Objective To access the diagnostic value of Prostate Imaging Reporting and Data System (PIRADS version 2)for prostate cancer (PCa) in prostate specific antigen (PSA) grey zone(4-10 ng/mL).Methods Treatment naive PCa and BPH patients with an increase of PSA 4-10 ng/mL from 2200 patients underwent prostate MRI from 2012 to 2016 were included,multiparameter magnetic resonance imaging (mp-MRI) prior biopsy or prostatectomy and clinical data were obtained,mp-MRI were retrospectively analyzed quantitatively by a radiology expert with 15 years experience in urogenital system imaging diagnosis and a doctor with 5 years experience in radiology diagnosis blind to the pathology results according to PIRADS v2,PIRADS v2 score and lesion zone were recorded respectively,in case of disagreement,dicision was made through discuss.TRUS guided biopsy or prostatectomy pathology serves as gold reference.Diagnostic value of PIRADS v2 for PSA grey zone PCa was calculated by receiver operating characteristic (ROC) curve,logistic regression analysis was used to access the risk factors of PCa.Results 15 PCa and 30 BPH patients were in eluded.There was no significant difference between these two groups in age,tPSA,fPSA,f/tPSA,prostate volume and PSA density.The area under ROC curve of PIRADS v2 in diagnosing PCa was 0.932[95 ％ CI 0.822-0.984],P＜0.01.Using a cutoff PIRADS＞4,the diagnosis sensitivity was 88.89 ％,specificity 87.10 ％,and positive predictive value 80 ％,negative predictive value 93.10％,respectively.Logistic regression analysis showed that PIRADS v2 score was an independent risk factor for predicting PCa,with a hazard ratio 17.847[3.745-85.078],P＜0.01.There was a positive correlation between PIRADS v2score and gleason score,r=0.585,P=0.022.Conclusion PIRADS v2 has a significantly high diagnosis value in diagnosing PSA grey zone PCa and a good correlation with pathology results.

Background The advantages of endothelium keratoplasty(EK)include without corneal surface incision and sutures,remaining normal corneal topography,minimizing astigmatism and providing a healthy donor endothelial cell count and function.Using anterior segment optical coherence tomography(AS-OCT) to examine the morphology of the corneal graft after EK is helpful for the evaluation of the outcome of EK.ObjectiveThis study applies AS-OCT to observe the relationship of recipient cornea and donor graft and offer a basis for the evaluation of operative outcome.MethodsThe clinical data from 44 eyes of 42 patient who received DSAEK in Peking University Eye Center from September 2007 through April 2009 was reviewed retrospectively.These patients included 30 male and 12 female with the age from 15 to 83 years.Structure of cornea and relationship between recipient cornea and graft disc after surgery were clinically examined and recorded by slit-lamp digital camera and AS-OCT.This study was approved by the Ethics Committee of Peking University.Written informed consent was obtained from all of the patients before the operation.ResultsThe donor graft attached to posterior central surface of recipient in 28 eyes under the slit-lamp microscopy and AS-OCT.The thickness of donor graft was decreased,and graft sticked more closely to recipient cornea and was more transparent with the lapse of time.Complete dislocation of the donor graft in early stage was found in 5 eyes(11.36%) and partial dislocation in 2 eyes(4.55%).Curliness of graft edge occurred in 1 eye(2.27%) and eccentricity of donor graft in 8 eyes(18.18%).ConclusionAS-OCT can display the morphology and structure of cornea as well as the relationship between donor graft and recipient after DSAEK.It is helpful for evaluating the clinical effectiveness of DSAEK.

