Professor Lin Chuangjian noticed that middle-aged and elderly individuals,as well as patients with weakened spleen and kidney function,are prone to developing gouty arthritis of phlegm-turbidity and blood stasis obstruction type.The clinical manifestations of gouty arthritis of phlegm-turbidity and blood stasis obstruction type were characterized by recurrent and prolonged episodes,marked joint pain(worse at night),joint deformities,numbness and stiffness of the skin,difficulty in walking,spasm of muscles,and limited joint movement,and were probably accompanied by facial and pedal edema,chest and epigastric fullness,dizziness and tinnitus,flushed cheeks and dry mouth,and soreness and weakness of the lower back and knees.Gouty arthritis of phlegm-turbidity and blood stasis obstruction type is a fundamentally-deficiency and incidentally-excess syndrome,characterized by phlegm-turbidity-stasis as the symptomatic features,and spleen-kidney deficiency as the root cause.During syndrome differentiation,Professor Lin emphasizes the relationship between phlegm-turbidity-stasis and the zang-orga nis of spleen and kidneys,and considers that the dysfunction of spleen and kidneys is the root cause of phlegm-turbidity-stasis formation.During treatment,therapeutic principle of simultaneously treating the symptom and root cause was followed,primary methods of fortifying the spleen and tonifying the kidneys,removing phlegm and resolving turbidity,and activating blood circulation to resolve stasis were adopted,and Bushen Juanbi Yipi Decoction was used as the foundational prescription.Bushen Juanbi Yipi Decoction consists of the herbs of Notopterygii Rhizoma et Radix,Angelicae Pubescentis Radix,Cinnamomi Cortex,Gentianae Macrophyllae Radix,Angelicae Sinensis Radix,Chuanxiong Rhizoma,Glycyrrhizae Radix et Rhizoma Praeparata cum Melle,Piperis Kadsurae Caulis,Mori Ramulus,Olibanum,Aucklandiae Radix,salt-processed Morindae Officinalis Radix,Taxilli Herb,Saposhnikoviae Radix,Smilacis Glabrae Rhizoma,Microctis Folium,Atractylodis Macrocephalae Rhizoma,Pinelliae Rhizoma Praeparatum,Clematidis Radix et Rhizoma,and Eupatorii Herba.In clinical practice,adjunct herbs for fortifying spleen,ventilating lung,soothing liver,or tranquilizing heart may be added based on accompanying symptoms.Professor Lin's diagnostic and therapeutic approach will provide valuable insights for the traditional Chinese medicine management of gouty arthritis.

Objective To investigate the role of Toll-like receptor 4(TLR4)in the regulation of homocys-teine(Hcy)-induced ferroptosis in macrophages.Methods Mouse macrophage cells RAW264.7 were cultured and divided into control group,Hcy intervention group(Hcy group),and Hcy plus ferroptosis inhibitor group(Hcy+Fer-1 group).After transfection with interference fragments,macrophages were treated with Hcy,and then divided into control group,Hcy intervention group(Hcy group),TLR4 interference negative control plus Hcy intervention group(si-NC+Hcy group),and TLR4 interference plus Hcy intervention group(si-TLR4+Hcy group).Macrophages were transfected with overexpression lentivirus and treated with Hcy,then were divided into control group,Hcy intervention group(Hcy group),a TLR4 overexpression negative control plus Hcy intervention group(OE-NC+Hcy group),and a TLR4 overexpression plus Hcy intervention group(OE-TLR4+Hcy group).After 48 hours of intervention,real-time fluorescent quantitative PCR and western blot were used to detect the expression levels of TLR4 in macrophages treated with Hcy;western blot was used to detect the expression levels of ferroptosis-related proteins ACSL4,GPX4,and FTH1 in macrophages,and ferrous ion assay kit to detect the concentration of Fe2+in macrophages;reactive oxygen species(ROS)assay kit and laser confocal microscopy were used to detect the content of intracellular reactive oxygen species.Results Compared with those in the control group,the expression level of the pro-ferroptosis protein ACSL4 was increased in the Hcy group(P<0.05),while the expression levels of anti-ferroptosis proteins GPX4 and FTH1 were decreased(P<0.05);the concentration of Fe2+was increased(P<0.05),and the content of ROS was increased.Meanwhile,the protein and mRNA expres-sion levels of TLR4 were both increased in the Hcy group(P<0.05).After macrophages were transfected with TLR4 interference fragments,compared with those in the si-NC+Hcy group,the expression levels of GPX4 and FTH1 were increased(P<0.05);the expression level of ACSL4 was decreased(P<0.05);the concentration of Fe2+was decreased(P<0.05),and the content of ROS was reduced in the si-TLR4+Hcy group.After macro-phages were transfected with TLR4 overexpression lentivirus,compared with those in the OE-NC+Hcy group,the expression levels of GPX4 and FTH1 were decreased(P<0.05),and the expression level of ACSL4 was increased(P<0.05)in the OE-TLR4+Hcy group.Conclusion Hcy induces the occurrence of ferroptosis in macrophages,and Toll-like receptor 4 has a positive feedback regulatory effect on ferroptosis in macrophages.

