Objective To explore the causes of readmission after prostatectomy for BPH and to discuss the treatment approaches. Methods A total of 106 cases who were eligible for the study were reviewed.47 cases had residual and recurrent adenoma;of these cases,42 underwent TURP and 5 open prostatectomy again.32 cases developed urethral stricture;of these cases 27 underwent transurethral cold knife incision plus electric resection of scar and 3 urethral orifice reconstruction and 2 suprapubic cystostomy.11 cases who had experienced bleeding after TURP underwent transurethral bladder washing and coagulating.7 cases had neuropathic bladder dysfunction;of these cases 2 underwent transurethral bladder neck circle muscle resection,3 intermittent self-catheterization and 2 suprapubic cystostomy.6 cases had prostatic cancer;of these cases 1 underwent radical prostatectomy,3 palliative TURP plus orchiectomy and 2 orchiectomy.2 cases had incontinence after TURP;of the 2 cases 1 used external collecting device and 1 was transfered to other hospital for surgery.1 case had abdominal incision hernia and then underwent hernia repair. Results Among 106 cases, 97 cases underwent operations and of them 84 (86.6%) cases achieved successful results.The follow-up time was 6 months to 15 years with a mean of 5 years and 8 months.9 cases with urethral stricture required regular urethral dilation after surgery.4 cases who had had unsuccessful surgery underwent suprapubic cystostomy.Other 9 cases did not undergo operations due to poor health and other reasons. Conclusions Correct preoperative diagnosis, rational surgical type and adequate intraoperative and postoperative management are key to preventing readmission. Transurethral surgery is most favorable treatment choice for readmitted patients after prostatectomy for BPH.

BACKGROUND: It is proposed that elevated serum homocysteine is an important independent risk factor for ischemic stroke (IS), and 5, 10-methylenetetrahydrofolate reductase (MTHFR) is the key enzyme for homocysteine metabolism. The relationship between genetic mutation of MTHFR and IS remains controversial.OBJECTIVE: To examine the association of hyperhomocysteinemia and two MTHFR gene polymorphisms with IS in Northwest Chinese population.DESIGN: Case-control study.SETTING: Department of Neurology, First Hospital Affiliated to Jilin University, and Department of Neurology, Xijing Hospital, Fourth Military Medical University of Chinese PLA.PARTICIPANTS: Ninety-seven consecutive patients with ischemic stroke (71 males and 26 females) treated between November 2001 and May 2002were recruited, who were diagnosed by CT scan or MRI in the Department of Neurology, Xijing Hospital, Fourth Military Medical University of Chinese PLA. The control group consisted of 94 subjects (58 males and 36 females) without history of ischemic stroke. All the subjects were free of intracranial hemorrhage, cancer, renal dysfunction, and none used multivitamins or estrogen.METHODS: Serum homocysteine was measured by fluorescence polarization immunoassay. Polymerase chain reaction-restriction length polymorphism (PCR-RFLP) method was employed to detect the genotype at the two sites of C677T and A1298C in MTHFR gene.MAIN OUTCOME MEASURES: Serum homocysteine levels and the genotypic frequency frequencies of the two mutations of MTHFR.RESULTS: The 677T allele frequency was 59.3% in IS patients and 44.7% in the controls, showing significant differences (P=0.006), but no difference in 1298C allele frequency was detected between the two groups (22.7% vs 19.7%, P ＞ 0.05). Homozygous 677TT genotype was closely associated with hyperhomocysteinemie (P ＜ 0.01). In multivariate logistic regression analysis,677T gene mutation and hyperhomocysteinemie were all associated with the IS, with an OR of 1.870 and 1.031 (P＜ 0.05), respectively.CONCLUSION: Hyperhomocysteinemie is a risk factor of IS, and C677T mutation significantly increases homocysteine levels, and serves also as an independent genetic risk factor of IS.

A 68?year?old female patient was admitted to the hospital for multiple masses in the mouth and lungs as well as on dorsal hands for more than 20 days without obvious subjective symptoms. No abnormalities were found by physical examination. Dermatological examination showed two bean?sized dark?red nodules on the upper jaw as well as one pigeon egg?sized dark?red nodule on the left dorsal hand, and all the nodules were hard with smooth surfaces and limited mobility. Positron emission tomography?computed tomography (PetCT) revealed multiple metastases to the brain, lymph nodes, lungs, gastrointestinal tract, both kidneys, multiple bones and intermuscular tissues. Pathology of nodules from the upper jaw showed lowly differentiated tumor cells with osteoid matrix, chondroid structures and tumor bone in local areas, and immunohistochemical examination of tumor cells found positive staining for S100(focally), vimentin, CD99, P63 and Ki?67(60%), but negative staining for keratin. A diagnosis of osteosarcoma of the right side of the upper jaw was considered. Pathology of nodules from the dorsal hand revealed no obvious abnormalities in the epidermis, while there was a diffuse infiltration of medium?to large?sized histiocyte?like cells in the whole dermis with cell atypia and irregularly red?stained bone matrix and tumor bone in some regions. Immunopathology showed positive staining for Ki67(60%), and negative staining for CD3, CD10, CD20, Bcl?2, and Bcl?6. A diagnosis of cutaneous metastasis of osteosarcoma was made. The patient refused further treatment and died 6 months after the onset of lesions.

