Neurogenic bladder caused by herpes zoster is not common.An 86 years old male patient with 6 months of dysuria and urinary retention caused by herpes zoster underwent sacral neuromodulation (SNM) operation. The symptoms of dysuria and fecal incontinence were improved significantly after operation.

Objective To evaluate the diagnostic efficiency of deep fungal infection by detecting the serum galactomannan ( GM) and bronchoalveolar lavage fluid ( BALF) GM, serum G test and fungal culture of BALF in patients with suspected invasive fungal infection ( IFI) in lungs.Methods A retrospective analysis was performed of the results of serum /BALF GM test ,serum G test and BALF culture from 148 patients with suspected pulmonary IFI .The indexes involved sensitivity , specificity , positive predictive value , negative predictive value , as well as diagnostic capacity for deep fungal infection with separated or combined tests .Results Among the 148 cases, 48 cases were clinically diagnosed with IFI and the rest were excluded.Among the 48 IFI cases, 3 cases were positive in serum GM test , 25 cases were positive in BALF GM test , 31 cases were positive in G test and 30 cases were positive in fungal culture .The combined detection showed a sensitivity of 91.6%,specificity of 70.0%, positive predictive value of 59.5% and negative predictive value of 94.6%.Conclusion The combination of GM/G tests and fungal culture can significantly improve the clinical diagnostic efficiency of pulmonary IFI .

Objective To investigate the flora distribution and drug resistance status in the Affiliated Hospital of Academy of Military Medical Sciences so as to provide experimental data for clinical doctors to use antibiotics more efficiently.Methods The clinical data of pathogenic bacterial infections over nearly one year in our hospital were retro -spectively analyzed .Results There were 3815 strains of pathogenic bacteria isolated from the sample .The percentage of Gram-positive strains was 36.4%while that of Gram-negative bacteria was 63.6%.The most common bacteria were Esche-richia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus epidermidis.In terms of drug tolerance , Enterobacteriaceae remained highily sensitive to carbapenems .The total resistance rate was 2%-5%.The resistance rate of A.baumannii to meropenem and imipenem was 60%.There were still a few pan-drug resistant strains among K.pneumoniae,A.baumannii and P.aeruginosa,but there were no drug resistant strains to vancomycin , tige-cycline and linezolid in Staphylococcus.The resistance rate of Enterococcus faecium to vancomycin was 9%.The bacteria were distributed predominantly in ICU ,Department of Hematology and Department of Oncology .The samples were mainly composed of phlegm specimens .Conclusion The high distribution in the three departments mentioned above is largely re-lated to the diseases being treated .The specimens from the lower respiratory tract show more types of bacteria that are mostly drug-resistant, and the isolating rate of vancomycin resistant Enterococcus and carbapenems resistant K.pneumoniat is com-paratively high .

Objective To investigate the laboratory diagnosis of filamentous fungi which are rarely seen in clinical practice.Methods Five strains of fungi were isolated from clinical samples and initially identified by the morphological method.Total DNA of fungi was extracted and amplified by the PCR method using universal primers of ITS2-ITS4 gene, respectively.The PCR products were sequenced and the obtained sequences were then analyzed by the blastn program incorporated in NCBI.Results The five strains of fungi were diagnosed as Scedosporium apiospermum,Schizophyllum commune,Scopulariopsis brevicaulis,Rhizopus stolonifer,and Fusarium solani.Conclusion The laboratory diagnosis of filamentous fungi which rarely occur in clinical practice should integrate various methods,including morphological, microbiological,and molecular biological methods.

