Defining minimal invasive surgical therapy for benign prostatic obstruction surgery: Perspectives from a global knowledge, attitude, and practice survey

Objective:To scrutinize the definitions of minimal invasive surgical therapy(MIST)and to investigate urologists’knowledge,attitudes,and practices for benign prostatic obstruction surgeries.Methods:A 36-item survey was developed with a Delphi method.Questions on definitions of MIST and attitudes and practices of benign prostatic obstruction surgeries were included.Urologists were invited globally to complete the online survey.Consensus was achieved when more than or equal to 70%responses were“agree or strongly agree”and less than or equal to 15%responses were“disagree or strongly disagree”(consensus agree),or when more than or equal to 70%responses were“disagree or strongly disagree”and less than or equal to 15%responses were“agree or strongly agree”(consensus disagree).Results:The top three qualities for defining MIST were minimal blood loss(n=466,80.3%),fast post-operative recovery(n=431,74.3%),and short hospital stay(n=425,73.3%).The top three surgeries that were regarded as MIST were Urolift®(n=361,62.2%),Rezum®(n=351,60.5%),and endoscopic enucleation of the prostate(EEP)(n=332,57.2%).Consensus in the knowledge section was achieved for the superiority of Urolift®,Rezum®,and iTIND®over transurethral resection of the prostate with regard to blood loss,recovery,day surgery feasibility,and post-operative continence.Consensus in the attitudes section was achieved for the superiority of Urolift®,Rezum®,and iTIND®over transurethral resection of the prostate with regard to blood loss,recovery,and day surgery feasibility.Consensus on both sections was achieved for EEP as the option with the better symptoms and flow improvement,lower retreatment rate,and better suitable for prostate more than 80 mL.Conclusion:Minimal blood loss,fast post-operative recovery,and short hospital stay were the most important qualities for defining MIST.Urolift®,Rezum®,and EEP were regarded as MIST by most urologists.

Surgical therapy and prognosis of sarcomatoid carcinoma of the gallbladder

BACKGROUND: Sarcomatoid carcinoma of the gallbladder is rare and its characteristics are poorly understood. This study aimed to understand the behavior and prognosis of sarcomatoid carcinoma of the gallbladder as well as its clinical manifestations and survival rate of patients after radical or palliative surgery, and to review the reported data worldwide and our 10 patients. METHODS: From 2004 to 2009, ten patients were pathologically diagnosed with sarcomatoid carcinoma of the gallbladder and underwent operation at our center. These characteristics, clinical presentations, tumor-node-metastasis (TNM) staging, surgical modes, and prognosis were reviewed, retrospectively. We collected the data of 46 patients reported in the English-language literature worldwide and analyzed the survival with ours. The survival rate was estimated using the Kaplan-Meier method, and was compared using the log-rank test. RESULTS: The median age of the 10 patients was 67 years (inter-quartile range 59-74 years), and the size of tumor inter-quartile ranged from 3.1 to 7.9 cm. In this series, 9 patients received radical surgery, and one undewent palliative surgery. There was no surgical mortality, and one patient underwent a second operation because of liver metastasis. The median survival time of the patients was 9 months (inter-quartile range 6-12 months), with 3 patients still being alive until follow-up; however, two patients had tumor recurrence. The data from the 56 patients (10 patients in our series and 46 reported elsewhere) statistically indicated that the median age was 66 years (inter-quartile range 61-74.5 years) and the overall median survival was 5.5 months (inter-quartile range 2.5-10 months). The survival time in the patients undergoing radical surgery (n=42) was significantly longer than that in the patients undergoing palliative surgery (n=14) (P=0.031). CONCLUSIONS: The survival of the patients with sarcomatoid carcinoma of the gallbladder is poor. Some patients may die shortly after the surgery because of recurrence or metastasis. However, radical surgery is still necessary if possible. (Hepatobiliary Pancreat Dis Int 2010; 9: 175-179)

Management of type IIIb dens invaginatus using a combination of root canal treatment,intentional replantation,and surgical therapy:A case report

