ao-Yuan Li

Does a smaller tract in percutaneous nephrolithotomy contribute to less invasiveness? A prospective comparative study.

OBJECTIVES To determine the systemic response to percutaneous nephrolithotomy (PCNL) and mini-PCNL (MPCNL) and evaluate whether MPCNL is less invasive than PCNL, as experimental studies suggest that the acute-phase reaction is proportional to surgery-induced tissue damage. METHODS In all, 165 consecutive patients who had undergone MPCNL (93) or PCNL (72) were prospectively assessed. Blood samples were collected 24 hours before; during surgery; at the end of anesthesia; and 12, 24, and 36 hours after surgery. The extent of the systemic response to surgery-induced tissue trauma was measured, by assessing the levels of acute-phase markers tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), IL-10, C-reactive protein (CRP), and serum amyloid A (SAA), at all sampling times in all patients. RESULTS No significant differences were observed between the 2 groups in preoperative variables. Baseline levels of TNF-alpha, IL-6, IL-10, CRP, and SAA were comparable in both groups. An increase was noted in TNF-alpha, IL-6, CRP, and SAA after surgery but no significant differences were assessed between MPCNL and PCNL during the entire period. IL-10 did not change at the different sampling times. CONCLUSIONS Our data fail to demonstrate significant advantages of MPCNL in terms of reduced surgical trauma and associated invasiveness compared with standard PCNL based on the variables objectively measured in this study.

Comparison of Penile Size and Erectile Function after High-intensity Focused Ultrasound and Targeted Cryoablation for Localized Prostate Cancer: A Prospective Pilot Study

INTRODUCTION Erectile dysfunction (ED) represents a common quality-of-life issue of any treatment used for prostate cancer, including high-intensity focused ultrasound (HIFU) and targeted cryoablation of the prostate (TCAP). There is a paucity of comparative studies regarding the difference in the erectile function and penile size of patients undergoing HIFU or TCAP. AIM The aim of this study is to compare the erectile function and penile size of patients undergoing HIFU or TCAP. METHODS Patients with a preoperative erectile function domain of the International Index of Erectile Function (IIEF-EF) score ≥ 26 were prospectively included. All patients were preoperatively evaluated by IIEF-EF and penile color Doppler ultrasound. Penile length and circumference were measured in flaccidity and at maximum erection. At 6, 12, 18, 24, 36 months after surgery, patients were assessed with the same protocol. MAIN OUTCOME MEASURES IIEF-EF score, penile color Doppler ultrasound, penile length, and circumference at different time points. RESULTS There were 55 patients in the HIFU group and 47 in the TCAP group. At each time point, there were significant differences in mean IIEF-EF scores and penile color Doppler results between the two groups. At 36 months, TCAP patients experienced lower erectile function recovery rate compared with HIFU patients (TCAP=46.8%; HIFU=65.5%; P=0.021). No significant decreases in penile length and circumference were found in the two groups (all P values ≥ 0.05). CONCLUSIONS Our data demonstrate TCAP caused significantly decreased erectile function than HIFU. We found no change in penile size after HIFU or TCAP. The option of HIFU may be more attractive to the patient who wants to avoid ED afterward, to maintain their quality of life.

Urinary fibronectin as a predictor of a residual tumour load after transurethral resection of bladder transitional cell carcinoma.

To determine whether the level of urinary fibronectin predicts the residual tumour load after transurethral resection (TUR) of bladder transitional cell carcinoma (TCC).

Single‐port transvesical laparoscopic radical prostatectomy for organ‐confined prostate cancer: technique and outcomes

To report a novel technique for performing single‐port transvesical laparoscopic radical prostatectomy (STLRP) and to evaluate the oncological and functional outcomes in 16 patients with organ‐confined prostate cancer.

Prospective comparison of five mediators of the systemic response after high-intensity focused ultrasound and targeted cryoablation for localized prostate cancer

To evaluate whether high‐intensity focused ultrasound (HIFU) is less invasive than targeted cryoablation of the prostate (TCAP), as experimental studies suggest that the acute‐phase reaction is proportional to surgery‐induced tissue damage.

Prospective Study of CRMP4 Promoter Methylation in Prostate Biopsies as a Predictor For Lymph Node Metastases.

Background For patients with prostate cancer (PCa), the presence of pelvic lymph node metastasis (LNM) is a strong predictor of poor outcome. However, the approaches with promising sensitivity and specificity to detect LNM are still lacking. We investigated the value of collapsin response mediator protein 4 (CRMP4) promoter methylation in biopsies as a predictor for LNM. Methods CRMP4 promoter methylation at two previously identified CpG sites was determined in 80 case-matched biopsy samples (the training set) using bisulfite pyrosequencing. The predictive cutoff value was independently validated using cohort I of 339 PCa patients (Southern China) and cohort II of 328 case patients (Germany, across China). Mann-Whitney U test, the receiver operating characteristic curve, McNemars test, and logistic regression were used to assess data. All statistical tests were two-sided. Results In the training set, CRMP4 promoter methylation (≥15.0% methylated) was statistically significantly associated with LNM (P < 001). Successful validations were achieved in both cohorts I and II (sensitivity = 92.3%, 95% confidence interval [CI] = 79.3 to 97.9, and sensitivity = 92.2%, 95% CI = 81.1 to 97.8, respectively; specificity = 92.7%, 95% CI = 80.2 to 99.1, and specificity = 91.3%, 95% CI = 87.4 to 94.4, respectively). The sensitivity of CRMP4 promoter methylation is superior to conventional MRI (cohort I: 92.3% vs 26.2%, P < 001; cohort II: 92.2% vs 33.3%, P < 001). CRMP4 promoter methylation is an independent predictor of LNM (cohort I: hazard ratio [HR] = 8.35, 95% CI = 5.64 to 12.35, P < 001; cohort II: HR = 12.46, 95% CI = 5.82 to 26.70, P < 001) in a multivariable analysis model. Conclusion CRMP4 promoter methylation in diagnostic biopsies could be a robust biomarker for LNM in PCa.

