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Objective@#To evaluate the consistency between prostate biopsy and postoperative pathological grade, analyze the influencing factors that may lead to upgrade or downgrade, and to establish a prediction model.@*Methods@#The clinical data of biopsy GS3+ 3=6(GR1, 330 cases) and GS3+ 4=7(GR2, 340 cases) patients from January 2013 to December 2018 in the first affiliated hospital, College of Medicine of Zhejiang university were retrospectively analyzed. The median age was 67 years old(ranging 35 to 100 years old). The median BMI was 23.74 kg/m2(ranging 16.22-38.74 kg/m2). The Median tPSA was 10.266 ng/ml(ranging 0.017-147.575 ng/ml). The median prostate volume was 29.43 ml(5.92-187.20 ml). The median PSAD was 0.34 (ranging 0.01-4.02). The median percentage of positive puncture cores was 0.25 (ranging 0.08-1.00). There were 161 patients in clinical stage ≤T1c, 344 patients in T2a-T2c and 165 patients in clinical stage ≥T3. 670 cases all accepted the radical prostatectomy. Consistency of prostate biopsy and radical prostatectomy Gleason grade was recorded. If the postoperative Gleason grade was higher than that in biopsy, it was defined as upgrade. Otherwise, it was defined as downgrade. Multivariate logistic regression model was used to evaluate the influencing factors leading to upgrades in GR1 patients or downgrades in GR2 patients. Nomograms were drawn based on the models with AUC and Horsmer-Lemeshaw test conducted to test the discrimination and calibration of the models.@*Results@#Among the 670 patients included, 165 cases (50.0% of GR1) upgrades and 27 cases (7.9% of GR2) downgrades. PSAD≥0.25(OR=3.015) and clinical stage≥T2b(OR=7.185)were independent influencing factors for the upgrade in GR1 patients, while PSAD<0.15(OR=4.208) and clinical stage≤T1c(OR=4.530) were independent influencing factors for downgrade. The nomograms were drawn with the above variables. The AUC of the model (0.781 for GR1 group, 0.741 for GR2 group) and the hosmer-remeshaw test results (P=0.993 for GR1 group, P=0.234 for GR2 group) show that the nomograms have good discrimination and calibration.@*Conclusions@#PSAD and clinical stage are independent influencing factors for the upgrade or downgrade. Nomograms may provide help for clinicians to judge the accuracy of prostate biopsy. However, the nomograms still needs to be verified in clinical practice
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Objective To evaluate the consistency between prostate biopsy and postoperative pathological grade,analyze the influencing factors that may lead to upgrade or downgrade,and to establish a prediction model.Methods The clinical data of biopsy GS3 + 3 =6 (GR1,330 cases) and GS3 + 4 =7 (GR2,340 cases) patients from January 2013 to December 2018 in the first affiliated hospital,College of Medicine of Zhejiang university were retrospectively analyzed.The median age was 67 years old (ranging 35 to 100 years old).The median BMI was 23.74 kg/m2(ranging 16.22-38.74 kg/m2).The Median tPSA was 10.266 ng/ml(ranging 0.017-147.575 ng/ml).The median prostate volume was 29.43 ml (5.92-187.20 ml).The median PSAD was 0.34 (ranging 0.01-4.02).The median percentage of positive puncture cores was 0.25 (ranging 0.08-1.00).There were 161 patients in clinical stage ≤ T1c,344 patients in T2a-T2c and 165 patients in clinical stage ≥ T3.670 cases all accepted the radical prostatectomy.Consistency of prostate biopsy and radical prostatectomy Gleason grade was recorded.If the postoperative Gleason grade was higher than that in biopsy,it was defined as upgrade.Otherwise,it was defined as downgrade.Multivariate logistic regression model was used to evaluate the influencing factors leading to upgrades in GR1 patients or downgrades in GR2 patients.Nomograms were drawn based on the models with AUC and Horsmer-Lemeshaw test conducted to test the discrimination and calibration of the models.Results Among the 670 patients included,165 cases (50.0％ of GR1) upgrades and 27 cases (7.9％ of GR2) downgrades.PSAD ≥ 0.25 (OR =3.015) and clinical stage ≥ T2b (OR =7.185) were independent influencing factors for the upgrade in GR1 patients,while PSAD ＜ 0.15 (OR =4.208) and clinical stage ≤ T1c (OR =4.530) were independent influencing factors for downgrade.The nomograms were drawn with the above variables.The AUC of the model (0.781 for GR1 group,0.741 for GR2 group) and the hosmer-remeshaw test results (P=0.993 for GR1 group,P =0.234 for GR2 group) show that the nomograms have good discrimination and calibration.Conclusions PSAD and clinical stage are independent influencing factors for the upgrade or downgrade.Nomograms may provide help for clinicians to judge the accuracy of prostate biopsy.However,the nomograms still needs to be verified in clinical practice
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Objective To understand the cognitive level of chronic obstructive pulmonary disease (COPD) disease management and pulmonary rehabilitation among medical staff in the respiratory departments and community of public health institutions in Panyu of Guangzhou, in order to assess the status of prevention and treatment of COPD in this area. Methods From March to October 2017, a questionnaire survey was conducted among 339 medical staff in Panyu, including respiratory doctors, nurses and therapists of four tertiary hospitals, five secondary hospitals, and three first-level hospitals, GPs, nurses and therapists at 16 community health service centres, among them, there are 147 respiratory and general practitioners (hereinafter referred to as doctors), 171 respiratory and general nurses (hereinafter collectively referred to as nurses), and 22 rehabilitation therapists (hereinafter collectively referred to as therapists). Using Epidata software to create questionnaire database entry data. Results The awareness rate of COPD airflow limitation severity of nurses was only 19.9％, which was lower than that of doctors (39.7％) and therapists (22.7％). Doctors, nurses, and therapists are familiar with the low percentage of the GOLD guidelines, which are respectively only 12.3％, 7.6％, and 4.5％. Nurses were diagnosed with pulmonary function as a basis for COPD, and the awareness rate was only 60.2％ lower than that of doctors (82.9％) and therapists (81.8％). In alleviating COPD patients′shortness of breath, only 31.8％therapists chose short-acting beta-agonists, lower than doctors (61％) and nurses (45％). There is disagreement about the long-term use of inhaled corticosteroids in COPD. Medical staff have the highest awareness of lip-reducing and abdominal breathing, followed by Taiji and Ba Duan Jin exercises, and low awareness of modern rehabilitation programs such as elastic bands, upper and lower limb exercises. The effective pulmonary rehabilitation program should last at least 8 weeks, and the awareness rate of this therapy practice was 40.9％, higher than doctors (13.7％) and nurses (18.1％). Medical staff believe that the main factors affecting patient compliance are the cost of the drug and the patient′s lack of understanding of the benefits of the treatment. Additionally, 40.4％ of doctors, 51.5％ of nurses, and 54.5％of therapists believe that community health services cannot manage COPD. The reasons that affect community management of COPD, doctors believe that patient compliance and lack of man power, nurses believe that the main shortage of manpower and equipment, the therapist believes that the lack of medical awareness and poor patient compliance. Conclusion Doctors, nurses, and therapists have inconsistent understandings of COPD disease management and pulmonary rehabilitation, and each has its own focus. It is necessary to strengthen learning exchanges for each weak knowledge point. The awareness rate of modern rehabilitation exercise for pulmonary rehabilitation is not as high as that of traditional Chinese medicine. It is necessary to pay attention to the promotion of the benefits and significance of COPD pulmonary rehabilitation treatment and improve compliance.
