1.Correlation between spinal sagittal imbalance and knee joint parameters detected by whole-body EOS imaging
Feng ZHOU ; Pengfei FU ; Yufan QIAN ; Pingcheng XU ; Jiongjiong GUO ; Lei ZHANG
Chinese Journal of Tissue Engineering Research 2026;30(3):596-603
BACKGROUND:With changing lifestyles and aging,sagittal spinal imbalance has become a common orthopedic issue significantly affecting knee and pelvic function.Understanding the impact of sagittal spinal imbalance and its compensatory mechanisms is crucial for improving the clinical management of chronic pain.OBJECTIVE:To evaluate the alignment of the spine-pelvis-lower extremities using whole-body EOS imaging,analyze the correlation between spinal sagittal imbalance and knee joint parameters,and explore their compensatory mechanisms.METHODS:A total of 71 patients with chronic low back pain or patellofemoral pain who visited Department of Orthopedics,First Affiliated Hospital of Soochow University between January 1,2021 and December 31,2023 were included.Radiographic measurements were performed using whole-body EOS to determine pelvic tilt,pelvic incidence,lumbar lordosis,sagittal vertical axis,global tilt,hip-knee-angle,knee flexion angle,lateral distal femoral angle,and medial proximal tibial angle.Patients were classified into normal group(pelvic incidence-lumbar lordosis<10°),compensated group(10°<pelvic incidence-lumbar lordosis<20°),and decompensated group(pelvic incidence-lumbar lordosis>20°)based on the SRS-Schwab spinal deformity classification according to pelvic incidence-lumbar lordosis difference.The differences in radiographic parameters among the groups were analyzed.The differences in American Knee Society Knee Score and Oswestry Disability Index scores were compared among each group.Patients were divided into chronic low back pain group and non-chronic low back pain group,patellofemoral pain group and non-patellofemoral pain group based on clinical symptoms,and the relationship between radiographic parameter differences and clinical symptoms was analyzed.RESULTS AND CONCLUSION:(1)When pelvic incidence-lumbar lordosis was less than 20°,lateral distal femoral angle and medial proximal tibial angle tended to stabilize.When pelvic incidence-lumbar lordosis was greater than 20°,it showed a linear correlation with lateral distal femoral angle and medial proximal tibial angle,with lateral distal femoral angle increasing and medial proximal tibial angle decreasing with increasing pelvic incidence-lumbar lordosis values.(2)Compared with the normal group,the compensated group had significantly increased pelvic tilt(P<0.01),while knee joint parameters hip-knee-angle and knee flexion angle showed no significant differences;the decompensated group showed significant increases in pelvic tilt(P<0.01),and decreases in hip-knee-angle,and knee flexion angle(P<0.01).Compared with the compensated group,the decompensated group showed a significant decrease in hip-knee-angle(P<0.05),but had no significant differences in pelvic tilt and knee flexion angle.(3)Compared with the non-patellofemoral pain group,patients with patellofemoral pain had significant decreases in spinal lumbar lordosis,lateral distal femoral angle,and medial proximal tibial angle(P<0.05)and a significant increase in pelvic incidence-lumbar lordosis(P<0.05).(4)Patients with low back pain had significant differences in radiographic parameters compared with the non-chronic low back pain group(P<0.05).(5)Compared with the normal group,both the compensated and decompensated groups showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P<0.05).Compared with the compensated group,the decompensated group showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P<0.05).(6)Pelvic incidence-lumbar lordosis values increased with age and were higher in females compared with males.(7)This study systematically reveals the spine and lower limbs play an important role in disease progression and clinical symptoms.Associated symptoms low back pain and patellofemoral pain are related to the stability of the spine-pelvis-lower extremity alignment.Furthermore,spinal sagittal imbalance is more severe in elderly and female patients.
