Clinical and Radiological Factors for Predicting Clinically Significant Prostate Cancer in Biopsy-Naive Patients With PI-RADS 3 Lesions.

OBJECTIVE: This study intends to examine the anticipatory power of clinical and radiological parameters in detecting clinically significant prostate cancer in patients demonstrating Prostate Imaging Reporting and Data System 3 lesions. METHODS: This was a retrospective study. The study included participation from 453 patients at the First Affiliated Hospital of Soochow University, sampled between September 2017 through August 2022. Each patient underwent a routine 12-core prostate biopsy followed by a 2 to 5 core fusion-targeted biopsy. We utilized both univariate and multivariate logistic regression analyses to identify the parameters that have a correlation with clinically significant prostate cancer. The predictive ability of these parameters was assessed using the receiver operating characteristic curve, leading to the creation of a nomogram. RESULTS: Clinically significant prostate cancer was detected in 68 out of 453 patients with Prostate Imaging Reporting and Data System 3 lesions (15.01%). Among Prostate Imaging Reporting and Data System 3a and 3b patients, 4.78% (3.09% of the total) and 33.75% (11.92% of the total), respectively, had clinically significant prostate cancer. Systematic biopsy improved prostate cancer and clinically significant prostate cancer detection rates by 7.72% and 3.09%, respectively, compared to targeted biopsy. Without systematic biopsy, there would be an undetected rate of 15% for prostate cancer and 8.13% for clinically significant prostate cancer in Prostate Imaging Reporting and Data System 3b patients. Several clinical parameters, including age, prostate-specific antigen density, lesion volume, apparent diffusion coefficient, and digital rectal examination, were statistically significant in the logistic regression analysis for clinically significant prostate cancer. The individual diagnostic accuracies of these parameters for clinically significant prostate cancer were 0.648, 0.645, 0.75, 0.763, and 0.7, respectively, but their combined accuracy improved to 0.866. A well-fit nomogram based on the identified risk factors was constructed (χ2 = 10.254, P = .248). CONCLUSION: The combination of age, prostate-specific antigen density, lesion volume, apparent diffusion coefficient, and digital rectal examination presented a higher diagnostic value for clinically significant prostate cancer than any single parameter in patients with Prostate Imaging Reporting and Data System 3 lesions. Systematic biopsy proved crucial for biopsy-naive patients with Prostate Imaging Reporting and Data System 3 lesions and should not be omitted.

Application of flexible ureteroscope in the treatment of middle and upper ureteral calculi complicated with lower ureteral stricture / 现代泌尿外科杂志

【Objective】 To explore the safety and efficacy of flexible ureteroscope in the treatment of upper and middle ureteral calculi complicated with lower ureteral stricture after the failure of rigid ureteroscopy. 【Methods】 Clinical data of 36 patients with middle and upper ureteral calculi and lower ureteral stricture treated with rigid ureteroscopy but failed during Oct.2019 and Oct.2021 were retrospectively analyzed. The patients’ average age was (46.2±13.2) years, and the maximum diameter of calculi was (1.3±0.3) cm. The intraoperative, postoperative and follow-up data were recorded. 【Results】 All 36 patients successfully completed first-stage operation. Intraoperatively, the stenosis degree was F6-8 and could be dilated to F9-11. The mean length of stenosis was (1.1±0.34) cm. No serious postoperative complications such as infection or bleeding occurred. Two patients were lost and 34 patients were followed up. There was no obvious hydronephrosis on ultrasound examination. The stone removal rates were 76.5%, 88.2% and 97.1%, respectively, in months 1, 2 and 3 after operation. One patient with residual stones underwent secondary ureteroscopy in month 3 and large stones were removed with stone removal basket. 【Conclusion】 In patients with middle and upper ureteral calculi and lower ureteral stricture, after the failure of rigid ureteroscopy, flexible ureteroscope is safe and effective, and can significantly increase the success rate of first-stage surgery.

