Objective    To assess the early outcome of transapical transcatheter aortic valve replacement (TAVR) for patients with aortic insufficiency. Methods    The patients with aortic valvular disease who underwent transapical TAVR from October 2020 to October 2022 in the Department of Cardiac and Vascular Surgery, the First Affiliated Hospital of Anhui Medical University were enrolled in the current retrospective study. The patients with aortic stenosis were assembled in a group A, and the patients with aortic insufficiency were assembled in a group B. The improvements of heart function and complications were assessed for the two groups. Results    A total of 56 patients were enrolled, including 32 males and 24 females with an average age of 73.34±5.10 years. There were 31 patients in the group A and 25 patients in the group B. There was no statistical difference between the two groups in the age, gender, height, weight, hypertension, coronary artery disease, peripheral vascular disease, chronic obstructive pulmonary disease, renal disorder or classification of heart function (P>0.05). Also, there was still no statistical difference in the rate of permanent peacemaker implants, emergent open surgery, valve re-implants, or perivalvular leakage (P>0.05). After TAVR, the left ventricular diastolic diameter, left ventricular ejection fraction, complicated moderated mitral and tricuspid regurgitation were significantly improved in both groups compared with preoperative findings (P<0.05); however, there was no statistical difference in these parameters between groups (P>0.05). Conclusion    Interventional valve (J-Valve) in the treatment of patients with aortic insufficiency through transapical TAVR significantly improves cardiac function and reduces functional valve regurgitation.

Objective:To investigate the efficacy and safety of black tomato concentrated sauce in the treatment of benign prostatic hyperplasia(BPH) with lower urinary tract symptoms(LUTS).Methods:An open, randomized and controlled trial was conducted, and 150 BPH patients with LUTS were randomly assigned to three groups: experimental group(60 cases), placebo group (45 cases) and positive control group(45 cases) in the Department of Urology, Lanzhou University Second Hospital from December 2018 to September 2020.Inclusion criteria: age≥50 years old; first diagnosis of BPH, or interrupted medical treatment of BPH for more than 1 month; maximum urinary flow rate (Q max) <15ml/s; prostate volume (PV)≥20ml; IPSS≥8, QOL≥2. Exclusion criteria: lower urinary tract obstruction not caused by BPH, post-void residual urine volume(PVR) >250 ml; history of acute urinary retention in the last 3 months; prostate nodules and suspected prostate cancer were revealed by digital rectal examination and transrectal B-ultrasoundor; prostate-specific antigen (PSA)≥10 ng/ml; neurogenic bladder, perivous history of bladder, prostate, or urethra operations; suffering from serious heart, lung, liver, kidney and other diseases. The patients in the experimental group were orally treated with black tomato concentrated sauce(30 g/once, 3 times/day). The patients in the placebo group were orally administrated with placebo. In the positive control group, the patients with PV≤30ml were orally treated with tamsulosin(0.2mg/once, 1 time/day), the patients with PV>30ml were orally administrated with tamsulosin and finasteride(5 mg/once, 1 time/day). All enrolled patients were treated for 3 months. At the end of third month, the IPSS, QOL, PV, PVR, Q max, average urinary flow rate(Q ave), total PSA(tPSA), free PSA (fPSA), testosterone(TST) and the incidence of adverse reaction were assessed. Results:128 of 150 cases, including 52 cases in experimental group, 36 cases in placebo group and 40 cases in positive control group, completed the study, the rest was excluded due to not take medication regularly and fail to follow-up. There were no significant differences in baseline parameters among experimental group, placebo group and positive control group ( P>0.05) in age[(63.21±8.61) vs.(62.36±6.32) vs. (63.94±7.78)years old], body mass index[(23.74±3.17) vs. (23.94±3.09) vs. (24.26±2.91)kg/m 2], IPSS[(17.5±6.6) vs. (15.4±5.8) vs. (17.9±6.8)], QOL[4.0(3.0, 4.0) vs. 4.0(3.0, 4.5) vs. 4.0(3.0, 5.0)], Q max [(8.60±3.04) vs. (9.13±2.92) vs. (9.58±3.26) ml/s], Q ave[(4.39±1.69) vs. (4.66±1.76) vs. (4.88±1.60)ml/s], PV [32.00(25.55, 45.40)vs. 30.00(24.45, 38.35)vs. 34.80(27.65, 56.65)ml], PVR[23.50(8.25, 45.75) vs.5.50(0, 47.75) vs. 29.00(0, 84.00)ml], tPSA [1.53(0.89, 3.00) vs. 1.23(0.69, 1.98) vs. 2.23(0.90, 4.15)ng/ml], fPSA [0.37(0.28, 0.76) vs. 0.37(0.22, 0.52) vs. 0.54(0.30, 0.97) ng/ml] and TST[(443.64±156.32) vs. (493.97±176.16) vs. (450.89±135.08)ng/dl]. After 3 months of treatment, the IPSS in experimental group was(9.9±5.7), QOL score 2.0(2.0, 3.0), Q max(11.78±5.24)ml/s, Q ave(5.86±3.00)ml/s, tPSA 1.64(0.96, 3.32)ng/ml and TST (475.91±177.33)ng/dl, which were significantly different compared with pre-treatment( P<0.05). In positive control group, IPSS was (9.0±6.2), QOL 2.0(2.0, 3.0), Q max(11.73±4.50)ml/s, Q ave(6.11±2.53)ml/s, tPSA 1.57(0.80, 3.09)ng/ml, fPSA 0.37(0.24, 0.63)ng/ml and TST (526.11±126.88)ng/dl, which were statistically different compared with pre-treatment( P<0.01). However, there were no significant differences in all the above indexes in placebo control group compared with the baseline( P>0.05). The numerical changes of IPSS, QOL, Q maxand Q ave between experimental group and placebo group had statistically significant differences ( P<0.05). The changes of IPSS, QOL, Q max, Q ave, PV, tPSA, fPSA and TST between positive control group and placebo group had significant differences ( P<0.05). The changes of PV, tPSA and fPSA between positive control group and experimental group had statistically significant differences ( P<0.05). The incidence of adverse reactions was 5.77% (3/52, including 1 headache and 2 stomach discomfort) in experimental group, 5.56% (2/36, including 1 headache and 1 stomach discomfort) in placebo group, and 10.00%(4/40, including 1 dizzy, 1 nasal obstruction and 2 erectile dysfunction) in positive control group. And there was no statistical difference in the incidence of adverse reactions among three groups ( P>0.05). Conclusions:Black tomato concentrated sauce shows an excellent effect on patients with LUTS/BPH, and improves the quality of life with few adverse events.

