Outcomes of health-related quality of life after open, laparoscopic, or robot-assisted radical prostatectomy in China.

PURPOSE: To compare the outcomes of health-related quality of life (HRQOL) in patients undergoing open (ORP), laparoscopic (LRP), or robot-assisted (RARP) radical prostatectomy. PATIENTS AND METHODS: We retrospectively analyzed 347 men with clinically localized prostate cancer treated with ORP (n=97), LRP (n=71), or RARP (n=179) by high-volume surgeons in our institution between January 2014 and December 2016. The primary endpoint was HRQOL including urinary incontinence and erectile dysfunction. RESULTS: One year after surgery, 15.9% of men reported moderate to severe urinary incontinence (ORP 16.5%, LRP 15.4%, and RARP 15.7%), with only 4.6% using pads. There were no statistically significant differences in the ratios of no pad usage and urinary incontinence bother after 12 months postoperatively among the three groups. However, 67.7% of the men reported moderate to severe erectile dysfunction (ORP 66%, LRP 66.1%, and RARP 69.3%) 12 months after surgery. There was no statistically significant difference in the international index of erectile function-5 (IIEF-5) postoperatively among the different surgical groups. In the univariate and multivariate analyses, age at surgery, preoperative IIEF-5, and neurovascular bundle preservation were the risk factors for moderate to severe sexual bother. Interestingly, 16.1% of men with an erection hardness score of grade 3-4 were hesitant to become sexually active postoperatively. CONCLUSION: ORP, LRP, and RARP have similar early HRQOL outcomes with respect to urinary incontinence and erectile dysfunction. In contrast to urinary continence, erectile dysfunction is still a serious concern for patients who undergo radical prostatectomy.

[Diagnosis and treatment of prostatic malignant mesenchymal tumors: Analysis of 20 cases].

OBJECTIVE: To explore the diagnosis, treatment, and prognosis of prostatic malignant mesenchymal tumors (PMMT). METHODS: We retrospectively analyzed the clinical and follow-up data about 20 cases of PMMT and reviewed the literature relevant to the diagnosis, treatment, and prognosis of the disease. RESULTS: Based on the results of pathology and immunohistochemistry, the 20 PMMT cases included leiomyosarcoma (n = 7), rhabdomyosarcoma (n = 5), prostatic stromal sarcoma (n = 3), chondrosarcoma (n = 1), and undifferentiated PMMT (n = 4). Twelve of the patients were treated by radical prostatectomy (3 concurrently by sigmoid colostomy and 1 by cystostomy), 2 by pelvic tumor resection following arterial embolization, 1 by total pelvic exenteration, 1 by colostomy with pelvic lymph node biopsy, and 4 by conservative therapy because of metastasis to the lung, pelvis and bone. Of the 20 patients, 9 died of systemic metastasis within 3 months after treatment, 3 died at 6, 7, and 14 months, respectively, 3 survived with tumor for 5, 11, and 12 months, respectively, 2 survived without tumor for 12 and 24 months so far, all subjected to periodic chemotherapy postoperatively, and 3 lost to follow-up. CONCLUSION: PMMT is a tumor of high malignancy and rapid progression, for which transrectal ultrasound-guided biopsy remains the main diagnostic method. The clinical stage of the tumor is an important factor influencing its prognosis and the survival rate of the patients can be improved by early diagnosis and combined therapy dominated by radical prostatectomy.

Ureteral obstruction and urinary fistula due to fibrin glue after partial nephrectomy: A case report and review of the literature.

In the present study, we report the case of a 69-year-old female who developed urinary leakage following partial nephrectomy (PN) to remove left renal masses. The results of CT and MR urography revealed left proximal ureteral obstruction and urinary fistula. Reoperation was performed on the 16th postoperative day to explore the left kidney and ureter in order to relieve the obstruction. The left proximal ureter was found to be enfolded by fibrin glue and showed marked stiffness and adhesion during the reoperation. The lesion of the ureter was resected and the ureter was anastomosed with the routine double-J stent. Pathological examination of surgical specimens revealed fat fibrous scar tissue hyperplasia with inflammatory cell infiltration. The patient recovered completely without exudate. Our experience suggests that care should be taken to avoid touching the ureter with fibrin glue during PN surgery.

[Diagnosis and treatment of cystic renal cell carcinoma: a report of 14 cases].

