Objective:To assess the changing trends in Gleason score (GS)of Chinese prostate carci-noma (PCa)from January 1995 to December 2014.Methods:In the study,875 patients admitted to hospital from January 1995 to December 2004 (1995 -2004)and from January 2005 to December 2014 (2005 -2014)were divided into two groups.The mean levels and proportions of GS,primary and se-condary grades were studied.The patients were divided into four groups according to age: <60,60 -69,70 -79 and ≥80 years.Types of specimen included needle biopsy (NB),transurethral resection of the prostate (TURP)and radical prostatectomy (RP).Histological types were made up by acinar carci-noma and other types (including atrophic,pseudohyperplastic,foam,signet ring cell and ductal carcino-ma,and so on).The total prostate-specific antigen (tPSA)involved groups of <20.0 μg/L and ≥20.0 μg/L.We observed the mean levels and proportions of GS in age,types of specimen,histological types and total prostate-specific antigen in different periods,and used SPSS 17.0 software for statistical analysis.Results:Compared with 1995 -2004,the mean levels of GS,primary and secondary grades decreased 0.32 (P =0.003),0.19 (P =0.001)and 0.12 (P =0.016)in 2005 -2014,respectively. The proportions of ≤6 in GS increased 10.9% (P =0.003),and ≥8 decreased 14.0% (P <0.001). The difference of GS 7 was not statistically significant.In the primary grade,the ratio of grades≤3 in-creased 12.8% (P =0.001 ),and grade 4 decreased 7.4% (P =0.037),grade 5 decreased 5.5%(P =0.007).The ratio of secondary grades≤3 increased 7.6% (P =0.037).The difference of grades 4 and 5 was not statistically significant.Conclusion:GS in Chinese patients with PCa showed a down-ward trend,which is one of the notable features in the past 20 years in China.The types of specimen and age are important factors in GS,while the histological types and tPSA have less impact on the GS.

Objective To discuss the technical method,safety and clinical efficacy of CT-guided 125I radioactive seed implantation for the treatment of mediastinal lymph node metastases.Methods CT-guided 125I radioactive seed implantation was carried out in 11 patients with mediastinal lymph node metastases.Before 125I seed implantation,the interstitial brachytherapy treatment planning system (TPS) was employed to formulate a treatment plan.The particles with radioactivity of (1.11-2.96) × 107Bq (0.3-0.8 mCi) were used for the implantation.Postoperative complications were recorded.The local lesion control rate and the effective rate of pain relief were evaluated at one,3,6 and 12 months after 125I seed implantation.Results After 125I seed implantation,pneumothorax occurred in 3 patients,tracheal fistula in one patient,and pulmonary infection in one patient.The local lesion control rates at one,3,6 and 12 months were 81.8％,90.9％,72.7％ and 72.7％ respectively;the effective rate of pain relief at one week,one,3,6 and 12 months were 100％,90.9％,90.9％,81.8％ and 72.7％ respectively.Conclusion For the treatment of mediastinal lymph node metastases,CT-guided radioactive 125I seed implantation is less-invasive with less complications,and it carries reliable local lesion control rate.Therefore,this technique is a safe therapeutic means.

