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Objective:To evaluate the efficacy and safety of Rezūm Water Vapor Thermal Therapy system in the treatment of patients with benign prostatic hyperplasia (BPH).Methods:The clinical data of 22 patients with benign prostatic hyperplasia treated with Rezūm Water Vapor Thermal Therapy system in Boao Yiling Life Care Center in Hainan from December 2020 to January 2021 were retrospectively analyzed, with age of (61.0±5.9) years, prostate volume of (43.7±8.4) ml. international prostate symptom score (IPSS) of (19.3±3.7), quality of life (QOL) score of (4.2±0.8), maximum urinary flow rate (Q max) of (11.9±3.4) ml ml/s, and residual urine volume (PVR) of (14.0±19.0). For 19 patients with sexual life, the International Index of Erectile Function Questionnaire-5 (IIEF-5) were 17.0±5.5, the Men's Sexual Health Questionnaire-Ejaculatory Dysfunction Score (MSHQ-EjD) ejaculatory function score were 10.0±3.2, and the ejaculatory satisfaction score were 1.5±1.0. Twenty-two patients underwent Rezūm Water Vapor Thermal Therapy under intravenous anesthesia (general anesthesia without intubation) in the dorsal lithotomy position. The Rezūm system consisted of reusable thermal steam treatment device and disposable prostate thermal steam treatment instrument. The thermal steam treatment device used radiofrequency energy to heat sterile distilled water, generating high-temperature steam at 103℃. In a 9-second timeframe, the tissue temperature within each treatment area was raised approximately 70℃, causing cell death and resulting in a shrink in prostate tissue volume. The disposable prostate thermal steam treatment instrument could be inserted through a cystoscope and had a retractable needle tip that extends to a length of 10.25 mm. The needle tip had 12 evenly distributed holes arranged in three rows of four holes each, with a spacing of 120° between rows, allowing for even diffusion of thermal steam along the circumference. The patient was placed in a lithotomy position, and the disposable prostate thermal steam treatment instrument was used to examine the prostate, urethra, and bladder via cystoscopy, assessing the lateral lobes and median lobe of the prostate. The tissue spacing within each field of view of the treatment instrument is 0.5 cm, and the distance from the bladder neck to the verumontanum is calculated. The first needle was injected at 3 o’clock along the left lobe, withdrawing 2 fields of view each time. During the release of thermal steam, the needle tip was positioned perpendicular to the prostate urethral mucosa, and each needle injection delivered 0.42 ml of sterile distilled water-formed thermal steam into the prostate tissue. The thermal steam injection lasted for 9 seconds, followed by a 2-3 seconds waiting period before retracting the needle tip. One needle was injected per 2 fields of view, progressing towards the proximal urethra of the verumontanum. The same method was used to treat the right lobe. For cases with significant median lobe enlargement, two fields of view were retracted at the bladder neck, and the needle was inserted at a 45° angle. The second needle was injected at intervals determined by the extent of median lobe enlargement. Each puncture point was observed for no significant bleeding, and the instrument was then removed, with an F16/F18 silicone catheter left in place. The operative time as well as indwelling catheter time were recorded. The clinical parameters such as IPSS, QOL, prostate volume, Qmax, PVR, QOL, IIEF-5 and MSHQ-EjD at preoperative and 12 to 22 weeks post operation were compared. Adverse events from the Rezūm procedure to 12-22 weeks postoperatively were recorded. Results:All the operations were successfully completed. The operation time of Rezūm system was 3.9±1.6 min, and the indwelling catheter time after operation was 4.8±1.1 days. The IPSS scores of 22 patients at 12-22 weeks after operation were 4.4±3.3, whose reduction was 14.9±4.4 compared with these at baseline( P<0.01). The PV was (37.7±8.4)ml, Qmax was (25.5±9.6)ml/s, PVR was (6.2±8.1)ml, and QOL was 1.6±0.9, all demonstrating statistically significant differences compared to preoperative values ( P<0.05). Among the 19 cases with sexual activity, the IIEF-5 score was 20.4±3.2, and the ejaculatory function score of MSHQ-EjD was 13.1±3.1, both showing statistically significant differences compared to preoperative scores ( P<0.05). The ejaculatory satisfaction score of MSHQ-EjD was 1.1±0.5, and there was no statistically significant difference compared to preoperative scores ( P>0.05). None of the 22 cases required medication or further surgical treatment for BPH after surgery. There were no urethral injuries, rectal or bladder perforations during the surgeries, and no severe complications such as rectal fistula or bladder neck contracture occurred postoperatively. There were no deaths reported. Postoperative discomfort in the urethra occurred in 19 cases, urethral pain in 8 cases, hematuria in 15 cases, poor sleep quality in 2 cases, and constipation in 1 case, all of which resolved within 7 to 10 days after surgery. Erectile dysfunction and retrograde ejaculation occurred in one case each at 4 to 5 weeks postoperatively but did not reoccur thereafter. Prostatitis and nodular hyperplasia of the middle lobe of the prostate occurred in one case each at 21 weeks and 25 weeks postoperatively, respectively, and no treatment was administered. Conclusions:In the real world, the short-term overall effect of Rezūm Water Vapor Thermal Therapy system in the treatment of benign prostatic hyperplasia is satisfactory, which shows good efficacy and safety.