Oxidative stress induced necroptosis activation is involved in the pathogenesis of hyperoxic acute lung injury

Necroptosis has been found to be involved in the pathogenesis of some lung diseases, but its role in hyperoxic acute lung injury (HALI) is still unclear. This study aimed to investigate contribution of necroptosis to the pathogenesis of HALI induced by hyperbaric hyperoxia exposure in a rat model. Rats were divided into control group, HALI group, Nec-1 (necroptosis inhibitor) group and edaravone group. Rats were exposed to pure oxygen at 250 kPa for 6 h to induce HALI. At 30 min before hyperoxia exposure, rats were intraperitoneally injected with Nec-1 or edaravone, and sacrificed at 24 h after hyperoxia exposure. Lung injury was evaluated by histology, lung water to dry ratio (W/D) and bronchoalveolar lavage fluid (BALF) biochemistry; the serum and plasma oxidative stress, expression of RIP1, RIP3 and MLKL, and interaction between RIP1 and RIP3 were determined. Results showed hyperoxia exposure significantly caused damage to lung and increased necroptotic cells and the expression of RIP1, RIP3 and MLKL. Edaravone pre-treatment not only inhibited the oxidative stress in HALI, but also reduced necroptotic cells, decreased the expression of RIP1, RIP3 and MLKL and improved lung pathology. Nec-1 pretreatment inhibited necroptosis and improved lung pathology, but had little influence on oxidative stress. This study suggests hyperoxia exposure induces oxidative stress may activate necroptosis, involving in the pathology of HALI, and strategies targeting necroptosis may become promising treatments for HALI.

Loupe-assisted versus microscopic varicocelectomy: is there an intraoperative anatomic difference?

The aim of this study was to compare the intraoperative difference in anatomic details between loupe-assisted and microscopic varicocelectomy within the same spermatic cord. Between April 2011 and August 2011, 26 men with 33 sides containing grade 2-3 varicocele were enrolled in this study. First, one surgeon performed the open inguinal varicocelectomy under × 3.5 loupe magnification. The presumed vascular channels and lymphatics were isolated and marked without ligation. Another surgeon then microsurgically dissected and checked the same spermatic cord using an operating microscope to judge the results in terms of the ligation of the internal spermatic veins and the preservation of the arteries and lymphatics. There were significant differences in the average number of internal spermatic arteries (1.51 vs 0.97), internal spermatic veins (5.70 vs 4.39) and lymphatics (3.52 vs 1.61) between the microscope and loupe-assisted procedures (P < 0.001, P < 0.001, P < 0.001, respectively). Meanwhile, in varicocele repair with loupe magnification, an average of 1.30 ± 1.07 (43/33) internal spermatic veins per side were missed, among the overlooked veins, 1.12 ± 0.93 (37/33) were adhered to the preserved testicular artery, as well as 0.55 ± 0.79 lymphatics and 0.36 ± 0.55 arteries that were to be ligated. In conclusion, microscopic varicocelectomy could preserve more internal spermatic arteries and lymphatics and could ligate more veins than the loupe-assisted procedure. To some degree, loupe magnification is inadequate for the reliable identification and dissection of the tiny vessels of the spermatic cord, as most of the overlooked veins were adhered to the preserved testicular artery.

Calpain-2 triggers prostate cancer metastasis via enhancing CRMP4 promoter methylation through NF-κB/DNMT1 signaling pathway

Metastasis is the major cause of cancer‐specific death in patients with prostate cancer (PCa). We previously reported that collapsing response mediator protein‐4 (CRMP4) is a PCa metastasis‐suppressor gene and the hypermethylation in CRMP4 promoter is responsible for the transcription repression in metastatic PCa. However, the underlying mechanisms remain unknown. In this study, we aimed to investigate the role of calpain‐2 in CRMP4 promoter hypermethylation and its functional modulation in PCa metastasis.

MP81-18 INTRACAVERNOUS INJECTION OF BONE MARROW MESENCHYMAL STEM CELLS MODIFIED WITH PDE5-RNAI IMPROVES ERECTILE DYSFUNCTION IN AGED RATS

replacement), indicates an enrichment of stem cell markers upon castration; CD44, NKX3.1 and ALDH1 isoforms. Microarray analysis has confirmed upregulation of CD44 and ALDH1A1 at castrated state, versus downregulation upon androgen replacement at early time points (24 hours). We isolated CD44þ/-ALDHhigh/low subpopulations by flow cytometry for transcriptome analysis. Castration in the BM-18 model induces an increase in the subpopulations of CD44þ/ALDHlow (from 0.44% to 2.3%) and CD44þ/ALDHhigh (from 0.06% to 0.38%). However, the same subpopulations are not increased in the LAPC-9 model upon castration, while only the CD44-/ALDHhigh subset is enriched (from 3.5% to 7.1%). Organoids derived from bulk BM-18 and LAPC-9 tumors are reestablishing tumor formation upon intraosseous inoculation. CONCLUSIONS: Different androgen-independent cancer stem cell subpopulations may be distinguished by the ALDH activity status in combination with CD44. The androgen-independent cells in the BM-18 androgen-dependent model are reflected by enrichment of CD44 expression, as well as a rare double positive population. In the androgen-independent LAPC-9 model, CD44 expression is decreased potentially reflecting androgen-dependent CD44þ cells, and ALDH activity increased in CD44cells.