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To reflect specialty teaching characteristics and levels in clinical standardized training of medical professional degree postgraduates and highlight the thinking of evidence-based medicine culture,in urology rotation training practice,we conducted clinical pathway teaching according to picot principle (PICOT-CP teaching).According to the requirements of the teaching syllabus,the six kinds of major diseases were brought into PICOT-CP teaching.After the screening of pre teacher training,teaching tools and teaching cases,and based on the form of PICOT-CP,we standardized the implementation of clinical teaching of Urology,fully used subject website platform to discuss the interaction between teachers and students,and assessed the effect in combination with the departmental rotation examination and the teaching questionnaire survey of the students and the training teachers.Preliminary practice shows that PICOT-CP teaching helps to stimulate students' interest in learning,improve their overall quality,expand their clinical thinking,and establish their concept of evidence-based medicine.In addition,PICOT-CP teaching is beneficial to the teaching norms of teachers' teaching and can improve teaching level.
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ObjectiveTo clarify the effect of medical students' non-intelligence factors on their academic records.MethodsTotally 104 medical students' non-intelligence factors and surgical academic records were collected and relationship between them was studied.Results① There were significant differences in academic records between students with different non-intelligence levels( F =4.21,P＜0.05 );better academic records were achieved in those with higher non-intelligence level than in those with good and poor non-intelligence level ( P ＜ 0.05 ).② There were significant differences in post clinical internship academic records between students with different non-intelligence levels ( F =8.65,P ＜0.01 ),better academic records were achieved in those with higher and good non-intelligence level( P ＜0.01,P ＜ 0.05 ).③ Medical students with higher and good non-intelligence level got obvious improvements in academic records after clinical internship,while students with medium non-intelligence level showed no difference ( P ＞ 0.05).ConclusionsMedical students' non-intelligence factors have obvious effect on their academic records.Keeping students' non-intelligence factors properly could improve their academic records.
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Objective To investigate the therapeutic effect of post-traumatic complex posterior urethral stricture in the male patients.Methods Clinical data of 479 male patients with post-traumatic complex posterior urethral stricture were reviewed.One-stage resection of the stenosis and end-to-end anastomosis was performed in 422 patients and scrotal flap with blood pedicle posterior urethroplasty in 57.Results The mean operation time was 115 minutes(range,90-140 minutes).The mean blood loss was 225 ml(range,100-300 ml).No intraoperative blood transfusion was needed.The mean follow-up time was 15 months(range,12-24 months).Among the 422 patients performed end-to-end anastomosis,386 patients had good voiding and 36 had dysuria because of the formation of anastomotic stoma valve(21 patients)or stricture ring(15 patients).The problem was resolved by transurethral valve/stricture ring resection.Among 57 patients undergone posterior urethroplasty,45 patients had good voiding nine patients were found with anterior urethra-skin tube anastomotic stoma stricture,of which four patients were treated by urethral dilatation and five by endourethrotomy; three patients were found with posterior urethra-skin tube anastomotic stoma stricture,of which one patient was treated by urethral dilation and two by endourethrotomy.Conclusions One-stage resection of the stenosis and end-to-end anastomosis is the main treatment for post-traumatic complex posterior urethral stricture.If the condition of the patients does not allow the end-to-end anastomosis,posterior urethroplasty can be an alternative.
