Treatment of intravesical instillation with fulguration-hydrodistention on female interstitial cystitis / 北京大学学报(医学版)

OBJECTIVE@#To investigate the efficacy and safety of intravesical instillation of heparin/alkalized lidocaine (lidocaine mixed with sodium bicarbonate) combined with hydrodistension and transurethral fulguration in the treatment of female interstitial cystitis (IC).@*METHODS@#Female patients who attended the Department of Urology at the First Hospital of China Medical University between January 2012 and December 2020 and met the diagnostic criteria proposed in the guidelines of the American Urological Association with a new diagnosis of IC were selected for retrospective analysis. Cystoscopy and biopsy of suspicious lesions were performed at the time of diagnosis. All the patients were treated with an intravesical instillation regimen of 2% lidocaine 10 mL + 5% sodium bicarbonate 5 mL + heparin 25 000 IU for a continuous period of 12 months, with or without water dilatation and transurethral electrocautery according to the patient's preference, categorized as hydrodistension and transurethral fulguration (HD/TF) group and non-HD/TF group. The patients were evaluated before and 1, 6, and 12 months after treatment for O'Leary-Sant interstitial cystitis patient symptom index scores (ICSI), interstitial cystitis patient problem index scores (ICPI), visual analog scale (VAS) of suprapubic pain, and functional bladder capacity (FBC) changes.@*RESULTS@#A total of 79 patients were collected in this study. Four (5.1%) of these patients underwent cystectomy due to pathological diagnosis of cancer or treatment failure. The remaining patients were followed up 1, 6 and 12 months after treatment. Repeated-measures ANOVA showed a significant decrease in ICPI, ICSI and VAS and an increase in FBC after treatment compared with before treatment (P < 0.05). FBC continued to decrease during the 1, 6 and 12 months' post-treatment follow-ups, with statistically significant differences; ICSI continued to decrease during the 1 and 6 months post-treatment follow-ups, with statistically significant differences, while the difference between ICSI at 6 months post-treatment and at 12 months' post-treatment was not statistically significant. In the HD/TF group, ICPI continued to decrease in the follow-up from 1 and 6 months after treatment, and the difference was statistically significant, while the difference between ICPI 6 months after treatment and 12 months after treatment was not statistically significant. There was no statistically significant difference between the remaining indicators 1, 6 and 12 months after treatment. ICPI, ICSI, VAS and FBC improved earlier and the changes in VAS and FBC were more significant in the HD/TF group compared with the non-HD/TF group (P < 0.05).@*CONCLUSION@#Heparin/alkalized lidocaine combination of intravesical instillation with hydrodistension and transurethral fulguration for IC is an effective treatment option. Heparin/alkalized lidocaine combination of intravesical instillation may be the first choice of treatment, which can significantly reduce the economic burden of patients and medical insurance system. If patients can accept it, transurethral fulguration with hydrodistension may be considered.

Research progress of intravesical recurrence after radical resection of upper tract urothelial carcinoma / 现代泌尿外科杂志

Urothelial carcinoma (UC) is the second most common genitourinary tumor, and upper tract urothelial carcinoma (UTUC) accounts for 5% to 10% of UC. Intravesical recurrence (IVR) occurs in 22% to 47% of patients after radical resection. This article reviews the mechanism, characteristics, related risk factors, regular bladder monitoring, diagnosis and treatment, and preventive measures of IVR, hoping to provide reference for clinical work.

Changes of complement fragment C3a and its receptor in lung injury induced by silica nanoparticles / 环境与职业医学

