Objective:To explore the value of the vesical imaging-reporting and data system (VI-RADS) score based on multiparametric MRI (mpMRI) combined with quantitative tumor MRI parameters in assessing the muscle invasion of bladder cancer.Methods:The study was a case-control study. The data of 87 bladder cancer patients confirmed by pathology who underwent mpMRI of the bladder were retrospectively collected from the First Medical Center of Chinese PLA General Hospital between January 2019 and April 2023 The pathological findings were used as the gold standard to categorize them into the muscle invasive bladder cancer (MIBC) group (29 cases) and non-muscle invasive bladder cancer (NMIBC) group (58 cases). Quantitative parameters were measured based on preoperative mpMRI images, including the length of tumor bladder wall contact, the perpendicular distance between the bladder tumor and the tangent of the bladder wall, the maximal diameter of the bladder tumor, and the volume of the bladder tumor. Bladder cancer was classified according to the VI-RADS scoring criteria. The Mann-Whitney U test was used for intergroup comparisons. Multivariate logistic regression analysis was performed to obtain the independent risk factors related to muscle invasion of bladder cancer and to establish the model. The receiver operating characteristic curves were analyzed for MRI quantitative parameters and logistic regression models, and area under the curve (AUC) comparisons were performed using the DeLong test. Results:The differences in tumor bladder wall contact length, perpendicular distance from the tumor to the tangent line of the bladder wall, maximum diameter, bladder tumor volume, and the VI-RADS scores were statistically significant between the MIBC group and the NMIBC group ( P<0.05). Multifactorial logistic regression analysis showed that tumor bladder wall contact length ( OR=21.07, 95% CI 3.56-124.89, P=0.001) and VI-RADS score ( OR=11.90, 95% CI 3.53-40.12, P<0.001) were the independent risk factors for evaluating the muscle invasion of bladder cancer. The difference between the VI-RADS score and the tumor bladder wall contact length for assessing muscular infiltration of bladder cancer had AUCs of 0.802 (95% CI 0.704-0.899) and 0.759 (95% CI 0.652-0.865). The combined model of VI-RADS score combined with tumor bladder wall contact length had an AUC of 0.891 (95% CI 0.812-0.970), which was higher than the diagnostic efficacy of applying tumor bladder wall contact length or VI-RADS score alone ( Z=3.05, 2.37, P=0.002, 0.018). Conclusion:Tumor contact length with the bladder wall is an independent risk factor for assessing muscle invasion of bladder cancer and the combination of VI-RADS score may enhances diagnostic accuracy.

Objective:To investigate the value of biparametric-MRI (bpMRI) based peritumoral radiomics for preoperative prediction of extraprostatic extension (EPE) in prostate cancer (PCa).Methods:In this cross-sectional study, consecutive bpMRI of patients undergoing prostatectomy for PCa were retrospectively collected from the First Medical Center (center 1) and the Third Medical Center (center 2) of Chinese PLA General Hospital. A total of 274 patients were finally enrolled. Patients at center 1 from January 2020 to December 2022 were randomly divided into a training set (149 cases) and an internal validation set (63 cases) by stratified random sampling. Patients at center 2 from January 2023 to March 2024 were assigned to the external test set (62 cases). Patients were categorized into EPE-positive group and EPE-negative group according to pathological assessment postoperatively. In the training set, there were 49 cases in EPE-positive group and 100 cases in EPE-negative group. In the internal validation set, there were 26 cases in EPE-positive group and 37 cases in EPE-negative group. In the external test set, there were 22 cases in EPE-positive group and 40 cases in EPE-negative group. Axial T 2WI and apparent diffusion coefficient (ADC) images were manually annotated to obtain index lesion regions of interest (ROIs), with the peritumoral ROIs subsequently delineated by semi-automatic segmentation technique. Radiomics features were extracted from intra-tumoral, peri-tumoral, and intra-tumoral plus peri-tumoral ROIs. The training set data was employed to select and optimize features to build the radiomics models. The logistic regression analysis was used to develop radiomics, clinical, and integrated models. The predictive performance was assessed by the area under the receiver operating characteristic curve (AUC) in the external test set, and compared by the DeLong test. The sensitivity and specificity were compared by the exact McNemar test. Results:In the external test set, the peri-tumoral radiomics model based on bpMRI showed the highest performance in evaluating EPE, with an AUC of 0.739 (95% CI 0.611-0.842), which was identified as the optimal radiomics model. EPE grade ( OR=6.151, 95% CI 3.371-11.226, P<0.001) was incorporated into the clinical model, with an AUC of 0.780 (95% CI 0.657-0.875) in the external test set. The integrated model had an AUC of 0.817 (95% CI 0.698-0.904) in the external test set. There was no statistically significant difference in comparisons of AUCs among the three models (all P>0.05). The sensitivity of the integrated model (68.2%) showed no significant difference from those of the clinical model and the optimal radiomics model (77.3% and 86.4%, respectively; P=0.500 and P=0.289). However, the specificity of the integrated model (85.0%) was significantly higher than those of the clinical model (67.5%, P=0.016) and the optimal radiomics model (50.0%, P<0.001). Conclusion:A bpMRI-based peritumoral radiomics integrating clinical model demonstrates high performance for preoperative prediction of EPE in PCa.

