Use of Facebook by Academic Medical Centers in Taiwan During the COVID-19 Pandemic: Observational Study.

BACKGROUND: The battle against COVID-19 remains ongoing, and social media has played an important role during the crisis for both communication and health promotion, particularly for health care organizations. Taiwan's success during the COVID-19 outbreak is well known and the use of social media is one of the key contributing factors to that success. OBJECTIVE: This nationwide observational study in Taiwan aimed to explore the use of Facebook by academic medical centers during the COVID-19 pandemic. METHODS: We conducted a nationwide observational study of all Facebook fan page posts culled from the official accounts of all medical centers in Taiwan from December 2019 to April 2020. All Facebook posts were categorized into either COVID-19-related posts or non-COVID-19-related posts. COVID-19-related posts were split into 4 categories: policy of Taiwan's Center for Disease Control (TCDC), gratitude notes, news and regulations from hospitals, and education. Data from each post was also recorded as follows: date of post, headline, number of "likes," number of messages left, number of shares, video or non-video post, and date of search. RESULTS: The Facebook fan pages of 13 academic medical centers, with a total of 1816 posts, were analyzed. From January 2020, the percentage of COVID-19 posts increased rapidly, from 21% (January 2020) to 56.3% (April 2020). The trends of cumulative COVID-19 posts and reported confirmed cases were significantly related (Pearson correlation coefficient=0.93, P<.001). Pages from private hospitals had more COVID-19 posts (362 versus 289), as well as more video posts (72 posts, 19.9% versus 36 posts, 12.5%, P=.011), when compared to public hospitals. However, Facebook pages from public hospitals had significantly more "likes," comments, and shares per post (314, 5, 14, respectively, P<.001). Additionally, medical centers from different regions displayed different strategies for using video posts on Facebook. CONCLUSIONS: Social media has been a useful tool for communication during the COVID-19 pandemic. This nationwide observational study has helped demonstrate the value of Facebook for academic medical centers in Taiwan, along with its engagement efficacy. We believe that the experience of Taiwan and the knowledge it can share will be helpful to health care organizations worldwide during our global battle against COVID-19.

Anthropogenic Cycles of Arsenic in Mainland China: 1990-2010.

Arsenic (As) is a trace element in the global environment with toxicity to both humans and ecosystem. This study characterizes China's historical anthropogenic arsenic cycles (AACs) from 1990 to 2010. Key findings include the following: (1) the scale of China's AACs grew significantly during the studied period, making China the biggest miner, producer, and user of arsenic today; (2) the majority of arsenic flows into China's anthroposphere are the impurity of domestically mined nonferrous metal ores, which far exceeds domestic intentional demands; (3) China has been a net exporter of arsenic trioxide and arsenic metalloid, thus suffering from the environmental burdens of producing arsenic products for other economies; (4) the growth of arsenic use in China is driven by simultaneous increases in many applications including glass making, wood preservatives, batteries, semiconductors, and alloys, implying the challenge for regulating arsenic uses in multiple applications/industries at the same time; (5) the dissipative arsenic emissions resulting from intentional applications are at the same order of magnitude as atmospheric emissions from coal combustion, and their threats to human and ecosystem health can spread widely and last years to decades. Our results demonstrate that the characterization of AACs is indispensable for developing a complete arsenic emission inventory.

Impact of preoperative urodynamic testing for urinary incontinence and pelvic organ prolapse on clinical management in Chinese women.

AIM: To assess the impact of preoperative urodynamic testing on the clinical management of urinary incontinence and pelvic organ prolapse. METHODS: Urodynamic testing was performed prior to surgery in 307 patients with pelvic organ prolapse or urinary incontinence. The resulting changes to planned treatment were recorded and retrospectively assessed. RESULTS: Results of urodynamic testing prompted changes to the treatment plan in 136 cases (44.2%), including 86 cases of no or slight-stress urinary incontinence, 28 cases of bladder outlet obstruction, 12 cases of occult stress urinary incontinence and 10 cases of detrusor overactivity and urge urinary incontinence. Urodynamic testing excluded disadvantageous factors in 69 cases (22.4%), including 46 cases of overactive bladder and 23 cases of voiding dysfunction. The information provided to patients when seeking informed consent was augmented by the results of urodynamic testing in 63 cases (20.5%). Urodynamic testing was of no value in 39 cases (12.7%). CONCLUSIONS: Preoperative urodynamic testing for urinary incontinence and pelvic organ prolapse can result in changes to treatment plans, exclusion of disadvantageous factors, and augmentation of information provided to patients when seeking informed consent.

