PSA密度对前列腺癌病理结果的预测价值

目的:评估前列腺特异抗原密度(prostate specific antigen density,PASD)对前列腺癌根治术后不良病理结果的预测价值.方法:回顾性分析50例病理确诊为前列腺癌患者的临床资料,收集患者术前总前列腺特异抗原(total prostate specific antigen,tPSA)、PSAD及穿刺活检Gleason评分结果,比较在手术切缘阳性(positive surgical margins,PSM)、前列腺包膜外侵犯(extracapsular prostatic extension,EPE)、精囊入侵(seminal vesicle invasion,SVI)患者中以上各项指标的差异,对有统计学差异的因素行多元Logistic回归分析,筛选影响浸润的最主要因素,同时运用工作特征曲线(ROC曲线)比较各指标的预测价值.结果:PSM,EPE和SVI患者之间PSAD存在统计学差异,PSAD曲线下面积高于PSA与Gleason评分.多元Logistic回归分析结果表明,PSAD和Gleason评分对PSM和EPE有着统计学意义的预测价值,且PSAD和PSA与SVI有关.结论:PSAD可作为接受前列腺癌根治术的患者术后不良的预测指标.     

根治性前列腺切除术后大体病理较术前穿刺病理升级的危险因素分析

目的:前列腺穿刺病理Gleason评分(GS)和根治性前列腺切除术后病理Gleason评分经常出现差异.本文主要研究肿瘤病理升级的可能影响因素.方法:选择1999-01至2007-11在本院行前列腺穿刺活检确诊并行根治性前列腺切除术的95例前列腺癌患者,考察的临床资料包括患者确诊时的年龄,前列腺特异性抗原水平(PSA),前列腺体积(PV),前列腺特异性抗原密度(PSAD),术前是否接受新辅助内分泌治疗(NHT),穿刺病理GS,手术后病理GS及肿瘤体积(TIV).使用t-检验或卡方检验比较不用组别之间的变量,分别使用单因素和多因素Logistical回归分析引起GS升级的相关因素.结果:患者的平均年龄是67岁,平均PSA水平为24.3 ng/ml,平均前列腺体积是33.1ml.将前列腺体积分为≤25ml(25例),25-50ml(59例),≥50ml(11例)三组,将穿刺病理GS分为4-5(13例),6(35例),7(32例),8-10(15例)四组.前列腺体积较大组(≥50m1)比体积较小组(≤25ml,25-50m1)的肿瘤升级比率明显较低(48% vs 24%,18%,p＜0.05).穿刺病理GS较高组(8-10)比较低组(4-5,6,7)的肿瘤升级比率明显减低(46% vs 34%,25%,13%,p＜0.05).多因素Logistic回归分析显示,PV、穿刺GS及内分泌治疗与病理升级呈负相关(p＜0.05),而肿瘤体积及PSAD与其呈正相关(p＜0.05).结论:较大的前列腺体积,较高的穿刺病理GS,接受内分泌治疗以及较低的PSAD均可降低其肿瘤升级的可能.泌尿外科医师在决定由穿刺活检确诊的前列腺癌患者的治疗方案时应想到上述结论.     

穿刺单针阳性前列腺癌的术后病理特征分析

摘要 目的：回顾性分析单针阳性患者的术后病理特征及Gleason评分的变化情况。方法：收集2018年9月-2020年6月在本院泌尿外科行穿刺活检,病理诊断为单针阳性的86例前列腺癌患者展开研究,按患者年龄、手术前PSA检测值、Gleason评分、临床分期（cTNM）进行分组,其中：年龄组（年龄≥70岁、年龄＜70岁）、术前PSA组（PSA＜10 ng/mL、≥10 ng/mL）、术前Gleason评分组（6分、3+4=7分、4+3=7分、≥8分）、临床分期组（cT1期组、cT2期组）。所有患者均采用腹腔镜下前列腺癌根治术和单针穿刺活检,观察纳入患者的基线资料,比较分析不同组别患者术后病理特征的差异和临床意义。结果：不同年龄患者病理特征无差异,PSA≥10 ng/mL组Gleason评分≥7分和Gleason评分升级患者占比显著高于PSA＜10 ng/mL组（P＜0.05）;cT2期组占比较低（P＜0.05）;cT2期组患者Gleason评分≥7分患者占比显著高于cT1期组（P＜0.05）,但两组切缘阳性和Gleason评分升级相比无统计学意义（P＞0.05）;不同Gleason评分患者术后pT0、切缘阳性、Gleason评分升级差异无统计学意义（P＞0.05）;不同Gleason评分患者术后病理分期差异有统计学意义,Gleason评分为4+3=7分患者病理分期＞2显著高于6分、3+4=7分和≥8分（P＜0.05）;Logistic回归分析结果显示,年龄＞70岁、PSA≥10 ng/mL、cT2期和Gleason评分≥7分是影响术后病理特征的主要危险因素（P＜0.05）。结论：前列腺单针阳性患者存在Gleason评分术后升高情况,部分患者伴有切缘阳性、病理分期≥T2特征,所以临床中无法将穿刺单针阳性作为前列腺癌患者低风险检测指标,需要结合患者其它各项指标对其进行个体化治疗方案。     

