【Objective】 To analyze the causes of the failure of previous operations in female patients with stress urinary incontinence (SUI), and to evaluate the efficacy and safety of modified transobturator outside-in tape (TOT). 【Methods】 A total of 42 female SUI patients who had failed in previous anti-incontinence surgery during Aug.2016 and Jul.2022 were enrolled. The causes of failure were analyzed. All patients were treated with modified TOT, and the operation time, estimated blood loss, duration of catheterization, symptom improvement and complications were observed. The outcomes were evaluated with the International Consultation on Incontinence Questionnaire Short Form (ICI-Q-SF), pad test and urodynamic study. 【Results】 All operations were technically successful. The average operation time was (32.4±18.6) min, and estimated blood loss was (54.2±34.5) mL. There were no obvious complications. After operation, the ICI-Q-SF score significantly decreased (P<0.05), and the abdominal leak point pressure (ALPP) significantly increased (P<0.05), while the post-voided residual (PVR) and maximum urine flow rate (Qmax) remained unchanged (P>0.05). The overall effective rate was 88.1%. 【Conclusion】 Modified TOT can be used for the treatment of patients with failed anti-SUI surgery, which is simple and easy to perform, with a low complication rate and satisfactory postoperative results.

Objective:To investigate the efficacy and safety of transurethral Moses holmium laser enucleation of the prostate (MoLEP) in the treatment of small-volume benign prostatic hyperplasia (BPH).Methods:The clinical data of 132 patients with small BPH (prostate volume <40 ml) who underwent MoLEP from October 2017 to April 2020 in the First Affiliated Hospital of Nanjing Medical University were analyzed retrospectively.The age of the patients was (63.93±5.21) years old, including 12 patients with cystolithiasis. The prostate volume of 132 patients was (32.16±7.81) ml, the preoperative international prostate symptom score (IPSS) was 23.00(15.00-34.00), the quality of life score (QOL) was 5(2-6), the maximum urinary flow rate (Q max) was 7.80(0.80-9.80)ml/s and residual urine volume (PVR) was 158(51-409) ml. 89 patients had the preoperative maximum detrusor contractility (64.23±8.11) cmH 2O. Surgical methods: the 120 W Moses laser platform(Lumenis Inc)was used, the cutting power was adjusted to 80 W (2.0J×40Hz) (narrow pulse width mode), and the hemostatic power 24W (0.8J×30Hz) (wide pulse width mode). Patients with bladder calcifications underwent Moses laser bladder stone lithotripsy.After the initial resection by the level of verumontanum was performed, an anatomic plane was exposed and carried forward until the bladder neck. If prostate stones were found, Moses holmium laser lithotripsy can be performed directly. After operation, the bladder was continuously flushed with normal saline. The catheter was removed 24 hours after the operation. The operation status, intraoperative and postoperative complications were recorded. IPSS, QOL, Q max and PVR were followed up 3 months after surgery. Postoperative urinary incontinence is defined as the need for 2 pads or more within 24 hours. Results:The operations of 132 cases (including 12 cases with bladder stones) were successfully completed. 30 cases with prostate calcifications were found during the operation. The operation time (enucleation time) was (16.83±4.03) min. There were no perioperative complications such as blood transfusion, transurethral resection syndrome, urinary retention and venous thromboembolism. No bladder neck contracture or recurrence of bladder stones was found after surgery. Postoperative urethral stricture occured in 2 cases (1.5%), and postoperative urinary incontinence in 27 cases (20.5%). There were 102 cases (77.3%) with chronic interstitial inflammatory cell infiltration. Three months after operation, IPSS was 7(0-14), QOL was 2(0-5), Q max was 17.55(9.40-26.50)ml/s and PVR was 27(0-46) ml, which were significantly improved compared with preoperatively( P<0.05). Conclusions:MoLEP can significantly improve lower urinary tract symptoms (LUTS) and life quality of patients with small-volume BPH.At the same time, the incidence of complications such as urethral stricture and urinary incontinence is lower. The operation is safe and reliable, and bladder stone lithotripsy can be performed at the same time.

