[Effectiveness analysis of hybrid endoscopic submucosal dissection in patients with colorectal epithelium-derived tumors]

Objective: To compare the clinical benefits of classic endoscopic submucosal dissection (ESD) and hybrid ESD for the treatment of colorectal epithelium-derived tumors. Methods: The current investigation was a retrospective multicenter study of 418 patients who underwent ESD between January 2015 and April 2021 at Beijing Jishuitan Hospital. The patients were assigned to one of two groups based on the surgical procedure they underwent; a classic ESD group or a hybrid ESD group. The primary outcome was the rate of en bloc resection and complete resection. SPSS 26.0 was used for statistical analysis. Homogeneity of variance was assessed via Cochran's test. Normally distributed data with homogeneity of variance were analyzed via the t-test for independent samples. Non-normally distributed data and data with unequal variance were analyzed via the Kruskal-Wallis non-parametric test. Categorical data were analyzed via the Chi-square test or Fisher's exact test. Multivariable assessment was performed via logistic regression analysis. Results: The en bloc resection rates [89.4% (84/94) vs. 87.0% (194/223), χ2=0.34, P=0.558] and complete resection rates [85.1% (80/94) vs. 82.1% (183/223), χ2=0.33, P=0.510] were similar. Compared with classic ESD, procedures were shorter in the hybrid ESD group [22(7, 213) vs. 47(12, 680) min, Z=0.23, P<0.001], dissection was completed more rapidly [0.14(0.02, 0.32) vs. 0.10(0.02, 0.41) cm2/min, Z=0.08, P<0.001], and there was a higher rate of perforation (9.6% vs. 2.2%, χ2=2.67, P=0.006). Laterally spreading tumor granular type nodular mixed, non-granular type pseudo-depressed, flat-elevated type (odds ratio 2.826, P=0.012), and tumor location (odds ratio 6.970, P=0.005) were independently associated with complete resection in the hybrid ESD group. Conclusion: Classic ESD and hybrid ESD had similar en bloc and complete resection rates for colorectal epithelium-derived tumors, but hybrid ESD had shorter operation times. With respect to hybrid ESD, factors associated with failure of complete resection included lesion type and crossing tissue boundaries.

[Human urine-derived stem cell-derived exosomes improve diabetic erectile dysfunction in rats]

Objective

To investigate the improving effect of human urine-derived stem cell-derived exosomes (USC-Exo) on the endothelial function and erectile function of male rats with diabetic ED (DED) and explore their action mechanism.

METHODS

USC-Exo were extracted from the culture medium of USC by ultracentrifugation and identified. Cavernous sinus endothelial cells (CCEC) were collected from SD male rats and cultured in endothelial cell growth medium-2 (EGM-2) (the normal control group), EGM-2 + L-glucose at 25 mM (the high glucose group), EGM-2 + L-glucose at 25 mmol/L) + USC-Exo at 10 μg/ml (the Exo group), and EGM-2 + L-glucose at 25 mmol/L + USC-Exo at 10 μg/ml) + 3-methyladenine at 2 mmol/L (the 3-MA group), respectively. Changes of the autophagic flux in the CCECs transfected with mRFP-GFP-LC3 adenovirus were detected under the fluorescence microscope. The proliferation and tube-forming ability of the cells were assessed by CCK8 and Matrigel assays, respectively. DED was induced by intraperitoneal injection of streptozotocin in 10 of the rats, which were equally and randomly divided into a DED and an Exo group, and another 5 normal male rats were taken as controls. The rats in the normal and DED groups were injected intracavernously with 100 μl of PBS, and those in the Exo group with 100 μl of USC-Exo at the concentration of 1 μg/μl. Four weeks after treatment, the maximum intracavernous pressure (ICPmax) and mean arterial pressure (MAP) were measured, the endothelial marker CD31 detected by immunofluorescence assay, the expressions of the CD31, Beclin1 and LC3 I/II proteins examined by Western blot, and the number of autophagosomes in the cavernous endothelial cells determined under the transmission electron microscope.

RESULTS

USC-Exo significantly increased the number of autophagosomes in the CCEC in the high glucose group compared with that in the normal controls (39.5 ± 6.2 vs 12.5 ± 5.4, P < 0.05). The expression of Beclin1 and proliferation of the CCEC were significantly higher in the Exo than in the high glucose group (P < 0.05). The autophagy inhibitor 3-MA evidently reversed the increasing effect of USC-Exo on the proliferation of the CCEC. The tube-forming ability of the CCEC was significantly increased in the Exo group compared with that in the high glucose group (15.3 ± 3.2 vs 6.3 ± 2.1, P < 0.05), which was also reversed in the 3-MA group. Both ICPmax and the ICPmax/MAP ratio were significantly higher in the Exo than in the DED group (［86.6 ± 12.6］ vs ［37.9 ± 10.9］ mmHg, P < 0.05; 89.3 ± 14.1 vs 41.7 ± 11.5, P < 0.05), and so were the expressions of CD31, Beclin1 and LC3 I/II (P< 0.05) and the number of autophagosomes in the cavernosal endothelial cells (3.7 ± 0.6 vs 1.0 ± 1.0, P < 0.05).

CONCLUSIONS

USC-Exo can significantly improve the endothelial and erectile functions of DED rats by increasing the autophagy of cavernosal endothelial cells.

[Compound Chamomile and Lidocaine Hydrochloride Gel applied at different time-windows for premature ejaculation: A prospective single-center randomized controlled study]

OBJECTIVE

To investigate the efficacy and safety of Compound Chamomile and Lidocaine Hydrochloride Gel (CCLH) (Kamistad) applied at different time-windows on premature ejaculation (PE).

METHODS

This prospective study included 72 PE patients treated by application of CCLH to the glans and penile body in our hospital from February to October 2021. According to the time of drug administration before insertion into the vagina, we randomly divided the patients into a 5-minute group (n = 39) and a 15-minute group (n = 33). Before and after 1 and 2 weeks of treatment, we compared the intravaginal ejaculation latency time (IELT), PE diagnostic tool (PEDT) score, quality of life, and adverse reactions between the two groups of patients.

RESULTS

Totally 62 of the patients completed the follow-up, 35 in the 5-minute group and 27 in the 15-minute group, and all showed significant improvement in IELT (P < 0.01) and PEDT score (P < 0.05) after treatment compared with the baseline. No allergic reactions, such as redness and swelling, developed at the application site in any of the patients, and no adverse significant effect was observed on the erectile hardness in 61 of the cases. Six cases showed increased erectile hardness instead. Fifty-seven of the patients experienced no obvious penile numbness or reduced sexual satisfaction, and all could complete their sexual activities.

CONCLUSION

Compound Chamomile and Lidocaine Hydrochloride Gel applied at different time-windows is effective on PE, with a 5-minute rapid onset of action before intercourse, and no obvious adverse effects.

Establishing a nonlethal and efficient mouse model of male gonadotoxicity by intraperitoneal busulfan injection

An ideal animal model of azoospermia would be a powerful tool for the evaluation of spermatogonial stem cell (SSC) transplantation. Busulfan has been commonly used to develop such a model, but 30%–87% of mice die when administered an intraperitoneal injection of 40 mg kg⁻¹. In the present study, hematoxylin and eosin staining, Western blot, immunofluorescence, and quantitative real-time polymerase chain reaction were used to test the effects of busulfan exposure in a mouse model that received two intraperitoneal injections of busulfan at a 3-h interval at different doses (20, 30, and 40 mg kg⁻¹) on day 36 or a dose of 40 mg kg⁻¹ at different time points (0, 9, 18, 27, 36, and 63 days). The survival rate of the mice was 100%. When the mice were treated with 40 mg kg⁻¹ busulfan, dramatic SSC depletion occurred 18 days later and all of the germ cells were cleared by day 36. In addition, the gene expressions of glial cell line-derived neurotrophic factor (GDNF), fibroblast growth factor 2 (FGF2), chemokine (C-X-C Motif) ligand 12 (CXCL12), and colony-stimulating factor 1 (CSF1) were moderately increased by day 36. A 63-day, long-term observation showed the rare restoration of endogenous germ cells in the testes, suggesting that the potential period for SSC transplantation was between day 36 and day 63. Our results demonstrate that the administration of two intraperitoneal injections of busulfan (40 mg kg⁻¹ in total) at a 3-h interval to mice provided a nonlethal and efficient method for recipient preparation in SSC transplantation and could improve treatments for infertility and the understanding of chemotherapy-induced gonadotoxicity.

