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1.
Article in Chinese | WPRIM | ID: wpr-907328

ABSTRACT

Objective:To investigate whether the combination of conventional axial and thin-layer sagittal diffusion-weighted imaging (DWI) can improve the detection ability of acute brainstem infarction (ABI).Methods:Patients with ABI diagnosed clinically and admitted to Weihai Municipal Hospital, Shandong University from January 2019 to July 2020 were enrolled retrospectively. All patients underwent conventional axial and thin-layer sagittal DWI examination after admission. Those who could not make a definite diagnosis were confirmed by DWI reexamination before discharge. The numbers of positive and negative cases of brainstem infarction at different sites detected by conventional axial and conventional axial+ thin-layer sagittal DWI were recorded.Results:A total of 65 patients with ABI were included. Conventional axial DWI was positive in 51 patients (78.5%) and was negative in 14 (21.5%); conventional axial+ thin-layer sagittal DWI were positive in 60 patients (92.3%) and was negative in 5 (7.7%). In 8 patients with medullary infarction, only 4 (50.0%) were positive on conventional axial DWI, and 6 (75.0%) were positive on conventional axial+ thin-layer sagittal DWI; in 50 patients with pontine infarction, only 44 (88.0%) were positive on conventional axial DWI, and 48 (96.0%) were positive on conventional axial+ thin-layer sagittal DWI; in 4 patients with midbrain infarction, only 1 (25.0%) was positive on conventional axial DWI, and 3 (75.0%) were positive on conventional axial+ thin-layer sagittal DWI; in 3 patients with pontine+ midbrain infarction, only 2 (66.7%) were positive on conventional axial DWI, and 3 (100.0%) were positive on conventional axial DWI+ thin-layer sagittal DWI. The detection rate of ABI on conventional axial+ thin-layer sagittal DWI was significantly higher than that on conventional axial DWI, and difference was statistically significant (92.3% vs. 78.5%; χ2=4.993, P=0.026). Conclusion:The combination of conventional axial and thin-layer sagittal DWI improved the detection rate of ABI. For ABI patients whose axial DWI did not find lesions or whose diagnosis was not clear, thin-layer sagittal DWI should be added.

2.
Chinese Journal of Urology ; (12): 824-829, 2021.
Article in Chinese | WPRIM | ID: wpr-911127

ABSTRACT

Objective:To evaluate the feasibility, safety and efficacy of the magnetic resonance imaging guided focused ultrasound surgery (MRgFUS) in the treatment of localized prostate cancer (PCa).Methods:The data of 5 patients treated by MRgFUS from August 2020 to June 2021 in our institution were retrospectively analyzed. The median age was 73 (58-80) years, with the median PSA of 7.34 (5.19-8.40) ng/ml, and a median prostate volume of 27.96 (21.50-37.91) ml. The median pretreatment international prostate symptom score (IPSS) was 13(0-18). Of the 3 patients with intention of erectile function preservation, the pretreatment international index of erectile function-15 (IIEF-15) score was 12, 23 and 3, respectively. All patients had histopathology-proven PCa of grade group ≤ International Society of Urological Pathology (ISUP) 3, pre-operative PSA level <20 ng/ml, and a clinical stage ≤T 2b. A total of 6 lesions was confirmed by biopsy, with 3 of ISUP grade group 3 and 3 of ISUP grade group 1. All 5 patients underwent MRgFUS which was guided by a real-time magnetic resonance imaging (MRI). PSA, MRI and repeated biopsy were conducted to monitor recurrence. Questionnaires consisted of IPSS, IIEF-15, and the International Consultation on Incontinence-questionnaire-Short Form (ICI-Q-SF) were recorded before and after MRgFUS to evaluate the impact on functional preservation. Results:A total of 5 patients received MRgFUS. In total, 5 of the 6 lesions were treated. 1 lesion unvisible on MRI was not clinically significant and was left untreated. The median time in MRI scanner was 190 (140-355) min, and the median sonication time was 64 (35-148) min with the median sonications of 8 (5-13). The median catheter indwelling time was 1 (1-8) days. No other adverse effects were reported. The PSA level of all 5 patients decreased, with the nadir PSA of 1.196 ng/ml, 4.398 ng/ml, 4.135 ng/ml, 1.562ng/ml and 1.350ng/ml, respectively. 4 of the patients had a PSA decrease over 50%. No PCa lesion was seen on MRI at 3-month follow-up visit. As for functional preservation, the post-MRgFUS IPSS declined compared with the baseline score, and the IPSS of last follow-up was 5(0-14). Of the 3 patients with intention to preserve the erectile function, the erectile function score of IIEF-15 were 12, 30 and 9 three months after the treatment, respectively. No incontinence occurred postoperatively.Conclusions:MRgFUS is a feasible and safe way for the treatment of low- to intermediate-risk localized PCa, with satisfactory performance on functional preservation and low incidence of complications. The oncological outcomes still need to be establised with longer follow-up time and larger sample studies.

