Value of cognitive fusion targeted and standard systematic transrectal prostate biopsy for prostate cancer diagnosis.

ABSTRACT: The aim of this study was to compare the accuracies of cognitive fusion-guided targeted biopsy (TB), systematic biopsy (SB), and combined TB+SB for the detection of prostate cancer (PCa) and clinically significant PCa (csPCa) in males with lesions detected by magnetic resonance imaging (MRI). We conducted a retrospective analysis of individuals who underwent prostate biopsy at Peking University People's Hospital (Beijing, China), with an emphasis on patients with both transrectal TB and SB. The main objective was to determine the precisions of SB, TB, and TB+SB for diagnosing PCa and csPCa. We also evaluated the detection rates of TB, SB, TB+ipsilateral-SB (ipsi-SB), TB+contralateral-SB (contra-SB), and TB+SB for PCa and csPCa in patients with unilateral MRI lesions. We compared the diagnostic yields of the various biopsy schemes using the McNemar's test. A total of 180 patients were enrolled. The rates of PCa detection using TB, SB, and TB+SB were 52.8%, 62.2%, and 66.7%, respectively, and the corresponding rates for csPCa were 46.1%, 56.7%, and 58.3%, respectively. Among patients with unilateral MRI lesions, the PCa detection rates for TB, SB, TB+ipsi-SB, TB+contra-SB, and TB+SB were 53.3%, 64.8%, 65.6%, 61.5%, and 68.0%, respectively. TB+ipsi-SB detected 96.4% of PCa and 95.9% of csPCa cases. These findings suggest that the combination of TB+SB has better diagnostic accuracy compared with SB or TB alone. For patients with unilateral MRI lesions, the combination of TB+ipsi-SB may be suitable in clinical settings.

Bioinspired Ultra Tear-Resistant Elastomer with a Slidable Double-Network Structure.

Tear resistance is of vital importance in the fabrication and application of synthetic soft materials. However, the paradox of simultaneously improving the tearing energy and elasticity remains a huge challenge for conventional approaches. Here, inspired by the skin, we successfully constructed an extraordinary tear-resistant, superelastic elastomer by the introduction of nanosized polycyclodextrin into the elastomer network to form a slidable interpenetrate double network structure. The tearing energy of the SDEP elastomer is up to 274 KJ/m2, which is comparable to metals and alloys and increased more than 100 times compared with the chemically cross-linked elastomer. The fracture strain exceeded 3300%, which is hardly achieved by other materials with high tearing energy. This comprehensive improvement of antitearing and super elasticity property was achieved by (i) a slide ring effect to dissipate energy and blunt a crack tip; (ii) straightening and reorientation of the slidable double network to deflect the advancing of a crack tip; (iii) a double network sharing the load. These results provide a novel strategy to fabricate elastic, tear-resistant soft material, which may contribute to the practical application as tear-resistant flexible electronics and irregular-shaped stretchable devices.

Development and Initial Validation of the Novel Scale for Assessing Quality of Life of Prostate Cancer Patients Receiving Androgen Deprivation Therapy.

BACKGROUND: There has been no a specific scale to measure quality of life (QOL) for prostate cancer patients receiving androgen deprivation therapy (ADT) to date. This study aimed to develop and initially validate the scale to evaluate QOL for prostate cancer patients receiving ADT. METHODS: The scale was developed following international recommendations. Moreover, the items were all generated through literature review and referenced questionnaires. After being reviewed by expert panelists, the revised scale was formed and then completed by a convenience sample of 200 prostate cancer patients from our hospital. Explore factor analysis (EFA) was applied to test the construct validity, then split-half reliability, Cronbach's alpha, and test-retest reliability were applied to assess the reliability and stability of the scale. RESULTS: The revised scale contained 22 items and a total of 200 participants had completed the scale. One hundred participants were randomly selected from the total 200 participants to perform EFA with varimax rotation on the revised scale, and "hot flashes" item was deleted for low factor loading. We selected only 3 items from each factor, then, the final scale was formed with 18-items. We selected another 100 participants to perform the EFA again on the final scale. It was demonstrated that the structure with 6 factors explained 72.5% of total variance and factor loading value was above 0.40 in all items of the factors. Moreover, the split-half reliability coefficient, Cronbach's alpha, and test-retest reliability coefficient were calculated to be 0.74, 0.63, and 0.89, respectively, exhibiting good reliability on the whole. CONCLUSIONS: The scale was identified to be a valid and reliable instrument to measure QOL for prostate cancer patients receiving ADT. Moreover, further research is needed to overcome the potential drawbacks.

