Comparison of urinary incontinence following three different prostate apex disconnection techniques in transurethral thulium laser prostatectomy.

OBJECTIVE: This study investigates the incidence of urinary incontinence following transurethral thulium laser prostatectomy with three different prostate apex disconnection techniques: semi-separation, pre-separation, and post-separation. The findings aim to provide references for clinical treatment. PATIENTS AND METHODS: A retrospective analysis was conducted on 74 patients treated with transurethral thulium laser prostatectomy for prostatic hyperplasia from April 2022 to March 2023. Complete clinical and follow-up data were available for 52 patients. Clinical and follow-up data were collected for these patients. A comparison was made of urinary incontinence following the three different types of prostate apex disconnection in transurethral thulium laser prostatectomy. RESULTS: In this study, the immediate postoperative urinary incontinence rate for transurethral thulium laser prostatectomy was 9.62% (5/52), the short-term incontinence rate was 11.54% (5/52), and the long-term incontinence rate was 9.62% (5/52). The immediate postoperative incontinence rates for semi-separation, pre-separation, and post- separation were 8.33% (1/12), 8.33% (2/24), and 12.5% (2/16), respectively. The short-term incontinence rates for semi-separation, pre-separation, and post-separation were 8.33% (1/12), 8.33% (2/24), and 18.75% (3/16), respectively. The long-term incontinence rates for semi-separation, pre-separation, and post-separation were 8.33% (1/12), 8.33% (2/24), and 12.5% (2/16), respectively. CONCLUSIONS: The incidence of urinary incontinence following transurethral thulium laser prostatectomy was lower with semi-separation and pre-separation compared to post-separation.

["Double Grooves-Double Rings" technique of transurethral Thulium laser enucleation of the prostate: learning curve of single surgeon].

Objective: To evaluate the learning curve of the "Double Grooves-Double Rings" (DGDR) technique of transurethral Thulium laser enucleation of the prostate (ThuLEP) for benign prostatic hyperplasia (BPH) by a single surgeon. From June 2021 to July 2022, 84 patients mean age (69.0±8.0) years,preoperative prostate volume (90.9±40.3)ml with BPH underwent ThuLEP in the Department of Urology, Peking University First Hospital.Performed by a single surgeon who had no experience of transurethral resection of prostate (TURP) and any laser surgeries. The case scatter plots with the best fitting line were drawn to analyze the learning curve. According to the date of the surgeries, the patients were equally divided into three learning stages (28 patients for each group). The T-PSA,prostate volume,operative time,enucleation time, enucleation efficiency,catheter indwelling time, hemoglobin drop and perioperative complications (including re-TURP, blood transfusion, stress incontinence≥3 months and urethral stricture) were compared among the groups. The learning curve was divided into three stages, and the cutting point was shown on the 14th case. Except the prostate volume [stage1 (75.7±30.7) ml, stage2 (93.40±39.6)ml, stage3 (103.5±46.2) ml, P<0.05], there was no significant difference of the baseline data between three groups (P>0.05). Compared with those of stage 1(100.6±24.7) min,(0.55±0.22) g/min, a statistically significant improvement was observed in both of the operative time and the enucleation efficiency among stage 2[(84.5±36.6) min, (0.87±0.33) g/min and stage 3 (71.2±26.3) min, (1.27±0.45) g/min, P<0.05]. The learning curve of the DGDR technique for ThuLEP can be divided into three stages. A ThuLEP beginner can preliminarily master this technique after completing 14 cases.

Analysis of risk factors for stone remnants and recurrence after lateral decubitus percutaneous nephrolithotomy.

OBJECTIVE: This study aims to explore the risk factors for stone remnants and recurrence after lateral decubitus percutaneous nephrolithotomy (PCNL), providing insights to enhance the stone-free rate and reduce the stone recurrence rate. PATIENTS AND METHODS: A retrospective analysis was conducted on 356 patients with renal or upper ureteral stones who underwent lateral decubitus PCNL from January 2015 to August 2022. Among them, 271 patients had complete clinical and follow-up data. General clinical information, perioperative data, and follow-up data were collected. Univariate and multivariate logistic regression analyses were performed to identify risk factors for stone remnants and recurrence after lateral decubitus PCNL. RESULTS: The stone-free rate after lateral decubitus PCNL was 88.6% (195/271), and the stone recurrence rate within three years was 28.1% (76/271). Stone size (p<0.001) and stone co-infection (p=0.047) were identified as independent risk factors for stone remnants after lateral decubitus PCNL. Multiple stones (p=0.003) were an independent risk factor for stone recurrence after lateral decubitus PCNL. CONCLUSIONS: Stone size and stone co-infection are independent risk factors for stone remnants after lateral decubitus PCNL. Multiple stones are an independent risk factor for stone recurrence after lateral decubitus PCNL.

