Transurethral plasmakinetic resection versus enucleation for benign prostatic hyperplasia: comparison of intraoperative safety profiles based on endoscopic surgical monitoring system.

OBJECTIVE: To compare the intraoperative safety profiles of transurethral plasmakinetic resection of the prostate (PK-TURP) with transurethral plasmakinetic endoscopic enucleation of the prostate (PK-EEP) in the treatment of benign prostatic hyperplasia (BPH) based on endoscopic surgical monitoring system (ESMS). METHODS: A total of 128 patients who were diagnosed with BPH were stratified based on prostate volume (PV) and accepted PK-EEP or PK-TURP treatment at 1:1 ratio. The ESMS as a novel method was used to monitor blood loss and fluid absorption during the operation. Clinical parameters such as intraoperative blood loss volume, fluid absorption volume, operation time, tissue weight of resection, preoperative and postoperative red blood cell count (RBC), hemoglobin concentration (HB), hematocrit (HCT), electrolyte, postoperative bladder irrigation time, indwelling catheter time, hospital stay time and other associated complications were documented and compared between two groups. RESULTS: No significant differences in majority of baseline characteristics were observed among patients with different prostate volumes between two surgical methods. For patients with prostate volume < 40 ml, the average operation time of patients who received PK-EEP treatment was much more than those who received PK-TURP (P = 0.003). On the other hand, for patients with prostate volume > 40 ml, the PK-TURP surgery was associated with a significant increase in intraoperative blood loss (P = 0.021, in PV 40-80 ml group; P = 0.014, in PV > 80 ml group), fluid absorption (P = 0.011, in PV 40-80 ml group; P = 0.006, in PV > 80 ml group) and postoperative bladder irrigation time as well as indwelling catheter time but decrease in resected tissue weight compared to the PK-EEP treatment. CONCLUSION: The ESMS plays an important role in comparison of intraoperative safety profiles between PK-TURP and PK-EEP. Our data suggest that PK-TURP treatment is associated with a decreased operation time in patients with prostate volume < 40 ml and the PK-EEP treatment is associated with decreased intraoperative blood loss, fluid absorption and increased tissue resection for patients with prostate volume > 40 ml. Our results indicate that the size of prostate should be considered when choosing the right operation method.

Treatment strategy for traumatic innominate arterial injury.

PURPOSE: To discuss and share the experience of treatment of traumatic innominate arterial injury. METHODS: A retrospective analysis was performed on patients with innominate arterial injuries admitted from January 2016 to July 2018 at the department of vascular surgery, Beijing Jishuitan Hospital, China. All the arterial injuries were confirmed by arteriography. Clinical data including mechanism of injury, type of injury, demographics, concomitant injuries, time interval from trauma to blood flow reconstruction, and operation methods were collected. Follow-up program included outpatient visit and duplex-ultrasonography. SPSS version 23.0 was adopted for data analysis. Categorical variables are presented as number and/or frequency and continuous variables as mean ± standard deviation. RESULT: Altogether 7 patients were included and 6 (85.7%) were male. The mean age of patients was (29.43 ± 7.98) years, range 19-43 years. Six patients had isolated innominate arterial injuries and the rest 1 combined innominate arterial and vein injuries. The injury causes were road accidents in 3 patients, stab wound in 2, gunshot wound in 1, and crush injury in 1. All the 7 patients presented hemorrhagic shock at admission, which was timely and effectively corrected. No perioperative death or technical complications occurred. Intimal injury (n = 2) and partial transaction (n = 2) of the innominate artery were treated with covered stents. Two patients with complete transection of artery received vascular reconstruction by artificial grafts. One patient with partial transaction received balloon dilation and open surgical repair (hybrid operation). The mean time interval from trauma to blood flow reconstruction was (4.27 ± 0.18) h, range 4.0-4.5 h; while the operation time was (48.57 ± 19.94) min, range 25-75 min. Cerebral infarction occurred in one patient with brain injury due to anticoagulation contraindication. The average follow-up was (13.29 ± 5.65) months, range 6-24 months. No severe stenosis, occlusion, and thrombosis of covered stents or artificial vessels were found by color Doppler ultrasound. CONCLUSION: Urgent control of hemorrhage and restoration of blood supply are critical for the treatment of traumatic innominate arterial injury. Endovascular therapy is a feasible and effective method with short operation time and less trauma.

