Objective To discuss the diagnosis and treatment of the postoperative acquired primary hyperfibrinolysis secondary to bipolar plasmakinetic transurethral resection of the prostate ( BP-TURP ) . Methods A case with benign prostatic hyperplasia was retrospectively reviewed, who was an 88-year-old patient admitted on 14th October, 2013 because of repeated urinary retention for 10 years, and catheter indwelling for 20 days.Blood pressure was 101/59 mmHg on admission (1 mmHg=0.133 kPa).Digital rectal examination showedⅡ°prostate, smooth surface, rubbery and no nodules.Routine blood showed the leucocyte 4.6 ×109/L, neutrophils 0.62, hemoglobin 108 g/L, red blood cells 3.30 ×1012/L, platelet 90 ×109/L.Preoperative coagulation function showed prothrombin time (PT) 12.8 s (10-14), activated clotting time live enzymes (APTT) 34.8 s (21 -37), fibrinogen (FiB-C) 2.38 g/L (2 -4), D-dimer 0.50 mg/L (0-0.55), fibrin degradation products (FDP) 2.0 mg/L ( <5.0).Abdominal ultrasound showed hyperplasia of prostate ( 52 mm ×46 mm ×37 mm ) , protruding into the bladder about 20 mm. Abdominal CT scanning showed bladder diverticulum and stones, hyperplasia of prostate and calcification. The operation time of BP-TURP was 90 min with no significant intraoperative bleeding, and continuous bladder irrigation drainage was clear.Results Four hours after the operation, continuous bladder irrigation drainage became bright red.Seven hours after operation, blood pressure was 83/56 mmHg, and blood routine showed white blood cells 8.1 ×109/L, neutrophils 0.92, red blood cells 2.93 ×1012/L, hemoglobin 95 g/L, platelet 67 ×109/L.Transfusion of 4.5 U red blood cell suspension was administered.The prostatic fossa hemorrhage was suspected and bleeding was not alleviated after adjusting the catheter.Prostatic fossa electro-coagulation hemostasis was performed and bladder neck obvious oozing of blood was detected intraoperatively, and no venous sinus bleeding or obvious blood clots were detected.Four hours after the secondary surgery, continuous bladder irrigation drainage became pink again, and the conservative treatment had no effect.Blood coagulation function showed PT 16.9 s, APTT 43.5 s, FiB-C 0.34 g/L, D-dimer 1.70 mg/L, FDP 57.4 mg/L.The patient was diagnosed as postoperative acquired primary hyperfibrinolysis, and repeat plasma, red blood cell suspension, and tranexamic acid transfusion was administered.Continuous bladder irrigation drainage gradually became clear.Blood coagulation function index gradually returned to normal.Routine urine test showed red blood cells ( microscopy ) 4 -5/HPF. Conclusions After BP-TURP, acquired primary hyperfibrinolysis may occur.The outcome is good after timely diagnosis and effective treatment.

ObjectiveTo observe the effect of constraint-induced movement therapy (CIMT) combined with motor imagery therapy (MIT) on the upper extremity function of stroke patients with hemiplegia.Methods120 hemiplegic patients caused by brain injury were randomly divided into the control group, CIMT group, MIT group and combined therapy group with 30 cases in each group. The every group was treated with commensurate rehabilitation management respectively, 4 weeks as one course of treatment. All patients were assessed with the Simple Test for Evaluating Hand Function (STEF), the upper limb movement Fugl-Meyer Assessment (FMA), and Modified Barthel Index (MBI) before and after the treatment.ResultsBefore the treatment, there was no significant difference in STEF, scores of upper limb movement FMA and MBI among the four groups ( P>0.05). After the treatment, the STEF, scores of upper limb movement FMA and MBI of the CIMT group and MIT group improved ( P<0.05), that of the combined therapy group were superior to any other group ( P<0.01).ConclusionCIMT and MIT can promote the recovery of upper extremity function of hemiplegic patient, but the better therapeutic effect will be obtained when these two therapies combined.

ObjectiveTo investigate the clinical effects and side-effect of mesenchymal stem cell(MSCs) transplantation on spinal cord injury(SCI),traumatic brain injury(TBI),multiple sclerosis(MS) or Parkinson's disease(PD).MethodsThe bone marrow(222～350 ml) of 11 patients with SCI(n=6),TBI(n=3),MS(n=1) or PD(n=1) were harvested from the patients' ilia and then MNCs were isolated.The MNCs were injected intravenously or into subarachnoid space by lumbar puncture.The neural function and side-effect were observed before and after MSCs transplantation and the patients were followed up.ResultsThe data demonstrated the improvement of sense and motor function in 5 patients with SCI,one had no improvement by 2 months following-up.These patients' sense and motor levels improved obviously.Their muscle strength of lower extremity increased,the muscular tone decreased and urinary bladder function improved.Changes in neurological deficits and improvements in function may appear within 2 days after transplantation,most of them within 2 weeks.There were significantly amelioration in 3 patients with TBI treated with MSCs transplantation,one of them could walk with cane independently after 3 months.One's PVS score elevated from 5 to 8 scales after transplantation.The tremor was alleviated after 1 week,and the muscular tone decreased,which lead to reduce the dose of Madopar after 3 months,in patient with PD.The patient with MS showed no improvement in short time.The side-effect included fever(7/11),headache(2/11) and abdominal dissension(1/11).1 patient feel numb in his legs while injection into subarachnoid,and appeared meningeal stimulation after injection.ConclusionThere were significantly clinical effects in treatment of SCI,TBI,MS,and PD with MSCs transplantation in short time,and with few side-effect. The long-term clinical effects need more observation with larger samples.