前列腺癌血清PSA、f/tPSA与Gleason评分、临床分期的相关性研究

目的 探讨前列腺癌病人血清PSA、f/tPSA（血清游离PSA与总PSA的比值）与前列腺癌Gleason评分、临床分期的相关性.方法 查阅我院1998年1月～2005年6月归档的前列腺癌病历资料,建立临床资料数据库,对归档病理切片进行Gleason评分.采用Spearman等级相关分析,分析血清PSA、f/tPSA与前列腺癌Gleason评分、临床分期的关系.结果 269例前列腺癌中,前列腺癌PSA值与Gleason评分呈正相关（r=0.361,P＜0.01）,与前列腺癌临床分期呈正相关（r=0.586,P＜0.01）;f/tPSA与Gleason评分有弱负相关（r=-0.128,P=0.035）,与前列腺癌临床分期呈负相关（r=-0.226,P＜0.01）.结论 血清PSA、f/tPSA与前列腺癌预后密切相关的指标临床分期和Gleason评分有关.     

血清前列腺特异性抗原及直肠指检与前列腺癌的相关性研究

目的 分析血清PSA、直肠指检(DRE)与前列腺癌检出率、临床分期以及病理分级的相关性. 方法 回顾性分析1997年1月至2010年12月796例PSA、DRE和病理结果完整患者的前列腺穿刺活检资料,采用Spearman相关性研究分析PSA和DRE与前列腺癌相关指标间的关系,进一步将PSA及DRE分组后进行比较. 结果 PSA与前列腺癌检出率、临床分期及病理分级相关(r=0.537,P＜0.0001;r=0.365,P＜0.0001;r=0.556,P＜0.0001);DRE结果与前列腺癌诊断率及病理分级有相关性(r=0.212,P＜0.0001;r=0.126,P=0.02).分组分析显示不同PSA水平组中前列腺癌检出率、前列腺癌分期以及Gleason评分差异有统计学意义(P＜0.05).而在相同PSA水平时,只有PSA 10.0 ～ 19.9 μg/L组和20.0～99.9μg/L组中DRE阳性和阴性患者的前列腺癌检出率差异有统计学意义(P＜0.05).相同PSA组中不同DRE结果患者的前列腺癌分期以及Gleason评分差异无统计学意义(P＞0.05). 结论 PSA水平与前列腺癌的检出率、肿瘤分期及Gleason评分有显著相关性,DRE结果仅在部分PSA水平患者中影响肿瘤检出率.     

穿刺前列腺癌Gleason评分与血清PSA的相关性分析

目的:探讨穿刺前列腺癌Gleason评分与血清PSA水平的相关性。方法:收集我院2011年5月~2014年6月经前列腺穿刺确诊为前列腺癌且临床资料完整的患者标本81例,对其穿刺组织的Gleason评分与血清PSA水平进行Spearman等级相关性分析。结果:前列腺癌组织Gleason评分与患者血清PSA水平呈正相关(r=0.347,P0.01),PSA值越高,Gleason评分越高。结论:前列腺癌患者血清PSA水平与Gleason评分相关。     

miR-18a在前列腺癌患者血清中的表达及其临床意义

目的探讨前列腺癌患者microRNA-18a(miR-18a)在血清中的表达及其诊断价值。方法采用实时荧光定量PCR(qRT-PCR)检测60例前列腺癌患者(PCa)、30例良性前列腺增生患者(BPH)和20例健康对照者(HC)血清miR-18a的表达水平。分析miR-18a表达水平与前列腺癌Gleason分级、TNM分期及PSA的关系。通过分析受试者工作特征(ROC)曲线判断miR-18a表达水平在前列腺癌诊断中的灵敏度和特异度。结果PCa患者血清miR-18a的表达水平分别明显高于BPH组和HC组(P<0.01);miR-18a与Gleason评分、肿瘤分期有关(P<0.01);miR-18a与PSA之间呈正相关(r=0.701,P=0.000);miR-18a的ROC曲线下面积(AUC)为0.928(95%CI:0.880~0.976,P=0.000),敏感度为84.3%,特异度为75.8%。结论miR-18a在PCa患者血清中表达水平明显增高,对于PCa的诊断有潜在的临床参考价值。     

前列腺特异抗原联合分级对前列腺癌患者分期的预测

目的探讨血清前列腺特异抗原(PSA)联合分级对前列腺癌患者的分期进行预测的方法。方法回顾分析我院泌尿外科187例穿刺活检诊断为前列腺癌患者的临床资料。采用等级相关分析、秩和检验、逐步判别多因素分析方法,分析血清PSA水平、游离PSA百分比(FPSA/TPSA值)与Gleason评分(GS)、分期的关系。结果前列腺癌患者GS越高,血清PSA水平越高(r=0.369,P<0.001)。分期越晚,血清PSA、GS越高(r=0.398,0.530,P均<0.001)。FPSA/TPSA值与分期不相关(P>0.70),但当PSA≤10μg/L时,FPSA/TPSA值与分期呈负相关(r=-0.600,P<0.05)。当PSA>20μg/L时,67%~87%的患者可能为C或D期。用PSA、GS预测分期的公式为x=-3.488+0.041×PSA+0.428×GS。结论血清PSA水平与GS呈正相关。血清PSA水平、GS分别与分期呈正相关。当PSA≤10μg/L时,FPSA/TPSA值与分期呈负相关。运用判别公式x=-3.488+0.041×PSA+0.428×GS可以预测前列腺癌患者的分期。     

