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2.
Respir Res ; 20(1): 22, 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30704469

RESUMO

BACKGROUND: Infectious Disease Society of America/American Thoracic Society (IDSA/ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality, but the major problem associated with IDSA/ATS minor criteria might be a lack of consideration of weight in prediction in clinical practice. Would awarding different points to the presences of the minor criteria improve the accuracy of the scoring system? It is warranted to explore this intriguing hypothesis. METHODS: A total of 1230 CAP patients were recruited to a retrospective cohort study. This was tested against a prospective two-center cohort of 1749 adults with CAP. 2 points were assigned for the presence of PaO2/FiO2 ≤ 250 mmHg, confusion, or uremia on admission and 1 point for each of the others. RESULTS: The mortality rates, and sequential organ failure assessment (SOFA) and pneumonia severity index (PSI) scores increased significantly with the numbers of IDSA/ATS minor criteria present and minor criteria scores. The correlations of the minor criteria scores with the mortality rates were higher than those of the numbers of IDSA/ATS minor criteria present. As were the correlations of the minor criteria scores with SOFA and PSI scores, compared with the numbers of IDSA/ATS minor criteria present. The pattern of sensitivity, specificity, positive predictive value, and Youden's index of scored minor criteria of ≥2 scores or the presence of 2 or more IDSA/ATS minor criteria for prediction of mortality was the best in the retrospective cohort, and the former was better than the latter. The validation cohort confirmed a similar pattern. The area under the receiver operating characteristic curve of scored minor criteria was higher than that of IDSA/ATS minor criteria in the retrospective cohort, implying higher accuracy of scored version for predicting mortality. The validation cohort confirmed a similar paradigm. CONCLUSIONS: Scored minor criteria orchestrated improvements in predicting mortality and severity in patients with CAP, and scored minor criteria of ≥2 scores or the presence of 2 or more IDSA/ATS minor criteria might be more valuable cut-off value for severe CAP, which might have implications for more accurate clinical triage decisions.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/mortalidade , Pneumonia/diagnóstico , Pneumonia/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Estudos de Coortes , Confusão/etiologia , Confusão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Oxigênio/sangue , Valor Preditivo dos Testes , Padrões de Referência , Estudos Retrospectivos , Uremia/etiologia , Adulto Jovem
3.
Am J Med Sci ; 356(4): 329-334, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30360800

RESUMO

BACKGROUND: The Infectious Disease Society of America/the American Thoracic Society (IDSA/ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality. It is unclear whether the patients with non-severe CAP meeting the minor criteria most strongly associated to mortality should have the priority for treatment and intensive care. It is warranted to explore this intriguing hypothesis. METHODS: A retrospective cohort study of 1230 patients with CAP was performed. This was tested against a prospective 2-center cohort of 1749 adults with CAP. RESULTS: The patients with CAP fulfilling the predictive findings most strongly associated to mortality, i.e. PaO2/FiO2 ≤ 250 mm Hg, confusion, and uremia, showed higher mortality rates than those not fulfilling the predictive findings in subgroup analyses of the retrospective cohort. The more the number of predictive findings present, the higher the mortality rates. The prospective cohort confirmed a similar pattern. Interestingly, the patients with non-severe CAP meeting the predictive findings demonstrated unexpectedly higher mortality rates compared with the patients with severe CAP not meeting the predictive findings in the prospective cohort (P = 0.003), although there only existed death of an uptrend in the retrospective cohort. Two similar and intriguing paradigms about sequential organ failure assessment (SOFA) scores and pneumonia severity index (PSI) scores were confirmed in the 2 cohorts. CONCLUSIONS: The patients with non-severe CAP fulfilling the predictive findings most strongly associated to mortality demonstrated higher SOFA and PSI scores and mortality rates, and might have the priority for treatment and intensive care.

4.
Ying Yong Sheng Tai Xue Bao ; 29(1): 68-74, 2018 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-29692014

RESUMO

The paper studied the effects of altitude on reproductive characteristics in 12 populations of Saussurea przewalskii at the eastern Qinhai-Tibetan Plateau, China. The results showed that the size, reproductive organ biomass, vegetative organ biomass, capitulum number, and seed number of individual plant decreased with the increasing altitude, and the capitulum mass and hundred-grain mass increased continuously. S. przewalskii could ensure its reproduction by reducing plant body size to decrease resource consumption, and increasing the allocation of limit resources to flower biomass. In order to ensure sexual reproduction, the reproductive allocation of the plants increased with increasing the altitude. There was a trade-off between capitulum number and capitulum mass, and between seed number and hundred-grain mass, which allowed the plants to maximize their fitness under stressful conditions.


