Efficacy and Safety of a Self-Improved Continuous Bladder Irrigation Sensor Device in Patients after Transurethral Resection of the Prostate: A Prospective Study.

Purpose To explore the efficacy and safety of a self-improved continuous bladder irrigation (CBI) sensor device after transurethral resection of the prostate (TURP). Materials and Methods A total of 160 patients with benign prostatic hyperplasia who received TURP from June 2021 to May 2022 were selected. According to the envelope randomization method, patients were divided into a control group (80 cases) and study group (80 cases). In the control group, the speed of bladder flushing fluid was adjusted according to the clinical experience of nurses. On the basis of the control group, the self-improved CBI sensor device was used in the study group to observe the postoperative comfort and complication rate in the two groups. Results The comfort of patients in the study group was significantly higher than that of patients in the control group (97.50% vs. 88.75%, P = .023), and the number of postoperative complications in the control group was significantly higher than that in the study group (8.75% vs. 1.25%, P = .021). Meanwhile, the average amount of irrigation fluid in the study group was obviously lower than that in the control group (26.4 L vs. 27.8 L, P = .011). In addition, patients in the study group had a significantly shorter hospital stay than the controls (3.3 days vs. 3.6 days, P = .005). Conclusion Implementation of the new self-improved CBI sensor device for patients after TURP can improve their awareness regarding disease-related knowledge, alleviate their fear and anxiety, improve their compliance and comfort with treatment and nursing, and reduce the incidence of complications.

Efficacy and safety of pelvic floor magnetic stimulation combined with mirabegron in female patients with refractory overactive bladder: a prospective study.

Objective: To observe the efficacy and safety of pelvic floor magnetic stimulation (PFMS) combined with mirabegron in female patients with refractory overactive bladder (OAB) symptoms. Patients and methods: A total of 160 female patients with refractory OAB symptoms were prospectively randomized into two groups. Eighty cases in the combination group accepted PFMS and mirabegron therapy and 80 cases as control only accepted mirabegron therapy (The clinical trial registry number: ChiCTR2200070171). The lower urinary tract symptoms, OAB questionnaire (OAB-q) health-related quality of life (HRQol), symptom bother score and OABSS between two groups were compared at the 1st, 2nd and 4th week ends. Results: All of 160 patients were randomly assigned to two groups, of which 80 patients were included in the combination group and 80 in the mirabegron group. The incidences of LUTS, including urgency, frequent urination, and incontinence episodes, in the 2nd week and the 4th week after combination treatment were significantly lower than those in the mirabegron group (p < 0.05). The incidence of drug-related adverse events between two groups was similar, and there was no statistically significant difference (p > 0.05). With respect to secondary variables, the OAB-q HRQol score in the combination group was statistically superior in comparison with that in the mirabegron group between the 2nd week and the 4th week (p < 0.05). This was consistent with the primary outcome. Meanwhile, from the second to fourth week, the OAB-q symptom bother score and OABSS in the combination group were both lower than in the mirabegron group (p < 0.05). Conclusion: Combination therapy of PFMS and mirabegron demonstrated significant improvements over mirabegron monotherapy in reducing refractory OAB symptoms for female patients, and providing a higher quality of life without increasing bothersome adverse effects. Clinical Trial Registration: https://www.chictr.org.cn/, ChiCTR-INR-22013524.

RIRS with FV-UAS vs. MPCNL for 2-3-cm upper urinary tract stones: a prospective study.

