EBF1-COX4I2 signaling axis promotes a myofibroblast-like phenotype in cancer-associated fibroblasts (CAFs) and is associated with an immunosuppressive microenvironment.

Immunotherapy has limited response rates in colorectal cancer (CRC) due to an immunosuppressive tumor microenvironment (TME). Combining transcriptome sequencing, clinical specimens, and functional experiments, we identified a unique group of CAF subpopulations (COX4I2 + ) with inhibited mitochondrial respiration and enhanced glycolysis. Through bioinformatics predictions and luciferase reporter assays, we determined that EBF1 can upstreamly regulate COX4I2 transcription. COX4I2 + CAFs functionally and phenotypically resemble myofibroblasts, are important for the formation of the fibrotic TME, and are capable of activating the M2 phenotype of macrophages. In vitro experiments demonstrated that COX4I2 + CAFs promote immunosuppressive TME by blocking CD8 + T cell infiltration and inducing CD8 + T cell dysfunction. Using multiple independent cohorts, we also found a strong correlation between the immunotherapy response rate of CRC patients and COX4I2 expression in their tumors. Our results identify a CAF subpopulation characterized by activation of the EBF1-COX4I2 axis, and this group of CAFs can be targeted to improve cancer immunotherapy outcomes.

Spatiotemporal heterogeneity of LMOD1 expression summarizes two modes of cell communication in colorectal cancer.

Cellular communication (CC) influences tumor development by mediating intercellular junctions between cells. However, the role and underlying mechanisms of CC in malignant transformation remain unknown. Here, we investigated the spatiotemporal heterogeneity of CC molecular expression during malignant transformation. It was found that although both tight junctions (TJs) and gap junctions (GJs) were involved in maintaining the tumor microenvironment (TME), they exhibited opposite characteristics. Mechanistically, for epithelial cells (parenchymal component), the expression of TJ molecules consistently decreased during normal-cancer transformation and is a potential oncogenic factor. For fibroblasts (mesenchymal component), the expression of GJs consistently increased during normal-cancer transformation and is a potential oncogenic factor. In addition, the molecular profiles of TJs and GJs were used to stratify colorectal cancer (CRC) patients, where subtypes characterized by high GJ levels and low TJ levels exhibited enhanced mesenchymal signals. Importantly, we propose that leiomodin 1 (LMOD1) is biphasic, with features of both TJs and GJs. LMOD1 not only promotes the activation of cancer-associated fibroblasts (CAFs) but also inhibits the Epithelial-mesenchymal transition (EMT) program in cancer cells. In conclusion, these findings demonstrate the molecular heterogeneity of CC and provide new insights into further understanding of TME heterogeneity.

Early administration of Wumei Wan inhibit myeloid-derived suppressor cells via PI3K/Akt pathway and amino acids metabolism to prevent colitis-associated colorectal cancer.