Background Silica nanoparticles (SiNPs) enter the human body through respiratory tract, digestive tract, and skin, causing body damage. Lung is one of the main damaged organs. Objective To observe the expressions of complement activated fragment C3a and its receptor C3aR in the lungs of mice exposed to SiNPs through respiratory tract, and to explore the involvement of C3a/C3aR in lung injury induced by SiNPs exposure. Methods The ultrastructure of SiNPs (particle size 5-20 nm) was determined under a transmission electron microscope, and the hydrodynamic diameter and surface Zeta potential of SiNPs were determined using a nanoparticle size analyzer. A total of 88 SPF C57BL/6J mice were randomly divided into five groups: a blank control group without any treatment (14 mice), a vehicle control group treated with 50 μL stroke-physiological saline solution by intratracheal instillation (14 mice), and three SiNPs exposure groups (low-dose group, medium-dose group, and high-dose group with 20 mice in each group, who were given 50 μL SiNPs suspension of 7, 21, and 35 mg·kg−1 respectively and exposed once every 3 days for 5 times). The mice were anesthetized on day 1 (1-day model group) and day 15 (15-day model group) after exposure, then sacrificed after extraction of bronchoalveolar lavage fluid (BALF), and lung tissues were retained. The morphological changes of lung tissues were observed by HE staining, the expression level of C3a in BALF was detected by enzyme-linked immunosorbent assay, the deposition of C3a and C3aR in lung tissues were observed by immunohistochemistry, the protein expression level of C3aR was determined by Western blotting, and the localization and semi-quantitative detection of C3a and C3aR in lung tissues was observed by immunofluorescence. Results SiNPs agglomerated in stroke-physiological saline solution. The average hydrodynamic diameter was (185.60±7.39) nm and the absolute value of Zeta potential was (43.33±0.76) mV. The condition of mice in the 1-day model group and the 15-day model group was good, while 2 mice died in the medium-dose group of the 1-day model group due to misoperation. The autopsy results of the two mice showed congestion of the lung tissue, emphysema, and no imperfection of trachea integrity. No death was observed in other dose groups. The HE staining results showed pathological damage to the mouse lung, including alveolar wall thickening and inflammatory cell infiltration after SiNPs exposure. The pathological damage became more serious with the increase of dose. Regarding pathological changes, the 15-day model group was slightly relieved compared with the 1-day model group, but there were still pathological changes. The enzyme-linked immunosorbent assay results showed that there was no difference in the expression level of C3a between the blank control group and the vehicle control group (P＞0.05), the expression levels of C3a in the medium-dose group and the high-dose group were significantly higher than that in the vehicle control group (P<0.05). The immunohistochemistry results showed that C3a deposition was consistent with the enzyme-linked immunosorbent assay results. The Western blotting and the immunohistochemistry results showed that C3aR expression was low in the blank control group and the vehicle control group, while the expression in each dose group tended to increase with the increase of dose. The immunofluorescence results showed that the fluorescence signals of C3a and C3aR were weak in the blank control group and the vehicle control group in the 1-day model group and the 15-day model group, while the fluorescence signals in the lung tissues of mice in the SiNPs exposure groups tended to increase with the increase of dose. Conclusion The increased expressions of C3a and C3aR in complement activation may be related to lung injury induced by intratracheal instillation of SiNPs, suggesting that C3a/C3aR may be involved in lung injury induced by SiNPs exposure.

Suppression of NLRP3 inflammasome by ivermectin ameliorates bleomycin-induced pulmonary fibrosis / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Ivermectin is a US Food and Drug Administration (FDA)-approved antiparasitic agent with antiviral and anti-inflammatory properties. Although recent studies reported the possible anti-inflammatory activity of ivermectin in respiratory injuries, its potential therapeutic effect on pulmonary fibrosis (PF) has not been investigated. This study aimed to explore the ability of ivermectin (0.6 mg/kg) to alleviate bleomycin-induced biochemical derangements and histological changes in an experimental PF rat model. This can provide the means to validate the clinical utility of ivermectin as a treatment option for idiopathic PF. The results showed that ivermectin mitigated the bleomycin-evoked pulmonary injury, as manifested by the reduced infiltration of inflammatory cells, as well as decreased the inflammation and fibrosis scores. Intriguingly, ivermectin decreased collagen fiber deposition and suppressed transforming growth factor-‍β1 (TGF-‍β1) and fibronectin protein expression, highlighting its anti-fibrotic activity. This study revealed for the first time that ivermectin can suppress the nucleotide-binding oligomerization domain (NOD)‍-like receptor family pyrin domain-containing protein 3 (NLRP3) inflammasome, as manifested by the reduced gene expression of NLRP3 and the apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC), with a subsequent decline in the interleukin‍-‍1β (IL‍-‍1β) level. In addition, ivermectin inhibited the expression of intracellular nuclear factor-‍κB (NF‍-‍κB) and hypoxia‑inducible factor‑1α (HIF‍-‍1α) proteins along with lowering the oxidative stress and apoptotic markers. Altogether, this study revealed that ivermectin could ameliorate pulmonary inflammation and fibrosis induced by bleomycin. These beneficial effects were mediated, at least partly, via the downregulation of TGF-‍β1 and fibronectin, as well as the suppression of NLRP3 inflammasome through modulating the expression of HIF‑1α and NF-‍κB.

