Clinical application of "Double R" anastomosis technique in laparoscopic pancreaticoduodenectomy procedure.

ABSTRACT: Laparoscopic pancreaticoduodenectomy (LPD) is widely used as a treatment for periampullary tumors and pancreatic head tumors. However, postoperative pancreatic fistula (POPF), which significantly affects mortality and length of hospital stay of patients, remains one of the most common and serious complications following LPD. Though numerous technical modifications for pancreaticojejunostomy (PJ) have been proposed, POPF is still the "Achilles heel" of LPD.To reduce POPF rate and other postoperative complications following LPD by exploring the best approach to manage with the pancreatic remnant, a novel duct-to-mucosa anastomosis technique named Double Layer Running Suture (Double R) for the PJ was established. During 2018 and 2020, a totally 35 patients who underwent LPD with Double R were included, data on the total operative time, PJ duration, estimated blood loss, recovery of bowel function, postoperative complications, and length of hospital stay were collected and analyzed.The average duration of surgery was (380 ±â€Š69) minutes. The mean time for performing PJ was (34 ±â€Š5) minutes. The average estimated blood loss was (180 ±â€Š155) mL. The overall POPF rate was 8.6% (3/35), including 8.6% (3/35) for the biochemical leak, 0% (0/35) for Grade B, and 0% (0/35) for Grade C. No patient suffered from biliary fistula, post-pancreatectomy hemorrhage, and intra-abdominal infection, the 30-day mortality was 0%.Double R anastomosis is potentially a safe, reliable, and rapid anastomosis with a low rate of POPF and post-pancreatectomy hemorrhage. It provides surgeons more options when performing LPD. However, its safety and effectiveness should be verified further by a larger prospective multicenter study.

Comparison of transcatheter arterial chemoembolization with raltitrexed plus liposomal doxorubicin vs. tegafur plus pirarubicin for unresectable hepatocellular carcinoma.

BACKGROUND: There is still no general consensus on the optimal chemotherapeutic agent selection for transcatheter arterial chemoembolization (TACE) in unresectable hepatocellular carcinoma (HCC). The present study aimed to compare the efficacy and safety of TACE with raltitrexed plus liposomal doxorubicin (R + PGLD) vs. tegafur plus pirarubicin (T + P) in patients with unresectable HCC. METHODS: A total of 148 patients with unresectable HCC treated with TACE between January 2012 and December 2016 were retrospectively analyzed. Of them, 74 patients were in the R + PGLD group and 74 patients were in the T + P group (1:1). The treatment response of the tumor, overall survival (OS) time, and adverse effects were compared between the two groups. RESULTS: There were no significant differences in patient characteristics or embolization effect (lipiodol deposition) between the two groups (P>0.05). R + PGLD treatment had a better clinical efficacy than T + P treatment (OR: 64.9% vs. 45.9%, P=0.031; DC: 89.2% vs. 74.3%, P=0.032). Portal vein invasion, hepatic vein invasion, tumor size and BCLC stage were associated with OR or DC after TACE using R + PGLD treatment. Survival analysis revealed that patients who received TACE with R + PGLD had a better prognosis than those treated with T + P. Moreover, some complications in the R + PGLD group, including vomiting, myelosuppression and cardiotoxicity, were significantly lower than those in the T + P group (P<0.05). CONCLUSIONS: TACE with raltitrexed and liposomal doxorubicin could reduce the incidence of adverse reactions and significantly improve the OS of patients with unresectable HCC.

Oleic acid promotes cell invasion through an integrin-linked kinase signaling pathway in renal cell carcinoma.

The change of fatty acid composition has been regarded as an indicator of altered lipid metabolism during human tumourigenesis, but the details are still unclear. We have previously demonstrated a monounsaturated fatty acid (MUFA) named oleic acid (OA) was involved in renal cell carcinoma (RCC) cell growth, as an extracellular signaling molecule to regulate 786-O cell proliferation via the integrin-linked kinase (ILK) pathway. In this study, we further observe the effects of OA on cell invasion of RCC and the potential mechanism by which OA worked was determined. The transwell invasion assay showed OA increased cell invasion of RCC in a dose-dependent manner. Western blotting results indicated ILK, COX-2, and MMP-9 proteins were involved for their high expressions and these effects were reversed when down-regulating the expression of ILK by special siRNA. The MMPs inhibitor GM6001 could weaken the abilities of OA on RCC cells invasion. These results suggested MUFA indeed affected cell invasion of RCC, which was depended by the regulation of ILK pathway.