ETHNOPHARMACOLOGICAL RELEVANCE: Wumei Wan (WMW), a traditional Chinese medicine prescription, has been proved to be effective in treating Colitis-associated colorectal cancer (CAC), but it has not been proven to be effective in different stages of CAC. AIM OF THE STUDY: The purpose of our study is to investigate the therapeutic effect and mechanism of WMW on the progression of CAC. MATERIALS AND METHODS: Azioximethane (AOM) and dextran sulfate sodium (DSS) were used to treat mice for the purpose of establishing CAC models. WMW was administered in different stages of CAC. The presentative chemical components in WMW were confirmed by LC-MS/MS under the optimized conditions. The detection of inflammatory cytokines in the serum and colon of mice were estimated by qRT-PCR and ELISA. The changes of T cells and myeloid-derived suppressor cells (MDSCs) in each group were detected by flow cytometry. The metabolic components in serum of mice were detected by UPLC-MS/MS. Expression of genes and proteins were detected by eukaryotic transcriptomics and Western blot to explore the key pathway of WMW in preventing CAC. RESULTS: WMW had significant effect on inhibiting inflammatory responses and tumors during the early development stage of CAC when compared to other times. WMW increased the length of mice's colons, reduced the level of IL-1ß, IL-6, TNF-α in colon tissues, and effectively alleviated colonic inflammation, and improved the pathological damage of colon tissues. WMW could significantly reduce the infiltration of MDSCs in the spleen, increase CD4+ T cells and CD8+ T cells in the spleen of CAC mice, and effectively reform the immune microenvironment in CAC mice. Transcriptomics analysis revealed that 2204 genes had different patterns of overlap in the colon tissues of mice between control group, AOM + DSS group, and early administration of WMW group. And KEGG enrichment analysis showed that PI3K/Akt signaling pathway, ECM-receptor interaction, IL-17 signaling pathway, MAPK signaling pathway, pancreatic secretion, thermogenesis, and Rap1 signaling pathway were all involved. The serum metabolomics results of WMW showed that the metabolic compositions of the control group, AOM + DSS group and the early stage of WMW were different, and 42 differential metabolites with the opposite trends of changes were screened. The metabolic pathways mainly included pyrimidine metabolism, glycine, serine and threonine metabolism, tryptophan metabolism, and purine metabolism. And amino acids and related metabolites may play an important role in WMW prevention of CAC. CONCLUSION: WMW can effectively prevent the occurrence and development of CAC, especially in the initial stage. WMW can reduce the immune infiltration of MDSCs in the early stage. Early intervention of WMW can improve the metabolic disorder caused by AOM + DSS, especially correct the amino acid metabolism. PI3K/Akt signaling pathway was inhabited in early administration of WMW, which can regulate the amplification and function of MDSCs.

Wumei Wan attenuates angiogenesis and inflammation by modulating RAGE signaling pathway in IBD: Network pharmacology analysis and experimental evidence.

BACKGROUND: Wumei Wan (WMW) has been used to address digestive disorder for centuries in traditional Chinese medicine. Previous studies have demonstrated its anti-colitis efficacy, but the underlying mechanism of its action remains to be further clarified. PURPOSE: To investigate the underlying mechanisms of WMW in the treatment of chronic ulcerative colitis (UC) through network pharmacology and experimental validation. METHODS: Traditional Chinese Medicine Systems Pharmacology (TCMSP) platform were used to identify the ingredients and potential targets of WMW. The microarray gene data GSE75214 datasets from GEO database was used to define UC-associated targets. Cytoscape3.7.2 was employed to construct the protein-protein interaction (PPI) network and compounds-disease targets network. GO enrichment analysis and KEGG pathway analysis were performed by R software for functional annotation. UPLC-TOF-MS/MS method was used to quantitatively analyze the active ingredients of WMW. For experimental validation, three cycles of 2% dextran sulfate sodium salt (DSS) were used to construct chronic colitis model. The hub targets and signal pathway were detected by qPCR, ELISA, western blotting , immunohistochemical and immunofluorescence. RESULTS: Through network analysis, 104 active ingredients were obtained from WMW, and 47 of these ingredients had potential targets for UC. A total of 41 potential targets of WMW and 13 hub targets were identified. KEGG analysis showed that WMW involved in advanced glycation end products-receptor of advanced glycation end products (AGE-RAGE) signaling pathway. Taxifolin, rutaecarpine, kaempferol, quercetin, and luteolin of WMW were the more highly predictive components related to the AGE-RAGE signaling pathway. In vivo validation, WMW improved DSS-induced colitis, reduced the expression of inflammatory cytokines and chemokines. Notably, it significantly decreased the mRNA expression of Spp1, Serpine1, Mmp2, Mmp9, Ptgs2, Nos2, Kdr and Icam1, which were associated with angiogenesis. In addition, we confirmed WMW inhibited RAGE expression and diminished DSS-induced epithelial barrier alterations CONCLUSION: Our results initially demonstrated the effective components and the strong anti-angiogenic activity of WMW in experimental chronic colitis. Sufficient evidence of the satisfactory anti-colitis action of WMW was verified in this study, suggesting its potential as a quite prospective agent for the therapy of UC.

