高分辨率MR血管壁成像测量壁强化指数评估颅内动脉瘤不稳定性

目的探讨高分辨率MR(HRMR)血管壁成像(VWI)所测壁强化指数(WEI)评估颅内动脉瘤不稳定性的价值。方法回顾性分析174例未破裂颅内动脉瘤患者。以3D-DSA观察动脉瘤大小、位置、形态。基于HRMR血管壁成像主观评估是否有动脉瘤壁强化(AWE),并采用软件计算WEI。采用ELAPSS及PHASES评分评估动脉瘤生长风险及破裂风险。以Spearman相关分析观察WEI与动脉瘤生长及破裂风险的相关性。结果 174例患者共248个无症状未破裂颅内囊状动脉瘤,HRMR VWI示AWE 78个、无AWE 170个。AWE与无AWE动脉瘤大小、位置、形态、ELAPSS评分、生长风险、PHASES评分、5年破裂风险差异均有统计学意义(P均0.05)。AWE动脉瘤WEI高于无AWE动脉瘤(P0.001)。Spearman相关分析显示,WEI与动脉瘤3年、5年生长风险(r_s=0.40、0.40,P均0.01)及5年破裂风险(r_s=0.24,P0.01)均呈正相关。结论 HRMR VWI所测WEI越高,提示动脉瘤不稳定性越高。     

中国农村地区现在吸烟者戒烟意愿及其影响因素研究

目的 了解中国农村地区现在吸烟者戒烟意愿,探索其影响因素,为控烟工作提供参考。方法 本研究数据来源于2018年中国慢性病及危险因素监测,采用多阶段分层整群抽样的方法抽取184 509名≥18岁居民,其中10 241名农村现在吸烟者纳入研究。采用χ²/F检验对戒烟意愿与人口学信息、烟草使用情况、烟草相关危害知识的认知、慢性病患病情况等因素进行单因素分析,多因素分析采用非条件多因素logistic回归分析。结果 3 453名（37.46%）考虑在未来12个月内戒烟。logistic回归分析显示,偶尔吸烟者的戒烟意愿高于每天吸烟者（OR=0.693,95%CI：0.494~0.971）,每天吸烟量<1包者的戒烟意愿高于≥1包者（OR=0.628,95%CI：0.511~0.771）,12个月内有戒烟经历者的戒烟意愿高于12个月内未戒过烟的现在吸烟者（OR=0.438,95%CI：0.357~0.537）,烟草危害认知程度高者戒烟意愿更高（OR=1.056,95%CI：1.028~1.086）,差异均有统计学意义（P<0.05）。结论 中国农村地区现在吸烟者戒烟意愿与吸烟状况、吸烟量、戒烟情况、烟草危害认知有关。建议加强对农村地区的健康教育宣传,提供简短的戒烟干预,提高农村现在吸烟者的戒烟意愿。     

Humeral Head Replacement in the Treatment of Comminuted Proximal Humeral Fracture

ObjectiveTo investigate the outcomes of humeral head replacement in the treatment of patients with comminuted proximal humeral fracture.MethodsBetween February 2013 and September 2016, 56 patients underwent humeral head replacement in our hospital. Of them, 18 cases were diagnosed as comminuted proximal humeral fracture before the operation. The mean age of the patients was 69.5 years old (ranging from 61 to 79 years old). Of them, there were six males and 12 females. All the patients in this group had fresh fractures. They were all treated by artificial humeral head replacements. After the prosthesis was fixed by bone cement reliably, the greater or lesser trochanter and prosthesis handle were sutured and fixed firmly. The interval time from injury to operation ranged from 1 to 5 days. The Constant Functional Score, operation time, blood loss, nerve injury, joint dislocation rate, and infection rate were recorded at the final follow‐up. The clinical data of these patients were retrospectively studied. All of the data were recorded in average form.ResultsIn this study, the mean duration of follow‐up was 4 years, ranging from 3 to 6 years. The operation time ranged from 75 to 120 min, with the average of 82 min. The blood loss ranged from 100 to 400 mL, with the average of 210 mL. The mean score of Constant Functional Score was 83.5 ± 3.1. Of them, 14 cases achieved excellent and good (scores of more than 80), and four cases achieved moderate and poor (scores of less than 80). No patient suffered from joint dislocation, unstable joint, or infection after the operation. There were two patients with axillary nerve injury before the operation. However, the function could be recovered within 3–6 weeks after the surgery.ConclusionThe artificial humeral head replacement could be applied for the treatment of patients with comminuted proximal humeral fracture. During the surgery process, the stable structure of shoulder joint could be completely restructured, and the rehabilitation plan should be adjusted reasonably and timely after the operation.     

