Urine Flow Acceleration Is Superior to Qmax in Diagnosing BOO in Patients with BPH

Summary： We performed a retrospective, case-control study to evaluate whether the urine flow acceleration （UFA, mL/s2） is superior to maximum uroflow （Qmax, mL/s） in diagnosing bladder outlet obstruction （BOO） in patients with benign prostatic hyperplasia （BPH）. In this study, a total of 50 men with BPH （age： 58±12.5 years） and 50 controls （age： 59±13.0 years） were included. A pressure-flow study was used to determine the presence of BOO according to the recommendations of Incontinence Control Society （ICS）. The results showed that the UFA and Qmax in BPH group were much lower than those in the control group [（2.05±0.85） vs. （4.60±1.25） mL/s2 and （8.50±1.05） vs. （13.00±3.35） mL/s] （P〈0.001）. Accol;ding to the criteria （UFA〈2.05 mL/s2, Qmax〈10 mL/s）, the sensitivity and specificity of UFA vs. Qmax in diagnosing BOO were 88%, 75% vs. 81%, 63%. UFA vs. Omax, when compared with the results of P-Q chart （the kappa values in corresponding analysis）, was 0.55 vs. 0.35. The pros- tate volume, post void residual and detrusor pressure at Qmax between the two groups were 28.6±9.8 vs. 24.2±7.6 mL, 60.4±1.4 vs. 21.3±2.5 mL and 56.6±8.3 vs. 21.7±6.1 cmHzO, respectively （P〈0.05）. It was concluded that the UFA is a useful urodynamic parameter, and is superior to Qmax in diagnosing BOO in patients with BPH.

Effects of solifenacin on overactive bladder patients

Objective To investigate the effects of solifenacin on the detrusor instability of patients with overactive bladder ( OAB ) . Methods A total of 20

Efficacy and safety of antifibrinolytic agents in spinal surgery: a network meta-analysis

Background: Significant blood loss is still one of the most frequent complications in spinal surgery, which often necessitates blood transfusion. Massive perioperative blood loss and blood transfusion can create additional risks. Aprotinin, tranexamic acid (TXA), and epsilon-aminocaproic acid (EACA) are antifibrinolytics currently offered as prophylactic agents to reduce surgery-ass oci a ted blood loss. The aim of this study was to evaluate the efficacy and safety of aprotinin, EACA, and low/high doses of TXA in spinal surgery, and assess the use of which agent is the most optimal intervention using the network meta-analysis (NMA) method. Methods: Five electronic databases were searched, including PubMed, Cochrane Library, ScienceDirect, Embase, and Web of Science, from the inception to March 1,2018. Trials that were randomized and compared results between TXA, EACA, and placebo were identified. The NMA was conducted with software R 3.3.2 and STATA 14.0. Results: Thirty randomized controlled trial (RCT) studies were analyzed. Aprotinin (standardized mean difference [SMD]=-0.65, 95% credibility intervals [CrI;-1.25,-0.06]), low-dose TXA (SMD=-0.58, 95% CrI [-0.92,-0.25]), and high-dose TXA (SMD =-0.70, 95% CrI [-1.04,-0.36]) were more effective than the respective placebos in reducing intraoperative blood loss. Low-dose TXA (SMD=-1.90, 95% CrI [-3.32,-0.48]) and high-dose TXA (SMD =-2.31, 95% CrI [-3.75,-0.87]) had less postoperative blood loss. Low-dose TXA (SMD=-1.07, 95% CrI [-1.82,-0.31]) and high-dose TXA (SMD =-1.07, 95% CrI[-1.82,-0.31]) significantly reduced total blood loss. However, only high-dose TXA (SMD =-2.07, 95% CrI [-3.26,-0.87]) was more effective in reducing the amount of transfusion, and was significantly superior to low-dose TXA in this regard (SMD =-1.67, 95% CrI [-3.20,-0.13]). Furthermore, aprotinin (odds ratio [OR]= 0.16, 95% CrI [0.05, 0.54]), EACA (OR = 0.46, 95% CrI [0.22, 0.97]) and high dose of TXA (OR = 0.34, 95% CrI [0.19, 0.58]) had a significant reduction in transfusion rates. Antifibrinolytics did not show a significantly increased risk of postoperative thrombosis. Results of ranking probabilities indicated that high-dose TXA had the greatest efficacy and a relatively high safety level. Conclusions: The antifibrinolytic agents are able to reduce perioperative blood loss and transfusion requirement during spine surgery. And the high-dose TXA administration might be used as the optimal treatment to reduce blood loss and transfusion.

Ontogeny of the mammalian kidney:expression of aquaporins 1,2,3,and 4

Background:Determining the expression and functions of aquaporins(AQPs)in the adult kidney has generated important information about the roles of this protein family in the renal regulation of water homeostasis.However,limited information describes the expression of AQPs in fetal kidneys,and most reports on fetal renal AQPs originate from animal studies.Although there are the maturation and regulation of the renalconcentrating mechanism,the ways in which changes in the expression of AQPs contribute to the formation of urine during the perinatal period remain unclear.Data sources:This review summarizes current knowledge about the spatial and temporal expression patterns of AQP1,AQP2,AQP3,and AQP4 in the fetal and postnatal kidneys in different animal species and in human beings.Results:AQP1 and AQP2 expression can be detected earlier in gestation in human beings and sheep compared with mice and rats.AQP1 expression is detected earlier in the proximal tubules than the expression of AQP2,AQP3,and AQP4 in the collecting ducts.Conclusion:Further studies investigating the regulation of AQPs during kidney development may provide insights into normal water-handling mechanisms and the pathophysiology of fetal kidneys,which may determine new directions for the clinical treatment of kidney diseases.