Attenuation coefficients of gamma and X-rays passing through six materials

The aim of this study was to determine the attenuation of gamma and X-rays with different energies caused by passage through different materials.To this end,different materials with a range of atomic numbers were chosen to measure gamma and X-ray attenuation coefficients and to explore the mechanisms of interaction of gamma and X-rays with matter of various kinds.It is shown that the attenuation coefficients first decrease and then increase with increase in the radiation(photon)energy.The attenuation of gamma and X-rays passing through materials with high atomic number is greater than that in materials with low atomic number.The attenuation minimum is related to the atomic number of the irradiated materials.The larger the atomic number is,the lower the energy corresponding to attenuation minimum is.Photoelectric and Compton effects are the main processes when gamma rays pass through individual materials with high and low atomic numbers,respectively.Therefore,for radiotherapy and radiation protection,different methods should be considered and selected for the use of gamma and X-rays of different energies for use in different materials.

Open abdomen in trauma patients:a double-edged sword

The use of open abdomen(OA) as a technique in the treatment of exsanguinating trauma patients was first described in the mid-19 th century. Since the 1980 s, OA has become a relatively new and increasingly common strategy to manage massive trauma and abdominal catastrophes. OA has been proven to help reduce the mortality of trauma. Nevertheless, the OA method may be associated with terrible and devastating complications such as enteroatmospheric fistula(EAF). As a result, OA should not be overused, and attention should be given to critical care as well as special management. The temporary abdominal closure(TAC) technique after abbreviated laparotomy was used to improve wound healing and facilitate final fascial closure of OA. Negative pressure therapy(NPT) is the most commonly used TAC method.

New model of PIRADS and adjusted prostatespecific antigen density of peripheral zone improves the detection rate of initial prostate biopsy:a diagnostic study

This study explored a new model of Prostate Imaging Reporting and Data System(PIRADS)and adjusted prostate-specific antigen density of peripheral zone(aPSADPZ)for predicting the occurrence of prostate cancer(PCa)and clinically significant prostate cancer(csPCa).The demographic and clinical characteristics of 853 patients were recorded.Prostate-specific antigen(PSA),PSA density(PSAD),PSAD of peripheral zone(PSADPZ),aPSADPZ,and peripheral zone volume ratio(PZ-ratio)were calculated and subjected to receiver operating characteristic(ROC)curve analysis.The calibration and discrimination abilities of new nomograms were verified with the calibration curve and area under the ROC curve(AUC).The clinical benefits of these models were evaluated by decision curve analysis and clinical impact curves.The AUCs of PSA,PSAD,PSADPZ,aPSADPZ,and PZ-ratio were 0.669,0.762,0.659,0.812,and 0.748 for PCa diagnosis,while 0.713,0.788,0.694,0.828,and 0.735 for csPCa diagnosis,respectively.All nomograms displayed higher net benefit and better overall calibration than the scenarios for predicting the occurrence of PCa or csPCa.The new model significantly improved the diagnostic accuracy of PCa(0.945 vs 0.830,P<0.01)and csPCa(0.937 vs 0.845,P<0.01)compared with the base model.In addition,the number of patients with PCa and csPCa predicted by the new model was in good agreement with the actual number of patients with PCa and csPCa in high-risk threshold.This study demonstrates that aPSADPZ has a higher predictive accuracy for PCa diagnosis than the conventional indicators.Combining aPSADPZ with PIRADS can improve PCa diagnosis and avoid unnecessary biopsies.

Efficacy of stepwise mini-incision microdissection testicular sperm extraction for nonobstructive azoospermia with varied etiologies

Stepwise mini-incision microdissection testicular sperm extraction(mTESE)is a procedure that attempts to minimize testicular damage.However,the mini-incision approach may vary in patients with different etiologies.Here,we performed a retrospective analysis of 665 men with nonobstructive azoospermia(NOA)who underwent stepwise mini-incision mTESE(Group 1)and 365 men who underwent standard mTESE(Group 2).The results showed that the operation time(mean±standard deviation)for patients with successful sperm retrieval in Group1(64.0±26.6min)was significantly shorter than that in Group2(80.2±31.3min),with P<0.001.The total sperm retrieval rate(SRR)was 23.1%in our study,and there was no significant difference between Group 1 and Group 2(P>0.05),even when the etiologies of NOA were taken into consideration.The results of consecutive multivariate logistic regression analysis(odds ratio[0R]:0.57;95%confidence interval[Cl]:0.38-0.87;P=0.009)and receiver operating characteristic(ROC)analysis(area under the ROC curve[AUC]=O.628)showed that preoperative anti-Mullerian hormone(AMH)level in idiopathic NOA patients was a potential predictor for surgical outcomes after initial three small incisions made in the equatorial region without sperm examined under an operating microscope(Steps 2-4).In conclusion,stepwise mini-incision mTESE is a useful technique for NOA patients,with comparable SRR,less surgical invasiveness,and shorter operation time compared with the standard approach.Low AMH levels may predict successful sperm retrieval in idiopathic patients even after a failed initial mini-incision procedure.