Effects of grain type and conditioning temperature during pelleting on growth performance, ruminal fermentation, meat quality and blood metabolites of fattening lambs

Ruminants can tolerate moderate concentrations of dietary tannin, making it feasible to replace corn with sorghum in ruminant diets; however, conditioning temperature of pelleted total mixed ration (PTMR) greatly affects nutrient digestibility. The objective was to determine effects of grain type and conditioning temperature during pelleting on growth performance, ruminal fermentation, meat quality and blood metabolites of fattening lambs. This was a 2 × 3 factorial study, with corn and sorghum and three conditioning temperatures (65, 75 and 85 °C) in a randomized complete design, with 36 lambs (120 ± 10.2 d and 24.9 ± 3.3 kg) grouped by weight and randomly allocated. The resulting six PTMRs were referred to as 65-S, 75-S and 85-S for sorghum-based diets, and 65-C, 75-C and 85-C for corn-based diets, for low, medium and high pelleting temperatures, respectively. There was no grain type × conditioning temperature (Grain × Temp) interaction on growth performance and apparent nutrient digestibility. Furthermore, grain type did not affect DM intake (DMI), average daily gain (ADG) or feed conversion ratio (FCR) of fattening lambs. Pelleting at 75 °C improved ADG (P < 0.03) and FCR (P < 0.02) of fattening lambs compared to other temperatures. There was a Grain × Temp interaction (P < 0.01) on ruminal pH (lowest in lambs fed 75-S). There tended (P = 0.07) to be a Grain × Temp interaction for total volatile fatty acid (VFA), and there were Grain × Temp interactions for molar proportions of acetate (P < 0.04), butyrate (P < 0.03) and branch-chained VFA (P < 0.01). Lambs fed sorghum-based PTMR had greater molar proportion of propionate (P < 0.03) and lower acetate to propionate ratio (A:P, P < 0.04). Lambs fed sorghum-based PTMR had higher plasma concentrations of urea nitrogen (N) (P < 0.03), glucose (P < 0.01) and alkaline phosphatase (P < 0.05), whereas other blood metabolites were not affected by treatments. There were Grain × Temp (P < 0.03) interactions for color coordinates of longissimus and mid-gluteal muscle. Lambs fed sorghum-based PTMR had lower (P < 0.01) dressing percentage and meat quality than those fed corn-based PTMR. We concluded that sorghum can replace corn in lamb diets without compromising growth performance and feed efficiency; furthermore, feeding sorghum vs corn improved rumen fermentation, with reduced A:P ratio and enhanced N and glucose utilization. Finally, pelleting at 75 °C increased feeding value of either sorghum- or corn-based PTMR for fattening lambs.

Psychological burden prediction based on demographic variables among infertile men with sexual dysfunction

There has been increasing interest in the psycho-socio-relational and sexual disorders of infertility, as the risk of psychological burden among infertile men with sexual dysfunctions is significant. The purpose of this study was to develop and to validate a predictive model to estimate individual psychological burden among infertile men with sexual dysfunction and study the association between them. Comprehensive data were collected for infertile men (n = 480) who sought treatment for infertility in a reproductive medicine center between June 2012 and December 2013. Using independent predictors of psychological burden from the least absolute shrinkage and selection operator, univariable and multivariable analyses were developed into two models. Predictive accuracy was compared between the models. We explored the association between sexual dysfunction and psychological burden. A total of 480 patients were analyzed using 10-fold cross-validation. Independent predictors of psychological burden were incorporated into a model to measure anxiety (corrected-area under curve (AUC): 77.3%) and a model to measure depression (corrected-AUC: 70.2%). Anxiety and depression were both associated with erectile dysfunction (P < 0.05), with anxiety demonstrating the strongest association. Only anxiety was associated with premature ejaculation (P < 0.05). Premature ejaculation was not found to be associated with depression (P > 0.05). Predictive models for psychological burden among infertile men with sexual dysfunction are presented, and we found that there is an association between psychological burden and sexual dysfunction. According to the models, proper counseling and treatment of sexual dysfunction in infertile men may reduce the psychological burden, help attain natural pregnancy, and improve the quality of life.

[Proposals for the diagnosis and treatment of andrologic diseases during the novel coronavirus pneumonia epidemic]

In December, 2019, several cases of novel coronavirus pneumonia (NCP) were reported in Wuhan, Hubei. Since then, more and more NCP cases, confirmed or suspected, have been found in China and other parts of the world, and the virus is now showing a tendency towards a wider spread. During the NCP epidemic, all medical workers are confronted with special challenges in the diagnosis and treatment of various diseases and required of even more accurate therapeutic protocols as well as stricter observation of the principles for the prevention and control of NCP. Therefore, the Andrology Branch of Chinese Medical Association convened relevant experts to summarize the special points for andrologic clinicians to attend to in the diagnosis and treatment of male diseases during the NCP epidemic.

[Effect of anatomical changes of frontal recess and frontal sinus on airflow after nasalisation by image reconstruction and numerical simulation]

Objective: To describe the influence of post-operative anatomical structure changes on nasal airflow characteristics by 3D reconstruction and numerical simulation in real cases after nasalisation with Draf Ⅲ so as to explore the correlation between the changes of anatomical structure and subjective symptoms as well as airflow characteristics. Methods: Ten patients underwent nasalization with Draf Ⅲ in Department of Rhinology in Beijing Tongren Hospital from 2006 to 2018 were selected retrospectively. Postoperative follow-up of all patients was more than 1 year. All patients had no abnormalities in their paranasal sinus CT scans and Lund-Kennedy scores were 0 except scar. VAS scores including nasal obstruction, stimulation in frontal sinus, and headache were collected at the same period. The control model was a normal person. Numerical simulation was used for calculating airflow characteristics in deep inspiratory period of both models. Independent sample Mann-Whitney U test and Spearman correlation test were used by software SPSS 22.0. Results: The airflow pressure in frontal sinus ostium was (7.21±1.39)×10(4) Pa (Mean±SD), which was lower than that in normal subjects (8.99×10(4) Pa) under deep inspiratory simulation. But, the velocities in frontal sinus ostium and frontal sinus were (40.10±2.46) m/s and (28.19±1.73) m/s respectively, which were higher than those in normal one (2.70 m/s, 0.73 m/s). The airflow patterns of the two models were basically similar. There was no significant difference in the opening size and volume of frontal sinus between different groups after grouped by three symptoms respectively. No correlation could be found between the opening size and volume of the frontal sinus with the appearance and severity of three subjective symptoms. Conclusions: The airflow pattern and distribution after nasalisation with Draf Ⅲ are like those of normal person. There is no correlation between the changes of anatomy in frontal recess and frontal sinus and nasal airflow characteristics as well as subjective symptoms.

A novel experience of deferential vessel-sparing microsurgical vasoepididymostomy

Microsurgical longitudinal intussusception vasoepididymostomy (LIVE) has been widely used to treat epididymal obstructive azoospermia since 2004. Although the deferential vasculature plays an important role in supplying blood to the testis and epididymis, little attention has been paid to the potential benefits of sparing the deferential vessels during the anastomosis in LIVE. This study aimed to evaluate the efficacy and safety of deferential vessel-sparing LIVE in humans. From December 2013 to December 2015, 69 azoospermic men with epididymal obstruction due to a genital infection, trauma, or idiopathic factors underwent deferential vessel-sparing LIVE in the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. The outcomes of these patients were analyzed retrospectively. The mean age was 31.1 years for men and 28.3 years for their partners. Fifty-nine (85.5%, 59/69) men were followed up after surgery for approximately 16 months. Patency was noted and confirmed by semen analysis (>10 000 sperm/ml) in 83.1% (49/59) of men. The natural pregnancy rate was 40.7% (24/59) by the end of the study, with 87.5% (21/24) of these natural pregnancies achieved within 12 months after surgery. No severe adverse events or complications were observed. In this study, we present a novel technique for sparing the deferential vessels during LIVE. The preliminary outcomes show this technique to be safe with favorable patency and pregnancy rates.