Establishment of a rat silicosis model via non-exposed tracheal instillation in combination with a ventilator / 中国职业医学

@#Objective - To establish a new non exposed intratracheal instillation method for establishing a rat silicosis model. Methods ， The specific pathogen free SD rats were randomly divided into control group and experimental group with ten rats in ， each group. Rats in the control group were given 1.0 mL of 0.9% sodium chloride solution and rats in the experimental group - were given 1.0 mL of silica suspension with a mass concentration of 50 g/L adopting to the one time intratracheal instillation ， - ， method and then followed by ventilator assisted ventilation immediately. When the tidal volume stabilized at 2.0 mL the ventilator was removed and the tracheal intubation was pulled out. Five rats in each group were sacrificed after two and four ， - Results weeks after modeling and hematoxylin eosin staining and Masson staining of lung tissue were performed. There was ， ， no death in the two groups of rats during the experiment. After two and four weeks the control group had normal lung structure ， ， ， normal alveolar cavity size no inflammatory cell infiltration thin alveolar wall only a small amount of collagen distribution ， around the lung interstitium and bronchus. At the second week of modeling the alveolar wall of the rats in the experimental ， ， ， group was slightly thickened interstitial lymphocytes and macrophages were infiltrated slight hyperplasia was found and a ， small amount of fibroblasts were visible. At the 4th week of modeling the alveolar wall of the rats in the experimental group was ， ， ， ， significantly thickened fibrous nodules were formed and fibroblasts fibrocytes collagen fibers were significantly increased. Conclusion - The combination of ventilator and non exposed intratracheal instillation method can be used to successfully ， ， . establish a rat silicosis model which is simple safe and effective

Effect of Intravesical Instillation Therapy on Cancer-specific Survival Rate of Stage T1 Non-muscle-invasive Bladder Transitional Cell Carcinoma Patients After Transurethral Resection / 肿瘤防治研究

Objective To investigate the effect of transurethral resection of bladder tumor (TURBT) with or without intravesical instillation therapy on cancer-specific-survival rate (CSS) of T1 stage non-muscle-invasive bladder transitional cell carcinoma (BTCC) patients. Methods The data of patients diagnosed with T1 stage non-muscle-invasive BTCC from 2010 to 2015 were obtained from the SEER database. The different dividing groups were based on TURBT with or without intravesical instillation therapy. A 1:1 PSM method was used to balance the differences in baseline data between each group. Herein, Kaplan-Meier methods were used to draw survival curves, and the difference between OS and CSS were compared by Log rank test. In addition, univariate and multivariate Cox regressionanalyses were used to explore the independent risk factors of CSS. Results The OS and CSS of patients in the TURBT combined with intravesical instillation therapy group were higher than those of the TURBT alone group (P < 0.05). TURBT combined with intravesical instillation therapy was a protective factor in prognosis with T1 stage non-muscle-invasive BTCC patients (HR=0.783, 95%CI: 0.650-0.942, P < 0.01). Conclusion TURBT combined with intravesical instillation therapy improves the CSS of patients with T1 stage non-muscle-invasive BTCC.

Effect of intratracheal instillation of PM2.5 suspensionon pulmonary fibrosis in mice and the intervention of neotuberostemonine / 中国药科大学学报

@#To investigate the effects of intratracheal instillation of PM2.5 suspension on bleomycin (BLM)-induced pulmonary fibrosis in mice and the intervention of neotuberostemonine (NTS), the BLM dose (1.5 or 3.0 U/kg) and PM2.5 frequency (1 or 2 times per week) were studied by factorial experiment design. After intratracheal instillation of BLM (1.5 or 3.0 U/kg) on day 0, PM2.5 (5 mg/kg) was intratracheally injected to mice once or twice a week from day 1 to day 21, and the mice in the treatment group were given 30 mg/kg NTS by gavage once a day from day 8 to day 21. The degree of pulmonary fibrosis was evaluated by lung coefficient, hydroxyproline (HYP) content, HE staining and Masson staining lung sections as well as their semi-quantitative index (HE inflammatory score and collagen volume fraction, CVF). The results showed that the HE scores increased significantly in mice singly given PM2.5 once a week, the HYP content and HE score increased in mice singly given PM2.5 twice a week, but their CVF values did not significantly increase. However, the CVF values increased significantly in mice treated with PM2.5 and BLM co-infusion. These results suggested that PM2.5 (administered singly) could significantly increase BLM-induced collagen deposition and greatly aggravate pulmonary fibrosis although it mainly caused pulmonary inflammation rather than pulmonary fibrosis. NTS could significantly reduce the CVF value and α-SMA protein level of the model mice. It can be concluded that PM2.5 has great influence on patients with respiratory diseases, while NTS can improve pulmonary fibrosis induced by the combination of PM2.5 and BLM.

