目的:探索表观弥散系数(apparent diffusion coefficient,ADC)在前列腺影像报告和数据系统(prostate imaging-reporting and data system,PI-RADS)3分且前列腺特异性抗原(prostate specific antigen,PSA)灰区患者中对减少非必要前列腺...目的:探索表观弥散系数(apparent diffusion coefficient,ADC)在前列腺影像报告和数据系统(prostate imaging-reporting and data system,PI-RADS)3分且前列腺特异性抗原(prostate specific antigen,PSA)灰区患者中对减少非必要前列腺穿刺活检的应用价值。方法:回顾性收集2019年1月—2023年12月在中国科学技术大学附属第一医院(安徽省立医院)泌尿外科接受经会阴前列腺穿刺活检患者的临床资料。对于PI-RADS 3分病灶ADC值的计算,由1位泌尿外科医生只选择病灶上最可疑的区域,即在ADC图像上最可疑区域依次绘制2个圆形感兴趣区(region of interest,ROI)(大小为10~20 mm~(-2)),影像系统将自动计算ADC值,最终的ADC值取2次绘制的ROI所对应ADC值的平均值,记为ADC_(min)。采用Mann-Whitney U检验比较各临床变量在良、恶性组的组间差异,使用受试者工作特征(receiver operating characteristic,ROC)曲线及其曲线下面积(area under curve,AUC)、灵敏度和特异度来评价各临床变量的诊断价值。结果:本研究共纳入121例患者,其中88例患者术后病理为良性、33例患者为前列腺癌(prostate cancer,PCa)(包括16例临床有意义前列腺癌患者)。前列腺体积(prostate volume,PV)、前列腺特异性抗原密度(prostate specific antigen density,PSAD)和ADC_(min)在组间比较时差异均有统计学意义。在诊断效能方面,ADC_(min)(AUC=0.810,95%CI:0.729~0.876)明显优于前列腺特异性抗原(PSA)(AUC=0.593,95%CI:0.446~0.630)、PV(AUC=0.691,95%CI:0.600~0.772)、PSAD(AUC=0.683,95%CI:0.592~0.765)。当ADC_(min)<600μm^(2)/s时,93.33%(14/15)的患者术后病理为PCa;当ADC_(min)>750μm^(2)/s时,仅有13.33%(10/75)的患者术后病理为PCa。结论:对于PI-RADS 3分且PSA灰区患者而言,ADC_(min)在区分前列腺穿刺活检术后病理良恶性中有很好的应用价值,ADC_(min)越小,患者患PCa的风险就越大。展开更多
BACKGROUND Emphysematous pyelonephritis(EPN)is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection,predominantly affecting diabetic and immunocomp...BACKGROUND Emphysematous pyelonephritis(EPN)is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection,predominantly affecting diabetic and immunocompromised patients.It carries high morbidity and mortality,requiring early diagnosis and timely intervention.Various prognostic scoring systems help in triaging critically ill patients.The National Early Warning Score 2(NEWS 2)scoring system is a widely used physiological assessment tool that evaluates clinical deterioration based on vital parameters,but its standard form lacks specificity for risk stratification in EPN,necessitating modifications to improve treatment decisionmaking and prognostic accuracy in this critical condition.AIM To highlight the need to modify the NEWS 2 score to enable more intense monitoring and better treatment outcomes.METHODS This prospective study was done on all EPN patients admitted to our hospital over the past 12 years.A weighted average risk-stratification index was calculated for each of the three groups,mortality risk was calculated for each of the NEWS 2 scores,and the need for intervention for each of the three groups was calculated.The NEWS 2 score was subsequently modified with 0-6,7-14 and 15-20 scores included in groups 1,2 and 3,respectively.RESULTS A total of 171 patients with EPN were included in the study,with a predominant association with diabetes(90.6%)and a female-to-male ratio of 1.5:1.The combined prognostic scoring of the three groups was 10.7,13.0,and 21.9,respectively(P<0.01).All patients managed conservatively belonged to group 1(P<0.01).Eight patients underwent early nephrectomy,with six from group 3(P<0.01).Overall mortality was 8(4.7%),with seven from group 3(87.5%).The cutoff NEWS 2 score for mortality was identified to be 15,with a sensitivity of 87.5%,specificity of 96.9%,and an overall accuracy rate of 96.5%.The area under the curve to predict mortality based on the NEWS 2 score was 0.98,with a confidence interval of(0.97,1.0)and P<0.001.CONCLUSION Modified NEWS 2(mNEWS 2)score dramatically aids in the appropriate assessment of treatment-related outcomes.MNEWS 2 scores should become the practice standard to reduce the morbidity and mortality associated with this dreaded illness.展开更多
