Treatment of primary epididymal adenocarcinoma: a case report and review of the literature.

BACKGROUND: Epididymal tumors, especially malignant tumors, have low incidence and are rare in our clinical work. However, they may progress quickly and have poor prognosis. For such rare clinical cases with extremely low incidence rates, and as they are prone to misdiagnosis and missed diagnosis and have a very poor prognosis, clinical workers need to pay special attention and consider the possibility of primary epididymal malignant tumors. CASE REPORT: A 63-year-old Chinese male patient from Asia was admitted due to scrotal pain. Upon examination, an abnormal lesion was found in the right epididymal region. After thorough evaluation, surgical resection was performed, and the postoperative pathological result confirmed the presence of epididymal adenocarcinoma. After further ruling out secondary lesions, primary epididymal adenocarcinoma was considered. Right retroperitoneal lymph node dissection was performed under laparoscopic for treatment, and 1/11 lymph node metastasis was detected after surgery. The patient is currently under close follow-up. CONCLUSIONS: The number of clinical cases of primary epididymal malignant tumors is very limited, there is currently no standardized diagnosis and treatment process, and there is a lack of systematic evaluation methods regarding the effectiveness of different treatment options such as chemotherapy, radiotherapy, immunotherapy, and targeted therapy. In addition, the outcome is difficult to predict. In this article, we reviewed relevant literature and systematically elaborated on the diagnosis and treatment of epididymal malignant tumors, hoping to provide useful information for relevant experts.

Retroperitoneal lymphoma with double inferior vena cava shown using a 3D visualization model: A case report and literature review.

Cases of a retroperitoneal tumor with double inferior vena cava (IVC) are rarely reported. The present report documents a case of a retroperitoneal lymphoma with double IVC, and discusses its embryological, clinical and radiological significance. In addition, previous cases of a double IVC are reviewed. In the present report, a 52-year-old male patient was hospitalized for a retroperitoneal lymphoma tumor and double IVC. CT urography was performed, whilst a three-dimensional visualization model was also established based on CT data, to reveal a retroperitoneal tumor with double IVC. The present case involved a double IVC with interiliac vein, which was type 2b from the left IVC. The retroperitoneal tumor was identified to be a lymphoma measuring 116x83 mm by percutaneous puncture biopsy. Surgical treatment is generally not recommended for lymphoma. Therefore, this patient was transferred to the Hematology Department for treatment according to the lymphoma management guidelines. The size of the tumor was reduced after chemotherapy during the patient's follow-up. In conclusion, the three-dimensional visualization model can directly and accurately present the anatomical features of the double IVC and its surrounding tissue structure. In addition, variations in the features of IVC can have important clinical significance. It is also important for surgeons, interventional radiologists and clinicians to understand such abnormalities in anatomical features to avoid misdiagnosis and reduce the occurrence of serious intraoperative complications.

Effect of Bi, Sb, and Ti on Microstructure and Mechanical Properties of SAC105 Alloys.

The Sn-Ag-Cu (SAC) solder alloys with a low Ag (Ag < 3 wt.%) content have attracted great attention owing to their low cost, increased ability in bulk compliance, and plastic energy dissipation. However, some of their mechanical properties are generally lower than the SAC alloys with a higher Ag content. Adding alloying elements is an effective approach for improving the mechanical properties of the SAC alloys. In this study, the effect of Bi, Sb, and Ti on Sn-1 wt.%Ag-0.5 wt.%Cu (SAC105) solder alloys was investigated. The SAC solders with four compositions: SAC105-1 wt.%Bi, SAC105-1 wt.%Sb, SAC105-1 wt.%Bi-1 wt.%Sb, SAC105-1 wt.%Bi-1 wt.%Sb-0.4 wt.%Ti were prepared. The microstructure and phase compositions were characterized using electron scanning microscopy, and X-ray diffraction. The thermal properties and wettability were also examined. Uniaxial tensile tests and nano-indentation tests were conducted to evaluate the mechanical properties. The results show that adding Bi or Sb could increase the strength of SAC105 alloys mainly due to the solid solution strengthening effect. The creep resistance of SAC105 alloys was also improved with the additions of Bi and Sb. The co-additions of Bi and Sb into SAC105 alloys exhibit an enhanced creep resistance than that calculated by the theoretical calculation. The further addition of Ti into SAC105-1Bi-1Sb alloys demonstrated a much-improved creep resistance, which could be attributed to the synergistic effects of both solid solution strengthening and the precipitation hardening effects.

