A nomogram based on age, prostate-specific antigen level, prostate volume and digital rectal examination for predicting risk of prostate cancer

Nomograms for predicting the risk of prostate cancer developed using other populations may introduce sizable bias when applied to a Chinese cohort. In the present study, we sought to develop a nomogram for predicting the probability of a positive initial prostate biopsy in a Chinese population. A total of 535 Chinese men who underwent a prostatic biopsy for the detection of prostate cancer in the past decade with complete biopsy data were included. Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy. Age, prostate-specific antigen （PSA）, prostate volume （PV）, digital rectal examination （DRE） status, % free PSA and transrectal ultrasound （TRUS） findings were included in the analysis. A nomogram model was developed that was based on these independent predictors to calculate the probability of a positive initial prostate biopsy. A receiver-operating characteristic curve was used to assess the accuracy of using the nomogram and PSA levels alone for predicting positive prostate biopsy. The rate for positive initial prostate biopsy was 41.7% （223/535）. The independent variables used to predict a positive initial prostate biopsy were age, PSA, PV and DRE status. The areas under the receiver-operating characteristic curve for a positive initial prostate biopsy for PSA alone and the nomogram were 79.7% and 84.8%, respectively. Our results indicate that the risk of a positive initial prostate biopsy can be predicted to a satisfactory level in a Chinese population using our nomogram. The nomogram can be used to identify and counsel patients who should consider a prostate biopsy, ultimately enhancing accuracy in diagnosing prostate cancer.

Genetic and epigenetic variants influencing the development of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease(NAFLD) is common worldwide.The importance of genetic and epigenetic changes in etiology and pathogenesis of NAFLD has been increasingly recognized.However,the exact mechanism is largely unknown.A large number of single nucleotide polymorphisms(SNPs) related to NAFLD has been documented by candidate gene studies(CGSs).Among these genes,peroxisome proliferatoractivated receptor-γ,adiponectin,leptin and tumor necrosis factor-α were frequently reported.Since the introduction of genome-wide association studies(GWASs),there have been significant advances in our understanding of genomic variations of NAFLD.Patatinlike phospholipase domain containing family member A3(PNPLA3,SNP rs738409,encoding I148M),also termed adiponutrin,has caught most attention.The evidence that PNPLA3 is associated with increased hepatic fat levels and hepatic inflammation has been validated by a series of studies.Epigenetic modification refers to phenotypic changes caused by an adaptive mechanism unrelated to alteration of primary DNA sequences.Epigenetic regulation mainly includes microRNAs(miRs),DNA methylation,histone modifications and ubiquitination,among which miRs are studied most extensively.miRs are small natural single stranded RNA molecules regulating mRNA degradation or translation inhibition,subsequently altering protein expression of target genes.The miR-122,a highly abundant miR accounting for nearly 70% of all miRs in the liver,is significantly under-expressed in NAFLD subjects.Inhibition of miR-122 with an antisense oligonucleotide results in decreased mRNA expression of lipogenic genes and improvement of liver steatosis.The investigation into epigenetic involvement in NAFLD pathogenesis is just at the beginning and needs to be refined.This review summarizes the roles of genetics and epigenetics in the development of NAFLD.The progress made in this field may provide novel diagnostic biomarkers and therapeutic targets for NAFLD management.

Structural bone allografts with intramedullary vascularized fibular autografts for the treatment of massive bone defects in extremities

Objective:To report the clinical outcome of repairing massive bone defects biologically in limbs by homeochronous using structural bone allografts with intramedullary vascularized fibular autografts. Methods: From January 2001 to December 2005, large bone defects in 19 patients (11 men and 8 women, aged 6 to 35 years) were repaired by structural bone allografts with intramedullary vascularized fibular autografts in the homeochronous period. The range of the length of bone defects was 11 to 25 cm (mean 17.6 cm), length of vascularized free fibular was 15 to 29 cm (mean 19.2 cm), length of massive bone allografts was 11 to 24 cm (mean 17.1 cm). Location of massive bone defects was in humerus(n=1), in femur(n=9) and in tibia(n=9), respectively. Results: After 9 to 69 months (mean 38.2 months) follow-up, wounds of donor and recipient sites were healed inⅠstage, monitoring-flaps were alive, eject reaction of massive bone allografts were slight, no complications in donor limbs. Fifteen patients had the evidence of radiographic union 3 to 6 months after surgery, 3 cases united 8 months later, and the remained one case of malignant synovioma in distal femur recurred and amputated the leg 2.5 months, postoperatively. Five patients had been removed internal fixation, complete bone unions were found one year postoperatively. None of massive bone allografts were absorbed or collapsed at last follow-up. Conclusion: The homeochronous usage of structural bone allograft with an intramedullary vascularized fibular autograft can biologically obtain a structure with the immediate mechanical strength of the allograft, a potential result of revascularization through the vascularized fibula, and accelerate bone union not only between fibular autograft and the host but also between massive bone allograft and the host.

