李曰庆教授辨证治疗前列腺疾病经验

李曰庆教授从医50余载,在中医外科和泌尿男科领域辛勤耕耘,勇于创新,取得了令人瞩目的成就,并在临床中应用中西医结合的治疗方法对泌尿男科等疾病进行治疗,经过多年临床积累了很多极具特色的用药经验。在慢性前列腺炎的诊疗上李曰庆教授强调辨证与辨病相结合,因证施治,综合治疗。在前列腺增生的治疗上,李教授提出从肾虚、血瘀、痰浊论治的辨证思路,采取温肾、活血及化痰的治疗方法。主要围绕李曰庆教授治疗前列腺疾病的理论及思路展开论述,旨在更好地指导临床。     

Pulse inversion sonography in the early phase of the sonographic contrast agent Levovist: differentiation between benign and malignant focal liver lesions.

OBJECTIVE: To determine whether examination of focal liver lesions by pulse inversion sonography in the early perfusion phase of the contrast agent Levovist (SH U 508A; Schering AG, Berlin, Germany) enables distinction between benign and malignant lesions. METHODS: Seventy-two patients were examined. The cause of the lesion was confirmed by liver biopsy, computed tomography, or both or by hepatic iminodiacetic acid-enhanced scintigraphy. Forty-two patients had malignant liver lesions, and 30 had benign liver lesions. After injection of 2 g of Levovist intravenously, analysis of Levovist arrival was performed by the interval delay imaging technique for 60 seconds. RESULTS: The early arrival of Levovist less than 30 seconds after injection was used as an indicator for malignancy and had specificity of 67% and sensitivity of 60% (P < .05). The central starlike fill-in as a sign for focal nodular hyperplasia had specificity of 100% and sensitivity of 67% (P < .001). The rimlike pattern followed by centripetal fill-in as a sign for hemangioma had specificity of 100% and sensitivity of 18% (P < .01). In contrast, the early diffuse stippled arrival pattern was found in 60% of malignant lesions and also in 33% of cases of focal nodular hyperplasia and in 1 patient with an adenoma. CONCLUSIONS: Analysis of Levovist arrival time cannot distinguish between a malignant or benign lesion in individual cases. However, the central starlike arrival pattern is characteristic of focal nodular hyperplasia.     

急性尿潴留增加患者经尿道前列腺电切术后早期并发症的风险

【摘要】〓目的〓探讨前列腺增生患者(BPH)术前伴有急性尿潴留(AUR)经尿道前列腺电切术(TURP)后早期并发症。方法〓回顾性分析我院2010年1月~2011年12月因BPH行TURP术的患者临床资料,年龄大于50岁的BPH患者仅行TURP术为我们的研究对象,将其分为两组,一组术前AUR(+),另一组术前AUR(-),神经源性膀胱、前列腺癌、药物或尿道狭窄所致AUR患者不纳入本研究。对比两组患者术后早期并发症:尿路感染(UTI)、血尿、重置尿管、尿失禁、休克、输血率、败血症、下尿路症状(LUTS)。结果〓AUR(+)组144例,AUR(-)组116例,AUR(+)组与AUR(-)相比,术后尿路感染(45.83% vs 10.34%, OR:7.33, 95% CI:3.71~14.50)、血尿(19.4% vs 6.9%, OR: 3.25, 95% CI: 1.41~7.50)、重置尿管(8.33% vs 2.59%, OR: 3.42, 95% CI: 0.94~12.44),差异具有统计学意义;尿失禁(1.39%)、休克(0.69%)、输血(4.17%)仅发生在AUR(+)组,LUTS症状、败血症在两组差异无统计学意义。结论〓术前伴有AUR患者TURP术后早期并发症的风险较不伴有AUR的患者更高。     

构建三通道碎石系统处理合并前列腺增生的复杂性膀胱结石

目的 探讨一种新型碎石模式的构建及处理合并前列腺增生的复杂性膀胱结石的临床效果.方法 以电切镜鞘、肾镜镜鞘、膀胱侧视镜构建出三通道碎石系统,结合气压弹道碎石治疗42例合并前列腺增生的复杂性膀胱结石,比较碎石效果及术前、术后3个月I-PSS、QOL评分、BOO分级、Qmax差异.结果 42例患者均一次清石成功,碎石时间（43.6±11.2） min;无膀胱穿孔、明显水外渗、大出血、严重尿道损伤等并发症;顺利进行进一步经尿道前列腺电切术.术后3月I-PSS评分（9.5±3.6）分,QOL评分（1.3±1.2）分,Qmax（17.7±5.9） mL,以及BOO分级与术前比较差异均有统计学意义.结论 电切镜鞘、肾镜镜鞘及膀胱侧视镜构建出的三通道碎石系统可以连续高效地处理合并前列腺增生的复杂性膀胱结石,临床效果良好.     

Upregulation of let-7a inhibits vascular smooth muscle cell proliferation in vitro and in vein graft intimal hyperplasia in rats

Background

Proliferation of vascular smooth muscle cells (VSMCs) is a crucial event in the pathogenesis of intimal hyperplasia, which is the main cause of restenosis after vascular reconstruction. In this study, we assessed the impact of let-7a microRNA (miRNA) on the proliferation of VSMCs.

Methods

Using miRNA microarrays analysis for miRNA expression in the vein graft model. Lentiviral vector-mediated let-7a was transfected into the vein grafts. In situ hybridization was performed to detect let-7a. Cultured rat VSMCs were transfected with let-7a mimics for different periods of time. Cell proliferation, migration and cell cycle activity were monitored following transfection of the let-7a mimics. Immunohistochemical and Western blotting analysis the expression levels of c-myc and K-ras.

Results

We found that let-7a was the most downregulated miRNA in the vein graft model. In vivo proliferation of VSMCs was assessed in a rat model of venous graft intimal hyperplasia. Let-7a was found to localize mainly to the VSMCs. Let-7a miRNA expression was increased in VSMCs in the neointima of the let-7a treated group. Intimal hyperplasia was suppressed by upregulation of let-7a via lentiviral vector-mediated mimics. In cultured VSMCs, the expression of let-7a increased upon starving, and the upregulation of let-7a miRNA significantly decreased cell proliferation and migration. Immunohistochemical and Western blotting analysis demonstrated that treatment with let-7a mimics resulted in decreased expression levels of c-myc and K-ras.

Conclusions

The results indicate that let-7a miRNA is a novel regulator of VSMC proliferation in intimal hyperplasia. These findings suggest that let-7a miRNA is a promising therapeutic target for the prevention of intimal hyperplasia.