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1.
Chinese Journal of Urology ; (12): 18-22, 2021.
Article in Chinese | WPRIM | ID: wpr-884951

ABSTRACT

Objective:To detect the value of utilizing bpMRI in prostate biopsy in the detection of prostate cancer with PSA≤20ng/ml.Methods:The clinical data of 394 patients who underwent prostate biopsy in the First Affiliated Hospital of Nanjing Medical University from November 2017 to October 2019 were retrospectively analyzed. Of all the patients, 177 underwent modified systematic biopsy, named TRUS group, 217 patients accepted pre-biopsy bpMRI examination, undergoing modified systematic biopsy if Prostate Imaging Reporting and Data System (PI-RADS) score < 3 or MRI-TRUS cognitive fusion targeted prostate + systematic biopsy if PI-RADS score ≥ 3, named MRI group. The median age of TRUS group was 66 (61, 74) years old, prostate specific antigen (PSA) was 9.52 (7.26, 12.30) ng / ml, and prostate volume (PV) was 36.84 (28.95, 57.72)ml. The median age of MRI group was 66 (59, 72) years old, PSA was 8.84 (6.65, 12.16) ng/ml, and PV was 39.45 (29.25, 58.69)ml. There was no difference in above parameters between the two groups. The χ 2 test was used to compare the detection rate of prostate cancer and clinically significant prostate cancer (CsPCa) between the two groups. Results:There was no significant difference in the detection rates of prostate cancer between TRUS group and MRI group [51.41% (91/177) vs. 48.39% (105/ 217), P = 0.550], but the detection rates of CsPCa were significantly different [26.55% (47/177) vs. 36.41% (79/217), P = 0.037]. In patients with PSA ≤ 10 ng / ml, there was no significant difference in the detection rates of prostate cancer between the two groups [43.62% (41/94) vs. 43.08% (56/130), P = 0.936], but there was a significant difference in the detection rates of CsPCa [17.02% (16/94) vs. 28.46% (37/130), P = 0.047]. There was no significant difference in the detection rates of prostate cancer [60.24% (50/83) and 56.17% (48/87), P= 0.504] and the detection rates of CsPCa [37.35% (31/83) vs. 48.28% (42/87), P = 0.150] between the two groups. The total detection rates of the last two needles in TRUS group and MRI group were 23.16% (41/177) and 36.63% (86/217), respectively, with significant difference ( P=0.001); the detection rates of CsPCa in the last two needles were 11.86% (26/177) and 29.03% (63/ 217), respectively, with significant difference ( P < 0.001). In MRI group, the detection rates of prostate cancer in patients with PI-RADS score <3, 3, 4, 5 were 21.21% (7/33), 25.84% (23/89), 73.24% (52/71), 95.83% (23/24), respectively; the detection rates of CsPCa were 12.12% (4/33), 17.98% (16/89), 54.93% (39/71), 83.33% (23/24), respectively. Conclusions:In patients with PSA ≤ 20 ng / ml, prostate biopsy based on bpMRI may improve the detection of CsPCa, especially in patients with PSA ≤ 10 ng/ml.

2.
Chinese Journal of Urology ; (12): 810-813, 2021.
Article in Chinese | WPRIM | ID: wpr-911124

ABSTRACT

Objective:To explore the clinical application of robot-assisted laparoscopic single-position nephroureterectomy and bladder sleeve resection for upper urinary tract urothelial carcinoma (UTUC).Methods:The clinicopathological data of 15 UTUC patients admitted to Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from October 2018 to May 2020 were retrospectively analyzed. There were 8 males and 7 females, with a median age of 58.6 (ranging 52.6-69.6) years, including 8 cases of renal pelvic cancer, 2 cases of upper ureteral cancer, 5 cases of middle and lower ureteral cancer.The tumor located on the left side in 5 cases and right side in 10 cases. All 15 patients underwent robot-assisted one-step transperitoneal nephroureterectomy and bladder sleeve resection by the same surgeon. The patients were placed in a 70° healthy side lying position with a 10° head lower and foot high position. After routinely dissecting the kidneys and controlling the renal hilum, we continued to dissect the ureter down to the orifice of the bladder. The lymph node dissection was performed when dissecting the kidney and ureter. Then the ureter was resected like a sleeve and the bladder was sutured. Observation indicators, such as operation time, blood loss, postoperative drainage tube and urinary catheter placement days, were recorded.Results:All 15 patients were successfully completed the operation in the same position and the same robot berth without conversion. The median operation time was 103 (ranging 82-185) min, and the intraoperative median blood loss was 60 (ranging 30-120) ml. The postoperative median drainage catheter placement time was 3 (ranging 2-5) d, the postoperative median hospital stay was 5 (ranging 4-7) d, and the postoperative urinary catheters were placed for 14 days. Postoperative pathological examinations of 15 patients showed UTUC without positive margins. The median follow-up time was 15 (ranging 10-30) months. All 15 patients survived. One patient was found a recurrence in the bladder after cystoscopy. There was no tumor progression after bladder tumor resection and bladder perfusion chemotherapy, and no tumor recurrence or metastasis was seen in the remaining 14 cases.Conclusions:Robot-assisted single-position transperitoneal nephroureterectomy for UTUC does not need to change patient position and robot berth, which effectively shortens the operation time, and achieves good tumor control effect. The short-term follow-up results were satisfactory.

