Enqing Xiong

Detection of Nanobacteria Infection in Type III Prostatitis

OBJECTIVES To investigate the relationship between nanobacterial infection and type III prostatitis. The etiology of type III prostatitis remains unclear to date, although the recently discovered nanobacteria (NB) have been implicated in this disease. METHODS A total of 48 patients with chronic pelvic pain syndrome for whom conventional therapy had failed were selected and randomly divided into two groups, one receiving anti-NB treatment and the other receiving a placebo. The NB were isolated and cultured from expressed prostatic secretions and urine samples before and after treatment. The morphologic features were recorded and 16s rRNA gene expression was determined. The curative effect was evaluated by the NB-positive rate and symptomatic changes using the National Institutes of Health Chronic Prostatitis Symptom Index. RESULTS After anti-NB treatment, the NB-positive rates had decreased from 62.5% to 16.7% in the expressed prostatic secretions and from 12.5% to 0% in the urine samples after prostatic massage (P <0.001). In the patients receiving a placebo, the positive rates had no obvious change in either the expressed prostatic secretions or the urine samples after prostatic massage (P >0.05). The NB were coccoid or coccobacillary and clustered in a diameter of 100 to 500 nm. The BLAST result revealed that the 16s rRNA gene sequence from the NB in the patients with chronic pelvic pain syndrome was 97%, similar to that of the known NB with identity (97%). After anti-NB treatment, the Chronic Prostatitis Symptom Index scores decreased significantly. In contrast, no change in the Chronic Prostatitis Symptom Index scores was seen after placebo treatment. CONCLUSIONS The results of our study have shown that nanobacterial infection might be an important etiologic factor of type III prostatitis. Anti-NB treatment could be an effective therapy against refractory type III prostatitis.

Suppression of CX43 expression by miR-20a in the progression of human prostate cancer.

The aberrant expression of microRNAs (miRNAs) has been found in various types of cancer. The present study found miR-20a to be significantly upregulated in prostate cancer compared with normal prostate tissues. The proliferation and colony formation assays revealed that the downregulation of miR-20a by miR-20a inhibitor suppresses the proliferation of MDA-PCa-2b cells in vitro and also inhibits tumor growth in vivo. Furthermore, a gap junction protein, α 1 (CX43), was identified as a direct target gene of miR-20a. The upregulation of CX43 was detected in MDA-PCa-2b cells after treatment with miR-20a inhibitor both in vitro and in vivo. In conclusion, the findings show that miR-20a significantly contributes to the progression of prostate cancer by targeting CX43.

Better Compliance Contributes to Better Nocturnal Continence With Orthotopic Ileal Neobladder Than Ileocolonic Neobladder After Radical Cystectomy for Bladder Cancer

OBJECTIVES To investigate, in a randomized controlled study, the degree of continence after the creation of orthotopic ileocolonic and ileal neobladders after cystectomy and to explore a possible mechanism for the difference in continence between these 2 types of orthotopic neobladder. METHODS From 2003 to 2007, 71 male patients underwent orthotopic lower urinary tract reconstruction with either an ileocolonic or ileal neobladder after radical cystectomy. The degrees of continence and voiding patterns were individually evaluated using urodynamic examinations and a detailed patient questionnaire. The abnormal upper tract was evaluated using intravenous urography and ultrasonography. RESULTS Complete daytime continence was achieved in 90.9% and 89.4% of the patients and functional nocturnal continence 48.5% and 76.3% of patients in the ileocolonic neobladder and ileal neobladder groups, respectively. The urodynamic data showed that the initial volume of both the ileocolonic and the ileal neobladder appeared to not be significantly different statistically, although the compliance of the ileocolonic neobladder was lower than that of the ileal neobladder (P < .05). No difference was found in the parameters such as flow rate, urethral profile length, maximal urethral pressure, or neobladder neck pressure between the 2 neobladder types. CONCLUSIONS Although the ileocolonic and ileal neobladders can both achieve a large initial volume, the ileal neobladder has an advantage in the aspect of obtaining satisfactory nocturnal continence because of its greater compliance compared with that of the ileocolonic neobladder.