Objective We aimed to investigate the patterns of fasting blood glucose(FBG)trajectories and analyze the relationship between various occupational hazard factors and FBG trajectories in male steelworkers.Methods The s...Objective We aimed to investigate the patterns of fasting blood glucose(FBG)trajectories and analyze the relationship between various occupational hazard factors and FBG trajectories in male steelworkers.Methods The study cohort included 3,728 workers who met the selection criteria for the Tanggang Occupational Cohort(TGOC)between 2017 and 2022.A group-based trajectory model was used to identify the FBG trajectories.Environmental risk scores(ERS)were constructed using regression coefficients from the occupational hazard model as weights.Univariate and multivariate logistic regression analyses were performed to explore the effects of occupational hazard factors using the ERS on FBG trajectories.Results FBG trajectories were categorized into three groups.An association was observed between high temperature,noise exposure,and FBG trajectory(P<0.05).Using the first quartile group of ERS1 as a reference,the fourth quartile group of ERS1 had an increased risk of medium and high FBG by 1.90and 2.21 times,respectively(odds ratio[OR]=1.90,95%confidence interval[CI]:1.17–3.10;OR=2.21,95%CI:1.09–4.45).Conclusion An association was observed between occupational hazards based on ERS and FBG trajectories.The risk of FBG trajectory levels increase with an increase in ERS.展开更多
文摘目的:探索表观弥散系数(apparent diffusion coefficient,ADC)在前列腺影像报告和数据系统(prostate imaging-reporting and data system,PI-RADS)3分且前列腺特异性抗原(prostate specific antigen,PSA)灰区患者中对减少非必要前列腺穿刺活检的应用价值。方法:回顾性收集2019年1月—2023年12月在中国科学技术大学附属第一医院(安徽省立医院)泌尿外科接受经会阴前列腺穿刺活检患者的临床资料。对于PI-RADS 3分病灶ADC值的计算,由1位泌尿外科医生只选择病灶上最可疑的区域,即在ADC图像上最可疑区域依次绘制2个圆形感兴趣区(region of interest,ROI)(大小为10~20 mm~(-2)),影像系统将自动计算ADC值,最终的ADC值取2次绘制的ROI所对应ADC值的平均值,记为ADC_(min)。采用Mann-Whitney U检验比较各临床变量在良、恶性组的组间差异,使用受试者工作特征(receiver operating characteristic,ROC)曲线及其曲线下面积(area under curve,AUC)、灵敏度和特异度来评价各临床变量的诊断价值。结果:本研究共纳入121例患者,其中88例患者术后病理为良性、33例患者为前列腺癌(prostate cancer,PCa)(包括16例临床有意义前列腺癌患者)。前列腺体积(prostate volume,PV)、前列腺特异性抗原密度(prostate specific antigen density,PSAD)和ADC_(min)在组间比较时差异均有统计学意义。在诊断效能方面,ADC_(min)(AUC=0.810,95%CI:0.729~0.876)明显优于前列腺特异性抗原(PSA)(AUC=0.593,95%CI:0.446~0.630)、PV(AUC=0.691,95%CI:0.600~0.772)、PSAD(AUC=0.683,95%CI:0.592~0.765)。当ADC_(min)<600μm^(2)/s时,93.33%(14/15)的患者术后病理为PCa;当ADC_(min)>750μm^(2)/s时,仅有13.33%(10/75)的患者术后病理为PCa。结论:对于PI-RADS 3分且PSA灰区患者而言,ADC_(min)在区分前列腺穿刺活检术后病理良恶性中有很好的应用价值,ADC_(min)越小,患者患PCa的风险就越大。
文摘BACKGROUND Emphysematous pyelonephritis(EPN)is a life-threatening necrotizing renal parenchyma infection characterized by gas formation due to severe bacterial infection,predominantly affecting diabetic and immunocompromised patients.It carries high morbidity and mortality,requiring early diagnosis and timely intervention.Various prognostic scoring systems help in triaging critically ill patients.The National Early Warning Score 2(NEWS 2)scoring system is a widely used physiological assessment tool that evaluates clinical deterioration based on vital parameters,but its standard form