Objective:To investigate the risk factors for detecting clinically significant prostate cancer (CSPCa) in patients with Prostate Imaging Reporting and Data System (PI-RADS) score≤3 on multi-parameter magnetic resonance imaging (mpMRI).Methods:Retrospective analysis was performed on the case data of 335 patients with suspected prostate cancer and PI-RADS score ≤3 who were admitted to Beijing Friendship Hospital, Capital Medical University from January 2013 to October 2022. All patients underwent 24-needle prostate biopsy. Clinical data such as age, body mass index, past medical history, serological laboratory indicators, and mpMRI imaging data were collected. The patients were grouped according to whether the puncture pathology was CSPCa or not, and the differences in clinical data between the two groups were analyzed by t-test, rank sum test and Chi-test. Multivariate Logistic regression analysis was further used to determine independent risk factors for MRI invisible prostate cancer, and receiver operating characteristics (ROC) curves were drawn. At the same time, further subgroup analysis was conducted based on whether prostate-specific antigen (PSA) was positive before puncture and PI-RADS score, respectively, and the same statistical method was used to further determine the influence of different serological indicators and PI-RADS score on the analysis results of risk factors. Results:Among all patients, 81 were CSPCa patients and 254 were non-CSPCa patients. Multivariate Logistic regression analysis showed that prostate-specific antigen density (PSAD) and PI-RADS score of 3 were independent risk factors for MRI invisible prostate cancer. At the same time, compared with suspected lesions located only in the transitional zone, the incidence of CSPCa in patients with suspected lesions located in the peripheral zone would increase, and the incidence of CSPCa would further increase when suspected lesions were found in both the transitional zone and the peripheral zone. In PSA-negative patients, only suspected lesion location was an independent risk factor for MRI invisible prostate cancer, while in PSA-positive patients, prostate volume, PSAD, and PI-RADS scores were independent risk factors. In subgroup analysis with different PI-RADS scores, suspicious lesions in both the transitional zone and peripheral zone indicate a higher likelihood of CSPCa. For patients with PI-RADS scores of 1 to 2, suspicious lesions in the peripheral zone alone may also indicated CSPCa, while for patients with PI-RADS scores of 3, the lower free prostate-specific antigen/total prostate-specific anti-principle was more accurate in predicting CSPCa.Conclusions:For patients who are clinically suspected of prostate cancer but whose PI-RADS score is less than or equal to 3 points indicated by mpMRI, it is necessary to further focus on the results of different serological indicators according to whether their PSA is positive and PI-RADS score respectively to judge whether patients should receive systemic prostate puncture, instead of using PSA level as a single indication for puncture. At the same time, clinicians should also pay full attention to the location of suspected lesions, when they are located in the peripheral zone, or there are suspected lesions in both the peripheral zone and the transitional zone, the possibility of CSPCa should be fully considered.

In recent years, more and more studies have shown that autophagy is closely related to female reproductive process. Autophagy is a widespread and highly conserved degradation system in eukaryotes that can be activated under conditions such as hypoxia, starvation, lack of nutrients, or extreme pH. In terms of reproductive health, autophagy can improve reproductive dysfunction by removing damaged organelles and regulating cell growth and metabolism. Appropriate regulation of autophagy helps to improve oocyte quality, delay ovarian aging, fine-regulate endometrial growth, and ensure successful implantation of embryos. However, the abnormality of autophagy pathway may cause problems such as activation of pelvic inflammatory cytokines, reduced endometrial receptivity, abnormal follicle development, and weakened invasion ability of trophoblast cells, thus leading to the occurrence and development of reproductive disorders such as endometriosis, chronic endometritis, polycystic ovary syndrome, early-onset ovarian insufficiency, and recurrent spontaneous abortion. This article reviews the mechanism and therapeutic targets of autophagy in female reproductive diseases, providing clinical ideas and diagnosis and treatment strategies for improving female reproductive health.

Objective:To comprehensively evaluate treatment outcomes and assisted reproductive approaches in infertility patients with CYP17A1-deficient congenital adrenal hyperplasia [including 17α-hydroxylase/17,20-lyase deficiency (17-OHD) and isolated 17,20-lyase deficiency (IDL)]. Methods:In this study, PubMed, Embase, Web of Science, Ovid, CNKI, Wanfang Data base, and the Chinese Biomedical Literature Database were systematically searched. The data extracted included basic patient information, treatment plans, and pregnancy outcomes, which were then analyzed descriptively.Results:Totally 19 articles were included, covering 23 cases of successful live births. Among the 23 patients with successful live births, there were 19 patients with 17-OHD, including 17 cases became pregnant through in vitro fertilization and embryo transfer (IVF-ET), 1 case through natural pregnancy, and 1 case through oocyte donation pregnancy; there were 4 cases with IDL, including 2 cases through natural pregnancy and 2 cases through IVF-ET pregnancy. Conclusion:IVF-ET is the preferred fertility treatment option for patients with partial form of 17-OHD. For IDL patients who have natural ovulation, natural pregnancy can be attempted. Glucocorticoids play a crucial role in improving pregnancy outcomes, but their use needs to be individualized.

