Integration of Multiparameter MRI into Conventional Pretreatment Risk Factors to Predict Positive Surgical Margins After Radical Prostatectomy.

INTRODUCTION/BACKGROUND: Positive surgical margins (PSMs) after radical prostatectomy (RP) can increase the risk of biochemical recurrence in prostate cancer (PCa) patients. However, the prediction of the likelihood of PSMs in patients undergoing similar surgical procedures remains a challenge. We aim to develop a predictive model for PSMs in patients undergoing non-nerve-sparing RP. PATIENTS AND METHODS: In this retrospective study, we analyzed data from PCa patients who underwent minimally invasive non-nerve-sparing RP at our hospital between June 2017 and June 2021. We identified independent risk factors associated with PSMs using clinical and MRI-based parameters in univariate and multivariate logistic regression analyzes. These factors were then used to develop a nomogram for predicting the probability of PSMs. The predictive performance was validated using calibration and receiver operating characteristic curve, area under the curve ,and decision curve analysis. RESULTS: Multivariate analyzes revealed prostate-specific antigen density, tumor size, tumor location at the apex, tumor contact length, extracapsular extension (ECE) level, and apparent diffusion coefficient value as independent risk factors. A nomogram was developed and validated with high accuracy (C-index = 0.78). Furthermore, we found that 44.2% of patients diagnosed with organ-confined disease had ECE after surgery, and 29.1% of patients with Gleason scores ≤7 had higher pathological scores. Interestingly, the tumor burden calculated from PCa biopsy cores was overestimated when compared to postoperative PCa specimens. CONCLUSION: We developed a reliable nomogram for predicting the risk of PSMs in PCa patients undergoing non-nerve-sparing RP. The study highlights the importance of incorporating these parameters in personalized surgical management.

A severe case of human coronavirus 229E pneumonia in an elderly man with diabetes mellitus: a case report.

BACKGROUND: With pandemic of coronavirus disease 2019 (COVID-19), human coronaviruses (HCoVs) have recently attached worldwide attention as essential pathogens in respiratory infection. HCoV-229E has been described as a rare cause of lower respiratory infection in immunocompetent adults. CASE PRESENTATION: We reported a 72-year-old man infected by HCoV-229E with rapid progression to acute respiratory distress syndrome, in conjunction with new onset atrial fibrillation, intensive care unit acquired weakness, and recurrent hospital acquired pneumonia. Clinical and radiological data were continuously collected. The absolute number of peripheral T cells and the level of complement components diminished initially and recovered after 2 months. The patient was successfully treated under intensive support care and discharged from the hospital after 3 months and followed. CONCLUSION: HCoV-229E might an essential causative agent of pulmonary inflammation and extensive lung damage. Supportive treatment was essential to HCoVs infection on account of a long duration of immunological recovery in critical HCoV-229E infection.

Clinical Manifestations of Fibrosing Mediastinitis in Chinese Patients.

BACKGROUND: Fibrosing mediastinitis (FM) is a rare disease. FM is thought to be related to prior granulomatous mediastinal infection, such as histoplasmosis or tuberculosis. The majority of cases have been reported in endemic regions for histoplasmosis. The characteristics of cases of FM in China, where the prevalence of tuberculosis is high, have not been reported. We analyzed the clinical, imaging, and bronchoscopic features of Chinese patients with FM to promote awareness of this disease. METHODS: Between January 2005 and June 2015, twenty patients were diagnosed with FM in our hospital. Medical records and follow-up data were collected. Imaging and biopsy findings were reviewed by radiologists and pathologists. RESULTS: A total of 20 patients were analyzed (8 males and 12 females). The age ranged from 43 to 88 years with a mean age of 69.5 years. Previous or latent tuberculosis was found in 12 cases. Clinical symptoms included dyspnea (18/20), cough (17/20), expectoration (7/20), and recurrent pneumonia (3/20). Chest computed tomography scans showed a diffuse, homogeneous, soft tissue process throughout the mediastinum and hila with compression of bronchial and pulmonary vessels. Calcification was common (15/20). Pulmonary hypertension was present in 9 of 20 cases. Diffuse black pigmentation in the bronchial mucosa was frequently seen on bronchoscopy (12/13). The patients' response to antituberculosis treatment was inconsistent. CONCLUSIONS: FM in Chinese patients is most likely associated with tuberculosis. Some characteristics of FM are different from cases caused by histoplasmosis.

