Establishment and validation of nomogram for positive surgical margin of prostate cancer / 中华泌尿外科杂志

Objective:To establish a nomogram model for predicting positive resection margins after prostate cancer surgery, and to perform the corresponding verification, in order to predict the risk of positive resection margins after surgery.Methods:A total of 2 215 prostate cancer patients from The First Affiliated Hospital of Naval Medical University, Hospital, Peking University First Hospital, Peking University Third Hospital, Peking University, and First Affiliated Hospital of Xi′an Jiaotong University were included in the PC-follow database from 2015 to 2018, and a simple random sampling method was used. They were divided into 1 770 patients in the modeling group and 445 patients in the verification group. In the modeling group, the age (<60 years, 60 to 70 years, >70 years), PSA (<4 ng/ml, 4-10 ng/ml, 11-20 ng/ml, >20 ng/ml), pelvic MRI (negative, suspicious, positive), clinical stage of the tumor (T 1-T 2, ≥T 3), percentage of positive needles (≤33%, 34%-66%, >66%), Gleason score of biopsy pathology (≤6 points, 7 points, ≥8 points). Univariate and multivariate logistic analysis were performed to screen meaningful indicators to construct a nomogram model. The model was used for validation in the validation group. Results:The results of multivariate analysis showed that preoperative PSA level ( OR=2.046, 95% CI 1.022 to 4.251, P=0.009), percentage of puncture positive needles ( OR=1.502, 95% CI 1.136 to 1.978, P=0.002), Gleason score of puncture pathology ( OR=1.568, 95% CI 1.063 to 2.313, P=0.028), pelvic MRI were correlated ( OR=1.525, 95% CI 1.160 to 2.005, P=0.033). Establish a nomogram model for independent predictors of positive margin of prostate cancer. The area under the receiver operating characteristic (ROC) curve of the validation group is 0.776. The area under the ROC curve of the preoperative PSA level, percentage of puncture positive needles, puncture pathology Gleason score, pelvic MRI, postoperative pathology Gleason score were 0.554, 0.615, 0.556, 0.522, and 0.560, respectively. The difference between the nomogram model and other indicators was statistically significant ( P<0.05). Conclusions:The constructed nomogram model has higher diagnostic value than the preoperative PSA level, percentage of puncture positive needles, Gleason score of puncturing pathology, pelvic MRI, and postoperative pathological Gleason score in predicting positive margin.

Predictive risk factors for Gleason score upgrading of low-risk prostate cancer / 中华老年医学杂志

Objective:To investigate the risk factors for Gleason score upgrading after radical prostatectomy in clinical low-risk prostate cancer patients aged≥65 years.Methods:A total of 485 clinical low-risk prostate cancer patients aged≥65 years at five centers of the national multi-center PC-follow database from January 2015 to March 2019 were retrospectively analyzed.Data including age at diagnosis, prostate-specific antigen(PSA), MRI prostate imaging, puncture Gleason score, operation method, puncture method, positive incision margin and capsule penetration were collected.Differences in Gleason scores before and after operation were compared, and the risk factors for Gleason score upgrading after radical resection were evaluated by univariate and multivariate Logistic regression analysis.Results:Of 485 patients with a puncture Gleason score of 3+ 3=6, 261(53.8%)cases had postoperative pathological upgrading, in whom 228(87.4%)cases had Gleason score upgrading of 7, 22(8.4%)had Gleason score upgrading of 8, and 11(4.2%)had Gleason score upgrading of 9 or more.The rate of Gleason score upgrading was elevated with increased preoperative PSA levels, positive pelvic MRI, and higher positive rates of puncture biopsy.The incidences of postoperative capsule penetration(27.2% vs.12.5%, P<0.001)and positive incision margin(25.2% vs.17.4%, P=0.036)had statistically significant differences between the pathologically upgraded group and the pathologically non-upgraded group.Multivariate analysis showed that preoperative PSA level, percentage of positive puncture biopsies, biopsy Gleason score and pelvic MRI were independent predictors of prostate cancer. Conclusions:For clinical low-risk prostate cancer patients aged≥65 years with high risk factors for Gleason score upgrading, repeated biopsies should be carried out when necessary and the treatment plan should be adjusted accordingly.