[Effects of Compound Aconitum Polysaccharide on Glycosylation of Tumor Cells].

Objective To observe inducing or inhibiting effects of Chinese medicine (CM) poly- saccharides on glycoprotein chain synthetized different glycosyltransferases, thus disclosing targets of CM polysaccharides and its mechanisms. Methods In vivo anti-tumor effects of CM polysaccharides were observed using the inhibiting rate of tumor growth by dividing different Aconitum containing groups. Effects of CM polysaccharides on liver cancer cell SK-HEP-1 glycosyltransferase and tumor related gene expressions were observed. Meanwhile, changes of polylactosamine expression were detected using flow cytometry (FCM) with polylactosamine specific biotin labeling lectin. Results Compared with the model group, the average tumor weight was significantly lower in each medication group (P <0. 01). Compared with the adriamycin group, no significant difference in average tumor weight of the three compound groups (P>0. 05). The expression level of polylactosamine was reduced after adding Aconitum polysac- charide; and CM compound polysaccharides respectively. Conclusions Polysaccharide compound showed similar anti-tumor effect as that of adriamycin. Besides, polylactosamine expression level was reduced in the three compound groups along with increased prepared Aconitum polysaccharide, with more obvious anti-tumor effects shown.

[Effects of diabetic hyperlipidemia on bladder function and its possible mechanisms in a male rabbit model].

OBJECTIVE: To evaluate the effects of chronic hyperlipidemia on bladder function and its possible mechanisms and examine the functional and histological changes of bladder in a diabetic hyperlipidemic model. METHODS: A total of 30 male New Zealand white rabbits (2.5 to 3.0 kg) were numbered sequentially and randomly divided into 2 groups (hyperlipidemic group and control group). Then urodynamic test and detrusor strip contraction study were performed to assess bladder function.Histological studies of bladder and internal iliac arteries were performed with hematoxylin and eosin staining. The ultrastructure of bladder detrusor tissue was examined by transmission electron microscopy. Also the bladder tissue M2, 3-muscarinic receptor protein levels were examined by immunohistochemistry. RESULTS: After 12 weeks, the urodynamic test of the test group showed significantly increased non-voiding contractions (10/14 vs 1/13, P < 0.05) and decreased compliance ((2.16 ± 0.17) vs (4.18 ± 0.21) ml/cm H2O, P < 0.01) versus the control group. The functional experiments showed that carbachol-induced contractions significantly decreased in hyperlipidemic rabbits than those in controls. As to the relaxant actions of selective muscarinic receptor M3 antagonist solifenacin, the bladder strips of hyperlipidemic rabbits were significantly more sensitive than those of the controls.Histological examination showed thickened intima of internal iliac arteries, urothelial disruption and mild fibrosis in the hyperlipidemic rabbits. Transmission electron microscopy of hyperlipidemic bladder muscle tissues showed swollen mitochondrial damage. As to the immunohistochemical results, compared with the control group, the hyperlipidemic group showed significantly increased M3 receptor expression both in bladder urothelium (146 ± 14 vs 108 ± 9, P < 0.01) and smooth muscle layer (131 ± 17 vs 116 ± 15, P < 0.05) . And the expression was more obvious in urothelium layer. CONCLUSIONS: Involuntary detrusor overactivity with decreased bladder compliance and decreased contractions of detrusor are present in hyperlipidemic rabbits. And chronic bladder ischemia and increased M3 receptor expression may contribute to bladder dysfunction.

