Is a Course of Intermittent Self-dilatation with Topical Corticosteroids Superior at Stabilising Urethral Stricture Disease in Men and Improving Functional Outcomes over a Course of Intermittent Self-dilatation Alone? A Systematic Review and Meta-analysis.

Context: Intermittent self-dilatation (ISD) is a therapeutic strategy used to stabilise a urethral stricture and postpone or avoid further treatment. Adding corticosteroids to this mode of management might further enhance its outcomes by downregulation of collagen deposition and excessive scar tissue formation. Objective: To explore whether a course of ISD with topical corticosteroids is superior at stabilising urethral stricture disease in men and improving functional outcomes over a course of ISD alone. Evidence acquisition: This systematic review and meta-analysis was undertaken by the European Association of Urology Urethral Strictures Guideline Panel according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines (CRD42021256744). The primary benefit outcome was successful stabilisation of the urethral stricture. Treatment-related complications were the primary harm outcome. Evidence synthesis: In total, 978 records were screened for eligibility, ultimately leading to five included studies, all randomised controlled trials, comprising 250 patients, of whom 124 underwent a course of ISD with corticosteroids and 126 underwent a course of ISD alone, all after direct vision internal urethrotomy (DVIU). Successful stabilisation of the stricture was achieved in 77% and 64% of patients in the group with and without corticosteroids, respectively (p = 0.04). No extra complications related to the addition of corticosteroids to the ISD regimen were reported. The risk of bias of the included studies was generally unclear to high. Conclusions: Based on the currently available data, a course of ISD with topical corticosteroids appears to be safe and superior at stabilising a urethral stricture after DVIU in the short term to a course of ISD alone. However, given the unclear to high risk of bias in the included studies, further high-quality studies are needed to fully underpin this. Patient summary: This study shows that addition of topical corticosteroids to intermittent self-dilatation after direct vision internal urethrotomy can better stabilise the stricture in the short term.

Benefits and Harms of Conservative, Pharmacological, and Surgical Management Options for Women with Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel.

CONTEXT: While the management of bladder outlet obstruction (BOO) in men has been a topic of several systematic reviews and meta-analyses, no such evidence base exists for female BOO. OBJECTIVE: The aim of this systematic review was to evaluate the benefits and harms of therapeutic interventions for the management of BOO in women. EVIDENCE ACQUISITION: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The study protocol was registered with PROSPERO (CRD42020183839). A systematic literature search was performed and updated by a research librarian in May 2021. The study population consisted of adult female patients diagnosed with BOO, who underwent treatment. EVIDENCE SYNTHESIS: Out of 6344 records, we identified 33 studies enrolling 1222 participants, of which only six randomized controlled trials (RCTs) were found. One placebo-controlled crossover randomized trial assessed the role of baclofen in 60 female patients with dysfunctional voiding. The trial met its primary endpoint with a significantly greater decrease in the number of voids per day in the baclofen group (-5.53 vs -2.70; p = 0.001). The adverse events were mild and comparable in both groups (25% vs 20%). One placebo-controlled crossover randomized trial assessed the role of sildenafil in 20 women with Fowler's syndrome. There were significant improvements from baseline in maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual (PVR), but with no statistically significant difference when compared with placebo. In a large RCT including 197 female patients with functional BOO, the alpha-blocker alfuzosin significantly improved IPSS, Qmax, and PVR compared with baseline, but the differences were not statistically significant compared with the placebo group. Several small single-arm prospective series reported improvement of BOO-related symptoms and voiding parameters with urethroplasty, sling revision, urethral dilation, vaginal pessary, and pelvic organ prolapse repair. CONCLUSIONS: Evidence to support the use of conservative, pharmacological, and surgical treatments for BOO is scarce. PATIENT SUMMARY: According to the present systematic review of the literature, evidence to support the use of conservative, pharmacological, and surgical treatments for either anatomical or functional bladder outlet obstruction is scarce.

