Application of prostatic exosomal protein in the diagnosis of histological prostatitis in patients with benign prostatic hyperplasia / 现代泌尿外科杂志

【Objective】 To investigate the feasibility of prostatic exosomal protein (PSEP) detection kit in the diagnosis of histological prostatitis (HP) in patients with benign prostatic hyperplasia (BPH), and to explore the correlation between PSEP and other clinical parameters. 【Methods】 A total of 104 patients with BPH or BPH plus HP treated during Nov.2021 and Nov.2022 were involved. The patients were instructed to fill out the International Prostate Symptom Score (IPSS) scale independently before surgery. Clinical data such as prostate volume, residual urine volume, free prostate specific antigen (fPSA), total prostate specific antigen (tPSA), and fPSA/tPSA were collected. Preoperative midstream morning urine was collected for PSEP detection. 【Results】 The sensitivity and specificity of PSEP in the diagnosis of BPH were 93.51% and 70.37%, respectively, which were highly consistent with the postoperative pathological diagnosis results (Kappa=0.663). Serum PSEP level was positively correlated with tPSA level (r=0.242, P=0.040). 【Conclusion】 PSEP has a high clinical diagnostic value in the diagnosis of HP, which can provide a reliable basis for the diagnosis of HP in BPH patients and improve the diagnosis rate.

COVID 19 INFECTION IN A PATIENT NEWLY DIAGNOSED WITH HIV/TB COINFECTION – A CASE REPORT

HIV/TB coinfection, COVID 19 with HIV/TB, immune reconstitution inflammatory syndrome (IRIS), TB lymphadenopathy

CASE REPORT- RECURRENT DUODENAL ULCER PERFORATION

Peptic ulcer disease remains one of the most common outpatient diagnosis in GI clinical practice. A large majority of cases are contributed to H.pylori infection and/or NSAID use. Other less common causes are Zollinger Ellison syndrome, antral G-cell hyperfunction, trauma, burns, smoking and psychologic stress. The three most common complications are bleeding, perforation and obstruction. Perforated peptic ulcers presents as acute abdomen to the emergency department usually. Ulcer recurrence is often related to H.pylori and/or NSAIDs. It can also be due to gastrin secreting tumors or even smoking. Recurrence of peptic ulcer perforation has limited documentation and has no standardized method of management. With an unknown incidence, it's a surgeon's dilemma and has to be managed speci?c to each presentation. Here, I would like to discuss a case of a 70 year old man, who presented with recurrent episodes of duodenal perforation in an interval of 2 years.

Prevalence of late-onset hypogonadism among middle-aged and elderly males in China: results from a national survey / 亚洲男科学杂志(英文版)

This study aimed to propose an operational definition of late-onset hypogonadism (LOH) that incorporates both clinical symptoms and serum testosterone measurements to evaluate the prevalence of LOH in aging males in China. A population-based sample of 6296 men aged 40 years-79 years old was enrolled from six representative provinces in China. Serum total testosterone (TT), sex hormone-binding globulin (SHBG), and luteinizing hormone (LH) were measured and free testosterone (cFT) was calculated. The Aging Males' Symptoms (AMS) scale was used to evaluate the LOH symptoms. Finally, 5078 men were included in this analysis. The TT levels did not decrease with age (P = 0.59), and had no relationship with AMS symptoms (P = 0.87 for AMS total score, P = 0.74 for ≥ 3 sexual symptoms). The cFT levels decreased significantly with age (P < 0.01) and showed a negative association with the presence of ≥ 3 sexual symptoms (P = 0.03). The overall estimated prevalence of LOH was 7.8% (395/5078) if a cFT level <210 pmol l

Clinical characteristics and risk factors of elderly male patients with type 2 diabetes mellitus complicated with coronary atherosclerotic heart disease / 中国综合临床

