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.

A nested case-control study of maternal-neonatal transmission of hepatitis B virus in a Chinese population

AIM:To examine the determinants of maternal-neonatal transmission of hepatitis B virus(HBV) METHODS:A nested case-control study was conducted in Changsha,Hunan,People's Republic of China from January 1,2005 to September 31,2006 To avoid potential maternal blood contamination,we collected vein blood of newborns immediately after birth and before initial hepatitis B vaccination to determine the HBV infection status of the newborn For each HBsAg-positive infant,one HBsAg-negative infant born to an HBsAg-positive mother was matched by hospital at birth(same),gender(same),and date of birth(within 1 mo) A faceto-face interview was conducted to collect clinical and epidemiological data Conditional logistic regression analysis was used to estimate the independent effects of various determinants on maternal-neonatal transmission of HBV RESULTS:A total of 141 HBsAg-positive infants and 141 individually matched HBsAg-negative infants were included in the final analysis Maternal first-degree family history of HBV infection,intrahepatic cholestasis,and premature rupture of membranes were risk factors for perinatal transmission of HBV,whereas systematic treatment and HBV immunoglobulin injections for mothers with HBV infection were protective factors for maternal-neonatal transmission of HBV,after adjustment for potential confounding factors CONCLUSION:For HBsAg-positive mothers,systematic treatment,HBV immunoglobulin administration,and controlling intrahepatic cholestasis and pregnancy complications may reduce the incidence of perinatal transmission of HBV.

Application of preoperative artificial neural network based on blood biomarkers and clinicopathological parameters for predicting longterm survival of patients with gastric cancer

BACKGROUND Because of the powerful abilities of self-learning and handling complex biological information,artificial neural network(ANN)models have been widely applied to disease diagnosis,imaging analysis,and prognosis prediction.However,there has been no trained preoperative ANN(preope-ANN)model to preoperatively predict the prognosis of patients with gastric cancer(GC).AIM To establish a neural network model that can predict long-term survival of GC patients before surgery to evaluate the tumor condition before the operation.METHODS The clinicopathological data of 1608 GC patients treated from January 2011 to April 2015 at the Department of Gastric Surgery,Fujian Medical University Union Hospital were analyzed retrospectively.The patients were randomly divided into a training set(70%)for establishing a preope-ANN model and a testing set(30%).The prognostic evaluation ability of the preope-ANN model was compared with that of the American Joint Commission on Cancer(8th edition)clinical TNM(cTNM)and pathological TNM(pTNM)staging through the receiver operating characteristic curve,Akaike information criterion index,Harrell's C index,and likelihood ratio chi-square.RESULTS We used the variables that were statistically significant factors for the 3-year overall survival as input-layer variables to develop a preope-ANN in the training set.The survival curves within each score of the preope-ANN had good discrimination(P<0.05).Comparing the preope-ANN model,cTNM,and pTNM in both the training and testing sets,the preope-ANN model was superior to cTNM in predictive discrimination(C index),predictive homogeneity(likelihood ratio chi-square),and prediction accuracy(area under the curve).The prediction efficiency of the preope-ANN model is similar to that of pTNM.CONCLUSION The preope-ANN model can accurately predict the long-term survival of GC patients,and its predictive efficiency is not inferior to that of pTNM stage.

Emodin ameliorates lipopolysaccharides-induced corneal inflammation in rats

· AIM: To investigate the effect of emodin on pseudomonas aeruginosa lipopolysaccharides(LPS)-induced corneal inflammation in rats.· METHODS: Corneal infection was induced by pseudomonas aeruginosa LPS in Wistar rats. The inflammation induced by LPS were examined by slit lamp microscope and cytological checkup of aqueous humor.Corneal tissue structure was observed by hematoxylin and eosin(HE) staining. The activation of nuclear factor kappa B(NF-κB) was determined by Western blot.Messenger ribonucleic acid(m RNA) of tumor necrosis factor-α(TNF-α) and intercellular adhesion molecule-1(ICAM-1) in LPS-challenged rat corneas were measured with reverse transcription-polymerase chain reaction(RT-PCR).· RESULTS: Typical manifestations of acute corneal inflammation were observed in LPS-induce rat model,and the corneal inflammatory response and structure were improved in rats pretreated with emodin. Treatment with emodin could improve corneal structure, reduce corneal injure by reducing corneal inflammatory response. Emodin could inhibit the decreasing lever of inhibitor of kappa B alpha(IкBα) express, and the m RNA expression of TNF-α and ICAM-1 in corneal tissues was also inhibited by emodin. The differences were statistically significant between groups treated with emodin and those without treatment(P 【0.01).·CONCLUSION: Emodin could ameliorate LPS-induced corneal inflammation, which might via inhibiting the activation of NF-κB.