BACKGROUND TypeⅢb dens invaginatus(DI)with a lateral canal located at the mid-third of the root is rarely reported.Here,we report a rare case of typeⅢb DI in the left upper anterior tooth with a lateral canal that led to persistent periodontitis.CASE SUMMARY A 15-year-old female patient presented with a chief complaint of pain associated with recurrent labial swelling in the area of the left anterior tooth.A diagnosis of typeⅢb DI and chronic periodontitis was made.Intentional replantation was performed after conventional endodontic treatment failed.After 6 mo,the patient was asymptomatic,but a sinus tract was observed.Cone-beam computed tomography images showed bone loss in the mesial of the mid-root.Based on methylene blue staining and microscopy images,the lateral foramen located at the middle third of the root was surgically treated.After 3 years of follow-up,the clinical findings and radiographic assessment presented a favorable prognosis of bone healing without root absorption or ankylosis.CONCLUSION TypeⅢb DI with a lateral canal can be successfully treated by root canal treatment,intentional replantation,and surgical therapy.

Nonsurgical periodontal-therapy improves glycosylated hemoglobin levels in pre-diabetic patients with chronic periodontitis

AIM To evaluate the effect of nonsurgical periodontal therapy on glycosylated haemoglobin levels in pre-diabetic patients with chronic periodontitis(CHP).METHODS Sixty pre-diabetic patients with CHP were selected and equally allocated to case and control group. All subjects were evaluated at base line for periodontal parameters(plaque index, oral hygiene index, modified gingival index, probing pocket depth, clinical attachment level) and systemic parameters [glycosylated hemoglobin(HbA1c), fasting lipid profile, and fasting blood glucose]. The case group received non-surgical periodontal therapy. Subjects were re-evaluated for periodontal and systemic parameters after three months.RESULTS Both groups were comparable at baseline. Three months after non surgical periodontal therapy(NSPT), there was significant improvement in periodontal parameters in case group. The mean difference in systemic parameters like HbA1c and fasting plasma glucose from baseline to fourth month for case group was 0.22 ± 0.11 and 3.90 ± 8.48 respectively and control group was-0.056 ± 0.10 and-1.66 ± 6.04 respectively, which was significant between case and control group(P < 0.05). In the case group there was a significant decrease in HbA1c from baseline to three months following NSPT(P < 0.05).CONCLUSION This study showed that periodontal inflammation could affect the glycemic control in otherwise systemically healthy individuals. Periodontal therapy improved periodontal health status and decreased glycosylated haemoglobin levels, thus reducing the probability of occurrence of inflammation induced prediabetes in patients with CHP.

Surgical cardiac synchronization therapy for the cardiomyopathy heart failure with micro-invasive thoracoscopy techniques

Objective The cardiac synchronization therapy (CRT) was proven to have good treatment for the cardiacconduction disorders patients with serious heart failure. But many disadvantages were gradually be noticed,such as difficulty of sinus electrode implantation,coronary sinus injury and bleeding,still one third

Colonoscopy-assisted removal of an impaction foreign body at the rectosigmoid junction: A case report

BACKGROUND When an anorectal foreign body is found,its composition and shape should be evaluated,and a timely and effective treatment plan should be developed based on the patient's symptoms to avoid serious complications such as intestinal perforation caused by displacement of the foreign body.CASE SUMMARY A 54-year-old male was admitted to our outpatient clinic on June 3,2023,due to a rectal foreign body that had been embedded for more than 24 h.The patient reported using a glass electrode tube to assist in the recovery of prolapsed hemorrhoids,however,the electrode tube was inadvertently inserted into the anus and could not be removed by the patient.During hospitalization,the patient underwent surgery,and the foreign body was dragged into the rectum with the aid of colonoscopy.The anus was dilated with a comb-type pulling hook and an anal fistula pulling hook to widen the anus and remove the foreign body,and the local anal symptoms were then relieved with topical drugs.The patient was allowed to eat and drink,and an entire abdominal Computed tomography(CT)and colonoscopy were reviewed 3 d after surgery.CT revealed no foreign body residue and colonoscopy showed no metal or other residues in the colon and rectum,and no apparent intestinal tract damage.CONCLUSION The timeliness and rationality of the surgical and therapeutic options for this patient were based on a literature review of the clinical signs and conceivable conditions in such cases.The type,material and the potential risks of rectal foreign bodies should be considered.