[Oxidative stress induces damage to epididymal epithelial tight junction protein ZO-1 and impairs epididymal function in varicocele rats]

OBJECTIVE

To investigate oxidative stress-mediated damage to the epididymal epithelial tight junction protein ZO-1 and its impact on epididymal function in varicocele rats.

METHODS

We randomly divided 45 male adolescent SD rats into three groups of equal number: sham operation (left renal vein exposed and isolated), experimental (left renal vein constricted and collaterals of the left spermatic vein fully ligated), and treatment (60-day intragastric administration of vitamin E at 150 mg/kg/d after modeling). At 60 days after modeling, we observed the histological changes in the left epididymis, detected the expressions of ZO-1 and other tight junction-related proteins by real-time quantitative PCR, immunohistochemistry, immunofluorescence staining and Western blotting, determined sperm motility, and measured the levels of superoxide dismutase (SOD), total antioxidant capacity (T-AOC), methylene dioxyamphetamine (MDA) and α-glucosidase (α-Glu) in the epididymal tissue of the rats.

RESULTS

Compared with the rats of the sham operation group, those of the experimental group showed disorganized epithelial structure and decreased number of epithelial cells in the left epididymis, with some epithelial cells desquamated into the lumen. The expression of ZO-1 was significantly lower in the experimental than in the sham operation group (P < 0.05) but markedly upregulated after VE treatment (P < 0.05). In comparison with the sham operation group, the animals in the experimental group exhibited remarkably increased content of MDA in the epididymal tissue (［0.41 ± 0.05］ vs ［1.21 ± 0.18］ nmol/mg prot, P < 0.05) but decreased levels of SOD (［814.65 ± 73.64］ vs ［298.62 ± 67.84］ U/mg prot, P < 0.05), T-AOC (［0.84 ± 0.07］ vs ［0.24 ± 0.04］ nmol/mg prot, P < 0.05) and α-Glu (［11.72 ± 2.72］ vs ［5.82 ± 1.24］ U/mg prot, P < 0.05). VE treatment, however, remarkably reduced the content of MDA (［0.69 ± 0.12］ nmol/mg prot) and elevated the levels of SOD (［497.73 ± 48.03］ U/mg prot), T-AOC (［0.42 ± 0.06］ nmol/mg prot) and α-Glu (［9.11 ± 1.91］ U/mg prot) as compared with those in the experimental group (all P < 0.05). The percentage of progressively motile sperm was significantly lower in the experimental than in the sham operation group (［31.33 ± 6.32］% vs ［71.21 ± 5.21］%, P < 0.05), but markedly increased after VE treatment (［60.68 ± 5.31］%, P < 0.05).

CONCLUSIONS

Varicocele reduces the expression of the EETJ protein ZO-1 and impairs epididymal function via oxidative stress, while vitamin E can effectively upregulate the ZO-1 expression and improve epididymal function by decreasing oxidative stress in the epididymis of varicocele rats.

[Protective effect of urine-derived stem cells on erectile dysfunction in rats with cavernous nerve injury]

OBJECTIVE

To investigate the protective effect of human urine-derived stem cells (USCs) on erectile function and cavernous structure in rats with cavernous nerve injury (CNI).

METHODS

Sixty adult male SD rats with normal sexual function were randomly divided into four groups of equal number: sham operation, bilateral CNI (BCNI) model control, phosphate buffered saline (PBS), and USC. The BCNI model was established in the latter three groups of rats by clamping the bilateral cavernous nerves. After modeling, the rats in the PBS and USC groups were treated by intracavernous injection of PBS at 200 μl and USCs at 1×106/200 μl PBS respectively for 28 days. Then, the maximum intracavernous pressure (mICP) and the ratio of mICP to mean arterial pressure (mICP/MAP) of the rats were calculated by electrical stimulation of the major pelvic ganglions, the proportion of nNOS- or NF200-positive nerve fibers in the total area of penile dorsal nerves determined by immunohistochemical staining, the levels of endothelial cell marker eNOS, smooth muscle marker α-SMA and collagen I detected by Western blot, and the smooth muscle to collagen ratio and the cell apoptosis rate in the corpus cavernosum measured by Masson staining and TUNEL, respectively.

RESULTS

After 28 days of treatment, the rats in the USC group, as compared with those in the PBS and BCNI model control groups, showed significant increases in the mICP (［81 ± 9.9］ vs ［31 ± 8.3］ and ［33 ± 4.2］ mmHg, P <0.05), mICP/MAP ratio (0.72 ± 0.05 vs 0.36 ± 0.03 and 0.35 ± 0.04, P <0.05), the proportions of nNOS-positive nerve fibers (［11.31 ± 4.22］% vs ［6.86 ± 3.08］% and ［7.29 ± 4.84］% , P <0.05) and NF200-positive nerve fibers in the total area of penile dorsal nerves (［27.31 ± 3.12］% vs ［17.38 ± 2.87］% and ［19.49 ± 4.92］%, P <0.05), the eNOS/GAPDH ratio (0.52 ± 0.08 vs 0.31 ± 0.06 and 0.33 ± 0.07, P <0.05), and the α-SMA/GAPDH ratio (1.01 ± 0.09 vs 0.36 ± 0.05 and 0.38 ± 0.04, P <0.05), but a remarkable decrease in the collagen I/GAPDH ratio (0.28 ± 0.06 vs 0.68 ± 0.04 and 0.70 ± 0.10, P <0.05). The ratio of smooth muscle to collagen in the corpus cavernosum was significantly higher in the USC than in the PBS and BCNI model control groups (17.91 ± 2.86 vs 7.70 ± 3.12 and 8.21 ± 3.83, P <0.05) while the rate of cell apoptosis markedly lower in the former than in the latter two (3.31 ± 0.83 vs 9.82 ± 0.76, P <0.01; 3.31 ± 0.83 vs 9.75 ± 0.91, P <0.05).

CONCLUSIONS

Intracavernous injection of USCs can protect the erectile function of the rat with cavernous nerve injury by protecting the nerves, improving the endothelial function, alleviating fibrosis and inhibiting cell apoptosis in the cavernous tissue.

The effect of the degree of left renal vein constriction on the development of adolescent varicocele in Sprague-Dawley rats

Experimental models have allowed inquiry into the pathophysiology of varicocele (VC) beyond that possible with human patients. A randomized controlled study in rats was designed to clarify the influence of the degree of left renal vein constriction on the development of adolescent VC. Fifty adolescent male Sprague–Dawley rats (Rattus norvegicus) were randomly assigned to five groups of 10: the experimental groups (I–IV) underwent partial ligation of left renal veins with 0.5-, 0.6-, 0.7-, and 0.8-mm diameter needles, respectively. The control group (V) underwent a sham operation. The diameter of the left spermatic vein (LSV) was measured at baseline and 30 days postoperatively. In addition, the lesion of the left kidney was examined with the naked eye and assessed by Masson's trichrome staining. VC was successfully induced in 2 (20%), 4 (40%), 7 (70%), and 10 (100%) rats in groups I–IV, respectively. The other rats failed to develop VCs primarily due to left renal atrophy. No VC was observed in group V. The postsurgical LSV diameters in VC rats in groups III and IV were 1.54 ± 0.16 and 1.49 ± 0.13 mm, respectively (P > 0.05), and their increments were 1.36 ± 0.10 and 1.31 ± 0.10 mm, respectively (P > 0.05). These results suggest that suitable constriction of the left renal vein is critical for adolescent VC development. In addition, the 0.8-mm diameter needle may be more suitable for inducing left renal vein constriction in adolescent rat models.

Subinguinal microsurgical varicocelectomy with intraoperative microvascular Doppler ultrasound leads to the pain-free outcome after surgery

OBJECTIVE

To determine efficacy of intraoperative microvascular Doppler ultrasound in assisting subinguinal microsurgical varicocelectomy for pain relief in the treatment of painful varicoceles, compared to the microsurgery without Doppler ultrasound.

METHODS

Total 153 patients underwent microsurgical varicocelectomy were randomly allocated to two groups: Groups 1 and 2 included 82 and 71 patients monitored with and without using intraoperative microvascular Doppler ultrasound, respectively. The assessments were compared between two groups, including intraoperative parameters (vessel numbers and operative time) and postoperative outcomes (pain resolution, complications and recurrence).