The effects of low dose X-irradiation on osteoblastic MC3T3-E1 cells in vitro.

BACKGROUND: It has been indicated that moderate or high dose of X-irradiation could delay fracture union and cause osteoradionecrosis, in part, mediated by its effect on proliferation and differentiation of osteoblasts. However, whether low dose irradiation (LDI) has similar roles on osteoblasts is still unknown. In this study, we investigated whether and to what extent LDI could affect the proliferation, differentiation and mineralization of osteoblasts in vitro. METHODS: The MC3T3-E1 cells were exposed to single dose of X-irradiation with 0, 0.1, 0.5, 1.0 Gy respectively. Cell proliferation, apoptosis, alkaline phosphatase (ALP) activity, and mineralization was evaluated by methylthiazoletetrazolium (MTT) and bromodeoxyuridine (BrdU) assay, flow cytometry, ALP viability kit and von Kossa staining, respectively. Osteocalcin (OCN) and core-binding factor α1 (Cbfα1) expressions were measured by real time-PCR and western blot, respectively. RESULTS: The proliferation of the cells exposed to 2.0 Gy was significantly lower than those exposed to ≤1.0 Gy (p < 0.05) from Day 4 to Day 8, measured by MTT assay and BrdU incorporation. For cells exposed to ≤1.0 Gy, increasing dosages of X-irradiation had no significant effect on cell proliferation and apoptosis. Importantly, LDI of 0.5 and 1 Gy increased ALP activities and mineralized nodules of MC3T3-E1 cells. In addition, mRNA and protein expressions of OCN and Cbfα1 were also markedly increased after treatment with LDI at 0.5 and 1 Gy. CONCLUSIONS: LDI have different effects on proliferation and differentiation of osteoblasts from those of high dose of X-irradiation, which might suggest that LDI could lead to promotion of fracture healing through enhancing the differentiation and mineralization of osteoblasts.

[Distribution characteristics of cancerous foci in the prostate among patients undergoing single positive core biopsy].

OBJECTIVE: To determine the distribution characteristics of cancerous foci in the prostate by retrospective analysis on the radical prostatectomy (RP) samples from patients with prostate cancer diagnosed by single positive core biopsy and treated by RP. METHODS: Thirty-seven patients with prostate cancer diagnosed by ultrasound-guided biopsy and single positive core biopsy underwent RP. We reviewed the pre- and post-operative data of the patients, compared the results of biopsies and pathological examination of the RP samples, and analyzed the factors that led to the underestimation of the overall prostate cancer risks. RESULTS: Post-operative pathological results showed multifocal distribution of the tumors in 70% of the patients (26/37) and obviously increased Gleason score (7-9) in 56% (21/37). The clinical stages of the tumors had been significantly underestimated preoperatively. The underestimation of their clinical stages might be due to a larger proportion of cancer tissues in a single positive core biopsy, and that of the overall cancer risks attributed to PSAD > 0.2 microg/L. Larger prostate volume (> or = 40 ml) increased the possibility of multifocal distribution. CONCLUSION: The risk of prostate cancer diagnosed by single positive core biopsy might be underestimated, and the cancerous foci were characterized by multifocal distribution in the prostate.

Expression of ß1,3-N-acetylglucosaminyltransferases during differentiation of human acute myeloid leukemia cells.