Short-term efficacy of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy via Huang’s three-step maneuver for advanced upper gastric cancer: Results from a propensity scorematched study

BACKGROUND Robotic surgery has been considered to be significantly better than laparoscopic surgery for complicated procedures.AIM To explore the short-term effect of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy(SPSHL)for advanced gastric cancer(GC)by Huang’s three-step maneuver.METHODS A total of 643 patients who underwent SPSHL were recruited from April 2012 to July 2017,including 35 patients who underwent robotic SPSHL(RSPSHL)and 608 who underwent laparoscopic SPSHL(LSPSHL).One-to-four propensity score matching was used to analyze the differences in clinical data between patients who underwent robotic SPSHL and those who underwent laparoscopic SPSHL.RESULTS In all,175 patients were matched,including 35 patients who underwent RSPSHL and 140 who underwent LSPSHL.After matching,there were no significant differences detected in the baseline characteristics between the two groups.Significant differences in total operative time,estimated blood loss(EBL),splenic hilar blood loss(SHBL),splenic hilar dissection time(SHDT),and splenic trunk dissection time were evident between these groups(P<0.05).Furthermore,no significant differences were observed between the two groups in the overall noncompliance rate of lymph node(LN)dissection(62.9%vs 60%,P=0.757),number of retrieved No.10 LNs(3.1±1.4 vs 3.3±2.5,P=0.650),total number of examined LNs(37.8±13.1 vs 40.6±13.6,P=0.274),and postoperative complications(14.3%vs 17.9%,P=0.616).A stratified analysis that divided the patients receiving RSPSHL into an early group(EG)and a late group(LG)revealed that the LG experienced obvious improvements in SHDT and length of stay compared with the EG(P<0.05).Logistic regression showed that robotic surgery was a significantly protective factor against both SHBL and SHDT(P<0.05).CONCLUSION RSPSHL is safe and feasible,especially after overcoming the early learning curve,as this procedure results in a radical curative effect equivalent to that of LSPSHL.

The enhancement of performance and imbibition effect of slickwater-based fracturing fluid by using MoS_(2)nanosheets

Slickwater-based fracturing fluid has recently garnered significant attention as the major fluid for volumetric fracturing;however,lots of challenges and limitations such as low viscosity,poor salt tolerance,and possible formation damage hinder the application of the conventional simple slickwater-based fracturing fluid.In addition,nanomaterials have proven to be potential solutions or improvements to a number of challenges associated with the slickwater.In this paper,molybdenum disulfide(MoS_(2))nanosheets were chemically synthesized by hydrothermal method and applied to improve the performance of conventional slickwater-based fracturing fluid.Firstly,the microstructure characteristics and crystal type of the MoS_(2)nanosheets were analyzed by SEM,EDS,TEM,XPS,and Raman spectroscopy techniques.Then,a series of evaluation experiments were carried out to compare the performance of MoS_(2)nanosheet-modified slickwater with the conventional slickwater,including rheology,drag reduction,and sand suspension.Finally,the enhanced imbibition capacity and potential mechanism of the nanosheet-modified slickwater were systematically investigated.The results showed that the self-synthesized MoS_(2)nanosheets displayed a distinct ultrathin flake-like morphology and a lateral size in the range of tens of nanometers.In the nano-composites,each MoS_(2)nanosheet plays the role of cross-linking point,so as to make the spatial structure of the entire system more compact.Moreover,nanosheet-modified slickwater demonstrates more excellent properties in rheology,drag reduction,and sand suspension.The nanosheet-modified slickwater has a higher apparent viscosity after shearing 120 min under 90℃ and 170 s^(−1).The maximum drag reduction rate achieved 76.3%at 20℃,and the sand settling time of proppants with different mesh in the nano-composites was prolonged.Spontaneous imbibition experiments showed that the gel-breaking fluid of nanosheet-modified slickwater exhibited excellent capability of oil-detaching,and increase the oil recovery to∼35.43%.By observing and analyzing the interfacial behavior of MoS_(2)nanosheets under stimulated reservoir conditions,it was found that the presence of an interfacial tension gradient and the formation of a climbing film may play an essential role in the spontaneous imbibition mechanism.This work innovatively uses two-dimensional MoS_(2)nanosheets to modify regular slickwater and confirms the feasibility of flake-like nanomaterials to improve the performance of slickwater.The study also reveals the underlying mechanism of enhanced imbibition efficiency of the nano-composites.

