Manual reduction in testicular torsion and subsequent treatment after successful reduction: a series of reports in a single institution.

Introduction: To explore the factors affecting the success of testicular torsion manual reduction and the safety of subsequent conservative treatment after successful reduction. Methods: Clinical data of 66 patients with testicular torsion treated in our emergency department from February 2017 to February 2022 were retrospectively collected. Manual reduction without anesthesia was performed in 19 patients. Patients with successful manual reduction chose different subsequent treatments according to the wishes of themselves and their guardians, including continuing conservative treatment and surgical exploration. Relevant clinical data were collected and analyzed. Results: Manual reduction was successful in 11 patients (11/19). Seven of them chose to continue conservative treatment, and four underwent surgical exploration immediately. Among the 7 patients who were treated conservatively, 3 underwent surgical treatment due to scrotal discomfort or testicular torsion at different stages, and the remaining 4 patients showed no recurrence of torsion during follow-up. Compared with other patients, patients with successful manual reduction had the shorter duration of pain (p < 0.05). The time from visiting our hospital to surgery in patients who attempted manual reduction was slightly shorter than those who underwent surgery directly (p > 0.05). The testes of these 11 patients were all successfully preserved. Conclusions: The short duration of pain may contribute to the success of manual reduction, and manual reduction did not increase the preparation time before surgery. Due to the unpredictable risk of recurrence, immediate surgical treatment is still recommended, or postponed elective surgical treatment should be offered in the next days or weeks.

Inflammatory myofibroblastic tumors in the kidney and abdominal wall mimicking malignancy: A case report.

RATIONALE: Inflammatory myofibroblastic tumor (IMT) is uncommon, coexistence of IMTs in the kidney and abdominal wall are more uncommon. PATIENT CONCERNS AND DIAGNOSIS: We report a 74-year-old female who presented with 6 months history of left flank pain and approximately 5 kg weight loss that were diagnosed as renal cell carcinoma and locally metastatic abdominal wall tumor. INTERVENTIONS AND OUTCOMES: A left radical nephrectomy and excision of the abdominal wall tumor were done. The pathologic result was IMTs. After follow-up for 66 months, the patient showed no signs of tumor recurrence. LESSONS: Coexistence of IMTs in the kidney and abdominal wall is extremely rare and is often diagnosed as malignancy. Therefore, IMTs should be considered in the diagnosis of the patient with both kidney and abdominal wall tumors.

Omega-3 polyunsaturated fatty acids ameliorates testicular ischemia-reperfusion injury through the induction of Nrf2 and inhibition of NF-κB in rats.

OBJECTIVE: This study was designed to investigate the protective effect of Omega-3 polyunsaturated fatty acids (n-3 PUFAs) on testicular ischemia-reperfusion (I/R) injury in rats. METHODS: A total of 24 rats were randomly divided into the following three groups: Group A (Control group, n=8), Group B (I/R group, n=8), Group C (I/R group treated with n-3 PUFAs, n=8). Histological examination was used to assess changes in testicular structure. Tissue oxidative stress biomarkers, malondialdehyde (MDA) as well as Superoxide, and antioxidant indexes, including total antioxidant capacity (T-AOC); catalase (CAT); glutathione (GSH); glutathione/glutathione disulfide ratio (GSH/GSSG); superoxide dismutase (SOD) were determined. In addition, nuclear transcription factor erythroid 2-related factor 2 (Nrf2), Nrf2-dependent antioxidant enzymes, such as heme oxygenase-1 (HO-1) and NADPH quinine oxidoreductase-1 (NQO-1), and nuclear factor kappa B (NF-κB) were detected. RESULTS: Compared to I/R group, n-3 PUFAs could obviously increase the mean seminiferous tubular diameter in the histological examination. After n-3 PUFAs treatment, the level of tissue MDA and Superoxide were significantly decreased, while tissue T-AOC, CAT, GSH, GSH/GSSG and SOD levels were significantly increased, compared to I/R group (P<0.05). Besides, the expression levels of Nrf2, HO-1, and NQO-1 were significantly higher and the NF-κB expression level was significantly lower in the n-3 PUFAs treated group than that in I/R group (P<0.05). CONCLUSIONS: These results provided evidences that n-3 PUFAs ameliorated testes damage caused by testicular I/R injury through its antioxidative capacity and anti-inflammatory effects, involving the activation of Nrf2 and the inhibition of NF-κB.

Association between polymorphic CAG repeat lengths in the androgen receptor gene and susceptibility to prostate cancer: A systematic review and meta-analysis.