Comparison of traditional vascular reconstruction with covered stent in the treatment of subclavian artery injury.

PURPOSE: To explore the significance of traditional vascular reconstruction and covered stent for limb salvage after subclavian artery injury. METHODS: Patients with subclavian artery injury admitted to Beijing Jishuitan Hospital from January 2010 to December 2018 were retrospectively analyzed. All the injuries have been confirmed by intraoperative exploration, computed tomography angiography or digital subtraction angiography. Complete or partial amputation injuries were excluded. Mild artery defect or partial intimal damage was treated by interventional implantation, while other patients received open surgeries, including direct suture of small defect less than 2 cm and transplantation with autologous vein or artificial blood when the defect was more than 2 cm. Patients were divided into open surgery group and stent implantation group based on the treatment they received. Patients were followed up at 2 weeks (first stage) and 6 months (second stage) after operation to investigate limb salvage. Student's t-test was used to compare the general data between two groups and Chi-square test to analyze the rate of limb salvage. RESULTS: Altogether 50 cases of subclavian artery injury were treated, including 36 cases of open surgery and 14 cases of stent implantation. Combination of nerve injury was observed in 27 cases (75.0%) in open surgery group and 12 cases (85.7%) in stent implantation group. Amputation developed in 3 cases with open surgery and 1 case with stent implantation. Consequently the rate of successful limb salvage was respectively 91.7% (33/36) and 92.9% (13/14), revealing no significant difference (p > 0.05). CONCLUSION: Rapid reconstruction of blood circulation is crucial following subclavian artery injury, no matter what kinds of treatment strategies have been adopted. Interventional stent implantation can achieve a good effect for limb salvage.

Literature review of peripheral vascular trauma: Is the era of intervention coming?

Traumatic peripheral vascular injury is a significant cause of disability and death either in civilian environments or on the battlefield. Penetrating trauma and blunt trauma are the most common forms of vascular injuries. Besides, iatrogenic arterial injury (IAI) is another pattern of vascular trauma. The management of peripheral vascular injuries has been improved in different environments and wars. There are different types of vascular injuries, such as vasospasm, contusion, intimal flaps, intimal disruption or hematoma, external compression, laceration, transection and focal wall defects, etc. The main clinical manifestations of vascular injuries are shock following massive hemorrhage and limb necrosis due to tissue and organ ischemia. Ultrasound, computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are most valuable for assessment of peripheral vascular injuries. Angiography remains the gold standard for diagnosing vascular trauma. Immediate hemorrhage control and rapid restoration of blood flow are the primary goals of vascular trauma treatment. There are many operative treatment methods for vascular injuries, such as vascular suture or ligation, vascular wall repair and vascular reconstruction with blood vessel prostheses or vascular grafts. Embolization, balloon dilation and covered stent implantation are the main endovascular techniques. Surgical operation is still the primary treatment for vascular injuries. Endovascular treatment is a promising alternative, proved to be safe and effective, and preferred selection for patients. In summary, rapid diagnosis and timely surgical intervention remain the mainstays of the treatment. However, many issues need to be resolved by further studies.

Clinical outcomes of AngioJet pharmacomechanical thrombectomy versus catheter-directed thrombolysis for the treatment of filter-related caval thrombosis.