3.
Chinese Journal of Urology ; (12): 696-699, 2021.
Article in Chinese | WPRIM | ID: wpr-911098

ABSTRACT

Objective:To investigate the curative efficacy of radical prostatectomy (RP) for T 4 stage prostate cancer invading bladder neck. Methods:The clinical data of 22 patients with T 4 stage prostate cancer invading bladder neck treated with RP from April 2013 to March 2021 were analyzed retrospectively. The mean age of the patients was (64.09±6.33) years, and the preoperative blood PSA was 57.70(39.40, 68.56) ng/ml. Preoperative MRI or PSMA-PET examination revealed bladder neck invasion, including 16 cases (72.73%) of urinary retention. Clinical stage of T 4N 0M 0 accounted for 40.91% (9/22), T 4N 1M 0 accounted for 45.45% (10/22), and T 4N 1M 1 accounted for 13.64% (3/22). Preoperative patients were not treated with neoadjuvant endocrine or chemotherapy. Laparoscopic or robotic assisted laparoscopic radical prostatectomy and pelvic lymph node dissection were performed. Results:The 22 operations were successfully completed without conversion. The operation time was(184.27±34.82) min, the amount of intraoperative bleeding was (210.91±83.03) ml, the retention time of drainage tube was (4.73 ± 1.03) days, the recovery of gastrointestinal function took 3 (2, 3) days, and the postoperative hospital stay was (6.68 ± 1.39) days. Postoperative pathology showed that the Gleason score of 7 points accounted for 4.54% (1/22), 8 points accounted for 13.64% (3/22), and 9 points accounted for 81.82% (18/22). The positive rate of margin was 81.82% (18/22). Pathological stage of T 4N 0M 0 accounted for 22.73% (5/22), T 4N 1M 0 accounted for 63.64% (14/22), and T 4N 1M 1 accounted for 13.64% (3/22), of which extracapsular or seminal vesicle invasion accounted for 90.91% (20/22). The incidence of postoperative complications above grade 3 was 9.09% (2/22), and the rate of urinary control recovery after 3 months of surgery was 90.91% (20/22). 16 patients with preoperative urinary retention were able to urinate normally after operation. All patients were treated with adjuvant androgen deprivation therapy (ADT) with or without antiandrogens, and 13 cases (59.09%) were treated with adjuvant radiotherapy. The postoperative PSA value before adjuvant treatment was 2.53 (0.51, 5.44) ng/ml. The median survival time was not reached. Two patients died of prostate cancer at 71 and 84 months and one patient died of heart disease at 28 months. Conclusions:RP surgery could effectively relieve the condition of urinary retention with low incidence of operative complications. Although the positive rate of surgical margin is high, RP could be used as one of the treatment options for T 4 stage prostate cancer invading bladder neck, while the long-term effect is still needed to be further analyzed.

4.
Article in Chinese | WPRIM | ID: wpr-880798

ABSTRACT

OBJECTIVE@#To evaluate the effect of rosmarinic acid (RA) on mitophagy and hypertrophy of cardiomyocytes exposed to high glucose (HG).@*METHODS@#Rat cardiomyocytes (H9c2) exposed to HG (25 mmol/L) were treated with 50 μmol/L RA or with both RA treatment and Parkin siRNA transfection, with the cells cultured in normal glucose (5.5 mmol/L) and HG as the controls. The expressions of PINK1, Parkin and LC3II/LC3I in the cells were detected by Western blotting. The formation of mitochondrial autophagosomes was observed by transmission electron microscope. Flow cytometry was employed to detect the level of reactive oxygen species (ROS) and apoptotic rate of the cells. The activities of respiratory chain complex enzymes were measured by spectrophotometry. Fluorescence enzyme labeling and @*RESULTS@#RA treatment significantly increased the expression levels of PINK1, Parkin and LC3-II/I (@*CONCLUSIONS@#RA can protect rat cardiomyocytes against oxidative stress injury and cardiomyocyte hypertrophy induced by HG by activating Parkin-mediated mitophagy.


Subject(s)
Animals , Cinnamates , Depsides , Glucose , Hypertrophy , Mitophagy , Myocytes, Cardiac , Protein Kinases , Rats , Reactive Oxygen Species , Ubiquitin-Protein Ligases/genetics
5.
Chinese Medical Journal ; (24): 1397-1403, 2020.
Article in English | WPRIM | ID: wpr-827600

ABSTRACT

BACKGROUND@#Intensive therapy with disease modifying anti-rheumatic drugs (DMARDs) has been reported to improve the outcomes of rheumatoid arthritis (RA). However, real-world study on the effect of intensive therapy on RA sustained remission is still lacking. This study aimed to investigate the outcome of sustained intensive DMARD therapy (SUIT) for RA in a real-world 5-year consecutive cohort.@*METHODS@#Based on a consecutive cohort of 610 out-patients with RA, remission of RA was assessed in 541 patients from 2012 to 2017, by dividing into SUIT, non-SUIT, and intermittent SUIT (Int-SUIT) groups. Changes in the disease activity scores were evaluated by 28-joint disease activity score based on erythrocyte sedimentation rate (DAS28-ESR), 28-joint disease activity score based on C-reactive protein (DAS28-CRP), and clinical deep remission criteria (CliDR). Cumulative remission rates between different groups were compared using Kaplan-Meier curves and predictive factors of sustained remission were identified by univariate and multivariate logistic regression analysis.@*RESULTS@#The remission rates of the SUIT group decreased from 12.0% (65/541) to 5.6% (20/359) based on DAS28-ESR, from 14.0% (76/541) to 7.2% (26/359) based on DAS28-CRP, and from 8.5% (46/541) to 3.1% (11/359) based on CliDR, respectively, with a gradually decreasing trend during the 5 years. The SUIT regimen led to a significantly higher cumulative remission rate than non-SUIT regimen based on DAS28-ESR (39.7% vs. 19.5%, P = 0.001), DAS28-CRP (42.0% vs. 19.6%, P = 0.001), and CliDR (24.5% vs. 8.7%, P = 0.001). The cumulative remission rates of patients treated with SUIT regimen were significantly higher than those treated with Int-SUIT regimen based on DAS28-ESR (39.7% vs. 25.7%, P = 0.043) and CliDR (24.5% vs. 14.2%, P = 0.047), but there was no significant difference between the two groups based on DAS28-CRP (42.0% vs. 27.4%, P = 0.066). Multivariate logistic regression analysis showed that the use of SUIT regimen was an independent favorable predictor according to different remission definitions (for DAS28-ESR: odds ratio [OR], 2.215, 95% confidence interval [CI]: 1.271-3.861, P = 0.005; for DAS28-CRP: OR, 1.520, 95% CI: 1.345-1.783, P = 0.002; for CliDR: OR, 1.525, 95% CI: 1.314-1.875, P = 0.013).@*CONCLUSION@#Sustained intensive treatment of RA is an optimal strategy in daily practice and will lead to an increased remission rate.