Clinical features and microsurgical reconstruction of congenital unilateral absence of the vas deferens with obstructive azoospermia:a tertiary care center experience

Patients with congenital unilateral absence of the vas deferens(CUAVD)manifest diverse symptoms from normospermia to azoospermia.Treatment for CUAVD patients with obstructive azoospermia(OA)is complicated,and there is a lack of relevant reports.In this study,we describe the clinical features and evaluate the treatments and outcomes of CUAVD patients with OA.From December 2015 to December 2020,33 patients were diagnosed as CUAVD with OA in Shanghai General Hospital(Shanghai,China).Patient information,ultrasound findings,semen analysis,hormone profiles,and treatment information were collected,and the clinical outcomes were evaluated.Of 33 patients,29 patients were retrospectively analyzed.Vasoepididymostomy(VE)or cross VE was performed in 12 patients,the patency rate was 41.7%(5/12),and natural pregnancy was achieved in one of the patients.The other 17 patients underwent testicular sperm extraction as the distal vas deferens(contralateral side)was obstructed.These findings showed that VE or cross VE remains an alternative treatment for CUAVD patients with OA,even with a relatively low rate of patency and natural pregnancy.

Microsurgical subinguinal varicocelectomy with spermatic cord double traction and vein stripping

We retrospectively reviewed data for 286 patients with varicocele who underwent microsurgical subinguinal varicocelectomy from March 2015 to May 2017 in Shanghai General Hospital(Shanghai,China).In this surgical approach,the testis was delivered,and the gubernacular and external cremasteric veins were stripped.In addition,the spermatic cord was delivered downward with continuous double traction away from the external ring.The remaining procedure was similar to the conventional approach.We followed patients for at least 3 months and evaluated postoperative semen parameters,pain symptoms,and complications.We excluded data for 32 men due to inadequate follow-up(<3 months).Of the remaining 254 patients,73 had oligoasthenospermia,121 had nonobstructive azoospermia,and 60 had symptomatic varicoceles.Total progressive sperm counts increased in the oligoasthenospermic patients from a median preoperative value of 9.15×10^6 ml^?1 to 25.33×10^6 ml^?1(n=34),and 35.6%(26/73)initially oligoasthenospermic men contributed to unassisted pregnancies.Sperm returned to the ejaculate in 12.4%(15/121)azoospermia patients.In patients with scrotal pain(n=60),43(71.7%)reported complete resolution of pain,16(26.7%)reported partial resolution,and 1(1.7%)reported no change.No patients experienced varicocele recurrence.This doubletraction strategy avoids opening the external oblique aponeurosis,and results in less damage and faster recovery.In addition,the stripping strategy eliminates potential damage to the testis caused by the varicose veins.Our results showed that microsurgical subinguinal varicocelectomy using spermatic cord double traction in conjunction with testicular delivery for vein stripping is a safe and effective approach for varicocele repair.

Neuroendocrine cells of prostate cancer: biologic functions and molecular mechanisms

Prostate cancer (PCa) is a major health risk for older men worldwide. Existing systemic therapies mostly target androgen receptor (AR). Although treatments are initially effective, the disease always recurs. A potential mechanism for the treatment failure is that PCa contains, in addition to the AR-positive luminal type tumor cells, a small component of neuroendocrine (NE) cells. The function of NE cells in PCa remains poorly understood, and one important characteristic of these cells is their lack of expression of AR and resistance to hormonal therapy. In addition, many patients develop the more aggressive small-cell neuroendocrine carcinoma (SCNC) after hormonal therapy. Although this clinical phenomenon of disease transformation from adenocarcinoma to SCNC is well established, the cell of origin for SCNC remains unclear. Recently, loss of function of Rb and TP53 and amplification and overexpression of MYCN and Aurora A kinase have been identified as important biomarkers and potential disease drivers. In this article, we systematically review the histology of normal prostate and prostate cancer including the main histologic types: adenocarcinoma and SCNC. We also review the findings from many studies using cellular and animal models as well as human specimens that attempt to understand the molecular mechanisms of treatment failure, disease progression, and tumor transformation from adenocarcinoma to SCNC.