3.
Chinese Journal of Urology ; (12): 691-695, 2021.
Article in Chinese | WPRIM | ID: wpr-911097

ABSTRACT

Objective:To analyze the prognosis of patients with positive resection margin after radical prostatectomy, as well as the prostate-specific antigen (PSA)level and risk factors for PSA progression.Methods:A retrospective analysis was performed on the data of 141 patients with pathologically diagnosed prostate cancer who underwent RP from May 2012 to August 2020 in Beijing Hospital. The mean age was (67.4±6.7)years, the preoperative median PSA was 9.6 (1.4-152.8) ng/ ml and the median follow-up time was 56 months. Postoperative pathology was T 2 stage 74 (52.5%), T 3 stage 63 (44.7%), T 4 stage 4 (2.8%). Biochemical recurrence after radical resection was defined as PSA rose to more than 0.2 ng/ml and showed an upward trend after two consecutive follow-ups. In this study, serum PSA ≥ 0.1 ng/ml without biochemical recurrence after radical operation was defined as PSA progression. The PSA level, risk factors of PSA progression and prognosis of patients with positive resection margin were analyzed. Univariate and multivariate Cox regression analysis was used to analyze the correlation between age, preoperative PSA level, pathological stage (pT), ISUP classification, surgical approach, lymph node dissection, single/multiple positive margins and PSA progression. Results:The median follow-up of 141 patients was 52 months(1-104 months). There were 69 (48.9%) patients in the PSA progression group and 72 (51.1%) patients in the non PSA progression group. In the PSA progression group, 13 (18.8%) patients did not receive treatment and 8 (61.5%) patients had biochemical recurrence. 4 (5.8%) patients received radiotherapy alone, and 2 (50.0%) patients had biochemical recurrence. 52 (75.4%) patients received endocrine therapy or endocrine therapy combined with radiotherapy, and 5 (9.6%) patients developed castration resistance. Multivariate Cox regression analysis showed preoperative PSA ( HR=1.015, 95% CI 1.005-1.025, P =0.004), ISUP grade and group ( HR=1.351, 95% CI 1.091-1.673, P =0.006), surgical method ( HR=2.233, 95% CI 1.141-4.370, P =0.019) was correlated with PSA progression. Conclusions:The incidence of surgical positive margin is high after RP. Nearly half of the patients with surgical positive margin developed a PSA progression status. Preoperative PSA, ISUP grade group, and the surgical approach are risk factors for PSA progression in patients with positive surgical margins. Patients with these risk factors should be monitored more closely and treated more aggressively.

4.
Chinese Journal of Geriatrics ; (12): 1407-1411, 2021.
Article in Chinese | WPRIM | ID: wpr-911028

ABSTRACT

Objective:To evaluate the efficacy and safety of robotic arm assisted laparoscopic hysterosacral fixation in patients with pelvic organ prolapse(POP), and its impact on lower urinary tract function.Methods:This study retrospectively analyzed the clinical data of POP patients who had undergone robotic arm assisted laparoscopic hysterosacral fixation at our center from June 2019 to October 2020, and conducted exploratory research.Results:A total of 6 patients were included in the study, with POP quantitative staging above stage Ⅲ.The ages ranged from 70 to 82 years.The number of births each patient had given ranged from 1 to 3, & all were via vaginal deliveries.There were no significant changes in urodynamic parameter scores in any patients before and after surgery, but half of the patients had detrusor overactivity before surgery, which all disappeared after surgery.In addition, synchronous X-ray images showed that the postoperative pelvic organs were closer to the normal anatomical position.At the same time, quantitative staging of POP had achieved clear improvement, and related scale scores also significantly improved.One patient complained of occasional lumbar and back discomfort with postoperative over-stretching during outpatient review, which improved after symptomatic treatment.Conclusions:robotic arm assisted Laparoscopic hysterosacral fixation is satisfactory in efficacy and safety for POP patients, with good postoperative restoration of the uterus to the anatomical position and has insignificant influence on the function of the lower urinary tract.It is worth further assessment for wide application.

