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.

Circular RNA(circRNA)is a novel class of endogenous non-coding RNA with complex biological func-tions,participating in various physiological and pathological processes.Due to their relatively stable stucture and tissue-specific and temporal expression patterns,circRNA have become a recent focus of biomedical research.Heart failure(HF)is characterized by impaired ventricular filling and/or ejection function caused by primary myocardial injury and car-diac overload,leading to the inability of the heart to meet the metabolic demands of the body's tissues.It is the end stage of numerous cardiac diseases.Studies have found that circRNA may play a crucial regulatory role in the progression of HF,particularly in cardiomyocyte hypertrophy,cardiomyocyte apoptosis,autophagy and myocardial fibrosis.This review summarizes the formation,classification,functional forms,and roles in HF of circRNA,aiming to provide new insights for the prevention and treatment of HF.

Humans ; Tranexamic Acid/therapeutic use* ; Arthroplasty, Replacement, Knee ; Antifibrinolytic Agents/therapeutic use* ; Blood Loss, Surgical ; Postoperative Hemorrhage

ObjectiveTo explore the protective effect and mechanism of Yangxin Dingji capsules on isoproterenol （ISO）-induced ventricular arrhythmia in SD rat cardiomyocytes based on the transforming growth factor-β activated kinase 1 （TAK1）-mitogen-activated protein kinase kinase 3 （MKK3）-p38 mitogen-activated protein kinase （p38 MAPK） signaling pathway. MethodFifty male SPF-grade SD rats were randomly divided into a normal group， a model group， a propranolol group， a low-dose Chinese medicine group， and a high-dose Chinese medicine group. The ventricular arrhythmia model was constructed using the ISO "6+1" method. The propranolol group received propranolol at 0.015 g·kg^-1·d^-1. The Chinese medicine groups received Yangxin Dingji capsules at doses of 0.5、 2 g·kg^-1·d^-1， respectively. The normal and model groups were given an equal volume of 0.9% NaCl solution. Electrocardiogram （ECG） changes in SD rats were recorded using the BL-420F biological function experimental system. Hematoxylin-eosin （HE） staining was used to observe the pathological changes in the heart. Serum levels of cardiac troponin I （cTnI）， creatine kinase-MB （CK-MB）， interleukin-1β （IL-1β）， tumor necrosis factor-α （TNF-α）， and transforming growth factor-β₁ （TGF-β₁） were measured using enzyme-linked immunosorbent assay （ELISA）. The mRNA expression of IL-1β and TNF-α was assessed using real-time fluorescence quantitative polymerase chain reaction （Real-time PCR）. Reactive oxygen species （ROS） expression was detected using immunofluorescence. Protein expression levels of TAK1， phosphorylated TAK1 （p-TAK1）， MKK3， phosphorylated MKK3 （p-MKK3）， p38 MAPK， phosphorylated p38 MAPK （p-p38 MAPK）， nuclear factor-κB （NF-κB）， phosphorylated NF-κB （p-NF-κB）， IL-1β， and TNF-α were measured using Western blot or immunohistochemistry. ResultCompared with normal group， the model group showed significant ventricular arrhythmia in ECG， with an increased arrhythmia score （P<0.01）. Pathological damage to myocardial tissue was evident， and serum levels of cTnI， CK-MB， IL-1β， TNF-α， and TGF-β₁ were elevated （P<0.01）. The mRNA and protein expression of IL-1β and TNF-α in myocardial tissue was also increased （P<0.01）. ROS level and protein expression of p-TAK1， p-MKK3， p-p38 MAPK， and p-NF-κB were elevated in myocardial tissue （P<0.01）. In the propranolol and Chinese medicine groups， the incidence of sustained ventricular tachycardia （SVT） and arrhythmia scores were significantly reduced compared to model group （P<0.05， P<0.01）. Pathological damage to cardiomyocytes was alleviated， and levels of myocardial injury markers and inflammatory factors in serum and myocardial tissue were decreased. The ROS level in myocardial tissue was also reduced （P<0.01）， with a noticeable reduction in related molecules in the p38 MAPK pathway （P<0.05， P<0.01）. ConclusionThe expression of p38 MAPK pathway molecules was up-regulated in myocardial tissue of ISO-induced ventricular arrhythmia rats. Yangxin Dingji capsules may inhibit cardiac inflammation damage by regulating the expression of related molecules in the p38 MAPK pathway， thereby exerting a protective effect on myocardial cells， with TAK1 being a potential target.

