Treatment of hormonal refractory prostate cancer (HRPC) is nowadays a challenge in the clinic. Although different types of treatment such as chemotherapy, radiotherapy, biotherapy, and radioisotope treatment have been used, their effects on patients' survival is uncertain. Docetaxel plus prednisone has been confirmed to be the first line regimen, which can effectively increase patients' survival. Zoladronic acid has been demonstrated to be efficacious in reducing bone related events, and has been widely applied in bone metastasis of prostate cancer. Targeted therapy is currently under intensive investigation for HRPC treatment, and many early clinical studies have shown their effective results, and further studies with larger samples may prove their efficacy. This review will cover different topics in terms of the treatment of hormonal refractory prostate cancer and update the progresses in recent clinical trials.

Objective To compare the feasibility and safety of laparoscopic Roux-en-Y choledochojejunostomy versus open Roux-en-Y choledochojejunostomy.Methods From October 2011 to June 2013,37 patients underwent laparoscopic Roux-en-Y choledochojejunostomy (observation group) and 42 underwent open Roux-en-Y choledochojejunostomy (control group).We retrospectively compare the two groups in terms of operation time,intraoperative blood loss,length of incision,postoperative hospital stay,postoperative gastrointestinal function recovery time,incision infection rate and the incidence of biliary fistula after surgery.Results In observation group operation time was (275.43 t 12.28) min,higher than that of control group (189.12 ± 19.35) min (P =0.031),intraoperative blood loss was (83.13 ±6.34) ml,incision length (5.76 ±0.7) cm,postoperative recovery time of gastrointestinal tract of (43.33 ±3.15) h,postoperative hospital stay (12.65 ± 2.19) d,were in favor of the observation group which were respectively (180.37 ±9.67) ml,(18.51 ±1.9) cm,(70.45 ±4.97) h and (22.16 ±4.61) d (t =33.17,36.73,33.17,P ＜ 0.05).Postoperative incision infection rate in observation group was 5.4％,lower than the control group (19.07％) (chi-square =22.12,P ＜ 0.05).Between the two groups there was no significant difference in the incidence of biliary fistula.Conclusions Laparoscopic Roux-en-Y hepatojejunostomy is safe,effective,and less traumatic procedure.

Objective To evaluate the efficiency of our self-designed enriched filtrator of stem cells in screening and collecting enriched human bone marrow stem cells (BMSCs) for rapid construction of bioactive materials.Methods Bone marrow blood from 32 patients was circulated in our self-designed enriched filtratorand filtered through beta-tricalcium phosphate(β-TCP).The numbers of BMSCs were counted pre-and post-filtration to assess the enrichment efficiency.The numbers of nucleated cells,red blood cells and platelets were compared pre-and post-filtration to assess the effects of the enriched filtrator of stem cells on blood cells.Bacteriological examinations were performed to test the safety of the device.Scanning electron microscopy was carried out to observe the adhesion of BMSCs on β-TCP.Results There was a significant difference between the pre-fihration colony number of BMSCs cultured (232.8 ± 128.6/mL) and the post-filtration one (37.8 ± 34.9/mL) (t =10.743,P ＜ 0.001).The efficiency of BMSCs enrichment of the device was 85.6％ ±8.4％ (from 63.8％ to 97.1％).There were no significant differences between pre-filtration and post-filtration in the numbers of nucleated cells [(16.8 ± 5.4) × 109/mL versus (16.3 ±5.0) ×l09/mL],red blood cells [(3.9±0.6) ×1012/mL versus (3.8±0.6) ×1012/mL] and platelets [(120.4 ± 54.6) × 109/mL versus (123.0 ± 51.8) × 109/mL] (P ＞ 0.05).All the bacteriological examinations of the bone marrow samples were negative.After in vitro osteogenic induction culture,formation of numerous BMSCs colonies was observed on the β-TCP by scanning electron microscopy.Conclusion Since our self-designed enriched filtrator can efficiently collect enriched BMSCs and combine them with β-TCP simultaneously,the device is capable of rapid and safe construction of bioactive materials.

