml) prostate biopsy study
Jinwei SHANG ; Lai DONG ; Rongjie SHI ; Ruizhe ZHAO ; Tian HAN ; Minjie PAN ; Bin YANG ; Yamin WANG ; Wei XIA ; Lixin HUA ; Gong CHENG
Chinese Journal of Urology 2024;45(5):386-390
Objective:To explore the strategy of prostate biopsy in patients with prostate specific antigen(PSA)gray zone based on prostate imaging reporting and data system (PI-RADS).Methods:The clinical data of 427 patients who underwent transperineal prostate biopsy in the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2022 were retrospectively analyzed. The median age was 66 (61, 72) years old. The median PSA was 6.62 (5.46, 8.19) ng/ml. The median PSA density (PSAD) was 0.15 (0.11, 0.21) ng/ml 2. The median prostate volume (PV) was 43.68 (31.12, 56.82) ml. PSA velocity (PSAV) data were available in 65 patients with negative MRI examination(PI-RADS <3), and the median PSAV was 1.40 (0.69, 2.89) ng/(ml· year). Among the patients with positive MRI(PI-RADS≥3), there were 174 patients with only 1 lesion and 83 patients with ≥2 lesions. A total of 170 patients with negative MRI underwent systematic biopsy, and 257 patients with positive MRI underwent systematic combined targeted biopsy. The PI-RADS score, regions of interest(ROI), PSAD, f/tPSA and PSAV were analyzed to explore the biopsy strategy for patients with PSA gray area based on bpMRI imaging. Results:Of the 427 patients included in the study, 194 were positive and 233 were negative. Among the patients with positive biopsy pathology, 140 cases were clinically significant prostate cancer (CsPCa). Among the MRI-negative patients, there were 33 cases with PSAV ≥1.4 ng/(ml·year), and 10 cases of prostate cancer and 6 cases of CsPCa were detected by systematic biopsy.In 32 cases with PSAV <1.4 ng/(ml·year), 3 cases of prostate cancer and 0 case of CsPCa were detected by systematic biopsy. The sensitivity of systematic biopsy for the diagnosis of prostate cancer and CsPCa in patients with PSAV≥1.4 ng/(ml·year) were 76.9% (10/13) and 100.0% (6/6) respectively, the specificity were 55.8% (29/52) and 54.2% (32/59) respectively, the negative predictive value were 90.6% (29/32) and 100.0% (32/32) respectively, and the positive predictive value were 30.3% (10/33) and 18.2% (6/33) respectively. In MRI-positive patients with PI-RADS 3, the prostate cancer detection rates of targeted biopsy combined with systematic biopsy, systematic biopsy and targeted biopsy were 41.7% (45/108), 32.4% (35/108) and 35.2% (38/108), respectively ( P=0.349). The detection rates of CsPCa were 27.8% (30/108), 21.3% (23/108) and 25.0% (27/108), respectively ( P=0.541). In patients with PI-RADS 4-5 and PSAD > 0.15 ng/ml 2, the detection rates of CsPCa in targeted biopsy combined with systematic biopsy, systematic biopsy and targeted biopsy were 67.8% (61/90), 58.9% (53/90) and 67.8% (61/90), respectively ( P=0.354). Conclusions:For MRI-negative patients, all CsPCa could be detected by perineal systematic biopsy when PSAV ≥1.4 ng/(ml·year), and active observation could be performed when PSAV <1.4 ng/(ml·year). For MRI-positive patients, targeted combined systemic biopsy was required when PI-RADS score was 3, and targeted biopsy only could be performed when PI-RADS score ≥4 and PSAD >0.15 ng/ml 2, otherwise targeted combined systemic biopsy was required.