Surgical Management of Traumatic Facial Paralysis:A Case Review Study

Objective To evaluate efficacy of surgical treatment in traumatic facial paralysis.Methods:Thirty-three cases were reviewed,including temporal bone fracture and iatrogenic facial nerve injury.All the patients were treated with various surgical methods according to their pathogeny.Results The mean percentage facial function improvement (House-Brackmann GradeⅠ-Ⅱ) was 86% in temporal bone fracture and function was improved after proper operation to iatrogenic facial nerve injury.Conclusions Patients with traumatic facial paralysis receive proved outcomes itreaed with proper surgical methods according to their particular condition of nerve injury.

The "meso" of the rectum and the "meso" of the pancreas: similar terms but distinct concepts in surgical oncology

A correspondence between the ＂meso＂ of the rectum and of the pancreas has recently been reported. Here we highlight the differences between mesorectum and mesopancreas. Based on anatomical findings from a series of 89 consecutive pancreaticoduodenectomies and 71 consecutive total mesorectal excisions, we observed that in contrast to the mesorectum, the mesopancreas did not have well-defined anatomic boundaries and was continuous and connected through its components with the para-aortic area. In rectal cancer,tumor deposits and nodal involvement could be confined to the mesorectum（i.e., within the mesorectal fascia）, whereas in pancreatic carcinoma, tumor deposits and nodal metastases occurred in the boundless mesopancreatic area. Total mesorectal excision was made en bloc with the rectum by dissecting along the mesorectal fascia; this was not the case for mesopancreatic excision since anatomical demarcation of the mesopancreas did not exist. Moreover, the growth pattern of pancreatic cancer showed greater dispersion, which was more prominent at the invasive front of the tumor and could potentially affect the status of the resection margin. These findings indicate that the mesorectum and mesopancreas are completely distinct from the pathological, surgical, and oncological standpoints.

Wingless/It/β-catenin signaling in liver metastasis from colorectal cancer:A focus on biological mechanisms and therapeutic opportunities

The liver is the most common site of metastases in patients with colorectal cancer.Colorectal liver metastases(CRLMs)are the result of molecular mechanisms that involve different cells of the liver microenvironment.The aberrant activation of Wingless/It(Wnt)/β-catenin signals downstream of Wnt ligands initially drives the oncogenic transformation of the colon epithelium,but also the progression of metastatization through the epithelial-mesenchymal transition/mesenchymalepithelial transition interactions.In liver microenvironment,metastatic cells can also survive and adapt through dormancy,which makes them less susceptible to pro-apoptotic signals and therapies.Treatment of CRLMs is challenging due to its variability and heterogeneity.Advances in surgery and oncology have been made in the last decade and a pivotal role for Wnt/β-catenin pathway has been recognized in chemoresistance.At the state of art,there is a lack of clear understanding of why and how this occurs and thus where exactly the opportunities for developing anti-CRLMs therapies may lie.In this review,current knowledge on the involvement of Wnt signaling in the development of CRLMs was considered.In addition,an overview of useful biomarkers with a revision of surgical and non-surgical therapies currently accepted in the clinical practice for colorectal liver metastasis patients were provided.

