AIM: To assess the effectiveness of selective laser trabeculoplasty(SLT)in the treatment of primary open angle glaucoma(POAG).METHODS:Totally 24 patients(33 eyes)with POAG who had poor control of intraocular pressure(IOP)from June 2022 to December 2023 were included in this retrospective study, and all of them were treated with SLT. Furthermore, the IOP, mean deviation(MD), mean sensitivity(MS), and the thickness and vascular density(VD)of optic disc nerve layer were compared after treatment. RESULTS: There were significant reducion in IOP at 1, 3, 6, 12 mo after treatment(all P<0.001). There were no statistically significant differences in MD and MS before treatment and at 6 and 12 mo after treatment(all P>0.05), and there were no statistical significant differences in the thickness and VD of optic disc(all P>0.05).CONCLUSION: SLT can significantly reduce IOP in POAG patients in the short term, without damaging the visual field and optic disc nerves, while the effectiveness of SLT decreases over time.

A chemical investigation of secondary metabolites (SMs) from Aspergillus nidulans resulted in the identification of five novel dioxopiperazine (DKP)-diphenyl ether hybrids, designated as diphenylemestrins A-E (1-5). These compounds 1-5 represent the first known dimers combining DKP and diphenyl ether structures, with compound 4 featuring an uncommon dibenzofuran as the diphenyl ether component. The structural elucidation and determination of absolute stereochemistry were accomplished through spectroscopic analysis and electronic circular dichroism (ECD) calculations. Notably, diphenylemestrin C (3) exhibited moderate cytostatic activity against NB4 cells, with a half maximal inhibitory concentration (IC₅₀) value of 21.99 μmol·L^-1, and induced apoptosis at higher concentrations.
Aspergillus nidulans/metabolism* ; Diketopiperazines/pharmacology* ; Molecular Structure ; Phenyl Ethers/pharmacology* ; Humans ; Apoptosis/drug effects* ; Cell Line, Tumor

Objective:To preliminarily examine the feasibility and outcome of single-port laparoscopic radical prostatectomy with full-length urethral preservation (FLUP-SPRP).Method:This study was a prospective case series study. A total of 25 patients with prostate cancer who met the enrollment criteria and agreed to this surgical procedure from March 2022 to December 2022 were collected at the Department of Urology, the Second Affiliated Hospital of Nanjing Medical University. The age of the patients was (67.2±7.6) years (range: 61 to 76 years). This novel procedure was performed by an experienced surgeon who performed single hole radical prostatectomy skillfully. Patient urinary control, tumor control, and related surgical complications after surgery were regularly monitored. Postoperative urinary control was evaluated using the daily amount of urine pad, 0 to 1 piece of urine pad was to restore urinary control, and 0 to 1 piece of pad within 24 hours after catheter removal was immediate urinary control.Result:All prodecures were successfully completed without transit to open surgery. The surgical time was (128.4±22.4) minutes (range: 100 to 145 minutes), the intraoperative blood loss was (68.2±13.7) ml (range: 50 to 120 ml). The urethral injury occurred in 4 cases during surgery and was repaired by sutures. The urinary control recovery rates within 24 hours, 1 week, 4 weeks, and 7 weeks after surgery were 80.0%, 84.0%, 92.0% and 100%, respectively. Postoperative large section pathology revealed 1 case with a positive basal margin of the prostate and negative margins of all prostate glands around the urethra. Postoperative complications included urinary tract infection in 3 cases, urodynia in 2 cases, and acute urinary retention in 1 case. MRI follow-up 3 months after surgery showed normal anatomy of the bladder and urethra. The follow-up values of prostate specific antigen at 3 and 6 months after surgery were less than 0.1 μg/L.Conclusions:The preliminary results of this study indicate that the FLUP-SPRP procedure is safe and feasible. The early results of postoperative urinary control and oncology are as expected.