To observe the efficacy and safety of retrograde intrarenal surgery (RIRS) combined with flexible vacuum-assisted ureteral access sheath (FV-UAS) and minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with 2-3 cm upper urinary tract stones. A total of 160 patients with 2-3 cm upper urinary tract stones were prospectively randomized into 2 groups-80 in the FV-UAS group and 80 cases as control in the MPCNL group. The stone-free rates (SFRs) at different times (postoperative 1st day and 4th week) were considered as the primary outcome of the study. The secondary end points were operative time, hemoglobin decrease, postoperative hospital stay, and operation-related complications. There was no obvious difference between the two groups in patient's demographics and preoperative clinical characteristics (all P > 0.05). Postoperative data showed that mean decrease in hemoglobin level was less in FV-UAS group than that in MPCNL group (5.3 vs. 10.8 g/L, P < 0.001). Postoperative hospital stay in FV-UAS group was more shorten than that in MPCNL group (2.7 vs. 4.9 days, P < 0.001). There was no statistical significance between the two groups in SFRs during postoperative 1st day and 4th week (both P > 0.05). However, in terms of the rates of bleeding and pain, MPCNL group were both significantly higher than FV-UAS group (6.2 vs. 0.0%, P = 0.023; 16.2 vs. 2.5%, P = 0.003; respectively). Our study showed that RIRS with FV-UAS, a new partnership to treat 2-3 cm upper urinary tract stones, was satisfying as it achieved a high SFR rate and a low rate of complications. This method was safe and reproducible in clinical practice.

Comparative efficacy between retrograde intrarenal surgery with vacuum-assisted ureteral access sheath and minimally invasive percutaneous nephrolithotomy for 1-2†cm infectious upper ureteral stones: a prospective, randomized controlled study.

Objective: To observe the efficacy and safety of retrograde intrarenal surgery combined with vacuum-assisted ureteral access sheath (V-UAS) and minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with 1-2 cm infectious upper ureteral stone. Patients and methods: A total of 173 patients with 1-2 cm infectious upper ureteral stone were prospectively randomized into two groups. Eighty-six in the V-UAS group and 87 cases as control in the MPCNL group. The SFRs at different times (Postoperative 1 day, 2nd week and 4th week) was considered as the primary outcome of the study. The secondary end points were operative time, postoperative hospital stay and operative complications. Results: There was no obvious difference between two groups in patients' demographics and preoperative clinical characteristics (all P > 0.05). Postoperative data showed that the SFR at postoperative 1 day in the V-UAS group was significantly lower than that in the MPCNL group (73.2% vs. 86.2%, P = 0.034). However, there was no statistical significance between two groups in SFRs during postoperative 2 weeks and 4 weeks (All P > 0.05). The levels of WBC, CRP and PCT were all significant lower in the V-UAS group than those in the MPCNL group at the postoperative 24 h and 48 h (all P < 0.05). Postoperative complications included fever (≥38.5°C), bleeding, pain and urosepsis. In terms of the rates of fever, pain and urosepsis, MPCNL group were all significantly higher than those in the V-UAS group (10.3 vs. 2.4%, P = 0.031; 14.9 vs. 2.4%, P = 0.003; 4.6 vs. 0.0%, P = 0.044; respectively). No significant difference was found between two groups in bleeding. Meanwhile, postoperative hospital stay in the V-UAS group was more shorten than that in the MPCNL group (3.7 vs. 5.9 days, P < 0.001). Conclusions: Our study showed that RIRS with V-UAS, a new partnership to treat 1-2 cm infectious upper ureteral stones, was satisfying as it achieved a high SFR rate and a low rate of infectious complications. This method was safe and reproducible in clinical practice.

The application of intraoperative neurophysiological monitoring in selective dorsal neurotomy for primary premature ejaculation: a prospective single-center study.

Selective dorsal neurotomy (SDN) is a surgical treatment for primary premature ejaculation (PE), but there is still no standard surgical procedure for selecting the branches of the dorsal penile nerves to be removed. We performed this study to explore the value of intraoperative neurophysiological monitoring (IONM) of the penile sensory-evoked potential (PSEP) for standard surgical procedures in SDN. One hundred and twenty primary PE patients undergoing SDN were selected as the PE group and 120 non-PE patients were selected as the normal group. The PSEP was monitored and compared between the two groups under both natural and general anesthesia (GA) states. In addition, patients in the PE group were randomly divided into the IONM group and the non-IONM group. During SDN surgery, PSEP parameters of the IONM group were recorded and analyzed. The differences in PE-related outcome measurements between the perioperative period and 3 months' postoperation were compared for the PE patients, and the differences in effectiveness and complications between the IONM group and the non-IONM group were compared. The results showed that the average latency of the PSEP in the PE group was shorter than that in the normal group under both natural and GA states (P < 0.001). Three months after surgery, the significant effective rates in the IONM and non-IONM groups were 63.6% and 34.0%, respectively (P < 0.01), and the difference in complications between the two groups was significant (P < 0.05). IONM might be useful in improving the short-term therapeutic effectiveness and reducing the complications of SDN.