Bi-specific antibodies (BsAb) P210/MMC, P210/TNP and P40/CD3 were prepared with different approaches. Among 11 fusions, 7, 484 wells were planted, and 223 dual positive wells were obtained from 1, 111 growth wells, only five hybrid-hybridomas secreting BsAb were obtained, showing the difficulties to prepare BsAb. It was shown that bridge assay is very important for identification of the BsAb. Among 12 triomas secreting y and ? chains, only two had BsAb. Therefore, the frequency for y and ? to combine to BsAb was 16.7(2/12). BsAb(P210/TNP) with versatile adaptor could mediate cytotoxic effects on target cells of different cytotoxic agents conjugated with TNP.Moreover, BsAb(P40/CD3) could mediate cytotoxic effects of peripheral blood lymphocytes (PBLs) on target cells. With local injection, four times treatments could abolish the tumor xenografts in nude mice.

The efficacy of Chinese herbal formula in treating depression has been proved in many studies. In this study, six different Kaixin San formulas were compared to investigate their effects on central monoamine neurotransmitters of chronic stress rats and against depression based on their different components in plasma, in order to discuss the efficacy-comparability relationship and the possible efficacy mechanism. The classic isolation method and the chronic unpredictable mild stress (CUMS) depression model were combined to investigate the changes in contents in hippocampus and monoamine neurotransmitters (NE, DA, 5-HT) and the components of some formulas in plasma with HPLC and UPLC-Q-TOF-MSE methods. As a result, Dingzhi Xiaowan recorded in Essential Recipes for Emergent Use Worth A Thousand significantly increased the behavioral scores, NE and 5-HT contents in hippocampus and NE, DA and 5-HT contents in cortex, with the best anti-depressant effect. Dingzhi Xiaowan recorded in Complete Records of Ancient and Modern Medical Works showed a notable increase in sucrose preference and open field score in model rats, NE content in hippocampus and NE, DA and 5-HT contents in cortex, with a certain anti anti-depressant effect. Kaixin San recorded in Ishinpo showed remarkable rise in weight of model rats. NE content in hippocampus and DA content in cortex. Puxin Decoction recorded in A Supplement to Recipes Worth A Thousand Gold showed 5-HT content in hippocampus and DA content in cortex. Kaixin San recorded in Yimenfang only showed DA content in cortex. Kaixin Wan recorded in Essential Recipes for Emergent Use Worth A Thousand did not mention the antidepressant effect. According to the results, the formulas' different anti-depressant effects may be related to the different plasma components.
Animals ; Behavior, Animal ; drug effects ; Biogenic Monoamines ; analysis ; Brain Chemistry ; drug effects ; Chronic Disease ; Drugs, Chinese Herbal ; pharmacology ; Male ; Medicine, Chinese Traditional ; Neurotransmitter Agents ; analysis ; Norepinephrine ; analysis ; Rats ; Rats, Sprague-Dawley ; Serotonin ; analysis ; Stress, Psychological ; metabolism

Objective To study the diagnosis and treatment of primary adenosquamous carcinoma (ASC) of liver.Methods The clinical and histopathological data of 2 patients with ASC were analyzed retrospectively.The cases were confirmed by surgery and histopathological examination.Results The tumors were located in the left liver in these 2 patients.Both patients presented with abdominal pain and they underwent surgical resection.On gross pathological examination,the tumors were irregular in shape with unclear boundaries.Microscopically,the tumor cells were arranged in a nesting pattern with a tubular structure,which was an adenosquamous carcinoma structure.One patient survived 4 months after surgery and the other patient died of intrahepatic tumour recurrence 7 months after surgery.Conclusions The diagnosis of primary hepatic ASC relied on histopathological examination.Surgical resection was safe and feasible.

Objective To study the clinical efficacy of tolterodine tartrate combined with transcutaneous electrical nerve stimulation(TENS)in the treatment of elderly female patients with overactive bladder(OAB).Methods 30 patients with OAB were randomly divided into single treatment with tolterodine tartrate and combination treatment of tolterodine tartrate and TENS for 10d.The efficacy was evaluated by overactive bladder symptom score(OABSS),patient perception of bladder condition(PPBC),quality of life(QOL),visual analogy scale(VAS)and 5 grade pain scores.Results The post-treatment symptoms of urgent urination and urinary incontinence,OABSS,PPBC,QOL,VAS and 5 grade pain scores in single treatment group[(1.67±1.45)times /d,(1.53±1.25)times /week,(6.67±2.55)scores,(2.07±0.96)scores,(2.07±1.03)scores,(3.67±0.90)scores and(4.07±0.80)scores]were improved as compared with pre-treatment[(6.40±1.45)times /d,(3.93±1.03)times/week,(13.00±1.00)scores,(4.20±0.68)scores,(3.80±0.68)scores,(7.13± 1.19)scores and(9.40± 1.55)](t=8.94,5.74,8.94,7.03,5.44,9.01 and 11.85,all P＜0.01).The above indexes in combination treatment group after treatment[(1.27±0.80)times/d,(1.20±0.77)times/week,(5.33±1.72)scores,(1.67±0.62)scores,(1.47±0.52)scores,(2.93±0.80)scores and(3.40±0.99)scores]were also improved as compared with pretreatment[(6.20±1.26)times/d,(4.00±1.25)times/week,(12.73±1.03)scores,(4.07±0.80)scores,(4.00±0.65)scores,(7.47±0.74)scores and(9.67±1.35)scores](t=12.77,7.36,14.29,9.21,11.77,16.09 and 14.55,all P＜0.01).The VAS and 5 grade pain scores were higher in combination treatment group than in single treatment group(t=4.879 and 2.746,P＜0.01).Conclusions Tolterodine tartrate combined with TENS is safe and effective for the treatment of elderly female patients with OAB,and may alleviate pain and improve quality of life.

