Objective To evaluate the effectiveness of using the anterolateral thigh flap and splitthickness skin grafting to repair large skin defect secondary to the excision of massive penoscrotal Paget's disease.Methods Clinical data of 6 patients with massive penoscrotal Paget's disease were retrospectively reviewed.The patients were admitted to our institute from Feb.2005 to Oct.2010 with mean age of 64 (55-68) years.No other neoplasm and enlarged inguinal lymph node were detected on physical examination,ultrasonography and CT scan.All cases underwent wide local excision of skin lesion which was taken 2 cm beyond the boundary under epidural anesthesia.An anterolateral thigh flap was used to reconstruct the scrotum,and the skin defect of penis was repaired by split-thickness skin grafting.Results Operation was uneventful for the 6 patients,with mean skin defect of 185 (150-210) cm2.The mean operative duration was 270 (210-300) min,and the mean blood loss was 75 (35-150) ml.Negative surgical margins were confirmed on postoperative pathology.Five patients recovered smoothly with satisfying cosmetic appearance,and one patient demonstrated partial necrosis of the flap which was repaired on secondary surgery.The mean follow-up was 37 (10-60) months,and no relapse was found.Conclusions It is an effective method to use anterolateral thigh flap and split-thickness skin grafting to repair large skin defect secondary to excision of massive penoscrotal Paget's disease.

Objective To explore the pattern of cognitive impairments mainly caused by the white matter lesions(WML) in the frontal lobe in patients with subcortical ischemic vascular disease (SIVD).Methods Fifty SIVD patients were divided into severe WML group (visual score >3, n=27) and mild WML group(visual score ≤3, n=23) according to their severities of the WML in frontal lobe .Seven patients without SIVD were collected as controls .All patients underwent a set of neuropsychological battery ,and the results were analyzed .Results There was no statistical significance among three groups on basic data .Compared with mild WML group and control group , non frontal white matter scores and numbers of lacunes in frontal lobe of severe WML group were significantly higher ( all P=0.000).Compared with mild WML group,the Montreal cognitive assessment scale in severe WML group were significantly lower ( P=0.047 ) , and scores related to the executive function were significantly lower ( P=0.006 ) , even after adjusting the numbers of lacunes in frontal lobe ,there was statistically significant difference (P=0.038). Multiple regression confirmed that the Z scores of executive functions were mainly affected by white matter lesions located in the frontal lobe ( P=0.000 ) .Conclusion WML located in the frontal lobe mainly affect the executive function in patients with SIVD .

Objective To study the relationship between infection and hypokalemic paralysis and its clinical features.Methods A systemic analysis was made on the infection courses,clinical manifestations, serum levels of potassium and creatine phosphokinase,the results of electrophysiological and virological examinations in present 34 patients and 115 cases reported in literature with hypokalemic paralysis.Results There were differences in the clinical manifestations and denominations among the present and reported cases. No definite evidences for virus infections were found among patients who were characterized by acute flaccid paralysis accompanied with hypokalemia in the infection curses. The prognosis of the disorder was better after the patients were given potassium, and most of them didn't recur.Conclusion No enough evidences showed that this disorder was an independent disease.It should be named as "concomitant infectious hypokalemic paralysis" appropriately. It was probably a syndrome accompanied by infection on the base of hereditary susceptibility.

Objective To evaluate the safety of simultaneous transurethral green laser vaporization therapy in benign prostatic hyperplasia (BPH) and nonmuscle-invasive bladder transitional cell carcinoma (NMIBT).Methods The clinical data of 27 patients (observation group) who had undergone simultaneous transurethral green laser vaporization therapy in BPH and NMIBT between May 2004 and October 2010 were analyzed retrospectively.Meanwhile 27 patients(control group) only had undergone green laser vaporization therapy in NMIBT during the same period were selected.Clinicopathologic parameters,rate of recurrence and progression,rate of recurrence in the bladder neck and prostatic urethra were determined and compared.Results The time of follow-up in observation group and control group were (28.61 ± 19.53) and (30.20 ± 21.46) months.The rates of recurrence,progression and recurrence in the bladder neck and prostatic urethra between observation group and control group had no significant differences [ 18.5％ (5/27) vs.25.9％ (7/27),3.7％ (1/27) vs.0,0 vs.0] (P ＞0.05).Conclusion Simultaneous transurethral green laser vaporization of NMIBT and BPH can be safely performed without increasing the risk of tumor recurrence in the prostatic urethra.

