Factors associated with blood loss during radical prostatectomy for localized prostate cancer in the prostate-specific antigen (PSA)-era: an overview of the Department of Defense (DOD) Center for Prostate Disease Research (CPDR) national database

Radical Prostatectomy (RP) has been traditionally associated with significant operative blood loss and high risk of transfusion. However, over the last few years, centers of excellence have reported less bleeding and transfusion. To verify and document changes in the epidemiology of bleeding and transfusion of men electing RP, we undertook an analysis of such cases in the Department of Defense (DoD) Center for Prostate Disease Research (CPDR) Multicenter Research Database. Using the Department of Defense Center for Prostate Disease Research (CPDR) Multicenter National Research Database, a query of all RPs performed between January 1, 1985 and December 31, 2000 was conducted revealing 2918 cases with blood-loss data available for analysis from nine hospital sites. These cases were analyzed over time (calendar year) and changes in the characteristics of the patients, disease severity, and surgical results were compared with estimated blood loss (EBL) and transfusion data. Among the 2918 evaluable men, 2399 (82%) underwent a retropubic RP, 97% had clinical T1-2 disease, and 77% had a PSA level ≥10.0 ng/mL. Overall median operation time was 3.8 h, and EBL was 1000 cc. Examining trends over time, there was a dramatic decline in median operative time, EBL, and transfusion rate. In multiple linear regression analysis, operative time, operative approach, surgery year, lymphadenectomy status, and neoadjuvant hormonal therapy were significant predictor of EBL. Blood loss difference between retropubic and perineal RP became insignificant in the latter years. Radical prostatectomy is being performed more commonly on men with earlier stage disease in the PSA-Era. The operation is now performed more rapidly with less blood loss and fewer transfusion requirements. In a broad practice experience represented here, autologous blood donation would appear to be unnecessary for the majority of men and the blood loss advantage traditionally associated with perineal RP is no longer evident.     

Sequential non-invasive mechanical ventilation following short-term invasive m echanical ventilation in COPD induced hypercapnic respiratory failure

ＩｎＣｈｉｎａ ,80 % - 90 %ｏｆｐａｔｉｅｎｔｓｗｉｔｈｃｈｒｏｎｉｃｏｂｓｔｒｕｃｔｉｖｅｐｕｌｍｏｎａｒｙｄｉｓｅａｓｅ (ＣＯＰＤ )ｅｘａｃｅｒｂａｔｅｄｂｅｃａｕｓｅｏｆｂｒｏｎｃｈｉａｌ ｐｕｌｍｏｎａｒｙｉｎｆｅｃｔｉｏｎ Ｓｏｍｅｏｆｔｈｏｓｅｅｘｐｅｒｉｅｎｃｉｎｇｓｅｖｅｒｅｒｅｓｐｉｒａｔｏｒｙｆａｉｌｕｒｅｏｆｔｅｎｒｅｑｕｉｒｅｍｅｃｈａｎｉｃａｌｖｅｎｔｉｌａｔｉｏｎ(ＭＶ) ,ｗｈｉｃｈｃａｎｈｅｌｐｔｏｃｏｎｔｒｏｌｐｕｌｍｏｎａｒｙｉｎｆｅｃｔｉｏｎａｎｄｔａｋｅｔｈｅｒ…     

Clinical observation of serum IL-18, IL-10 and sIL-2R levels in patients with chronic hepatitis C pre- and post antiviral treatment

Objective To discuss the roles of serum interleukin-18 (IL-18), interleukin-10 (IL-10) and soluble interleukin-2R (sIL-2R) in the pathogenesis of chronic hepatitis C and to observe the effects of interferon (IFN) on the above- mentioned serum cytokines. Methods The levels of above- mentioned cytokines were detected in 10 healthy individuals, 24 asymptomatic hepatitis virus C (HCV) carriers and 27 patients with chronic hepatitis C ( before and after IFN treatment) using enzyme linked immunosorbent assay (ELISA). Results The levels of the cytokines in patients with chronic hepatitis C are higher than in healthy people （P<0.05) and in asymptomatic HCV carriers（P<0.05). The values of the cytokines show a significant positive correlation to ALT （P<0.05). Levels of tested cytokines decreased observably after IFN treatment （P<0.05). The grades of the serum levels for sIL-2R and IL-10 before IFN treatment （from high to low） were categorized accordingly: non-response group＞ partial- response group ＞complete- response group （P<0.05). Conclusions The tested cytokines co-participate in the pathogenesis of chronic hepatitis C, and can be used to evaluate the effect of IFN on the immune state of organisms. Furthermore, sIL-2R and IL-10 are important for predicting the anti-viral efficacy of IFN.     

Effects of local and intravenous anesthetics on the activity of glutamate transporter type 2

Glutamate transporters may be important targets for anesthetic action in the central nervous system. The authors investigated the effects of the intravenous anesthetics, thiopental and ketamine, and the local anesthetics, lidocaine and bupivacaine, on the activity of glutamate transporter type 2, EAAT2. EAAT2 was expressed in Xenopus oocytes by injection of its mRNA. By using two-electrode voltage clamping, membrane currents were recorded after the application of L-glutamate (30 microM) in the presence or absence of various concentrations of anesthetics. Lidocaine and bupivacaine did not change glutamate-induced inward currents at the tested concentrations (1-1000 microM). Thiopental and ketamine also did not affect the activity of EAAT2 at the tested concentrations (0.3-300 microM). Our results suggest that the two commonly used local anesthetics (lidocaine and bupivacaine) and intravenous anesthetics (thiopental and ketamine) do not affect the activity of EAAT2 expressed in oocytes. EAAT2 may not be a target for these anesthetics.     

