经直肠应变力弹性成像评估良性前列腺增生组织硬度变化及膀胱出口梗阻程度的应用价值

目的探讨经直肠应变力弹性成像(TRTE)评估良性前列腺增生(BPH)组织硬度变化及膀胱出口梗阻程度的应用价值,分析前列腺组织硬度指标与膀胱出口梗阻程度的相关性。方法选择2018-06～2020-02在该院男科就诊并行TRTE检查的患者111例作为研究对象,其中BPH患者81例(BPH组),非BPH患者30例(非BPH组)。应用TRTE获取患者前列腺弹性图像,比较两组弹性评分、外腺应变、内腺应变和应变比(SR)。采用Spearman秩相关分析BPH组外腺应变、内腺应变、SR及弹性评分与AG值的相关性。结果BPH组外腺应变、SR及弹性评分显著高于非BPH组(P 0.05)。BPH组内腺应变[0.13(0.10,0.17)]小于外腺应变[0.32(0.24,0.42)],差异有统计学意义(Z=-7.569,P=0.000)。Spearman秩相关分析结果显示,BPH组AG值与内腺应变呈负相关(P 0.05),与SR和弹性评分呈正相关(P 0.05)。结论 TRTE可用于评估前列腺组织的弹性质地,BPH的发生会使前列腺组织硬度增加,内腺应变、SR、弹性评分与膀胱出口梗阻程度具有相关性。     

PVR和PSAD:前列腺癌与良性前列腺增生的鉴别

目的　探讨前列腺移行区体积 (TZV)与前列腺总体积 (PGV)的比值 ,即 TZV/ PGV=PVR和 PSA密度 (PSAD)鉴别前列腺癌(PCa)与良性前列腺增生 (BPH)的应用价值。方法　采用专用直肠超声探头检测 70例 PCa及 96例 BPH病人的前列腺 PZV及 PGV,并计算其体积比值 ,同时测量血 PSA值 ,计算 PSAD。结果　在 BPH与 PCa两组间 ,PSAD及 PVR有统计学意义 (P<0 .0 1 )。结论　 PVR和 PSAD对鉴别 PCa与BPH有较高的应用价值 ,可作为临床前列腺癌的初步筛选指标。     

超声评估膀胱重量预测前列腺增生患者并发急性尿潴留

目的探讨超声评估膀胱重量(UEBW)与良性前列腺增生(BPH)并发急性尿潴留(AUR)的关系。方法回顾性分析133例BPH患者的相关资料,通过经腹壁测量膀胱内容积与膀胱壁的厚度计算膀胱重量;经直肠测量前列腺体积、移行区体积,并计算移行区指数。结果 BPH并发AUR组(46例,占34.6%)与非AUR组(87例,占65.4%)的年龄(73.6岁vs.70.7岁,P<0.05)、前列腺体积(47.14 cm3vs.41.98 cm3,P<0.05)、移行区体积(29.04 cm3vs.24.28 cm3,P<0.05)、移行区指数(0.62 vs.0.56,P<0.01)、超声评估膀胱重量(UEBW)(72.66 g vs.45.24 g,P<0.01)均有明显的差异;Logistic回归显示BPH患者并发AUR的两个独立危险因素分别为UEBW和年龄;患者的UEBW>50 g时,其发生AUR的相对危险度是UEBW<50 g的14.09倍。结论 UEBW的增大与BPH患者并发AUR的关系密切,可以作为预测BPH患者并发AUR的良好指标。     

61例正常儿童小脑形态发育情况观察

目的 观察61例正常儿童小脑发育情况,并探讨其规律.方法 对61例0～10岁脑发育正常的儿童行3.0T MRI 3D T1序列扫描.于后处理工作站上重建标准方位后测量小脑的上下径、左右径、前后径及小脑蚓上下径.分析上述指标与儿童年龄之间的相关性,获得其发育规律及各测量值的正常范围.结果 本组儿童小脑横径、前后径、上下径及小脑蚓部上下径随年龄呈对数增长.相关性公式如下：横径=1.4110（年龄）＋7.5266（R2=0.8264）;前后径=0.6328（年龄）＋4.489 （R2 =0.751）;上下径=0.6100（年龄）＋4.2316 （R2 =0.7754）;蚓部上下径=0.3198（年龄）＋3.8193 （R2 =0.6899）.0～2岁正常儿童小脑发育迅速,各指标迅速增加;2岁后逐渐转为缓慢增长.获得各年龄段儿童小脑上下径、左右径、前后径及小脑蚓上下径的正常范围.结论 2岁以下儿童小脑迅速增大,2岁以后增大速度放缓.     