Comparative Study of Intraperitoneal Instillation of Levobupivacaine (0.25%) Plus Dexmedetomidine Versus Ropivacaine (0.25%) Plus Dexmedetomidine for Post-operative Analgesia in Patients Undergoing Laparoscopic Cholecystectomy

Background: Instillation of intraperitoneal lignocaine, bupivacaine, levobupivacaine, and ropivacaine has been used followinglaparoscopic gynecological and general surgical procedures to reduce post-operative pain through randomized trials formany years. Hence, the present study was undertaken for assessing and comparing the efficacy of intraperitoneal instillationof levobupivacaine (0.25%) and ropivacaine (0.25%) for post-operative analgesia in patients undergoing laparoscopiccholecystectomy (LC).Materials and Methods: Ninety patients were enrolled and were randomly divided into three groups of 30 each. Group L:Patients were given 20 ml of 0.5% levobupivacaine plus dexmedetomidine at 1 μg per kg body weight and making total volume40 ml by adding normal saline (NS), intraperitoneally after gallbladder removal. Group R: Patients were given 20 ml of 0.5%ropivacaine plus dexmedetomidine at 1 μg per kg body weight and making total volume 40ml by adding NS, intraperitoneallyafter gallbladder removal. Group C: Patients were given 40 ml of NS. Postoperatively, the patients were assessed for painutilizing visual analog scale (VAS). The results were statistically analyzed using latest software.Results: The mean VAS score reading was lower in Group L and Group R in comparison to Group C at all the time intervals. Thenumber of patients requiring rescue analgesia was significantly higher in Group C in comparison to other study groups. Amongthe L group and R group, the number of patients requiring rescue analgesia was lower in Group L in comparison to Group R.Conclusion: Intraperitoneal instillation of local anesthetic solution in LC provided effective post-operative analgesia, butanalgesia provided by levobupivacaine plus dexmedetomidine was significantly better than ropivacaine plus dexmedetomidine

Comparative Study of Preclosure Periportal Instillation of Three Different Concentrations of Ropivacaine (0.125%, 0.25%, 0.5%) for Postoperative Analgesia in Laparoscopic Cholecystectomy

Introduction: Multimodal analgesia is currentlyrecommended for postoperative pain control in laparoscopicsurgeries. Our study aimed at comparing the postoperativeanalgesic efficacy of three different concentrations ofRopivacaine when instilled periportally just before closure inlaparoscopic cholecystectomy.Material and methods: 200 patients posted for laparoscopiccholecystectomy were randomly allocated into four groups of50 patients each. Three groups received preclosure periportalinstillation of 20 ml Ropivacaine 0.125%, 0.25% and 0.5%respectively whereas the fourth group received 20 ml normalsaline. Pain was recorded on visual analog scale at frequentintervals for 24 hours postoperatively and categorised as eithermild, moderate or severe. Tramadol 1mg/Kg was administeredas rescue analgesic in patients with moderate to severe pain.Results: A statistically significant difference was found amongthe four groups with the number of patients experiencingmild and moderate pain with P values of 0.009 and 0.02respectively. The number of patients experiencing mild andmoderate pain was significantly less with Ropivacaine 0.5%when compared with Ropivacaine 0.125% (P=0.01 and 0.03),Ropivacaine 0.25% (P=0.002 and 0.03) and normal saline(P=0.02 and 0.0007). The number of patients requiring rescueanalgesia at various time intervals was also significantly lesswith Ropivacaine 0.5% when compared to the other groups(P<0.05).Conclusion: Ropivacaine 0.5% when administeredas preclosure periportal instillation in laparoscopiccholecystectomy, provided better postoperative analgesiaand significantly less requirement of rescue analgesia, ascompared to equivalent volumes of Ropivacaine in lowerconcentrations of 0.25% and 0.125% which were no betterthan normal saline.

