Objective To compare the application of multifunctional ureterostomy stent and traditional ureterostomy internal stent in patients with total ureterostomy.Methods Prospectively,102 patients with bladder cancer and undergoing elective radical cystectomy with urinary diversion admitted to our hospital from March 2019 to March 2023 were selected for the study.According to the random number rank method,the patients were divided into the study group(51 cases)and the control group(51 cases).The control group was given a traditional single-J ureteral stomy stent drainage device,and the research group was given a multifunctional ureteral stomy stent drainage device.The differences of OAI score,renal function index(eGFR),recent complications,long-term complications and quality of life(FACT-BL score)were compared between the two groups.Results OAI scores 1 month,3 months and 6 months after surgery(study group:49.33±4.07,57.29±3.90,68.25±3.76;control group:44.25±4.61,52.31±4.58,59.06±4.37)and before surgery(study group:32.71±4.32;control group:33.18±4.74)compared with higher levels(P＜0.05),but the study group was higher than the control group(P＜0.05).Repeated measurement ANOVA results showed that eGFR at 3 months and 6 months after surgery(study group:86.07±4.07,88.01±3.01;control group:83.09±3.06,85.06±5.09)and before surgery(study group:82.05±6.04;control group:81.03±5.06)compared with higher levels(P＜0.05),but the study group was higher than the control group(P＜0.05).The total rate of recent complications in the study group was lower than that in the control group(7.84％VS 23.53％,P＜0.05).The total incidence of long-term complications in the study group was lower than that in the control group(43.14％VS 78.43％,P＜0.05).Emotional status score,physical status score,functional status score,social and family status score,BSS score,FACT-BL total score of the two groups 6 months after surgery(study group:20.25±2.36,24.92±1.87,25.65±1.11,26.02±1.14,32.75±1.76,129.59±5.74;Control group:18.65±3.10,20.18±3.02,23.51±1.29,21.51±2.24,30.26±3.07,114.10±10.37)and preoperative(study group:14.27±3.56,16.57±3.58,17.27±2.35,17.49±2.64,23.41±5.25,89.02±13.62;Control group:14.39±3.44,16.47±3.25,17.22±2.34,17.55±2.59,23.43±5.25,89.25±13.62)were increased(P＜0.05),and the study group was higher than the control group(P＜0.05).Conclusion The application of multifunctional ureteral stent in patients with ureteral cutaneous stomy with total cystotomy can effectively improve the adaptability of stomy,promote the recovery of renal function,reduce the risk of short-term and long-term complications,and improve the quality of life of patients.

Patients with inflammatory bowel disease (IBD) are at a significantly increased risk of colitis-associated colorectal cancer (CAC). The relationship between intestinal flora metabolites and CAC has attracted much attention. Regulating intestinal flora metabolism or increasing beneficial metabolites may play an important role in preventing CAC. This article reviewed the role of intestinal flora metabolites in CAC.

