Objective To evaluate the clinical value of transrectal ultrasound(TRUS)guided biopsies of the prostate cancer(PCA)with serum prostate specific antigen(PSA)level less than 4 μg/L.Methods Fifty-nine patients suspected PCA were underwent TRUS guided-biopsy.The ultrasonographic features of lesions and prostate gland were observed.The PSA,PSA density(PSAD),F/T(free/total PSA ratio),prostatic volume(PV)were compared between PCA group and non-PCA group,and further analyzed the sensitivity and specificity of PSAD and F/T at different thresholds for PCA diagnosis.Results In 59 patients,16 were proved to be cancer by pathological examination,the positive detection rate was 27%.In these 16 patients,12 had lesions on ultrasound,which locatqed in outer gland.The rich vascularity was observed in PCA more than in benign and precancerous lesion.There were statistical significant differences in PSA,PSAD,F/T,PV between PCA and non-PCA groups.When selecting threshold of PSAD and F/T were 0.09 and 0.20,respectively,there were the highest diagnostic specificity and sensitivity.The diagnostic specificity and sensitivity of PSAD were higher than those of F/T.Conclusions TRUS guided biopsies of the prostate is one of the most efficient methods for detection of PCA with PSA level less than 4μg/L.Combining TRUS features with PSA parameters can further increase positive detection rate of PCA.

This paper compared the practice and service mode of general practitioners ( GPs) from a selection of typical countries and regions and discovered that GPs from most of the countries were self-employed, with various forms of employment, freedom to practice and work in different institutions;fixed practices were supplemented, and service types were transformed from individual services to the multi-disciplinary team of services. Result: GPs’ free-dom to practice in different institutions requires a certain social environment and circumstances. The multi-disciplina-ry team of practices has become the development direction for the service modes of GPs. GPs have played different roles in establishing the referral system in the health systems of different countries. Consequently, the paper suggests that establishing a diverse and relaxed practice environment to provide conditions for the transformation of the service mode of GPs. The construction of a multi-disciplinary team to promote changes in community service modes was must be strengthened. Health insurance regulations should be encouraged to establish the gatekeeper system and realize a grading of systems. Social capital should be encouraged to organize general medical services to promote the develop-ment of the health care industry.

Objective To investigate the effects ofBushen Gujing Recipe in treating early diabetic nephropathy (DN).Methods Sixty patients of early DN with Yin-Yang deficiency syndrome were randomly divided into treatment group and control group, 30 cases in each group. The control group was treated with conventional western medicine treatment, and the treatment group was treated withBushen Gujing Recipe combined with the conventional therapy. The treatment course was three months. The clinical efficacy, integral of TCM syndrome, and urinary albumin excretion rate (UAER) of the two groups were compared.Results After the treatment, the integral of TCM symdrome of the treatment group was lower than control group, showed a statistically significant difference (P<0.05). The total effective rates of clinical efficacy were 81.48% (22/27) in treatment group, and 64.00% (16/25) in control group. The therapeutic effect of treatment group was better than control group (P<0.05). UAER showed a statistically significant difference between two groups (P<0.05).Conclusion Based on the western medicine treatment,Bushen Gujing Recipe can improve the symptoms of patients, alleviate the injury of kidney, and has good efficacy on DN.

