Reducing unnecessary biopsies while detecting clinically significant prostate cancer including cribriform growth with the ERSPC Rotterdam risk calculator and 4Kscore

Introduction

The use of risk calculators predicting clinically significant prostate cancer (csCaP) on biopsy reduces unnecessary biopsies and overdiagnosis of indolent disease compared to a Prostate Specific Antigen (PSA) strategy. Updating these tools using more specific outcome measures and contemporary predictors could potentially lead to further reductions. Our objective was to assess clinical impact of the 4 kallikrein (4K) score, the Rotterdam Prostate Cancer Risk Calculator (RPCRC), and the combination of both for predicting csCaP based on the latest International Society of Urological Pathology grading system and cribriform growth pattern.

疏血通对慢性阻塞性肺疾病合并肺动脉高压患者血清D-二聚体与呼吸功能的影响

【摘要】 目的 观察疏血通注射液对慢性阻塞性肺疾病（COPD）合并肺动脉高压患者血清D 二聚体（D D）的影响及呼吸功能改善作用。方法 将我院收治的80例COPD合并肺动脉高压患者随机分为观察组与对照组各40例，均给予吸氧、支气管舒张剂、糖皮质激素、抗生素、营养支持等常规治疗，观察组在此基础上给予疏血通注射液，两组均治疗21d。比较两组凝血功能，检测血气指标、肺动脉压、肺功能指标，评估呼吸系统评分，统计治疗过程中的不良反应。结果 观察组治疗21d后凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）显著高于对照组（P＜005），纤维蛋白原（FIB）、D D显著低于对照组（P＜005）。观察组治疗21d后动脉血氧分压（Pa02）、用力呼气1s率（FEV1/FVC）分别为（7124±1284）mmHg、（5784±1043）%显著高于对照组的（6536±1177）mmHg、（5241±945）%（P＜005），动脉血二氧化碳分压（PaC02）、肺动脉收缩压分别为（4541±819）mmHg、（4016±720）mmHg显著低于对照组的（5002±901）mmHg、（4473±806）mmHg（P＜005）。结论 疏血通可以改善COPD合并肺动脉高压患者血液高凝状态，增加血氧含量，降低肺动脉高压，改善呼吸功能。     

血流感染肺炎克雷伯菌中CRISPR-Cas系统的分布及其与毒力基因和耐药的关系

的 了解血流感染肺炎克雷伯菌中CRISPR-Cas系统的分布特征并分析其与毒力基因和耐药的关系。方法 收集非重复血流感染肺炎克雷伯菌248株，使用Vitek2-Compact全自动微生物分析系统进行菌株鉴定及药物敏感性分析，PCR检测CRISPR-Cas系统3个相关基因(CRISPR1、CRISPR2和cas1)、筛查6种常见高毒力荚膜血清型(K1、K2、K5、 K20、K54和K57)、12种毒力基因及检测13种耐药基因，用χ2检验比较携带有CRISPR-Cas系统菌株与不携带CRISPR-Cas系统菌株毒力及耐药差异。结果 CRISPR-Cas系统的检出率为29.8%(74/248)；K1型是携带CRISPR-Cas系统肺炎克雷伯菌的主要荚膜血清型，占 28.4%(21/74)；除kpn基因外，携带CRISPR-Cas系统菌株的毒力基因检出率均大于不携带CRISPR-Cas系统菌株，其中7种差异有统计学意义；除对氨苄西林耐药率达100%外，携带有CRISPR-Cas系统菌株的其他抗菌药物耐药率均小于不携带有CRISPR-Cas系统菌株，其中13种差异有统计学意义；携带CRISPR-Cas系统菌株的耐药基因阳性率小于不携带CRISPR-Cas系统的菌株，且blaKPC、blaSHV、qnrS基因差异有统计学意义。结论 高毒力荚膜血清型肺炎克雷伯菌中主要为K1型携带CRISPR-Cas系统，携带CRISPR-Cas系统的肺炎克雷伯菌相对于不携带CRISPR-Cas系统菌株的毒力基因阳性率高，耐药率低，耐药基因的阳性率低。CRISPR-Cas系统可能能降低耐药基因在肺炎克雷伯菌中的水平传播，尤其是在K1型肺炎克雷伯菌。     

In vitro dissolution and oral bioavailability study of fenofibrate nanomatrix system prepared by hot-melt extrusion

Solvent evaporation method for preparation of nanomatrix has the disadvantages, such as residual organic solvent, environmental pollution, explosion-proofing and so on. To overcome these shortcomings, a series of fenofibrate nanomatrix drug delivery system (NDDS) consisting of nano-porous silica Sylysia^®350 (S350) and pH sensitive material Eudragit^® L100-55 (EL100-55) were prepared using hot-melt extrusion (HME), and their in vitro dissolution and in vivo bioavailability were compared. Finally, the formulation with the highest in vivo bioavailability was selected as the optimized formulation for DSC and PXRD characterization. The results showed that the optimized NDDS showed a higher bioavailability than the reference formulation, although there was crystalline form drug remaining in NDDS. The relative bioavailability of the optimized formulation was 157.1% compared with the commercial product Lipanthyl^®. In addition, the relative bioavailability of the optimized formulation was 124.8% in comparison with the formulation prepared by solvent evaporation method, showing that the NDDS prepared by the HME method was effective in improving the bioavailability of fenofibrate. In conclusion, HME was a promising method to prepare NDDS.     

