Tadalafil, as a selective phosphodiesterase type 5 inhibitor (PDE5I), has revolutionized the treatment of erectile dysfunction (ED) in men. Conventional management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), which is highly complex and likely multifactorial, is associated with unwanted side effects. Innovative once-daily tadalafil regimen is effective in treating the signs and symptoms of BPH. In recent trials in men with BPH, tadalafil significantly improved total IPSS over the initial 12 weeks of medication. Moreover, tadalafil is effective in treating both ED and the signs and symptoms of BPH. In this study, we review the current state of this new management strategy for LUTS secondary to BPH, highlighting the published reports on the efficacy and tolerability of tadalafil.
Carbolines ; therapeutic use ; Humans ; Lower Urinary Tract Symptoms ; drug therapy ; etiology ; Male ; Prostatic Hyperplasia ; complications ; drug therapy ; Retrospective Studies ; Tadalafil ; Treatment Outcome

Chinese surgery journals are of small international impact which does not measure up to the state of development of surgery in China and they can not adequately publish Chinese researches to the world. To improve the visibility of Chinese surgery journals, this article suggests developing more English surgery journals, extending a co-operation with famous publishers, employing overseas experts as editorial committee and making more use of the Internet.
General Surgery ; International Cooperation ; Journal Impact Factor ; Peer Review, Research ; Periodicals as Topic ; standards

OBJECTIVETo observe the effects of three fluid resuscitation methods on apoptosis of visceral organs in rats with hemorrhagic shock.

METHODSA model of rat with severe hemorrhagic shock and active bleeding was established in 32 SD (Sprague-Dawley) rats. The rats were randomly divided into control group, no fluid resuscitation group (NF group), controlled fluid resuscitation group (NS40 group) and rapid large scale fluid resuscitation group (NS80 group). Each group contained 8 rats. The curative effects were compared. At the same time, the apoptosis in liver, kidney, lung and small intestinal mucosa of survivors after hemorrhage and resuscitation was detected by light microscopy in HE (hematoxylin and eosin) stained tissue sections, flow cytometry and terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL).

RESULTSThe survival rate of early fluid resuscitation (14/16) was markedly higher than that of NF group (3/8). There was some apoptosis in liver, kidney, lung and small intestinal mucosa of all survivors. Compared with NF and NS40 groups, the apoptosis of liver, kidney and small intestinal mucosa of NS80 group was obviously increased.

CONCLUSIONSAmong three fluid resuscitation methods, controlled fluid resuscitation can obviously improve the early survival rate and the apoptosis of liver, kidney and small intestinal mucosa in rats with severe and uncontrolled hemorrhagic shock, and may benefit improvement of prognosis.

Animals ; Apoptosis ; Blood Pressure ; Flow Cytometry ; Fluid Therapy ; methods ; In Situ Nick-End Labeling ; Intestine, Small ; pathology ; Kidney ; pathology ; Lactic Acid ; blood ; Liver ; pathology ; Lung ; pathology ; Male ; Organ Specificity ; Rats ; Rats, Sprague-Dawley ; Resuscitation ; methods ; Shock, Hemorrhagic ; pathology ; physiopathology ; therapy

Animals ; Apoptosis ; Blood Pressure ; Disease Models, Animal ; Flow Cytometry ; Fluid Therapy ; In Situ Nick-End Labeling ; Intestinal Mucosa ; pathology ; Lactic Acid ; blood ; Male ; Rats ; Rats, Sprague-Dawley ; Resuscitation ; Shock, Hemorrhagic ; mortality ; pathology ; therapy ; Survival Rate

OBJECTIVETo evaluate plasma arginine vasopressin (AVP) level in patients with traumatic brain injury and investigate the role of AVP in the process of brain edema.

METHODSA total of 30 patients with traumatic brain injury were involved in our study. They were divided into two groups by Glasgow Coma Scale: severe traumatic brain injury group (STBI, GCS less than or equal to 8) and moderate traumatic brain injury group (MTBI, GCS larger than 8). Samples of venous blood were collected in the morning at rest from 15 healthy volunteers (control group)and within 24 h after traumatic brain injury from these patients for AVP determinations by radioimmunoassay. The severity and duration of the brain edema were estimated by head CT scan.

RESULTSPlasma AVP levels (ng/L) were (mean+/-SD): control, 3.06+/-1.49; MTBI, 38.12+/-7.25; and STBI, 66.61+/-17.10. The plasma level of AVP was significantly increased within 24 h after traumatic brain injury and followed by the reduction of GCS, suggesting the deterioration of cerebral injury (P less than 0.01). And the AVP level was correlated with the severity (STBI r equal to 0.919, P less than 0.01; MTBI r equal to 0.724, P less than 0.01) and the duration of brain edema (STBI r equal to 0.790, P less than 0.01; MTBI r equal to 0.712, P less than 0.01).

