Prostate arterial chemoembolization for treatment of refractory hematuria and urinary retention in patients with localized advanced prostate cancer.

OBJECTIVES: To evaluate the safety and efficacy transcatheter arterial chemoembolization (TACE) for the treatment of refractory gross hematuria (RGH) and urinary retention (UR) secondary to localized advanced prostate cancer (PCa). PATIENTS AND METHODS: Thirty-two patients (mean age 72.5 years, range 60-89) with advanced PCa-related RGH that failed conventional therapy were included. Twenty-two of these patients had catheter-dependent due to PCa-related UR. TACE was performed with epirubicin (EPI)-eluting HepaSpheres (HS) plus intra-arterial (IA) infusion of docetaxel. Technical success, adverse events (AEs), overall survival (OS), control of RGH, removal of indwelling catheters, and local disease control, were evaluated. RESULTS: Technical success was achieved in 100% without major AEs. Mean follow up post-TACE was 27 months (range 8-56 months) with a mean OS of 30 months. GRH stopped within 5 days after TACE in all patients, 26 (86.7%) of these patients exhibited good bleeding control during a mean follow-up of 24 months; 17 (77.3%) of the 22 patients with UR had recovered spontaneous urination, 15 (88.2%) patients were catheter-free at their last follow-up with a mean of 24 months. BS was obtained in 73.3% (22/30) of patients at a mean follow-up of 29 months. At the last visit, 22 patients had a mean of 36 months follow-up and the mean percentage reduction in prostate volume was 55.5%, with a statistically different from baseline (P = 0.022). Negative biopsy results were obtained in 84.2% (16/19) of the patients at 12-47 months after TACE. Compared with baseline values, there was a significant improvements in IPSS, QoL, Qmax, and PVR (all P < 0.05). CONCLUSIONS: TACE using EPI-eluting HS plus IA infusion of docetaxel is a safe and effective treatment option for the advanced PCa patients with GRH and UR, and it could be considered as an alternative if there was no other therapeutic choice.

Comparison of Polyvinyl Alcohol Versus Combination of Lipiodol-Bleomycin Emulsion and NBCA-Lipiodol Emulsion for Renal Angiomyolipoma Embolization: A Prospective Randomized Study.

BACKGROUND. Consensus is lacking regarding optimal embolic agents for transcatheter arterial embolization (TAE) of renal angiomyolipomas (AMLs). OBJECTIVE. The purpose of our study was to compare the safety and efficacy of TAE with polyvinyl alcohol (PVA) and TAE with a combination of ethiodized oil (Lipiodol)-bleomycin emulsion and N-butyl cyanoacrylate (NBCA)-Lipiodol emulsion for the treatment of patients with large or symptomatic AMLs. METHODS. This prospective study enrolled patients referred for TAE of a large (> 4 cm) or symptomatic renal AML from July 2007 to December 2018. Patients were randomized to undergo TAE using PVA particles or a combination of Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion. Patients underwent serial clinical follow-up visits and follow-up CT or MRI examinations after TAE. Outcomes were compared between groups. RESULTS. Seventy-eight patients were enrolled. After exclusions, the analysis included 72 patients (15 men, 57 women; mean age, 35.0 years; 51 patients with hematuria, 66 patients with flank pain): 35 patients were randomized to treatment by PVA and 37 were randomized to treatment by a combination of Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion. Complete occlusion of all angiographically visible arterial supply was achieved in all patients. No major adverse event occurred in any patient. The mean follow-up after TAE was 77 ± 45 (SD) months (range, 37-180 months). The frequency of resolution of hematuria after initial TAE without recurrence was greater after treatment by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than by PVA (100.0% vs 80.0%, respectively; p = .03). At 12-month follow-up, the frequency of complete resolution of flank pain was higher after treatment by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than by PVA (100.0% vs 75.0%, p = .03). Mean reduction in AML volume at 36 months or longer after TAE versus at baseline was greater in patients treated by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than in those treated by PVA (98.0% vs 85.7%, respectively; p = .04). The frequency of complete response by modified RECIST (mRECIST) criteria at 36 months or longer after TAE was greater in patients treated by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than by PVA (94.6% vs 74.3%, p = .04). The rate of repeat TAE was higher among patients treated by PVA than among those treated by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion (25.7% vs 8.1%, p = .04). CONCLUSION. Superior outcomes after TAE of AML were achieved using Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than using PVA. CLINICAL IMPACT. TAE using a combination of Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion is a safe and effective treatment option for large or symptomatic AMLs. TRIAL REGISTRATION. Chinese Clinical Trial Registry ChiCTR2100053296.