6.
Chinese Journal of Urology ; (12): 840-845, 2020.
Article in Chinese | WPRIM | ID: wpr-869772

ABSTRACT

Objective:To investigate the use of bi-parametric magnetic resonance imaging (bpMRI)-based cognitive fusion targeted biopsy and systematic biopsy in patients with prostate imaging reporting and data system (PI-RADS)≥3.Methods:The clinical data of 220 patients with PI-RADS ≥3 who underwent bpMRI-transrectal ultrasound (TRUS) cognitive fusion targeted biopsy and systematic biopsy in the First Affiliated Hospital of Nanjing Medical University from May 2018 to November 2019 were retrospectively analyzed. The median age was 66 (60, 73) years old, median prostate specific antigen (PSA) was 8.73 (6.52, 11.93) ng/ml, medlian prostate volume was 39.25(29.26, 58.39) ml and the mean body mass index (BMI) was (24.02±2.60) kg/m 2. For each patient, bpMRI-TRUS cognitive fusion targeted biopsy and systematic biopsy were performed by two independent experienced urologists. The primary endpoint was the detection rate of CsPCa-A [clinically significant prostate cancer-A, defined as International Society of Urological Pathology (ISUP) grade group 2 or higher tumors]. The secondary endpoints were the detection rates of CsPCa-B (defined as ISUP grade group 3 or higher tumors) and CIPCa (clinically insignificant prostate cancer, defined as ISUP grade group 1 tumors). McNemar test and Chi-square test were used to compare the positive rates of CsPCa-A, CsPCa-B and CIPCa between targeted biopsy and systematic biopsy. Results:In this study, 112 patients (50.91%) were diagnosed with prostate cancer, and the detection was 42.73% (94/220) in targeted biopsy and 46.82% (103/220) in systematic biopsy.CsPCa-A was detected in 84 (38.18%) patients. Detection of CsPCa-A by targeted biopsy and systematic biopsy was not different significantly [30.00% (66/220) vs.34.09% (75/220), P=0.120]. CsPCa-A would have been missed in 8.18% (18/220) patients had not performed systematic biopsy, and in 4.09% (9/220) patients had not performed targeted biopsy. CsPCa-B was detected in 26.36% (58/220) patients. Detection of CsPCa-B by targeted biopsy and systematic biopsy was not different significantly [20.00% (44/220) vs. 23.18% (51/220), P=0.190]. CsPCa-B would have been missed in 6.36% (14/220) patients had not performed systematic biopsy, and in 3.18% (7/220) patients had not performed targeted biopsy. In addition, there was no difference in the positive rates of CIPCa between targeted biopsy combined with systematic biopsy, targeted biopsy only or systematic biopsy only [all three were 12.73% (28/220), P=1.000]. Nine post-biopsy adverse events were reported, including 5 cases of infection, 2 cases of vagal reflex and 2 cases of urinary retention. All of them were improved after symptomatic treatment. Conclusions:No significant difference was identified in the detection rate of CsPCa between targeted biopsy and systematic biopsy. However, combination of targeted biopsy and systematic biopsy could further improve the detection rate of CsPCa without increasing the detection of CIPCa. Therefore, a pre-biopsy bpMRI did have significant importance in the biopsy-na?ve patients, but did not seem to skip the need for systematic biopsy.

7.
Chinese Journal of Urology ; (12): 661-666, 2020.
Article in Chinese | WPRIM | ID: wpr-869740

ABSTRACT

Objective:To investigate the difference of prostate cancer (PCa) detection rate between transperineal cognitive fusion targeted biopsy (COG-TB) and software fusion targeted (FUS-TB).Methods:We retrospectively analyzed 157 patients accepted transperineal targeted biopsies from December 2018 to December 2019, including 67 cases of COG-TB and 90 cases of FUS-TB. All patients were prostate biopsy na?ve, with PSA levels ≤ 20 ng/ml and prostate imaging reporting and data system version 2.1 (PI-RADS v2.1) scores ≥ 3. There was no significant difference between COG-TB and FUS-TB in the age [(70.78 ± 8.86) vs. (70.52 ± 8.79) years old], body mass index [(24.36 ± 2.69)vs. (24.14 ± 3.15) kg/m 2], prostate volume [36.69 (27.52, 47.40) vs. 38.81 (28.80, 53.46) cm 3], PSA level [8.27 (6.0, 11.65) vs. 8.88 (6.40, 13.54) ng/ml], PSAD [0.23 (0.15, 0.36) vs. 0.21 (0.14, 0.34) ng/ml 2], suspicious digital rectal examination findings [16 (23.9%) vs. 17 (18.9%)] and PI-RADS scores [24 (35.8%), 24 (35.8%), 19 (28.4%) and 21 (23.3%) vs. 21 (23.3%), 42 (46.7%), 27 (30.0%) for PI-RADS 3, 4, and 5, respectively]. There was no significant difference in baseline characteristics between the two groups (all P<0.05). The overall and stratified detection rates of PCa and clinically significant prostate cancer (CsPCa) were compared between the two groups. The upgrading rates of Gleason score after radical prostatectomy against biopsy Gleason score were compared between the two groups. Results:There was no significant difference between COG-TB and FUS-TB in the detection rate of PCa [76.1% (51/67) vs. 68.9% (62/90), P=0.32]. Also, no significant difference was found in the detection rate of PCa stratified by PSA [0-10ng/ml: 69.1% (29/42) vs. 57.1% (28/49); 10-20ng/ml: 88.0% (22/25) vs. 82.9% (34/41); all P>0.05] and PI-RADS score [3: 45.8% (11/24) vs. 23.8% (5/21); 4: 91.7% (22/24) vs. 81.0% (34/42); 5: 94.7% (18/19) vs. 85.2% (23/27); all P>0.05]. Similarly, there was no dramatically difference between COG-TB and FUS-TB in the detection rate of CsPCa [58.2% (39//67) vs. 50.0% (45/90), P>0.05]. No significant difference was found in the detection of CsPCa stratified by PSA [0-10ng/ml: 45.2% (19/42) vs.36.7% (18/49); 10-20 ng/ml: 80.0% (20/25) vs. 65.9% (27/41) ; all P>0.05] and PI-RADS score [3: 29.2% (7/24) vs. 9.5% (2/21), 4: 66.7% (16/24) vs. 57.1% (24/42), 5: 84.2%(16/19) vs. 70.4% (19/27) ; all P>0.05]. Additionally, the two technique was not different significantly in the upgrading rate [28.9% (13/45) vs. 26.2% (11/42), P=0.78]. Conclusions:There is no significant difference between FUS-TB and COG-TB in the detection rate of PCa and CsPCa, along with the upgrading rate after RP in patients with PSA ≤ 20 ng / ml and PI-RADS v2.1 score≥3.