Assuntos
Altitude , Saussurea/fisiologia , China , Reprodução , Tibet
5.
Medicine (Baltimore) ; 94(36): e1474, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26356705

RESUMO

It is not clear whether the IDSA/ATS minor criteria for severe community-acquired pneumonia (CAP) could be simplified or even be modified to orchestrate improvements in predicting mortality.A retrospective cohort study of 1230 CAP patients was performed to simplify and to modify the scoring system by excluding 4 noncontributory or infrequent variables (leukopenia, hypothermia, hypotension, and thrombocytopenia) and by excluding these variables and then adding age ≥65 years, respectively. The simplification and modification were tested against a prospective 2-center validation cohort of 1409 adults with CAP.The increasing numbers of IDSA/ATS, simplified, and modified minor criteria present in the retrospective cohort were positively associated with the mortality, showing significant increased odds ratios for mortality of 2.711, 4.095, and 3.755, respectively. The validation cohort confirmed a similar pattern. The sensitivity, specificity, positive predictive value, and Youden index of modified minor criteria for mortality prediction were the best pattern in the retrospective cohort. High values of corresponding indices were confirmed in the validation cohort. The highest accuracy of the modified version for predicting mortality in the retrospective cohort was illustrated by the highest area under the receiver operating characteristic curve of 0.925 (descending order: modified, simplified, and IDSA/ATS minor criteria). The validation cohort confirmed a similar paradigm.The IDSA/ATS minor criteria could be simplified to 5 variables and then be modified to orchestrate improvements in predicting mortality in CAP patients. The modified version best predicted mortality. These were more suitable for clinic and emergency department.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia , Adulto , Fatores Etários , Idoso , China/epidemiologia , Estudos de Coortes , Infecções Comunitárias Adquiridas/sangue , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/fisiopatologia , Feminino , Humanos , Hipotensão/etiologia , Hipotermia/etiologia , Pulmão/diagnóstico por imagem , Masculino , Admissão do Paciente/normas , Pneumonia/sangue , Pneumonia/diagnóstico , Pneumonia/mortalidade , Pneumonia/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Radiografia , Projetos de Pesquisa , Taxa Respiratória , Estudos Retrospectivos , Índice de Gravidade de Doença , Trombocitopenia/etiologia
6.
Am J Med Sci ; 350(3): 186-90, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26280118

RESUMO

BACKGROUND: It is not clear whether low-blood pressure criterion could be removed from CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30/min, low blood pressure and age ≥65 years) score to orchestrate an improvement in identifying patients with community-acquired pneumonia (CAP) in low-mortality rate settings. METHODS: A retrospective cohort study of 1,230 CAP patients was performed to simplify the CURB-65 scoring system by excluding low-blood pressure variable. The simplification was validated in a prospective 2-center cohort of 1,409 adults with CAP. RESULTS: The hospital mortalities were 1.3% and 3.8% in the retrospective and prospective cohorts, respectively. The mortality rates in the 2 cohorts increased directly with the increasing scores, showing significant increased odds ratios for mortality. The pattern of sensitivity, specificity, positive predictive value and Youden's index of a CUR-65 (Confusion, Urea >7 mmol/L, Respiratory rate ≥30/min and age ≥65 years) score of ≥2 for prediction of mortality was better than that of a CURB-65 score of ≥3 in the retrospective cohort. Higher values of corresponding indices were confirmed in the validation cohort. The higher accuracy of CUR-65 score for predicting mortality was illustrated by the area under the receiver operating characteristic curve of 0.937, compared with 0.915 for CURB-65 score in the retrospective cohort (P = 0.0073). The validation cohort confirmed a similar paradigm (0.953 versus 0.907, P = 0.0002). CONCLUSIONS: CURB-65 score could be simplified by removing low blood pressure to orchestrate an improvement in predicting mortality in CAP patients who have a low risk of death. A CUR-65 score of ≥2 might be a more valuable cutoff value for severe CAP.


Assuntos
Mortalidade Hospitalar , Pneumonia Bacteriana/mortalidade , Índice de Gravidade de Doença , Estudos de Coortes , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/mortalidade , Confusão/diagnóstico , Confusão/epidemiologia , Feminino , Mortalidade Hospitalar/tendências , Humanos , Hipotensão/diagnóstico , Hipotensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/diagnóstico , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Curva ROC , Taxa Respiratória , Estudos Retrospectivos , Sensibilidade e Especificidade , Ureia/sangue , Uremia/diagnóstico , Uremia/epidemiologia
7.
Int J Infect Dis ; 38: 141-5, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26255891