BACKGROUND: The inferior vena cava filter is utilized worldwide to intercept thrombi and to reduce the risk of fatal pulmonary embolism (PE). However, filter-related thrombosis is a complication of filter implantation. Endovascular methods such as AngioJet rheolytic thrombectomy (ART) and catheter-directed thrombolysis (CDT) can treat filter-related caval thrombosis, but the clinical outcomes of both treatment modalities have not been determined. AIM: To compare the treatment outcomes of AngioJet rheolytic thrombectomy vs catheter-directed thrombolysis in patients with filter-related caval thrombosis. METHODS: In this single-center retrospective study, 65 patients (34 males and 31 females; mean age: 59.0 ± 13.43 years) with intrafilter and inferior vena cava thrombosis were enrolled between January 2021 and August 2022. These patients were assigned to either the AngioJet group (n = 44) or the CDT group (n = 21). Clinical data and imaging information were collected. Evaluation measures included thrombus clearance rate, periprocedural complications, urokinase dosage, incidence of PE, limb circumference difference, length of stay, and filter removal rate. RESULTS: Technical success rates were 100% in the AngioJet and CDT groups. In the AngioJet group, grade II and grade III thrombus clearance was achieved in 26 (59.09%) and 14 (31.82%) patients, respectively. In the CDT group, grade II and grade III thrombus clearance was accomplished in 11 (52.38%) patients and 8 (38.10%) patients, respectively (P > 0.05).The peridiameter difference of the thigh was significantly reduced in patients from both groups after treatment (P < 0.05). The median dosage of urokinase was 0.08 (0.02, 0.25) million U in the AngioJet group and 1.50 (1.17, 1.83) million U in the CDT group (P < 0.05). Minor bleeding was shown in 4 (19.05%) patients in the CDT group, and when it was compared with that in the AngioJet group, the difference was statistically significant (P < 0.05). No major bleeding occurred. Seven (15.91%) patients in the AngioJet group had hemoglobinuria and 1 (4.76%) patient in the CDT group had bacteremia. There were 8 (18.18%) patients with PE in the AngioJet group and 4 (19.05%) patients in the CDT group before the intervention (P > 0.05). Computed tomography angiopulmonography (CTA) showed that PE was resolved after the intervention. New PE occurred in 4 (9.09%) patients in the AngioJet group and in 2 (9.52%) patients in the CDT group after theintervention (P > 0.05). These cases of PE were asymptomatic. The mean length of stay was longer in the CDT group (11.67 ± 5.34 d) than in the AngioJet group (10.64 ± 3.52 d) (P < 0.05). The filter was successfully retrieved in the first phase in 10 (47.62%) patients in the CDT group and in 15 (34.09%) patients in the AngioJet group (P > 0.05).Cumulative removal was accomplished in 17 (80.95%) out of 21 patients in the CDT group and in 42 (95.45%) out of 44 patients in the ART group (P > 0.05). The median indwelling time for patients with successful retrieval was 16 (13139) d in the CDT group and 59 (12231) d in the ART group (P > 0.05). CONCLUSION: Compared with catheter-directed thrombolysis, AngioJet rheolytic thrombectomy can achieve similar thrombus clearance effects, improve the filter retrieval rate, reduce the urokinase dosage and lower the risk of bleeding events in patients with filter-related caval thrombosis.

Osteotome sinus floor elevation with or without grafting: a preliminary clinical trial.

OBJECTIVES: This clinical trial aimed (1) to evaluate the predictability of the osteotome sinus floor elevation (OSFE) technique, (2) to study the influence of simultaneous grafting on the clinical success of placing dental implants in the posterior maxilla using OSFE and (3) to observe the bone changes in the elevated space with OSFE without grafting. MATERIAL AND METHODS: Two hundred and eighty Straumann implants were placed in the posterior maxillae of 202 patients using OSFE. One hundred and ninety-one implants were placed in 125 patients without grafting. The implants were allowed to heal for 3-4 months for non-grafted implants and for 6-8 months for grafted cases. For radiographic analyses, periapical and panoramic radiographs were taken of 30 implants at 3 and 9 months to assess the bone changes for the elevated sites without grafting. RESULTS: Two hundred and sixty-eight of 280 implants fulfilling the survival criteria represented a cumulative survival rate of 95.71%. The residual bone height (RBH) was 5.6+/-2.5 mm for the non-grafted group and 4.7+/-2.1 mm for the grafted group. The perforation rate was 4.29%. No significant differences were found between the two groups in RBH, survival rate or membrane perforation rate. The radiographic analyses demonstrated that new bone formation in the elevated sinus was visible and the endo-sinus bone gain was 2.26+/-0.92 mm and 2.66+/-0.87 mm at 3- and 9- month follow-up, respectively. Crestal bone loss (CBL) was 0.89+/-0.5 and 1.2+/-0.48 mm at 3 and 9 months. For the two test groups, RBH did not have a significant influence on the survival of the implants. At the 9-month follow-up, the endo-sinus bone gain and CBL were not significantly correlated to RBH. The implant protrusion length was significantly correlated to the endo-sinus bone gain. CONCLUSIONS: The findings of this study indicated that uneventful osseointegration may be predictable on applying OSFE whether with or without grafting in atrophic posterior maxilla. Spontaneous new bone formation seemed to be expected with implants placed using OSFE without simultaneous grafting.