OBJECTIVE: To study the effect of down-regulating miR-488 targeting Jag1 on the injury of hypoxia-reoxygenation myocardial H9c2 cells. METHODS: A hypoxic-reoxygenated myocardial H9c2 cell injury model was constructed. miR-488 inhibitor was used to transfect the cells. CCK-8 method and flow cytometry were used to detect cell proliferation and apoptosis in each group. Lactate dehydrogenase (LDH), superoxide dismutase (SOD), malonaldehyde (MDA), catalase (CAT) levels were detected. Western blotting was used to detect the expression of Bcl-2 associated X Protein (Bax) and B cell lymphoma/lewkmia-2 (Bcl-2). Target genes of miR-488 were predicted, and a luciferase reporter system was used to verify the targeting relationship between the two. Myocardial H9c2 cells were co-transfected with miR-488 inhibitor and Jag1 siRNA, and treated with hypoxia and reoxygenation, cell proliferation, apoptosis, LDH, SOD, MDA, CAT levels, and Bax, Bcl-2 protein expression were detected. RESULTS: The expression of miR-488 in the hypoxia-reoxygenated myocardial H9c2 cells was increased, along with reduced cell proliferation, increased apoptosis, increased Bax protein expression, decreased Bcl-2 protein expression, increased MDA, decreased CAT and SOD, and increased LDH level in the supernatant of cell culture. When myocardial H9c2 cells were transfected with miR-488 inhibitor and treated with hypoxia and reoxygenation, the expression of miR-488 was decreased, along with increased cell proliferation, decreased apoptosis, decreased Bax protein expression, increased Bcl-2 protein expression, decreased MDA, increased CAT and SOD, and decreased LDH level in the supernatant of cell culture. Down-regulation of miR-488 could target and down-regulate Jag1 expression. And Jag1 siRNA could reverse the effect of miR-488 inhibitor on the proliferation, apoptosis, LDH, SOD, MDA, CAT levels and the expression of Bax and Bcl-2 of hypoxic-reoxygenated myocardial H9c2 cells. CONCLUSION Down-regulating miR-488 targeted Jag1 can attenuate hypoxia-reoxygenation induced myocardial H9c2 cell injury.
Apoptosis/genetics* ; Down-Regulation ; Humans ; Hypoxia/genetics* ; Jagged-1 Protein/genetics* ; MicroRNAs/genetics* ; Myocardial Reperfusion Injury ; Myocytes, Cardiac