Objective:To investigate and analyze the effect of ubiquitin-editing protein A20 on monocytes activity in patients with ventilator-associated pneumonia (VAP).Methods:Twenty-four VAP patients (VAP group) and twelve healthy controls (control group) were included from the First Affiliated Hospital of Zhengzhou University between February 2019 and September 2019. Peripheral blood mononuclear cells (PBMCs) and bronchial alveolar lavage fluid (BALF) (both infection site and non-infection site) were collected from VAP patients, while PBMCs were collected from healthy controls. A20 level in CD14 + monocytes were measured. CD14 + monocytes and CD4 + T cells were purified from VAP patients. CD14 + monocytes were transfected by A20 siRNA. Transfected CD14 + monocytes were directly/indirectly co-cultured with autologous CD4 + T cells. The secretion of interferon-γ (IFN-γ) and interleukin-17 (IL-17) by CD4 + T cells was investigated. Transfected CD14 + monocytes were directly/indirectly co-cultured with NCI-H889 cells. Cytotoxicity, and cytokines/granzyme B level, and tumor necrosis factor-related apoptosis inducing ligand (TRAIL)/Fas ligand (FasL) level was assessed. Student t test or SNK-q test was used for comparison. Results:VAP group had elevated percentage of circulating CD14 +A20 + cells than control group [(66.14±19.62)% vs. (52.52±13.71)%, P<0.05], and also had increased A20 mean fluorescence intensity (MFI) than control group [(268.0±72.56) vs. (197.4±60.01), P<0.05]. The percentage of CD14 +A20 + cells in BALF from infection site was higher than from non-infection site in VAP group [(66.14±19.62)% vs. (52.52±13.71)%, P<0.05], while A20 MFI in infection site was also up-regulated compared with non-infection site [(268.0±72.56) vs. (197.4±60.01), P<0.05]. In direct contact co-culture, A20 siRNA transfected CD14 + monocytes, which were purified from peripheral blood and BALF of VAP patients, induced elevated percentage of IFN-γ and IL-17 secreting CD4 + T cells than un-transfection or control siRNA transfection ( P<0.05). However, there were no significant differences of CD4 +IFN-γ + or CD4 +IL-17 + percentages among un-transfection, control siRNA transfection, and A20 siRNA transfection ( P>0.05). A20 siRNA transfected CD14 + monocytes, which were purified from peripheral blood and BALF of VAP patients, induced increased target cell death in both direct and indirect contact co-culture than un-transfection or control siRNA transfection ( P<0.05). Tumor necrosis factor-α, IL-6, granzyme B level and TRAIL MFI was also up-regulated ( P<0.05). There was no remarkable difference of target cell death between direct and indirect contact co-culture ( P>0.05). Conclusions:A20 was increasingly expressed in monocytes of VAP patients, and might dampen the activity of monocytes.

Objective To determine the rate of hemorrhagic complications and the possible risk factors in transrectal ultrasound(TRUS)guided prostate biopsies.Methods TRUS guided prostate biopsies were carried out in 252 patients.Chi-aquare test,t test,conditional Logistic regression were used to comparatively analyze the risk factors(age,presence of prostate cancer,the volume of prostate,arterial hypertension,diabetes mellitus,use of acetylsalicylic acid and anticoagulant,number of samples)between hemorrhagic patients and non-hemorrhagic groups.Results Hematuria was the most frequent sing in all complications,corresponding to 19.1% of the cases.According to the general feature analysis between two groups,age and the volume of the prostate were significant different.Multiple factor Loigistic regression analysis showed that patients with or without hemorrhagic complications were significant differences in age(OR=0.97,95% CI:0.942～1.000)and the volume of the prostate(OR=0.989,95% CI:0.9790～0.999).Patients with or without hematuria were significant differences in presence of prostate cancer(OR=0.479,95% CI:0.236～0.975),the volume of the prostate(OR=0.987,95% CI:0.976～0.999)and use of acetylsalicylic acid and anticoagulant(OR=3.589,95% CI:1.133～11.366).Conclusions TRUS guided prostate biopsy is a safe and effective procedure.Age and the volume of prostate are influencing factors for hemorrhagic complications.Presence of prostate cancer and the volume of prostate are influencing factors for hematuria.Use of acetylsalicylic acid and anticoagulant are risk factors for hematuria after biopsy.

BACKGROUND: Inherent modal analysis and harmonic response analysis on the human normal lumbosacral vertebraehave been reported, but there is a lack of comparative research on their modal analysis results before and after pediclescrew fixation.OBJECTIVE: To explore the dynamic characteristics of human lumbosacral vertebrae using three-dimensional finiteelement method.METHODS: Finite element model of lumbosacral vertebrae (L1-S1) before and after pedicle screw fixation was developedand validated based on CT images, and the modal analysis and harmonic response analysis were then conducted.RESULTS AND CONCLUSION: (1) Representative nodes were selected at the spinous process segments of L1, L3 andL5, and numbered as A, B, and C, respectively. (2) The maximum displacement of each node in Y and Z directions oflumbosacral vertebral model after internal fixation was significantly decreased compared with those of the normallumbosacral vertebral model, suggesting that screw fixation system plays a protective role in lumbosacral vertebrae, andreduces its amplitude under external load, thus diminishing its sensitivity to external load. (3) The lumbosacral vertebralmodal analysis can provide basis for further study on dynamic analysis, and the parameters such as natural frequency,modal shape and vibration amplitude of the lumbar spine have been determined.