Efficacy of α-blocker in improving ureteral stent-related symptoms: a meta-analysis of both direct and indirect comparison.

OBJECTIVE: To critically evaluate the efficacy of an α-blocker in improving ureteral-stent-related symptoms and preliminarily investigate the difference between different types of α-blockers. METHODS: Relevant randomized controlled trials were identified through searching PubMed, the Cochrane Library, Embase, and other sources. After quality assessment and data abstraction, direct comparison based on the Ureteral Stent-related Symptom Questionnaire (USSQ) between α-blockers and control was performed by RevMan 5.3. Indirect comparison between different types of α-blockers was performed by ITC 1.0. Sensitive and subgroup analyses were used to handle important clinical factors. RESULTS: Sixteen randomized controlled trials containing 1,489 cases were included. Compared with control, α-blockers significantly reduced the overall urinary symptom, pain index, general health index, and scores related to sexual matters, while no significant difference was found in work performance and additional problem scores. Subgroup analysis showed that the duration of stent insertion, patient's age, stent size, and the type of α-blocker had the potential to influence the outcomes. Through indirect comparison, we found alfuzosin and terazosin to be better than tamsulosin in pain relief and general health improvement. CONCLUSION: α-Blocker was effective in treating ureteral stent-related symptoms, as it improved the major indexes of USSQ post-insertion or post-removal. Alfuzosin and terazosin seemed to be better than tamsulosin, which needs further verification because of the lack of direct comparison currently.

Comparative efficacy of tamsulosin versus nifedipine for distal ureteral calculi: a meta-analysis.

OBJECTIVE: The aim of this study was to systematically compare the therapeutic effect and safety of tamsulosin with nifedipine in medical expulsive therapy for distal ureteral calculi. METHODS: Databases, including PubMed, EMBASE, the Cochrane Library, and Clinical Trial Register Centers, were comprehensively searched. Relevant randomized controlled trials (RCTs) were selected, and quality assessment was performed according to the Cochrane Handbook. RevMan software was used to analyze the outcome measures, which consisted of expulsion rate, expulsion time, and complications. RESULTS: Twelve RCTs consisting of 4,961 patients were included (tamsulosin group, 2,489 cases; nifedipine group, 2,472 cases). Compared with nifedipine, tamsulosin significantly increased the expulsion rate (risk ratio =1.29, 95% CI [1.25, 1.33], P<0.0001) and reduced the expulsion time (standard mean difference =-0.39, 95% CI [-0.72, -0.05], P=0.02). Regarding safety, tamsulosin was associated with fewer complications than nifedipine (risk ratio =0.45, 95% CI [0.28, 0.72], P=0.0008), and further subgroup analysis showed that tamsulosin was associated with a lower risk of both mild and moderate-to-severe complications. CONCLUSION: On the bias of current evidence, tamsulosin showed an overall superiority to nifedipine for distal ureteral calculi <10 mm in aspects of expulsion rate, expulsion time, and safety. Tamsulosin was supposed to be the first drug to be recommended to patients willing to receive medical expulsive therapy.

High-methionine diets accelerate atherosclerosis by HHcy-mediated FABP4 gene demethylation pathway via DNMT1 in ApoE(-/-) mice.

