Objective To estimate the diagnostic significance and indication of repeated prostate biopsy in patients with persistently abnormal serum PSA.Methods From Jan 2004 to Sep 2011,90 patients with persistently abnormal serum PSA levels underwent transperineal ultrasound guided template prostate biopsy.They were diagnosed as benign lesions (BPH 66/90,PIN 10/90,ASAP 14/90)by previous first biopsies.The ages were 43 to 86 years old (mean age 71),and their PSA levels were fluctuated in a range of 3.1 to 168.0 μg/L (mean 17.6 μg/L),26 patients were abnormal in digital rectal examination (DRE).Results According to the repeated biopsies,it was divided into three groups including benign group (57/90),PIN or ASAP group (5/90) and PCa group (28/90).21.2％ patients were confirmed as PCa (14/66) in BPH group,while 60％ (6/10) patients in PIN group and 57.1％ (8/14) patients in ASAP group were confirmed as PCa.There were significant differences in BPH group compared with PIN or ASAP group (P＜0.05).The mean prostate volume (PV) was (65.9±22.6) ml in benign group and (50.4±20.8) mlin PCa group,while abnormal DRE were foundin 7/41 in benign group and 5/9 in PCa group.There was significant differences in PV and DRE between the two groups (P＜0.05).There were no significant differences in age,PSA,PSAD,PV or DRE between PIN and ASAP group (P＞0.05).Conclusions Repeated biopsy can improve the diagnosis of PCa in patients with persistently abnormal serum PSA.Smaller PV or abnormal DRE in the patients who were diagnosed as BPH by previous first biopsies may strongly need repeated biopsies,while in the patients who were diagnosed as PIN/ASAP by previous first biopsies,repeated biopsies were required despite any age,PSA,PSAD,PV or DRE.

Objective To analyze the risk factors for ventilator-associated pneumonia(VAP)in children after cardiopulmonary bypass(CPB).Methods Between January 2003 and June 2010,116 consecu tive cases receiving postoperative ventilation for more than 48 hours were included in this study.The patients were assigned into a VAP group(n =57)and non-YAP group(n =59).Univariate and multivariate logistic regression analysis were used to identify the risk factors.Results The overall incidence of VAP was 4.18％(57/1 365).The mortality of VAP was 26.32％(15/57).Univariate risk factors included severe pulmonary hypertension,CPB time,aortic cross-clamping time,secondary CPB support,plasma albumin,low ratio of ar terial oxygen tension to inspired oxygen fraction(PaO2/FiO2),mechanical ventilation time,the volume of postoperative drainage per kilogram of body weight,re-intubations,tracheotomy,gastric tube retention,pre vention of stress ulcer.Multivariate logistic regression analysis showed that risk factors included CPB time≥150 min,mechanical veritilation time ≥4 d,the volume of postoperative drainage per kilogram of body weight ≥ 18 ml and tracheotomy.A total of 90 pathogens were obtained by sputum culture in 57 VAP patients.There were 54 cases(60.0％)gram negative bacilli,32 cases(35.6％)of gram positive bacilli and 4 cases (4.4％)of eumycetes.Conclusion These results suggest that the patients with risk factors described above need more careful and postoperative surveillance and management.

Objective To retrospectively analyze the clinical data of 3 middle-aged and elderly cases with inflammatory myofibroblastic tumor (IMT) of the kidney,in order to improve its diagnosis and treatment.Methods The records of 3 patients who were diagnosed as IMT of the kidney by pathology in our hospital from Jan 2005 to Jun 2014 were reviewed to identify the characteristics including age,gender,clinical manifestation,tumor imaging and pathological features,treatment and prognosis.Results The mean age of the patients was 60 years.One patient underwent partial nephrectorny,1 patient underwent radical nephrectomy,and another patient received nephroureterectomy with bladder cuff excision.Patients were followed up for 8 months to 10 years,and no tumor recurrence was found.Conclusions IMT of the kidney is the tumor of low malignant potential with a good prognosis.Surgery is the first choice for the diagnosis and treatment.