CONCLUSIONSThe plasma AVP level is closely associated with the severity of traumatic brain injury. AVP may play an important role in pathogenesis of brain edema after traumatic brain injury.

Adult ; Arginine Vasopressin ; blood ; Brain Edema ; blood ; etiology ; physiopathology ; Brain Injuries ; blood ; complications ; physiopathology ; Female ; Humans ; Male ; Middle Aged

OBJECTIVETo investigate the potential and early effect of hypertonic saline resuscitation on T-lymphocyte subpopulations in rats with hemorrhagic shock.

METHODSA model of rat with severe hemorrhagic shock was established in 18 Sprague-Dawley (SD) rats. The rats were randomly divided into Sham group, HTS group (hypertonic saline resuscitation group) and NS group (normal saline resuscitation group). Each group contained 6 rats. The CD4(+) and CD8(+) subpopulations of T-lymphocytes in peripheral blood were detected respectively before shock and after resuscitation by double antibody labelling and flow cytometry.

RESULTSIn the early stage after hemorrhagic shock, fluid resuscitation and emergency treatment, the CD4(+) lymphocytes of peripheral blood in HTS and NS groups markedly increased. Small volume resuscitation with HTS also induced peripheral CD8(+) lymphocytes to a certain extent, whereas NS resuscitation showed no effect in this respect. Consequently, compared with Sham and HTS groups, CD4(+)/CD8(+) ratio of peripheral blood in NS group was obviously increased, and showed statistically differences.

CONCLUSIONIn this model of rat with severe hemorrhagic shock, small volume resuscitation with HTS is more effective than NS in reducing immunologic disorders and promoting a more balanced profile of T-lymphocyte subpopulations regulating network.

Animals ; Blood Pressure ; CD4-CD8 Ratio ; Disease Models, Animal ; Isotonic Solutions ; administration & dosage ; Male ; Rats ; Rats, Sprague-Dawley ; Resuscitation ; methods ; Saline Solution, Hypertonic ; administration & dosage ; Shock, Hemorrhagic ; immunology ; physiopathology ; therapy ; T-Lymphocyte Subsets ; immunology

OBJECTIVETo summarize the clinical management of abdominal compartment syndrome (ACS) in burn patients with severe burn injury.

METHODSTwelve serious burn patients with abdominal compartment syndrome hospitalized in our center from January 2001 to April 2005 were enrolled in the study. Among them 3 patients were treated with conservative method, 4 with escharectomy of abdominal wall, 5 with laparotomy for decompression. The clinical results were analyzed statistically. Bladder pressure, central venous pressure, systolic blood pressure and arterial blood oxygen partial pressure (PaO2 ) were measured and compared before and after operation.

RESULTSAmong these 12 patients, 5 died with the overall mortality of 41.67%. But only 3 died among 9 patients undergone operation. Most of patients were oliguric,with abnormal bladder pressure, central venous pressure, and systolic blood pressure 24 hours before operation. But these parameters were significantly improved after operation ( P <0. 01).

CONCLUSIONEarly abdominal escharectomy and timely abdominal decompression are vital for the management of ACS in burn patients.

Abdomen ; pathology ; Adult ; Aged ; Burns ; complications ; therapy ; Compartment Syndromes ; etiology ; surgery ; Female ; Humans ; Male ; Middle Aged

OBJECTIVESTo study the impact of asymptomatic prostatitis on semen parameters.

METHODBased on the count of WBC in EPS, we assigned 152 patients with asymptomatic (type IV) prostatitis to Groups A (WBC + to + +) and B (WBC + + + to + + + +), and included 68 normal healthy men controls in Group C. All the patients were examined for the volume, pH value and liquefaction time of the semen, sperm concentration, sperm survival rate, grade a sperm percentage, morphologically normal sperm percentage, WBC count, and accompanying inflammatory cytokines.

RESULTSThe semen liquefaction time, grade a sperm percentage and morphologically normal sperm percentage were (24.5 +/- 5.2) min, 20.0 +/- 4.1 and 10.5 +/- 4.8 in Group A, (30.4 +/- 5.0) min, 10.0 +/- 3.8 and 7.5 +/- 4.2 in Group B, and (18.5 +/- 5.3) min, 32.3 +/- 4.5 and 17.8 +/- 3.6 in Group C, with statistically significant differences between A and B (P < 0.01). The pH value, semen volume, sperm survival rate and sperm concentration were 7.6 +/- 0.3, (3.0 +/- 1.1) ml, 56.0 +/- 6.0 and (65.9 +/- 11.3) x 10(6)/ml in Group A, 7.7 +/- 0.3, (2.8 +/- 1.2) ml, 52.3 +/- 6.3 and (62.5 +/- 10.3) x 10(6)/ml in Group B, and 7.5 +/- 0.2, (2.9 +/- 1.2) ml, 62.1.0 +/- 5.3 and (87.7 +/- 10.1) x 10(6)/ml in Group C, with no significant differences among the three groups (P > 0.05). The contents of interleukin-1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha) in the semen were (58.64 +/- 30.82) pg/ml and (50.57 +/- 27.48) pg/ml in Group B, significantly increased as compared with (17.68 +/- 5.65) pg/ml and (23.50 +/- 4.80) pg/ml in Group C (P < 0.01).