RESUMO

OBJECTIVES: The individual 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality. It is not clear whether the combinations of predictive findings might imply diverse severities or different mortalities. METHODS: A prospective two centre cohort study was performed of 385 severe CAP patients fulfilling three or more IDSA/ATS minor criteria amongst 1430 patients. RESULTS: Hospital mortality rose sharply from 5.7%, 9.9%, and 16.5%, respectively, for patients with none of three predictive findings most strongly associated to mortality (PaO2/FiO2 ≤ 250mm Hg, confusion and uraemia), one of those, and two of those to 38.6% for patients with all those (p<0.001). The number of three predictive findings present had a significantly increased odds ratio for mortality of 2.796 (p<0.001), and had the degree of positive association with sequential organ failure assessment scores at 72hours, incurring significantly longer hospital stay and higher costs. CONCLUSIONS: Different combinations of 2007 IDSA/ATS minor criteria for severe CAP were associated to diverse severities and different mortalities. The combination of PaO2/FiO2 ≤ 250mm Hg, confusion and uraemia predicted more severity and higher mortality compared with others.


Assuntos
Infecções Comunitárias Adquiridas/mortalidade , Pneumonia/mortalidade , Idoso , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Índice de Gravidade de Doença
8.
Beijing Da Xue Xue Bao Yi Xue Ban ; 45(4): 597-9, 2013 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-23939170

RESUMO

OBJECTIVE: To evaluate the efficacy of microsurgical vasectomy reversal on patients after vasectomy. METHODS: In the study, 41 patients after vasectomy were admitted for microsurgical vasectomy reversal. The mean (range) age was 45 (29 to 66) years for the men. The mean duration of obstruction was 12 years. All the patients were seen by the surgeon for a complete history and physical examination. Semen analyses proved azoopermia, and their serum levels of sexual hormone were normal. They were all offered scrotal exploration. Microvasovasostomy was performed if the sperm was found in the material coming from the proximal vas lumen. The decision for microvasoepididymostomy was made during surgery, if the fluid was creamy, containing only debris or there was no fluid whatsoever when the vas was milked toward the cut end. Microvasovasostomy was performed in 40 patients, of whom 6 were with lateral microvasoepididymostomy and 1 with bilateral microvasoepididymostomy. The initial semen analysis was then done after usually 3 months postoperatively. Patency was arbitrarily defined as>10 000 sperm/mL in ejaculate in at least one semen analysis after surgery. Postoperative patency rate and postoperative impregnation rate were followed. RESULTS: The 41 patients were followed up for 3 to 72 months, and 5 cases were lost. In the 28 patients who had obstructions for less than 15 years, 3 were lost. Sperm was found by semen analysis in 21 patients. Their sperm density was 2×10(6) to 46×10(6) sperms/mL and motility was 0% to 60%. The semen analysis revealed azoospermia in 2 patients after 12 months, who were advised to undergo intracytoplasmic sperm injection. Natural conception occurred in 6 patients followed for more than 12 months. The overall patency rate was 84% (21/25). Among the patients with a follow-up of >6 months, the natural paternity rate was 29% (6/21). In the 13 patients who had obstructions for more than 15 years, 2 were lost. The patency and pregnancy rates were 64% (7/11) and 14% (1/7) respectively. Their sperm density was 0.02×10(6) to 30× 10(6) sperms/mL and motility was 0% to 43%. CONCLUSION: Microsurgical vasectomy reversal is an effective method to treat vasal obstruction due to vasectomy. The patency and pregnancy rates are related to the time of vasectomy. The patency and pregnancy rates are higher in patients with obstruction for less than 15 years than those for more than 15 years.


Assuntos
Vasectomia , Vasovasostomia , Adulto , Idoso , Azoospermia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Taxa de Gravidez , Contagem de Espermatozoides , Injeções de Esperma Intracitoplásmicas , Espermatozoides , Fatores de Tempo
9.
Asian J Androl ; 15(5): 658-61, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23872664

RESUMO

We retrospectively evaluated the clinical outcome of penile prosthesis implantation (PPI) in Chinese patients with severe erectile dysfunction (SED). From July 2000 to December 2011, 224 patients (mean age: 35.9±11.8 years, range: 20-75 years) with SED underwent PPI by experienced surgeon according to standard PPI procedure at our centre. A malleable prosthesis (AMS 650) was implanted in 45 cases (20.1%), and a three-piece inflatable prosthesis (AMS 700 CXM or AMS 700 CXR) was implanted in 179 cases (79.9%). Surgical outcomes, including postoperative complications, clinical efficacy and couple satisfaction, were evaluated over than 6 months postoperatively using medical record abstraction, IIEF-5, quality of life (QoL) scores, and the patient/partner sexual satisfaction score proposed by Bhojwani et al. Of the 224 patients eligible for the study, 201 subjects (89.7%) completed follow-up. All of patients could perform sexual intercourse post PPI with the mean postoperative IIEF-5 and QoL scores were 20.02±2.32 and 5.28±0.76, respectively, which were significantly improved compared with the preoperative scores (6.29±1.5 and 2.13±0.84, P<0.01). Of the 201 men, mechanical malfunction occurred in four cases (2.0%) and three cases were re-implanted new device, and two cases (1.0%) developed a mild curvature of the penis. Scrotal erosion with infection occurred in one case with diabetes mellitus (0.5%) and required complete removal of the implanted AMS 700 CXM. Satisfactory sexual intercourse at least twice per month was reported by 178 men (88.6%), and overall satisfaction with the PPI surgery was reported by 89.0% of men and 82.5% of partners. Patient satisfaction in the three-piece inflatable prosthesis group was higher than in the malleable prosthesis group (P<0.05). Satisfaction, however, between the types of prostheses, did not differ in the partner survey. PPI is a safe and effective treatment option for Chinese patients with SED and experienced surgeon perform PPI according to standard PPI procedure could reduce the postoperative complications of PPI and could improve patient satisfaction ratio and QoL.


