Better timing for HoLEP: a retrospective analysis of patients treated with HoLEP over a 10-year period with a 1-year follow-up.

The aim of this study was to explore the optimal timing of holmium laser enucleation of the prostate (HoLEP) in patients presenting benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS). A retrospective analysis was conducted based on the perioperative and postoperative outcome data of 1212 patients who underwent HoLEP in Shanghai Ninth People's Hospital (Shanghai, China) between January 2009 and December 2018. According to the preoperative International Prostate Symptom Score (IPSS), all patients whom we analyzed were divided into Group A (IPSS of 8-18) and Group B (IPSS of 19-35). Peri- and postoperative outcome data were obtained during the 1-year follow-up. IPSS changes were the main postoperative outcomes. The postoperative IPSS, quality of life, peak urinary flow rate, postvoid residual, and overactive bladder symptom score (OABSS) improved significantly. The IPSS improved further in the group with severe LUTS symptoms, but the postoperative IPSS was still higher than that in the moderate LUTS group. OABSSs showing moderate and severe cases after follow-up were more frequent in Group B (9.1%) than in Group A (5.2%) (P < 0.05). There were no significant intergroup differences in the intraoperative American Society of Anesthesiologists or hospitalization expense scores, and the medication costs, as well as the total costs, were significantly higher in Group B. In this retrospective study, HoLEP was an effective treatment for symptomatic BPH. For patients with LUTS, earlier surgery in patients with moderate severity may result in a marginally better 12-month IPSS than that in men with severe symptoms.

"Fenestration and Tunnel Method" a Modification for the Holmium Laser Transurethral Prostatectomy of Large-Volume Prostates >80 ml: A Retrospective Study Based on 1-Year Follow-Up.

The purpose of this study was to promote the holmium laser enucleation of the prostate (HoLEP) technology for large-volume prostates (>80 ml) and compare it with the traditional method, we modified the technique and applied this technology to clinical practice. A retrospective study comprising 118 patients who underwent HoLEP surgery from February 2018 to December 2019 was conducted in our center. Group A consisted of 57 patients with large-volume prostate (>80 ml) who received modified "fenestration and tunnel method" from February 2019 till December 2019, while group B consisted of 61 patients who received the traditional trivalvular operation method from February 2018 to December 2018 for comparison. Control subjects are selected such that they match the cases concerning certain characteristics, and perioperative data, voiding outcomes, and complications were evaluated at 1- and 12-month follow-up. The international prostatic symptomatic score (IPSS), quality of life (QoL), and maximum flow rate (Qmax) at 1 month and 12 months were both significantly improved compared with the preoperative baseline, and no significant differences were found between Groups A and B. The mean enucleation time, operation time, catheter indwelling duration, and hemoglobin decrease during the operation of Group A showed superiority compared with Group B (p<.05). The modified "fenestration and tunnel method" of HoLEP was statistically superior to the traditional trivalvular method in terms of the operation time, enucleation time, catheter indwelling duration, and hemoglobin decrease. For large-volume prostates (>80 ml), modified HoLEP was suggested to be a better treatment option.

Comparison of comfort and complications of Implantable Venous Access Port (IVAP) with ultrasound guided Internal Jugular Vein (IJV) and Axillary Vein/Subclavian Vein (AxV/SCV) puncture in breast cancer patients: a randomized controlled study.

BACKGROUND: Axillary vein/subclavian vein (AxV/SCV) and Internal jugular vein (IJV) are commonly used for implantable venous access port (IVAP) implantation in breast cancer patients for chemotherapy. Previous research focused on comparison of complications while patient comfort was ignored. This study aims to compare patient comfort, surgery duration and complications of IVAP implantation between IJV and AxV/SCV approaches. METHODS: Two hundred forty-eight breast cancer patients were enrolled in this randomized controlled study from August 2020 to June 2021. Patients scheduled to undergo IVAP implantation were randomly and equally assigned to receive central venous catheters with either AxV /SCV or IJV approaches. All patients received comfort assessment using a comfort scale table at day 1, day 2 and day 7 after implantation. Patient comfort, procedure time of operation as well as early complications were compared. RESULTS: Patient comfort was significantly better in the AxV/SCV group than that of IJV group in day 1 (P < 0.001), day 2 (P < 0.001) and day 7(P = 0.023). Procedure duration in AxV/SCV group was slightly but significantly shorter than IJV group (27.14 ± 3.29 mins vs 28.92 ± 2.54 mins, P < 0.001). More early complications occurred in AxV/SCV group than IJV group (11/124 vs 2/124, P = 0.019). No difference of complications of artery puncture, pneumothorax or subcutaneous hematoma between these two groups but significantly more catheter misplacement in AxV/SCV group than IJV group (6/124 vs 0/124, P = 0.029). Absolutely total risk of complications was rather low in both groups (8.87% in AxV/SCV group and 1.61% in IJV group). CONCLUSIONS: Our study indicates that patients with AxV/SCV puncture have higher comfort levels than IJV puncture. AxV/SCV puncture has shorter procedure duration but higher risk of early complications, especially catheter misplacement. Both these two approaches have rather low risk of complications. Consequently, our study provides an alternative choice for breast cancer patients to reach better comfort.