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BACKGROUND: Muscarine receptor plays a key role in adjusting contraction of detrusor muscle cell, and M3R, isoforms of its receptor, can mediate contraction of detrusor muscle cell directly. Ca2+ is the direct factor in stimulating contraction of detrusor muscle cell. Of several 10 kinds of Ca2+conjugable receptors protein, Ca2+ conjugated with different receptor proteins can adjust various reactions.OBJECTIVE: To investigate the effect of Ca2+-calmodulin (Ca2+-CaM) on contraction of M3R-mediated detrusor muscle cell.DESIGN: Compared observation .on the basis of detrusor muscle cell.SETTING: Ourological Center of Southwest Hospital of the Third Military Medical University of Chinese PLA.MATERIALS: The experiment was completed at Central Laboratory of Southwest Hospital of the Third Military Medical University of Chinese PLA. Healthy Wistar rats were selected in this study.METHODS: The primary cultured detrusor muscle cells were divided into experimental group and control group. Cells were inoculated in 6-well plate, and 10-4 mmol/L carbachol and M2R antagonist were added to cells of the experimental group during 70% confluence to block M3R and M2R respectively. Ca2+ concentration and CaM activity were detected by Ca2+ test kit and CaM test kit respectively.MAIN OUTCOME MEASURES: Changes of [Ca2+]I concentration and CaM activity of cells in both groups.RESULTS: The mean channel fluorescence values (log) of [Ca2+]I and CaM were higher in the experimental group than those in the control group(3.26±0.38, 2.06±0.12; 2.87±0.34, 2.14±0.24, P ＜ 0.05).CONCLUSION: Results in this study suggest that Ca2+-CaM participates in adjusting contraction of M3R-mediated detrusor muscle cells through signal transduction.
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Objectives To observe the changes of the detrusor excitability and contractility and to study the mechanism of the unstable bladder. Methods Detrusor strips were obtained from prostectomy patients with benign prostatic hyperplasia. According to the results of urodynamic examination, patients were divided into detrusor instability (DI) and detrusor stability group(DS). Test of mechanical tension and stimulations with electricity and carbachol were performed on the excitability and contractility of the detrusor strips from 8 patients selected from each of the groups in vitro . Results The minimum tension of the detrusor strips when contraction occurred in DI and DS was (0 324?0 132)g and (0 822?0 216)g, respectively. There was significant difference between DI and DS ( P
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Objective To explore the distribution of pathogens and the characteristics of the urine pH values in urinary tract infection (UTI),and provide a new idea for clinical prevention and treatment of UTI.Methods The data of 606 strains of pathogens and the infected urine pH values from urinary samples of patients with UTI from January 2007 to November 2009 in our hospital were obtained.The distribution of pathogens was detected,and these pathogens were divided into 3 groups according to the genus.Urine pH value of different pathogens was analyzed.Results Among 606 strains from UTI,the group of escherichia ranked the first with 186 strains (30.7%),and the infected urine pH by this bacteria ranged from 6.21 to 6.33.A total of 152 strains of candida were detected (25.1%),and the infected urine pH value was from 5.81 to 5.95.There were 86 strains of enterococcus detected (14.2%),and the infected urine pH was from 6.10 to 6.28.By contrasting the infected urine pH of these 3 groups,the infected urine pH by candida was acidic significantly (P
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Objective To improve the diagnosis and treatment of hermaphroditism.Methods The data of 138 cases of hermaphroditism who were hospitalized in our department between March 2005 and April 2008 were reviewed and and analyzed to summarize our experience in the diagnosis and treatment.Results Among the 138 cases with a age ranging from 2 to 36(mean 17 years old),42 were socially male and 96 were socially female.With the help of medical examination,,laboratory examination,ultrasonic examination,radiological examination and pathologic diagnosis,54 patients were diagnosed as female pseudohermaphroditism,66 as male pseudohermaphroditism,10 patients as true hermaphroditism,2 patients as pure gonadal dysgenesis,2 as testicle degeneration,and the left 4 patients as Klinefelter syndrome.Among the 138 patients,132 patients were received surgery operation,including 76 of them receiving laparoscopy.After operation,121 patients were maintained female sex,11 patients were maintained male sex.Female pseudohermaphroditism were all maintained female sex.Fifty-nine patients of male pseudohermaphroditism were maintained female sex.There were 4 patients being maintained male sex,and 3 patients having not received operation.Of the cases of the true hermaphroditism,8 patients were maintained female sex and 2 patients were maintained male sex.Conclusion Early accurate diagnosis is very important to the treatment of hermaphroditism.Etiologic diagnosis is useful in the course.Although it is good for the hermaphroditism to maintain female sex,the decision of the patients and the family should be considered.