Objective The purpose of this study was to compare the image quality of readout-segmented EPI (RS-EPI) and that of standard single-shot echo-planar imaging (SS-EPI) in patients with scrotal diseases. Methods Initial diagnosis of scrotal diseases were included in the prospective study, all patients underwent scrotum routine MRI and RS-EPI, SS-EPI sequence at 3.0 T. A total of 38 patients were recruited qualitative assessment ,and 29 patients proved by operation and pathology (malignant 21 cases and benign 8 cases) were included quantitative analysis.For qualitative comparison of image quality, two readers independently assessed the two sets of DWI, which consisted of identification of structure and geometric distortion of scrotum (epididymis,testes, lesion) using a 5-point Likert scale. For assessment of image parameters, signal-to-noise ratio (SNR), contrast, contrast-to-noise ratio (CNR),apparent diffusion coefficient value of normal testis and testis distortion ratio of anatomical(T2WI)/DWI fusion image were calculated. Inter-observer agreement was assessed with the Kappa statistics, the differences of scores of
RS-EPI and SS-EPI were compared by using Wilcoxon rank-sum test, and image parameters were compared by using paired sample t test. Results There was good reader agreement in the scores, the Kappa value were 0.77, 0.74, 0.80, 0.87. The difference of identification of structure and geometric distortion on RS-EPI and SS-EPI had statistic significance, the RS-EPI was superior to SS-EPI in image quality (all P<0.05).The SNR, contrast of benign lesion for two sequences had no statistic significance(P values were 0.352, 0.124, respectively), but the difference of CNR had statistic significance(P<0.05). The SNR,contrast and CNR of malignant lesion for two sequences had statistic significance (all P<0.05). The mean size of the testis was (35.61 ± 9.78)mm, the mean distance in fusion image of RS-EPI or SS-EPI with T2WI were (3.80 ± 1.32)mm and (7.54 ± 2.62)mm, and the mean distortion ratios of the two set were (11.1 ± 0.6)% and (22.4 ± 19.2)%, respectively, the difference of two sets had statistic significance(P<0.05). There was no significant difference in the ADC obtained by using either DWI method(t=0.396,P=0.796), the mean ADC values of normal testes for RS-EPI and SS-EPI, respectively, were (1.18 ± 0.06) × 10-3mm2/s, (1.24 ± 0.11) × 10-3mm2/s.Conclusion RS-EPI DWI images is a feasible technique in the scrotum for producing high-resolution DWI with reduced geometric distortion and offers potentially superior image quality compared to SS-EPI at 3.0 T.

AIMTo research the effect of intermittent hypoxia during sleep on hypothalamus-pituitary-adrenal (HPA) axis and growth hormone (GH) level.

METHODSRats were respectively exposed to intermittent hypoxia, room air and continuous hypoxia, after 1 day, 3 days, 7 days and 30 days, mRNA levels of corticotropin-releasing hormone (CRH) and growth hormone releasing hormone (GHRH) in hypothalamus of rats were detected using RT-PCR, and the levels of CRH, GHRH, corticotropin(ACTH), cortex ketone, and growth hormone in plasma were measured.

RESULTSAfter 30 days, the CRH mRNA levels in rats hypothalamus which exposed to intermittent hypoxia were increased significantly than those exposed to continuous hypoxia as well as normal control but GHRH decreased, there was no difference between continuous hypoxia and normal control. After 1 day, 3 days, and 7 days, there was no difference between continuous hypoxia and intermittent hypoxia. After 30 days, the plasmic level of CRH,ACTH and cortex ketone increased, GHRH decreased and GH had no obvious change.

CONCLUSIONThe rats' HPA axis level increases and GHRH restrained with chronic intermittent hypoxia during sleep, feedback regulation disorders.

Animals ; Corticotropin-Releasing Hormone ; metabolism ; Growth Hormone ; metabolism ; Growth Hormone-Releasing Hormone ; metabolism ; Hypothalamo-Hypophyseal System ; Hypoxia ; Male ; Pituitary-Adrenal System ; Rats ; Rats, Wistar ; Sleep Apnea Syndromes ; metabolism

OBJECTIVE To explore the mechanisms of the volatiles of Wendan granule for the treatment of senile dementia,network pharmacology method integrating absorption,distribution,metab-olism, and excretion (ADME) screening, target fishing, network constructing, pathway analyzing, and correlated diseases prediction was applied. METHODS Twelve small molecular compounds of WDG were selected as the objects from 74 volatiles with the relative abundances above 2%,and their ADME parameters were collected from Traditional Chinese Medicine Systems Pharmacology platform (TCMSP), and then the corresponding targets, genes, pathways and diseases were predicted according to the data provided by TCMSP,DrugBank,Uniport and the Database for Annotation,Visualization and Integrated Discovery(DAVID).The related pathways and correlation analysis were explored by the Kyoto Encyclo-pedia and Genomes (KEGG) database. Finally, the networks of compound-target, target-pathway and pathway-disease of WDG were constructed by Cytoscape software. RESULTS Twelve compounds interacted with 49 targets, of which top three targets were Gamma-aminobutyric acid receptor subunit alpha-1 (GABRA1), Prostaglandin G/H synthase 2 (PGHS-2) and Sodium-dependent noradrenaline transporter.Interestingly,these targets were highly associated with depression,insomnia and Alzheimer′s disease that mainly corresponded to mental and emotional illnesses. CONCLUSION The integrated network pharmacology method provides precise probe to illuminate the molecular mechanisms of volatiles of WDG for relieving senile dementia related syndromes,which will also facilitate the application of traditional Chinese medicine in modern medicine,as well as follow-up studies such as upgrading the quality stan-dard of clinical medicine and novel drug development.