Objective To explore the expression of acid seining ion channels-3 (ASIC3) in lung tissue in rats with acute lung injury (ALI). Method Twenty four male Sprague-Dawley (SD) rats were randomly divided into four groups: LPS groups (LPS 2 h, LPS 4 h, LPS 6 h group, n=6), stimulated by LPS for 2, 4, 6 hours, respectively; normal control group, injected with saline (NS group, n=6). The ALI models were produced through venous injection of LPS, and the criteria was the characteristic pathological changes in the lung tissue. Ar-terial blood gas analysis was observed, lung wet and dry weight ratio (W/D), lung histopathology and ASIC3 ex-pression were detected. Data were expressed as mean±standard deviation. Independent Sample T test and One-way ANOVA and Kendall's tau_b were used for comparison in SPSS 13.0, and changes were considered as statistieal-ly significant if P value was less than 0.05. Results The partial pressure of oxygen (PaO2) in LPS 2 h, LPS 4 h, LPS 6 h group was (67.47±6.01), (59.17±7.18), (52.54±7.62) , respecively, and was significantly lower than that in eontrol group (98.15±1.06) (P<0.01). Compare with control group, pH was significantly lower in LPS4 h group (7.28±0.04), LPS6 h group (7.24±0.03) (P<0.01). Inflammation cells gradually increased, alveolar septum was widened, edema existed in interstitial spaces, and pulmonary structures gradually destroyed in LPS groups.The expression of ASIC3 in LPS4 h, LPS 6 h group was (205.91±10.12), (196.51± 18.60), respectively, and was significantly lower thanthat in control group (220.23±10.11) (P<0.05). The W/D in LPS 6 h group was (5.18±0.21), and was significantly higher than that in the control group (4.45± 0.18) (P<0.05). Conclusions ASIC3 is expressed in alveolar epithelial cells and bronchial epithehal cells in LPS-induced ALI rats.

Objective To observe the clinical efficacy of ezetimibe combined with atorvastatin calcium on hyperlipidemia,and to evaluate the role of ezetimibe on lipid management in elderly patients with coronary heart disease (CHD) after coronary intervention.Methods A total of 150 elderly CHD patients with hyperlipidemia to undergo coronary intervention in our hospital were selected.Patients were randomly divided into the control group and the experimental group (n=75,each).Patients in control group were treated with atorvastatin,and in the experimental group with ezetimibe plus atorvastatin.The change of blood lipids levels and the incidence of adverse reactions were compared between the two groups 1 month after the treatment.Results The numbers of patients with normal serum levels of total cholesterol (TC),triglycerides (TG),low density lipoprotein (LDLC) were much more in the experimental group than in the control group after treatment [68 cases (90.7％) vs.50 cases (66.7％),62 cases (82.7％) vs.44 cases (58.7％),56 cases (74.7％) vs.38 cases (50.7％),x2 =12.87,10.42,9.23,respectively,all P＜0.01].There was no significant difference in the incidence of adverse reactions between the two groups [5.3％ (4 case) vs.2.7％ (2 cases),x2 =0.17,P ＞ 0.05].Conclusions Compared with atorvastatin calcium treatment,ezetimibe combined with atorvastatin calcium treatment has a better clinical efficacy on hyperlipidemia with no increase of adverse reactions in elderly CHD patients.

Objective To explore the efficacy and safety of greenlight photoselective vaporization of prostate (PVP) in high-risk elder patients with benign prostatic hyperplasia (BPH). Methods A total of 120 high-risk elder patients with BPH underwent PVP procedure. The operating time, blood 1oss, indwelling catheterization and operation-related complications were monitored. The variables such as international prostate symptom score (IPSS), Quality of life (QOL) score, maximum urinary flow rate (Qmax) and residual urine volume (RUV) were recorded and compared pre- and post-operatively. Results All the 120 patients had a good peri-operative condition. The mean operating time was (52. 6 ± 5.8 )min, intraoperative blood loss was (20.4 ±9.5) ml. Among the 120 cases,26 did not received postoperative catheterization. In the other 94 cases received postoperative catheterization, the mean catheterization time was (24. 5 ± 15.9) hour. IPSS and QOL scores decreased from (28.5 ± 3.8) and (5.0 ± 0.8) preoperatively to (7.2 ± 1.8) and (1.5 ± 0.6)postoperatively. Qmax increased from ( 5.2 ± 3.1 ) ml/s to ( 15.2 ± 4.3 ) ml/s, and RUV decreased from ( 118.6 ± 15.2) ml to ( 16. 5 ± 4. 6) ml. There was significant difference for these parameters before and after the operation (Ps ＜ 0. 05 ). Conclusion The PVP is considered to be a safe, effective and minimally invasive procedure to treat BPHin high-risk elder patients. It is easy to manipulate, with advantages of shorter operating time,less blood loss, better tolerance and rapid recovery, especially for high-risk elder patients with BPH.