Comparative study on prostate cancer detection rates of MRI-guided in-bore biopsy versus cognitive fusion biopsy for patients with prostate specific antigen levels<20 μg/L / 中华老年医学杂志

Objective:To compare the differences in prostate cancer detection rate between MRI-guided in-bore biopsy(MRI-BX)and cognitive fusion biopsy(COG-BX)in patients with prostate specific antigen(PSA)levels<20 μg/L.Methods:From January 2015 to December 2018, clinical data of 195 patients with PSA levels<20 μg/L were consecutively included in this retrospective study.Of these patients, 80 underwent MRI-BX procedures and 115 underwent COG-BX procedures.Clinical data including age, PSA, prostate volume, PSA density(PSAD), Prostate Imaging Reporting and Data System(PI-RADS)scores, overall prostate cancer detection rate and detection rate of clinically significant prostate cancer were compared and analyzed.Results:There was no significant difference in age, PSA, prostate volume, PSAD and PI-RADS scores between the two groups.There was no significant difference in total prostate cancer detection rate between the MRI-BX and COG-BX groups(53.8% or 43/80 vs.50.4% or 58/115, P=0.649), while the detection rates for clinically significant prostate cancer showed a significant difference between the two groups(58.1% or 25/43 vs.82.8% or 48/58, P=0.006). There was no significant difference in prostate cancer detection rate between the MRI-BX and COG-BX groups in patients with PSA<10 μg/L(45.2% or 28/62 vs.48.0% or 36/75, P=0.740), while a significant difference was found in the detection rate of clinically significant prostate cancer between the two groups in patients with PSA<10 μg/L(50.0% or 14/28 or 91.7% or 33/36, P=0.001). Conclusions:The overall prostate cancer detection rate does no differ between MRI-BX and COG-BX in patients with PSA levels<20 μg/L or with suspicious MRI lesions(PI-RADS3), but the COG-BX procedure has a higher detection rate than the MRI-BX procedure for clinically significant prostate cancer, especially in patients with PSA<10 μg/L.

Clinical study of neonatal cardiac output measurement methods / 中华儿科杂志

<p><b>OBJECTIVE</b>To assess agreement between the ultrasonic cardiac output monitor (USCOM) and conventional echocardiography (ECHO) in the measurement of cardiac output in newborn infants, investigate the accuracy and clinical utility of the USCOM in healthy neonates. To explore a more convenient, faster, more accurate hemodynamic monitoring method, for improving the outcome of the critically ill neonates.</p><p><b>METHOD</b>From October 1(st), 2011 to March 31(st), 2012, a total of 49 infants were included, 20 were term infants, 29 were preterm infants. Cardiac outputs were measured by both ultrasonic cardiac output monitor and echocardiography in all the infants, 60 times measurements were done in both the term infants the preterm infants. The cardiac output of the left and right ventricles, heart rate, diameter and velocity time integral of the aortic valve and pulmonary artery valve of each infant were recorded. The consistency of two methods was analyzed as described by Bland-Altman.</p><p><b>RESULT</b>Term the term infant group includea 20 term infants, 11 were male and 9 were female, the mean gestational age were (38.1 ± 0.56) weeks, mean age were (2 ± 1) days, mean weight were (3.2 ± 0.29) kg, mean Apgar score were 10. The mean left ventricular output measured by Echo was (242.3 ± 38.9) ml/(kg·min), measured by USCOM was (211.7 ± 38.5) ml/(kg·min); The mean right ventricular output measured by ECHO was (318.9 ± 47.0) ml/(kg·min), measured by USCOM was (340.7 ± 76) ml/(kg·min). Agreement between Echo and USCOM for left ventricular output (LVO) was (bias, ± limits of agreement, mean % error): (30.6 ± 51.1) ml/(kg·min), 21%, and for right ventricular output (RVO): (-21.8 ± 105) ml/(kg·min), 33.2%. The diameter of the aortic valve and pulmonary artery valve measured by conventional echocardiography were significantly larger than that estimated by ultrasonic cardiac output monitor (P < 0.001). The velocity time integral of the pulmonary artery valve measured by ultrasonic cardiac output monitor were significantly larger than measured by conventional echocardiography (P < 0.001). The heart rate, velocity time integral of the aortic valve measured by two methods had no significant differences (P > 0.05). The preterm neonates group included 29 preterm infants, 18 were male and 11 were female, the mean gestational age were (32.6 ± 2.8) weeks, mean age were (2 ± 1) days, mean weight were (1.88 ± 0.57) kg. All the infants were diagnosis as preterm infant, low birth weight. The mean left ventricular output measured by ECHO was (259.8 ± 70) ml/(kg·min), measured by USCOM was (235.6 ± 61.8) ml/(kg·min), the mean right ventricular output measured by ECHO was (318.9 ± 47.0) ml/(kg·min), measured by USCOM was (340.7 ± 76) ml/(kg·min). Agreement between Echo and USCOM for left ventricular output (LVO) was (bias, ± limits of agreement, mean % error): (24.1 ± 71.2) ml/(kg·min), 27.4%, and for right ventricular output (RVO): (-29.5 ± 192.9) ml/(kg·min), 51.8%. The diameter of the aortic valve and pulmonary artery valve measured by conventional echocardiography were significantly larger than estimated by ultrasonic cardiac output monitor (P < 0.001). The velocity time integral of the pulmonary artery valve measured by USCOM were significantly larger than that measured by conventional echocardiography (P < 0.001). The heart rate, velocity time integral of the aortic valve measured by two methods had no significant differences (P > 0.05).</p><p><b>CONCLUSION</b>Agreement between USCOM and conventional ECHO in the LVO measurement is acceptable, both in the term group and the preterm group. LVO measurement measured by USCOM is recommended. The accuracy and clinical utility of the USCOM in neonates is acceptable. USCOM is a convenient, fast and accurate hemodynamic monitoring method in neonates. While the agreement between USCOM and conventional ECHO in the RVO measurement is poor, especially in the preterm group, the results of the RVO cannot be considered interchangeable in the two methods.</p>

