OBJECTIVETo investigate the clinical manifestations, pathological characteristics, and treatments of urothelial-type mucinous adenocarcinoma of the prostate (UMAP).

METHODSWe reported a case of UMAP, reviewed relevant literature, and analyzed the clinicopaothological features, diagnosis, treatment, and prognosis of the disease.

RESULTSThe patient was a 60-year-old male and underwent transurethral resection of the prostate for dysuria. Postoperative pathology indicated mucinous adenocarcinoma and sigmoidoscopy revealed no primary colon cancer. Immunohistochemical staining showed the negative expressions of PSA and P504s and positive expressions of CK7, CK34 β E12, CK20, and CDX2. Thus UMAP was confirmed and treated by intensity-modulated radiotherapy. Then the patient was followed up for 30 months, which showed desirable therapeutic result, with neither local progression nor distant metastasis.

CONCLUSIONUMAP has a bad prognosis and its diagnosis depends on pathological and immunohistocchemical examinations. It responds well to radical prostatectomy but is not sensitive to endocrine therapy. Radiotherapy can be considered for those who are not fit to receive radical prostatectomy.

Adenocarcinoma, Mucinous ; metabolism ; pathology ; therapy ; Humans ; Keratins ; metabolism ; Male ; Middle Aged ; Neoplasm Proteins ; metabolism ; Prognosis ; Prostatectomy ; Prostatic Neoplasms ; metabolism ; pathology ; therapy ; Racemases and Epimerases ; metabolism

Objective To observe the incidence and explore the potential factors of nonresponse to cardiac resynchronization therapy (CRT) in patients with severe chronic congestive heart failure. Method CRT was performed in 119 patients with NYHA function class Ⅲ - Ⅳ and left ventricular ejection fraction ≤35% [96 men and 23 women, age (60.5 ± 11.3 ) years ]. Results Seven patients died for different reasons between 1 - 6 months post CRT and clinical and echocardiographic (Echo) data at 6 months post CRT were analyzed from the remaining 112 patients. The incidence of nonresponse to CRT was 28.57%.Compared to the response group, complete right bundle branch block, longer course of congestive heart failure, higher pulmonary systolic pressure and serum creatinine level and non-optimal target vessels positioning of the left venticle lead( the great cardiac vein and the middle cardiac vein)were the independent predictors for nonresponse after CRT( all P ＜ 0.05). Compared with nonresponse group, the dosages of digoxin and diuretics used for heart failure were significantly reduced in response group ( P ＜ 0.01 ).Conclusions The incidence of nonresponse after CRT was 28.57% in this patient cohort Higher pulmonary systolic pressure and serum creatinine level and non-optimal target vessels positioning of the left venticle lead ( the great cardiac vein and the middle cardiac vein) were the independent predictors for nonresponse after CRT.

BACKGROUNDIt has been reported that there is a significant difference in the local tissue concentration of transforming growth factor (TGF)-β1 between chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis without nasal polyps (CRSwNP) patients. TGF-β has been reported to play an important role in regulating epithelial cell repair in lower airway remodeling and may be a critical factor involved in the remodeling process of chronic rhinosinusitis (CRS).

METHODSEthmoidal mucosal samples collected from CRS and healthy control patients were analyzed for TGF-β1, TGF-β receptor I, TGF-β receptor II, Smad3, phospho-Smad3, Smad7, and Smad anchor for receptor activation by Western blotting analysis. The proliferation of sinonasal epithelial cells at baseline and after TGF-β1 and/or EGF stimulation was evaluated by the MTT assay.

RESULTSIn CRSsNP, TGF-β1, TGF-β receptor I, TGF-β receptor II, and Smad3 protein levels were significantly higher than controls. In CRSwNP, TGF-β1, Smad3, and pSmad3 protein levels were significantly lower than controls. Smad7 protein was significantly higher in CRS than controls. In vitro experiments demonstrated that the baseline proliferation levels of sinonasal epithelial cells were lower in CRS than controls.

CONCLUSIONSCRSwNP is characterized by a lower level of TGF-signaling compared with the control. In CRSsNP, although the upstream signaling of TGF-β was enhanced, the high Smad7 protein expression may restrain the downstream signaling components (e.g., pSmad3) and the TGF-β antiproliferative effect on sinonasal epithelium. The difference in the local tissue concentration of TGF-β1 between CRSsNP and CRSwNP patients did not result in significant differences in epithelial proliferation.