5.
Chinese Journal of Radiology ; (12): 975-980, 2021.
Article in Chinese | WPRIM | ID: wpr-910261

ABSTRACT

Objective:To investigate the diagnostic value of quantitative parameters of synthetic MRI in patients with prostate cancer (PCa).Methods:From April 2018 to April 2019, 25 PCa patients confirmed by whole-mount pathology were prospectively enrolled in Beijing Hospital. All patients underwent prostate MRI examinations including DWI and synthetic MRI. Four kinds of tissue types were identified in pathology, including PCa, stromal hyperplasia (SH), glandular hyperplasia (GH) and prostatitis. According to the pathological results, quantitative parameters including ADC, T 1, T 2 and proton density (PD) values were measured on DWI and synthetic MRI. One-way analysis of variance or Kruskal-Wallis H test was performed to compare the difference of each parameter among PCa, SH or GH in the transitional zone (TZ). The difference of each parameter between PCa and prostatitis in the peripheral zone (PZ) was evaluated by using independent sample t test or Mann-Whitney U test. The diagnostic performance of each parameter in discriminating PCa from other benign conditions was evaluated by using ROC curve. Area under the curve (AUC) of each parameter was compared by using DeLong test. Results:The overall differences of T 1, T 2 PD and ADC values were statistically significant among PCa and other benign conditions. The T 1, T 2 and ADC values of PCa in the TZ were lower than those in the SH ( P=0.041, 0.030,<0.001) and GH (all P<0.001). The PD value of PCa in the TZ was lower than that in the GH ( P=0.040). The differences of T 1, T 2, PD and ADC values between PCa and prostatitis in the PZ were significant ( P<0.05). The AUC of ADC value (0.943) was higher than that of T 1 (0.691, P=0.001), PD (0.555, P=0.002) and T 2 (0.754, P=0.016) values in differentiating PCa from SH. For discriminating PCa and GH, T 1, T 2 and ADC showed similar AUC ( P>0.05), which were higher than AUC of PD value ( P=0.001). For discriminating PCa and prostatitis, T 1, T 2, PD and ADC values showed similar AUC ( P>0.05). Conclusions:Quantitative parameters of synthetic MRI were practical tools for discriminating PCa from other benign pathologies.

6.
Chinese Journal of Geriatrics ; (12): 323-328, 2021.
Article in Chinese | WPRIM | ID: wpr-884889

ABSTRACT

Objective:To investigate the features of volume, distribution, grading and staging of prostate cancer(PCa)examined via whole-mount histopathology in transitional PCa.Methods:A total of 129 PCa patients undergone radical prostatectomy(RP)between July 2017 and March 2020 whose whole-mount prostate specimens were prepared after surgery were retrospectively studied.Pathological data on tumor locations, diameters and classification of the International Society of Urologic Pathology(ISUP), radiological data on regions of interest(ROI)and scores of the Prostate Imaging and Reporting Data System(PI-RADS v2)were recorded.The results of pathological whole-mount sections and prostate imaging were compared, and the characteristics and detection rates of lesions in different prostate regions were analyzed.Results:Of all 129 prostate specimens from RP, a total of 213 PCa lesions were detected through whole-mount histopathology.There were 21(9.9%)lesions involving both the peripheral zone(PZ)and the transition zone(TZ), with an average diameter of(2.82±0.71)cm.Of all lesions, 85(39.9%)involved PZ and 107(50.2%)involved TZ, with an average diameter of(1.36±0.81)cm and of(1.60±0.94)cm, respectively.The percentage of lesions involving TZ was higher than that lesions involving PZ, with larger diameters( P<0.05). Of 64 patients with complete MRI data, 105 PCa lesions were detected histopathologically by using whole mount sections, while 75 PCa lesions were detected by MRI, with a statistical difference( P<0.05). For lesions≥1.0 cm or lesions with an ISUP grade group≥2, the detection rate of MRI was lower in TZ lesions( P<0.05). Conclusions:PCa lesions within TZ account for a large proportion and have a relatively large tumor dimeter.PCa lesions within TZ are more likely to be missed in clinical examinations and on MRI, and clinicians should pay close attention during diagnosis and treatment.