Clinical association between pre-treatment levels of plasma fibrinogen and bone metastatic burden in newly diagnosed prostate cancer patients

Background:Due to the different treatments for low-volume metastatic prostate cancer(PCa)as well as high-volume evaluation of bone metastatic status is clinically significant.In this study,we evaluated the correlation between pre-treatment plasma fibrinogen and the burden of bone metastasis in newly diagnosed PCa patients.Methods:A single-center retrospective analysis,focusing on prostate biopsies of newly diagnosed PCa patients,was performed.A total of 261 patients were enrolled in this study in a 4-year period.All subjects were submitted to single-photon emission computerized tomography-computed tomography to confirm the status of bone metastasis and,if present,the number of metastatic lesions would then be calculated.Clinical information such as age,prostate-specific antigen(PSA),fibrinogen,clinical T stage,and Gleason score were collected.Patients were divided into three groups:(i)a non-metastatic group,(ii)a high volume disease(HVD)group(>3 metastases with at least one lesion outside the spine),and(iii)a low volume disease(LVD)group(metastatic patients excluding HVD ones).The main statistical methods included non-parametric Mann-Whitney test,Spearman correlation,receiver operating characteristic(ROC)curves,and logistic regression.Results:Fibrinogen positively correlated with Gleason score(r=0.180,P=0.003),PSA levels(r=0.216,P<0.001),and number of metastatic lesions(r=0.296,P<0.001).Compared with the non-metastatic and LVD groups,the HVD group showed the highest PSA(104.98 ng/mL,median)and fibrinogen levels(3.39 g/L,median),as well as the largest proportion of Gleason score>7(86.8%).Both univariate(odds ratio[OR]=2.16,95%confidential interval[CI]:1.536-3.038,P<0.001)and multivariate(OR=1.726,95%CI:1.206-2.472,P=0.003)logistic regressions showed that fibrinogen was independently associated with HVD.The ROC curve suggested that fibrinogen acts as a predictor of HVD patients,yielding a cut-off of 3.08 g/L,with a sensitivity of 0.684 and a specificity of 0.760(area under the curve=0.739,95%CI:0.644-0.833,P<0.001).Conclusions:Pre-treatment plasma fibrinogen is positively associated with bone metastatic burden in PCa patients.Our results indicate that fibrinogen might be a potential predictor of HVD.

分步法小切口改良睾丸显微取精术在隐睾下降固定术后非梗阻性无精子症的临床应用研究（英文）

目的:探讨分步法小切口改良睾丸显微取精术在隐睾下降固定术后非梗阻性无精子症的有效性。创新点:既往有隐睾下降固定术手术史的非梗阻性无精子症的患者睾丸局部粘连严重,所以睾丸显微取精术时睾丸暴露困难,因此手术难度明显增大。术者将常规睾丸显微取精术改良为分步法小切口睾丸显微取精术,术中无需完全游离暴露睾丸,仅通过小切口睾丸显微取精术就可使一半的患者成功获取精子。因此分步法小切口改良睾丸显微取精术可在不降低睾丸取精成功率的前提下缩短手术时间和减少手术创伤。方法:收集2015年5月至2017年3月于上海交通大学附属第一人民医院泌尿中心男科接受睾丸显微取精术的20例既往有隐睾下降固定术手术史的非梗阻性无精子症,采用分步法小切口改良睾丸显微取精术获取睾丸精子。分步法小切口改良睾丸显微取精术具体步骤为:第一步,小切口睾丸取精术;第二步,将小切口延长为标准切口,行标准睾丸显微取精术;第三步,对侧睾丸标准睾丸显微取精术。结论:小切口睾丸显微取精术可快速有效获取睾丸内表浅位置饱满的生精小管,标准的睾丸显微取精术可作为小切口睾丸显微取精术失败时的补救措施。分步法小切口睾丸显微取精术可降低睾丸损伤前提下,快速有效地获取睾丸精子。这种手术方式特别适用于睾丸内存在表浅饱满生精小管的非梗阻性无精子症,如隐睾下降固定术后的非梗阻性无精子症。