Observation on the effect of noninvasive mechanical ventilation in patients with chronic obstructive pulmonary disease with respiratory failure / 中国基层医药

Objective To analyze the therapeutic effect of noninvasive mechanical ventilation in chronic obstructive pulmonary disease (COPD) patients with respiratory failure.Methods Sixty patients with COPD respiratory failure were randomly divided into two groups.30 cases in the conventional treatment group used conventional comprehensive therapy.30 cases in the nonfinvasive mechanical ventilation group were given noninvasive mechanical ventilation based on conventional treatment.The total effective rate,time to correct the abnormal breathing,hospitalization time were compared between the two groups.Before and after treatment,the arterial blood gas analysis indicators and heart rate,respiratory rate,probability,mortality for ventilator ventilation were compared in the two groups.Results The total effective rate of the noninvasive mechanical ventilation group was 96.67％,which was higher than 73.33％ of the conventional treatment group(x2 =6.405,P ＜ 0.05).The time to correct the abnormal breathing,hospitalization time of noninvasive mechanical ventilation group were (5.51 ± 1.41) d,(9.51 ± 2.13) d,respectively,which were shorter than (9.39 ± 2.56) d,(12.99 ± 3.57) d of the conventional treatment group (t =8.223,9.633,all P ＜ 0.05).Before treatment,the arterial blood gas analysis parameters and heart rate had no statistically significant differences between the two groups (all P ＞ 0.05).After treatment,the frequency of PaCO2,PaO2,heart rate and respiratory rate in the conventional treatment group were (60.45 ± 3.94)mmHg,(60.24 ± 4.12)mmHg,(92.58 ± 0.61)times/min,(22.45 ± 3.14)times/min,respectively,which in the noninvasive mechanical ventilation group were (52.24 ± 1.23) mmHg,(76.24 ± 5.26) mmHg,(83.92 ± 0.62) times/min,(17.26 ± 2.23) times/min,respectively,the differences between the two groups were statistically significant(t =5.133,3.734,5.166,6.360,all P ＜ 0.05).The invasive rate of invasive ventilator and mortality of noninvasive mechanical ventilation group were 3.33％ and 0.00％,respectively,which were lower than 20.00％,13.33％ of the conventional treatment group (x2 =7.214,6.247,all P ＜ 0.05).Conclusion Noninvasive mechanical ventilation is effective in treatment of patients with COPD respiratory failure,which can effectively improve the indicators of arterial blood gas and heart rate and respiratory rate,improve the prognosis of patients,improve the ventilation probability of invasive ventilator.

The Effect of Isokinetic Muscle Strength Training on Cognitive Function and Motor Function of Patients with Alzheimer's Disease / 现代生物医学进展

Objective:To assess the effect of isokinetic muscle strength training on cognitive function and motor function of patients with Alzheimer's disease (AD).Methods:Forty patients with AD were randomly assigned to trial group and control group.All patients in both groups received conventional treatment,while the patients in the trial group received isokinetic muscle strength training at the same time.After two months,the cognitive function and motor function were assessed.Results:After two months,the trial group showed improvement in cognition CAMCOG whereas the control group declined.Compared to the control group,the trial group presented significant improvement on the functional capacity such as Berg balance,timed-up and go,as well as Functional reach.Conclusion:Isokinetic muscle strength training may be recommended as an augmentation treatment for patients with AD.

Absorbable screw fixation for the treatment of tibial avulsion fracture of the tibial attachment of the posterior cruciate ligament through posterior middle mini incision of knee joint / 中国骨伤