7.
Chinese Journal of Urology ; (12): 746-751, 2020.
Article in Chinese | WPRIM | ID: wpr-869744

ABSTRACT

Objective:To investigate the detection rate and the characteristics of detected prostate cancer foci on multi-parametric MRI (mp-MRI) and to evaluate the potential influence factors.Methods:A total of 66 patients undergoing radical prostatectomy (RP) from August 2017 to July 2019 in Beijing Hospital were retrospectively studied. The median age was 67(56-80)years, with the median preoperative PSA level of 8.73 (1.22-72.46)ng/ml, and median prostate volume of 35.9(16.8-131.8) ml. All patients underwent mp-MRI before surgery and the whole mount section of RP specimens was prepared. Two radiologists reviewed all the foci independently and then matched each foci with an urological pathologist. The primary outcome was the detection rate of prostate cancer. The potential influence factors were also investigated.Results:Of all 66 patients, a total of 62(93.9%) patients were diagnosed with prostate cancer on a preoperative mp-MRI. On whole mount section, 109 prostate cancer foci were detected, of which 77 foci were correctly diagnosed on mp-MRI, with the overall sensitivity of 70.6%. For all the foci detected, 53(48.6%) were grade group 1 disease of International Society of Urological pathology (ISUP), 31(27.5%) were ISUP grade group 2 disease, 19(17.4%) were ISUP grade group 3 disease, and 6(5.5%) were ≥ISUP grade group 4 disease. Mp-MRI detected 62/67(92.5%) lesions with tumor diameter ≥1 cm, 49/56(87.5%) lesions with tumor Gleason score ≥7, and 59/66(89.4%) index lesions. The tumor diameter( OR=3.183, 95% CI 1.580-6.411, P=0.001)and index lesion status( OR=4.042, 95% CI 1.127-14.503, P=0.032)were independently associated with the detection of prostate cancer foci on mp-MRI. Conclusions:mp-MRI is an effective technique for prostate cancer detection. Sensitivity increased with increased tumor size and index lesion status. The tumor diameter and index lesion status were independently associated with the detection of prostate cancer foci on mp-MRI.

8.
Chinese Journal of Urology ; (12): 205-209, 2020.
Article in Chinese | WPRIM | ID: wpr-869629

ABSTRACT

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.

9.
Chinese Journal of Urology ; (12): 126-130, 2020.
Article in Chinese | WPRIM | ID: wpr-869609

ABSTRACT

Objective To analyze effects of androgen deprivation therapy on lipid metabolism and nutritional status in patients with prostate cancer.Methods The clinical data of 255 elderly patients (≥ 65 years old) with prostate cancer who received endocrine therapy and complete follow-up data from January 2010 to December 2018 were analyzed retrospectively.The median age of the 255 patients was 76 years (65-92).The average PSA of patients was (58.15 ± 9.62) ng/ml,where 101 patients had PSA < 10 ng/ml,62 patients had PSA 10-20 ng/ml,and 92 patients had PSA > 20 ng/ml.All patients were diagnosed pathologically by prostate biopsy.As for Gleason score,Gleason score≤6,Gleason score =7 and Gleason score ≥ 8 had 62,103 and 90 patients,respectively.Endocrine therapy included maximum androgen blockade (197 cases) and drug castration (58 cases),and continued for at least 1 year.Among them,123 cases had complete blood lipid index data,and the subgroup analysis was based on the age of 80 years old,including 98 cases aged 65 to 80 years old and 25 cases over 80 years old.A total of 186 cases had complete data of total protein and albumin,of which 147 cases were 65 years old and 80 years old and 39 cases were more than 80 years old.Before treatment,cholesterol was (4.08 ±0.87) mmoL/L,including (4.14 ±0.86) mmol/L in the 65-80 years old group,(3.82 ± 0.88) mmol/L in > 80 years old group;triglyceride was (1.23 ± 0.56) mmol/L,65-80 age group was (1.26 ± 0.56) mmol/L and > 80 years old group was (1.11 ± 0.57) mmol/L;High density lipoprotein cholesterol was(1.09 ± 0.24)mmol/L,65-80 age group was (1.10 ±0.25) mmol/L and > 80 years group was (1.04 ± 0.21) mmol/L.Low density lipoprotein cholesterol was (2.50 ± 0.78) mmol/L,65 ~ 80 age group was (2.55 ± 0.77) mmol/L and (2.34 ± 0.83) mmol/L in >80 years old group.The total protein before endocrine therapy was (63.81 ± 5.93) g/L,including (63.95 ± 5.79) g/L in the 65-80 years old group,(63.30 ± 6.49) g/L in > 80 years old group.In terms of pre-treatment albumin (39.68 ± 3.50) g/L,including (39.82 ± 3.60) g/L in the 65-80 years old group and (39.21 ± 3.12) g/L in > 80 years old group.The differences of various indexes before and after treatment were analyzed.Results The results of blood lipid data analysis of 123 cases showed that,there were increased significant differences(P < 0.01) in cholesterol (4.80 ± 1.82)mmol/L,triglyceride (1.59 ± 1.17) mmol/L,high density lipoprotein cholesterol (1.21 ± 0.25) mmol/L and low density lipoprotein cholesterol (3.07 ± 1.53) mmol/L after endocrine therapy compared with baseline.In the subgroup analysis,the levels of cholesterol,triglyceride,high density lipoprotein cholesterol and low density lipoprotein cholesterol in 65-80-year-old group after treatment were (4.92 ± 1.95) mmol/L,(1.64 ± 1.25) mmol/L,(1.20 ± 0.25) mmol/L,and (3.15 ± 1.66) mmol/L,respectively,which were significantly higher than those before treatment (P <0.01).In the group over 80 years old,the blood lipid index after treatment was higher than that before treatment,including cholesterol (4.35 ± 1.08) mmol/L,triglyceride (1.39 ± 0.73) mmoL/L,high density lipoprotein cholesterol (1.27 ± 0.26) mmol/L and low density lipoprotein cholesterol (2.76 ± 0.93) mmol/L.The levels of cholesterol,triglyceride and high density lipoprotein cholesterol were significantly higher than those before treatment (P < 0.05),but there was no significant difference in low density lipoprotein cholesterol between before and after treatment (P > 0.05).The results of data analysis of 186 cases of total protein and albumin showed that,the total protein after treatment was (62.81 ±7.34) g/L,which was not significantly different from that before treatment (P > 0.05).The total protein in 65-80 years old group after treatment was (62.36 ± 7.36) g/L,which decrease and have statistical significantly different from that before treatment (P < 0.05);The total protein in > 80 years old group after treatment was (64.49 ± 7.12) g/L,it was higher than that before treatment,but the difference was not statistically significant (P > 0.05).The level of albumin after endocrine therapy was (38.34 ± 4.48) g/L,which was significantly different from that before treatment (P < 0.01).The levels of albumin in 65-85 years old group and > 80 years old group after treatment were (38.32 ± 4.54) g/L and (38.44 ± 4.30) g/L respectively,but only in the group of 65 to 80 years old,there were significant differences compared with those before treatment (P < 0.05).Conclusion Endocrine therapy can not only significantly increase total cholesterol,triglyceride,low density lipoprotein cholesterol and high density lipoprotein cholesterol in elderly patients with prostate cancer,but also significantly reduce albumin after treatment.

