Benign Retrovesical Pelvic Mass in Men : Diagnostic and Management Dilemma

Aim : To identify the diagnostic difficulties and management issues of benign pelvic masses in males and high light the diagnostic protocol for these rare pelvic masses. Methods : A prospective single center study over a period of six years and three months. History, physical examination, operative findings and histopathological (HPE) diagnosis were recorded. Results : A total of 20 male patients presented with retrovesical mass, aged 17 to 65 years old (mean age 36.7 years) were evaluated. masses were found to be of prostatic origin in seven cases (5 prostatic utricle cyst and 2 prostatic abscess), connective tissue in seven, seminal vesicle origin in four, mullerian duct remnant in one case, and embryonic urogenital vestigial remnants in one case. Of these 20 patients, 19 presented with acute or chronic lower urinary tract symptoms and in one case, the mass was asymptomatic and found incidentally. Ultrasound showed cystic lesions in 17 patients and solid masses in three. Nine cases underwent exploratory laparotomy. Further biopsies of specimen demonstrated tissue of origin in all cases (8/9) except one. HPE report confirmed the same clinical and operative diagnosis in six cases. Conclusion : Benign retrovesical mass presents with lower tract obstructive symptoms, palpable pelvic mass and retention of urine. Needle or open biopsy is required in most cases to establish a histopathological diagnosis. Benign retrovesical mass is rare, we faces difficulty in diagnosis and management. Hence, diagnostic protocols can be helpful to manage retrovesical pelvic masses.

Development of species-specific primers for detection of Xanthomonas campestris pv. campestris causing black rot of crucifers

Aim: Black rot of crucifers caused by Xanthomonas campestris pv. campestris (Pammel) Dowson (Xcc) is a major seed-borne disease. The present study aimed to develop a rapid diagnostic protocol for the specific and sensitive detection of this pathogen. Methodology: A specific primer set was designed based on rpf gene and optimization of PCR condition was done for specific detection of Xcc. Sensitivity of PCR for primer set was then determined by diluting the Xcc DNA and cells. Results: Specific primer set was able to amplify a specific band of 304 bp in all 11 isolates of Xcc but failed to amplify other Xanthomonas species and one each of Ralstonia solanacearum, Erwinia caratovora subsp. caratovora, Bacillus subtilis, Pseudomonas fluorescens and P. aeruginosa. The primer set was highly sensitive as it was able to detect 10 pg μl-1 bacterial DNA and up to 3x103 CFU ml-1 corresponding to 12 viable cells of Xcc which were used as template for PCR reaction Interpretation: The results suggest that developed PCR primers are highly specific and sensitive and it can be used to detect the pathogen at an early stage of infection for disease management.

Diagnosis of Knee Osteoarthritis Risk through Abnormal Musculo-postural Features

Background: In several parts of the globe, knee osteoarthritis (KOA) occurs as a painful chronic disease. The aim of the study was to determine the risk factors for musculo-postural abnormalities by detecting abnormal anatomical leg parameters caused by knee-osteoarthritis (KOA). Methods: Baseline data were collected and evaluated from 207 patients aged between 40-65 years (58.94% females) with KOA and an equal number of subjects without-KOA. Anatomical measurements included the gap at the knee between the short head of the biceps femoris and the level of the bed (KGB), diameter of muscles at the thigh (DTM), the calf (DCM) and 4cm above and below the patella (DAP and DBP) and flexion supine, prone and standing (KFS, KFP and KFSt) and extension supine, prone and standing (KES, KEP and KESt) in different postural positions for both legs of both groups using appropriate instruments and Body Mass Index (BMI). The study was also correlated with radiological images.  Results: Risk factors for KOA based on abnormal leg anatomical-features were observed with statistical significance (P<0.001) and R2 (97-100%). The present results were evaluated after analyses of anatomical and flexion and extension range of motion measurements in different postural positions for both legs with KOA along with radiological features. The BMI of the experimental group was higher than that of the control group with high statistical significance (P<0.001). Conclusions: Abnormal muscle morphology and musculo-postural-features of the legs may be a suitable diagnostic protocol for the detection of early progression and risk of KOA.

Determination of the Impact of Functional Instability of Parathyroid Hormone and the Calcium-Phosphorus Ratio as Risk Factors during Osteoarthritic Disorders using Receiver Operating Characteristic Curves

