[Modified transperitoneal laparoscopic radical prostatectomy: technique and clinical outcomes].

OBJECTIVE: To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. METHODS: A total of 105 patients received the operation with age ranging from 51 to 73 years from January 2008 to June 2010. Mean level of serum prostate specific antigen was 13.6 µg/L and mean prostatic volume was 45 ml. Pathological studies of biopsy confirmed the prostate carcinoma with Gleason score 6-8. Radionuclide bone scan revealed no metastasis. Based on previously retroperitoneal radical prostatectomy, modified technique was applied involving surgical approach, bladder neck dissection and vesicourethral anastomosis. RESULTS: Mean operative time was 93 min (65 - 150 min). Intraoperative blood loss was 115 ml (50 - 400 ml). No complication of bowl injury occurred. Positive surgical margin was present in 24 patients. Normal continence were seen in 64 patients after catheter removed. Recovery of incontinence within 3 months was seen in 33 patients and 3 to 12 months in 5 patients respectively. Three patients with incontinence were still in the follow-up. CONCLUSIONS: Transperitoneal laparoscopic radical prostatectomy provides large working space and clear anatomic exposure. Higher efficiency and lower complication rate are obtained through modified laparoscopic technique involving seminal vesicle isolation, bladder neck dissection and vesicourethral anastomosis.

Plasma Purification Treatment Relieves the Damage of Hyperlipidemia to PBMCs.

Background: Hyperlipidemia {hypercholesterolemia [cholesterol >5.18 mmol/L) or hypertriglyceridemia [triglycerides >2.3 mmol/L], mixed hyperlipidemia [cholesterol >5.18 mmol/L and triglycerides >2.3 mmol/L], and high low-density lipoproteinemia [low-density lipoprotein (LDL) >3.4 mmol/L]} is a strong risk factor for arteriosclerosis and cardiovascular disease (CVD). Therapy with lipid-lowering drugs often results in many side effects. Our study aimed to investigate the potential effects of non-drug therapy with double-filtration plasmapheresis (DFPP) on lipid metabolism-, endoplasmic reticulum (ER) stress-, and apoptosis-related proteins in peripheral blood mononuclear cells (PBMCs) before and after lipid clearance in patients with hyperlipidemia. Methods: Thirty-five hyperlipidemia patients were selected. Proteins related to lipid metabolism [CD36, proprotein convertase subtilisin/kexin type 9 (PCSK9), and LDL receptor], ER stress [glucose-regulated protein 78 (Grp78), C/EBP homologous protein (CHOP), activating transcription factor 4 (ATF4), and eukaryotic initiation factor 2α (EIF2α)], and apoptosis [B-cell lymphoma-2 (Bcl-2), Bcl-2-associated X protein (BAX), and cysteinyl aspartate specific proteinase-3 (Caspase-3)] were assayed by Western blot, reactive oxygen species (ROS) were measured by flow cytometry (FCM), and ELISA detected serum inflammatory [interleukin (IL)-1ß, IL-6, and tumor necrosis factor α (TNF-α)] factors. Results: Compared with their pre-DFPP values, the values of most lipid metabolic parameters, such as cholesterol, triglycerides, LDL, lipoprotein a [Lp(a)], and small dense LDL (sdLDL) cholesterol, were reduced after DFPP. DFPP was associated with the downregulation of proteins related to lipid metabolism, ER stress, and apoptosis, resulting in decreased ROS and serum inflammatory factor release. Conclusion: DFPP has lipid-lowering activity and can also regulate lipid metabolism-, ER stress-, and apoptosis-related proteins in PBMCs and reduce the levels of inflammatory factors in patients with hyperlipidemia (ClinicalTrials.gov number: NCT03491956).

[Persistent Müllerian duct syndrome: a report of 2 cases and review of the literature].

OBJECTIVE: To study the etiopathogenesis, clinical manifestations, diagnosis and management of persistent Müllerian duct syndrome (PMDS). METHODS: Two cases of PMDS were reported, one accompanied by transverse testicular ectopia and the other associated with cryptorchidism. Corporeal hysterectomy and orchidopexy were given to both the patients and cryptorchidectory the latter. RESULTS: Vascular supply and texture of the testis were normal in both the 2 patients after 1.5-2 years' follow-up. CONCLUSION: PMDS is male pseudohermaphroditism, for which means should be taken to preserve the blood supply and fertility function of the testis in surgical management, and attention should be paid to possible development of testis tumor in follow-up.