Investigation on clinical efficacy of the fourth-generation ultrasonic lithotripsy system in the treatment of urinary tract stones / 中国基层医药

ObjectiveTo evaluate the fourth-generation ultrasonic lithotripsy system for treating the urinary tract stones.Methods243 cases of urinary tract stones who received treatment of fourth-generation EMS ultrasonic lithotripsy system were analyzed retrospectively.ResultsImmediate phase I lithotrotrisy was performed successfully in 227 cases and the successful rate of phase I was 93.3％ (227/243).Delayed phase Ⅱ lithotripsy was performed for 16 patients.Complications happened in 2 cases,one case occurred hydropneumothorax during operation,required indwelling thoracic drainage tube processing,the other had severe bleeding which conservative treatment was ineffective,cured by the intervention of super-selective renal artery embolization.Conclusion Fourth generation of ultrasonic lithotripsy for treating stones on different anatomical locations of urinary system was safe,practical and efficient,worthy of clinical application.

Clinical analysis of de novo hepatitis B virus infection after liver transplantation / 中华器官移植杂志

ObjectiveTo summary clinical character of de novo hepatitis B virus infection after liver transplantation,and explore the strategy of prevention and treatment.MethodsThe clinical data of recipients undergoing liver transplantation and the recipients who developed de novo hepatitis B virus infection after liver transplantation between Jan. 2000 to Dec. 2010 were retrospectively analyzed.Results365 patients who underwent liver transplantation were negative for serum HBsAg before liver transplantation.Among them,11patients were diagnosed as having de novo hepatitis B virus infection after liver transplantation,with the morbidity being 3.0 ％(11/365).Most recipients did not have any clinical presentation.They were just found HBsAg positive during the follow-up period.The liver functions were normal.All 11patients received anti-virus therapy after they were found having positive HBsAg and replicated HBV-DNA.One patient whose primary disease was hepatitis C combined with primary hepatic carcinoma was treated with pegylated interferon,thereafter,he was found having YMDD-mutation of HBV-DNA,and he was treated with entecavir.The rest 10 patients received anti-virus treatment with nucleoside analog.The 10 recipients were injected with hepatitis B immunoglobin during operation.After anti-HBV therapy,one patient died from acute liver failure because of inefficient treatment,and one patient died from tumor recurrence.The remaining nine patients survived:HBeAg of one patient became negative,and HBV-DNA replications of the four patients became negative (＜1×105 copies/L).The liver function of the patients who survived was normal.ConclusionFor recipients who were HBsAg negative before liver transplantation,when they received liver transplantation,,they should be given strict screening of blood product for transfusion.The liver transplantation patient who is HBsAg negative in serum before liver transplantation,and whose donor is HBcAb positive in serum and/or HBV-DNA positive in serum,should be treated with HBIG and/or nucleoside analog during operation or after operation,as we said above is a ideal strategy to prevent de novo hepatitis B virus infection after liver transplantation.The prognosis of de novo hepatitis B virus infection after liver transplantation is mild.

