Objective To investigate the value of prostate-bladder angle (PBA) measured by MRI in the diagnosis of benign prostate obstruction (BPO). Methods A retrospective analysis was carried out on 87 benign prostatic hyperplasia (BPH) patients referred for lower urinary tract symptoms (LUTS) between March 2009 and November 2009. PBA was measured by MRI and urodynamic parameter Qmax was measured as well. With the diagnostic criteria of BPO as Qmax＜10 ml/s, the patients were divided into two groups: obstruction group and non-obstruction group. PBA was compared between these two groups. The sensitivity and the specificity of PBA in diagnosing BPO were also analyzed. Results The age range of the patients was 57-90 years with a median age 73 years; Qmax was 2.325.4 ml/s with median Qmax 7.9 ml/s; PBA was 4°-52° with median PBA 27°. There were 25 patients in the non-obstruction group with PBA between 4°- 21°(13°); in the obstruction group,there were 62 patients with PBA between 15°- 52°(34°). PBA was found statistically different between the obstruction and non-obstruction group (P＜0.01). With the cutoff at PBA≥20°for the diagnosis of BPO, the sensitivity and specificity of the diagnosis were 90. 3 % (56/62)and 96.0% (24/25), respectively. Conclusion PBA measured by MRI is valuable and can be used as a new non-invasive parameter in the diagnosis of BPO.

Objective To compare transurethral enucleation of plasma chamber(TUERP)plasma and tran-surethral resection of the prostate(PKRP) treatment efficacy,security and the impact on sexual function.Methods 80 cases of BPH patients were randomly divided into two groups,TUERP and PKRP.Follow-up for 12 months,compared two groups maximum urinary flow rate(Qmax),residual urine volume(PVR),serum prostate-specific antigen(PSA) level,prostate volume(PV),international prostate symptom score(IPSS),quality of life score(QOL),the bladder prostate prominent(IPP)and other indicators and erectile dysfunction and retrograde ejaculation changing circum-stances were compared.Results In the weight of prostate surgery there were significant differences,in which removal of the weight of TUERP group significantly higher than PKRP group.After 12 months,32 cases of TUERP patients and 31 patients of PKRP group completed follow-up.After 1,3,6,12 months,Qmax,PVR,IPSS,QOL improved than that before surgery.Two groups were compared after a month,and there were significant differences in prostate volume,which TU/ERP group was significantly smaller than PKRP group.After3 months in the prostate volume and residual U-rine volume there were significant differences,both TUERP group Was significantly smaller than PKRP group.After 6 months and 12 months in the prostate volume,residual urine volume and there were significant differences in PSA,both TUERP group was significantly smaller than PKRP group.ED,and retrograde ejaculation occured after the rate of two between the two groups was no significant difference.Conclusion Transurethral enueleation of plasma chamber on sexual function in patients,but through the appropriate personalized treatment,sexual function in some patients was recoverable.

Objective To investigate the correlation between neuronal injury and the expression of caspase-3 and caspase-activated deoxyribonuclease (CAD) after focal cerebral ischemia-reperfusion in rats, also to study the effect of caspase-3 particular inhibitor. Methods The focal cerebral ischemia model (occluding middle cerebral artery of the rats) was made by using modified inserting thread method and reperfusion after embolizing for one hour. Using HE staining, TUNEL staining and microscopy to observe the morphological changes of ischemic neurons at six different time points including 6,12,24,48 and 72 h, using immunohistochemistry to observe the changes of caspase-3 and CAD protein in two groups (model group and interfere group). Results There was no significant difference between the two groups using HE staining and microscopy. While there was difference of TUNEL staining positive cells in all time points, except 6 h time point; Both the two groups reached the expression peak of caspase-3 in 24 h, and the number was 2. 360± 0. 318 and 0. 804 ± 0. 206 respectively(t' = 10. 039, P < 0. 01), there was statistical significance from 12 h to 48 h between the two groups ; The expression peak time of CAD protein in two groups was 48 h, and the number was 3.061 ± 0. 567 and 0. 812 ± 0. 240 respectively (t' = 8. 960, P < 0. 01), there was statistical significance from 12 to 72 h between two groups. Conclusions Caspase-3-CAD-DNA degradation is one important way of neuronal injury in cerebral ischemia-reperfusion of rats, caspase-3 inhibitor can protect neuron in a certain degree.