Clinical characteristics and prognostic analysis of 16 cases of systemic lupus erythematosus complicated with acute pancreatitis / 中华消化杂志

Objective To investigate the clinical characteristics and prognosis of patients with systemic lupus erythematosus (SLE) complicated with acute pancreatitis (AP) .Methods From January 1999 to December 2013 ,the clinical data of 16 patients with SLE complicated with AP among the total 2 526 cases of SLE was collected .A retrospective analysis was performed and the clinical data of patients was classified and documented ,which included general information ,past history ,clinical symptoms , laboratory findings ,imaging findings ,treatment and outcome .The rank sum test was performed for analysis of non‐normal distributed measurement data ,and the Fisher′s exact test was used for count data analysis .Results The incidence of SLE complicated with AP was 0 .63% (16/2 526) .Among them ,ten patients were mild acute pancreatitis (MAP) and six patients were severe acute pancreatitis (SAP) .All patients were treated with fasting ,gastrointestinal decompression ,nutritional support ,anti‐acid ,anti‐inflammatory ,glucocorticoid and somatostatin and so on . Six patients were cured , seven patients improved and three patients died (two SLE complicated with SAP ,one SLE complicated with MAP) . Compared with the SLE patients complicated with SAP ,the SLE patients complicated with MAP were more easily to have lupus nephritis(6/6 versus 5/10 ,Fisher′s exact test) ,hematological system injuries (6/6 versus 5/10 ,Fisher′s exact test) ,liver injuries (5/6 versus 0/10 ,Fisher′s exact test) ,more organs involved (mean 7 versus 3 ,Z= -3 .225) and higher SLE disease active indexes (DAI) score (mean 13 .5 versus 6 .5 ,Z= -2 .876);the differences were statistically significant (all P<0 .05) .Compared with the cured and improved SLE patients complicated with AP ,lupus encephalopathy (2/3 versus 1/13 ,Fisher′s exact test) ,more organs involved (mean 7 versus 5 ,Z= -2 .276) and higher SLE DAI score (mean 21 versus 12 ,Z= -2 .195) was more common in dead SLE patients complicated with AP;the differences were statistically significant (all P< 0 .05) .Conclusions SLE patients complicated with SAP are more easily to get lupus nephritis ,hematological system injuries ,liver injuries ,activity of SLE and multiple‐organ systems involved . The prognosis of SLE patients complicated with AP was poor in those with activity of SLE ,multiple‐organ involved and lupus encephalopathy .

Promoting effects of activated Nodal signal pathway on definitive endo-derm induction from mouse embryonic stem cells / 中国病理生理杂志

[ ABSTRACT] AIM:To study the process of promoting mouse embryonic stem cells ( ESC) to specify to definitive endoderm by up-regulating of Nodal signal pathway in order to find the best cultivated systems of differentiation of mouse ESC to definitive endoderm cells.METHODS:The cells were divided into different groups based on the culture medium:ESC group ( serum-free medium +LIF) , natural differentiation group ( serum-free medium) and activin A group ( serum-free medium +50μg/L activin A).The cells and the sterilized coverslips with cells were collected at 1, 3, 5 and 7 d of the cultivation.The proportion of CXCR4 +cells was detected by flow cytometry.The expression of CXCR4 was determined by immunocytochemical method, and the protein expression of OCT4 and CXCR4 was detected by Western blot.RE-SULTS:The proportion of CXCR4 +cells showed no dramatic change in ESC group along with the extending of cultivation day, while there were gradually increased in natural differentiation group and activin A group and the highest level was ob-served at 5 d.Among the 3 groups, the proportion of CXCR4 +cells at 5 d was the highest in activin A group.The brown or tan staining in the cells observed under microscope was considered as positive CXCR4 by immunocytochemistry.The pro-tein levels of OCT4 and CXCR4 in ESC group along with the extending of cultivation days was observed.The expression levels of OCT4 were gradually decreased in the cells in natural differentiation group and activin A group, while those of CX-CR4 were gradually increased with the highest level at 5 d.It was highest in the cells in activin A group.CONCLUSION:The proportion of definitive endoderm was the highest at 5 d of the induction during in vitro mouse ESC differentiation.Up-regulation of Nodal signal pathway by adding activin A at the early stage of mouse ESC differentiation promotes mouse ESC to specify to definitive endoderm with CXCR4 molecular marker.

