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Objective:To investigate the safety and efficacy of modified Retzius-sparing robot-assisted laparoscopic radical prostatectomy for localized transitional zone prostate cancer.Methods:From May 2019 to February 2021, the clinical data of 284 patients with transitional zone(TZ) prostate cancer was retrospectively analyzed. Among them, 91 cases underwent modified Retzius-sparing robot-assisted laparoscopic radical prostatectomy(modified RS-RARP), and 193 cases underwent conventional robot-assisted laparoscopic radical prostatectomy (RARP). The Retzius space was directly entered during modified RS-RARP.The mean age of modified RS-RARP group and conventional RARP group was (67.8±9.1) years old and (69.5±8.4) years old, respectively. BMI of the two groups was (21.57±2.25)kg/m 2 and (21.8±1.8)kg/m 2 respectively; prostate volume was (31.2±13.5)ml and (29.3±12.9)ml respectively; preoperative PSA of the two groups were (10.2±6.1)ng/ml and (9.3±5.8)ng/ml respectively; and there was no significant difference in the above mentioned data( P>0.05). For Gleason score, there were 8 cases of score 6, 74 cases of score 7, 9 cases of score 8 in modified RS-RARP group and 21 cases of score 6, 153 cases of score 7, 19 cases of score 8 in conventional RARP group. For Clinical stage, there were 11 cases of T 1 stage, 80 cases of T 2 stage in modified RS-RARP group, and 20 cases of T 1 stage, 173 cases of T 2 stage in conventional RARP group. There was no significant difference in the above mentioned data( P>0.05). The operation time, intraoperative blood loss, ratio of transfusion, incidence of complication, positive rate of surgical margin and recovery of urinary continence were compared. Results:All 284 cases of surgery were completed. The operative time of modified RS-RARP was (89.2±10.1) minutes, which was significantly less than that of conventional RARP group[(100.5±12.3)min]. The intraoperative blood loss of the two groups was (245.0±50.0) ml and (250.0±50.0) ml respectively. The number of positive surgical margin was 14(15.4%) and 33(17.1%) respectively. There was no significant difference between the two groupsfor the above mentioned parameters( P>0.05). The ratio of urinary continence recovery in the modified RS-RARP group within 1 month was 49.45%, which was significantly higher than that of conventional RARP group (31.09%)( P<0.05). Conclusions:Compared with conventional RARP, modified RS-RARP might shorten the operation time and help the recovery of urinary continence for patients with TZ prostate cancer.
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Objective:Since December 2019, novel coronavirus infection has occurred in Hubei province and spread throughout the country quickly. This new crown viral pneumonia was named as coronavirus disease of 2019 (COVID-19) by WHO. However, at present, there is a high incidence of acute aortic dissection in winter and spring. How to prevent the spread of the epidemic and choose the appropriate treatment is an important topic for the patients with acute aortic dissection.Methods:From January 16, 2020 to February 26, 2020, a total of 37 of acute aortic dissection operations were carried out in several cardiovascular surgery centers in Hubei Province. There were 18 cases of Stanford type A aortic dissection and 19 cases of Stanford type B aortic dissection. There were 10 cases (55.55%) with ascending aorta replacement and 7 cases (38.89%) with Bentall procedure for aortic root surgery, and total arch replacement with stented elephant trunk implantation were performed in 14 cases (77.8%). In 19 patients with Stanford type B aortic dissection, thoracic endovascular aortic repair was performed, with the left subclavian artery chimney technique in 2 cases.Results:No deaths occurred within 30 days of hospitalization. Preoperative nucleic acid testing excluded 7 cases of novel coronavirus infection, and 3 suspected cases underwent emergency surgery. the three-level protective standard was adopted in the majority of the surgeries(62.2%, 23/37), and 11 patients were negative in the reexamination of viral nucleic acid after the operation.Conclusion:During the epidemic period, patients with acute aortic dissection should be carefully identified with actife COVID-19 before surgery. The treatment principles-" prevention and control of pneumonia epidemic should be emphasized, conservative medical management should be taken in the comfirmed cases, the selective operation should be delayed as far as possible, and the operation should be reasonable performed in critical cases" should be followed, which can save patients' lives to the greatest extent and prevent the spread of the virus.
