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The purpose of this paper is to investigate the altered brain areas activated in functional magnetic resonance imaging before and after escitalopram antidepressant treatment in patients with major depressive disorder. Functional magnetic resonance studies showed abnormal activity in brain regions such as prefrontal cortex， cingulate cortex and striatum in patients prior to treatment， meantime， the abnormal activation of anterior cingulate， dorsolateral prefrontal and thalamus reflected the outcomes of escitalopram antidepressant therapy. Following the treatment with escitalopram， the fMRI activation of brain areas returned to normal， and those changes were significantly correlated with the improvement of depressive symptoms. So this paper provides a review of the brain functional activity changes in patients with major depressive disorder before treatment and at different time point of medication， as well as the correlation between altered brain functional activity and clinical symptoms.
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Objective To study the efficacy and safety of intravesical chemotherapy combined with intravenous chemotherapy for high grade T1 (T1G3) bladder cancer after transurethral resection of bladder tumor(TURBT).Methods From January 2012 to December 2015,111 patients with high grade T1 (T1 G3) bladder cancer were retrospectively reviewed.Thirty-six patients received TURBT and intravesical chemotherapy and intravenous chemotherapy (group A),75 patients received TURBT and intravesical chemotherapy(group B).In group A,there were 28 males and 8 females,with average age 66.2 years;in group B,there were 59 males and 16 females,with mean age 67.9 years.There was no statistical difference between the two groups in age,sex,smoking history,tumor diameter,tumor number.1-year recurrence-free survival (RFS),1-year progression-free survival (PFS),intravenous chemotherapy adverse reaction were analyzed.Results All the patients were followed-up for 12 months.9 patients relapsed in group A,1-year RFS rate 75％,and the median RFS of the 9 patients was 9 (3-11) months.36 patients relapsed in group B,1-year RFS rate 52％,and the median RFS of the 36 patients was 7 (3-11) months.There was statistically significant difference between the two group(P =0.02).One patient progressed in group A,1-year PFS rate 97.2％,and the PFS was 9 months.Six patients progressed in group B,1-year PFS rate 92％,and the median PFS was 9.5(6-12) months.There was no statistically significant difference (P =0.305) between the two group.Only 1 case (3％) appeared Ⅲ° or above intravenous chemotherapy adverse reaction.Conclusions Intravesical chemotherapy combined with intravenous chemotherapy offers a better RFS rate than the intravesical chemotherapy alone for patients with T1G3 bladder cancer after TURBT,and there are very low rates of serious side effects.Intravenous chemotherapy may be considered as a new therapy strategy for T1G3 bladder cancer after TURBT.
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This study was aimed to determine effect of Bu-Shen Kang-Shuai (BSKS) Tablet on HO-1 mRNA and its associated oxidative stress levels among atherosclerotic rabbits. A total of 56 rabbits were randomly divided into the normal group (8 rabbits) and the experimental group (48 rabbits). Normal diet was given to the normal group. Atherosclerotic rabbits models were established in the experimental group. At the eighth week, rabblits in the experi-mental group were randomly divided into the model group, BSKS Tablet group and simvastatin group. Blood samples were collected before medication, 8-, 12-, 16-week after medication from rabbits of each group. Rabbits were sacri-ficed under aseptic conditions at the last blood collection. Expressions of aortic HO-1 mRNA and PPARα mRNA were measured by Q-PCR method. The level of MMP-9 was measured by immunohistochemical assay. Serum HbCO, COX-2 activity and cGMP level were measured by ELISA assay. The results showed that after the intervention of BSKS Tablet, serum HbCO level decreasd, cGMP was obviously increased. However, there was no obvious change on the COX-2 activity. The immunohistochemical assay showed that BSKS Tablet obviously reduced MMP-9 level of rabbits. There was only small amount of aortic HO-1 mRNA expression in the normal group. However, the expres-sion of aortic HO-1 mRNA in the atherosclerosis group was increased. After intervention of BSKS Tablet, the ex-pression of HO-1 mRNA was increased with statistical significance (P < 0.05). Simvastatin had similar antioxidant effect. It was concluded that the compound preparation of traditional Chinese medicine (TCM) BSKS Tablets had an important antioxidant effect in treatment of atherosclerosis. Its protective mechanism may be through the regulation of HO-1 mRNA gene expression and effects of HO-1/CO-cGMP pathway activities of related enzymes while peroxida-tion stability of atherosclerotic plaque.