Adult ; Aged ; Benzamides ; pharmacology ; Cells, Cultured ; Dioxoles ; pharmacology ; Female ; Humans ; Intracellular Signaling Peptides and Proteins ; metabolism ; Male ; Middle Aged ; Protein-Serine-Threonine Kinases ; antagonists & inhibitors ; metabolism ; Receptors, Transforming Growth Factor beta ; antagonists & inhibitors ; metabolism ; Serine Endopeptidases ; metabolism ; Signal Transduction ; drug effects ; Sinusitis ; metabolism ; Smad3 Protein ; metabolism ; Smad7 Protein ; metabolism ; Transforming Growth Factor beta ; metabolism ; Transforming Growth Factor beta1 ; antagonists & inhibitors ; metabolism ; Young Adult

OBJECTIVETo evaluate the efficacy and safety of percutaneous coronary intervention (PCI) combined cardiac resynchronization therapy (CRT) for refractory heart failure secondary to ischemic cardiomyopathy (ICM).

METHODSPCI and CRT were performed in 7 ICM patients confirmed by angiography with NYHA class IV, QRS duration >/= 130 ms in 6 of them, III degrees AVB in 1 patient, fast ventricular heart rate Af in 1 patient, ventricular fibrillation history in 2 patient. All of them had their LVEDD >/= 55 mm, and LVEF

RESULTSThe procedures of PCI and CRT were performed successfully in all patients. Five patients received right atrial and biventricular pacing, one patient with Af received biventricular pacing and atrial-ventricular node radiofrequency ablation at the same procedure, and the another one patient received CRTD. One out of seven patients died of re-AMI 4 months after the combination therapy, and the other 6 patients had been alive 5 - 41 (23.2 +/- 13.8) months during the follow-up period. The heart function of the 7 patients had further improved after PCI and CRT combined therapy compared to that of PCI or CRT only. Their NYHA class decreased from IV to II, 6-minute walking distance increased steadily, and mitral regurgitation reduced and QRS duration shortened significantly. The LVEDD decreased and LVEF increased significantly in 2 patients without ventricular aneurysm, and slight improvement or no change were in the other 5 patients.

CONCLUSIONFor patients with refractory heart failure secondary to ICM, the combination of PCI and CRT could obviously improve their heart function, quality of life and prognosis, which also very safe in perforation.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; Cardiac Pacing, Artificial ; methods ; Combined Modality Therapy ; Female ; Heart Failure ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Myocardial Ischemia ; complications ; therapy ; Treatment Outcome

Objective The purpose of this study was to analyze the anatomy variation of coronary vein system in patients with ischemic heart disease (IHD) and non-ischemic heart disease (NIHD).Method Forty-one patients with IHD and 87 patients with NIHD [101 men, mean age (63.5 ± 10. 6)years] were included in this study. Results Coronary sinuses were successfully cannulated and venographies were obtained in 127 cases. Transvenous LV pacing leads were successfully placed in optimal coronary vein in 123 cases (96. 09% ). The majority (76. 38% ) patients had at least one or more vessel abnormalities (thinness, stenosis, tortuousity, lack of lateral marginal vein or postero-lateral vein). The incidence of thin and tortuousity was significantly higher in lateral marginal vein than that in postero-lateral vein (P <0. 05 -0. 01 ). The incidence of lack of postern-lateral marginal vein was more frequent than the lack of lateral vein (P < 0. 05 ). The rate of abnormality in both vessels was 25. 2%. Incidence of vein lack in male was more frequent than in female ( P < 0. 05 ). The thin and tortuousity of vessels in female were more frequent than in male ( P < 0. 05 ) . The incidence of thin and tortuousity of postero-lateral and abnormality of both vessels was significantly higher in IHD than in NIHD patients ( P < 0. 05 ). All coronary sinus myocardial bridges occurred in NIHD. Stenoses of left anterior descending (LAD) and left circumflex (LCX) were mostly associated with abnormality of lateral vessels. Conclusions The anatomic variations of lateral and postern-lateral coronary vein were more frequent in this patient cohort. Vein lack in male was more frequent and the thin and tortuousity of vessels were less in male than in female patients. The ratio of vessel abnormality is higher in patients with IHD. Coronary arteries stenosis and position of infarction are associated with anatomic variations of coronary vein system.

