Combined Detection Of INSL3 And RAF-1 MRNA In Peripheral Blood To Evaluate The Tendency Of Testicular Torsion

Part 1: Analysis of clinical and medical characteristics of patients with testicular torsion ObjectiveThis part intends to make a retrospective analysis of the clinical data of patients with testicular torsion treated in our hospital in recent 8 years,focusing on the statistical analysis of the clinical characteristics and treatment characteristics of patients with testicular torsion in our hospital.In addition,it intends to understand the clinical characteristics of testicular torsion patients in our hospital and the relationship between the clinical characteristics and the clinical outcome.Method:A total of 105 patients with testicular torsion treated in our hospital from April 2013 to January 2021 were included in the study.Besides,their related medical records were retrospectively analyzed.Result:A total of 105 cases were included,including 70 cases of left testicular torsion(66.7%)and 35 cases of right testicular torsion(33.3%).Most of them were adolescent males,with an average age of 15.86 ±5.85 years old.There were 98 cases of intrathecal torsion,4 cases of extrathecal torsion and 3 cases of undetermined type.Patients with intrathecal torsion accounted for more than 90% of the total number of patients.The time from symptom onset to hospitalization in our department was less than 6 hours in 16 cases and 6-12 hours in 8 cases.81 cases were > 12 hours,accounting for 77.0% of the total number of patients.Acute testicular epididymitis was considered in the local hospital and was treated with anti-infection and pain relief.A total of 35 patients were transferred to our department due to the lack of obvious relief of symptoms,accounting for 33.3% of the total number of patients.In the local hospital,10 cases were transferred to our hospital immediately after considering testicular torsion by color Doppler ultrasound(CDS)examination,accounting for 9.5% of the total number of patients.Nearly half of the patients were transferred from grass-roots hospitals,and more than half of the patients with testicular torsion came to our hospital for more than 6 hours.Among the 105 patients included in this study,16 patients successfully retained testes,and the success rate of testicular salvage was about 15.2%.Conclusion:Most of the patients with testicular torsion were diagnosed at puberty,and intrathecal torsion was common in recent years.The success rate of testicular rescue was 15.2%,which was lower than that reported in the literature.The first visit time of more than 70% of patients was more than12 hours,which exceeded the "prime time" of testicular rescue.Public publicity and science popularization about testicular torsion diseases should be strengthened.Part 2: Combined detection of INSL3 and RAF1 m RNA in peripheral blood of patients with testicular torsion to evaluate the tendency of testicular torsionObjective: This part intends to explore the relationship between the expression of INSL3 and RAF-1 genes in peripheral blood and the pathogenesis of testicular torsion.Method: Peripheral venous blood was collected from patients with scrotal pain from December 2019 to January 2021.The expression of INSL3 and RAF-1 genes in peripheral venous blood was measured by RT-PCR method.In addition,the relationship between them and the pathogenesis of testicular torsion was evaluated.Result:A total of 48 cases were included in the study,including torsion group(n = 24)and non-torsion group(n = 24).△CT value was adopted to analyze RT-PCR data,the △CT values of INSL3 and RAF-1 genes in peripheral venous blood of patients with testicular torsion were higher than those of non-testicular torsion group(P < 0.05).By ROC curve analysis,the critical value of △CT INSL-3 for distinguishing testicular torsion patients from non-testicular torsion patients was 14.41,AUC was 0.7292,95%CI:0.5849-0.8734,the sensitivity corresponding to the critical value was 95.83%,and the specificity was 45.83%.The critical value of △CT RAF-1 between patients with testicular torsion and those without testicular torsion was 7.38 and AUC was 0.7378,95% CI 0.5947-0.8809,and the sensitivity and specificity corresponding to the critical value were 100% and 41.67%,respectively.The joint index of INSL3 and RAF-1 was calculated according to multi-factor logistics regression.The critical value of the combination index of these two factors was 0.56 and AUC was 0.8229,95%CI : 0.7005-0.9454,and the sensitivity and specificity corresponding to the critical value were 91.67% and 70.83% respectively.Conclusion: The expression of INSL3 and RAF-1 genes in peripheral blood of testicular torsion patients is lower vompared with non-testicular torsion patients.As a consequence,it may have important value in evaluating the risk of individual testicular torsion..