Homocysteine (Hcy) is an independent risk factor for atherosclerosis, but the underlying molecular mechanisms are not known. We investigated the effects of Hcy on fatty acid-binding protein 4 (FABP4), and tested our hypothesis that Hcy-induced atherosclerosis is mediated by increased FABP4 expression and decreased methylation. The FABP4 expression and DNA methylation was assessed in the aorta of ApoE(-/-) mice fed high-methionine diet for 20weeks. Over-expression of FABP4 enhanced accumulation of total cholesterol and cholesterol ester in foam cells. The up-regulation of DNA methyltransferase 1 (DNMT1) promoted the methylation process and decreased FABP4 expression. These data suggest that FABP4 plays a key role in Hcy-mediated disturbance of lipid metabolism and that DNMT1 may be a novel therapeutic target in Hcy-related atherosclerosis.

[Effect of oxymatrine on JAK2/STAT3 signaling in renal tissues of rats with septic shock].

OBJECTIVE: To explore the effect of oxymatrine (OMT) on JAK2/STAT3 signaling in renal tissues of rats with septic shock. METHOD: The cecal ligation and puncture (CLP) was adopted to establish the rat septic shock model. Fifty-six male SD rats were randomly divided into 7 groups: the sham operation group, the model (CLP) group, CLP + OMT high, middle, low-dose (52, 26, 13 mg x kg(-1), vena caudalis bolus) groups and the positive control (CLP + dexamethasone, 10 mg x kg(-1)) group. The pathological changes in renal tissues were examined with lightmicroscope. BUN content was determined by urine enzymatic method. Expressions of tumournecrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) mRNA in renal tissues were determined by RT-PCR. Expression of JAK2 and STAT3 in renal tissues determined by Western blot. Changes in tumournecrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1beta) contents in renal tissue were determined by radioimmunoassay. RESULT: OMT of different doses could inhibit the JAK2 and STAT3 activation in renal tissues (P<0.05), and decrease the protein expression of JAK2, STAT3, TNF-alpha and IL-1beta mRNA (P<0.05). Besides, it could reduce TNF-alpha and IL-1beta contents in renal tissue homogenate (P<0.05), serum BUN content (P<0.05), and improve such lesions as tissue hyperemia, edema and inflammatory cell infiltration, with identical results in medium and high-dose OMT groups, and the positive control group. CONCLUSION: OMT can inhibit JAK2/STAT3 signaling activity to reduce the expression of proin-flammatory factors (TNF-alpha, IL-1beta) and treat the renal injury in rats with septic shock.

[Replantation of amputated penis in Chinese men: a meta-analysis].

OBJECTIVE: To evaluate the methods for the replantation of the amputated penis in Chinese men. METHODS: We performed a meta-analysis on the domestic literature relating replantation of the amputated penis, particularly its successful methods published from 1964 to January 2012. RESULTS: We identified 109 reports on 111 cases of replantation of the amputated penis that met the inclusion criteria, including 103 adults and 8 children. The mean age, warm ischemia time and total ischemia time were 29 +/- 11 years (range 2 - 56 years), 5.2 +/- 5.7 hours (range 0 - 38 hours) and 6.3 +/- 5.7 hours (range 1 - 38 hours). Fifty-three of the cases were treated by microsurgery and 44 by non-microsurgery. Complications occurred in 81 (73%) of the cases, including ED in 14 cases, urethral stricture in 16, urinary fistula in 8, skin necrosis in 58 and skin sensory abnormality in 31. The incidences of ED, urethral stricture and urinary fistula exhibited significant differences between the microsurgery and non-microsurgery groups of the partial amputation patients (P < 0.05). The incidence of ED was correlated negatively with the number of anastomosed dorsal nerves (r = -0.3, P = 0.05), anastomosis of dorsal veins (r = -0.2, P = 0.02) and anastomosis of arteries (r = -0.2, P = 0.03), but positively with skin sensory abnormality (r = 0.4, P < 0.01), that of urethral stricture negatively with the anastomosis of dorsal nerves (r = -0.2, P = 0.02) and arteries (r = -0.2, P = 0.016), but positively with the anastomosis of corpus cavernosum (r = 0.3, P = 0.01), that of skin necrosis negatively with the total number of anastomosed blood vessels (r = -0.2, P = 0.04), and that of complications negatively with the number of anastomosed dorsal nerves (r = -0.3, P = 0.01), dorsal veins (r = -0.2, P = 0.04), arteries (r = -0.2, P = 0.023) and micro-anastomosis (r = -0.3, P < 0.05). CONCLUSION: Early micro-anastomosis of the most possible penile dorsal veins, arteries and dorsal nerves is essential for the survival of the replanted penis and reduction of complications, and therefore can be regarded as a "standard" method for penile replantation in China.