Objective To introduce a urodynamic classification of female patients with symptoms of overactive bladder(OAB) and discuss its clinical significance.Methods From January 2015 to January 2017,62 female patients from Peking University People's Hospital who diagnosed clinically with OAB and underwent preoperative urodynamic test were involved in this study.Female OAB patients can be stratified into four groups based on the chief complaints and the urodynamic test,including type Ⅰ-no evidence of detrusor overactivity(DO) on urodynamic test,patients can feel urgency and have no urinary incontinence,type Ⅱ-involuntary detrusor contraction present,patients aware and able to abort them and have no urinary incontinence,type Ⅲ-involuntary detrusor contraction present,patients aware and able to contract the sphincter but can not abort contractions and have urinary incontinence and type Ⅳ-contractions present,and patients unaware and unable to contract the sphincter or abort contractions and have urinary incontinence.According to the classification,the amount of the four types of OAB patients were 8,22,25 and 7,respectively.The data of height,age,weight showed no statistical significance (P ＞ 0.05).The amount of the concomitant diseases of the type Ⅰ,Ⅱ and Ⅲ showed no obviously difference (P ＞ 0.05),but the type Ⅳ was higher than the other three types(P ＜ 0.05).The preoperative OABSS(6.38 ± 1.51 vs.6.41 ± 1.76,P ＞ 0.05) and AUASS scores (16.38 ± 5.26 vs.16.59 ± 5.11,P ＞ 0.05) of the type Ⅰ and Ⅱ have shown no obviously difference.The preoperative OABSS(9.00 ± 2.35 vs.9.71 ± 3.04,P ＞ 0.05) and AUASS(20.59 ± 3.95 vs.22.00 ± 4.97,P ＞ 0.05) scores of the type Ⅲ and Ⅳ have shown no obviously difference.The preoperative scores of the OABSS scores and AUASS scores of the type Ⅲ and the type ⅣV were obviously higher than that of the type Ⅰ and the type Ⅱ (P ＜ 0.05).In this study,16 of the 62 patients were treated with tolterodine,46 patients were treated with solifenacin,with the average duration of drug therapy of 3.4 months (0.5-20.0 months).The postoperative scores of the OABSS and AUASS were followed up.The treatment outcomes among different OAB types were compared.Results The 62 patients were followed up from 6 to 20 months,with an average of 11.2 months.The improvement of the OABSS scores of the type Ⅰ and Ⅱ(3.63 ± 0.74 vs.3.86 ± 0.89,P ＞ 0.05) have shown no obviously difference.The improvement of the OABSS scores of the type Ⅲ (6.40 ± 1.17) were obviously higher than the type Ⅰ,Ⅱ and Ⅳ (1.71 ± 1.38) (P ＜ 0.05).The improvement of the OABSS scores of the type Ⅳ were obviously inferior to the type Ⅰ,Ⅱ and Ⅲ (P ＜ 0.05).The improvement of the AUASS scores of the type Ⅰ and Ⅱ (11.75 ± 4.33 vs.12.30 ±5.34,P ＞0.05)have shown no obviously difference.The improvement of the AUASS scores of the type Ⅲ (15.28 ± 4.32)were obviously higher than the type Ⅰ,Ⅱ and ⅣV (8.14 ± 4.34) (P ＜ 0.05).The improvement of the AUASS scores of the type ⅣV were obviously inferior to the type Ⅰ,Ⅱ and Ⅲ (P ＜ 0.05).Conclusions The type Ⅳ OAB presented with the worst outcome and the type Ⅲ OAB presented with the best among the four types of OAB.The classification system will have a suggestive significance to predict the prognosis and the therapeutic effect of the patients with OAB.

Objective To evaluate the clinical outcome of bleeding control by preoperative embolization of internal iliac artery with DSA and intra?operative presetting abdominal aorta balloon, combine with the operation techniques of exposure, reduc?tion and internal fixation of pelvic fracture through lateral?rectus approach. Methods From March 2012 to May 2015, 7 patients with type C3 pelvic fractures admitted to our department from March 2012 to May 2015, treated with preoperative embolization of internal iliac artery under digital subtraction angiography 2 h before surgery and presetting abdominal aorta balloon were retrospec?tively reviewed. There were 3 males and 4 females, with an average age of 34 years (range, 16 to 61 years). According to AO classi?fication, all 7 cases belonged to type C3 (3.2:5 cases;C3.3:2 cases), including 5 cases with limb fracture, 2 cases with craniocere?bral trauma, 4 cases with pulmonary contusion, 2 cases with injury of abdominsal organs. Time from injury to operation was 19 days on average (10 to 33 days). Patients received damage control surgery treatment including bleeding control and temporary ex?ternal fixation, and ipsilateral tractions with heavy weight, intensive care and corrections of general situation before operation. The fracture model was manufactured by 3D printing and fracture reduction was simulated on computer preoperatively. Embolization of internal iliac artery was performed in the side of severe displaced sacroiliac joint with DSA 2 hours preoperatively. Reduction was performed to stabilize anterior-posterior pelvic ring and acetabular fractures via the intraoperative lateral?rectus approach. And 2 cases were performed by temporary balloon occlusion of abdominal aorta (≤60 min) for bleeding control in reduction of in the side of sacroiliac joint fractures. Results All the 7 cases had undergone the operations successfully, and the operating time was from 135-320 min with blood loss from 440-3 350 ml. According to Matta radiological evaluation postoperatively, reduction of pelvic fracture was rated as anatomic in 5 cases, satisfactory in 2, without complications. All 7 cases were complicated with lumbosacral plexus injury or lumbosacral trunk injury at different degrees (M0 2 cases, M1 2 cases, M2 2 cases, M3 1 case). According to the BMRC scoring system, 5 cases had well recovered and the other 2 cases had no improvement after three months (M4 2 cases, M5 3 cases). Conclusion Surgical management of pelvic fracture through preoperative internal iliac artery embolization and intra?oper?ative occlusion of abdominal aorta could effective control bleeding and achieve favorable conditions for reduction. Lateral?rectus approach can provide adequate exposure of the anterior and posterior ring, and this approach could also provide excellent visual control of reduction and fixation.