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Objective To explore the pathological and clinical features of renal epithelioid angiomyolipoma (EAML). Methods From February 2001 to June 2010,4 cases of renal epithelioed angiomyolipoma (EAML) diagnosed in our unit were reviewed on their clinical and histopathological feathers retrospectively.The prognosis of renal EAML were evaluated according to the immunohistochemical findings.Of the 4 cases,the first case had a history of nodular sclerosis and presented a sign of hemorrage caused by the rupture of the tumor.The second case also showed a sign of hemorrage complicated with hemorrhagic shock.The third case had no symptom,but suffered from clear cell carinoma concomitantly on the other kidney.The fourth case came for consultation for his bilateral angiomyolipoma.All the 4 cases had fat composition founded in their CT scans. Results The first case was taken biopsy on the tumor of her right kidney,and lost of follow-up 6 months later.The second case undertaken radical nephrectomy,and no tumor recurrence detected after 10 months follow-up.The third case undertaken right nephron-sparing nephrectomy,and left nephron-sparing nephrectomy 6 months later.No recurrence detected during the follow-up 8 months later.Bilateral resection of the angiomyolipoma was performed on the fourth case,and a malignancy on the left kidney was deteceded 6 years later,then a radical nephrectomy was performed.But liver metastasis was founded half a year later during the follow-up.Immunohistochemcial staining of these tumors showed positive HMB45 and Melan-A but negative CK and EMA. Conclusions Renal EMAL has malignant potentiality,and the aggressiveness of it makes the close follow-up compulsive.Immunohistochemcial study is useful for diagnosis and differential diagnosis,even helpful to assess the prognosis.
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Objective To investigate the efficacy and safety of low dose of oral desmopressin in elderly women with nocturia. Methods Eligible female patients with nocturia older than 60 years were included in this study.A total of 97 patients were randomly divided into 2 groups.Care was taken to match the patients of the two groups by age and clinical criteria.Control group (n=48 ) received liquid restriction during nighttime.Experimental group (n=49) received 0.1 mg desmopressin at bedtime and liquid restriction for 8 weeks.Patients were required to visit the outpatient clinic from the first visit,and after 4 and 8 weeks of treatment.Patients maintained flow volume charts and used diaries to record voiding data throughout the study.At each visit,all patients were evaluated by blood biochemical routine test,mean nocturnal urine volume,mean number of nocturia,mean duration of the first sleep period and sleep quality.At baseline,all the patient's blood sodium,liver and kidney function were normal. Results After 4 weeks of treatment with desmopressin,28 patients (57.1％) had less than 2 voids.15 patients (31.3％) in the control group had less than 2 voids.After 8 weeks,35 patients (71.4％) with desmopressin had less than 2 voids.16 patients (33.3％) in the control group had less than 2 voids.Compared with control group,nocturia cure rate in experimental group was significantly higher after 4 weeks and 8 weeks (P ＜ 0.05).After 8weeks,desmopressin significantly decreased mean nocturnal urine output from 590 ± 70 ml to 376 ± 50 ml (P ＜ 0.05).Mean nocturnal urine output in the control group was not significantly decreased from 600 ± 90 ml to 550 ± 60ml (P ＞0.05) ; Mean number of nocturia before and after receiving desmopressin were 2.9 and 1.6 respectively which differed significantly (P ＜ 0.05).Mean number of nocturia before and after in control group were 2.8 and 2.3 respectively with no significant difference (P ＞ 0.05).The mean duration of the first sleep period increased by 73％ (from 2.2 to 3.8 h) in the desmopressin group,compared with an increase of 19％ (from 2.1 to 2.5 h) in the control group (P ＜ 0.05).39 (79.6％) patients in demopressin group were satisfied with sleep quality compared with only 15 (31.3％) patients in control group were satisfied (P ＜ 0.05).No serious complications were found during the medication.All the patient's blood sodium,liver and kidney function remained normal during treatment. Conclusions Low does oral administration of desmopressin could be an effective and well-tolerated treatment for nocturnal polyuria in elderly women.
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Objective To study the role of B-mode ultrasound found bladder trabeculation in evaluating the degree of bladder outlet obstruction (BOO) and the bladder function in benign prostatic hyperplasia (BPH) patients.Methods Conducted prospective research to determine differences in clinical data and urodynamic parameters between BPH patients with and without bladder trabeculation diagnosed by abdominal ultrasound.Results Thirty-six BPH patients with bladder trabeculation were compared with 68 BPH patients without bladder trabeculation.The mean age was (73.7 ± 10.1 ) years for the patients with bladder trabeculation and ( 69.6 ± 6.2 ) years without bladder trabeculation, IPSS was 24.4 ± 6.6 and 22.8 ± 8.3 respectively, in which no significant differences were found ( P ＞ 0.05 ).The detrusor pressure at maximum flow rate was ( 131.7 ± 57.3 ) cm H20 and (92.1 ± 47.8 )cm H2O ) respectively.The linearized passive urethral resistance relation was 4.6 :± 1.1 and 3.5 ± 1.5 respectively, showing a significant difference ( P ＜.05 ) between the two groups.Seventy-two point two percent (26/36) of the patients with bladder trabeculation had a low compliance bladder, among whom 23.1% (6/26) of the patients had bilateral hydronephrosis with renal insufficiency.The percentage for the control group was 42.6% (29/68) and 10.3% (3/29) respectively (P ＜ 0.05).Conclusions The bladder trabeculation found by B-ultrasound in BPH patients suggests the existence of BOO and a high risk of bilateral hydronephrosis.Bladder trabeculation in patients without urinary retention suggests they are in compensation status.Relief of the obstruction is helpful to recovery of bladder function and the reduction of complications.
