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 explore the influence of hematopoietic growth factors on the TBI patients in the conditioning regimen for stem cell transplantation,and to evaluate the effect of cytokines on treatment of acute radiation disease.Methods The usage of hematopoietic growth factors,implantations and the side-effects of the patients and donors of TBI in the conditioning regimen for stem cell transplantation were retrospectively analysed from 1990 to 2012,and the effect and side-effects of cytokines on the hematopoietic function recovery and stem cell mobilization were observed.Results All patients recovered from their hematopoietic function except one died due to the side-effecs.The median time of white blood cell recover was 10 d in auto-SCT and 12 d in allo-SCT in the G-CSF group.The median day of platelet recovery was 11.67 ± 1.53 in rhIL-11 arm and 13.70 ±6.27 in no rhIL-11 arm in the auto-SCT group.The incidence rates of dental ulcer and diarrhea in the TBI patients were 48％ and 44％,respectively.The occurrence of side-effect was rare in the period of cytokines treatment,but was over 50％ during stem cell mobilization.Conclusions Cytokines play very important roles in the hematopoietic function recovery and stem cell mobilization in the TBI patients.

Objective To explore the significance of 1.5-Tesla MRI in the early diagnosis of prostate cancer,and analyze the imaging features in T2WI which are helpful for the diagnosis on early prostate cancer.Methods The clinical data of patients with PSA ＜ 20 μg/L who received prostate biopsy between Feb.2006 and Jan.2011 were reviewed including pelvic MRI and biopsy results.We retrospectively analyzed T2WI image features and evaluated the signal of peripheral zone,seminal vesicles,prostate capsule and the relationship with their surrounding tissues.The results of the reading were analyzed with reference to histopathologic evaluation of prostate biopies.Results Among 359 patients,137 patients were diagnosed prostate cancer and 332 cases were found with low signal lesions on peripheral zone of T2WI.Univariate logistic regression analysis showed that age and PSA are closely related to the diagnosis of prostate cancer (P ＜ 0.05).Low signal lesions on peripheral zone of T2WI are more helpful for the diagnosis of prostate cancer on the image.Number,shape,margin of lesions,the contour of the prostatic capsule,the boundary of peripheral zone and transitional zone are significantly associated with the diagnosis of prostate cancer.Through multivariate logistic regression analysis,it was found that age (P ＜ 0.05),PSA (P ＜ 0.05),prostate volume (P ＜ 0.05),lesion shape (flaky vs nodular,P ＜ 0.05 ; diffuse vs nodular,P ＜ 0.05) and the contour of the prostatic capsule (disappearing vs completely clear,P ＜ 0.05) are risk factors of prostate cancer.The areas under receiver operating characteristic curve are 0.833 (P ＜ 0.05).Conclusions In T2WI,lesion shape and the contour of the prostatic capsule are risk factors of prostate cancer.Age,PSA,prostate volume are also significantly associated with the diagnosis of prostate cancer.

Objective To explore the clinical value of image gradings of T2 weighted imaging (T2WI) and diffusion weighted imaging (DWI) for prostate cancer diagnosis in patients with prostate specific antigen (PSA) less than 20 μg/L.Methods A total of 133 patients with PSA＜20 μg/L who received prostate biopsies in our hospital from December 2011 to January 2013 were recruited.The prostate was divided into six regions in MRI images.T2WI and DWI image gradings on each region in peripheral zone were evaluated with reference to histopathological evaluation of prostate biopsies.The significance of grading system for the diagnosis of prostate cancer in the two scanning methods alone or in combination were compared.Results 60 patients were diagnosed as prostate cancer.The positive biopsy rates were 2.8％,13.5％,20.4％,34.6％,52.6％ and 88.9％,respectively in grade 0-5 based on T2WI imaging grading.The positive biopsy rates were 11.1％,16.1％,48.5％,71.0％ and 86.1％,respectively in grade 1-5 based on T2WI+ DWI imaging grading.The positive biopsy rate was significantly increased with the increments of pre-established T2WI and T2WI+DWI image gradings (Z=-9.8552,-13.4148,both P＜0.0001).Receiver operating characteristic analysis showed that the diagnostic capability was better in T2WI combined with DWI than in T2W1 alone in prostate cancer detection (AUC:0.743 vs.0.715,P=0.0072).Conclusions T2WI image grading can predict the risk of prostate cancer in patients with PSA＜20 μg/L,and DWI can enhance the ability to predict prostate cancer.

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.