[Clinical efficiency of holmium laser enucleation of the prostate for small-volume benign prostatic hyperplasia with severe LUTS].

OBJECTIVE: To evaluate the safety and clinical efficiency of holmium laser enucleation of the prostate (HoLEP) in the treatment of small-volume BPH (SBPH) complicated by severe lower urinary tract symptoms (LUTS). METHODS: We retrospectively analyzed the clinical data on 82 cases of SBPH with severe LUTS treated by HoLEP from January 2017 to December 2018. The patients were aged (65.5 ± 7.6) years, with a mean prostate volume of <40 ml, a total IPSS of 24.8 ± 4.6, a QOL score of 5.2 ± 0.8, the maximum urinary flow rate (Qmax) of (7.6 ± 3.7) ml/s, and a mean PSA level of (1.8 ± 1.4) µg/L. RESULTS: All the operations were successfully completed, the mean operation time averaging (30.2 ± 5.0) min, enucleation time (26.7 ± 5.6) min and comminution time (3.5 ± 1.1) min, and the enucleated tissue weighing (20.3 ± 4.9) g. After surgery, the bladders were irrigated for (3.5 ± 1.9) h, with (3.0 ± 1.7) L of rinse solution, and catheterization lasted (24.8 ± 9.7) h. Histopathology revealed moderate or severe lymphocytic infiltration in 69 cases (84.1%). At 6 months after operation, significant improvement was observed in the IPSS, QOL, Qmax and PSA level compared with the baseline (P < 0.05). To date, no urethral stricture-related reoperation was ever necessitated. CONCLUSIONS: HoLEP is safe and effective for the treatment of SBPH complicated by severe LUTS and can be employed after adequate preoperative evaluation of the patient.《.

Biotic shortcut deselenization coupled to abiotic sulfide oxidation enabled pollutants co-removal and products recovery.

Selenate and sulfide are both contaminants which severely pollute water bodies. Respective bioremediation of selenate- and sulfide-contaminated wastewaters requires abundant electron donors and acceptors. Here, we present a novel concept coupling biological selenate to selenite (shortcut deselenization) and chemical sulfide-driven selenite reduction, to remove multiple pollutants simultaneously. Vial tests showed that shortcut deselenization could save at least two thirds of operation time and one third of carbon source, compared to the complete deselenization to elemental selenium. Subsequent co-removal of sulfide and selenite was optimized at reaction pH of ∼10 and reactant molar ratio of ∼4. Using a newly-designed continuous flow system, >95% removal of both selenate and sulfide was achieved by coupling shortcut deselenization to sulfide oxidation. A series of characterization tools revealed that the final collected precipitates were comprised of high-purity hexagonal selenium (97.4%, wt) and inconsiderable sulfur (2.6%, wt). Superior over selenate-reducing solutions generally producing selenium mixed with reagents or microorganisms, the selenium products generated here were highly purified thus very favorable for further recovery and reuse. Overall, this proof-of-concept study provided a promising technology not only for co-removal of multiple pollutants, but also for substantial costs saving, as well as for valuable products recovery.

TGF-ß1 promotes epithelial-to-mesenchymal transition and stemness of prostate cancer cells by inducing PCBP1 degradation and alternative splicing of CD44.

