Background “Swiss Cheese” ventricular septal defects (VSDs) is a kind of rare and complex congenital heart defects and the surgical management remains controversial and a challenge. We reviewed our preliminary clinical experience on biventricular surgical repair of “Swiss Cheese” VSDs with two-patch and right ventricle apex excluding technique in 10 cases. Methods From May 2014 to December 2019, a series of 10 patients (M/F=3/7) were admitted in our center. 9 cases underwent one-stage surgical repair with two-patch and right ventricle apex excluding technique and 1 case received a second-stage surgical repair with the same technique. Surgical repair was done with cardiopulmonary bypass (CPB) in all cases. 2 fresh autologous pericardium patches were used to close defects of the outflow tract area and the apex trabecular area respectively and as a result, the right ventricular apex was excluded from the right ventricular inflow tract. Results All the operations were successful. Median CPB time and aortic clamping time were 96 min and 68 min respectively. Delayed chest closure were done in 2 cases within 48-72 hours postoperatively. The Median time of mechanical ventilation and ICU stay were 131.3 hours and 8 days respectively. Median length of stay after operation was 11 （9-42）days. There was no mortality and major complication except for 2 cases of ventilator associated pneumonia. There was no death and major complication during the median follow-up time of 3.2 years.. The latest echocardiography results showed the left and right heart function was normal in all the cases. Conclusions Biventricular surgical repair of “Swiss Cheese” VSDs with two-patch of fresh autologous pericardium and right ventricle apex excluding technique in infants is safe and feasible with favorable early and mid-term results. Long term results need to be evaluated with more cases.

Extrachromosomal circular DNA (circulome) is a newly evolved hallmark in cancer whereas its role in shaping the cancer genome heterogeneity is yet to be sufficiently understood. Here, we comprehensively characterize and exploit the circulome-associated genome heterogeneity in 80 urothelial bladder carcinoma (UBC) patients by whole-genome/exome sequencing, Circle-Seq, long-read sequencing, and RNA-seq. Our results reveal a high load and heterogeneity of UBC circulome. Many single locus and chimeric circular DNAs originating from different chromosomes are identified, including extremely chimeric circular DNAs carrying seven oncogenes and circles from nine chromosomes. Circular DNAs contribute to increased oncogene dosage and could influence genome-wide gene expression. Increased expression of DNA repair genes (LIG3, POLQ, BRCA1, and BRCA2) promote circulome generation in UBCs. The circulome is in cis correlated with hypermutation (kataegis), copy number variation, oncogene amplification, structure variation, and poor clinical outcome. These results strongly support circulome associations with UBC genome heterogeneity, progression, and outcome.

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Background: To investigate the value of contrast-enhanced transrectal ultrasound (CETRUS) in reducing unnecessary biopsy during prostate cancer screening and predicting biochemical recurrence in patients with localized prostate cancer. Methods:This was a prospective study of patients suspected of prostate cancer who were evaluated with CETRUS followed by prostate biopsy. Prostate blood flow on CETRUS was graded using a 5-point scale. The relationship between CETRUS score and biopsy outcomes was analyzed; Univariate and multi-variate analyses were used to determine the probable prognostic factors with biochemical recurrence in patients with localized prostate cancer underwent radical prostatectomy. Results:A total of 347 patients were enrolled. Prostate cancer was found in 164 patients. A significant positive correlation (r = 0.69, p < 0.001) was found between CETRUS scores and prostate cancer. Using CETRUS score ≥ 2 as the threshold for biopsy could have reduced the number of biopsies by 12.1% (42/347) without missing cancer and spared 23.0% (42/183) of patients from unnecessary biopsy. 77 patients with localized prostate cancer underwent radical prostatectomy and followed up. 17 of 77 patients exhibited biochemical recurrence. The 3-year biochemical recurrence-free survival rates were 86% for patients with CETRUS low scores (≤ 3) and 59% for patients with high scores (> 3; p = 0.015). Multivariate Cox regression analysis showed that CETRUS score was an independent predictor of biochemical recurrence (HR: 7.02; 95% CI: 2.00-24.69; p = 0.002). Conclusions:CETRUS score may be a useful tool to reduce unnecessary biopsy during prostate cancer screening and predict biochemical recurrence of localized prostate cancer after radical prostatectomy. BackgroundProstate cancer is the most common solid neoplasm and the second leading cause of cancer death in men in the U.S. [1]. With increasing incidence and mortality, an estimated 60,300 new cases were diagnosed and 26,600 deaths were attributed to this disease in China in 2015 [2]. Approximately one million prostate biopsies are conducted per year in the U.S.. However, prostate-specific antigen (PSA) testing, the most widely used screening tests for prostate cancer, leads to 750,000 unnecessary biopsies-and attendant pain, inconvenience, financial burden, and risk of infection [3]. Therefore, Hong-wei Zhao and Yong Fang: Project development, Data Collection, Study design, Manuscript editing; Jian Li, Jia-Zheng Cao and Juan Lin: Manuscript writing, Study design, Data Collection, Statistical analysis; Zhu Wang, Jian-yao Lv,and Jin-huan We:Manuscript editing, Data Collection; Jinhuan Wei and Zhen-hua Chen: Data Collection,Statistical analysis; Hao-hua Yao, Yi-hui Pan, Zhen-li Gao, Jun-hang Luo, Wei Chen,and Lei Shi: Data Collection, Datainterpretation. All authors read and approved the final manuscript.