8.
Chinese Journal of Rheumatology ; (12): 107-110, 2020.
Article in Chinese | WPRIM | ID: wpr-868180

ABSTRACT

Objective:To investigate the role of conjunctival impression cytology in the diagnosis of Sj?gren's syndrome (SS) and the immunological factors influencing conjunctival lesions.Methods:A total of 57 patients complaining about dry eye were collected, including 38 patients with primary Sj?gren's syndrome (pSS) and 19 patients with non-SS. Conjunctival impression cytology tests were performed for all patients, and they were scored by the Nelson method. Thirty-one patients with SS underwent serological tests such as autoantibodies, immunoglobulins, and complement. The correlation between the relevant data was compared using the t test and the rank sum test. Results:The Nelson grade ≥2 is the positive cut-off value for the diagnosis of SS. The sensitivity was 68.4%, and the specificity was 89.5%, and the area under the receiver operating characteristic curve (ROC) was 0.767. In patients with SS, there was statistical correlation between the results of conjunctival impression cytology and antinuclear antibody (ANA) ( χ2=4.664, P=0.031), anti-SSA antibody ( χ2=8.58, P<0.01), anti-SSB antibody ( χ2=6.13, P=0.013), anti-SSA-52 antibody ( χ2=6.48, P=0.011), immunoglobulin (Ig)G ( t=-4.344, P<0.01) and rheumatoid factor (RF) ( U=25.0, P<0.01). Conclusion:Con-junctival impression cytology has certain value in the diagnosis of SS and can be used to evaluate conjunctival lesions in SS. Serum ANA, anti-SSA antibody, anti-SSB antibody, anti-SSA-52 antibody, IgG, and RF levels are significantly associated with the degree of conjunctival lesions, and can be considered as an indirect evidence of conjunctival involvement in SS.

9.
Article in Chinese | WPRIM | ID: wpr-865106

ABSTRACT

Objective:To investigate the application value of hand-sewn esophagojejunal anastomosis (EJA) in totally laparoscopic total gastrectomy (TLTG).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 35 patients with early or advanced upper gastric cancer who were admitted to Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine between July 2018 and December 2019 were collected. There were 24 males and 11 females, aged (60±10)years, with a range of 35-75 years. All the 35 patients underwent TLTG combined with hand-sewn EJA. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) postoperative pathological examination; (4) follow-up and survival. Follow-up was conducted using telephone interview, outpatient examination, short message service and WeChat to detect tumor recurrence, metastasis and survival of patients up to January 2020.Measurement data with normal distribution were repressented as Mean± SD. Measurement data with skewed distribution were represented as M (range). Count data were expressed as absoulte numbers or persentages. Results:(1) Intraoperative situations: all the 35 patients underwent TLTG combined with hand-sewn EJA successfully. The operation time, volume of intraoperative blood loss, time of hand-sewn EJA, costs of consumables used in the intraoperative resection and reconstruction, and costs of consumables used in EJA of the 35 patients were 305 minutes(range, 232-406 minutes), 94 mL(range, 50-300 mL), 37 minutes(range, 20-65 minutes), 13 674 yuan(range, 11 929-15 255 yuan) and 491 yuan(range, 223-1 044 yuan), respectively. Of the 35 patients, 4 received intraoperative blood transfusion. (2) Postoperative situations: time to first out-of-bed activity, postoperative indwelling time of gastric tube, time to initial liquid diet intake, the time to abdominal drainage tube removal and duration of postoperative hospital stay of the 35 patients were 2 days(range, 1-3 days), 4 days(range, 2-11 days), 5 days(range, 4-12 days), 8 days(range, 5-15 days) and 9 days(range, 7-16 days), respectively. Of the 35 patients, 3 had perioperative complications. One patient had inflammation and infection in the pancreatic tail and was discharged at postoperative 16 days after conservative treatment of fasting, somatostatin to reduce the pancreatic secretion, adequate drainage, anti-infection and nutritional support. One had postoperative intestinal incomplete obstruction and was discharged at postoperative 12 days after treatment with gastrointestinal decompression and enema for relief of obstruction. One had pulmonary infection who was discharged at postoperative 9 days after symptomatic and supportive treatment. None of the 35 patients had perioperative anastomotic leakage or bleeding. Of the 35 patients, 1 was diagnosed with esophagojejunostomy stenosis at postoperative 2 months and was improved after endoscopic dilatation. The incidence of long-term anastomosis-related complications of the 35 patients was 2.9%(1/35). (3) Postoperative pathological examination: the pathological examination of the upper margin of intraoperative frozen section and postoperative paraffin section showed negative in the 35 patients. Of the 35 patients, 16 had tumor located at cardia including 4 cases with tumor involving in lower esophagus, 19 had tumor located at stomach; 21 had tumor pathological type as highly or moderately differentiated adenocarcinoma, 11 had poorly differentiated adenocarcinoma, 3 had signed-ring cell carcinoma; 14 had early gastric cancer, 21 had advanced gastric cancer; 7 had tumor invaded at mucosa lamina propria and muscularis, 7 had tumor invaded at submucosa, 1 had tumor invaded at muscularis, 1 had tumor invaded at subserosal, 17 had tumor invaded at serosal, 2 had tumor invaded at extra-serosal adipose tissue. The TNM staging of the 35 patients: 14 were in stage ⅠA , 2 in stage ⅠB, 4 in stage ⅡB, 3 in stage ⅢA, 4 in stage ⅢB and 8 in stage ⅢC. Of the 35 patients, 15 had vascular invasion and 16 had nerve invasion. The tumor diameter, the number of lymph nodes dissected and the number of positive lymph nodes of the 35 patients were 3.9 cm(range, 0.6-12.0 cm), 24(range, 10-40) and 2(range, 0-11). (4) Follow-up and survival: all the 35 patients were followed up for 1-18 months, with a median time of 5 months. Of the 35 patients, tumor recurrence or metastasis was not found in 34 patients, and the other 1 patient was diagnosed with liver metastases of tumor at postoperative 6 months and survived with tumor.Conclusion:Hand-sewn EJA in TLTG is safe and feasible.