RESULTS

The average numbers of internal spermatic veins ligated (13.87±6.43 vs 11.72±5.66) and arteries preserved (1.96±0.87 vs 1.73±0.86) were significantly greater in Group 1 with Doppler ultrasound. Precisely, the smaller size of the internal spermatic veins was ligated and the more encircled arteries were also preserved in Group 1. In two groups with and without using Doppler ultrasound, 56 (68.3%) and 36 (50.7%) patients experienced a complete resolution of pain, 21 (25.6%) and 29 (40.9%) patients experienced partial resolution, whereas 5 (6.1%) and 6 (8.5%) patients experienced no change in the chronic pain, respectively. Thus, patients in Group 1 had a better outcome in chronic pain resolution (P = 0.033). The operative time, complications and recurrence rate were not different between the two groups.

CONCLUSIONS

Subinguinal microsurgical varicocelectomy is an effective method to treat painful varicoceles. With the assistance of Doppler Ultrasound monitoring, greater numbers of vessels were identified and a better outcome of pain resolution was achieved.

[Microsurgical management of male infertility in china: 15-year development and prospects]

Male infertility is a common and complex disease in urology and andrology, and for many years there has been no effective surgical treatment. With the emergence of microsurgery and assisted reproductive medicine (IVF/ICSI), rapid development has been achieved in the treatment of male infertility. The Center for Male Reproductive Medicine and Microsurgery at Weill Cornell Medical College of Cornell University has been playing an important leading role in developing microsurgical techniques for the management of male infertility. The development of microsurgical treatment of male infertility in China has experienced the 3 periods of emerging, making, and boosting ever since its systematic introduction from Weill Cornell Medical College 15 years ago. At present, many Chinese hospitals have adopted microsurgery in the management of male infertility, which has contributed to the initial establishment of a microsurgical treatment system for male infertility in China. However, some deficiencies do exist concerning microsurgical treatment of male infertility, as in normalized technical training programs for competent surgeons, unified criteria for evaluation of surgical outcomes, and detailed postoperative follow-up data. This article presents an overview on the 15-year development of microsurgical management of male infertility in China, points out the existing deficiencies, and offers some propositions for the promotion of its development.

[Anatomical variability of the left spermatic vein and establishment of the experimental left varicocele model in adolescent rats]

OBJECTIVE

To identify the anatomical variability of the left spermatic vein (LSV) and determine its effect on the induction of experimental left varicocele (ELV) in adolescent rats.

METHODS

We equally randomized 30 adolescent male SD rats to groups A (LSV collaterals fully ligated and the left renal vein constricted), B (only the left renal vein constricted), and C (sham operation), observed the courses of the LSVs and measured their diameters. At 30 days after operation, we analyzed the changes in the left kidneys and the diameters of the LSVs.

RESULTS

Irregular collaterals were observed in 90% of the LSVs and no abnormal changes were found in the left kidneys after surgery. The postoperative LSV diameter was remarkably increased in group A as compared with the baseline ([1.47 +/- 0.15 ] vs [0.16 +/- 0.08] mm, P < 0.01), but showed no significant difference in group B ([0.31 +/- 0.49] vs [0.15 +/- 0.07] mm, P > 0.05) and C ([0.17 +/- 0.07] vs [0.16 +/- 0.06] mm, P > 0.05), and it was significantly longer in A than in B (P < 0.01). The success rate of ELV induction was 100% in group A and 10% in group B, but no varicocele was observed in group C.

CONCLUSION

Correct identification of the anatomical course of the LSV and ligation of its irregular collaterals are essential for the establishment of a stable and consistent ELV model.

High-grade Neuroendocrine Carcinoma With Focal Squamous Metaplasia of Renal Pelvis Associated With Renal Calculus: Study of a Case

Mixed neuroendocrine and non-neuroendocrine type of tumor in renal pelvis is rare and presents a high-grade malignancy. We present a case report that a 57-year-old man had no history of small cell cancer but presented a high-grade neuroendocrine carcinoma with focal squamous metaplasia and multiple stones simultaneously in the right renal pelvis. The patient underwent nephroureterocystectomy 9 months before this presentation, with evidence of multiple metastatic tumors in various parts of the body. The case of mixed neuroendocrine tumor with stones in the renal pelvis carries a poor prognosis and poses a therapeutic challenge to urologists.

[Suprapubis-assisted umbilical laparoendoscopic mini-dual-site surgery for varicocele: a report of 80 cases]

OBJECTIVE

To study the safety, effectiveness and feasibility of suprapubis-assisted umbilical laparoendoscopic mini-dual-site surgery (SAU-LEMDS) in the treatment of varicocele.

METHODS

This study included 80 varicocele patients aged 24 - 44 (mean 28.5 +/- 2.6) years, 25 cases of grade I, 45 cases of grade II and 10 cases of grade III, 58 cases in the left side, 6 in the right and 16 in both sides, and all with asthenospermia. The patients were treated by SAU-LEMDS under subarachnoid anesthesia combined with general anesthesia in a supine position with a head-down-feet-up slope of 15 degrees. Two 5 mm trocars were inserted bilaterally at the umbilical edge, one with a 5 mm 30 degrees laparoscope placed in it, and another into the abdominal cavity below the pubic hairline with a 5 mm laparoendoscopic clipper placed in it. The operation procedure was similar to that of standard laparoscopic ligation of spermatic veins, with reservation of the spermatic artery and double-ligation of spermatic veins. And the procedure was repeated for the contralateral lesion in the bilateral cases. Postoperative follow-up was conducted for the incidences of orchiatrophy and testicular hydrocele and changes of seminal parameters.

RESULTS

All the operations were successful, with the mean operation time of (10 +/- 5.0) min (range 8 to 25 min) for the unilateral cases and (18 +/- 6.5) min (range 15 to 30 min) for the bilateral cases, the mean blood loss of (1.5 +/- 0.5) ml (range 1 to 2 ml), and the mean postoperative hospital stay of (2 +/- 0.5) d (range 1.5 to 3 d). The patients were followed up for 6 -24 (12 +/- 2.5) months, which showed significant improvement in sperm motility as compared with the baseline ([28.53 +/- 5.21] vs [19.62 +/- 3.56]%, P < 0.05), with 28 cases (35.0%) restored to normal. Recurrence was found in 4 cases (5.0%). Testicular hydrocele occurred in 7 cases (8.75%), but orchiatrophy in none. The scars in the umbilicus and suprapubis were invisible because of the wrinkles and pubic hair.

CONCLUSION

SAU-LEMDS is safe, effective and feasible for the treatment of varicocele. It is superior to umbilical laparoendoscopic single-site surgery (U-LESS) for its less invasiveness, simpler operation, and better cosmetic appearance.

Association between the PARP1 Val762Ala polymorphism and cancer risk: evidence from 43 studies

BACKGROUND

Poly (ADP-ribose) polymerase-1 (PARP-1) plays critical roles in the detection and repair of damaged DNA, as well as cell proliferation and death. Numerous studies have examined the associations between PARP1 Val762Ala (rs1136410 T>C) polymorphism and cancer susceptibility; nevertheless, the findings from different research groups remain controversial.

METHODS

We searched literatures from MEDLINE, EMBASE and CBM pertaining to such associations, and then calculated pooled odds ratio (OR) and 95% confidence interval (CI) by using random-effects model. The false-positive report probability (FPRP) analysis was used to confirm the validity of significant findings. Moreover, potential effects of rs1136410 variants on PARP1 mRNA expression were analyzed for three ethnicities by combining data from HapMap (genotype) and SNPexp (mRNA expression).

RESULTS

The final meta-analysis incorporated 43 studies, consisting of 17,351 cases and 22,401 controls. Overall, our results did not suggest significant associations between Ala variant (Ala/Ala or Ala/Val genotype) and cancer risk. However, further stratification analysis showed significantly increased risk for gastric cancer (Ala/Ala vs. Val/Val: OR = 1.56, 95% CI = 1.01-2.42, Ala/Val vs. Val/Val: OR = 1.34, 95% CI = 1.14-1.58, dominant model: OR = 1.41, 95% CI = 1.21-1.65 and Ala vs. Val: OR = 1.29, 95% CI = 1.07-1.55). On the contrary, decreased risk for brain tumor (Ala/Val vs. Val/Val: OR = 0.77, 95% CI = 0.68-0.87, dominant model: OR = 0.77, 95% CI = 0.68-0.87 and Ala vs. Val: OR = 0.82, 95% CI = 0.74-0.91). Additionally, we found that the Ala carriers had a significantly increased risk in all models for Asians. Our mRNA expression data provided further biological evidence to consolidate this finding.