Assuntos
Disfunção Erétil/cirurgia , Implante Peniano , Pênis/cirurgia , Adulto , Idoso , China , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Implante Peniano/métodos , Prótese de Pênis , Implantação de Prótese , Qualidade de Vida , Estudos Retrospectivos , Parceiros Sexuais , Resultado do Tratamento
10.
Zhonghua Nan Ke Xue ; 19(5): 443-5, 2013 May.
Artigo em Chinês | MEDLINE | ID: mdl-23757969

RESUMO

OBJECTIVE: To evaluate the effect of daily low-dose tadalafil on erectile dysfunction (ED) induced by pelvic fracture urethral disruption (PFUD). METHODS: This study included 46 cases of PFUD-induced ED treated from Jan 2008 to Dec 2011. The patients were aged 33.9 +/- 7.2 years (range 25 -51 yr), and the interval between injury and treatment was 19.6 +/- 12.7 months (range 3 - 72 mo), all with normal erectile function before PFUD. Based on the nocturnal penile tumescence and rigidity (NPTR) recorded by erectometry without medication of phosphodiesterase type 5 inhibitor (PDE-5I), the patients were divided into an abnormal nocturnal erection group and a non-nocturnal erection group, and treated with tadalafil 10 mg once daily for 3 months. The therapeutic effect was evaluated by IIEF-5 scores and the rate of yes responses to questions 2 and 3 of the Sexual Encounter Profile (SEP). RESULTS: Totally 38 (82.6%) of the patients accomplished the treatment and follow-up, 26 (68.4%) in the abnormal nocturnal erection group and 12 (31.6%) in the non-nocturnal erection group. After 3 months of daily tadalafil treatment at 10 mg, the IIEF-5 scores were significantly improved in the abnormal nocturnal erection group than in the non-nocturnal erection group (P < 0.05), and the rate of yes responses to SEP2 and SEP3 was remarkably higher in the former than in the latter (76.9% vs 41.7% and 65.4% vs 25.0%, P < 0.05). CONCLUSIONS: Daily low-dose tadalafil can effectively improve the erectile function of PFUD-induced ED patients, particularly in those with nocturnal erection.


Assuntos
Carbolinas/administração & dosagem , Disfunção Erétil/tratamento farmacológico , Adulto , Carbolinas/uso terapêutico , Relação Dose-Resposta a Droga , Disfunção Erétil/etiologia , Disfunção Erétil/fisiopatologia , Fraturas Ósseas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/lesões , Ereção Peniana , Tadalafila , Resultado do Tratamento , Uretra/lesões
11.
Urology ; 80(4): 953.e1-8, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22950999

RESUMO

OBJECTIVE: To investigate the injected autologous adipose-derived stem cells (ADSCs) in improving stress urinary incontinence in a rodent model of parturition-related stress incontinence and the possible mechanism. METHODS: The 40 rats were developed stress urinary incontinence models by postpartum balloon dilation of the vagina for 4 hours followed by bilateral ovariectomy. ADSCs were isolated from the peri-ovarian fat and labeled with thymidine analog 5-ethynyl-2-deoxyuridine (EdU). Twenty stress urinary incontinence rats received peri-urethral injection of phosphate-buffered saline as the negative controls and the other 20 stress urinary incontinence rats received peri-urethral injection of EdU-labeled ADSCc. Twenty control rats underwent sham ovariectomy without balloon dilation and served as positive controls. Four weeks later, voiding function was assessed by cystometry. Urethral histologic examination (Masson trichrome stain, picrosirius red stain, Hart elastin stain, Gordon and Sweet stain, and immunohistochemical stain) and Western blot were performed on urethral tissues. RESULTS: Both leak point pressure and bladder capacity were significantly increased in ADSC-treated rats, compared to the balloon-injured ovariectomized rats. Histologic examination revealed normalized appearance of the fibromuscular structure of the urethra as well as increased peri-urethral blood vessel density in ADSC-treated rats. On Western blot, vascular endothelial growth factor and P-extracellular signal-regulated kinases (ERKs)1/2 protein was expressed at a higher rate in tissues from ADSC-treated rats compared to phosphate-buffered saline-treated rats. CONCLUSION: Peri-urethral injection of ADSCs is associated with more normal urinary function and urethral structure in rats with parturition-related incontinence. The activation of vascular endothelial growth factor and ERK1/2 may be responsible for the paracrine effects from ADSCs.