The expressions of ß1,3-N-acetylglucosamonyltransferase-2 and -8 (ß3GnT-2, ß3GnT-8),-the two main glycosyltransferases responsible for the synthesis of poly-N-acetyllactosamine (polyLacNAc) in glycans, and ß3GnT-5 participating in the syntheses of sphingoglycolipids were studied in leukemia cell lines during differentiation using RT-PCR method. ß3GnT-2 and ß3GnT-8 distribute widely in six myeloid and monocytoid leukemia cell lines with different abundances, while ß3GnT-4 was only present in NB4 cells. ATRA (all-trans retinoic acid) and dimethylsulfoxide (DMSO), which induce the differentiation of HL-60 and NB4 (two human acute myeloid leukemia cell lines) to myelocytic lineage, up-regulated these two enzymes with various degrees at 2 and 72 h of treatment. In HL-60 cells treated with ATRA, the increase of ß3GnT-8 was more than ß3GnT-2, while in NB4 cells treated with DMSO, the increase of ß3GnT-2 was more than ß3GnT-8. However, when HL-60 and NB4 were differentiated to monocytic lineage induced by phorbol 12-myristate 13-acetate the expressions of ß3GnT-2 and ß3GnT-8 showed no alterations or the increase of expressions was far less than those in myelocytic differentiation. By means of FITC-labeled tomato lectin affinity staining and flow-cytometry, it was found that the product of ß3GnT-2 and -8, polyLacNAc was also increased on the cell surface of HL-60 and NB4 treated with ATRA or DMSO, but unchanged when treated with PMA. These results were in accordance with the up-regulation of the mRNAs of ß3GnT-2 and -8. The expression of ß3GnT-5, however, was not changed both in myelocytic and monocytic differentiations. The difference in the up-regulation of ß3GnT-2 and -8, especially their products may become a useful index to discriminate the myelocytic and monocytic differentiation of leukemia cells.

PpGalNacT2 participating in vanadium-induced HL-60 cell differentiation.

The current study demonstrates vanadium plays the role of antitumor, and its antitumor effect is dosage-dependent. N-acetyl-galactosamine-transferase 2 (polypeptide: N-acetyl-α-galactosaminyl-transferases 2, ppGalNAc-T2) is a member of ppGalNAcTs (polypeptide: N-acetyl-α-galactosaminyl-transferases) family, which proves to play a vital role in the tumor emergence and development process. In this study, we focused on ppGalNAc-T2 and vanadium and aimed to determine whether ppGalNAc-T2 is correlated with vanadium's antitumor effect. We discovered that ppGalNAc-T2 changed with the variation of HL-60 cell growth induced by vanadium at mRNA level. Peanut agglutinin (PNA) is an exogenous lectin. PpGalNacT2 can be indirectly recognized by PNA. By means of flow cytometry and immunofluorescent staining, we found the deviation of PNA binding increased significantly at high concentration vanadium. Then we docked one of the possible compound substances of vanadium onto the body, VO(3) (molecular formula O(13)V(4), partial vanadate tetramer) and ppGalNAcT2, and simulated them via molecular dynamics, which showed that VO(3) may inhibit the activity of the enzyme by stemming conformational changes of a key loop of ppGalNAcT2. To sum up, our results suggested that ppGalNacT2 participated in vanadium induced HL-60 cell differentiation, which might be able to provide a new mechanism of vanadium's antitumor effect.

[Viviperception on renal vessel variation by retroperitoneal laparoscopy a report of 525 cases].

OBJECTIVE: To study the variation of renal vessels with retroperitoneal laparoscopy so as to increase the safety of retroperitoneal laparoscopic surgeries. METHODS: A total of 525 patients underwent retroperitoneal laparoscopic nephrectomy or partial nephrectomy at our hospital between January 2004 and June 2008. There were 316 males and 209 females with a mean age of (58 ± 13) years old. The procedures were as follows: (1) patients lay on one side with their waist up and the retroperitoneal cavity was established with our institutional method; (2) gerota's fascia was separated widely along the ventral surface of major psoas muscle; (3) the tissues around renal arteries and veins were isolated by ultrasonic scalpel. Careful observation was performed to explore if there were duplicated or accessory renal vessels; (4) renal vessels were cut by Endo-GIA/Hem-o-lok or blocked by bulldog clamps; (5) whole or partial kidney was finally resected (remaining procedures omitted). RESULTS: Among all patients, 58 patients (11.0%, 58/525) had a variation of renal vessels. There were double renal arteries on one side (n = 18), double renal veins (n = 10), 3 renal veins (n = 1) and double arteries and veins on one side (n = 3). Twenty-five patients (4.8%, 25/525) had one accessory renal artery on one side while 19 (76.0%, 19/25) accessory renal arteries went toward the upper kidney pole. The diameter of one patient's left spermatic vein was similar with that of renal vein and they were joined by lumber vein. CONCLUSION: The variation of renal artery is more common than that of renal vein. The accessory renal arteries are common and usually go toward the upper kidney pole. The variation of renal vessels should be considered before and during a laparoscopic procedure.