Penile replantation: report of two cases and review of the literature.

Penile amputation and successful replantation is very uncommon, and there is no routine standardized procedures for dealing with this medical condition. Here we report two cases of penile amputation and replantation involving different degrees of vascular insult leading to different pathogenesis, clinical presentation, surgical approach and prognosis. This report described the microsurgical procedure and postoperative care using bipedicled scrotal flap to achieve successful engraftment and function. A review of the published data and future methods to increase success of such surgical procedures is provided.

Multiple factors related to detrusor overactivity in Chinese patients with benign prostate hyperplasia.

BACKGROUND: Detrusor overactivity (DO) is a known cause of lower urinary tract symptoms and occurs in 50% - 75% of benign prostate hyperplasia (BPH) patients. We sought to investigate the clinical and urodynamic factors that are associated with the presence of DO in Chinese BPH patients. METHODS: Two hundred and eighty-seven consecutive patients with clinical BPH were retrospectively evaluated in this study. Each patient underwent urodynamic evaluation and completed the International Prostate Symptom Score (IPSS) and Quality of Life (QoL) questionnaire. Patients with neurological symptoms or other diseases likely to affect detrusor functions were strictly excluded. The 184 BPH patients included in the study were divided into groups according to the presence of DO as shown in urodynamic tests. Univariate analysis of factors associated with the presence of DO were performed using Student's t-test and the Mann-Whitney test; multivariate analysis used stepwise Logistic regressions. The relationship between degree of bladder outlet obstruction (BOO) and DO was also investigated using a linear-by-linear association test. RESULTS: Of 184 BPH patients, DO was present in 76 (41.3%). On univariate analysis, patients with DO were older (P = 0.000), and showed smaller maximal bladder capacity (MBC, P = 0.000) and voided volume (P = 0.000), higher maximal detrusor pressure (P = 0.000) and projected isovolumetric pressure (PIP) (P = 0.005), higher Abrams-Griffiths number (P = 0.000) and degree of bladder outlet obstruction (P = 0.000), higher IPSS (P = 0.000) and irritative IPSS subscores (P = 0.000). Stepwise Logistic regression analysis showed that PIP (OR = 1.012, 95% CI 1.002 - 1.023, P = 0.019), age (OR = 1.030, 95%CI 1.005 - 1.067, P = 0.059), and MBC (OR = 0.993, 95%CI 0.990 - 0.996, P = 0.000) were independent risk factors for DO in BPH patients. Linear-by-linear association tests indicated a positive linear association between DO and severity of BOO, with incidence of DO increasing with BOO grade (P = 0.000). CONCLUSIONS: In Chinese BPH patients, PIP, MBC, and age were independent factors affecting the presence of DO. DO incidence continuously increases with the degree of BOO.

[Differences of urodynamic tests between patients of detrusor hyperactivity with impaired contractility with and without bladder outlet obstruction and effect of anticholinergic medications in these patients].