Amyloid beta deposition related retinal pigment epithelium cell impairment and subretinal microglia activation in aged APPswePS1 transgenic mice

AIM：To identify the pathological role of amyloid beta（Aβ） deposition in retinal degeneration,and explore Aβ deposition on the retinal pigment epithelium cells（RPE） layer and the associated structural and functional changes in Alzheimer＇s disease transgenic mice.METHODS：RPE changes in the eyes of APPswe/PS1 transgenic and none transgenic（NTG） mice over 20 months old were examined.Histological changes were investigated via hematoxylin and eosin（H＆E） staining and transmission electron microscopy（TEM） examination,whereas the expression of amyloid precursor protein（APP）,Aβ,Zonula occludens-1（ZO-1） and Ionized calcium binding adaptor molecule-1（IBA-1） were investigated using immunohistochemistry and immunofluorescence techniques.All of the obtained results were quantitatively and statistically analyzed.RESULTS：In aged transgenic mice,an APP-positive immunoreaction and Aβ deposition were detected on the RPE layer but were undetectable in NTG mice.The RPE demonstrated some vacuole changes,shortened basal infoldings and basal deposition in histopathological examination and TEM tests,wherein irregular shapes were indicated by ZO-1 disorganization through fluorescence.Furthermore,IBA-1 positive cells were observed to have accumulated and infiltrated into the RPE layer and localized beneath the RPE/Bruch＇s membrane（Br M） complex,which was accompanied by an increase in BrM thickness in aged transgenic mice in comparison to NTG mice.The IBA-1 positive cells were found to be co-stained with Aβ deposition on the RPE flat mounts.CONCLUSION：The observed Aβ deposition in the RPE layer may cause RPE dysfunction,which is associated with microglia cells infiltration into the retina of aged transgenic mice,suggesting that Aβ deposition probably plays a significant role in RPE-related degenerative disease.

Feasibility of similarity coefficient map for improving morphological evaluation of T_2* weighted MRI for renal cancer

The purpose of this paper is to investigate the feasibility of using a similarity coefficient map（SCM） in improving the morphological evaluation of T2＊ weighted（T2＊W） magnatic resonance imaging（MRI） for renal cancer.Simulation studies and in vivo 12-echo T2＊W experiments for renal cancers were performed for this purpose.The results of the first simulation study suggest that an SCM can reveal small structures which are hard to distinguish from the background tissue in T2＊W images and the corresponding T2＊ map.The capability of improving the morphological evaluation is likely due to the improvement in the signal-to-noise ratio（SNR） and the carrier-to-noise ratio（CNR） by using the SCM technique.Compared with T2＊ W images,an SCM can improve the SNR by a factor ranging from 1.87 to 2.47.Compared with T2＊ maps,an SCM can improve the SNR by a factor ranging from 3.85 to 33.31.Compared with T2＊W images,an SCM can improve the CNR by a factor ranging from 2.09 to 2.43.Compared with T2＊ maps,an SCM can improve the CNR by a factor ranging from 1.94 to 8.14.For a given noise level,the improvements of the SNR and the CNR depend mainly on the original SNRs and CNRs in T2＊W images,respectively.In vivo experiments confirmed the results of the first simulation study.The results of the second simulation study suggest that more echoes are used to generate the SCM,and higher SNRs and CNRs can be achieved in SCMs.In conclusion,an SCM can provide improved morphological evaluation of T2＊W MR images for renal cancer by unveiling fine structures which are ambiguous or invisible in the corresponding T2＊W MR images and T2＊ maps.Furthermore,in practical applications,for a fixed total sampling time,one should increase the number of echoes as much as possible to achieve SCMs with better SNRs and CNRs.

