The Learning Curve of Unilateral Biportal Endoscopic (UBE) Spinal Surgery by CUSUM Analysis.

Objective: To assess the learning curve of the unilateral biportal endoscopic (UBE) technique for the treatment of single-level lumbar disc herniation by cumulative summation (CUSUM) method analysis. Methods: A retrospective analysis was conducted to assess 97 patients' general condition, operation time, complications, and curative effect of single segmental UBE surgery performed by a spinal surgeon in his early stage of this technique. The learning curve of operation time was studied using a CUSUM method, and the cut-off point of the learning curve was obtained. Results: The operation time was 30 - 241(97.9 ± 34.7) min. The visual analog scale score of lower limb pain decreased from 5.75 ± 0.81 before the operation to 0.39 ± 0.28 at the last follow-up (P < 0.05). The Oswestry disability index score decreased from 66.48 ± 4.43 before the operation to 14.57 ± 3.99 at the last follow-up (P < 0.05). The CUSUM assessment of operation time revealed the learning curve was the highest in 24 cases. In the learning stage (1-24 cases), the operation time was 120.3 ± 43.8 min. In the skilled stage (25-97 cases), the operation time was 90.5 ± 27.8 min. Conclusions: About 24 cases of single segmental UBE operation are needed to master the UBE technique.

Associations of LRP5 Gene With Bone Mineral Density, Bone Turnover Markers, and Fractures in the Elderly With Osteoporosis.

Objective: The study aimed to explore the associations of rs4988300 and rs634008 in the low-density lipoprotein receptor-related protein 5 (LRP5) gene with bone mineral density (BMD), bone turnover markers (BTM), and fractures in elderly patients with osteoporosis (OP). Methods: Our study included 328 unrelated OP patients with or without fractures. Genomic DNA was extracted for genotyping. BTM levels were assessed by electrochemiluminescence (ECL). Dual-energy X-ray absorptiometry (DXA) was employed to measure BMD in the lumbar spine (LS) and proximal femur. Basic features between the OP and fracture groups were analyzed using the t-test. The Chi-square test was performed to analyze the differences in allele and genotype frequencies. The associations of single-nucleotide polymorphisms (SNPs) with BMD and BTM in the subgroups were investigated by the analysis of covariance (ANCOVA) adjusted for confounding factors. Results: In both females and males, individuals with fractures exhibited higher BTM levels and lower BMD values than those with OP (P < 0.05). The allele and genotype frequencies of rs4988300 in the subgroups were significantly different (P < 0.05). In both females and males suffering from OP, participants with rs4988300 GG or rs634008 TT presented lower procollagen I N-terminal propeptide (PINP) levels (P < 0.05). Women with OP carrying rs4988300 GG exhibited lower BMD values at FN and TH (P < 0.05). In both females and males with fractures, individuals carrying rs4988300 GG genotype or rs634008 TT genotype exhibited lower PINP levels and BMD values at FN and TH than those with other genotypes (P < 0.05). Conclusions: Rs4988300 and rs634008 polymorphisms in the LRP5 gene are associated with bone phenotypes in the elderly with OP or fractures.

Association of Adrenergic Receptor α2A (α2A-AR) Gene rs1800544 Polymorphism with Bone Mineral Density and Bone Turnover Markers in an Elderly Chinese Population.