[Trends in upper urinary tract reconstruction surgery over a decade based on a multi-center database].

OBJECTIVE: To study the trend of surgical type, surgical procedure and etiological distribution of upper urinary tract repair in recent 10 years. METHODS: The preoperative and perioperative variables and follow-up data of upper urinary tract reconstruction surgery in RECUTTER (Reconstruction of Urinary Tract: Technology, Epidemiology and Result) database from 2010 to 2021 were searched, collected and analyzed. The surgical type, surgical procedure, duration of hospitalization, time of operation, incidence of short-term complications, and proportion of the patients undergoing reoperations were compared between the two groups of 2010-2017 period and 2018-2021 period. RESULTS: A total of 1 072 patients were included in the RECUTTER database. Congenital factors and iatrogenic injuries were the main causes of upper urinary tract repair. Among them, 129 (12.0%) patients had open operation, 403 (37.6%) patients had laparoscopic surgery, 322 (30.0%) patients had robot-assisted laparoscopic surgery and 218 (20.3%) patients had endourological procedure. In the last decade, the total number of surgeries showed a noticeable increasing annual trend and the proportion of robot-assisted laparoscopic surgery in 2018-2021 was significantly higher than that in 2010-2017 (P < 0.001). The 1 072 patients included 124 (11.6%) cases of ileal ureter replacements, 440 (41.1%) cases of pyeloplasty, 229 (21.4%) cases of balloon dilation, 109 (10.2%) cases of ureteral reimplantation, 49 (4.6%) cases of boari flap-Psoas hitch surgery, 60 (5.6%) cases of uretero-ureteral anastomosis, 61 (5.7%) cases of lingual mucosal onlay graft ureteroplasty or appendiceal onlay flap ureteroplasty. Pyeloplasty and balloon dilatation had been the main types of surgery, while the proportion of lingual mucosal onlay graft ureteroplasty plus appendiceal onlay flap ureteroplasty had increased significantly in recent years (P < 0.05). In addition, the time of operation was significantly increased (P < 0.05) after 2018, which was considered to be related to the sharp increase in the proportion of robot-assisted laparoscopic surgery. We found that minimally invasive surgery (endourological procedure and robot-assisted laparoscopic surgery) as an independent risk factor (P=0.050, OR=0.472) could reduce the incidence of short-term post-operative complications. CONCLUSION: We have justified the value of the RECUTTER database, created by the Institute of Urology, Peking University in data support for clinical research work, and provided valuable experience for the construction of other multi-center databases at home and abroad. In recent 10 years, we have observed that, in upper urinary tract reconstruction surgery, the surgery type tends to be minimally invasive and the surgery procedure tends to be complicated, suggesting the superiority of robot-assisted laparoscopic surgery.

[Treatment of Siewert type II adenocarcinoma of the esophagogastric junction: the perspectives from thoracic surgery].

A greater controversy remains in clinical diagnosis and treatment of Siewert type II adenocarcinoma of esophagogastric junction (AEG), compared with Siewert type I and III AEG. In 2018, the first edition of Chinese Expert Consensus on the Surgical Treatment for Adenocarcinoma of Esophagogastric Junction was published in the Chinese Journal of Gastrointestinal Surgery. In the past few years, the advance in minimally invasive thoracoscopic surgery has been proven to reduce thoracic trauma in Siewert type II AEG. Meanwhile, distal thoracic esophagectomy can achieve more complete resection, and upper abdomen-right thoracic approach can ensure the mediastinal lymph node dissection and improve long-term survival. The concept and practice of endoscopic surgery and the comprehensive treatment also give new supplements to the treatment regimen of Siewert type II AEG. More clinical researches should be conducted to address the surgical residual safety and lymph node dissection issues.