A Comparative Study of Bupivacaine Vs Ropivacaine Wound Instillation through Surgical Drain for Postoperative Analgesia in Modified Radical Mastectomy

Introduction: Modified radical mastectomy (MRM) isassociated with extensive tissue dissection and substantialpostoperative pain. Various modes of postoperative analgesiahave been used to alleviate the suffering of these patients.One of that is wound instillation, in our study we comparedthe effects of bupivacaine and ropivacaine for post-operativeanalgesia when instilled through the surgical drains in patientsundergoing MRM.Material and methods: After obtaining the InstitutionalEthics Committee approval and written informed consent,60 female patients aged between 18 and 60 years withAmerican Society of Anaesthesiologist status I/II scheduledto undergo MRM were enrolled for the study. Patients wererandomised into two groups (30 each), a total of 40 cc of eitherbupivacaine (0.125%) or ropivacaine (0.2%) instilled throughsurgical drains. Visual analogue score and hemodynamicswere compared in the postoperative period every 2 hourlytill 12 hours. Quantitative data were compared by usingunpaired t-test and qualitative data by using Chi-Square testand Fisher’s Exact test.Results: Duration of analgesia was found to be significantlylonger in bupivacaine group (512.37±63.06 minutes) ascompared to ropivacaine (427.97±43.26 minutes) (p<0.0001). Systolic and diastolic blood pressure were high andstatistically significant in bupivacaine group as compared toropivacaine but clinically not significant.Conclusion: Both local anaesthetics, bupivacaine andropivacaine showed near similar pharmacological effectshowever the duration of analgesia was observed more withbupivacaine when instilled through the surgical drains. Woundinstillation, being a non-invasive technique is an effectivemode of providing postoperative analgesia in MRM ascompare to other invasive modalities.

The value of intravesical instillation of Nocardiarubra cell wall skeleton in preventing recurrent after transurethral resection for the treatment of non-muscle invasive bladder cancer / 中华泌尿外科杂志

Objective To investigate the efficacy and safety of Nocardiarubra cell wall skeleton (N-CWS) bladder irrigation in prevention of recurrence after transurethral resection for the treatment of non-muscle invasive bladder cancer (NMIBC).Methods The clinical data of patients with NMIBC treated by N-CWS and epirubicin collected between October 2013 and November 2018 at the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.All patients underwent TURBT.Among the 118 NMIBC patients,the average age was (65.1 ± 1 1.9) years,and the sex ratio (male/female) was 1.9∶1 (77/41).Patients were divided into two group:N-CWS group (n =55) and epirubicin group (n =63) according to different instillation regimens.N-CWS was given as an instillation of 800 μg in 50 ml of saline and maintained in the bladder for 2 h in the N-CWS group.Epirubicin was given as an instillation of 50 mg in 50 ml of saline and maintained in the bladder for 1 h in the epirubicin group.In the N-CWS group,mean agewas (64.9 ± 12.1) years and 37 (67.3％) were male.Multiple tumors were present in 17 (69.1％) patients.Tumor size was ≤3 cm in 49(89.1％) and 7(12.7％) had a history of NMIBC.Stage was Ta and T1 in 36(65.5％) and 19(34.5％),respectively.Grade 1,Grade 2 and Grade 3 were the primary grades in 38(69.1％),13(23.6％) and 4(7.3％),respectively.Low risk,intermediate risk and high risk were present in 14 patients(25.5％),16 (29.1％) and 25 (45.5％),respectively.In the epirubicin group,mean age was (65.3 ± 11.2) years and 40(63.5％)were male.Multiple tumors were present in 19(30.2％) patients.Tumor size was ≤3 cm in 56(88.9％) and 11 (17.5％) had a history of NMIBC.Stage was Ta and T1 in 37(58.7％) and 26 (41.3％),respectively.Grade 1,Grade 2 and Grade 3 were the primary grades in 44(69.8％),12(19.0％)and 7(11.1％),respectively.Low risk,intermediate risk and high risk were present in 13 (20.6％),19 (30.2％) and 31 (49.2％),respectively.The tumor recurrence,progression and adverse reactions after Intravesical Instillation in both groups were followed up and recorded.No significant differences were found between the two groups.Results A total of 118 patients were followed up.Mean follow-up time was (33.7 ± 5.4) months.25.5％ (14/55) in the N-CWS group vs.42.8％ (27/63) in the epirubicin group had recurrence after 5 years (x2 =3.922,P =0.048).The five-year RFS was higher in the N-CWS group than in the epirubicin group (74.2％ vs.56.5％,P =0.044).No significant difference was found in the progression rate between the two groups(5.5％ vs.7.9％,P =0.867).The incidences of adverse events in the two groups were 16.4％ (9/55) and 19.0％ (12/63),respectively.The N-CWS group had significantly fewer cases with urinary frequency and dysuria than the epirubicin group.No significant differences were found in other side effects.Conclusions Intravesical instillation of N-CWS after NMIBC TURBT was found to be a promising procedure to prevent recurrence and prolong the recurrence-free survival with less side effects.