Objective To verify the safety and feasibility of applying laparoendoscopic singlesite radical prostatectomy (LESS-LRP) in the treatment of prostate cancer. Methods From Sept. to Dec. 2010, LESS-LRP was used to treat 2 early stage prostate cancer patients. The LESS-LRP was preformed through extra-peritoneal approach by using standard laparoscopic instruments and a 5 mm flexible laparoscope. This technique were evaluated in respects of operative time, estimated blood loss, intraoperative complications, drainage time, post-operative pain score (VAPS), post-operative hospital stay, pathological results and post-operative PSA levels. Results All procedures of the 2cases were completed with LESS-LRP without conversion to standard laparoscopic or open radical prostatectomy. The operative times for LESS-LRP were 280 and 285 min, estimated blood loss were 400 and 200 ml, respectively. There was no severe intraoperative complication. The drainage times were 2 and 6 d, the VAPS in the first post-operative day were 1 and 0, and post-operative hospital stay were 14 and 7 d. There was no secondary bleeding or wound infection. The 2 prostate cancer cases were all in pathological stage pT2c N0 M0. Surgical margins of the specimens were negative. The first case showed PSA of 0. 033 ng/ml 1 month after the surgery. Conclusion LESS-LRP can be an exploratory option in clinical for the treatment of prostate cancer.

Objective To verify the clinical safety and feasibility of applying laparoendoscopic single-site surgery (LESS) in the treatment of elder patients with urological tumors. Methods From August 2010 to March 2011, LESS technique was used to do prostatectomy in five cases, nephrectomy in 3 cases and adrenalectomy in four cases. Quadport was inserted through a transumbilical incision. Flexible tip 5 mm laparoscope and standard laparoscopic instruments were employed. This technique was evaluated in respects of operative time, estimated blood loss, intraoperative complications, drainage time, post-operative visual analogue pain scale (VAPS), post-operative hospital stay and pathological change. Results All the procedures in this group were completed successfully with LESS. There was no additional trocarand conversion to standard laparoscopic or open surgery. Application of Quadport reduced the clash of instruments. Carefully performing surgery and avoiding blunt dissection to reduce intraoperative bleeding is the cornerstone of success. The operative time and estimated blood loss were (192.0±76.7) min and (174.6±167.2) ml, respectively. There was no severe intraoperative complication and blood transfusion. The VAPS in the first post-operative day was (0.9 ± 1.0) minutes and the drainage time was (3.5±1.7) d while post-operative hospital stays were (7.9±3.4) d. There was no occurrence of secondary bleeding and wound infection. Conclusions LESS is a safe and feasible alternative for the treatment of urological tumors in elderly patients, but needs further clinical investigation.

ObjectiveTo verify the safety and feasibility of retroperitoneal laparoendoscopic singlesite surgery (LESS) adrenalectomy in the treatment of adrenal gland tumors or cyst.MethodsFrom Oct.2009 to Jan.2012,7 patients underwent retroperitoneal LESS adrenalectomy with Quadport technology by one surgeon.The mean patient age was 46 ( 39 - 55 ) years.The mean largest tumor diameter was 2.3 (1.8-3.6) cm.All procedures were performed through retroperitoneal approach by using Quadport,tip flexible laparoscope with 0° lens and conventional laparoscopic instruments.This technique was evaluated in respects of operative time,estimated blood loss,intraoperative complications,drainage time,visual analog pain scale (VAPS) score,post-operative hospital stay and pathological results.ResultsSeven cases of LESS adrenalectomy were completed successfully.There was no additional trocar added,no conversion to conventional laparoscopic or open approach.The mean operative time was 106 (70 - 180) min,and the mean estimated blood loss was 59 (5 -200) ml.The mean first day post-operative VAPS score was 2 (1 -3),drainage time was 2 (2 -3) d.Post-operative hospital stay was 5 (3 -6) d.No perioperative complication was observed.Pathological results showed 1 case of adrenal pheochromocytoma,5 cases of adrenal cortical adenoma and 1 case of adrenal cyst.ConclusionRetroperitoneal LESS adrenalectomy is a safe and feasible option for the treatment of adrenal tumors and cyst.