Analysis of results related to the percent free prostate specific antigen among men without prostate diseases in Xi’an area

To measure the percent of free prostate specific antigen （fPSA） among men without prostate diseases in Xi＇an area, and to study the relationship of percent fPSA with age and pathological grade, clinical stage of prostate cancer （PCa） with percent fPSA, and to analyze the difference between the data in China and the.overseas data to determine appropriate reference range for Chinese male. Methods： A total of 713 participants were enrolled into the study, with PSA, fPSA in serum measured and the percent fPSA calculated. Out of 713 cases, 679 without prostate diseases were divided into 5 groups by age, and then the relationships of PSA, fPSA and percent fPSA with age were studied, respectively. The relationship of pathological grade and clinical stage with percent fPSA of the 34 participants with PCa was also studied. With the help of the related data of men without prostate disease, the appropriate reference range for Chinese male was established. Results： The increases in PSA or fPSA were correlated with age, while there was no significant correlation between age and percent fPSA. The percent fPSA was also correlated with pathological grade and clinical stage of PCa. The percent fPSA of men without prostate disease in Xi＇an area was significandy lower than that in the related overseas data. The reference range of percent fPSA for Chinese male was≥ 15%. Conclusion： Percent fPSA might be more useful than PSA in the detection of prostate cancer. As the percent fPSA is decreased, the pathological grade is decreased, and the clinical stage is increased, the malignant degree is increased. The reference range of ≥15% is more appropriate for Chinese male.     

Efficacy and safety of combined therapy with terazosin and tolteradine for patients with lower urinary tract symptoms associated with benign prostatic hyperplasia: a prospective study

Background The primary objectives of the treatment for the lower urinary tract symptoms （LUTS） associated with benign prostatic hyperplasia （BPH） are to produce rapid, sustained, and safe improvements in the symptoms that affect the quality of life in the majority of men over 50. In this study, we evaluated the efficacy and safety of the combined therapy with terazosin （α1-adrenergic receptor antagonist） and tolterodine （anticholinergic agent） for LUTS associated with BPH. Methods This combination study included 69 patients diagnosed with LUTS associated with BPH based on the International Prostate Symptom Scores （IPSS）, urinary flow rate, prostate volume, urinary residual, and their serum prostate-specific antigen levels. Initially, 191 patients were treated with terazosin 2 mg once daily for one week. Those patients with continued LUTS after the initial treatment were allocated randomly into two groups： terazosin group （n=-36） in which patients were treated with terazosin 2 mg once daily for six weeks, and combination group （n=33） in which patients were treated with both terazosin 2 mg once daily and tolterodine 2 mg twice daily for 6 weeks. Results The IPSS were significantly improved in both groups after treatment, and the reduction of IPSS in the combination group was significantly greater than that in the terazosin group （P〈0.01）. A decrease in urgency, frequency and nocturia were the main contributory factors causing the reduction of IPSS in the combination group. The differences about the peak urinary flow rate and the residual urine from the baseline values were noted in both groups after treatment but were not significant between the two groups. The incidence of adverse effects in the combination group was higher than that in the terazosin group. As expected the most common adverse effect was mouth dryness which was associated with anticholinergic drugs such as tolterodine. Conclusions Patients with LUTS associated BPH appear the improved IPSS after combined therapy with terazosin and tolterodine. This study, although short term and limited numbers of patients, provides evidence that the combined therapy with terazosin plus tolterodine is a good approach for meeting the objectives of rapid, sustained, and safe improvements in the LUTS associated with BPH. And the profile of patients in this study might be used as the indication of such combined therapy for LUTS associated with BPH without urodynamic evaluation.     

Transurethral electrochemical treatment of benign prostatic hyperplasia

Objective To study the mechanism and feasibility of transurethral electrochemical therapy for the treatment of benign prostatic hyperplasia(BPH).Methods Between March 1998 and March 2000,specifically designed devices and catheters for electrochemical therapy were applied to 6 prostate specimens obtained by suprapubic prostatectomy in order to treat BPH patients with urinary retention for whom surgery was contraindicated.Sixteen patients(with a mean age of 77.3 years old)underwent electrical treatment totaling 160-220 coulombs under topical urethral anesthesia for 68-132min.The catheters remained inside the patient for 7-10d.Results Irreversible destructive changes occurred within cathodal tissue,while carbonization occurred within anodic tissue.The radius of tissue change was 7-8 mm and 1-2mm,respectively.In vivo trial: 11(69? patients could be weaned off the catheters with satisfactory urination.Three months after therapy,the mean intemational prostate symptom score(IPSS)was 14.5,mean peak flow rate was 10.5ml/s,and mean residual urine was 39ml.No serious complications were observed.Conclusion Transurethral electrochemical treatment is potentiallya minimally invasive alternative for treatment of BPH,especially for elderly patients at high risk.     

The Antiandrogen Withdrawal Syndrome

Objective To evaluate the response to antiandrogen withdrawal in patients with advanced prostate cancer treated with combined androgen blockade.Methods Twenty-four cases of advanced prostate cancer (10in stage C and 14 in stage D) were retrospectively studied.All the patients were treated with combined androgen blockade(bilateral orchiectomy and flutamide).After initial response to hormone therapy for 7 to 36 months,flutamide was discontinued because of deterioration of the disease.Serum prostate specific antigen(PSA) levels were checked every 2 to 4 weeks and symptoms observed.Results The results following withdrawal of flutamide were as follows:8 patients showed a decling in PSA(mean 74.8%),of whom 6 cases had the PSA decling greater than 50%.Clinical symptoms improved in 4 cases.The nodules of the prostate were smaller than before in cases.The mean duration of response was 4.3 months.Conclusion In patients with hormone refractory advanced prostate cancer after initial combined androgen blockade therapy,a trial of “antiandrogen withdrawal”is a reasonable choice of therapeutic maneuver.     