3D digital image microscope system-assisted vasovasostomy and vasoepididymostomy in rats

Optimal vision and ergonomics are essential factors contributing to the achievement of good results during microsurgery.The three-dimensional(3D)digital image microscope system with a better 3D depth of field can release strain on the surgeon's neck and back,which can improve outcomes in microsurgery.We report a randomized prospective study of vasoepididymostomy and vasovasostomy using a 3D digital image microscope system(3D-DIM)in rats.A total of 16 adult male rats were randomly divided into two groups of 8 each:the standard operating microscope(SOM)group and the 3D-DIM group.The outcomes measured included the operative time,real-time postoperative mechanical patency,and anastomosis leakage.Furthermore,a user-friendly microscope score was designed to evaluate the ergonomic design and equipment characteristics of the microscope.There were no differences in operative time between the two groups.The real-time postoperative mechanical patency rates were 100.0%for both groups.The percentage of vasoepididymostomy anastomosis leakage was 16.7%in the SOM group and 25.0%in the 3D-DIM group;however,no vasovasostomy anastomosis leakage was found in either group.In terms of the ergonomic design,the 3D-DIM group obtained better scores based on the surgeon's feelings;in terms of the equipment characteristics,the 3D-DIM group had lower scores for clarity and higher scores for flexibility and adaptivity.Based on our randomized prospective study in a rat model,we believe that the 3D-DIM can improve surgeon comfort without compromising outcomes in male infertility reconstructive microsurgery,so the 3D-DIM might be widely used in the future.

Prostate-specific Antigen Density Variation Rate as a Potential Guideline Parameter for Second Prostate Cancer Detection Biopsy

Background： The diagnostic value of current prostate-specific antigen （PSA） tests is challenged by the poor detection rate of prostate cancer （PCa） in repeat prostate biopsy. In this study, we proposed a novel PSA-related parameter named PSA density variation rate （PSADVR） and designed a clinical trial to evaluate its potential diagnostic value for detecting PCa on a second prostate biopsy. Methods： Data from 184 males who underwent second ultrasound-guided prostate biopsy 6 months after the first biopsy were included in the study. The subjects were divided into PCa and non-PCa groups according to the second biopsy pathological results. Prostate volume, PSA density （PSAD）, free-total PSA ratio, and PSADVR were calculated according to corresponding formulas at the second biopsy. These parameters were compared using t-test or Mann-Whitney U-test between PCa and non-PCa groups, and receiver operating characteristic analysis were used to evaluate their predictability on PCa detection. Results： PCa was detected in 24 patients on the second biopsy. Mean values of PSA, PSAD, and PSADVR were greater in the PCa group than in the non-PCa group （8.39 μg/L vs. 7.16 μg/L, 0.20 vs. 0.16, 14.15% vs. 1.36%, respectively）. PSADVR had the largest area trader the curve, with 0.667 sensitivity and 0.824 specificity when the cutoff was 10%. The PCa detection rate was significantly greater in subjects with PSADVR 〉10% than PSADVR _〈10% （28.6% vs. 6.5%, P 〈 0.001 ）. In addition, PSADVR was the only parameter in this study that showed a significant correlation with mid-to-high-risk PCa （r = 0.63, P = 0.03）. Conclusions： Our results demonstrated that PSADVR improved the PCa detection rate on second biopsies, especially for mid-to-high-risk cancers requiring prompt treatment.

Potential therapeutic effect of epigenetic therapy on Ireatment-induced neuroendocrine prostate cancer

Although adenocarcinomas of the prostate are relatively indolent, some patients with advanced adenocarcinomas show recurrence of treatment-induced neuroendocrine prostate cancer, which is highly aggressive and lethal. Detailed biological features of treatment-induced neuroendocrine prostate cancer have not been characterized owing to limited biopsies/resections and the lack of a cellular model. In this study, we used a unique cellular model （LNCaP/NE1.8） to investigate the potential role of cancer stem cells in treatment-induced neuroendocrine prostate cancer with acquired resistance to hormonal therapy and chemotherapy. We also studied the role of cancer stem cells in enhancing invasion in treatment-induced neuroendocrine prostate cancer cells that recurred after long-term androgen-ablation treatment. Using an in vitro system mimicking clinical androgen-ablation, our results showed that the neuroendocrine-like subclone NE1.8 cells were enriched with cancer stem cells. Compared to parental prostate adenocarcinoma LNCaP cells, NE1.8 cells are more resistant to androgen deprivation therapy and chemotherapeutic agents and show increased cancer cell invasiveness. Results from this study also suggest a potential epigenetic therapeutic strategy using suberoylanilide hydroxamic acid, a histone deacetylase inhibitor, as a chemotherapeutic agent for therapy-resistant treatment-induced neuroendocrine prostate cancer cells to minimize the risk of prostate cancer recurrence and metastasis.