10.The comprehensive analysis of bi-parametric magnetic resonance imaging in the diagnosis and treatment of hematospermia
Yamin WANG ; Rongjie SHI ; Lai DONG ; Ruizhe ZHAO ; Shangqian WANG ; Gong CHENG ; Lixin HUA
Chinese Journal of Urology 2024;45(12):940-945
Objective:To investigate the value of bi-parameter magnetic resonance imaging (bpMRI) in diagnosis and treatment of hematospermia.Methods:The clinical data and bpMRI of 182 patients with hematospermia (hematospermia group) and 51 patients without urinary system diseases (control group) were retrospectively analyzed. Both the control group and the hematospermia group underwent semen quality analysis, blood routine, urine routine, coagulation function, serum PSA test, and bpMRI examination before treatment. There were no significant differences in age [40(33, 50)years vs. 39(31, 53) years, Z=-0.77, P=0.43], body mass index [23.9(22.0, 25.7)kg/m2 vs. 24.5(22.3, 26.1) kg/m 2, Z=-0.50, P=0.62], smoking rate [24.7%(45/182) vs. 27.5%(14/51), χ2=0.16, P=0.69], alcohol consumption rate [29.1%(53/182) vs. 29.4%(15/51), χ2=0.002, P=0.97], and comorbid hypertension [20.9%(38/182) vs. 17.6%(9/51), χ2=0.26, P=0.61] between the hematospermia group and the control group. There was a statistically significant difference in PSA levels between the hematospermia group and the control group [2.82(2.08, 3.68)ng/ml vs 1.59(0.88, 2.28) ng/ml, Z=6.08, P=0.03].The median duration of illness in the hematospermia group was 10(5, 15) months, the median number of red blood cells reported in semen analysis was 17(10, 23)/HP, 59(32.4%) cases had infections in urine routine results, 15(8.2%) cases had infections in blood routine results, and 19(10.4%) cases had coagulation abnormalities. Hematospermia patients can be divided into five categories based on their causes: 105 cases of infection and inflammation, 42 cases of obstruction, 19 cases of tumors, 8 cases of systemic diseases, and 8 cases of iatrogenic factors and trauma. The treatment option was based on etiology: ①Infections, Inflammation, Systemic Diseases, Iatrogenic Factors, and Trauma: Remove the underlying cause and observe or watchful waiting. ②Recurrence of Systemic Diseases, Infections, and Inflammation: Treat the underlying cause with appropriate medication, including nonsteroidal anti-inflammatory drugs (NSAIDs), α-receptor blockers, etc. If there is an infection, administer oral antibiotics for 1-2 weeks. ③Obstruction and Tumors: Perform seminal vesiculoscopy surgery or radical prostatectomy. The efficacy evaluation was porfeomed after 12 months of treatment. Cure: Hematospermia symptoms disappear, with no recurrence. Effective: Symptoms significantly improve, no visible hematospermia, semen analysis shows marked improvement in red blood cells, and neither clinical symptoms nor semen analysis worsen. Not Cured: Visible hematospermia persists, and semen analysis shows no change in red blood cells compared to before treatment. Recurrence: Clinical symptoms improve but significant visible hematospermia reappears, and semen analysis shows red blood cell count >5/HP. Results:The proportion of patients with PI-RADS scores ≥ 3 in the hematospermia group was higher than that in the control group [29.1%(53/182)vs. 13.7%(7/51), χ2=4.94, P=0.03], and the difference was statistically significant. Comparing the imaging characteristics and related parameters of two groups of bpMRI, the results showed that the length and width of the left and right seminal vesicles in the hematospermia group were greater than those in the control group. The length of the left seminal vesicle was [29.9(25.9, 33.4)mm vs. 23.0(21.2, 25.4)mm, Z=7.30, P<0.01], the width of the left seminal vesicle was[20.4(17.8, 23.5)mm vs. 17.2(15.1, 18.5)mm, Z=5.85, P<0.01], the length of the right seminal vesicle was [28.9(24.8, 32.4)mm vs. 23.4(21.5, 28.1)mm, Z=4.68, P<0.01], and the width of the right seminal vesicle was[19.8(17.7, 23.1)mm vs. 17.2(15.1, 18.6)mm, Z=5.45, P<0.01]. The differences were statistically significant. After 12 months of follow-up, 152(83.5%) cases were cured, 21(11.5%) cases were defined as effective, 4(2.2%) cases were not cured, and 5(2.7%) cases had recurrence. Conclusions:The bpMRI examination can clearly identify the location of the hematospermia lesion and the timing of the bleeding. Based on the results of bpMRI, determining the cause and selecting the appropriate treatment strategy is reliable, convenient, and effective.

Result Analysis
Print
Save
E-mail