Risk factors for spontaneous abortion from a prevention perspective in rural China: a population-based follow-up study.

OBJECTIVES: We conducted this study to investigate the risk factors for spontaneous abortion among rural Chinese women. METHODS: Risk factors prior to pregnancy associated with spontaneous abortion were identified among 17,248 rural women enrolled in a prospective population-based follow-up study. The risk of spontaneous abortion was estimated with odds ratio (OR) and 95% confidence interval (CI) for several factors. A nonconditional logistic regression analysis was then performed to identify the independently associated factors. RESULTS: The total sample of this study population consisted of 17,248 pregnant women including 921 of them whose pregnancies resulted in spontaneous abortion and the incidence of spontaneous abortion was 5.04%. After the adjustment of confounding factors, menarche age, serum creatinine, family genetic diseases or maternal congenital defects was associated with an increased risk of spontaneous abortion while folic acid supplementation reduced the risk among rural Chinese women. CONCLUSIONS: The findings of our study suggest that multiple modifiable factors may increase the risk of spontaneous abortion which may help relevant departments better to guide detailed effectively prevention strategies toward spontaneous abortion to improve the reproductive quality of rural population. Further studies are required to elaborate these risk factors for spontaneous abortion.

Large for gestational age and macrosomia in pregnancies without gestational diabetes mellitus.

Objective: This study aims to estimate the prevalence and risk factors of macrosomia and LGA (large for gestational age) in non-GDM (gestational diabetes mellitus) pregnant women in Fuyang, Anhui Province of China.Methods: A large population-based cohort study was conducted among non-GDM pregnant women aged 18-45 years. Maternal sociodemographic data prior to pregnancy were collected using interviewer-administered standardized questionnaire. Maternal obstetrical delivery records and newborn hospital records were extracted from antenatal care booklets and hospital discharge abstracts. Logistic regression analysis was used to identify the predictors of macrosomia and LGA.Results: The incidence of macrosomia and LGA was 9.2 and 15.9%, respectively. Mothers ≥35 years of age (aOR 2.75, 95% CI 1.98, 3.80), male neonates (aOR 1.68, 95% CI 1.51, 1.89), overweight and obese (aOR 1.61, 95% CI 1.34, 1.92 and aOR 3.05, 95% CI 2.05, 4.56, respectively) were associated with increased risk of macrosomia. Compared with the less educated mothers, the educated mothers were more likely to have increased risk of macrosomia. IFA (iron and folic acid) supplements intake during pregnancy was more likely to deliver macrosomia or LGA (aOR1.32, 95% CI 1.08, 1.49 and aOR1.42, 95% CI 1.24, 1.61, respectively) as compared with no IFA supplements intake. SCr (serum creatinine concentration) >80 µmol/L was related to decreased risk of macrosomia (aOR 0.73, 95% CI 0.61, 0.86) and LGA (aOR 0.67, 95% CI 0.59, 0.77) as compared with normal range (44-80 µmol/L).Conclusions: There was a high prevalence of macrosomia and LGA in non-GDM pregnant women in China. Healthcare educations and reasonable body weight are necessary for pregnant women to prevent macrosomia and LGA. Pregnant women should be checked regularly and have the first prenatal visit as soon as possible.

[Effects of Zhikeping on aortic oxyradical and the expression of ICAM-1 in a rat model of experimental early atherosclerosis].

OBJECTIVE: To investigate the effects of Zhikepingon the oxyradical andintercellular adhesion molecule-1 (ICAM-1) of experimental early atherosclerosis. METHOD: The model of SD rat early atherosclerosis was induced by cholesterol diet. The suspension of Zhikeping and simvastatin were administered intragastrically, respectively. After 10 weeks, the serum lipids, superoxide dismutase (SOD) and maleic dialdehyde (MDA) were detected by automatic biochemistry analyzer. ICAM-1 and its expression of mRNA in aortic wall were detected- by immunohistochemistry and RT-PCR, respectively. Aortic histomorphology was cbserved by HE stainning. RESULT: The results showed that the serum lipids, superoxide dismutase (SOD) and maleic dialdehyde (MDA) of treated groups were obviously improved as compared with those of the control group. The tissue pathological damage was improved indifferent degree, and ICAM-1 and its expression of mRNA was decreased obviously. CONCLUSION: It is suggested the mechanism of anti-atherosclerosis of Zhikeping have close relationship with the function of its anti-oxidizing and anti-adhesiveness that can protect aortic endothelial cell.