Objective:The clinical efficacy, safety and quality of life in female patients with stress urinary incontinence (SUI)treated by midurethral sling were studied by multicenter retrospective study.Methods:From January 2018 to December 2018, 531 female patients with severe stress urinary incontinence from seven domestic urinary center were included in this study, including 78 cases from General Hospital of Central Theater Command, 122 cases from Shanghai Jiao tong University School of Medicine Affiliated Ren Ji Hospital, 67 cases from Shanghai Jiaotong University Affiliated First People’s Hospital, 68 cases from People’s Hospital of Jiangsu Province, 71 cases from The First Affiliated Hospital of Xi’an Jiaotong University, 65 cases from Zhejiang Provincial People’s hospital, 60 cases from Xiamen University First Affiliated Hospital. Among the 531 patients, 214 cases received TVT sling with an average age of (58.14±10.16) years. 181 cases were in postmenopausal(84.6%). The number of births ≥2 times was 89 (41.6%) cases. The score of ICI-Q-SF was 16.00±1.73. There were 166 cases of moderate incontinence (77.6%) and 48 cases of severe incontinence (22.4%). There were 317 patients in the TOT/TVT-O group with an average age of (58.33±10.25) years. 247 cases were in postmenopausal(77.9%). The number of births ≥2 times was 120 (37.8%) cases. The score of ICI-Q-SF was 15.79±1.75. There were 256 cases of moderate incontinence (80.8%) and 61 cases of severe incontinence (19.2%). There was no statistically significant difference in general data parameters between the two groups ( P>0.05). 1, 6, 12 months after the operation, the two groups of patients incontinence questionnaire Summary(ICI-Q-SF), common complications and Patient Global Impression of Improvement(PGI-I), satisfaction evaluation follow-up. ICI-Q-SF score improved > by 50% (cure + significant improvement) and 1-hour pad test <10 g (qualitative index) were used as the evaluation index of surgical success. Result:Both of the two surgical methods have high successive rate. There was no significant difference between 94.9% (203/214) of the TVT group and 93.7% (297/317) of the TOT/ TVT-O group ( P>0.05). Postoperative improvement of urinary incontinence (cure rate) [88.3% (189/214)]in the TVT group was slightly higher than that in the TOT/ TVT-O group [77.0% (244/317)] ( P<0.05). There was no change in the recurrence rate of urinary incontinence in the follow-up 6 and 12 months after the operation. There was no statistically significant difference between 4.4% (9/203) in the TVT group and 5.4% (16/297) in the TOT/TVT-O group ( P>0.05). The subjective cure rate 12 months after the operation was 96.3% (206/214) in the TVT group and 95.9% (304/317) in the TOT/TVT-O group ( P>0.05). 10 patients occurred bladder perforation occurred in the TVT group, and no bladder perforation occurred in the TOT/TVT-O group ( P<0.001). The incidence of pain and discomfort in the TVT group was significantly lower at 1.9% than that in the TOT/TVT-O group at 6.9% ( P<0.01). There was no statistically significant difference between the two groups in the incidence of complications such as dysuria/urinary retention, frequent urination/urgency incontinence. Both of them exposed sling ( P>0.05). Conclusion:Both TVT and TOT/TVT-O sling can effectively treat female stress urinary incontinence, and both can improve the sexual satisfaction of patients after the surgery, with fewer complications and other advantages. The selection of specific surgical methods in clinical practice can be individualized according to the patient's physical conditions, clinical needs and the operation methods familiar to doctors.

Objective To quantitatively assess renal hemodynamic changes in hypertensive acute kidney injury in rabbits induced by L-NAME using 64-slice spiral CT functional imaging techniques,and to explore the application of these techniques in evaluation of early kidney functional changes.Methods Fourteen female New Zealand white rabbits were randomly divided into normal control group (n=6)and L-NAME group (n=8).The control group was injected NaCl solution and the L-NAME group was injected the same amount of L-NAME solution to make hypertensive acute kidney injury model.64-slice spiral CT and SPECT were scanned af-ter injection.Blood samples were collected before and after injecting NaCl and L-NAME solution to detect serum creatinine (Cr).Cr level and CT perfusion parameters of the two groups were analyzed and compared with the pathology results.GFRCT detected by con-trast-enhanced CT and GFRSPECT detected by SPECT were analyzed by the rank correlation test.Results Renal blood volume,blood flow,permeability surface,time to peak,and peak value had statistically significant differences between the control and L-NAME group (P <0.05).GFRCT and GFRSPECT had obvious correlation.GFRCT of L-NAME group was obviously lower than that of the con-trol group.The kidneys of L-NAME group showed obviously injured under both light microscope and microscope.Conclusion 64-slice spiral CT functional imaging techniques can dynamically observe and quantitatively assess early hypertensive kidney dysfunc-tion,especially unilateral renal blood flow abnormalities.It is an effective examination in quantitatively assessing kidney function.

OBJECTIVETo study the technique and clinical outcomes of laparoscopic radical prostatectomy for high risk prostate cancer.