Objective To investigate curative efficacy of transurethral endoscopic surgery for foreign body-induced lower urinary tract injury. Methods A retrospective case series study was conducted to analyze the clinical data of 31 patients with foreign body-induced lower urinary tract injury admitted to Henan Provincial People's Hospital from January 1998 to January 2018. There were 27 males and four females, aged 6-68 years [(27. 1 ± 16. 3)years]. Foreign bodies were located at the bladder in 12 patients, at urethra in 16, and at bladder and urethra in three. The foreign bodies were placed into the body by patients themselves in 23 patients, by other people in one, iatrogenic implantation in six, and by unknown approach in one. All patients underwent urethral surgeries, and individualized treatment plan was formulated according to the specific conditions such as the foreign body type, size, shape, location,activity and combined injury. The success rate, operation time and hospitalization time were recorded. The sexual function of the married males was evaluated by international index of erectile function-5 (IIEF-5) (IIEF-5 score≥22 points as normal) before and after the operation. The urination after the operation was evaluated by the maximum urinary flow rate ( Qmax) ( Qmax<15 ml/s as abnormal) and the complications were recorded. Results All the patients underwent successful surgeries and the foreign bodies were removed, including 26 patients who underwent transurethral endoscopic surgery alone with success rate of 84％ and five patients underwent open surgery due to failed transurethral endoscopic removal. All patients were followed up for 6-36 months [(27. 0 ± 7. 7)months]. The operation lasted for 20-72 minutes [(42. 0 ± 21. 7) minutes]. The hospitalization time was 2-7 days [(4. 0 ± 1. 7) days]. During the follow-up, 11 married males obtained normal sexual function after surgery [ postoperative IIEF-5:(23. 4 ± 1. 1) points vs. preoperative IIEF-5: (23. 8 ± 0. 9) points]. Twenty-nine patients had normal urination [Qmax=(21. 7 ± 5. 9)ml/s]. Two patients had narrow urinary tract (Qmax<15 ml/s), of whom one patient received regular urethral dilatation and another received resection and anastomosis of urethral stricture, both with satisfactory improvement of urination. Three patients had fever caused by urinary tract infection and recovered within 2 weeks after anti-infection treatment. There were no serious complications such as male sexual dysfunction, complex urethral stricture or septic shock. Conclusions Transurethral endoscopic surgery for foreign body-induced lower urinary tract injury has high success rate, minor impact on the sexual function of male patients and low incidence of complications, which is worthy of clinical practice.

