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Objective:To compare the differences of prostate cancer (PCa) and clinically significant prostate cancer (CsPCa) positive rate and postoperative complications between transperineal cognitive prostate biopsy (COG-TPBx) and transrectal cognitive prostate biopsy (COG-TRBx) based on biparametric magnetic resonance imaging (bpMRI).Methods:The data of 276 patients undergoing prostate biopsy from January 2019 to June 2021 in the First Affiliated Hospital of Nanjing Medical University were retrospectively reviewed. 157 patients underwent COG-TPBx(TPBx group) and 119 patients underwent COG-TRBx (TRBx group). The average age [(66.39 ± 8.31) vs. (66.30 ± 8.42)years], body mass index (BMI) [(23.85±2.49) vs. (23.68±2.61) kg/m 2], PSA values [9.43(1.47-19.80) vs. 8.94(0.66-19.99) ng/ml], prostate volume [37.92(13.99-167.40) vs. 40.78(11.67-188.21) cm 3], PSA density [0.21(0.04-1.17) vs. 0.20(0.04-1.04) ng/(ml·cm 3)], and suspicious digital rectal examination [17.20% (27/157) vs. 21.10% (25/119) ] were not significantly different between TPBx group and TRBx group. The positive rate of PCa, CsPCa, as well as post-biopsy complications of the two groups were compared. Results:There were no significant differences in the positive rate of PCa [49.68%(78/157) vs. 47.06%(56/119), P=0.666] and CsPCa [38.22%(60/157) vs. 34.45%(41/119), P=0.520] between the two groups. In stratification analysis, TPBx group has a significantly higher positive rate of both PCa [54.69%(35/64)] and CsPCa[43.75%(28/64)] in apex zone than TRBx group[39.62%(21/53) and 20.75%(11/53), all P<0.05). Moreover, the postoperative complications were not significantly different in TPBx group compared to that in TRBx group [10.19% (16/157) vs. 12.61%(15/119), P= 0.567]. Conclusions:Our investigations revealed that the overall positive rate of PCa, CsPCa, and the complications were not statistically different between COG-TPBx and COG-TRBx. COG-TPBx has a significantly higher positive rate of both PCa and CsPCa in apex zone.
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Objective:To detect the value of utilizing bpMRI in prostate biopsy in the detection of prostate cancer with PSA≤20ng/ml.Methods:The clinical data of 394 patients who underwent prostate biopsy in the First Affiliated Hospital of Nanjing Medical University from November 2017 to October 2019 were retrospectively analyzed. Of all the patients, 177 underwent modified systematic biopsy, named TRUS group, 217 patients accepted pre-biopsy bpMRI examination, undergoing modified systematic biopsy if Prostate Imaging Reporting and Data System (PI-RADS) score < 3 or MRI-TRUS cognitive fusion targeted prostate + systematic biopsy if PI-RADS score ≥ 3, named MRI group. The median age of TRUS group was 66 (61, 74) years old, prostate specific antigen (PSA) was 9.52 (7.26, 12.30) ng / ml, and prostate volume (PV) was 36.84 (28.95, 57.72)ml. The median age of MRI group was 66 (59, 72) years old, PSA was 8.84 (6.65, 12.16) ng/ml, and PV was 39.45 (29.25, 58.69)ml. There was no difference in above parameters between the two groups. The χ 2 test was used to compare the detection rate of prostate cancer and clinically significant prostate cancer (CsPCa) between the two groups. Results:There was no significant difference in the detection rates of prostate cancer between TRUS group and MRI group [51.41% (91/177) vs. 48.39% (105/ 217), P = 0.550], but the detection rates of CsPCa were significantly different [26.55% (47/177) vs. 36.41% (79/217), P = 0.037]. In patients with PSA ≤ 10 ng / ml, there was no significant difference in the detection rates of prostate cancer between the two groups [43.62% (41/94) vs. 43.08% (56/130), P = 0.936], but there was a significant difference in the detection rates of CsPCa [17.02% (16/94) vs. 28.46% (37/130), P = 0.047]. There was no significant difference in the detection rates of prostate cancer [60.24% (50/83) and 56.17% (48/87), P= 0.504] and the detection rates of CsPCa [37.35% (31/83) vs. 48.28% (42/87), P = 0.150] between the two groups. The total detection rates of the last two needles in TRUS group and MRI group were 23.16% (41/177) and 36.63% (86/217), respectively, with significant difference ( P=0.001); the detection rates of CsPCa in the last two needles were 11.86% (26/177) and 29.03% (63/ 217), respectively, with significant difference ( P < 0.001). In MRI group, the detection rates of prostate cancer in patients with PI-RADS score <3, 3, 4, 5 were 21.21% (7/33), 25.84% (23/89), 73.24% (52/71), 95.83% (23/24), respectively; the detection rates of CsPCa were 12.12% (4/33), 17.98% (16/89), 54.93% (39/71), 83.33% (23/24), respectively. Conclusions:In patients with PSA ≤ 20 ng / ml, prostate biopsy based on bpMRI may improve the detection of CsPCa, especially in patients with PSA ≤ 10 ng/ml.
