Correlation between the incidence of inguinal hernia and risk factors after radical prostatic cancer surgery: a case control study.

OBJECTIVE: The incidence of recurrent hernia after radical resection of prostate cancer is high, so this article discusses the incidence and risk factors of inguinal hernia after radical resection of prostate cancer. METHODS: This case control study was conducted in The First People's Hospital of Huzhou clinical data of 251 cases underwent radical resection of prostate cancer in this hospital from March 2019 to May 2021 were retrospectively analyzed. According to the occurrence of inguinal hernia, the subjects were divided into study group and control group, and the clinical data of each group were statistically analyzed, Multivariate Logistic analysis was performed to find independent influencing factors for predicting the occurrence of inguinal hernia. The Kaplan-Meier survival curve was drawn according to the occurrence and time of inguinal hernia. RESULTS: The overall incidence of inguinal hernia after prostate cancer surgery was 14.7% (37/251), and the mean time was 8.58 ± 4.12 months. The average time of inguinal hernia in patients who received lymph node dissection was 7.61 ± 4.05 (month), and that in patients who did not receive lymph node dissection was 9.16 ± 4.15 (month), and there was no significant difference between them (P > 0.05). There were no statistically significant differences in the incidence of inguinal hernia with age, BMI, hypertension, diabetes, PSA, previous abdominal operations and operative approach (P > 0.05), but there were statistically significant differences with surgical method and pelvic lymph node dissection (P < 0.05). The incidence of pelvic lymph node dissection in the inguinal hernia group was 24.3% (14/57), which was significantly higher than that in the control group 11.8% (23/194). Logistic regression analysis showed that pelvic lymph node dissection was a risk factor for inguinal hernia after prostate cancer surgery (OR = 0.413, 95%Cl: 0.196-0.869, P = 0.02). Kaplan-Meier survival curve showed that the rate of inguinal hernia in the group receiving pelvic lymph node dissection was significantly higher than that in the control group (P < 0.05). CONCLUSION: Pelvic lymph node dissection is a risk factor for inguinal hernia after radical resection of prostate cancer.

[Application of a modified vascular blocking technique in intrafascial nerve-sparing laparoscopic radical prostatectomy].

OBJECTIVE: To investigate the clinical effect of a modified vascular blocking technique in intrafascial nerve-sparing laparoscopic radical prostatectomy (INLRP). METHODS: We retrospectively studied the clinical data on 13 cases of INLRP completed via a modified vascular blocking technique between July 2021 and August 2022. The patients ranged in age from 64 to 73 (68.8 ± 3.15) years, with elevated PSA of 4.71－16.12 (9.71 ± 3.50) µg/L preoperatively. Prostate cancer was confirmed in all the cases by ultrasound-guided perineal prostate needle biopsy, with Gleason 6 in 7 cases and Gleason 7 in 6 cases. MRI revealed no preoperative tumor breakthrough in the prostatic capsule or pelvic lymph node metastasis. All the patients received INLRP with a modified superficial suture dorsal vein complex (DVC) combined with lateral prostatic pedicle vascular blocking. RESULTS: Prostatic capsule rupture occurred in 1 case during the operation, with positive resection margin indicated by rapid intraoperative frozen biopsy, so the lateral fascia resection was modified. No positive resection margin was found in any of the cases in postoperative pathological examinations. Urinary continence was restored in 8 cases immediately after surgery and in the other 5 within 2 weeks after catheter removal. At 1 month after surgery, all the patients were medicated with low-dose tadalafil (5 mg qd), and IIEF-5 scores of >15 were achieved in 4 cases (31%) at 1 month and in another 8 (62%) at 3 months postoperatively. CONCLUSION: INLRP via modified vascular blocking showed the advantages of desirable intraoperative bleeding control and postoperative tumor control, restoration of urinary continence and relatively satisfactory recovery of erectile function. However, due to the small sample size, short follow-up time and lack of control, our findings need to be further verified by more clinical studies.

[Entecavir improves the reproductive function of male patients with chronic hepatitis B].