10.
Chinese Journal of Geriatrics ; (12): 1331-1334, 2020.
Article in Chinese | WPRIM | ID: wpr-869557

ABSTRACT

Objective:To investigate the effect of maximal androgen blockade(MAB)therapy on serum calcium, phosphorus and other metabolic indices in elderly patients with prostate cancer.Methods:Clinicopathological data of prostate cancer patients treated with MAB in our department from January 2010 to December 2018 were retrospectively analyzed.All patients underwent prostate biopsy for definitive diagnosis.Detailed data on patient's age, body mass index(BMI), previous medical history, treatment plan and peripheral blood indicators before and after endocrine treatment, such as blood calcium, phosphorus, hemoglobin, fasting blood glucose, triglycerides and cholesterol, were collected.Results:Patients had a mean age of(75.5±5.8)years and a mean BMI of(24.6±3.2)kg/m 2.Blood calcium levels exhibited a downward trend after MAB treatment compared pre-treatment[(2.12±0.44)mmol/L vs.(2.17±0.31)mmol/L, t=0.82, P=0.42], but had no significant difference.Serum phosphorus concentrations were higher and the calcium-phosphorus ratio was lower after MAB treatment than before treatment[(1.02±0.26)mmol/L vs.(1.17±0.34)mmol/L, 2.10±0.28 vs.1.88±0.60, t=-4.12 and 3.56, P<0.01]. After MAB treatment, blood fasting glucose[(6.50±1.55)mmol/L vs.(5.34±1.04)mmol/L, t=-7.82, P<0.01], triglycerides[(1.66±1.32)mmol/L vs.(1.22±0.59)mmol/L, t=-3.38, P<0.01]and cholesterol[(4.70±1.08)mmol/L vs.(4.16±0.90)mmol/L, t=-4.72, P<0.01]were elevated, while hemoglobin concentrations[(122.11±20.43)g/L vs.(130.78±23.98)g/L, t=3.98, P<0.01]were decreased compared with pre-treatment levels. Conclusions:MAB therapy can cause varying degrees of metabolic abnormalities in calcium and phosphorus metabolism, hemoglobin concentrations, blood glucose and lipid levels in elderly prostate cancer patients.The above indicators should be closely monitored during treatment, and treatment-related complications should be proactively prevented.

