Objective: To evaluate the long-term efficacy and safety of low-intensity extracorporeal shock wave therapy (Li-ESWT) for refractory prostate-pelvic syndrome (PPS). Methods: Clinical data of 173 patients with refractory PPS undergoing Li-ESWT at our hospital during Jan.2020 and Jan.2023 were retrospectively analyzed.All patients received weekly treatment for 8 consecutive weeks.Changes in the National Institutes of Health chronic prostatitis symptom index (NIH-CPSI)，international prostate symptom score (IPSS)，visual analog scale (VAS)，and international index of erectile function-5 (IIEF-5) were compared before treatment，immediately，1，3，and 6 months after treatment. Results: A total of 142 patients (82.1%) completed all follow-ups.Compared to baseline data，there was a statistically significant improvement in NIH-CPSI，IPSS，VAS，and IIEF-5 scores immediately after treatment and 1，3，and 6 months after treatment (P<0.01).No significant adverse reactions or complications were observed throughout the follow-up.At the time of treatment completion，115 patients (81.0%) had a decrease of ≥6 in NIH-CPSI; 99 patients (69.7%) had a decrease of ≥3 in IPSS; 121 patients (85.2%) had a decrease of ≥3 in VAS; 105 patients (73.9%) had an increase of ≥4 in IIEF-5.At the 6-month follow-up，patients who responded to treatment maintained satisfactory therapeutic effects. Conclusion: Li-ESWT can significantly improve clinical symptoms and quality of life for patients with refractory PPS，with therapeutic effects lasting at least 6 months.

Objective: To explore the association between preoperative aspartate transaminase to alanine transaminase (AST/ALT) ratio and the outcomes of urothelial cancers. Methods: After a systematic search of Web of Science，PubMed and Embase before Aug.2024，14 studies were included in the Meta-analysis.The hazard ratios (HRs) with 95% confidence interval (CI) for overall survival (OS)，cancer-specific survival (CSS)，and recurrence-free survival (RFS) were analyzed using STATA 15.0 software. Results: The Meta-analysis included a total of 8190 patients.Urothelial cancer patients with an elevated preoperative AST/ALT ratio had worse OS (HR=1.92，95% CI：1.38-2.67，P<0.001)，CSS (HR=2.12，95% CI：1.48-3.05，P<0.001)，and RFS (HR=1.63，95% CI：1.27-2.10，P<0.001).In subgroup analyses，preoperative AST/ALT ratio had a better predictive value for OS，CSS，and RFS in patients with bladder cancer than in patients with upper tract urothelial carcinoma，and a better predictive value in Asian population than in Caucasian population (P<0.001). Conclusion: A high preoperative AST/ALT ratio is associated with poor OS，CSS and RFS in urothelial cancers，particularly among the Asian population.

Objective: To analyze the relationship between perirenal fat thickness (PFT) and the severity of closed renal trauma，so as to provide reference for treatment selection and prediction of the severity of injury. Methods: The clinical data of 73 patients with unilateral closed renal trauma due to traffic accidents treated in our hospital during Jan.2012 and Dec.2022 were reviewed.According to American Association for the Surgery of Trauma (AAST)，the patients were classified into mild group (AAST Ⅰ-Ⅲ) and severe group (AAST Ⅳ-Ⅴ).The PFT of the healthy kidneys during injury was measured on the PACS software CT images，and the correlation between PFT and severity of injury was analyzed using logistic regression.The difference in PFT between patients across treatment modalities using one-way ANOVA. Results: The mean age of patients was (44.7±17.1) years.There were 16 patients (21.9%) in the severe group and 57 (78.1%) in the mild group，the mean PFT being (5.5±1.9) mm.The severe group had significantly lower PFT than the mild group \[(4.4±1.4) mm vs. (5.8±2.0) mm，P=0.003\].After age，gender，body mass index，diabetes，protective devices and complicated organ injuries were adjusted，multivariable logistic analysis indicated that increased PFT was associated with lower risk of severe injury (OR=0.628，95% CI：0.430-0.918，P=0.016).One-way ANOVA analysis showed statistically significant differences in PFT among patients with conservative，interventional and surgical treatment options \[（5.8±2.0）mm vs.（4.4±1.5）mm vs.（4.5±1.1）mm，P=0.034\]. Conclusion: PFT，which is closely related to the severity of closed renal trauma，is a reliable indicator to predict the severity of injury and the choice of treatments.