2.Correlation between spinal sagittal imbalance and knee joint parameters detected by whole-body EOS imaging
Feng ZHOU ; Pengfei FU ; Yufan QIAN ; Pingcheng XU ; Jiongjiong GUO ; Lei ZHANG
Chinese Journal of Tissue Engineering Research 2026;30(3):596-603
BACKGROUND:With changing lifestyles and aging,sagittal spinal imbalance has become a common orthopedic issue significantly affecting knee and pelvic function.Understanding the impact of sagittal spinal imbalance and its compensatory mechanisms is crucial for improving the clinical management of chronic pain.OBJECTIVE:To evaluate the alignment of the spine-pelvis-lower extremities using whole-body EOS imaging,analyze the correlation between spinal sagittal imbalance and knee joint parameters,and explore their compensatory mechanisms.METHODS:A total of 71 patients with chronic low back pain or patellofemoral pain who visited Department of Orthopedics,First Affiliated Hospital of Soochow University between January 1,2021 and December 31,2023 were included.Radiographic measurements were performed using whole-body EOS to determine pelvic tilt,pelvic incidence,lumbar lordosis,sagittal vertical axis,global tilt,hip-knee-angle,knee flexion angle,lateral distal femoral angle,and medial proximal tibial angle.Patients were classified into normal group(pelvic incidence-lumbar lordosis<10°),compensated group(10°<pelvic incidence-lumbar lordosis<20°),and decompensated group(pelvic incidence-lumbar lordosis>20°)based on the SRS-Schwab spinal deformity classification according to pelvic incidence-lumbar lordosis difference.The differences in radiographic parameters among the groups were analyzed.The differences in American Knee Society Knee Score and Oswestry Disability Index scores were compared among each group.Patients were divided into chronic low back pain group and non-chronic low back pain group,patellofemoral pain group and non-patellofemoral pain group based on clinical symptoms,and the relationship between radiographic parameter differences and clinical symptoms was analyzed.RESULTS AND CONCLUSION:(1)When pelvic incidence-lumbar lordosis was less than 20°,lateral distal femoral angle and medial proximal tibial angle tended to stabilize.When pelvic incidence-lumbar lordosis was greater than 20°,it showed a linear correlation with lateral distal femoral angle and medial proximal tibial angle,with lateral distal femoral angle increasing and medial proximal tibial angle decreasing with increasing pelvic incidence-lumbar lordosis values.(2)Compared with the normal group,the compensated group had significantly increased pelvic tilt(P<0.01),while knee joint parameters hip-knee-angle and knee flexion angle showed no significant differences;the decompensated group showed significant increases in pelvic tilt(P<0.01),and decreases in hip-knee-angle,and knee flexion angle(P<0.01).Compared with the compensated group,the decompensated group showed a significant decrease in hip-knee-angle(P<0.05),but had no significant differences in pelvic tilt and knee flexion angle.(3)Compared with the non-patellofemoral pain group,patients with patellofemoral pain had significant decreases in spinal lumbar lordosis,lateral distal femoral angle,and medial proximal tibial angle(P<0.05)and a significant increase in pelvic incidence-lumbar lordosis(P<0.05).(4)Patients with low back pain had significant differences in radiographic parameters compared with the non-chronic low back pain group(P<0.05).(5)Compared with the normal group,both the compensated and decompensated groups showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P<0.05).Compared with the compensated group,the decompensated group showed a significant decrease in American Knee Society Knee Score scores and a significant increase in Oswestry Disability Index scores(P<0.05).(6)Pelvic incidence-lumbar lordosis values increased with age and were higher in females compared with males.(7)This study systematically reveals the spine and lower limbs play an important role in disease progression and clinical symptoms.Associated symptoms low back pain and patellofemoral pain are related to the stability of the spine-pelvis-lower extremity alignment.Furthermore,spinal sagittal imbalance is more severe in elderly and female patients.
3.Prescribing rate, healthcare utilization, and expenditure of older adults using potentially inappropriate medications in China: A nationwide cross-sectional study.
Zinan ZHAO ; Mengyuan FU ; Can LI ; Zhiwen GONG ; Ting LI ; Kexin LING ; Huangqianyu LI ; Jianchun LI ; Weihang CAO ; Dongzhe HONG ; Xin HU ; Luwen SHI ; Xiaodong GUAN ; Pengfei JIN
Chinese Medical Journal 2025;138(23):3163-3167
BACKGROUND:
The use of potentially inappropriate medications (PIMs) is a major concern for medication safety as it may entail more harm than potential benefits for older adults. This study aimed to explore the prescribing rate, healthcare utilization, and expenditure of older adults using PIMs in China.