Intraperitoneal nebulization versus intraperitoneal instillation of ropivacaine for postoperative pain management following laparoscopic donor nephrectomy / 대한마취과학회지

BACKGROUND: Laparoscopic donor nephrectomy is considered less painful than open nephrectomy but is still associated with significant postoperative pain. Studies reported that intraperitoneal instillation of local anesthetics provides uncertain pain relief after laparoscopic surgery. This randomized, double-blind study evaluated the effect of intraperitoneal nebulization of ropivacaine on postoperative pain relief after laparoscopic donor nephrectomy. METHODS: Sixty patients undergoing elective laparoscopic donor nephrectomy were randomly assigned to receive either an instillation of 20 ml 0.5% ropivacaine after the induction of pneumoperitoneum or nebulization of 5 ml 1% ropivacaine before and after surgery. The primary outcome was the degree of pain relief (static and dynamic) after surgery. The secondary outcomes were postoperative fentanyl consumption, incidence of shoulder pain, unassisted walking and postoperative nausea and vomiting (PONV). Data were collected in the postanesthesia care unit (PACU) and at 6, 24, and 48 h after surgery. RESULTS: Compared to patients in the instillation group, those in the nebulization group showed significant reductions in postoperative pain and fentanyl consumption, and none complained of significant shoulder pain (visual analog scale score ≥ 30 mm). Within 20 h of surgery, 13.3% of patients in the instillation group and 93.3% in the nebulization group started unassisted walking (absolute risk reduction, 38%; P = 0.001). In the nebulization group, PONV was significantly reduced in the PACU and at 6 h. CONCLUSIONS: Intraperitoneal nebulization of ropivacaine reduced postoperative pain, fentanyl consumption, referred shoulder pain, and PONV while enabling earlier mobility without any difference in the length of hospital stay.

Short-term efficacy and predictive factors of BCG instillation in high risk non-muscle invasive bladder cancer / 中华泌尿外科杂志