[Correlation between preoperative inflammatory biomarkers and postoperative pneumonia or long-term prognosis in patients with esophageal cancer after neoadjuvant therapy].

Objective: To examine the correlation between neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR) and neutrophil-monocyte ratio (NMR) for postoperative pneumonia or long-term overall survival in patients with esophageal cancer after neoadjuvant therapy. Methods: The clinical data of 137 patients, including 111 males and 26 females, with the age of (M(QR))61(10) years (range: 45 to 75 years), undergoing radical resection of esophageal cancer after neoadjuvant therapy admitted at Department of Thoracic Surgery, West China Hospital from January 2016 to May 2019 were analyzed retrospectively. The blood routine one or two days before surgery and the occurrence of pneumonia after surgery were collected via hospital information system. The absolute count of neutrophils, lymphocytes and monocytes was recorded, to calculate NLR, LMR and NMR. The survival of patients was recorded systematically via follow-up. In the first part, the influencing factors of postoperative inflammation were analyzed, to group the patients into two groups according to the occurrence of postoperative pneumonia. χ2 test, t-test or rank-sum test were conducted for inter-group comparison. In the second part, cutoff values of inflammatory biomarkers were obtained with the receiver operating characteristic (ROC) curve and grouped, with postoperative pneumonia as endpoint criteria. Independent factors correlated with postoperative pneumonia were determined through univariate and multivariate Logistic regression analysis. In the third part, the analysis on prognosis factors was carried on, with the survival as endpoint criteria. Cutoff values of inflammatory biomarkers were obtained with X-Tile software and grouped. The survival analysis was carried on with univariate and multivariate Cox proportional hazards regression model, and the Kaplan-Meier curve was drawn finally. The results of survival analysis were verified by Log-rank test. Results: Median follow-up time was 614 (299) days (range: 382 to 1 612 days). Cutoff values of NLR, LMR, and NMR obtained via the ROC curve were 3.0, 3.9, and 6.2, respectively. According to the multivariate Logistic regression analysis, NLR>3.0 (OR=2.740, 95% CI: 1.221 to 6.152, P=0.015) and LMR>3.9 (OR=0.140, 95% CI: 0.022 to 0.890, P=0.037) were independent prognosis factors for postoperative pneumonia in patients with esophageal cancer after neoadjuvant therapy. Cutoff values of NLR, LMR, and NMR obtained with X-Tile software were 3.3, 4.2, and 7.2, respectively. Through multivariate Cox proportional risk regression analysis, late tumor ypTNM staging (8th AJCC) (HR=2.087, 95% CI:1.079 to 4.038, P=0.029), poor pathologic response (HR=2.251, 95% CI: 1.117 to 4.538, P=0.023), and LMR>4.2 (HR=0.347, 95% CI: 0.127 to 0.946, P=0.039) could be independent prognosis factors for overall survival. Kaplan-Meier survival analysis indicated that the overall survival of patients with LMR ≤4.2 was worse (P=0.002), with the 1-year overall survival rate of 82.9%, and the 1-year overall survival rate of patients with LMR>4.2 was 94.6%. Conclusion: Preoperative LMR ≤3.9 and NLR>3.0 can be considered as independent prognosis factors for postoperative pneumonia, while LMR≤4.2 as one of independent prognosis factors for overall survival.

[Application of three-dimensional digital subtraction angiography on hepatic artery chemoembolization].

Objective: To explore the clinical value of 3D-DSA technology in the diagnosis and treatment guidance of hepatic artery chemoembolization. Methods: Liver cancer patients in the treatment groups were collected to receive 3D-DSA imaging guidance at the Affiliated Hospital of Xuzhou Medical University between March and May 2017. In addition, routine 2D-DSA imaging was selected for treatment-received group. Intra-operative blood vessels and tumor-like lesions were observed. The total exposure dose (CAK, unit mGy), cumulative irradiation intensity per unit area (DAP, unit mGy.cm2) and dosage of contrast agent (ml) were calculated separately for two groups of patients. The same senior physicians and technicians operated both groups of patients. Comparisons of measurement were analyzed by t-test and chi-square test was used for count data. Results: Data of twenty patients were collected from the two groups. Tumor location, target vessels structure and shape of development were clear in all patients in the treatment group. The control group had 17 cases of tumor development and the target vascular structure was clear in 16 cases. CAK mean treatment group was lower than control group (554.11 + 38.87) mGy and (644.53 + 26.70) mGy, and DAP mean treatment group was lower than the control group (125.25 + 7.54) mGy·cm(2) and (143.49 + 6.18) mGy·cm(2). The two groups were compared (P value < 0.05), and the differences were statistically significant. The mean dose of contrast agent in the two groups were lower than control group (64.42 + 3.92) ml, (70.79 + 4.47) ml, and the differences between the two groups were statistically significant (P < 0.05). Conclusion: 3D-DSA imaging technology can provide effective diagnosis and guidance in the treatment of hepatic artery chemoembolization. It can effectively reduce the radiation exposure dose and radiation intensity, and it is of high clinical value for interventional embolization of liver cancer.