Tension band plates have greater risks of complications in temporary epiphysiodesis

PurposeThis study aimed to compare the efficacy of decreasing leg-length discrepancy (LLD) and postoperative complications between tension band plates (TBP) and percutaneous transphyseal screws (PETS).MethodsThis retrospective study reviewed LLD patients who underwent temporary epiphysiodesis at the distal femur and/or proximal tibia from 2010 to 2017 (minimum two years follow-up). Efficacy of decreasing LLD was assessed one and two years postoperatively. Complications were classified with the modified Clavien-Dindo-Sink complication classification system. Knee deformities were assessed by percentile and zone of mechanical axis across the tibial plateau.ResultsIn total, 53 patients (25 boys, 28 girls) underwent temporary epiphysiodesis (mean age, 11.4 years). The efficacy of decreasing LLD at two years between the TBP (n = 38) and PETS (n = 15) groups was comparable. Seven grade III complications were recorded in six TBP patients and in one PETS patient who underwent revision surgeries for knee deformities and physis impingement. Four grade I and two grade II complications occurred in the TBP group. The mechanical axis of the leg shifted laterally in the PETS group and medially in the TBP groups (+7.1 percentile versus -4.2 percentile; p < 0.05). Shifting of the mechanical axis by two zones was noted medially in four TBP patients and laterally in two PETS patients.ConclusionMore implant-related complications and revision surgeries for angular deformities were associated with TBP. A tendency of varus and valgus deformity after epiphysiodesis using TBP and PETS was observed, respectively. Patients and families should be informed of the risks and regular postoperative follow-up is recommended.Level of evidenceLevel III     

Narrative review of prostate cancer grading systems: will the Gleason scores be replaced by the Grade Groups?

The Gleason grading system, proposed by Dr. Donald F. Gleason in 1966, is one of the most important prognostic factors in men with prostate cancer (PCa). At consensus conferences held in 2005 and 2014, organized by the International Society of Urological Pathology (ISUP), the system was modified to reflect the current diagnostic and therapeutic approaches. In particular, in the 2014 Conference, it was recognized that there were weaknesses with the original and the 2005 ISUP modified Gleason systems. Based on the results of a research conducted by Prof. JI Epstein and his group, a new grading system was proposed by the ISUP in order to address some of such deficiencies: i.e., the five distinct Grade Groups (GGs). Since 2014, results of studies have been published by different groups and societies, including the Genitourinary Pathology Society (GUPS), giving additional support to the prognostic role of the architectural Gleason patterns and, in particular, of the GGs. A revised GG system, taking into account the percentage of Gleason pattern (GP) 4, cribriform and intraductal carcinoma, tertiary GP 5, and reactive stroma grade, has shown to have some advantages, however not ready for adoption in the current practice. The aim of this contribution was to review the major updates and recommendations regarding the GPs and GSs, as well as the GGs, trying to give an answer to the following questions: “How has the grade group system been used in the routine?” and “will the Gleason scoring system be replace by the grade groups?” We also discussed the potential implementation in the future of molecular pathology and artificial intelligence in grading to further define risk groups in patients with PCa.     

Towards a new WHO classification of renal cell tumor: what the clinician needs to know—a narrative review

In 1952, renal cell carcinomas had been divided into 2 categories—clear cell or granular cell—depending upon their cytoplasmic staining characteristics. In the following years, the inventory of renal epithelial tumors has expanded by the addition of tumors named by their architectural pattern (i.e., papillary RCC, tubulocystic RCC), anatomic location (i.e., collecting duct carcinoma, renal medullary carcinoma), associated diseases (i.e., acquired cystic disease-associated RCCs). With the extensive application of molecular diagnostic techniques, it becomes possible to detect genetic distinctions between various types of renal neoplasm and discover new entities, otherwise misdiagnosed or diagnosed as unclassified RCC. Some tumors such as ALK rearrangement-associated RCC, MiT family translocation renal carcinomas, SDH-deficient renal cancer or FH-deficient RCC, are defined by their molecular characteristics. The most recent World Health Organization (WHO) classification of renal neoplasms account for more than 50 entities and provisional entities. New entities might be included in the upcoming WHO classification. The aim of this review is to summarise and discuss the newly acquired data and evidence on the clinical, pathological, molecular features and on the prognosis of new RCC entities, which will hopefully increase the awareness and the acceptance of these entities among clinicians and improve prognostication for individual patients.