BACKGROUND:It is unclear whether serial cel passage in vitro influences the differentiation of bone marrow mesenchymal stem cel s into neural stem cel s.
OBJECTIVE:To investigate the effect of cel passage on the differentiation of bone marrow mesenchymal stem cel s into neural stem cel s.
METHODS:Rat bone marrow mesenchymal stem cel s were isolated and cultured by the whole bone marrow adherence method. Bone marrow mesenchymal stem cel s at passages 3, 6, 9, 12 were incubated in serum-free medium. After culture for 7 and 14 days, cel biological characterization was observed and differenitaiton ability into neural stem cel s was observed by detecting Nestin expression in cel s using flow cytometry. Then, the cel s were further induced to differentiate and cel multipotential differentiation capacity was detected by measurement of nerve enolase and glial acidic protein expression.
RESULTS AND CONCLUSION:Under induction, bone marrow mesenchymal stem cel s at different passages were al differentiated into Nestin-positive neural stem cel s. However, there was a significant difference in differentiation proportion of cel s at different passages (P<0.05). Strongest differentiation ability was found in the passage 6 cel s, with the Nestin expression up to (93.7±2.3)%at 7 days of induction and (96.2±1.8)%at 14 days of induction. The proportion of differentiated cel s at passages 6 and 9 was signfi cantly higher than that at passages 3 and 12. Moreover, adherent cel s were positive for nerve enolase and glial acidic protein. Al these findings indicate that the differentiation of bone marrow mesenchymal stem cel s into neural stem cel s is correlated with cel passage. Cel s at lower or higher passages are both detrimental to cel differentiation.

Objective To investigate the influence of intensive insulin therapy on the short-term prognosis in children after cardiac surgery.Methods A total of 320 children including 192 males and 128 females who underwent cardiac surgery were enrolled in this study from Jan 2009 to Dec 2010 at the cardiac surgery department of Chengdu cardiovascular hospital.The age of these children ranged from 3 months to 12years old.According to insulin administration time and blood glucose control level,they were randomly divided into two groups.In group A,there were 165 patients who received continuous insulin infusion to maintain postoperative gloucose levels between 4.4 and 6.1 mmol/L,while 155 patients in group B received insulin infusion when their glucose levels were higher than 11.1 mmol/L to control the levels between 6.1 and 11.1 mmol/L.Then the postoperative complications and blood glucose controlling were compared and analyzed.Results A total of 320 children were enrolled,and 4 800 recorded data were analyzed.The mean blood glucose level was (5.58 ±0.54) mmol/L in group A and (7.73 ±0.85) mmol/L in group B (P ＜0.01 ),and both of them were controlled within the target range.The incidence of hypoglycemia ( ＜3.3 mmor/L) was 1.65％ (38/2310)in group A and 1.04％ (26/2490) in group B.The incidence of severe hypoglycemia ( ＜2.2 mmol/L) was 0.13 ％ ( 3/2 310 ) in group A and 0.08 ％ ( 2/2 490 ) in group B.The incidences of hypoglycemia and severe hypoglycemia were significantly increased in group A compared to group B ( P ＜0.01 ).The incidence of infection in group A was lower than that in group B [3.03％ (5/165) vs 9.68％ (15/155),P ＜0.05],but there was no significant difference between the two groups in the incidences of malignant arrhythmia,circulation failure or shock,multiple organ dysfunctive syndrome and mortality.Conclusion Intensive insulin therapy can't improve the short-term prognosis in children after cardiac surgery.

Objective To improve the recognization of bilateral adrenal tumors from different tissues and to discuss the treatment.Methods One case of bilateral adrenal tumors from different tissues:pheochromocytoma in one side and adrenocortical adenoma in the other side was reported and the data of syptoms,physical features,auxillary examination,diagnosis and treatment were retrospectively reviewed.Results The patient was diagnosed as adrenocorticotropic hormone (ACTH) -independent Cushing's syndrome in other hospital and received laparoscopic adrenalectomy for right adrenal tumor.During the operation the blood pressure fluctuated seriously and was even more than 200 mm Hg.The pathological report showed the mass was pheochromocytoma.After the operation,the patient's clinical manifcstation was not changed.Half a year later the lab test showed blood ACTH was still less than 5 pg/ml,24 h urinary-free cortisol (UFC) was 571.32 μg,and 24 h urinary catecholamines (U CA) was:noradrenalin (NE) 22.80 μg,epinephrine (E) 2.55 μg,dopamine (DA) 92.92 μg.CT detected a mass in left adrenal gland.The patient received laparoscopic adrenalectomy for left adrenal tumor after being transferred to Peking Union Medical College Hospital.The tumor was proved as adrenocortical adenoma by postoperational pathology.One week after the operation,the 24 h UFC was 56.2 μg.Conclusions Bilateral adrenal tumors from different tissues are very rare in clinic.Adrenalectomy for tumors from both sides and remaining the normal adrenal glands are recommended.