METHODSA total of 65 patients with high risk prostate cancer were treated with surgery in the First Affiliated Hospital of Nanjing Medical University from January 2011 to June 2013. The mean age was 67 years (range 45-75 years). The mean preoperative prostate specific antigen (PSA) level was 26.7 µg/L (range 11.2-65.5 µg/L). The transrectal biopsy revealed Gleason score of 3+3 in 4 patients, Gleason 3+4 in 27 patients, Gleason 4+3 in 11 patients, Gleason 4+4 in 21 patients and Gleason 4+5 in 2 patients. The bone metastasis was excluded by scintigraphy examination. The surgical procedures were performed through transperitoneal approach. Extended pelvic lymph nodes dissection was performed after the removal of the prostate. Adjuvant radiotherapy or hormonal therapy was administrated according to the pathological results. Serum PSA was detected every 1 to 2 month and urinary continence was evaluated every 3 month in the first year, and then serum PSA was detected every 2 to 3 month.

RESULTSThe mean operative time was (134±21) minutes and the median blood loss was (300±146) ml. Bladder neck reconstruction was performed in 15 cases. The drainage was removed on postoperative day 4 and the catheter was removed on day 7. Pathologic results demonstrated pT2 in 25 patients, pT3a in 28 patients, pT3b in 9 patients and pT4 in 3 patients. Positive surgical margin was presented in 15 patients. A median of 19 lymph nodes (range 11-24 nodes) were retrieved during lymphadenectomy and 11 patients had lymph nodes metastasis with a total of 19 positive nodes. Forty-three patients recovered continence after the removal of catheter. Eleven patients received adjuvant hormonal therapy and 19 patients received adjuvant radiation therapy. With the median of 20 months follow-up (range 12-30 months), 5 patients got biochemical recurrence.

CONCLUSIONSLaparoscopic radical prostatectomy with extended lymph nodes dissection for high risk prostate cancer is safe and technical feasible. It provides accurate information on tumor stage and grade. It is an important component of multimodality for the treatment of high risk prostate cancer.

Aged ; Biopsy ; Humans ; Laparoscopy ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Grading ; Postoperative Period ; Prostate-Specific Antigen ; blood ; Prostatectomy ; Prostatic Neoplasms ; diagnosis ; surgery

Objective To evaluate the value of multi-slice spiral computed tomography (MSCT) in diagnosing postoperative intestinal obstruction of rectal cancer.Methods The CT imaging results and clinical manifestation of 50 patients with postoperative intestinal obstruction of rectal cancer confirmed by pathology were reviewed retrospectively.These cases including Miles (24 cases),Dixon (18 cases),Hartmann(8 cases) procedure were collected from Tianjin People's Hospital from 2011 to 2013.Conservative management was done in 10 cases and the remaining 40 patient underwent surgical intervention.Statistical difference between the three kinds of surgical causes of intestinal obstruction was analysed by x2 test.Results Most common cause after Miles and Hartmann postoperative intestinal obstruction was of adhesion,while anastomotic stenosis was the most common reason of intestinal obstruction after Dixon procedure.The difference of incidence of intestinal obstruction caused by hernia and anastomotic stenosis between the three kinds of operation method was statistically significant (x2 =5.382、20.486,P ＜ 0.05).Conclusions MSCT could identify the etiology and site of postoperative intestinal obstruction of rectal cancer,providing favorable imaging evidence for clinical treatment.

Objective To assess the value of contrast-enhanced ultrasound (CEUS) on quantitative analysis of re?nal cortex perfusion in hypertensive rabbits model. Methods Hypertensive rabbit modal (n=10) were established by inject?ing N-nitro-L-arginin methylester (L-NAME). CEUS and Cystatin C (CysC) serum level analysis were performed at differ?ent time points:before and the 2nd, 4th, 6th and 8th week after injecting L-NAME. Time-intensity curve and area under curve (AUC) were analyzed quantatively while correlation of AUC and CysC were also analyzed. Results Serum level of Cys C in?creased significantly at the 6th week after L-NAME administration which is earlier than the increase of serum levels of Scr and BUN. AUC decreased at first then increased after L-NAME administration. Upon addition of L-NAME, rise time (RT) and peak intensity (PI) decreased while mean transit time (MTT), time from peak to one half (HPT) and time to peak (TTP) in?creased. Our study confirmed a positive correlation between AUC and Cys C (r=0.950, P<0.001). Conclusion Setting up rabbits model by L-NAME is convenient and reproducible, which is an useful tool in experimental study of preclinical and clinical phase of hypertensive renal injury. CEUS combining with CysC serum level analysis is considered as an effective technology for evaluating renal function in hypertensive patients.