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Objective To evaluate the clinical and pathological features of patients with prostate cancer who were diagnosed by single positive core biopsy and treated by radical prostatectomy (RP).Methods Between July 2012 and June 2016,164 patients with prostate cancer diagnosed by single positive core biopsy underwent RP.The mean age was 66.3 years old (ranged 41-82 years old),and the mean PSA level was 12.3 ng/ml (ranged 0.6-59.5 ng/ml).The biopsy Gleason score showed 6 scores in 113 cases,3 + 4 =7 scores in 21 cases,4 + 3 =7 scores in 18 cases,≥8 scores in 12 cases.Clinical stage was cT1 in 71 cases,cT2 in 92 cases,and cT3 in 1 case.The patients were divided into subgroups according to age,preoperative PSA level,biopsy Gleason score and clinical stage,and the pathological results were compared among these subgroups.Results Of the 164 patients,67 cases had Gleason score ≤ 6,52 cases Gleason score 3 + 4 =7,24 case Gleason score 4 + 3 =7,and 11 cases Gleason score ≥ 8.Ten patients had pT0 disease according to the RP specimen,3 had extraprostatic extensions,5 had seminal vesicle invasions,and 24 had positive surgical margins.Compared to the biopsy,the Gleason score of RP specimens was higher in 53 cases,concordant in 77 cases,and lower in 24 cases.There was no significant difference in the postoperative pathological features between the age group ＜ 70 years and the group ≥ 70 years.Compared with PSA ＜ 10 ng/ml,the likelihood of postoperative Gleason score ＞ 7 was significantly increased in PSA ≥10 ng/ml group [41.4％ (36/87) vs.66.2％ (51/77),P＜0.05].When the biopsy Gleason score was divided into four groups (6,3 + 4 =7,4 + 3 =7,≥ 8),there were significant differences in postoperative pathological stages among the four groups (P ＜ 0.05),and the patients with biopsy Gleason score 6 were more likely to have no residual cancer (stage T0) when compared with other Gleason scores [8.8％ (10/113) vs.0,P =0.09].The probability of no residual cancer in clinical T1 stage patients was significantly higher than that in T2 stage [11.3％ (8/71) vs.2.8％ (2/92),P =0.02],while the probability of Gleason score upgrading was significantly lower [23.9％ (17/71) vs.39.1％ (36/92),P ＜ 0.05].Conclusions Most single core prostate cancer have clinically significant disease.The treatment plan must be evaluated individually for patients with single core prostate cancer.
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Objective To evaluate the effect of health education combined with lung function test on smoking cessation in smoking sanitation workers. Methods Sixty-nine sanitation workers who smoke were divided into two groups by using the table of random number, routine group (n=35) and lung function test group (n=34). The routine group was given health education. According to the lung function, those in the lung function test group were divided into normal lung function group (19 cases) and abnomal lung function group (15 cases) who received both health education and lung function test. Success rate of smoking cessation and the relapse rate were compared at 2 and 6 months follow-up. Results At 2 and 6 months follow-up, the smoking cessation rates of routine group were [10(29%), 4(11%)], which were lower than those of the normal lung function group [7(37%), 3(16%)], the differences were not statistically significant (P>0.05). The smoking cessation rates of routine group were lower than those in abnormal lung function group[11 (73%), 10(67%)] (P<0.05). The smoking cessation rates of the normal lung function group were significantly lower than those of abnormal lung function group (P<0.05). The relapse rate of routine group[6(17%) and the normal lung function group[4(21%)]at 6 months follow-up were not significantly different. The relapse rate of the normal lung function group and that of abnormal lung function group were not significantly different. Conclusion Health education combined with lung function test could help smokers with abnormal lung function to give up smoking successfully.
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Objective To investigate the application of artificial neural network analysis on computerized transrectal ultrasound (ANNAcTRUS) in early detection of prostate cancer.Methods Sixty men with or without prior biopsies, either due to elevated PSA or abnormal digital rectal findings, were included in this study from January 2014 to July 2015.Patient's mean age was (65.6 ± 8.9) years (51-89 years).Their PSA level was (9.8 ± 4.9)μg/L.The patients received the ANNAcTRUS targeted 6-core biopsy.Each patient received six targeted biopsies of suspicious regions, which was identified by ANNAcTRUS online system.Histopathologic examination was further carried out to confirm the result of the targeted biopsies.Results According to the results of ANNAcTRUS,52 of 60 patients received biopsy in ANNAcTRUS group.ANNAcTRUS targeted 6-core biopsy was able to detect prostate cancer in 24 (46.2％) of 52 patients.The distribution of Gleason Score was as follows : 3 + 3 (n =9), 3 + 4 (n =8), 4 + 3 (n =4), 4 +4 (n =2) and 5 +4 (n =1).For patients without prior negative biopsy,ANNAcTRUS targeted 6-core biopsy was able to detect prostate cancer in 17 (51.5％) of 33 patients.Conclusions ANNAcTRUS targeted 6-core biopsy illustrates a higher detection rate of prostate cancer.Furthermore, ANNAcTRUS targeted 6-core biopsy tends to detect low-grade prostate cancer.