OBJECTIVE: To explore the differences of urodynamic parameters and lower urinary symptoms between detrusor hyperactivity with impaired contractility (DHIC) patients and DHIC patients with bladder outlet obstruction (BOO) and evaluate the effects and risks of anticholinergic medications in these patients. METHODS: A retrospective analysis was performed in 56 DHIC patients at our hospital between February 2000 to February 2011. Among them, 19 patients were complicated with BOO. Urodynamic studies were conducted and lower urinary symptoms assessed in all patients. Then the urodynamic parameters and lower urinary symptoms scores were compared between the DHIC and DHIC plus BOO patients. Among them, 27 received anticholinergic medications and there were 11 BOO patients. After 2-month anticholinergic medications, the differences of lower urinary symptom score were analyzed and anticholinergic-induced retention was also investigated. RESULTS: As compared with the DHIC patients, the DHIC plus BOO patients had a higher post-voiding residual urine (70 (23 - 106) vs 20 (10 - 81) ml, P = 0.02), higher total international prognostic scoring system (IPSS) score (25.6 ± 3.9 vs 22.1 ± 4.1, P = 0.00) and higher total voiding symptom score (15.3 ± 2.9 vs 11.8 ± 3.3, P = 0.00). After 2-month anticholinergic medications, the IPSS score of DHIC plus BOO patients decreased from 25.7 ± 4.6 to 23.6 ± 4.9 (P = 0.01), 2/11 patients developed urinary retention. The IPSS scores of DHIC patients decreased from 22.8 ± 4.7 to 21.4 ± 4.6 (P = 0.01) and none had urinary retention. CONCLUSIONS: The DHIC plus BOO patients have more aggravated bladder empting and more severe lower urinary symptoms especially during voiding phase. Anticholinergic medications may alleviate the lower urinary symptoms in DHIC and DHIC plus BOO patients. But anticholinergic-induced retention is common among the DHIC plus BOO patients.

[Aggressiveness and extent of prostatic inflammation relates with serum PSA levels in type IV prostatitis].

OBJECTIVE: To investigate the relationship of the histopathologic grade and extent of prostatic inflammation with the level of serum PSA in patients with type IV prostatitis. METHODS: We performed transrectal ultrasound-guided prostate biopsy for 120 patients suspected of prostate cancer and included in this study only those with benign prostate hyperplasia (BPH) and prostatitis (n = 46), excluding the cases with prostate cancer and those with BPH but no prostatitis. We evaluated the relationship between prostatic inflammation and serum PSA levels based on the three-grade pathohistologic criteria for the extent, location and aggressiveness of prostatic inflammation. The serum tPSA levels, fPSA levels, % fPSA, and PSAD were compared among different groups. RESULTS: As for the extent of inflammation, 35 of the 46 included cases were grade I (tPSA: [8.46 +/- 4.09] microg/L; fPSA: [1.75 +/- 0.93] microg/L; PSAD: 0.15 +/- 0.11), 7 were grade II (tPSA: [15.26 +/- 5.26] microg/L; fPSA: [2.54 +/- 0.72] microg/L; PSAD: 0.26 +/- 0.07) and 4 were grade III (tPSA: [21.05 +/- 7.58] microg/L; fPSA: [3. 19 +/- 1.13] microg/L; PSAD: 0.42 +/- 0.19), with statistically significant differences among the three groups in the levels of tPSA (P = 0.001), fPSA (P = 0.008) and PSAD (P < 0.001). Regarding the location of inflammation, 19 cases were grade I, 17 were grade II and 10 were grade II, with no significant differences in tPSA, fPSA and %fPSA among the three grades (P > 0.05). As for the aggressiveness of inflammation, 32 cases were grade I (tPSA: [8.37 +/- 4.07] microg/L; fPSA: [1.76 +/- 0.93] microg/L; PSAD: 0.14 +/- 0.11), 10 were grade II (tPSA: [13.30 +/- 5.69] microg/L; fPSA: [3.27 +/- 2.21] microg/L ; PSAD: 0.25 +/- 0.06) and 4 were grade III (tPSA: [21.05 +/- 7.58] microg/L; fPSA: [3.19 +/- 1.13] microg/L; PSAD: 0.42 +/- 0.19), with statistically significant differences among the three grades in the levels of tPSA (P = 0.002), fPSA (P = 0.024) and PSAD (P < 0.001). The extent of inflammation was positively correlated with the levels of tPSA (r = 0.6, P < 0.001), fPSA (r = 0.5, P = 0.001) and PSAD (r = 0.6, P < 0.001), and so was the aggressiveness of inflammation (tPSA: r = 0.5, P < 0.001; fPSA: r = 0.4, P = 0.008; PSAD: r = 0.7, P < 0.001), but a negative correlation was found between the aggressiveness of inflammation and %fPSA (r = -0.4, P = 0.013). CONCLUSION: The aggressiveness and extent of prostatic inflammation in asymptomatic prostatitis patients are significantly correlated with the level of serum PSA, which may help pathologists to avoid unnecessary repeated biopsies for patients with high-grade prostatitis.