Objective To investigate the effects and mechanisms of supplemented Buyang Huanwu decoction(BYHWD)on zinc home-ostasis and reproductive function in oligoasthenozoospermia(OAS)rats.Methods As many as 60 male SD rats were randomly divided into control,OAS,L-carnitine(0.323 g/kg),BYHWD low-dose(BYHWD-L,19.5 g/kg),BYHWD medium-dose(BYHWD-M,39 g/kg),and BYHWD high-dose(BYHWD-H,78 g/kg)groups,with 10 rats in each group.Except for the control group,all other groups were admini-stered adenine by gavage to establish an OAS model.After successful construction of the model,each group was treated by gavage with the corresponding drug doses or physiological saline once daily for 4 weeks.The general condition of the rats was recorded,testicular and epididymal coefficients were calculated,and sperm water volume and vitality were measured.Enzyme linked immunosorbent assay(ELISA)was used to measure the levels of serum testosterone(T),estradiol(E2),follicle-stimulating hormone(FSH),luteinizing hormone(LH),prolactin(PRL),as well as the levels of interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor α(TNF-α)and zinc containing enzymes alcohol dehydrogenase(ADH),alkaline phosphatase(ALP),and lactate dehydrogenase(LDH)in testicular tissue.The zinc con-tent in testicular tissue were also measured.Pathological changes in testicular tissue were observed using hematoxylin eosin(HE)staining.Toll-like receptor 4(TLR4),myeloid differentiation factor 88(MyD88),and nuclear factor kappa-B(NF-κB)protein expression in testicu-lar tissue were identified using immunohistochemistry.Results Compared to the control group,the OAS group exhibited significantly lower testicular and epididymal coefficients,sperm motility,sperm count,serum T and E2 levels(P＜0.05)and significantly higher FSH,LH,and PRL levels(P＜0.05).Furthermore,the OAS group showed significantly lower testicular tissue zinc content and levels of zinc containing enzymes ADH,ALP,and LDH(P＜0.05)than the control group.Conversely,IL-1β,IL-6,and TNF-α levels,along with protein expressions of TLR4,MyD88,and NF-κB were significantly higher in the OAS group than in the control group(P＜0.05).Compared to the OAS group,each drug intervention group showed improvements in testicular and epididymal coefficients,sperm motility,sperm count,T and E2 levels,testicular zinc content and zinc containing enzymes(ADH,ALP,and LDH)levels.Furthermore,the intervention groups demonstrated reduced FSH,LH,PRL,IL-1β,IL-6,and TNF-α levels,and TLR4/MyD88/NF-κB signaling pathway protein expression(P＜0.05).Conclusion BYHWD improves the reproductive function of OAS rats,potentially by regulating zinc homeostasis and TLR4/MyD88/NF-κB signaling pathway,consequently reducing the inflammatory response.