[Therapeutic effect of transcatheter arterial chemoembolization combined with ultrasound-guided microwave ablation for treatment of liver cancer in special sites].

Objective: To investigate the efficacy and clinical value of transcatheter arterial chemoembolization (TACE) combined with ultrasound-guided microwave ablation for the treatment of liver cancer in special sites. Methods: The patients with liver cancer in special sites (the liver cancer was adjacent to the gallbladder, dome of diaphragm, gastrointestinal tract, heart, great vessels, and portal vein, with the shortest distance from the tumor to the organ/lumen < 0.5 cm ) were enrolled as treatment group, and the patients with primary liver cancer in normal sites treated in our hospital during the same period were randomly enrolled as control group. They underwent TACE combined with ultrasound-guided microwave ablation. The 6-month, 12-month, 18-month and 24-month survival rates of the patients in two groups were analyzed. Results: The clinical data of 40 patients with liver cancer in special sites, including 9, 7, 5, 11, 3, 3, and 2 patients with liver cancer adjacent to the gallbladder, dome of diaphragm, gastrointestinal tract, portal vein, hepatic vein, inferior vena cava, and heart, respectively, and another 40 patients in control group were collected in the study. The negative rate of alpha-fetoprotein (AFP) was 83.3% in the treatment group and 82.8% in the control group. The 6-month, 12-month, 18-month, and 24-month survival rates were 100.0%, 95.0%, 90.0%, and 80.0%, respectively, in the treatment group, and 100.0%, 97.5%, 92.5%, and 85.0%, respectively, in the control group. Conclusion: TACE combined with ultrasound-guided microwave ablation is as effective for liver cancer in special sites as for those in normal sites, with high safety, and is feasible in clinical application.

The -665 C>T polymorphism in the eNOS gene predicts cardiovascular mortality and morbidity in white Europeans.

We recently identified rs3918226 as a hypertension susceptibility locus (-665 C>T), TT homozygosity being associated with higher hypertension risk. T compared with C allele transfected cells had lower endothelial nitric oxide synthase (eNOS) expression. In the family-based Flemish Study on Environment, Genes and Health Outcomes (50.9% women; mean age 40.3 years), we investigated whether 32 TT homozygotes had worse outcomes than 2787 C allele carriers. Over 15 years (median), total and cardiovascular mortality and cardiovascular and coronary events amounted to 269 (9.5%), 98 (3.5%), 247 (8.8%) and 120 (4.3%), respectively. While accounting for family clusters, the hazard ratios associated with TT homozygosity were 4.11 (P=0.0052) for cardiovascular mortality (4 deaths), 2.75 (P=0.0067) for cardiovascular events (7 endpoints) and 3.10 (P=0.022) for coronary events (4 endpoints). With adjustment for cardiovascular risk factors, these hazard ratios were 6.01 (P=0.0003), 2.64 (P=0.0091) and 2.89 (P=0.010), respectively. Analyses unadjusted for blood pressure and antihypertensive treatment produced consistent results. For all fatal plus nonfatal cardiovascular events, the positive predictive value, attributable risk and population-attributable risk associated with TT homozygosity were 21.9, 61.5 and 2.0%, respectively. In conclusion, TT homozygosity at the position -665 in the eNOS promoter predicts adverse outcomes, independent of blood pressure and other risk factors.

RPA1 expression in esophageal carcinoma and its influence on radiosensitivity of esophageal carcinoma TE-1 cells.