Textural differences based on apparent diffusion coefficient maps for discriminating pT3 subclasses of rectal adenocarcinoma.

BACKGROUND: The accuracy of discriminating pT3a from pT3b-c rectal cancer using high-resolution magnetic resonance imaging (MRI) remains unsatisfactory, although texture analysis (TA) could improve such discrimination. AIM: To investigate the value of TA on apparent diffusion coefficient (ADC) maps in differentiating pT3a rectal adenocarcinomas from pT3b-c tumors. METHODS: This was a case-control study of 59 patients with pT3 rectal adenocarcinoma, who underwent diffusion-weighted imaging (DWI) between October 2016 and December 2018. The inclusion criteria were: (1) Proven pT3 rectal adenocarcinoma; (2) Primary MRI including high-resolution T2-weighted image (T2WI) and DWI; and (3) Availability of pathological reports for surgical specimens. The exclusion criteria were: (1) Poor image quality; (2) Preoperative chemoradiation therapy; and (3) A different pathological type. First-order (ADC values, skewness, kurtosis, and uniformity) and second-order (energy, entropy, inertia, and correlation) texture features were derived from whole-lesion ADC maps. Receiver operating characteristic curves were used to determine the diagnostic value for pT3b-c tumors. RESULTS: The final study population consisted of 59 patients (34 men and 25 women), with a median age of 66 years (range, 41-85 years). Thirty patients had pT3a, 24 had pT3b, and five had pT3c. Among the ADC first-order textural differences between pT3a and pT3b-c rectal adenocarcinomas, only skewness was significantly lower in the pT3a tumors than in pT3b-c tumors. Among the ADC second-order textural differences, energy and entropy were significantly different between pT3a and pT3b-c rectal adenocarcinomas. For differentiating pT3a rectal adenocarcinomas from pT3b-c tumors, the areas under the curves (AUCs) of skewness, energy, and entropy were 0.686, 0.657, and 0.747, respectively. Logistic regression analysis of all three features yielded a greater AUC (0.775) in differentiating pT3a rectal adenocarcinomas from pT3b-c tumors (69.0% sensitivity and 83.3% specificity). CONCLUSION: TA features derived from ADC maps might potentially differentiate pT3a rectal adenocarcinomas from pT3b-c tumors.

[Anatomical and tensile mechanical analysis of hip joint capsule repair in total hip replacement].

OBJECTIVE: To explore the tensile mechanics and anatomical characteristics of the posterior hip capsule, and provide biomechanical and anatomical evidence for capsule repair in total hip replacement. METHODS: Six bone-capsule-bone specimens were obtained from posterior hip joint of fresh frozen cadavers. The maximum strain, load, elastic modulus and load strain curves of the capsule ligament complex specimens were recorded by Instron Universal Material Testing Machine. Twelve cadaveric hip specimens were dissected to the capsule. The tensile strain of normal capsule and conventionally reconstructed capsule at 90 degrees of hip flexion were documented. The suture area of the posterior capsule was divided into nine sections, and the thicknessof different sections was measured and compared. Posterior capsule of the cadavers was repaired in conventionally way and anatomical way separately and simulated rehabilitation was conducted. The effect of rehabilitation on the repaired capsule was observed. RESULTS: The load-strain curve of capsule ligament complex conforms to rheological and viscoelastic characteristics. The maximum tensile strain of the complex was (39.21±5.23)%, the maximum load was (142.06± 34.15) N, the tensile strength was (1.65±0.38) MPa, and the elastic modulus is (14.23±5.62) MPa. At 90 ° hip flexion, the tensile strain of repaired capsule was higher than that of normal capsule, and the difference was statistically significant (P< 0.05). Tensile strain of conventionally reconstructed capsule is:upper part (37.0±4.9)%, middle part ( 53.3±1.1)%, lower part (68.3±6.2)%, tensile strain of normal capsule is:upper part (17.0±2.6)%, middle part (24.1±1.4)%, lower part (26.0± 4.3)% . The thickness of the posterior joint capsulein different sections is statistically significant (P<0.05), and capsule at 0.5cm proximal to the femoral insertion is suitable for suture. There the average thickness of capsule is:upper part (3.48 ± 0.11) mm, middle part (2.36 ± 0.09) mm, lower part (1. 59±0.24) mm. The posterior inferior joint capsule is thinnest at (1.42± 0.02) cm proximal to the femoral insertion, and sutures should be avoided here. After simulating rehabilitation, avulsion occurred in the lower part of the posterior capsule repaired conventionally (10/12), and the anatomically repaired capsule remained intact. CONCLUSION: The lower part of conventionally repaired capsule is overstretched and tends to fail. Anatomically repaired capsule conforms to tensile mechanics and is helpful to reduce the failure rate of repair.