Objective To evaluate the effect of pre-cut-endoscopic mucosa resection of colorectal laterally spreading tumor. Methods 65 patients with LST were enrolled from January 2014 to February 2014. LST was detected by chromoendoscopy and NBI combined with magnifying endoscopy technique. The size, site, morphological features, were observed and the histopathological features of the specimen of LST was analyzed. All the 65 LSTs were resect by pre-cut-EMR. The clinical results including enbloc resection rate, all bloc resection rate, procedure time, complication and recurrence rates were retrospectively evaluated. Results All the 65 LSTs lesions ranged from 2.0 cm to 5.0 cm, with a mean diameter of (2.4 ± 1.7) cm. The site of 65 LSTs was in rectum 28 (43.1 %), 11 LSTs in sigmoid colon (16.9 %), 6 LSTs in descending colon (9.2 %), 2 LSTs in splenic flexure of colon (3.1 %), 9 LSTs in transverse colon (13.8 %), 4 LSTs in Hepatic flexure of colon (6.2 %), 2 LSTs in ascending colon(3.1 %), and 3 LSTs in cecum (4.6 %). Morphology of 23 LSTs were homogeneous granular type (35.4 %), 27 LSTs were mixed non-granular type (41.5 %), 13 LSTs were flat elevated type (20.0 %), and 2 LSTs were pseudo-depressed type (3.1 %). The histopathological diagnoses of LST included 12 tubular adenoma (18.5 %), 19 villous-tubular adenoma (29.2 %), 26 villous adenoma (40.0 %), 7 advanced intraepithelial tumor (10.7 %), 1 intramucosal carcinoma (1.5 %). Enbloc resection was achieved in 65 patients (100.0 %) with a mean operation time of (18.0 ± 11.7) min. 5 cases were bleeding during the operation (7.7 %), 1 case was bleeding 7 days after operation (1.5 %), no perforation was happened. 65 patients were followed up for 3 ~ 12 months, and no local recurrence was found. Conclusion Pre-cut-endoscopic mucosal resection an effective and safe therapy for colorectal LST larger than 2.0 cm.

As the final resolution for end-stage lung disease, lung transplantation can not only significantly prolong the survival, but also remarkably improve the quality of life of recipients. In recent decades, with the advancement of surgical techniques, immunosuppressants and post-transplantation management, the quantity of lung transplantation has been surged around the globe. However, the shortage of donor lung has severely restricted the development of lung transplantation. It is necessary to develop innovative approaches to expand the donor pool. The number of donors and effective preservation and functional maintenance of potential donor lungs play a key role in expanding the donor pool. The quality of donor lung is a critical precondition to ensure the long-term survival of lung transplant recipients. Preservation and functional maintenance of donor lung are of significance for guaranteeing the quality of lung allograft. In this article, research progresses on the management and maintenance of donor lung before procurement, the procurement of donor lung and the preservation and functional maintenance of lung allograft were reviewed, aiming to provide reference for the development of lung transplantation in clinical practice.

Objective: To study the value of unmethylated cytosine guanine dinucleotide oligodeoxynucleotide (DSP30) and IL-2 in the conventional cytogenetic (CA) detection of the chromosomal aberrations in chronic lymphocytic leukemia (CLL) . Methods: Bone marrow or peripheral blood cells of CLL patients were cultured with DSP30 plus IL-2 for 72 h, following which R-banding analysis was conducted. Fluorescence in situ hybridization (FISH) was performed in 85 patients. CA results were compared with data obtained by FISH. Results: Among 89 CLL patients, the success rate of chromosome analysis was 94.38% (84/89) . Clonal aberrations were detected in 51 patients (51/84, 60.71%) . Of them, 27 (27/51, 52.94%) were complex karyotype. Among 85 CLL patients tested by FISH, chromosomal abnormalities were detected in 74 (74/85, 87.06%) patients, of which 2 (2/74) patients were complex karyotypes, accounting for 2.70%. Of the 85 CLL patients examined by FISH, 50 had abnormal karyotype analysis, 30 had normal karyotype, 5 failed to have chromosome analysis. Among them, 25 cases showed clonal aberrations by FISH assay but normal by CA, and 4 cases were normal by FISH but displayed aberrations in chromosome analysis, and totally 78 (91.76%) cases with abnormality detected by the combination of the two methods. The frequency of 13q- abnormality detected by FISH was significantly higher than that by CA analysis (69.41%vs 16.67%, P<0.001) , while the frequency of 11q-,+12 and 17p- detected by two methods showed no significant difference (P>0.05) . The detection rate of complex abnormalities in conventional karyotype analysis was higher than that in FISH (50.98%vs 2.70%) . In addition, 11 low-risk and 9 intermediate-risk patients according to FISH results showed complex karyotype by cytogenetics, and were classified into high-risk cytogenetic subgroup. Conclusion DSP30 and IL-2 are effective in improving the detection rate of CA in CLL patients (60.71%) and CA is more effective to detect complex karyotype. However, FISH had a higher overall abnormality detection rate (87.06%) than CA, especially for 13q-. The combination of CA and FISH not only enhanced the detection rate of clonal aberrations to 91.76%, but also provided more precise prognosis stratification for CLL patients, thus to provide more information for clinical implication.