术前中性粒细胞绝对值/淋巴细胞比值联合血清瘦素、睾酮对前列腺癌根治术后生化复发的评估价值

摘要 目的：探讨术前中性粒细胞绝对值/淋巴细胞比值（NLR）联合血清瘦素、睾酮对前列腺癌（PCa）根治术后生化复发的评估价值。方法：选取2018年1月～2020年1月于我院接受根治性切除术治疗的82例PCa患者。术前均检测NLR、血清瘦素、睾酮水平。术后对所有患者均进行2年随访观察,按照是否发生生化复发分为复发组（n=34）以及无复发组（n=48）。比较两组NLR、血清瘦素、睾酮水平差异。收集患者临床资料,采用多因素Logistic回归分析PCa根治术后生化复发的影响因素。采用受试者工作特征（ROC）曲线分析NLR以及血清瘦素、睾酮预测PCa根治术后生化复发的评估价值。结果：复发组术前NLR以及瘦素水平均高于无复发组（P＜0.05）,而睾酮水平低于无复发组（P＜0.05）。复发组术前前列腺特异抗原（PSA）≥10 ng/mL、TNM分期T2期人数占比以及Gleason评分均高于无复发组（P＜0.05）。多因素Logistic回归分析显示,术前PSA≥10 ng/mL、TNM分期T2期、Gleason评分较高、术前NLR较高、瘦素水平较高、睾酮水平较低是PCa根治术后生化复发的危险因素（P＜0.05）。ROC曲线分析显示,联合检测术前NLR、血清瘦素、睾酮水平预测PCa根治术后生化复发的ROC曲线下面积为0.897,高于三项指标单独检测的0.678、0.712、0.733。结论：PCa根治术后生化复发受术前PSA、NLR、血清瘦素、睾酮水平、TNM分期、Gleason评分等因素影响,术前NLR联合血清瘦素、睾酮对PCa根治术后生化复发的预测价值较高。     

血糖与前列腺癌患者的关系

目的:探讨前列腺活检患者的血糖与前列腺癌患者的关系。方法:前瞻性收集416例初次经直肠超声引导下前列腺穿刺活检患者的血糖、前列腺特异性抗原(PSA)和Gleason评分等临床资料,所有患者以血糖浓度6.1 mmol/L为界分成两组,比较高血糖组和正常血糖组前列腺癌检出率和Gleason评分的差异。结果:416例前列腺活检患者中,检出前列腺癌165例,高血糖组38例(40.00%),正常血糖组127例(39.56%),差异无统计学意义(P0.05);低级别前列腺癌(Gleason7分)患者的构成比分别为0.184、0.071,差异有统计学意义(P0.05),Spearman等级相关分析显示前列腺癌患者的血糖值与Gleason评分呈负相关(r=-0.228,P0.05)。结论:血糖对前列腺活检患者中前列腺癌检出率没有影响,但提高了低级别前列腺癌患者的构成比,血糖是影响前列腺癌Gleason评分的一个独立因素。     

血清PSA含量与前列腺癌临床分期、病理分级的相关性

目的:探讨血清前列腺特异性抗原(PSA)与前列腺癌(PCa)临床分期、病理分级的相关性.方法:对自2004年7月～2009年12月南京市13692例50岁以上的男性在健康体检时行血清PSA检测.以PSA≥4.0ng/ml定为前列腺癌可疑病例.建议行前列腺穿刺活检以确诊.共筛查出PCa患者140例,比较不同PSA值PCa患者的Gleason评分及临床分期.结果:随着PSA值的升高,前列腺癌筛查阳性率亦随之升高,低分化前列腺癌患者血清PSA含量明显高于高分化前列腺癌和中分化前列腺癌患者(P＜0.05),晚期前列腺癌患者血清PSA含量明显高于早期PCa患者(P＜0.01).血清PSA含量≥20ng/ml的前列腺癌人群中低分化前列腺癌及晚期前列腺癌的比例高于血清PSA含量＜20ng/ml的前列腺癌人群(P＜0.01).结论:血清PSA可以为前列腺癌患者的诊断、治疗及预后判断提供重要依据.     

