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 （〉 104 m I- 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.

Moxibustion eases chronic inflammatory visceral pain through regulating MEK, ERK and CREB in rats

AIM To investigate the effects of herb-partitioned moxibustion(HPM) on phosphorylation of mitogen-activated extracellular signal-regulated kinase(MEK)1, extracellular signal-regulated kinase(ERK)1/2 and c AMP response element binding protein(CREB) in spinal cord of rats with chronic inflammatory visceral pain(CIVP), and to explore the central mechanism of HPM in treating CIVP.METHODS Male Sprague-Dawley rats were randomized into normal, model, HPM, sham-HPM, MEK-inhibitor and dimethyl sulfoxide(DMSO) groups. The CIVP model was established using an enema mixture of trinitrobenzene sulfonic acid and ethanol. HPM was applied at bilateral Tianshu(ST25) and Qihai(CV6) acupoints in the HPM group, while in the sham-HPM group, moxa cones and herb cakes were only placed on the same points but not ignited. The MEK-inhibitor and DMSO groups received L5-L6 intrathecal injection of U0126 and 30% DMSO, respectively. Abdominal withdrawal reflex(AWR), mechanical withdrawal threshold(MWT) and thermal withdrawal latency(TWL) were applied for the assessment of pain behavior. The colonic tissue was observed under an optical microscope after hematoxylin-eosin staining. Expression of phosphor(p)MEK1, p ERK1/2 and p CREB in rat spinal cord was detected using Western blotting. The levels of MEK, ERK and CREB m RNA in rat spinal cord were detected using real-time polymerase chain reaction. RESULTS Compared with the normal group, the AWR scores were increased significantly(P < 0.01) and the MWT and TWL scores were decreased significantly(P < 0.05) in the model, sham-HPM and DMSO groups. Compared with the model group, the AWR scores were decreased significantly(P < 0.01) and the MWT and TWL scores were increased significantly in the HPM and MEK-inhibitor groups(P < 0.05). Compared with the sham-HPM and DMSO groups, the AWR scores were decreased significantly(P < 0.01) and the MWT and TWL scores were increased significantly(P < 0.05) in the HPM and MEK-inhibitor groups. Compared with the normal group, the expression of p MEK1, p ERK1/2 and p CREB proteins and the levels of MEK, ERK and CREB m RNA in rat spinal cord were increased significantly in the model, sham-HPM and DMSO groups(P < 0.01 or < 0.05). Compared with the model group, the expression of p MEK1, p ERK1/2 and p CREB proteins and the levels of MEK, ERK and CREB m RNA in rat spinal cord were reduced significantly in the HPM and MEK-inhibitor groups(P < 0.01 or < 0.05). Compared with the sham-HPM and DMSO groups, expression of p MEK1, p ERK1/2 and p CREB proteins and the levels of MEK, ERK and CREB m RNA in rat spinal cord were reduced significantly in the HPM and MEK-inhibitor groups(P < 0.01 or < 0.05). CONCLUSION HPM down-regulates protein phosphorylation of MEK1, ERK1/2 and CREB, and m RNA expression of MEK, ERK and CREB, inhibiting activation of the MEK/ERK/CREB signaling pathway in the spinal cord of CIVP rats, which is possibly a critical central mechanism of the analgesic effect of HPM.

Tumor Antigen-pulsed CD8α^+ Dendritic Cells Induce T Cell-mediated Graft-versus-tumor Effect In Vitro

The graft-versus-tumor （GVT） effect of T cells induced by tumor antigen-pulsed CD8α＋ dendritic cells （DCs） in vitro was investigated in this study. Immature CD8c（DCs were prepared from C57BL/6 （H-2b） bone marrow cells by using a cytokine cocktail. On the 3rd day of culture, CD8α＋ DCs were pulsed by allogeneic （Balb/c, H-2d） EL9611 leukemia antigen, or RM-1 syngeneic prostate cancer antigen, with the concentration series of 0, 2.5, 5.0, 10.0, 20.0 μg/mL, respectively, then antigen-loaded immature CD8α＋ DCs were co-cultured with syngeneic T cells according to the DC/T ratio of 1：1, 2：1 and 4：1. T cell proliferation was measured by MTT assay. Cytokines including interferon gamma （IFN-γ） and interleukin-10 （IL-10） in CD8α＋ DCs and T co-culture supernatant were detected by using ELI SA. Cytotoxic effect of antigen-specific T cells was tested by LDH release assay. Conventional mature DCs （mDCs） induced, from C57BL/6 （H-2b） bone marrow cells by using granulocyte-macrophage colony stimulating factor （GM-CSF） and interleukin-4 （IL-4） served as a control. The results showed that the proliferative activity of T cells stimulated by CD8α＋ DCs loaded with allogeneic or syngeneic tumor antigen was augmented with the CD8＆ DC/T ratio increased （P〈0.05）. When antigen concentration 〈 5 μg/mL and CD8a＋ DC/T ratio 〈 2：1, the ability of CD8α＋ DCs to stimulate T cell proliferation was higher than mDC control in allogeneic tumor antigen-pulsed groups （P〈0.05）, but not in syngeneic tumor antigen-pulsed groups （P〉0.05）. The level of IFN-γ and IL-10 in CD8α＋DCs and T cell co-culture supernatant were increased in both allogeneic and syngeneic antigen-pulsed groups （P〈0.05）, and the cytokine level was higher in allogeneic antigen-pulsed groups than in syngeneic antigen groups when the CD8α＋ DC/T was 1：1 or 2：1 （P〈0.05）. There existed a negative correlation between the level of IL-10 and T cell proliferation. T cell cytotoxieity assay showed that when CD8α＋ DCs were pulsed with allogeneic tumor antigen, the maximal T cell killing efficiency could reach （100±7.7）%, whereas syngeneic tumor antigen-pulsed group had only （65.0±3.4）%. It was concluded that syngeneic and allogeneic tumor antigen-pulsed immature CD8α＋ DCs could stimulate T cells to exert the GVT effect in vitro, and the GVT effect was more obvious with allogeneic tumor antigen than with syngeneic tumor antigen. The optimal condition was low allogeneic tumor antigen pulsation （〈 5 μg/mL） and low CD8α＋ DC/T ratio （1：1 and 2：1）.