Objective:To explore the efficacy of single-plane bi-parameter magnetic resonance imaging (bpMRI) in the diagnosis of prostate cancer.Methods:The clinical data of 343 patients who underwent transperineal template prostate magnetic resonance-transrectal ultrasound (MRI-TRUS) cognitive fusion biopsy at the First Affiliated Hospital of Nanjing Medical University from January 2020 to July 2021 were retrospectively analyzed, with median age of [65.0(59.0, 72.0)] years, median body mass index (BMI) of [24.1(22.2, 25.6)]kg/m 2, median prostate volume (PV) of [41.7(29.1, 53.3)]ml, median PSA[6.9 (5.5, 8.4) ng/ml], median PSAD of[0.17(0.12, 0.22) ng/ml 2], and abnormal rate of digital rectal examination (DRE) [6.4%(22/343)]. All patients underwent initial biopsy and bi-parameter magnetic resonance imaging (bpMRI) examination before biopsy, and the images were interpreted using prostate image reporting and data system version 2.1 (PI-RADS v2.1). The detection rates of prostate cancer and clinically significant prostate cancer (csPCa) were compared between single-plane bpMRI and bpMRI. When PI-RADS≥3 score, MRI results were positive; when PI-RADS ≤2 score, MRI results were negative. Results:In the single-plane bpMRI group, 121 MRI results were negative and 222 were positive. Positive patients included 95 with PI-RADS 3 score, 94 with PI-RADS 4 score, and 33 with PI-RADS 5 score. In bpMRI group, 141 MRI results were negative and 202 were positive. Among the positive patients, 67 patients with PI-RADS 3 score, 102 patients with PI-RADS 4 score, and 33 patients with PI-RADS 5 score. The detection rates of single-plane bpMRI and bpMRI for prostate cancer were 22.3% (27/121) and 15.6% (22/141) in MRI negative cases[22.3% (27/121) and 15.6% (22/141), P=0.17], and PI-RADS scores with 3 points [35.8% (34/95) vs. 44.8% (30/67), P=0.25], 4 points [89.4% (84/94)vs. 90.2% (92/102), P=0.85] and 5 points [90.9% (30/33) vs. 93.9% (31/33), P=1.00] showed no significant difference in stratification. The detection rate of csPCa in the single-plane bpMRI group and bpMRI group was significantly different in the MRI negative cases [7.4% (9/121) and 2.1% (3/141), P=0.04]. PI-RADS scores with 3 points [22.1% (21/95) vs. 29.9% (20/67), P=0.27], 4 points [80.9% (76/94) vs. 79.4% (81/102), P=0.80] and 5 points [84.9% (28/33) vs. 90.9% (30/33), P=0.71] showed no significant difference in stratification. Conclusions:For those suspected of prostate cancer patients with PSA 4-10 ng/ml and PI-RADS score ≥3, single-plane bpMRI or bpMRI examination has the same efficacy in term of the detection rate of prostate cancer and csPCa.

Cerebral small vessel disease refers to a series of clinical, imaging and pathological syndromes caused by various diseases affecting small arteries, arterioles, capillaries, venules, and venules in the brain, thereby causing ischemia or hemorrhage in brain tissue. At present, intravenous thrombolytic therapy is the first choice for the treatment of acute ischemic stroke, however a large number of studies have shown that the presence of cerebral small vessel disease before acute ischemic stroke increases the risk of intravenous thrombolysis. In this article, the recent research progresses about the relationship between cerebral small vessel disease and hemorrhagic transformation after venous thrombolysis in acute ischemic stroke are reviewed, aiming to provide a new reference for clinical intravenous thrombolytic therapy.

Cerebral small vessel disease refers to a series of clinical, imaging and pathological syndromes caused by various diseases affecting small arteries, arterioles, capillaries, venules, and venules in the brain, thereby causing ischemia or hemorrhage in brain tissue. At present, intravenous thrombolytic therapy is the first choice for the treatment of acute ischemic stroke, however a large number of studies have shown that the presence of cerebral small vessel disease before acute ischemic stroke increases the risk of intravenous thrombolysis. In this article, the recent research progresses about the relationship between cerebral small vessel disease and hemorrhagic transformation after venous thrombolysis in acute ischemic stroke are reviewed, aiming to provide a new reference for clinical intravenous thrombolytic therapy.

Stroke has increasingly become one of the three major diseases threatening human beings,among which acute ischemic stroke is the most common.Intravenous thrombolysis has become the first choice for acute ischemic stroke,but a large number of studies have shown that intravenous thrombolysis increases the risk of hemorrhagic transformation.The latest advances in clinical types,incidence,mechanism and risk factors of hemorrhagic transformation after thrombolysis with recombinant human tissue plasminogen activator are reviewed in this article,and the possible predictors of hemorrhagic transformation are discussed,aiming to provide new reference for clinical thrombolytic therapy.

Objective To investigate the diagnostic performance of ADC value for predicting proliferation and invasiveness of cervical squamous cell carcinoma (SCC).Methods Totally 96 patients with pathologically confirmed SCC underwent preoperative conventional MRI and DWI.Mini-ADC value,mean-ADC value and mini-ADC ratio (mini-ADC/meam ADC) were measured and compared for various patient groups divided based on Ki-67 labeling index and clinicopathological characteristics.Results The mini-ADC values were significantly lower in patients with high Ki-67 expression,tumor size ≥4 cm,high FIGO staging,low pathological grade,depth of cervical stromal infiltrating ≥ 1/2,parametrial involvement,lymphovascular invasion (LVI),lymph node metastasis and perineural invasion (PNI,all P＜ 0.05).Compared with mean-ADC value and mini-ADC ratio,mini-ADC value exhibited the most effective diagnostic performance in predicting clinicopathological characteristics with the highest areas under the ROC curve and efficacy.Mini-ADC value showed negative correlation with Ki-67 index (r=-0.48,P＜0.001) as well as other clinicopathological characteristics,including tumor size,FIGO staging,pathological grading,depth of cervical stromal infiltrating,parametrial involvement,LVI,lymph node metastasis and PNI (r=-0.36,-0.34,-0.27,-0.40,-0.33,-0.60,-0.61,-0.41,respectively,all P＜0.05).Conclusion Mini-ADC value can effectively reflect the proliferation and invasiveness of cervical SCC.

Primary Sj(o)gren's syndrome (pSS) is a chronic autoimmune disease characterized by lymphoplasmacytic infiltration of the exocrine glands that results in multiple organs and systems damage.Renal injury affects 0.3％-27.0％ patients,The most frequent form of nephropathy in pSS is tubulointerstitial nephritis.The main clinical manifestation is renal tubular acidosis.The renal prognosis in patients with pSS is usually favorable,but renal failure may occur.At present,it still lacks of strict consensus or guideline for the treatment.