BACKGROUNDOver the past two decades, the clinical presentation of renal masses has evolved, where the rising incidence of small renal masses (SRMs) and concomitant minimal invasive treatments have led to noteworthy changes in paradigm of kidney cancer. This study was to perform a proportional meta-analysis of observational studies on perioperative complications and oncological outcomes of partial nephrectomy (PN) and radiofrequency ablation (RFA).

METHODSThe US National Library of Medicine's life science database (Medline) and the Web of Science were exhaustly searched before August 1, 2013. Clinical stage 1 SRMs that were treated with PN or RFA were included, and perioperative complications and oncological outcomes of a total of 9 565 patients were analyzed.

RESULTSPatients who underwent RFA were significantly older (P < 0.001). In the subanalysis of stage T1 tumors, the major complication rate of PN was greater than that of RFA (laparoscopic partial nephrectomy (LPN)/robotic partial nephrectomy (RPN): 7.2%, open partial nephrectomy (OPN): 7.9%, RFA: 3.1%, both P < 0.001). Minor complications occurred more frequently after RFA (RFA: 13.8%, LPN/RPN: 7.5%, OPN: 9.5%, both P < 0.001). By multivariate analysis, the relative risks for minor complications of RFA, compared with LPN and OPN, were 1.7-fold and 1.5-fold greater (both P < 0.01), respectively. Patients treated with RFA had a greater local progression rate than those treated by PN (RFA: 4.6%, LPN/RPN: 1.2%, OPN: 1.9%, both P < 0.001). By multivariate analysis, the local tumor progression for RFA versus LPN/RPN and OPN were 4.5-fold and 3.1-fold greater, respectively (both P < 0.001).

CONCLUSIONSThe current data illustrate that both PN and RFA are viable strategies for the treatment of SRMs. Compared with PN, RFA showed a greater risk of local tumor progression but a lower major complication rate, which is considered better for poor candidates. PN is with no doubt the golden treatment for SRMs, and LPN has been widely accepted as the first option for nephron-sparing surgery by experienced urologists. RFA may be the best option for select patients with significant comorbidity.

Catheter Ablation ; adverse effects ; methods ; Humans ; Kidney Neoplasms ; surgery ; therapy ; Nephrectomy ; adverse effects ; methods

Objective To explore the perioperative nursing of holmium laser enucleation of the prostate (HoLEP).Methods 45 patients with benign prostatic hyperplasia (BPH)and blad-der outlet obstruction (BOO)underwent holmium laser enucleation of the prostate.The nursing focused on psychological care and preoperative preparation,monitoring postoperative vital signs, the bladder flush unobstructed,preventing of lower limb venous thrombosis,telling patients drink water early according to the bowel sounds,postoperative health guidance and discharge guidance. Results 45 patients who underwent HoLEP had no complications,less postoperative bleeding and discharged from hospital successfully.Conclusion Preoperative psychological nursing for patients with hyperplasia of prostate,preoperative preparation,assisting postoperative bed,monitoring vi-tal signs,guaranteeing the bladder flush unobstructed,taking nursing measures to prevent the vein thrombosis of lower limbs according to DVT score,and skin care,postoperative rehabilitation exer-cise,health guidance and discharge guidance ensure the recovery and discharge from hospital.So it is worthy of promotion.