Objective To investigate the role of Toll-like receptor 4(TLR4)in the regulation of homocys-teine(Hcy)-induced ferroptosis in macrophages.Methods Mouse macrophage cells RAW264.7 were cultured and divided into control group,Hcy intervention group(Hcy group),and Hcy plus ferroptosis inhibitor group(Hcy+Fer-1 group).After transfection with interference fragments,macrophages were treated with Hcy,and then divided into control group,Hcy intervention group(Hcy group),TLR4 interference negative control plus Hcy intervention group(si-NC+Hcy group),and TLR4 interference plus Hcy intervention group(si-TLR4+Hcy group).Macrophages were transfected with overexpression lentivirus and treated with Hcy,then were divided into control group,Hcy intervention group(Hcy group),a TLR4 overexpression negative control plus Hcy intervention group(OE-NC+Hcy group),and a TLR4 overexpression plus Hcy intervention group(OE-TLR4+Hcy group).After 48 hours of intervention,real-time fluorescent quantitative PCR and western blot were used to detect the expression levels of TLR4 in macrophages treated with Hcy;western blot was used to detect the expression levels of ferroptosis-related proteins ACSL4,GPX4,and FTH1 in macrophages,and ferrous ion assay kit to detect the concentration of Fe2+in macrophages;reactive oxygen species(ROS)assay kit and laser confocal microscopy were used to detect the content of intracellular reactive oxygen species.Results Compared with those in the control group,the expression level of the pro-ferroptosis protein ACSL4 was increased in the Hcy group(P<0.05),while the expression levels of anti-ferroptosis proteins GPX4 and FTH1 were decreased(P<0.05);the concentration of Fe2+was increased(P<0.05),and the content of ROS was increased.Meanwhile,the protein and mRNA expres-sion levels of TLR4 were both increased in the Hcy group(P<0.05).After macrophages were transfected with TLR4 interference fragments,compared with those in the si-NC+Hcy group,the expression levels of GPX4 and FTH1 were increased(P<0.05);the expression level of ACSL4 was decreased(P<0.05);the concentration of Fe2+was decreased(P<0.05),and the content of ROS was reduced in the si-TLR4+Hcy group.After macro-phages were transfected with TLR4 overexpression lentivirus,compared with those in the OE-NC+Hcy group,the expression levels of GPX4 and FTH1 were decreased(P<0.05),and the expression level of ACSL4 was increased(P<0.05)in the OE-TLR4+Hcy group.Conclusion Hcy induces the occurrence of ferroptosis in macrophages,and Toll-like receptor 4 has a positive feedback regulatory effect on ferroptosis in macrophages.

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 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: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 geni-tal 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 stric-tures 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 suc-cessfully 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 nor-mal 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 re-intervention.There were 6 instances of stenosis recurrence,with 5 cases requiring regular urethral dila-tions 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 indi-cated 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 im-proving 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.

【Objective】 To explore the impacts of groove negative pressure drainage on the short-term prognosis of patients with transperineal anastomotic urethroplasty. 【Methods】 A retrospective case-control study was conducted to analyze the clinical data of 78 patients who underwent transperineal anastomotic urethroplasty during May 2021 and Apr.2022, including 42 patients in the groove negative pressure drainage group (experimental group) and 38 in the rubber strip drainage group (control group). The postoperative drainage volume, rate of scrotal edema, rate of infection, visual analog scale (VAS) score, and maximum urine flow rate were compared between the two groups. 【Results】 Compared with the control group, the experimental group had a longer length of incision [ (12.9±1.6)cm vs. (12.1±1.5)cm, P=0.041] and larger drainage volume 3 days after surgery [(66.1±51.9)mL vs. (36.0±16.9)mL, P=0.001] , but lower rate of scrotal edema (21.4% vs.47.2%, P=0.016) and lower VAS score (3.2±1.0 vs.3.9±1.1, P=0.008). There were no significant differences in the infection rate 7 days after surgery and the maximum urine flow rate 1 month after surgery (P>0.05). 【Conclusion】 Groove negative pressure drainage can be used to drain the effusion of perineum tissue adequately and decrease wound-specific complications, which is beneficial to the rapid recovery after transperineal anastomotic urethroplasty.