OBJECTIVETo investigate the clinical efficacy of superior mesenteric artery (SMA)-oriented laparoscopic complete mesocolic excision (CME) with a medial-to-lateral approach in the treatment of right colonic cancer.

METHODSA total of 166 patients with right colonic cancer who were admitted to The First Affiliated Hospital of Nanjing Medical University from January 2015 to December 2016 underwent SMA-oriented laparoscopic CME by the same surgical team. Clinical data of these patients were retrospectively analyzed.

RESULTSAll the 166 cases were enrolled in this study, including 96 male and 70 female patients. Right colon adenocarcinoma was diagnosed by preoperative colonoscopy, enhanced computerized tomography(CT) and pathological examination, and the tumor was resectable. There were no emergency surgery patients for bowel obstruction or perforation, no patients with multiple primary cancers, and no stage IIII( patients with liver or lung metastasis. All the patients underwent SMA-oriented laparoscopic CME successfully, without conversion to laparotomy. No ureteral injury, duodenal injury, and superior mesenteric vein injury occurred during the operation. R0 resections were performed in all the cases. The average operation time was (102.4±28.3) min, blood loss was (67.2±26.3) ml, number of lymph nodes retrieved was 20.5±7.6, postoperative anal exhaust time was (2.1±1.1) d, postoperative hospital stay was (7.9±1.4) d. There was no perioperative death or anastomotic leakage. Two patients with small bowel obstruction were readmitted within 30 days after operation. The postoperative complications occurred in 15.1%(25/166) of the patients, including wound infection (2 cases), chylous fistula (20 cases), anastomotic bleeding (1 case), small bowel obstruction (2 cases). A total of 161 patients (97.0%) were followed up for 1 to 24 months, and 10 patients had distant metastasis during the follow-up period. The 2-year overall survival (OS) rate was 96.4%.

CONCLUSIONSuperior mesenteric artery-oriented laparoscopic complete mesocolic excision with a medial-to-lateral approach for right colonic cancer has good short-term efficacy.

OBJECTIVETo investigate the surgical outcome and its influencing factors in patients of congenital basilar invagination (BI) with atlanto-axial dislocation (AAD).

METHODSFrom May 2004 to August 2010, 120 patients who had BI with AAD were surgically treated with direct posterior intraoperative distraction-reduction and fixation technique, 93 patients were successfully followed up by means of questionnaire survey, telephone and clinical evaluation. Pre- and postoperative dynamic cervical X-rays, computed tomographic scans, 3-dimentional reconstruction views and magnetic resonance imaging were performed. Pre- and postoperative Japanese Orthopaedic Association (JOA) score, distance between odontoid tip and Chamberlain's line and atlantodental interval were measured to evaluate the surgical result. Statistical analysis was performed by means of paired t test and Pearson Correlation analysis.

RESULTSThere were 93 cases were followed up for 24-99 months with an average of 46.5 months. Until the final follow-up, clinical symptoms were improved in 79 patients (84.9%), and were stable in 7 patients (7.5%) and deteriorated in 4 patients (4.3%). Three patients died postoperatively (3.2%). Patients without intramedullary signal intensity change (ISIC) had better surgical outcome. Patients with compression from anterior odontoid tip and posterior bone margin of occipital foramen had the worst surgical outcome (F = 3.987, P < 0.01). Overall, good decompression and bone fusion were shown on postoperative image in 87 patients (93.5%). There were 3 deaths in this series because of basilar artery thrombosis, posterior fossa hematoma and unknown reasons each.

CONCLUSIONSThe direct posterior intraoperative distraction-reduction and fixation technique is an effective simple and safe method for the treatment of BI with AAD. Anterior compression from odontoid tip and posterior compression from bone margin of occipital foramen-atlantal posterior arch play important roles in its developing mechanism. ISIC on MRI is a predictive factor for the worse surgical outcome.