METHODS:
A cross-sectional analysis was conducted using a national representative database of all medical insurance beneficiaries across China, extracting ambulatory visit records of adults aged 65 years and above between 2015 and 2017. Descriptive analysis was conducted to measure the rate of patients exposed to PIM, prescribing rate of each PIM, average annual outpatient visits per patient, average total medication costs for each visit, average annual cost of PIMs for each patient, and average annual medication costs for each patient. Generalized linear model with logit link function and binomial distribution was used to examine the adjusted associations between PIMs and independent variables.
RESULTS:
In total, 845,278 (33.2%) participants were identified to be exposed to at least one PIM. Patients aged 75-84 years (38.1%, 969,809/2,545,430) and ≥85 years (37.9%, 964,718/2,545,430) were more likely to be prescribed with PIMs. Beneficiaries of the Urban Employee Basic Medical Insurance (UEBMI) and living in eastern and southern regions were more frequently prescribed with PIMs. Compared with patients without PIM exposure (7.5 visits, drug cost of RMB 1545.0 Yuan), patients with PIM exposure showed higher adjusted average annual number of outpatient visits (10.7 visits, β = 3.228, 95% confidence interval [CI] = 3.196-3.261) and higher annual drug costs (RMB 2461.8 Yuan, Coef. = 916.864, 95% CI = RMB 906.292-927.436 Yuan).
CONCLUSIONS
The results showed that the use of PIM among older adults was common in China. This study suggests that the use of PIM could be considered as a clear target, pending multidimensional efforts, to promote rational prescribing for older adults.
Humans
;
Aged
;
Cross-Sectional Studies
;
Aged, 80 and over
;
Male
;
Female
;
China
;
Inappropriate Prescribing/economics*
;
Patient Acceptance of Health Care/statistics & numerical data*
;
Potentially Inappropriate Medication List/statistics & numerical data*
;
Health Expenditures/statistics & numerical data*
4.Effectiveness of arthroscopic double fixation and enhanced suture of long head of biceps tendon in situ for repairing rotator cuff tear.
Pengfei FU ; Jinxiang TIAN ; Biao GUO ; Dongqiang YANG
Chinese Journal of Reparative and Reconstructive Surgery 2025;39(4):451-456
OBJECTIVE:
To investigate the effectiveness of arthroscopic double fixation and enhanced suture of long head of biceps tendon (LHBT) in situ for repairing rotator cuff tear.
METHODS:
A retrospective analysis was conducted on 31 patients with rotator cuff tears and LHBT injuries admitted between June 2022 and November 2023. All patients underwent arthroscopic double fixation and enhanced suture of LHBT in situ. There were 12 males and 19 females, with an average age of 61.6 years (range, 53-76 years). There were 10 cases of acute injury and 21 cases of chronic injury. According to DeOrio and Cofield classification criteria, the degree of rotator cuff tear rated as medium-sized tears in 3 cases, large tears in 12 cases, and massive tears in 16 cases. Associated injuries included 5 cases of shoulder joint adhesions, 12 cases of subscapularis muscle tears, and 31 case of shoulder impingement syndromes. The shoulder range of motion (ROM) (forward flexion, abduction, lateral external rotation, lateral internal rotation) and pain/function scores [visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, Constant-Murley score] were recorded before operation and at last follow-up. MRI at last follow-up were taken to evaluate the rotator cuff healing and structural integrity.
RESULTS:
All 31 surgeries were successfully completed with operation time ranging from 90 to 210 minutes (mean, 144 minutes). The 3-5 anchors (mean, 3.8 anchors) were used during operation. All incisions healed by first intention. All patients were followed up 12-29 months (mean, 18.5 months). At 3 months after operation, 2 cases developed joint adhesions, 3 had internal rotation limitations, and 2 experienced residual pain at the intertubercular groove, all resolved with conservative management. No Popeye deformity occurred during follow-up. At last follow-up, shoulder ROM (forward flexion, abduction, lateral external rotation, lateral internal rotation) and pain/function scores (VAS, UCLA, and Constant-Murley scores) showed significant improvements compared to preoperative values ( P<0.05). At last follow-up, MRI evaluation showed that the rotator cuff healing rate reached 90.3% according to the Sugaya classification criteria. LHBT exhibited normal morphology, course, and continuity without dislocation. Surrounding synovial sheath showed no thickening or effusion.
CONCLUSION
Arthroscopic double fixation and enhanced suture of LHBT in situ for repairing rotator cuff tear can significantly reduce shoulder joint pain, improve ROM, and achieve a high rotator cuff healing rate.