血清窖蛋白-1在慢性阻塞性肺疾病相关肺动脉高压患者中的表达及意义

目的 研究血清窖蛋白-1 （Cav-1） 在慢性阻塞性肺疾病 （COPD） 相关肺动脉高压 （PAH） 患者中的表达及其意义。方法 选取稳定期COPD患者65例， 根据是否合并PAH分成COPD组 ［肺动脉收缩压 （PASP） ＜40 mmHg， 35例］ 及COPD-PAH组 （PASP ≥40 mmHg， 30例）。另选取在本院健康体检的志愿者30例作为对照组。对比各组基线资料、 动脉血气分析、 肺功能指标， 以及血清Cav-1、 白细胞介素 （IL） -6和肿瘤坏死因子-α （TNF-α） 的表达水平。绘制受试者工作特征 （ROC） 曲线， 评价Cav-1对COPD合并PAH的诊断价值。结果 COPD-PAH组与COPD组第一秒用力呼吸容积 （FEV1） /用力肺活量 （FVC）、 FEV1占预计值百分比 （FEV1%） 及氧分压 ［p （O2 ）］ 低于对照组， 而二氧化碳分压 ［p （CO2 ）］、 PASP均高于对照组 （P＜0.01）。COPD-PAH组p （O2 ） 低于COPD组， p （CO2 ）、 PASP均高于COPD 组 （P＜0.01）。对照组、 COPD组及COPD-PAH组Cav-1表达水平呈逐渐降低趋势， 而IL-6、 TNF-α表达水平呈逐渐升高趋势 （P＜0.01）。血清Cav-1诊断COPD合并PAH的ROC曲线下面积为0.902 （0.821～0.955）， 最佳截断值为 6.66 μg/L， 此时诊断敏感度为76.7%， 特异度为85.7%， 与多普勒超声诊断仪测量PASP结果比较一致性较好 （Kappa 值=0.627）。结论 血清Cav-1在COPD相关PAH患者表达明显下调， 可以作为预测COPD相关PAH的新型血清标志物。     

The diagnostic significance of repeat ultrasound-guided biopsy of musculoskeletal soft-tissue lesions with initially inconclusive biopsy results

IntroductionTo determine the diagnostic yield of repeat ultrasound (US)-guided biopsy of musculoskeletal soft-tissue lesions with initially inconclusive biopsy results, and to explore predictive factors for success of repeat biopsy.Materials and methodsThis retrospective study included 42 patients who underwent a repeat (second) US-guided biopsy session to target a musculoskeletal soft-tissue lesion because an initial US-guided biopsy session provided inconclusive results. Both biopsy sessions were performed in a tertiary referral center for soft-tissue sarcomas.ResultsThe diagnostic yield of repeat US-guided biopsy was 47.6%. Malignant nature of the lesion (P = 0.031), sharp lesion borders on US (P = 0.011), and good to very good lesion visibility on US (P = 0.017) were significantly associated with a diagnostic repeat US-guided biopsy. There was also a trend towards significance (P = 0.073) for a higher number of biopsy passes through the lesion. Other patient characteristics (age and gender), magnetic resonance imaging features (lesion homogeneity on T1-weighted, T2-weighted, and gadolinium chelate enhanced sequences, borders, enhancement pattern, depth and size), US features (lesion appearance, vascular flow, and depth), biopsy-related factors (days between initial and repeat US-guided biopsy, needle diameter, maximum length of acquired samples), and operator-related factors (same or different radiologists/pathologists for initial and repeat biopsies), were not associated with the diagnostic success of the repeat US-guided biopsy.ConclusionsRepeat US-guided biopsy of a musculoskeletal soft-tissue lesion with initially inconclusive biopsy results can be useful to establish a final diagnosis. Lesion features on US (borders and visibility) may be used to prospectively determine the utility of a repeat US-guided biopsy.     

Utility of the 3‐Vessel and 3‐Vessel and Trachea Views in Prenatal Diagnosis of a Pulmonary Artery Sling

A pulmonary artery (PA) sling is a very rare congenital cardiovascular anomaly, and only a few studies have reported PA slings in fetuses. The relationship of the PA, aorta, ductus arteriosus, and trachea can be evaluated in the 3‐vessel and 3‐vessel and trachea views during fetal echocardiography. A PA sling can be detected by abnormal positioning of the left PA in relation to the trachea when sweeping from the 3‐vessel view cranially to the 3‐vessel and trachea view. Here we report 3 cases of fetal PA slings and their follow‐ups. Two cases were confirmed by postnatal echocardiography, and the other case was confirmed by a cardiovascular cast after pregnancy termination. We emphasize that the 3‐vessel and 3‐vessel and trachea views are of crucial importance in the prenatal diagnosis of a PA sling.