Biparametric prostate MRI and clinical indicators predict clinically significant prostate cancer in men with "gray zone" PSA levels.

PURPOSE: To predict clinically significant prostate cancer (cs-PCa) by combining the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) score based on biparametric magnetic resonance imaging (bp-MRI) and clinical indicators in men with prostate-specific antigen (PSA) levels in the gray zone of 4-10 ng/mL. METHOD: We retrospectively analyzed 364 patients with elevated PSA levels in the gray zone who had pathologically confirmed disease and had undergone MRI examinations from January 2015 to October 2019; a training group (n = 255) and validation group (n = 109) were randomly established. Multivariate logistic regression analysis of the training group was performed to identify the independent predictors for cs-PCa, thereby establishing a predictive model that was evaluated in the training and validation groups by analyzing the receiver operating characteristic (ROC) curve. RESULTS: In the training group, the PI-RADS v2 score and prostate volume (PV) were independent predictors of cs-PCa (P < 0.05). The prediction model comprising the PI-RADS v2 score and PV had a larger AUC than the other predictors alone in the training group. The diagnostic sensitivity and specificity of the prediction model were 84.1 % and 83.4 %, respectively. The prediction model was indicated to have better predictive performance in the validation group. CONCLUSIONS: The prediction model exhibits a satisfactory predictive value for cs-PCa in men with PSA levels in the gray zone. PI-RADS v2 is the strongest univariate predictor for the detection of cs-PCa in men with PSA in the gray zone, but combining this with the PV can provide superior predictive ability.

Comparison of Scoring Systems in Predicting Severity and Prognosis of Hypertriglyceridemia-Induced Acute Pancreatitis.

BACKGROUND: In China, hyperlipidemia is the second major reason of acute pancreatitis. AIMS: Comparison of Scoring Systems in identification patients at risk for severe acute pancreatitis (SAP), pancreatic necrosis (PNec), and infected pancreatic necrosis (IPN) early in the course of hypertriglyceridemia-induced acute pancreatitis (HTG-AP). METHODS: Predictive accuracy of scoring systems was measured by the area under the receiver operating characteristic curve (AUC) in a retrospective study. Pairwise AUC comparisons were performed to calculate the difference between scoring systems. RESULTS: A total of 238 patients diagnosed with HTG-AP were included. Sixty patients (25.2%) were classified as SAP. Twenty-nine patients (12.2%) had evidence of PNec. Nine patients (3.8%) were diagnosed with IPN. One patient (0.4%) died during hospitalization. In predicting SAP in HTG-AP, the AUCs of APACHE-II, SOFA, SIRS, Ranson's, BISAP, and MMS were 0.77, 0.83, 0.73, 0.88, 0.83, and 0.85, respectively; in predicting PNec, were 0.75, 0.77, 0.75, 0.86, 0.80, and 0.75, respectively; and in predicting IPN, were 0.92, 0.86, 0.76, 0.85, 0.84, and 0.87, respectively. Pairwise AUC comparisons revealed that Ranson's, MMS, BISAP, and SOFA had higher accuracy than SIRS, Ranson's and MMS had higher accuracy than APACHE-II in predicting SAP; Ranson's had the same accuracy with BISAP, but higher than other four criteria in predicting PNec; APACHE-II had higher accuracy than SIRS in predicting IPN. CONCLUSIONS: APACHE-II had high performance in predicting IPN, and all other score systems had medium performance in predicting SAP, PNec, and IPN in HTG-AP. Each score has its merit and weakness; BISAP may be the best criterion in predicting severity and prognosis of HTG-AP.