Objective:To explore the clinical outcome of early endoscopic realignment with flexible cystoscope for pelvic fracture urethral injury.Methods:We retrospectively collected and analyzed the clinical data of patients with pelvic fracture urethral injuries in ER of Beijing Jishuitan Hospital from March 2018 to June 2022.Seventy-six male patients with PFUI were reviewed and 60 patients were included due to the integrity of data collected. The patients were divided into early endoscopic realignment (EER) group and suprapubic cystostomy (SC) group according to the acute management. There were 33 patients and 27 patients in EER group and SC group, respectively. The age of the patients were (42.2±13.8)years and (44.1±15.0) years in EER group and SC group, respectively. The causes of the injuries were car accident, falling and crush, the percentage of the patients were 60.6%(20 cases), 33.3%(11 cases), 6.1%(2 cases) and 55.6%(15 cases), 44.4%(12 cases), 0 in EER group and SC group, respectively. The difference between two groups was statistically insignificant. The procedure of EER began with a cystostomy guided by B ultrasound, then an antegrade cystoscopy was performed through the cystostomy while negociating the bladder neck to the proximal side of injured urethra. A ureteral stent was inserted into the broken urethra and retrieved by a forceps through retrograde urethroscopy with another flexible cystoscope. We inserted a guidewire into the ureteral stent before removing it and placed a 16F urethral catheter along the guidewire. We analyzed the difference between two groups including the incidence, the length and the management of urethral stricture and the complexity of urethroplasty if needed. The simple urethroplasty was defined as performing anastomosis after dissection of the bulbar urethral and removing the scar tissue, while the procedure was defined as complex urethroplasty if ancillary procedures, such as separating the corporal bodies and partial pubectomy, was needed.Results:The EER group and SC group had 33 patients and 27 patients, respectively. The mean operation time of EER was (24.5±7.0)minutes and there was no intra-operative complications. Postoperatively, 4 cases of bleeding and 2 cases of UTI were found, which were successfully treated by conservative managements. Twenty-eight out of 33 patients(84.8%) in EER group developed urethral stricture and the mean length of it was (3.10±1.20)cm. However, all patients in SC group developed urethral stricture (100.0%) with the mean stricture length of (3.83±1.18)cm. The difference between two groups in term of the length of stricture was statistically significant ( P=0.026). 24 patients(85.7%) in EER group were treated by urethroplsty, 2 patients(7.1%) with endoscopic urethrotomy and 2 patients (7.1%) with dilation. All were treated with urethroplasty but 2 patients with endoscopic in SC group. In EER group, 8 strictures (33.3%)finished with simple urethroplasty and 16 strictures (66.7%) with complex urethroplasty.While in SC group, 6 strictures(24.0%) completed with simple urethroplasty and 19 strictures (76.0%)with complex urethroplasty. The complexity of urethroplasty performed in EER group was not statistically significant when compared with it in SC group( P=0.538). Conclusions:The procedure of EER with flexible cystoscope is reliable and safe. Most patients with formed urethral stricture after PFUI would be treated with urethroplasty. EER can reduce the urethral stricture formation and may decrease the need of the ancillary procedures during the urethroplasties if needed.

Objective:To evaluate the efficacy of low-intensity extracorporeal shock wave therapy (LI-ESWT) in patients with traumatic erectile dysfunction.Methods:The present study included 62 patients with traumatic erectile dysfunction, including 30 patients treated with low intensity shock waves and 32 controlled patients. The treatment groups were performed six times (twice per week), each by 3 000 impulses. The follow-up was performed 4, 8 and 12 weeks after LI-ESWT. The International Index of Erectile Function-5 (IIEF-5), nocturnal penile tumescence (NPT) and the Erection Hardness Score (EHS) were used to evaluate the therapeutic efficacy of LI-ESWT.Results:LI-ESWT could significantly improve IIEF-5 (15.67±3.89 vs. 9.41±4.66, P<0.01). 67% of patients in the LI-ESWT group and none of the control group answering 'yes’ to the SEP-Q2 elevated. In the low intensity shock wave treatment group and the control group 67% and 0 of patients, respectively, achieved erection hard enough for vaginal penetration, that is an EHS (Erection Hardness Score) of 3 ( P<0.01). According to changes in the IIEF-5 score treatment was effective in 70% of men who received low intensity shock wave treatment but in none in the control group ( P<0.01). Therapeutic efficacy could last 12 weeks ( P<0.05). No adverse events were reported during and following treatment. Conclusions:These studies suggest that LI-ESWT could improve the IIEF and EHS of traumatic ED patients.