Abstract:

Abstract:

Abstract:

Abstract:The pursuit of early diagnostic biomarker and ideal therapeutic target for prostate cancer has never been stopped. So far, a number of proteins have emerged as potential clinical candidates in the treatment. One of most important novel biomarker is prostate stem cell antigen (PSCA). PSCA is a glycosylphosphatidylinositol (GPI)-anchored cell surface protein that belongs to the LY-6/thy-1 family. It is highly over-expressed in human prostate cancer cells, but is mildly expressed in normal tissues. This restricted expression profile makes it be a potential biomarker of diagnosis and prognosis for prostate cancer, and an attractive candidate target for immunotherapy. Many investigations have revealed that PSCA expression is positively correlated with Gleason score, tumor stage and bone metastasis in prostate cancer. Since PSCA is a prostate cancer-specific membrane antigen and has restricted pattern of expression, it has been targeted in several immunotherapeutic strategies, including monoclonal antibodies, antibodies conjugated to cytotoxins, genetically engineered T cells, PSCA vaccination and peptide-loaded dendritic cells (DC). This article presents the currents progress of PSCA in the diagnosis, prognosis and therapy for prostate cancer, and provides a general introduction of some different findings about its expression in other cancers

Abstract:Objective To compare and analyze the complications of transurethral resection of the prostate (TURP) vs two-micron (thulium) laser vaporesection of the prostate (TmLRP). Methods A total of 196 benigh prostatic hyperplasia (BPH) patients who were treated with TURP (n＝114) and TmLRP (n＝82) respectively in our department from January 2010 to October 2012 were enrolled in this study. The two groups had no significant difference in age and prostate volume (P＞0.05). The intra-operative complications, such as transurethral resection syndrome and capsular rupture, and the post-operative complications, including severe cystospasm, acute epididymitis, urinary incontinence, and erectile dysfunction were compared and analyzed between the two groups. Results The incidences of intra-operative transurethral resection syndrome and capsular rupture were obviously less in TmLRP group than in TURP group (P＜0.05). Within one week after operation, TmLRP group had obviously less incidences of severe bladder spasm and acute epididymitis than TURP group (P＜0.05). Within one week to one month after operation, secondary hemorrhage, severe bladder irritation, and dysuria due to residual prostate tissue were more common in TURP group than in TmLRP group (P＜0.05). Within one to three months after operation, group TmLRP had less urinary incontinence than TURP group (P＜0.05). Within three months to six months after operation, there were obviously less erectile dysfunction occurred in TmLRP group than in TURP group (P＜0.05). Conclusion TmLRP results in significantly less intra-operative and post-operative complications than TURP, and it is a safe and efficient approach for the treatment of BPH.

Abstract:Objective To assess the safety and efficacy of transurethral plasmakinetic resection of prostate (PKRP) in the treatment of benign prostatic hyperplasia (BPH) in the aged patients at high risk. Methods Clinical data of 165 BPH patients at high risk with age of (73.3±5.6) years, ranging from 70 to 84 years, undergoing PKRP in our department from March 2009 to February 2013 were collected and retrospectively analyzed. The safety of PKRP was evaluated. All patients were followed up at least for 3 months. Parameters of urination were measured before PKRP and at 3 months after operation. Results The duration of procedure was (67±23)min ranging from 32 to 125min; the weight of resected prostate glands was (46.3±24.2)g, ranging from 16 to 86g; the blood loss was (85.0±23.1)ml, ranging from 50 to 154ml. There was no any case requiring blood transfusion; no transurethral resection syndrome or aggravation of original complication occurred during the operation and peri-operative period. All the 165 patients were followed up for 3 months at least, and no urinary incontinence was found after the operation. Compared with pre-operation, the peak flow rate was increased from (6.9±3.8) to (16.5±3.5)ml/s, while the international prostate symptom score (IPSS) was decreased from (21.6±5.8) to (7.3±4.2), the quality of life (QOL) from (4.6±0.8) to (1.2±0.9), and the residual urine volume (RUV) from (65.2±31.6) to (7.5±4.5)ml, respectively, on the 90th day postoperatively (P＜0.05). Conclusion PKRP is a safe and effective treatment for BPH patients, especially for the aged patients at high risk.