Differentiating Transition Zone Cancers From Benign Prostatic Hyperplasia by Histogram Analysis of Apparent Diffusion Coefficient Maps With Standard and Ultrahigh b-value Diffusion-weighted MR Imaging.

OBJECTIVE: To compare the diagnostic performance of standard and ultrahigh b-value Diffusion-weighted Imaging (DWI) using volumetric histogram analysis in differentiating transition zone (TZ) cancer from benign prostatic hyperplasia (BPH). METHODS: 57 TZ cancer and 61 BPH patients received standard (1000 s/mm) and ultrahigh b-value (2000 s/mm) DWI. The diagnostic ability of ADC histogram parameters derived from two DWI for differentiating TZ cancer from BPH was determined by receiver operating characteristic curve. RESULTS: Median, minimum, the 10th, 25th percentile ADC in both ADC1000 and ADC2000 and skewness in ADC2000 had significant differences between TZ cancer and BPH (for all, P < 0.05).The 10th percentile ADC showed highest area under the ROC curve (AUC) in both ADC1000 and ADC2000.The 10th percentile ADC of ADC2000 showed significantly higher AUC than did ADC1000 (P = 0.0385). CONCLUSIONS: The 10th percentile ADC obtained from ultrahigh b-value DWI performed better for differentiating TZ cancer from BPH.

Preoperative diffusion-weighted imaging value of rectal cancer: preoperative T staging and correlations with histological T stage.

PURPOSE: To assess the ability of diffusion-weighted imaging (DWI) for evaluating T stage and correlation with histological T stage of rectal cancer. METHOD: The diagnostic accuracy, sensitivity, and specificity of T2WI and DWI combined with T2WI for T stage were evaluated. Mean tumor apparent diffusion coefficient (ADC) was compared with histological T stage. RESULT: There were no significant differences in the diagnostic accuracy, sensitivity, and specificity no matter what kind of T stage was concerned. The difference between ADC values and histological T stage were significantly different. CONCLUSION: DWI was useful for evaluating T stage of rectal cancer. The ADC may predict the histological grade.

Comparative study of sex differences in distal femur morphology in osteoarthritic knees in a Chinese population.

OBJECTIVES: The purpose of this study was to investigate sex differences in resected distal femoral morphology in Chinese osteoarthritic knees. METHODS: The study included 130 osteoarthritic knees in 65 men and 65 women in China. None had anterior femoral osteophyte or serious patellar femoral joint degeneration. The following were measured using computed tomography and analyzed to identify morphological differences according to sex in the resected distal femurs: anterior lateral condylar height (ALCH), anterior medial condylar height (AMCH), and mediolateral (ML) and anteroposterior (AP) dimensions. The ML/AP aspect ratio was calculated. RESULTS: The average ALCH and AMCH were 8.2±1.8 mm, 3.1±1.5 mm for men and 7.4±1.7 mm, 3.6±1.5 mm for women. There were significant differences between men and women in ALCH values (P = 0.014) but not in AMCH values (P = 0.09). Women had smaller ML/AP aspect ratios than men for a given AP dimension. This indicated that the femoral ML dimension of a prosthesis with a given AP dimension may have overhang in women. CONCLUSIONS: This study suggested that sex differences should be taken into account in the design of femoral prosthesis for Chinese men and women.