Humans
;
Male
;
Middle Aged
;
Arthroscopy/methods*
;
Rotator Cuff Injuries/physiopathology*
;
Female
;
Retrospective Studies
;
Aged
;
Range of Motion, Articular
;
Suture Techniques
;
Treatment Outcome
;
Rotator Cuff/surgery*
;
Shoulder Joint/physiopathology*
;
Tendons/surgery*
5.Safety, dosimetry, and efficacy of an optimized long-acting somatostatin analog for peptide receptor radionuclide therapy in metastatic neuroendocrine tumors: From preclinical testing to first-in-human study.
Wei GUO ; Xuejun WEN ; Yuhang CHEN ; Tianzhi ZHAO ; Jia LIU ; Yucen TAO ; Hao FU ; Hongjian WANG ; Weizhi XU ; Yizhen PANG ; Liang ZHAO ; Jingxiong HUANG ; Pengfei XU ; Zhide GUO ; Weibing MIAO ; Jingjing ZHANG ; Xiaoyuan CHEN ; Haojun CHEN
Acta Pharmaceutica Sinica B 2025;15(2):707-721
Peptide receptor radionuclide therapy (PRRT) with radiolabeled SSTR2 agonists is a treatment option that is highly effective in controlling metastatic and progressive neuroendocrine tumors (NETs). Previous studies have shown that an SSTR2 agonist combined with albumin binding moiety Evans blue (denoted as 177Lu-EB-TATE) is characterized by a higher tumor uptake and residence time in preclinical models and in patients with metastatic NETs. This study aimed to enhance the in vivo stability, pharmacokinetics, and pharmacodynamics of 177Lu-EB-TATE by replacing the maleimide-thiol group with a polyethylene glycol chain, resulting in a novel EB conjugated SSTR2-targeting radiopharmaceutical, 177Lu-LNC1010, for PRRT. In preclinical studies, 177Lu-LNC1010 exhibited good stability and SSTR2-binding affinity in AR42J tumor cells and enhanced uptake and prolonged retention in AR42J tumor xenografts. Thereafter, we presented the first-in-human dose escalation study of 177Lu-LNC1010 in patients with advanced/metastatic NETs. 177Lu-LNC1010 was well-tolerated by all patients, with minor adverse effects, and exhibited significant uptake and prolonged retention in tumor lesions, with higher tumor radiation doses than those of 177Lu-EB-TATE. Preliminary PRRT efficacy results showed an 83% disease control rate and a 42% overall response rate after two 177Lu-LNC1010 treatment cycles. These encouraging findings warrant further investigations through multicenter, prospective, and randomized controlled trials.
6.Status and influencing factors of air quality in static state of clean operating rooms in 41 medical institutions in Xi'an from 2017 to 2021
Ruru LIU ; Xin WANG ; Chen CHEN ; Fei WANG ; Wenhao LI ; Pengfei WANG ; Yulong LIU ; Han FU
Chinese Journal of Nosocomiology 2025;35(15):2368-2373
OBJECTIVE To investigate the current status of air quality in clean operating rooms in Xi'an and explore the possible influencing factors,thus to provide data support for improving the quality of operating room manage-ment.METHODS According to GB50333-2013"Architectural technical code for hospital clean operating depart-ment",on-site monitoring was conducted from 2017 to 2021 on the air quality of 242 clean operating rooms in 41 hospitals in Xi'an,and the results were compared and analyzed.RESULTS Among the operating rooms being sur-veyed,130 were from secondary hospitals,112 from tertiary hospitals;seventy-nine were ClassⅠoperating rooms,26 were ClassⅡ,137 were ClassⅢ.The pass rate for settling bacterial was 98.35%,with 94.94%for ClassⅠoperating rooms,which was significantly lower than that in ClassⅡand ClassⅢ operating rooms(χ2=6.565,P=0.022).The pass rate for dust particles was 69.01%,with 43.04%for ClassⅠoperating rooms,and there was significant difference among different levels of operating rooms(χ2=37.304,P<0.001).The pass rate for dust particles in tertiary hospitals was 61.61%,lower than that in secondary hospitals(75.38%;χ2=5.340,P=0.021).The pass rate for dust particles≥0.5μm and≥5μm were 85.12%and 74.79%,respectively.Among the operating rooms with unqualified dust particles,those with both≥0.5 μm and≥5 μm dust particles not meeting standards accounted for 29.33%,and those with only≥0.5 μm dust particles not meeting standards accounted for 18.67%.Multivariate logistic regression analysis showed that influencing factors for air quality in clean operating rooms included the year of monitoring and the level of the operating room,while the sampling area and hospital level were not statistically associated with the outcomes.CONCLUSION The overall air quality of op-erating rooms in Xi'an is not optimistic,the pass rate is affected by the year of monitoring and the clean levels of the operating rooms,indicating a need to strengthen routine management and monitoring of clean operating rooms.