All about Peyronie’s disease

Peyronie’s disease(PD)is an acquired connective tissue disorder of the tunica albuginea of the corpus cavernosum,characterized by excessive fibrosis and plaque formation.PD can result in significant physical and psychological morbidity;as it may prevent intercourse and cause adverse impacts on partner relationships.The exact etiology and pathophysiology remain unclear,and many misconceptions about the disease associations,course and treatment exist.The disease has two distinct stages.The acute stage is characterized by pain,and disease may progress during this stage.Non-surgical managements at this stage aim to alleviate pain and stabilize the disease.Results for non-surgical treatment are often conflicting.The chronic stage occurs 6e12 months later,where pain disappears and the deformity stabilizes.Surgical treatment is reserved for significant deformity or with inability to penetrative intercourse.The choice of the surgical technique depends on the length of the penis,degree of deformity,erectile function,patients’expectations and surgeon’s preference.

Intramedullary nailing for pathological fractures of the proximal humerus caused by multiple myeloma: A case report and review of literature

BACKGROUND Multiple myeloma(MM)bone disease is indicative of MM,and reduces patient life quality.In addition to oncological,antineoplastic systemic therapy,surgical therapy in patients with MM is an essential treatment within the framework of supportive therapy measures and involves orthopedic tumor surgery.Nevertheless,there are few reports on intramedullary(IM)nailing in the treatment of MM-induced proximal humeral fracture to prevent fixation loss.We here describe a case of pathological fracture of the proximal humerus caused by MM successfully treated with IM nailing without removal of tumors and a review of the current literature.CASE SUMMARY A 64-year-old male patient complaining of serious left shoulder pain and limited movement was admitted.The patient was finally diagnosed with MM(IgAλ,IIIA/II).After treatment of the pathological fracture with IM nailing,the patient's function recovered and his pain was rapidly relieved.Histopathological examination demonstrated plasma cell myeloma.The patient received chemotherapy in the Hematology Department.The humeral fracture displayed good union during the 40-mo follow-up,with complete healing of the fracture,and the clinical outcome was satisfactory.At the most recent follow-up,the patient's function was assessed using the Musculoskeletal Tumor Society score,which was 29.CONCLUSION Early surgery should be performed for the fracture of the proximal humerus caused by MM.IM nailing can be used without removal of tumors.Bone cement augmentation for bone defects and local adjuvant therapy can also be employed.

Clinical characteristics and prognosis of orbital solitary fibrous tumor in patients from a Chinese tertiary eye hospital

BACKGROUND Solitary fibrous tumor(SFT) is predominant within the pleura but very rare in the orbit,which is why the diagnosis of orbital SFT poses challenges in clinical practice.Accordingly,an integrated approach that incorporates specific clinical features,histological,histopathological,and immunohistochemical(IHC) examinations,and molecular analyses is warranted.AIM To retrospectively explore the clinical and imaging characteristics,treatment,outcomes of a series of patients with orbital SFT.METHODS We conducted a retrospective review of a series of patients diagnosed with a histopathologic orbital SFT treated at a single institution.All data on demographics,clinical characteristics,imaging,treatment,postoperative histopathological and IHC examinations,and prognosis were collected.RESULTS In total,13 patients were enrolled,7(53.8%) of whom had the tumor located in the superomedial quadrant of the orbit.Computed tomography revealed a solitary ovoid lesion in 10(76.9%) patients and irregular lesion in 3(23.1%) patients.Magnetic resonance imaging results were as follows:On T1 weighted images,3(23.1%) patients had hypointense mixed signals,whereas 10(76.9%) patients showed isointense mixed signals;on T2 weighted images(T2 WI),3(23.1%),4 (30.8%),and 6(46.2%) patients exhibited hypointense mixed,isointense mixed,and hyperintense signals,respectively.Notably,12(92.3%) patients showed significant enhancement,whereas there were patchy slightly enhanced areas in the tumor.All patients were treated by surgery.IHC analysis demonstrated that the tumor cells were immunoreactive for CD34,CD99,STAT-6,and vimentin in all patients.The lesions showed Ki-67 positivity < 5% in 1(7.7) patient,5%-10% in 10(76.9%),and > 10% in 2(15.4%).Two(15.4%) patients exhibited tumor recurrence.CONCLUSION The clinical manifestations and radiologic characteristics of orbital SFT are diverse and not specific.Accurate diagnosis and treatment require detailed radiological and histopathological/IHC evaluation.