Efficacy and safety of combination of mirabegron and solifenacin in patients with double-J stent related overactive bladder: a prospective study.

To observe the efficacy and safety of solifenacin and/or mirabegron as a medical expulsive therapy (MET) in patients with double-J stent-related overactive bladder (OAB) symptoms. A total of 219 patients with double-J stent-related OAB symptoms were prospectively randomized into two groups. One-hundred and nine cases in the combination group accepted mirabegron and solifenacin therapy and 110 cases as control only accepted solifenacin therapy. The lower urinary tract symptoms and overactive bladder questionnaire (OAB-q) health-related quality of life (HRQol) and symptom bother score between two groups were compared at the 1st, 2nd and 4th week ends. All of 219 patients were randomly assigned to two groups, of which 109 patients were included in the combination group and 110 in the solifenacin group. The incidences of LUTS, including urgency, frequent urination, and incontinence episodes, in the 2nd week (44.9% vs. 64.5%, P = 0.028; 48.6% vs. 62.7%, P = 0.036; and 40.4% vs. 56.4%, P = 0.018) and the 4th week (14.7% vs. 30.9%, P = 0.004; 16.5% vs. 33.6%, P = 0.003; and 11.9% vs. 26.4%, P = 0.007) after combination treatment were significantly lower than those in the solifenacin group. The incidence of drug-related adverse events in the solifenacin group was higher than that in the combination group, but there was no statistically significant difference (P > 0.05). In terms of secondary variables, the OAB-q HRQol score in the combination group was statistically superior in comparison with that in the solifenacin group between the second and fourth week (77.9 vs. 76.4, P = 0.020; and 87.9 vs. 85.6, P = 0.001). The OAB-q symptom bother score was higher in the solifenacin group than in the combination group (37.6 vs. 36.4, P = 0.016; and 26.2 vs. 24.8, P = 0.003). Combination therapy of solifenacin and mirabegron demonstrated significant improvements over solifenacin monotherapy in reducing OAB symptoms associated with double-J stents, and providing a higher quality of life without increasing bothersome adverse effects.

Use of Extracorporeal Physical Vibration Lithecbole Through Greater Sciatic Foramen for Treatment of Distal Ureteral Calculi.

Introduction: To evaluate the efficacy and safety of performing extracorporeal physical vibrational lithecbole (EPVL) through greater sciatic foramen (GSF) for distal ureteral calculi (DUC) treatment. Materials and Methods: All patients with a diagnosis of DUC (6-10 mm in diameter) were enrolled in this study from October 2018 to May 2020. Patients were randomly divided into three groups receiving EPVL through GSF (Group A, n = 58), or abdominal (Group B, n = 60), or combined with oral use of tamsulosin at 0.4 mg daily (Group C, n = 63). Results: There was no significant difference observed in terms of demographic characteristics or size of stones among the three groups (p > 0.05). Compared with the Groups B and C, patients of the Group A displayed a significantly higher score of comfort, with a significantly decreased number of renal colic attacks or analgesics required (p < 0.01). The stone-free rate also significantly increased after 1 and 2 weeks of treatment (p < 0.01), despite such a significant difference among these groups vanishing after 4 weeks of treatment. Conclusion: EPVL in the prone position uses the GSF as the path and is a safe and effective approach to treat the distal ureteral calculi.

Mirabegron in medical expulsive therapy for distal ureteral stones: a prospective, randomized, controlled study.