[Treatment of upper urinary calculi through novel modular flexible ureteroscope: a report of 36 cases].

OBJECTIVE: To evaluate the feasibility and efficacy of novel modular flexible ureteroscope in the treatment of upper urinary calculi. METHODS: From Nov. 2013 to Jul. 2014, 36 cases of upper urinary calculi were treated with holmium laser lithotripsy through novel modular flexible ureteroscope. The clinical data including the location and diameter of the calculi, time of operation, stone-free rate, complications and hospital stay after operation were analyzed retrospectively. RESULTS: The operation was performed successfully in 34 cases, the average time of operation was 108.5 min (70-145 min), the post-operation hospital stay was 2-5 d (average 2.3 d), and the stone-free rate was 83.33%. No serious complications occurred except postoperative fever in 2 cases and haemorrhage in 1 case. CONCLUSION: The novel modular flexible ureteroscope is a safe and effective medical instrumentation for treatment of upper urinary calculi.

[Clinical characteristics of IgG4 related retroperitoneal fibrosis: a report of 5 cases and literature review].

OBJECTIVE: To explore the clinical characteristics, treatment and prognosis of IgG4-related retroperitoneal fibrosis (RPF). METHODS: All the patients diagnosed as RPF in Peking University People's Hospital between February 2008 and October 2014 were included. Among them, 5 patients were identified as IgG4 related RPF. We analyzed their medical records and summarized the clinical, laboratory, and imaging features of IgG4 related RPF, which had taken the recent literature into account. RESULTS: All the 5 patients were male, with the average age 62.2 years (55-67 years). They mainly complained of abdominal pain, flank pain and weight loss, two of whom had concurrent antoimmune pancreatitis. Renal insufficiency was present in 3 patients (3/5). Four patients (4/4) showed increased erythrocyte sedimentation rate (ESR), while 3 patients (3/4) had higher serum C-reactive protein (CRP) and IgG. In addition, 4 patients (4/4) had significantly elevated serum IgG4 level. On computed tomography (CT) imaging, 5 patients showed retroperitoneal mass which surrounded the abdominal aorta and the iliac arteries, and even enveloped the ureters and the inferior vena cava. Only one patient received tissue pathological examination, which indicated the numbers of IgG4-positive plasma cells per high power field>10 and a ratio of IgG4-positive cells to all IgG-bearing cells>40%. One patient received simple surgical intervention, and 1 patient received medical treatment alone, while the remaining 3 patients received combined treatment of surgery and medications. follow-up was available for the 4 patients, all of whom had good prognosis. CONCLUSION: Part of RPF was actually IgG4-related, which was also nominated as IgG4 related RPF. It was a rare disease with unknown etiology, characterized by the elevated serum IgG4 concentration (≥1.35 g/L), with marked tissue infiltration by lymphocytes and IgG4-positive plasma cells with fibrosis, in addition to the presence of retroperitoneal mass. Glucocorticoids were the first-line therapy and IgG4 related RPF had a favourable prognosis.

[Pathogenesis and therapy of hydronephrosis after hematopoietic stem cell transplantation].