In recent years, more and more studies have shown that autophagy is closely related to female reproductive process. Autophagy is a widespread and highly conserved degradation system in eukaryotes that can be activated under conditions such as hypoxia, starvation, lack of nutrients, or extreme pH. In terms of reproductive health, autophagy can improve reproductive dysfunction by removing damaged organelles and regulating cell growth and metabolism. Appropriate regulation of autophagy helps to improve oocyte quality, delay ovarian aging, fine-regulate endometrial growth, and ensure successful implantation of embryos. However, the abnormality of autophagy pathway may cause problems such as activation of pelvic inflammatory cytokines, reduced endometrial receptivity, abnormal follicle development, and weakened invasion ability of trophoblast cells, thus leading to the occurrence and development of reproductive disorders such as endometriosis, chronic endometritis, polycystic ovary syndrome, early-onset ovarian insufficiency, and recurrent spontaneous abortion. This article reviews the mechanism and therapeutic targets of autophagy in female reproductive diseases, providing clinical ideas and diagnosis and treatment strategies for improving female reproductive health.

Objective:To comprehensively evaluate treatment outcomes and assisted reproductive approaches in infertility patients with CYP17A1-deficient congenital adrenal hyperplasia [including 17α-hydroxylase/17,20-lyase deficiency (17-OHD) and isolated 17,20-lyase deficiency (IDL)]. Methods:In this study, PubMed, Embase, Web of Science, Ovid, CNKI, Wanfang Data base, and the Chinese Biomedical Literature Database were systematically searched. The data extracted included basic patient information, treatment plans, and pregnancy outcomes, which were then analyzed descriptively.Results:Totally 19 articles were included, covering 23 cases of successful live births. Among the 23 patients with successful live births, there were 19 patients with 17-OHD, including 17 cases became pregnant through in vitro fertilization and embryo transfer (IVF-ET), 1 case through natural pregnancy, and 1 case through oocyte donation pregnancy; there were 4 cases with IDL, including 2 cases through natural pregnancy and 2 cases through IVF-ET pregnancy. Conclusion:IVF-ET is the preferred fertility treatment option for patients with partial form of 17-OHD. For IDL patients who have natural ovulation, natural pregnancy can be attempted. Glucocorticoids play a crucial role in improving pregnancy outcomes, but their use needs to be individualized.

Objective:To investigate the effect of visceral fat thickness before operation on the operative difficulty and postoperative complications in renal transplantation recipients.Methods:A total of 179 patients diagnosed with end-stage renal disease who underwent kidney transplantation in Beijing Friendship Hospital, Capital Medical University from January 2020 to January 2022 were retrospectively included. According to the visceral fat thickness measured by CT before transplantation (distance from anterior wall of abdominal aorta to parietal peritoneum at 1 cm above umbilicus), patients were divided into two groups, with 103 patients in thin visceral fat group with visceral fat thickness ≤7.5 cm and 76 patients in thick visceral fat group with visceral fat thickness>7.5 cm. The epidemiological data before renal transplantation, operative time, intraoperative blood loss, postoperative complications, renal function after transplantation and patients′ recovery state were analyzed and compared between the two groups. Measurement data were expressed as mean±standard deviation ( ± s), and independent sample t-test was used for comparison between groups. The Chi-square test was used to compare the count data. Results:The mean age and body mass index of patients in thin visceral fat group [(38.70±11.50) years and (21.28±2.93) kg/m 2] were lower than those in thick visceral fat group [(43.14±11.42) years and (24.78±3.37) kg/m 2], and the differences were statistically significant ( P< 0.05). There was no significant difference in other preoperative epidemiological data between the two groups ( P>0.05). In terms of operation difficulty, the mean operation time of thin visceral fat group was (117.16±34.33) min, which was significantly shorter than that of thick visceral fat group (137.11±20.02) min. The mean intraoperative blood loss in the thin visceral fat group was (89.12±45.95) mL, which was lower than that in the thick visceral fat group (125.39±54.88) mL, the differences were statistically significant ( P<0.001). In terms of postoperative complications, 41 patients in the thin visceral fat group had postoperative infection, incision pain and intraoperative effusion, and the incidence was 39.8% (41/103), which was significantly lower than that in the thick visceral fat group (78.9%, 60/76), the difference was statistically significant ( P<0.001); However, there was no significant difference in the incidence of Clavien-Dindo grade 3 or higher complications between the two groups ( P> 0.05). There was no significant difference in serum creatinine levels at 3, 5, 7 days and 1, 2 months after surgery among patients with different visceral fat thickness ( P> 0.05). However, the mean serum creatinine level in the thin visceral fat group was (116.06±36.45) μmol/L, which was lower than that in the thick visceral fat group (133.35±72.26) μmol/L, and the difference was statistically significant ( P=0.038). There was no significant difference in the incidence of delayed renal function recovery between the two groups ( P> 0.05). At the same time, there was no significant difference in postoperative drainage tube indwelling time and hospital stay between the two groups ( P> 0.05). Conclusions:The thicker visceral fat in end-stage renal disease patients before transplantation, the higher the incidence of general postoperative complications, but the severity of complications, patients′ recovery after transplantation and the short-term function of the transplanted kidney are not significantly related to the thickness of visceral fat in the recipients. Meanwhile, although the visceral fat thickness of the recipients in this study was correlated with serum creatinine levels at 3 months after transplantation, its correlation with long-term graft renal function and graft survival time remains to be further studied.