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The eukaryotic genome is folded into higher-order conformation accompanied with constrained dynamics for coordinated genome functions. However, the molecular machinery underlying these hierarchically organized three-dimensional (3D) chromatin architecture and dynamics remains poorly understood. Here by combining imaging and sequencing, we studied the role of lamin B1 in chromatin architecture and dynamics. We found that lamin B1 depletion leads to detachment of lamina-associated domains (LADs) from the nuclear periphery accompanied with global chromatin redistribution and decompaction. Consequently, the inter-chromosomal as well as inter-compartment interactions are increased, but the structure of topologically associating domains (TADs) is not affected. Using live-cell genomic loci tracking, we further proved that depletion of lamin B1 leads to increased chromatin dynamics, owing to chromatin decompaction and redistribution toward nucleoplasm. Taken together, our data suggest that lamin B1 and chromatin interactions at the nuclear periphery promote LAD maintenance, chromatin compaction, genomic compartmentalization into chromosome territories and A/B compartments and confine chromatin dynamics, supporting their crucial roles in chromatin higher-order structure and chromatin dynamics.
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Humans , Chromatin , Chromosomes , Genome , Lamin Type B/geneticsABSTRACT
Objective To investigate the clinical indicators which could be used to differentiate incarcerated stones from unincarcerated stones by comparing clinical characteristics of patients.Methods 96 patients who were diagnosed as ureteral stones treated by ureteroscopic lithotripsy (URSL) from June 2017 to November 2017 were selected in the study.Clinical characteristics of patients were collected.The total study consisted of 62 male and 34 female patients.The patients' age ranged from 24 to 78 years old and average age was (54.5 ± 12.7) years old.There were 35 patients were diagnosed as ureteral stones with hypertension,9 patients with diabetes,85 patients with hydronephrosis,respectively.The number of patients,whose stone located in upper ureters,middle ureters and lower ureters were 49,19,28,respectively.The average of maximum stone diameter,maximum cross-sectional area of the stone,stone volume,hounsfield units of stone and maximum ureteral wall thickness (UWTmax) at the stone site were (7.75 ± 2.68) mm,(36.12 ± 24.43) mm2,(304.06 ± 303.39) mm3,(755.75 ± 318.05) HU,and (3.18 ± 1.13) mm,respectively.Percussion tenderness over kidney region were positive in 11 cases,weak positive in 64 cases and negative in 21 cases,respectively.Stone-free rate after operation were 93.8％.Patients were divided into two groups,incarcerated or unincarcerated,and statistical differences between clinical characteristics of the two groups were analyzed by univariate analysis.The differences were further compared by multivariate logistic regression analysis to find independent predictors of impacted stones.The ROC curve was used to find the optimal UWT for diagnosis of impacted stone.The accuracy of this value was evaluated and patients were grouped by this value to compare the differences between groups.Results The operation and follow-up were successfully performed in all patients.Univariate analysis showed there were no statistical significance differences in gender [(24 males and 16 females)vs.(38 males and 18 females)],age [(53.4 ± 12.3) years vs.(48.7 ± 12.7) years],previous history of diabetes (4 cases vs.5 cases) and stone location [(19 upper stones,9 middle stones,12 lower stones) vs.(30 upper stones,10 middle stones,16 lower stones)],between the two groups (P ＞ 0.05).Among the clinical characteristics of patients in incarcerated and unincarcerated groups,UWTmax were (4.15 ± 0.94) mm and (2.58 ± 0.76) mm,previous history of hypertension were 20 cases and 15 cases,ipsilateral URSL history were 14 cases and 10 cases,hounsfield units of stone were (847.66 ± 282.39) HU and (698.65 ± 325.50) HU,hydronephrosis were 40 cases and 50 cases,maximum stone diameter were (8.67 ± 2.28)mm and (7.17 ± 2.75)mm,maximum cross-sectional area of the stone were (43.83 ± 23.65) mm2 and (31.14 ± 23.64) mm2,stone volume were (386.20 ± 296.60) mm3 and (253.04 ± 296.29) mm3,percussion tenderness over kidney region were positive in 8 cases(20.0％),weak positive in 27 cases,negative in 5 cases and positive in 3 cases,weak positive in 37 cases,negative in 16 cases,respectively.The difference was statistically significant (P ＜ 0.05).Multivariate logistic regression analysis showed UWTmax (OR =10.40,P ＜ 0.001) at the stone site was significantly correlated with impacted ureteral stones and it was an independent predictor of impacted stones.ROC curve analysis showed that the optimal cut-off value of UWTmax was 3.26 mm.The sensitivity of the value to predict impacted stone is 82.5％ and the specificity is 87.5％.Depending on the cut off value of 3.26 mm,cases were divided into two groups,40 cases were in high UWTmax (≥3.26 mm)group and 56 cases were in low UWTmax (＜ 3.26 mm)group.Higher UWTmax was accompanied with a higher incidence of ureteral edema[77.5％ (31/40) vs.32.1％ (18/56)],polyps [30.0％ (12/40) vs.7.1％ (4/56)],strictures[37.5％ (15/40)vs.12.5％ (7/56)] and a lower stone-free rate[87.5％ (35/40) vs.98.2％ (55/56)].The difference was statistically significant (P ＜ 0.05).Conclusions UWTmax can be used to differentiate impacted stones from unimpacted stones before surgery.The patients with Higher UWTmax (≥3.26 mm) was accompanied with a higher incidence of stone impacted,ureteral edema,polyps,and strictures,and a lower rate of stone clearance.