Unusual features in an adult pancreatic hemangioma: CT and MRI demonstration.

Hemangiomas in the pancreas are very rare and only a few cases in adulthood have been reported in the literature. We describe a case of pancreatic hemangiomas in an adult with unique imaging findings. A 23-year-old woman visited the hospital for an incidentally detected pancreatic mass. CT and MRI revealed a multilocular cyst with fluid-fluid levels and no obvious enhancement. The patient underwent surgery and the mass was confirmed as a pancreatic hemangioma. The radiological features and differential diagnosis of this rare lesion are discussed.

Aggressive osteoblastoma of the temporal bone: a case report and review of the literature.

Osteoblastoma can take place in any part of the skeleton. Its occurrence in the calvarium is extremely rare. The aggressive form of osteoblastoma is a rare variant. To our knowledge, this is the second case of aggressive osteoblastoma arising in the temporal bone. We report an 18-year-old patient with aggressive osteoblastoma involving the left temporal bone. Computed tomography of temporal bone showed an osteolytic lesion with granular mineralization and mottled ossified density. Permanent histopathologic sections and immunohistochemical stains revealed an aggressive osteoblastoma.

Computed tomography morphometric study of gender differences in osteoarthritis proximal tibias.

One hundred and thirty osteoarthritic knees(65 males, 65 females) from a Chinese population were measured by computed tomography for tibial mediolateral (ML), middle anteroposterior (AP), medial anteroposterior (MAP), lateral anteroposterior (LAP) dimensions and ML/AP aspect ratio. The ML/AP aspect ratio were classified into 3 groups based on AP dimensions(<48 mm, 48-52 mm, >52 mm) to compare the morphologic differences of proximal tibia between males and females. The mean ML, AP, MAP and LAP dimensions of proximal tibia showed significant differences for sex (P < .01). We found a progressively decreased in the ML/AP aspect ratio with an increasing AP dimension, and males have larger ML/AP aspect ratio than that of females under a given AP dimension (P < .01). This indicates that under a given AP dimension prosthesis, the tibial ML dimension have the potential to be undersized in males and to overhang in females. This study may provide important reference in designing proper gender-specific tibia prosthesis with different ML/AP aspect ratio for Chinese males and females.

Transfect bone marrow stromal cells with pcDNA3.1-VEGF to construct tissue engineered bone in defect repair.

BACKGROUND: We previously showed that nano-hydroxyapatite/carboxymethyl chitosan (n-Ha/CMCS) displayed excellent mechanical properties, good degradation rates and exceptional biocompatibility, with negligible toxicity. The aim of this study was to determine the effect of the same composite with vascular endothelial growth factor (VEGF)- transfected bone marrow stromal cells (BMSCs) in a rabbit radial defect model. METHODS: The nano-hydroxyapatite was produced through co-precipitation. The n-HA/CMCS scaffold was produced by particle filtration and lyophilization followed by genipin crosslinking. Total RNA from rabbit bone was reverse-transcribed to synthesize VEGF165-pcDNA3.1 that was transfected into the BMSCs. The composite was implanted into a rabbit radial defect model, and the osteogenic activity examined by gross morphology, X-ray examination and hematoxylin and eosin (HE) staining. RESULTS: The microstructure and mechanical property of the n-HA/CMCS scaffold resembled natural cancellous bone. Compared with glutaric dialdehyde crosslinked scaffolds, the genipin crosslinked scaffold was less toxic, and displayed a higher capacity to promote cell adhesion and proliferation. Spontaneous fluorescence of the composite permitted visualization of the composite-bone interface and the adhesion behavior of cells on the scaffold under laser scanning confocal microscopy. The scaffold with VEGF-transfected BMSCs bridged the bony defect and promoted healing, with most of the implanted material being replaced by natural bone over time with little residual implant. Using X-ray, we noted obvious callus formation and recanalization of the bone marrow cavity. Furthermore, HE stained sections showed new cortical bone formation. CONCLUSIONS: The n-HA/CMCS scaffold composite with VEGF-trasnfected BMSCs is biocompatible, nontoxic, promotes the infiltration and formation of the microcirculation, and stimulates bone defect repair. Furthermore, the degradation rate of the composite matched that of growing bone. Overall, this composite material is potentially useful for bone defect repair.