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Objective To observe the effects of urine on TGF-?1 and Smad3 expression in cultured human urethral fibroblasts and explore the mechanism of urethral scar fibrosis.Methods The human urethral fibroblasts were cultured and stimulated by urine or 350 ?mol/L uric acid.The mRNA and protein expression of TGF-?1 and Smad3 were measured by PT-PCR and immunofluorescent staining,respectively.Collagen Ⅰlevels in the supernatants in different groups were detected by ELISA.Results TGF-?1 and Smad3 were detected in human urethral fibroblasts by immunofluorescent staining.After being presented with urine or uric acid at physiological concentration,both TGF-?1 and Smad3 in human urethral fibroblasts were increased significantly at both the protein and mRNA levels(P
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Objective To explore the expression of neuron specific enolase(NSE)and neuronal nitric oxide synthase(nNOS)in the interstitial cells of Cajal(ICCs)in vitro from guinea pigs.Methods The ICCs of bladder were primary cultured from guinea pigs by collagenase digestion.The control group was smooth muscle cell(SMC)of bladder primary cultured from guinea pigs.The expression of c-kit and smooth muscle actin(SMA)were detected by immumofluorescence.RT-PCR and Western blotting were used to detect the mRNA level and protein content of NSE and nNOS at 1,3 and 5 d after primary culture.Results The expression of c-kit was positive in the ICCs of bladder but negative in the control group,while the expression of SMA was negative in the ICCs of bladder but positive in the control group.Both NSE and nNOS of the ICCs of bladder were high in the mRNA and protein content,but were negative in the control group.Conclusion NSE and nNOS were expressed stably in the ICCs of bladder in vitro,indicating that the ICCs of bladder may be involved in the regulation of bladder function.
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Objective To explore the expression of connexin 43 in the interstitial cells of Cajal (ICCs) from guinea pig bladder in vitro. Methods Bladder ICCs were primarily cultured from guinea pigs by collagenase digestion method. Primarily cultured bladder smooth muscle cells (SMCs) from guinea pig were taken as control. The expressions of c-kit and smooth muscle actin (SMA) were detected by immunofluorescent method. Immumofluorescent method and Western blotting were used to detect the expression of Connexin 43 in 2 groups of cells. Results The expression of c-kit was positive in ICCs but negative in the control group. On the contrary, the expression of SMA was negative in ICCs but positive in the control group. Connexin 43 expression was significantly higher in ICCs than that in the control group (P
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Objective To study the mRNA expression of Toll-like receptor (TLR) 2 and 4 in human urinary tract epithelium. Methods The epithelial cells of nephric tubule, pelvis, ureter and bladder were cultured in vitro, and their mRNA expressions of TLR2 and TLR4 were measured by RT-PCR. Results The mRNA expression of TLR2 in nephric tubule, pelvis, ureter and bladder was 0.326, 0.589, 0.602 and 0.735, and that of TLR4 was 0.223, 0.327, 0.379, 0.365, respectively. The mean TLR2 mRNA copy was significantly higher than TLR4 in each tissue (P
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Objective To study the therapeutic effect of resiniferatoxin(RTX)on prostatic pain from chronic prostatitis.Methods Complete Freund's adjuvant(CFA)was injected into rat bilateral ventral prostate to form chronic prostatic inflammation in 15 male SD rats.Two weeks later,RTX was injected into lumbosacral vertebral canal(n=5)or bilateral ventral prostate(n=5).Another 5 SD rats served as normal control.Neuropeptide level and the mRNA expression of substance P(SP)and calcitonin gene-related peptide(CGRP)in lumbosacral spinal cord and dorsal root ganglia(DRG)were measured by immunohistochemistry,radioimmunoassay,and RT-PCR.Results SP and CGRP level and their mRNA expression increased significantly in rat with prostatitis.Neuropeptide level and their mRNA expression were decreased after RTX was injected into vertebral canal and prostate.Conclusion Local injection of RTX can effectively inhibit synthesis and release of SP and CGRP,suggesting that RTX may be helpful to the analgesic therapy of chronic prostatitis.