[Involvement of p38 MAPK pathway in GLP-1-induced inhibition of apoptosis in human umbilical vein endothelial cells].

The aim of the present study was to investigate the effect of glucagon-like peptide-1 (GLP-1) on palmitate-induced apoptosis of human umbilical vein endothelial cells (HUVECs) and the underlying mechanism. HUVECs were cultured in vitro, and then treated by palmitate to induce apoptosis. Meanwhile, GLP-1 was added to explore its effect. After 24 h of the treatments, Caspase-3 activity and DNA fragmentation were measured using ELISA kits. Phospho-p38 mitogen-activated protein kinase (p-p38 MAPK) expression was detected by Western blot. The results showed that incubating HUVECs with 0.125 mmol/L GLP-1 increased Caspase-3 activity and DNA fragmentation. GLP-1 significantly inhibited palmitate-induced increases of Caspase-3 activity and DNA fragmentation in a concentration-dependent manner. Moreover, GLP-1 inhibited the up-regulation of p-p38 MAPK expression induced by palmitate in HUVECs. These results suggest GLP-1 protects HUVECs against lipo-apoptosis, and this effect may be mediated through inhibiting p38 MAPK pathway.

[Analysis of lower urinary tract symptoms in patients with lumbar disk herniation].

OBJECTIVE: To evaluate the characteristic and clinical significance of lower urinary tract symptoms (LUTS) caused by lumbar disk herniation. METHODS: A total of 80 male patients from February 2000 to April 2010 in our hospital with lumbar disk herniation underwent an urodynamic test. And they were divided into the normal bladder function group (Group A), the early-stage of bladder dysfunction group (Group B) and the late-stage of bladder dysfunction group (Group C) according to the urodynamic results. LUTS in these patients were assessed by the international prostate symptom score (IPSS) and quality of life (QOL) questionnaire. The results were analyzed statistically among these three groups. RESULTS: In Groups A (n=30), B (n=22) and C (n=28), the total IPSS scores were 9.4±4.6, 11.3±3.3 and 15.0±3.4 while the QOL scores 2.1±1.1, 2.2±1.0 and 3.4±1.3 respectively. The total voiding symptom scores were 3.8±2.7, 6.2±2.6 and 10.4±3.1 respectively and the differences were significant (all P<0.05). The total storage symptom scores were 5.6±3.4, 5.1±2.9 and 4.6±2.3 in 3 groups respectively and the difference was insignificant (P>0.05). Between Groups A and B, the differences of total voiding symptom score were significant (P<0.01) while those of the total IPSS and QOL score were insignificant (both P>0.05). Between Groups B and C, the differences of the total IPSS, QOL score and total voiding symptom score were significant (all P<0.05). CONCLUSIONS: The LUTS caused by lumbar disk herniation are notable during the late stage of bladder dysfunction. As one typical early manifestation, the voiding symptom may aid an early diagnosis of the disease.

Risk factors for interstitial cystitis/painful bladder syndrome in patients with lower urinary tract symptoms: a Chinese multi-center study.