Objective To detecte the neovascularizations in carotid plaques using contrast-enhanced ultrasound (CEUS) and explore the relationship between the neovascularizations and the peripheral leukocytes in the patients with acute cerebral infarction. Methods Sixty-two patients with large artery atherosclerosis cerebral infarction were selected as cerebral infarction group;and 54 age-and gender-matched patients with atherosclerosis and without cerebral cerebrovascular events were recruited control group.The dominant carotid artery plaques were performed by CEUS,the peak of time-intensity curve(TIC-P) and the mean of time-intensity curve (TIC-M) were measured by off-line quantitative analysis.The peak (FC-P), time to peak (FC-TP),sharpness (FC-S) and under the curve area (FC-AUC) were obtained from fitting curves of time-intensity. The correlations between parameters of contrast-enhanced ultrasound and leukocyte counts were analyzed by Pearson correlation analysis. Results ①In the cerebral infarction group, the total leukocytes and neutrophils were higher than those in the control group,while the number of lymphocytes was lower than that of the control group(all P <0.05). ②In the cerebral infarction group,the TIC-P and TIC-M values were greater than those in the control group ( P < 0.05).Compared with the control group,the FC-P,FC-S and FC-AUC values in the cerebral infarction group were increased (all P <0.05). ③There was a negative correlation between PIG-P,TIC-M of FC-P and lymphocytes( r = -0.291,-0.263 and -0.270;all P <0.05).FC-S and FC-AUC were positively correlated with neutrophils ( r =0.261,0.298;all P < 0.05). Conclusions Carotid plaque neovascularizations is related to peripheral leukocyte count.CEUS help us know more the vulnerability of plaque.

Objective:To provide more options for preoperative localization diagnosis in patients with primary hyperparathyroidism (PHPT), the diagnostic efficacy of parathyroid 4-dimensional computed tomography (4D-CT) in patients with PHPT was evaluated.Methods:This was a single-center retrospective study including 57 patients with surgical proved PHPT. All of the patients underwent 4D-CT, 99Tc m -sestamibi parathyroid imaging (MIBI), and ultrasonography (US) preoperatively. The reference standard for correct localization was based on operation reports and pathology confirmation. The patients were grouped according to the preoperative serum calcium levels, tumor diameter, or ectopic lesions (yes/no), respectively. The sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) of 4D-CT, MIBI and US, alone or in combination, were analyzed in total and each subgroup patients. Results:Fifty-seven patients (39 women, 18 men; mean age of 56.5 years) were evaluated, including four cases with multi-gland disease and thirteen cases with ectopic parathyroid lesions. In all the patients, similar diagnostic efficacy was found in 4D-CT (AUC: 0.943) and MIBI (AUC: 0.927), both of which were higher than that of US (AUC: 0.847) ( P = 0.01 for 4D-CT vs. US; P = 0.04 for MIBI vs. US). In a subset analysis for ectopic quadrants, the diagnostic efficacy of 4D-CT was significantly higher than that of MIBI ( P = 0.04) or US ( P = 0.01), with the sensitivity of 100%, 69.2%, and 61.5%, and AUC of 0.989, 0.846, and 0.808 for 4D-CT, MIBI and US, respectively. Conclusions:4D-CT has similar diagnostic efficacy for preoperative localization to MIBI in patients with PHPT, and it is superior to MIBI and US in identifying the ectopic parathyroid gland. 4D-CT can be recommended as an alternative preoperative localization method, especially when parathyroid lesions could not be precisely located by US and MIBI.