CONCLUSIONS

Despite some limitations, this meta-analysis found evidence for an association between the PAPR1 Val762Ala and cancer susceptibility within gastric cancer, brain tumor and Asian subgroups.

[Qilin pills combined with levofloxacin for asthenospermia accompanied with accessory sex gland infection: a clinical observation]

OBJECTIVE

To observe the efficacy of the combination of Qilin Pills and levofloxacin in the treatment of asthenospermia accompanied with accessory sex gland infection.

METHODS

We randomly assigned 80 asthenospermia patients with accessory sex gland infection to groups 1 and 2 of equal number, the former treated with Qilin Pills + levofloxacin, and the latter with levofloxacin only. Qilin Pills were administered at the dose of 6 g tid for 30 days, and levofloxacin at the dose of 0.5 g qd for 20 days. We obtained semen parameters, including the percentage of progressively motile sperm and peroxidase-positive white blood cell (WBC) count, before and after medication, and compared the clinical effects between the two groups.

RESULTS

All the patients accomplished the clinical trial. The therapeutic effectiveness rates in improving progressive sperm motility were 60% in group 1 and 17.5% in group 2, with statistically significant differences between the two groups (P < 0.05). As for the peroxidase-positive WBC count in semen, the effectiveness rates were 87.5% and 82.5%, respectively, with no significant differences between the two groups (P > 0.05).

CONCLUSION

For the treatment of asthenospermia accompanied with accessory sex gland infection, Qilin Pills combined with levofloxacin is evidently better than levofloxacin alone in improving sperm motility, and it has no obvious adverse effects.

Transurethral bipolar plasma kinetic resection of ejaculatory duct for treatment of ejaculatory duct obstruction

To evaluate the efficacy of transurethral bipolar plasma kinetic resection of ejaculatory duct for ejaculatory duct obstruction. The clinical information of 42 cases of ejaculatory duct obstruction was analyzed between July 2008 and June 2012. The diagnostic criteria included semen analysis, fructose and neutral α-glucosidase measurement in seminal plasma, transrectal ultrasonography, magnetic resonance imaging and vasography necessarily. Endoscopic procedure with bipolar plasma kinetic resection of ejaculatory duct was performed in all patients. Among these cases followed up 6 ≈ 24 months after operation, 38 patients (90.5%) had improved semen parameters, 23 azoospermic patients (60.5%) had sperm in the semen and 13 patients' wife (31%) achieved pregnancies in 42 cases of bipolar plasma kinetic resection of ejaculatory duct. Postoperative complications ensued as epididymitis in 1 case, watery ejaculate in 1, but no serious complication was observed. Bipolar plasma kinetic resection of ejaculatory duct appears to represent a promising endoscopic treatment alternative for ejaculatory duct obstruction patients, with high efficacy, less complications, quicker recovery and satisfactory follow-up parameters.

[Efficacy of compound xuanju capsule combined with bromocriptine on hyperprolactinemia-induced erectile dysfunction]

OBJECTIVE

To investigate the effect of Compound Xuanju Capsule (CXC) combined with bromocriptine on hyperprolactinemia-induced erectile dysfunction (ED).

METHODS

We randomly assigned 46 patients with hyperprolactinemia-induced ED to receive bromocriptine (trial group, n = 23) and bromocriptine plus CXC (control group, n = 23), respectively, both for 12 weeks. Then we compared the two groups of patients in erectile function and the levels of serum prolactin and testosterone.

RESULTS

After 12 weeks of treatment, the IIEF-5 scores were significantly improved in both the trial and the control groups as compared with the baseline (19.5 +/- 4.1 vs 13.0 +/- 3.8 and 16.4 +/- 3.7 vs 13.7 +/- 3.5, P<0.05), the level of serum prolactin was remarkably decreased ([156.07 +/- 26.31] vs [478.35 +/- 62.28] mIU/L and [164.73 +/- 28.58] vs [445.26 +/- 57.83] mIU/L, P<0.05), while the level of serum testosterone was markedly increased ([15.34 +/- 5.27] vs [3.80 +/- 1.09] nmol/L and [12.02 +/- 2.36] vs [4.07 +/- 1.25] nmol/L, P<0.05). Post-treatment erectile function was significantly better in the trial than in the control group (P<0.05), and the post-treatment serum testosterone level remarkably higher in the former than in the latter (P<0.05), but there was no significant difference in the serum prolactin level after treatment between the two groups (P>0.05).

CONCLUSION

The combination of Compound Xuanju Capsule and bromocriptine is highly effective in the treatment of hyperprolactinemia-induced ED, and its effect is even better than that of bromocriptine alone.

A modified single-armed technique for microsurgical vasoepididymostomy

This study is to evaluate the effectiveness of a modified single-armed suture technique for microsurgical vasoepididymostomy (VE) in patients with epididymal obstructive azoospermia. From September 2011 to December 2011, microsurgical two-suture longitudinal intussusception VEs were performed using our modified single-armed suture technique in 17 men with epididymal obstructive azoospermia at our hospital. Two of these patients underwent repeated VEs after previous failed VEs, and one patient underwent unilateral VE because of an occlusion of the left abdominal vas deferens. The presence of sperm in the semen sample at 3 months postoperation was used as the preliminary endpoint of this study. Each patient provided at least one semen sample at the 3-month time point, and the patency was assessed by the reappearance of sperm (>10(4) ml(-1)) in the semen. The mean operative time for the modified technique was 219 min. Patency was noted in 10 men (58.8%), including one patient who underwent repeated VE. The patient who underwent unilateral anastomosis manifested no sperm postoperatively in his semen. Sperm granulomas were not detected in this cohort. The results of this study demonstrate that our modified technique for microsurgical longitudinal intussusception VE is effective. We believe that it is a practical alternative that may reduce operation time and obviate the suture crossing.

Microsurgical denervation of the spermatic cord for treatment of idiopathic chronic orchialgia

A patient referred to our hospital, diagnosed with left idiopathic chronic orchialgia, was evaluated with a thorough medical and psychiatric history, physical examination, scrotal ultrasound and magnetic resonance imaging. Conservative management failed. The patient had temporary pain relief after undergoing outpatient cord block three times. Microsurgical denervation of the left spermatic cord was operated in March, 2011. A pain questionnaire was used to determine efficacy before and after operation, and complete pain relief was noted at one week after operation. The follow up period was 12 months, at the end of which the pain score was still zero. No complications, including testicular atrophy and hydrocele, occurred. Microsurgical denervation of the spermatic cord can be a minimally invasive, safe and effective management option for treatment of idiopathic chronic orchialgia.

Percutaneous ultrasound-guided radiofrequency ablation treatment and genetic testing for renal cell carcinoma with Von Hippel-Lindau disease

Percutaneous ultrasound-guided radiofrequency ablation is increasingly being studied in the treatment of renal tumors. Because percutaneous ultrasound-guided radiofrequency ablation is a minimally invasive and nephron-sparing procedure, it is ideally suited for patients with a single kidney, multiple tumors, or contraindications to conventional surgery. We report on a patient with Von Hippel-Lindau (VHL) disease who had multicentric tumors in the single kidney that was successfully treated with percutaneous ultrasound-guided radiofrequncy ablation. The one-year follow-up showed that there was no local recurrence or metastasis. And genetic testing showed the patient had a T to G heterozygotic missense mutation at nucleotide 515 of VHL gene exon 1.

[Qilin pills for oligoasthenospermia: a multi-centered clinical trial]

OBJECTIVE

To observe the efficacy of Qilin Pills in the treatment of oligoasthenospermia.