Backgrounds: The disease risk factor prediction with calcium-phosphorus ratio (CPR) and/or parathyroid hormone (PTH) levels are suitable biomarkers. The aim of the present study was to investigate the functional instability of these biomarkers in the blood on the risk of osteoarthritic disorder (OAD) by using receiver operating characteristic (ROC) curves. Methods: Separate evaluations were performed for subjects 132 with OAD and 109 without OAD symptoms using questionnaires, standardized physical and radiographic examinations, and risk factor identification (hypoparathyroidism, hypocalcaemia and hyperphosphatemia diseases). The blood levels of PTH, calcium, and phosphorus were measured by using appropriate kits. ROC curve and logistic regression analyses were performed for the PTH and CPR levels. Results: The area under the ROC curve (AUC), 95% CI for the AUC, for the OAD compared with the non-OAD cohorts were 0.985, 0.969-1.000, and P<0.001 for the PTH analysis and 0.579, 0.506-0.652, and P<0.05 for the CPR analysis. In the OAD cohort, the AUC and the PTH risk were higher for men than for women; AUC=1.000 for men, and AUC=0.977 for women, with both AUC values highly significant (P<0.001). The CPR risk was higher for men (AUC=0.614, 95% CI=0.483-0.746, P=0.079) than for women (AUC=0.516, 95% CI=0.419-0.613, P=0.736) but was not statistically significant in either sex. Conclusion: A functional instability risk that is higher in male than female OAD cohorts causes lower PTH and CPR levels during OADs, which can be considered one of the OAD diagnostic protocols besides radiological images.

Abbreviated MRI Protocols for Detecting Breast Cancer in Women with Dense Breasts

OBJECTIVE: To evaluate the validity of two abbreviated protocols (AP) of MRI in breast cancer screening of dense breast tissue. MATERIALS AND METHODS: This was a retrospective study in 356 participants with dense breast tissue and negative mammography results. The study was approved by the Nanjing Medical University Ethics Committee. Patients were imaged with a full diagnostic protocol (FDP) of MRI. Two APs (AP-1 consisting of the first post-contrast subtracted [FAST] and maximum-intensity projection [MIP] images, and AP-2 consisting of AP-1 combined with diffusion-weighted imaging [DWI]) and FDP images were analyzed separately, and the sensitivities and specificities of breast cancer detection were calculated. RESULTS: Of the 356 women, 67 lesions were detected in 67 women (18.8%) by standard MR protocol, and histological examination revealed 14 malignant lesions and 53 benign lesions. The average interpretation time of AP-1 and AP-2 were 37 seconds and 54 seconds, respectively, while the average interpretation time of the FDP was 3 minutes and 25 seconds. The sensitivities of the AP-1, AP-2, and FDP were 92.9, 100, and 100%, respectively, and the specificities of the three MR protocols were 86.5, 95.0, and 96.8%, respectively. There was no significant difference among the three MR protocols in the diagnosis of breast cancer (p > 0.05). However, the specificity of AP-1 was significantly lower than that of AP-2 (p = 0.031) and FDP (p = 0.035), while there was no difference between AP-2 and FDP (p > 0.05). CONCLUSION: The AP may be efficient in the breast cancer screening of dense breast tissue. FAST and MIP images combined with DWI of MRI are helpful to improve the specificity of breast cancer detection.

Progress in diagnosis and management of syncope in children / 北京大学学报(医学版)

Syncope is a common emergency of children and adolescents,which has serious influence on the quality of life.Neurally-mediated syncope,including postural tachycardia syndrome,vasovagal syncope,orthostatic hypotension and orthostatic hypertension,is the main cause of syncope in children and adolescents.The main manifestations of neurally-mediated syncope are diverse,such as dizziness,headache,chest tightness,chest pain,pale complexion,fatigue,pre-syncope and syncope.Although the clinical manifestations are similar,each subtype of syncope has its hemodynamic feature and optimal treatment option.The diagnosis rate of syncope in children has been greatly improved on account of the development of the diagnostic procedures and methods.In recent years,with the promotion of head-up tilt test and drug-provocated head-up tilt test,the hemodynamic classification of neurally-mediated syncope gets continually refined.In recent years,with the effort of clinicians,an appropriate diagnostic protocol for children with syncope has been established.The initial evaluation consists of history taking,physical examination,standing test and standard electrocardiography.After the initial evaluation,some patients could be diagnosed definitely,such as postural tachycardia syndrome,orthostatic hypotension,and situational syncope.Those with a specific entity causing syncope need selective clinical and laboratory investigations.Patients for whom the cause of syncope remained undetermined should undergo head-up tilt test.The precise pathogenesis of neurally-mediated syncope is not entirely clear.In recent years,studies have shown that neurally-mediated syncope may be related to several factors,including hypovolemia,high catecholamine status,abnormal local vascular tension,decreased skeletal muscle pump activity and abnormal neurohumoral factors.Currently based on the possible pathogenesis,the individualized treatment of neurally-mediated syncope has also been studied in-depth.Generally,the management of neurallymediated syncope includes non-pharmacological and pharmacological interventions.Patient education is the fundamental part above all.In addition to exercise training,the first-line treatments mainly include oral rehydration salts,beta adrenoreceptor blockers,and alpha adrenoreceptor agonists.By analyzing the patient's physiological indexes and biomarkers before treatment,the efficacy of medication could be well predicted.The individualized treatment will become the main direction in the future researches.