BACKGROUND Adrenergic receptor α2A (α2A-AR) is up-regulated in osteoporotic bone osteoblasts. Previous research demonstrated an association between polymorphism of a2A-AR gene and bone mineral density (BMD) as well as bone turnover markers (BTMs) in the Slovenian population. The present study aimed to investigate the association of rs1800544 polymorphism of α2A-AR gene with BMD and BTMs in the Chinese elderly population with osteoporosis (OP) or with osteoporotic fractures. MATERIAL AND METHODS A total of 346 unrelated elderly individuals were recruited in the study. Rs1800544 polymorphism was determined by Snapshot technology. BTMs were determined by electrochemiluminescence. BMDs at lumbar spine (LS) and proximal femur were measured with dual-energy X-ray absorptiometry (DEXA). Hardy-Weinberg equilibrium and distribution of genotype frequencies were verified using the chi-squared test. Analysis of co-variance (ANCOVA) adjusted for confounding factors was performed to explore the relationship of rs1800544 polymorphism with BMD and BTMs in all participants and in subgroups. RESULTS The genotype distributions in all subjects and in subgroups conformed to Hardy-Weinberg equilibrium (P>0.1). Distribution of genotype frequencies of subgroups showed no significant differences (P>0.05). Patients with GG genotype in the fracture group had significantly higher serum BTMs level compared with those carrying other genotypes (P<0.05). No significant association between rs1800544 and BTMs was detected in the elderly population with OP. Comparison of BMD at each site in all participants did not show any significant difference in subgroups with CC, CG, and GG genotypes (P>0.05). CONCLUSIONS Rs1800544 polymorphism is associated with BTMs level in Chinese elderly individuals with osteoporotic fractures, indicating the involvement of genetic variation of a2A-AR gene in bone metabolism.

[Expressions of ERK and p-ERK in advanced prostate cancer].

OBJECTIVE: To investigate the expressions of extracellular signal-regulated kinase (ERK) and p-ERK in benign and malignant prostate tissues, and whether it can be used as a marker for the prognosis of advanced prostate cancer (PCa). METHODS: Using immunohistochemical Envision, we detected the expressions of ERK1/2 and p-ERK1/2 in 20 cases of benign prostatic hyperplasia (BPH) and 40 cases of advanced PCa and analyzed their correlation with PCa metastasis, Gleason score, PSA level, and prognosis. RESULTS: The expression of ERK1/2 was remarkably higher in the advanced PCa than in the BPH cases (82.5% vs 55%, P<0.05), which was not associated with cancer metastasis, Gleason score, PSA level, or survival time of the patients with advanced PCa, and so was that of p-ERK1/2 (75.0% vs 35%, P<0.05), which was not associated with the Gleason score or PSA level of the PCa patients, either. The expression rates of p-ERK in the metastasis, non-metastasis, survival >5 yr, and survival ≤ 5 yr groups were 61.9%, 89.5%, 57.9%, and 90.5%, respectively, with statistically significant differences among these groups (P<0.05). CONCLUSIONS: ERK1/2 and p-ERK1/2 proteins are highly expressed in advanced PCa and p-ERK1/2 is associated with the metastasis and prognosis of advanced PCa.

Giant hydronephrosis due to ureteropelvic junction obstruction: A rare case report, and a review of the literature.

The hydronephrotic kidney, resulting from a ureteropelvic junction obstruction (UPJO), presents commonly as a clinical condition, with the presence of usually no more than 1-2 liters in the collecting system, but a very small number of cases of giant hydronephroses (GHs) has been reported in adults. A GH is defined as the adult renal pelvis containing >1 liter of urine, or at least 1.5% of the body weight. In the majority of cases, the range of the hydronephrotic kidney remains restricted to the renal area. However, the patient described in the present case report had a range for the hydronephrotic kidney which occupied almost the entire abdominal cavity (~24 l), and cases such as these are rarely presented; therefore the aim of the present case study was to document a clear case of GH resulting from UPJO, also accompanied by a review of the current literature.

Arsenic trioxide inhibits viability and induces apoptosis through reactivating the Wnt inhibitor secreted frizzled related protein-1 in prostate cancer cells.