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Objective To compare the postoperative outcomes and early continence rate between conventional robot-assisted laparoscopic radical prostatectomy (RARP) and Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RSRARP).Methods The date from 50 patients who underwent RSRARP and 122 patients who underwent conventional RARP between 2016 September to 2017 included study.Ninety-two patients (forty-six patients in RARP group and forty-six patients in RSRARP group) were collected by propensity-score matching which were performed using eight preoperative variables.Preoperative data of patients in RSRARP group [patients age (67.1 ± 5.7) years,BMI (24.6 ± 2.7) kg/m2,tPSA 10.7 ng/ml (0-40.7 ng/ml),Gleason score 7 points (6-9 points),prostate volume 31.9 ml (10.0-95.4 ml),ECOG score 0 points (0-1 points),urinary domain of EPIC 94.8 points (63.9-100 points),clinical stage from T1cN0 M0 to T3a N0 M0] and conventional RARP group [patients age (67.2 ± 6.7) years,BMI (25.2 ± 3.1) kg/m2,tPSA 10.7 ng/ml (0-40.7 ng/ml),Gleason score 7 points (6-9 points),prostate volume 36.8 ml (8.9-81.0 ml),ECOG score 0 points (0-1 points),urinary domain of EPIC 95.8 points (63.9-100.0 points),clinical stage from T1c N0Mo to T3a N0M0] had no significant differences.We reviewed console time,estimated blood loss,the rate of leakage,complications,average daily drainage,pathological result,continence,urinary domain of EPIC one month,two months and three months after operation.Results All 92 cases were successfully performed robotically.Mean operation time was significantly more in RARP group than in RSRARP group [(223.9 ±48.9) min vs.(198.91 ±34.2)min,P ＜ 0.05)].There was no significant difference between the postoperative data of patients in RSRARP group [estimated blood loss 200 ml (50-1 200 ml),average daily drainage 82.5 ml (11.7-571.0 ml),the rate of leakage 6％,Clavien-Dindo grade Ⅰ (9％),Clavien-Dindo grade Ⅱ (4％),pathological stage pT1 (2％),pT2 (52％),pT3 (46％)] and RARP group [estimated blood loss 200 ml (100-1 200 ml),average daily drainage 102.9 ml (23.3-534.7 ml),the rate of leakage 4％,Clavien-Dindo grade Ⅰ (9％),Clavien-Dindo grade Ⅱ (2％),pathological stage pT1 (0),pT2 (46％),pT3 (54％)] (P ＞ 0.05).Early continence rate one week and one month after surgery was significantly higher in RSRARP group than in RARP group (78％ vs.35％,91％ vs.79％,P＜0.05).Urinary domain of EPIC one month and two months after surgery was significantly more in RSRARP group than in RARP group [(91.4±8.3) vs.(84.6±10.9),(95.0±7.5) vs.(91.6±7.8),P＜0.05].There was no significant difference in the rate of positive surgical margin between RSRARP group and RARP group (22％ vs.17％,P ＞ 0.05).Conclusions RSRARP were time-saving,safe and effective for the surgical treatment of localized prostate cancer.It seemed to yield a better outcome regarding early return to urinary continence postoperatively.
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Objective To assess the value of free-hand transperineal multiparametric nagnetic resonance imaging/transrectal ultrasound (mpMRI/TRUS) fusion-guided targeted biopsy (TB) for the diagnosis of prostate cancer(PCa).Methods Patients with elevated PSA level and/or an abnormal DRE finding were recruited prospectively between January 2015 and September 2016.Patients were classified to various scores from 2 to 5 according to prebiopsy mpMRI PI-RADS.Based on free-hand transperineal mpMRI/TRUS fusion-guiding,a 2-cores TB for each cancer-suspicious lesion were carried out and followed 12-cores systematic biopsy (SB) protocol.Pathological findings of biopsy and radical prostatectomy (RP) specimens were analyzed.Results A total of 397 patients were enrolled in this study.The median age of the patients was (68.2 ± 7.4) years old,ranging 42-78 years.The median PSA level was (15.0 ±12.4)ng/ml,ranging 3.0-88.3 ng/ml.DRE showed abnormality in 28 patients(7.1％).The median prostate volume was (41.6 ± 16.4)cm3,ranging 24.6-89.8 cm3.The PCa detection rate of TB was significantly increased compared with SB (44.8 ％ vs.34.8％) (P =0.003),especially in clinically significant PCa (P ＜ 0.001) and intermediate/high-risk PCa (P =0.003),respectively.Of the all 588 mpMRI targeted lesions,277 lesions were positive.A total of 105 index tumors were identified in RP specimens,the locations of TB-proven cancer showed 96.6％ (85/88) in correspondence with the location of the index lesion in RP specimens.Conclusions Free-hand transperineal mpMRI/TRUS fusion-guided TB providing greater detection of intermediate-high risk PCa while limits over detection of low risk PCa.Moreover,TB can reliably predict the location of an index tumor.