BACKGROUND: Previous studies have been conducted to reveal the relationship between androgen receptor CAG polymorphism and risk of prostate cancer, yet the results were elusive and controversial. Thus, this meta-analysis was performed to clarify this association. METHODS: To obtain the relevant available studies, online databases PubMed, Embase, and Web of science were searched until September 1st, 2016. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of such association. Subgroup analyses were conducted based on ethnicity and source of controls. Moreover, Begg's funnel plots and Egger's linear regression test were conducted to test the publication bias. RESULTS: Overall, our results enrolled 51 studies indicated that significant increased risk of prostate cancer was associated with androgen receptor CAG polymorphism (OR  =  0.77, 95% CI: 0.67-0.89). In addition, compared with CAG repeat <20, 22, carriers of ≧20, 22 repeats had decreased risk of prostate cancer (cut-off point  =  20: OR  =  0.27, 95% CI: 0.13-0.52; cut-off point  =  22: OR  =  0.82, 95% CI: 0.70-0.97). However, when cut-off point  =  23, no significant result was detected in such association (pooled OR  =  0.88, 95% CI: 0.63-1.24). When cut-off point is 22, the results were positive only in Asian population (OR  =  0.53, 95% CI: 0.32-0.89) in the subgroup analysis by ethnicity. Besides, when the studies were stratified by source of controls, the results were not significant in both the subgroup of population-based controls and hospital-based controls. CONCLUSIONS: This meta-analysis suggested the carriers of short polymorphic CAG repeats might increase susceptibility to prostate cancer, which held potential as a detecting marker of the risk of prostate cancer.

RTA-408 Protects Kidney from Ischemia-Reperfusion Injury in Mice via Activating Nrf2 and Downstream GSH Biosynthesis Gene.

Acute kidney injury (AKI) induced by ischemia-reperfusion is a critical conundrum in many clinical settings. Here, this study aimed to determine whether and how RTA-408, a novel oleanane triterpenoid, could confer protection against renal ischemia-reperfusion injury (IRI) in male mice. Mice treated with RTA-408 undergoing unilateral ischemia followed by contralateral nephrectomy had improved renal function and histological outcome, as well as decreased apoptosis, ROS production, and oxidative injury marker compared with vehicle-treated mice. Also, we had found that RTA-408 could strengthen the total antioxidant capacity by increasing Nrf2 nuclear translocation and subsequently increased Nrf2 downstream GSH-related antioxidant gene expression and activity. In vitro study demonstrated that GSH biosynthesis enzyme GCLc could be an important target of RTA-408. Furthermore, Nrf2-deficient mice treated with RTA-408 had no significant improvement in renal function, histology, ROS production, and GSH-related gene expression. Thus, by upregulating Nrf2 and its downstream antioxidant genes, RTA-408 presents a novel and potential approach to renal IRI prevention and therapy.

[Analysis of the cause of missed diagnosis in transperineal prostate biopsy with 4 cases report].

OBJECTIVE: To investigate the causes of missed diagnosis in transrectal ultrasound-guided transperineal prostate biopsy. METHODS: The biopsy results of total 278 patients who received transrectal ultrasound-guided transperineal prostate biopsy from January 2012 to December 2014 in Subei People's Hospital were retrospectively analyzed, using 11 systemic divisions. RESULTS: One hundred and twenty-nine patients were diagnosed with prostate cancer, and 149 patients were hyperplasia of prostate. Fifty-six patients with biopsy-negative and obvious symptoms of lower urinary tract obstruction were underwent transurethral resection of the prostate. Four of which were found to be prostate cancer. CONCLUSION: Early-stage prostate cancer, special prostate tumor location, inadequate biopsy tissue, special patients in limited position, and dissatisfied anesthesia may increase the risk of missed diagnosis. Targeted and individualized puncture may improve the effectiveness.

The role of testicular artery in laparoscopic varicocelectomy: a systematic review and meta-analysis.

PURPOSE: We performed this meta-analysis to evaluate the efficacy and safety of artery preserving versus artery non-preserving in laparoscopic varicocelectomy. METHODS: All publications up until October 2015 were searched in PubMed, EMBASE, Ovid, Web of Science, and Cochrane library. Randomized controlled trials (RCTs) and cohort studies (CSs) that compared the difference in two operative approaches in laparoscopic varicocelectomy were included. Statistical analysis was performed using Stata version 12.0. RESULTS: A total of four RCTs and ten CSs involving 503 cases with artery preserving and 911 cases with artery non-preserving met our inclusion criteria. Meta-analysis showed that artery preserving had higher recurrence rate [risk ratio (RR) = 2.91, 95 % confidence interval (CI) 1.83-4.61; P = 0.000], lower incidence of hydrocele formation (RR = 0.18; 95 % CI 0.08-0.42; P = 0.000), and prolonged operating time [standard mean difference (SMD) = 1.27; 95 % CI 0.17-2.37; P = 0.023], compared with artery non-preserving in laparoscopic varicocelectomy. The results were similar in postoperative catch-up growth (RR = 1.00; 95 % CI 0.86-1.17; P = 0.985) and testicular atrophy (RR = 0.36; 95 % CI 0.09-1.54; P = 0.169). Besides, no significant difference was found in sperm concentration, motility, and normal morphology between two groups, as well as on postoperative pregnancy rate (RR = 0.95; 95 % CI 0.65-1.40; P = 0.809). CONCLUSION: With the advantages of less recurrence, easier operating and less time spending, and comparable results in other respects, artery non-preserving is preferable to artery preserving in laparoscopic varicocelectomy, although there is a relatively high incidence of hydrocele formation. Considering the limitation of included studies, more large-scaled RCTs are required to confirm the present findings.