CD44 is a marker of cancer stem cell (CSC) in many types of tumors. Alternative splicing of its 20 exons generates various CD44 isoforms that have different tissue specific expression and functions, including the CD44 standard isoform (CD44s) encoded by the constant exons and the CD44 variant isoforms (CD44v) with variant exon insertions. Switching between the CD44v and CD44s isoforms plays pivotal roles in tumor progression. Here we reported a novel mechanism of CD44 alternative splicing induced by TGF-ß1 and its connection to enhanced epithelial-to-mesenchymal transition (EMT) and stemness in human prostate cancer cells. TGF-ß1 treatment increased the expression of CD44s and N-cadherin while decreased the expression of CD44v and E-cadherin in DU-145 prostate cancer cells. Other EMT markers and cancer stem cell markers were also upregulated after TGF-ß1 treatment. RNAi knockdown of CD44 reversed the phenotype, which could be rescued by overexpressing CD44s but not CD44v, indicating the alternatively spliced isoform CD44s mediated the activity of TGF-ß1 treatment. Mechanistically, TGF-ß1 treatment induced the phosphorylation, poly-ubiquitination, and degradation of PCBP1, a well-characterized RNA binding protein known to regulate CD44 splicing. RNAi knockdown of PCBP1 was able to mimic TGF-ß1 treatment to increase the expression of CD44s, as well as the EMT and cancer stem cell markers. In vitro and in vivo experiments were performed to show that CD44s promoted prostate cancer cell migration, invasion, and tumor initiation. Taken together, we defined a mechanism by which TGF-ß1 induces CD44 alternative splicing and promotes prostate cancer progression.

Comparison of comfort and complications in breast cancer patients of implantable venous access port (IVAP) with ultrasound guided internal jugular vein (IJV) and axillary vein/subclavian vein (AxV/SCV) puncture: a randomized controlled study protocol.

BACKGROUND: Internal jugular vein (IJV) and axillary vein/subclavian vein (AxV/SCV) are commonly used for implantable venous access port (IVAP) implantation in breast cancer (BC) patients with chemotherapy. Previous studies focused on complications between these different approaches and ignored patient comfort. In this study, we aim to compare patient comfort between IJV and AxV/SCV approaches, as well as surgery duration and complications. METHODS: This is a single-center prospective randomized controlled clinical trial. A total of 200 patients diagnosed with invasive BC will be enrolled in this study. After signing written informed consent, patients schedule to undergo IVAP implantation will be randomized at a 1:1 ratio to receive central venous catheters (CVC) with either IJV or AxV/SCV approaches. Baseline as well as demographic data and procedure time of port implantation will be recorded. All patients will receive assessment of comfort with a comfort scale table at days 1, 2 and 7 after implantation surgery. Patients will be followed up and complications will be recorded until devices are removed at the end of the treatment period, or in case of complications. Patient comfort, procedure time of implantation and complications will be compared and analyzed between these two arms. DISCUSSION: To the best of our knowledge, this is the first study to compare patient comfort as primary outcome measure between IJV and AxV/SCV puncture. This study will further confirm the benefits of ultrasound guidance and may provide a better choice of IVAP implantation for BC patients. TRIAL REGISTRATION: This study has been registered at Chinese Clinical Trial Registry (ChiCTR, www. chictr.org.cn) and Chinese Ethics Committee of Registering Clinical Trials (No. ChiCTR2000034986).

[Shovel-shaped electrode transurethral plasmakinetic enucleation versus plasmakinetic resection of the prostate in the treatment of benign prostatic hyperplasia].