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Sepsis is a severe systemic inflammatory response mostly caused by gram-negative bacterial infections. The rates of mortality in sepsis patients remain high. To date little is known about whether exogenous carbon monoxide can directly or indirectly inhibit or even kill gram negative bacteria. In our study, we demonstrate a critical role of CO-releasing molecules in the suppressive effects on bacterial vitality and toxicity. We found the bacterial growth and colony forming were markedly suppressed in the presence of CORM-2 with significant cell damage, decreased or disappeared pili and flagella. In contrast, qRT-PCR showed the expression of fliA was downregulated, while dnaK and waaQ were upregulated in E. coli+CORM-2. Subsequent in vivo experiments showed the mouse survival in the CORM- 2 intervened-E.coli injection tended to improve with 60%-100% survival rates, and colony distribution in major organs were significantly decreased with attenuated histological damage. In parallel, cytokine levels and myeloperoxidase accumulation in livers and lungs decreased significantly compared with E. coli group. These data provide the first evidence and a potential strategy that exogenous carbon monoxide can significantly suppress bacterial vitality and toxicity. This may be associated with the regulatory functions of CORM-2 on the expression of essential genes [fliA, dnaK and waaQ] in E. coli
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Objective To investigate C‐reactive protein in patients with acute brain injury (CRP) ,platelet (PLT) dynamic chan‐ges and clinical significance .Methods A hospital in 2014-2015 120 cases of acute brain injury ,depending on whether surgery di‐vided into :64 cases of surgical group ,56 cases of non‐surgical group .According to Glasgow Outcome Scale (Glasgow Outcome Score ,GOS) divided into 61 cases of poor prognosis group (GOS 1 -3 scores) ,59 patients with good prognosis (GOS 4 -5 scores) .Another choice the same period 50 cases of healthy control group .After the patients were injured 1 d ,3 d ,7 d dynamic tes‐ting CRP ,PLT levels .Results The surgical group and the non‐surgical group patients after injury 1 d serum CRP levels were sig‐nificantly increased ,decreased gradually after all ,the two groups showed a downward trend ,but the surgery group were decreased slowly ,always maintain a high level ,still significantly at 14 d the control group (P<0 .05) .Patients with non‐surgical group de‐creased significantly ,significantly higher than the decline in the extent of the surgery group (P<0 .05) .Surgical and non‐surgical group patients after injury when PLT 1 d showed no increased after 3d began to rise ,increased significantly when 7 d ,PLT levels were elevated degree of surgical group was significantly higher than the non‐surgical group (P<0 .05) .Good prognosis group and a poor prognosis group ,serum CRP on admission were increased ,and reached a peak after 1 d ,after declining in both groups ,with good prognosis group decreased significantly ,while the poor prognosis group ,no significant decline in CRP levels ,continued high levels of state for a long time When postoperative 7d still significantly higher than the normal level (P<0 .05) .At each time point the poor prognosis group ,serum CRP levels were significantly higher than the good prognosis group (P< 0 .05) .When the good prognosis group and a poor prognosis group was mean change 1d PLT little water ,began to increase after the 3 d were poor progno‐sis group of patients was significantly higher than 7 d PLT good prognosis group (P<0 .05) .Conclusion Patients with acute brain injury CRP ,PLT dynamic changes are certain rules ,is to determine the acute phase of the disease of brain injury and prognosis of change .