Assuntos
Tecido Adiposo/transplante , Sistema de Sinalização das MAP Quinases , Transplante de Células-Tronco , Uretra/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , Animais , Colágeno Tipo I/metabolismo , Colágeno Tipo III/metabolismo , Modelos Animais de Doenças , Feminino , Músculo Liso/patologia , Músculo Estriado/patologia , Neovascularização Fisiológica , Ovariectomia , Parto , Ratos , Ratos Sprague-Dawley , Uretra/irrigação sanguínea , Uretra/metabolismo , Uretra/patologia , Bexiga Urinária/fisiologia , Incontinência Urinária por Estresse/metabolismo , Incontinência Urinária por Estresse/terapia , Micção/fisiologia , Urodinâmica
12.
Zhonghua Jie He He Hu Xi Za Zhi ; 34(8): 609-13, 2011 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-22168985

RESUMO

OBJECTIVE: To evaluate the changes in the number and maturation of lung tissue dendritic cells (DCs) and to assess the chronic inflammation in a cigarette smoke-induced COPD model in rats. METHODS: Thirty male F344 rats were randomly divided into 3 groups (n = 10): a control group, a smoke-exposure group and a smoking cessation group. Rat lung pathomorphological changes were observed by hematoxylin-eosin (HE) stain. Lung tissue CD(11c)(+) DCs, CD(86)(+) DCs and CD(8)(+) T cell numbers were observed by immunohistochemistry method. Flow cytometry was used for detection of CD(11c)(+)/CD(86)(+) DCs and CD(11c)(+)/MHCII(+) DCs proportions. RESULTS: The airway inflammatory pathological score and the mean linear intercept (MLI) obtained from he smoke-exposure group and the smoking cessation group (390 ± 33, 324 ± 28) and [(68 ± 11) µm, (58 ± 9) µm] were higher than those in the control group (56 ± 13) and (36 ± 6) µm (F = 459.85 and 34.03, all P < 0.05). In the smoke-exposure group and the smoking cessation group, the positive rate of CD(11c)(+) DCs [(1.47 ± 0.12)%, (1.30 ± 0.17)%], and the positive rate of CD(86)(+) DCs [(1.26 ± 0.18)%, (1.02 ± 0.08)%] were higher than those in the control group [(0.96 ± 0.08)%, (0.65 ± 0.03)%] (F = 6.55 and 30.26, all P < 0.05), but there was no significant difference between the smoke-exposure group and the smoking cessation group (t = 1.10 and 1.47, all P>0.05). In the smoke-exposure group and the smoking cessation group, CD(8)(+) T positive rate [(2.72 ± 0.15)%, (2.35 ± 0.23)%] was higher than that in the control group [(1.39 ± 0.11)%] (F = 16.07, P < 0.05). CD(11c)(+)/CD(86)(+) DCs and CD(11c)(+)/MHCII(+)DCs percentages [(5.5 ± 0.4)%, (4.8 ± 0.4)%], [(4.2 ± 0.4)%, (3.3 ± 0.3)%] decreased in the smoke-exposure group and the smoking cessation group as compared to the control group [(8.0 ± 0.5)%, (6.1 ± 0.5)%] (F = 14.34 and 12.82, all P < 0.05). There was no significant difference between all the above index from the smoke-exposure group and the smoking cessation group (t = 1.10 and 2.11, all P > 0.05). CONCLUSIONS: Cigarette smoke exposure induced increased DCs transmigrated and influenced the maturation of DCs in COPD rats. Even after smoking cessation, non-specific chronic inflammation was still present, suggesting that DCs number and maturation abnormality may be involved in the chronic inflammation of COPD.


