Objective:To investigate the clinical characteristics of prostatic abscesses (PA)primarily presenting as urinary retention in the elderly patients and the therapeutic effect of TURP.Methods:A retrospective analysis was conducted on the case records of four elderly patients with PA who presented primarily with urinary retention and were admitted to our hospital between July 2020 and August 2022. The median age of the four patients was 68.0 (62.0, 77.0) years, all of whom were admitted to the hospital due to progressive difficulty of urination and inability to urinate. All four patients exhibited chills and high fever, with three cases presenting prior to admission and one case post-admission. One patient developed secondary sepsis, and 2 patients experienced perineal pain. Two patients had a history of diabetes, and 2 had a history of hypertension. The rectal digital examination of these four patients revealed prostate enlargement, with 2 cases of tenderness and one case of fluctuation sensation on the prostate. Blood and urine bacterial cultures were carried out in 4 patients, of which 3 patients were positive of blood culture with 2 cases of Escherichia coli and one case of Klebsiella pneumoniae, 2 patients were positive of the urine culture with one case of Escherichia coli and one case of Klebsiella pneumoniae, and one patient was negative of blood and urine culture.Serum C-reactive protein (CRP)and procalcitonin (PCT) increased in these 4 patients, with 118-190 mg/L and 1.39-13.45 ng/ml respectively. One of the 4 patients had elevated serum PSA levels, with a value of 16.95 ng/L, while the remaining 3 patients had normal serum PSA levels. The median international prostate symptom score (IPSS) score before surgery was 31.5(28.7, 34.3) points for these 4 patients, and the median quality of life (QOL) score was 5.0(4.2, 5.8) points. The transabdominal ultrasound examination of these 4 patients showed that the prostate was enlarged and the echo of the prostate was uneven, and the hypoechoic area in the prostate was found in 2 cases. On plain CT scan of the prostate in these cases, the prostate was enlarged, and there was an area of uneven reduction in density. MRI plain scan of the prostate in 2 cases showed abscess in the peripheral zone of the prostate. Among the 4 cases of PA, 3 cases were diagnosed before operation. The size of abscess was 1.7-5.8 cm, including one case of multiple abscess. Another case of PA was found during TURP for benign prostatic hyperplasia. Four patients were undergoing TURP after antibiotic treatment. During the operation, the pus cavity was found at the prostatic capsule, and the pus cavity wall at the urethral side was removed to make the pus cavity fully open. Three-chamber F20 Foley catheter was placed in the urethra eventually.Results:The operation was successfully completed in these 4 patients, and the operation time was 30 to 90 minutes. Postoperative pathology reported benign prostatic hyperplasia with acute/chronic inflammatory cell infiltration. One patient developed fever on the day after operation, with the highest temperature of 38.6 ℃, and improved after pharmaceutical treatment. Urinary catheter was retained for 5 days postoperatively. Five days after surgery, the urinary catheter was removed and all 4 patients had unobstructed urination. One patient experienced transient urinary incontinence caused by urinary tract infection, which improved after 2 weeks of treatment with increased water intake and oral antibiotics. One month after the operation, the abscess cavity of all patients was completely disappeared and urination was smooth. One-month postoperative follow-up revealed complete resolution of abscess cavities in all patients by prostate CT. The median postoperative IPSS was 13.5(8.5, 17.0)( P=0.0286), and the median QOL score was 1.0(0.3, 1.8)( P=0.0284), both showing statistically significant differences compared to preoperative values. Over the follow-up period ranging from 19 to 44 months, no abscess recurrence was noted in the 4 cases, and retrograde ejaculation was noted in 2 cases. Complications such as urethral stricture, urinary incontinence, and urinary retention did not occur. One patient developed epididymitis and orchitis 6 weeks post-surgery, which improved following 2 weeks of conservative treatment. Conclusions:The symptoms of elderly PA patients primarily presenting as urinary retention were severe. TURP can relieve the symptoms of lower urinary tract obstruction while draining the pus cavity, and the therapeutic effect is satisfactory.