11.
Journal of Chinese Physician ; (12): 1106-1109, 2020.
Article in Chinese | WPRIM | ID: wpr-867346

ABSTRACT

Myocardial infarction refers to severe coronary artery stenosis, which leads to continuous and complete occlusion of coronary artery and myocardial necrosis. Coronary artery stenosis (>50%) or occlusion can be seen in 90% of patients undergoing coronary angiography, but 10% of patients have no obvious stenosis, that is, non obstructive myocardial infarction (MINOCA). The incidence rate of MINOCA was about 6%, showing an upward trend year by year, with an average age of 55 years, of which 40% of women. Its etiology is complex, the onset is urgent, and the clinical manifestations are complex and changeable. The incidence of major adverse cardiovascular events (MACE) is very high, and the mortality rate within one year is as high as 3.5%. There is no unified diagnosis and treatment plan at present. In this paper, the etiology, diagnosis and treatment of MINOCA were reviewed.

12.
Chinese Journal of Geriatrics ; (12): 278-282, 2019.
Article in Chinese | WPRIM | ID: wpr-745507

ABSTRACT

Objective To investigate the effects of radical prostatectomy on the overall survival (OS)and tumor-specific survival in prostate cancer(PCa)patients aged 75 years and older.Methods Clinical data of patients aged 75 and older with localized PCa from Surveillance,Epidemiology,and End Results(SEER)Database from 2004 to 2016 were retrospectively analyzed.There were 17 899 cases of PCa undergoing radical prostatectomy and 3 648 cases of PCa without surgery in this study.The OS and prostate cancer-specific survival(PSS)were compared between the surgery group and the nonsurgery group.Results For 75-79-year-old patients with high-risk localized PCa,the OS and PSS in the surgery group were better than in the non-surgery group (OR =1.49,95 % CI:1.22 ~ 1.82,P < 0.01;OR=1.43,95%CI:1.09~2.04,P<0.05).For patients aged 75-79 years with low-risk PCa and patients aged 80 years and older with low-,middle-,or high-risk PCa,the OS was worse in the surgery group than in the non-surgery group(OR =0.54,95%CI:0.38~0.76,P<0.01;OR =0.47,95%CI:0.34~0.66,P<0.01;OR =0.58,95%CI:0.44~0.78,P<0.01;OR =0.59,95%CI:0.51 ~0.68,P<0.01).For patients aged 75-79 years with low-or medium-risk PCa and patients aged 80 years and older with medium-risk PCa,there was no statistical difference in PSS between the surgery and non-surgery groups(P>0.05).Conclusions Age limits for prostatectomy should be extended as a result of increasing average life expectancy.Patients aged 75-79 years with high-risk PCa can be considered for surgical treatment,while it should not be recommended for patients aged 75-79 years with low-or medium-risk localized PCa or aged more than 80 years.Many factors should be considered in making treatment decisions for prostate cancer.

13.
Chinese Journal of Urology ; (12): 740-744, 2018.
Article in Chinese | WPRIM | ID: wpr-709590

ABSTRACT

Objective To analyze the associated factors of positive surgical margin after radical prostatectomy.Methods A retrospective analysis was conducted on 320 patients who underwent radical prostatectomy from June 2007 to June 2017,whose age was 45-80 years(mean 67.9) and PSA was 0.05-123.19 ng/ml (mean 14.4ng/ml).The patients were divided into groups by age,PSA,PI-RADS score,clinical stage,biopsy Gleason score and operation approach.Chi-square test was used for single factor analysis and binary logistic regression analysis for multivariate analysis to evaluate the correlation between clinical and pathological data and positive cutting edge.Result Among the total 320 patients,there were 94 (29.4%) patients had positive surgical margin after radical prostatectomy.There were 26 (21.0%) positive surgical margin located at ventral sites,18(14.5%) located at dorsal sites,21 (16.9%) located at base,and 59(47.6%) located at tip.The positive rate of surgical margin was different in different positive areas of MRI (P <0.01),among which the MRI showed cancer located in the tip of prostate had the highest positive rate (47.6%) of surgical margin after prostatectomy.Univariate risk factor analysis was performed which showed that PSA(P =0.023),positive needle percentage (P =0.001),biopsy pathologic Gleason score(P =0.029),PI-RADS score (P =0.022) and prostate cancer risk score (P =0.006) had significant correlation with positive surgical margin.The age (P =0.257),clinical stage (P =0.161) and operation approch (P =0.260) had no significant correlation.Then multivariate analysis showed that PI-RADS score (P =0.023) and positive needle percentage (P =0.047) could be used as independent predictors of positive surgical margin.Conclusions PI-RADS score and percentage of positive biopsy needles were independent risk factors for positive surgical margin after prostatectomy.There was highest positive rate of surgical margin when MRI showed cancer located at the tip of prostate.