Assuntos
Células Dendríticas/patologia , Inflamação , Doença Pulmonar Obstrutiva Crônica/patologia , Fumar/efeitos adversos , Animais , Contagem de Células , Células Dendríticas/citologia , Modelos Animais de Doenças , Pulmão/citologia , Masculino , Ratos , Ratos Endogâmicos F344 , Abandono do Hábito de Fumar
13.
Beijing Da Xue Xue Bao Yi Xue Ban ; 43(4): 562-4, 2011 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-21844967

RESUMO

OBJECTIVE: To evaluate the intraoperative factors affecting the patency of microsurgical vasoepididymostomy. METHODS: From January 2009 to July 2010, 73 men with obstructive azoospermia had undergone longitudinal intussusception vasoepididymostomy (LIVE). The mean age (range) was 31 years (23 to 48) for the patients and their mean infertility was 50.9 months (2 to 180). All the patients were included in three groups by the clinical variables in surgery: anastomosis number, anastomosis sites, epididymal fluid analysis. Bilateral and lateral anastomosis was in 50 and 23 cases, respectively. The anastomosis on caput, corpus and caudal was in 19, 46, and 8 cases respectively. Motile sperm in the epididymal fuild continuing flowage could be found in 55 patients. By contrast, immotile sperm could be found in 18 patients. Semen analysis was done at the end of 3 months, and patency was arbitrarily defined as >10 000 sperm/mL in ejaculate in at least one semen analysis after surgery. RESULTS: Of all the patients, 53 were followed up. Sperm was present in the ejaculate in 38 patients postoperatively. The overall patency rate was 71.7% (38/53). Patency rates of bilateral surgery and of lateral surgery achieved 80.7% and 27.6%; of caput anastomosis 38.5%, of corpus anastomosis 78.8%, of caudal anastomosis 100%, of motile sperm with epididymal fluid continuing flowage 83.7% and of immotile sperm 40%, respectively. In the study, 17 patients (33.3%, 17/53) reported spontaneous pregnancy. CONCLUSION: Except for microsurgical technology, bilateral anastomosis, corpus or caudal anastomosis, and motile sperm with epididymal fluid continuing flowage may improve patency rate postoperatively.


Assuntos
Azoospermia/cirurgia , Epididimo/cirurgia , Microcirurgia/métodos , Ducto Deferente/cirurgia , Vasovasostomia/métodos , Adulto , Anastomose Cirúrgica/métodos , Azoospermia/diagnóstico , Epididimo/patologia , Humanos , Masculino , Resultado do Tratamento , Ducto Deferente/patologia , Adulto Jovem
14.
Beijing Da Xue Xue Bao Yi Xue Ban ; 43(4): 582-5, 2011 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-21844972

RESUMO

OBJECTIVE: To collect clinical data of patients with erectile dysfunction-no sexual life (ED-NS), and investigate its characteristics with a simple evaluating questionnaire. METHODS: Sixty-one patients who complained erectile dysfunction without sexual life for more than six months and 57 normal controls were enrolled in our study. The mean age of the ED-NS patients was 26.2 ± 4.3 years, compared with 24.9 ± 4.1 years of normal controls, without significant difference (P>0.05). The erectile function was assessed with a simple questionnaire including 16 questions, such as sexual libido, general erectile function, nocturnal penile erection, erectile function during foreplay without sexual life, erectile function during audio-video sexual stimulation, confidence, depressions, etc. The patients filled "yes" or "no" in the blank of the questionnaire according to their erectile function. The frequency distributions of each question between the two groups were analyzed with chi-square test of four-fold table. RESULTS: Compared with normal control group, the frequency distributions of 13 questions in ED-NS group were significantly different, such as sexual libido (χ²=35.891, P<0.05), confidence of erection (χ²=75.608, P<0.05), general erectile function(χ²=54.433, P<0.05), nocturnal penile erection(χ²=29.815, P<0.05), erectile function during foreplay without sexual life(χ²=21.211, P<0.05), confidence of erection during foreplay without sexual life(χ²=70.445, P<0.05), erectile function during audio-video sexual stimulation(χ²=34.422, P<0.05), etc. But in both groups, some patients didn't have masturbation so that they couldn't answer the masturbation questions. CONCLUSION: We have created a new conception about the patients without sexual life, erectile dysfunction-no sexual life, which defines it as the inability to have enough erection hardness and duration so as to have enough confidence in attempting sexual intercourse for more than six months. We will establish a special index of the ED-NS questionnaire to assess erectile function of ED-NS. Further study is needed.


Assuntos
Disfunção Erétil/diagnóstico , Inquéritos e Questionários , Adulto , Estudos de Casos e Controles , Humanos , Masculino , Inquéritos e Questionários/normas , Adulto Jovem
15.
Asian J Androl ; 13(4): 630-5, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21602833