Sample size needed to detect gene-gene interactions using association designs

It is likely that many complex diseases result from interactions among several genes, as well as environmental factors. The presence of such interactions poses challenges to investigators in identifying susceptibility genes, understanding biologic pathways, and predicting and controlling disease risks. Recently, Gauderman (Am J Epidemiol 2002;155:478-84) reported results from the first systematic analysis of the statistical power needed to detect gene-gene interactions in association studies. However, Gauderman used different statistical models to model disease risks for different study designs, and he assumed a very low disease prevalence to make different models more comparable. In this article, assuming a logistic model for disease risk for different study designs, the authors investigate the power of population-based and family-based association designs to detect gene-gene interactions for common diseases. The results indicate that population-based designs are more powerful than family-based designs for detecting gene-gene interactions when disease prevalence in the study population is moderate.     

导痰祛瘀口服液的工艺研究

目的:研究导痰祛瘀口服液的提取工艺。方法:采用 Ｌ９(３４)正交试验设计及Ｕ４７均匀试验设计,以大黄中的大黄素含量及石菖蒲中挥发油含量分别为指标进行试验。结果:较好渗漉条件为 ５５%乙醇渗漉１０倍量,５%ＮａＯＨ作润湿液,流速为３ｍｌ/ｍｉｎ;较好蒸馏条件为药材粉碎成粗粉,加水１６倍,蒸馏５ｈ。结论:研究所得工艺较合理。     

巨噬细胞移动抑制因子在子宫内膜异位症中的表达及其临床意义

目的:探讨巨噬细胞移动抑制因子(macrophage m igration inhibitory factor,M IF)与子宫内膜异位症的发病及疾病进展的关系。方法:采用对照性临床研究。研究组为不同分期的子宫内膜异位症患者,对照组为行子宫切除术的子宫肌瘤患者:ELISA检测外周血中M IF的浓度,进行不成对的方差t检验,并与CA125浓度进行直线相关性分析;相对定量RT-PCR检测比较子宫内膜异位灶及正常在位子宫内膜组织中M IF的表达。结果:子宫内膜异位症患者外周血中M IF浓度比正常女性增加354%,子宫内膜异位症Ⅲ~Ⅳ期升高尤为显著。外周血中CA125浓度随着疾病的进展而升高,但是与M IF浓度之间无相关性。子宫内膜异位灶组织中M IF的表达较在位子宫内膜组织增强。结论:M IF与子宫内膜异位症的发生发展密切相关,提示M IF可能参与了子宫内膜异位症的发生发展过程,但是,外周血M IF浓度测定尚不能作为子宫内膜异位症的特异性和敏感性指标。     

Pin1基因真核表达载体的构建及在宫颈癌HeLa细胞中的表达

目的构建一种含人肽基脯氨酰顺反异构酶Pin1的质粒,以绿色荧光蛋白作为报告基因,观察其在宫颈癌HeLa细胞中的表达。方法从人宫颈癌HeLa细胞中,以RT-PCR方法扩增出人Pin1基因全长cDNA序列(CDS),插入增强绿色荧光蛋白表达质粒pEGFP-C1,脂质体法转染HeLa细胞,荧光显微镜下观测绿色荧光蛋白的表达,免疫印迹法检测GFP-Pin1蛋白的表达。结果RT-PCR扩增出人Pin1基因;构建pEGFP-C1-Pin1重组质粒,体外成功转染入宫颈癌HeLa细胞,在荧光显微镜下可见强绿色荧光蛋白的表达,免疫印迹法证实存在GFP-Pin1蛋白高表达;经G418筛选获得单细胞克隆。结论重组质粒pEGFP-Pin1体外转染HeLa细胞后,目的基因能够在细胞内有效表达,检测方法简便可靠,为利用转染该目的基因的细胞进行下一步研究提供了实验基础。     

本院近5年截瘫患者的医院感染分析

目的探讨截瘫患者医院感染的病原菌对药物敏感情况。方法回顾分析我院自2001年12月～2006年12月246例截瘫患者的有关临床资料。结果78例患者发生医院感染,医院感染率为31.71%,感染部位主要以呼吸道、皮肤软组织、手术切口、泌尿道为多;医院感染的病原菌主要是条件致病菌,以G-菌为主。结论医护人员必须严格无菌操作,根据细菌药敏结果合理选用抗菌药物;加强营养,提高患者机体抵抗力。     

四肢骨折后石膏固定病人家庭病床的护理

目的探讨四肢骨折后石膏固定病人家庭病床护理疗效。方法对我科近2年四肢骨折后经手法复位、石膏固定后无并发症的家庭病床病人38例实施家庭护理,重点指导病人及家属对患肢的安置、血运的观察、石膏的护理方法及常见并发症。结果本组38例中13例病人石膏拆除时有轻度水肿,经理疗和功能锻炼后半月内均缓解。5例因骨缺损未能如期拆除石膏,2例拆除石膏后膝关节僵硬,经被动和主动功能锻炼1周后好转,1个月后恢复。1例冠心病心衰合并肺部感染经治疗后好转,其余病人均如期愈合,无1例褥疮、骨愈合不良等并发症。结论正确指导家庭病床的病人及家属掌握四肢骨折石膏固定后的家庭护理方法,可得到与住院治疗病人相同的疗效。