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Objective To study the change of clinical and urodynamic parameters in the patients with lower urinary tract symptom (LUTS) caused by detrusor overactivity (DO). Methods Two hundred and twenty-seven patients with LUTS underwent clinical evaluation from October 2006 to December 2008, including Prostate Volume (PV), International Prostate Symptom Score (IPSS), Peak Flow rate (PF) and Residual Urine (RU) measurement. Pressure flow studies were performed. The detrusor overactivity was recorded to classify the patients into 2 groups, DO group and none DO group. The clinical and urodynamic parameters were compared between the two groups. Results Mean patient age was 70 years (range 52 to 89). According to the urodynamic results, there were 126 patients in DO group and 101 patients in none DO group. The mean patients age was older in DO group than the none DO group(P＜0.05). Adjusted by age, the PV, PF, and RU were no different between the two groups(P>0.05). The mean first sensation of bladder, bladder compliance, cystometric capacity, bladder outlet obstruction parameters, single voiding volume and max detrusor pressure during contraction were different between the two groups(P＜0.05). Conclusions The main risk factors of DO are the ageing and BOO. The non invasive parameters such as PV、 PF、 and RU could not be used to judge DO. The changes of urodynamic parameters caused by DO were hyperaesthesia of bladder、lower bladder compliance、 higher max detrusor pressure and lower max cystometric capacity. This study emphasis the importance of the urodynamic studies in the aged patients with LUTS.
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Objective To assess the clinical characteristics of benign prostatic hyperplasia (BPH) patients and patients's attitude towards BPH and BPH therapy. Methods The question-naires were distributed to 3560 BPH patients throughout the country during the period of Prostate Health Educational Programmer (PHELP). The survey was mainly focused on the questions of patient understanding toward BPH, the preference of treatment and international prostate score scale.Results The evaluations based on 2878 completed patient's questionnaires showed that 86. 0% of patients were diagnosed with moderate or severe low urinary tract syndrome. The main reasons for seek treatment was irritative symptoms (64. 1%), obstructive symptoms ( 41. 7%), physical checkup (41.0%), worry about prostate cancer(14. 5%). Most of patients sought treatment from big hospitals. Most of patients (69.1%) had right understanding towards BPH. Nocturia was the most bothersome of lower urinary tract symptoms(LUTS) suggestive of BPH. Rapid LUTS improvement was the patient's main objective (87.4%). Conclusions Chinese patients did not recognize the complications of BPH progression. Irritative symptoms are the main reasons for seek treatment. Nocturia is most bothersome syndrome, which deteriorates quality of life mostly.
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Objective To study the relationship between the bladder outlet obstruction(BOO)and the area under the curve of detrusor during voiding related parameters. Methods One hundred and thirty-eight patiens with benign prostate hyperplasia(BPH) underwent clinical evaluation, including physical examination, flow rate and post-void residual volume measurement. Pressure flow studies were performed. Mean patient age was 68 years (range 56 to 82). The AG number and the LinPURR were recorded to classify the patients into 3 groups, namely unobstructed, equivocal obstructed and obstructed, as the traditional classification. Two new parameters including the area under the curve of detrusor pressure during voiding(AUCdet) and the area under the curve of detrusor pressure during voiding adjusted for voided volume(AUCdet/Vol) were calculated and compared with the traditional classification using the Linear discriminant analysis. Results According to the traditional classification, there were 33 unobstructed, 32 equivocal and 44 obstructed cases. The AUCdet and AUCder/Vol of the 3 groups were different(P＜0.001). Linear discriminant analysis showed that of the cases, 90. 9%(30/33), 43.8%(14/32) and 70. 5%(31/44) were identically categorized by the traditional and the AUCdet/Vol classifications in the unobstructed, equivocal and obstructed groups, respectively. Conclusions The area under the curve of detrusor pressure during voiding related parameters appear to be good parameters of the BOO in patients with BPH. Further studies are needed to test the reliability and validity of these new parameters.
