Report of 3162 cases of holmium laser enucleation of the prostate and review / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the safety, effectiveness, and outcomes of holmium laser enucleation of the prostate (HoLEP) for patients with symptomatic enlarged prostate after 11 years of experience.</p><p><b>METHODS</b>The 3162 evaluable patients treated with holmium laser enucleation of the prostate at our institution between August 2001 and August 2011 were retrospectively analyzed. Study variables included International Prostate Symptom Score, quality of life, maximum urinary flow rate, and incidence of complications.</p><p><b>RESULTS</b>HoLEP were performed successfully completed, not patients which occurs as electric cutting syndrome. The operation time was (60.8 ± 18.4) minutes; average resection of prostate quality was (45.4 ± 24.4) g. The hemoglobin reduce though surgery was (1.81 ± 0.93) g/L; percentage of red blood cell change was 1.24% ± 0.43%, and sodium blood drop was (1.14 ± 0.35) mmol/L. Postoperative patients of hospital stay (3.1 ± 1.1) days, average time of indwelling catheter time was (2.3 ± 0.8) days. Patients were followed up for 6-131 months time, an average of 32.4 months. Postoperative patients with international prostate symptom score progressive declined. The quality of life score was 2.2 ± 1.7, and it less than preoperative (5.7 ± 3.3, t = 2.447, P < 0.01). The time of follow-up droped further, and postoperative comparative differences have statistical significance (t = 2.179, 2.228, 2.306 and 2.365, P < 0.05). The maximum urinary flow rate also improved (P < 0.05). Postoperative complications included bladder neck contracture (4 cases), urinary tract infection (107 cases), urethral stricture (11 cases) and urinary incontinence (11 cases). The 11 patients reoperation.</p><p><b>CONCLUSIONS</b>HoLEP treatment of benign prostatic hyperplasia could achieve the advantages of open surgery the same effect. It had fewer damage, faster recovery, fewer complications, and is a good treatment option.</p>

Cost-effectiveness analysis on the once-in-a-lifetime cervical cancer screening program for women living in rural and urban areas of China / 中华流行病学杂志

<p><b>OBJECTIVE</b>To estimate the cost-effectiveness of once-in-a-lifetime cervical cancer screening program and to predict the optimal modality for its operation on women living in rural and urban areas of China, based on Markov modeling and simulation.</p><p><b>METHODS</b>Three modalities including visual inspection with acetic acid plus Lugol's iodine (VIA/VILI), conventional Pap Smear (Pap Smear), and simple HPV DNA testing (careHPV) were hypothesized for the rural cohort, whereas other five modalities including Pap Smear, liquid-based cytology (LBC), simple HPV DNA testing (careHPV), Hybrid Capture 2 HPV DNA testing (HC2), and LBC plus HC2 (LBC + HC2) were tested for the urban cohort. A Markov model was constructed based on the factors as natural history, screening, diagnosis and treatment on cervical cancer using data related to the epidemics and the costs from rural and urban areas of the country. Long-term effectiveness and cost-effectiveness were predicted through simulation of the model.</p><p><b>RESULTS</b>Compared to the non-screening scenario, the amount of life years saved were 277.97 - 2727.53 and 134.02 - 1446.84 years per 100 000 women, respectively, for different cohorts in rural and urban areas. The cost-effectiveness ratios were 1520.99 - 2453.74 and 3847.35 - 44 570.35 RMB per life year saved, respectively, for different cohorts in rural and urban areas. The incremental cost-effective ratio for careHPV starting from 40 years old (careHPV@40) and careHPV from 30 years old (careHPV@30) dominated other strategies for the rural cohort, while careHPV@40, careHPV@30, HC2 from 30 years old (HC2@30), and LBC + HC2 from 30 years old (LBC + HC2@30) were dominant for the urban cohort.</p><p><b>CONCLUSION</b>All eight once-in-a-lifetime cervical cancer screening modalities were cost-effective based on our model. In particular, careHPV screening starting from 40 years old seemed to be the most cost-effective one for women living in both rural and urban areas.</p>

Effectiveness and health economic analysis of strategies on cervical cancer screening and early diagnosis and treatment / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the appropriate strategies which are suitable for the areas with diverse health and economic resource settings in China by estimating the life outcomes and cost-effectiveness of several cervical cancer screening strategies.</p><p><b>METHODS</b>Markov model was used to calculate the long-term effectiveness, utility, benefit and cost among screened and unscreened cohorts in rural and urban areas, and then analyses of cost-effectiveness, cost-utility and cost-benefit were performed. The assessed screening strategies were acetic acid of visual inspection combined with Lugol's iodine staining (VIA/VILI), conventional Pap smear and simple HPV DNA testing (careHPV) in rural areas, and conventional Pap smear, simple HPV DNA testing (careHPV), HPV DNA testing (HC2) and liquid-based cytology (LBC) alone or combined with HPV DNA testing (LBC+HC2) in urban areas. We estimated the life outcomes and cost-effectiveness of the above screening strategies at one-year, 3-year and 5-year intervals.</p><p><b>RESULTS</b>All of the screening strategies were effective to decrease cervical cancer mortality and to increase life years, with a trend of shorter screening interval having better effectiveness. However, no matter in urban or rural areas, compared with careHPV testing at 5-year interval, the costs of other screening strategies were 1.28 - 13.86 folds, 1.31 - 14.14 folds, and 1.27 - 12.80 folds higher to avoid one death, to save a year of life, and a QALY, and the benefit per cost of other screening strategies was 9.9%-90.2%.</p><p><b>CONCLUSIONS</b>careHPV testing at 5-year interval has the best cost-effectiveness performance and the highest benefit-cost ratio with the moderate life outcomes. It is the optimal cervical cancer screening strategy to be generalized in our country. careHPV testing at 3 years interval can be considered in more developed areas to achieve better effectiveness.</p>

Holmium laser enucleation of the prostate / 中华男科学杂志

Holmium laser enucleation of the prostate (HoLEP), as a new hi-tech introduced from abroad, may bring about exactly the same results as open surgery, and is even superior to transurethral resection of the prostate (TURP), especially in handling the front prostate, with its advantages of minimal invasiveness, better safety, shorter operation time, less blood loss, and quicker recovery, which can be achieved through peeling off the prostate alongside the external sphincter and getting it removed in three parts or as a whole. So far, the author has accomplished more than 3 000 surgeries using this technique, without any serious complications. Any patient that can accept anesthesia and endoscopic surgery can be treated by HoLEP. This article presents an overview of the methods, skills and key points of HoLEP, gives a comprehensive analysis of HoLEP based on the anatomic features of the internal and external prostate, and offers a detailed introduction of the requirements of the operator, criteria for the accomplishment of the operation, and prevention and management of surgical damages.

Working Memory after Stroke / 中国心理卫生杂志

Objectives:To study working memory deficit after stroke.Methods:118 patients with stroke di- agnosed by CT scans(study group)and 118 healthy people(control group)were collected from April to December in 2003.All objects were evaluated with Wechsler Memory Scale(WMS),Trail Making Test A and B,and Wisconsin Card Test(WSCT).Results:There were significant difference between the study group and control group in execu- tive function,attention function,visual recognition and visual recall;The study group had more error in Trail making Test B,A and executive error((?)?SE was 200.0?15.2,76.3?10.4,23.9?0.9)than control group(133.3?7.2, 24.2?1.6,9.9?0.5).Compared with control,patients with stroke of different locations had different deficits in work- ing memory:①for frontal stroke,the deficit manifested in executive function,digital span(P0.05).④for thalamic stroke,the deficit manifested in executive function,digital span,visual recognition and visual recall,(P