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Objective To investigate the role of Ca 2+ signaling in the overexpression of detrusor smooth muscle cell connexin 43 by cyclic stretch in vitro. Methods The detrusor smooth muscle cells (DSMC) grown on collagen-coated silicone membranes were subjected to cyclic stretch-relaxation. The Cx43 mRNA in DSMC were detected with RT-PCR, and the concentration of intracellular free Ca 2+ in DSMC was measured by confocal microscopy in conjunction with the calcium indicator, Fura-3 (Molecular Probes). Results The overexpression of Cx43 mRNA induced by cyclic stretch was significantly inhibited by EGTA.The increase of intracellular free Ca 2+ induced by stretch was also inhibited completely by EGTA, 61.95% by GdCl3, 29.98% by Nifedipine, 87.98% by Ryanodine and Thapsigargin. Conclusion The stretch-induced Ca 2+ entry, via the Ca 2+-induced Ca 2+ release mechanism, may play an important role in DSMC connexin 43 overexpression induced by cyclic stretch.
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Objective To explore the myogenic basis of the increased excitability and contractile activity in detrusor instability (DI) and investigate the differences of spontaneous contractions by ryanodine receptor (RyR) channels regulation in sarcoplasmic reticulum (SR) between DI and normal bladder muscle and of the RyR channels protein expression. Methods DI model was confirmed by filling cystometry from rats that underwent partial bladder outlet obstruction (BOO) about 8 weeks ago. Muscle strips were dissected from fresh bladder under microscope and the isometric tension in DI and normal strips were detected. The contractions were recorded in these strips exposed to some agents. SR microsome protein was obtained from DI and normal bladder muscle preparations and was used for Western blot analysis to determinate RyR channels expression. Results Treated with RyR channels blocker ryanodine , the contractile frequence significantly increased in normal strips, but not in DI muscle. Western blot analysis showed that RyR channels expression in DI muscle was significantly less than that in normal preparations. Conclusion RyR channels act a negative role in spontaneous contractile activity and the presumed mechanism may involve in Ca 2+ release of RyR channels which causes activation of Ca 2+ -dependent K + channels to decrease contractility. But this crosstalk mechanism is weaken in DI muscle, which provides a chance for spontaneous contractile overactivity.
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Objective To study the relationship between muscarinic receptor(MR) subtype density changes and the producing of unstable bladder Methods The rat model of unstable bladder was established and the MR subtype density of control and unstable bladders were defermined by RT-PCR Results There were only m 2RNA and m 3RNA in the detrusor of control and unstable bladders, but no m 1, m 2 and m 3 mRNA, the amount of m 2RNA(1 67?0 42)was larger obviously than m 3RNA(0 64?0 19),the ratio was 2 59∶1 in control group, and the density of both m 2 and m 3 in unstable bladder increased to (2 03?0 65) and(1 53?0 46)respectively, and the increase of m 3 was more significant ( P
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Objective To look for the neurological evidence of the referred pain of the chronic prostatitis and the relationship between the pain of the chronic prostatitis, bladder, and pelvic floor. Methods The distribution of plasma extravasation was determined with Evans blue dye after irritation of the prostate and bladder of the SD rat with capsaisin, and the distribution of dye extravasation was analyzed. Substance P expression within the dorsal horn of the spinal cord was determined by hybridization in situ after irritation of the prostate, bladder and superficial somatic region of the pelvic floor with formalin. Results Pain irritation of the prostate resulted in plasma extravasation in L_5 to S_2 dermatomes (mainly in L_6 to S_1). In rats receiving bladder irritation, the distribution of plasma extravasation showed a similar pattern to that observed in rats receiving prostatic irritation. Irritation of the prostate, bladder and pelvic floor resulted in similar substance P expression within the dorsal horn of the spinal cord (L_6 to S_1). Conclusions Our results strongly suggest that referred pain status in inflammation of the bladder and prostate is neurogenically mediated. There are significant overlaps of nociceptive neurons within the spinal cord, which receive nociceptive inputs from the prostate, bladder and pelvic floor. Pathological changes in the prostate, bladder and pelvic floor can result in similar pain sensations.