前列腺PI-RADS V2.1评分联合血清PSA相关指标对灰区前列腺癌的诊断价值研究

摘要 目的：探讨前列腺影像报告和数据系统第2.1版（PI-RADS V2.1）评分联合血清前列腺特异抗原（PSA）相关指标对灰区前列腺癌的诊断价值。方法：回顾性分析2016年1月至2019年12月的187例经病理证实且PSA为灰区（4-10 ng/mL）的前列腺癌或前列腺增生患者资料。根据病理结果分为前列腺癌（PCa）组与前列腺增生组（BPH）组。由两名经验丰富的MRI诊断医师通过盲法对所有患者MRI图像进行PI-RADS V2.1评分,统计并计算血清PSA相关指标：总前列腺特异抗原（t-PSA）、游离前列腺特异抗原（f-PSA）、游离前列腺特异抗原与总前列腺特异抗原比值（f-PSA/t-PSA）、前列腺特异抗原密度（PSAD）。采用t检验比较各项指标在两组间的差异性,并使用受试者工作曲线（ROC）分析各项指标对灰区前列腺癌的诊断效能。结果：PI-RADS V2.1评分与PSAD在PCa与BPH组之间的差异具有统计学意义（P＜0.05）,而t-PSA、f-PSA、f-PSA/t-PSA在PCa与BPH组之间的差异均无统计学意义（P＞0.05）。根据ROC曲线分析,PI-RADS V2.1评分、PSAD、PI-RADS V2.1评分联合PSAD诊断灰区前列腺癌的曲线下面积（AUC）分别为0.814、0.671及0.838,且PI-RADS V2.1评分联合PSAD的AUC显著高于单独应用PI-RADS V2.1评分（Z=1.989,P＜0.05）与PSAD（Z=3.174,P＜0.05）。结论：PI-RADS V2.1评分与PSAD对诊断灰区前列腺癌具有较高诊断效能,且联合PI-RADS V2.1评分与PSAD能进一步提高诊断效能。     

血清睾酮联合红细胞分布宽度、白蛋白碱性磷酸酶比值对腹腔镜前列腺癌根治术后生化复发的预测价值

摘要 目的：分析血清睾酮联合红细胞分布宽度（RDW）、白蛋白碱性磷酸酶比值（AAPR）对腹腔镜前列腺癌根治术（LRP）后生化复发的预测价值。方法：选取2017年1月～2019年1月海南省人民医院收治的90例接受LRP治疗的前列腺癌（PCa）患者,根据LRP后是否生化复发将分为生化复发组（n=34）和无生化复发组（n=56）。收集PCa患者基础资料,并检测两组术前血清睾酮、RDW、AAPR水平。采用多因素Cox回归分析LRP后生化复发的影响因素,受试者工作特征（ROC）曲线分析血清睾酮、RDW、AAPR对LRP后生化复发的预测价值。结果：随访3年,90例PCa患者LRP后生化复发34例,生化复发率为37.78％。单因素分析显示,生化复发组与年龄、PSA、Gleason评分、病理分期、睾酮、AAPR、RDW有关（P＜0.05）。多因素Cox回归分析显示,年龄增加、PSA＞20 ng/mL、Gleason评分8分、病理分期pT₃期、RDW升高为LRP后生化复发的独立危险因素,睾酮升高、AAPR升高为独立保护因素（P＜0.05）。ROC曲线分析显示,血清睾酮、RDW、AAPR单独与联合预测LRP后生化复发的曲线下面积（AUC）分别为0.771、0.754、0.772、0.922,三项联合预测LRP后生化复发的AUC大于单独预测（P＜0.05）。结论：RDW升高是LRP后生化复发的危险因素,血清睾酮、AAPR升高是保护因素,可作为LRP后生化复发的辅助预测指标,血清睾酮、RDW、AAPR联合预测LRP后生化复发的价值较高。     

影像引导下前列腺定向穿刺活检术的研究进展

确诊前列腺癌的金标准无疑是病理组织学检查,影像引导下的前列腺定向穿刺活检又是这当中最有效、最便捷的方式。而基于前列腺特异抗原(prostate specific antigen,PSA)筛查以及6分活检结果的前列腺癌诊断,已经由于其对低度肿瘤的过度诊断和对临床上有意义前列腺癌(格林森评分≥7)的诊断不足遭到批评。所以纵观国内外,影像引导已经增加到先用多参数MRI(multi-parametric magnetic resonance imaging,mpMRI)扫描检出病变组织再进行前列腺定向穿刺活检,包括,in-bornMRI引导,认知融合引导,以及MRI/TRUS融合引导下的活检。本文就一些影像引导下前列腺定向穿刺活检术的研究进展进行综述。     

