Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a complex disease that is often accompanied by mental health disorders. However, the potential mechanisms underlying the heterogeneous clinical presentation of CP/CPPS remain uncertain. This study analyzed widely targeted metabolomic data of expressed prostatic secretions (EPS) and plasma to reveal the underlying pathological mechanisms of CP/CPPS. A total of 24 CP/CPPS patients from The Second Nanning People's Hospital (Nanning, China), and 35 asymptomatic control individuals from First Affiliated Hospital of Guangxi Medical University (Nanning, China) were enrolled. The indicators related to CP/CPPS and psychiatric symptoms were recorded. Differential analysis, coexpression network analysis, and correlation analysis were performed to identify metabolites that were specifically altered in patients and associated with various phenotypes of CP/CPPS. The crucial links between EPS and plasma were further investigated. The metabolomic data of EPS from CP/CPPS patients were significantly different from those from control individuals. Pathway analysis revealed dysregulation of amino acid metabolism, lipid metabolism, and the citrate cycle in EPS. The tryptophan metabolic pathway was found to be the most significantly altered pathway associated with distinct CP/CPPS phenotypes. Moreover, the dysregulation of tryptophan and tyrosine metabolism and elevation of oxidative stress-related metabolites in plasma were found to effectively elucidate the development of depression in CP/CPPS. Overall, metabolomic alterations in the EPS and plasma of patients were primarily associated with oxidative damage, energy metabolism abnormalities, neurological impairment, and immune dysregulation. These alterations may be associated with chronic pain, voiding symptoms, reduced fertility, and depression in CP/CPPS. This study provides a local-global perspective for understanding the pathological mechanisms of CP/CPPS and offers potential diagnostic and therapeutic targets.
Humans ; Male ; Prostatitis/blood* ; Adult ; Pelvic Pain/blood* ; Metabolomics ; Prostate/metabolism* ; Middle Aged ; Chronic Pain/blood* ; Metabolome ; Case-Control Studies ; Tryptophan/blood* ; Depression/blood* ; Oxidative Stress/physiology* ; Chronic Disease ; Lipid Metabolism/physiology*

Chronic prostatitis is a common male disease with a high incidence rate and a serious impact on the patients' quality of life. The pathogenesis of chronic prostatitis remains unclear though it is considered to be possibly related to infection, inflammation, and abnormal pelvic nerve muscle activity. Recently, a growing number of studies have reported immune imbalance and changes of inflammatory cytokines in patients with chronic prostatitis as well as a close correlation of abnormal immune response with the occurrence of diseases, pelvic pain symptoms, mental symptoms, hyperalgesia, and so on. This review summarizes the latest advances in the studies of immunologic mechanisms of chronic prostatitis.
Chronic Disease ; Cytokines ; blood ; Humans ; Hyperalgesia ; immunology ; Male ; Pelvic Pain ; immunology ; Prostatitis ; blood ; immunology ; Quality of Life

OBJECTIVETo assess the effects of minimal invasive surgery through an incision near the rectus abdominis muscle for treatment of pelvic fractures sustained in earthquake.

METHODSNine patients with pelvic fractures during Ludian earthquake (August 3, 2014) were treated with minimal invasive surgery through an incision near the rectus abdominis muscle followed by anterior ring fixation and reconstruction plate or posterior ring fixation with percutaneous sacroiliac lag screws. The operative time, incision length, blood loss volume, and pre- and postoperative pain levels were recorded. The surgical complications such as lateral femoral cutaneous nerve injury and hip adduction incapability were observed.

RESULTSThe minimal invasive surgery achieved satisfactory clinical effects and allowed convenient operation with better surgical exposure, shorter operative time, less blood loss and pain. The patients showed excellent fracture reduction and stable internal fixation without lateral femoral cutaneous nerve injury or hip adduction incapability.

CONCLUSIONSThe minimal invasive surgery through an incision near the rectus abdominis muscle is suitable for treatment of pelvic fractures with anteriorly interior fixation, especially in rescuing victims in the event of an earthquake where blood supply can be very limited.

Blood Loss, Surgical ; Bone Plates ; Disasters ; Earthquakes ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans ; Minimally Invasive Surgical Procedures ; Pain, Postoperative ; Pelvic Bones ; pathology ; Reconstructive Surgical Procedures ; Rectus Abdominis ; surgery

OBJECTIVETo investigate the relationship of the common Traditional Chinese Medicine (TCM) syndrome pattern of chronic pelvic pain syndrome (CPPS) with the contents of substance p and beta endorphin in the plasma, and provide reference data for the clinical diagnosis, differentiation and treatment of CPPS by TCM.