Objective To investigate the clinical value of proximal femoral nail antirotation ( PFNA) in treatment of intertrochanteric fractures.Methods From April 2007 to July 2009,112 patients with intertrochanteric fractures were treated by using PFNA.There were 34 males and 78 females,at mean age of 76 years.Of all,80 patients were with type 31-A2 fracture and 32 with type 31-A3 fractures according to AO classification.According to Singh index classification,there were 4 patients at grade Ⅰ,21 at grade Ⅱ,70 at grade Ⅲ and 15 at grade Ⅳ.The fracture was caused by low-energy injury in 97 patients and by high-energy injury in 15.The Salvati-Wilson score was used to evaluate the hip function postoperatively.Results Ninety patients received 12-24 months follow-up (average 18.6 months).The Salvati-Wilson score was (29.98 ± 5.18 ) points.The result was excellent in 41 patients,good in 40,fair in 6 and poor in 3,with excellenct rate of 90％.The introduction of the nail in operation was difficult in 22 patients,of which 3 patients suffered femoral cortex rupture.Displacement or separation of the fracture segments occurred in 34 patients and distal locking difficulty in nine during the screw blade tapping process.Local complications included hip pain in 21 patients,thigh pain in 4,apparent coxa vara in 2 and delayed healing in 7.There were no cutting-out or femoral shaft fractures no matter what type of Singh index was.The systemic complications included cardiovascular and cerebrovascular disease in one patient,pulmonary infection in four,deep vein embolism in one and perineum congestion or swelling in seventeen.Conclusion PFNA is effective in treating intertrochanteric fractures especially osteoporotic fractures,but delayed healing of the fractures and the mismatch between the intramedullary nail and the proximal femoral morphology remain to be addressed.

Objective To study the clinical value of three-dimensional CT reconstruction model of portal venous system combined with finite element analysis to measure portal venous pressure in patients with portal hypertension.Methods A retrospective study was conducted on 27 patients who were diagnosed to have portal hypertension at the Second Affiliated Hospital of Kunming Medical University from May 2016 to May 2018.There were 17 males and 10 females,with ages ranging from 34 to 77 years (mean 56 years).All these patients underwent transjugular intrahepatic portal venous shunt (TIPS) during which the portal venous pressure was measured.The imaging data was imported into the three-dimensional software of medical imaging to reconstruct the three dimensional model of portal vein,and the finite element analysis software of ANSYS was used to calculate the portal venous pressure by calculation with given boundary conditions.Pearson correlation was used to analyze the correlation between the actual measurement of portal venous pressure and the predicted value.Results The actual measured value of portal vein pressure before TIPS in 27 patients with portal hypertension was (3 783 ±930) Pa,and the predicted value was (4 238 ± 1 218) Pa.There was no significant difference (P ＞ 0.05).The predicted value of portal venous pressure was positively correlated with the actual measured value (r =0.402,95 ％ CI:0.026-0.678,P ＜ 0.05).Conclusion Non-invasive measurement of portal venous pressure based on three-dimensional portal venous reconstruction combined with finite element analysis correlated with actual portal venous pressure in patients with portal hypertension.