Objective:To evaluate the effect of transurethral resection of the prostate on nocturia and sleep quality in men with benign prostatic hyperplasia.Methods:This retrospective study included 122 patients who underwent TURP(transurethral resection of the prostate) for BPH(benign prostatic hyperplasia)from December 2016 to December 2018.The age was(69.7±7.9)years old. There was 20 cases with diabetes and 40 cases with hypertension. The preoperative mean prostate volume was (64.4±41.2)ml and mean BMI was (24.3±2.7)kg/m 2. The preoperative IPSS score was (20.5±5.5) points, the number of nocturia events(assessed by the seventh question of IPSS) was (4.4±1.9) times, hours of undisturbed sleep (HUS) was (1.7±1.0) h, 110 cases with HUS <3 h; nocturia quality-of-life questionnaire (N-QOL) was (24.9±6.3) points, quality of life (QOL) was (4.4±0.9) points. 111 patients had the urodynamic examination done. The maximum urine flow rate was (6.4±3.1) ml/s, the maximum bladder volume was (318.5±83.6) ml, the residual urine volume was (153.9±158.9) ml, and the maximum detrusor pressure was (78.4±35.5)cmH 2O.Detrusor muscle strength decreased in 27 cases, 18 cases had OAB, 9 cases of effective bladder capacity declined and 60 cases had bladder outlet obstruction. 42 cases had an effective bladder volume <200 ml, of which 33 had a maximum bladder capacity >200 ml with nocturia (4.5±1.9) times, 9 cases had a maximum bladder capacity ≤200 ml with nocturia (4.7±1.7) times. All 122 patients were treated with TURP. Result:122 patients were followed up for 3-20 months. After operation the number of nocturia significantly decreased to (1.9±1.23) times ( P<0.05), HUS significantly improved to(3.4±1.3) h ( P<0.05), and 91 cases had HUS ≥3 with 82.7% remission rate; N-QOL significantly improved to (37.3±6.7) points ( P<0.05), IPSS significantly decreased to (4.9±4.2) points ( P<0.05), and QOL significantly decreased (0.8±0.9) points ( P<0.05). 121 patients had nocturia ≥2 voids before surgery, and 96 patients had improved (≥50% reduction of nocturnal frequency). There were 68 patients with nocturia ≥2 voids after operation with total score of preoperative IPSS (21.8±5.3), and 54 patients with nocturia <2 voids with total score of preoperative IPSS (19.2±5.5)( P<0.05). Patients with a effective bladder capacity less than 200 ml were divided into a group with a maximum bladder volume ≤200 ml and a group with a maximum bladder capacity>200 ml. The nocturia did not improve significantly after surgery ( P>0.05) in the group with a maximum bladder volume ≤200 ml, and the nocturia in the group with a maximum bladder capacity >200 ml had significantly improvement ( P<0.05). The group with a maximum bladder capacity ≤200 ml had nocturia (3.4±1.5) times after surgery, which was no significant different from that before surgery ( P=0.12); nocturia (1.9±1.1) times after operation in the group with maximum bladder volume>200 ml, and there was significant difference compared with before surgery ( P<0.05). Conclusion:TURP can significantly prolong the HUS of BPH patients with nocturia, and improve the life and sleep quality of patients. TURP partly reduces the number of nocturia, but some patients still suffer from nocturia after operation. The high total score of IPSS before operation and the maximum bladder volume ≤200 ml are the risk factors for nocturia after operation.