[Objective] To Compare the effectiveness of conventional local anesthesia (CLA) and two-plane local anesthesia (TPLA) in percutaneous nephrolithotomy (PCNL) so as to provide reference for clinical selection of appropriate anesthetic methods. [Methods] Clinical data of 345 patients with renal or ureteral calculi who underwent PCNL under local infiltration anesthesia in our hospital during Jan.2013 and Dec.2023 were retrospectively analyzed.The patients were divided into CLA group (n=114) and TPLA group (n=231) according to anesthetic methods.The intraoperative visual analogue scale (VAS) score, stone-free rate and incidence of complications were compared between the two groups. [Results] There were no significant differences in the baseline data between the two groups (P>0.05). When the cutaneous and renal channels were established, the VAS score was lower in the TPLA group than in the CLA group [(3.2±0.5) vs. (3.8±0.4), P=0.023]. However, there was no significant difference in the VAS score during lithotripsy [(3.3±0.5) vs. (3.4±0.5), P=0.061]. There were no significant differences between the two groups in terms of operation time, stone-free rate, hemoglobin drop, postoperative hospital stay, and time to remove nephrostomy tube and DJ tube retention time (P>0.05). [Conclusion] Both CLA and TPLA can provide good analgesia in PCNL, but TPLA can significantly reduce the pain sensation when the cutaneous and renal channels are established.

Objective To investigate the changing trends in etiology and treatment of male urethral stricture in recent 10 years.Methods A total of 940 male patients with urethral stricture admitted to the Department of Urology of Beijing Jishuitan Hospital during Jan.2013 and Dec.2022 were continually collected.The clinical data were divided into two groups according to the time of admission,namely the group from 2013 to 2017 and the group from 2018 to 2022,for a comparative analysis of the previous and subsequent 5 years.The etiology,location,length and the type of treatment of urethral stricture were retrospectively analyzed.Results The causes of the 940 cases of male urethral stricture were trauma in 447(47.55％),iatrogenic injury in 220(23.40％),idiopathic causes in 128(13.62％),lichen sclerosus(LS)in 78(8.30％),infection in 46(4.89％),and other causes in 21(2.23％).The treatment methods were urethroplasty in 691(73.51％),direct vision internal urethrotomy(DVIU)in 122(12.98％),urethral dilatation in 86(9.15％),and suprapubic cystostomy in 41(4.36％).Compared with the previous 5 years,in the past 5 years,the proportion of urethral stricture caused by trauma decreased significantly(60.34％vs.41.71％,P＜0.001),while the proportion of iatrogenic injury increased significantly(17.63％vs.26.05％,P=0.005).In the past 5 years,the proportion of urethroplasty increased from 68.81％to 75.66％(P=0.027),while the proportion of DVIU decreased from 19.66％to 9.92％(P＜0.001).Inthe past 5 years,the proportion of membranous urethral stenosis decreased significantly(26.98％vs.50.85％,x2=51.06,P＜0.001),the proportion of penile urethral stricture(21.40％vs.7.80％,=26.37,P＜0.001)and meatal stenosis(9.30％vs.4.75％,x2=5.80,P＜0.001)increased significantly.Conclusion In the past decade,trauma was the main cause of male urethral strictures,but its proportion showed a decreasing trend.Iatrogenic injury led to a gradual increase in urethral strictures,which was the second leading cause of male urethral stricture.The application of urethroplasty increased significantly,making it the main treatment method for male urethral stricture.