Objective To report outcomes of patients with PSA ≥ 30 μg/L with initial negative transperineal template-guided saturation biopsy (TTSB). Methods From 2003 to 2010,a total of 1824 patients underwent transperineal saturation biopsies with the prostate template at the Peking Union Medical College Hospital.44 of them had initial negative biopsy with PSA ≥ 30 μg/L were reviewed in this study.The mean age was 68 years old (range,51 to 80).The mean biopsy cores were 28.7 (range,11 to 44).The median PSA level was 40 μg/L (range,30 to 128),and the median prostate volume was 73 ml (range,30 to 190).They were divided into four groups:TURP group,chronic prostatitis group,repeat biopsy group and miscellaneous group. Results Patients were followed up for a mean of 49 months (range,12 to 91).All patients of TURP group (15 cases) were identified as prostatic hyperplasia by postoperative pathology.2 of them had a second TTSB for PSA ＞ 10 μg/L after TURP,which were negative.5 patients of chronic prostatitis group had a declining PSA level after antibiotic therapy for 3 to 4 weeks.One patient took a second biopsy,which was identified as prostatitis.All patients of repeat biopsy group (18 cases) showed no significant decrease in PSA level during follow-up and undertook biopsies 2 to 4 times,6 of which were proved to be prostate cancer.All patients of the miscellaneous group (6 cases) had a declining PSA and didn't take a second biopsy. Conclusions Close follow-up and regular PSA testing for patients who had a high PSA level with initial negative biopsy would be help to avoid both false negative of prostate cancer and unnecessary biopsy.

Objective To evaluate the effects of inhaled nitric oxide(INO) in the early period after Fontan operation. Methods Twenty children receiving INO [(10 ～ 25) × 10 -6] after fight heart bypass for congenital heart disease were evaluated. The changes of hemodynamic and respiratory parameters were observed at two different intervals. The levels of methemoglobin (MetHb)and nitrogen dioxide(NO2)were monitored. Results In INO therapy group,CVP decreased from (20.8±4.8) mm Hg to (14.3±1.8) mm Hg,TPG decreased from (16.3 ±3.0) mm Hg to (8.8±2. 1) mm Hg,PaO2/FiO2 increased from (70.3±16.9) mm Hg to (120.5 ±14.0) mm Hg,and arterial oxygen saturation increased from 0. 78 ±0. 14 to 0. 91 ±0. 09 ,blood lactic acid level decreased from (3.98 ± 0. 86) mmol/L to (1.29 ± 1.60) mmol/L. No toxic side effect was observed. Conclusion INO has no significant long-term effect on patients after Fontan operation, but it can improve respiratory function, and reduce the incidence of low cardiac output syndrome and high cava pressure caused by reactive elevation of pulmonary vascular resistance in the early postoperative period after Fontan operation.

Objective To investigate the clinical feature and treatment of adenomyomatosis of the gallbladder(GBA).Methods Thirty-three cases of GBA admitted from 1992 to 2007 were reviewed retrospectively and their clinical characters were sununarized. Results These cases were divided into three types grossly:14 cages of diffuse type,10 cases of segmental type and 9 Cages of localized type.Cholelithiasis wag associated in 21 cases and 11 cases with cholecystitis.Main clinical presentations included pain in the upper abdomen,discomfort after meal,nausea and vomit.Preoperative correct diagnosis was achieved in only six cases.Twenty-eight patients underwent laparoscopic cholecystectomy and three did open cholecystectomy.Concomirant exploration of common bile duct with T tube drainage and resection of liver ansioma was performed in one each.Adenomyomatosis of the gallbladder was diagnosed by pathologic examination in all cases. Condusions Due to the high rate of combination with cholelithiasis and cholecystitis,GBA has no specific clinical manifestations.The preoperative diagnosis lies on radiological examinations.Cholecystectomy is an appropriate treatment as adenomyomatesis of the gallbladder has a malignant potential.

Objective To evaluate the effects of inhaled nitric oxide (iNO) in management of postoperative pulmonary hypertension in the patients with congenital heart disease. Methods Thirty-two children with refractory pulmonary hypertension or pulmonary hypertensive crisis after open heart operations for congenital heart disease were treated with iNO. The changes of hemodynamics were observed. Results In iNO therapy group,the mean pulmonary artery pressure(mPAP) decreased from (38.0 ±3.2) mm Hg to (28.0 ±2.1) mm Hg,pulmonary vascular resistance (PVR) decreased from (62.2 ±6.7) kPa/(L·S) to (49.9 ±5.6) kPa/(L·S) ,PaO2/FiO2increased from (67.0 ±30. 1 ) mm Hg to (92. 6 ±25.0) mm Hg,and arterial oxygen saturation increased from 0. 78 ±0. 14 to 0. 84 ±0. 09 respectively. No toxic side effect was observed.Conclusion iNO is effective, safe to reduce pulmonary hypertension. It may play an important role in the treatment of postoperative pulmonary hypertension or pulmonary hypertensive crisis in the patients with congenital heart disease.