14.
Chinese Journal of Geriatrics ; (12): 904-906, 2018.
Article in Chinese | WPRIM | ID: wpr-709383

ABSTRACT

Objective To summarize the clinical features of prostatic ductal adenocarcinoma and to explore its therapeutic approaches.Methods A case report on an elderly patient with prostatic ductal adenocarcinoma who received endocrine therapy,chemotherapy,radiotherapy,and Enzalutamide therapy after prostate biopsy in November 2013.We summarized and analyzed the patient's clinical manifestations and reviewed relevant literature.Results The patient showed a low sensitivity to Docetaxel;the PSA level of the patient was over 30 times lower than the baseline level after monotherapy with Enzalutamide;bilateral pulmonary nodules and mediastinal lymph nodes reduced in size;a bone scan showed no significant change in bone metastases.At present,there is no report on treatment for prostatic ductal adenocarcinoma with Enzalutamide.Conclusions Enzalutamide therapy is effective and safe for prostate ductal adenocarcinoma and should be encouraged in clinical practice.Studies with larger sample sizes and longer follow-ups are needed in the future.

15.
Chinese Journal of Geriatrics ; (12): 846-849, 2016.
Article in Chinese | WPRIM | ID: wpr-502383

ABSTRACT

Objective To evaluate the correlation of MRI image with the detection rate of prostate cancer and cancer malignancy grade.Methods The prostate biopsy data of patients with prostate specific antigen (PSA) less than 20 μg/L were retrospectively analyzed.The correlations of MRI results with the cancer detection rate,Gleason score and tumor metastasis were analyzed and compared.Results Of 218 cases,88 prostate cancer patients (40.4%) were detected out by prostate puncture biopsy.In 126 MRI-positive prostate cancer patients,the detection rate of prostate cancer by prostate puncture biopsy was 57.9% (73 cases).In 92 MRI-negative prostate cancer patients,the detection rate of prostate cancer by prostate puncture biopsy was 16.3% (15 cases).The sensitivity,specificity,positive prognostic rate and negative prognostic rate by MRI were 82.95%,58.78%,57.94% and 83.70%,respectively.The area under receiver operating characteristic (ROC) curve for MRI to predict prostate cancer was 0.709.MRI results had a correlation with Gleason score.Conclusions MRI image has significant correlation with prostate cancer detection rate and Gleason score in patients with PSA less than 20 μg/L.

16.
Chinese Journal of Urology ; (12): 439-441, 2015.
Article in Chinese | WPRIM | ID: wpr-463599

ABSTRACT

Objective To analyze the correlation factors on bone metastatic rate in prostate cancer patients with prostate specific antigen ( PSA ) less than 20 μg/L.Methods A retrospective analysis was made in 143 prostate cancer patients in Beijing Hospital from March 1997 to December 2013 with PSA less than 20μg/L.Their PSA was 0.05-19.97μg/L and median PSA was 10.72μg/L.According to Gleason score, the patients were divided into three group with Gleason score≤6, 7,≥8.According to T stage, the patients were divided into ≤T2 or ≥T3 .According to PSA, the patients were divided into 66%.The correlation of bone scan with PSA, Gleason score, T stage or percentage of positive cores in biopsy was evaluated.Results The bone metastatic rate of each group with Gleason score was 6 ( 9.5%) , 8 ( 16.0%) and 7 ( 23.3%) , respectively.There was significant difference among them ( P=0.025 ) .According to T stage, the positive rate of each group was 6(7.1%) and 15(25.9%), and there was significant difference between them (P=0.036).According to PSA, the positive rate of each group was 2 ( 18.2%) , 9 ( 13.0%) , and 10 ( 15.9%) and there was no significant difference (P=0.153).According to percentage of positive cores on the bone scan, the positive rate of each group was 6 ( 8.8%) , 9 ( 19.1%) and 6 ( 21.4%) and there was no significant difference ( P=0.862).Conclusions In prostate cancer patients with PSA less than 20 μg/L, Gleason score and T stage are significantly correlated with bone metastatic rate.However, bone metastatic rate had no correlation with PSA and percentage of positive cores in biopsy.