血清PSA值与穿刺标本Gleason评分预测前列腺癌病理分级

目的 探讨准确有效预测前列腺癌病理分级的方法.方法 分析75例前列腺癌患者术前血清PSA水平、穿刺活检标本和前列腺癌根治术后标本Gleason评分资料,对血清PSA水平与根治术后标本Gleason评分进行等级相关分析,对穿刺活检标本与根治术后标本Gleason评分进行配对秩和检验.结果 75例患者术前血清PSA值4～230 ng/ml,平均33.5 ng/ml;穿刺活检标本Gleason评分2～9分,平均(4.4±2.3)分;根治术后标本Gleason评分2～10分,平均(4.8±2.5)分.术前血清PSA水平与根治术后标本Gleason评分呈正相关(rs=0.279,P=0.015),穿刺活检标本与根治术后标本Gleason评分差异有统计学意义(P=0.011).结论 前列腺癌患者术前血清PSA水平越高,根治术后标本Gleason评分也越高;穿刺标本Gleason评分有低估的缺点,必要时应行病理分级后再评估.     

经直肠超声引导下前列腺穿刺活检540例临床分析

目的评价经直肠超声引导下前列腺穿刺活检诊断前列腺癌（PCa）的临床应用价值,提高PCa的诊治水平。方法回顾性分析血PSA升高和（或）直肠指检前列腺结节及超声检查有异常的540例患者经直肠超声引导下前列腺穿刺活检的临床资料和声像图表现。其中直肠指诊异常者248例;超声显示有异常回声结节者178例,145例为低回声,占81.4％,42例在声像图上未发现异常;380例PSA〉10μg／L。结果540例活检中PCa220例,阳性率为40．7％,前列腺肉瘤4例,前列腺增生症269例,前列腺增生症并上皮内瘤（PIN）35例,前列腺炎9例,前列腺结核2例,非典型增生1例。结论经直肠超声引导下前列腺穿刺活检是诊断PCa的一种安全有效的检查方法。     

D期前列腺癌药物去势的疗效与AR、PSA的相关性研究

目的:探讨D期前列腺癌(PCa)患者药物去势治疗的效果与雄激素受体(AR)、前列腺特异性抗原(PSA)的相关性。方法:对33例D期PCa患者给予LHRH类似物 抗雄激素药物进行药物去势治疗,结合免疫组化进行统计分析。结果:AR、PSA与癌组织分化程度的之间的差异有统计学意义。Gleason不同评分组间血清PSA水平之间差异有统计学意义(P<0.05),PCa Gleason评分值与原位PSA免疫标记表达呈明显的负相关性(P<0.01);原位PSA免疫标记表达与血清PSA不具有相关性。结论:PCa组织中AR、PSA表达与D期PCa患者行药物去势疗法疗效有密切关系;血清PSA变化是监测PCa肿瘤复发与疗效的可靠瘤标。     

前列腺癌分期方法的临床评价

目的 :探讨临床参数对前列腺癌分期的临床意义。　方法 :通过病理诊断、MRI检查及全身骨扫描对 112例经前列腺活检病理证实的前列腺癌进行分期 ,结合血清前列腺特异抗原 (PSA)、穿刺后Gleason评分、穿刺阳性针数百分率评价其临床意义。　结果 :112例前列腺癌中 ,血清PSA、Gleason评分、穿刺阳性针数百分率对前列腺癌分期有显著相关性 (r=0 .6 98,r=0 .6 74 ,r=0 .6 71,P均 <0 .0 0 1) ,但对B期和C期前列腺癌的诊断差异无显著性 (χ2=2 .6 75 ,P =0 .0 96 ;χ2 =0 .70 4 ,P =0 .4 0 1) ,血清PSA较Gleason评分和穿刺阳性针数百分率对D期的诊断差异有显著性 (χ2 =5 .135 ,P =0 .0 2 3;χ2 =4 .5 93,P =0 .0 32 )。血清PSA、Gleason评分和穿刺阳性针数百分率的敏感性分别为 76 .7%、83.3%和 77.8% ,特异性为 5 0 %、77.3%和 5 4 .5 % ,准确性为 71.4 %、82 .1%和 73.2 %。　结论 :血清PSA、Gleason评分、穿刺阳性针数百分率可预测前列腺癌的分期 ,穿刺后Gleason评分对前列腺癌分期的预测较血清PSA和穿刺阳性针数百分率更准确。血清PSA对远处转移性前列腺癌的预测更有意义     

穿刺标本Gleason评分预测前列腺癌病理分级准确性的研究

目的 分析前列腺癌患者穿刺标本与根治术标本Gleason评分的相关性,探讨影响穿刺标本Gleason评分准确性的可能因素.方法 回顾性分析86例接受根治性前列腺切除术的前列腺癌患者资料,比较穿刺标本与根治术标本Gleason评分的符合情况,应用二分类Logistic回归分析筛选影响穿刺标本Gleason评分准确性的可能因素.结果 86例患者穿刺标本平均Gleason评分为6.1,根治术标本平均Gleason评分为6.5,穿刺标本与根治术标本Gleason评分相比,评分相符42例(48.8%),评分偏低32例(37.2%),评分偏高1 2例(14.0%),差异具有统计学意义(P＜0.05),偏差与患者年龄、血清PSA、前列腺体积、临床分期无显著相关性(P＞0.05),与穿刺针数(OR=2.905)及穿刺阳性率(OR=4.225)有显著相关(P＜0.05).结论 穿刺针数与穿刺阳性针数百分比是影响穿刺标本Gleason评分准确性的可能因素,增加前列腺穿刺活检针数将可能有助于提高穿刺标本预测前列腺癌病理分级的准确性.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.