Objective To describe a novel surgical technique for male long-segment urethral stric- ture after pelvic trauma using the intact and pedieled pendulous urethra to replace the bulbar and membra- nous urethra,and then reconstructing anterior urethra.Methods Three patients with long-segment post- traumatic bulbar and membranous urethral strictures with short left pendulous urethras who had undergone several failed previous surgeries were treated with staged pendulous-prostatic anastomotic urethroplasty fol- lowed by reconstruction of the anterior urethra.This procedure was divided into 3 stages.The first-stage sur- gery was mobilization of anterior urethra down to the coronary sulcus and then re-routing the prostatic urethra followed by pendulous-prostatic anastomotic urethroplasty with transposition of penis to perineum.The sec- ond-stage surgery was transecting the anterior urethra at the site of coronary sulcus 6 months later when it was re-vaseularized,then straightening the penis and performing urethroperineostomy.The third-stage surgery was reconstruction of anterior urethra 6 months later.Results Case 1 reported satisfactory voiding postopera- tively.Retrograde urethrography showed that the urethra was patent with no post-voiding residual urine (PVR),and bilateral vesicoureteral reflux almost disappeared.The Qmax was 18.8ml/s,and 18ml/s after the third stage surgery and at 2-year follow-up.Case 2 also had satisfactory voiding.A 22F urethral catheter could smoothly pass through the urethra,and Qmax was 19.5 ml/s with no PVR at 2-year follow-up.Case 3 underwent the first stage surgery through perineal and pubic routes.The urethrorectal and urethroperineal fis- tulas were excised and repaired simultaneously.After operation the fistulas healed,but the stenostomia resul- ting from wound infection needed further treatment.Conclusions This procedure is effective for men with complex long-segment post-traumatic bulbar and membranous urethral strictures,especially for those undergo- ing failed previous surgical treatment.

OBJECTIVETo develope a tree analysis pattern of mass spectral urine profiles to discriminate bladder transitional cell carcinoma (TCC) from non-cancer lesions using surface-enhanced laser desorption and ionization time-of-flight mass spectrometry (SELDI-TOF-MS) technology.

METHODSUrine samples from 61 bladder transitional cell carcinoma (TCCs) patients, 53 healthy volunteers and 42 patients with other urogenital diseases were analyzed using IMAC-Cu-3 ProteinChip. Proteomic spectra were generated by SELDI-TOF- MS. A preliminary "training" set of spectra derived from analysis of urine from 46 TCC patients, 32 patients with benign urogenital diseases (BUD), and 40 age-matched unaffected healthy men were used to train and develop a decision tree classification algorithm which identified a fine-protein mass pattern that discriminated cancers from non-cancers effectively. A blinded test set including 38 cases was used to determine the sensitivity and specificity of the classification system.

RESULTSThe algorithm identified a cluster pattern that, in the training set, segregated cancer from non-cancer with a sensitivity of 84.8% and specificity of 91.7%. The discriminatory pattern was correctly identified. A sensitivity of 93.3% and a specificity of 87% for the blinded test were obtained when compared the TCC versus non-cancers.

CONCLUSIONSELDI-TOF-MS technology is a rapid, convenient and high-throughput analyzing method. The urine tree analysis proteomic pattern as a screening tool is effective for differential diagnosis of bladder cancer. More detailed studies are needed to further evaluate the clinical value of this pattern.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Transitional Cell ; diagnosis ; urine ; Cystitis ; diagnosis ; urine ; Decision Trees ; Diagnosis, Differential ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia ; diagnosis ; urine ; Protein Array Analysis ; Proteomics ; methods ; Reproducibility of Results ; Sensitivity and Specificity ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization ; methods ; Urinary Bladder Neoplasms ; diagnosis ; urine

OBJECTIVETo establish an advanced purification techniques of the essential oils obtained from Pogostemon cablin.

METHODMolecular distillation (MD) was applied.