A Strategic Imperative for Promoting Hospital Branding: Analysis of Outcome Indicators.

BACKGROUND: Optimizing the use of social media to promote hospital branding is important in the present digital era. In Taiwan, only 51.1% of hospitals have official Facebook fan pages. The numbers of likes for these hospitals are also relatively low. OBJECTIVE: Our objective was to establish a special branding team for social media operation, led by top administrators of our hospital. Here we present our strategic imperative for promoting hospital branding as well as an analysis of its effectiveness. METHODS: Led by top administrators, the branding team was formed by 11 divisions to create branding strategies. From 2016 to 2018, the team implemented action plans. All information unique to the hospital was posted on Facebook, as well as on the hospital's official website. To determine the plans' efficiencies, we obtained reference data from Google Analytics, and we compared Facebook Insights reports for 2016 with those for 2017 and 2018. RESULTS: One of the branding team's main missions was to establish branding strategies and to integrate segmental branding messages. In each quarter we regularly monitored a total of 52 action plan indicators, including those for process and outcome, and discussed the results at team meetings. We selected 4 main performance outcome indicators to reflect the effectiveness of the branding efforts. Compared with 2016, the numbers of likes posted on the Facebook fan page increased by 61.2% in 2017 and 116.2% in 2018. Similarly, visits to the hospital website increased by 4.8% in 2017 and 33.1% in 2018. Most Facebook fan page and website viewers were in 2 age groups: 25 to 34 years, and 35 to 44 years. Women constituted 60.42% (14,160/23,436) of Facebook fans and 59.39% (778,992/1,311,605) of website viewers. According to the Facebook Insights reports, the number of likes and post sharing both increased in 2017 and 2018, relative to 2016. Comment messages also increased from 2016 to 2018 (P=.02 for the trend). The most common theme of posts varied over time, from media reports in 2016, to innovative services in both 2017 and 2018. Likes for innovative services posts increased from 2016 through 2018 (P=.045 for the trend). By the end of 2018, we recorded 23,436 cumulative likes for posts, the highest number among medical centers in Taiwan. CONCLUSIONS: We achieved the largest number of Facebook fans among all medical centers in Taiwan. We would like to share our experience with other hospitals that might be interested in engaging in social media for future communications and interactions with their patients.

Existence and stability of traveling wavefronts for discrete three species competitive-cooperative systems.

The purpose of this work is to investigate the existence and stability of traveling wavefronts for competitive-cooperative systems with three species. The existence result can be derived by using the technique of monotone method with the help of a pair of explicit supersolution and subsolution. Moreover, some su cient conditions ensure the linear determinacy for the minimal speed is given. Then, applying the weighted energy method, we prove that the traveling wavefronts are asymptotically stable in the weighted Banach spaces provided that the initial perturbations of the traveling wavefronts also belong to the same spaces.

The Chinese version of ICIQ: a useful tool in clinical practice and research on urinary incontinence.

AIMS: In China, more and more research on the management of urinary incontinence (UI) is being conducted; a robust questionnaire to evaluate the symptoms and impact of UI will be very helpful. Thus, the Chinese version of The International Consultation on Incontinence Questionnaire (ICIQ) was developed. METHODS: Initial translation and back translation of the ICIQ-UI short form, the ICIQ-FLUTS, the ICIQ-FLUTS long form, the ICIQ-LUTSqol, and the ICIQ-FLUTSsex were completed by native Chinese and English speaker, respectively. Then, the psychometric properties of the Chinese version of the five ICIQ modules, including the content/face validity, internal consistency, and test-retest reliability were examined. RESULTS: The back translation of the questionnaires was consistent with the original English questionnaires. The Chinese version of the five ICIQ modules was easily completed, and the missing data were less than 2.5%. The Cornbach's alpha coefficient was 0.71-0.96. In the test-retest, the agreement rate of the two tests exceeded 95% and the kappa values were 0.72-0.93 (P < 0.001). CONCLUSIONS: The Chinese version of the five ICIQ modules was easily understood, and had adequate internal consistency and reliability. It can be used in the study of Chinese-speaking groups around the world.