10.
Article in Chinese | WPRIM | ID: wpr-828896

ABSTRACT

OBJECTIVE@#To explore the clinical characteristics and outcomes of adult critically ill patients with COVID-19 and identify the risk factors correlated with in-hospital deaths.@*METHODS@#This study was conducted among 20 confirmed adult cases of COVID-19 in the Intensive Care Unit (ICU) of Honghu People's Hospital in Jingzhou City, Hubei Province. According to the final outcome, the patients were divided into survivor group and death group with 10 patients each. The demographic data, clinical manifestations and signs, laboratory findings, treatment measures and clinical outcomes were obtained from electronic medical records to compare the clinical characteristics and outcomes between the two groups. Univariate logistic analysis was used to analyze the risk factors associated with in-hospital death.@*RESULTS@#The mean age of patients with confirmed COVID-19 was 70 ± 12 years, and 40% of them were male. The patients were admitted to ICU 11 ± 9 days after symptom onset. The most common symptoms on admission were cough (19 cases), fatigue or myalgia (18 cases), fever (17 cases) and dyspnea (16 cases). Eleven (55%) of the patients had underlying diseases, among which hypertension was the most common (11 cases), followed by cardiovascular disease (4 cases) and diabetes (3 cases). Six (30%) of the patients received invasive mechanical ventilation and continued renal replacement therapy but eventually died. Acute cardiac injury was the most common complication (19 cases). Half of the patients died between the 2nd and 19th day after ICU admission. Compared with dead patients, the surviving patients had a lower average body weight (61.70±2.36 68.60±7.15 kg, =0.01) and a higher Glasgow Coma Index (14.69 ± 0.70 12.70 ± 2.45, =0.03), and were less likely to develop shock (2 10, =0.001) or acute respiratory distress syndrome (2 10, =0.001).@*CONCLUSIONS@#Critically ill patients with COVID-19 are generally older. A higher body weight and a lower lymphocyte count are potentially associated with a greater likeliness of fatality in ICU patients with COVID-19.


Subject(s)
Aged , Aged, 80 and over , Betacoronavirus , Coronavirus Infections , Critical Illness , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral , Retrospective Studies
11.
International Journal of Surgery ; (12): 344-349, 2019.
Article in Chinese | WPRIM | ID: wpr-751637

ABSTRACT

The prognosis of pancreatic cancer is very poor,40%-50% of patients have liver metastasis at the time of initial diagnosis,and only 15%-20% of patients have the chance of surgical resection.At present,there is no consensus on the treatment strategy of pancreatic cancer with simultaneous liver metastasis.Surgeons are still looking forward to surgical resection for patients with longer survival time.The application of neoadjuvant therapy and radiofrequency ablation may bring new breakthroughs in the treatment of pancreatic cancer with simultaneous liver metastasis.This article reviews the surgical,neoadjuvant and palliative treatment of pancreatic cancer with simultaneous liver metastasis.

12.
Article in Chinese | WPRIM | ID: wpr-745125

ABSTRACT

Objective To investigate the causes and preventive measures for deviation of guide needle in orthopedics robot surgery.Methods A robotic surgery was simulated on a wooden stick.The guide needle was inserted under the guidance of the robot.A lateral deviation force was applied respectively onto the tail and tip of the needle.The actual offset distance at the guide needle tip was measured and compared with the 1mm offset allowed by robot monitoring.Results The offset distance of the guide needle tip was 0,5+0.07 mm when the deviation force was applied onto the tail,significantly smaller than the 1 mm offset allowed by the robot monitoring(l=22.588,P<0.001).The offset distance of the guide needle tip was 4.92+0.16 mm when the deviation force was applied onto the tip,significantly larger than the 1 mm offset allowed by the robot monitoring(t=17.416,P<0.001).Conclusions The deviation of guide needle may be caused chiefly by the deviation force onto the tip.As the actual offset distance of the guide needle tip may be larger than that shown on the robot monitor in orthopedics robotic surgery,the intraoperative monitoring should serve only as a reference to the deviation of the guide needle.The operative details may be the key to prevention of such deviations.