Modified Madigan Prostatectomy： A Procedure Preserved Prostatic Urethra Intact

A total of 92 patients with benign prostatic hyperplasia (BPH) were subjected to modified Madigan prostatectomy (MPC) for a much satisfactory effect in open prostatectomy surgery. Exposing anterior prostatic urethra near the bladder neck and conjunct cystotomy modified the MPC procedure. This modified procedure preserved prostatic urethra intact and could also deal with intracystic lesions at the same time. The intact of prostatic urethra was kept completely or largely in 86 cases. The amount of blood loss during modified procedure was less. The mean operative time was 105 min. Seventy patients had been followed up for 3-24 months. The postoperative average Qmax was 19.2ml/s. The cystourethrography revealed that the urethra and bladder neck were intact in 10 patients postoperatively. Furthermore, the prostatic urethra was obviously wider after modified MPC. The modified MPC can reduce the occurrence of urethra injury and enlarge the MPC indications. The modified technique is easy to perform with less complications and much satisfactory clinical result.     

DIFFERENTIATION BETWEEN BENIGN PROSTATIC HYPERPLASIA AND PROSTATE CANCER IN THE TRANSITIONAL ZONE EVALUATED BY 1H MAGNETIC RESONANCE SPECTROSCOPIC IMAGING

Objective To quantitatively evaluate the metabolic changes of benign prostatic hyperplasia(BPH) and prostate cancer in the transitional zone using magnetic resonance spectroscopic imaging(MRSI),and to analyze the characteristics and differences of the spectra in this zonal area.Methods Eighteen patients with prostate cancer in the transitional zone underwent magnetic resonance imaging(MRI)/MRSI examinations.The(Choline Creatine)/Citrate(CC/Ci) ratio and the Choline/Creatine(Cho/Cr) ratio were evaluated in each voxel with cancer or BPH confirmed by pathological results.Discriminant analysis was used to determine the power of the two ratios in differentiation between cancer and BPH.Results The CC/Ci ratio and Cho/Cr ratio for cancer voxels were significantly higher than those in the voxels with BPH in the transitional zone(CC/Ci:2.36±1.31 vs.0.85±0.29,P<0.01;Cho/Cr:4.14±1.79 vs.1.26±0.45,P<0.01).As for the discriminant function with the CC/Ci ratio and the Cho/Cr ratio,the specificity,sensitivity,and accuracy were 98.6%,85.7%,92.9% respectively for the differentiation between cancer and BPH.Conclusions The prostate cancer is characterized by higher CC/Ci ratio and Cho/Cr ratio compared to BPH in the transitional zone.Both CC/Ci ratio and Cho/Cr ratio have high specificity,sensitivity,and accuracy in their discriminative power between cancer and BPH in this zonal area.     

The Expression of Lactoferrin in BPH-EPS,BPH-free EPS and Prostate Cancer Secretion

Objective:To examine the expression of lactofertin(Lf) in both the expressed prostatic seeretion(EPS)of BPH patients,normal males and the secretion of prostate cancer cell lines PC-3 and DU145.The potential correlation of Lf with prostatic carcinogenesis was also investigated.Methods:Forty EPS samples obtained from 20 BPH patients and 20 normal males as well as the secretions of prostate cancer cell lines PC-3 and DU145 were subjected to two-dimensional gel electrophoresis(2-DE).Mass spectrometry was performed to confirm the nature of the expressed proteins in EPS and prostatic cancer secretion.Results:Based on the resulting electrophoretograms and the followed mass spectrometry analysis,several differentially expressed proteins were detected and the up-regulation of Lf (MW 35KDa,pI 7-7.5)in BPH-EPS,compared with BPH-free EPS,was also observed.More importantly, Lf was absent in prostate cancer cell lines PC-3 and DU145.Condusion:The results indicate Lf may be produced specifically by benign prostatic epithelium and prostate lost its Lf secretion during the process of carcinogenesis.     

Patient-controlled intravenous fentanyl for cystospasm after transurethral resection of the prostate

Objective： To evaluate the clinical efficacy and safety of patient-controlled intravenous analgesia （PCIA） with fentanyl for cystospasm after transurethral resection of the prostate. Methods： Sixty benign prostatic hyperplasia （BPH） patients scheduled for transurethral resection of the prostate （TURP） under general anesthesia with laryngeal mask airway （LMA） were randomly divided into groups F and S. Group F （n=30） received PCIA device with fentanyl 10 ug/kg＋8 mg ondansetron, and Group S （n=30） received placebo （PCIA device with 8 mg ondansetron）. The visual analog scale （VAS） scores for pain were evaluated at 0, 2, 4, 8, 16, 24, and 48 h by the same staff. And recorded were incidence of cystospasm, side effects, application of hemostatic, duration of drawing Foley catheter and continuous bladder irrigation, time of exhaust after operation, time of post-operative stay and cost of hospitalization. Results： The incidence of cystospasm in Group F was significantly lower than that in Group S in the 48 h after operation （P〈0.05）, the VAS scores for pain in Group F was significantly lower than that in Group S within the 48 h after operation （P〈0.01）. The time of exhaust after operation in Group F was significantly later than in Group S （P〈0.05）. No significant difference was observed in applications of hemostatic, duration of drawing Foley catheter, duration of continuous bladder irrigation, time of post-operative stay and cost of hospitalization between the 2 groups. Conclusion： PCIA with fentanyl （10 ug/kg） relieves pain with little side effect and reduces cystospasm satisfactorily.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…