OBJECTIVETo sum up the experience in diagnosis and treatment of Fournier's gangrene and find an optimal evaluation tool for its prognosis by comparing currently used prognostic scoring systems.

METHODSWe retrospectively analyzed 16 cases of Fournier's gangrene diagnosed and surgically treated in our hospital between 2004 and 2012. Using Fournier's Gangrene Severity Index (FGSI), Uludag Fournier's Gangrene Severity Index (UFGSI), Age-Adjusted Charlson Comorbidity Index (ACCI), and Surgical Apgar Score (sAPGAR) , we obtained the prognostic scores of the patients and made comparisons among different scoring systems.

RESULTSFGSI, UFGSI, ACCI, and sAPGAR were all clinically used scoring systems. Statistically significant differences were found in the scores of ACCI and UFGSI but not in those of FGSI and sAPGAR between the death and survival groups, with the maximum area under the ROC curve and minimum standard error for the ACCI score.

CONCLUSIONBoth ACCI and UFGSI are useful for evaluating the prognosis of Fournier's gangrene. However, ACCI is even better for its higher sensitivity and specificity and easier clinical collection.

Age Factors ; Aged ; Fournier Gangrene ; diagnosis ; mortality ; surgery ; Humans ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Severity of Illness Index

The status of acupuncture-moxibustion is more and more recognized by mainstream medicine in the world in recent years, and literature regarding acupuncture-moxibustion with high impact factor (IF) published in the worldwide mainstream medicine journals is also gradually growing by years. To understand the situation of related literature, literature regarding acupuncture-moxibustion with IF of more than 10 in Science Citation Index (SCI) during the recent 5 years was retrieved. The number, the types, the diseases involved, the publishing states of the acquired articles and the source, the citation, the IF of the publishing journals were analyzed and summarized. Additionally, some of the research foci, the new research tendencies and the deficiencies of research were discussed. The thoughts and suggestions are expected to be provided for further research of acupuncture.
Acupuncture Therapy ; statistics & numerical data ; Bibliometrics ; Humans ; Journal Impact Factor ; Moxibustion ; statistics & numerical data ; Publications ; statistics & numerical data

AIM: To observe the efficacy and safety of intravitreal injection of Conbercept for the treatment of wet age-related macular degeneration( AMD) .
METHODS:Retrospective analysis. A total of 20 patients involving 22 eyes were diagnosed of wet AMD and confirmed by routine ophthalmic examination, fundus fluorescein angiography ( FFA ) and optical coherence tomography. All these affected eyes received intravitreal injection of 10 mg/ml of 0. 5mg Conbercept, once monthly, for 3 successive times during the initial treatment. The need for repeated treatment was determined according to patients'disease conditions. The patients were followed up once monthly for ≥6mo. The changes in best corrected visual acuity ( BCVA ) , central retinal thickness ( CRT ) and choroidal neovascularization ( CNV) lesion leakage of the affected eyes before and after treatment were compared and analyzed.
RESULTS:Within 1, 3 and 6mo after treatment, the mean BCVA ( logMAR ) of the affected eyes increased when compared with before treatment;the difference was statistically significant(P<0. 01). In 1, 3 and 6mo after treatment, the mean CRT of the affected eyes decreased when compared with before treatment;the difference was statistically significant(P<0. 01). During the last follow-up, FFA showed that macular CNV lesion leakage disappeared in 20 eyes(90%) while leakage mitigated in 2 eyes ( 9%) . During the follow - up, there were no treatment - related serious ocular complications and systemic serious adverse reactions.
CONCLUSION: Clinically, intravitreal injection of Conbercept for the treatment of wet AMD can increase visual acuity of the affected eyes. It also can decrease CRT of the affected eyes, and inhibit neovascular leakage. There are no treatment-related adverse reactions.

OBJECTIVETo study the treatment of spinal fractures in ankylosing spondylitis.

METHODSNineteen cases of spinal fractures complicating ankylosing spondylitis admitted in our hospital were studied retrospectively.

RESULTSAll of 19 cases were up to the diagnosis standards of ankylosing spondylitis. Eleven patients had cervical fracture and 8 had thoracolumbar fracture. Of the patients with cervical fracture, fractures occurred at C(5 - 7) in 9 patients. Of the patients with thoracolumbar injury, stress fractures were seen in 7 patients and all of seven fractures occurred at T(10)-L(2). Sixteen of the 19 patients sustained fractures through three columns of the spine. Nine patients had spinal cord injures; eight of the 9 cases had cervical fracture. All of the 19 patients were treated operatively. Four different surgical procedures were used in patients with cervical fracture; decompression, fusion and stabilization with instrumentation by anterior approach were performed in 9 patients. Of the patients with thoracolumbar fractures, four different operations were performed; fusion by both anterior and posterior approach plus a long posterior instrument were used in 5 cases. Eighteen patients had an average follow-up period of 46.6 months. Nine patients with preoperative neurological deficits improved in 8 and was stabilized in 1. Radiographic evidence of fusion was observed in all of the 18 patients. Two patients suffered neurological deterioration during surgery. One patient died from cerebrovascular infarction. Two patients had pneumonia after the operative procedure.