Objective:To investigate the clinical characteristics of prostatic abscesses (PA)primarily presenting as urinary retention in the elderly patients and the therapeutic effect of TURP.Methods:A retrospective analysis was conducted on the case records of four elderly patients with PA who presented primarily with urinary retention and were admitted to our hospital between July 2020 and August 2022. The median age of the four patients was 68.0 (62.0, 77.0) years, all of whom were admitted to the hospital due to progressive difficulty of urination and inability to urinate. All four patients exhibited chills and high fever, with three cases presenting prior to admission and one case post-admission. One patient developed secondary sepsis, and 2 patients experienced perineal pain. Two patients had a history of diabetes, and 2 had a history of hypertension. The rectal digital examination of these four patients revealed prostate enlargement, with 2 cases of tenderness and one case of fluctuation sensation on the prostate. Blood and urine bacterial cultures were carried out in 4 patients, of which 3 patients were positive of blood culture with 2 cases of Escherichia coli and one case of Klebsiella pneumoniae, 2 patients were positive of the urine culture with one case of Escherichia coli and one case of Klebsiella pneumoniae, and one patient was negative of blood and urine culture.Serum C-reactive protein (CRP)and procalcitonin (PCT) increased in these 4 patients, with 118-190 mg/L and 1.39-13.45 ng/ml respectively. One of the 4 patients had elevated serum PSA levels, with a value of 16.95 ng/L, while the remaining 3 patients had normal serum PSA levels. The median international prostate symptom score (IPSS) score before surgery was 31.5(28.7, 34.3) points for these 4 patients, and the median quality of life (QOL) score was 5.0(4.2, 5.8) points. The transabdominal ultrasound examination of these 4 patients showed that the prostate was enlarged and the echo of the prostate was uneven, and the hypoechoic area in the prostate was found in 2 cases. On plain CT scan of the prostate in these cases, the prostate was enlarged, and there was an area of uneven reduction in density. MRI plain scan of the prostate in 2 cases showed abscess in the peripheral zone of the prostate. Among the 4 cases of PA, 3 cases were diagnosed before operation. The size of abscess was 1.7-5.8 cm, including one case of multiple abscess. Another case of PA was found during TURP for benign prostatic hyperplasia. Four patients were undergoing TURP after antibiotic treatment. During the operation, the pus cavity was found at the prostatic capsule, and the pus cavity wall at the urethral side was removed to make the pus cavity fully open. Three-chamber F20 Foley catheter was placed in the urethra eventually.Results:The operation was successfully completed in these 4 patients, and the operation time was 30 to 90 minutes. Postoperative pathology reported benign prostatic hyperplasia with acute/chronic inflammatory cell infiltration. One patient developed fever on the day after operation, with the highest temperature of 38.6 ℃, and improved after pharmaceutical treatment. Urinary catheter was retained for 5 days postoperatively. Five days after surgery, the urinary catheter was removed and all 4 patients had unobstructed urination. One patient experienced transient urinary incontinence caused by urinary tract infection, which improved after 2 weeks of treatment with increased water intake and oral antibiotics. One month after the operation, the abscess cavity of all patients was completely disappeared and urination was smooth. One-month postoperative follow-up revealed complete resolution of abscess cavities in all patients by prostate CT. The median postoperative IPSS was 13.5(8.5, 17.0)( P=0.0286), and the median QOL score was 1.0(0.3, 1.8)( P=0.0284), both showing statistically significant differences compared to preoperative values. Over the follow-up period ranging from 19 to 44 months, no abscess recurrence was noted in the 4 cases, and retrograde ejaculation was noted in 2 cases. Complications such as urethral stricture, urinary incontinence, and urinary retention did not occur. One patient developed epididymitis and orchitis 6 weeks post-surgery, which improved following 2 weeks of conservative treatment. Conclusions:The symptoms of elderly PA patients primarily presenting as urinary retention were severe. TURP can relieve the symptoms of lower urinary tract obstruction while draining the pus cavity, and the therapeutic effect is satisfactory.

OBJECTIVE: To investigate the interventional effect of the Chinese herbal preparation Xi Fu Pai Chen(XFPC) on pulmonary inflammation and fibrosis in rats with silicosis. METHODS: A total of 144 adult specific pathogen free male SD rats were randomly divided into 6 groups: blank control group, silicosis model group, drug administration control group and groups of low-dose,medium-dose and high-dose XFPC, with 24 rats in each group. Lung silicosis model was established by single inhalation tracheal instillation method, which was treated with 50.0 g/L silica suspension, in groups except in the blank control group. On the 7 th day of modeling, the rats in the drug administration control group were orally given tetrandrine(5 mg/kg body weight), while those in the low-, medium-and high-dose groups were given 43, 86 and 192 g/L of XFPC by atomization inhalation once a day for 20 minutes, 5 days a week for 4 weeks. At the end of drug administration, the histopathological changes of the lung were observed. The number and classification of cells in bronchoalveolar lavage fluid(BALF)were examined, and the levels of malondialdehyde(MDA) and interferon-gamma(IFN-γ) in BALF were measured by enzyme-linked immunosorbent assay. RESULTS: On the 7 th day after modeling, the body weight in the drug administration control group and XFPC high-dose group decreased compared with the blank control group(P<0.05). On the 35 th day after modeling, the body weights of rats in the other 5 groups were lower than that in the blank control group(P<0.05). The pathological changes of lung tissue(infiltration of inflammatory cells, fibrosis and size of silicon nodule) in drug administration control group and XFPC low-dose group were better than those in silicosis model group by naked eyes and under light microscope. The lung coefficient, the proportion of neutrophils and the level of MDA and IFN-γ in BALF of the drug administration control group and XFPC low-dose group decreased(P<0.05), and the proportion of macrophages in BALF increased(P<0.05) compared with the silicosis model group. There was no significant difference in lung coefficients and the relevant indices of BALF between XFPC medium-, high-dose groups and silicosis model group(P>0.05). CONCLUSION: Low dosage XFPC can improve pulmonary fibrosis and inflammation in rats with silicosis, and its mechanism of action may be related to reducing the levels of IFN-γ and MDA in BALF.

Objective To evaluate the diagnostic accuracy of transcranial doppler(TCD)as an additional screening tool for intracranial arterial steno-occlusive disease in patients with acute ischaemic stroke(AIS)by comparing with the computed tomography angiography(CTA). Methods Two hundred and twenty-four consecutive patients who were hospitalized within 7 days of the onset of symptoms and fulfilled the criteria for the clinical di-agnosis of AIS between May 2013 and May 2014 were enrolled for the study. Among the 224 patients,there were 118 males and 106 females with an average age of 61.2±12.6 years. High-resolution brain CTA was performed after completion of TCD. Results There was slight distinction of the diag-nostic accuracy of TCD for different arteries. TCD demonstrated the most accurate diagnosis for carotid artery vascular system,with a sensitivity of 96.19%and specificity of 98.60%. For the vertebrobasilar vascular system,TCD diagnosis showed a sensitivity of 71.11%and specificity of 94.31%. TCD findings were complementary to the CTA results(real-time embolization,collateral flow patterns and steal phenomenon). Conclusion TCD shows a high diagnostic accuracy comparing to CTA in evaluating intracranial and extracranial arterial stenosis in patients with AIS,especially for the carotid artery vascular system analysis within a short time interval. TCD can also provide additional real-time dynamic findings complementary to the information provided by CTA.