13.
National Journal of Andrology ; (12): 618-621, 2018.
Article in Chinese | WPRIM | ID: wpr-689710

ABSTRACT

<p><b>Objective</b>To investigate the role of the serum inhibin B (INHB) level in evaluating the testicular function of the prepubertal patient with varicocele (VC) after high ligation of the spermatic vein (HLSV).</p><p><b>METHODS</b>This study included 31 prepubertal male patients with left VC, averaging 12.55 years of age and 9 complicated by right VC. We collected peripheral blood samples before and at 4, 12 and 26 weeks after HLSV as well as spermatic venous blood samples intraoperatively for determination of the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), anti-sperm antibody (AsAb) and serum INHB by ELISA.</p><p><b>RESULTS</b>Compared with the baseline, statistically significant differences were observed in the INHB level in the peripheral blood at 12 and 26 weeks after operation ([255.18 ± 69.97] vs [141.78 ± 59.82] pg/ml, P < 0.05) and that in the spermatic venous blood intraoperatively ([255.18 ± 69.97] vs [412.44 ± 259.42] pg/ml, P < 0.01). Spearman's analysis showed a negative correlation between the level of INHB and that of FSH (r = -0.224, P < 0.01).</p><p><b>CONCLUSIONS</b>The level of serum INHB in the peripheral blood of the prepubertal VC patient is decreased within 6 months after HLSV and negatively correlated with that of FSH. The levels of INHB and FSH may well reflect the testicular function of the prepubertal VC patient.</p>


Subject(s)
Adolescent , Antibodies , Blood , Biomarkers , Blood , Child , Follicle Stimulating Hormone , Blood , Humans , Inhibins , Blood , Luteinizing Hormone , Blood , Male , Spermatozoa , Allergy and Immunology , Testosterone , Blood , Varicocele , Blood
14.
Chinese Journal of Trauma ; (12): 896-903, 2017.
Article in Chinese | WPRIM | ID: wpr-666412

ABSTRACT

Objective To compare the biomechanical characteristics of lengthened sacroiliac screw and long sacroiliac screw fixated in different ways for the treatment of central vertical sacral fractures to provide reference for clinical practice.Methods A finite element model with three dimensions of Tile type C pelvic ring injury (central type Denis Ⅲ fracture of sacrum) was produced.The central sacral fractures were fixated with lengthened sacroiliac screw or long sacroiliac screw in 7 types of models respectively as follows.(1) One long sacroiliac screw was fixated in S1 segment from the right (C1);(2) One long sacroiliac screw was fixated in S2 segment from the right (C2);(3)Two long sacroiliac screws were fixated in S1 and S2 segments respectively from the right (C12);(4) One long sacroiliac screw was fixated in S1 segment from the right and one long sacroiliac screw was fixated in S2 segment from the left (C12hybrid);(5) One lengthened sacroiliac screw was fixated in S1 segment from the right (J1);(6) One lengthened sacroiliac screw was fixated in S2 segment from the right (J2);(7)Two lengthened sacroiliac screws were fixated in S1 and S2 segments respectively from the right (J12).The shift and angle displacement of the central superior surface of sacrum in the case of standing on both feet were measured and compared.The maximum Von Mises stresses in different positions were measured.And various mechanical indices (including stresses of various parts and stress distribution of screws and pelvis,etc) were also quantified and compared.Results The stability of the posterior ring-screw complex was optimal when the sacrum was fixated with S1 & S2 lengthened sacroiliac screws.The maximum Von Mises stresses of screw were affected by sacral segments,namely,S1 > S2 > S1& S2.The maximum Von Mises stress of screws in S1 and S2 segments were similar.The maximum stress of the lengthened sacroiliac screw was lower than that of the long sacroiliac screw.The maximum Von Mises stress of bilateral sacroiliac joints in the lengthened sacroiliac screw fixation model was similar to that of normal pelvis.The maximum stress in the left sacroiliac joint of the long sacroiliac screw fixation model was larger than that of the normal pelvis.The maximum Von Mises stress of screw-bone interface of the long sacroiliac screw fixation model was larger than that of the lengthened sacroiliac screw fixation model.The screw stress distribution of the lengthened sacroiliac screw was superior to that of the long sacroiliac screw,and the screw stress distribution of the double segment fixation was superior to that of the single segment fixation.There was relatively less difference between the pelvic stress distribution of double segment fixation model and that of the normal pelvic model.Conclusion The fixation of S1 & S2 lengthened sacroiliac screws utilized in central sacral fractures of Tile C pelvic ring injury results in a more stable posterior pelvic ringscrew complex,more dispersed screw stress and better pelvic stress distribution which is closed to normal,and can also reduce the risk of internal fixation failure as well as lower back pain.

15.
Chinese Journal of Urology ; (12): 375-378, 2017.
Article in Chinese | WPRIM | ID: wpr-610023

ABSTRACT

Objective To compare the dijference of prostate cancer detection rate (PCDR) between 12 + 1-core biopsy and 6-core biopsy of the prostate system guided by transrectal ultrasonography (TRUS).Methods The clinical data of 2 707 patients with prostate biopsy from July 1999 to June 2012 were retrospectively analyzed.These patients were 54 to 92 years old,mean age was 69 years old.The range of PSA was 0.02-158.56 ng/ml,with an average of 16.97 ng/mt.People in the range of PSA 0-4.00,4.01-10.00,10.01-20.00,20.01-30.00,and > 30.00 were 161,826,827,312,581,respectively.The volume of the prostate ranged from 14.1 to 82.6 cm3,mean 47.9 cm3.The 1 603 cases before the July 2009 were performed 6-core biopsy guided by the finger,followed by 1104 TRUS-guided 12 + 1-core biopsy.In addition,after March 2012,60 patients accepeted the MRI examination before prostate biopsy.The strategy of prostate biopsy was medial 6-core,lateral 6-core,the 13th core was positioned at abnormal signal area of TRUS and MRI.Explore the difference of PCDR medial 6-core,lateral 6-core,systematic 12-and 12 + 1-core,and the difference of 13th core and the other 12 cores,with the cut off value of PSA quartile of 30 ng/ml and PV quartile of 46 cm3.Results Comparison of clinical characteristics of prostate biopsy between positive group and negative group was performed,and the result suggested that The positive outcome of prostate cancer biopsy was related with element such as high PSA,old age [(71.7 ±7.1)vs.(68.3 ± 8.1),P =0.008],large fPSA [(8.5 ± 36.4) vs.(2.3 ± 3.4),P < 0.001],small prostate volume [(41.3 ±22.9) vs.(52.3 ±29.3),P <0.001],small value of f/t[(0.12 ± 0.07) vs.(0.17 ±0.10,P <0.001)],high density of PSA [(2.04 ± 9.36) vs.(0.32 ± 0.42),P < 0.001],digital rectal examination [72.0% (522/725) vs.23.1% (457/1 982),P < 0.001],irregular echo level [41.1% (695/1 693) vs.28.0% (284/1 014),P < 0.001],hypoechoic [64.3% (695/1 081) vs.17.5% (284/1 626),P < 0.001],microcalcifcation[56.8% (586/1 032) vs.23.5% (393/ 675),P < 0.001].PCDR of 12 + 1-core biopsy was significantly higher than lateral 6-core biopsy[41.5% (458/1 104)vs.37.0% (408/1 104),P =0.033].However,PCDR of 12-core biopsy had no statistical differences with 6-core biopsy[40.7% (449/1 104) vs.37.0% (408/1 104),P =0.081].PCDR of TRUS-guided biopsy was higher than that of finger-guided biopsy in patients with PSA≤30 ng/ml and PV >46 cm3 [30.0% (254/846)vs.22.2% (284/1 280),P <0.001;31.7% (124/391)vs.18.1% (131/723),P <0.001].PCDR of the 13th core positioned at abnormal signal area of TRUS and MRI was higher than the average PCDR of other 12 cores [70.9% (107/151) vs.56.6% (3 109/5 496),P < 0.001].Conclusion PCDR of TRUS-guided biopsy was higher than that of finger-guided biopsy in patients with PSA≤30 ng/ml and PV >46 cm3.PCDR of 12 + 1-core biopsy was significantly higher than that of lateral 6-core biopsy.However,PCDR of 12-core biopsy had no statistical differences with that of 6-core biopsy.PCDR of the 13th core positioned at abnormal signal area of TRUS was higher than the average PCDR of other 12 cores.