Vertebral refracture following percutaneous vertebral augmentation (PVA) is commonly seen in elderly patients with osteoporotic thoracolumbar compression fractures (OTLCF). It can lead to recurrent pain, loss of vertebral height, progression of kyphosis, and even neurological dysfunction, significantly impairing patients′ quality of life. Current diagnosis and treatment face multiple challenges, including high misdiagnosis rate, difficulty in choosing between surgical and non-surgical treatment options, lack of standardized surgical protocols, interference from intralesional bone cement during procedures, inadequate stability of internal fixation in osteoporotic bone, and suboptimal compliance of anti-osteoporotic therapy. Establishing a standardized diagnostic and therapeutic framework is urgently needed. To standardize the management process and improve outcomes for vertebral refractures after PVA in elderly OTLCF patients, Spinal Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized experts in the field to develop Guideline for the diagnosis and treatment of vertebral refracture after percutaneous vertebral augmentation in elderly patients with osteoporotic thoracolumbar compression fractures ( version 2025), based on current literature and clinical experience, and adhering to principles of scientific rigor and clinical applicability. A total of 11 recommendations were proposed, encompassing diagnosis, treatment, and rehabilitation of vertebral refracture after PVA in elderly patients with OTLCF, aiming to provide a foundation for a standardized management.

The rapid increase in the incidence of early-onset colorectal cancer (EOCRC) has significantly reduced the median age of diagnosis for this disease, resulting in a substantial socio-economic burden. Currently, colonoscopy remains the primary screening tool for colorectal cancer; however, compliance among the target population is low, partly due to the invasive nature of the procedure. Screening plays a crucial role in disease prevention and treatment, as it can effectively increase disease detection rates and significantly improve the prognosis of patients through early intervention. Therefore, the development of highly sensitive and specific early screening methods for EOCRC is of considerable clinical importance. This article reviews the current screening strategies for early diagnosis of EOCRC patients, with a focus on the research progress of non-invasive screening such as fecal and blood-based testing, aiming to provide references for clinicians in selecting screening methods.

Objective:To evaluate the efficacy of preoperative prediction of regional lymph node (RLN) metastasis in renal cell carcinoma (RCC) using a machine learning model based on habitat imaging radiomics from renal MRI.Methods:This cross-sectional study retrospectively analyzed 220 patients with RCC who underwent nephrectomy and RLN dissection at four medical centers of Chinese PLA General Hospital from January 2010 to August 2023. The cohort included 65 patients with RLN metastasis and 155 without. A stratified random sampling method was used to divide 175 patients from the first medical center into a training set ( n=140) and an internal test set ( n=35) in an 8∶2 ratio, while 45 patients from the third, fourth, and fifth medical centers constituted the external test set. The primary RCC lesions were categorized into 15 habitat subregions based on corticomedullary-phase enhancement and T 2WI signal intensity on MRI, and the volume fractions of different subregions were analyzed. In the training cohort, radiomics features derived from the habitat subregions were used to construct a radiomics model employing various machine learning algorithms, including extremely random trees (ET), gradient boosting decision trees (GBDT), random forest (RF), and support vector machine (SVM). The optimal model was selected and combined with RLN short-axis diameter to develop a combined model. The efficacy of each model in predicting RLN metastasis was evaluated using the receiver operating characteristic (ROC) curve. Results:The volume fraction of hyper-enhanced hyper-intense regions in the non-metastatic group was significantly higher than that in the metastatic group (0.05±0.09 vs. 0.02±0.03; t=3.00, P=0.003). Among the machine learning models constructed using 15 optimal habitat radiomics features, the SVM model demonstrated the best performance, with area under the ROC curve (AUC) values of 0.85 (95% CI 0.72-0.98) in the internal test set and 0.82 (95% CI 0.67-0.98) in the external test set, surpassing those of the ET, GBDT, and RF models. The combined model, integrating the SVM model with RLN short-axis diameter, achieved AUC values of 0.94 (95% CI 0.85-1.00) in the internal test set and 0.89 (95% CI 0.78-1.00) in the external test set, with RLN short-axis diameter contributing AUC values of 0.81 (95% CI 0.66-0.96) and 0.81 (95% CI 0.68-0.94), respectively. The diagnostic sensitivity of the combined model was 91.7% in the internal test set and 85.7% in the external test set, with specificities of 78.3% and 67.7%, respectively. Conclusion:The combined model based on MRI habitat imaging radiomics and RLN short-axis diameter demonstrates excellent preoperative assessment capability for RLN metastasis in RCC.