BACKGROUND: Despite 100 years of research, the continued absence of well-established risk factors impedes the diagnosis and treatment of interstitial cystitis/painful bladder syndrome (IC/PBS). We aimed to identify risk factors in patients with lower urinary tract symptoms (LUTS) without urinary tract infection or benign prostate hyperplasia in China. METHODS: A total of 397 outpatients with LUTS presenting for care to urology clinics in several hospitals throughout China were surveyed using a standardized questionnaire and validated outcome measures. The definitions for painful bladder syndrome based on the O'Leary-Sant interstitial cystitis symptom and problem indices were used. The prevalence of possible risk factors was analyzed using the Fisher's exact test and Pearson chi-square test, and multivariate predictive models were developed using binary Logistic regression methods. RESULTS: Of those multi-centre patients surveyed, including 174 women and 223 men, 41% (162/397) met criteria for painful bladder syndrome. There was a significant difference between women and men (55% (95/174) vs. 30% (67/223), P < 0.001). Women with IC/PBS were more likely than those without IC/PBS to report a history of gynecological infections (odds ratio (OR): 2.85; 95% confidence interval (CI): 1.32 - 6.16, P = 0.007), intake of stimulatory foods (OR: 3.52; 95%CI: 1.50 - 8.30; P = 0.004), irritable bowel (OR: 3.46; 95%CI: 1.22 - 9.80; P = 0.014) and/or anorectal disease (OR: 2.68; 95%CI: 1.12 - 6.40, P = 0.023). After adjusting for confounding factors, bladder pain was significantly associated with stimulatory foods (OR: 3.85; 95%CI: 1.58 - 9.36, P = 0.003) and anorectal disease (OR: 2.76; 95%CI: 1.09 - 7.04, P = 0.03) in women. Caffeine beverage intake (OR: 3.54; 95%CI: 1.54 - 8.12, P = 0.003) was identified the only modifiable association noted in multivariate analysis of men. CONCLUSIONS: We found that stimulatory foods, anorectal disease and caffeine beverages are potential risk factors for IC/PBS. Further studies are necessary to determine their role in the pathogenesis of this disorder.

[Analysis of relation between types of bony metastasis and PSA and tumor differentiation of prostate cancer].

OBJECTIVE: To analyze the relationship between radiological characteristics of bony metastasis and PSA, Gleason score (GS) for prostate cancer patients. METHODS: The investigators collected the clinical data of 44 patients with prostate cancer bony metastasis and divided them into 3 groups based upon the radiological characteristics of bony metastasis. The 3 groups were osteoblast group, osteoclast group and mixed group. RESULTS: The mean age of patients was 70 years old. There were 33 cases (75.00%), 9 cases (20.45%) and 2 cases (4.55%) in osteoblast group, osteoclast group and mixed group respectively. The mean total serum PSA values were 590.3+/-177.0 microg/L, 249.0+/-66.6 microg/L and 156.5+/-42.1 microg/L in osteoblast group, osteoclast group and mixed group respectively. No statistic significance was found for the difference of total PSA in 3 groups. Mean GS in osteoblast group was 7.4 (6-10). Twenty-two cases (66.7%) were of a medium-high differentiation (GS7). Mean GS in osteoclast group was 8.0 (6-10). Among which, 3 cases (33.3%) were of a medium-high differentiation while 6 cases (66.7%) of a low differentiation. Statistic significance was found for the difference of GS in 2 groups. Two cases in mixed group were assigned 8 of GS. CONCLUSION: There is no confirmed correlation between types of bony metastasis and total serum PSA for prostate cancer patients. But the tumor differentiation reflected by Gleason score may affect the type of bony metastasis.

[Clinical comparison of flexible endoscopic realignment with traditional open realignment].

OBJECTIVE: To evaluate the clinical value of flexible endoscopic realignment for posterior urethral disruption as compared with traditional open realignment. METHODS: A total of 58 patients suffering posterior urethral disruption in Beijing Jishuitan Hospital from January 2003 to May 2009 were examined. Twenty-three patients (Group A) were performed with flexible endoscopic realignment and 35 patients (Group B) were performed with traditional open realignment. The operation duration and post-operative complications were compared between two groups. RESULTS: All operations were successfully performed. The operative duration was significantly shorter in Group A than that in Group B [(29 +/- 10) min vs (58 +/- 11) min, P = 0.000]. Also, the patients in Group A had a significantly decreased rate of stricture and false urethral passages formation (17.4% vs 42.9%, 0 vs 20%, both P < 0.05). There were no significant difference in urinary infection, repeat procedures, incontinence and impotence between two groups (P > 0.05). CONCLUSION: As compared with traditional open realignment, flexible endoscopic realignment has the advantages of short operation duration, lesser trauma and fewer complications. Therefore it is an excellent method for the treatment of urethral injury.