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Objective To compare the outcomes of standard laparoscopic radical prostatectomy (SLRP) and retropubic radical prostatectomy (RRP) via meta-analysis.Methods A systematic literature search of articles from January 1992 to April 2015 was conducted via Pubmed,Web of Science,Cochrane Library,and EMBASE databases,and the references of the retrieved articles.Fixed-or random-effect models were used to summarize the estimates to evaluate operation time,blood loss,transfusion,catheterization time,hospital stay,surgical margin status,perioperative complications,postoperative erectile dysfunction,and postoperative urinary incontinence in these two approaches.Results A total of 17 articles were included in this study.Compared with RRP group,the operation time was longer in SLRP group (SMD =1.20,95％ CI 0.83,1.58).On the contrary,the SLRP group held advantages in blood loss (SMD =-2.02,95％ CI -2.67,-1.37),transfusion (RR =0.22,95％ CI 0.16,0.30),catheterization time (SMD =-1.44,95 ％ CI-2.34,-0.54),hospital stay (SMD =-0.97,95 ％ CI-1.29,-0.66) (P ＜ 0.05).Moreover,these two approaches showed no difference in surgical margin status (RR =0.94,95 ％ CI 0.84,1.05),perioperative complications (RR =0.78,95％ CI 0.60,1.02),postoperative erectile dysfunction (RR =1.13,95 ％ CI 0.97,1.31),and postoperative urinary incontinence (RR =0.85,95 ％ CI 0.57,1.28) (P ＞0.05).Conclusions Compared with RRP,SLRP could be a more suitable approach to treat localized prostate cancer.Random clinical trials are needed in the future to better evaluate these two approaches.
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Objective To explore influence and variation of smoking and occupational exposure to air pollution on lung function.Methods Ninety eight sanitation staffs from Panyu District were divided into smoking and non-smoking sanitation groups; and all subject accepted the Chronic Obstructive Pulmonary Disease Assessment Test (CAT) scales,questionnaires,lung function test,and data statistical analysis.Healthy people accepted health examination from Guangzhou Panyu medical health center were used as the control group.Results (1) Forced expiratory volume in the first second (FEV1％),forced expiratory volume in the first second/ forced vital capacity(FEV1/FVC),maximal expiratory flow in 50％ vital capacity (FEF50％),maximal expiratory flow in 75％ vital capacity (FEF75％),maximal mid-expiratory flow (MMEF) of non-smoking sanitation group was significantly lower than non-smoking healthy group (P ＜ 0.01).(2) Abnormal rates of FEF50％,FEF75％,and MMEF of non-smoking sanitation group were significantly higher than non-smoking healthy group (P ＜ 0.01).(3) Abnormal rates of FEF50％,and FEF75％ of sanitation group were significantly higher than healthy group with or without smoking.(4) Abnormal rates of FEV1％ and FEV1/FVC did not have significant difference between non-smoking sanitation group and non-smoking healthy group,but had significant difference between non-smoking and smoking healthy groups.It means smoking and occupational exposure had different impacts on pulmonary function.(5)Moderate score of nonsmoking sanitation group and smoking healthy group were significantly higher than non-smoking healthy group by P =0.049 and P =0.001,respectively.Conclusions Occupational exposure to air pollution and smoking can lead to small airway damage,which was not as obvious as pulmonary function changes.It is necessary to regularly monitor lung function for sanitation staffs who risk occupational exposure to air pollution.Increasing physical exercise would benefit to improve sport lung endurance of the people in our country.