Increased expressions of vascular endothelial growth factor (VEGF), VEGF-C and VEGF receptor-3 in prostate cancer tissue are associated with tumor progression.

AIM: To investigate the differences in microvessel densities (MVD) and the expressions of vascular endothelial growth factor (VEGF), VEGF-C and VEGF receptor-3 (VEGFR-3) between prostate cancer (PCa) tissues and adjacent benign tissues, and to explore the correlations among MVD, Jewett-Whitmore staging, Gleason scores and expressions of VEGF, VEGF-C and VEGFR-3 in the progression of PCa. METHODS: An immunohistochemical approach was adopted to detect the expressions of CD34, VEGF, VEGF-C and VEGFR-3 in both cancer areas and peripheral benign areas of 71 primary prostatic adenocarcinoma specimens. A statistic analysis was then performed according to the experimental and clinic data. RESULTS: Significantly upregulated expressions of VEGF, VEGF-C and VEGFR-3 were all found in malignant epithelium/cancer cells compared with adjacent benign epithelium (P<0.01). Patients in stage D had a significantly higher score than patients in stage A, B or C when comparing the expression of VEGF-C or VEGFR-3 in the tumor area (P<0.01). In addition, significant correlations were observed between Jewett-Whitmore staging and VEGF-C (r(s)=0.738, P<0.01), clinical staging and VEGFR-3 (r(s)=0.410, P<0.01), VEGF-C and Gleason scores (r(s)=0.401, P<0.01), VEGFR-3 and Gleason scores (r(s)=0.581, P<0.001) and MVD and VEGF (r(s)=0.492, P<0.001). CONCLUSION: Increased expressions of VEGF and VEGF-C were closely associated with progression of PCa. The main contribution of increased VEGF expression for PCa progression was to upregulate MVD, which maintained the growth advantage of tumor tissue. However, the chief role of increased expressions of VEGF-C and VEGFR-3 was to enhance lymphangiogenesis and provide a main pathway for cancer cells to disseminate.

[Correlation of epididymal protease inhibitor Eppin and Semenogelin on human ejaculated spermatozoa].

OBJECTIVE: To evaluate the correlation of epididymal protease inhibitor(Eppin) and Semenogelin(Sg) on human ejaculated spermatozoa. METHODS: The experimental approaches include: (1) Immunoprecipitation of Eppin with anti-Eppin from semen; (2) Colocalization of Eppin and Sg by immunofluorescence; (3) Immunoprecipitation of rEppin and rSg;(4) Far-Western blotting of rEppin and rSg;(5) Competition of saturated 125I-rSg binding to rEppin with unlabeled Sg, and direct binding of 125I-rSg to rEppin on a blot; (6) Autoradiography of 125I-rSg with rEppin. RESULTS: Eppin-Sg complex present on the surface of human ejaculated spermatozoa, Cys-239 is the only cystein for rEppin binding rSg. Reduction and carboxymethylation of Cys-239 blocks binding of 125I-rEppin to rSg. CONCLUSION: Our study demonstrates that Eppin and Sg bind to each other on human ejaculated spermatozoa. A disulfide linkage occurs between Sg and Eppin, indicating the specificity of binding.

[Anemia in patients on combined androgen block therapy for prostate cancer].

OBJECTIVE: To study the effect of combined androgen block therapy on hemoglobin (Hb) and hematocrit value (Ht) in patients with prostate cancer. METHODS: One hundred and thirty-six patients with adenocarcinoma of the prostate were treated with combined androgen block (orchiectomy and flutamide 250 mg, Tid). Complete blood counts were detected before initiation and after 1, 2, 3, 6, 9 and 12 months of therapy. RESULTS: Hb level declined significantly in all patients from a mean baseline of (136 +/- 14) g/L to (126 +/- 16) g/L, (121 +/- 14) g/L, (120 +/- 15) g/L, (113 +/- 12) g/L, (121 +/- 13) g/L and (123 +/- 15) g/L at 1, 2, 3, 6, 9 and 12 months. Ht decreased from a mean baseline of 0.424 +/- 0.041 to 0.390 +/- 0.038, 0.381 +/- 0.042, 0.378 +/- 0.038, 0.366 +/- 0.041, 0.384 +/- 0.039 and 0.387 +/- 0.040. The differences between Hb, Ht before and after treatment were significant (P < 0.05). CONCLUSION: Patients with prostate cancer being treated with combined androgen block would develop a significant degree of anemia. Hemoglobin and hematocrit level should be monitored periodically. This kind of anemia can be treated by recombinant human erythropoietin.

