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.

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.

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.

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.

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 investigate the risk factors for postoperative delirium in patients undergoing noncardiac surgery. Methods From September-December 2009, 480 patients undergoing elective noncardiac surgery were included in this study. The criteria for enrolment of the patients in this study were (1) age ≥ 65 yr,(2) age ＜ 65 yr if associated with coronary artery disease, hypertension, diabetes mellitus, brain injury, cerebral hemorrhage, cerebral infarct, emphysema, chronic bronchitis; duration of operation ≥ 3 h and intraoperative blood loss was expected to exceed 20% of blood volume. The diagnosis of delirium was based on Confusion Assessment Method (CAM). Multivariate logistic regression was used to analyze the risk factors for postoperative delirium.Results Postoperative delirium developed in 79 patients during the first three postoperative days. The incidence of postoperative delirium was 16.5%. The logistic stepwise regression analysis indicated that the risk factors for delirium included advanced age, method of anesthesia, long operation, postoperative pain, emphysema and alcholic. Conclusion Age, method of anesthesia, long operation, postoperative pain, emphysema and alcholic are risk factors for postoperative delirium in patients undergoing noncardiac surgery.

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.

Objective To investigate the status of geriatric doctors' acknowledge and treatment of outpatients with lower urinary tract symptoms in 15 Chinese cities.Methods The investigation was conducted in 15 Chinese cities and involved 1056 geriatric doctors from December 2013 to February 2014.The questionnaire survey was made in behavior,attitude,skill and knowledge(BASK)of LUTS.The geriatric doctors participated in the investigation by answering the questionnaires about acknowledge for definition,etiology,diagnosis and treatment of the LUTS,and in results discussion,which was aimed at improving participants' cognition for diagnosis and treatment of elderly LUTS and at strengthening the practice.The final objective was to promote diagnosis standardization and to improve the level of clinical diagnosis and treatment for the elderly 1UTS.Results 95.9％ of geriatric doctors considered that they knew well the main clinical manifestations of LUTS.However,34.3 ％ of geriatric doctors were able to classify the symptoms of LUTS correctly.More than 90.0 ％ of geriatric doctors considered that the causes of LUTS were variable and they mastered the common cause of LUTS.But,38.0％ of them were able to completely master the causes of LUTS and 35.5％ would actively ask outpatients about the symptoms.70.0％ of the doctors thought they were familiar with the initial manifestations of LUTS and benign prostatic hypertrophy(BPH).However,many Chinese geriatric doctors didn't follow up the guidelines and 30.0％ of them failed to evaluate the severity of LUTS via IPSS(International Prostatic Symptom Score).75.8％ of geriatric doctors considered that they would give the patients the best treatment options by comprehensive assessment.However,60.0％ of them didn't know that α1 receptor blocker was the first line of treatment option of patients with moderate severe LUST.More than half of them were unclear that the patients with prostate volume under 40 ml could be treated by α1 receptor blocker.82.3％ of geriatric doctors considered that LUTS and hypertension should be treated respectively.But,55.0％ of them didn't know that ALLHAT trial has proved that Doxazosin would increase the risk of cardiovascular event.Conclusions The geriatric doctors are now able to pay attention to outpatients with LUTS,but still should further strengthen their acknowledge on the definition,cause,diagnosis and treatment of LUTS.

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 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.