7.Based on the anchor analysis of network pharmacology,the mechanism and role of emodin in the treatment of liver injury were investigated
Guang TIAN ; Shiyuan QIN ; Chengwen SONG ; Zhengfei TAN ; Bendong FU ; Pengfei YI ; Luyuan PENG
Chinese Journal of Veterinary Science 2025;45(9):1965-1976
To screen potential drugs for the treatment of acute Liver Injury(ALI)through network pharmacology and mitochondrial dynamics,and to investigate their actions and mechanisms.Based on the commonly utilized Liver Pure Tablets and Liver-Protecting Capsules in the market,a com-ponent library of liver disease drugs was screened and established.Pharmacological anchoring anal-ysis was carried out.Potential liver disease therapeutic drugs were screened out through molecular docking,and feedback verification was performed using animal experiments.Acute liver injury mouse models were established through excessive induction with acetaminophen(APAP),and the histopathological changes of liver tissues were examined.The protective effect of the drug on ALI was evaluated by detecting alanine aminotransferase(ALT),aspartate aminotransferase(AST),superoxide dismutase(SOD),catalase(CAT),glutathione(GSH),and malondialdehyde(MDA)using enzyme-linked immunosorbent assay(ELISA).qRT-PCR was employed to detect peroxi-some proliferator-activated receptor gamma coactivator 1-alpha(PPARG1A),mitofusin 1(MFN1),mitofusin 2(MFN2),dynamin-related protein 1(DRP1),optic atrophy 1 protein(OP A1),Steroid receptor coactivator(SRC),and advanced glycosylation end-product specific re-ceptor(AGER)to explore the protective mechanism of the drug on ALI.The result showed that Network pharmacology identified a total of 662 intersection targets of three types of prescription drugs and ALI.Eventually,72 core targets were screened out.Pathway enrichment analysis indi-cates that the potential mechanism might be associated with the lipid and atherosclerosis signaling pathways.The results of the relevant molecular docking indicate that the most likely optimal drug might be emodin(EMO).EMO ameliorated the pathological damage in mice with acute liver inju-ry,significantly decreased the contents of transferase factors ALT and AST,simultaneously in-creased the contents of antioxidant enzymes CAT,GSH and SOD,and reduced the content of oxi-dative metabolic end product MDA.It also upregulated the mRNA expression levels of MFN1、MFN2,OPA1,DRP1,SRC and PPARGC1A proteins in liver tissue,and inhibited the mRNA ex-pression level of AGER protein.The drug EMO,jointly screened out by network pharmacology through anchoring and molecular docking,might promote mitochondrial fusion metabolism,allevi-ate liver oxidative stress,and improve liver injury in ALI mice via the Lipid and atherosclerosis pathway.