METHODSWe observed 98 cases of CPPS, which were classified into a lower-part damp-heat invasion group (group A, n = 32), a blood stasis-induced collateral obstruction group (group B, n = 34), and a damp-heat stagnation group (group C, n = 32) according to the TCM syndrome differentiation. Another 35 normal healthy young men were enrolled as controls. We measured the contents of substance p and beta endorphin in the plasma by immunoradiometry and ELISA, and analyzed their relationship with the TCM syndrome pattern.

RESULTSThe contents of plasma substance p were significantly higher in groups A ([1135.76 +/- 166.45] pg/ml), B ([1 337.84 +/- 170.81] pg/ml), and C ([1 210.01 +/- 162.27] pg/ml) than in the control ([574.99 +/- 113.09] pg/ml) (all P < 0.01), while the contents of plasma beta endorphin in groups A ([212.70 +/- 29.49] pg/ml), B ([157.99 +/- 24.01] pg/ml), and C ([180.81 +/- 20.20] pg/ml) were remarkably lower than that in the control ([274.73 +/- 27.64] pg/ml) (all P < 0.01).

CONCLUSIONIn the plasma of CPPS patients, the content of substance p is significantly elevated and that of beta endorphin markedly reduced, which suggests that they may be involved in the inflammatory reaction of CPPS. The levels of plasma substance p and beta endorphin can be used as valuable reference for the TCM classification of chronic prostatitis.

Case-Control Studies ; Chronic Disease ; Humans ; Male ; Medicine, Chinese Traditional ; adverse effects ; Pelvic Pain ; blood ; classification ; Prostatitis ; blood ; classification ; Substance P ; blood ; Syndrome ; beta-Endorphin ; blood

Pulmonary embolism (PE) is generally thought to occur between days 5 to 7 after acute injury. However, PE can occur early after injury and the features of early PE after injury have not been well studied. We report on two cases of acute PE within two days after thoracic and lower extremity injury. First, a 39-year-old female presented to the emergency department complaining of chest pain and dyspnea. Fifteen hours earlier, she had fallen from a 1 m height drawer at home. She had a history of idiopathic pulmonary arterial hypertension. Initial blood pressure was normal; however, oxygen saturation was 83% on room air. Chest computerized tomography (CT) showed a low density filling defect in the left main pulmonary artery. However, no deep vein thrombus was observed on low extremity CT angiogram. Second, a 21-year-old male was transferred from a local clinic to the emergency department. He had pelvic ramus, right femur shaft and ankle fracture from a motorcycle accident, which had occurred 36 hours ago. Initial vital signs were stable and he had no symptoms related to PE, except leg pain. We performed CT scan in order to rule out injury associated with pelvic bone fracture. CT scan showed filling defects in the segmental pulmonary artery of the left lower lobe. We did not find deep vein thrombus on low extremity CT angiogram. PE related to trauma can occur in early days after injury and is not commonly associated with deep vein thrombus. Emergency physicians should consider PE in the differential for patients with unexplained dyspnea, even early after injury.
Adult ; Ankle Fractures ; Blood Pressure ; Chest Pain ; Dyspnea ; Emergencies ; Emergency Service, Hospital ; Extremities ; Female ; Femur ; Humans ; Hypertension ; Leg ; Lower Extremity ; Male ; Motorcycles ; Oxygen ; Pelvic Bones ; Pulmonary Artery ; Pulmonary Embolism* ; Thorax ; Thrombosis ; Tomography, X-Ray Computed ; Veins ; Venous Thromboembolism ; Vital Signs ; Young Adult