Protective Effect of Emodin against Lipopolysaccharides-induced Corneal Injury in Rats

Objective To investigate the effect of emodin on lipopolysaccharides （LPS）-induced corneal injury in rats. Methods Three parallel incisions on the central surface of corneal epithelium were made and LPS was applied on them to induce corneal injury in Wistar rats. All rats were randomly divided into emodin group （n=40） and keratitis group （n=40）. Rats in the emodin group received subconjunctival injection of emodin and rats in the keratitis group received its vehicle 30 minutes before LPS exposure. At different time points-1 3, 6, 12, and 24 hours after LPS exposure, the symptoms of all rats were observed and the severity of their ocular inflammation was examined with a slit lamp microscope, then 8 rats in each group were killed through cervical dislocation and their eyes were enucleated and prepared to observe pathological changes of corneal tissue under a light microscope. The activation of nuclear factor-loB （NF-κB） under different condi- tions was determined by Western blot. Immunocytochemistry staining with an antibody against intercellular adhesion molecule-1 （ICAM-1） was performed to identify positive cells in corneal tissues. Results The model of acute keratitis was successfully established in Wistar rats. LPS could induce a typical corneal inflammatory response, such as hyperemia, corneal edema and opacity, which were observed in model rats. Compared with keratitis group, both ocular behaviors and damages of the corneal structure were improved in emodin group. Furthermore, the activation of NF-κB and the expression of ICAM-1 induced by LPS were markedly inhibited in emodin group. Conclusion Emodin can inhibit the activation of NF-κB and the expression of ICAM-I induced by LPS in corneas, protect against acute corneal injury, and improve symptoms in rats.

Nomograms for pre-and postoperative prediction of long-term survival among proximal gastric cancer patients: A large-scale,single-center retrospective study

BACKGROUND The incidence of proximal gastric cancer(GC)is increasing,and methods for the prediction of the long-term survival of proximal GC patients have not been well established.AIM To develop nomograms for the prediction of long-term survival among proximal GC patients.METHODS Between January 2007 and June 2013,we prospectively collected and retrospectively analyzed the medical records of 746 patients with proximal GC,who were divided into a training set(n=560,75%)and a validation set(n=186,25%).A Cox regression analysis was used to identify the preoperative and postoperative risk factors for overall survival(OS).RESULTS Among the 746 patients examined,the 3-and 5-year OS rates were 66.1%and 58.4%,respectively.In the training set,preoperative T stage(cT),N stage(cN),CA19-9,tumor size,ASA core,and 3-to 6-mo weight loss were incorporated into the preoperative nomogram to predict the OS.In addition to these variables,lymphatic vascular infiltration(LVI),postoperative tumor size,T stage,N stage,blood transfusions,and complications were incorporated into the postoperative nomogram.All calibration curves used to determine the OS probability fit well.In the training set,the preoperative nomogram achieved a C-index of 0.751[95%confidence interval(CI):0.732-0.770]in predicting OS and accurately stratified the patients into four prognostic subgroups(5-year OS rates:86.8%,73.0%,43.72%,and 20.9%,P<0.001).The postoperative nomogram had a C-index of 0.758 in predicting OS and accurately stratified the patients into four prognostic subgroups(5-year OS rates:82.6%,74.3%,45.9%,and 18.9%,P<0.001).CONCLUSION The nomograms accurately predicted the pre-and postoperative long-term survival of proximal GC patients.