Objective To verify the efficacy and safety of intravesical instillation of Cystistat in reducing complications caused by intravesical chemotherapy after TUR-BT in non-muscle invasive bladder cancer patients. Methods One hundred and twenty patients who met the inclusion/exclusion criteria were enrolled into this multi-centered, randomized and blank controlled clinical study. Selected patients were randomized into the observation group and control group. TUR-BT was carried out in both groups followed by pirarubicin (THP) and Cystistat intravesical instillation in the observation group, and THP intravesical instillation alone in control group. Visual analog scale (VAS) was used as the primary efficacy variable. The secondary efficacy variables were assessments of hematuria and bladder irritation symptoms. Adverse events, laboratory tests and changes of vital signs before and after treatment were strictly observed during observation to evaluate the efficacy and safety of Cystistat.Results Demographics and baseline characteristics were comparable in both groups. The differences and the improvement rate of VAS score in the 2 groups were significant, both P＜0.01. The changes of VAS score and the improvement rate before and after treatment were (2. 24±1.70) and (92. 92±14.76) % in observation group and (0. 70±1.82) and (20. 59±87.34)% in control group respectively. According to the covariance analysis, there were significant differences in changes of VAS score between the observation group and the control group. Also, the improvement rate of VAS score was significant from visit 2. The urine frequency decreased from 9.06±4.09 to 6. 69±2.89 in observation group and increased from 8. 85±3. 32 to 10. 15±4.40 in control group, P＜0.01. There were also significant differences in changes of nocturia before and after treatment between these two groups (P＜0.01), the nocturia decreased from 2. 88±1.74 to 1. 47±1.62 in observation group and 3. 22±2.30 to 2.91±1.73 in control group, respectively. The changes of WHO assessment for hematuria,urgency and dysuria were not significantly different between the 2 groups. No Cystistat related adverse event was observed. Conclusions Cystistat combined instillation can significantly improve the VAS score of patients with chemotherapeutic agent instillation. Relief of bladder pain, frequency and nocturia are more rapidly and more durable in Cystistat combined instillation group. The improvement is more effective in patients with a high VAS score. Cystistat instillation with chemotherapeutics agents is both well tolerated and safe.

Objective To study the impact of surgical teamwork in totally laparoscopic splenectomy and pericardial devascularization (LSPD) in the treatment of portal hypertension,and advice on technical hints.Methods A retrospective study was conducted on the clinical features of eighty-four patients who underwent totally laparoscopic splenectomy and pericardial devascularization in the Second Affiliated Hospital of Kun Ming Medical University from January,2014 to December,2017.Results Totally laparoscopic procedures were performed successfully in 80 patients.The procedure was converted to hand-assisted laparoscopic splenectomy and pericardial devascularization in 3 patients because of uncontrollable bleeding.One patient who initially underwent laparoscopic cholecystectomy developed an intraoperative blood loss of 1 500 ml.The surgery was terminated and was continued one week later after stabilization of the patient.Of the 80 patients who underwent totally LSPD,the operation time ranged from 116.0 to 243.0 (146.0 ± 33.0) min.The intraoperative blood loss ranged from 60.0 to 600.0 (214.0 ± 31.0) ml.Routine coagulation function and portal vein color Doppler ultrasound examination carried out within 3 months after surgery detected postoperative portal vein thrombosis in four patients.They responded successfully to antiplatelet and anticoagulant therapy.There were no perioperative deaths,variceal bleeding,gastrointestinal fistula and infection.Conclusions With proper surgical steps and skilled laparoscopic technique carried out by an experienced team of surgeons,totally laparoscopic splenectomy and pericardial devascularization was safe and effective in treating portal hypertension.Strict perioperative management provided a guarantee for the safe operation.

In contrast to the gradual reduction in the number of locally transmitted malaria cases in China, the number of imported malaria cases has been increasing since 2008. Here, we report a case of a 39-year-old Chinese man who acquired Plasmodium ovale wallikeri infection while staying in Ghana, West Africa for 6 months in 2012. Microscopic examinations of Giemsa-stained thin and thick blood smears indicated Plasmodium vivax infection. However, the results of rapid diagnostic tests, which were conducted 3 times, were not in agreement with P. vivax. To further check the diagnosis, standard PCR analysis of the small-subunit rRNA gene was conducted, based on which a phylogeny tree was constructed. The results of gene sequencing indicated that this malaria is a variant of P. ovale (P. ovale wallikeri). The infection in this patient was not a new infection, but a relapse of the infection from the one that he had contracted in West Africa.
Adult ; Azure Stains ; Base Sequence ; China ; DNA, Protozoan/chemistry/genetics ; DNA, Ribosomal/chemistry/genetics ; Ghana ; Humans ; Malaria/*diagnosis/parasitology ; Male ; Molecular Sequence Data ; Phylogeny ; Plasmodium ovale/*classification/genetics/isolation & purification ; Polymerase Chain Reaction ; Recurrence ; Sequence Analysis, DNA ; Travel

OBJECTIVETo investigate the impact of androgen receptor splice variant 7 (AR-V7) expression on overall survival for patients with metastatic prostate cancer.