Sacroiliac joint block can be performed for the diagnosis and treatment of sacroiliac joint dysfunction. Although sacroiliac joint block is a common procedure, complications have not been reported in detail. We report a case of iliacus pyomyositis and sacroiliac joint infection following a sacroiliac joint block. A 70-year-old female patient received sacroiliac joint blocks to relieve pelvic pain. The patient was admitted to the emergency room two days after the final sacroiliac joint block (SIJB) with the chief complaints of left pelvic pain corresponding to a visual analogue scale (VAS) score of 9 and fever. A pelvic MRI indicated a diagnosis of myositis. After 1 month of continuous antibiotic therapy, the patient's erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level remained elevated. A 67Ga SPECT/CT was done. Abnormal uptake was seen at the left sacroiliac joint (SIJ), and septic sacroiliitis was suspected. The CRP normalized to 0.29 mg/dl and the ESR decreased to 60 mm/hr, and the patient had no fever after 57 days of antibiotic therapy. She was directed for follow up at an outpatient clinic.
Ambulatory Care Facilities ; Blood Sedimentation ; C-Reactive Protein ; Emergencies ; Female ; Fever ; Follow-Up Studies ; Humans ; Muscles ; Myositis ; Pelvic Pain ; Pyomyositis ; Sacroiliac Joint ; Sacroiliitis

Primary vaginal cancer combined with uterine prolapse is very rare. We present a case of 80-year-old postmenopausal women complaints of something coming out per vagina for the past 20 years, along with blood stained discharge, foul odor leukorrhea, and severe pelvic pain for the last 3 months. A 4 x 5 cm ulcer was present on middle third of vaginal wall with marked edema and ulceration of surrounding tissue. The prolapse was reduced under intravenous sedation in operating room. On gynecologic examination, uterus was normal in size, no adnexal mass was examined, and both parametrium were thickened. Papanicolaou smear was normal. Biopsy of the ulcer at vaginal wall revealed invasive squamous cell carcinoma of vagina. Magnetic Resonance Imaging of abdomen and pelvis showed left hydronephrosis and liver metastasis. Positron emission tomography (PET)/computed tomography (CT) revealed metastasis to lung, liver and iliac bone. She died from progression of disease one month after diagnosis.
Abdomen ; Aged, 80 and over ; Biopsy ; Blood Stains ; Carcinoma, Squamous Cell ; Diagnosis ; Edema ; Female ; Humans ; Hydronephrosis ; Leukorrhea ; Liver ; Lung ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Odors ; Operating Rooms ; Papanicolaou Test ; Pelvic Pain ; Pelvis ; Positron-Emission Tomography ; Postmenopause ; Prolapse ; Ulcer ; Uterine Prolapse* ; Uterus ; Vagina ; Vaginal Neoplasms*

PURPOSE: Diagnosis of pelvic inflammatory disease (PID) is based on clinical history and examination; however, it may be difficult to distinguish from other disease entities. Multidetector computed tomography (MDCT) is a useful radiologic modality, which can be performed in an emergency department (ED). The aim of the current study was to clarify the MDCT characteristics of clinically severe PID by comparison of patients with clinically more severe and less severe forms of PID. In addition, we evaluated the independent predictors of MDCT findings in the severe PID group. METHODS: We conducted a retrospective study of female patients with symptoms and signs of PID who visited the ED at our institution during a five-year period. Patients who underwent abdominal MDCT and were diagnosed with PID were retrospectively enrolled in the study. For determination of CT characteristics, each patient was evaluated for pelvic edema, amount of ascites, Hounsfield units (HU) of ascites, salpingitis, oophoritis, intrauterine devices, peritoneal fat infiltration, cervicitis, abnormal endometrial enhancement, tubo-ovarian abscess, adjacent bowel wall thickening, localized ileus, and perihepatitis. Patients were divided into two groups: clinically more severe and less severe forms of PID. Patients having the clinically more severe form of PID were defined as follows: (1) initial body temperature over 38.3degrees C, (2) initial systolic blood pressure < 90 mmHg, (3) intractable abdominal pain, or (4) uncontrollable nausea or vomiting despite medication. We compared data between the two groups. RESULTS: A total of 136 patients were enrolled in this study. Thirty eight patients had the clinically more severe form (28%) and 98 patients had the less severe form (72%). In comparison with subjects in the group having the less severe form, the amount of ascites (p<0.001), salpingitis (p<0.05), and tubo-ovarian abscess (p<0.01) differed statistically between the groups. The HU value of ascites in the more severe group, 19.56+/-11.14 HU, was significantly greater, compared with that of the group having the less severe form. Results of multivariate logistic regression analysis revealed an association of the amount of ascites, a high HU value, and atubo-ovarian abscess with increased odds of the more severe form (adjusted OR 3.25, 95% CI 1.01-10.45; adjusted OR 5.84, 95% CI 1.80-18.95; and adjusted OR 8.42, 95% CI 1.73-40.96, respectively). CONCLUSION: Patients with clinically more severe PID show more clinically important findings on MDCT, such as a greater amount of ascites, higher HU value of ascites, and tubo-ovarian abscess. Leukocytosis, increased neutrophil percentage, and elevated CRP were observed in patients with severe PID.
Abdominal Pain ; Abscess ; Ascites ; Blood Pressure ; Body Temperature ; Edema ; Emergencies ; Female ; Humans ; Ileus ; Intrauterine Devices ; Leukocytosis ; Logistic Models ; Multidetector Computed Tomography ; Nausea ; Neutrophils ; Oophoritis ; Pelvic Inflammatory Disease ; Pelvic Pain ; Retrospective Studies ; Salpingitis ; Uterine Cervicitis ; Vomiting