[The relationship between copy number and microsatellite instability of mitochondrial DNA in colorectal cancer].

OBJECTIVE: To study the relationship between the abnormality of mitochondrial DNA (mtDNA) copy number and the clinical parameters and microsatellite instability (MSI) in colorectal cancer. METHODS: Total DNA was extracted from cancer and pericancer tissue from 50 colorectal cancer (CRC) biopsy samples. Non-coding region sequencing was done and the copy number of mtDNA was quantitated with real-time PCR in mitochondrial ND1 gene. The relationship between clinical indicators, mtMSI and mitochondrial copy number was detected. RESULTS: The mean copy number of mtDNA 312 +/- 185 in the tumor tissue was significantly lower than that 525 +/- 125 of the corresponding non-tumor tissue of these patients (P < 0.001). No significant correlation was found between mtDNA copy number and other variables including age, gender, pathological type and clinical stage (P > 0.05). However, there was a significant correlation between copy number and mtMSI (P < 0.001). CONCLUSION: There is a significant reduction of mtDNA in CRC patients, which may be caused by mtMSI.

[Quantitative study of bacteriological infections in dogs undergoing gunshot wound in seawater].

OBJECTIVE: To investigate the changes in bacterial proliferation and the time of infection occurrence in dogs wounded by gunshot in seawater. METHOD: Fourteen canine models of gunshot wound in seawater were established, with another 2 dogs receiving the wound without seawater immersion serving as control. Gross observation and quantitative bacterial analysis were performed at 0, 6, 12 and 24 h after the injury respectively, and two dynamic models for the bacterial growth were set up on the basis of statistical analysis of the results. RESULTS: Bacterial quantity in both of the two groups tended to increase with time, but at each time point after the injury, the seawater group had higher bacterial count than the other group. Within 6 h after the injury, the bacterial count reached the critical point for clinical infection in seawater group. The two bacterial growth dynamics models were (1) Y=9.12 x 10(3+0.247X) and (2) Y=1.35 x 10(3+0.227X) for the seawater group and land group respectively, with the variant X representing time after gunshot injury, and Y the bacterial count per gram tissue. Using the dynamic models, we found that to reach the same bacteria count, the land group needed 4 h more than the seawater group(4.2 h). CONCLUSIONS: Bacterial proliferation is accelerated in the wounds in seawater to result in earlier infection onset with more severity, suggesting that early debridement within 4 h after the injury, complete washing of the wound and early administration of the antibiotics are necessary for the wound management.

Correlation of serum ß2-microglobulin levels with prostate-specific antigen, Gleason score, clinical stage, tumor metastasis and therapy efficacy in prostate cancer.

BACKGROUND AND AIMS: Despite previous reports implying a role of ß2-microglobulin (ß2M) in the development of prostate cancer (PCa), the correlation of serum ß2M with the clinicopathological features, therapy efficacy and prognosis of patients with PCa have not been fully clarified. The present study aims to investigate the serum levels of ß2M in patients with PCa and explore the potential use of ß2M as a tumor marker for diagnosis, treatment and prognosis of PCa. METHODS: Serum ß2M levels in 120 patients with PCa, 50 patients with benign prostate hyperplasia (BPH) and 85 healthy age-matched controls were measured by enzyme immunoassay. The correlation of serum ß2M with the clinicopathological features, therapy efficacy and the prognosis of PCa were subsequently assessed. RESULTS: Our results showed that: (i) PCa patients had significantly higher levels of ß2M compared to those of patients with BPH or those of healthy controls. (ii) Serum ß2M were markedly elevated in patients with high stage or grade PCa as compared to patients with low stage or grade PCa. (iii) We measured significantly higher levels of ß2M in patients with metastasis as compared to patients lacking metastasis. (iv) During follow-up, serum ß2M showed a marked decrease after successful therapy and a significant further increase in recurrent disease. CONCLUSIONS: Our results demonstrate that serum ß2M is correlated closely with the clinical stage, Gleason grade, PSA, distant metastasis and therapy efficacy in patients with PCa. Serum ß2M may be a useful biomarker for clinical diagnosis, follow-up and prognosis of PCa.