OBJECTIVE: To compare the safety and effectiveness of shovel-shaped electrode transurethral plasmakinetic enucleation of the prostate (PKEP) with those of plasmakinetic resection of the prostate (PKRP) in the treatment of benign prostatic hyperplasia (BPH). METHODS: We retrospectively analyzed the clinical data about 78 BPH patients received in Shanghai Ninth People's Hospital from June 2016 to January 2017, 39 treated by shovel-shaped electrode PKEP and the other 39 by PKRP. We observed the patients for 6 months postoperatively and compared the effects and safety of the two surgical strategies. RESULTS: No statistically significant difference was observed between the PKEP and PKRP groups in the operation time (ï¼»69.3 ± 8.8ï¼½ vs ï¼»72.2 ± 7.9ï¼½ min, P = 0.126), but the former, as compared with the latter, showed a markedly less postoperative loss of hemoglobin (ï¼»3.9 ± 2.8ï¼½ vs ï¼»13.9 ± 5.2ï¼½ g/L, P <0.001) and shorter bladder irrigation time (ï¼»12.5 ± 1.2ï¼½ vs ï¼»43.4 ± 2.8ï¼½ h, P <0.001), catheterization time (ï¼»64.0 ± 4.5ï¼½ vs ï¼»84.8 ± 3.0ï¼½ h, P <0.001) and hospital stay (ï¼»3.1 ± 0.3ï¼½ vs ï¼»5.5 ± 0.4ï¼½ d, P <0.001). There were no statistically significant differences between the PKEP and PKRP groups in the postoperative maximum urinary flow rate (Qmax) (ï¼»21.62 ± 1.07ï¼½ vs ï¼»21.03 ± 0.96ï¼½ ml/s, P = 0.12), International Prostate Symptoms Score (IPSS) (5.85 ± 0.90 vs 6.03 ± 0.81, P = 0.279), quality of life score (QoL) (2.0 ± 0.73 vs 2.28 ± 0.72, P = 0.09), postvoid residual urine volume (PVR) (ï¼»19.59 ± 6.01ï¼½ vs ï¼»20.21 ± 5.16ï¼½ ml, P = 0.629), or the incidence rates of urinary incontinence (2.56% ï¼»1/39ï¼½ vs 7.69% ï¼»3/39ï¼½, P >0.05) and other postoperative complications. CONCLUSIONS: Both PKEP and PKRP are effective methods for the treatment of BPH, but PKEP is worthier of clinical recommendation for a better safety profile, more thorough removal of the prostate tissue, less blood loss, shorter hospital stay, and better improved quality of life of the patient.

[Mixed amanita phalloides poisoning with rhabdomyolysis: analysis of 4 cases].

We report the clinical characteristics, treatments and outcomes of 4 rare cases of mixed amanita fuliginea and amanita rimosa poisoning with rhabdomyolysis, and review the research progress in the intoxication mechanism and treatment. The latent time of amanita poisoning, defined as the period from the ingestion of poisonous mushroom to the onset of gastrointestinal symptoms, was about 8 days, and the severity of poisoning was associated with the amount of mushroom ingested. All the 4 patients developed multiple organ dysfunctions within 3 to 4 days after mushroom ingestion, predominantly in the liver, kidney and central nervous system accompanied with acute gastrointestinal injury and rhabdomyolysis. The treatment measures included persistent hemofiltration and intermittent hemoperfusion once daily for 5-7 days, and plasma exchange was administered in 2 cases for 1 or 2 times. High-dose vitamin C, glucose and corticosteroid were also given to the patients. After the treatments, two patients were cured and the other two died due to an excess intake of poisonous mushroom and lack of early preemptive therapies. Early emetic, gastric lavage, catharsis, fluid infusion and diuresis are critical to interrupt the enterohepatic circulation of amanita phalloides toxins and prevent the development of multiple organ dysfunction. Enhanced hemofiltration and sequential plasma therapy might effectively eliminate toxin from the blood to protect against further organ damages.

Comparison of Vela and holmium laser enucleation of the prostate: a retrospective clinical trial with a 12-month follow-up.

PURPOSE: This study aimed to estimate the validity and applicability of Vela laser enucleation of the prostate (VoLEP) in the management of benign prostatic hyperplasia (BPH). METHODS: A retrospective chart review of 112 patients with BPH who underwent VoLEP (n = 60) or holmium laser enucleation of the prostate (HoLEP) (n = 56) was conducted at our institution from January 2015 to June 2015. The general and perioperative characteristics of the patients were collected. The 12-month follow-up data, including the lower urinary tract symptom (LUTS) indexes (International Prostate Symptom Score [I-PSS], quality-of-life [QoL] score and maximum flow rate [Qmax]), as well as rates of perioperative and late complications, were analyzed. RESULTS: No significant differences were observed in pre- and perioperative parameters, including operation time (58.05 ± 10.14 vs. 60.14 ± 12.30 min, P = 0.44), serum sodium decrease (3.49 ± 0.83 vs. 3.48 ± 0.84 mmol/L, P = 0.97), hemoglobin decrease (1.28 ± 0.38 vs. 1.24 ± 0.77 g/dL, P = 0.71), catheterization time (3.63 ± 1.10 vs. 3.89 ± 1.11 days, P = 0.21) and hospital stay (4.57 ± 1.25 vs. 4.68 ± 1.18 days, P = 0.63) between the two groups of patients. Compared with the HoLEP group, the noise during operation was lower in VoLEP group (47.22 ± 10.31 vs. 59.45 ± 9.65 db, P < 0.05). During 1, 6 and 12 months of follow-up visits, the LUTS indexes (I-PSS, QoL score and Qmax) were remarkably improved in both groups when comparing with the baseline values. Furthermore, LUTS indexes were comparable in both groups (P > 0.05). CONCLUSION: Similarly as the holmium laser, the Vela laser is a potent, safe, efficient durable and surgical treatment option for minimally invasive surgery in patients with BPH-induced LUTS.

