Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethra...Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.展开更多
Background： To evaluate whether serotonin （5-HT）, 5-HT2A receptor （5-HT2AR）, and 5-HT transporter （serotonin transporter [SERT]） are associated with different disease states of depression, myocardial infarction...Background： To evaluate whether serotonin （5-HT）, 5-HT2A receptor （5-HT2AR）, and 5-HT transporter （serotonin transporter [SERT]） are associated with different disease states of depression, myocardial infarction （MI） and MI co-exist with depression in Sprague-Dawley rats. Methods： After established the animal model of four groups include control, depression, MI and MI with depression, we measured 5-HT, 5-HT2AR and SERT from serum and platelet lysate.Results： The serum concentration of 5-HT in depression rats decreased significantly compared with the control group （303.25 ± 9.99 vs. 352.98 ±13.73; P =0.000）, while that in MI group increased （381.78 ±14.17 vs. 352.98 ±13.73; P = 0.000）. However, the depression ＋ MI group had no change compared with control group （360.62 ±11.40 vs. 352.98 ±13.73; P = 0.036）. The changes of the platelet concentration of 5-HT in the depression, MI, and depression ＋ MI group were different from that of serum. The levels of 5-HT in above three groups were lower than that in the control group （380.40 ± 17.90, 387.75 ±22.28,246.40 ±18.99 vs. 500.29 ±20.91 ; P = 0.000）. The platelet lysate concentration of 5-HT2AR increased in depression group, MI group, and depression ＋ MI group compared with the control group （370.75 ±14.75,393.47 ±15.73,446.66 ±18.86 vs. 273.66 ±16.90; P= 0.000）. The serum and platelet concentration of SERT in the depression group, MI group and depression ＋ MI group were all increased compared with the control group （527.51 ±28.32, 602.02 ±23.32, 734.76 ±29.59 vs. 490.56 ±16.90; P 0,047, P = 0.000, P = 0.000 in each and 906.38 ±51.84, 897.33 ±60.34, 1030.17 ±58.73 vs. 708.62 ±51.15; P = 0.000 in each）. Conclusions： The concentration of 5-HT2AR in platelet lysate and SERT in serum and platelet may be involved in the pathway of MI with depression. Further studies should examine whether elevated 5-HT2AR and SERT may contribute to the biomarker in MI patients with depression.展开更多
基金the National Key Research and Development Plan of China(Technology helps Economy 20202016YFC0106300)+1 种基金the National Natural Science Foundation of China(82174230)Major Program Fund of Technical Innovation Project of Department of Science and Technology of Hubei Province(2016ACAl52).
文摘Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.
文摘Background： To evaluate whether serotonin （5-HT）, 5-HT2A receptor （5-HT2AR）, and 5-HT transporter （serotonin transporter [SERT]） are associated with different disease states of depression, myocardial infarction （MI） and MI co-exist with depression in Sprague-Dawley rats. Methods： After established the animal model of four groups include control, depression, MI and MI with depression, we measured 5-HT, 5-HT2AR and SERT from serum and platelet lysate.Results： The serum concentration of 5-HT in depression rats decreased significantly compared with the control group （303.25 ± 9.99 vs. 352.98 ±13.73; P =0.000）, while that in MI group increased （381.78 ±14.17 vs. 352.98 ±13.73; P = 0.000）. However, the depression ＋ MI group had no change compared with control group （360.62 ±11.40 vs. 352.98 ±13.73; P = 0.036）. The changes of the platelet concentration of 5-HT in the depression, MI, and depression ＋ MI group were different from that of serum. The levels of 5-HT in above three groups were lower than that in the control group （380.40 ± 17.90, 387.75 ±22.28,246.40 ±18.99 vs. 500.29 ±20.91 ; P = 0.000）. The platelet lysate concentration of 5-HT2AR increased in depression group, MI group, and depression ＋ MI group compared with the control group （370.75 ±14.75,393.47 ±15.73,446.66 ±18.86 vs. 273.66 ±16.90; P= 0.000）. The serum and platelet concentration of SERT in the depression group, MI group and depression ＋ MI group were all increased compared with the control group （527.51 ±28.32, 602.02 ±23.32, 734.76 ±29.59 vs. 490.56 ±16.90; P 0,047, P = 0.000, P = 0.000 in each and 906.38 ±51.84, 897.33 ±60.34, 1030.17 ±58.73 vs. 708.62 ±51.15; P = 0.000 in each）. Conclusions： The concentration of 5-HT2AR in platelet lysate and SERT in serum and platelet may be involved in the pathway of MI with depression. Further studies should examine whether elevated 5-HT2AR and SERT may contribute to the biomarker in MI patients with depression.