In recent years, living kidney donors is getting valuable with the increasingly needs of kidney transplantation. However, living kidney donors can receive no benefits but greater incidence and severity of pain compared to other kinds of renal surgeries. Thus, it is getting popular on how to relief the postoperative pain during perioperative period for living kidney donors. As multidisciplinary cooperation developing, preoperative predictive nursing, changed analgesia mode, modified pneumoperitoneum, and postoperative application of different kinds of analgesic drugs can further relief the postoperative pain of living kindney donors. This paper sums up different modalities of pain relief in patients undergoing live donor nephrectomy to provide reference to clinical decision of living kidney transplantation.

Objective:To evaluate the feasibility and perioperative safety of retroperitoneal laparoscopic nephrectomy for autosomal dominant polycystic kidney disease (ADPKD) before kidney transplantation.Methods:A total of 22 patients with ADPKD who underwent laparoscopic polycystic nephrectomy before kidney transplantation in Beijing Friendship Hospital, Capital Medical University from January 2013 to December 2020 were enrolled in this retrospective study. Preoperative epidemiological data, operation time, intraoperative blood loss, perioperative blood transfusion, conversion rate, postoperative gastrointestinal function recovery time, drainage tube placement time, postoperative hospital stay, incidence and severity of complications were collected.Results:The mean age of all patients in this study was (50.95±9.28) years old, and the mean preoperative polycystic kidney diameter was (18.83±2.38) cm. In all patients, 20 patients were scheduled for polycystic nephrectomy due to transplantation and 2 patients were done for polycystic renal cyst rupture and hemorrhage. The mean operation time of all patients was (191.14±70.46) min, and the median intraoperative blood loss was 100 mL. Among them, 5 patients had large intraoperative blood loss, and were given intraoperative blood transfusion. Two of all patients were converted to open due to severe intraoperative adhesions. In terms of postoperative recovery, the mean recovery time of gastrointestinal function was (2.09±0.61) d, the mean time of abdominal drainage tube placement was (5.32±2.08) d, the mean postoperative hospital stay was (7.55±2.34) d. In terms of postoperative complications, 4 patients developed postoperative incision pain, bleeding or other complications, but all improved after symptomatic treatment.Conclusions:For patients with ADPKD, original polycystic kidney can be effectively resected by retroperitoneoscopy before transplantation. At the same time, the operation time is short, and patients have quick postoperative recovery, even the incidence and severity of postoperative complications are low. Therefore, retroperitoneal laparoscopic nephrectomy can be used as the first choice for the removal of original polycystic kidney before renal transplantation in ADPKD patients.

