1.Research progress on CD8+T cell dysfunction in chronic hepatitis B virus infection.
Nan ZHANG ; Chuanhai LI ; Rongjie ZHAO ; Liwen ZHANG ; Qing OUYANG ; Liyun ZOU ; Ji ZHANG
Chinese Journal of Cellular and Molecular Immunology 2025;41(5):456-460
Hepatitis B virus (HBV)-specific CD8+ T cells play a central role in controlling HBV infection; however, their function is impaired during chronic HBV infection, manifesting as a state of dysfunction. Recent studies have revealed that CD8+ T cell dysfunction in chronic HBV infection differs from the classical exhaustion observed in other viral infections or tumors. In 2024, several pivotal studies further elucidated novel mechanisms underlying CD8+ T cell dysfunction in chronic HBV infection and identified new therapeutic targets, including 4-1BB and transforming growth factor-beta (TGF-β). This review, while elucidating the dysfunction of CD8+ T cells in chronic HBV infection and its underlying mechanisms, focuses on summarizing the key findings from these latest studies and explores their translational value and clinical significance.
Humans
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Hepatitis B, Chronic/virology*
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CD8-Positive T-Lymphocytes/immunology*
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Hepatitis B virus/physiology*
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Animals
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Transforming Growth Factor beta/immunology*
2.Clinical efficacy of robot-assisted Wallace ileal conduit in the treatment of ureteral obstruction after radical cystectomy
Tianxiao HONG ; Chaoran ZHAO ; Rongjie BAI ; Pengchao LI
Journal of Modern Urology 2025;30(10):860-864
Objective To investigate the feasibility and efficacy of robot-assisted Wallace ileal conduit in the treatment of ureteral obstruction following radical cystectomy.Methods A retrospective analysis was conducted on the clinical data of 8 patients with postoperative distal ureteral obstruction after radical cystectomy treated at the First Affiliated Hospital of Nanjing Medical University during Aug.2018 and Jun.2024.The cohort included 7 males and 1 female,aged 51-68 years(mean:58.8 years).Preoperative imaging confirmed the obstruction site and predicted its etiology.All patients underwent robot-assisted Wallace ileal conduit and were regularly followed postoperatively.Perioperative data were statistically analyzed.Results All 8 procedures were successfully completed.The operation time ranged from 120 to 398 minutes(mean:298.38 minutes),and intraoperative blood loss from 50 to 300 mL(mean:112.5 mL).Postoperative complications occurred in 3 cases according to the Clavien-Dindo classification:one Grade Ⅰ and two Grade Ⅱ,with no major postoperative complications(Grade Ⅲ and above)observed.During a follow-up of 21-77 months,hydronephrosis and renal function showed varying degrees of improvement.Conclusion Robot-assisted Wallace ileal conduit is safe,feasible,and effective in the treatment of ureteral obstruction following radical cystectomy.However,for malignant obstruction caused by tumor recurrence,combined comprehensive therapy is necessary to reduce recurrence risk.
3.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.
4.Clinical efficacy of robot-assisted Wallace ileal conduit in the treatment of ureteral obstruction after radical cystectomy
Tianxiao HONG ; Chaoran ZHAO ; Rongjie BAI ; Pengchao LI
Journal of Modern Urology 2025;30(10):860-864
Objective To investigate the feasibility and efficacy of robot-assisted Wallace ileal conduit in the treatment of ureteral obstruction following radical cystectomy.Methods A retrospective analysis was conducted on the clinical data of 8 patients with postoperative distal ureteral obstruction after radical cystectomy treated at the First Affiliated Hospital of Nanjing Medical University during Aug.2018 and Jun.2024.The cohort included 7 males and 1 female,aged 51-68 years(mean:58.8 years).Preoperative imaging confirmed the obstruction site and predicted its etiology.All patients underwent robot-assisted Wallace ileal conduit and were regularly followed postoperatively.Perioperative data were statistically analyzed.Results All 8 procedures were successfully completed.The operation time ranged from 120 to 398 minutes(mean:298.38 minutes),and intraoperative blood loss from 50 to 300 mL(mean:112.5 mL).Postoperative complications occurred in 3 cases according to the Clavien-Dindo classification:one Grade Ⅰ and two Grade Ⅱ,with no major postoperative complications(Grade Ⅲ and above)observed.During a follow-up of 21-77 months,hydronephrosis and renal function showed varying degrees of improvement.Conclusion Robot-assisted Wallace ileal conduit is safe,feasible,and effective in the treatment of ureteral obstruction following radical cystectomy.However,for malignant obstruction caused by tumor recurrence,combined comprehensive therapy is necessary to reduce recurrence risk.