Objective:The preliminary results was reported regarding the treatment of mesenteric torsion by mesenteric fixation in the last decade, especially preventing recurrence of mesenteric torsion by mesenteric fan-shaped fixation.Methods:We selected 12 patients who received emergency operation in Chongqing Hospital of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from December 2010 to March 2022. All of them were made a definite diagnose of mesenteric torsion by the preoperative CT scan or exploratory laparotomy. The recurrence of mesenteric torsion will be prevented by taking the operation of mesenteric fan-shaped fixation. This technique is suitable for the patient who is suffering total mesenteric torsion, but enteric necrosis is excluded affirmatively. The operation is consists of the following progress: (1) Exploratory laparotomy to check for necrosis of the bowel and for lesions other than torsion. (2) Mesenteric torsion derotation.(3) Mesenteric linear fixation; the right posterior lower border of the small mesentery (terminal ileal mesentery) is intermittently sutured to the posterior peritoneum of the right lower quadrant to increase the width of the base of the small mesentery. (4) Mesenteric fan-shaped fixation, which is fan-shaped to the lower left and fixed in the posterior peritoneum, shortening the length of the mesentery and further increasing the width of the mesentery and posterior peritoneal fixation.Results:A total of 12 patients with mesenteric torsion were treated by operation for 15 times in all. Among them, 3 cases received resection of most small bowel were performed without recurrence; 3 patients received only derotation for a total of 4 times, 2 cases recurred, 1 of them recurred twice; 4 cases underwent derotation and mesenteric linear fixation,and 1 case recurred. Four patients with derotation and mesenteric fan-shaped fixation recovered well without recurrence.Conclusion:Mesenteric fan-shaped fixation may be an effective operative type to reduce or avoid postoperative recurrence of mesenteric torsion.

Objective:The preliminary results was reported regarding the treatment of mesenteric torsion by mesenteric fixation in the last decade, especially preventing recurrence of mesenteric torsion by mesenteric fan-shaped fixation.Methods:We selected 12 patients who received emergency operation in Chongqing Hospital of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from December 2010 to March 2022. All of them were made a definite diagnose of mesenteric torsion by the preoperative CT scan or exploratory laparotomy. The recurrence of mesenteric torsion will be prevented by taking the operation of mesenteric fan-shaped fixation. This technique is suitable for the patient who is suffering total mesenteric torsion, but enteric necrosis is excluded affirmatively. The operation is consists of the following progress: (1) Exploratory laparotomy to check for necrosis of the bowel and for lesions other than torsion. (2) Mesenteric torsion derotation.(3) Mesenteric linear fixation; the right posterior lower border of the small mesentery (terminal ileal mesentery) is intermittently sutured to the posterior peritoneum of the right lower quadrant to increase the width of the base of the small mesentery. (4) Mesenteric fan-shaped fixation, which is fan-shaped to the lower left and fixed in the posterior peritoneum, shortening the length of the mesentery and further increasing the width of the mesentery and posterior peritoneal fixation.Results:A total of 12 patients with mesenteric torsion were treated by operation for 15 times in all. Among them, 3 cases received resection of most small bowel were performed without recurrence; 3 patients received only derotation for a total of 4 times, 2 cases recurred, 1 of them recurred twice; 4 cases underwent derotation and mesenteric linear fixation,and 1 case recurred. Four patients with derotation and mesenteric fan-shaped fixation recovered well without recurrence.Conclusion:Mesenteric fan-shaped fixation may be an effective operative type to reduce or avoid postoperative recurrence of mesenteric torsion.

Rosuvastatin(RVS)is an excellent drug with anti-inflammatory and lipid-lowering properties in the aca-demic and medical fields.However,this drug faces a series of challenges when used to treat atherosclerosis caused by hyperhomocysteinemia(HHcy),including high oral dosage,poor targeting,and long-term toxic side effects.In this study,we applied nanotechnology to construct a biomimetic nano-delivery system,macrophage membrane(M?m)-coated RVS-loaded Prussian blue(PB)nanoparticles(MPR NPs),for improving the bioavailability and targeting capacity of RVS,specifically to the plaque lesions associated with HHcy-induced atherosclerosis.In vitro assays demonstrated that MPR NPs effectively inhibited the Toll-like receptor 4(TLR4)/hypoxia-inducible factor-1α(HIF-1α)/nucleotide-binding and oligomerization domain(NOD)-like receptor thermal protein domain associated protein 3(NLRP3)signaling pathways,reducing pyroptosis and inflammatory response in macrophages.Additionally,MPR NPs reversed the abnormal distribution of adenosine triphosphate(ATP)-binding cassette transporter A1(ABCA1)/ATP binding cassette transporter G1(ABCA1)/ATP binding cassette transporter G1(ABCG1)caused by HIF-1α,promoting cholesterol efflux and reducing lipid deposition.In vivo studies using apolipoprotein E knockout(ApoE-/-)mice confirmed the strong efficacy of MPR NPs in treating atherosclerosis with favorable bio-security,and the mechanism behind this efficacy is believed to involve the regulation of serum metabolism and the remodeling of gut microbes.These findings suggest that the synthesis of MPR NPs provides a promising nanosystem for the targeted therapy of HHcy-induced atherosclerosis.