Objective:To analyze the clinical characteristics and prognostic value of prostate-specific antigen (PSA) dynamic features in patients with metastatic castration resistant prostate cancer (mCRPC) received abiraterone acetate (AA) therapy.Methods:The data of 89 patients with mCRPC who received AA therapy from January 2017 to June 2021 in Shanghai Tongji Hospital were retrospectively reviewed. The age of patients was (75.7 ± 8.3) years old, median PSA before AA was 56.88 (19.31, 143.75) ng/ml. The PSA dynamic features included PSA nadir (PSAN) and PSAN time. PSAN was defined as the lowest value of PSA after treatment, and PSAN time was defined as time to PSAN after AA treatment. PSAN was divided into 3 groups: PSAN1 (<0.1 ng/ml), PSAN2 (0.1- 4.0 ng/ml) and PSAN3 (>4.0 ng/ml) groups. PSA response was defined as a maximum PSA decline rate ≥50%, and no PSA decline after treatment was defined as primary resistance. Cox regressions adjusted to clinical factors were performed to evaluate the influence of PSA dynamic features on patients' radiographic progression-free survival (rPFS) and overall survival (OS). Log-rank test was used to evaluate the survival time of patients in different PSAN groups. Receiver operator characteristic (ROC) curve and area under the curve (AUC) were performed to analyze the predictive value of PSA dynamic features on survival outcomes of patients.Results:The follow-up time was 17 (12, 23) months, and 75 (84.3%) patients showed PSA responses. The median PSAN was 1.82 (0.01, 11.70) ng/ml, median PSAN time was 5.0(3.0, 9.5)months. Multivariate Cox regression indicated that PSAN was an independent risk factor for rPFS ( PSAN2: HR=5.308, P=0.017; PSAN3: HR=13.209, P<0.001), and PSAN time ≥ 5 months( HR=0.309, P<0.001)was an independent protective factor for rPFS. Also, the PSAN3 was an independent risk factor for OS( HR=9.459, P=0.048). Log-rank test indicated that the rPFS of PSAN1 group (median not reached) was significantly longer than PSAN2 [median 13.0(95% CI 8.2-17.8) months, P=0.001] and PSAN3 [8.0 (95% CI 4.1-11.9) months, P<0.001] groups. ROC curve and AUC showed that PSAN had a higher predictive value in rPFS outcomes compared with T stage, metastatic disease volume, and Eastern Cooperative Oncology Group (ECOG) score (0.82 vs. 0.69, 0.68, 0.53, P<0.05). PSAN had a higher predictive value in OS outcomes than metastatic disease volume and ECOG(0.83 vs. 0.63, 0.58, P<0.05). Conclusions:Lower PSAN needs longer PSAN time. PSAN is an independent risk factor for rPFS and OS, and PSAN time is an independent protective factor for rPFS.

There are few reports on the use of Allium stents in the treatment of membranous urethral stricture in China. Its safety and effectiveness need to be observed. This study retrospectively analyzed the data of 5 patients admitted to our hospital for the treatment of membranous urethral stricture using Allium-covered metal urethral stents in the past 5 years. The preoperative International Prostatic Symptom Score (IPSS) score was 8.80±1.30, quality of life(QOL)score was 4.20 ±0.84, and the International Index of Erectile Function-5(IIEF-5) score was 20.20 ± 1.92, respectively. Six months after the operation, the IPSS score was 3.60±1.52, the QOL score was 1, and the IIEF-5 score was 19.80±1.48. This operation is easy with little invasion. It can alleviate the dysuria of patients with membranous urethral stricture and has little impact on the sexual function of patients. It is generally safe and controllable, but the appropriate time for implantation still needs to be explored.

Objective:To investigate the clinical characters and prognostic value of PSA flare and bone flare in metastatic castration resistant prostate cancer(mCRPC) patients received Abiterone acetate(AA) therapy.Methods:A retrospective study was conducted for 93 mCRPC patients treated with AA from Jul.2016 to Dec.2020. Mean age was (75.4±8.9)years, median PSA was 58.2 (16.4, 148.6)ng/ml. Patients received at least 6 months of AA treatment. PSA flare was defined as an increase of PSA after AA therapy followed by a decrease. Bone flare was defined as disease progression after 3 months of therapy, typically based on increased lesion intensity or number, and reevaluation 6-9 months later showed improvement in the scan. The clinical characters and prognostic value of the flare phenomenon was evaluated and analyzed respectively.Results:The median follow up time was 16 months(6, 54 months), fourteen patients showed PSA flare at first month after AA treatment, and median time of duration was 2 months(1, 7 months). The serum alkaline phosphatase (ALP) had a similar rising trend along with PSA flare[115.5(98.0, 198.5)U/L vs. 119.0(97.0, 288.8)U/L, P=0.016]. Seven patients showed bone flare and 3 cases co-existed with PSA flare. Multivariate Cox regression analysis indicated bone flare was an independent protective factor for progression free survival(PFS)( HR=0.117, 95% CI 0.015-0.895, P=0.039), PSA flare had no significant influence on PFS ( HR=1.314, 95% CI 0.554-3.121, P=0.536)and overall survival(OS)( HR=1.348, 95% CI 0.393-4.263, P=0.635). Log-rank test showed patients with bone flare had a longer PFS( P=0.016) and OS( P=0.047) compared with patients without bone flare. Conclusions:PSA flare always faded away after 2 months AA therapy and had no influence on PFS and OS. Bone flare maybe an indication for better prognosis.

