Risk factors and misdiagnosis of intraductal carcinoma of prostate (IDC-P)in patients with metastatic prostate cancer / 中华泌尿外科杂志

Objective:To investigate the risk factors and missed diagnosis of intraductal carcinoma of prostate (IDC-P) in patients with metastatic prostate cancer.Methods:The preoperative PSA, prostate MRI, bone scans and lung CT of all patients who underwent prostate biopsy in Department of Urology, Xiangya Hospital, Central South University from January 2018 to July 2020 were reviewed. A total of 261 patients with high suspicion of metastatic prostate cancer were screened for inclusion. Two full-time senior pathologists of urogenital tumors in Xiangya Hospital independently reviewed their pathological sections and detected IDC-P according to the 2016 WHO tumor classification. Diagnostic criteria are defined as malignant epithelial cells filling large acini and prostatic ducts, with preservation of basal cells and solid or dense cribriform pattern/loose cribriform or micropapillary pattern with either marked nuclear atypia or non-focal comedonecrosis.Results:The detection rate of IDC-P was 29.12%(76/261), while the actual reporting rate was only 9.96%(26/261). The results of subgroup analysis including age, PSA level, Gleason score as well as different metastatic sites showed that detection rate of IDC-P was 33.69% in the PSA≥50 ng/ml subgroup, much higher than 17.57% in the PSA <50 ng/ml subgroup ( P=0.0039); And it was 32.33% in the Gleason score ≥ 8 subgroup, much higher than 3.45% in the Gleason score < 8 subgroup ( P<0.01). It was not significantly different in different age subgroups as well as different metastatic site subgroups. These data suggest that PSA ≥ 50 ng/ml as well as Gleason score ≥ 8 may be risk factors of IDC-P.157 samples were stained by immunohistochemistry. The detection rates of IDC-P were 84.21% (16/19) in P63 (+ ) samples, 36.00% (9/25) in ERG (+ ) samples. There were 3 samples with both P63 (+ ) and ERG (+ ), all of which had IDC-P. Conclusions:There is misdiagnosis of IDC-P on prostate needle biopsy in patients with metastatic prostate cancer currently. PSA ≥ 50 ng/ml and Gleason score ≥ 8 are risk factors of IDC-P. Thus, attention should be paid to the possibility of IDC-P in such patients. When the diagnosis is difficult, immunohistochemical staining for ERG and P63 is helpful in IDC-P determination.

Assessment of left atrial appendage structure and thrombosis in patients with atrial fibrillation by real-time three-dimensional transesophageal echocardiography / 中华医学超声杂志（电子版）

Objective To examine the morphology and emptying score of the left atrial appendage (LAA) by real-time three-dimensional echocardiography (RT-3D TEE) in patients with atrial fibrillation (AF), and to identify the independent risk factors for left atrial thrombosis. Methods In total, 90 patients who underwent RT-3D TEE examination in Zhuhai People's Hospital from January 2015 to January 2017 were enrolled, including 53 with AF (AF group) and 37 without AP (NAF group). Of the 53 cases of AF, 11 had LAA thrombus (thrombus group), 13 had spontaneous development (spontaneous development group), and 29 had no abnormal LAA (non-abnormal group). RT-3D TEE was used to measure and calculate the LAA lobe number, emptying fraction, width index (LAA-WI), length index (LAA-LI), open area index (LAA-OI), maximum volume index (LAA-VImax), minimum volume index (LAA-VImin), ejection fraction (LAA-EF), velocity (LAA-v), and maximum volume index (LA-VImax). Analysis of variance was used to compare LAA lobe number among the thrombus group, spontaneous development group, non-abnormal group, and NAF group, and LSD-t test was adopted for further comparisons between any two groups. The t-test was used to compare the emptying fractions measured by the two-dimensional area method, three-dimensional area method, and three-dimensional volume method between the AF group and NAF group, as well as age, LAA-WI, LAA-LI, LAA-OI, LAA-VImax, LAA-VImin, LAA-EF, LAA-v, LA-VImax, and lobe number between the thrombus group or spontaneous development group and non-abnormal group. Logistic regression analysis was used to analyze the independent risk factors for left atrial thrombosis. Results The average number of LAA lobes in the thrombus group, spontaneous development group, non-abnormal group, and NAF group were (3.57±0.77), (3.28±0.99), (2.57±0.68), and (2.76±1.13), respectively. The average number of LAA lobes was higher in the thrombus group than in the spontaneous development group, non-abnormal group, and NAF group, and the difference between the thrombus group and NAF group was statistically significant (t=2.294, P＜0.05). The emptying fractions measured by the two-dimensional area method, three-dimensional area method, and three-dimensional volume method were significantly lower in the AF group than in the NAF group (t=8.671, 7.082, 10.432, all P＜0.05). LAA-WI, LAA-OI, LAA-VImax, LAA-VImin, LA-VImax, and lobe number in the thrombus group or the spontaneous development group were all significantly greater than those in the non-abnormal group [(18.27±2.14) mm/m2vs (12.76±1.93) mm/m2, (3.45±0.46) cm2/m2vs (2.64±0.37) cm2/m2, (6.63±0.73) ml/m2vs (4.72±0.48) ml/m2, (4.22±0.53) ml/m2 vs (2.51±0.22) ml/m2, (4.57±0.32) ml/m2vs (4.21±0.28) ml/m2, (3.62±0.11) vs (2.57±0.08)], while LAA-EF and LAA-v were significantly smaller than those in the non-abnormal group [(34.12±2.31)% vs (48.09±2.74)%, (29.11±1.08) cm/s vs (48.18±2.11) cm/s] (t=9.849, 7.107, 11.000, 14.787, 4.367, 40.471, 19.814, 42.417, all P ＜ 0.001), although there was no significant difference in age or LAA-LI. Logistic regression analysis showed that LAA emptying fraction was an independent risk factor for thrombosis or spontaneous development ( OR=2.323, 95% CI: 1.471-2.821). Conclusions Using RT-3DTEE to evaluate the complex structure of LAA is feasible and accurate. Increased lobe number and decreased emptying fraction are associated with thrombosis. Decreased emptying fraction is an independent risk factor for thrombosis.