OBJECTIVE: To observe the efficacy and safety of Mirabegron in patients with distal, ureteral stones ≤ 10 mm. PATIENTS AND METHODS: A total of 90 patients with distal ureteral stones ≤ 10 mm were prospectively randomized into two groups. Forty-five cases in the study group and 45 cases as control. The stone-free rates (SFRs) and renal colic episodes between two groups were compared at the 1st, 2nd and 4th week end by imaging examinations. RESULT: All of 90 patients were randomly assigned to two groups. In patients with ≤ 5 mm stones, the SFRs in the 1st week (63.6% vs. 33.3%, P = 0.040), the 2nd week (86.4% vs. 54.2%, P = 0.018), and the 4th week (90.9% vs. 66.7%, P = 0.046) after treatment were all significantly higher than that in the control group by the stratification analysis of stone size. Even though SFRs were all higher for patients with > 5 mm stones in study group, there was no statistically significant difference (All P > 0.05). In terms of renal colic episodes, the frequency of occurrence of the study group was significantly lower than that of the control group and need less antalgic. CONCLUSIONS: The MET with Mirabegron has a significant role in improve SFR for the patients with distal ureteral stones ≤ 5 mm and no effect in > 5 mm stones. Furthermore, Mirabegron reduces the need for antalgic in ≤ 10 mm stones with low incidence of adverse effects.

External physical vibration lithecbole facilitating the expulsion of upper ureteric stones 1.0-2.0 cm after extracorporeal shock wave lithotripsy: a prospective randomized trial.

To observe the efficacy and safety of External Physical Vibration Lithecbole (EPVL) in patients with upper ureteric stones 1.0-2.0 cm after extracorporeal shock wave lithotripsy (ESWL). A total of 271 patients with upper ureteric stones 1.0-2.0 cm were prospectively randomized into two groups. One hundred and twenty-seven cases in the treatment group accepted EPVL therapy and 144 cases as control after ESWL. The stone expulsion status and stone-free rates (SFRs) between two groups were compared at the 1st, 2nd and 4th weekends by imaging examinations. All of 271 patients were randomly assigned to two groups, of which 127 patients were included in the treatment group and 144 in the control group. EPVL was successful in assisting the discharge of stone fragments. The rate of stone expulsion at day 1 in the treatment group was significantly higher than in the control group (79.5% vs. 64.6%, P = 0.006). The SFRs of the 1st weekend (76.3% vs. 61.8%, P = 0.010), the 2nd weekend (88.2% vs. 77.1%, P = 0.017) and the 4th weekend (92.1% vs. 84.0%, P = 0.042) in the treatment group were all significantly higher than that in the control group. However, no statistical significance was found in complications between the two groups (P > 0.05). Furthermore, in the treatment group the patients were treated a mean 4.3 sessions of EPVL. EPVL and ESWL are ideal complementary partners in the treatment of upper ureteric stones 1.0-2.0 cm, satisfying both high SFR and low complication. This method is safe and reproducible in clinical practice, and it also needs large-scale multicenter prospective studies further to prove the above conclusions.

[Updated application of penile electrophysiological examination in the diagnosis and treatment of male sexual dysfunction].

Electrophysiological examination of penile nerves involves detection of somatic and autonomic nerves, including dorsal nerve somatosensory evoked potential, cavernous muscle reflex, skin sympathetic response, cavernous electromyography, and others, which plays an important role in the diagnosis of male sexual dysfunction, such as ED and premature ejaculation, as well as in the selection of treatment methods and evaluation of therapeutic effects. Due to the complex mechanisms of the brain, spinal cord and peripheral nerve pathways relating to erectile and ejaculatory centers in men and many unknown areas in penile electrophysiological techniques, penile electrophysiological examination has not been widely accepted by doctors and patients. Further studies are needed to provide more scientific and convincing evidence in this field.

Clinical significance of integrin-linked kinase in laryngeal squamous cell carcinoma.