Objective To investigate the short-term efficacy,safety and factors affecting the efficacy of BCG intravesical therapy in high risk non-muscle-invasive bladder cancer (NMIBC) patients.Methods A total of 161 high-risk non-muscle invasive bladder cancer (NMIBC) patients were reviewed in our hospital from March 2014 to December 2017.They were all treated with BCG instillation after transurethral resection of bladder tumor (TURBT).There were 121 males (75.2％) and 40 females (24.8％).Median age was 65 years old,including 17 cases (10.6％) ＜50 years old,23 cases (14.3％) within 50-59 years old,72 cases (44.7％) within 60-69 years old,49 cases ≥70 years old (30.4％).There were 112 patients (69.6％) with primary bladder cancer and 49 (30.4％) patients with recurrent bladder cancer.56 cases (34.8％) had single tumor and 105 cases (65.2％) had multiple tumors.The tumors size in 106 cases (65.8％) was less than 3 cm,and tumor size in 55 cases (34.2％) was more than 3 cm.43 patients (26.7％) suffered carcinoma in situ.10 patients (6.2％) suffered urothelial carcinoma with variant types.According to the American Joint Commission for Cancer (AJCC) version 7 TNM staging system,25 cases (15.5％) were classified into Ta stage,129 cases (80.1％) were classified into T1 stage,and 7 cases (4.3％) were classified into Tis stage.There were 8 cases (5％) with low-grade cancer and 153 cases (95％) with high-grade cancer.69 patients (42.9％) received chemo-instillation before.43 cases were directly perfused without re-TURBT and 118 cases were perfused after re-TURBT.They were all treated with BCG instillation after transurethral resection of bladder tumor (TURBT).The 120 mg BCG were dissolved into 50 ml saline for instillation and were kept for 2 hours.Induction scheme of six-weekly and three fortnightly instillations started two weeks after the initial TUR or re-TUR.Maintenance instillations were then be offered in a scheme of ten monthly instillations.During treatment,patients were offered cystoscopy and cytology every three months,while CT and chest radiographs were reviewed every 6-12 months.Recurrence status and adverse effects were recorded.Univariate and multivariate regression analyses were performed to predict risk factors for failure of BCG instillation in bladder cancer.Results A total of 161 patients were followed up.The median follow-up time was 13 months,ranging 7-22 months.The overall recurrence rate was 26.1％ (42/161) and the 1-year recurrence-free survival rate was 79.0％.On univariate analysis,recurrence history,history of instillation chemotherapy application and history of re-staging transurethral resection influenced recurrence.Multivariate regression analysis showed recurrence status was an independent prognostic factor regarding recurrence-free survival.The incidence of adverse events in all 161 instillation patients was 40.4％ (26/65).Grade 1,grade 2 and grade 3 adverse events accounted for 53.8％ (35/65),40.0％ (26/65) and 6.2％ (4/65) respectively.6 cases (3.7％) reduced the dose of BGC and 1 case stop the instillation due to the intolerance of BCG.Conclusion Short-term efficiency and safety were confirmed in BCG-treated high-risk NMIBC patients.And recurrence status was an independent prognostic factor for recurrence-free survival.

Treatment and follow-up observation of fifty-four patients with glandular cystitis / 中国医师进修杂志

Objective To evaluate the treatment effect of bladder instillation chemotherapy on glandular cystitis. Methods The clinical data of glandular cystitis of 54 cases were retrospectively analyzed, all cases were treated individually and the applications of chemotherapeutic drugs bladder instillation were not adopted. Results Follow-up period ranged from 2.5 to 9.0 years, and the average was 4.6 years. Lower urinary tract symptoms score before treatment, 3 month , 6 month, 2 years , 4 years after treatment was (8.5 ± 3.7), (5.7 ± 2.3), (3.9 ± 1.3), (4.0 ± 1.9), (4.2 ± 1.9) scores, and the scores after treatment were improved significantly compared with that before treatment (P < 0.05). Recurrence rate 3 months , 6 months, 2 years and 4 years after treatment was 3.7％(2/54), 13.0％(7/54), 5.6％(3/54) and 1.9％(1/54). Conclusions Eliminating the inducements and improvement of symptoms provides a significantly curative effect in glandular cystitis. Postoperative bladder instillation chemotherapy is not recommended.

Research progress on parameters of negative pressure wound therapy with instillation / 中华整形外科杂志

Negative pressure wound therapy with instillation (NPWTi) is used in the treatment of various types of wounds. A series of parameters related to NPWTi have not been unified yet, including flushing fluid selection, flushing mode, and rinsing fluid soaking time, negative pressure size, treatment time, etc. This paper reviews the research progress of these parameters.

A Review On Siddha External Therapy 杗asiyam (nasal Instillation)

Siddha system of medicine, one of the ancient, traditional Indian systems of medicine has unique diagnostic methods, therapeutics and treatment procedures. It has a vast range of external modalities of treatment for health management. This external management is classified into 32 types. They include minor surgical procedures and treatment procedures. These therapies are used both as mainstream and supportive therapies � both curative and prophylactic. Most of the therapies are aimed to maintain the equilibrium of the three humours (Vatham, Pitham, Kabam). Among them Nasiyam (Nasal instillation) is one of the external therapies which is a non-invasive procedure. Nasiyam is the process by which the drug is administered through nostrils. This is the treatment procedure to balance the Thirithodam in its normal level. This paper documents the efficacy of Nasiyam, methods of application, shelf life, effect of Nasiyam in treating various diseases, the list of single drug and compound drug formulations that can be used as Nasiyam, Indications and contraindications are discussed in detail. Nasiyam therapy is used to treat the diseases of vitiated Kabam such as migraine, sinusitis, bronchial asthma, nasal polyp etc.