METHODS

We conducted a multi-centered open controlled clinical trial by including 220 oligoasthenospermia patients in a trial group and another 110 as controls. The patients in the trial group were treated with Qilin Pills at the dose of 6 g tid, and the controls given Wuziyanzong Pills at 6 g bid, both for a course of 12 weeks. Then we evaluated the clinical effects of Qilin Pills with sperm concentration, the numbers of grade a and grade a + b sperm, and sperm motility as the primary, and the pregnancy rate of the patients'spouses as the secondary therapeutic indexes.

RESULTS

A total of 310 patients accomplished the clinical trial, 208 in the trial and 102 in the control group. Compared with the baseline, significant improvement was observed in the semen parameters after 4, 8 and 12 weeks of treatment in both the trial and control groups except sperm density and the number of grade a sperm in the control after 4 weeks (P < 0.01), and the improvement was even more significant in all the semen parameters at the same time points in the trial than in the control group (P < 0.01).

CONCLUSION

Qilin Pills can evidently improve the seminal quality of oligoasthenospermia patients with no obvious adverse events.

Over-expression of VEGF165 in the adipose tissue-derived stem cells via the lentiviral vector

BACKGROUND

Many researchers studied the possibility of using stem cells as gene therapeutic vector. But few related reports on the adipose tissue-derived stem cells (ADSCs) are available. Therefore we intended to construct a lentiviral VEGF(165) expression vector and then infect the ADSCs to produce therapeutic seed cells.

METHODS

EHS1001-68950485313912 clone was mutated by PCR method to produce consensus fragment of VEGF(165) transcript (NM_001025368). Lentivirus was enveloped with pGC-FU, pHelper 1.0 and pHelper 2.0 plasmids in 293T cells. And then the ADSCs (multiplicity of infection = 20) were transfected with the vectors after titer determination. Stable expression of VEGF(165) in ADSCs was confirmed by immunofluorescence staining, enzyme-linked immunosorbent assay (ELISA) and Western blotting analysis.

RESULTS

DNA sequencing and 293T transfection verified VEGF(165) was linked to the GFP fused vector. The virus titer is up to 2 × 10(8) determined by quantitative PCR. VEGF(165) transduced cells could show green fluorescence confirmed by immunofluorescence staining (almost 95%). ELISA analyses could detect out the density of VEGF was 850.86 - 1202.13 pg/ml (mean (923.00 ± 31.22) pg/ml) in the supernatant of VEGF(165)-transduced cells but not detected in the GFP-transduced cells (P < 0.001) and the Western blotting analyses also confirmed VEGF(165) expression in VEGF(165)-transduced cells.

CONCLUSIONS

The VEGF(165) over-expression ADSCs were obtained and may be used as a cell therapeutic tool and may be applied for vascular regeneration, especially in the treatment of erectile dysfunction.

Primary mucinous adenocarcinoma of the renal pelvis with elevated CEA and CA19-9

Primary adenocarcinoma of the renal pelvis is rarely reported in the literature. Here we present a case of primary mucinous adenocarcinoma of the renal pelvis with elevated serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels. A 56-year-old woman was referred to our center with intermittent fever and left-sided back pain for 1 month. Computed tomography showed bilateral nephrolithiasis, mild right hydronephrosis and left pyonephrosis accompanied with ambiguous soft tissues. A radionucleorenogram showed that the glomerular filtration rate of the left and right kidney was 0 and 79 ml/min, respectively. Left nephrectomy was performed without lymph node dissection. Histopathology revealed mucinous adenocarcinoma and elevated serum CEA and CA19-9 levels were found. She died of multiorgan metastasis after 5 months. A review of the literature is also reported.

[Daily medication of low-dose tadalafil improves endothelial function and erectile hardness of ED patients]

OBJECTIVE

To evaluate the effects of daily medication of low-dose tadalafil on the improvement of endothelial function and erectile hardness in erectile dysfunction (ED) patients.

METHODS

A total of 60 ED patients and 24 controls were treated with oral tadalafil at 5 mg/d for 6 - 8 weeks, and evaluated by international index of erectile function-5 (IIEF-5), erectile hardness grading scale (EHGS) and brachial artery flow-mediated dilation (FMD) test before and after the treatment. All the data obtained were analyzed by independent-sample and paired-sample t tests, respectively.

RESULTS

The treatment and follow-up were accomplished in 51 of the ED cases. Compared with the controls, the ED patients showed significantly lower scores on IIEF-5 (23.6 +/- 1.0 vs 10.3 +/- 4.5, P < 0.01), EHGS (3.7 +/- 0.5 vs 2.0 +/- 0.6, P < 0.01) and FMD (14.1 +/- 2.1 vs 8.1 +/- 1, P < 0.01). Daily medication of tadalafil achieved an effectiveness rate of 96.1% (49/51) in the treatment of the ED patients, and significantly improved their scores on IIEF-5 (16.9 +/- 3.9 vs 10.6 +/- 4.5, P < 0.01), EHGS (2.6 +/- 0.7 vs 2.0 +/- 0.6, P < 0.01) and FMD (9.2 +/- 1.7 vs 8.1 +/- 0.9, P < 0.01), as compared with pretreatment.

CONCLUSION

Long-term daily medication of low-dose tadalafil can significantly improve endothelial function and erectile hardness of ED patients.

[Value of 3D 1H-MRS with body coil at 3T in the differential diagnosis of the prostate cancer]

OBJECTIVE

To assess the value of three dimensional proton magnetic resonance spectroscopy (3D 1H-MRS) with body coil at 3T in the differential diagnosis of prostate cancer.

METHODS

Forty patients suspected of prostate cancer underwent MRI and MRS examinations, and then transrectal ultrasound guided prostate biopsy for pathological diagnosis. The MRI and MRS features of benign prostate hyperplasia, prostate cancer and prostatic intraepithelial neoplasia (PIN) were analyzed in comparison with the pathological reports, and the receiver operating characteristic curve was drawn for the diagnosis of cancer from peripheral zones.

RESULTS

The examinations were accomplished for all the patients. The mean ratios of (Cho + Cre)/Cit in the interstitial and glandular hyperplasia tissues, the cancer tissue of the central and peripheral glands, the healthy peripheral gland and PIN were 0.75 +/- 0.23, 0.59 +/- 0.14, 1.79 +/- 0.90, 1.18 +/- 0.95, 0.46 +/- 0.18, and 0.97 +/- 0.10, respectively, with statistically significant differences between the cancer and normal prostate tissues (P < 0.01). The optimum threshold for the diagnosis of prostate cancer in the peripheral zone was 0.68 with a sensitivity of 88.6% and a specificity of 88.7%.

CONCLUSION

The 3D 1H-MRS with body coil at 3T has a high sensitivity and specificity in the differential diagnosis of prostate cancer, and can provide valuable information for the diagnosis of PIN.

Degradation of forage chicory by ruminal fibrolytic bacteria

AIMS

Determine the susceptibility of forage chicory (Cichorium intybus L.) to degradation by ruminal fibrolytic bacteria and measure the effects on cell-wall pectic polysaccharides.

METHODS AND RESULTS

Large segments of fresh forage chicory were degraded in vitro by Lachnospira multiparus and Fibrobacter succinogenes, but not by Ruminococcus flavefaciens or Butyrivibrio hungatei. Cell-wall pectins were degraded extensively (95%) and rapidly by L. multiparus with a simultaneous release of uronic acids and the pectin-derived neutral monosaccharides arabinose, galactose and rhamnose. Fibrobacter succinogenes also degraded cell-wall pectins extensively, but at a slower rate than L. multiparus. Immunofluorescence microscopy using monoclonal antibodies revealed that, after incubation, homogalacturonans with both low and high degrees of methyl esterification were almost completely lost from walls of all cell types and from the middle lamella between cells.

CONCLUSIONS

Only two of the four ruminal bacteria with pectinolytic activity degraded fresh chicory leaves, and each showed a different pattern of pectin breakdown. Degradation was greatest for F. succinogenes which also had cellulolytic activity.

SIGNIFICANCE AND IMPACT OF THE STUDY

The finding of extensive removal of pectic polysaccharides from the middle lamella and the consequent decrease in particle size may explain the decreased rumination and the increased intake observed in ruminants grazing forage chicory.

[Testicular microlithiasis influences seminal profile and testicular blood flow in infertile men]

OBJECTIVE

To investigate the testicular blood flow in patients with testicular microlithiasis (TM) and its correlation with the seminal profile in infertile men.