<p><b>OBJECTIVE</b>To investigate method of absorbable screw fixation for the treatment of tibial avulsion fracture of the tibial attachment of the posterior cruciate ligament through posterior middle mini incision of knee joint, and evaluate its clinical results.</p><p><b>METHODS</b>From January 2007 to December 2011,50 patients with tibial avulsion fracture of the tibial attachment of the posterior cruciate ligament were treated with absorbable screw fixation through posterior middle mini incision. Among the patients, 38 patients were male and 12 patients were female,ranging in age from 18 to 62 years old,with an average of 36.8 years old. The duration of the disease ranged from 1 to 52 weeks. During the opeation, the blood vessels and nerves should be protected. Clinical results were evaluated according to the physical examination, Lysholm and IKDC clinical rating scales.</p><p><b>RESULTS</b>There were no nails broken in surgery, no postoperative complications such as infection, sinus formation and fracture fragment displacement. One patient had delay healing of incision. All the patients were followed up, and the duration ranged from 6 to 42 months,with an average of 30 months. All the patients got bony union at the latest follow-up. Two patients had functional limitation of knee joint due to delayed review. At the latest follow-up, Lachman test and posterior drawer test were either negative or limited in grade I of laxity. The range of motion of 50 patients improved from preoperative (94.5 +/- 6.2)degrees (90 degrees to 110 degrees) to postoperative (135.5 +/- 4.0) degrees (130 degrees to 140 degrees). Lysholm score of all patients improved from preoperative 37.0 +/- 10.0(25 to 56) to 87.0 +/- 4.8 (81 to 98) at the latest follow-up. Additionally,IKDC scores increased from preoperative 40.3 +/- 9.6 (27 to 61) to 85.1 +/- 2.6 (82 to 96) at the latest follow-up. There were statistical differences in the Lysholm and IKDC scores comparing preoperative data with that at the latest follow-up. Based on Lysholm score,42 patients got an excellent result, 5 good and 3 poor; according to IKDC score,41 patients got A degree and 9 patients got B degree.</p><p><b>CONCLUSION</b>Absorbable screw fixation is a safe and effective method for the treatment of tibial avulsion fracture of the tibial attachment of the posterior cruciate ligament. A middle posterior approach with a mini incision can short operative time and reduce the chance of injuries of blood vessels and nerves. Absorbable screw fixation has a satisfactory clinical efficacy with strictly control of surgical indications.</p>

Expression of IL-21 in the peripheral blood of myasthenia gravis patients and its correlation with anti-AChR-Ab class switch / 中南大学学报(医学版)

OBJECTIVE@#To explore the role of IL-21 in the pathogenesis of myasthenia gravis (MG) and its influence on the the class switch of anti-AChR antibodies.@*METHODS@#Blood was taken from 26 patients and 18 healthy controls, and the expression of IL-21R mRNA in peripheral blood mononuclear cells (PBMCs) was detected by RT-PCR. The expression of IL-21R on B lymphocytes was measured by flow cytometry, while the concentrations of serum IL-21 and the levels of anti-AChR-IgG and its isotype IgG(1), IgG(2), and IgG(3) were tested by ELISA.@*RESULTS@#The serum concentration of IL-21 in the MG group was higher than that in the control group (31.686±8.499 pg/mL, 15.147±6.366 pg/mL) and the difference was significant (P0.05). Compared with the control group, the expression of IL-21R on B lymphocytes also increased in the MG group (P0.05). Expression of IL-21R mRNA in the PBMCs showed no correlation with the level of serum anti-AChR-IgG and its isotype IgG(1), IgG(2), and IgG(3), respectively(P>0.05); however the expression of IL-21R in B lymphocytes showed positive correlation with anti-AChR-IgG and it's isotype IgG(1) and IgG(3) (P0.05).@*CONCLUSION@#IL-21 might induce the class switch of anti-AChR antibodies to IgG(1) and IgG(3) isotype through IL-21R on B lymphocytes which promotes the pathogenesis of the MG.

Controlled study on treatment of cervical spondylopathy of the nerve root type with acupuncture, moxibustion and massage as main / 中国针灸

<p><b>OBJECTIVE</b>To probe into clinical value of comprehensive program of acupuncture, moxibustion and massage as main for treatment of cervical spondylopathy of the nerve root type.</p><p><b>METHODS</b>Five centers, single blind, randomized controlled method were used, 660 cases were divided into a treatment group of 317 cases and a control group of 311 cases. They were treated respectively with comprehensive program of acupuncture, moxibustion and massage as main, and comprehensive program of physical therapy as main. Establish syndrome detection scale and multiply dimensional effect assessment indexes, and evaluate the therapeutic effects and safety.</p><p><b>RESULTS</b>The cured rate, the cured-markedly effective rate were 42.9%, 64.4% in the treatment group, respectively, better than 16.7%, 36.3% in the control group (P<0.01); after treatment of 2 weeks, clinical symptoms improved in the both groups, but the treatment group was better than the control group in the improvement degrees of neck-shoulder-limb pain, neck rigidity, abnormality of cervical anteflexion, etc. (P<0.01 or P<0.05); the treatment group was shorter than the control group in the time of producing the effect and therapeutic course (P<0.01).</p><p><b>CONCLUSION</b>Comprehensive program of acupuncture, moxibustion and massage as main is safe and effective for treatment of cervical spondylopathy, with a better therapeutic effect compared with the comprehensive program of physical therapy.</p>