OBJECTIVE: To investigate the pathogenesis and therapy of hydronephrosis after hematopoietic stem cell transplantation (HSCT). METHODS: From March 2004 to March 2014, 23 patients with hydronephrosis after HSCT were identified. With these data, the pathogenesis of hydronephrosis after HSCT were analyzed. According to the surgical intervention of hydronephrosis and ureteral dialation of ureteral stricture, the patients were divided into two groups, rank-sum test and exact probability test were used to evaluate whether there were significant differences in the time of hemorrhagic cystitis (HC) occurred, ureteritis and viremia. RESULTS: HC, ureteritis, ureteral stenosis were all the causes of hydronephrosis after HSCT. In this study, 69.6% (16/23) of the patients suffered from HSCT were cured by conservative treatment, 30.4% (7/23) by surgical intervention, and 13.0% (3/23) by insertion DJ stent or nephrostomy.Of the patients [17.4% (4/23)] who suffered ureteral stenosis, 2 were cured after the balloon dialation of ureter, 1 needed DJ tube long-term insertion, and 1 was still followed-up. rank-sum test and exact probability test results showed that the patients who needed surgical intervention might suffer from HC later than other patients, and their incidences of viremia and ureteritis were higher, but the differences between the two groups were not statistically significant (P = 0.524, P = 0.169, and P = 0.124, respectively). The results also showed that the ureteritis incidences of the patients who suffered from ureteral stricture and needed ureteral dialation were higher than that of the other patients, and the difference between the two groups was statistically significant (P = 0.024). The patients who needed ureteral dialation suffered from HC later and their incidences of viremia was higher, but the differences between the two groups were not statistically significant (P = 0.73 and P = 0.27). CONCLUSION: HC, ureteritis and ureteral stenosis may cause hydronephrosis after HSCT. Patients may treated by conservative treatment first. Patients who suffered from HC later, viremia and especially ureteritis should be paid more attention to, and be treated with surgical intervention when necessary. The patients with ureteral stenosis could be treated by ureteral balloon dialation.

[Percutaneous renal puncture guide by a novel real-time needle-tracking ultrasound system for percutaneous nephrolithotomy: analysis of 16 cases].

OBJECTIVE: To evaluate the feasibility and efficacy of percutaneous renal puncture in percutaneous nephrolithotomy guided by novel needle-tracking ultrasound system. METHODS: From may to october 2013, 16 cases of percutaneous nephrolithotomy were performed under the guidance of ultrasound system. The clinical data including the time of completing percutaneous renal puncture, the color of urine sucked out from the kidney calices, and the complications were analyzed retrospectively. RESULTS: Of the 16 patients, 18 percutaneous renal access were established guided by ultrasound system. All of them were successtul for the first time, and the average time of completing percutaneous renal punctures was (26.90 ± 11.37) s (15 to 54 s). After the operation, the hemoglobin decreased by (9.56 ± 5.27)%(1.41% to 24.06%), and no complications occurred except for postoperative fever in 2 case. CONCLUSION: The novel ultrasound system is a safe and effective technique that can reduce the technical difficulty of percutaneous renal puncture in percutaneous nephrolithotomy.

Metabolic syndrome and androgen deprivation therapy in metabolic complications of prostate cancer patients.