Objective To summarize the epidemiological features,diagnosis and treatment of the penile fractures in single clinical center in recent 25 years so as to improve the treatment level.Methods A retrospective case series study was conducted on 23 patients with penile fractures from January 1993 to June 2017.The average age of patients was 37.78 years (range,21-66 years).Nineteen patients were married and four were not.Fourteen patients had penile fractures in summer,five in winter,three in spring and one in autumn.Three patients had Bachelor's degree or above,while 20 had less than university education.There were nine urban and 14 rural residents.Nineteen patients were caused by violent intercourse,two by violent masturbation,one by oral sex and one without willing explanation.All patients were unilateral rupture of albuginea penis,including five with urethral rupture.No misdiagnosis or missed diagnosis occurred.The time from injury to surgery was average 32 h (1993-2002),10.5 h (2003-2012),and 3.8 h (2013-2017),respectively.Emergency operations were performed using the degloved distal foreskin to repair the albuginea penis.The penile erectile function,urination and complications were recorded.Results All patients were followed up for 6-62 months (mean,26 months).In all patients,morning erection was restored at days 1 to 3 after operation,and normal urination was attained after the removal of urethral catheter.Normal sexual life was restored within 3 months after the operation.Penis elephantiasis combined with poor postoperative skin healing was seen in one patient,and mild penile erection pain was reported by one patient.No obvious erectile dysfunction,abnormal urination or other severe complications were reported.Conclusions The epidemiological features of penile fractures include low incidence,relatively concentrated region and age of onset,diversity of causes,and patients with insufficient education.Penile fractures can be diagnosed based on medical history and body examination.Emergency surgery is the first choice for penile fracture,with satisfactory outcomes and few postoperative complications.

Objective: To investigate the mechanisms of nuclear export signal of androgen receptor (NESAR) in the regulation of androgen receptor (AR) protein expression and stability in prostate cancer.Methods: The green fluorescent protein fusion protein expression vectors pEGFP-AR(1-918aa), pEGFP-NESAR (743-817aa), pEGFP-NAR (1-665aa) and pEGFP-NAR-NESAR, and lysine mutants of NESAR pEGFP-NESAR K776R, pEGFP-NESAR K807R and pEGFP-NESAR K776R/K807R, were transiently transfec-ted into prostate cancer cell line PC3.Fluorescence microscopy, Western blot and immunoprecipitation were used to detect NESAR regulation of androgen receptor stability.Results: Under the fluorescence microscope, NESAR-containing fusion proteins were cytoplasmic localization, and their fluorescence intensities were much weaker than those without NESAR.The expression levels of NESAR-containing fusion proteins were significantly lower than those without NESAR.The half-lives of GFP-NESAR and GFP-NAR-NESAR were less than 6 h, while the expression of GFP and GFP-NAR was relatively stable and the half-life was more than 24 h in the presence of cycloheximide.The expression levels of GFP-NESAR were significantly increased by proteasome inhibitor MG132 treatment in a dose-dependent manner;in contrast, MG132 did not show any significant effect on the protein levels of GFP.When new protein synthesis was blocked, MG132 could also prevent the degradation of GFP-NESAR in the transfected cells in the presence of cycloheximide, while it had no significant effect on GFP protein stability in the parallel experiment.GFP immunoprecipitation showed that the ubiquitination level of GFP-NESAR fusion protein was significantly higher than that of the GFP control.The mutations of lysine sites K776 and K807 in NESAR significantly reduced the level of ubiquitination, and showed increased protein stability, indicating that they were the key amino acid residues of NESAR ubiquitination.Conclusion: NESAR was unstable and decreased the stability of its fusion proteins.NESAR was the target of polyubiquitination and mediated the degradation of its fusion proteins through the ubiquitin-proteasome pathway in prostate cancer cells.Our research provides a new way to regulate the level and/or activity of AR proteins, thus helping us understand the molecular mechanisms of AR degradation and strict control of AR in the progression to castration-resistance.