The clinical curative effect of transurethral resection of the ejaculatory duct for iatrogenic ejaculatory duct obstruction after prostatic hyperthermia

Dear Sir, I am a urologic doctor from Urology Department of The First Affiliated Hospital of Sun Yat-Sen University of Medical Science. Recently our group find there are some patients diagnosed with iatrogenic ejaculatory duct obstruction （EDO） after prostatic hyperthermia. This finding showed it was dangerous that some nullibreeding patients of prostatitis were treated with prostatic hyperthermia, which could induce EDO and urethrosten.osis.

The Influence of Survival Analysis on Runx3 Gene Expression in the Primary Tumor of Patients Suffering from Stomach Carcinoma

Background: Runt domain transcription factor 3 (Runx3) is a putative tumor suppressor in human neoplasia. Previous researches suggested that a lack of Runx3 function contributed to human gastric carcinogenesis, however, it is not clear whether Runx3 is closely associated with clinicopathological features of primary stomach tumor and survival rate of patients. Aims: The article is to investigate the influence of survival analysis on Runx3 gene expression in the primary stomach tumor. Methods: Runx3 mRNA expression was detected in 108 primary gastric tumors and non-tumor tissue by semiquantitative reverse transcription-PCR (RT-PCR). All patients were followed up more than five years after radical gastrectomy. Results: There was a loss or substantial decrease of Runx3 mRNA expression in 108 cases of gastric tumors as compared with that in normal gastric mucosa (p 0.001). According to the gray scale median of Runx3 mRNA in primary tumors, the 108 cases were separated into two groups: The lower expressing group (≤0.403) and the over one (>0.403). By comparing analysis of clinical information between two groups, it was found that the lower expression of Runx3 mRNA in the primary tumor was not only associated with the poor clinicopathological factors, but also the inferior survival duration and cumulative survival rate of patients (p 0.05). Conclusions: These results strongly suggest that Runx3 was an independent prognostic factor and a potential therapeutic target for gastric cancer.

Microsurgical vasovasostomy for the treatment ol ntractable chronic scrotal pain after vasectomy

Dear Editor, We present herein two rare cases of intractable chronic scrotal pain after vasectomy. The patients were effectively treated with microsur-gical vasovasostomy （MVV）. We also discuss the possible aetiologies of the pain and other surgical options.

Ion-introduction of Chinese herbs com-bined with Gucitie on 100 cases of hy-perosteogeny

BACKGROUND: Hyperosteogeny is often caused when walking or standing for a long period of time and certain postures must be kept. Traction or avulsion of muscles, hemorrhage and granulation of hematoraa led to formation of spurs or lip-liked hyperosteogeny.OBJECTIVE: To explore the therapeutic effects of ion-introduction combined with Gucitie on 100 cases of hyperosteogeny.

针灸治疗原发性高血压的系统评价再评价

目的:对针灸治疗原发性高血压(EH)的系统评价或Meta分析进行再评价,提出合理建议以促进临床研究规范化.方法:采用计算机检索荷兰医学文摘数据库(EMBASE)、PubMed、中国知网(CNKI)、重庆维普数据库(CQVIP)、中国生物医学文献数据库(CBM)及万方学术期刊全文数据库(Wanfang),搜集针灸治疗EH的系统评价或Meta分析.时间从建库至2020年7月,按照纳入标准与排除标准,对文献进行筛选和数据提取.采用系统回顾和荟萃分析的首选报告项目(PRISMA)量表,系统评价方法学质量评价工具2(AMSTAR 2)量表,推荐分级的评价、制定与评估(GRADE)量表对文献进行质量与证据等级评估.结果:共纳入14篇文献,含10篇中文文献和4篇英文文献,为2012年至2019年期间发表,涵盖70个结局指标.方法学质量均为极低,文献报告质量相对完全或存在一定缺陷,证据质量等级均为低级或极低级.结论:目前针灸治疗EH的系统评价和Meta分析的方法学质量和结局指标证据等级都较低,报告质量也有待进一步提高.