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Objective To analyze the clinical features of patients with prostate adenocarcinoma under 50 years.Methods Between January 2008 and April 2014,we reviewed 21 cases with prostate cancer under 50 years old.The mean age in those patients was 48 years old (ranged 42-49 years old).Their tPSA level was elevated,including＞10 μg/L in 17 cases,4-10 μg/L in 4 cases.21 cases were all confirmed by pathology.The results Gleason score showed 6 scores in 3 cases,7 scores in 6 cases (3+4 scores in 5 cases and 4+3 scores in one case),8 scores in 7 cases and 9 scores in 5 cases.In the study,clinical stage was for T2N0M0 in 16 cases,T3N0M0 in 1 case,T4NxM0 in 1 case and T3-4N1M1 in 3 cases.The treatments were hormonal therapy was chosen in 5 cases and radical prostatectomy was performed in 16 cases,including 16 cases with T2N0M0 stage and one case with T3N0M0.Results In those patients who accepted the radical prostatectomy,the duration of follow-up ranged from 3 to 65 months (mean 23 months).During the follow-up,14 patients had a lower incidence of biochemical recurrence.1 patient (T2,PSA 82.8 μg/L,GS 9) had external beam radiotherapy one month after the radical prostatectomy because of tumor invasion into the prostatic capsule.Then his PSA level returned to the 0.2 μg/L.1 patient (T3,PSA 38.9 μg/L,GS 8) had external beam radiotherapy 18 months after the radical prostatectomy because of biochemical recurrence and the tPSA level returned to the 4.0 μg/L.All patients who underwent radical prostatectomy had favourable recovery of urinary continence.In 5 patients who had androgen deprivation therapy,2 patients died after 63 or 65 months and one patient was lost to follow-up.The PSA level in one patient decreased from 71.8 μg/L to 2 μg/L after four months treatment.One patient had castration resistant prostate cancer and the adjuvant external beam radiotherapy was considered,subsequently.Conclusions Men under the 50 years old,who are diagnosed with localised prostate cancer,usually demonstrated the early clinic stage and high Gleason scores.It should not be discouraged from RP.Young men with metastatic prostate cancer have a poor prognosis.
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Objective To investigate the diagnosis and treatment of cystic renal cell carcinoma.Methods The clinical data of 67 cases of cystic renal cell carcinoma treated from January 2005 to April 2013 were analyzed retrospectively.Preoperative imaging procedures indicated masses of renal cysts in 67 cases,including malignant tumors in 59 cases.Intraoperative pathological examination was performed in 59 cases and the pathological results showed malignant tumors in 56 cases,renal cyst in 2 cases and multilocular cyst of kidney in 1 case.The surgical procedures included radical nephrectomy (n=19),partial nephrectomy (n =12),retroperitoneal laparoscopic radical nephrectomy (n =9),retroperitoneal laparoscopic partial nephrectomy (n =20),retroperitoneal laparoscopic cyst unroofed then transferred to radical nephrectomy (n =6),and retroperitoneal laparoscopic partial nephrectomy transferred to radical nephrectomy (n =1).Results The 67 cases were diagnosed as renal carcinoma,including clear renal cell carcinoma with cystic changes in 31 cases and multilocular renal cell carcinoma in 36 cases.Sixty-two cases were followed up for 10-110 months (median 56 months),and there was no recurrence or metastasis,among which 7 cases diagnosed as benign pre-operation or intra-operation but malignant by pathological examination after surgery were followed up for 61-103 months (median 82 months).Conclusions Imaging plays an important role in the early diagnosis of cystic renal cell carcinoma.Intraoperative pathological examination should be performed in suspected cases.Nephron-sparing surgery is preferred with good outcome.
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Objective To explore the prevalence of thyroid nodules in Guangzhou City in a health physical examination.Methods The data of Doppler ultrasound cases from the department of internal medicine and convalescence,Panyu sanatorium were analyzed.Results ①The detection rates of tiny and non-small thyroid nodule in female individuals [44.1％ (207/469) and 21.7％ (102/469)] were higher than those of males [34.8％ (155/445) and 7.6％(34/445),x2 =8.27,35.88,all P ＜ 0.05]; ②The prevalence of tiny nodules increased gradually in the 21-30-year old people,reached the peak in the 51-60-year old people,and then decreased; ③ The rate of solid and mixed thyroid nodules in females [33.5％(157/469) and 26.2％(123/469)] gradually increased with growing age than those of males [22.0％(98/445) and 14.6％(65/445),x2 =14.89,18.87,all P ＜ 0.05] ; ④ The detection rate of multi-nodule in female[40.1％(188/469)] was higher than that of male[21.3％(95/445),x2 =37.5,P ＜ 0.05].Conclusions The elderly people have a higher risk of thyroid nodular,the detection rate of thyroid nodule in female people was higher than that in males.We should pay more attention to thyroid disease in elderly women.