CONCLUSIONSSpinal fractures in ankylosing spondylitis are associated with a high rate of neurological injury. Shearing fracture usually occurs at the lower cervical spine (C(5 - 7)) and stress fracture at thoracolumbar spine. Most of the fractures involve three columns of spine. Surgical intervention may be indicated in this injury. Fracture union and neurological improvement can be achieved in most patients treated by operation. We suggest that, fusion and stabilization with instrumentation by anterior approach is indicated in most cervical shearing fracture, and a combined fusion by both sides plus a long posterior instrument is probably beneficial in patients with thoracolumbar stress fracture. Complications is not rare after surgery and appropriate preventive measures are necessary for these patients.

Adult ; Aged ; Cervical Vertebrae ; diagnostic imaging ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Hyperostosis, Diffuse Idiopathic Skeletal ; complications ; surgery ; Lumbar Vertebrae ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Osteoporosis ; complications ; Postoperative Care ; Postoperative Complications ; prevention & control ; Radiography ; Retrospective Studies ; Spinal Fractures ; etiology ; surgery ; Thoracic Vertebrae ; diagnostic imaging ; pathology ; surgery ; Treatment Outcome

OBJECTIVETo introduce the framework of evidence-based practice with a case of castration-resistant prostate cancer (CRPC) as an example.

METHODSA clinical question was formulated according the clinical scenario. A systematic search was conducted for the published literature in the databases of PubMed, EMBASE, Cochrane Library, Clinical Trial Registries, and Web of Knowledge up to Dec 2014. The identified literature was reviewed for quality appraisal before the evidence was applied to clinical practice.

RESULTSThe treatment was effective and the patient achieved disease remission.

CONCLUSIONEvidence-based practice should be integrated with clinical scenario, current evidence, and patients' willingness, and follow a systematic framework.

Evidence-Based Medicine ; Humans ; Male ; Orchiectomy ; Prostatic Neoplasms, Castration-Resistant ; therapy

Objective To investigate the protectve effects and underlying mechanisms of deferroxamine on glutamate-induced injury in cultured hippocampal neurons.Methods Primarily cultured hippocampal neurons from fetal rat were used in a model of glutamate induced neurotoxicity.There were two experimental groups.Neurons were pretreated with deferroxamine before glutamate in the deferroxamine group, and neurons were treated with glutamate only in the control group.The morphological change was examined under microscope.Hoechst 33342 DNA staining method was used to study the ratio of condensed nuclei.The levels of lactate dehydrogenase (LDH), malonaldehyde (MDA) and hydroxyl radical were determined using biochemistry.The change in calcium signal was detected using microfluorescent technique.Results The neurons pretreated by deferroxamine had intact morphology with the ratio of condensed nuclei at 14% ± 6% compared to 58% ± 6% (t= 8.98, P ＜0.01 ) in the control group.LDH level was (36.42 ± 8.99) U/L in the deferroxamine group and was (68.06 ± 11.26) U/L in the control group ( t =3.25,P＜0.05).The respective levels of hydroxyl radical were (34.21 ±4.23) U/L and (47.06 ±8.79) U/L (t = 3.11, P ＜0.05 ).The respective levels of MDA were (12.26 ± 2.78 ) nmol/mg and (28.86±5.19) nmol/mg(t =4.88,P＜0.01).Conclusion Deferroxamine can protect neurons from glutamate induced damage.The mechanisms include an inhibition of Ca2+ overload and reduction in the levels of MDA and hydroxyl radicals.