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Objective:To investigate the use of bi-parametric magnetic resonance imaging (bpMRI)-based cognitive fusion targeted biopsy and systematic biopsy in patients with prostate imaging reporting and data system (PI-RADS)≥3.Methods:The clinical data of 220 patients with PI-RADS ≥3 who underwent bpMRI-transrectal ultrasound (TRUS) cognitive fusion targeted biopsy and systematic biopsy in the First Affiliated Hospital of Nanjing Medical University from May 2018 to November 2019 were retrospectively analyzed. The median age was 66 (60, 73) years old, median prostate specific antigen (PSA) was 8.73 (6.52, 11.93) ng/ml, medlian prostate volume was 39.25(29.26, 58.39) ml and the mean body mass index (BMI) was (24.02±2.60) kg/m 2. For each patient, bpMRI-TRUS cognitive fusion targeted biopsy and systematic biopsy were performed by two independent experienced urologists. The primary endpoint was the detection rate of CsPCa-A [clinically significant prostate cancer-A, defined as International Society of Urological Pathology (ISUP) grade group 2 or higher tumors]. The secondary endpoints were the detection rates of CsPCa-B (defined as ISUP grade group 3 or higher tumors) and CIPCa (clinically insignificant prostate cancer, defined as ISUP grade group 1 tumors). McNemar test and Chi-square test were used to compare the positive rates of CsPCa-A, CsPCa-B and CIPCa between targeted biopsy and systematic biopsy. Results:In this study, 112 patients (50.91%) were diagnosed with prostate cancer, and the detection was 42.73% (94/220) in targeted biopsy and 46.82% (103/220) in systematic biopsy.CsPCa-A was detected in 84 (38.18%) patients. Detection of CsPCa-A by targeted biopsy and systematic biopsy was not different significantly [30.00% (66/220) vs.34.09% (75/220), P=0.120]. CsPCa-A would have been missed in 8.18% (18/220) patients had not performed systematic biopsy, and in 4.09% (9/220) patients had not performed targeted biopsy. CsPCa-B was detected in 26.36% (58/220) patients. Detection of CsPCa-B by targeted biopsy and systematic biopsy was not different significantly [20.00% (44/220) vs. 23.18% (51/220), P=0.190]. CsPCa-B would have been missed in 6.36% (14/220) patients had not performed systematic biopsy, and in 3.18% (7/220) patients had not performed targeted biopsy. In addition, there was no difference in the positive rates of CIPCa between targeted biopsy combined with systematic biopsy, targeted biopsy only or systematic biopsy only [all three were 12.73% (28/220), P=1.000]. Nine post-biopsy adverse events were reported, including 5 cases of infection, 2 cases of vagal reflex and 2 cases of urinary retention. All of them were improved after symptomatic treatment. Conclusions:No significant difference was identified in the detection rate of CsPCa between targeted biopsy and systematic biopsy. However, combination of targeted biopsy and systematic biopsy could further improve the detection rate of CsPCa without increasing the detection of CIPCa. Therefore, a pre-biopsy bpMRI did have significant importance in the biopsy-na?ve patients, but did not seem to skip the need for systematic biopsy.
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Objective:To investigate the difference of prostate cancer (PCa) detection rate between transperineal cognitive fusion targeted biopsy (COG-TB) and software fusion targeted (FUS-TB).Methods:We retrospectively analyzed 157 patients accepted transperineal targeted biopsies from December 2018 to December 2019, including 67 cases of COG-TB and 90 cases of FUS-TB. All patients were prostate biopsy na?ve, with PSA levels ≤ 20 ng/ml and prostate imaging reporting and data system version 2.1 (PI-RADS v2.1) scores ≥ 3. There was no significant difference between COG-TB and FUS-TB in the age [(70.78 ± 8.86) vs. (70.52 ± 8.79) years old], body mass index [(24.36 ± 2.69)vs. (24.14 ± 3.15) kg/m 2], prostate volume [36.69 (27.52, 47.40) vs. 38.81 (28.80, 53.46) cm 3], PSA level [8.27 (6.0, 11.65) vs. 8.88 (6.40, 13.54) ng/ml], PSAD [0.23 (0.15, 0.36) vs. 0.21 (0.14, 0.34) ng/ml 2], suspicious digital rectal examination findings [16 (23.9%) vs. 17 (18.9%)] and PI-RADS scores [24 (35.8%), 24 (35.8%), 19 (28.4%) and 21 (23.3%) vs. 21 (23.3%), 42 (46.7%), 27 (30.0%) for PI-RADS 3, 4, and 5, respectively]. There was no significant difference in baseline characteristics between the two groups (all P<0.05). The overall and stratified detection rates of PCa and clinically significant prostate cancer (CsPCa) were compared between the two groups. The upgrading rates of Gleason score after