[Tamsulosin in the treatment of benign prostatic hyperplasia patients with acute urinary retention].

OBJECTIVE: To evaluate the clinical efficacy of alpha-1 A adrenoceptor antagonist (tamsulosin) in the treatment of benign prostatic hyperplasia (BPH) patients with acute urinary retention. METHODS: Seventy-two BPH patients with acute retention of urine were randomly divided into treatment group and control group of 36 patients each. All the patients were treated with indwelling catheter, oral antibiotics and the patients in treatment group tamsulosin 0.4 mg once a day for 3 days. The catheter was removed after 72 hours of treatment. RESULTS: After removal of the catheter, 44% (32/72) of patients voided successfully. The effect rates were 61% (22/36) in the tamsulosin treatment group and 28% (10/36) in the control group(P < 0.01). CONCLUSIONS: Treatment with tamsulosin was effective in raising the success rate of voiding without catheter after an episode of acute urinary retention. The efficacy of treatment was not influenced by the volume of prostate.

A practical therapeutic protocol for cervical tuberculosis.

PURPOSE: Cervical tuberculosis (CTB) is a relatively rare entity, even in endemic countries. Currently, management ranges from conservative to radical surgical approaches. We report our experience in diagnosing and treating 66 cases of CTB in the past eight years using our CTB therapeutic protocol. METHODS: All patients diagnosed with CTB were followed up over a 3.5-year period. Patients were divided into three grades using clinicoradiological criteria designed to evaluate the initial severity of the disease. Overall performance status was assessed based on the American Spinal Injury Association (ASIA) scale. Neurological recovery was evaluated with the ASIA scale as well as using X-rays and computed tomography every four weeks for the initial three months and every three months thereafter. RESULTS: The mean follow-up duration was 38.2 ± 6.2 months. No mortality occurred. One case of recurrence due to irregular antitubercular treatment (ATT) was cured by abscess clearing and regular ATT. All other patients had good clinicoradiological outcomes, regardless of grading. CONCLUSIONS: The use of our proposed scoring system and management protocol allowed speedy management of CTB.

Genetic polymorphisms in the cytochrome P450 1A1 and 2E1 genes, smoking, drinking and prostate cancer susceptibility: a case-control study in a Han nationality population in Southern China.

AIM: To investigate the association among the polymorphisms of the cytochrome P450 1A1 and 2E1 genes, smoking, drinking and the risk of prostate cancer (PCa) in a Han nationality population in Southern China. METHODS: A case-control study including 225 PCa patients and 250 age-matched controls was conducted. The six polymorphic sites of the CYP 1A1 and CYP2E1 genes were analysed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) or allele-specific PCR technique using genomic DNA isolated from peripheral blood lymphocytes. RESULTS: We found that the CYP1A1 Val/Val genotype significantly increased the risk for PCa (OR, 2.26; 95% CI, 1.09-4.68). In contrast, the CYP2E1 C1/C2 (OR, 0.67; 95% CI, 0.46-0.99) or C2/C2 genotype (OR, 0.31; 95% CI, 0.10-1.00) significantly decreased the risk. Furthermore, the individuals carrying the CYP1A1 Val allele and the CYP2E1 C1/C1 genotype showed the highest risk (OR, 2.50; 95% CI, 1.45-4.29). Though there was no significant difference with smoking history (P = 0.237) or drinking habit (P = 0.499) between cases and controls, a deep smoking habit (OR, 2.02; 95% CI, 1.28-3.17) and heavy smoking history (OR, 1.61; 95% CI, 1.04-2.50) significantly increased the susceptibility of PCa after stratification by smoking method and accumulative smoking amount. Moreover, both the CYP1A1 Val allele (OR, 2.82; 95% CI, 1.49-5.35) and CYP2E1 C1/C1 genotype (OR, 2.57; 95% CI, 1.31-5.02) had obvious interaction with heavy smoking history that significantly raised the risk. We also discovered a significant interaction between the CYP2E1 C1/C1 genotype and drinking (OR, 1.85; 95% CI, 1.04-3.28). CONCLUSIONS: Individuals carrying the CYP1A1 Val allele or the CYP2E1 C1/C1 genotype with a smoking or drinking habit were at increased risk of PCa, which also showed a positive correlation with exposure dose of tobacco.