高龄良性前列腺增生中小体积前列腺伴膀胱出口梗阻患者的尿动力学特点

目的探讨高龄良性前列腺增生(BPH)中小体积前列腺伴膀胱出口梗阻(BOO)患者的尿动力学特点。方法年龄>70岁的高龄BPH中有BOO的患者115例,根据前列腺体积分为前列腺体积≤30 ml组45例,>30 ml组70例,比较两组年龄、血清前列腺特异性抗原(TPSA)水平、残余尿量、最大尿流率(Qmax)、平均尿流率、排尿量、排尿时间、膀胱顺应性、Qmax时膀胱压力、逼尿肌收缩能力。结果前列腺体积≤30 ml组年龄、Qmax时膀胱压力及Qmax时逼尿肌压力均明显低于前列腺体积>30 ml组,而残余尿量明显高于前列腺体积>30 ml组(P<0.05);前列腺体积≤30 ml组逼尿肌收缩乏力发生率明显高于前列腺体积>30 ml组(χ~2=3.86,P=0.049)。结论小体积前列腺的BPH,在经尿动力学检查判断为BOO时,合并发生膀胱排空障碍及逼尿肌收缩能力降低的可能性更大。     

后尿道形态改变在诊断良性前列腺增生致下尿路症状中的应用

目的探讨经直肠超声观察良性前列腺增生(BPH)致下尿路症状(LUTS)时后尿道形态的改变。方法 BPH患者65例,应用经直肠超声检查,测量前列腺体积和膀胱残余尿量,观察后尿道走行及尿道内口,采用国际前列腺症状评分(IPSS)评价LUTS,根据超声测量结果将患者分为后尿道形态正常组30例和后尿道形态改变组35例,对比两组患者LUTS、前列腺增生程度及膀胱残余尿量分级所占比例,采用Pearson相关性分析后尿道形态及尿道内口的改变与IPSS评分、膀胱残余尿量、前列腺体积的关系。结果两组患者LUTS、膀胱残余尿量分级所占的比例比较差异均有统计学意义(P<0.05),两组前列腺增生程度比较差异无统计学意义(P>0.05)。后尿道形态及尿道内口的改变与IPSS评分、膀胱残余尿量呈正相关性(P<0.05),与前列腺体积无相关(P>0.05)。结论经直肠超声观察后尿道走行及尿道内口形态改变可作为BPH致LUTS的直接证据。     

组织弹性成像硬度预测药物治疗老年良性前列腺增生病人夜尿症状的效果

目的探讨前列腺组织弹性成像硬度预测α受体阻滞剂治疗老年良性前列腺增生(BPH)病人夜尿症状的效果。方法收集136例因夜尿增多服用α受体阻滞剂单药治疗的>60岁的BPH病人的临床资料,包括年龄、BMI、国际前列腺症状评分(IPSS)、IPSS排尿症状评分(IPSSv)、IPSS存储症状评分(IPSSs)、最大尿流率(Qmax);经直肠超声测量总前列腺体积(TPV)、移行区体积(TZV)、残余尿量(residual urine,PVR),通过前列腺移行区组织实时剪切波弹性成像(shear wave sonoelastography,SWE)得到弹性模量(Emean)。采用Logistic回归分析使用药物后夜尿症状改善的影响因素。结果136例病人中54例(39.7%)夜尿症状改善。与夜尿未改善的病人相比,夜尿改善组病人的年龄、TPV、TZV、Qmax和弹性模量Emean更小,差异有统计学意义(P<0.05);2组BMI、IPSS、IPSSv、IPSSs和PVR差异无统计学意义(P>0.05)。多因素分析显示,年龄(OR=2.837,95%CI:1.352~5.827)和Emean(OR=4.258,95%CI:2.065~8.710)是BPH病人夜尿改善的独立影响因素。Emean预测老年BPH病人用药后夜尿改善的AUC为0.747(95%CI:0.628~0.852),最佳截断值为38.4 kPa,灵敏度和特异度分别为74.14%、70.68%。结论前列腺组织弹性成像硬度可以预测α受体阻滞剂治疗BPH夜尿症状的效果。     