OBJECTIVE: Aromatase is the key enzyme for the conversion of C19 steroids into estrogen in certain human tissues. We studied to evaluate the aromatase expression in eutopic endometirum and endometriotic lesion and its relationship to clinical and laboratory parameters. METHODS: The study included 78 cases of endometriotic lesion and 14 cases of eutopic endometrium and 30 cases of normal uterine endometrium obtained through laparoscopic surgery and curettage. The frozen tissue specimens were examined by immunohistochemistry using aromatase. Clinical symptoms, laboratory findings, and operative findings were analyzed and compared in according to aromatase expression. RESULTS: We observed positive immunohistochemical expression for aromatase in endometriotic lesion from 46/78 patients (59.0%). Aromatase expression was elevated in comparison to eutopic endometrium (5/14 patients, P=0.032) and the difference was more pronounced when eutopic endometriums from patients with endometriosis were compared with those of healthy controls (2/30 patients, P<0.001). Aromatase-positive patients had more moderate-to-severe chronic pelvic pain, higher CA-125 level significantly. Also in operative findings, severe grade endometriosis, bilateral endometriomas, and associated leiomyoma and adenomyosis were more frequent in aromatase positive patients. High values of white blood cell count, erythrocyte sedimentation rate, CA 19-9 were more frequent in aromatase positive patients notwithstanding insignificant differences. CONCLUSION: Unopposed local biosynthesis of estrogens by increased expression of aromatase in eutopic endometrium and endometrial tissue could be involved in the development or maintenance of endometriosis and other uterine estrogen-triggered diseases. Our findings suggest increased expression of aromatase may be related with severity, activity, and chronic pelvic pain in patients with endometriosis.
Adenomyosis ; Aromatase ; Blood Sedimentation ; Curettage ; Endometriosis ; Endometrium ; Estrogens ; Female ; Humans ; Immunohistochemistry ; Laparoscopy ; Leiomyoma ; Leukocyte Count ; Pelvic Pain ; Steroids ; Biomarkers, Tumor

OBJECTIVE: This study was performed to compare the characteristics, hematologic findings, microbiologic results, and radiologic findings of the patients with Fitz-Hugh-Curtis Syndrome (FHCS) to those without perihepatitis. METHODS: From January 2003 to June 2006, 120 patients of PID with FHCS and 212 patients of PID only were included in this study. Patients' medical records including cervical cultures, chlamydia polymerase chain reaction (PCR), abdomen and pelvic computed tomography (CT), and transvaginal sonography were analysed retrospectively. RESULTS: PID with FHCS group had significantly higher incidence of right upper quadrant abdominal pain (p<0.01) and significantly lower incidence of lower abdominal pain than PID only group (p<0.01). PID with FHCS group was associated with significantly higher erythrocyte sedimentation rate (ESR) in comparison to that of PID only group. In addition, significantly higher incidence of chlamydia infection and intrauterine device user were noted in PID with FHCS group. CONCLUSIONS: In PID patients with right upper quadrant abdominal pain, accompanied by elevated ESR, suspicion of chlamydia infection, and intrauterine device in situ, physicians should actively perform procedures including abdomen and pelvic CT and laparoscopic surgery for early diagnosis of FHCS.
Abdomen ; Abdominal Pain ; Blood Sedimentation ; Chlamydia ; Chlamydia Infections ; Early Diagnosis ; Female ; Hepatitis ; Humans ; Incidence ; Intrauterine Devices ; Laparoscopy ; Medical Records ; Pelvic Inflammatory Disease ; Peritonitis ; Polymerase Chain Reaction