RESULTFour distillates were obtained, chemical constituents of which were analyzed with GC-MS. Compared with those in original oils, the contents of active compounds (patchouli alcohol and pogostone) rose by 27%-47% in the distillates II and III.

CONCLUSIONMolecular distillation (MD) effectively raises the contents of patchouli alcohol and pogostone. The work is of great economic and scientific significance for the industrialization of P. cablin and the discovery of new drugs.

Gas Chromatography-Mass Spectrometry ; Lamiaceae ; chemistry ; Oils, Volatile ; chemistry ; isolation & purification ; Plants, Medicinal ; chemistry ; Sesquiterpenes ; isolation & purification ; Technology, Pharmaceutical ; methods

OBJECTIVETo investigate the occupational stressors and modifiers of pediatricians and nurses in order to find the measurements for control of the job stress.

METHODS427 pediatricians and nurses working in five hospitals of a city served as subjects. Of them, the staff in section of pharmacy and toll offices in each hospital mentioned above served as control group. The General Job Stress Questionnaire was used to investigate the job stress by self-assessment.

RESULTSThe scores of job demand, job risk, drug using, daily job stress, positive feelings, patient A behavior, physical environment and feeling balance in pediatricians and nurses were higher than those of control group, but the scores of job-person conflict, environmental control, technology utility, mental health, responsibility on things were lower than those of control group (P<0.05). The points of job future, job locus of control, self-esteem, job satisfaction, job load variance, depression in nurses were higher than those of pediatricians, and non-work activities, job risk and daily life stress were lower than those of doctors (P<0.05). The main affecting factors on job strain of pediatric staff included job monotony, higher job demand, more non-work job, lower job control, more job risk, job future ambiguous, poorer social support, lower job locus control and lower self-esteem.

CONCLUSIONThe stress degree of pediatric staff is higher than that of controls. The pediatricians have more job stress than that of nurses. The main stressors of pediatric staff are job monotony, higher job demand, more non-worker activity, lower job control, higher job risk and ambiguous job future. The main modifiers are good social support, external job locus of control and higher self-esteem.

Adult ; Burnout, Professional ; Female ; Humans ; Male ; Medical Staff, Hospital ; psychology ; Nursing Staff, Hospital ; psychology ; Pediatrics ; Surveys and Questionnaires ; Young Adult

OBJECTIVETo evaluate the various operative details of strictures of the posterior urethra that are essential for a successful result.

METHODSThe clinical data of 191 patients with posterior urethral strictures or distraction defects from January 1990 to January 2006 were analyzed retrospectively. All patients underwent a retrograde and voiding urethrogram, 62 patients had urethral ultrasonography, 48 patients had urethroscopy, 3 patients had MRI. Repair was performed with a simple anastomosis after urethral mobilization in 66 patients, separation of the corporeal bodies in 48 patients, separation of the corporeal bodies and inferior pubectomy in 30 patients, transpubic anastomosis in 18 patients, pull-through operation in 3 patients, and optical urethrotomy in 26 patients. Followup ranged from 6 to 48 months.

RESULTSThe mean stricture length was 3.6 cm (range from 1.5 to 8.0 cm). Posterior urethral strictures is in 31 (16%), posterior distraction defects is in 160 (84%), of which the length of the distraction defects < 3 cm is in 102 (53.4%), and the the length of the distraction defects > 3 cm is in 58 (30.6%). The overall successful results (Qmax > 15 ml/s) after operation was 84.3%. Optical urethrotomy was 69%, the successful results with anastomotic urethroplasty were 97% with a simple anastomosis; 79% with separation of the corporeal bodies; 80% with separation of the corporeal bodies and inferior pubectomy; 83% with transpubic anastomosis; and 67% with pull-through operation.

CONCLUSIONSThe anastomotic urethroplasty is better than the optical urethrotomy, the length of the strictures or distraction defect which is lower than 3 cm is much more successfully corrected.

Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Urethral Stricture ; surgery ; Urologic Surgical Procedures, Male ; methods

OBJECTIVETo evaluate the selection of different procedures and the feasibility for the treatment of long segment urethral stricture.