Objective To investigate the relationship between polymorphisms of PPARγ gene(rs1801282, rs3856806 and rs4684847) and hypertension in Uygur. Methods Polymorphisms of PPARγ gene,rs1801282, rs3856806 and rs4684847, were identified in 145 hypertension patients and 165 healthy volunteersby matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF-MS). Results(1)Frequencies of rs1801282 CC genotype and C allele were 75.9% and 87.2% in hypertension grouprespectively, which were higher than those in control group (63.6% and 79.7%, respectively, P < 0.05);(2) After risk analysis, individuals with GG and CG genotypes of rs1801282 had 0.273 and 0.594 times higherrisks to develop hypertension than those with CC genotype respectively , while individuals with C allele had 1.742times higher risk to develop hypertension than those with G allele ; (3) Multivariate logistic regression analysisshowed that polymorphism of rs1801282, overweight and obesity were risk factors for the incidence ofhypertension. (4) No significant differences in both frequencies of rs3856806 and rs4684847 genotypes andallele were noted between hypertension group and control group (P > 0.05). (5) SBP in rs1801282 CC genotypecarriers was higher than in CG / GG gene ones, whereas TC was opposite (P < 0.05). Conclusions In theUygur, individuals with CC genotype and C allele at rs1801282 of PPARγ gene are at higher risk ofhypertension. Polymorphism of rs3856806 and rs4684847 may be irrelevant with hypertension in the Uygur.

OBJECTIVETo observe clinical effects of posterior short-segment fixation with undermining decompress by posterior ligament complex for the treatment of upper lumbar burst fractures.

METHODSFrom October 2010 to March 2013,23 patients with upper lumbar burst fractures (Denis B type) were treated by posterior short-segment fixation with undermining decompress by posterior ligament complex. There were 18 males and 5 females aged from 26 to 64 years old with an average of 45.7 years old. Twelve patients were caused by falling down, 5 cases were caused by traffic accident, 4 cases were the bruise injury caused by heavy object and 2 cases were caused by other injury. Fourteen patients were L1 fracture and 9 patients were L2 fracture. Thirteen patients were combined with nerve injuries (degree D according to ASIA classification). Internal fixation were removed from 12 to 20 months with an average of 14.3 months. JOA scores and imaging changes were recorded and compared at different time points.

RESULTSAll patients were followed up from 18 to 24 months with an average of 20.4 months. Thirteen patients with nerve injuries were completely recovered at 3 to 6 months after operation. JOA score at 1 year after operation was 20.63 ± 0.92, and 20.38 ± 1.06 at 3 months after removal of internal fixation,which were improved obviously than 9.90 ± 2.73 at 3 months after operation. (P > 0.05) Anterior height of injured vertebrae, vertebral body angle and local Cobb angle was (95.0 ± 0.53)%, (2.78 ± 1.36) and (2.43 ± 1.52) °respectively, and improved obviously than that of before operation (P < 0.05). There was no statistical significance in JOA scores at 3 months after removal of internal fixation and 1 year after operation (P > 0.05).

CONCLUSIONposterior short-segment fixation with undermining decompress by posterior ligament complex for the treatment of upper lumbar burst fractures has advantages of minimally invasive, could effective recover vertebrae height, maintain stability of spine, decrease low back pain. It is a safe and effective operative method.

Adult ; Decompression, Surgical ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Lumbar Vertebrae ; injuries ; Male ; Middle Aged ; Spinal Fractures ; surgery

Adult ; Aged ; Chyle ; Female ; Humans ; Kidney ; surgery ; Laparoscopy ; methods ; Lymphatic Diseases ; surgery ; Lymphatic System ; surgery ; Male ; Middle Aged ; Retroperitoneal Space ; Urine ; Urologic Surgical Procedures ; methods

BACKGROUNDWe presented the technique and outcomes of laparoscopic radical cystectomy performed in 28 patients with bladder cancer to evaluate its clinical efficacy and feasibility.

METHODSAmong the 28 patients, aged from 58 to 73 years (mean 68.5 years), 26 were transitional cell carcinoma grads II - III and 2 squamous carcinoma. Laparoscopic radical cystectomy plus bladder reconstruction was performed in all cases, among them 15 with ileum, 10 with rectum pouch, and 3 with ureterostomy. The operating time, the blood loss, the intestine function and the complications were observed.

RESULTSAll procedures were successful. The operating times were 7 - 10 hours, the blood loss was 400 - 1500 ml (mean 850 ml), the intestine function recovered at 72 hours after operation, and all ureteral catheters were removed at 2 weeks after surgery. The results of intravenous urography were normal at 3-month, 1-year, and 2-year follow-up after surgery.

CONCLUSIONSLaparoscopic radical cystectomy for invasive bladder cancer is safe and efficient, with good operating field, reliable hemostasis, mini-invasion, less celiac complications, and rapid recovery. This surgery is worth being extended.

Aged ; Carcinoma, Transitional Cell ; surgery ; Cystectomy ; methods ; Humans ; Ileum ; surgery ; Laparoscopy ; methods ; Male ; Middle Aged ; Urinary Bladder Neoplasms ; surgery ; Urinary Diversion ; methods ; Urinary Reservoirs, Continent