Anesthesia mumps with airway obstruction after radical nephrectomy: A case report and literature review.

Anesthesia mumps have rarely been reported. This article presents the diagnosis and treatment of a case of anesthesia mumps with airway obstruction in the urology department and reviews previous cases of the disease. A 58-year-old man had a history of hypertension and diabetes, and his blood pressure and glucose levels were well controlled. He underwent laparoscopic radical nephrectomy for a right renal tumor. Postoperatively, a swelling of approximately 5 × 4 cm was observed in the left parotid region and left eyelid, no palpable crepitation was detected, and the skin overlying the left parotid gland was mildly hyperemic and tender. Enhanced computed tomography of the head and neck revealed obvious swelling of the laryngopharyngeal airway, and electronic laryngoscopy showed narrow airway. Laboratory test results including white blood cell count, C-reactive protein, serum amylase, and lipase levels were normal. Glycosylated hemoglobin level was 6.8%, and the salivary culture from Stensen's duct was negative. The patient was managed with endotracheal intubation and a ventilator to maintain breathing along with anti-infection, expectorant, and symptomatic treatment. The swelling in the left parotid gland gradually resolved without recurrence, and the patient was extubated on the 7th postoperative day. In this case, the pathophysiology of anesthesia mumps may have been related to the incorrect positioning of the thick short neck and the use of a head ring, which can result in the squeezing of vessels. In most cases, the salivary gland swelling resolves with observation and symptomatic treatment. In patients with anesthesia mumps, emergency airway management and careful observation are necessary if upper airway obstruction occurs. This case report should increase awareness of anesthesia mumps and its complications among anesthesiologists, surgeons, and postoperative caregivers.

Root Reason for the Failure of a Practical Zn-Ni Battery: Shape Changing Caused by Uneven Current Distribution and Zn Dissolution.

In recent years, with the increasing application of lithium-ion batteries in energy storage devices, fire accidents caused by lithium-ion batteries have become more frequent and have arisen wide concern. Due to the safety of aqueous electrolyte, aqueous Zn-based batteries have attracted vast attention, among which Zn-Ni batteries stand out by virtue of their excellent rate performance and environmental friendliness. However, poor cycling life limits the application of Zn-Ni batteries. To figure out the main cause, a failure analysis of a practical Zn-Ni battery has been carried out. During the cycling of the Zn-Ni battery, the evolution of gas, the shape changing, and the aggregation of additive and binder of Zn anode can be observed. Combined with the finite element analysis, we finally reveal that the key factor of battery failure is the shape changing of the Zn anode caused by uneven current distribution and the dissolution of Zn. The shape changing of the Zn anode reduces the effective surface area of anode and increases the possibility of dead Zn, which makes the battery unable to discharge even in the presence of a large amount of Zn. These findings are helpful to deepen the understanding of the working and failure mechanisms of the Zn anode and provide effective guidance for subsequent research.

[Repair of distal phalanx finger wound with modified great toe fibular flap with distal artery pedicle as reflux vein].

OBJECTIVE: To investigate the effectiveness of the modified great toe fibular flap using the distal artery pedicle as reflux vein for repairing distal phalanx finger wound. METHODS: Between June 2018 and January 2020, 15 patients who suffered tissue defect of the distal phalanx finger were treated, including 12 males and 3 females, the average age was 40.2 years (range, 24-56 years). All of them were caused by machine crush injury. There were 2 cases of thumb, 6 cases of index finger, 3 cases of middle finger, 3 cases of ring finger, and 1 case of little finger. The defects ranged from 1.7 cm×1.3 cm to 3.0 cm×2.0 cm. The time from injury to admission was 0.6-4 hours, with an average of 2.3 hours. The medial fibular proper digital artery was further dissociated to the distal end and anastomosed with the recipient vein as the reflux vein. The area of flaps ranged from 2.0 cm×1.5 cm to 3.2 cm×2.2 cm. RESULTS: All the flaps survived without vascular crisis, and the wounds healed by first intention. Except for 1 case that the suture was too tight, the incision was partially split after the stitches were removed, and it healed spontaneously after dressing change, the other patients had good healing of the donor site incision and normal foot function. All 15 patients were followed up 3-18 months, with an average of 9.3 months. The appearance of finger pulps were satisfactory with full and threaded. The color, texture, and elasticity of the flaps were good, and the two-point discrimination was 6-8 mm at last follow-up. The flexion and extension of fingers were normal. At last follow-up, hand function was evaluated according to the upper limb function evaluation trial standard of the Chinese Medical Association Hand Surgery Society, and the results were 13 cases of excellent and 2 cases of good. CONCLUSION: Modified great toe fibular flap using the distal arterial pedicle as a reflux vein can improve the venous drainage of the flap and contribute to increase the success rate of the flap without additional injury.