RESUMO

This study sought to investigate the clinical efficacy and safety of combined oral therapy with sildenafil and doxazosin GITS compared to sildenafil monotherapy in treating Chinese patients with erectile dysfunction (ED) and lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH/LUTS). The trial was conducted in hospitals in Beijing, Shanghai, Changsha, Wuhan and Guangzhou, five major cities in China. A total of 250 patients diagnosed with ED and BPH/LUTS aged 50-75 years, and who had International Index of Erection Function-5 (IIEF-5) scores ≤21 and International Prostate Symptom Score (IPSS) ≥10 points, were enrolled and randomly divided into Group A (168 cases; doxazosin GITS 4 mg once daily plus sildenafil 25-100 mg on demand) and Group B (82 cases; sildenafil 25-100 mg on demand). Efficacies were evaluated by IIEF-5 and IPSS scores and a quality of life (QoL) questionnaire, and adverse effects were evaluated during the treatment period. There were no statistically significant differences in mean age, and IIEF-5, IPSS and QoL scores pre-treatment between the two groups. After treatment, IIEF-5, IPSS and QoL scores were significantly improved in Group A, while only IIEF-5 scores were significantly improved in Group B compared with pre-treatment. There were no significant differences in side effects between the two groups. The results indicated that combined therapy with sildenafil and doxazosin GITS for the treatment of ED and BPH/LUTS is safe and effective compared to sildenafil monotherapy.


Assuntos
Doxazossina/administração & dosagem , Disfunção Erétil/tratamento farmacológico , Piperazinas/administração & dosagem , Hiperplasia Prostática/tratamento farmacológico , Sulfonas/administração & dosagem , Transtornos Urinários/tratamento farmacológico , Idoso , Grupo com Ancestrais do Continente Asiático , China , Humanos , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Purinas/administração & dosagem , Qualidade de Vida , Citrato de Sildenafila , Resultado do Tratamento , Transtornos Urinários/etiologia
16.
J Androl ; 32(5): 491-5, 2011 Sep-Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21164145

RESUMO

In this study, we investigated the safety and efficacy of a poly acid-co-glycolide biodegradable scaffold (Maxpol-T) coated by autologous fibroblasts (AF) for penile girth enlargement in small penis syndrome (SPS). Eighty patients with SPS were enrolled in a clinical study at 2 medical centers; 69 patients completed the study protocol. Scrotal skin was harvested under local anesthesia, and AFs were cultured and seeded on a Maxpol-T scaffold; the cografted scaffold was implanted under the Buck's fascia of penile shaft via a circumcising incision. Patients were followed up at 1, 3, and 6 months to evaluate penile girth changes. Patient satisfaction was assessed via Visual Analogue Scale and scored on the International Index of Erectile Function-5 (IIEF-5). Mean preoperative penile girth in the flaccid and erect state was 8.18 ± 0.83 cm and 10.26 ± 1.22 cm, respectively. At the 6-month postoperative follow-up, mean penile girth in the flaccid and erect state was increased to 12.19 ± 1.27 cm and 13.18 ± 1.31 cm, respectively (P < .001 for change in both flaccid and erect state). Sixty-five patients (94.2%) reported satisfaction with the procedure. Among them, 4 cases (5.8%) were dissatisfied, 7 cases (10.1%) were satisfied, 26 cases (37.7%) were very satisfied, and 32 cases (46.4%) were extremely satisfied. All men maintained IIEF-5 scores of more than 22. Complications included prolonged subcutaneous edema in 3 patients (4.3%) and pinpoint erosion at the suture area in 3 patients (4.3%). Implantation of autologous fibroblasts seeded on a Maxpol-T collagen scaffold holds promise as a safe and novel technique for penile girth enhancement in patients with SPS.


Assuntos
Fibroblastos/transplante , Pênis/cirurgia , Engenharia Tecidual/instrumentação , Engenharia Tecidual/métodos , Procedimentos Cirúrgicos Urológicos Masculinos/instrumentação , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Humanos , Ácido Láctico , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Ácido Poliglicólico , Copolímero de Ácido Poliláctico e Ácido Poliglicólico , Síndrome , Tecidos Suporte , Adulto Jovem
17.
Zhonghua Yi Xue Za Zhi ; 90(33): 2324-7, 2010 Sep 07.
Artigo em Chinês | MEDLINE | ID: mdl-21092490

RESUMO

OBJECTIVE: To study the curative effect of operation to flatfoot deformity with concurrent spinal disease in children. METHODS: A retrospective survey was performed in 8 flatfoot patients with concurrent spinal disease from January 2004 to January 2008. Every case received special operative treatment. After casting, achilles tendon prolongation, reefing or tendon transfer, rehabilitation therapy was performed sequentially. Radiographs and clinical outcomes were evaluated during the follow-up. RESULTS: Six patients were followed up. There were 2 feet in 1 female and 7 feet in 5 males. The complications included tethered cord syndrome (n = 1), T12-S1 vertebral canal arachnoid cyst (n = 1), cerebral palsy and scoliosis (n = 1) and scoliosis and spinal bifida occult (n = 3). The average age was 8.4 (4 - 14) years old and the average follow-up time 22 (14 - 64) months. All cases were satisfied with the appearance and function according to Maryland foot score. Five were excellent, 2 good and 2 fair postoperatively versus 2 fair and 7 failed preoperatively. The total excellent and good rate was 77.8%. In the early stage after tendon transfer in 4 patients, the lateral view of height arch, talus-first metatarsal angle, calcaneus-navicular-first metatarsal angle and talonavicular coverage angle improved. Yet it lost the improved angle and reverted to the pre-operative state. No degenerative change was detected in tarsus joints during the long follow-up. CONCLUSION: The special and sequential surgical procedure may be an effective regimen in the treatment of flatfoot deformity with concurrent spinal disease in children.