OBJECTIVE: To study the effect of entecavir on the reproductive function of male patients with chronic hepatitis B (CHB). METHODS: This study included 56 CHB male patients (aged 18－45 ï¼»33.14 ± 5.38ï¼½ years) initially treated with entecavir at 0.5 mg/d for 24 weeks from 2015 to 2018 and another 24 healthy fertile male volunteers (aged 21－45 ï¼»32.62 ± 5.94ï¼½ years) as normal controls. We obtained the body mass index (BMI), reproductive hormone levels, semen parameters and IIEF-5 scores from the subjects and compared them between the two groups before and after treatment. RESULTS: There were no statistically significant differences between the CHB and normal control groups in age, BMI, lifestyle and baseline reproductive hormone levels except in the levels of FSH (ï¼»3.92 ± 1.29ï¼½ vs ï¼»3.08 ± 0.85ï¼½ mIU/ml, P = 0.003) and E2 (ï¼»35.79 ± 7.49ï¼½ vs ï¼»28.25 ± 7.09ï¼½ pg/ml, P < 0.01). The semen parameters were significantly lower in the CHB patients than in the normal controls, including total sperm motility (ï¼»37.75 ± 13.33ï¼½% vs ï¼»49.58 ± 9.27ï¼½%, P = 0.004), the percentage of progressively motile sperm (PMS) (ï¼»30.70 ± 10.03ï¼½% vs ï¼»42.46 ± 8.90ï¼½%, P < 0.01), sperm concentration (ï¼»51.51 ± 19.50ï¼½ vs 70.33 ± 30.62) ×106/ml, P = 0.007), and total sperm count (ï¼»160.2 ± 51.8ï¼½ vs ï¼»225.91 ± 97.97ï¼½ ×106, P = 0.002), and so were the IIEF-5 scores (19.32 ± 2.34 vs 21.25 ± 2.35, P = 0.0006). After 24 weeks of entecavir treatment, the CHB patients showed no significant difference from the baseline in the semen volume, semen pH and days of abstinence, but remarkable improvement in total motility (ï¼»37.75 ± 13.33ï¼½ vs ï¼»44.1 ± 11.89ï¼½%, P = 0.004), PMS (ï¼»30.70 ± 10.03ï¼½ vs ï¼»38.30 ± 7.42ï¼½%, P < 0.01), sperm concentration (ï¼»51.51 ± 19.50ï¼½ vs ï¼»62.00 ± 24.64ï¼½ ×106/ml, P = 0.007), total sperm count (ï¼»160.21 ± 51.8ï¼½ vs ï¼»207.65 ± 81.69ï¼½ ×106, P = 0.0002), and IIEF-5 score (20.13 ± 1.82 vs 19.32 ± 2.34, P = 0.02). CONCLUSIONS: CHB patients have lower sexual function and semen quality than normal males. Entecavir can significantly improve the liver function, sexual function and semen quality of the CHB patients, but whether it directly improves the sexual function and semen quality of the patients or indirectly through liver function improvement needs to be further studied.

Clinical Features of 167 Inpatients with Autosomal Dominant Polycystic Kidney Disease at a Single Center in China.

BACKGROUND The aim of this study was to describe the clinical characteristics of Chinese ADPKD inpatients and to identify the factors associated with disease severity. MATERIAL AND METHODS We included 167 hospitalized patients (inpatients) with ADPKD in this study. Multiple regression analyses were conducted to determine factors correlated with estimated glomerular filtration rate (eGFR). Patients were stratified into subgroups according to the presence of symptoms, in which clinical parameters were analyzed and compared. RESULTS The mean age of hospitalized ADPKD patients was 48.7 years old, lumbar and/or abdominal pain was seen in 40.12% of patients, following by nephrolithiasis (38.92%), hematuria (30.54%), and urinary tract infection (24.55%). Serum thrombocyte level and hemoglobin exhibited significant positive correlations with eGFR. Symptomatic patients accounted for 71.26% of the studied population. Patients with hypertension had increased risk of presence of symptoms (OR=2.794, 95%CI=1.341-5.822). Low thrombocyte and hemoglobin levels were observed in patients with hematuria. CONCLUSIONS Thrombocyte level was positively correlated with eGFR but was not associated with presence of PKD-related symptoms, suggesting thrombocyte level might be an independent serum biomarker for disease progression. Hypertension was associated with increased risk of symptom occurrence, indicating the relationship between hypertension and disease progression. This study reveals the clinical characteristics of inpatients with ADPKD in China and provides clinicians with useful insights into this intractable disease.