The lifetime cost of hepatocellular carcinoma : a claims data analysis from a medical centre in Taiwan.

BACKGROUND: Hepatocellular carcinoma (HCC) is the second most common cancer in Taiwan. For males in Taiwan, it is the most dangerous cancer, with both the highest incidence and mortality rate. OBJECTIVE: To determine cancer-related medical care costs for long-term survivors of HCC. METHODS: The estimation of the lifetime cost was based on the insurer perspective and adopted an incidence-based approach. Data was sourced from the 1999-2002 cancer registry statistics of patients with HCC and the claims data of Taipei Veterans General Hospital (TVGH). In total there were 2873 HCC patients at TVGH. In addition to this data, the research used population National Health Insurance claims data from the National Health Research Institutes (1996-2002) as the comparison group. The probabilities of survival, dying of cancer or dying of other causes were estimated using cancer registry statistics. To estimate lifetime (10-year) cost, we divided the disease process into three phases: initial, continuing and terminal. The cost of HCC was calculated as the sum of the average cost of each phase. The expected lifetime cost for treatment of an HCC patient was estimated by incorporating the phase-specific costs with the survival and mortality rates. RESULTS: The results showed that 895 patients survived <1 year, and treatment for each of these patients cost on average New Taiwan dollars ($NT) 206 573 ($US 1 = $NT 33, year 2002 value) over this period. For those who survived > or =1 year, the terminal phase of treatment resulted in the highest costs, $NT 237 032. On average, for each patient, the initial phase cost was $NT 140 403 and the monthly cost for the continuing phase was $NT 8687. For the average HCC patient, the 10-year lifetime cost was $NT 418 554 (in nominal $NT). CONCLUSION: Our study showed that the terminal phase cost the most out of the three treatment phases. The aggregate lifetime cost of HCC is useful for health policy making and clinical decision making.

[Urodynamic analysis of dysuria in female patients].

OBJECTIVE: To compare the urodynamic diagnostic types of dysuria in female patients of different age groups. METHODS: Six hundred and sixteen female patients with dysuria were evaluated from March 1997 to July 2008. No patients had history of nervous system disease and history of lower urinary tract operations. They had detrusor pressure-flow studies and uroflowmetry. The urodynamic diagnostic types were analyzed in 3 different age groups. RESULTS: In 3 groups of 18 - 40 years, 40 - 60 years and > or = 60 years, the diagnosis of bladder outlet obstruction (BOO) had the highest proportion (54.8%, 59.1% and 45.0% respectively). The distribution of detrusor overactivity, detrusor under-activity and normal function had no significant difference between 3 groups. The distribution of BOO and acontractile detrusor had significantly difference between 3 groups. When groups of 18 - 40 years and 40 - 60 years were combined into 18 - 60 years group and compared with the older group, the proportion of BOO, acontractile detrusor and detrusor under-activity showed significantly difference. The proportions of BOO in the two groups were 57.3% and 45.0%, acontractile detrusor 15.6% and 23.9%, detrusor under-activity 17.4% and 25.0%, respectively. The proportion of reduced bladder sensation among detrusor under-activity patients in the older group was significantly higher. CONCLUSIONS: In the urodynamic diagnoses of voiding difficulty in female patients, bladder outlet obstruction has the highest proportion. This proportion decreases in the older patients. The proportion of acontractile detrusor and detrusor under-activity increases in the older group.

[Correlation of lower urinary tract symptoms with erectile dysfunction in men aged 50 years and above].