Jagged1 and DLL4 expressions in benign and malignant pancreatic lesions and their clinicopathological significance

BACKGROUND： Pancreatic ductal adenocarcinoma （PDAC） is characterized by a poor prognosis. Despite intensive research, markers for the early diagnosis, prognosis, and targeting therapy of PDAC are not available. This study aimed to investigate the protein expressions of laggedl and DLL4 in PDAC tumor, benign pancreatic and normal pancreatic tissues, and analyze the associations of the two proteins with the clinical and pathological characteristics of PDAC. METHODS： A total of 106 PDAC tumor tissues and 35 peritumoral tissues were collected from January 2000 to December 2011 at our hospitals. Thirteen normal pancreatic tissues and 55 benign pancreatic specimens were collected at the same period. Immunohistochemical staining was used to measure Jagged1 and DLL4 protein expressions in these tissues. RESULTS： The percentage of positive Jaggedl and DLL4 was significantly higher in PDAC than in normal pancreatic tissues, benign pancreatic tissues, and peritumoral tissues （P〈0.01）. The higher Jaggedl and DLL4 expressions in PDAC were significantly associated with poor differentiation, maximum tumor size 〉5 cm, invasion, regional lymph node metastasis, and TNM Ⅲ/Ⅳ disease （P〈0.05）. In PDAC, Jaggedl expression positively correlated with DLL4 expression. Univariate Kaplan-Meier analysis showed that positive Jagged1 and DLL4 expressions were significantly associated with shorter survival in patients with PDAC. Multivariate Cox regression analysis showed that positive Jagged1 and DLL4 expressions were independent prognostic factors for poor prognosis of patients with PDAC. CONCLUSION： Positive Jagged1 and DLL4 expression is closely correlated with severe clinicopathological characteristics and poor prognosis in patients with PDAC.

Regulation of bile acid metabolism-related signaling pathways by gut microbiota in diseases

Over the past decade,there has been increasing attention on the interaction between microbiota and bile acid metabolism.Bile acids are not only involved in the metabolism of nutrients,but are also important in signal transduction for the regulation of host physiological activities.Microbial-regulated bile acid metabolism has been proven to affect many diseases,but there have not been many studies of disease regulation by microbial receptor signaling pathways.This review considers findings of recent research on the core roles of farnesoid X receptor(FXR),G protein-coupled bile acid receptor(TGR5),and vitamin D receptor(VDR)signaling pathways in microbial–host interactions in health and disease.Studying the relationship between these pathways can help us understand the pathogenesis of human diseases,and lead to new solutions for their treatments.

Immunohistochemical analysis of PD-L1 and tumor-infiltrating immune cells expression in the tumor microenvironment of primary signet ring cell carcinoma of the prostate

Primary signet ring cell carcinoma(SRCC)of the prostate is a rare neoplasm.However,its potential tumorigenic mechanism,clinicopathological features,and prognostic outcome have not been systematically described.To determine the pathogenic mechanism,we detected distributions of programmed cell death-ligand 1(PD-L1),programmed death 1(PD-1),and cellular components in the tumor microenvironment,including tumor-infiltrating lymphocytes(CD4 and CD8),tumor-associated macrophages(TAMs;CD163 and CD68),and tumor-associated fibroblasts(vimentin and alpha-smooth muscle actin[α-SMA]),in tumor tissues from four patients with primary prostatic SRCC compared with corresponding adjacent tissues and tumor tissues from 30 patients with prostate adenocarcinoma(PCa)by immunohistochemical staining.We found higher expression of PD-L1,CD163,and CD68 in primary SRCC specimens than that in both corresponding adjacent nontumor specimens and PCa specimens with different Gleason scores,indicating that TAMs may participate in the malignant biological behavior of primary SRCC of the prostate.For further analysis,we searched electronic journal databases and Surveillance,Epidemiology,and End Results(SEER)to identify 200 eligible patients including our four cases.According to Kaplan–Meier survival curve analysis,patients<68 years old,with radical prostatectomy(RP),Gleason score of 7–8,and lower clinical stage had longer overall survival(OS).Moreover,Cox multivariate analysis indicated that race(hazard ratio[HR]=1.422),surgical approach(HR=1.654),and Gleason score(HR=2.162)were independent prognostic factors for OS.Therefore,primary SRCC of the prostate represents a distinct and aggressive subtype of prostate cancer associated with a higher distribution of PD-L1 and TAMs,which warrants further clinical investigation.