Prediction of extraprostatic cancer by prostate specific antigen density,endorectal MRI,and biopsy Gleason score in clinically localized prostate cancer

BACKGROUNDS: The present study was designed to identify the preoperative parameters, including PSA-based parameters, and endorectal MRI, predictive of pathological stage in males who underwent radical prostatectomy. METHODS: We studied 114 patients who underwent radical retropubic prostatectomy and pelvic lymphadenectomy for clinically localized prostate cancer. Clinical stage was assessed by DRE, pelvic CT scan, endorectal MRI, and bone scan. The correlation between the preoperative parameters, including PSA-based parameters, clinical stage, and histological findings of biopsy specimens, and the pathological stage was analyzed. Logistic regression analysis was performed to identify a significant set of independent predictors for local extent of disease. RESULTS: Seventy-six (66.6%) patients had organ confined cancer and 38 (33.4%) patients had extraprostatic cancer. Of the 38 patients with extraprostatic cancer, four had seminal vesicle involvement, while, none had pelvic lymph node involvement. Biopsy Gleason score, PSA, PSA-alpha1-antichymotrypsin (PSA-ACT), PSA-density (PSAD), PSA-transition zone density, PSA-ACT density, and PSA-ACT transition zone (TZ) density were significantly higher and percent free PSA was lower in the patients with organ confined cancer than those with extraprostatic cancer (P < 0.01). PSAD showed the largest area under the ROC curve (AUC) among those parameters (AUC = 0.732). Sixty-eight (74.7%) of 91 patients with T2 on endorectal MRI had organ confined cancer, while 15 (65.2%) of 23 patients with T3 had extraprostatic cancer (P < 0.01). Multivariate logistic regression analysis indicated that Gleason score (> or =7 vs. < or =6), endorectal MRI findings, and PSAD were significant predictors of extraprostatic cancer (P < 0.01). CONCLUSIONS: The present study demonstrated that preoperative PSAD was the most valuable predictor among PSA-based parameters for extraprostatic disease in patients with clinically localized prostate cancer. The combination of PSAD, endorectal MRI findings, and biopsy Gleason score can provide additional information for selecting appropriate candidates for radical prostatectomy.     

Nutritional problems associated with end-stage renal disease in the developing world

Protein-energy malnutrition is a major problem in dialysis patients. There is increased morbidity and mortality in dialysis patients with malnutrition. There are very few published studies on nutritional parameters and adequacy of dialysis from the developing world and especially from Africa. There was a significant improvement in neuromuscular function and nutrition in 22 hemodialysis patients in Egypt with optimization of dialysis dose and nutritional status. In a study of 82 continuous ambulatory peritoneal dialysis (CAPD) patients in Durban, South Africa, there was a reduction in the number of hospital admissions in adequately dialyzed patients (achieving Kt/V of >2.1). In another study of 84 CAPD patients from the same center, 76.2% of patients were assessed as being malnourished, with loss of appetite being an important etiological factor. Strategies to optimize dialysis dose, together with services of a renal dietician, will assist in improving the nutrition of patients with chronic renal failure.     

Kinematic evaluation of cervical sagittal balance and thoracic inlet alignment in degenerative cervical spondylolisthesis using kinematic magnetic resonance imaging

Background Context

T1 slope is a novel thoracic parameter used to assess cervical spine sagittal balance. Thoracic index (TI) parameters including T1 slope and cervical sagittal alignment parameters may play an important role in degenerative cervical spondylolisthesis (DCS). Current literature regarding the relationship between TI and cervical sagittal alignment parameters in patients with DCS is limited.