OBJECTIVE: To investigate the incidence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in men aged > or = 50 years and to achieve the correlation between LUTS (obstructive symptoms and stimulant symptoms) and ED. METHODS: We investigated 245 men aged > or = 50 years and with regular sex mates using International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5), designed diagnostic interrogation and medical examination, and statistically analyzed the results of IPSS, IIEF-5, LUTS and their correlation with erectile function. RESULTS: The incidence of ED was 81.9% (140/171) among the men with LUTS, 73.1% (38/52), 82.1% (46/56) and 88.9% (56/63) respectively in the 50-59, 60-69 and > or = 70 age groups, with significant differences in IPSS, IIEF-5 (P < 0.01) and the severity of ED (P < 0.01) among different age groups. ED incidence was found significantly correlated with the severity of LUTS (r = 0.52, P < 0.01), 71.3% (57/80), 89.6% (60/67) and 95.8% (23/24) respectively in the groups of mild, moderate and severe LUTS. The mean scores on obstructive and stimulant symptoms were (3.1 +/- 3.6) and (6.8 +/- 4.9), and their correlation coefficients with IIEF-5 were r = -0.41 (P < 0.01) and r = -0.59 (P < 0.01), respectively. CONCLUSION: The incidence of ED is high in men with LUTS and positively correlated with the severity of LUTS. Stimulant symptoms have greater influence than obstructive symptoms on the sexual life of old and middle-aged males.

Suprapubic cystostomy versus nonsuprapubic cystostomy during monopolar transurethral resection of prostate: a propensity score-matched analysis.

We aim to reassess the safety of the monopolar transurethral resection of the prostate (M-TURP) without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patients who underwent M-TURP at Peking University First Hospital between 2003 and 2013. A total of 1680 patients who had undergone M-TURP were identified, including 539 patients in the noncystostomy group and 1141 patients in the cystostomy group. After propensity score matching, the number of patients in each group was 456. Smaller reductions in hemoglobin and hematocrit (10.9 g vs 17.6 g and 3.6% vs 4.7%, respectively) were found in the noncystostomy group. In addition, patients undergoing surgery without cystostomy had their catheters removed earlier (4.6 days vs 5.2 days), required shorter postoperative stays in the hospital (5.1 days vs 6.0 days), and were at lower risk of operative complications (5.7% vs 9.2%), especially bleeding requiring blood transfusion (2.9% vs 6.1%). Similar findings were observed in cohorts of prostates of 30-80 ml and prostates >80 ml. Furthermore, among patients with a resection weight >42.5 g or surgical time >90 min, or even propensity-matched patients based on surgical time, those with cystostomy seemed to be at a higher risk of operative complications. These results suggest that M-TURP without suprapubic cystostomy is a safe and effective method, even among patients with larger prostates, heavier estimated resection weights, and longer surgical times.

A nomogram predicting re-operation due to secondary hemorrhage after monopolar transurethral resection of prostate.

We aim to develop a nomogram to predict re-operation due to secondary hemorrhage after Monopolar transurethral resection of the prostate (M-TURP). We identified patients undergoing M-TURP at Peking University First Hospital from 2000 to 2013. Univariate and multivariate logistic regression models were developed to predict the occurrence re-operation due to secondary hemorrhage. The discriminatory ability of the nomogram was tested using the area under the receiver operating characteristic curve (ROC), and internal validation was performed via bootstrap resampling. Of the 1901 patients who underwent M-TURP during the study period, 9.1% (173 patients) experienced hemorrhage after M-TURP, and they had a 22.0% re-operation rate (38 patients). Benign prostatic hyperplasia (BPH)-related complications (odds ratio, 0.386; 95% CI, 0.177-0.841), percent of resected prostate (OR, 0.156; 95% CI, 0.023-1.060) and suprapubic cystostomy (OR, 0.298; 95% CI, 0.101-0.881) were independently associated with re-operation. The nomogram accurately predicted re-operation (area under the ROC curve 0.718). The negative predictive value was 88.0%, while the positive predictive value was 47.9%. Re-operation due to secondary hemorrhage after M-TURP was associated with no BPH-related complications, lower percent of resected prostate and no suprapubic cystostomy and was accurately predicted with using the nomogram.