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Clopidogrel combinated with aspirin can significantly improve the prognosis of cardiovascular disease in patients with coronary heart disease undergoing PCI, but at the same time, which can increase the risk of cardiovascular hemorrhage. However, plus TCM can significantly improve the therapeutic effect, reduce symptoms of angina, reduce the adverse drug reaction to alleviate the suffering of the patients, in particular, which can reduce the dosage of medicine to improve the quality of life of patients, reduce the application time of using clopidogrel to reduce the financial burden of patients,then improve patient compliance. This review provided reference to combat PCI postoperative treatment using the combination of Chinese and western medicine methods.
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Objective To study the prostate volume,prostate weight and the clinical parameters in BPH patients and to investigate the interrelationships between the relevant parameters. Methods The complete data of 80 cases of BPH underwent open surgery were reviewed and analyzed.SPSS software was uesd to make the statistical analysis. Results The volume of surgical specimen has been positively correlated with PV( r=0.872,P
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Objective To study the volume of total prostate and the volume of its transitional zone in different age groups of elderly men. Methods 213 elderly men of 50 to 79 years of age from a community of Beijing city were divided into 3 groups and studied. The volume of total prostate and the volume of the transitional zone were measured by rectal ultrasonography and the index of the transitional zone was calculated. All the data were evaluated with statistical analysis. Results The number of subjects in the 50～59 age group was 75,in the 60～69 age group 81 and in the 70～79 age group 57.The volume of total prostate was 23.82?8.83,29.16?10.01 and 33.77?11.74 respectively and the transitional zone 1.52?1.19, 3.60?3.66 and 7.25?7.02ml respectively. The index of transitional was 0.10?0.12, 0.13?0.11, 0.20?0.11 respectively. The difference in volume of the total prostate has not been statistically significant whereas the difference in the volume of the transitional zone between the 3 age groups has been significant. Conclusions The volume of total prostate and that of the transitional zone increases with age. The speed of hyperplasia of the transitional zone has been faster than that of the whole prostate.The index of the transitional zone indicates the difference of the whole prostate and the transitional zone in hyperplasia.
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Objectives To review our initial experience with the Ho:YAG laser in treating superficial bladder tumors.Methods Ho:YAG laser was applied for treating 52 cases of bladder tumors which were confirmed by cystoscopy and pathology with totally 87 tumors.All tumors were in stage Ta～T 2 and tumors grade G1～G2.The optical fiber was put into bladder through cystoscopy.Ho:YAG laser was used endoscpically to cut and vaporize bladder tumor and normal bladder mucosa near the tumor.Results Nine of 52 patients were performed under local anesthesia in outpatient.Operation time was apparently short (mean 25 minutes) Histopathology of biopsies showed no cancer cells left.There were no intraoperative complication such as bleeding,perforation and delay complication.Catheter time is very short,about 1～3 days or without catheter at all.None of the ureteral orifice were damaged in seven cases of bladder tumors near the ureteral orifice.Six patients were recrred during our follow-up in 50 patients (12%).Conclusions It has been demonstrated that Ho:YAG laser therapy is provided with advantages of simple procedure,the absence of complication,high patient satisfaction,and ability to be used in the outpatient.It is more convenience than TUR-Bt in tumors in the neck of bladder or apex of bladder.
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Objective To observe the syndrome manifestations of rabbit atherosclerosis models and explore the syndrome attribution rules of the models.Methods The 24 male Japanese rabbits were randomized into a control group(n=8)and a experimental group(n=16).The control group was given normal feed,and the experimental group was treated with high-fat diet and immune injury and surgical injury through the femoral artery balloon.They were fed totally for 10 weeks.Vascular morphological changes and blood lipid determine were used to evaluate the models.The ear,tongue,eye,and the overall state of rabbits were regularly observed to see the changes of TCM syndromes.Results The rabbits of the experimental group gradually reduced the amount of activity in early stage.When the climate changed,their nasal secretion was increased,and they had wheezing breathing,fever and other common cold symptoms like red auricle.In the medium stage,the fatty plaque or belt around the eyes,cold auricle,and listlessness could be seen,and the blood fat was significantly higher than that of the control group.To the tenth week,the dark tongue with blood spots and purple cold auricle appeared in the rabbits of the experimental group.It was difficult to draw blood from the ear,and the emboli could be seen in the vessels of auricles.Compared with the control group,the oxidized low density lipoprotein and malondialdehyde of the experimental group were significantly increased,and the activity of superoxide dismutase decreased.Conclusion The syndromes of rabbit atherosclerosis models are in the changing state,in early stage they can be manifested as Qi deficiency,in middle stage the manifestation can be Qi deficiency with phlegm retention,and in late stage there will be Qi deficiency with blood stasis.The rule is similar to that of the pathogenesis of atherosclerosis in clinic.