METHODS

We selected 88 infertile men and examined them by testicular color Doppler and routine seminal tests.

RESULTS

Testicular microlithiasis was found in 19 (19.3%) of the patients, classic testicular microlithiasis (CTM) in 7 (8.0%), and limited testicular microlithiasis (LTM) in 10 (11.3%). No significant differences were observed in the age of onset, bilateral testicular volume, resistance index (RI) of bilateral testicular arteries, semen amount and the rate of teratospermia. The bilateral testicular peak systolic velocity (PSV), sperm count and sperm motility were significantly lower in the CTM than in the LTM group (P < 0.05), but showed no statistically significant difference between the LTM and the non-calcification group.

CONCLUSION

TM may be one of the causes of poor sperm function in infertile men.

[Diagnosis and treatment of primitive neuroectodermal tumor of the penis: a case report and review of the literature]

OBJECTIVE

To investigate the clinical and pathological characteristics, treatment and prognosis of peripheral primitive neuroectodermal tumor (PNET) of the urinary tract and reproductive system.

METHODS

The clinical data and pathological characteristics of a PNET patient was analyzed and relevant literature reviewed.

RESULTS

The diagnosis was established by pathological and immunohistochemical method. The patient underwent radical surgery, followed by chemotherapy.

CONCLUSION

Pathology and immunohistochemistry help the diagnosis of PNET. For the treatment of the tumors in the early stage, surgery is the best choice, and for that in the late stage, it can be followed by chemotherapy. The PNET of the penis is a rare disease and evidence still lacks for the evaluation of its prognosis.

[An experimental study of the culture, isolation and biological characteristics of rat adipose tissue-derived stromal cells in vitro]

OBJECTIVE

To establish a method for the isolation and culture of rat adipose tissue-derived stromal cells (ADSCs) and explore some biological characteristics of the acquired ADSCs.

METHODS

Adipose tissues were isolated from the inguinal fat of SD rats. Primary ADSCs were obtained by the method of collagenase I digestion, inoculated, cultured in the Dulbecco modified Eagle medium with 10% fetal bovine serum, and subcultured at the right moment. The morphology and proliferation characteristics of the cells were observed under the inverted phase contrast microscope every day. Their growth curves were detected and experiments of freezing and resuscitation performed. The third passage ADSCs were induced into osteoblasts by osteogenic inducing fluid and into adipocytes by adipogenic inducing fluid. The osteogenic phenotypes were examined by Von Kossa staining and the adipocytes by Oil Red O staining.

RESULTS

ADSCs were successfully obtained and cultured from the rat adipose tissue. They appeared fibroblast-like and could proliferate rapidly in vitro, the third passage having the most active proliferative ability. Calcium nodes characteristic of osteoblasts were observed in the ADSCs on Von Kossa staining after induction with dexamethasone, ascorbic acid and beta-sodium glycerophosphate, and red-stained fats characteristic of adipocytes were noted in the cytoplasm on Oil Red O staining after induction with IBMX, indomethacin and insulin. The ADSCs showed no significant decrease in their proliferation activity and capability of differentiating into diverse cell types after cryopreserved in liquid nitrogen for a month.

CONCLUSION

A simple and effective method for the isolation and culture of rat ADSCs was successfully established. The ADSCs obtained could grow and proliferate rapidly in vitro, capable of differentiating into diverse cell types, easy to be preserved and promising to be seed cells for cell therapy and tissue engineering. The procedure of schizolysising erythrocytes with NH4Cl could be omitted in the isolation of the rat ADSCs and dexamethasone is not indispensable in the induction of ADSCs into adipocytes.

[A clinical study of sertraline and vardenafil in the treatment of premature ejaculation complicated by erectile dysfunction]

OBJECTIVE

To evaluate the efficacy and safety of sertraline and vardenafil in the treatment of patients with concomitant erectile dysfunction (ED) and premature ejaculation (PE).

METHODS

Sixty patients with concomitant ED and PE received at our clinic of andrology were randomly divided into a vardenafil group and a sertraline group. The vardenafil group received flexible doses of vardenafil from 10 mg to 20 mg and the sertraline group 50 mg daily, both for 2 months. The differences in IIEF-5 before and after the treatment were recorded and compared, and the results of ED treatment evaluated. Intravaginal ejaculatory latency time (IELT) was recorded to evaluate the outcome of PE treatment.

RESULTS

In the vardenafil group, 24 patients had their ED improved and the efficacy rate was 80%, as compared with 27% in the sertraline group. There was significant difference between the two groups (P < 0.05). Twenty patients had their PE improved in vardenafil group, with an efficacy rate of 67% as compared with 40% in the sertraline group. The difference was significant between the two groups (P < 0.05). In both of the two groups, a significantly higher rate of PE improvement was found in patients with improved ED than in those without. Only mild side effects were recorded, and none withdrew from the treatment.

CONCLUSION

To patients with concomitant ED and PE, the key to the treatment is to improve their erectile function, and for this purpose, vardenafil works better than sertraline.

[Retroperitoneoscopic radical nephrectomy for renal cancer--a report of 43 cases]

BACKGROUND & OBJECTIVE

With the development of laparoscopic technique, more and more renal cancer patients have accepted laparoscopic radical nephrectomy instead of open radical nephrectomy. This study was to introduce our experiences of retroperitoneoscopic radical nephrectomy, and evaluate its therapeutic efficacy.

METHODS

Between Nov. 2003 and Aug. 2006, retroperitoneoscopic radical nephrectomy was performed in 43 renal cancer patients; retroperitoneal approach was structured without water balloon, and Hem-o-lok clips were used to control renal vessels during operation. In the same period, open radical nephrectomy was performed in 34 renal cancer patients. Treatment outcomes of the 2 groups were compared.

RESULTS

There was no significant difference in operation time between laparoscopy group and open approach group (149 min vs. 140 min, P=0.24). The amount of blood loss during operation was significantly less in laparoscopy group than in open approach group (53 ml vs. 199 ml, P<0.01). The time of intestinal function recovery, ambulation, indwelling drainage tube, and hospitalization stay after operation were significantly shorter in laparoscopy group than in open approach group (P<0.01). Incision infection occurred in 2 patients in open approach group; no severe perioperative complications presented in laparoscopy group. During the follow-up of 1-32 months, 1 patient in open approach group had lung metastasis; none in laparoscopy group had recurrence or metastasis.

CONCLUSIONS

Retroperitoneoscopic radical nephrectomy has the advantages of mini-invasion and rapid recovery. The method of structuring retroperitoneal approach without water balloon is safe and effective. Hem-o-lok clip is a reliable and economical device for renal vascular control.

[Diagnosis and treatment of iatrogenic ejaculatory duct obstruction following prostatic hyperthermia (report of 3 cases)]

OBJECTIVE

To investigate the characteristics of diagnosis and treatment of iatrogenic ejaculatory duct obstruction following prostatic hyperthermia.

METHODS

Retrospective analyses were made of the clinical data of 3 cases of ejaculatory duct obstruction following prostatic hyperthermia.

RESULTS

The 3 cases were diagnosed as urethrostenosis and deformity of the posterior urethra by transurethral ultrasound and semen analysis. And all the 3 patients had undergone prostatic hyperthermia for prostatitis. Transurethral resection of the ejaculatory duct (TURED) was performed to remove the obstruction and the postoperative semen analysis showed both semen volume and sperm count to be normal.

CONCLUSION

Urethra microwave thermotherapy, urethra radiofrequency, or per urethra rheophore ablation can be adopted in the treatment of protatitis, but should be strictly indicated and cautiously selected lest secondary iatrogenic ejaculatory duct obstruction should result. For the treatment of this obstruction, TURED is the first choice.

[Expression and significance of caspase-1 in benign hyperplastic prostate tissues]

OBJECTIVE

To investigate the expression and significance of caspase-1 in normal and hyperplastic prostate tissues.

METHODS

Twenty-eight paraffin-embedded sections, including 21 benign prostatic hyperplasia (BPH) and 7 normal prostate tissue samples, were investigated immunohistochemically for caspase-1.

