Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia(2021 Edition)

Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.

Chlorogenic acid alleviates hypoxic-ischemic brain injury in neonatal mice

Recent studies have shown that chlorogenic acid(CGA),which is present in coffee,has protective effects on the nervous system.However,its role in neonatal hypoxic-ischemic brain injury remains unclear.In this study,we established a newborn mouse model of hypoxic-ischemic brain injury using a modified Rice-Vannucci method and performed intraperitoneal injection of CGA.We found that CGA intervention effectively reduced the volume of cerebral infarct,alleviated cerebral edema,restored brain tissue structure after injury,and promoted axon growth in injured brain tissue.Moreover,CGA pretreatment alleviated oxygen-glucose deprivation damage of primary neurons and promoted neuron survival.In addition,changes in ferroptosis-related proteins caused by hypoxic-ischemic brain injury were partially reversed by CGA.Furthermore,CGA intervention upregulated the expression of the key ferroptosis factor glutathione peroxidase 4 and its upstream glutamate/cystine antiporter related factors SLC7A11 and SLC3A2.In summary,our findings reveal that CGA alleviates hypoxic-ischemic brain injury in neonatal mice by reducing ferroptosis,providing new ideas for the treatment of neonatal hypoxic-ischemic brain injury.

Case series of COVID-19 patients from the Qinghai-Tibetan Plateau Area in China

BACKGROUND Coronavirus disease 2019(COVID-19)is a serious infection caused by the new coronavirus severe acute respiratory syndrome coronavirus 2.The disease was first identified in December 2019 and has caused significant morbidity and mortality worldwide.AIM To explore the clinical characteristics and treatments for COVID-19 in the Qinghai-Tibetan Plateau Area in China.METHODS We retrospectively analyzed the blood cell counts(neutrophils and lymphocytes),blood gas analysis,and thoracic computed tomography changes of patients from Qinghai Province before,during,and after treatment(January 23,2020 to February 21,2020).In addition,we summarized and analyzed the information of critical patients.All data were analyzed using SPSS 17.0(SPSS Inc.,Chicago,IL,United States).The quantitative and count variables are represented as the mean±SD and n(%),respectively.RESULTS The main symptoms and signs of patients with COVID-19 were fever,dry cough,cough with phlegm,difficulty breathing,and respiratory distress with a respiration rate≥30 times/min,finger oxygen saturation≤93%in the resting state,and oxygenation index less than 200 but greater than 100(after altitude correction).Eighteen patients with COVID-19,of whom three were critical,and the others were in a mild condition,were included.The main manifestations included fever,dry cough,and fatigue.Three patients developed difficulty breathing and had a fever.They were eventually cured and discharged.Adjuvant examinations showed one case with reduced white cell count(6%)(<4×10^(9)/L),six with reduced count of lymphocytes(33%)(<0.8×10^(9)/L),and one with abnormal blood glucose level.All 18 patients were discharged,and no death occurred.CONCLUSION Our findings provide critical insight into assessing the clinical diagnosis and treatment for COVID-19 in the Tibetan plateau area.

Anti-inflammatory effects of acupuncture in the treatment of chronic obstructive pulmonary disease

Numerous randomised controlled trials have suggested the positive effects of acupuncture on chronic obstructive pulmonary disease(COPD).However,the underlying therapeutic mechanisms of acupuncture for COPD have not been clearly summarized yet.Inflammation is central to the development of COPD.In this review,we elucidate the effects and underlying mechanisms of acupuncture from an antiinflammatory perspective based on animal studies.Cigarette smoke combined with lipopolysaccharide is often used to establish animal models of COPD.Electroacupuncture can be an effective intervention to improve inflammation in COPD,and Feishu(BL13)and Zusanli(ST36)can be used as basic acupoints in COPD animal models.Different acupuncture types can regulate different types of inflammatory cytokines;meanwhile,different acupuncture types and acupoint options have similar effects on modulating the level of inflammatory cytokines.In particular,acupuncture exerts anti-inflammatory effects by inhibiting the release of inflammatory cells,inflammasomes and inflammatory cytokines.The main underlying mechanism through which acupuncture improves inflammation in COPD is the modulation of relevant signalling pathways:nuclear factor-κB(NF-κB)(e.g.,myeloid differentiation primary response 88/NF-κB,toll-like receptor-4/NF-κB,silent information regulator transcript-1/NF-κB),mitogen-activated protein kinase signalling pathways(extracellular signal-regulated kinase 1/2,p38 and c-Jun NH2-terminal kinase),cholinergic anti-inflammatory pathway,and dopamine D2 receptor pathway.The current synthesis will be beneficial for further research on the effect of acupuncture on COPD inflammation.