With the increasing utilization of cancer therapy, the incidence of lung injury associated with these treatments continues to rise. The recognition of pulmonary toxicity related to cancer therapy has become increasingly critical, for which interstitial lung disease (ILD) is a common cause of mortality. Cancer therapy-related ILD (CT-ILD) can result from a variety of treatments including chemotherapy, targeted therapy, immune checkpoint inhibitors, antibody-drug conjugates, and radiotherapy. CT-ILD may progress rapidly and even be life-threatening; therefore, prompt diagnosis and timely treatment are crucial for effective management. This review aims to provide valuable information on the risk factors associated with CT-ILD; elucidate its underlying mechanisms; discuss its clinical features, imaging, and histological manifestations; and emphasize the clinical-related views of its diagnosis. In addition, this review provides an overview of grading, typing, and staging treatment strategies used for the management of CT-ILD.
Humans ; Lung Diseases, Interstitial/diagnosis* ; Neoplasms/therapy* ; Risk Factors ; Immune Checkpoint Inhibitors/adverse effects* ; Antineoplastic Agents/therapeutic use*

Objective To investigate the effects of different inspired oxygen concentrations on periop-erative cerebrovascular function in patients with a history of ischemic stroke.Methods A total of 150 patients scheduled for elective surgery with a history of ischemic stroke were enrolled from Renji Hospital,Shanghai Jiao Tong University School of Medicine,between June 2020 and March 2024.Using a random number table,patients were allocated into two groups:F30 group(intraoperative fraction of inspired oxygen,FiO2=30%)and F80 group(FiO2=80%),with 75 patients in each group.Bilateral middle cerebral artery(MCA)blood flow was continu-ously monitored using transcranial Doppler(TCD),including mean flow velocity(Vm),resistance index(RI),and pulsatility index(PI).Cerebral oxygen saturation(rScO2)was measured using a FORE-SIGHT oximeter.Arterial blood gas analysis was performed preoperatively,1 hour after induction,and before extubation to assess pH,partial pressure of arterial carbon dioxide(PaCO2),oxygenation index(OI),base excess(BE),hematocrit(Hct),and lactate(Lac).Peripheral blood samples were collected 24 hours postoperatively to measure thrombox-ane A2(TXA2)and prostacyclin(PGI2)levels.At 1 month postoperatively,telephone follow-up was conducted to evaluate the risk of recurrent cerebral ischemic events using the ABCD2 score and Essen Stroke Risk Score(ESRS).Results No significant differences were observed in baseline characteristics between the two groups.Perioperative arterial blood gas parameters did not differ significantly between groups(P>0.05).Compared with the F30 group,the F80 group exhibited a smaller reduction in mean flow velocity(Vm)of the affected MCA at the end of surgery(8.18%±3.34%vs.13.57%±5.32%,P<0.05),while no significant intergroup differences were found in RI or PI.At 1 hour after induction and before extubation,rScO2 of the affected hemisphere was signifi-cantly increased in the F80 group as compared with the F30 group(P<0.05),whereas no significant difference was observed in the contralateral hemisphere.Before extubation and on postoperative day 1,TXA2 levels were significantly lower and PGI2 levels higher in F80 group compared with F30 group(P<0.05).The proportion of patients at high risk of cerebral ischemia by ABCD2 and ESRS at 1 month postoperatively did not differ between groups(P>0.05).Conclusion In patients with a history of stroke,intraoperative administration of 80%FiO2under general anesthesia better maintains perioperative cerebral hemodynamic stability and cerebral oxygen satura-tion,improves cerebrovascular endothelial function,but does not significantly affect the short-term incidence of postoperative cerebrovascular events compared with 30%FiO2.