Computed tomographic measurement of gender differences in bowing of the sagittal femoral shaft in persons older than 50 years.

Surgeons do not give enough weight to the effects of bowing of the sagittal femoral shaft in total knee arthroplasty (TKA), which can result in damage to the cortex, fractures, or malalignment of the femoral component. To determine gender differences in bowing, we used spiral computed tomography to scan the femurs of 26 men and 47 women older than 50 years who required TKA. Skeletal extraction of the total sagittal femoral shaft from computed tomographic images was done by a matrix laboratory. The extracted curves were evenly divided into 3 sections. Comparison of the curvature on different sections of the same side of the femur showed that the distal third was significantly bowed. In addition, the curvature of the distal third was significantly larger in women than in men. Such morphological characteristics put forward new requirements in how intramedullary guide rods are used in TKA.

Localized Castleman disease of plasma cell type in the abdomen.

Castleman disease is a relatively rare entity, with the hyaline-vascular type the predominant form. Although the plasma cell type is uncommon, it still comprises approximately 10% of cases of localized diseases. In addition, the abdomen is a rare site for involvement and localized Castleman disease of the plasma cell type in the abdomen is rare. The radiologic features of localized plasma cell type in the abdomen are mostly limited to case reports. In addition to the conventional imaging findings, we present some new imaging findings of localized plasma cell type in the abdomen.

[Ultrasound guided transrectal prostate biopsy: 11-year experience].

OBJECTIVE: To summarize the experience in ultrasound guided transrectal prostate biopsy and analyze the influencing factors of the biopsy results. METHODS: 687 patients with prostate specific antigen (PSA) > 4 microg, tubercles in prostate detected by digital rectal examination and/or prostate abnormality detected by magnetic resonance imaging, aged (70 +/- 8), underwent ultrasound guided transrectal 6 - 12 core prostate biopsy 1996 - 2007. Since 2006 the criteria for biopsy included PSA of 4 - 10 microg/ml, free PSA/total PSA ratio (F/T ratio) 0.15. RESULTS: 269 of the 687 cases, with the mean age of (72 +/- 8), were diagnosed as with prostate cancer. 294 and 121 of the 687 patients (42.8% and 17.6% respectively) accepted prostate biopsy because of elevated PSA or abnormality of DRE. The number of patients accepting prostate biopsy increased yearly (10 cases in 1996 to 98 cases in 2007). The positive biopsy rate was 39.8%, with the highest rate of 60.0% in 1999 and lowest rate of 30.4% in 2005. The highest number of prostate cancer diagnosed was the highest (42 cases) in 2007 and the lowest (4 cases) in 1996. PSA level was positively co-related with positive biopsy rate. The application of F/T ratio improved the positive biopsy rate in the patient with the PSA of 4 - 10 microg/ml. The incidence rates of the main complications hematuria, bloody stool, and fever were 46.3%, 8.7%, and 1.9% respectively. CONCLUSION: Elevated PSA has become the most common reason for prostate biopsy. The combination with PSA, F/T ratio, and increased biopsy core number improve the positive biopsy rate. The ultrasound guided transrectal prostate biopsy is efficient and safe in the diagnosis of prostate cancer.