RESULTS

The rate of caspase-1 expression in the BPH tissues was 71.4% (15/21 ) while that in the normal prostate tissues was 100%. The expression level of caspase-1 in both epithelial cells and interstitial cells of the hyperplastic prostate tissues was obviously lower than that of the normal prostate tissues (P < 0.01). Within the BPH tissues, the expression level of caspase-1 in the epithelial cells was higher than in the interstitial cells, and the difference was statistically significant (P < 0.01).

CONCLUSION

The expression of caspase-1 is dramatically reduced in the hyperplastic prostate tissues, which indicates that the decline of caspase-1-dependent apoptosis might be involved in the progress of benign prostatic hyperplasia.

[Culture and identification of human adult Leydig cells]

OBJECTIVE

To obtain a simple and effective method to isolate and purify adult Leydig cells.

METHODS

The testes of human adults were digested and then the density gradient centrifugation of the cells was performed with four different Percoll concentrations (60%, 34%, 26%, 21%) to isolate Leydig cells, whose characteristics were identified by cytological observation staining, 3beta-HSD staining and detection of hCG and testosterone secretion.

RESULTS

High-concentration (> 90%) purified Leydig cells were acquired, and many identification experiments demonstrated the adequate testosterone secretory function of the isolated and purified Leydig cells.

CONCLUSION

This method is easy and efficient for the isolation and purification of adult Leydig cells.

Endotoxins in the prostatic secretions of chronic prostatitis patients

AIM

To evaluate the clinical significance of the quantitative determinations of endotoxins in the expressed prostatic secretions (EPS) of chronic prostatitis (CP) patients.

METHODS

The EPS of 45 patients with CP and 15 normal volunteers were obtained for microscopic examination, bacterial culture and endotoxin determination. The level of endotoxins was determined by the Limulus-amebocyte-lysate test with chromogenic substrate.

RESULTS

Patients with CP had higher mean levels of endotoxins in EPS than normal volunteers [52.06 +/- 32.83 EU/L vs. 4.77 +/- 4.14 EU/L (P <0.05)]. The levels of endotoxins in CP type II, type IIIa and type IIIb were 68.62 +/- 34.78 EU/L, 45.30 +/- 23.33 EU/L and 15.83 +/- 5.31 EU/L, respectively [type II vs. type IIIa (P >0.05), type IIIb vs. normal controls (P <0.05), type II/type IIIa vs. normal controls P >0.05)].

CONCLUSION

CP patients have elevated levels of endotoxins in the EPS, which suggests that inflammation is a feature of this disease. EPS endotoxin determination is not only helpful in diagnostic confirmation, but also in evaluating the response to treatment in CP patients.

Body and brain development following exposure to 60Co gamma-irradiation during pregnancy in mice

We studied the dose-response effects of gamma-irradiation on the weight gains of the body and the brain in ICR mice exposed to various doses of 60Co gamma-irradiation ranging from 0 to 1.5 Gy on day 13 of pregnancy (El3). We found that 0.5 Gy gamma-irradiation caused a significant reduction in brain weight but not in body weight among 6-week-old mice. Higher doses (1.0, 1.5 Gy) seriously inhibited body and brain development, resulting in significantly low weights at 6 weeks of age. A significantly lower brain weight among fetuses exposed to 1.5 Gy was found as early as 24 hours after exposure, while significant reductions in the body weight of these same fetuses appeared 3 days after exposure. The effects of radiation on brain and body development were similar for both males and females.

Neurogenesis of heterotopic gray matter in the brain of the microcephalic mouse

Neurogenesis of heterotopic gray matter in the brain of the microcephalic mouse prenatally exposed to X-rays at embryonic day 13 (E13) was studied immunohistochemically. Bromodeoxyuridine (BrdU) as a marker to label the migrating position of neuroblasts generated at various embryonic stages showed that no "inside-out" pattern of neuronal migration occurred in the heterotopic cell mass similar to that seen in the laminated cortex. Further results in which midkind (MK) immunoreactive radial glial fibers did not appear in the heterotopic cell mass demonstrated that heterotopia formed in the absence of radial glia system. Different types of cells (pyramidal and non-pyramidal neurons) in the heterotopic cell mass were identified with immunoreactivity for anti-parvalbumin and anti-calbindin D-28K antibodies in addition to current histological methods. Two major types of neurons were mixed together with random distribution in the heterotopic cell mass. This finding indicates that irradiation might have no selective effects on the precursors of pyramidal and non-pyramidal neurons. Moreover, anti-glial fibrillary acidic protein (GFAP) immunostaining showed that numerous astrocytes were present in the heterotopic cell mass. The fact that astrocytes appeared in the heterotopia without the transition from classic radial glial cells to astrocytes suggests that astrocytes might be generated directly from a separate astroglial precursor.

Purkinje cell degeneration in mice lacking the xeroderma pigmentosum group G gene

Laboratory mice carrying the nonfunctional xeroderma pigmentosum group G gene (the mouse counterpart of the human XPG gene) alleles have been generated by using gene-targeting and embryonic stem cell technology. Homozygote animals of this autosomal recessive disease exhibited signs and symptoms, such as postnatal growth retardation, reduced levels of activity, progressive ataxia and premature death, similar to the clinical manifestations of Cockayne syndrome (CS). Histological analysis of the cerebellum revealed multiple pyknotic cells in the Purkinje cell layer of the xpg homozygotes, which had atrophic cell bodies and shrunken nuclei. Further examination by an immunohistochemistry for calbindin-D 28k (CaBP) showed that a large number of immunoreactive Purkinje cells were atrophic and their dendritic trees were smaller and shorter than in wild-type littermates. These results indicated a marked degeneration of Purkinje cells in the xpg mutant cerebellum. Study by in situ detection of DNA fragmentation in the cerebellar cortex demonstrated that some deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin in situ nick labeling (TUNEL)-positive cells appeared in the granule layer of the mutant mice, but few cell deaths were confirmed in the Purkinje layer. These results suggested Purkinje cell degeneration in the mutant cerebellum was underway, in which much Purkinje cell death had not appeared, and the appearance of some abnormal cerebellar symptoms in the xpg-deficient mice was not only due to a marked Purkinje cell degeneration, but also to damage of other cells.

Effects of the restriction of food and water intake on the distribution and retention of radioiodine in mice

The effects of the restriction of food and water intakes on gastrointestinal absorption, distribution to organs and excretion of 131I were investigated in C3H/He mice. The animals were divided into four groups and administered orally 37 kBq carrier-free Na 131I in 0.25 ml normal saline. One group of animals was given food and water ad libitum throughout the experimental period. Food and water to the remaining groups were restricted before and/or after the administration of 131I. The animals in each group were sacrificed 4 h and 24 h after administration, and the activity of 131I in thyroid, blood, liver, kidney, gastrointestinal tract, urine, feces, and carcass was measured. There was a significant increase in the retention of 131I in the thyroid and the concentration of 131I in the blood due to the restriction of food and water after the administration of 131I. In contrast, a significant decrease in the urinary excretion was observed in these animals. In those animals, which fasted before administration only, the retention of 131I in the thyroid and other organs were decreased. Therefore, for an accurate diagnosis and effective therapy with radioiodine as well as effective radiation protection, the intake of food and water should be taken into account.

Determination of the spatial distribution of major elements in the rat brain with X-ray fluorescence analysis

An energy dispersive X-ray fluorescence analysis was applied for determining the spatial (two-dimensional) distribution of elemental concentrations in rat brain sections. Freeze-dried brain sections prepared from normal and ischemic rats with middle cerebral artery occlusion were scanned with a collimated X-ray beam (0.18 mm in diameter, 50-kV acceleration voltage). The fluorescent Kalpha X-rays of P, S, Cl, and K were detectable, so that the two-dimensional distribution of fluorescent X-ray intensities could be determined for these elements. Furthermore, quantitative determination was possible for P and K by using the fundamental parameter technique. However, the accurate determination of Na and Ca was difficult, because of the low energy of Kalpha X-ray of Na, and the interference of K-Kbeta with Ca-Kalpha. The change in elemental concentrations in ischemic tissue, including the decrease in K concentration and increase in Cl concentration, was demonstrated by this method as a two-dimensional contour map. Since it is possible to obtain a pictorial representation of the elemental concentration in tissue sections, this method may be useful to evaluate the ionic changes in injured brain tissue in relation to histological or autoradiographical observations.