METHODSSeventy-six patients with complex urethral stricture greater than 8 cm long underwent different procedures of urethroplasty. Of them various mucosa grafts urethral reconstruction were adopted in 42 cases (colonic mucosal graft, n = 26; buccal mucosal graft, n = 10; bladder mucosal graft, n = 6); One-stage pedicle flaps urethroplasty in 20; two-stage urethroplasty of Johanson procedure in 12; and penile urethra-prostatic urethra anastomosis, three-stage urethroplasty in 2.

RESULTSIn early followed up (within 6 months postoperatively), 67 patients (88%) voided well and complications developed in 10. Among the 70 patients who lasted more than 1 year after operation, 51 cases were followed up. Forty-four patients voided well, and complications developed in 8. Of the 8 cases urethral restructure developed in 2 (18%) for pedicle flaps urethroplasty, 2 for colonic mucosal urethroplasty (9%), 1 for buccal mucosal graft (1/7), 1 for bladder mucosal graft (1/3); penile chordee in 2 (2/5), and one of them was accompanied by hair bearing neourethra for two-stage urethroplasty of Johanson procedure.

CONCLUSIONSColonic mucosal and buccal mucosal grafts urethroplasty are feasible procedures for the treatment of long segment urethral stricture, and Colonic mucosal graft urethroplasty may be considered when more conventional procedures fail or complicated urethral strictures greater than 10 cm long.

Adolescent ; Adult ; Aged ; Follow-Up Studies ; Humans ; Intestinal Mucosa ; surgery ; Male ; Middle Aged ; Mouth Mucosa ; surgery ; Surgically-Created Structures ; Treatment Outcome ; Urethral Stricture ; pathology ; surgery ; Urologic Surgical Procedures, Male ; methods

BACKGROUNDAccurate evaluation of response following chemotherapy treatment is essential for surgical decision making in patients with breast cancer. Modalities that have been used to monitor response to neo-adjuvant chemotherapy (NAC) include physical examination (PE), ultrasound (US), and magnetic resonance imaging (MRI). The purpose of this study was to evaluate the accuracy of PE, US, and MRI in predicting the response to NAC in patients with breast cancer.

METHODSAccording to the response evaluation criteria in solid tumors guidelines, the largest unidimensional measurement of the tumor diameter evaluated by PE, US, and MRI before and after NAC was classified into four grades, including clinical complete response, clinical partial response, clinical progressive disease, clinical stable disease, and compared with the final histopathological examination.

RESULTSOf the 64 patients who received NAC, the pathologic complete response (pCR) was shown in 13 of 64 patients (20%). The sensitivity of PE, US, and MRI in predicting the major pathologic response was 73%, 75%, and 80%, respectively, and the specificity was 45%, 50%, and 50% respectively. For predicting a pCR, the sensitivity of PE, US, and MRI was 46%, 46%, and 39%, respectively, and the specificity was 65%, 98%, and 92% respectively.

CONCLUSIONSCompared with final pathologic findings, all these three clinical and imaging modalities tended to obviously underestimate the pCR rate. A more appropriate, universal, and practical standard by clinical and imaging modalities in predicting the response to neo-adjuvant chemotherapy in vivo is essential.

Adult ; Aged ; Breast Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; Chemotherapy, Adjuvant ; Female ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Physical Examination ; Ultrasonography

OBJECTIVEto investigate the effect of somatostatin on inflammatory immune disorders and prognosis in patients with severe sepsis caused by abdominal diseases.

METHODSfifty-three patients with severe abdominal sepsis (age > 18 years, APACHE-II score > 15) from June 2005 to June 2009 were randomly divided into Somatostatin group (n = 23) and SSC Group (n = 30). Fifteen healthy volunteers of the same age range were chosen as Control group. The SSC group was treated with classical SSC therapy, and the Somatostatin Group was treated with the same regime plus 14-peptide somatostatin continuous infusion at the dose of 6 mg/24 h for 7 days. The serum levels of interleukin-10 (IL-10), tumor necrosis factor-α (TNF-α) were determined by using ELISA. CD(4)(+), CD(8)(+) T cell subsets were determined by fluorescence activated cell sorter(FACS) and CD(4)(+)/CD(8)(+) was calculated. APACHE-II score was observed on admission (d1) and day 3, 7 and 14 after treatment. Morality rates in 28 days in two groups were recorded.