BACKGROUND: In the patients with congenital scoliosis, the spinal motor units exhibit developmental disorders and poor range of motion. It has been found that the compensation ability of coronal lumbosacral region (L4-S1) is associated with the occurrence of non-compensable trunk migration postoperatively.OBJECTIVE: To establish the three-dimensional finite element models of coronal lumbosacral region of normal and patients with congenital scoliosis and to compare the strain, displacement, stress and stiffness under different loading conditions among models.METHODS: One normal subject and two congenital scoliosis patients with different coronal lumbosacral region flexibility were selected, DICOM image datawere obtained by spiral CT scanning at the lumbosacral region, and then imported into MIMICS software, and a three-dimensional model was established according to the gray values of each tissue on CT,followed by simplified by GEOMAGIC, and finally imported into ABAQUS foftware to conduct a mechanic analysis under different loading conditions.RESULTS AND CONCLUSION: (1) Under different lateral forces, in the three models, the maximum stress mainly distributed on the frontal region of L4 cortical bone, and maximum displacement concentrated on L5. (2) There was no significant change in the stress distribution in the two scoliosis models, but the compensable model showed larger displacement change, and its stiffness was significantly less than that of the non-compensable model, indicating that the compensable model is easy to deform. (3) These findings suggest that three-dimensional finite element model is helpful to perform a biomechanical analysis for coronal lumbosacral region of congenital scoliosis, among which, a compensable model exhibits large displacement, suggesting a good flexibility.

ObjectiveTo develop doxorubicine-loaded nanomicelles based on a type of novel starshaped 4-arm PLGA-PEG-NH2 amphiphilic block copolymers.Methods 4s-(PLGA-PEG-NH2) synthesized by 4s-PLGA and (H2N-PEG-NH2) according to N,N'-dicyclohexylcarbodiimide(DCC) condensation reaction was demonstrated by 1H NMR spectroscopy and gel permeation chromatography(GPC); DOX-loaded 4s-(PLGA-PEG-NH2) nanomicelles were self-assembled by doxorubicin(DOX) and 4s-(PLGA-PEG-NH2) via emulsion-solvent evaporation method and characterized in terms of morphology,particle size and size distribution,drug loading,encapsulation efficacy,cell uptake and cytotoxicity studies.Results4s-(PLGA-PEG-NH2) were capable of selfassembling intocore-shell nanomicelles structure and encapsulating DOX into their hydrophobic cores.The mean size of DOX-loaded 4s-(PLGA-PEG-NH2) was nanometer size; drug loading and encapsulation efficacy were around 7.5％ and 75.2％,respectively.Mean surface charge of the micelles was around -17.6 mV.In vitro cell uptake and cytotoxicity studies indicated that comparing to the DOX-loaded linear-(PLGA-PEG-PLGA)nanomicelles,DOX-loaded 4s-(PLGA-PEG-NH2) nanomicelles showed better performance in uptaking by HeLa cells and higher cytotoxicity to cancer cells.Conclusion4s-(PLGA-PEG-NH2) amphiphilic block copolymers can be successfully used in encapsulating DOX,self-assemblingcore-shell nanomicelles in aqueous solvent.Therefore,4s-(PLGA-PEG-NH2) copolymers can be considered as a promising drug carrier in effectively carrying hydrophobic drug,improving the efficacy while reducing the side effect.