Objective:To preliminarily examine the feasibility and outcome of single-port laparoscopic radical prostatectomy with full-length urethral preservation (FLUP-SPRP).Method:This study was a prospective case series study. A total of 25 patients with prostate cancer who met the enrollment criteria and agreed to this surgical procedure from March 2022 to December 2022 were collected at the Department of Urology, the Second Affiliated Hospital of Nanjing Medical University. The age of the patients was (67.2±7.6) years (range: 61 to 76 years). This novel procedure was performed by an experienced surgeon who performed single hole radical prostatectomy skillfully. Patient urinary control, tumor control, and related surgical complications after surgery were regularly monitored. Postoperative urinary control was evaluated using the daily amount of urine pad, 0 to 1 piece of urine pad was to restore urinary control, and 0 to 1 piece of pad within 24 hours after catheter removal was immediate urinary control.Result:All prodecures were successfully completed without transit to open surgery. The surgical time was (128.4±22.4) minutes (range: 100 to 145 minutes), the intraoperative blood loss was (68.2±13.7) ml (range: 50 to 120 ml). The urethral injury occurred in 4 cases during surgery and was repaired by sutures. The urinary control recovery rates within 24 hours, 1 week, 4 weeks, and 7 weeks after surgery were 80.0%, 84.0%, 92.0% and 100%, respectively. Postoperative large section pathology revealed 1 case with a positive basal margin of the prostate and negative margins of all prostate glands around the urethra. Postoperative complications included urinary tract infection in 3 cases, urodynia in 2 cases, and acute urinary retention in 1 case. MRI follow-up 3 months after surgery showed normal anatomy of the bladder and urethra. The follow-up values of prostate specific antigen at 3 and 6 months after surgery were less than 0.1 μg/L.Conclusions:The preliminary results of this study indicate that the FLUP-SPRP procedure is safe and feasible. The early results of postoperative urinary control and oncology are as expected.

ObjectiveTo observe the clinical effect of Qingxin Zishen decoction on hot flashes after endocrine therapy for prostate cancer and explore its therapeutic mechanism. MethodA total of 60 patients who met the criteria and were admitted to Jiangsu Province Hospital of Chinese Medicine from December 2021 to December 2022 were collected and randomly divided into a treatment group and a control group， with 30 cases in each group. The treatment group was treated with Qingxin Zishen decoction， while the control group was only given routine nursing. The observation period of this study was eight weeks. The improvement of hot flash frequency， hot flash degree， hot flash score， ISS score， and TCM syndrome score were observed in the two groups before and after treatment. The changes of serum endothelin-1 （ET-1）， nitric oxide （NO）， calcitonin gene-related peptide （CGRP）， prostate specific antigen （PSA）， and testosterone were detected. ResultIn terms of efficacy， after treatment， the frequency， degree， and score of hot flashes， ISS score， and TCM syndrome score decreased in the treatment group （P<0.05）. Compared with the control group， all indicators were better in the treatment group （P<0.05）. In terms of laboratory indicators， after treatment， the serum NO level in the treatment group was increased. ET-1 level was decreased. The ratio of ET-1/NO was decreased， and the CGRP level was decreased （P<0.05）. However， testosterone and PSA levels were not significantly changed . Compared with the control group， after treatment， the serum NO level in the treatment group was higher， and the level of ET-1 was lower. The ratio of ET-1/NO and the CGRP level were lower （P<0.05）. There were no significant differences in testosterone and PSA levels between the two groups. ConclusionQingxin Zishen decoction can significantly improve hot flashes in patients with prostate cancer after endocrine therapy. The mechanism of Qingxin Zishen decoction may be to improve the vasomotor function by regulating the expression level of vasomotor factors， so as to treat hot flashes.

Since the introduction of laparo-endoscopic single-site surgery(LESS) in China in 2008, this technique has developed rapidly in the domestic urology field. This paper systematically reviews and summarizes the historical process of the development of single-site laparoscopy technique in domestic urology. From the exploration period, the rapid development period, the rational thinking period to the current breakthrough development period, the technology has made great progress in related theoretical foundations, surgical operation skills, device development and clinical norms. It has many advantages such as less postoperative pain, minor damage in body surface, and rapid recovery. But the limitations including narrow operating space and great instrument interference are still remain. At present, the development of domestic single-site laparoscopy technique is generally stable and standardized. The robotic single-site surgery system may be able to effectively solve the problem of instrument interference, but the clinical advantages and application value of the robotic single-site surgery system still need to be further clarified by prospective, multi-center, large sample and high-quality clinical research.