Abstract:Objective To assess the efficacy and safety of photoselective vaporization of the prostate with 120W green light laser in the treatment of benign prostatic hyperplasia (BPH) in high-risk aged patients. Methods Clinical data of 86 high-risk patients with a mean age of 76.5 (ranging from 70 to 93) years who underwent photoselective vaporization of prostate (120W) for the treatment of BPH in our department from May 2010 to December 2012 were collected and retrospectively analyzed. Results All surgery procedures were completed successfully. The operation time was (28.7±9.4)min, and intra-operative blood loss was (14.8±9.0)ml, with no one requiring blood transfusion intra-operatively. The duration of post-operative indwelling catheter was (2.0±0.7)d, and hospitalization time was (3.2±1.1)d. Postoperative complications included transient dysuria, mild urinary tract irritation, secondary hematuria, and transient urge incontinence. All these symptoms were relieved after treatment. There were significant differences in International Prostate Symptom Score (IPSS), maximum flow rate and residual urine volume at 1 and 6 months after operation compared with pre-operation(P＜0.01). Conclusions Photoselective vaporization of prostate (120W) has advantages of shorter operation time, less blood loss, rapid recovery, and high safety. It is an ideal and minimally invasive approach for high-risk elderly patients with BPH.

Abstract:Objective To investigate the urodynamics of bladder function in patients suffering from benign prostate hyperplasia (BPH) and prostatitis. Methods One hundred and eighty-seven inpatients with BPH hospitalized in our department from June 2009 to June 2012 were recruited in this study. They were assigned to two groups according to being accompanied with prostatitis or not, that is, BPH group (n＝91) and BPH combined with chronic prostatitis (CP) group (BPH/CP group, n＝96). Urodynamic indices, such as maximum bladder capacity, maximum detrusor pressure, bladder stability and maximal urethral closure pressure were measured and then compared between the two groups. Results There was no significant difference in the urodynamic parameters, including maximum bladder capacity (P＝0.741), maximum detrusor pressure (P＝0.872) and maximal urethral closure pressure (P＝0.590) between the two groups. But, simple BPH patients had better bladder stability than the BPH/CP group [(158.0±42.7) vs (79.6±30.0)ml, P＝0.032]. Conclusion BPH combined with CP mainly manifests bladder instability urodynamically, which further leads to urinary frequency, urgency and discomfortableness.

Abstract:Objective To evaluate the clinical efficiency of argon-helium cryoablation for prostate cancer. Methods The ENDOCARE cryosurgical system with 2mm Cryoprobes was used to treat the prostate cancer guided by transrectal ultrasound or abdomen ultrasound in 26 patients with a mean age of 73.2 (ranging from 65 to 89) years in our department from 1990 to 2012. Biopsy of the prostate was carried out under the guide of ultrasound at 1 and 3 months after cryotherapy for pathological observation. Results The patients were all followed up for 3 to 24 months. The biopsy results showed that 19 cases were pathologically negative and 7 cases were positive. The obstructions of bladder outlet were all relieved, and hematuria was attenuated or disappeared. Serum prostatic specific antigen (PSA) level was decreased obviously. Bone metastases partially disappeared or shrunk. Bone pain was relieved to some extent. Twenty of them were able to urinate. All patients had their serum levels of PSA lower than 4ng/ml at 3 to 24 months after cryoablation. Conclusion Cryoablation combined with anti-androgen drug has better clinical outcome in the treatment of prostate cancer, with advantages of short hospitalization period, no blood loss, little injury and rapid recovery.

Abstract:Objective To investigate the changes of blood glucose, HbA1c, and incidence of hypoglycemia in the very old patients (over 80 years) with type 2 diabetes mellitus (T2DM) after the treatment of lantus with glucobay or Novomix 30, and the clinical significance. Methods A total of 120 very old T2DM patients poorly controlled with oral hypoglycemic drugs admitted in our department from July 2011 to June 2012 were subjected in this study. They were randomly divided into lantus with glucobay group and Novomix 30 group (n＝60 in each group). Lantus was injected before breakfast, and glucobay was taken with meals, while Novomix 30 was injected before morning and evening meals for total 16 weeks. Fasting blood glucose (FBG) and 2-hour postprandial blood glucose (2hPBG), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), the decrease of HbA1c, and the incidence of hypoglycemia were compared between the two groups. Results After the treatment, blood glucose, TG, TC, LDL-C and HbA1c were decreased in the two groups though without significant difference (P＞0.05). HbA1c was decreased from (8.8%±2.0%) to (7.1%±1.2%) in the glucobay group, and from (8.9%±2.4%) to (7.0%±1.2%) in Novomix 30 group, with no significant difference between them (P＞0.05). The incidence of hypoglycemia was significantly lower in glucobay group than in Novomix 30 group (3.3% vs 13.3%, P＜0.01). Conclusion Lantus combined with glucobay and Novomix 30 have the similar improvement in FBG, 2hPBG, TG, TC, LDL-C and HbA1c. But the combination with glucobay has significantly lower incidence of hypoglycemia.

