Pelvic Injury Discriminative Model Based on Data Mining Algorithm / 法医学杂志

OBJECTIVES@#To reduce the dimension of characteristic information extracted from pelvic CT images by using principal component analysis (PCA) and partial least squares (PLS) methods. To establish a support vector machine (SVM) classification and identification model to identify if there is pelvic injury by the reduced dimension data and evaluate the feasibility of its application.@*METHODS@#Eighty percent of 146 normal and injured pelvic CT images were randomly selected as training set for model fitting, and the remaining 20% was used as testing set to verify the accuracy of the test, respectively. Through CT image input, preprocessing, feature extraction, feature information dimension reduction, feature selection, parameter selection, model establishment and model comparison, a discriminative model of pelvic injury was established.@*RESULTS@#The PLS dimension reduction method was better than the PCA method and the SVM model was better than the naive Bayesian classifier (NBC) model. The accuracy of the modeling set, leave-one-out cross validation and testing set of the SVM classification model based on 12 PLS factors was 100%, 100% and 93.33%, respectively.@*CONCLUSIONS@#In the evaluation of pelvic injury, the pelvic injury data mining model based on CT images reaches high accuracy, which lays a foundation for automatic and rapid identification of pelvic injuries.

Application of nocturnal penile tumescence test in the diagnosis of erectile dysfunction / 中华男科学杂志

ED is a common male disease, often caused by neurological, vascular or psychological factors, and the diagnostic methods for ED vary widely. The nocturnal penile tumescence test (NPT) by RigiScan is an objective assessment method used mainly to detect ED and has gained a wide clinical application in recent years. This review focuses on the application value of the six RigiScan parameters in the diagnosis of ED, namely, the number of erections, total erection time, event rigidity of tip/base, event tumescence of tip/base, tumescence activated unit and rigidity activated unit, aiming to provide some help to clinicians and researchers with the application of NPT.

Adding a vacuum erection device to regular use of Tadalafil improves penile rehabilitation after posterior urethroplasty / 亚洲男科学杂志(英文版)

This study aimed to evaluate whether adding a vacuum erection device (VED) to regular use of Tadalafil could achieve better penile rehabilitation following posterior urethroplasty for pelvic fracture-related urethral injury (PFUI). Altogether, 78 PFUI patients with erectile dysfunction (ED) after primary posterior urethroplasty were enrolled and divided into two treatment groups: VED combined with Tadalafil (Group 1, n = 36) and Tadalafil only (Group 2, n = 42). Changes in penile length, testosterone level, International Index of Erectile Function-5 (IIEF-5) questionnaire, Quality of Erection Questionnaire (QEQ), and nocturnal penile tumescence (NPT) testing were used to assess erectile function before and after 6 months of ED treatment. Results showed that the addition of VED to regular use of Tadalafil preserved more penile length statistically (0.4 ± 0.9 vs -0.8 ± 0.7 cm, P < 0.01). IIEF-5 score and QEQ score in Group 1 were higher than Group 2 (both P < 0.05). After treatment, 21/36 (58.3%) Group 1 patients and 19/42 (45.2%) Group 2 patients could complete vaginal penetration. Group 1 patients also had markedly improved testosterone levels (P = 0.01). Unexpectedly, there was no significant difference in NPT testing between two therapies. For PFUI patients with ED after posterior urethroplasty, the addition of VED to regular use of Tadalafil could significantly improve their conditions - improving erection and increasing penile length - thus increasing patient satisfaction and confidence in penile rehabilitation.