Crohn′s disease complicated with mesenteric fibromatosis is rare in clinical practice. We report a case that the patient with Crohn′s disease developed mesenteric fibromatosis after 1.5 years of infliximab treatment, hoping to enrich clinicians′ experience.

42 cases with gastroesophageal varices were prospectively included. The groups were treated with endoscopic band ligation or combined with tissue adhesive. The results showed that the left gastric vein internal diameter, average blood flow velocity and blood flow volume after the treatment of band ligation combined with tissue adhesive were significantly lower than that of the treatment of band ligation alone, and the differences were statistically significant ( P < 0.05). Spleen and portal vein internal diameter, blood flow and average velocity, the liver and spleen size, shear wave velocity and liver function grade of the two groups after treatment did not change significantly ( P > 0.05). The effective rate of band ligation combined with tissue adhesive in the treatment of esophageal and gastric varices (66.67%, 52.38%) were higher than that of band ligation alone (42.85%, 23.81%) ( P > 0.05), and the re-bleeding rate of the latter was higher (9.52% and 19.05%, P > 0.05). Hence, it is suggested that the combined therapy is safe and more effective, and has no apparent effect on liver function and portal hypertension.

Crohn′s disease complicated with mesenteric fibromatosis is rare in clinical practice. We report a case that the patient with Crohn′s disease developed mesenteric fibromatosis after 1.5 years of infliximab treatment, hoping to enrich clinicians′ experience.

Degos disease is a rare multi-system necrotic vasculitis disease. Autoimmune abnormality, heredity, infection and coagulation abnormality may be involved in the disease. Usually skin manifestations would be the first manifestation of this disease. However, intestinal perforation and hemorrhage are the main causes of death, which are not easy to be recognized or diagnosed by gastroenterologist. A case of this rare disease with intestinal microperforation is reported for reference.

Objective:To analyze the association between NUDT15 gene polymorphism and adverse reactions induced by azathioprine (AZA) myelosuppression in patients with inflammatory bowel disease (IBD) , and to provide reference for clinical treatment of IBD. Methods:Literatures of randomized controlled trials of NUDT15 gene mutation and AZA in the treatment of IBD were searched with computer from China Knowledge Network, Wanfang database, VIP database, PubMed, Cochrane Library and Web of Science. The quality evaluation and data of studies meeting the inclusion criteria were screened and retrieved to perform meta analysis. Results:Ten literatures were enrolled including 3095 patients. Meta analysis showed that the mutation rate of NUDT15 gene in Asian IBD population was significantly higher than that of TPMT gene (21.5% vs. 2.8%, OR = 0.10, 95% CI: 0.07-0.15, P<0.001) with significant difference. NUDT15 gene mutation was significantly associated with AZA-related leukopenia ( OR = 0.40, 95% CI: 0.34-0.47, P<0.001) . IBD patients with NUDT15 mutation were more likely to develop leukopenia in the early stage of AZA application ( OR = 2.69, 95% CI: 1.67-4.33, P<0.001) . Besides, homozygous mutants of NUDT15 gene (TT type) were more likely to have grade Ⅲ-Ⅳ bone marrow suppression ( OR = 0.09, 95% CI: 0.04-0.18, P<0.001) . Conclusions:In Asian IBD population, bone marrow suppression caused by AZA is significantly associated with NUDT15 gene mutation, which is more closely associated than TPMT gene mutation and usually occurs within 8 weeks of AZA application. At the same time, homozygous mutations of NUDT15 gene (TT) increase the risk of severe myelosuppression.