Assuntos
Pé Chato/complicações , Pé Chato/cirurgia , Doenças da Coluna Vertebral/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos
18.
Beijing Da Xue Xue Bao Yi Xue Ban ; 42(4): 413-7, 2010 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-20721254

RESUMO

OBJECTIVE: To investigate the clinical efficacy and patient and partner's satisfaction with penile prosthesis implantation (PPI) for treating Chinese patients with severe erectile dysfunction (SED). METHODS: One hundred and sixty-eight SED patients were successfully treated by PPI from July 2000 to June 2010. Of the 146 (86.9%) patients who had been followed up over 6 months post-operation, 36 (24.7%) had been implanted with one piece malleable prosthesis (AMS650) and 110 (75.3%) with three piece inflatable prosthesis (AMS700CXM).All the patients had been followed up by using international index of erectile dysfunction (IIEF5), Quality of Life Score (QOL) for evaluating clinical efficacy and using Visual Analogue Scale (VAS) for evaluating patient and partner's satisfaction and the duration of the follow-up was 6 to 119 months. RESULTS: The mean age of patients was 35.9+/-12.1 years(20 to 75 years), All the operations were successful and sexual intercourse with PPI was performed post 4 to 6 weeks without severe complications like infection and erosion. The prosthesis survive rate and frequent sexual intercourse rate were 98.6% and 87.7% respectively. IIEF5 scores pre and post PPI were 6.3+/- 1.7 and 21.3+/-1.6 respectively,the QOL scores pre and post PPI were 5.1+/-0.9 and 1.5+/-0.5 respectively, and both of them showed significant improvement (P<0.01). As for VAS, the patient and partner's overall satisfaction rates were 92.5% and 90.4% respectively. Moreover, better satisfaction was showed with AMS700CXM as compared with AMS650 (P<0.05) in patients with SED. CONCLUSION: PPI is the safe and effective treatment option for Chinese patients with SED. The AMS700CXM penile prosthesis is better than AMS650 for patients' overall satisfaction.


Assuntos
Disfunção Erétil/cirurgia , Satisfação do Paciente , Implante Peniano , Cônjuges/psicologia , Adulto , Seguimentos , Humanos , Masculino , Medição da Dor , Qualidade de Vida/psicologia
20.
Urology ; 72(3): 571-3; discussion 573-4, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18619653

RESUMO

OBJECTIVES: To determine the effectiveness of superselective cavernous artery embolization. METHODS: Eight patients with high-flow priapism were included in this study. All were treated by superselective cavernous artery embolization with microcoils and gelatin sponges. The follow-up examinations consisted of color duplex ultrasonography. The International Index of Erectile Function 5-item questionnaire was used to investigate the patients' erectile function before the onset of priapism, at embolization, and 6 months after embolization. RESULTS: A unilateral cavernous fistula was found in 7 patients and bilateral fistulas in 1. Of the 8 patients, 2 (1 with unilateral and 1 with bilateral fistulas) initially underwent embolization with a gelatin sponge but presented with recurrence of tumescence 1 week after treatment and required a repeat embolization procedure with microcoils. The other 6 patients (75%) were successfully detumescent after embolization with microcoils. The 6 patients (75%) who underwent embolization with microcoils alone had normal erectile function with a mean International Index of Erectile Function score of 22.20 at 6 months after embolization. The 2 patients (25%) who had required repeat embolization had erectile dysfunction, with a mean International Index of Erectile Function score of 13.00. CONCLUSIONS: Superselective cavernous artery embolization with microcoils is a safe and effective treatment of high-flow priapism. The use of microcoils resulted in greater embolization success and preservation of erectile function, especially in the treatment of a unilateral arterial fistula in a young patient.


Assuntos
Embolização Terapêutica/métodos , Priapismo/diagnóstico por imagem , Priapismo/terapia , Urologia/métodos , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Pênis/diagnóstico por imagem , Doenças do Pênis/terapia , Ereção Peniana , Pênis/diagnóstico por imagem , Radiografia , Inquéritos e Questionários , Resultado do Tratamento , Ultrassonografia Doppler/métodos
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