Objective:To investigate the effects of transepithelial photorefractive keratectomy (TransPRK) and femtosecond small incision lenticule extraction (SMILE) on corneal biomechanics measured by the Ocular Response Analyzer in the early postoperative period.Methods:A cohort study was conducted.The right eyes of 56 patients who underwent TransPRK and 52 patients who underwent SMILE in Dalian Medical University Affiliated Dalian Third People's Hospital from November 2020 to June 2021 were continuously included.The postoperative follow-up was 3 months.The central corneal thickness (CCT) and keratometry (Km) were measured 1 month and 3 months after surgery.The corneal-compensated intraocular pressure (IOPcc), corneal resistance factor (CRF), corneal hysteresis (CH), and 19 repeatable mechanical infrared signal waveform parameters measured by the Ocular Response Analyzer were recorded before the surgery, 1 month and 3 months after the surgery, respectively.The measurement indexs at different time points between two groups were compared.This study adhered to the Declaration of Helsinki and the study protocol was approved by the Ethics Committee of Dalian Medical University Affiliated Dalian Third People's Hospital (No.2019-KT-010). Written informed consent was obtained from each patient before surgery.Results:There was no significant difference in CCT, Km, and IOPcc between the two groups at 1 month and 3 months after the surgery (all at P>0.05). In both groups, CRF, CH, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, h1, h2, h11, h21, dive1, dive2 and mslew1 were decreased, while path1, path2, path11, and aplhf were increased at 1 month after the surgery compared with before surgery, showing statistically significant differences (all at P<0.05). In both groups, CRF, CH, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, h1, h2, h11, h21, dive1 decreased, while path1, path2, path11, and aplhf were increased at 3 months after the surgery in comparison with before surgery, showing statistically significant differences (all at P<0.05). In SMILE group, the dive2 were decreased at 3 months after the surgery compared with before surgery, and the difference was statistically significant ( P<0.01). At 1 month after the surgery, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, dive1 and dive2 were higher, while CH, path1, path2, and path11 were smaller in TransPRK group than in SMILE group, showing statistically significant differences between them (all at P<0.05). At 3 months after the surgery, p1area, p2area, p1area1, p2area1, w1, w2, w11, w21, h2, h21, dive1 and dive2 were higher, while path1, path2, and path11 were smaller in TransPRK group than in SMILE group, showing statistically significant differences between them (all at P<0.05). Conclusions:Corneal biomechanics are weakened after both TransPRK and SMILE.In the early postoperative period, the mechanical infrared waveform parameters measured by the Ocular Response Analyzer are better after TransPRK than after SMILE.

Objective:To explore the spatial autocorrelation and macro influencing factors of stroke mortality in Zhejiang Province in 2015-2020 and provide a scientific basis for stroke prevention and control strategy.Methods:The data on stroke death were obtained from Zhejiang Chronic Disease Surveillance System. The spatial distribution of stroke mortality was explored by mapping and spatial autocorrelation analysis. The spatial panel model analyzed the correlation between stroke mortality and socioeconomic and healthcare factors.Results:From 2015 to 2020, the average stroke mortality was 68.38/100 thousand. The standard mortality of stroke was high in the areas of east and low in the west, high in the south and low in the north. Moreover, positive spatial autocorrelation was observed (Moran's I=0.274-0.390, P<0.001). Standard mortality of stroke was negatively associated with per capita gross domestic product (GDP) ( β=-0.370, P<0.001), per capita health expenditure ( β=-0.116, P=0.021), number of beds per thousand population ( β=-0.161, P=0.030). Standard mortality of ischemic stroke was negatively associated with per capita GDP ( β=-0.310, P=0.002) and standard management rate of hypertension ( β=-0.462, P=0.011). Standard mortality of hemorrhagic stroke was negatively associated with per capita GDP ( β=-0.481, P<0.001), per capita health expenditure ( β=-0.184, P=0.001), number of beds per thousand population ( β=-0.288, P=0.001) and standard management rate of hypertension ( β=-0.336, P=0.029). Conclusions:A positive spatial correlation existed between stroke mortality in Zhejiang Province in 2015-2020. We must focus more on preventing and controlling strokes in relatively backward economic areas. Moreover, to reduce the mortality of stroke, increasing the investment of government medical and health funds, optimizing the allocation of medical resources, and improving the standard management rate of hypertension are important measures.