The clinical value of 3D dynamic contrast enhanced MR angiography on haemorrhage of esophageal and gastric varices compared with endoscopy / 中华放射学杂志

Objective To investigate the clinical value of three dimensional dynamic contrast enhanced MRA(3D DCE MRA)on esophageal and gastric varices compared with endoscopy.Methods From April 2003 to June 2008,153 patients with portal hypertension who underwent both 3D DCE MRA and endoscopy were reviewed retrospectively.All the patients were divided into bleeding group and non-bleeding group according to the clinical symptoms.The location and degree of the esophagogastric varices on 3D DCE MRA were assessed with postprocessing images,including subtraction,MIP and thin-slab maximum intensity projection(thin-MIP),and were compared with the results of endoscopy.The maximum,minimum and mean diameters of esophagogastric varices inside and outside of the wall were measured on the reformed images.The correlation between the findings of 3D DCE MRA and endoscopy were analyzed with Spearman rank correlation coefficient test The rates of esophagogastric varices outside of the wall in bleeding and non-bleeding group were compared by means of Chi-square test Results In bleeding group,severe esophageal varices were documented in 59 patients,moderate in 6 patients,mild in 5 patients;in non-bleeding group,severe esophageal varices were documented in 32 patients,moderate in 4 patients,mild in 5 patients.Severe,moderate,and mild gastric varices were documented in 28,34 and 16 in bleeding group,while they were 7,12 and 9 in non-bleeding group.Esophageal and gastric varices can be wholly presented on MIP images after subtraction,while the esophagogastric varices inside and outside of the wall can be differentiated on thin-MIP images.The location and degree of esophagogastric varices on 3D DCE MRA were correlated with the findings of the endoscopy.The range of r was from 0.544 to 0.878(P＜0.01).In 91 patients with severe esophageal varices,27 patients presented outside esophageal varices in bleeding group(n=59)and 24 patients presented outside esophageal varices in non-bleeding group(n=32).There was a significant difference in ratio of outside esophageal varices between bleeding group and nonbleeding group(X~2=7.199,P＜0.01).In 35 patients with severe gastric varices,22 patients showed adventitial gastric varices in bleeding group(n=28)and 4 patients showed adventitial gastric varices in non-bleeding group(n=7).The ratio of adventitial gastric varices in bleeding group was not significantly different from that of non-bleeding group(P=0.340).Conclusions 3D DCE MRA can display and differentiate the esophagogastric varices both inside and outside of the wall by three dimensional reconstruction.The results of 3D DCE MRA and endoscopy have good correlation.It is of importance in evaluating the esophageal varices outside of the wall,because they may indicate decreased risk of haemorrhage in patients with severe degree of esophageal varices.

Relationship between expression of COX-2 and clinicopathological features in esophageal carcinoma / 中国病理生理杂志

AIM: To examine COX-2 expression in esophageal carcinoma,and to study relationships between COX-2 expression and clinicopathological features and prognosis of esophageal carcinoma patients.METHODS: 89 paraffin-embedded tissue samples from patients with esophageal carcinoma were collected,its clinicopathological features such as tumour differentiation,depth of invasion,length and site of the tumor,regional lymph node metastases,distant metastasis were recorded.Survival time of 81 cases were also recorded.By SP immunohistochemistry method,the expression of COX-2 in tumor samples was examined.RESULTS: COX-2 expression in esophageal carcinoma was markedly higher than that in nomal esophagus,the expression was higher in less differentiated and deeper invaded cases(P0.05).Cases of esophageal carcinoma with lower COX-2 expression had longer survival time than those with higher COX-2 expression(P