Safety and efficacy of levofloxacin versus ciprofloxacin for the treatment of chronic bacterial prostatitis in Chinese patients

Levofloxacin is a synthetic fluoroquinolone that is usually used to treat chronic bacterial prostatitis. We investigated the safety and efficacy of levofloxacin compared with ciprofloxacin for the treatment of chronic bacterial prostatitis in Chinese patients. This was a multicenter, open-label, randomized controlled non-inferiority trial. Four hundred and seventy-one patients with clinical symptoms/ signs were enrolled into the study, and 408 patients were microbiologically confirmed chronic bacterial prostatitis, who were randomized to either oral levofloxacin （500 mg q,d.） or ciprofloxacin （500 mg b.i^d.） for 4 weeks. Bacterial clearance rate, clinical symptoms/signs, adverse reactions and disease recurrence were assessed. The clinical symptoms and signs （including dysuria, perineal discomfort or pain） and bacteria cultures in 209 patients treated with levofloxacin and 199 patients treated with ciprofloxacin were similar. The most common bacteria were Escherichia cofiand Staphylococcus aureus. One to four weeks after the end of 4 weeks treatment, the bacterial clearance rate （86.06% vs. 60.03%; P〈O.05） and the clinical efficacy （including clinical cure and clinical improvement（93.30% vs. 71.86%; P〈0.05）） were significantly higher in the levofloxacin-treated group than in the ciprofloxacin-treated group. The microbiological recurrence rate was significantly lower in the levofloxacin-treated group than in the ciprofloxacin-treated group （4.00% vs. 19.25%; P〈0.05）. Rates of adverse events and treatment-related adverse events were slightly lower in the levofloxacin-treated group than in ciprofloxacin-treated group. Levofloxacin showed some advantages over ciprofloxacin in terms of clinical efficacy and disease recurrence, with a low rate of adverse events, for the treatment of chronic bacterial prostatitis in Chinese patients.

Blood perfusion of the contralateral testis evaluated with contrast-enhanced ultrasound in rabbits with unilateral testicular torsion

The changes of blood perfusion of contralateral testis after unilateral testicular torsion remain controversial.In this study,28 New Zealand white male rabbits were randomly divided into five groups.Group A(n=8),the control group,underwent a sham operation on the unilateral testis without inducing testicular torsion.In groups B,C,and D(n=5 each),unilateral testicular torsion was induced,and,after 3,6 or 24 h,respectively,detorsion was performed.In group E(n=5),permanent unilateral testicular torsion was applied.Contrast-enhanced ultrasound was used to observe the blood perfusion of the contralateral testis at the following stages:pre-torsion(preopration),immediately post-torsion(postopration),pre-detorsion,immediately post-detorsion,and late-stage post-detorsion(6-12 h post-detorsion in groups B-D)or at a similar time point(15-21 h post-torsion in group E).Time-intensity curves were generated,and the following parameters were derived and analyzed:arrival time,time to peak intensity,peak intensity,and half-time of the descending peak intensity.The analysis revealed that blood perfusion of the contralateral testis increased immediately after testicular torsion on the opposite side(P<0.05),which increased with prolonged testicular torsion of the other testis.This research demonstrated that contrast-enhanced ultrasound was valuable in evaluating blood perfusion of the contralateral testis after unilateral testicular torsion.

Preventive effect of gelatinizedly-modified chitosan film on peritoneal adhesion of different types