Continued sustained release of VEGF by PLGA nanospheres modified BAMG stent for the anterior urethral reconstruction of rabbit

OBJECTIVE@#To study the biocompatibility and neovascularization of the PLGA nanospheres wrapped with vascular endothelial growth factor (VEGF), which can improve bladder acellular matrix graft (BAMG) with local continuous release of VEGF.@*METHODS@#A total of 18 rabbit model (length of stenosis: 3 cm) with anterior urethral stricture were used as experimental animals and divided into three groups. Group A as the control group: Simple BAMG scaffold materials for urethral reconstruction. Group B as the blank group: PLGA microspheres modified BAMG for urethral reconstruction. Group C: PLGA conjugated with VEGF and modified BAMG for the urethral reconstruction. All rabbits underwent urethral angiography after 7 days, 15 days, 1 month and 3 months after the operation, and one rabbit in each group was sacrificed to be prepared for the organization histologic examination, HE staining, masson staining, CD31, 34 and a-SAM immunohistochemical detection in the repaired sites.@*RESULTS@#In group A, significant urethral restenosis occurred in two rabbits after 15 days of the operation, HE and masson staining showed a lot of collagen arranged in the repaired sites, and there were a large number of inflammatory cell infiltration, and there were also CD31, 34 in the repaired sites. a-SAM microvascular tag count showed a small amount of microvascular; Group B showed anastomotic restenosis, HE and masoon staining showed inflammatory cell infiltration and collagen deposition; Group C: urethrography showed lumen patency. There were a small amount of inflammatory cell infiltration after 7 and 15 days after the operation, and there were also CD31, 34 in the repaired sites. The a-SAM microvascular tag count showed many microvascular. And the difference was significant.@*CONCLUSIONS@#Anterior urethral reconstruction with sustained-release of VEGF by PLGA nanospheres modified BAMG stents can reduce postoperative restenosis. It can also reduce collagen deposition and scar formation, promote angiogenesis of the repair tissue; therefore it in valuable in the tissue-engineered urethral reconstruction.

Stem cell therapy for erectile dysfunction / 中华男科学杂志

Erectile dysfunction (ED), as a pathological phenomenon, refers to repeated or sustained difficulty to achieve and maintain sufficient penile erection to complete satisfactory sexual intercourse or sexual activity in male. The erectile reflex interruption induced by cavernous nerve (CN) damage is a direct cause of ED. In addition, the apoptosis of smooth muscle cells and endothelial cells in the corpus cavernosum caused by CN injury, along with the reduction of corpus cavernosum smooth muscle fibers, can increase the incidence of ED. Therefore, early intervention of the pathological process of CN injury and promotion of CN regeneration are essential for the treatment of ED. In recent years, the stem cell therapy for ED has become a focus in clinical research. This article offers an overview on the application of embryonic stem cells, mesenchymal stem cells, muscle-derived stem cells, and adipose stem cells in the treatment of ED.

Restoration of erectile function by reconstructing cavernous nerves with small intestinal submucosa grafts / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the restoration of erectile function by reconstructing cavernous nerves (CN) with small intestinal submucosa (SIS) grafts.</p><p><b>METHODS</b>We prepared SIS grafts, established rat models and divided the models into a CN ablation, a sham-operation and an SIS graft group. The CNs at both sides were severed with 1 cm ablated in the first group, and 0.5 cm removed in the third, followed by reconstruction with the SIS grafts. Three months after surgery, the apomorphine test was performed to evaluate the erectile function, and then all the rats were sacrificed to detect the expression of nNOS in the penis.</p><p><b>RESULTS</b>Penile erection was observed in 72.73% (8/11) of the rats for (1.07 +/- 0.89) times within 30 min in the SIS graft group, as compared with 0% (0/11) of the rats for (0.00 +/- 0.00) times in the CN ablation group (P < 0.01), and 90.91% (10/11) of the rats for (2.19 +/- 1.17) times in the sham-operation group (P < 0.01). The number of nNOS nerve fibers was significantly larger in the SIS graft than in the CN ablation group (70.36 +/- 10.09 versus 22.09 +/- 4.76, P < 0.01), but both were significantly smaller than that of the sham-operation group (90.81 +/- 5.69, P < 0.01).</p><p><b>CONCLUSION</b>The SIS grafting technique contributes to the recanalization of the severed CN and restoration of erectile function in rats after surgical injury.</p>