16.
Chinese Journal of Urology ; (12): 108-113, 2016.
Article in Chinese | WPRIM | ID: wpr-488032

ABSTRACT

Objective To assess the improvement of prostate cancer detection rate ( PCDR) with the advance of prostate biopsy technologies and analyse the changing epidemiology of patients with positive prostate biopsy, especially the PCDR and classficaton of risk.Methods From March 1999 to March 2015, a total of 3 762 patients were recruited to the department of urology, the first affiliated hospital of Nanjing medical university.All patients underwent a systematic 6-, 8-or 13-core biopsy, guided by finger or TRUS. The PCDR of different prostate specific antigen ( PSA) interval was analyzed.The PCDR of 6-or 8-core biopsy guided by finger and 13-core biopsy guided by TRUS were compared.The trends of PSA level, age and Gleason score in the patients with positive biopsy were summarized.Results A total of 3 762 patients underwent prostate biopsies and PCa were detected in 1479 patients (39.3%).Finger-guided 6-core biopsy was performed on 1 106 patients, and PCa were detected in 343 cases ( 31.0%) .Finger-guided 8-core biopsy was performed on 398 patients, and PCa were diagnosed in 144 cases (36.2%).Since 2009, 2 258 patients underwent TRUS-guided 13-core biopsy, and 992 ( 43.9%) were diagnosed as PCa, higher than that of finger-guided biopsies ( 43.9% vs.32.4%, P4 ng/ml) were lower than that of positive in digital rectal examination.The PCDR of 6 needles biopsy was higher in prostate peripheral zone than that of prostate medial zone (37.5% vs.31.4%, P<0.001) and further analysis indicated that the PCDR of extra 13th biopsy of the area with abnormal TRUS or MRI findings was higher than the mean positive rate of the other 12 biopsies.Regarding adverse effects, 34.9%(1312/3762) reported slight gross hematuria or microscopic haematuria, 56 ( 1.5%) developed gross hematuria, 72 (1.9%) occurred rectal bleeding, 63(1.7%) needed short-term hospitalization due to fever, one patient suffered hepatorenal function failure and one patient died after biopsy.Since 1999, the PSDR rise gradually. With the increase of tPSA level, Gleason score increased in biopsy positive patients.The percentage of low risk PCa patients increased from 6.5% to 15.7% gradually in last decade, while the percentage of intermediate or high risk PCa patients is still over 80%.Since 2009, the percentage of patients who underwent prostate biopsies because of evaluated PSA level was higher than before ( 46.7% vs.34.1%, P<0.001).The PCDR of patients with an evaluated tPSA level showed no difference compared with the patients presented lower urinary tract symptoms ( LUTS ) ( 45.2% vs.43.2%, P =0.362 ) , while their mean Gleason score in positive patients was lower than that of LUTS group(6.76 vs.7.25,P<0.001). Conclusions The PCDR of TRUS-guided 13-core transrectal prostate biopsy was significantly higher than that of finger-guided 6-or 8-core biopsy.Due to the application of PSA test, the PCDR increased gradually and the mean age of positive patients decreased.The higher the age, the higher the PCDR.Gleason score was higher when patients with positive DRE, compared to an evaluated tPSA level.Biopsies of prostate peripheral zone is helpful to improve the PCDR.The higher the tPSA level, the higher the Gleason score. With the application of PSA test, TRUS-guided 13-core prostate biopsy detected more low risk PCa, and most of PCa were still clinical significant.

17.
National Journal of Andrology ; (12): 1020-1024, 2014.
Article in Chinese | WPRIM | ID: wpr-319575

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the safety and feasibility of testis-sparing surgery (TSS) in the treatment of testicular tumor.</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 8 cases of benign testicular tumor treated by TSS in our hospital from October 2005 to March 2012.</p><p><b>RESULTS</b>The 8 patients, aged 18-67 (mean 45) years, were preoperatively diagnosed with benign testicular tumor and all underwent partial testis resection. Rapid intraoperative pathology showed the incisal margins to be negative. Postoperative pathological examination confirmed Sertoli cell tumor in 3 cases, adenomatoid tumor in another 3, and mature teratoma in the other 2. The patients were followed up for 6 months to 7 years (mean 4 years), which revealed no relapse and metastasis, nor significant differences from the baseline in the testosterone level, IIEF score, and routine semen parameters.</p><p><b>CONCLUSION</b>Testis-sparing surgery is one of the effective options for the management of benign testicular tumor, which can maximally preserve the testis tissue and protect the patient's sexual function.</p>