一氧化氮合酶同工酶在前列腺增生患者膀胱和前列腺组织中的表达研究

用免疫组化法检测了 5 2例有膀胱出口梗阻 (BOO)的前列腺增生 (BPH)患者膀胱和前列腺组织中神经元型一氧化氮合酶 (n NOS)、诱导型一氧化氮合酶 (i NOS)和内皮型一氧化氮合酶 (e NOS)的表达。结果显示 :1BPH组和对照组膀胱壁、膀胱颈和前列腺组织 n NOS染色均呈阳性 ,主要分布于平滑肌细胞间的神经纤维、血管内皮细胞、内皮下组织、前列腺上皮细胞及上皮下组织 ;BPH组阳性染色明显低于对照组 (P<0 .0 1)。 2 i NOS阳性染色仅见于 BPH组前列腺的上皮细胞及上皮下组织中。3BPH组和对照组膀胱壁、膀胱颈和前列腺组织中均有 e NOS阳性染色 ,主要分布于血管内皮细胞及内皮下组织和前列腺上皮细胞及上皮下组织 ,两组间没有显著性差异 (P>0 .0 5 )。认为 :1BPH患者膀胱壁 n NOS神经减少 ,是一种梗阻后的去神经现象 ,可引起膀胱充盈相松弛异常 ,与膀胱不稳定的发生有关。2 BPH患者膀胱颈部和前列腺组织中 n NOS神经减少 ,可造成平滑肌基础张力增加 ,产生动力性 BOO。3i NOS在 BPH患者前列腺组织中有特异性表达 ,提示它参与了前列腺增生的病理生理过程。 4 BPH患者膀胱壁、膀胱颈部和前列腺均有 e NOS阳性染色 ,与正常对照组无差异 ,推测 e NOS在 BPH的发生和发展中不起主要作用     

血清tPSA、fPSA/tPSA及PSAD在前列腺良恶性疾病鉴别诊断中的价值

目的探讨血清总前列腺特异抗原（tPSA）、游离PSA（fPSA）与tPSA的比值（F／T）、前列腺特异抗原密度（PSAD）在前列腺增生（BPH）和前列腺癌（PCa）鉴别诊断中的价值。方法检测65例BPH患者及38例PCa患者的血清tPSA、fPSA,经腹部B超测定前列腺的前后径、左右径、上下径,并计算出F／T、前列腺体积（PV）及PSAD,进行比较。结果在灰区外高值区,tPSA、PSAD在两组间差异有显著性（P均〈0．01）,F／T差异无显著性（P〉0．05）;在灰区,两组间tPSA差异无显著性（P〉0．05）,而F／T、PSAD差异有显著性（P均〈0．01）;在灰区外低值区,tPSA、F／T及PSAD在两组间差异无显著性（P〉0．05）。结论以F／T及PSAD作为tPSA的辅助指标,对PSA灰区PCa的诊断具有明显临床意义。     

良性前列腺增生症下尿路症状的治疗进展

良性前列腺增生症（benign prostatic hyperplasia，BPH）是一种特殊的组织病理疾病，其特征表现为基质及上皮细胞的增生。而BPH在临床上又常表现为下尿路症状（lower urinary tract symptoms，LUTS），包括尿频、尿急、夜尿、尿不尽感等。随着年龄的增长，这些症状将逐渐加重，对于50岁以上的男性来说，BPH伴随下尿路症状已经成为一种常见疾病。BPH在病理生理方面，则表现为膀胱出口梗阻，膀胱出口梗阻的病因主要包括两方面，首先是静力因素，即前列腺的腺组织和非腺组织增生、肥大，直接挤压后尿道而引起机械性梗阻；二是动力因素，即分布在膀胱颈、前列腺包膜和腺体平滑肌中α2肾上腺素能受体被活化，平滑肌收缩、肌张力增高，引起膀胱出口梗阻。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.