Treatment of urethral strictures using lingual mucosas urethroplasty: experience of 92 cases / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Urethroplasty of complex urethral stricture is a difficult procedure, and there is no widely accepted standard approach described in the published literature. We evaluated the efficacy and safety of urethroplasty using lingual mucosa grafts (LMGs) for the repair of urethral strictures.</p><p><b>METHODS</b>Between August 2006 and April 2009, 92 cases of urethral strictures (length ranging from 2.5 cm to 18 cm, mean 6.5 cm) were treated using LMGs. Of the 92 patients, 38 with long-segment urethral strictures (9 - 18 cm) underwent dual LMG or LMG combined with foreskin flap or buccal mucosal graft urethroplasty.</p><p><b>RESULTS</b>Follow-up was obtained for 3 - 33 months (mean 17.2 months) postoperatively. Complications occurred in 8 patients, including urinary fistulas in 4 patients; recurrent strictures developed in 4 patients at 3 - 4 months post-operatively. The remaining patients voided well postoperatively, with peak flows between 14.3 ml/s and 54.6 ml/s (mean 28.4 ml/s).</p><p><b>CONCLUSIONS</b>The tongue is an excellent source of graft material for the repair of anterior mucosal strictures. Dual LMG substitution urethroplasty can successfully treat longer, more complex urethral strictures.</p>

Reinforcing the continent mechanism of continent cutaneous diversions by wrapped rectus abdominis muscle flap: a preliminary experimental study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Continent cutaneous diversion (CCD) has been widely used in almost any lower urinary reconstruction. We have been continually trying to modify this procedure because of the high complications rate, especially as they relate to the efferent tube. In this study, we reported a modified procedure with a tapered ileum wrapped by the rectus abdominalis flap (RAMF) and assessed the feasibility of this new technique to achieve urinary continence.</p><p><b>METHODS</b>A procedure in which two ileal segments were tapered and connected to a U-shaped reservoir was performed in ten dogs. A RAMF with its blood supply was wrapped around one of the tapered ileum. In control groups, the tapered ileum was brought to the abdominal skin. Urodynamic studies were conducted In the 1st, 3rd and 6th months post-operatively. The data of maximum inner pressure (MIP) and functional pressure length (FPL) in every group at each phase were recorded. Retrograde radiograms of the efferent limbs were performed before sacrifice.</p><p><b>RESULTS</b>MIP in the study group was significantly higher than that in the control group at each phase (P < 0.05). However, no significant differences in MIP or FPL were found in the study group between an empty and full reservoir. In the control group, MIP increased (P < 0.05) and FPL decreased significantly (P < 0.05) compared with an empty and full reservoir. Retrograde radiograms confirmed that efferent limbs were positioned straigh beneath the abdominal wall. Histological examination of the study group demonstrated a layer of striated muscle around the outside surface of the ileum.</p><p><b>CONCLUSION</b>The continent mechanism of tapered ileum can be enhanced by extra support from wrapped RAMF.</p>

Expression of Omi/HtrA2 UP-regulated in the spermatozoa of chronic bacterial prostatitis patients / 中华男科学杂志

<p><b>OBJECTIVE</b>To determine the expression of Omi/HtrA2 in the spermatozoa of chronic bacterial prostatitis patients and explore the potential mechanism of chronic prostatitis inducing male infertility.</p><p><b>METHODS</b>Forty-one patients diagnosed as suffering from chronic prostatitis were included, and so were 12 healthy normal men as controls. Spermatozoa in the semen were purified by Percoll gradient technique to separate the seminal plasma and other round cells. Sperm concentration, motility, morphology, pro-inflammatory cytokines, Omi/HtrA2 mRNA and protein levels in the spermatozoa of the patients were measured.</p><p><b>RESULTS</b>Significantly increased levels of pro-inflammatory cytokines were observed in the seminal plasma of the prostatitis patients, and so were Omi/HtrA2 mRNA and protein levels as compared with the normal men.</p><p><b>CONCLUSION</b>Chronic prostatitis patients presented important alterations in semen quality parameters and up-regulated expression of Omi/HtrA2 mRNA and proteins in the spermatozoa.</p>