RESULTScompared with Control group, IL-10 and TNF-α levels were significantly elevated in patients with severe abdominal sepsis (P < 0.05), while CD(4)(+), CD(8)(+) T cell and CD(4)(+)/CD(8)(+) decreased significantly (P < 0.05). Compared with the Somatostatin group CD(4)(+), CD(8)(+) T cell and CD(4)(+)/CD(8)(+) on d7 and d14 in SSC Group were significantly increased (P < 0.05), while IL-10 and TNF-α decreased significantly(P < 0.05). APACHE-II scores on d3, d7, d14 of Somatostatin group were significantly lower than those of SSC group, and 28 d mortality rate also declined.

CONCLUSIONSin patients with severe abdominal sepsis, systemic inflammatory response and immune suppression exist simultaneously. Somatostatin has a dual immunomodulatory activity in these patients.

APACHE ; Case-Control Studies ; Female ; Humans ; Interleukin-10 ; blood ; Male ; Prognosis ; Prospective Studies ; Sepsis ; drug therapy ; etiology ; immunology ; Somatostatin ; therapeutic use ; T-Lymphocyte Subsets ; immunology ; Tumor Necrosis Factor-alpha ; blood

Adult ; Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Mouth Mucosa ; transplantation ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; Treatment Outcome ; Urethral Stricture ; surgery ; Young Adult

OBJECTIVESTo compare the sensitivity of mammogram and breast dedicated MRI in detecting ductal carcinoma in situ with microinvaion (DCIS-MI) and ductal carcinoma in situ (DCIS) lesions, and to further investigate the independent predictive factors of mammogram and MRI sensitivity.

METHODSFrom August 2009 to November 2011, 122 consecutive confirmed breast cancer patients who had received operations were recruited for this clinical research. These patients were divided into two groups including DCIS (72 cases) and DCIS-MI (50 cases) based on pathologic reports. All the patients were female, with mean ages of 52.6 years and 54.4 years. Preoperative bilateral breast mammogram, breast dedicated MRI depictions and reports as well as histopathological reports were collected.

RESULTSSensitivity of MRI outstood mammogram in each subgroups: 84.7% vs. 42.4% in DCIS (χ(2) = 27.028, P = 0.000), 94.0% vs. 80.0% in DCIS-MI group (χ(2) = 4.540, P = 0.040). And further analysis showed that MRI was more sensitive to high nuclear grade DCIS and DCIS-MI lesions than low nuclear grade ones (OR = 3.471, P = 0.031).

RESULTSof logistic regression analysis proved microcalcification was an independent predictive factor of mammogram sensitivity (OR = 11.287, P = 0.001).

CONCLUSIONSSensitivity of breast dedicated MRI is superior to mammogram in detecting DCIS and DCIS-MI groups. Lesions with microcalcifiation is an independent predictive marker which meant that mammogram would achieve high detection rate in cancers presented calcification on mammogram image when compared with non-calcification. Diagnostic performance of breast MRI is less affected by clinical and pathological characteristics of the early stage breast cancer patients but further increased detection rate is observed in DCIS and DCIS-MI with high nuclear grade lesions which indicated that MRI could detect more early stage cancers with relative more aggression biological behaviour and provide these patients with early surgical interventions before possible progression to invasive breast cancers.

Breast Neoplasms ; diagnosis ; Calcinosis ; diagnosis ; Carcinoma, Ductal, Breast ; diagnosis ; Carcinoma, Intraductal, Noninfiltrating ; diagnosis ; Female ; Humans ; Magnetic Resonance Imaging ; Mammography ; Middle Aged ; Sensitivity and Specificity