BACKGROUND: Incidence of prostate cancer in Chinese males grows significantly in the past decades. Androgen deprivation therapy has been generally employed in the treatment of locally advanced and metastatic prostate cancer for many years, yet only little data was known about the metabolic syndrome in patients receiving hormonal therapy. This study described the prevalence and the changing trends of hormone-related metabolic complications, and analyzed their correlation with different therapies. METHODS: In 125 patients treated with castration or maximal androgen blockage for at least 12 months, metabolic indicators were analyzed. RESULTS: Totally, 13.5% patients in castration group and 30.1% patients in maximal androgen blockage group were diagnosed metabolic syndrome 12 months after the beginning of treatments (χ(2) = 4.739, P = 0.029). In castration group, increased triglyceride and decreased high-density lipoprotein-cholesterol were significant at the month 12, increased fasting plasma glucose and blood pressure were significant at the month 4. In maximal androgen blockage group, increased triglyceride and decreased high-density lipoprotein-cholesterol were significant at the month 4, increased fasting plasma glucose and blood pressure were significant at the month 8. Total testosterone and free testosterone in maximal androgen blockage group were significantly lower than castration group at all visits, which were proved to show positive or negative correlations with metabolic indications. Severity of metabolic complications in maximal androgen blockage group was generally more serious than people received castration, with significantly statistical difference or not. Trends of high-density lipoprotein-cholesterol and fasting plasma glucose were significant different between two kinds of therapy (P = 0.005, P = 0.019, respectively). CONCLUSIONS: Prostate cancer patients receiving androgen deprivation therapy were at high risk of suffering metabolic syndrome. Severity of metabolic complications under different hormonal therapies were not completely consistent, suggested that androgen deprivation therapy may be individualized.

[Analysis of serum electrolytes in urolithiasis patients].

OBJECTIVE: To define the difference of serum calcium (Ca), phosphorus (P), potassium (K), sodium (Na), chlorine (Cl), carbon dioxide combining power (CO2CP), hydrogen ion concentration (pH) of urine and urine specific gravity (SG) between those patients suffering from urolithiasis and non-urolithiasis at the same time period. METHODS: Data from 1 164 patients admitted to the Department of Urology, Peking University People's Hospital from January, 2005 to July, 2007 were retrospectively reviewed. Seven hundred fourteen patients suffered from urolithiasis, and 450 patients were diagnosed as non-urolithiasis. Blood and urine were taken from the patient the next morning after admission. Serum levels of Ca, P, K, Na, Cl, CO2CP and urine pH and SG were checked by automatic biochemistry analyzer. The data were analyzed by software SPSS 13.0. RESULTS: Patients' ages in urolithiasis group varied from 5 to 87 years and the male to female ratio was 1.8:1. The patients in non-urolithiasis group aged from 12 to 94 years and the male to female ratio was 3.8:1. There was difference in the levels of serum Na, K, Cl, CO2CP, Ca and P between urolithiasis and non-urolithiasis groups (P<0.05). In male patients, serum Na, Ca and P levels in urolithiasis group were higher than those in non-urolithiasis group(P<0.05), serum K and urine pH levels were lower in urolithiasis group than those in non-urolithasis group (P<0.05). In female patients, serum Na level was higher in urolithiasis group than that in non-urolithiasis group (P=0.080). Logistic regression analysis showed that beta value of serum Na level in male and female group was 0.10 (P<0.01) and 0.09 (P=0.054) respectively. CONCLUSION: There was difference in serum electrolyte levels between urolithiasis group and non-urolithiasis group. The chang of serum Na level may play role in pathogenesis of urolithiasis.

[Intravesical laparoscopic repair of vesicovaginal fistula].

OBJECTIVE: To introduce a new technique to treat vesicovaginal fistula (VVF) with intravesical laparoscopic repair, and assess its safety and efficacy. METHODS: Four female patients with iatronic VVF were treated with intravesical laparoscopic method between October 2008 and March 2010. The second case underwent open surgery repair four months ago. All the fistulae were in posterior wall of bladder,with 0.8 cm, 1.0 cm, 1.2 cm and 0.5 cm in size respectively. One 10 mm superpubic trocar and 2.5 mm lateral trocars were placed in surgery. Carbon dioxide gas was used to distend the bladder. RESULTS: Four operations were completed successfully. The operative time was 80-140 min, and the blood loss was 50-100 mL. The indwelling catheter was removed after 4 weeks. All the patients were followed up for 1-8 months. Three patients showed no recurrence of fistula and had normal urination. One patient developed urinary leakage through the vagina again after 1 month. CONCLUSION: Intravesical laparoscopic technique is a safe and effective treatment with micro-trauma for iatrogenic VVF, but more clinical files are needed for further evaluation.