AIM: To determinate the RPA1 expression in esophageal carcinoma and the paired tumor-adjacent tissue, and to explore the influence of RPA1 on radiosensitivity of esophageal carcinoma TE-1 cells. METHODS: Firstly, the RPA1 expression of 40 cases esophageal carcinoma and their adjacent tissues were detected by immunohistochemistry. Secondly, The esophageal carcinoma cell subline-radiation resistance model (TE-1R) was constructed by radiation-induction, the RPA1 expression and proliferation activity of TE-1 and TE-1R cells were detected by Western blot and MTT assay respectively. After radiation, the expression of RPA1 and cell apoptosis were detected by Western blot and FACS respectively. Cell clone formation and survival rate were detected by clonogenic assay. Thirdly, Inhibiting RPA1 expression by siRNA in TE-1 cells, the expression of RPA1 was detected by RT-PCR and Western blot, Cell proliferation inhibition ratio and cell apoptosis after radiation were detected by MTT assay and FACS respectively. RESULTS: The RPA1 expression in esophageal carcinoma was significantly higher than that in the tumor-adjacent tissues, which was associated with tumor invasion and lymph node metastasis. The RPA1 expression in TE-1R cells was higher than that in TE-1 cells, while the proliferation activity of TE-1R cells was lower than that of TE-1 cells, and the apoptosis rate of TE-1R cells after radiation was less than that of TE-1 cells. In addtion, the clone formation and survival rate of TE-1R cells were higher than that of TE-1 cells. Moreover, inhibiting RPA1 expression by siRNA-RPA1 could promoted proliferation inhibition ratio and apoptosis rate of TE-1 cells after radiation. CONCLUSION: The over-expression of RPA1 in esophageal carcinoma was related with progression and metastasis. Moreover, radiation induced the excessive expression RPA1 in TE-1 cells, and the radiosensitivity of TE-1R cells was less than that of TE-1 cells. Furthermore, inhibiting RPA1 expression could increase radiosensitivity of TE-1 cells. Overall, RPA1 could influence radiosensitivity and might be one important mechanism of radiation resistance in TE-1 cells.

Strategy and long-term outcomes of endovascular treatment for Budd-Chiari syndrome complicated by inferior vena caval thrombosis.

OBJECTIVES: The aim of this study was to evaluate the strategy and long-term outcomes of endovascular treatment of Budd-Chiari syndrome (BCS) complicated by inferior vena cava (IVC) thrombosis. METHODS: The treatment strategy and outcomes of BCS complicated by IVC thrombosis were retrospectively evaluated in a single-center study. The treatment was aimed at the IVC thrombus, not hepatic vein occlusion. All 133 patients with BCS complicated by IVC thrombosis from February 2003 to March 2013 underwent endovascular treatment. For the fresh thrombus group (n=75) recanalization was performed after transcatheter thrombolysis with urokinase. For the mixed thrombus group (n=19) a small balloon pre-dilation of the IVC was performed first, followed by transcatheter thrombolysis using urokinase and a large balloon dilation of the IVC. For the old thrombus group (n=39) a large balloon dilation or/and stent placement was performed directly. Pre- and post-treatment follow-ups were recorded. RESULTS: The endovascular treatment was successful in 131 out of 133 patients (98.5%). Thirty seven patients had synchronous hepatic vein occlusion. The incidence of serious complications was 4.5% (6/133). Symptomatic pulmonary embolism occurred in three cases, cerebral hemorrhage in two, and cardiac tamponade in one. The cumulative 1-, 5-, and 10-year primary patency rate was 96.3%, 84.0%, and 64.6%, respectively. The cumulative 1-, 5-, and 10-year secondary patency rate was 99.0%, 96.1% and 91.3%, respectively. Segmental occlusion of the IVC and duration of anticoagulant therapy less than 6 months were independent risk factors for reocclusion. CONCLUSIONS: For patients with BCS complicated by IVC thrombosis, an individualized treatment strategy based on the property of the thrombus can result in excellent long-term patency.

Do level and variability of systolic blood pressure predict arterial properties or vice versa?