Improved outcomes after complete resection of underlying tumors for patients with paraneoplastic pemphigus: a single-center experience of 22 cases.

BACKGROUND: Paraneoplastic pemphigus (PNP) is an autoimmune-related acquired bullous disease. Delayed diagnosis and treatment of this clinically rare disease often result in poor prognosis. METHODS: Between January 1999 and December 2009, 22 patients with confirmed PNP who underwent surgical resection of underlying tumors were enrolled in this study. Clinicopathologic characteristics, treatment options, and perioperative and long-term results were analyzed. RESULTS: Among 22 patients, 2 patients died of severe infection several weeks after surgery. Postoperative major complications included pulmonary infections (n = 10) and septicemia (n = 4). Respiratory symptoms persisted in 13 patients. Tumors were completely resected in 20 patients. Two patients whose tumors were not completely resected died of relapse 2 and 32 months after surgery. Two patients with completely resected tumors died of respiratory failure 10 and 24 months after surgery, respectively. One patient whose pathological result was follicular dentritic cell sarcoma had a relapse recently. The remaining 15 patients have survived till now. CONCLUSIONS: Early detection, prompt treatment, and complete resection of PNP can effectively decrease the mortality and speed up the recovery.

CT angiography of pulmonary embolism using a 64 slice multi-detector scanner.

BACKGROUND: Multi-detector computed tomography (MDCT) has already been the first line investigation method for diagnosis of pulmonary embolism (PE). Reducing the amount of contrast medium used during CT scanning could decrease the incidental rate of adverse reactions. Our study amied to evaluate the image quality of pulmonary arteries using 64 slice multi-detector CT with small volumes of contrast media injection. METHODS: Forty nonconsecutive patients without PE or other lung diseases were randomly assigned to two groups. Group A underwent CT scanning with 16 x 1.25 mm collimation and a 70 ml contrast injection, while group B had CT with 64 x 0.625 mm collimation and 20 ml of contrast injection. Two readers independently depicted the segmental and subsegmental pulmonary arteries. Reasons we could not analyze the pulmonary artery or that led to misdiagnosis of pulmonary embolism were evaluated, including the degree of contrast enhancement of the main pulmonary artery, and factors that caused misdiagnosis of PE (flow-related artifacts, partial volume artifact, beam-hardening artifacts and enhancement of pulmonary vein). The independent samples t-test, Mann-Whitney U test and Pearson chi-square test were applied. RESULTS: There were no significant differences in image quality of segmental and subsegmental arteries between the two groups. No significant difference was found for factors that made pulmonary arteries non-analyzable or in the misdiagnosis of PE, except the degree of contrast enhancement. CONCLUSION: 64 x 0.625 mm collimation with 20 ml contrast injection could depict the pulmonary arteries well.

[Diagnostic performance of 64-channel multislice computed tomography in assessment of significant coronary artery disease in subjects suspected as acute coronary syndrome and stable angina.].

OBJECTIVE: To evaluate the diagnostic accuracy of 64-channel multislice spiral computed tomography (MSCT) in subjects with presentations suggestive of stable angina or acute coronary syndrome. METHODS: Subjects received both 64-channel MSCT and coronary angiography, from Feb. 2006 to Feb. 2007, were enrolled for retrospective analyses. Results of the quantitative coronary angiography were used as the "Golden criteria", accuracy of 64-channel MSCT were evaluated in the overall sample, as well as in subjects suspected of stable angina and acute coronary syndrome. RESULTS: A total of 120 subjects were enrolled in the analyses. On the patient level, the sensitivity, specificity, and accuracy of 64-channel MSCT in detecting significant stenoses were 92.5%, 50%, and 87.5%, respectively. The overall ROC area under curve was 0.71. On the artery level, sensitivity, specificity, positive predictive value, negative predictive value, and ROC area under curve of 64-channel MSCT were 69.9%, 83.8%, 81.1%, 73.7%, and 0.77, respectively. Further analyses showed the sensitivity, specificity, positive predictive value, negative predictive value, and ROC area under curve of 64-channel MSCT in subjects presenting as stable angina and in subjects presenting as acute coronary syndrome were as follows: 70.2% vs 69.2%, 76.2% vs 86.0%, 74.7% vs 85.6%, 71.9% vs 69.9%, and 0.73 vs 0.78. CONCLUSION: The accuracy rates of 64-channel MSCT in subjects presenting as stable angina and in subjects presenting as acute coronary syndrome were similar.