Objective:To investigate the clinical efficacy of tamoxifen and granulocyte colony stimulating factor (G-CSF) in the treatment of refractory thin endometrium.Methods:Prospective cohort study was performed. Patients treated in the Department of Reproductive Medicine of the Second Affiliated Hospital of Kunming Medical University from December 2019 to December 2020 were included, they all suffered from cancellation of fresh transplantation cycle due to endometrial thickness less than 7 mm, and estrogen treatment was given in the following frozen-thawed embyro transfer cycle but the thickness of endometrium still under 7 mm. They were divided into three groups according to their wishes: group A was treated with tamoxifen ( n=40), group B was treated with intrauterine perfusion of G-CSF ( n=38), and group C was treated with tamoxifen combined with intrauterine perfusion of G-CSF ( n=36). The endometrial receptivity and pregnancy outcomes among the three groups were compared. Results:There were no significant differences in the clinical characteristics of patients and the thickness of endometrium before treatment among the three groups (all P>0.05). The endometrial thickness after treatment was significantly improved compared with those before treatment among the three groups ( P<0.001). After treatment, endometrial thickness of group A [8.00(8.00, 9.00) mm] and group C [8.00(8.00, 10.00) mm] was higher than that of group B [7.00(7.00, 8.00) mm, P=0.002, P=0.001]. The type of Ⅲ endometrial blood flow of group C [72.2% (26/36)] was significantly improved compared with group A [40.0% (16/40), P=0.005)] and group B [42.1% (16/38), P=0.009]. The resistance index (RI), pulsatility index (PI) and systolic peak velocity/diastolic velocity (S/D) of group B (0.61±0.08, 0.81±0.11, 2.05±0.12) and group C (0.60±0.11, 0.78±0.15, 1.99±0.19) were lower than those of group A (0.66±0.04, 0.94±0.10, 2.17±0.06), and the differences among the three groups were statistically significant (RI: P=0.009, P=0.001; PI: P<0.001, P<0.001; S/D: P<0.001, P<0.001). The embryo implantation rate and the clinical pregnancy rate of group C were higher than those of group A and group B, and the early abortion rate of group C was lower than that of group A and group B, but there were no significant differences among the three groups (all P>0.05). Conclusion:Three treatment schemes have certain curative effects on improving the endometrial receptivity and pregnancy outcome of patients with refractory thin endometrium, among which tamoxifen combined with G-CSF is superior to single drug in improving the endometrial receptivity, but the combined group has not shown significant advantages in pregnancy outcome.

Objective:To investigate the clinical efficacy of tamoxifen and granulocyte colony stimulating factor (G-CSF) in the treatment of refractory thin endometrium.Methods:Prospective cohort study was performed. Patients treated in the Department of Reproductive Medicine of the Second Affiliated Hospital of Kunming Medical University from December 2019 to December 2020 were included, they all suffered from cancellation of fresh transplantation cycle due to endometrial thickness less than 7 mm, and estrogen treatment was given in the following frozen-thawed embyro transfer cycle but the thickness of endometrium still under 7 mm. They were divided into three groups according to their wishes: group A was treated with tamoxifen ( n=40), group B was treated with intrauterine perfusion of G-CSF ( n=38), and group C was treated with tamoxifen combined with intrauterine perfusion of G-CSF ( n=36). The endometrial receptivity and pregnancy outcomes among the three groups were compared. Results:There were no significant differences in the clinical characteristics of patients and the thickness of endometrium before treatment among the three groups (all P>0.05). The endometrial thickness after treatment was significantly improved compared with those before treatment among the three groups ( P<0.001). After treatment, endometrial thickness of group A [8.00(8.00, 9.00) mm] and group C [8.00(8.00, 10.00) mm] was higher than that of group B [7.00(7.00, 8.00) mm, P=0.002, P=0.001]. The type of Ⅲ endometrial blood flow of group C [72.2% (26/36)] was significantly improved compared with group A [40.0% (16/40), P=0.005)] and group B [42.1% (16/38), P=0.009]. The resistance index (RI), pulsatility index (PI) and systolic peak velocity/diastolic velocity (S/D) of group B (0.61±0.08, 0.81±0.11, 2.05±0.12) and group C (0.60±0.11, 0.78±0.15, 1.99±0.19) were lower than those of group A (0.66±0.04, 0.94±0.10, 2.17±0.06), and the differences among the three groups were statistically significant (RI: P=0.009, P=0.001; PI: P<0.001, P<0.001; S/D: P<0.001, P<0.001). The embryo implantation rate and the clinical pregnancy rate of group C were higher than those of group A and group B, and the early abortion rate of group C was lower than that of group A and group B, but there were no significant differences among the three groups (all P>0.05). Conclusion:Three treatment schemes have certain curative effects on improving the endometrial receptivity and pregnancy outcome of patients with refractory thin endometrium, among which tamoxifen combined with G-CSF is superior to single drug in improving the endometrial receptivity, but the combined group has not shown significant advantages in pregnancy outcome.