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Objective To compare the results of mitral valve reconstruction and replacement as treatments for moderate to severe ischemic mitral regurgitation(IMR), and report the mid-term outcome. Methods From June 2002 to May 2008, 83 pa-tients with moderate IMR(35 cases) and severe IMR (48 cases) underwent coronary artery bypass grafting(CABG) combined with mitral valvuloplasty (MVP) (n = 43) or mitral valve replacement (MVR) (n = 40). There were 49 males and 34 females with a mean age of (59.3±7.5) years(51 -77years). The procedures of MVP included annuloplasty with a Dacron or autologous per-icardium ring in 21cases, commissural annuloplasty in 9, quadrangular resection of the posterior leaflet in 9 and using St. Jude mitral annuloplasty ring in 4. In the cases underwent MVR, 28 patients received mechanical prostheses and 12 received biopros-theses. Results 30-day mortality rate was 2.3% for MVP and 5.0% for MVR (P >0.05). The 30-day complication rate was similar for the 2 groups but mechanical ventilation time was longer for MVR patients. Mild MR ocurred in 6 patients with MVP (P <0.05). Sevonty-six patients were followed by outpatient department visit or telephone for (20.2 ± 4.9) months (3 - 60 months). During the follow-up period, 7 patients with MVP had mild insufficiency but free off etber complications. All the valve prothesis functioned well. However, 3 cases had thromboembolic complications and 7 late deaths were recorded in MVR group. Five-year complication-free survival rate was 90% for MVP group and 61% for MVR. Conclusion MVP resulted in excellent durability and provided significant mid-term survival benefit over MVR. MVP should be the first choice for patients with chronic IMR.
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BACKGROUND: Previous studies demonstrated that smooth muscle injury or ischemia/reperfusion injury result in tissue factor (TF) increasing. However, few reports concern the expression and mechanism of TF in venous bypass grafting.OBJECTIVE: To examine changes in TF protein expression in response to venous bypass grafting.DESIGN, TIME AND SETTING: The animal observation experiment was performed at the Department of Cardiovascular Surgery, Affiliated Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from May 2006 to May 2008.MATERIALS: A total of 30 Sprague-Dawley (SD) rats.METHODS: Rats were underwent interposition bypass grafting of the common carotid artery via the ipsilateral external jugular vein. Namely, the proximal end of external jugular vein was ligated at the joints of external jugular vein and internal jugular vein, and the distal end of external jugular vein was ligated before branches. The proximal and distal ends of common carotid artery were occluded by artery clamp, and a 5 mm artery was removed. The proximal end of artery was anastomosed with distal end of artery, and the frontal wall was sutured with posterior wall. After that, the proximal end of external jugular vein was cut down and coincided with the distal end of common carotid artery.MAIN OUTCOME MEASURES: The expression of TF and proliferating cell nuclear antigen (PCNA) was detected by immunohistochemistry. Meantime, TF activity in vessel protein extracts was determined with TF activity assay kit, and the thickness of intima, media were calculated by computer imaging analysis system. The contralateral external jugular veins were served as the control.RESULTS: The adventitia of all vessels showed abundant TF staining. In early vein grafts, TF staining was markedly increased in the intima and media. However, intimal and media TF staining was absent in the contralateral control jugular veins and late vein grafts. The number of PCNA positive cells was increased in the vein grafts at day 3 after grafting, obvious increased at day 7, and reached the peak at day 14. TF activity in whole-vessel protein extracts was similar in control veins and early and late vein grafts. The thickness of neointima of the vein graft increased significantly at days 7, 14, and 28, and the thickness of media increased significantly at days 14 and 28.CONCLUSION: The changes of TF expression at various time points may relate to hyperplasia of neointima.
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Computer-based online research was performed in Pubmed Database from January 1995 to January 2008, China National Knowledge Infrastructure (CNKI) and Vip Database from January 2001 to January 2008. Forty-four publications referred to the seeding cell sources of tissue engineering heart valve demonstrated some disadvantages of clinically used mechanical prosthetic valve and biological valve. Tissue-engineered heart valve had advantages, such as no anticoagulant therapy, infection resistance, cellular viability and the potential to grow and to repair. Seeding cells have different sources, such as blood vessels, bone marrow, blood, umbilical cord, chorionic vesicle and embryonic stem cells, with particular regard to cell phenotypes and their suitability for extracellular matrix production for tissue engineering purposes. Despite an exciting potential for tissue-engineered heart valves, significant technical barriers and clinical problems must be solved and overcome. Further studies should be conducted before widespread clinical application can be envisioned, such as biodegradable polymers, stem cell differentiation, understanding how to harvest the potential of endogenous recruitment of cells and techniques to non-invasively assess the speed and quality of tissue healing and remodeling. This needs to engender a host of novel testing strategies and methods, which will include in vivo safety studies and preclinical studies.