AIM： To comparatively study the preventive effect of gelatinizedly-modified chitosan film on peritoneal adhesions induced by four different factors in rats. METHODS： Chitosan was chemically modified by gelatinization, and made into films of 60 μm in thickness, and sterilized. Two hundred Sprague-Dawley rats were randomly divided into five groups, Sham-operation group （group A）, wound-induced adhesion group （group B）, purified talc-induced adhesion group （group C）, vascular ligation-induced adhesion group （group D）, and infection-induced adhesion group （group E）, respectively. In each group, the rats were treated with different adhesion-inducing methods at the cecum of vermiform processes and then were divided into control and experimental subgroups. Serous membrane surface of vermiform processes were covered with the films in the experimental subgroups, and no films were used in the control subgroups. After 2 and 4 wk of treatments, the abdominal cavities were reopened and the adhesive severity was graded blindly according to Bhatia＇s method. The cecum of vermiform processes were resected for hydroxyproline （OHP） measurement and pathological examination. RESULTS： Adhesion severity and OHP level： After 2 and 4 wk of the treatments, in the experimental subgroups, the adhesions were significantly lighter and the OHP levels were significantly lower than those of the control subgroups in group B （2 wk： 0.199 ± 0.026 vs 0.285 ± 0.041 μg/mg pr, P 〈 0.001; 4 wk： 0.183 ± 0.034 vs 0.276 ± 0.03 μg/mg pr, P 〈 0.001）, D （2 wk： 0.216 ± 0.036 vs 0.274 ± 0.040 μg/mg pr, P = 0.004; 4 wk： 0.211 ± 0.044 vs 0.281 ± 0.047 μg/mg pr, P = 0.003） and E （2 wk： 0.259 ± 0.039 vs 0.371 ± 0.040 μg/mg pr, P 〈 0.001; 4 wk： 0.242 ± 0.045 vs 0.355 ± 0.029 μg/mg pr, P 〈 0.001）, but there were no significant differences in groups A （2wk： 0.141 ± 0.028 vs 0.137 =k 0.026 μg/mg pr, P = 0.737; 4 wk： 0.132 ± 0.031 vs 0.150 ± 0.035 μg/mg pr, P = 0.225） and C （2 wk： 0.395 ± 0.044 vs 0.378 ± 0.043 μg/mg pr, P = 0.387; 4 wk： 0.370 ± 0.032 vs 0.367 ± 0.041 μg/mg pr, P = 0.853）; Pathological changes： In group B, the main pathological changes were fibroplasias in the treated serous membrane surface and in group D, the fibroplasia was shown in the whole layer of the vermiform processes. In group E, the main pathological changes were acute and chronic suppurative inflammatory reactions. These changes were lighter in the experimental subgroups than those in the control subgroups in the three groups. In group C, the main changes were foreign body giant cell and granuloma reactions and fibroplasias in different degrees, with no apparent differences between the experimental and control subgroups. CONCLUSION： The gelatinizedly-modified chitosan film is effective on preventing peritoneal adhesions induced by wound, ischemia and infection, but the effect is not apparent in foreign body-induced adhesion.

Life-threatening meningitis resulting from transrectal prostate biopsy

After antibiotic prophylaxis with metronidazole and levofloxacin, a transrectal sextant biopsy was performed under the guide of transrectal ultrasonography （TRUS） for a 75-year-old suspicious patient with prostate adenocarcinoma. Although antibiotics were also given after this procedure, the patient still developed fever, anxious, agrypnia and headache. Blood cultures remained negative. Lumbar puncture was performed and was consistent with Escherichia coli bacterial meningitis.

Outcome of nephrostomy balloon dilation for vesicourethral anastomotic strictures following radical prostatectomy： a retrospective study