雌激素与尾悬吊法导致雄性C57小鼠骨质疏松关系的研究

目的探讨雌激素对尾悬吊导致雄性C57小鼠骨质疏松的影响及其内在机制。方法 32只成年C57BL/6J雄性小鼠,随机分成4组:对照组(control,C),模型组(model,M),雌激素组(estrogen,E),雌激素+雌激素受体抑制组(estrogen+ICI 182,780,E+I)。除C组外其余组小鼠尾悬吊两周,所有小鼠在第15d处死,取小鼠血清进行生化指标分析,取小鼠右侧股骨进行显微CT扫描和形态学染色,取小鼠左侧股骨进行生物力学检测并取股骨远端研磨后进行蛋白检测。结果尾悬吊两周导致雄性C57小鼠股骨出现明显骨质疏松,M组与C组相比差异有显著的统计学意义(P0.05)。雌激素干预能抑制骨质流失,E组多数骨相关参数与对照组相比,差异无统计学意义(P0.05)。而使用雌激素受体拮抗剂ICI182,780之后,雌激素骨保护效应消失,与M组相比差异无统计学意义(P0.05)。尾悬吊两周导致股骨远端离子型谷氨酸受体NMDA亚型NR2A表达降低,雌激素升高骨组织中NR2A表达水平。结论雄性C57小鼠尾悬吊2w表现出显著骨质疏松,雌激素通过激活雌激素受体明显改善骨质流失,可能是通过促进骨组织中NR2A表达而实现成骨细胞增殖和分化。     

二苯甲酮类防晒剂的结构和安全性研究

目的 通过对二苯甲酮3种衍生物二苯甲酮-1、二苯甲酮-2和二苯甲酮-3进行皮肤光毒实验和皮肤光变态反应,探讨3种不同结构防晒剂对皮肤的安全性.方法 用HyperChem7.0软件分别计算出上3种防晒剂的总能量、结合能、电子能、净电荷、偶极矩等结构参数,用SPSS13.0软件分析不同结构参数和防晒剂皮肤光毒反应指数及光变态反应指数的相关性.结果 光毒反应指数和结构参数中的总能量和电子能呈负相关(P<0.01),并随净电荷之和的增加而上升(P<0.01).光变态反应指数仅和结构参数中的结合能密切相关(P<0.01),和其他结构参数均无相关性(P>0.05).结论 初步确定光毒反应指数和结构总能量、电子能相关.光变态反应指数和结合能相关.从而初步建立结构总能量、电子能、净电荷之和-皮肤光毒反应模型以及结合能-光变态反应模型.     

Grading of degenerative disk disease and functional impairment: imaging versus patho-anatomical findings

Degenerative instability affecting the functional spinal unit is discussed as a cause of symptoms. The value of imaging signs for assessing the resulting functional impairment is still unclear. To determine the relationship between slight degrees of degeneration and function, we performed a biomechanical study with 18 multisegmental (L2-S2) human lumbar cadaveric specimens. The multidirectional spinal deformation was measured during the continuous application of pure moments of flexion/extension, bilateral bending and rotation in a spine tester. The three flexibility parameters neutral zone, range of motion and neutral zone ratio were evaluated. Different grading systems were used: (1) antero-posterior and lateral radiographs (degenerative disk disease) (2) oblique radiographs (facet joint degeneration) (3) macroscopic and (4) microscopic evaluation. The most reliable correlation was between the grading of microscopic findings and the flexibility parameters; the imaging evaluation was not as informative.     

Splenectomy reduces packed red cell transfusion requirement in children with sickle cell disease

Purpose

The purpose of the study was to measure the effect of splenectomy on packed-cell transfusion requirement in children with sickle cell disease.

Methods

Thirty-seven sickle cell children who underwent splenectomies between January 2000 and May 2006 at a children's hospital were reviewed. Data were collected 6 months preoperatively to 12 months postsplenectomy. Paired t test, analysis of variance, and multivariable regression analyses were performed.

Results

Of 37 children with median age 11 years (range, 2-18 years), 34 (21 males) had data that allowed analyses. Twenty-six had Hgb-SS, 5 had Hgb-SC, and 3 had Hgb S-Thal. Laparoscopic splenectomy was attempted in 36 and completed successfully in 34 (94% success). The number of units transfused decreased by 38% for 0 to 6 months and by 45% for 6 to 12 months postsplenectomy. Postoperatively, hematocrit levels increased and reticulocytes concurrently decreased with a reduction in transfusion clinic visits. The decrease in transfusion was not influenced by spleen weight, age, or hemoglobin type. Two children had acute chest syndrome (6%), and 1 had severe pneumonia (3%).

Conclusion

Laparoscopic splenectomy can be successfully completed in sickle cell children. Splenectomy significantly reduces the packed red cell transfusion requirement and frequency of clinic visits, in sickle cell children for at least 12 months postoperatively.     