Abstract:Objective To assess the safety and efficiency of long-term outcome after rotational atherectomy (RA) followed by long drug-eluting stent (DES) implantation in severe calcified coronary lesions. Methods Patients with severe calcified coronary lesions treated with RA followed by long DES in our department between January and December 2010 were enrolled. Their procedural success rate, preoperative complications, and postoperative major adverse cardiovascular events (MACE, including cardiac death, myocardial infarction and target lesion revascularization) were recorded and analyzed. All patients were available for our long-term follow-up. Results Twenty-one patients with complex calcified coronary lesions were treated with RA followed by long DES, with age of (65.2±6.9)years. There were 16 patients (76.2%) having hypertension, 7 (33.3%) having diabetes mellitus and 1 (4.8%) having chronic renal failure. There were totally 35 stents implantated in 20 calcified coronary lesions (1.75 per lesion). One patient did not finish the operation due to the drill head could not go through the lesion. The overall procedure success rate was 95.2% (20/21). The shortest length of the implanted stent was 28 mm, and the average length of total stent /lesions was 48 mm (ranging from 29 to 66 mm). The preoperative complications included 1 case of coronary spasm, and 1 case of chest pain with decreased heart rate, and the postoperative complication only had 1 case of gastrointestinal bleeding. There was no patient having the incidence of in-hospital MACE. During a median follow-up period of 26 months (ranging 20 to 31 months), only 1 patient (4.8%) had acute myocardial infarction at 1 month after operation, and the other were in stable sound condition. Conclusion RA followed by long DES implantation appears to be feasible and effective in treatment of complex calcified coronary lesions, with a high rate of procedural success and low incidence of MACE in a long-term period.

Abstract:Objective To evaluate the therapeutic effects of circumferential pulmonary vein ablation (CPVA) on the autonomic nerve function and prognosis of patients with paroxysmal atrial fibrillation (PAF). Methods A total of 110 consecutive patients with symptomatic and drug refractory PAF [age of (59.07±11.54) years, 67 males and 43 females] undergoing CPVA in our department from January to December 2011 were enrolled in this study. They all received pulmonary vein isolation (PVI) during CPVA. The time-domain analyses of heart rate variability (HRV) were obtained by 24-hour Holter monitoring before and at 2 days after ablation, and the efficacy of CPVA was evaluated and analyzed according to the changes of HRV. Results After the follow-up of (14.46±5.57) months, the success rate for atrial fibrillation (AF) was 72.45% for 98 patients who finished the study. According to the outcome, these patients were divided into 2 groups, success group (n＝71, 45 males and 26 females) and recurrence group (n＝27, 15 males and 12 females). Before ablation, there was no difference in HRV indices between the success group and recurrence group. After ablation, HRV indices were decreased significantly in both groups (P＜0.05), with those in success group dramatically lower than those in recurrence group (P＜0.05). Conclusions CPVA significantly reduces HRV and induces autonomic dysfunction, which may be one of the underlying mechanisms of its treatment for PAF. Enhancing denervation has effects on the long-term success of PAF ablation. These results identify the relationship between AF ablation and HRV.

Abstract:Objective To investigate the demands of continuing medical education (CME) on geriatrics in China. Methods A total of 123 attendants of 2012 Peking Union Medical College Hospital-Johns Hopkins Hospital (PUMCH-JHU) Geriatric Conference were investigated through a self-designed questionnaire. Results The attendants had a better understanding on geriatric syndromes, such as dementia (95.9%), incontinence (95.1%) and falls (94.3%), but a poor understanding on syncope (67.5%) and elder abuse (51.2%). Awareness and acceptance of living wills were 41.5% and 25.2% respectively. Only 42.3% subjects had correct concept of geriatric medicine. However, the participants had urgent desire to attend CME on geriatrics. Conclusion Geriatric knowledge should be improved among medical workers, and it must be carried out through different forms of CME.