Objective To evaluate the efficacy of donepezil for post-stroke aphasia. Methods Sixty patients with acute post-stroke aphasia were divided into treatment group and a control group. All patients had been treated for secondary prevention according to the guideline. The treatment group received donepezil hydrochloride (5 mg/d) for 12 weeks. The efficacy of treatment was measured by comparing the changes of scores of Western Aphasia Battery ( WAB) between baseline and 12 weeks later. Results Compared with the baseline, the changes of scores of all items of WAB and Aphasia Quotient ( AQ) in both group after 12 weeks follow-up were great, however, the change of AQ was significantly greater in donepezil group (34. 14 ± 17. 70) than that in control group (20. 69± 17. 26) (P =0. 004). The patients in donepezil group also showed significant recovery in spontaneous speech, comprehension, repetition, and naming than those in control group (P <0. 05 ). The rate of significant improving in donepezil group was 60. 0% which was significantly greater than that in control group ( 26. 7% ) ( P = 0. 009 ). Conclusion There are spontaneous recovery of post-stroke aphasia within 3 months. Donepezil may facilitate the recovery in spontaneous speech, comprehension,repetition,and naming functions.

The emergence of atypical El Tor strains from V .cholerae in South Asia and Africa has been attributed to several outbreaks in recent decades ,however ,backgrounds of such strains in China remain exclusive .In this study ,PCR am-plification of both El Tor and classical alleles for ctxB ,tcpA ,rstR and hlyA genes was attempted in sixty-nine El Tor isolates from Fujian between 1962 to 2005 ,in addition ,some amplicons were sequence-analyzed .Thus ,the time point of atypical EVC strains in Fujian was determined ,genetic diversities of such strains were investigated .It was revealed that ctxB-Cl ,tcpA-Cl and hlyA genes were detected in O1 serogroup EVC isolates from Fujian since 1962 .Although rstR-Cl gene was solely detected in isolates between 1994 to 2000 .It was indicated by sequence analysis that atypical EVC strains from Fujian possessed a novel T→G mutation at residual 204 of the ctxB gene .Remarkably ,two novel ctxB genotypes (ctxB-10 and ctxB-11) were identified in one strain .The residual 115-C of ctxB in ctxB-11 showed characteristics of ctxB-Cl ,however ,its residual 203-T demonstra-ted characteristics of ctxB-El .This observation implied that it was common in O1 serogroup EVC strains from Fujian hybrid-ized with classical alleles since 1962 ,which would be the earliest time-point for the emergence of atypical El Tor strains hitherto in literature .Emergence of atypical El Tor strains harboring rstR-Cl in Fujian occurred since 1994 .Meanwhile ,novel mutation sites and ctxB genotypes were observed in Fujian isolates ,including diverse combination of ctxB genotypes in one strain and combination of biotype-specific sites in ctxB sequences .In summary ,molecular characterization of O 1 serogroup EVC strains from Fujian was unique and geography-associated .

There is emerging evidence from clinical studies that the existence of liver cancer stem cells(CSCs)or tumor initiating cells is responsible for the high recurrence rates of tumor,generation of metastasis,and resistance to therapeutic regimens after therapy. Here,the characteristics of liver CSCs,clinical manifestation,molecular signaling Wnt/β-catenin,signal transducers and activators of transcription 3,NANOG,annexin A3/c-Jun N-terminal kinase,and chapter four-transmembrane 4 L six family member 5/CD44 in liver CSC self-renewal were briefly reviewed. In addition,potential targets for drug therapy were analyzed,providing some reference for drug discovery that selectively target liver CSC self-renewal signals.