OBJECTIVE: To investigate the expression of integrin-linked kinase (ILK) and its relationship with clinicopathological parameters in laryngeal squamous cell carcinoma (LSCC). METHODS: 116 patients who had previously undergone complete resection of tumor for LSCC were studied retrospectively. The level of ILK expression in tumor tissues and adjacent nontumor tissues were determined by immunohistochemistry. RESULTS: Increased expression of ILK was found in 65.5% of cases. The expression of ILK protein was significantly associated with tumor grade (p=0.046), lymph node metastasis (p=0.020), and pTNM stage (p=0.019). Kaplan-Meier survival estimates showed a significant correlation between ILK expression and patient survival rate (log-rank p<0.05). The multivariate survival analysis revealed that N status was statistically significant prognostic factor (p<0.001). Other parameters, such as ILK expression, cannot predict disease prognosis separately. CONCLUSION: Increased expression of integrin-linked kinase is associated with lymph node metastases and patient survival rate in laryngeal squamous cell carcinoma. However, it does not appear to be an independent prognostic predictor in LSCC.

[Advances in the studies of testicular microlithiasis].

With the increased attention to men's health and development of ultrasound imaging technology, clinicians are achieving a better understanding of testicular microlithiasis. This review presents an overview on recent studies of the etiology, pathogenesis, and imaging characteristics of testicular microlithiasis, its impact on male reproductive function, and its relation ship with testis tumors and other related diseases, as well as its treatment strategies and follow-up proposals, aiming to provide some new evidence for further understanding and management of the disease.

Comparative evaluation of efficacy of use of naftopidil and/or celecoxib for medical treatment of distal ureteral stones.

We performed a randomized, prospective study to assess the possible role of combined a1D-receptor antagonist naftopidil and nonsteroidal anti-inflammatory hormones celecoxib for the spontaneous expulsion of distal ureteral stones. Patients were randomized to one of the three treatment groups. Treatment group 1 patients received naftopidil 50 mg/day, group 2 patients received naftopidil 50 mg/day plus celecoxib 200 mg (Take two capsules (400 mg) by mouth immediately, then take one capsule (200 mg) by mouth every 12 h), and group 3 patients received celecoxib 200 mg (Take two capsules (400 mg) by mouth immediately, then take one capsule (200 mg) by mouth every 12 h). All patients were instructed to drink at least 2 L of fluids daily. Pain descriptions were recorded by the patients using the visual analog scale. All patients were followed up for 2 weeks. A total of 105 patients provided consent and 103 patients completed the study. Stone expulsion was observed in 29 patients in group 1 (29 of 35, 82.86 %), 33 patients in group 2 (33 of 35, 94.29 %) and 20 patients in group 3 (20 of 33, 60.61 %). A statistically significant difference was noted with Chi-square testing for stone expulsion rate between groups 1 and 3, and groups 2 and 3 (P = 0.04 and P = 0.000, respectively). Kaplan-Meier curves were plotted to access the expulsion rate of each group over time. A significant difference was shown for the expulsion rate between the group 3 and the other two groups. (P < 0.001 by log-rank test).Average time to expulsion for groups 1, 2 and 3 was 8.00 ± 2.07, 7.70 ± 2.34 and 10.65 ± 2.92 days, respectively (P = 0.000). Treatment with naftopidil and celecoxib appears to be beneficial in distal ureter stone clearance, shortened the expulsion time, and could be used reliably and successfully to reduce the frequency and intensity of the pain episodes particularly.

Clinical significance of TrkB expression in nasopharyngeal carcinoma.

Recent research has demonstrated that tropomyosin­related kinase B (TrkB) plays an important role in neuronal survival, differentiation and migration; yet, its specific role in human nasopharyngeal carcinoma (NPC) is unclear. To elucidate its role in NPC, we examined TrkB expression in NPC tissues and cell lines, and investigated the correlation between TrkB expression and prognosis in patients with NPC. Immunohistochemical analysis was performed on NPC specimens from 108 patients with follow-up information. Additionally, reverse transcriptase-polymerase chain reaction (RT-PCR) and western blot analyses were used to determine TrkB expression levels in NPC and noncancerous nasopharyngeal tissues. RT-PCR and western blot analyses were also used to determine TrkB expression levels in 7 NPC cell lines and a nasopharyngeal epithelium cell line. High TrkB expression was significantly correlated with T classification, lymph node metastasis and clinical stage, respectively. Patients with NPC who had high TrkB expression had reduced disease-free survival and overall survival when compared with patients who had low TrkB expression. Multivariate Cox regression analysis revealed that TrkB overexpression was an independent prognostic factor for patients with NPC. Furthermore, TrkB was overexpressed in NPC specimens and cell lines. TrkB expression levels were significantly increased in NPC specimens, and enhanced levels were correlated with a poor prognosis in patients with NPC. These findings suggest that TrkB may contribute to NPC progression and represent a novel prognostic indicator for patients with NPC.