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Objective To investigate the effect of body mass index (BMI) on laparoscopy and the open radical prostatectomy.Methods A retrospective analysis of 226 cases of radical prostatectomy from 2012 January to 2013 May was performed.106 patients underwent laparoscopic surgery,with aged 66.5±0.7,height (167.7±0.5) cm,weight (66.8±0.9) kg; 120 patients underwent open surgery,with aged (65.8±0.7) year,height (168.1±0.5) cm,weight (66.5±0.8) kg.Non-obese (BMI ＜25 kg/m2) and obese (BMI ≥ 25 kg/m2) were divided in each group.The preoperative serum PSA level,the operation time,the blood loss during operation,the preoperative and postoperative hemoglobin,Gleason score,and the postoperative indwelling catheter time were compared between non-obese group and obese group.In the laparoscopic surgery group including 76 non-obese cases (71.7％) and 30 obese cases (28.3％),no difference showed in PSA values and age before operation between the two sub-groups.In the open surgery group,including 84 non-obese cases (70.0％) and 36 obese cases (30.0％),no statistical difference of preoperative PSA values and age showed in the two sub-groups.Results In the laparoscopic group,the operation time is (nonobese 169.4±37.8 min and obese 188.5±42.3 min),and the blood Hb decrease(non-obese-22.8± 11.0g/L,obese-30.9±15.9 g/L) and the blood loss(non-obese 115.9±68.9 ml,obese 178.3±126.4 ml)showed significant difference in the two sub-groups (P＜0.05).The two sub-groups showed no statisticaldifference in postoperative indwelling catheter time and Gleason score (P＞0.05).In the open surgery group,the intraoperative hemorrhage (non-obese 413.7±289.4 ml,obese 594.4-±534.9 ml) and the hemoglobin decrease (non-obese-27.2± 13.3 g/L,obese-34.9± 15.8 g/L) showed significant difference (P＜0.05).The two sub-groups showed no significant difference in the preoperative hemoglobin,postoperative indwelling catheter time,Gleason score and operation time (P＞0.05).Conclusions For the patients who underwent prostatectomy,no matter by laparoscopic or open surgery,the blood loss was greater in obese subgroup than non-obese subgroup,and the operation time was much longer in obese group than non-obese group.
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In the western world, adenocarcinoma of the prostate is the most common malignant neoplasm of human males. In recent years, the incidence of the disease has increased dramatically in China. Surgery is an important treatment for prostate cancer. This article reviews the progress in radical retropubic and perineal prostatectomy, standard laparoscopic and robot-assisted laparoscopic radical prostatectomy. It covers the necessity, techniques and experience of surgery, nerve preserving techniques and erectile dysfunction, complications and outcomes, advantages and disadvantages of and comparison between various surgical approaches.
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Humans , Male , Laparoscopy , Prostate , Prostatectomy , Methods , Prostatic Neoplasms , General Surgery , RoboticsABSTRACT
<p><b>OBJECTIVE</b>To investigate the expression of activated leukocyte cell adhesion molecule(ALCAM) protein in prostatic intraepithelial neoplasia and adenocarcinoma, and the relationship between ALCAM expression and clinicopathological features of prostatic carcinoma.</p><p><b>METHODS</b>ALCAM protein expression was evaluated in the tissues of 41 human prostatic carcinomas by using immunohistochemistry (EnVision method).</p><p><b>RESULTS</b>ALCAM was widely expressed in prostatic epithelia. Overexpression of ALCAM was found in most prostatic intraepithelial neoplasias and low-grade cancers, whereas a decreased expression shown in some high-grade cancers. The ALCAM protein expression in prostatic carcinoma was correlated with pathological grading. However, no correlation of ALCAM expression was found with preoperative serum prostate-specific antigen levels or clinical stages.</p><p><b>CONCLUSION</b>Expression of ALCAM is disturbed in prostatic intraepithelial neoplasia and adenocarcinoma, indicating its involvement in the development of human prostatic carcinoma.</p>