Efficacy of herb-partitioned moxibustion at Qihai(CV 6) and bilateral Tianshu(ST 25) on colonic damage and the TLR4/NF-κB signaling pathway in rats with Crohn＇s disease

OBJECTIVE: To observe the effect of stimulating Qihai(CV 6) and bilateral Tianshu(ST 25) with herb-partitioned moxibustion(HPM) in rats with Crohn's disease(CD), and to investigate the possible anti-inflammatory mechanism of HPM.METHODS: Forty rats were randomly divided into four groups(n = 10 rats per group): normal control(NC), model control(MC), mesalamine(MES), and HPM. The CD rat model was established in the MC,MES, and HPM groups by administering a mixture of trinitrobenzenesulfonic acid and alcohol via enema. The HPM group received HPM on Qihai(CV 6)and bilateral Tianshu(ST 25), while the MES group received intragastric mesalamine. Colonic histomorphological scores, and serum concentrations of tumor necrosis factor α(TNF-α) and interleukin 1β(IL-1β) were assessed to evaluate the effects of HPM on colonic reparation and anti-inflammation.The expressions of Toll-like receptor 4(TLR-4), nuclear factor κB inhibitor α(IκB-α), IκB kinase α/β(IKKα/β), and NF-κB p65 were further analyzed to investigate the regulatory effects of the interventions on the TLR4/NF-κB pathway.RESULTS: CD rats showed inflammatory colonic damage and increased serum concentrations of TNF-α and IL-1β. The expressions of TLR4, IKKα/β,and NF-κB p65 in the colons of CD rats were significantly increased compared with the NC group,while the expression of IκBα(a key negative regulator of NF-κB p65) was decreased. HPM significantly mitigated colonic damage and reduced the serum concentrations of TNF-α and IL-1β. HPM downregulated the expressions of TLR4, IKKα/β, and NF-κB p65 in the colon, and upregulated the expression of IκBα. The effects of HPM in CD rats were similar to those of mesalamine.CONCLUSION: HPM alleviates colonic inflammation in CD rats. This may be achieved through regulation of TLR4, which induces NF-κB signal transduction.

Effect of moxibustion on CRF and CRFR1 expressions in hypothalamus of TNBS-induced experimental colitis rats

Objective： To observe the effect of moxibustion on the protein and mRNA expressions of corticotropin-releasing factor （CRF） and corticotropin-releasing factor receptor 2 （CRFR1） in hypothalamus of trinitrobenzene sulfonic acid （TNBS）-induced experimental colitis rats, and to explore the central mechanisms of moxibustion in improving visceral pain and the pain-related emotions in experimental colitis rats. Methods： Thirty-six Sprague-Dawley （SD） rats were randomly divided into a normal group （NG）, a model group （MG）, a herb-partitioned moxibustion group （HPMG） and a sham herb-partitioned moxibustion group （SHPMG）. Except the NG, rats in the remaining three groups all received TNBS enema to establish experimental colitis models. The HPMG received herb-partitioned moxibustion （HPM） at bilateral Tianshu （ST 25） and Qihai （CV 6） for intervention; for the SHPMG, the herbal cakes and moxa cones were only placed on the acupoints but not ignited; rats in the MG and NG were only fixed in the same way as those in the HPMG but did not receive any treatment. At the end of the intervention, the abdominal withdrawal reflex （AWR） score, the open field test （OFT） score and the elevated plus maze （EPM） score were observed to measure the changes in visceral pain and pain-related emotions of the rats. The enzyme-linked immunosorbent assay （ELISA） was used to examine the expressions of CRF and CRFR1 proteins in hypothalamus; the fluorescence-based quantitative polymerase chain reaction （PCR） was used to detect the expressions of CRF and CRFR1 mRNAs in hypothalamus. Results： Compared with the NG, the AWR score increased significantly and the OFT and EPM scores dropped significantly in the MG （all P〈0.05）, and the expressions of hypothalamic CRF and CRFR1 proteins and mRNAs increased significantly （all P〈0.01）. Compared with the MG and SHPMG, the AWR score dropped significantly and the OFT and EPM scores increased significantly in the HPMG （all P〈0.01）, and the expressions of hypothalamic CRF and CRFRI proteins and mRNAs decreased significantly （all P〈0.05）. There were no significant differences between the MG and the SHPMG （all P〉0.05）. Conclusion： HPM can down-regulate the abnormally increased expressions of CRF and CRFR1 proteins and mRNAs in hypothalamus of the TNBS-induced experimental colitis rats, which is plausibly one of its action mechanisms in mitigating visceral pain and the pain-related emotions in the experimental colitis rats.