The application of color Doppler flow imaging in the diagnosis and therapeutic effect evaluation of erectile dysfunction

We aim to investigate the correlations between hemodynamic parameters, penile rigidity grading, and the therapeutic effects of phosphodiesterase type 5 inhibitors using color Doppler flow imaging after intracavernosal injection in patients with erectile dysfunction. This study involved 164 patients. After intracavernosal injection with a mixture of papaverine (60 mg), prostaglandin E₁ (10 μg), and lidocaine (2%, 0.5–1 ml), the penile vessels were assessed using color Doppler flow imaging. Penile rigidity was classified based on the Erection Hardness Score system as Grades 4, 3, 2 or 1 (corresponding to Schramek Grades V to II). Then, the patients were given oral sildenafil (50–100 mg) and scored according to the International Index of Erectile Function (IIEF-5) questionnaire. The number of patients with penile rigidities of Schramek Grades II to V was 14, 18, 21, and 111, respectively. The IIEF-5 score was positively correlated with the refilling index of the penile cavernosal artery (r = 0.79, P < 0.05), the peak systolic velocity (r = 0.45, P < 0.05), and penile rigidity (r = 0.75, P < 0.05), and was negatively correlated with the end diastolic velocity (r = −0.74, P < 0.05). For patients with erectile dysfunction, both the IIEF-5 score after sildenafil administration, which is correlated with penile rigidity, and the hemodynamic parameters detected using color Doppler flow imaging may predict the effects of phosphodiesterase type 5 inhibitor treatment and could provide a reasonable model for the targeted-treatment of erectile dysfunction.     

非侵袭性检查指标对中老年男性膀胱出口梗阻的诊断价值

目的：探讨临床常用非侵袭性检查指标诊断膀胱出口梗阻（BOO）的准确性及可靠性。方法回顾性研究2003年11月—2015年11月在广州市第一人民医院就诊并接受压力—流率测定（PFS）的男性 LUTS ／BPH患者,以侵袭性的 PFS 为诊断 BOO 的“金标准”,以前列腺体积（PV）、移行带体积（TZV）、移行带指数（TZI）、前列腺特异性抗原（PSA）、最大尿流率（Qmax）、剩余尿量（PVR）、剩余分数（RF）等非侵袭性检查指标为诊断指标进行诊断试验评价。结果筛选1319例患者纳入统计分析。以 ICS 列线图为诊断标准,PV、TZV、TZI、PSA、Qmax、RF、PVR 诊断 BOO 的 ROC 曲线下面积（AUC）分别为0．803、0．807、0．698、0．775、0．740、0．679、0．641;以 Schaefer 列线图为诊断标准,PV、TZV、TZI、PSA、Qmax、RF、PVR 诊断 BOO 的 AUC 分别为0．806、0．814、0．713、0．773、0．721、0．684、0．642。结论 PV、TZV、TZI、PSA、Qmax、RF、PVR 等非侵袭性指标对筛查及诊断中老年男性 BOO 有一定的参考价值及临床意义,其中 TZV、PV、PSA、Qmax 的诊断准确性较高。     

孕妇血清GH、IGF-1、IGFBP3水平的变化及其与新生儿生长参数的相关性研究

目的 探讨生长激素(GH)、胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白3(IGFBP3)与妊娠期糖尿病(GDM)的关系及其对新生儿生长参数的影响.方法 选择2014年11月至2015年7月在南宁市妇幼保健院住院分娩、孕期检查为妊娠期糖尿病并且孕期通过医学营养治疗血糖控制良好的孕妇42例,作为GDM组,另随机选取同期糖耐量试验正常的孕妇40例,作为对照组.采用电化学发光法测定两组孕妇血清GH、IGF-1、IGFBP3水平.孕妇分娩后测量新生儿体质量、身长、头围、肩围、胸围、胎盘重量等生长参数.比较两组孕妇血清GH、IGF-1、IGFBP3的差异以及与上述新生儿生长参数的相关性.结果 GDM组孕妇的IGF-1和IGFBP3分别为(343.3±101.9)ng/mL和(5.5±1.1)μg/mL,均高于对照组的(267.5±84.9)ng/mL和(4.8±0.9)μg/mL,差异均有统计学意义(P<0.05);两组孕妇的GH、新生儿体质量、身长、头围、肩围、胸围、胎盘重量比较差异均无统计学意义(P>0.05).结论 孕妇外周血GH、IGF-1、IGFBP3水平与新生儿体质量、身长、头围、肩围、胸围、胎盘重量等生长参数无显著相关性,但是IGF-1、IGFBP3与GDM的发生相关,可作为一种预测GDM的潜在指标.