Tamsulosin and tolterodine in the medical expulsive therapy for intramural ureteral stones with vesical irritability: a prospective randomized study.

We performed a randomized, prospective study to assess the possible role of combined tamsulosin and tolterodine therapy for the relief of vesical irritability and in facilitating the spontaneous expulsion of intramural ureteral stones. Patients were randomized to one of three treatment groups. Treatment group 1 patients received tamsulosin 0.4 mg/day, group 2 patients received tamsulosin 0.4 mg/day plus tolterodine 2 mg (twice a day), and group 3 patients received tolterodine 2 mg (twice a day). Subjects rated the urgency associated with each micturition using the Urinary Sensation Scale. Pain descriptions were recorded by the patients using the Visual Analog Scale. Stone expulsion was observed in 30 patients in group 1, 29 patients in group 2 and 18 patients in group 3. Kaplan-Meier curves were plotted to access the expulsion rate of each group over time. A significant difference was shown for the expulsion rate between the tolterodine group and the other two groups. (P = 0.003 by log rank test). Average time to expulsion for groups 1, 2 and 3 was 7.62 ± 2.42, 7.79 ± 2.11 and 10.57 ± 2.71 days, respectively (P = 0.000). In groups 1, 2 and 3, the mean number of pain episodes was 2.27 ± 0.91, 1.39 ± 1.34 and 1.38 ± 1.20, respectively (P = 0.023). Treatment with tamsulosin and tolterodine appears to be beneficial in intramural ureteral stone clearance, particularly in intramural ureter stone with symptoms of vesical irritability.

Naftopidil and tolterodine in the medical expulsive therapy for intramural ureteral stones: a prospective randomized study.

We performed a randomized, prospective study to assess the possible role of combined naftopidil and tolterodine for facilitating the spontaneous expulsion of intramural ureteral stones. A total of 76 patients with intramural ureter stones were included in the study from December 2007 to February 2011. Patients were randomized to one of three treatment groups. Group A patients received naftopidil 25 mg/day, group B patients received naftopidil 25 mg/day plus tolterodine 2 mg (twice a day), and group C patients received tolterodine 2 mg (twice a day). Both groups were followed up for 2 weeks. The stone expulsion rate and time and the number of pain episodes were obtained. Subjects rated the urgency associated with each micturition using the Urinary Sensation Scale (USS). Pain descriptions were recorded by the patients using the visual analog scale (VAS). A significant difference was shown for the expulsion rate between the group C and the other two groups (P < 0.001 by log rank test). In groups A, B and C, the mean number of pain episodes was 2.25 ± 0.90, 1.38 ± 1.37 and 1.54 ± 1.18, respectively. The USS score for groups A, B and C at 3 days was 2.32 ± 0.55, 1.4 ± 0.58 and 1.34 ± 0.49, respectively. It was 1.75 ± 0.44, 1.2 ± 0.41 and 1.22 ± 0.42, respectively, at 7 days. On the other hand, a statistically significant difference was found between groups A and B, and groups A and C in relation to the visual analog scale score on days 3 and 7, respectively. Treatment with naftopidil and tolterodine appears to be beneficial in intramural ureteral stones clearance, particularly in the intramural ureter with symptoms of vesical irritability.

Simultaneously targeting bcl-2 and Akt pathways sensitizes nasopharyngeal carcinoma to tumor necrosis factor-related apoptosis-inducing ligand.