Objective:To investigate the effect of transurethral prostatectomy (TURP) on patients with detrusor underactivity (DU).Methods:From January 2015 to January 2019, 72 male patients from Peking University People’s hospital who underwent TURP treatment were retrospectively analyzed. The age of all patients range from 51 to 89, with an average age of 72 years old. All patients underwent urodynamic examination before surgery. The patients were divided into three groups according to BCI and P detQmax. DU group(BCI<100 and P detQmax≤40 cmH 2O) consisted of 31 patients. Then DU patients were divided into two groups according to the P detQmax: Group A, P detQmax≤20 cmH 2O, involving 9 patients; Group B, 20 cmH 2O

0.05). The preoperative Q max of group A was significantly inferior than that of group B and C, with statistically significant difference ( P<0.05) and group B was significantly inferior than group C, with statistically significant difference ( P<0.05). The preoperative PVR of group A was significantly higher than that of group B and group C, with statistically significant difference ( P<0.05)and group B was significantly higher than group C, with statistically significant difference ( P<0.05). The above indicators were followed up to compare the improvement for the three groups of patients. Seventy-two patients were followed up for free Q max(fQ max) PVR, IPSS and QOL score from March 2019 to June 2019. Results:The 72 patients were followed up for 3 to 52 months, with an average of 31.1 months. Postoperative IPSS of the three groups were(25.50±2.84), (16.78±4.04)and(14.98±3.41), respectively. The QOL were (2.90±1.29), (2.67±0.88)and(2.53±0.92), respectively. The fQ max was (5.44±2.60), (10.30±3.68)and(13.07±3.51) ml/s, respectively, and PVR was(104.00±46.00), (76.81±46.74)and(35.64±26.17)ml, respectively. Compared with the preoperative parameters, QOL in group A was significantly improved, with statistically significant difference ( P<0.05) and the IPSS, fQ max and PVR in group A were improved, but the difference was not statistically significant ( P>0.05). The IPSS, QOL, fQ max and PVR in group B and C were significantly improved compared with the preoperative parameters, and the difference was statistically significant ( P<0.05). Conclusions:The subjective and objective indicators of DU patients can be improved after TURP, while for those patients whose P detQmax≤20 cmH 2O, only QOL can be improved significantly, and the other indicators can not be improved. Therefore, adequate communication should be made before surgery to inform reasonable expectations for the DU patients.

Androgen deprivation therapy is one of the main treatments for prostate cancer patients. In recent years, many studies have revealed that androgen deprivation therapy increases the risk of cardiovascular disease, which leads to the cause of death alongside tumor-related deaths. The mechanism may be related to the elevation of testosterone levels, follicle-stimulating hormone levels and unstable atherosclerotic plaque. Standardized cardiovascular disease management in this population is a key issue to improve survival and prognosis. This paper summarizes a management plan covering 5 areas, including history collecting and data examination, assessment, referral, health education, and regimen selection.

Objective:To assess the association between warm ischemia time (WIT) and renal function in patients undergoing laparoscopic partial nephrectomy.Methods:A total of 344 patients treated with laparoscopic partial nephrectomy in Peking University People’s Hospital were included. There were 240 males (69.8%) and 104 females (30.2%) with a median age of 57 (23-89) years.The median BMI was 25.6 (16.7-36.0) kg/m 2.213 cases (61.9%) were associated with hypertension.There were 66 (19.2%) patients with diabetes mellitus. There were 92 cases (26.7%) with smoking history. The median preoperative creatinine was 73 (32-170) μmol/L. The median preoperative estimated glomerular filtration rate (eGFR) was 95 (33-142) ml/(min·1.73m 2). The maximum diameter of the tumor was 2.5 (7-9) cm.314 (91.3%) patients with renal cancer stage T 1. All patients underwent warm ischemia during the operation. The patients were divided into three groups for analysis. Restricted cubic spline regression analysis was used to assess the association between WIT as a continuous variable and percentage change of eGFR. Analysis of covariance was used to compare postoperative eGFR among the three groups, and to adjust for preoperative eGFR and tumor diameter. Results:There were statistically significant differences in the percentage change of postoperative eGFR ( P=0.009) and tumor diameter ( P<0.001) among the three groups. Restricted cubic spline regression analysis showed that with the prolongation of WIT, the percentage change of postoperative eGFR gradually decreased, and the curve began to stabilize after 30 minutes (R 2=0.044, P=0.015). The results of covariance analysis showed that after adjusting for baseline preoperative eGFR and tumor size, the effect of WIT on postoperative eGFR was significantly different among the three groups ( F=3.864, P=0.022). The postoperative eGFR in the WIT<20 min group was significantly higher than that in 20 min≤WIT<30 min group( P=0.009) and WIT≥30 min group( P=0.017). There was no significant difference in postoperative eGFR between the two groups with longer WIT( P=0.806). Conclusions:In partial nephrectomy, patients with WIT less than 20 minutes had higher postoperative eGFR levels than those with WIT greater than 20 minutes. However, when WIT exceeded 20 minutes, prolonged ischemia time did not lead to further decline in renal function.