Objective To study the effect of essential oil from Angelica sinensis(EOAS) on neuronal apoptosis induced by ischemia-reperfusion injury.Methods The high differentiated PC12 cells were divided into blank group,model group,control group (10 μmol · L-1 edaravone)and large-,medium-and small-dose expreimental groups(EOAS 25.00,12.50,6.25 μg · mL-1).Except blank group,the remaining groups were treated with sugar-free medium containing 10 mmol · L-1sodium dithionite (Na2S204) for 1 h,reoxygenation for 48 h.The cell proliferation was measured by methyl thiazolyl tetrazolium(MTT) assay.The activity of superoxide dismutase (SOD) and lactate dehydrogenase (LDH),contents of malondialdehyde (MDA) were measured by kit.The apotosis rate and the morphological apoptotic characteristics of cells were observed by flow cytometry and acridine orange/propidium iodide (AO/PI) double staining respectively.The relative activity of caspase-3 were examined with colorimetric assay.The expression of p-ERK1/2 proteins was measured by Western-blot.Results Compared with the blank group,the cell viability in the model group was (67.4 ±0.10)％ with significantly(P ＜0.01).Compared with the model group,the cell viability in the large-dose experimental group and control group were (86.2 ± 0.10)％,(94.5 ± 0.05)％ with significantly (P＜0.05,P ＜ 0.01).Compared with the blank group,the LDH and MDA content in the model group were (912.53±16.71)U · L-1and(9.05 ±0.25)μmol · L-1while SOD level was (12.53 ±0.29)U · mL-1with significantly(all P ＜0.01).Compared with the model group,the LDH and SOD level in the large-dose experimental group were (565.61 ± 11.72) U · L-1 and (12.53 ± 0.29) U · mL-1 with significantly (P ＜ 0.05,P ＜ 0.01) while MDA content in the large-,medium-dose experimental groups were (3.32 ± 0.68),(5.79 ± 0.68) μmol · L-1 with significantly(all P ＜0.01).The absorbance(A) in model group and large-,medium-and small-dose expreimental groups were 0.75 ± 0.06 and 0.10 ± 0.02,0.16 ± 0.03,0.49 ± 0.04.Compared with the model group,the difference had significantly(P ＜0.05,P ＜0.01).Compared with the blank group,the apoptosis rate in the model group was (31.17 ± 2.44)％ with significantly(P ＜ 0.01).Compared with the model group,the apoptosis rate in the large-,medium-dose experimental groups were (4.57 ± 0.32) ％,(5.93 ± 0.81) ％ with significantly (all P ＜ 0.01).Compared with the model group,p-ERK1/2 proteins of large-dose experimental group were up-regulated significantly (P ＜0.01).Conclusion The EOAS could inhibit the apoptosis of neurons after ischemia-reperfusion by activating ERK signaling pathway.

Objective To evaluate the operative outcomes of a triple procedure including simultaneous penetration keratoplasty (PKP),extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation,and to investigate the relationship between postoperative corneal refractive power and preoperative lens diopter.Methods This retrospective analysis study involved 15 patients who had undergone a triple procedure surgery in Beijing You'an hospital from April to October 2016.Outcomes including the best corrected visual acuity (BCVA),intraocular pressure (IOP),corneal refractive power,axial length,postoperative complications,corneal endothelial cell counts and the survival of corneal graft were determined one year after surgery.Results All corneal grafts were transparent and corneal endothelium were (1974.20 ±472.82) cell · mm-2.The mean postoperative LogMAR visual acuity (0.80 ±0.27) had a significant improvement compared with the mean preoperative LogMAR visual acuity (2.63 ±0.62) (t =13.042,P ＜0.001).There were no statistically significant differences in preoperative IOP (15.27 ± 2.37) mmHg (1 kPa =7.5 mmHg) and postoperative data (14.53 ± 3.04) mmHg (t =0.685,P =0.505),preoperative axial length (23.69 ±2.01) mm and postoperative data (23.62 ±2.12)mm (t =-0.138,P=0.893)and preoperative keratometry (45.01 ± 1.66) D of the control eye and postoperative data (42.56 ± 5.48) D (t =1.202,P =0.260).The postoperative spherical equivalent refractive was (0.40 ±4.65) D,and the target refraction was (0.58 ±0.25)D.Conclusion The triple procedures are safe and effective for the treatment of patients with coexisting corneal pathologies and cataracts.Selection of emmetropia lens diopter may result in the satisfactory postoperative visual acuity.However,unpredictable postoperative corneal curvature changes will still affect the final refractive state.

BACKGROUNDThe role of nasal obstruction in the pathogenesis of obstructive sleep apnea/hypopnea syndrome (OSAHS) has been debated for decades. In this prospective study, we compared the pharyngeal aerodynamic characteristics of OSAHS patients and normal people, and investigated the contribution of total nasal airway resistance to the pathophysiology of OSAHS.

METHODSComputational fluid dynamics (CFD) was used to extract the average pressure and average airflow velocity in three transverse cross-sectional planes of the pharynx for statistical analysis, and the correlation between nasal resistance and the average pressure in the pharyngeal cavity was investigated.

RESULTSThe negative pressure within the pharyngeal cavity was significantly higher in OSAHS patients than in normal subjects, and total nasal airway resistance correlated well with the average pressure in three consecutive transverse cross-sections of the pharyngeal cavity.