The 5-year survival rate of nasopharyngeal carcinoma (NPC) is disappointing despite the much improved technologies in its treatment. Thus, finding more effective treatment for NPC has become an urgent priority. The tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) can selectively induce apoptosis in most tumor cells while sparing normal cells. However, its potential in the treatment of NPC has been limited by the eventual emergence of drug resistance. Bcl-2 and Akt contribute to TRAIL resistance in some cancer cells. In this study, CNE-2 was found to be the most resistant NPC cell line to TRAIL, and whether Bcl-2 small-interfering RNA (siRNA) and phosphatidylinositol 3-kinase (PI3-K) inhibitors (LY294002 and Wortmannin) could prevent TRAIL resistance in CNE-2 was also investigated. Results showed that both Bcl-2 siRNA and PI3-K inhibitors could prevent TRAIL resistance in CNE-2. Bcl-2 siRNA sensitized CNE-2 by activating the intrinsic apoptotic pathway and PI3-K inhibitors sensitized CNE-2 by activating both intrinsic and extrinsic pathways. Further, simultaneously targeting Bcl-2 and Akt was found to be a more efficient approach to prevent TRAIL resistance in CNE-2 and this synergistic effect happened at the level of Bid downstream. At last, the combinative treatments did not enhance toxicity of TRAIL in MRC5, a human benign fibroblast cell line. This study suggests that simultaneously targeting Bcl-2 and Akt pathway might be effective in preventing TRAIL resistance of NPC cells.

Latent membrane protein 1 mediates the resistance of nasopharyngeal carcinoma cells to TRAIL-induced apoptosis by activation of the PI3K/Akt signaling pathway.

The 5-year survival rate of nasopharyngeal carcinoma (NPC) is still disappointing despite the much improved technologies in its treatment. Tumor necrosis factor-related apoptosis inducing ligand (TRAIL) can selectively induce apoptosis in most tumor cells while sparing normal cells. However, its potential in the treatment of NPC has been limited by the eventual emergence of drug resistance. Latent membrane protein 1 (LMP1) is a major oncogene of the human DNA tumor virus Epstein-Barr virus (EBV) and is associated with the development of NPC and the emergence of chemo-resistance in NPC. In this study, we investigated the potential role of LMP1 in TRAIL resistance in CNE-1 NPC cells. Results show that overexpression of LMP1 could induce TRAIL resistance in NPC cells without influencing death receptors. The LMP1-induced TRAIL resistance is associated with increased expression of FLIP and elevated cleavage of caspase-8 without altering the TRAIL-mediated mitochondrial events and Bid cleavage. Knockdown of the FLIP gene with siRNA prevented the LMP1-induced TRAIL resistance. Furthermore, we found that overexpression of LMP1 activated Akt. Inhibition of Akt with LY294002 completely prevented the LMP1-induced FLIP expression and TRAIL resistance. Together, these results show that LMP1 can inhibit the TRAIL-mediated apoptosis through activation of PI3K/Akt and expression of FLIP in CNE-1 NPC cells, and may provide new methods to prevent and reverse drug resistance in NPC.

Treatment of recurrent head and neck carcinoma involving the carotid artery: carotid reconstruction with ePTFE graft.

The aim of our study is to investigate the feasibility of reconstructing the carotid artery using expanded polytetraflouroethylene (ePTFE) in patients with recurrent head and neck carcinoma involving the carotid artery. Ten patients, who had recurrent head and neck carcinoma involving the carotid artery, received carotid artery resection and reconstruction with ePTFE, tissue defects were repaired by pectoralis major myocutaneous flap. Results show that eight patients did not present any vascular and neurologic complications. One patient presented slight hemiparesis, another patient developed wound infection and pharyngocutaneous fistula. The mean follow-up period was 33.1 ± 16.0 months. The 2-year survival rate was 50% (5/10), and there was one patient who survived for 60 months without locoreginal recurrence or distant metastasis. En bloc resection of tumor and involved carotid-associated ePTFE reconstruction provide effective improvement in the locoregional control of the recurrent head and neck carcinoma. The pedicle pectoralis major myocutaneous flap can provide not only wound bed with affluent blood supply for the vascular grafts, but also reparation of skin or the tissue defects of oropharynx and hypopharynx.