[A clinical study of osteotome sinus floor elevation and simultaneous implant placement in the periodontally compromised patients].

PURPOSE: To study the clinical effect of osteotome sinus floor elevation (OSFE) combined with simultaneous implant placement in the treatment of edentulous posterior maxilla subject to insufficient bone height in the periodontally compromised patients. METHODS: Forty-seven Straumanns implants were placed in the posterior maxilla in 35 patients with the procedure of OSFE. The final prostheses were restored after 3 to 6 months. The follow-up period was 6 to 30 months. Radiographs were taken and PD, PLI, BOP were measured and analyzed. RESULTS: The overall survival rate was 95.74% during the study period. Forty-five out of the 47 implants were clinically stable and loaded without pain or any subjective sensation. The perforation ratio of the membrane was 4.26%. The average of PD around the implants was (3.22±1.07) mm. The average of the marginal bone loss was (1.38±0.59) mm. CONCLUSIONS: OSFE without bone graft proves to be an effective and predictable treatment for atrophic edentulous posterior maxillary region in patients with periodontitis, but the long-term effect needs further observation.

Ginsenoside-Rd exhibits anti-inflammatory activities through elevation of antioxidant enzyme activities and inhibition of JNK and ERK activation in vivo.

Our previous study has reported that ginsenoside-Rd significantly inhibited the production of pro-inflammatory cytokines and mediators in carrageenan (Carr)-induced rat paw edema, which might be due to its blocking of the nuclear factor-κB (NF-κB) signaling pathway. The aim of the present study was to clarify the more detailed mechanisms of anti-inflammatory activity of ginsenoside-Rd in Carr-induced rat paw edema model. Rats were pretreated with dexamethasone or ginsenoside-Rd 1 h before the Carr injection. Six hours after Carr injection, the malondialdehyde (MDA) level and myeloperoxidase (MPO), superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase (CAT) activities in inflamed paw tissues were determined. The levels of nitric oxide (NO) and prostaglandin E2 (PGE2) in serum were measured. The expressions of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2) and NF-κB were detected by western blot. In addition, the extent of phosphorylation of extracellular signal-regulated protein kinase (ERK), p38 and c-Jun NH2-terminal kinase (JNK) was analyzed by western blot. The results showed that ginsenoside-Rd significantly attenuated MPO activity and MDA level, increased the activities of SOD, GPx and CAT, lowered the levels of NO and PGE2, down-regulated the expressions of iNOS, COX-2 and NF-κB, and suppressed the phosphorylation of ERK and JNK. Taken together, the possible mechanisms of anti-inflammatory activity of ginsenoside-Rd were: it could reduce the inflammatory cell infiltration into inflammatory sites, inhibit the tissue lipid peroxidation, increase the antioxidant enzyme activities, and suppress the proinflammatory enzyme expressions through the downregulation of NF-κB activation via suppression of ERK and JNK phosphorylation.

[Clinical application of implant-supported rehabilitation with osteotome sinus floor elevation without bone grafting and simultaneous implant placement].

PURPOSE: To study the clinical effect of osteotome sinus floor elevation (OSFE) without bone grafting combined with simultaneous implant placement in the treatment of edentulous posterior maxilla subject to insufficient bone height. METHODS: Sixty-seven Straumann SLA implants were placed in the posterior maxilla in 50 patients. The residual bone height (RBH) was (5.2+/-2.2)mm. The procedure of OSFE without bone grafting was applied. The final prostheses were restored after 3 to 6 months. The stability and osseointegration of the implants were clinically evaluated, also the endo-sinus bone gain around the implants were measured. The follow-up period was (12.8+/-5.6)months. RESULTS: The survival rate was 97.01% during the study period. 65 out of the 67 implants were clinically stable and were loaded without pain or any subjective sensation. 4 implants had detectable sinus membrane perforation during operation. The radiographic results demonstrated that the endo-sinus bone gain was (2.5+/-1.3) mm and the marginal bone loss (MBL) was (1.1+/-0.7)mm. CONCLUSION: OSFE alone with no grafting could yield predictable clinical results for atrophic edentulous posterior maxillary region. It may be feasible even with RBH less than 4 mm.