Oxidative stress factors in Parkinson's disease

Parkinson's disease(PD) is the second most common cause of neurodegeneration.Over the last two decades, various hypotheses have been proposed to explain the etiology of PD.Among these is the oxidant-antioxidant theory, which asserts that local and systemic oxidative damage triggered by reactive oxygen species and other free radicals may promote dopaminergic neuron degeneration.Excessive reactive oxygen species formation, one of the underlying causes of pathology in the course of PD has been evidenced by various studies showing that oxidized macromolecules including lipids, proteins, and nucleic acids accumulate in brain tissues of PD patients.DNA oxidation may produce various lesions in the course of PD.Mutations incurred as a result of DNA oxidation may further enhance reactive oxygen species production in the brains of PD patients, exacerbating neuronal loss due to defects in the mitochondrial electron transport chain, antioxidant depletion, and exposure to toxic oxidized dopamine.The protein products of SNCA, PRKN, PINK1, DJ1, and LRRK2 genes are associated with disrupted oxidoreductive homeostasis in PD.SNCA is the first gene linked with familial PD and is currently known to be affected by six mutations correlated with the disorder: A53T, A30P, E46K, G51D, H50Q and A53E.PRKN encodes Parkin, an E3 ubiquitin ligase which mediates the proteasome degradation of redundant and disordered proteins such as glycosylated α-synuclein.Over 100 mutations have been found among the 12 exons of PRKN.PINK1, a mitochondrial kinase highly expressed in the brain, may undergo loss of function mutations which constitute approximately 1–8% of early onset PD cases.More than 50 PD-promoting mutations have been found in PINK1.Mutations in DJ-1, a neuroprotective protein, are a rare cause of early onset PD and constitute only 1% of cases.Around 20 mutations have been found in DJ1 among PD patients thus far.Mutations in the LRRK2 gene are the most common known cause of familial autosomal dominant PD and sporadic PD.Treatment of PD patients, especially in the advanced stages of the disease, is very difficult.The first step in managing progressive PD is to optimize dopaminergic therapy by increasing the doses of dopamine agonists and L-dopa.The next step is the introduction of advanced therapies, such as deep brain stimulation.Genetic factors may influence the response to L-dopa and deep brain stimulation therapy and the regulation of oxidative stress.Consequently, research into minimally invasive surgical interventions, as well as therapies that target the underlying etiology of PD is warranted.

Realize molecular surgical knife in tumor therapy by nanotechnology

In cancer therapy,the main challenge is how to attack the tumor and avoid injuring any normal organs in the meantime.In the last decades,scientists have made great efforts to try targeting the tumors,but little progress is achieved because all of the known therapeutic techniques could not latch the tumor cells down and always bring

MULTIMODALITY THERAPY INCLUDING SURGICAL RESEC-TION FOR LIMITED SMALL CELL LUNG CANCER

From 1975 through 1990, 199 patients with limited small cell lung cancer (LSCLC) were subjected to multimodality treatment including surgical resection combined with chemotherapy or chemoradiotherapy in our department. The median postoperative survival time of the 199 patients was 39 months, and the 5-year survival rate was 26%, which was decreased with increase of tumor-stage. In comparison of the survival time of patients in Stage Ⅰ and those in Stage Ⅲa, there was a significant difference (P<0.01). There were no significant differences in survival rate of 3 and 5 years between the patients receiving chemotherapy prior to or after surgical resection. The improvement in survival was documented by surgical resection combined with chemotherapy or chemoradiotherapy for LSCLC. The effect of multimodality treatment is correlated with tumor P-TNM staging, the involvement of lymph node, especially that of the mediastinal lymph node, is a negative factor influencing the prognosis. Surgical resection as an initial management, followed by chemotherapy or chemoradiotherapy may be indicated in LSCLC patients of Stage Ⅰ, Stage Ⅱ and some Stage Ⅲa as the cancer can be resected completely.