[Modified transobturator bulbourethral sling suspension for the treatment of stress urinary incontinence after radical prostatectomy].

OBJECTIVE: To evaluate the clinical effect of modified transobturator bulbourethral sling suspension (TBSS) in the treatment of stress urinary incontinence following radical prostatectomy. METHODS: Seven male patients with stress urinary incontinence after radical prostatectomy were treated by modified TBSS in our hospital from June 2015 to June 2017 and the clinical data were analyzed retrospectively. RESULTS: The mean operation time of the 7 cases was 60－80 minutes and the mean intra-operative blood loss was 20－40 m1. The catheter was removed on the first day after surgery, and all the incisions were healed in stage Ⅰ. During a follow-up of 6－18 months, all the 7 cases were found cured, with transient acute urinary retention in 1 case and short-term perineal pain in another as post-operative complications. At 6 months after surgery, urodynamic examinations showed no statistically significant differences from the baseline in the maximum urinary flow rate (ï¼»15.0 ± 1.6ï¼½ vs ï¼»13.7 ± 2.1ï¼½ ml/s, P > 0.05), urine output volume (ï¼»318.6 ± 52.1ï¼½ vs ï¼»298.6 ± 36.3ï¼½ ml, P > 0.05), and postvoid residual urine volume (ï¼»11.4 ± 9.4ï¼½ vs ï¼»7.1 ± 5.7ï¼½ ml, P > 0.05). CONCLUSIONS: Modified TBSS, with the advantages of less invasiveness, few complications, and low cost, is an effective option for the treatment of stress urinary incontinence after radical prostatectomy.

A Low-Toxicity DNA-Alkylating N-Mustard-Quinoline Conjugate with Preferential Sequence Specificity Exerts Potent Antitumor Activity Against Colorectal Cancer.

Efficacy and safety are fundamental prerequisites for anticancer drug development. In the present study, we explored the anti-colorectal cancer (CRC) activity of SL-1, a DNA-directed N-mustard-quinoline conjugate. The N-mustard moiety in SL-1 induced DNA strand breaks, interstrand cross-links (ICLs), G2/M arrest, and apoptosis, whereas its quinoline moiety preferentially directed SL-1 to target the selective guanine sequence 5'-G-G/C-N-G-C/T-3'. Notably, SL-1 was highly cytotoxic to various CRC cell lines. Experiments using xenograft models revealed that SL-1 was more potent than 5-fluorouracil (5-FU) and oxaliplatin for suppressing the growth of RKO and RKO-E6 (oxaliplatin-resistant subline) cells as well as metastatic SW620 cells. In addition, SL-1 combined with 5-FU was more effective than oxaliplatin and 5-FU for suppressing RKO or SW620 cell growth in mice. Significantly, compared with cisplatin, oxaliplatin, or 5-FU, SL-1 alone or in combination with 5-FU did not cause obvious kidney or liver toxicity in ICR mice. In summary, SL-1, a DNA-directed alkylating agent, is established as an anti-CRC agent with high efficacy and low toxicity and thus warrants further development for the treatment of CRC patients.

Comparison of Holmium Laser Enucleation and Plasmakinetic Resection of Prostate: A Randomized Trial with 72-Month Follow-Up.