Objective To explore the clinical effect of extracorporeal shock wave lithotripsy (ESWL) for the treatment of horseshoe kidney stones.Methods A total of 42 cases of horseshoe kidney stones from March 1987 to January 2015 were enrolled.Among them,33 cases were male and 9 cases were female.Their age range was 19 to 71 years,average age was 42 years old.25 cases got left renal pelvis stone,17 cases were on the right renal pelvis side.The diameter range of stone was 0.4-3.7 cm,the average was 1.8cm.ESWL was applied to treat whole group.The prone position was used to removing calculus.The frequency of treatment was 2000-2700 times,with an average of 2500 times;the treatment voltage was 4-7KV.The gravel time of the treatment was 30-45min,the average was 35min.Results One time for ESWL was 29 cases,two times for ESWL was 8 cases,three times for ESWL was 3 cases,four times for ESWL was 2 cases.The first discharge stones time was 3 to 10 days.There was no special discomfort after operation.40 cases got hematuria after operation,which occurred in 1 to 3 days after ESWL Renal colic was in 7 cases which happened on 1-3 days after ESWL.Condusions Calculi in horseshoe kidney may be treated by ESWL.It is a safe and simple operation.The prone position may bring satisfactory effect.

Objective:To study the feasibility of transplantation of normal rat penile corpus cavernosum and major pelvic ganglion (MPG)into the renal subserous region of a Nu /Nu mouse based on allograft technology.Methods:Penile corpus cavernosum and MPG,harvested from Sprague-Dawley (SD)rats under sterile condition,were transplanted underneath the kidney capsule of Nu /Nu mice through the mi-crosurgery instruments and surgery microscope.The histopathologic changes and cellular proliferation in the transplanted penile corpus cavernosum and MPG were then analyzed at the end of 1week and 4 weeks after transplantation.Histological staining and immunohistochemical staining were used to evaluate the main outcome measures.Results:After 1 week,the tissue morphology of the transplanted corpus caverno-sum underneath the kidney capsule of Nu /Nu mice was consistent with normal penile corpus cavernosum, and blood could be observed in the penis cavernous sinus of the graft;after 4 weeks,the mophorlogy of the tranplanted corpus cavernosum near the kidney was consistent with normal penile corpus cavernosum, while fibrosis was noteworthy in the graft away from the kidney,but blood could still be seen in the penis cavernous sinus.After 1 week,the tissue morphology of the transplanted MPG was consistent with normal MPG,multiple islet-like cell clusters could be seen in the transplanted MPG in the renal subserous re-gion,and angiogenesis could be observed near the kidney;after 4 weeks,a network of blood vessels was clearly visible away from the kidney,and islet-like cell clusters were still clearly observed in the trans-planted MPG.In addition,ki67 positive cells were observed in the transplanted penile corpus cavernosum and MPG after 4 weeks of transplantation,which indicated that there was still cell proliferation activity in the grafts.Conclusion:The transplanted corpus cavernosum and MPG underneath the kidney capsule of Nu /Nu mice could survive at least 4 weeks.Moreover,the inner structure of the transplanted corpus ca-vernosum and MPG was close to the normal tissue.The underlining mechanism may be related to the lo-cal microenvironment underneath the kidney capsule of Nu /Nu mice and the neovascularization in the transplanted grafts.