Objective:To explore the clinical characteristics of elderly patients with type 2 diabetes mellitus (T2DM) complicated with coronary atherosclerotic heart disease (CHD) and analyze the risk factors of CHD in patients with T2DM.Methods:Using the method of retrospective cohort study, 406 elderly male patients with T2DM (≥75 years old) admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University from January 2017 to January 2020 were selected and divided into T2DM without CHD group (165 cases) and T2DM with CHD group (241 cases). The clinical characteristics in elderly patients with T2DM complicated with CHD and risk factors for CHD were analyzed.Results:The age ((86.78±5.35 )years old), course of T2DM((12.32±0.46) years), fasting blood glucose(FPG)((7.64±2.81) mmol/L), hemoglobin a1c (HbA1c)((7.59±1.21)%), the proportion of hypertension(84.65%(204/241)), D-dimer((0.50±0.13) mg/L), the incidence of thromboembolic events(46.06%(111/241)), blood serum creatinine ((94.81±12.70) μmol/L), urea nitrogen((8.31±4.46) mmol/L), uric acid((376.44±116.01) μmol/L) in T2DM with CHD group were higher than those in T2DM without CHD((78.51±4.81)years old, (10.66±0.67)years, (6.84±2.19) mmol/L, (7.02±2.15)%, 63.03%(104/165), (0.21±0.04 ) mg/L, 13.33%(22/165), (83.01±14.40) μmol/L, (6.79±2.89) mmol/L, (333.56±95.15) μmol/L ), and the differences were statistically significant( t=15.908, t=2.042, t=3.055, t=3.088, χ 2=23.828, t=5.059, χ 2=42.098, t=2.401, t=4.188, t=4.075; all P<0.05). The total bilirubin(TBil)(8.80(6.60, 11.60) μmol/L), glomerular filtration rate(GFR)((76.49±29.80) mL/(min·1.75 m 2)) in T2DM with CHD group were lower than those in T2DM without CHD group (11.25(8.23, 15.28) μmol/L, (91.81±28.31) mL/(min·1.75 m 2)), the differences were statistically significant( Z=2.304, t=5.126; all P<0.001). The total cholesterol((3.84±0.85) mmol/L), low-density lipoprotein cholesterol(LDL-C)((2.12±0.68 ) mmol/L) in T2DM with CHD group were lower than those in T2DM without CHD group((4.10±1.00) mmol/L, (2.45±0.85) mmol/L), the differences were statistically significant( t=2.828, 4.156; all P<0.05). The rate of starting lipid-lowering and stable plaque treatment in T2DM with CHD group (82.57%(199/261))was higher than that in T2DM without CHD group(42.42%(70/165)), and the difference was statistically significant (χ 2=70.614, P<0.001). Influenced by lipid-lowering therapy, the total cholesterol and LDL-C in T2DM patients with CHD were significantly decreased.Logistic regression analysis showed that age elevated( OR 1.346, 95% CI 1.263-1.434, P<0.001), elevated hemoglobin a1c concentration( OR 1.427, 95% CI 1.140-1.785, P=0.002), complicated with hypertension( OR 3.534, 95% CI 1.684-7.418, P=0.001), elevated D-dimer concentration( OR 3.969, 95% CI 1.227-12.841, P=0.021)and elevated uric acid concentration( OR 1.005, 95% CI 1.001-1.008, P=0.006)were independent risk factors for CHD in elderly male patients with T2DM. Conclusion:Elderly patients with T2DM complicated with CHD are more likely to be in hypercoagulable state, more likely to have thromboembolic events, and more obvious renal function damage.Poor fasting blood glucose control and decreased total bilirubin concentration are the influencing factors of CHD in elderly male patients with T2DM.Age elevated, elevated hemoglobin a1c concentration, complicated with hypertension, elevated D-dimer concentration and elevated uric acid concentration are independent risk factors for CHD in elderly male patients with T2DM.

Correlation of obesity & comorbid conditions with chronic venous insufficiency: Results of a single-centre study

Background & objectives: Chronic venous insufficiency (CVI) is a common clinical problem among obese patients. This study was conducted to evaluate the impact of body mass index (BMI) and associated morbidities such as diabetes, hypertension and hypothyroidism on venous disease clinical scores as per Clinical, Etiological, Anatomical, Pathological (CEAP) classification. Methods: In this study, adult patients with BMI more than 30 kg/m2 with signs of CVI were evaluated clinically and by using Duplex ultrasonography of venous system. The patients with C0, C1, C2, C3 and C4, C5, C6 clinical scores in CEAP classification were grouped as lower and higher clinical scores of CVI, respectively. Results: Of the 200 enrolled patients, 147 (73.5%) were males and were associated with higher grades of clinical scores (P=0.051). Superficial venous system was involved in 96 per cent patients and 91 per cent patients had reflux in the sapheno-femoral junction. A negative association was observed between hypertension and male gender (P=0.001). Higher BMI was associated with higher clinical scoring (P=0.053). BMI >40 kg/m2 was associated with primary aetiology (P=0.007) of CVI. There was no correlation between superficial, deep or perforator incompetence with BMI (P=0.506). Duplex-confirmed significant reflux was observed in patients with higher BMI (P=0.006). Age and BMI were positively correlated with clinical score (r=0.176; P=0.013 & r=0.140; P=0.049), respectively. Interpretation & conclusions: Our findings indicated that elderly male patients with high BMI seemed to be at a higher risk of advanced clinical grades of CVI. The impact of comorbid conditions such as diabetes, hypertension and hypothyroidism on CVI could not reach at significance in the present study.

Assessment of the physical status of elderly patients with prostate cancer / 中华男科学杂志

Prostate cancer (PCa) is the primary malignancy threatening men's health in the United States and its incidence is increasing in China year by year. Many PCa cases are found in the advanced stage or in the old age, treated with unstandardized options, with negligence of comprehensive assessment of the patient's physical status, which may frequently add to the physical, psychological and economic burdens of the patient and even result in death. On the other hand, some excessively conservative therapeutic options may cause the loss of the best time of management or lead to deterioration of the disease. Therefore, sufficient importance should be attached to the comprehensive assessment of the physical status of the elderly PCa patient before treatment and the choice of the best therapeutic protocol.