Rapamycin treatment dose-dependently improves the cystic kidney in a new ADPKD mouse model via the mTORC1 and cell-cycle-associated CDK1/cyclin axis.

Although translational research into autosomal dominant polycystic kidney disease (ADPKD) and its pathogenesis has made considerable progress, there is presently lack of standardized animal model for preclinical trials. In this study, we developed an orthologous mouse model of human ADPKD by cross-mating Pkd2 conditional-knockout mice (Pkd2f3 ) to Cre transgenic mice in which Cre is driven by a spectrum of kidney-related promoters. By systematically characterizing the mouse model, we found that Pkd2f3/f3 mice with a Cre transgene driven by the mouse villin-1 promoter (Vil-Cre;Pkd2f3/f3 ) develop overt cysts in the kidney, liver and pancreas and die of end-stage renal disease (ESRD) at 4-6 months of age. To determine whether these Vil-Cre;Pkd2f3/f3 mice were suitable for preclinical trials, we treated the mice with the high-dose mammalian target of rapamycin (mTOR) inhibitor rapamycin. High-dose rapamycin significantly increased the lifespan, lowered the cystic index and kidney/body weight ratio and improved renal function in Vil-Cre;Pkd2f3/f3 mice in a time- and dose-dependent manner. In addition, we further found that rapamycin arrested aberrant epithelial-cell proliferation in the ADPKD kidney by down-regulating the cell-cycle-associated cyclin-dependent kinase 1 (CDK1) and cyclins, namely cyclin A, cyclin B, cyclin D1 and cyclin E, demonstrating a direct link between mTOR signalling changes and the polycystin-2 dysfunction in cystogenesis. Our newly developed ADPKD model provides a practical platform for translating in vivo preclinical results into ADPKD therapies. The newly defined molecular mechanism by which rapamycin suppresses proliferation via inhibiting abnormally elevated CDK1 and cyclins offers clues to new molecular targets for ADPKD treatment.

Calbindin S100A16 Promotes Renal Cell Carcinoma Progression and Angiogenesis via the VEGF/VEGFR2 Signaling Pathway.

Purpose: Recent research has indicated that the calcium-binding protein S100A16 promotes carcinogenesis and tumor growth in several forms of cancer. The objective of this study was to examine the relationship between S100A16 and renal cell cancer. Methods: By using The Cancer Genome Atlas (TCGA) database, the differentially expressed gene S100A16 was identified, and its appearance and link to the prognosis of persons with renal cancer were confirmed. Cox regression was used in multivariate analysis, and a nomogram was developed for internal validation. The correlation between S100A16 and immune cells was analyzed in the TIMER database. Moreover, the potential mechanism of action was investigated utilizing GO and KEGG enrichment analyses. Proliferation, migration, and angiogenesis were investigated in vitro, and the involvement of S100A16 in the undesirable biological events of renal cell carcinoma (RCC) was further explored. Results: S100A16 was the differentially expressed molecule identified through database screening. Malignant tissues showed higher S100A16 expression than noncancerous tissues, and S100A16 expression was mostly localized in the cytoplasm. According to the TCGA and KM-plotter datasets, patients with RCC and low S100A16 expression had superior OS, PFI, and DSS. The C-index of the nomogram was 0.754 (0.726-0.782), and the accuracy of the prediction model was high. The TIMER database shows that the expression of S100A16 is associated with immune infiltration and may play an important role in promoting tumor cell immune escape in the RCC tumor microenvironment. S100A16 may influence the biological processes of RCC via the VEGF/VEGFR2 signaling route and PI3K-Akt signaling pathway and through P53 alteration and cell cycle according to the gene enrichment technique. In vitro cytological experiments demonstrated that S100A16 knockdown can inhibit the proliferation and migration of renal cancer cells and the expression levels of VEGF, VEGFR2, and phosphorylated AKT within renal cancer cells, thereby inhibiting angiogenesis in renal cancer cells and resulting in a poor prognosis of RCC. Conclusion: A decrease in S100A16 expression may dramatically increase the OS, PFI, and DSS of patients with RCC and may thus be used as a biomarker for predicting RCC. It may be associated with the immune infiltration of RCC and play a crucial role in the immune evasion of tumor cells within the RCC microenvironment. Intervention of s100a16 can promote the progression and angiogenesis of renal cell carcinoma through the VEGF/VEGFR2 signal transduction pathway and lead to poor prognosis of renal cell carcinoma. These findings suggest a potential target for the development of anticancer strategies for renal cancer.