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.Study on quality evaluation of Mongolian medicine Sanzi powder:fingerprint,chemical pattern recognition and multi-component quantification analysis
Jun LI ; Rongjie LI ; Fengye ZHOU ; Qian ZHANG ; Wei ZHANG ; Bohan ZHANG ; Shu WANG ; Xitong ZHAO ; Jianping CHEN
China Pharmacy 2025;36(4):414-420
OBJECTIVE To establish fingerprint,chemical pattern recognition and multi-component quantification analysis of Sanzi powder,and evaluate its quality.METHODS HPLC method was adopted.The fingerprints of 15 batches of Sanzi powder were established by using the Similarity Evaluation System for Chromatographic Fingerprint of Traditional Chinese Medicine(2012 edition).Cluster analysis,principal component analysis and orthogonal partial least squares-discriminant analysis were also conducted.The variable importance in projection(VIP)value greater than 1 was used as the index to screen the differential markers,and the contents of the differential markers were determined by the same HPLC method.RESULTS A total of 21 common peaks in the HPLC fingerprints of 15 batches of Sanzi powder were calibrated,and the similarities of them were 0.994-0.999;6 common peaks were identified,including gallic acid(peak 3),garminoside(peak 10),corilagin(peak 11),chebulinic acid(peak 16),ellagic acid(peak 18),crocin Ⅰ(peak 19).According to the results of cluster analysis,principal component analysis and orthogonal partial least squares-discriminant analysis,15 batches of samples could be clustered into two categories:S1,S5,S7,S9,S14 were clustered into one category;S2-S4,S6,S8,S10-S13,S15 were clustered into one category.VIP values of 11 differential components such as corilagin,chebulinic acid and ellagic acid were higher than 1.Among 15 batches of samples,the contents of corilagin,chebulinic acid and ellagic acid ranged 2.667-5.152,9.506-13.522,0.891-1.811 mg/g.CONCLUSIONS Established HPLC fingerprint and multi-component quantification analysis of Sanzi powder are rapid and simple,and can be used for quality evaluation of Sanzi powder by combining with chemical pattern recognition.Eleven components such as corilagin,chebulinic acid and ellagic acid are differential markers affecting the quality of Sanzi powder.
7.The relationship between blood uric acid levels and non-alcoholic fatty liver disease in patients with type H hypertension
Yao ZHANG ; Yingxin HUO ; Wei ZHAO ; Rongjie TANG ; Qiufang LIAN
The Journal of Practical Medicine 2024;40(18):2561-2565
Objective To explore the relationship between blood uric acid levels and non-alcoholic fatty liver disease in patients with type H hypertension.Methods The clinical data of 284 patients with type H hyper-tension admitted to the Cardiovascular Department,Xianyang Hospital,Yan'an University in 2022 were collected and retrospectively reviewed.The patients were divided into NAFLD group(n=88)and normal group(n=196)according to whether they had NAFLD.The general information and laboratory indicators were compared between the two groups.Multivariate logistic regression analysis was conducted to explore the influencing factors of NAFLD in H-type hypertension patients.The draw ROC curves were plotted to observe the role of SUA in predicting NAFLD and select the optimal cutoff value based on the maximum Youden index.Results The NAFLD group demonstrated higher levels in body mass index,systolic blood pressure,diastolic blood pressure,total cholesterol,triglycerides,low-density lipoprotein cholesterol,SUA,γ-Glutamyl transpeptidase and alanine aminotransferase compared to the normal group,but significantly lower levels at age and high-density lipoprotein cholesterol(P<0.05).The multivariate logistic regression analysis showed that elevated levels of BMI(OR=1.173,95%CI:1.066~1.291),SUA(OR=1.005,95%CI:1.001~1.010),and TG(OR=1.929,95%CI:1.042~3.574)were risk factors for NAFLD in patients with type H hypertension(P<0.05).The ROC curves showed that the area under the curve(AUC)of SUA,TG,BMI,and their combination were 0.709,0.707,0.750,and 0.796,respectively.Conclusion type H hypertensive NAFLD patients have high levels of BMI,SUA,TG compared to non-NAFLD patients.Elevated SUA is a risk factor for type H hypertensive NAFLD patients,with SUA>337 μmol/L as a significant value for predicting NAFLD.