Objective:To evaluate the clinical efficacy and safety of transurethral columnar balloon dilation of prostate (TUCBDP) in treatment of patients with benign prostatic hyperplasia(BPH).Methods:A retrospective analysis was performed on 25 cases of BPH treated by TUCBDP in the First Affiliated Hospital of Anhui Medical University from June 2016 to July 2018. The median age was 80(57-94) years, and the median volume of prostate was 75 (30-176) ml. The median preoperative maximum urine flow rate (Q max) was 6 (2-9) ml/s, the median quality of life score (QOL)was 4(3-5) points. The median preoperative international prostate symptom score (IPSS) and residual urine volume (RUV) was 25(18-34) and 85 (30-510) ml respectively.The median preoperative international index of erectile function questionnaire-5 (IIEF-5) score was 11(5-21)points and the median preoperative premature ejaculation diagnostic tool (PEDT) score was 10(6-17)points.The standard procedure of TUCBDP includes injecting 5ml of normal saline into the inner capsule, touching the inner capsule at the apex of prostate, fixing the catheter and then injecting water into the outer capsule to make the pressure reach 2.5 kPa. When the pressure of the outer capsule was maintained at 3 kPa for 5 minutes, the prostate was split. The peroperative IPSS, QOL, Q max and RUV was compared. The IIEF-5 and PEDT score before and after surgery were compared in patients with normal sexual activity to evaluate whether there were reverse ejaculation and semen reduction. Results:One case of BPH failed to rupture and the other two cases was split at 6 o’clock. The three cases were converted to plasma resection. The rest 22 cases were operated successfully with the median operation time of 17(11-23)min, the hemoglobin loss of 19(15-22)g/L. The continuous bladder flushing time was 1(1-2)d, the indwelling catheter time was 10(7-11)d and the hospital stay time was 11(7-12)d. Twenty of 25 cases were followed-up for 12 months. IPSS was 8 (4-14) points, Q max was 17(9-25)ml/s, and RUV was 10 (0-150) ml; there were significant differences between the peroperative and postoperative (all P<0.001). The median QOL was 1(1-2) point, decreased than peroperative( P<0.05). No adverse ejaculation and semen reduction were found in the post-operative patients with normal sexual life. The post-operative IIEF-5 and PEDT score was 16 (7-24) points and 8 (6-14) points respectively, which was not significantly different while compared with pre-operative IIEF-5 and PEDT score. Conclusions:TUCBDP was proved to be effective and safe for treating high-risk BPH patients with the advantages of short operation time, less bleeding, significant improvement of residual urine and dysuria.

Objective To explore the potential value of applying three-dimensional visualization technology in the robot-assisted laparoscopic nephron sparing partial nephrectomy.Methods From January to December 2018,98 patients with renal carcinoma undergoing robot-assisted laparoscopic nephron sparing surgery were retrospectively analyzed.Forty-one patients in the experimental group accomplished kidney CT examination and three-dimensional reconstruction before surgery,and fifty-seven patients in the control group only completed kidney CT examination.There were 20 males and 21 females in the experimental group with the age of (51.39 ± 14.80) years and body mass index (BMI) of (23.54 ± 3.08) kg/m2.The median tumor diameter was 3.40 cm (range 1.90-8.30 cm) and the mean R.E.N.A.L.score was (5.83 ± 1.51) in the experimental group including 11 cases of transperitoneal,17 cases of retroperitoneal and 13 cases of combined transperitoneal and retroperitoneal access.There were 35 males and 22 females in the control group with the age of (52.84 ± 12.28) years and BMI of (24.01 ±3.30)kg/m2.The median tumor diameter was 3.35 cm (range 1.40-7.0 cm) and the mean R.E.N.A.L.score was (6.17 ± 1.77) in the control group including 15 cases of transperitoneal,31 cases of retroperitoneal and 11 cases of combined transperitoneal and retroperitoneal access.There was no statistical difference between two groups in term of age,gender,BMI score,R.E.N.A.L.score,tumor size,tumor location and operative approach.Results Ninety-eight cases of operation were successfully completed without causing vascular and ureteral injury.The warm ischemia time in the experimental group was significantly shorter than that of the control group [median 15.0 (7.0-26.0) min vs.20.0 (10.0-28.0) min,P--0.02],while no statistical difference was observed in term of operation time [median 130.0 (65.0-340.0) min vs.139.0 (67.0-250.0) min,P =0.22].There was no significant difference between the two groups in the decrease of hemoglobin within 24 hours after operation [median 20.0 (4.0-39.0) g/L vs.15.5 (2.0-40.0) g/L,P =0.56] and the average length of hospital stay after operation [median 6.0(4.0-14.0) d vs.6.0(5.0-14.0) d,P =0.86].The trend of creatinine declining was not statistically significant between the two groups at both 24 hours [median:2.0 (-10.0-28.0) μmol/L vs.7.5 (-17.0-51.0) μ mol/L,P =0.24] and 6 months after operation [median:2.0 (-12.0-57.0) μ mol/L vs.4.5 (-3.0-24.0) μmol/L,P =0.39].Conclusions Preoperative three-dimensional reconstruction is helpful to shorten the warm ischemia time,but it did not show short-term and long-term protection for renal function.