Objective:To investigate the feasibility and safety of laparoendoscopic single-site combined with transurethral approach for unilateral retrograde nephroureterectomy in the treatment of upper urinary tract epithelial carcinoma.Methods:The clinical data of 12 patients from January 2018 to November 2019 with unilateral retrograde nephroureterectomy were analyzed retrospectively. There were 7 males and 5 females with an average age of 65.9 years, the age ranged from 50 to 78 years.There were 8 cases with left ureteral tumor, 6 cases with left renal pelvis tumor, 4 cases with right tumor(2 cases of right ureteral tumor and 2 cases of right renal pelvis tumor). Surgical methods: 1470 laser sleeve was used to remove the inner segment of the ureter bladder wall after the lower ureter was clipped through abdominal approach, and the urethra was inserted under the guidance of zebra guide wire.The operation time, intraoperative blood loss, intraoperative auxiliary cannula, postoperative hospital stay, postoperative drainage tube removal time, intraoperative and postoperative complications, postoperative pathology were recorded.Results:All of the operations were successful. The mean operation time was 194(135-260)min, the mean estimated blood loss was 50(25-100) ml, and the mean hospitalization time was 11.6(5-24)d. Among the 12 patients, 8 patients had abdominal drainage tube after operation. The mean time for drainage was 6.8(3-11)d. One patient added a 5 mm ancillary port.One patient had urinary leakage at the bladder anastomotic site, the catheter was removed 3 weeks later. The other patients had no postoperative incision infection, fever, bleeding, venous thrombosis and other related complications.No patient received blood transfusion and the pathological margin was negative. The median follow-up time was 12 months (5-15 months). One patient died of lumbar metastasis 8 months after operation, and others were neither tumor recurrence nor distant metastasis.Conclusions:The application of laparoendoscopic single-site combined with transurethral approach for unilateral retrograde nephroureterectomy in the treatment of upper urinary tract epithelial carcinoma is safe, accurate and effective, with less trauma and less bleeding. It is worth applying in clinical practice.

Objective? To investigate the changes of body temperature and the effect of nursing intervention in patients with low body mass index (BMI＜18.5 kg/m2) during thoracic surgery. Methods? Sixty patients with low BMI who underwent thoracic surgery in the Operating Department of the 4th Hospital of Hebei Medical University from June 2016 to December 2018 were randomly divided into observation group and control group, with 30 cases in each group. In addition, 30 patients with normal BMI (18.5-23.0 kg/m2) who underwent thoracic surgery in the same period were selected as the normal group. The observation group adopted comprehensive thermal insulation measures during the operation, and the control group and the normal group adopted routine insulation measures. The patient's body temperature of three groups was compared at each time point: entering operation room, disinfection, body cavity exploration , cutting specimens, closing the chest, suture skin and exiting operation time. the occurrence of adverse reactions during surgery, the blood coagulation index and lactic acid in the peripheral blood before and at the end of surgery, and the peripheral blood inflammatory factor levels were also compared. Results? There were no significant differences in body temperature between the three groups (P＞ 0.05). During the operation, the body temperature of the three groups decreased, and the recovery from the chest was restored. There were significant differences in body temperature between the three groups (P＜ 0.05) at the time point: closing the chest, suture skin and exiting operation room. The incidence of adverse reactions in the observation group was lower than that in the control group and the normal group, and the difference was statistically significant (P＜ 0.05). There was no significant difference in the incidence of adverse reactions between the control group and the normal group (P＞ 0.05). The coagulation and stress indexes of the observation group and the control group were significantly different from those of the normal group (P＜ 0.05). There was no significant difference in the coagulation,lactic acid and stress indexes between the observation group and the control group (P＞ 0.05). The coagulation, lactic acid and stress indexes of the three groups were significantly different before and after surgery (P＜ 0.05). There was a statistically significant difference in interleukin-6(IL-6) levels before and after surgery (F=134.241, P＜ 0.001); there was an interaction between the intervention and the time, and the difference was statistically significant (Finteraction =12.202, P＜0.001). There were significant differences between the three groups in the interleukin-10(IL-10) level group (between group F=7.792, P ＜ 0.001); the difference of IL-10 levels before and after surgery was statistically significant (Ftime=112.121, P＜ 0.001); There was an interaction between the intervention and the time, and the difference was not statistically significant (Finteraction=2.990,P=0.055). Conclusions? Compared with patients with normal BMI thoracic surgery, patients with low BMI have abnormal blood coagulation and stress indicators before surgery, and are more likely to have intraoperative blood pressure drop and adverse reactions. Comprehensive intraoperative warming measures can effectively prevent hypothermia in patients with low BMI.