CONCLUSIONAsymptomatic prostatitis effects significant changes in the major parameters of the patient's semen quality.

Adult ; Case-Control Studies ; Cytokines ; analysis ; Humans ; Leukocyte Count ; Male ; Middle Aged ; Prostatitis ; physiopathology ; Semen ; Semen Analysis ; Sperm Count ; Young Adult

Objective To investigate the epidemiological features of patients with nosoeomial invasive fungal infection. Methods Fungi in blood were identified by BaeT ALERT 3D, other clinical samples were cultured by Sabouraud' s dextrose agar (SDA) medium. Candidas were isolated and identified by CHRO Magar candida color medium. Fungus-cultured positive cases from Jan. 2004 to Nov. 2007 were analyzed on items as patients' age, underlying disease, sample, strain, and species distribution. All statistical analyses were carried out by SPSS 13.0. Results The overall incidence rate of invasive fungal infections was 4.12%. The average age of patients was 7-96 with most patients were male, with geriatric problems and different kinds of underlying diseases. Lower respiratory tract infection was the most frequent infection site, followed by urinary tract, gastrointestinal tract. The main pathogens of invasive fungal infections were Candidas (93.80%). Strains of Candida albicans were the most frequent organisms which accounted for 67.29% of all the isolates. Mould fungus infections accounted for only 6.20%. During the 4 years of observation, the detection rate of fungi, specimen sources and the distribution of species and compartment were different with significant differences (P<0.0083). Conduslon The epidemiological properties such as the source of specimen, the distribution of species and composition sections of invasive fungal infections were changing. Candida slaP. were still the main pathogens of invasive fungal infections but the sections of fungi changed. The incidence of Aspergillus infections had been increasing recently.

Objective Single mechanical ventilation for curing severe acute respiratory distress syndrome (ARDS) is sometimes not effective in improving oxygenation and removing excess CO₂ in the blood. The purpose of this study is to observe the effect of continuous renal replacement therapy（CRRT）combined with low-flow extracorporeal membrane oxygenation （ECMO）of V-V mode on clearance of inflammatory mediators，improving oxygenation and reducing PaCO₂ in canines with ARDS and hypercapnia. Methods 30 healthy adult canines were divided into 3 groups (n=10 each) using a random number table method sham group, ECMO (EC) group and CRRT+ECMO（CR+EC）group. A canine model of ARDS with hypercapnia were prepared by injected intravenously oleic acid. Sham group was only treated with invasive mechanical ventilation. EC group was treated with invasive mechanical ventilation and ECMO. CR+EC group was treated with CRRT combined with low-flow ECMO of V-V mode besides invasive mechanical ventilation. The heart rate(HR)，mean artery pressure (MAP)，cardiac output(CO) and concentration of serum TNF-α and IL-6 were examined at the beginning of modeling(T₀)，after 1，3，6 and 9 (T₁, T₃, T₆, T₉) hours of mechanical treatment respectively. Oxygenation index（OI），PaCO₂, temperature（T）were examined at the beginning of modeling，after 3, 6, 9 hours of mechanical treatment，and at the time point of 3 hours(T12) after ECMO treatment (EC group) and CRRT+ECMO treatment(CR+EC group)，respectively. The differences were compared between groups involved in above-mentioned indexes at different time points. Results Compared with the sham group, the HR decreased at T₆ and T₉ in the EC group and CR+EC group (P<0.05), and the concentration of IL-6 and TNF-α decreased at T₃, T₆ and T₉ in the CR+EC group (P<0.05). Compared with T₀, HR decreased at T₆ and T₉ in the EC group (P<0.05). Compared with T₀, the concentration of IL-6 and TNF-α decreased at T₃, T₆ and T₉ in the CR+EC group (P<0.05). Compared with the EC group, the HR decreased at T₆ and T₉ in the CR+EC group (P<0.05). Compared with the EC group, the concentration of IL-6 and TNF-α decreased at T₃, T₆ and T₉ in the CR+EC group (P<0.05). Compared with the sham group, the OI decreased at T₉ and T₁₂ in the CR+EC group (P<0.05). Compared with the sham group, PaCO₂ decreased at T₃, T₆ and T₉ in the EC group and CR+EC group (P<0.05). Compared with the EC group, the OI decreased at T₉ and T₁₂ in the CR+EC group (P<0.05). Compared with T₀, the OI decreased at T₆ and T₁₂ in the CR+EC group (P<0.05). Conclusion The CRRT combined with low-flow ECMO of V-V mode has positive effects on clearance of inflammatory mediators，reducing hypercapnia and improving oxygenation in the canines with ARDS and hypercapnia.