Ultrasonography-assisted flexible ureteroscope for the treatment of parapelvic renal cysts: A comparison between the 1470-nm diode laser and the holmium laser.

The present study aimed to compare the efficacy and safety of a flexible ureteroscopic holmium laser incision with flexible ureteroscopic 1470-nm diode laser incision for the treatment of parapelvic renal cysts. The current study collected and analysing the clinical data of 90 independent renal cysts cases retrospectively, including 43 renal cysts cases that received holmium laser surgery (holmium laser group) and 47 renal cysts cases that received 1470-nm diode laser surgery (1470-nm diode laser group). Each group was divided into a thin-walled cyst subgroup and thick-walled cyst subgroup according to cyst wall thickness. Intracapsular hematoma was significantly lower in the 1470-nm diode laser group compared with the holmium laser group (0/47 vs. 4/43; P=0.048). The incision diameter in the 1470-nm diode laser group was significantly larger than the holmium laser group in the thick-walled parapelvic renal cysts subgroup [1.70(1.50,1.90) vs. 1.30(1.25,1.70) cm; P=0.007]. The renal cystic diameter of the two groups was markedly reduced one and six months after surgery. The difference was non-significant in the diameter of the renal cyst in the thin-walled cysts subgroups between the two laser groups 6 months after surgery (1.01±0.38 vs. 1.03±0.53 cm; P=0.454). However, the diameter of the renal cyst in the thick-walled cysts subgroup treated with the 1470-nm diode laser was significantly lower compared with the thick-walled cysts subgroup treated with the holmium laser 6 months after surgery (1.21±0.57 vs. 1.88±0.94 cm; P=0.002). The results demonstrated that the use of a 1470-nm diode laser or holmium laser surgery under a flexible ureteroscope is a safe and effective treatment for parapelvic renal cysts. For thick-walled parapelvic renal cysts, the 1470-nm diode laser appears to exhibit a lower postoperative recurrence rate and better long-term postoperative effects due to its improved haemostatic effect and larger intraoperative incision diameter.

A novel frameshift PKD1 mutation in a Chinese patient with autosomal dominant polycystic kidney disease and azoospermia: A case report.

Autosomal dominant polycystic kidney disease (ADPKD) is primarily caused by mutations in polycystin 1, transient receptor potential channel interacting (PKD1) and PKD2, and characterized by numerous cysts in various organs, primarily the kidneys and liver. The present case report is on a 33-year-old Chinese male patient who suffered from abdominal pain and hypertension, and presented with long-term infertility. Laboratory tests indicated that the patient had a normal renal function, while abdominal computed tomography demonstrated that the patient had enlarged kidneys with a volume of 1,127.21 cm3. In a semen analysis, no sperm was detected, while a subsequent testicular biopsy analysis demonstrated numerous mature sperms with progressive motility which suggests that the cysts of the epididymis and the dilated seminal vesicles may have obstructed the ejaculation of semen. Genetic testing identified that a novel missense mutation (c.9053delT) that was responsible for the disease. ADPKD has various disease severities, which depend on whether there is a PKD1 or PKD2 mutation and whether the mutation impairs the function of the polycystin protein. Therefore, genetic testing is important for the clinical diagnosis and prognosis of ADPKD patients, as well as prenatal diagnosis.

Polymorphism of MMP-9 gene is not associated with the risk of urinary cancers: Evidence from an updated meta-analysis.