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Objective To explore the difference in efficacy between multiparametric MRI (Mp-MRI) based on prostate imaging reporting and data system version 2 (PI-RADS v2) and abbreviated biparametric MRI (Bp-MRI) in detecting prostate cancer (PCa) and clinically significant prostate cancer (csPCa), and to evaluate the consistency of image interpretation between different readers. Methods The imaging, pathological and clinical data of patients with prostatic Mp-MRI in our hospital from February 2015 to June 2018 were retrospectively analyzed. At the beginning, 250 patients were randomly selected. Two radiologists visually evaluated the images of those patients using two 5-point scoring schemes based on Mp-MRI and Bp-MRI. The remaining cases were independently proceeded by one of the radiologists using two schemes respectively. Weighted Kappa test was used to assess the consistency of the results interpreted by the two radiologists. The receiver operating characteristic (ROC) curve was used to evaluate the efficiency of the two scoring schemes in detecting PCa and csPCa, and with Z test to investigate whether there was any difference in detection efficiency between the two schemes. Results Nine hundred and seventy eight patients were eventually enrolled in the study. The results of the consistency assessment showed that there was good agreement between the two radiologists, whether using Mp-MRI or Bp-MRI, with the weighted Kappa coefficient of 0.800 and 0.812, respectively. The ROC curve analysis showed that the area under the curve (AUC) of PCa detected by Mp-MRI and Bp-MRI was 0.873 and 0.879, respectively, and the AUC of csPCa detected was 0.922 and 0.932, respectively. In addition, there was no statistically significant difference between the AUC of PCa and csPCa detected by the two schemes (P>0.05). Conclusion The Bp-MRI scoring scheme has good stability in the evaluation of benign and malignant prostate, and its detection efficiency of PCa or csPCa is not lower than that of standard Mp-MRI based on PI-RADS v2.
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Objective To evaluate the feasibility and safety of 180W greenlight laser in the treatment of benign prostatic hyperplasia (BPH) in the day surgery mode.Methods A retrospective review included 65 patients with benign prostate hyperplasia who were treated with photoselective vaporization of the prostate (PVP) under 180W greenlight system from Jan 2017 to Jan 2018,was performed.The patients' age ranged from 54 to 75 years old and the prostatic volume ranged from 42 to 93 ml.All patients were classified into two groups [day sugery group (n =29) and inpatient surgery group(n =36)] based on the wishes of patients.In day sugery group,the admission,operation and discharge were completed in 24 hours.The preoperative clinic parameters such as prostate volume,IPSS,Qmax QOL and PVR were recorded in the two groups.The prostatic volume in two groups was (67.3 ± 15.9) ml and (70.4 ± 16.1) ml,respectively.The IPSS and QOL scores in two groups were (23.2±4.6 vs.23.9±4.5) and (4.7±0.9 vs.4.4± 0.8),respectively.The Q and PVR in two groups were [(6.7 ± 2.5) ml/s vs.(6.8 ± 2.8) ml/s] and [(133.9 ± 81.3) ml vs.(105.8 ± 76.3) ml],respectively.The time of catheterization and postoperative hospitalization,total cost,postoperative adverse events were recorded,too.All the clinic data of preoperation,intraoperation and postoperation were compared between two groups.Results The operations and follow-up were successfully executed in all patients.There were not statistical significance differences in preoperative parameters between the two groups (P ＞ 0.05).There were not statistical significance differences in operating time [(67.8 ± 9.8) min vs.(70.9 ± 12.8) min],laser time [(49.8 ± 8.3) min vs.(51.6±10.4) min],energy used [(295.7±112.6) kJ vs.(285.0±108.2) kJ],between the two groups,too (P ＞ 0.05).A significantly less mean catheter duration,hospital stay and hospital charges were observed in the day surgery group [(14.6 ±2.0)hours,(0.5 ±0) days and (23 279 ±511) yuan,respectively] than in the inpatient surgery group [(51.7 ± 1 1.8) hours,(3.0 ± 0.8) days and (27 452 ± 440)yuan,respectively,P ＜0.05].3 cases of urinary retention and 1 case of gross hematuria after the catheter removal were recorded in the day surgery group,2 cases of urinary retention were recorded in the inpatient surgery group,and all of these 6 cases were cured through indwelling catheter.After 3 months follow up,there were not statistical significant differences io IPSS(12.4 ± 3.3 vs.10.6 ± 4.2),Q [(17.4±2.1)ml/s vs.(17.1 ±1.8) ml/s],and QOL (2.1 ±0.7 vs.2.3±0.7)between the two groups (P ＞ 0.05).However,significant difference of those items could be noticed when compared with those items before surgery (P ＜ 0.05).Conclusions In the day surgery mode,180W greenlight laser vaporization of the prostate is safe and effective,without the increase of surgical complications.The length of stay and hospitalization expenses were much less.Thus,this strategy is worth promoting in clinical practice.