radical prostatectomy against biopsy Gleason score were compared between the two groups. Results:There was no significant difference between COG-TB and FUS-TB in the detection rate of PCa [76.1% (51/67) vs. 68.9% (62/90), P=0.32]. Also, no significant difference was found in the detection rate of PCa stratified by PSA [0-10ng/ml: 69.1% (29/42) vs. 57.1% (28/49); 10-20ng/ml: 88.0% (22/25) vs. 82.9% (34/41); all P>0.05] and PI-RADS score [3: 45.8% (11/24) vs. 23.8% (5/21); 4: 91.7% (22/24) vs. 81.0% (34/42); 5: 94.7% (18/19) vs. 85.2% (23/27); all P>0.05]. Similarly, there was no dramatically difference between COG-TB and FUS-TB in the detection rate of CsPCa [58.2% (39//67) vs. 50.0% (45/90), P>0.05]. No significant difference was found in the detection of CsPCa stratified by PSA [0-10ng/ml: 45.2% (19/42) vs.36.7% (18/49); 10-20 ng/ml: 80.0% (20/25) vs. 65.9% (27/41) ; all P>0.05] and PI-RADS score [3: 29.2% (7/24) vs. 9.5% (2/21), 4: 66.7% (16/24) vs. 57.1% (24/42), 5: 84.2%(16/19) vs. 70.4% (19/27) ; all P>0.05]. Additionally, the two technique was not different significantly in the upgrading rate [28.9% (13/45) vs. 26.2% (11/42), P=0.78]. Conclusions:There is no significant difference between FUS-TB and COG-TB in the detection rate of PCa and CsPCa, along with the upgrading rate after RP in patients with PSA ≤ 20 ng / ml and PI-RADS v2.1 score≥3.
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Objective To investigate the related risk factors of hair loss in obese patients after laparoscopic sleeve gastrectomy (LSG).Methods The retrospective case-control study was conducted.The clinical data of 54 obese patients who underwent LSG in the East Hospital of Tongji University between November 2013 and June 2015 were collected.All the patients received LSG,and postoperative hair loss of patients was observed.Factors affecting postoperative severe hair loss were analyzed,including gender,age,preoperative body mass index (BMI),postoperative excess weight loss (EWL),total bilirubin (TBil),albumin (Alb),hemoglobin (Hb),iron,zinc,copper,folic acid,vitamin B12 and vitamin D.Observation indicators:(1) follow-up and postoperative hair loss situations:cases with follow-up,follow-up time,cases with hair loss,severity of hair loss,time of hair loss,treatment of hair loss;(2) univariate analysis affecting severity of hair loss after LSG;(3) multivariate analysis affecting severity of hair loss after LSG.Follow-up using outpatient examination and Wechat was performed to detect the changes of BMI and hair loss up to September 2016.Measurement data with normal distribution were represented as (x)±s and comparison between groups was done by the t test.Comparison of count data was analyzed by the chi-square test.Multivariate analysis was done using the Logistic regression model.Results (1) Follow-up and postoperative hair loss situations:all the 54 patients were followed up for 15 months.Forty-two patients had hair loss,including 21 with slight hair loss,10 with moderate hair loss and 11 with severe hair loss.A proportion of hair loss was 6/11 in male and 36/43 in female.The onset time and end time of hair loss were (3.4± 1.4) months and (9.0± 3.6) months,respectively.Of 42 patients,15 took oral medication (6 with ferrous sulfate,5 with decavitamin and 4 with zinc gluconate oral solution) against hair loss,with no obvious improvement.During the follow-up,42 patients stopped hair loss and gradually grow new hair.(2) Univariate analysis affecting severity of hair loss after LSG:gender,postoperative EWL and folic acid were factors affecting severity of hair loss after LSG (x2 =5.161,t =-5.114,4.266,P＜0.05).(3) Multivariate analysis of affecting severity of hair loss after LSG:postoperative EWL and folic acid were independent factors affecting severity of hair loss after LSG (OR=1.039,0.499,95％ confidence interval:1.011-1.068,0.300-0.802,P＜0.05).A prediction accuracy of severity of hair loss after LSG was 85.2％.Conclusion Postoperative EWL and folic acid are independent factors affecting severity of hair loss after LSG.
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Bariatric surgery is one of the most rapid,effective and sustained treatment options for obesity.In recent years,laparoscopic sleeve gastrectomy (LSG) has become increasingly popular due to simple manipulation,maintaining gastrointestinal structures,high safety and significant efficacy.Several published studies have reported an increased rate of gastroesophageal reflux disease (GERD) after the operation,or it can aggravate the preexisting symptoms.The mechanisn of GERD is very complex and controversial.