BACKGROUND:There are so many studies about ovariectomized rats at present, but the research on the change rules of bone mass, bone turnover markers, estrogen levels and their correlation in different periods of ovariectomized rats is rarely reported. OBJECTIVE:To analyze the change rules of bone mass, bone turnover markers, estrogen level and their correlation in different periods of ovariectomized rats. METHODS: Thirty-four 3-month-old female Sprague Dawley rats were randomly divided into three groups: baseline group, ovariectomized group and sham operated group. At the beginning of the experiment, the rats in the baseline group were sacrificed, then rats in the ovariectomized group and sham operated group were executed at 4, 8, 12 weeks postoperative respectively. The bone mineral density, bone mass content, area of different zones of the L1-3 lumbar vertebrae and femurs were detected by dual-energy X-ray absorption method, and meanwhile the serum levels of type I procolagen amino-terminal pro-peptide, I colagen carboxy-terminal peptide and estrogen were determined by ELISA. At last, we analyzed the correlation between body mass, bone mineral densityin vitro, type I procolagen amino-terminal pro-peptide, I colagen carboxy-terminal peptide and estrogen levels and the age of ovariectomized rats. RESULTS AND CONCLUSION: (1) The bone mineral density and bone mass content of the lumbar vertebral and femurs in the ovariectomized group were significantly lower than those in the sham operated group and baseline group at the 4th week after operation (P < 0.05). The bone mineral density and bone mass content in the ovariectomized group were ameliorated obviously at the 8th and 12th weeks compared with those at the 4th week after operation (P < 0.05). The bone mass loss was highest in the L1 and intertrochanteric regions. (2) Serum levels of type I procolagen amino-terminal pro-peptide and I colagen carboxy-terminal peptide in the ovariectomized group were significantly higher than those in the baseline group and sham operated group at the 4th week after operation, but there was no difference at the 8th and 12th weeks. (3) The serum estrogen level in the ovariectomized group was prominently lower than that in the sham operated group and baseline group at the 8th and 12th weeks after operation (P < 0.01 at the 8th week,P < 0.05 at the 12th week). (4) The age was positively correlated with body mass and bone mineral density of the lumbar vertebrae and femursin vitro, while the serum levels of type I procolagen amino-terminal pro-peptide and I colagen carboxy-terminal peptide were negatively correlated with the bone mineral density of the lumbar vertebrae and femurs in vitro (P < 0.01). These results suggested that the bone mass of the lumbar vertebrae and femurs in ovariectomized rats was decreased rapidly firstly, and then rose slowly with time; the bone mass in the L1 and intertrochanteric regions lost seriously; the bone turnover markers showed a significant increase at the beginning of ovariectomy and reduced gradualy to normal condition, while the estrogen level was increased at the first month after ovariectomy and then decreased rapidly. In addition, the body mass, bone turnover markers and estrogen level were associated with the change of bone mass.

OBJECTIVETo determine the age-related normal ranges of serum prostate-specific antigen (PSA) level in men free of prostate cancer in Beijing.

METHODSForm April 2010 to October 2011, 1611 healthy men undergoing routine physical examinations in our hospital were enrolled and received examinations with serum PSA test, digital rectal examination and transrectal ultrasound. The men with abnormalities in any two of the three examinations were referred to a prostate biopsy. The men with normal results in any two of the examinations or with a negative biopsy finding were defined as men without prostate cancer. Men with a prior history of prostate cancer/surgery or with urinary tract infection/obstruction were excluded.

RESULTSA total of 1572 men without prostate cancer were finally included in this study and stratified into 5 age groups, namely 40 to 49, 50 to 59, 60 to 69, 70 to 79, and older than 80 years groups. The median PSA values (95th percentile ranges) of these age groups were 0.506 (1.565), 1.04 (2.920), 1.16 (4.113), 1.34 (5.561), and 2.975(7.285), respectively, and the 25th to 75th percentiles were 0.343 to 0.923, 0.663 to 1.580, 0.693 to 2.203, 0.789 to 2.368, and 1.188 to 4.295, respectively. The serum PSA value was positively correlated with age (r=0.314, P<0.001).

CONCLUSIONUsing the age-related reference ranges for PSA can increase the sensitivity for screening prostate cancer in younger men and decrease the biopsy rate in elderly patients.

Adult ; Age Distribution ; Age Factors ; Aged ; Aged, 80 and over ; Asian Continental Ancestry Group ; statistics & numerical data ; China ; Humans ; Male ; Middle Aged ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; diagnosis