Abstract: Objective　To explore the epidemiological and clinical characteristics of non-tuberculous mycobacterial(NTM) pulmonary disease in Hainan in recent years, and to provide data support for the prevention and treatment of NTM pulmonary disease. Methods　Medical records of patients diagnosed with NTM pulmonary disease who treated at the Second Affiliated Hospital of Hainan Medical University (Hainan Provincial Tuberculosis Hospital) from January 2018 to December 2022 were collected. The demographics, regional distribution, temporal distribution, distribution of mycobacterial species, clinical symptoms, and radiological imaging changes of these patients were analyzed. Results　A total of 225 confirmed cases of NMT pulmonary disease were collected in this study, with 133(59.1%) female patients outnumbering 92(40.9%) male patients. The disease predominantly affected people over 50 years old, with 192 cases (85.3%), and the major onset age range was 61-<81 years old, with a median age of 63 and an average age of 62. Farmers comprised the majority of the patients, with 112 cases (49.8%). More patients were from the western region (90 cases, 40.0%) than from the central region (76 cases, 33.8%), followed by the eastern region (59 cases, 26.2%). A total of 10 strains were detected from 225 samples, with the most common strains being Mycobacterium intracellulare (92 cases, 40.9%), Mycobacterium chelonae/abscessus(80 cases, 35.6%), and Mycobacterium avium (15 cases, 6.7%), followed by Mycobacterium kansasii (5 cases, 2.2%), Mycobacterium fortuitum (4 cases, 1.8%), and Mycobacterium parascrofulaceum (3 cases, 1.3%). There were 10 cases (4.5%) of mixed infections, including Mycobacterium avium and Mycobacterium intracellulare (8 cases, 3.6%), Mycobacterium intracellulare and Mycobacterium chelonae/abscessus (1 case, 0.4%), and Mycobacterium fortuitum and Mycobacterium chelonae/abscessus (1 case, 0.4%). The primary clinical manifestations of NTM pulmonary disease included cough and sputum (219 cases, 97.3%), hemoptysis (92 cases, 40.9%), fever (61 cases, 27.1%), dyspnea (57 cases, 25.3%), night sweats (52 cases, 23.1%), weight loss (50 cases, 22.2%), and thoracodynia (35 cases, 15.6%). There was no significant difference in symptoms between male and female patients. Pleural thickening (188 cases, 83.6%) and bronchiectasis (151 cases, 67.1%) were the most common imaging changes in NTM pulmonary disease, followed by cavities (93 cases, 41.3%), emphysema (41 cases, 18.2%), and lung damage (28 cases, 12.4%). Male patients were more likely to have lung damage and emphysema, while female patients were more likely to have bronchiectasis. Conclusions　The distribution of NTM species is diverse in Hainan area, with Mycobacterium intracellulare, Mycobacterium chelonae/abscessus, and Mycobacterium avium are dominant species. NTM pulmonary disease and pulmonary tuberculosis have similar clinical features, which requires attention for differentiation in clinical practice.