PURPOSE: To evaluate the long-term and flexible cystourethroscopy results of holmium laser enucleation of the prostate (HoLEP) and to compare them with those of plasmakinetic resection of the prostate (PKRP). METHODS: In the long-term follow-up, variables, including the international prostatic symptomatic score, quality of life scores, maximum flow rate (Qmax), and international index of erectile function (IIEF), and the adverse events, including the need for retreatment, were specifically assessed. One hundred twenty-two HoLEP and 119 PKRP of the initial 280 patients included in this study were available, with 10 deceased and 29 lost to follow-up. RESULTS: We found that none of the assessable patients required reoperation for recurrent benign prostatic enlargement (BPE) in the HoLEP group, whereas two required reoperation in the PKRP group. There were no significant differences in most variables between the two groups in the long-term results. But in terms of Qmax, transrectal ultrasound prostate volume, prostate specific antigen (PSA) level, IIEF-5 score, and long-term posttrial follow-up of flexible cystourethroscopy, the HoLEP group showed better results. CONCLUSION: The long-term follow-up data of this randomized trial confirm that HoLEP and PKRP are both effective and durable surgical interventions for the treatment of lower urinary tract symptoms due to BPE. Given the clinically relevant advantages associated with HoLEP, the alternation of PSA level, sexual function, and urination can be improved.

Sulforaphane Treatment of Stress Urinary Incontinence Via the Nrf2-ARE Pathway in a Rat Model.

BACKGROUND/AIMS: To explore the effect of sulforaphane (SFN) treatment in rats through the induction of Stress Urinary Incontinence (SUI) via the Nrf2-ARE pathway. METHODS: A total of 18 female rats (Sprague-Dawley) were assigned to three groups: a control group, an SUI group, and an SUI+SFN group (six rats per group). Rats in the treatment groups were induced via postpartum vaginal balloon dilation and bilateral ovariectomy. Rats in the SUI+SFN group were treated via intraperitoneal injection once per day for a total of one month. Urethral sphincter muscle histological was observed by HE and Masson staining. Peak voiding pressure and interval of micturition were measured by cystometry. Oxidative stress markers and protein expression in the Nrf2-ARE pathway were examined by immunohistochemical staining and western blotting. RESULTS: Prolonged micturition interval and higher peak voiding pressure were observed in the SUI+SFN group. Disturbance of muscle morphology was ameliorated, muscle content was elevated, and collagen content was restrained in response to SFN treatment. The SOD, GSH-Px, and CAT activities were elevated in the SUI+SFN group compared to those in the control group. The level of cell apoptosis was decreased in SUI rats after SFN treatment; however, apoptosis was mainly located in the urethral mucosa instead of the muscle layer. SFN reduced the Bax/Bcl-2 expression ratio. Nrf2 and Nrf2 target antioxidant proteins were elevated in the SFN group. CONCLUSIONS: SFN was effective for SUI treatment via decreasing oxidative stress and activating the Nrf2-ARE pathway.

Evaluation of noise hazard during the holmium laser enucleation of prostate.

BACKGROUND: To evaluate noise hazard during holmium laser enucleation of the prostate (HoLEP), we designed a study to detect such a risk in this procedure. METHODS: This study was conducted over a 12-month period on 223 patients with benign prostatic hyperplasia (BPH), 121 of whom underwent HoLEP while those remaining underwent transurethral resection of the prostate (TURP). A sound level meter was used to detect the exposure of surgeons to noise. The recordings used were in accordance with the standards set by the Occupational Safety and Health Administration (OSHA) and the United States E nvironmental Protection A gency . Moreover, each of the 43 surgeons participating in a BPH discussion conference answered the questionnaire on the influence of noise, and 33 surgeons in our department volunteered for blood pressure monitoring post-surgically. RESULTS: The sound level produced by a high-powered holmium laser emitter during HoLEP was 67.37 ± 0.13 dB, which was significantly higher than the sound heard during TURP (46.41 ± 0.29 dB, P < 0.01). The 65-70 dB noise during HoLEP was proved to be a safe level in accordance with the OSHA standards. However, this level was considerably greater than the stated 55 dB. Moreover, it exceeded the normal communication protective level of 60 dB. In the analysis of responses from the surgeons, the HoLEP group obtained an average score that reflected disturbance caused by the laser emitter and an increase in average systolic pressure relative to that in the TURP group. CONCLUSIONS: The noise level during HoLEP is within hearing conservation levels. However, the noise disturbs intrateam communication and concentration during surgery. Some surgeons may experience discomfort post-surgically, but no significant difference among the groups is indicated. The findings suggest that measures should be taken to address the noise caused by the laser emitter during HoLEP.

["3+1" bladder function restoration combined with holmium laser enucleation of the prostate for benign prostatic hyperplasia with acontractile detrusor].