Objective To investigate the effects and mechanisms of supplemented Buyang Huanwu decoction(BYHWD)on zinc home-ostasis and reproductive function in oligoasthenozoospermia(OAS)rats.Methods As many as 60 male SD rats were randomly divided into control,OAS,L-carnitine(0.323 g/kg),BYHWD low-dose(BYHWD-L,19.5 g/kg),BYHWD medium-dose(BYHWD-M,39 g/kg),and BYHWD high-dose(BYHWD-H,78 g/kg)groups,with 10 rats in each group.Except for the control group,all other groups were admini-stered adenine by gavage to establish an OAS model.After successful construction of the model,each group was treated by gavage with the corresponding drug doses or physiological saline once daily for 4 weeks.The general condition of the rats was recorded,testicular and epididymal coefficients were calculated,and sperm water volume and vitality were measured.Enzyme linked immunosorbent assay(ELISA)was used to measure the levels of serum testosterone(T),estradiol(E2),follicle-stimulating hormone(FSH),luteinizing hormone(LH),prolactin(PRL),as well as the levels of interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor α(TNF-α)and zinc containing enzymes alcohol dehydrogenase(ADH),alkaline phosphatase(ALP),and lactate dehydrogenase(LDH)in testicular tissue.The zinc con-tent in testicular tissue were also measured.Pathological changes in testicular tissue were observed using hematoxylin eosin(HE)staining.Toll-like receptor 4(TLR4),myeloid differentiation factor 88(MyD88),and nuclear factor kappa-B(NF-κB)protein expression in testicu-lar tissue were identified using immunohistochemistry.Results Compared to the control group,the OAS group exhibited significantly lower testicular and epididymal coefficients,sperm motility,sperm count,serum T and E2 levels(P＜0.05)and significantly higher FSH,LH,and PRL levels(P＜0.05).Furthermore,the OAS group showed significantly lower testicular tissue zinc content and levels of zinc containing enzymes ADH,ALP,and LDH(P＜0.05)than the control group.Conversely,IL-1β,IL-6,and TNF-α levels,along with protein expressions of TLR4,MyD88,and NF-κB were significantly higher in the OAS group than in the control group(P＜0.05).Compared to the OAS group,each drug intervention group showed improvements in testicular and epididymal coefficients,sperm motility,sperm count,T and E2 levels,testicular zinc content and zinc containing enzymes(ADH,ALP,and LDH)levels.Furthermore,the intervention groups demonstrated reduced FSH,LH,PRL,IL-1β,IL-6,and TNF-α levels,and TLR4/MyD88/NF-κB signaling pathway protein expression(P＜0.05).Conclusion BYHWD improves the reproductive function of OAS rats,potentially by regulating zinc homeostasis and TLR4/MyD88/NF-κB signaling pathway,consequently reducing the inflammatory response.

Objective:To explore the value of the vesical imaging-reporting and data system (VI-RADS) score based on multiparametric MRI (mpMRI) combined with quantitative tumor MRI parameters in assessing the muscle invasion of bladder cancer.Methods:The study was a case-control study. The data of 87 bladder cancer patients confirmed by pathology who underwent mpMRI of the bladder were retrospectively collected from the First Medical Center of Chinese PLA General Hospital between January 2019 and April 2023 The pathological findings were used as the gold standard to categorize them into the muscle invasive bladder cancer (MIBC) group (29 cases) and non-muscle invasive bladder cancer (NMIBC) group (58 cases). Quantitative parameters were measured based on preoperative mpMRI images, including the length of tumor bladder wall contact, the perpendicular distance between the bladder tumor and the tangent of the bladder wall, the maximal diameter of the bladder tumor, and the volume of the bladder tumor. Bladder cancer was classified according to the VI-RADS scoring criteria. The Mann-Whitney U test was used for intergroup comparisons. Multivariate logistic regression analysis was performed to obtain the independent risk factors related to muscle invasion of bladder cancer and to establish the model. The receiver operating characteristic curves were analyzed for MRI quantitative parameters and logistic regression models, and area under the curve (AUC) comparisons were performed using the DeLong test. Results:The differences in tumor bladder wall contact length, perpendicular distance from the tumor to the tangent line of the bladder wall, maximum diameter, bladder tumor volume, and the VI-RADS scores were statistically significant between the MIBC group and the NMIBC group ( P<0.05). Multifactorial logistic regression analysis showed that tumor bladder wall contact length ( OR=21.07, 95% CI 3.56-124.89, P=0.001) and VI-RADS score ( OR=11.90, 95% CI 3.53-40.12, P<0.001) were the independent risk factors for evaluating the muscle invasion of bladder cancer. The difference between the VI-RADS score and the tumor bladder wall contact length for assessing muscular infiltration of bladder cancer had AUCs of 0.802 (95% CI 0.704-0.899) and 0.759 (95% CI 0.652-0.865). The combined model of VI-RADS score combined with tumor bladder wall contact length had an AUC of 0.891 (95% CI 0.812-0.970), which was higher than the diagnostic efficacy of applying tumor bladder wall contact length or VI-RADS score alone ( Z=3.05, 2.37, P=0.002, 0.018). Conclusion:Tumor contact length with the bladder wall is an independent risk factor for assessing muscle invasion of bladder cancer and the combination of VI-RADS score may enhances diagnostic accuracy.