No longitudinal study addressed whether systolic blood pressure level (SBPL) or within-visit variability (SBPV) predict arterial properties or vice versa. In families randomly recruited from a Flemish population, we determined SBPL and SBPV from five consecutive blood pressure readings. The indexes of SBPV were variability independent of the mean, the difference between maximum and minimum SBPL, and average real variability. We measured carotid intima-media thickness and distensibility by ultrasound and carotid-femoral pulse wave velocity by tonometry (SphygmoCor, version 8.2). Effect sizes were computed for 1-s.d. increments in the predictors, while accounting for covariables and family clusters. Among 1087 participants (50.4% women; mean age, 41.8 years), followed up for 2.55 years (median), higher SBPL predicted (P < or = 0.019) higher carotid intima-media thickness (+15 µm), lower carotid distensibility (-1.53 10(-3) kPa(-1)) and faster carotid-femoral pulse wave velocity (+0.285 m s(-1)) at follow-up, whereas none of the SBPV indexes predicted the arterial traits at follow-up (P> or = 0.11). In a subset of 713 participants, followed up for another 3.14 years, lower carotid distensibility predicted (P<0.01) higher SBPL (+2.57 mm Hg), variability independent of the mean (+0.531 units), difference between maximum and minimum SBPL (+1.75 mm Hg) and average real variability (+0.654 mm Hg). Higher carotid-femoral pulse wave velocity predicted a 1.11 mm Hg increase SBPL (P=0.031). In conclusion, temporality and effect size suggest that SBPL but not within-visit SBPV cause arterial stiffness and carotid intima-media thickness. Carotid stiffness, independent of SBPL, predicts within-visit SBPV, possibly because baroreflexes originating from a stiff carotid artery wall are impaired. Finally, stiffness of the aorta contributes to the age-related SBPL possibly, because faster returning reflected waves augments SBPL.

Anti-arrhythmic effects of captopril on coronary occlusion and reperfusion periods in pigs.

Anti-arrhythmic effects of captopril (Cap) were studied in the anesthetized pigs using a reversible balloon catheter. Results showed that Cap did not exert any influence on the weight percentage of ischemic area to the whole left ventricle, on the levels of serum creatine kinase (CK) and creatine kinase isozyme (CK-MB), nor on the incidence and duration of transient and persistent tachycardia, but reduced the incidence of ventricular fibrillation (2/12, 1/12 in high-dose group pigs treated with Cap 6 mg.kg-1 in the first 10 min, 25 micrograms.kg-1.min-1 in the later 90 min and 12/21, 11/21 in control group treated with normal saline through the occlusion and reperfusion periods, respectively, P < 0.05). It was suggested that Cap did not exhibit direct (or non-specific, if any) effects on anti-arrhythmias.

Effect of obstructive jaundice on renal Na-K ATPase activity and ATP contents, their response to E. coli or endotoxin and effect of 1-6 fructose diphosphate.

A two-week bile duct ligation (BDL) in Sprague-Dawley (SD) rats raised the serum billirubin level and decreased the mean arterial blood pressure and renal cortical ATP contents compared with those in sham-operated (SO) rats (3.6 +/- 1.15 mg% vs 0.54 +/- 0.36, P less than 0.001; 69 +/- 24 mmHg vs 86 +/- 21, P less than 0.05; 3.72 +/- 0.86 x 10(-10) mol/mg tissue vs 7.27 +/- 0.18, P less than 0.05). No difference could be found in the medullary ATP contents (8.42 +/- 2.20 vs 8.70 +/- 2.80, P = NS). In SO rats, injection of endotoxin (0.7 mg/kg BW) and E. coli (3.1 x 10(5) bacteria/100 g BW) reduced cortical ATP content to 1.86 +/- 0.97 and 1.30 +/- 0.47 (P less than 0.001), and medullar ATP to 1.33 +/- 0.31 and 2.12 +/- 0.46 (P less than 0.001) respectively. In BDL rats, the same treatment led to further decrease in cortical ATP to 1.25 +/- 0.40 and 0.62 +/- 0.20, medullary ATP to 0.97 +/- 0.41 and 1.64 +/- 0.83 (P less than 0.001). Basal Na-K ATPase activity in BDL is the same compared with that in SO both in the cortex (2.85 +/- 2.2 mumol/mgpr/h vs 2.19 +/- 0.75; P = NS) and medulla (2.79 +/- 1.83 vs 3.05 +/- 1.38; P = NS).(ABSTRACT TRUNCATED AT 250 WORDS)