Connexin 26 is Down-Regulated by KDM5B in the Progression of Bladder Cancer

Connexin 26 (Cx26) expression is down-regulated and KDM5B (H3K4 demethylase) is up-regulated in the progression of bladder cancer, suggesting that Cx26 expression may be down-regulated by KDM5B in bladder cancer. To test the hypothesis, the HT1376 and T24 human bladder carcinoma cells were transfected with the plasmids pcDNA3.1-KDM5B, and caused the down-regulation of Cx26 expression. In contrast, the HT1376 and T24 cells transfected with the plasmids pTZU6+1-shRNA-KDM5B1 and pTZU6+1-shRNA-KDM5B2 caused the up-regulation of Cx26 expression. Immunohistochemistry and Spearman’s rank correlation analysis showed that the immunohistochemical expression of KDM5B and Cx26 was inversely related in bladder carcinoma tissues but no relationship in benign tissues. Taken together, these results indicate that KDM5B represses Cx26 expression in the bladder cancer development. Thus, a negative value to Cx26 immunohistochemical expression and a positive value to KDM5B immunohistochemical expression could be an ancillary diagnosis of primary bladder malignancy.

Penile necrosis after circumcision owing to inappropriate postoperative treatment.

To the Editor: Male circumcision is one of the most common surgical procedures because of therapeutic or nontherapeutic reasons. Although some complications of circumcision have been previously reported [1], the most serious complication of circumcision, penile necrosis, is rarely reported. Herein, we report 6 cases of penile necrosis in older children owing to inappropriate postoperative treatment. Six male patients with a mean age of 16 years (range, 8∼24 years) underwent traditional circumcision in private hospitals. To prevent bleeding, the penile wounds were tightly dressed in 1 patient (8-years old) for 3 days resulting in necrosis of the distal glans (Fig. 1A). For promoting wound healing, 5 patients (12∼24 years) received microwave thermotherapy immediately after operation resulting in complete necrosis of the distal penile (Fig. 1B). After removing the gauze, the distal balanus and corpus penis presented as black and dry or gray and erosive without any sense or blood supply. These patients were subsequently referred to our hospital with penile necrosis accompanied by infection. Partial penectomy was performed to prevent the spread of infection. None of them received plastic surgery because phalloplasty is still difficult, costly, and rarely accessible in most areas of China. At present, strategies for circumcision include traditional excision, laser excision, and foreskin loop ligature using the plastibell. The reported incidence of foreskin bleeding, severe foreskin edema, and short foreskin after circumcision is about 0.64%, 0.82%, and 0.62%, respectively [2]. However, in some developing countries, the disordered medical market, untrained medical personnel, and unfamiliarity with surgical procedures and postoperative care increase the incidence of complications of circumcision. The incidence of foreskin edema, infection, bleeding, and wound dehiscence after circumcision was 35.71%, 12.11%, 12.42%, and 1.55%, respectively, in some small or private hospitals in China [3]. However, more serious complications after circumcision including penile necrosis have not been reported. In our report, an important cause of penile necrosis was tight dressing left in place for a long time after circumcision. Although a tight dressing can avoid postoperative bleeding, it may also compress the blood vessels and completely occlude the blood supply to the penis, finally resulting in avascular necrosis. Another important cause of penile necrosis in our report was the misuse of microwave thermotherapy. Transurethral microwave thermotherapy has been used in the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia [4]. However, in some developing countries, incredible microwave thermotherapy is performed widely after circumcision, although there have been no recommended guidelines. The uninformed personnel may assume that microwave thermotherapy can promote wound healing through its noncontact heating. Nevertheless, as noted in the cases we described, inappropriate use of microwave thermotherapy after circumcision may worsen wound healing or even result in avascular penile necrosis. www.elsevier.com/locate/jpedsurg