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Chinese Journal of Urology ; (12): 346-348, 2014.
Article in Chinese | WPRIM | ID: wpr-446805

ABSTRACT

Objective To analyze the impact of age on the detection rate,grade and stage of prostate cancer in patients with prostate specific antigen (PSA) 4-10 μg/L.Methods A retrospective analysis was made in 426 patients with PSA 4-10 μg/L who underwent prostate biopsy and divided into 4 group according to their age less than 60 (n=33),60-69 (n=163),70-79 (n=202) and more than 80 (n=28) to compare the correlation between age and the cancer detective rate.Among them,115 patients,diagnosed as prostate cancer,were further divided into 4 group according to their age less than 60 (n =3),60-69 (n=32),70-79 (n=69) and more than 80 (n=11).The correlation between age and the Gleason score or clinical stage was analyzed in 115 prostate cancer patients.Results The detective rate in each group was 9.1% (3/33),19.6% (32/163),34.2% (69/202) and 39.3% (11/28).There was significant difference in prostate cancer detective rate among those groups.The cancer detective rate became significantly higher as the age increased (P<0.001).In the patients with prostate cancer,the number of patients with Gleason score more than 7 in each group was 1 (50.0%),11 (37.9%),30 (44.8%),7 (63.6%).No significant correlation was found between age and grade (P=0.292 4).And each group had cases with localized prostate cancer was 2 (100.0%),14 (60.9%),39 (78.0%),4 (66.7%),with locally advanced prostate cancer 0,5 (21.7%),7 (14.0%),1 (16.7%),with metastatic prostate cancer 0,4 (17.4%),4(8.0%),1 (16.7%).No significant difference was found between each group and clinical stage (P =0.101 6,P=0.285 2,P=0.349 1).Conclusions The prostate cancer detective rate significantly increases with the age increasing.There is no significant correlation between age and grade or clinical stage in the patients with PSA 4-10 μg/L.

18.
Acta Pharmaceutica Sinica ; (12): 1317-21, 2010.
Article in Chinese | WPRIM | ID: wpr-382508

ABSTRACT

The difference between absorption of unfractionated heparin (UFH) and low molecular weight heparin (LMWH) after oral and oral cavity administration were studied respectively, and the compatible enhancer for oral cavity delivery system of both drugs was found. The LMWH and UFH films were prepared with two bioadhesive materials Carbopol and alginate sodium for oral cavity delivery. The activated partial thromboplastin time (APTT) was used to determine LMWH and UFH in plasma after oral, oral cavity and sc administration in rats. The results show that the enhancer (Labrasol) can increase the absorption of LMWH and UFH through oral cavity in rats but not obviously. The oral cavity iontophoretic delivery system is a useful method to improve the absorption of LMWH and UFH through oral cavity mucosa.

19.
Article in Chinese | WPRIM | ID: wpr-397948

ABSTRACT

Objectives To investigate preparation of gemcitabine albumin nanoparticles, and its property of slow-release, the cytotoxic effect on pancreatic cancer cells (PANC1) in vitro, for improving the effect of regional intra-arterial infusion chemotherapy in pancreatic cancer with new medicament in the future. Methods The gemcitabine albumin nanoparticles were prepared with bovine serum albumin and gemcitabine with the desolvation-crosslink method, the concentration of gemcitabine was detected by high performance liquid chromatography (HPLC). The cytotoxic effect on pancreatic cancer cells in vitro were detected with MTT colorimetric assay. Results The mean diameter of gemcitabine albumin nanoparticles was (156.2±2.2) nm, and Zeta potential was (-20.4±1.41)mV, drug loading was 10.8%, drug release time in virto was 3 hours respectively. Gemcitabine albumin nanoparticles (0.01~50 μg/ml) had a 31%~44% inhibitory rate on PANC1 cell, which was similar to the inhibitory rate of same concentration of gemcitabine (26%~47%). Conclusions The new preparation of gemcitabine albumin nanoparticles had obvious drug slow-release effect, which may help improve the effect of regional intra-arterial infusion chemotherapy for pancreatic cancer.

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Article in Chinese | WPRIM | ID: wpr-677744

ABSTRACT

Objective:To evaluate the biological safety of the sustained release bistratal drug film of dexamethasoni acetate (DA). Methods:A series of tests, including acute toxicity test, cytotoxity test (agar overlay), oral mucous membrane irritation test and haemolysis test were conducted. Results:Cytotoxic effect was not observed, nor was toxic effect in mouse toxicity test. The haemolysis rate of this material was 0.46%. Local mucous membrane irritation reaction was not found. Conclusion:The drug film of DA shows excellent biocompatibility on the preliminary tests.

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