Awareness and administration of antidiabetic drugs in patients with diabetes in Huairou district of Beijing / 中华全科医师杂志

Objective To investigate the awareness and administration of antidiabetic drugs in patients with diabetes in Huairou district of Beijing.Methods A questionnaire survey on knowledge and administration of antidiabetic drugs were conducted in 900 diabetic patients from 16 communities in Huairou district of Beijing from November 2014 to February 2015.The related factors influencing antidiabetic drug use were analyzed with logistic regression method.Results A total of 899 questionnaires were recovered. Results showed that the rate of metformin single use was the highest (23.7%, 213/899), the rate of combination use of metformin and acarbose was 11.8%(106/899), and that of metformin and glipizide was 17.1% (154/899).Survey showed that 65.9% (592/899) patients were compliant immediately for antidiabetic agents, 32.2% (290/899) were not immediately compliant, 1.9% (17/899) did not use antidiabetic agents.Logistic regression analysis showed that the factors affecting the use of antidiabetic agents were the types of medication (t=-4.351, P=0.000) , adverse effects of drugs (t=6.999, P=0.000), awareness of diabetes to health hazard (t=-10.969, P=0.000) and the doctor′s recommendation (t=-3.352, P=0.001).Conclusion The results showed that the administration of antidiabetic drugs in diabetic patients from Huairou district is basically followed the recommendation by 2013 edition of type 2 diabetes guidelines and the compliance rate of medication need to be further raised.

Clinical significance of PM-Scl antibody detection in systemic scleroderma / 国际检验医学杂志

Objective To analyze and discuss the expression of serum polymyositis‐scleroderma(PM‐Scl) antibody and its clinical significance in patients with systemic scleroderma(SSc) .Methods 315 hospitalized patients diagnosed with scleroderma by typical clinical manifestations or skin pathology from 2009 to 2012 were enrolled in the study .All patients were grouped into PM‐Scl antibody positive(PM‐Scl + ) group(90 cases) ,Scl‐70 antibody positive(Scl‐70+ ) group(70 cases) ,anti‐centromere antibody positive( ACA+ ) group(75 cases) and antibody negative group(80 cases) according to autoantibody spectrum .The severity of skin and visceral damage among all the groups were analyzed and compared .Results Patients in PM‐Scl+ group were characterized with different clinical manifestations .Compared with the other 3 groups ,the incidence of myositis in PM‐Scl+ group was significantly higher( all P< 0 .05) ;patients in Scl‐70+ group had higher incidence of visceral organ damage than PM‐Scl+ group(all P < 0 .05) .The incidence of skin lesions ,Raynaud′s phenomenon and capillary expansion in ACA+ group were higher than that of PM‐Scl+ ,while the incidence of interstitial lung disease ,heart disease and kidney disease were lower(all P< 0 .05) .Conclusion It is helpful for clinicists′ further understanding of common autoantibodies in Ssc patients and making correct assessment of the disease through analyzing the expression of PM‐Scl antibody .

Investigation on professional identity of medical students with long education periods / 中华医学教育探索杂志

Objective To explore the professional identity of medical students with long education periods and its influencing factors.Methods Survey on professional identity was conducted through self-designed questionnaire among 665 medical students with long education periods of every grade.Single factor analysis of variance and t test were applied to do statistical analysis.Results There were significantly statistical differences in influencing factors of professional identity among every grade of long periodical medical students (P ＜ 0.05).There were significant statistical differences among influencing factors of sex,educational background of parents and residing(P ＜ 0.05).Conclusions Because of characteristics of medical education and psychological changes of students,professional identity of students shows a first decline and then an increase.Personal and environmental factors exert influences on professional identity at varying degrees.

Relationship Between Hepatocellular Apoptosis and Glycogen Contents During Hepatic Cold Preservation Reperfusion and Its Mechanism / 中国普外基础与临床杂志

Objective To study the relationship between hepatocellular apoptosis and glycogen contents during hepatic cold preservation reperfusion and its mechanism.Methods Based on the model of four groups of rabbit livers with different hepatocellular glycogen contents, hepatocellular apoptosis and bax gene expression were observed during hepatic cold preservation reperfusion.Results Apoptotic hepatocytes were obviously found in 60 minute reperfusing livers subsequent to 9 hour cold storage, and there was significant difference in the numbers of apoptotic hepatocytes among all the groups. In the same time, there was the close relationship between the levels of bax gene expression and the glycogen contents of hepatocytes.Conclusion Intracellular abundant glycogen may significantly depress the hepatocellular apoptosis during hepatic cold preservation reperfusion by decreasing hepatocellular bax gene expression.

Protective mechanism of adenosine on intestinal barrier function in acute hemorrhagic necrotizing pancreatitis pigs / 中国普通外科杂志

Objective To study the protective mechanism of adenosine on intestinal barrier function in acute hemorragic necrotizing pancreatitis (AHNP) pigs; Methods Twelve small pigs were equally devided into two groups randomly after the AHNP model sitted up: (1) AHNP controll group (group A) and adenosine treated group (group B). The intestinal blood flow, intestinal permeability, bacterial culture and endotoxin in portal blood were compared between the two groups in pre and post AHNP. Results (1)The intestinal blood flow was dramatically decreased in group A, and much higher in group B than that in group A at the 8 h, 24 hour and day 7 after ANHP model was setted up (P0.001,P