OBJECTIVE: To explore the diagnosis and treatment of cystic renal cell carcinoma. METHODS: A total of 14 cases of cystic renal cell carcinoma were reviewed and analyzed. Their age range was 40 to 71 years old. Preoperative CT (computed tomography) scan revealed renal cyst-relative masses in 14 cases. The lesions were accompanied by calcification (n = 4) and with septa (n = 8). The preoperative diagnosis was a complex cystic mass in all but 2. Intraoperative pathological examination was undertaken in 12 cases. The findings were malignant cystic renal clear cell carcinoma (n = 10), renal cyst (n = 1) and multi-cell renal cyst (n = 1). The procedures included radical nephrectomy (n = 6), retroperitoneal laparoscopic radical nephrectomy (n = 4), retroperitoneal laparoscopic partial nephrectomy (n = 2), retroperitoneal laparoscopic cyst unroofed plus radical nephrectomy (n = 1) and retroperitoneal laparoscopic partial nephrectomy plus radical nephrectomy (n = 1). RESULTS: All 14 cases were confirmed postoperatively as cystic renal clear cell carcinoma. All patients received a mean follow-up period of 26 months (range: 4 - 72). Their overall results were excellent with no evidence of neoplastic recurrence or metastasis. CONCLUSION: Preoperative CT scan may aid the diagnosis of cystic renal clear cell carcinoma. Intraoperative pathological examination should be performed in suspected cases. Nephron-sparing surgery is indicated. Its prognosis is generally favorable.

Quantification of two polyacetylenes in Radix Ginseng and roots of related Panax species using a gas chromatography-mass spectrometric method.

A sensitive method for quantitating the pharmacologically active polyacetylenes panaxynol and panaxydol in Radix Ginseng was developed using a capillary gas chromatography-mass spectrometric (GC-MS) method. The detection mode of selected ion monitoring (SIM) allowed sensitive and selective quantitation of the two compounds in ginseng. Method validation showed that the GC-MS method has much lower detection and quantitation limits than the high-performance liquid chromatography (HPLC)-UV method. This indicates that GC-MS is particularly useful for the analysis of polyacetylene compounds, which have relatively low abundances compared with ginsenosides in ginseng. Based on the quantitative results of different types of ginseng herbs, it was found that the panaxydol and panaxynol contents were higher in forest ginseng than in cultivated ginseng. This method was further applied to the quantitative analyses of panaxynol and panaxydol in Radix Notoginseng and American ginseng. The ratio of panaxydol to panaxynol can be utilized as a marker for differentiating ginseng, notoginseng, and American ginseng. This study introduces the first GC-MS method for the quantitative analysis of polyacetylenes in herbs of the Panax genus.

Role of soluble Fas ligand in autoimmune diseases.

AIM: To investigate the role of soluble Fas ligand in autoimmune diseases. METHODS: RT-PCR was performed to amplify sFasL cDNA from the total RNA extracted from activated human peripheral blood lymphocytes. DNA fragments were cloned into PCR vector. After sequenced, sFasL gene fragments were inserted into pQE-31 vector and expressed in E. Coli M15 respectively. Proteins were purified through affinity chromatography column with ligand of 6XHis tag and identified by SDS-PAGE and Western blot. Mice were immunized with sFasL protein and specific anti-serum was harvested 6 wk after immunization. Monoclonal anti-human FasL antibody was made from the immunized mice. Serum level of sFasL in different patients was detected using anti-FasL antibodies from the immunized mice. RESULTS: The protein expressed was 24 ku by SDS-PAGE electrophrosis. The protein was specially bound to anti-human FasL antibody by Western blot analysis. The sFasL protein could induce Jurket cell apoptosis in vitro. The concentration of serum sFasL in patients with autoimmune diseases was higher than that in normal individuals. sFasL could reduce arthritis in collagen induced arthritis (CIA) mice model by subcutaneous injection. CONCLUSION: sFasL may be involved in either induction of apoptosis or autoimmune diseases. Furthermore, sFasL may have potential application in treatment of autoimmune diseases.

[The expression and application of human Fas ligand in E.coli].

AIM: To express recombinant human FasL molecule in E.coli. METHODS: RT-PCR was applied to amplify FasL cDNA from the total RNA extracted from activated human peripheral blood lymphocytes. The DNA fragment was cloned into PCR2.1 vector. After sequencing, the FasL gene was inserted into pQE-31 vector and expressed in E.coli M15. The FasL protein was purified through Ni-ATA affinity chromatography column and identified by SDS-PAGE and Western blot. The mice were immunized with the FasL protein and the specific anti-serum was harvested 6 weeks after immunization. The serum level of FasL from with different kinds of diseases patients were detected using the anti-FasL antibodies from the immunized mice. RESULTS: The expressed protein could be recognized by anti-human FasL antibody in Western-blot analysis with M(r)40 000. This protein could induce Jurket cells apoptosis. anti-FasL serum prepared from mouse could detect the serum FasL as sensitive as commercial ELISA kits. CONCLUSION: The human FasL protein is obtained. It lays the foundation for the further detecting the concentration of FasL and sFasL of patients.