Objective To evaluate clinical efficacy of extracorporeal shock wave lithotripsy (ESWL) for treating patients with double J (DJ) stent extubation difficulties.Methods A retrospective analysis were conducted from July 1999 to December 2013,total 30 cases (18 male and 12 female) were accepted the ESWL therapy for treating the DJ extubation difficult due to the stone scales surface.The average age in those patients was 46 years (range 24 to 83 years).The average duration of DJ stents indwelling was 8.3 months (range 1.5 to 36.0 months).There were 10 cases with single stone and 20 cases with multiple stones.The distribution of stone location included left kidney in 14 cases,right kidney in 6 cases,left ureter in 3 cases and right ureter in 7 cases.The ureteral stone scales around the DJ stent showed tubular distribution.The distribution of imaging characteristic included kidney stones around the DJ stent joint in 20 cases and surface coarse in 10 cases.The diameter of the stone ranged from 0.7 to 3.2 cm (mean 1.8 cm).All the 30 cases were treated by ESWL with the 2 000-3 300 times frequency (mean 2 800 times).Treatment voltage was 4-8 KV.Results Gravel time ranged from 40 to 70 min (mean 45 min).No intraoperative and postoperative complications occurred.Their DJ stents were easily extubated immediately after ESWL.One week after ESWL,all the patients reported the flushing of the stone.Conclusion ESWL is a simple,convenient and efficacy way to solve the DJ stent extubation difficulties due to the scales surface.

Objective To investigate the efficacy and safety of transrectal ultrasound guided transurethral balloon dilation of the prostate (TUDP) for the treatment of benign prostatic hyperplasia (BPH).Methods A total of 23 men with BPH who had undergone TUDP were retrospectively analyzed,including 16 men with indwelling urinary catheters before the operation.During the TUDP,the prostatic apex and membranous urethra were dilated by inner balloon,and the prostatic urethra and bladder neck were dilated by outer balloon.The patients were followed up at the 1st,3rd,6th and 12th month after the operation,and the observation parameters included subjective symptoms,such as international prostatic symptom score (IPSS) and quality of life (QOL) score,and objective parameters,such as maximum flow rate (Qmax) and post-void residual (PVR).Results The operation time was 30-165 min,and the intraoperative hemorrhage volume was 5-50 ml.The IPSS scores at 1st,3rd,6th and 12th month after the operation were 10.4± 4.2,8.7±3.2,9.5±4.6 and 8.3±1.5 respectively,which were significantly decreased in comparison to the IPSS score (22.0±7.2) before the operation (P＜0.05).The QOL scores at 1st,3rd,6th and 12th month after the operation were 2.1±1.1,1.6±1.0,1.8±1.1 and 1.6±1.0 respectively,which were significantly improved in comparison to the QOL score (4.9±0.9) before the operation (P＜0.05).The Qmax at 1st,3rd,6th and 12th month after the operation were (10.5±3.4),(12.4±4.2),(10.9±3.9) and (12.7±4.6) ml/s respectively,which were significantly increased in comparison to the Qmax(1.9± 1.9 ml/s) before the operation (P＜0.05).There were 5,4,2 cases of urinary incontinence at the 1st,2nd and 3rd month after the operation,but they recovered at the 4th month follow-up.Besides,there were 3 cases suffered from epididymitis.Conclusion Transrectal ultrasound guided TUDP is a safe,effective and cheap option for the treatment of BPH,especially for the primary hospitals.

ObjectiveTo assess the cause of tadalafil failure and the feasibility of successfully rechallenging nonresponding patients.Methods A total of 80 consecutive erectile dysfunction ( ED ) patients who claimed poor response to tadalafil were enrolled into the study.A self-administered tadalafil-use questionnaire composed of eight questions was applied to assess how they had used tadalafil.Subjects were given thorough instruction based on individual answers and four doses of tadalafil 20mg.After a 2-week follow-up,end point efficacy of rechallenge was evaluated using the sexual encounter profile (SEP),which was recommended by international advisory panel in 2004.ResultsA total of 45 subjects had one or more areas of major suboptimal use of tadalafil:21.2％ did not know that sexual stimulation was necessary for tadalafil to work,87.5％ attempted to use tadalafil less than four times,57.5％ took a maximal dose less than 20 mg,and 84％ felt nervous or anxious.Of the 65 patients undergoing tadalafil rechallenge,30 patients answered “yes” to SEP2 and SEP3.The response rate to rechallenge was 46.2％ ( 30/65 ).ConclusionsInappropriate use of tadalafil was major cause of tadalafil non-pesponse.The efficacy of tadalafil could be improved to a better extent by education of patients.