CD147 在前列腺癌中的表达及其与肿瘤临床病理特征的关系

目的:研究CD147在还没前列腺癌组织中的表达及其与肿瘤临床病理特征的关系。方法:选择2013年10月-2015年10月我院收治的前列腺癌患者61例作为研究对象,另选取同期接受手术治疗的前列腺增生患者49例作为对照组,术中收集前列腺癌患者的肿瘤组织和癌旁组织以及前列腺增生患者的组织标本,采用免疫组化法检测CD147在前列腺癌组织、癌旁组织及前列腺增生组织中的表达情况。结果:CD147在前列腺癌组织中的阳性表达率(95.08%)显著高于癌旁组织(32.79%)和前列腺增生组织(16.32%),差异具有统计学意义(P0.05);CD147在癌旁组织中的阳性表达率(32.79%)高于前列腺增生组织(16.32%),差异具有统计学意义(P0.05)。CD147的阳性表达与前列腺癌Gleason分级、临床分期、淋巴结转移及远处转移呈正相关关系(P0.05)。结论:CD147在前列腺癌组织中呈阳性表达,且Gleason病理分级≥5、临床分期T3~4、淋巴结转移N1及远处转移M1均为前列腺癌组织中CD147m RNA阳性表达的危险因素。     

Ectogenesis and the case against the right to the death of the foetus

Ectogenesis, or the use of an artificial womb to allow a foetus to develop, will likely become a reality within a few decades, and could significantly affect the abortion debate. We first examine the implications for Judith Jarvis Thomson’s violinist analogy, which argues for a woman’s right to withdraw life support from the foetus and so terminate her pregnancy, even if the foetus is granted full moral status. We show that on Thomson’s reasoning, there is no right to the death of the foetus, and abortion is not permissible if ectogenesis is available, provided it is safe and inexpensive. This raises the question of whether there are persuasive reasons for the right to the death of the foetus that could be exercised in the context of ectogenesis. Eric Mathison and Jeremy Davis have examined several arguments for this right, doubting that it exists, while Joona Räsänen has recently criticized their reasoning. We respond to Räsänen’s analysis, concluding that his arguments are unsuccessful, and that there is no right to the death of the foetus in these circumstances.     

On the diversity of the Cladocera in the tropics

The mythical concept of an impoverished tropical cladoceran fauna is refuted. On a planetary scale, around half of the cladoceran species presently known occur exclusively in the tropics-subtropics, often with considerable restriction to particular geographical subzones. On a regional (political) scale, the situation is often unclear because of the continued fragmentary nature of studies, and because political units are not a good basis for biogeographical comparisons. At the finest level of resolution (lake-perlake comparisons), there appears to be an upper limit of c. 50 cladoceran species per individual lake. No significant difference between lakes in the temperate zone and in the tropics could be established here. Daphnia is largely absent from the tropics, but is replaced by more Sidids, Moinids, and Bosminids, such that the average cladoceran community in the limnetic zone of a tropical lake is not characterized by less species but rather by lower population densities. This, in turn, is considered a consequence of higher prevalent predation levels in the tropics.     

Tubular networks in the terminal endings of the visual receptor cells in the human,the monkey,the cat and the dog

Summary A tubular network was found in the terminal endings of the visual receptor cells in the human, the monkey (Macaca mulatta), the cat and the dog. These tubules are arranged in close groups in the vicinity of the synaptic lamellae and the invaginated dendrites. According to the form, diameter, density of the tubules and to the consistence of the network formed by them one can distinguish at these places an initial type (type I), a transitory (type II) and a vesicular one (type III). In the the type III branching, bizarre forms are frequent. The diameter of all the tubules reaches 500–600 Å, their density and walls being the same as in the synaptic vesicles.Similar networks also occur in the axons of the visual receptor cells of the monkey.