To evaluate the efficacy of nephrostomy balloon dilation （NBD） for patients who developed vesicourethral anastomotic stricture （VAS） following radical prostatectomy. NBD was performed in patients who developed VAS following radical prostatectomy. Quality of life （QoL）, International Prostate Symptom Score （IPSS） and maximal urinary flow rate （Qmax） were evaluated. Four hundred and sixty-three prostate cancer patients underwent radical retropubic prostatectomy （RRP）, and 86 underwent laparoscopic radical prostatectomy （LRP）. Most patients （90.3%） had T2 or T3 prostate cancer and a pathological Gleason score of ; 7. Forty-five （8.2%） and four （4.7%） patients developed VAS due to radical or LRP, respectively. Forty （89%） patients underwent NBD, including three cases of repeat dilation. The median Qmax was 4 ml s- （interquartile range （IQR）, 2.3-5.6） before dilation and improved to 16 ml s- （IQR, 15-19） and 19 ml s-1 （IQR, 18-21） at the 1- and 12-month follow-up, respectively （P〈 0.01）. Fifteen （37.5%） patients had urinary incontinence prior to dilation, whereas only three （7.5%） patients had incontinence 12 months following dilation （P 〈 0.01）. The median IPSS score improved from 19 （IQR, 17-24） before dilation to 7 （IQR, 6-8） at 12 months following dilation, and the QoL score improved from 5 （IQR, 4-6） before dilation to 2 （IQR, 2-3） at 12 months following dilation （P 〈 0.01 in both）. VAS occurs in a small but significant proportion of patients following radical prostatectomy. NBD offers an effective remedy for VAS.

Effect of aging on penile ultrastructure

Aim: To clarify whether there are anatomical changes in tunica albuginea and corpora cavernosa in aged rats. Meth-ods: Seventeen male Sprague-Dawley rats were divided into three groups based on age. Group A consisted of youngrats (9 weeks), Group B, middle aged rats (14 weeks) and Group C, old rats (62 weeks). The penile samples wereobtained and observed under a scanning electron microscope. Results: The thickness (mean ± SD) of the tunica al-buginea was 0.14±0.02, 0.16±0.03 and 0.06±0.02 mm in Groups A, B and C, respectively. The tunica albug-inea of group C was significantly thinner than those of the other two groups (P < 0.05) and the elastic fibers were di-minished in the old rats. In the corpora cavernosa of old rats, the intracavernous pillars were irregular, in which manylarge collagen fibers could be observed, and the smooth muscle and elastic fibers were reduced. Conclusion; In oldrats, the tunica albuginea became thinner with diminished elastic fibers; the collagen fibers of corpora cavernosa wereincreased while the smooth muscle and elastic fibers were reduced. (Asian J Androl 2001 Dec; 3: 281 - 284 )

Antitumor effects of human interferon-alpha 2b secreted by recombinant bacillus Calmette-Guérin vaccine on bladder cancer cells

Objective:Our objective was to construct a recombinant bacillus Calmette-Guérin vaccine(rBCG) that secretes human interferon-alpha 2b(IFNα-2b) and to study its immunogenicity and in vitro antitumor activity against human bladder cancer cell lines T24 and T5637.Methods:The signal sequence BCG Ag85B and the gene IFNα-2b were amplified from the genome of BCG and human peripheral blood,respectively,by polymerase chain reaction(PCR).The two genes were cloned in Escherichia coli-BCG shuttle-vector pMV261 to obtain a new recombinant plasmid pMV261-Ag85B-IFNα-2b.BCG was transformed with the recombinant plasmid by electroporation and designated rBCG-IFNα-2b.Mononuclear cells were isolated from human peripheral blood(PBMCs) and stimulated with rBCG-IFNα-2b or wild type BCG for 3 d,and then cultured with human bladder cancer cell lines T24 and T5637.Their cytotoxicities were measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide(MTT) assay.Results:BCG was successfully transformed with the recombinant plasmid pMV261-Ag85B-IFNα-2b by electroporation and the recombinant BCG(rBCG-IFNα-2b) was capable of synthesizing and secreting cytokine IFNα-2b.PBMC proliferation was enhanced significantly by rBCG-IFNα-2b,and the cytotoxicity of PBMCs stimulated by rBCG-IFNα-2b to T24 and T5627 was significantly stronger in comparison to wild type BCG.Conclusions:A recombinant BCG,secreting human IFNα-2b(rBCG-IFNα-2b),was constructed successfully and was superior to control wild type BCG in inducing immune responses and enhancing cytotoxicity to human bladder cancer cell lines T24 and T5637.This suggests that rBCG-IFNα-2b could be a promising agent for bladder cancer patients in terms of possible reductions in both clinical dosage and side effects of BCG immunotherapy.