Abstract:Objective To analyze the clinical data of the elderly undergoing pancreaticoduonectomy (PD) and investigate the safety of the surgery. Methods Clinical data of 90 over 50-year-old patients undergoing PD for pancreatic and periampullary cancer in our department from 2007 to 2011 were collected and retrospectively analyzed. They were divided into two groups according to their age, that is, ≥70-year-old group (n＝27) and＜70-year-old group (n＝63). Their indices, including pre-operative Karnofsky Performance Status (KPS), hemoglobin (Hb), hematocrit (Hct), albumin (ALB), serum total bilirubin (TBIL), prealbumin (PALB), blood glucose, serum potassium, operation time, blood loss during operation, rate of postoperative intensive care unit (ICU) stay, duration of postoperative hospital stay, incidence of postoperative complications, and postoperative mortality, were analyzed and compared. Results The ≥70-year-old group had significantly lower KPS score [(71.11±6.98) vs (85.40±6.43), P＝0.00], ALB [(34.86±4.54) vs (37.02±4.13)g/L, P＜0.05], PALB [(127.36±41.19) vs (160.27±57.11)g/L, P＜0.05], and serum potassium [(3.38±0.48) vs (3.81±0.45)mmol/L, P＜0.01], but obviously higher blood glucose [(8.47±3.68) vs (6.41±2.12)mmol/L, P＜0.05], and postoperative rate of ICU stay (81.5% vs 39.68%, P＜0.01) when compared with ＜70-year-old group. The incidence of postoperative complications was higher in ≥70-year-old group than in the other group, though without significant difference (48.15% vs 39.42%, P＞0.05). No patient died after PD ≥70-year-old, but two patients died due to complications in ＜70-year-old group within 30d after operation. Conclusion It is feasible and safe to perform PD to elderly patients after careful patient selection, physical fitness improvement, and life-supporting treatment after operation.

Abstract:目的 分析中老年患者假膜性肠炎（PMC）的临床特征，提高临床对PMC的认识及诊治水平。方法 回顾性分析合肥市第一人民医院2008年5月至2012年3月收治的17例PMC患者的临床资料。结果 17例PMC住院患者平均年龄65岁，均存在基础疾病。患者均在使用抗生素过程中出现腹泻并伴有不同程度的腹痛等症状，其中4例合并腹水。15例联合使用两种及以上抗生素。肠镜多有典型的假膜样改变。经停用抗生素，使用甲硝唑、益生菌等治疗，14例好转出院。结论 应重视存在免疫力低下原发病的中老年患者使用抗生素时PMC的诊断；除腹泻、腹痛等症状外，腹水可能是PMC的临床特征之一；粪便涂片联合结肠镜检查有益PMC的诊断；及时停用抗生素，联合甲硝唑或万古霉素及益生菌是治疗PMC的主要方法。

Abstract:Objective To investigate the correlation of the serum levels of intestinal fatty acid binding protein (I-FABP) and D-lactate (D-Lac) with ischemic time and intestinal mucosa injury in rats with acute mesenteric ischemia. Methods A total of 60 rats were randomly and equally divided into 6 groups, that is, sham-operation group and 5 mesenteric ischemia groups according to mesenteric artery occluded for 30, 60, 90, 120 and 150 min respectively. Their serum levels of I-FABP and D-Lac were determined by ELISA. The content of I-FABP in the damaged intestinal mucosa was measured by immunohistochemical assay. Histopathological analysis was performed in the injured intestinal mucosa to evaluate the score of injury. The correlation of serum levels of I-FABP and D-Lac with tissue injury was analyzed. Results The serum I-FABP level was significantly increased from 30 min after ischemia, and reached a peak at 90 min [(1741.37±184.12)mg/L], and the cells positive to I-FABP accounted for 72.5% (P＜0.05). The serum level of D-Lac was significantly increased from 60 min after ischemia and showed a time-dependent manner (P＜0.05). The score of injury was also increased with the extent of ischemic time. Spearman’s rank correlation non-parameter test indicated that the serum level of D-Lac was positively correlated with intestinal mucosa injury (r＝1), but that of I-FABP had no such correlation (r＝0.6). Conclusions Serum I-FABP is increased at the early stage of acute mesenteric ischemia, and then after reaching peak, decreased with the elapse of ischemic time. Serum D-Lac is obviously increased at the late stage, and might be used to predict the severity of intestinal ischemic injury.

Abstract:Objective To determine the effect of different doses of testosterone on vascular endothelial growth factor (VEGF) in high-salt fed rats. Methods Thirty-two Wistar male rats were randomly assigned to 4 groups, sham-operation (Sham) group, castration (Cas) group, testosterone supplement after castration (TC) group, and flutamide-treated testosterone supplemented castrated (FTC) group, with 8 rats in each group. After all animals were fed with high-salt diet (8% NaCl) for 8 weeks, the rats of Sham group received a sham operation, while those in Cas, TC and FTC groups received surgical castration. Testosterone propionate (TP) was injected subcutaneously at 2mg/kg, once every 2 days in TC and FTC groups, and flutamide 1mg/(kg·d) was given intragastrically in FTC group, for 8 weeks after surgery. Serum levels of testosterone and VEGF were determined by enzyme-linked immunosorbent assay (ELISA). Expression of VEGF mRNA in the blood samples were determined by real-time PCR (RT-PCR). Results Serum levels of testosterone was obviously lower in Cas group, but significantly higher in TC and FTC groups when compared with Sham group [(0.26±0.02), (2.80±0.30), (5.47±1.29) vs (3.15±0.54)μg/ml, P＜0.01]. For serum level of VEGF, Cas FTC groups had obviously increased levels than Sham group [(47.246±19.733), (46.043±22.607) vs (20.837±13.823) ng/L, P＜0.01, P＜0.05], but no difference was found between Sham group and TC group [ (22.870±12.057)ng/L, P＞0.05]. Cas group and FTC group had lower expression of VEGF mRNA compared with Sham group (P＜0.01), but no difference with TC group(P＞0.05). Conclusion Under high-salt diet, high level of testosterone suppresses the expression and release of VEGF.