8.N/OFQ alleviates anxiety-like behaviors in nicotine withdrawal-induced rats and its mechanism related to HPA axis and inflammatory factors
Pengyang WU ; Rongjie ZHAO ; Lulu LI ; Qiuyue LI ; Chunjing ZHANG ; Lina WU ; Zhenglin ZHAO
Chinese Journal of Pathophysiology 2024;40(10):1926-1933
AIM:To investigate the ameliorative effect of nociceptin/orphanin(N/OFQ)on anxiety-like be-havior in nicotine(NIC)withdrawal-induced rats and its regulatory mechanisms on the expression of neurotransmitters as-sociated with the hypothalamic-pituitary-adrenal(HPA)axis and inflammatory factors.METHODS:Thirty-two adult male Sprague-Dawley rats were randomly divided into 4 groups:normal control group,NIC withdrawal model group,low-dose N/OFQ treatment group,and high-dose N/OFQ treatment group,with 8 rats in each group.To establish NIC with-drawal model,the rats in the NIC model and N/OFQ treatment groups were subcutaneously injected with NIC(0.4 mg/kg),twice a day for 7 consecutive days followed by 3 days of withdrawal.During the withdrawal period,the rats in the low and high-dose N/OFQ treatment groups received intracerebroventricular injection of N/OFQ(1 nmol or 10 nmol)once per day for 3 consecutive days.Ten minutes after the third administration,all rats underwent open filed(OF)and elevated plus maze(EPM)tests to detect behavioral changes.The serum concentrations of corticotrophin-releasing hormone(CRH),adrenocorticotropic hormone(ACTH),corticosterone(CORT),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β)and IL-6 were measured by ELISA.The mRNA expression levels of TNF-α,IL-1β and IL-6 in the central nu-cleus of the amygdala(CeA)of the brain were detected by RT-qPCR.Histological changes in neuron morphology in the CA1 region of the hippocampus were observed under a light microscope following hematoxylin and eosin(HE)staining.Norepinephrine(NE)levels in the CeA of the brain were determined by HPLC.The protein expression of tyrosine hydroxy-lase(TH)in the CeA of the brain was detected by Western blot.RESULTS:Compared with the NIC withdrawal model group,rats in the low and high-dose N/OFQ treatment groups showed significant increase in the distance and time spent in the central area of the open field(P<0.05 or P<0.01),as well as significant increase in the number of entries and the per-centage of time spent in the open arms of the EPM(P<0.05 or P<0.01).Furthermore,both low and high-dose N/OFQ treatment groups significantly inhibited serum concentrations of CRH,ACTH and CORT in NIC withdrawal rats(P<0.01).N/OFQ administration also significantly reduced the levels of inflammatory cytokines TNF-α,IL-1β,and IL-6 in the serum,as well as expression levels of TNF-α,IL-1β and IL-6 mRNA in the CeA(P<0.05 or P<0.01).The treatment with N/OFQ at both doses significantly alleviated neuronal damage in the CA1 region of the hippocampus and markedly re-duced thelevels of NE and TH protein expression in the CeA of NIC withdrawal rats(P<0.01).CONCLUSION:N/OFQ alleviates anxiety-like behavior in NIC withdrawal rats through mechanisms related to the regulation of HPA axis hormone levels and inflammatory factors.
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.

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