Surgical treatment for intra-articular calcaneal fractures / 中国骨伤

<p><b>OBJECTIVE</b>To evaluate clinical result of surgical treatment for intra-articular calcaneal fractures using calcaneal anatomy plate.</p><p><b>METHODS</b>From September 2004 to October 2009, 72 patients with intra-articular calcaneal fractures were reviewed. There were 61 males and 11 females, ranging in age from 19 to 54 years old,with an average of 39.7 years old. The course of the disease ranged from 1 to 17 days. All the patients performed X-ray and semi-coronal CT scan before and after operation. According to Sanders classification system, there were 40 cases of type III and 32 cases of type IV. All the patients were treated with lateral L-type incision and calcaneal anatomy plate. The therapeutic effects were evaluated according to the standard of calcaneal fracture of the American surgery association of foot and ankle.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 10 to 48 months, with a mean of 38 months. According to standard of calcaneal fracture of the American surgery association of foot and ankle, 14 patients got an excellent result, 38 good, 9 fair and 11 poor. Five patients got incision non-union. Arthritis of subtalar joint was found in 3 cases.</p><p><b>CONCLUSION</b>Open reduction and internal fixation of plate is effective to get good reduction for subtalar joint, which is a good method to treat intra-articular calcaneal fracture.</p>

Intraluminal enucleation in transurethral vaporization and electro-resection of the prostate / 中国基层医药

Objective To investigate the clinical efficacy of intraluminal enucleation in transurethrat vapor- ization and electro-reesection of the prostate.Methods A retrospective analysis was reviewed in 62 case of prostatic hypertrophy,which were treated with intraluminal enucleation in vaporization of prostate.All pacients had a sucessful operation.There were 12 case in unipolar vaporization and 50 in plasmakenitic bipolar vaporization.Results Opera- tion time ranged from 50 to 162 minutes,with an average of 76min.Bleeding ranged from 40 to 200 ml,with an av- erage of 110ml.There was no blood transfusion.The weight of prostate was 62～138g,the catheter was maintained for 3～5 days postoperatively.The hospital stay was 7～10 days,average 8 days.All patients were cured.There was a fllow-up for 1～20 months,with an average of 8 months.The IPSS decreased by 22 points on average,and peak urine flow(Qmax)increasd to(16.8?3.3)ml/s.There wre no urethralstricture,permanent urinary incontinence, TURS,postoperative hemorrhage,retrograde ejaculation and recurrence.Conclusions Intraluminal enucleation in treatment of prostalic hypertroply is a new,safe,and effective method,which should be popularized in clinical prac- tice.

An analysis of correlation between post-stroke depression and relevant factors / 中华全科医师杂志

Objective To investigate correlation between post-stroke depression (PSD) and multiple factors during onset of acute cerebral infarction. Methods Depression was measured with Hamilton Depression Rating Scales (HAMD) in 58 patients with acute cerebral infarction, and their neurological function were evaluated by neurological function defect (NFD) score. Their immunoglobulin G (IgG) index was calculated and level of nitric oxide (NO) in cerebrospinal fluid (CSF) was measured. Lesion and nature of cerebral infarction in 58 patients with acute stroke were located by CT. All the data were statistically analyzed with student-t test and ? 2 test, as well as linear regression model. Results Seventeen of 58 patients of stroke appeared PSD with an occurrence rate of 29.3%. Occurrence rate of PSD was significantly higher in patients with cerebral infarction than in those with cerebral hemorrhage  2=4.86, P