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Objective Benign prostatic hyperplasia ( BPH) is one of common diseases in aged males , and searching for new therapeutic drugs to BPH has been a research hotspot in recent years .This article was to study the inhibitory effect of eupatorium ja-ponicum thunb and foeniculum vulgare extract ( EFE) on benign prostatic hyperplasia in rats and its possible mechanism . Methods 48 male rats were randomly divided into 6 groups:normal control group without any treatment , model group of BPH treated with subcu-taneous injection of testosterone propionate , positive control group of BPH treated with dutasteride , high, middle and low dosage groups according to different EFE dosage (156 mg/kg, 234 mg/kg and 312 mg/kg).45 days after the treatment, the rats were sacrificed for measurement of the prostate glandular wet weight , the index of prostate gland ( PI ) , the morphological changes of prostate gland by light microscopy and the content of sex hormone . Results The prostate wet weight and PI decreased after EFE treatment for 45 days compared with the BPH model group(P<0.01 ).The hyperplastic glandular epithelium papilla waned and even disappeared in three EFE groups under the light microscope , and the epithelial cells became cubical or flat .High dosage EFE group (312 mg/kg) has simi-lar efficacy to dutasteride group .EFE significantly reduced serum testosterone content , dihydrotestosterone content and T/E2 ratio( P<0.05 ). Conclusion EFE can significantly inhibit prostatic hyperplasia in rats , and its mechanism is related to the decrease of the contents of serum testosterone and dihydrotestosterone as well as T/E2 ratio.
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Objective To prevent the occurrence of postoperative delirium after endoscopic surgery in patients with benign prostatic hyperplasia (BPH). Methods A total of 370 BPH patients receiving endoscopic surgery in our hospital were involved in this study. The clinical parameters including age, other systemic diseases, operation method, operation time and postoperative pain were investigated as predictive risk factors. Then the data were dealt by χ~2 test, single factor analysis or multivariate logistic regression analysis. Results Postoperative delirium occurred in 19 cases (5. 1%). Univariate analysis demonstrated that many factors were significantly correlated with the postoperative delirium in elderly patients, such as age (χ~2 = 7. 37, P<0. 05), other systemic diseases (χ~2=10.26, P<0.05), operation time (χ~2 = 19. 87, P<0.05) and postoperative pain (χ~2= 4.99, P<0. 05). The multivariate logistic regression analysis showed that age (OR = 5. 38, P< 0.05), other systemic diseases (OR = 4. 97, P<0. 05) and operation time (OR = 6. 53, P<0. 05) were important factors for postoperative delirium. Conclusions Paying more attention to the advanced age, giving sufficient preoperative preparation and reducing operation time may help to prevent postoperative delirium.
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Objective To summarize the perioperative care experience in patients with benign prostatic hyperplasia (BPH) treated by transurethral electrovaporization of the prostate (TVP). Methods A retrospective analysis of 693 cases of BPH treated by TVP from June 1998 to September 2002 was conducted. Results The operation time ranged (25～130) min (mean, 54 min). Four patients intraoperatively presented with the early symptoms of the transurethral resection syndrome (TURS) and were treated promptly, without deaths during operations. Follow-up checkups for (3～9) months in 422 cases showed that, from the preoperative period to the 3rd postoperative month, the I-PSS declined from (24.8?3.2) points to (11.4?1.9) points ( t=5.48; P