BACKGROUND: Growing evidence suggests that arsenic trioxide (As2O3) induces apoptosis and inhibits tumor cell growth in prostate cancer (PCa), although details of the mechanism are still inconclusive. We investigated the antitumor effect of As2O3 in human PCa cell lines LNCaP and PC3 and the underlying mechanisms by focusing on the Wnt signaling pathway. METHODS: The effect of As2O3 on the viability and apoptosis of PCa cells was investigated by cholecystokinin-8 and flow cytometry. The expression of the related proteins in the Wnt signaling pathway and the downstream target genes of the Wnt signaling pathway was examined by Western blot and quantitative real-time PCR assay. The methylation status of the SFRP1 gene promoter was assessed by bisulfite sequencing. RESULTS: As2O3 inhibited the viability of PCa cells and induced apoptosis of PCa cells in a dose-dependent manner. The protein level of phosphoglycogen synthase kinase-3ß was upregulated, whereas the protein level of ß-catenin and the mRNA levels of c-MYC, MMP-7, and COX-2 were downregulated in a dose-dependent manner in PCa cells treated with As2O3. In addition, As2O3 upregulated the protein and mRNA levels of secreted frizzled related protein-1, and increased the demethylation of the SFRP1 gene promoter. CONCLUSION: Our results suggest that As2O3 may inhibit cell viability and induce apoptosis through reactivating the Wnt inhibitor secreted frizzled related protein-1 in both androgen-dependent and -independent human PCa.

[65-month testosterone replacement therapy for androgen deficiency-induced ED: a case report and review of the literature].

OBJECTIVE: To explore the mechanism of erectile dysfunction (ED) with testosterone deficiency and discuss the feasibility of long-term testosterone replacement therapy (TRT) by observing a case of ED with testosterone deficiency treated by TRT for 65 months. METHODS: We treated an ED patient with testosterone deficiency by TST for 65 months, and evaluated the therapeutic effects by analyzing his IIEF-5 score, dynamic changes in testosterone, PSA, hemoglobin and red blood cell count, and adverse events. RESULTS: The patient was a 46-year-old man, with an IIEF-5 score of 7, baseline serum total testosterone (TT) of 2.79 ng/ml, and no response to phosphodiesterases-5 inhibitors (PDE5i). He was diagnosed with late-onset hypogonadism (LOH) and treated by TRT: testosterone undecanoate at 80 mg bid po for the first 2 weeks and then at 40 mg bid po. Two months after medication, the TT level was increased to normal (3.45 ng/ml), and physical fitness and anxiety symptoms were markedly improved, with no significant improvement in sexual function. Then we administered PDE5i on demand in addition, which elevated his IIEF-5 score to > 21. The combined medication of TRT and on-demand PDE5i lasted for 45 months followed by TRT alone for another 18 months. The patient was restored to normal penile erection and sexual satisfaction, with the IIEF-5 score remaining at > 21. Regular follow-up revealed no significant abnormalities in the testosterone level, PSA, and routine blood tests. CONCLUSION: TRT enhances the effect of PDE5i in the treatment of androgen deficiency-induced ED, and long-term TRT is safe and effective for androgen deficiency.

[Transurethral prostatectomy with the bipolar plasmakinetic technique for benign prostate hyperplasia: a report of 712 cases].

OBJECTIVE: To evaluate the effect and safety of transurethral prostatectomy with the bipolar plasmakinetic technique (PKRP) in the treatment of benign prostate hyperplasia (BPH). METHODS: A total of 712 BPH patients underwent transurethral prostatectomy with the bipolar plasmakinetic technique. The patients averaged 70.6 years of age and 52 g (range 35-102 g) in estimated prostate weight preoperatively. Comparative analyses were made on the maximum urine flow rate (Qmax), residual urine volume and scores on IPSS and QOL obtained pre- and post-operatively. RESULTS: The operations lasted 20-120 minutes (mean 51 min), the resected tissues weighed 15-96 g (mean 46 g), and no transurethral resection syndrome (TURS) occurred. The catheters were removed 4 -5 days after surgery. The patients were followed up for 1 -52 months (mean 27.6 mo). Obvious reduction was observed in the average Qmax from 4.7 ml/s preoperatively to 19. 1 ml/s postoperatively, in the mean IPSS score from 26.6 to 5. 8, and in the mean QOL score from 5.4 to 1.7, all with significant differences (P < 0.01). CONCLUSION: Transurethral prostatectomy with the bipolar plasmakinetic technique is a safe and effective means for the treatment of BPH.