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Zusammenfassung In den Endigungen der Photorezeptorzellen von Mensch, Affe (Macaca mulatta), Katze und Hund kommen aus Tubuli bestehende Komplexe vor. Organellenartig in geschlossenen Gruppen angeordnet, liegen sie in Nähe der synaptischen Lamellen und der invaginierten Dendriten. An diesen Stellen kann man nach Form, Durchmesser, Dichte und Konsistenz der von den Tubuli gebildeten Komplexe drei Typen unterscheiden: 1. einen initialen (Typus I), 2. einen Übergangstypus (Typus II) und 3. einen vesiculären Typus (Typus III). In letzterem kommen häufig verzweigte, bizarre Formen vor. Der Durchmesser sämtlicher Tubuli erreicht 500–600 Å. Ihre Dichte und ihre Wand gleicht denen der synaptischen Vesikel.Ähnliche Komplexe fanden wir auch in den Axonen der Photorezeptorzellen vom Affen.

     

Assessing the Physiological State of the Fucoids from the Barents Sea Littoral by the End of the Polar Night

Methods of amperometry and potentiometric titration were used to follow dark respiration (DR) and apparent photosynthesis (AP) in the fucoids Ascophyllum nodosum (L.) Le Jol, Fucus vesiculosus L., and F. serratus L. from the Barents Sea littoral by the end of the 40-day-long polar night. The macroalgae were shown to manifest species-specific low rates of photosynthesis and respiration. However, in spite of their low photosynthetic status due to the effects of subzero temperature and prolonged low or zero illumination, the macroalgae have been able to restore DR and AP to the initial level already by the day 9; the ability to restore AP depended on the level of illumination. The study of the changes in the carbonate–bicarbonate system in the light and darkness demonstrated that the macroalgae grown in darkness, in contrast to those grown in twilight, could absorb bicarbonate in darkness; however, they lost this capacity after two-day-long illumination at an irradiance of 7 mol/(m² s). Bicarbonate uptake in darkness and the capacity to restore the systems of photosynthesis and respiration in fucoid cells are discussed in the context of algal energy metabolism under the polar night conditions.     

Arranging the elements of the potassium channel: the T1 domain occludes the cytoplasmic face of the channel

The voltage-gated potassium channel is currently one of the few membrane proteins where functional roles have been mapped onto specific segments of sequence. Although high-resolution structures of the transmembrane portions of three bacterial potassium channels, the tetramerization domain and the cytoplasmic ball are available, their relative spatial arrangement in mammalian channels remains a matter of ongoing debate. Cryo-electron microscopic images of the six transmembrane voltage-gated Kv channel have been reconstructed at up to 18 Å resolution, revealing that the T1 domain tetramerizes and is suspended below the transmembrane segments. However, the resolution of these images is insufficient to reveal the location of the third piece of the puzzle, the inactivating ball domain. We have used the aberrant interactions observed in a series of chimæric channels to establish that an assembled T1 domain restricts access to the cytoplasmic face of the channel, suggesting that the N-terminal ball and chain may be confined in the space between the T1 domain and the transmembrane portion of the channel.     

Separation of the pineal vesicle from the wall of the third ventricle during the post-hatching development of the chicken

Summary According to light- and electron-microscopic observations the pineal organ of the 3-day-old chicken consists of a prominent end vesicle and a tapering parenchymal stalk. During this stage the pineal lumen is in open communication with the third ventricle. However, in the 40-day-old chicken, which still possesses a well-developed end vesicle, the proximal portion of the pineal stalk displays regressive changes leading to local fragmentation. At this stage the pineal stalk is reduced, and the pineal lumen is missing. In 1-year-old chickens the parenchyma of the proximal portion of the stalk is further diminished, and in 3-year-old domestic fowl is completely displaced by bundles of collagenous fibers, only some nerve fibers being present. This post-hatching pineal development may reflect the sequence of changes leading from pineal sense organs to pineal glands.This work was supported by a grant-in-aid for Scientific Research from the Ministry of Education, Science and Culture of Japan     

On the Dependence of the Quadratic Risk of the Classical Predictor and the Prediction-Horizon

When constructing predictors on the basis of the linear model of time series of various indicators often the question arises on the dependence of forecasting accuracy and the changing prediction horizon. The dependency of the quadratic risk of the classical predictor and the time horizon is considered.     

中国植物区系与其它地区区系的联系及其在世界区系中的地位和作用

基于吴征镒将中国全部种子植物３２３８个属的分布区划分为１５个大类型和３４个变型的基础上,简要地讨论了中国植物区系与其它地区区系的联系,以及它在被子植物起源方面的作用。主要论点如下：（１）与热带亚洲区系的联系。这种联系主要通过第７类型（热带亚洲分布）及其５个变型来体现的。本文列举了１０个科,龙脑香料、狭义隐翼科、交让木科、五隔草科、五列木科、肉实树科、心翼果科、八宝树科、兰花蕉科和四数木科,来说明这