[Spatial Distribution, Sources and Bioavailability of Heavy Metals in the Surface Sediments of Longjiang River, Southern China].

In order to evaluate the pollution status, possible sources, and bioavailability of heavy metals (As, Cd, Pb, Sb, Zn, and Tl), 33 surface sediments were collected from Longjiang River, Southern China. The total concentrations and potential bioavailable concentrations of the heavy metals were analyzed using ICP-MS. Enrichment factors (EFs), Pearson correlation analysis, and principal component analysis (PCA) were used to further assess their pollution degree and potential sources. Results showed that the surface sediments of Longjiang River have been suffering heavy metal (As, Cd, Pb, Sb, and Zn) pollution to different degrees. The maximum concentrations of As, Cd, Pb, Sb, and Zn were 67.0, 7.42, 227, 229, and 807 mg·kg-1, respectively, while the Tl concentration were very low, with little variation. Moreover, the polluted sites were mostly located in the mid-lower of the main stem and in tributaries (Dongxioajiang and downstream of Dahuanjiang), and the pollution degree of the heavy metals, in a descending order, were Cd > Sb > Zn > Pb > As > Tl. Pearson correlation analysis and PCA indicated that As, Cd, Pb, Sb, and Zn predominantly originated from anthropogenic inputs, including nonferrous metal mining and smelting, municipal sewage, and agricultural activities, and Tl mostly derived from natural rock weathering. The bioavailability of heavy metals in the sediments tended to be controlled by their sources. The percentages of bioavailable heavy metals (As, Cd, Pb, Sb, and Zn) in the highly anthropogenic impacted areas (the mid-lower of the main stem and downstream of Dongxiaojiang tributary) were also high, with the average percentages of bioavailable As, Cd, Pb, Sb, and Zn of 26%, 51%, 49%, 38%, and 47%, respectively. High EF values and high bioavailable percentages of heavy metals easily and greatly cause high ecological risk of Longjiang River.

[Comparison of different drugs on the treatment of benign prostate hyperplasia].

OBJECTIVE: To compare the differences of the efficacy and different therapeutic drugs on the treatment of benign prostatic hyperplasia (BPH) in order to ensure the optimal indication for different BPH patients. METHODS: A randomized, parallel-controlled, multicenter clinical trial was conducted. From September 2002 to December 2003 906 BPH patients were enrolled into 7 therapeutic groups, including selective-adrenoceptor antagonist (terazosin, doxazosin tamsulosin and naftopidil), 5 alpha-reductase inhibitor (finasteride and epristeride) and natural product (cernilton). International Prostate Symptom Score (IPSS) and Quality of Life (QOL), uroflowmetry, total prostatic volume (TPV) and transitional zone volume and residual urine were used as efficacy criteria. RESULTS: According to the baseline, the IPSS and Qmax were significantly correlated to the prostatic volume and transitional zone volume (P < 0.01). At average follow-up of 6 months, significant improvements in IPSS, QOL, Qmax and residual urine volume were observed in each therapeutic group, and no difference in IPSS improvement was found among the groups. Prostatic volume and transitional zone volume were significant decreased in 5alpha-reductase inhibitor groups (P < 0.05). In patients with baseline TPV greater than 35.5 cm3, the improvement of Qmax was more significant than that in patients with TPV less than 35.5 cm3 in finasteride group (P < 0.01) (5.7 ml/s and 2.2 ml/s respectively), and more significant symptomatic improvements were also found in cernilton, doxazosin and naftopidil group. In each group, the improvement of symptom were more significant in patients with IPSS higher than 20 points (P < 0.01). CONCLUSIONS: Each drug observed in this study can improve the subjective and objective symptoms significantly for BPH patients, especially for patients with higher IPSS baseline. When using 5alpha-reductase inhibitor, prostatic volume can be decreased significantly and more obviously subjective and objective improvement can be found in the patients with TPV greater than 35.5 cm3.