Abstract:目的 探讨不同浓度（1%，2%，3%）七氟烷对成年大鼠的认知功能及血清、海马组织中神经元特异性烯醇化酶（NSE）的影响。方法 将40只成年雄性SD大鼠随机分为1%七氟烷组、2%七氟烷组、3%七氟烷组及对照组（吸入空气），七氟烷吸入3h。处理后第1，2，3，4，5天进行Morris水迷宫的定位航行试验和第6天的空间探索试验。第6天测试完毕后取大鼠的血清和海马组织测定NSE的含量。结果 吸入不同浓度七氟烷组与对照组相同时间点比较，逃避潜伏期和总路程差异无统计学意义（P＞0.05）。同时，不同浓度七氟烷组间比较，逃避潜伏期和总路程差异也无统计学意义（P＞0.05）。吸入七氟烷或空气后第6天撤台，各组大鼠的目标象限停留时间百分比和穿越平台次数之间差异也无统计学意义（P＞0.05）。吸入1%和3%七氟烷组大鼠血清中NSE水平低于对照组（P＜0.01）；同时，吸入2%和3%七氟烷组大鼠血清中NSE水平高于吸入1%七氟烷组（P＜0.01，P＜0.05）。海马组织中的NSE含量各组间差异无统计学意义（P＞0.05）。结论 单次吸入1%，2%和3%的七氟烷，短期不影响成年大鼠的空间学习记忆能力。同时，吸入1%和3%七氟烷可以降低大鼠血清中NSE水平。

Abstract:

Abstract:

Abstract:Acute abdomen diseases in elderly is a series of severe diseases which demand urgent management, no matter emergent surgery, or needing for operation during the course of disease. Otherwise, it would be very dangerous, even be life-threatening. This paper aimed to summarize the clinical features, diagnosis, management principles, and operation as well as mini-invasive treatment for acute abdomen diseases in elderly.

Abstract:There is activation of the renin-angiotensin-aldosterone system (RAAS) in the pathophysiological process of many kinds of cardiovascular and renal diseases. So, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) become the first-line drugs for current antihypertensive therapies in medical practices. For a long period, rennin has been considered as the most classical and logical drug target. Aliskiren, however, as the first renin inhibitor, not until 2007, has been allowed for the treatment of hypertension. Nowadays, aliskiren attracts more and more attention because of its well-control in hypertension and greater protection from hypertensive complications. Since aliskiren has better effect on more complete RAAS inhibition, great achievements were made when it is used in combination therapy for its contribution to well-controlled baseline blood pressure and several cardioprotective and renoprotective effects. In this article, we reviewed extensively the progress of clinical application of aliskiren in recent years.

Abstract:Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelial nitric oxide synthase (NOS), which inhibits the formation of vasoactive substance, nitric oxide (NO), and further results in endothelial dysfunction. It is considered as a new predictor for endothelial dysfunction. Some researches have shown that ADMA is a risk factor of atherosclerosis, hypertension and ischemic stroke. In recent years, studies also showed that ADMA may cause cerebral blood flow autoregulation dysfunction, chronic low perfusion and blood-brain barrier damage, and is involved in the incidence and development of leukoaraiosis. Interference of the synthesis or metabolism of ADMA may bring forward a new means for the prevention and treatment of vasculopathy.

Abstract:Papillary fibroelastoma (PFE) is a generally rare benign cardiac tumor, which commonly involves left heart valves. Since having minimal effect on hemodynamics and valvular function, the majority of patients suffering from PFE are free of any symptom. However, some life-threatening complications might occur in these patients. These tumors are usually diagnosed incidentally during transthoracic echocardiography (TTE), cardiac surgery and at autopsy. The management remains undefined and controversial. The incidence and risk factors of the disease have not been reported yet. The development and popularization of echocardiography has resulted in an increase in its detection rate.