Adolescent ; Adult ; Atlanto-Axial Joint ; surgery ; Bone Screws ; Child ; Decompression, Surgical ; Female ; Follow-Up Studies ; Humans ; Joint Dislocations ; complications ; surgery ; Male ; Middle Aged ; Platybasia ; complications ; surgery ; Root Cause Analysis ; Spinal Fusion ; methods ; Young Adult

OBJECTIVETo assess the feasibility, safety and effectiveness of video-assisted thoracoscopic sympathectomy (VATS) for the treatment of congenital long QT syndrome.

METHODSUnder general anaesthesia, pleural cavity was entered via two or three small incisions in the left intercostal space. The left thoracic sympathetic chain was identified and resected from T2 approximately T5. The lower one at the third of the left stellate ganglion was also resected.

RESULTSVATS resulted in a significant shortening in corrected QT intervals in three patients. The average QT interval of the four patients was 537.5 ms before VATS and 512.5 ms after VATS. The heart rate of the patients remained unchanged. There were no major peri-operative complications apart from mild ptosis of the left upper eyelid in one patient who recovered in the following days. The syndrome recurred in one patient in syncopal events in four months after VATS.

CONCLUSIONVATS is a safe as well as an effective technique for the treatment of congenital long QT syndromes.

Adult ; Child ; Female ; Humans ; Long QT Syndrome ; congenital ; surgery ; Male ; Sympathectomy ; methods ; Thoracic Surgery, Video-Assisted ; methods

OBJECTIVETo explore the feasibility, effect, and clinic value of total laparoscopic gastric resection in patients with benign gastric disease.

METHODSThe clinical materials of 50 cases underwent total laparoscopic gastric resection (LG group) and 104 cases open surgery (OG group) between January 2002 and June 2006 were compared. The operation time, intraoperative blood loss, mean time of stay in hospital and postoperative complications were studied.

RESULTSAll operations in LG group were successfully preformed with laparoscopic technique, and the mean operation time was 105 min, mean intraoperative blood loss was 50 ml, and mean hospital stay was 7 days. Incisional wound infection occurred in 2 cases and no serious complications occurred in this group. In OG group, the mean operation time was 118 min, mean intraoperative blood loss was 108 ml, and mean hospital stay was 12 days. Wound infection occurred in 7 cases, disorder of gastric emptying was found in 3 cases, fistula of anastomotic stoma happened in 1 case and bowel obstruction occurred in 1 case. There was significant difference in operation blood loss and hospital stay between the two groups (P < 0.05).

CONCLUSIONSLaparoscopic gastric resection is a safe and feasible minimally-invasive surgery, it brings less pain, less bleeding, shorter hospital stay.

Adult ; Aged ; Feasibility Studies ; Female ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Male ; Middle Aged ; Retrospective Studies ; Stomach Diseases ; surgery ; Treatment Outcome

Objective:To explore the clinical characteristics and prognosis of multiple primary colorectal carcinoma.Methods:The clinical data of 42 cases of colorectal cancer admitted to the First Affiliated Hospital of Nanjing Medical University between January 2013 and December 2018 were retrospectively analyzed. The clinicopathological features, diagnosis, treatment and prognosis were summarized.Results:There were 42 patients with multiple primary colorectal carcinoma, accounting for 1.20% (42/3 499) of all colorectal carcinoma patients in the same period. The main pathological type was adenocarcinoma. Among them, 32 cases were synchronous multiple primary carcinoma. And the age ranged 38-86 years old, and the median age was 66 years old. A total of 73 colorectal cancer lesions were detected, mostly located in the proximal colon, sigmoid colon and rectum. A total of 527 lymph nodes were detected, and the positive rate was 1.9% (10). Patients with positive lymph nodes accounted for 37.5% (12/32), including 27 cases of multiple primary carcinoma, 3 cases of triple primary carcinoma, 2 cases of five primary carcinoma. The 1-year and 3-year overall survival rates were 83.75% and 74.38%, respectively. There were 10 cases of metachronous multiple primary carcinoma. Patients were aged 33-86 years old. The first cancer was mostly located in the rectum and sigmoid colon, and the second cancer was mostly located in the ascending colon area. A total of 276 lymph nodes were detected, and the positive rate was 12.3% (34). The 1-year and 3-year overall survival rates were 100.00% and 66.67%, respectively.Conclusions:Multiple primary colorectal cancer is not rare clinically and its distribution shows a certain regularity. More attention should be paid to improve the early diagnosis rate. Early operation is needed to improve the survival rate of patients.