8.Based on the anchor analysis of network pharmacology,the mechanism and role of emodin in the treatment of liver injury were investigated
Guang TIAN ; Shiyuan QIN ; Chengwen SONG ; Zhengfei TAN ; Bendong FU ; Pengfei YI ; Luyuan PENG
Chinese Journal of Veterinary Science 2025;45(9):1965-1976
To screen potential drugs for the treatment of acute Liver Injury(ALI)through network pharmacology and mitochondrial dynamics,and to investigate their actions and mechanisms.Based on the commonly utilized Liver Pure Tablets and Liver-Protecting Capsules in the market,a com-ponent library of liver disease drugs was screened and established.Pharmacological anchoring anal-ysis was carried out.Potential liver disease therapeutic drugs were screened out through molecular docking,and feedback verification was performed using animal experiments.Acute liver injury mouse models were established through excessive induction with acetaminophen(APAP),and the histopathological changes of liver tissues were examined.The protective effect of the drug on ALI was evaluated by detecting alanine aminotransferase(ALT),aspartate aminotransferase(AST),superoxide dismutase(SOD),catalase(CAT),glutathione(GSH),and malondialdehyde(MDA)using enzyme-linked immunosorbent assay(ELISA).qRT-PCR was employed to detect peroxi-some proliferator-activated receptor gamma coactivator 1-alpha(PPARG1A),mitofusin 1(MFN1),mitofusin 2(MFN2),dynamin-related protein 1(DRP1),optic atrophy 1 protein(OP A1),Steroid receptor coactivator(SRC),and advanced glycosylation end-product specific re-ceptor(AGER)to explore the protective mechanism of the drug on ALI.The result showed that Network pharmacology identified a total of 662 intersection targets of three types of prescription drugs and ALI.Eventually,72 core targets were screened out.Pathway enrichment analysis indi-cates that the potential mechanism might be associated with the lipid and atherosclerosis signaling pathways.The results of the relevant molecular docking indicate that the most likely optimal drug might be emodin(EMO).EMO ameliorated the pathological damage in mice with acute liver inju-ry,significantly decreased the contents of transferase factors ALT and AST,simultaneously in-creased the contents of antioxidant enzymes CAT,GSH and SOD,and reduced the content of oxi-dative metabolic end product MDA.It also upregulated the mRNA expression levels of MFN1、MFN2,OPA1,DRP1,SRC and PPARGC1A proteins in liver tissue,and inhibited the mRNA ex-pression level of AGER protein.The drug EMO,jointly screened out by network pharmacology through anchoring and molecular docking,might promote mitochondrial fusion metabolism,allevi-ate liver oxidative stress,and improve liver injury in ALI mice via the Lipid and atherosclerosis pathway.
9.Status and influencing factors of air quality in static state of clean operating rooms in 41 medical institutions in Xi'an from 2017 to 2021
Ruru LIU ; Xin WANG ; Chen CHEN ; Fei WANG ; Wenhao LI ; Pengfei WANG ; Yulong LIU ; Han FU
Chinese Journal of Nosocomiology 2025;35(15):2368-2373
OBJECTIVE To investigate the current status of air quality in clean operating rooms in Xi'an and explore the possible influencing factors,thus to provide data support for improving the quality of operating room manage-ment.METHODS According to GB50333-2013"Architectural technical code for hospital clean operating depart-ment",on-site monitoring was conducted from 2017 to 2021 on the air quality of 242 clean operating rooms in 41 hospitals in Xi'an,and the results were compared and analyzed.RESULTS Among the operating rooms being sur-veyed,130 were from secondary hospitals,112 from tertiary hospitals;seventy-nine were ClassⅠoperating rooms,26 were ClassⅡ,137 were ClassⅢ.The pass rate for settling bacterial was 98.35%,with 94.94%for ClassⅠoperating rooms,which was significantly lower than that in ClassⅡand ClassⅢ operating rooms(χ2=6.565,P=0.022).The pass rate for dust particles was 69.01%,with 43.04%for ClassⅠoperating rooms,and there was significant difference among different levels of operating rooms(χ2=37.304,P<0.001).The pass rate for dust particles in tertiary hospitals was 61.61%,lower than that in secondary hospitals(75.38%;χ2=5.340,P=0.021).The pass rate for dust particles≥0.5μm and≥5μm were 85.12%and 74.79%,respectively.Among the operating rooms with unqualified dust particles,those with both≥0.5 μm and≥5 μm dust particles not meeting standards accounted for 29.33%,and those with only≥0.5 μm dust particles not meeting standards accounted for 18.67%.Multivariate logistic regression analysis showed that influencing factors for air quality in clean operating rooms included the year of monitoring and the level of the operating room,while the sampling area and hospital level were not statistically associated with the outcomes.CONCLUSION The overall air quality of op-erating rooms in Xi'an is not optimistic,the pass rate is affected by the year of monitoring and the clean levels of the operating rooms,indicating a need to strengthen routine management and monitoring of clean operating rooms.
10.Therapeutic effect of TURP for prostatic abscesses primarily presenting as urinary retention in the aged males
Ben LIU ; Pengfei QI ; Dewang FU ; Qingyue SI ; Chenxi YU ; Zhifu HAN
Chinese Journal of Urology 2024;45(10):756-760
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.

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