OBJECTIVE: To investigate the clinical effect of "3+1" bladder function restoration combined with holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) with acontractile detrusor (ACD). METHODS: We treated 35 BPH patients with ACD by HoLEP followed by "3+1" bladder function restoration, that is, a 3-phase bladder function training plus simultaneous 1-drug medication after surgery. We recorded and analyzed the detrusor pressure, post-void residual urine volume (PVR), maximum urinary flow rate (Qmax), International Prognostic Scoring System (IPSS) scores, quality of life (QoL), voluntary micturition, satisfaction with the bladder function, hydronephrosis, ureterectasia, renal function, and urinary tract infection of the patients before and after treatment. RESULTS: Compared with the base line, at 6 months treatment, the patients showed significantly increased detrusor pressure (ï¼»35.1±2.7ï¼½vs ï¼»50.2±2.3ï¼½ cmH2O, P<0.05) and Qmax (ï¼»4.2±2.7ï¼½vs ï¼»21.1±4.1ï¼½ ml/s, P<0.05) but decreases in PVR (ï¼»173.0±31.6ï¼½ vs ï¼»30.5±12.9ï¼½ml, IPSS score (27.3±3.2 vs 5.1±1.4, P<0.05) and QoL (4.1±0.8 vs 0.8±0.1, P<0.05), elevated rates of voluntary urination (0% ï¼»0/35ï¼½ vs 100% ï¼»35/35ï¼½, P<0.05), regularurination (0% ï¼»0/35ï¼½ vs 85.71% ï¼»30/35ï¼½, P<0.05), grade Ⅰ satisfaction with bladder function (0% ï¼»0/35ï¼½ vs 85.71% ï¼»30/35ï¼½, P<0.05), reduced rate of overflowing urinary incontinence (28.57% ï¼»10/35ï¼½ vs 5.71% ï¼»2/35ï¼½, P<0.05), and increased percentages of normal renal function (34.29% ï¼»12/35ï¼½ vs 85.71% ï¼»30/35ï¼½, P<0.05) and non-infection of the urinary system (17.14% ï¼»6/35ï¼½ vs 94.29% ï¼»33/35ï¼½, P<0.05). After treatment, urination was markedly improved in 94.29% (33/35) of the patients. CONCLUSIONS: "3+1" bladder function restoration combined with HoLEP produced a desirable effect on BPH with ACD, though its long-term effect remains to be further investigated.

Elevation of ß-galactoside α2,6-sialyltransferase 1 in a fructoseresponsive manner promotes pancreatic cancer metastasis.

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive type of pancreatic cancer with clinical characteristics of local invasion and early metastasis. Recent cohort studies indicate high fructose intake is associated with an increase in pancreatic cancer risk. However, the mechanisms by which fructose promotes pancreatic tumorigenesis remain unclear. Herein, Kras+/LSLG12D mice were crossed with Elas-CreER transgenic mice to determine whether fructose intake directly contributes to tumor formation. Orthotopic tumor-xenograft experiments were performed to determine whether fructose substitution enhances the metastatic potential of PDAC cells. The mechanisms underlying the effects of fructose were explored by RNAseq analysis in combination with high-performance anion exchange chromatography. Dietary fructose was initially found to promote the development of aggressive pancreatic cancer in mice conditionally expressing KrasG12D in the adult pancreas. We further revealed that fructose substitution enhanced the metastatic potential of human PDAC cell via selective outgrowth of aggressive ABCG2-positive subpopulations and elevating N-acetylmannosamine levels that upregulated ß-galactoside α2,6-sialyltransferase 1 (ST6Gal1), thereby promoting distant metastasis. Finally, we observed that PDAC patients expressing higher levels of ST6Gal1 and GLUT5 presented poorer prognosis compared to other groups. In conclusion, our findings have elucidated a crucial role of ST6Gal1 in regulating the invasiveness of PDACs in a fructose-responsive manner.

SPOCK1 promotes tumor growth and metastasis in human prostate cancer.