Objective To investigate the clinical features and disease-causing mutations of familial hypomagnesaemia with hypercalciuria and nephrocalcinosis.Methods In February 2016,a 24 year old female patient with left kidney stone and nephrocalcinosis in bilateral kidneys was admitted to our hospital.One month prior to this admission,she had been treated by PCNL to remove the most part of left kidney stone in otherhospital.Mter admission,She was found hypomagnesaemia (serum magnesium 0.65 mmol/ L) and hypercalciuria (24h urine calcium 364.0 mg) but with normal renal function (serum creatinine 101.5μmol/L).And the remained part of left kidney stone was removed by flexible ureteroscope.As she was considered probably with an autosomal recessive FHHNC,an analysis of CLDN16 and CLDN19 gene mutations was performed using her and her parents'peripheral white blood cells.Results Mutation analysis revealed this patient had two heterozygous mutations in the CLDN16.One is an one-base deletion mutation in the 123th codon in exon 2:368delA.The other is a missense mutation in the 139th codon in exon 2:416C →T which resulted in an amino acid change Ala139Val.Her parents respectively had one of each heterozygous mutation.In the six months follow-up,an oral administration with hvdrochlorothiazide,potassium citrate,and calcium magesium supplements significantly reduced her hypomagnesaemia (serum magnesiun 1.0 mmol/L) and hypercalciuria (24-h urine calcium 156.0 mg),and no stone recurrence and aggravation of nephrocalcinosis and renal dysfunction occurred.Conclusions We diagnosed a patient with FHHNC who had a novel compound heterozygous mutation of CLDN16.This rare disease should be suspected if there are three constant clinical features of hypomagnesaemia,hypercalciuria and nephrocalcinosis,and verified with CLDN16 and CLDN19 gene test.Currently the option for treatment of FHHNC is symptomatic treatment until severe deterioration of renal function.The hydrochlorothiazide,potassium citrate,and calcium magesium supplements may have considerable effects on hypomagnesaemia and hypercalciuria.

Objective To analyze the expression levels of IL-11 and connective tissue growth factor (CTGF) in patients with breast cancer and their correlation with bone metastasis .Methods The 108 cases of breast cancer(breast cancer group) ,30 cases of breast benign tumor (breast benign tumor group) and 30 cases of healthy controls (control group) were performed by ELISA to de-tect the expression of serum IL-11 ,CTGF ,and their relationship with bone metastases was analyzed .All the patients were followed up for 2 years ,survival rates between different expression levels of IL-11 ,CTGF were compared .Results Compared with those in control group and breast benign tumor group ,the expressions of IL-11 ,CTGF in breast cancer group were increased (P<0 .05) , while there was no significant difference between control group and breast benign tumor group (P<0 .05) .The levels of serum IL-11 ,CTGF in different stages of breast cancer with bone metastases were significantly higher than those in breast cancer without bone metastases(P<0 .05) ,and the levels of IL-11 ,CTGF in bone metastases stage of Ⅲ - Ⅳ were higher than those in bone me-tastases stage ofⅠ - Ⅱ(P<0 .05) .Serum IL-11 and CTGF was positively correlated in breast cancer patients with or without bone metastases(r=0 .514 ,0 .477 ,P<0 .05) .At 2 year after surgery ,the survival rate in patients with high expression of IL-11 and CT-GF was significantly lower than that with low expression (χ2 =4 .50 ,5 .18 ,P<0 .05) .Conclusion The levels of serum IL-11 ,CT-GF in breast cancer patients are overexpressed ,which could be used as an effective serological tumor markers for diagnosis of bone metastases and assessment of prognosis .