Objective:To evaluate the long-term efficacy of AdVance sling bulbar urethral suspension and artificial urethral sphincter (AUS) implantation in the treatment of moderate to severe male stress urinary incontinence.Methods:The clinical data of 12 male patients with urinary incontinence who underwent surgical treatment in Peking University People's Hospital from June 2011 to June 2017 were retrospectively analyzed. The median age was 75(64-80) years. There were 9 cases after radical prostatectomy and 3 cases after transurethral prostatectomy. Patients had a median history of urinary incontinence of 3(1-9) years, and needed an average of 8(5-10) pads per day. Among them, 5 patients had moderate urinary incontinence and 7 patients had severe urinary incontinence. All patients underwent urinary incontinence surgery for the first time. Among the 12 patients, 6 received AdVance sling ball urethral suspension (AdVance group), and 6 received AUS implantation (AUS group). The median age of the AdVance group was 72 (64-73) years. The median number of pads used daily was 6 (5-8) tablets. Urinary incontinence Quality of Life questionnaire (I-QOL) score was (15.0±5.4). Five patients had moderate urinary incontinence and one patient had severe urinary incontinence. In the AUS group, the median age was 78(76-80) years old, the median daily pad use was 8(6-10) tablets, and the I-QOL score was (16.7±5.1), all of which were severe urinary incontinence. The daily pad usage, I-QOL and postoperative complications were recorded at 1 and 5 years after operation.Results:All patients completed the operation successfully. The postoperative follow-up was 5-7 years (mean 5.5 years). In AdVance group, 1 patient with severe urinary incontinence had no significant improvement in postoperative symptoms at 1 year after operation. The other 5 patients showed significant improvement in urinary incontinence symptoms. In the AdVance group, the median number of pads used per day was 2.5 (1-10), and the I-QOL score was (75.0±28.1), which were all significantly improved compared with that before operation ( P<0.05). The median number of pads used per day in the AdVance group 5 years after operation was 2.5(1-10), and the I-QOL score was (78.3±29.3), which were significantly improved compared with those before operation (all P<0.01). In the AUS group, no pad was needed at 1 year after operation, which was significantly improved compared with that before operation ( P<0.01). Urethral erosion occurred in 2 cases 3 years after operation, and the AUS was removed. Urinary incontinence recurred and returned to the preoperative state without reoperation. The other 4 cases did not need to use the pad 5 years after operation. In AdVance group, 3 patients had perineal pain within 3 months after operation, which was related to activity and relieved spontaneously. No wound infection, urethral erosion and other complications occurred. Urethral erosion occurred in 3 cases in AUS group. Conclusions:AdVance sling ball urethral suspension is effective for patients with moderate stress urinary incontinence and has fewer complications. AUS implantation is effective for patients with severe male stress urinary incontinence. However, the long-term complications of this operation may affect the postoperative efficacy.

The application of artificial intelligence(AI)in medical diagnosis and treatment is becoming increasingly widespread,providing doctors and patients with more high-quality,efficient and personalized medical services.However,it also raised a series of ethical issues such as data security,algorithm transparency,responsibility definition,fairness and justice,doctor-patient relationships,and other aspects.Based on the combing of existing research results,this paper analyzed the research status of medical ethics in the application of AI in diagnosis and treatment,as well as expected that future medical ethics research can further explore the ethical issues of AI technology in medical treatment in greater depth,thus ensuring the rational application of AI in the medical field and maximizing the protection of patients'rights and interests.