Prostate cancer is the most diagnosed noncutaneous cancer and ranks as the second leading cause of cancer-related deaths in American males. Metastasis is the primary cause of prostate cancer mortality. Survival rate is only 28% for metastatic patients, but is nearly 100% for patients with localized prostate cancers. Molecular mechanisms that underlie this malignancy remain obscure, and this study investigated the role of SPARC/osteonectin, cwcv, and kazal-like domain proteoglycan 1 (SPOCK1) in prostate cancer progression. Initially, we found that SPOCK1 expression was significantly higher in prostate cancer tissues relative to noncancerous tissues. In particular, SPOCK1 expression was also markedly high in metastatic tissues compared with nonmetastatic cancerous tissues. SPOCK1 expression knockdown by specific short hairpin RNA in PC3 cells was significantly inhibited, whereas SPOCK1 overexpression in RWPE-1 cells promoted cell viability, colony formation in vitro, and tumor growth in vivo. Moreover, the SPOCK1 knockdown in PC3 cells was associated with cell cycle arrest in G0/G1 phase, while the SPOCK1 overexpression in RWPE-1 cells induced cell cycle arrest in S phase. The SPOCK1 knockdown in PC3 cells even increased cell apoptosis. SPOCK1 modulation was also observed to affect cancerous cell proliferation and apoptotic processes in the mouse model of prostate cancer. Additionally, the SPOCK1 knockdown decreased, whereas the SPOCK1 overexpression increased cell migration and invasion abilities in vitro. Injection of SPOCK1-depleted PC3 cells significantly decreased metastatic nodules in mouse lungs. These findings suggest that SPOCK1 is a critical mediator of tumor growth and metastasis in prostate cancer.

Risk of Chronic Low Back Pain Among Parturients Who Undergo Cesarean Delivery With Neuraxial Anesthesia: A Nationwide Population-Based Retrospective Cohort Study.

To investigate the risk of chronic low back pain (LBP) in parturients undergoing cesarean delivery (CD) with neuraxial anesthesia (NA). LBP is common during pregnancy and also after delivery, but its etiology is poorly understood. Previous studies that investigated the correlation between epidural labor analgesia and chronic low back pain were inconclusive. These studies lacked objective diagnostic criteria for LBP and did not exclude possible confounders. We performed this nationwide population-based retrospective cohort study to explore the relationship between CD with NA and subsequent LBP. From the Taiwan National Health Insurance Research Database (NHIRD), we identified all primiparas who had given birth between January 1, 2000 and December 31, 2013. Using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes, we identified the women who had vaginal delivery (VD) and those who had CD. The mode of anesthesia was ascertained by the NHI codes. Multivariable logistic regression was used to estimate the odds of postpartum LBP in women undergoing CD with NA compared with those having VD. The outcome was a diagnosis of LBP according to the first ICD-9-CM diagnosis code. The patients were observed for 3 years after delivery or until diagnosis of postpartum LBP, withdrawal from the NHI system, death, or December 31, 2013. Of the 61,027 primiparas who underwent delivery during the observation period, 40,057 were eligible for inclusion in the study. Of these women, 27,097 (67.6%) received VD, 8662 (21.6%) received CD with spinal anesthesia, and 4298 (10.7%) received CD with epidural anesthesia (EA). Women who received CD with EA were found to have higher risk of LBP than did women who received VD, with the adjusted OR being 1.26 (95% CI: 1.17-1.34). CD with EA might increase the risk of subsequent chronic LBP.

[Modified morcellation procedure in holmium laser enucleation of the prostate].

OBJECTIVE: To evaluate the efficiency and safety of the modified versus conventional morcellation procedure in holmium laser enucleation of the prostate (HoLEP). METHODS: We treated 195 patients with benign prostatic hyperplasia (BPH) by HoLEP, using conventional morcellation for 100 cases and modified morcellation for the other 95. We recorded the morcellation time, the total volume of resected tissue, the rate of morcellation, and associated complications, and compared the data obtained between the two groups. RESULTS: The volumes of resected tissue were similar between the conventional and modified morcellation groups (ï¼»72.3±19.8ï¼½ vs ï¼»71.1±17.7ï¼½ g, P>0.05). The morcellation time was significantly longer in the conventional than in the modified morcellation group (ï¼»12.8±2.8ï¼½ vs ï¼»8.5±2.0ï¼½ min, P<0.01), and the morcellation rate was remarkably lower in the former than in the latter (ï¼»4.9±1.4ï¼½ vs ï¼»7.1±0.9ï¼½ g/min, P<0.01). No statistically significant differences were observed in the incidence of complications, bladder injury for instance, between the two groups of patients. CONCLUSIONS: The modified morcellation procedure can be used for mocellation of various types of tissue, with a higher efficiency than the conventional technique, and therefore deserves wide clinical application.