A correlative study of iron metabolism based on q-Dixon MRI in benign prostatic hyperplasia and prostate cancer

Clinical staging,Gleason score,and prostate-specific antigen(PSA)have been accepted as factors for evaluating the prognosis of prostate cancer(PCa).With the in-depth study of iron metabolism and the development of multiparametric magnetic resonance imaging technology,we used q-Dixon magnetic resonance imaging(MRI)to measure the iron content of the PCa patients'lesions,and used enzyme-linked immunosorbent assay(ELISA)to measure the iron metabolism indicators in the patients'serum samples,combined with the patients'postoperative clinical data for analysis.We found that the serum indexes were correlated with the T2 star values,International Society of Urological Pathology(ISUP)grade,and pathological classification in PCa patients(all P<O.001)but not in benign prostatic hyperplasia(BPH)patients(all P>O.05).The utilization of q-Dixon-based MRI and serum indexes allows the noninvasive measurement of iron content in prostate lesions and the assessment of differential iron metabolism between PCa and BPH,which may be helpful for evaluating the prognosis of PCa.

Successful microsurgical vasoepididymostomy for a case of cryptozoospermia

Dear Editor,Cryptozoospermia is defined as the apparent absence of spermatozoa from fresh semen samples,but they can.be found in centrifuged pellets.1 It is usually caused by a spermatogenic disorder,while cryptozoospermia associated with seminal duct obstruction is less common.2 Because of the extremely low sperm counts in semen samples,men with cryptozoospermia are often reliant on intracytoplasmic sperm injection(ICSI)for paternity.

Role of smooth muscle progenitor cells in vascular mechanical injury and repair

Smooth muscle progenitor cells are precursor cells that express both smooth muscle cell and stem cell markers,and can differentiate into smooth muscle cells under specific condition.Smooth muscle progenitor cells exist in many tissues,including bone marrow,blood vessels,peripheral blood,skeletal muscle,and kidney.Smooth muscle progenitor cells play an important role in the pathogenesis of vascular diseases,like atherosclerosis,vascular mechanical injury and repair,and vascular restenosis.Cytokines and growth factors are released upon injury,which promote smooth muscle progenitor cells to proliferate and differentiate into smooth muscle cells at injured sites.Massive growth of smooth muscle cells stabilizes atherosclerotic plaques and accelerates neointima formation,which leads to vascular restenosis.Some drugs are now used to inhibit the differentiation and proliferation of smooth muscle cells to prevent neointima formation.In this review,we have summarized some recent progress on the smooth muscle progenitor cells’origins,tissue distributions,and their role in vascular mechanical injury and repair.

Cost-effectiveness analysis of different anesthesia strategies for transperineal MRI/US fusion prostate biopsy

This study aims to conduct a cost-effectiveness analysis of three different anesthesia strategies,namely chatting while under local anesthesia(Chat-LA),total intravenous anesthesia(TIVA),and general anesthesia with laryngeal mask airway(GA-LMA),employed in transperineal magnetic resonance imaging(MRI)/ultrasound(US)fusion prostate biopsy(TP-MUF-PB).A retrospective study was conducted involving 1202 patients who underwent TP-MUF-PB from June 2016 to April 2023 at The First Affiliated Hospital of Soochow University(Suzhou,China).Clinical data and outcomes,including total costs,complications,and quality-adjusted life years(QALYs),were compared.Probability sensitivity and subgroup analyses were also performed.Chat-LA was found to be the most cost-effective option,outperforming both TIVA and GA-LMA.However,subgroup analyses revealed that in younger patients(under 65 years old)and those with smaller prostate volumes(<40 ml),TIVA emerged as a more cost-effective strategy.While Chat-LA may generally be the most cost-effective and safer anesthesia method for TP-MUF-PB,personalization of anesthesia strategies is crucial,considering specific patient demographics such as age and prostate volume.