The Optimal Allocation of Investment between Antivirals and Vaccines for Influenza Pandemic Preparedness Planning

Objectives To investigate that given a fixed amount of financial resources,what is the optimal combination of vaccine and antiviral stockpiles in terms of minimizing the attack rate.Methods Mathematic modeling was used to simulate the dynamics that with fixed influenza pandemic budget.Different budget conditions were observed if the combination changed.Framework between vaccines and antivirals was introduced by taking into account the uncertainty in vaccine and antiviral efficacy.Results Given a fixed budget,different budget allocations between vaccines and antivirals stockpile gave different attack rates.When the price of vaccine was lower than or similar with the antivirals,the attack rate increased with increasing investment in antiviral.But if the price of the vaccine was higher than the antivirals,the attack rate may not decrease with increasing investment in vaccine.Fixed the vaccine effectiveness,higher effectiveness of antiviral got a lower attack rate.When both antiviral and vaccine were with 50%probability of effectiveness,the attack rate changed by antiviral stockpile with a same pattern as they were with 100%efficacy probability,even it has a higher attack rate.Conclusions Assume the antivirals have 100%probability to be effective,budget was limited to a fix number,then in any event,population should stockpile a small amount of antivirals such that if the post-vaccination reproductive number turns out to be near 1,the additional intervention may further reduce the reproductive number to <1 and prevent the epidemic.Under the fixed budget,the price of the vaccines and antivirals will strongly affect the strategy of the stockpile allocation.When the price of vaccine is comparative lower,more investment of vaccine is better for the pandemic control,but if the vaccine price is too high then more investment in antiviral may be better.We found that attack rates and the optimal budget allocation depend on the probability to be effective of vaccine and antivirals.

A 32-gene risk index： a new prognostic approach for prostate cancer progression

Radical prostatectomy （RP） has been a widely accepted and standard treat-ment for clinically localized and locally advanced prostate cancer. However, effective clinical management of RP patient remains being challenged, given that conventional prognostic factors, including Gleason score, pT stage, surgical margin status and presurgery serum prostatespecific antigen （PSA）,

Inadequate glycaemic control and antidiabetic therapy among inpatients with type 2 diabetes in Guangdong Province of China

Background Diabetes mellitus has become epidemic in recent years in China. We investigated the prevalence of hyperglycaemia and inadequate glycaemic control among type 2 diabetic inpatients from ten university teaching hospitals in Guangdong Province, China. Methods Inadequate glycaemic control in diabetic patients was defined as HbA1c 〉 6.5%. Therapeutic regimens included no-intervention, lifestyle only, oral antiglycemic agents （OA）, insulin plus OA （insulin＋OA）, or insulin only. Antidiabetic managements included monotherapy, double therapy, triple or quadruple therapy. Results Among 493 diabetic inpatients with known history, 75% had HbA1c ≥ 6.5%. inadequate glucose control rates were more frequently seen in patients on insulin＋OA regimen （97%） ,than on OA regimen （71%） （P 〈0.001）, and more frequent in patients on combination therapy （81%-96%） than monotherapy （7,5%） （P 〈0.0,5）. Patients on insulin differed significantly from patients on OA by mean HbA1c, glycemic control rate, diabetes duration, microvascular complications, and BMI （P 〈0.01）. Conclusions This study showed that glycaemic control of type 2 diabetic patients deteriorated for patients who received insulin and initiation time of insulin was usually delayed, it is up to clinicians to move from the traditional stepwise therapy to a more active and early combination antidiabetic therapy to provide better glucose control.

Treatment of 60 Cases of Senile Herpes Zoster by Encircled Acupuncture plus Valaciclovir

目的：观察局部围针配合万乃洛韦治疗治疗老年带状疱疹的临床疗效及安全性。方法：60例老年带状疱疹患者分为两组：针药组采用局部围针配合万乃洛韦治疗，在皮肤损害的周围，离疱疹约0．8寸左右进针，针尖与皮肤呈15°，进行斜刺向疱疹中心，根据皮肤损害部位的大小，每隔1寸左右取1穴围刺。治疗期间同时予口服万乃洛韦，每次300mg，每日2次，连服10日；西药组单纯口服万乃洛韦，每次300mg，每日2次，连服10天。结果：针药组在止疱、止痛、结痂时间均显著低于西药组（P〈0．01），后遗神经痛发生率明显降低（P〈0．05）。结论：局部围针配合万乃洛韦治疗老年带状疱疹起效快，能有效缩短病程、降低后遗神经痛发生率。