Physicochemical And Phytochemical Evaluation Of Patola (trichosanthes Cucumerina Var. Cucumerina)

Introduction: Patola is an important plant drug used in many Ayurvedic medicinal preparations. The source plant of Patola is Trichosanthes cucumerina var. cucumerina, belonging to Cucurbitaceae family, found distributed (growing wild) throughout India especially in Bengal, Gujarat, Konkan, Deccan and Kerala. It is an extensively climbing annual herb with slightly downy or pubescent slender five angular 杅urrowed stems. It is found climbing over small trees, hedges and suitable supports. The present work is taken up with an objective to standardize Patola with detailed physical and preliminary phytochemical standards. Methods: Samples of Trichosanthes cucumerina var. cucumerina (Patola) was collected from Thellakom, Kottayam district. The plant was properly identified and authenticated by Dept of Botany, University of Kerala. The sample was shade dried and stored in an air tight container. Physicochemical, phytochemical, chromatographic and heavy metal analysis was carried out as per ICMR procedures. Result: On physicochemical evaluation water soluble extractive value was 9.07+ 0.012 and alcohol soluble extractive value was 18.72+ 0.027. Heavy metals copper, cadmium, iron and lead levels were within normal limits. HPTLC was carried out with Toluene: Ethyl acetate: Formic acid as solvent system and 3 spots were obtained. Conclusion: Patola, Trichosanthes cucumerina var. cucumerina, Phytochemicals, HPTLC, AAS.

Intraperitoneal Analgesia for Postoperative Pain Relief after Laparoscopic Surgeries

Background: Though laparoscopic surgeries is less invasive and produces less post-operative pain,post-laparoscopy pain is still a concern. Intraperitoneal (IP) instillation of local anaesthetics has been shown to minimize the postoperative pain after laparoscopic surgeries. This study was conducted to compare the efficacy of intraperitoneal instillation of dexmedetomidine with bupivcaine and bupivacaine alone in reducing postoperative pain. Methods: 60 patients, enrolled for laparoscopic surgeries were divided randomly into two groups of 30 each. Group B: Bupivacaine (30ml,0.25%) with 2 ml normal saline was instilled prior to removal of trocars, and Group BD: Bupivacaine(30ml,0.25%) withdexmedetomidine(1mcg/kg,diluted to 2 ml) was instilled under prior to removal of trocars . In postoperative period, Visual Analogue Score (VAS) was recorded up to 24 hours. Postoperative analgesic requirements, and side effects were recorded. Results: The Visual Analogue Score (VAS) during the first postoperative 24 hours was significantly lower in group BD compared to group B. Time to first of analgesia required was delayed and total analgesic consumption was lower in group BD compared to group B which was statistically significant. Conclusion: Intraperitoneal instillation of dexmedetomidine with bupivcaine is an effective and safe method for reducing pain after laparoscopic surgeries.

Systematic evaluation of pulmonary inflammation induced by fine particulate matter in a mouse model / 中国实验动物学报

Objective The aim of this study was to establish a PM2.5air pollution-induced mouse model of pulmo-nary inflammation and investigate its pathogenetic mechanism. Methods 150 specific pathogen-free BALB/c mice were subjected to intratracheal instillation of 2.5,5,or 10 mg/kg PM2.5suspension to construct airborne inflammation models. The blank group and saline group were taken as a control group. Mice were euthanized after 3rd,7th,21st,35th and 49th days to assess the pathological changes in lung tissues using HE staining and ELISA. Results The success rate of tracheal instillation was 96%. With the time prolongation and increasing doses of intratracheal PM2.5instillation,the histopathologi-cal scores of lung tissue increased gradually,showing alveolar macrophages with engulfed particles and lymphocyte accumu-lation in bronchiole and widened inter-alveolar space. The levels of BALF IL-6 and TNF-α of lung tissue homogenate were significantly increased in the high dose PM2.5(10 mg/kg)group, compared with the control groups. Conclusions A mouse model of PM2.5air pollution-induced lung inflammation is successfully established by intratracheal instillation of PM2.5suspension.This method is proved to be simple,safe and reliable,and is useful for further study of air pollution-in-duced and other inflammatory mechanisms.