OBJECTIVE: To evaluate the surgical methods for treating distal urethral stricture. METHODS: The clinical data of 80 patients with distal urethral stricture in Beijing Jishuitan Hospital, Captial Medical University between January 2018 and December 2022 were retrospectively collected. Including male genital lichen sclerosus (MGLS) 33 cases, iatrogenic injury 25 cases, postoperative hypospadias 12 cases, and other causes such as trauma 10 cases. Among these cases, strictures involved the urethral meatus in 54 instances, of which 38 were treated with meatotomy (MO), 7 with penile skin flap urethroplasty (PSFU), and 9 with oral mucosa graft urethroplasty (OMGU). There were also 26 instances where strictures involved both the navicular fossa and meatus; one case underwent PSFU while 25 underwent OMGU. Based on different surgical methods used for treatment purposes we divided the patients into MO group, PSFU group and OMGU group. The age of the three groups was (48.8±20.0) years, (53.3±21.8) years and (44.5±16.4) years. The mean±SD body mass index (BMI) was (28.6±3.9) kg/m², (29.6±3.2) kg/m² and (29.2±4.8) kg/m². The preoperative maximum flow rate was (5.8±2.3) mL/s, (6.8±2.4) mL/s and (5.7±3.1) mL/s. RESULTS: All the operations were successfully completed without Clavien Ⅲ or Ⅳ complications. The median length of strictures (measured intraoperatively) in the three groups were 1.1 (1.0, 1.6), 1.5 (1.1, 2.0) and 4.0 (2.5, 5.0) cm. The median operation time was 60.0 (60.0, 75.0), 85.0 (75.0, 112.5) and 180.0 (75.0, 330.0) min. The median estimated blood loss was 5.0 (2.0, 10.0), 15.0 (5.0, 42.5) and 180.0 (135.0, 216.3) mL. The median postoperative hospital stay was 3.5 (2.0, 5.0), 6.5 (3.5, 7.0) and 7.5 (7.0, 11.3) days. The median follow-up duration was 40.0 (26.3, 57.3), 55.0 (18.8, 62.8) and 52.5 (30.5, 64.0) months. The median postoperative maximum flow rate was 18.3 (15.5, 19.8), 19.2 (16.1, 20.1) and 17.2 (14.2, 19.6) mL/s. Among the 38 patients with MO, 33 cases had normal urination without reintervention, and 5 cases experienced recurrent strictures and required regular urethral dilation. Among the 8 patients with PSFU, 7 cases had normal urination without reintervention, and one case developed a urinary fistula, for which intervention was recommended but the patient opted to maintain the status quo. Among the 34 patients with OMGU, 28 cases had normal urination without reintervention. There were 6 instances of stenosis recurrence, with 5 cases requiring regular urethral dilations and one case requiring reconstructive surgery. The overall success rate of operation was 85.0%, and the reintervention rate was 15.0%. Statistical analysis revealed significant differences in etiologies among the three groups (P=0.002), as well as in stricture locations (P < 0.001), length of strictures (P < 0.001), operation time (P < 0.001), estimated blood loss (P < 0.001) and postoperative hospital stays (P < 0.001). However, no significant differences were observed in terms of age, BMI, history of previous urethral stricture surgeries, preoperative maximum flow rate, follow-up duration, postoperative maximum flow rate and reintervention rate. Univariate and multivariate Logistic regression analyses indicated that a history of previous urethral stricture surgeries was a risk factor for postoperative reintervention (P=0.026). CONCLUSION MO and PSFU are primarily suitable for treating short-segment (≤1.5 cm) distal penile urethral strictures, whereas OMGU is more appropriate for longer segment strictures. MO and OMGU can both be utilized in managing MGLS cases. PSFU and OMGU are more conducive to improving the appearance of the urethral meatus. The success rate of surgical management of distal penile urethral stricture is 85.0%, 15.0% of the patients still require surgical intervention after surgery, and having history of previous urethral stricture surgeries is a risk factor for postoperative reintervention.
Humans ; Urethral Stricture/surgery* ; Male ; Retrospective Studies ; Middle Aged ; Adult ; Urethra/surgery* ; Surgical Flaps ; Penis/surgery* ; Mouth Mucosa ; Urologic Surgical Procedures, Male/methods* ; Plastic Surgery Procedures/methods* ; Lichen Sclerosus et Atrophicus/surgery* ; Operative Time ; Skin Transplantation/methods* ; Aged