Subject(s)
Adolescent , Adult , Aged , Humans , Male , Middle Aged , Neoplasm Recurrence, Local , Organ Sparing Treatments , Methods , Retrospective Studies , Sertoli Cell Tumor , Pathology , General Surgery , Teratoma , Pathology , General Surgery , Testicular Neoplasms , Pathology , General Surgery , Testis
18.
National Journal of Andrology ; (12): 1093-1097, 2014.
Article in Chinese | WPRIM | ID: wpr-319560

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate the effect of adjuvant hormonal therapy (AHT) immediately after radical surgery for high- risk organ-confined or locally advanced prostate cancer using the PSA-related biochemical relapse rate within 2 years after surgery.</p><p><b>METHODS</b>We retrospectively analyzed 62 cases of high-risk organ-confined or locally advanced prostate cancer. The patients were treated by laparoscopic radical prostatectomy or radical retropubic prostatectomy after MRI and ECT systemic bone imaging examination, which revealed no regional lymph node or bone metastasis. Thirty-two of the patients (group A) received AHT orally or subcutaneously from 2 weeks to 1 months after operation, and another 30 (group B) were left untreated. We followed up the patients for 2 years, measuring the serum PSA level every 3 months, performing ECT every 6 months, and recording the adverse reactions, medication dura- tion, and the patients'quality of life.</p><p><b>RESULTS</b>All the operations were successfully accomplished. The rate of 2-year biochemical relapse-free survival was 78.13% (25/32) in group A and 53.33% (16/30) in group B.</p><p><b>CONCLUSION</b>AHT immediately after radical surgery can improve the rate of biochemical relapse-free survival of the patients with high-risk organ-confined or locally advanced prostate cancer and check the progression and metastasis of the disease.</p>


Subject(s)
Aged , Antineoplastic Agents, Hormonal , Therapeutic Uses , Chemotherapy, Adjuvant , Disease Progression , Disease-Free Survival , Humans , Laparoscopy , Male , Middle Aged , Neoplasm Recurrence, Local , Blood , Neoplasm Staging , Prostate-Specific Antigen , Blood , Prostatectomy , Methods , Prostatic Neoplasms , Blood , Drug Therapy , Pathology , General Surgery , Quality of Life , Retrospective Studies
19.
Article in Chinese | WPRIM | ID: wpr-341826

ABSTRACT

The survey of traditional knowledge related to Chinese materia medica resources is the important component and one of the innovative aspects of the fourth national survey of the Chinese materia medica resources. China has rich traditional knowledge of traditional Chinese medicine (TCM) and the comprehensive investigation of TCM traditional knowledge aims to promote conservation and sustainable use of Chinese materia medica resources. Building upon the field work of pilot investigations, this paper introduces the essential procedures and key methods for conducting the survey of traditional knowledge related to Chinese materia medica resources. The essential procedures are as follows. First is the preparation phrase. It is important to review all relevant literature and provide training to the survey teams so that they have clear understanding of the concept of traditional knowledge and master key survey methods. Second is the field investigation phrase. When conducting field investigations, survey teams should identify the traditional knowledge holders by using the 'snowball method', record the traditional knowledge after obtaining prior informed concerned from the traditional knowledge holders. Researchers should fill out the survey forms provided by the Technical Specification of the Fourth National Survey of Chinese Materia Medica Resources. Researchers should pay particular attention to the scope of traditional knowledge and the method of inheriting the knowledge, which are the key information for traditional knowledge holders and potential users to reach mutual agreed terms to achieve benefit sharing. Third is the data compilation and analysis phrase. Researchers should try to compile and edit the TCM traditional knowledge in accordance with intellectual property rights requirements so that the information collected through the national survey can serve as the basic data for the TCM traditional knowledge database. The key methods of the survey include regional division of Chinese materia medica resources, interview of key information holders and standardization of information.' In particular, using "snowball method" can effectively identify traditional knowledge holder in the targeted regions and ensuring traditional knowledge holders receiving prior informed concerned before sharing the information with researcher to make sure the rights of traditional knowledge holders are protected. Employing right survey methods is not only the key to obtain traditional knowledge related to Chinese materia medica resources, but also the pathway to fulfill the objectives of access and benefit sharing stipulated in Convention on Biological Resources. It will promote the legal protection of TCM traditional knowledge and conservation of TCM intangible, cultural heritage.


Subject(s)
China , Data Collection , Databases, Pharmaceutical , Drugs, Chinese Herbal , Materia Medica , Medicine, Chinese Traditional
20.
National Journal of Andrology ; (12): 1091-1094, 2013.
Article in Chinese | WPRIM | ID: wpr-267982

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the clinical effect and application value of the modified method of prepuce-degloving repair (PDR) in the treatment of urethrocutaneous fistula (UCF) following hypospadias surgery.</p><p><b>METHODS</b>We retrospectively analyzed 87 cases of UCF caused by hypospadias repair from May 2001 to December 2011, of which 61 were treated by simple closure or Y-V plasty of the fistula (group A), and the other 26 by modified PDR (group B). We compared the success rate of surgery and long-term recurrence between the two groups.</p><p><b>RESULTS</b>The total success rates of repair were 78.7 and 96.2% in groups A and B, respectively. Thirteen cases in group A did not respond to surgery, of which 6 failed to be cured by the second operation but later were treated successfully by modified PDR. In comparison, there was only 1 case of failure in group B, which was cured by a second PDR.</p><p><b>CONCLUSION</b>Modified PDR can significantly improve the success rate and reduce the recurrence rate of UCF after hypospadias surgery, which deserves wide clinical application.</p>


Subject(s)
Child , Child, Preschool , Foreskin , General Surgery , Humans , Hypospadias , General Surgery , Male , Reconstructive Surgical Procedures , Methods , Retrospective Studies , Treatment Outcome , Urinary Fistula , General Surgery , Urologic Surgical Procedures, Male
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