METHODSThe data of 113 diagnosed metastatic prostate cancer patients from January 2002 to June 2010 were collected retrospectively, including patient's age at diagnosis, prostate-specific antigen (PSA) level at diagnosis,Gleason score, clinical stage, PSA nadir during hormonal therapy, the time to PSA nadir, vital status, survival time and cause of death. The expression of AR-V7 in prostate cancer tissue was detected by using immunohistochemical staining. The correlation of AR-V7 expression and patient clinicopathological characteristics in all patients were analysed using Student t-test or Chi-square test. Cox proportional hazards regression models were used to evaluate the predictive role of AR-V7 expression and patient characteristics for overall survival.

RESULTSThe median PSA nadir was 0.7 µg/L (ranged from 0.0 to 143.0 µg/L). The median time to PSA nadir was 8.1 months (ranged from 0.9 to 71.0 months). The follow-up was performed until March 12, 2014. During the follow-up period, 67 of 113 metastatic prostate cancer patients (59.3%) died and the median overall survival was 96 months (ranged from 5 to 135 months). The AR-V7 detection rate was 20.4% (23/113). The serum PSA level in patients with positively expression of AR-V7 was significantly higher than that without AR-V7 expression (t = 2.521, P = 0.013). Multivariate Cox regression analysis indicated that the expression of AR-V7 (HR = 2.421, P = 0.002) and time to PSA nadir (HR = 1.019, P = 0.022) were independent prognostic factors of overall survival for metastatic prostate cancer patients.

CONCLUSIONSThe expression of AR-V7 in prostate cancer tissues and time to PSA nadir during hormonal therapy are independent prognostic factors of overall survival for metastatic prostate cancer patients. Therapy targeting AR-V7 may improve prognosis of metastatic prostate cancer patients.

Adult ; Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Prognosis ; Proportional Hazards Models ; Prostate-Specific Antigen ; blood ; Prostatic Neoplasms ; diagnosis ; metabolism ; pathology ; Protein Isoforms ; metabolism ; Receptors, Androgen ; metabolism ; Retrospective Studies

Objective To evaluate the validity and security of our self-designed bone marrow stem cell Screen-Enrich-Combine(-Biomaterials) Circulating System(SECCS) for bone non-union of limbs. Methods From May 2013 to December 2015, 24 patients with limb non-union were treated at our de-partment. They were aged from 20 to 65 years (mean, 42.8 years). Their non-union involved femur in 17 cases, tibia in 4, radius in one, humerus in one and fibula in one. In surgery, 80 mL bone marrow blood was aspirated from the anterior superior iliac spine for rapid preparation of bone substitute(β-TCP)composite with bone marrow stem cells by SECCS which was then implanted at the non-union locations. The bone marrow blood was collected before and after enrichment for stem cell counts. The bone union, clinical union time and related com-plications were evaluated by follow-up X-rays at 1, 3, 6 and 9 months after surgery. Results Each collection of bone marrow blood took 13.5 minutes on average. The enrichment rate of stem cells was 81.2%. 11,751 ± 1,011 stem cells were implanted per patient on average. All the patients were followed up for 9 to 48 months (mean, 19.2 months). Twenty-two patients acquired clinical union 9 months after operation and the other 2 suffered from malunion due to insufficient bone implant, yielding a union rate of 91.6% and an average union time of 6.5 months. No graft infection or internal fixation failure occurred and no severe complications hap-pened at the donor or implant sites.Conclusion The bioactive bone substitute manufactured by our self-designed SECCS can be used as a novel therapy for limb non-union, and this device is moreover charac-terized with convenience, limited invasion and satisfactory osteogenesis so that complications of autologous bone transplantation can be avoided.