CONCLUSIONSGreater negative pressure within the pharyngeal cavity contributed to the increased collapsibility of the pharynx in OSAHS patients, and the strong correlation between nasal resistance and pharyngeal pressure suggests that the nose plays a role in the pathogenesis of OSAHS.

Adult ; Humans ; Middle Aged ; Pharynx ; physiopathology ; Prospective Studies ; Sleep Apnea, Obstructive ; etiology ; physiopathology

OBJECTIVETo study the long-term effects and mortality of biventricular pacing therapy in patients with congestive heart failure.

METHODSTwenty-five patients, 18 men and 7 women, aged 34-75 [mean aged of (61.42 +/- 10.36)] years, with a cardiac function of New York Heart Association (NYHA) class III (n = 10) or IV (n = 15) received biventricular pacing therapy from Mar. 2001 to Feb. 2005. The etiologies of heart failure were idiopathic dilated cardiomyopathy (16 cases), hypertensive heart disease (3 cases) and ischemic heart disease (6 cases). Left ventricular end-diastolic dimension (LVEDD) was > 60 mm, Left ventricular ejection fraction (LVEF) was < 0.40 and QRS duration was > 130 ms in all the patients. Heart function parameters were repeatedly measured before and 3 months, 6 months, 1 year, 2 years and 3 years after pacemaker implantation. Mortality was also determined. The average follow up period was (20.88 +/- 11.51) months.

RESULTS(1) Mortality: 5 patients died during follow-up (3 non-cardiac and 1 cardiac sudden death and 1 acute myocardial infarction). (2) The mean 6-min walking distance was increased significantly (P < 0.05) at 3 months to 3 years of follow-up. (3) NYHA class: The cardiac function of all patients improved significantly, with a reduction of mean NYHA class of more than one grade at 3 months to 3 years follow-up. (4) LVEDD: LVEDD reduced significantly (P < 0.05) at 3 months to 3 years follow-up. (5) LVEF: LVEF increased significantly (P < 0.05) at 3 months to 2 years follow-up. LVEF also improved at third year's follow-up, but the difference was not significant statistically.

CONCLUSIONSCardiac resynchronization, a pacemaker-based therapy for heart failure, may enhance quality of life and heart function and reverse LV remodeling. The long-term effects of treatment were stable, leading to the reduction of mortality from advanced heart failure.

Adult ; Aged ; Cardiac Pacing, Artificial ; methods ; Death, Sudden, Cardiac ; Female ; Heart Failure ; mortality ; physiopathology ; therapy ; Humans ; Male ; Middle Aged ; Pacemaker, Artificial ; Survival Rate ; Treatment Outcome

BACKGROUNDAlthough liver transplantation has become a standard therapy for end-stage liver diseases, the experience of pediatric liver transplantation is limited in China. In this article we report our experience in pediatric liver transplantation, and summarize its characters in their indications, surgical techniques, and postoperative managements.

METHODSThirty-one children (< or = 18 years old) underwent liver transplantation in our centers. The mean age at transplantation was 12.4 years old (ranged from 5 months to 18 years) with 7 children being less than 4 years of age at transplantation. The most common diagnosis of patients who underwent liver transplantation were biliary atresia, Wilson's disease, primary biliary cirrhosis, glycogen storage disease, hepatoblastoma, urea cycle defects, fulminant hepatic failure, etc. The surgical procedures included 12 standard (without venovenous bypass), 6 pigyback, 6 reduced-size, 3 split, 3 living donor liver transplantation, and 1 Domino liver transplantation. The triple-drug (FK506, steroid, and mycophenolate mofetil) immunosuppressive regimen was used in most of patients. Patients were followed up for a mean of 21.8 months.

RESULTSFive of the 31 patients died during perioperative time; mortality rate was 16.1%. The reasons of death were infections, primary non-function, heart failure, and hypovolemic shock. Postoperative complications in 10 patients included biliary leakage, acute rejection, abdominal infection, hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, and pulmonary infection. Overall patient cumulative survival rate at 1-, 3-, and 5-year was 78.1%, 62.6%, 62.6%, respectively.

CONCLUSIONSThe most common indications of pediatric liver transplantation were congenital end-stage liver diseases. According to patients' age and body weight, standard, piggyback, reduced-size, split, or living donor liver transplantation should be performed. Pediatric liver transplantation especially requires higher surgical skills. The early postoperative management is the key to success. Postoperative bile leak was common, but most patients underwent liver transplantation had a better prognosis.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Liver Transplantation ; adverse effects ; mortality ; Male ; Postoperative Complications ; etiology ; Retrospective Studies ; Survival Rate