OBJECTIVE: Matrix metalloproteinases 9 (MMP-9) is a zinc-dependent gelatinase, which could decrease the expression of extracellular matrix proteins and influence the metastatic behavior of tumors. In order to draw a comprehensive and precise result about the relationship of MMP-9 and urinary cancers, we presented the current meta-analysis. METHODS: We searched the PubMed, EMbase, Web of Science, CBM, CNKI and Wanfang databases, the cited references were also manually searched again, covering all the papers published until August 2018. Quality assessment was conducted using the Newcastle-Ottawa Scale. All the meta-analysis was conducted with Stata version 12.0 software to assess the strength of the association. Linkage disequilibrium (LD) analyses of gene polymorphisms and in-silico analysis of MMP-9 expression were also conducted to illustrate the relationship. RESULTS: 17 case-control studies comprise of more than 6154 cases and 6330 controls were enrolled and analyzed. After analyzed, we found that there is no significant association between rs3918241, rs2250889, rs17576 and rs17577 of MMP-9 and urinary cancers. LD analysis uncovered a significant LD between rs3918241 and rs17577 in CEU, CHB&CHS, ESN, and JPT populations (CEU: r2 = 1.0; CHB&CHS: r2 = 1.0; ESN: r2 = 0.74; JPT: r2 = 0.77), as well as a remarkable LD between rs17576 and rs2250889 in CHB&CHS and JPT populations (CHB&CHS: r2 = 0.81; JPT: r2 = 0.82). Furthermore, in-silico results indicated that the expression of MMP-9 in cancer tissue was higher than that in normal tissue in prostate cancer (Transcripts Per Kilobase Million (TPM) = 7.14 vs. 1.36, P < 0.001), bladder cancer (TPM = 14.2 vs. 2.47, P < 0.001), kidney renal clear cell carcinoma (TPM = 7.43 vs. 1.61, P < 0.001), kidney renal papillary cell carcinoma (TPM = 5.52 vs. 1.74, P = 0.002). CONCLUSIONS: rs3918241, rs2250889, rs17576 and rs17577 polymorphisms of MMP-9 are not associated with altered risk of urinary cancer. More studies with large sample size focused on the combined effect of two or more polymorphisms of MMP-9 are necessary in the future.

Canonical Wnt inhibitors ameliorate cystogenesis in a mouse ortholog of human ADPKD.

Autosomal dominant polycystic kidney disease (ADPKD) can be caused by mutations in the PKD1 or PKD2 genes. The PKD1 gene product is a Wnt cell-surface receptor. We previously showed that a lack of the PKD2 gene product, PC2, increases ß-catenin signaling in mouse embryonic fibroblasts, kidney renal epithelia, and isolated renal collecting duct cells. However, it remains unclear whether ß-catenin signaling plays a role in polycystic kidney disease phenotypes or if a Wnt inhibitor can halt cyst formation in ADPKD disease models. Here, using genetic and pharmacologic approaches, we demonstrated that the elevated ß-catenin signaling caused by PC2 deficiency contributes significantly to disease phenotypes in a mouse ortholog of human ADPKD. Pharmacologically inhibiting ß-catenin stability or the production of mature Wnt protein, or genetically reducing the expression of Ctnnb1 (which encodes ß-catenin), suppressed the formation of renal cysts, improved renal function, and extended survival in ADPKD mice. Our study clearly demonstrates the importance of ß-catenin signaling in disease phenotypes associated with Pkd2 mutation. It also describes the effects of two Wnt inhibitors, XAV939 and LGK974, on various Wnt signaling targets as a potential therapeutic modality for ADPKD, for which there is currently no effective therapy.

Transparenchymal Renal Pelvis Injection of Recombinant Adeno-Associated Virus Serotype 9 Vectors Is a Practical Approach for Gene Delivery in the Kidney.

Gene therapy has great potential in treating human diseases, but little progress has been made in preclinical and clinical studies of renal diseases. To find an effective gene delivery approach in the kidney, transparenchymal renal pelvis injection was developed. Using adeno-associated virus serotype 9 (AAV9) vectors, the gene delivery efficiency and safety of this administration method were evaluated. The results showed that the exogenous gene was expressed in the tubular epithelial cells of the injected kidney, with a much lower expression level in the contralateral kidney. Extra-renal transduction in the liver was also observed in this study, with the liver function of AAV9-injected mice comparable to that of control mice. Altogether, the administration of AAV9 vectors by newly established transparenchymal renal pelvis injection achieved the desired exogenous gene expression in renal tubular cells, and hence might be one possible way for gene therapy in renal diseases.