lacks specificity for risk stratification in EPN,necessitating modifications to improve treatment decisionmaking and prognostic accuracy in this critical condition.AIM To highlight the need to modify the NEWS 2 score to enable more intense monitoring and better treatment outcomes.METHODS This prospective study was done on all EPN patients admitted to our hospital over the past 12 years.A weighted average risk-stratification index was calculated for each of the three groups,mortality risk was calculated for each of the NEWS 2 scores,and the need for intervention for each of the three groups was calculated.The NEWS 2 score was subsequently modified with 0-6,7-14 and 15-20 scores included in groups 1,2 and 3,respectively.RESULTS A total of 171 patients with EPN were included in the study,with a predominant association with diabetes(90.6%)and a female-to-male ratio of 1.5:1.The combined prognostic scoring of the three groups was 10.7,13.0,and 21.9,respectively(P<0.01).All patients managed conservatively belonged to group 1(P<0.01).Eight patients underwent early nephrectomy,with six from group 3(P<0.01).Overall mortality was 8(4.7%),with seven from group 3(87.5%).The cutoff NEWS 2 score for mortality was identified to be 15,with a sensitivity of 87.5%,specificity of 96.9%,and an overall accuracy rate of 96.5%.The area under the curve to predict mortality based on the NEWS 2 score was 0.98,with a confidence interval of(0.97,1.0)and P<0.001.CONCLUSION Modified NEWS 2(mNEWS 2)score dramatically aids in the appropriate assessment of treatment-related outcomes.MNEWS 2 scores should become the practice standard to reduce the morbidity and mortality associated with this dreaded illness.
基金supported by the Key Research and Development Program of the Ministry of Science and Technology of China(grant number:2016YF0900605)the Key Research and Development Program of Hebei Province(grant number:192777129D)+1 种基金the Joint Fund for Iron and Steel of the Natural Science Foundation of Hebei Province(grant number:H2016209058)the National Natural Science Foundation for Regional Joint Fund of China(grant number:U22A20364)。
文摘Objective We aimed to investigate the patterns of fasting blood glucose(FBG)trajectories and analyze the relationship between various occupational hazard factors and FBG trajectories in male steelworkers.Methods The study cohort included 3,728 workers who met the selection criteria for the Tanggang Occupational Cohort(TGOC)between 2017 and 2022.A group-based trajectory model was used to identify the FBG trajectories.Environmental risk scores(ERS)were constructed using regression coefficients from the occupational hazard model as weights.Univariate and multivariate logistic regression analyses were performed to explore the effects of occupational hazard factors using the ERS on FBG trajectories.Results FBG trajectories were categorized into three groups.An association was observed between high temperature,noise exposure,and FBG trajectory(P<0.05).Using the first quartile group of ERS1 as a reference,the fourth quartile group of ERS1 had an increased risk of medium and high FBG by 1.90and 2.21 times,respectively(odds ratio[OR]=1.90,95%confidence interval[CI]:1.17–3.10;OR=2.21,95%CI:1.09–4.45).Conclusion An association was observed between occupational hazards based on ERS and FBG trajectories.The risk of FBG trajectory levels increase with an increase in ERS.