Heart failure is the leading cause of death worldwide. Compound Danshen Dripping Pill (CDDP) or CDDP combined with simvastatin has been widely used to treat patients with myocardial infarction and other cardiovascular diseases in China. However, the effect of CDDP on hypercholesterolemia/atherosclerosis-induced heart failure is unknown. We constructed a new model of heart failure induced by hypercholesterolemia/atherosclerosis in apolipoprotein E (ApoE) and LDL receptor (LDLR) dual deficient (ApoE^-/-LDLR^-/-) mice and investigated the effect of CDDP or CDDP plus a low dose of simvastatin on the heart failure. CDDP or CDDP plus a low dose of simvastatin inhibited heart injury by multiple actions including anti-myocardial dysfunction and anti-fibrosis. Mechanistically, both Wnt and lysine-specific demethylase 4A (KDM4A) pathways were significantly activated in mice with heart injury. Conversely, CDDP or CDDP plus a low dose of simvastatin inhibited Wnt pathway by markedly up-regulating expression of Wnt inhibitors. While the anti-inflammation and anti-oxidative stress by CDDP were achieved by inhibiting KDM4A expression and activity. In addition, CDDP attenuated simvastatin-induced myolysis in skeletal muscle. Taken together, our study suggests that CDDP or CDDP plus a low dose of simvastatin can be an effective therapy to reduce hypercholesterolemia/atherosclerosis-induced heart failure.

【Objective】 To reduce the incidence of postoperative intestinal obstruction, we tried to improve surgical techniques by closing the cavity formed during radical cystectomy + ileal passage (Bricker) via laparoscopy to prevent the formation of abdominal hernia. 【Methods】 During Oct.2018 and Feb.2022, 41 patients were involved (conventional group). After standard laparoscopic radical cystectomy + pelvic lymphadenectomy, the ileum channel was established. The right medial retroperitoneum was sutured to cover the mesothelium and end of the ileum channel under open operation or endoscope. The space between the ureter and mesothelium of the ileum channel was sealed, and the end of the ileum channel and both ureters were externalized. During Feb.2022 and Dec.2022, 15 patients were involved (modified group). The right inner and outer lateral peritoneums below the ileal conduit were sutured to "bottom out" the gap between the ileal conduit and the right abdominal wall in addition to standard procedures. The recovery of intestinal function and incidence of bowel obstruction were compared between the two groups. 【Results】 In the conventional group, the intestinal function recovered within 2 to 6 days after surgery, with a median ventilation time of 3 days. Intestinal obstruction occurred in 3 patients, 2 of whom improved after conservative treatment while 1 underwent surgical exploration after ineffective conservative therapy. There were no significant differences in the time of discharge and ventilation between the two groups, but no intestinal obstruction occurred in the modified group. 【Conclusion】 Peritoneal externalization at the end of ileal passage can reduce the incidence of intra-abdominal hernia and postoperative intestinal obstruction, which is worthy of clinical application.