Reconstruction of penile function with tissue engineering techniques / 中华男科学杂志

Tissue engineering techniques, with their potential applied value for penile reconstruction, are of special interest for andrologists. The purpose of this review is to appraise the recent development and publications in this field. In the past few years, great efforts have been made to develop corpus cavernosum tissues by combining smooth muscle and endothelial cells seeded on biodegradable polyglycolic acid polymer (PGA) or acellular corporal collagen matrices scaffolds. Animal experiment demonstrated that the engineered corpus cavernosum achieved adequate structural and functional parameters. Engineered cartilage rods as an alternative for the current clinical standard of semirigid or inflatable penile implants could be created by seeding chondrocyte cylindrical PGA. A series of studies showed that, compared to commercially available silicone implants, the engineered rods were flexible, elastic and stable. Besides, a variety of decellularized biological materials have been used as grafts not only for substitution of tunica albuginea but also for penile enhancement, with promising results. For treating erectile dysfunction, a new approach to recovering erectile function by cell-based therapy could be the injection of functional cells into corpus cavernosum, which seemed to be promising when combined with cell manipulation by gene therapy prior to cell transfer.

Coculture of rat oral keratinocytes with inactive 3T3 fibroblasts / 上海第二医科大学学报

Objective To explore the cultural method of oral keratinocytes and make preparations for further investigation in using oral keratinocytes as a new choice of seed cells for the reconstruction of tissue-engineered urethra. Methods Oral keratinocytes of rabbits were isolated in vitro and seeded onto a culture dish with a feeder layer of 3T3 mouse fibroblasts inhibited by mitomycin(i3T3) or a culture dish without i3T3 respectively. Cell morphology was observed and cell growth was detected at intervals.Meanwhile,oral keratinocytes obtained from in vitro culture were performed immunofluorescence staining with broad-spectrum keratin antibody(AE1/AE3) and keratin 19 antibody(K19).The percentage of positive cells of passage 2 reactive to AE1/AE3 was assessed by flow cytometry. ResultsOral keratinocytes seeded onto a feeder layer of i3T3 exhibited finer morphous,better amplification capability,and could be passed for 7 or 8 generations.However,those cultured without i3T3 took on various morphous and could only be subcultured 2 generations before ageing.It was indicated by immunofluorescence staining that oral keratinocytes obtained from in vitro culture were positive for AE1/AE3 staining and 40% were positive for K19 staining.The result of flow cytometry revealed that the amout of positive keratinocytes reactive to AE1/AE3 was more than 95% of total cellular score. Conclusion Oral keratinocytes of rabbits can be cocultured with i3T3 in vitro and magnitude quantity can be attained,laying a favourable foundation for oral keratinocytes as a new choice of seed cells for urethral reconstruction with tissue engineering.

Cavernous nerve reconstruction to restore erectile function following radical prostatectomy / 中华男科学杂志

Recent years have seen an increasing incidence of prostate cancer (PCa) and a more frequent occurrence of the disease in younger men. Damage to cavernous nerves caused by radical prostatectomy is the main reason for post-operative erectile dysfunction. So reconstruction of cavernous nerves at the time of radical prostatectomy may restore the patient's erectile function. At present, clinical studies of using autologous sural nerve grafts to bridge transected cavernous nerves have achieved modest success, and laparoscopic sural nerve grafting during radical prostatectomy has also been proved safe and feasible. Besides, various grafts have been used to reconstruct cavernous nerves in animal models, among which biodegradable conduits containing growth-promoting factors or cells are a promising option for the repair of damaged cavernous nerves.