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Objective To study the relationship between IP 3 and detrusor cell contraction mediated by M 3R. Methods [3H]-IP contents of human cultured detrusor cells were detected after stimulated by carbachol,atropine,methoctramine and 4-DAMP respectively. Results [3H]-IP contents increased with carbachol concentration.On the different concentrations (10 -9、10 -8、10 -7、10 -6、10 -5、10 -4 mmol/L )of 4-DAMP,[3H]-IP contents were 3 926.57?273.29、2 780.52?211.09、2436.84?153.62、1 973.22?164.71、1 372.38?141.35 and 1 107.98?920.45 cpm respectively.On the some concertrations of Atropine,[3H]-IP contents were 3 602.69?280.17,2 891.31?207.45,1 983.97?145.74,1 269.57? 105.31,1 106.37?75.23,927.50?77.36/min,respectively.On the same concentrations of methoctramine, the [3H]-IP contents was 4 462.74?360.69、3 938.61?327.13、3 315.45?270.36、3 063.19? 246.79、2927.37?226.45 and 2 836.55?241.63 cpm.This donoted that 4-DAMP and atropine signficantly inhibited the effect of carbachol on PI decomposition(P0.05). Conclusions M 3R is much related to IP 3.
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Objective To explore the distribution of the nociceptive neurons that received inputs from the prostate, bladder, and pelvic floor in the spinal cord. Methods Substance P expression within the dorsal horn of the spinal cord was determined by in situ hybridization after formalin irritation of the prostate, bladder, and superficial muscle of the pelvic floor. Results Formalin irritation of the prostate, bladder, and pelvic floor resulted in similar substance P expression within the dorsal horn of the spinal cord (L_6 to S_1). Conclusion There should be significant overlaps of nociceptive neurons within the spinal cord, which receive nociceptive inputs from the prostate, bladder, and pelvic floor. Pathological changes of the prostate, bladder, and pelvic floor could result in similar pain sensations.
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To study the relationship between the density of muscarinic receptor (MR) subtype and the occurrence of bladder instability. The rat model of unstable bladder was established, and the density of MR subtype was determined in normal and unstable bladders. The results showed that there were only m 2 RNA and m 3 RNA present in the detrusor of normal and unstable bladders, and m 1, m 2 or m 3 mRNA subtypes were not detected. In the normal bladder, the amount of m 2 RNA (1 67?0 42) was obviously greater than m 3 RNA (0 64?0 19), and the ratio of them was 2 59∶1. In the unstable bladder, the density of both m 2 and m 3 increased to (2 03?0 65) and (1 53?0 46) respectively, and the increase of m 3 was more significant ( P
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Objective To explore the relationship between pain of prostatitis and activation of glia cells in spinal cord. Methods To investigate the activation of astroglia cells and microglia cells in spinal cord after irritation of the prostate of the rats with complete Freund′s adjuvant (CFA) at different time using immunohistochemical staining. Results Activation of astroglia cells and microglia cells were significantly increased in deeper laminae and superficial laminae of the dorsal horn of L_6-S_1 spinal cord on the third day, tenth day and twenty-eighth day after CFA irritation of the prostate, and the most obvious activation occurred on the tenth day. Conclusions Activation of glia cells in spinal cord may play an important role in the neuropathological process of the pain of prostatic inflammation. The molecular mechanisms should be further explored.