Identification of late-onset hypogonadism in middle-aged and elderly men from a community of China / 亚洲男科学杂志(英文版)

In this study, we investigated the essential criteria for late-onset hypogonadism (LOH) syndrome based on the presence of symptoms associated with low testosterone levels in Han Chinese men. Blood tests for total testosterone (TT) and sex hormone-binding globulin (SHBG) were performed, and the aging male symptoms (AMS) questionnaire was conducted in a randomly selected cohort composed of 944 Chinese men aged 40 to 79 years from nine urban communities. Three sexual symptoms (decreased ability/frequency of sexual activity, decreased number of morning erections, and decreased libido) were confirmed to be related to the total and free testosterone levels. The thresholds for TT were approximately 12.55 nmol l-1 for a decreased ability/frequency to perform sex, 12.55 nmol l-1 for decreased frequency of morning erections, and 14.35 nmol l-1 for decreased sexual desire. The calculated free testosterone (CFT) thresholds for these three sexual symptoms were 281.14, 264.90, and 287.21 pmol l-1 , respectively. TT <13.21 nmol l-1 (OR = 1.4, 95%CI: 1.0-1.9, P = 0.037) or CFT <268.89 pmol l-1 (OR = 1.5, 95%CI: 1.1-20, P = 0.020) was associated with an increase in the aforementioned three sexual symptoms. The prevalence of LOH was 9.1% under the criteria, including all three sexual symptoms with TT levels <13.21 nmol l-1 and CFT levels <268.89 pmol l-1. Our results may improve the diagnostic accuracy of LOH in older men.

Giant Sacral Chondrosarcoma in an Elderly Male : A Case Report

Primary sacral tumours are rare, therefore experience of managing their associated complications are very limited. Effective surgical treatment of pelvic chondrosarcoma remains a major challenge for orthopaedic surgeons, due to the complex anatomic structure of the pelvis, the lack of defined compartment borders, the close vicinity to vital structures, and the risk of jeopardizing pelvic structural stability. We report a rare case of a giant sacral chondrosarcoma (100cm x 80cm) in an elderly male who successfully underwent tumour resection with good functional outcome and recovery. Long term follow up is essential in vie

Relationship between sex hormone binding globulin and metabolic syndrome in elderly males / 中华内分泌代谢杂志

To investigate the relationship between sex hormone binding globulin (SHBG) and metabolic syndrome in elderly males in Shanghai,all the subjects (≥ 60 years old,male) underwent measurements of weight,height,waist and hip circumferences,and blood pressures,serum levels of fasting plasma glucose,total cholesterol,triglyceride,high density lipoprotein-cholesterol (HDL-C),and low density lipoprotein-cholesterol were determined (Hitachi,7600),while the levels of serum insulin,total testosterone,and SHBG were determined by using chemiluminescence methods.Free testosterone was calculated by using the Vermeulen equation.Metabolic syndrome was defined according to the criteria of the Chinese Diabetes Society (CDS 2004).The SHBG level in the metabolic syndrome group was significantly lower than that in non-metabolic syndrome group [(40.50 ± 26.16) nmol/L vs (47.80± 20.34) nmol/L,P＜0.01].With increasing number of metabolic syndrome components,the level of SHBG became lowered progressively.The subjects were divided into four subgroups according to SHBG Quartiles.From Quartile 1 to Quartile 4,body mass index,waist-hip ratio,diastolic blood pressure,fasting plasma glucose,triglyceride,fasting insulin,homeostasis model assessment for insulin resistance(HOMA-IR),free testosterone,free androgen index,and free testosterone percentage became progressively lowered,while age and HDL-C became raised (P＜0.05).SHBG was correlated significantly with age,body mass index,waist-hip ratio,diastolic blood pressure,fasting plasma glucose,HDL-C,and triglyceride.Age,HDL-C,and body mass index remained independently associated with SHBG in the multivariate regression analysis.In a logistic regression taking metabolic syndrome as the dependent variable,SHBG and HOMA-IR were included in the final model with statistical significance.Lowered SHBG is a risk factor of metabolic syndrome in elderly males.SHBG may be an independent predictor of metabolic syndrome,but the mechanism of how SHBG is involved in the metabolic syndrome needs to be further studied.

Correlation between Serum Testosterone and Type 2 Diabetes Mellitus in Elderly Male / 中国康复理论与实践

@#: Objective To explore the correlation between serum testosterone and type 2 diabetes mellitus in elderly male.Methods 1012 elderly male were divided into 2 groups according to their histry of DM.Blood glucose(FBG,PBG),cholesterol(CHO),triglyceride(TG),blood pressure(DBP,SBP),body mass index(BMI),serum insulin(FINS,PINS),serum testosterone(T)and estradiol(E2)were measured.Results Eldly male with type 2 diabetes showed higher FBG,PBG,TG,FINS,PINS and E2 level than those without DM(P<0.05),and with lower HDL-C and T level(P<0.05).The analysis of multiple stepwise regression showed that T level was correlated with the level of HDL-C,FINS,PINS and TG.Conclusion TG,HDL-C,FINS and PINS level correlate with T level in eldly male with type 2 diabetes mellitus.