Erectile Functional Restoration With Genital Branch of Genitofemoral Nerve to Pelvic Nerve Transfer After Spinal Root Transection in Rats.

OBJECTIVE: To investigate the feasibility of erectile function restoration by the genitofemoral nerve to pelvic nerve transfer in rats. METHODS: Thirty-six male rats were included in this study. Rats in the nerve transfer group (n = 12) were subjected to pelvic nerve, sacral roots, and L6 roots transection and then bilateral genitofemoral nerve to pelvic nerve transfer, rats in the nerve resection group (n = 12) were subjected to pelvic nerve, sacral roots, and L6 roots transection without nerve transfer, and rats in the control group (n = 12) served as controls. After reinnervation, intracavernous pressure (ICP) assessment was performed. Fluoro-Gold was injected into the corpus cavernosum. Immediately before euthanasia, transferred nerves were stimulated to test penile intracavernous pressure. The L6, S1, and L1-2 spinal cord segments were used for retrogradely labeled neurons. Regenerative nerve morphologic examination assessment was performed. RESULTS: Genitofemoral nerve stimulation induced an increase in ICP in the nerve transfer group. The mean ICP in this group was (33.8 ± 9.4 mm Hg), which is higher than the mean value in the nerve resection group (3.9 ± 1.0 mm Hg) but lower than that in the control group (69.8 ± 12.2 mm Hg; P < .05). The formation of new neural pathways was confirmed by the appearance of Fluoro-Gold labeled neurons in the L-1 and L-2 spinal cord segments in the nerve transfer group. Regenerative nerve morphologic examination showed good axonal regeneration after genitofemoral nerve transfer. CONCLUSION: Nerve regeneration can be obtained by genitofemoral nerve to pelvic nerve transfer, and erectile function can be restored.

Reinnervation of the rectum with transfer of the genital branch of the genitofemoral nerve to the pelvic nerve in rats.

OBJECTIVE The purpose of this study was to determine the feasibility of rectum reinnervation with transfer of a primarily genitofemoral nerve to the pelvic nerve in the rat. METHODS Thirty-six male rats were randomly divided into 3 groups: rats in the nerve transfer group (n = 12) were subjected to rectal denervation and then bilateral genitofemoral nerve-pelvic nerve transfer; rats in the nerve resection group (n = 12) underwent rectum denervation without nerve transfer; and rats in the control group (n = 12) underwent sham surgery. Rectum denervation was achieved by transection of the L-6 spinal nerves, the spinal nerves below L-6, and the pelvic nerve. Four months postoperatively, retrograde nerve tracing, regenerative nerve morphological examination, and rectal manometry assessment were performed. RESULTS Regenerative nerve morphological examination showed good axonal regeneration after genitofemoral nerve transfer. Nerve stimulation induced increased rectal pressures in 10 of 12 rats in the nerve transfer group. The mean rectal pressure in this group was 54.9 ± 7.1 mm Hg, which is higher than the mean value in the nerve resection group (5.5 ± 2.0 mm Hg) but lower than that in the control group (70.6 ± 8.5 mm Hg) (p < 0.05). The appearance of FluoroGold-labeled neurons in the L-1 and L-2 spinal cord segments in the nerve transfer group confirmed the formation of new neural pathways. CONCLUSIONS The results have demonstrated that genitofemoral nerve-pelvic nerve transfer can achieve nerve regeneration. In this animal model, the authors were able to reinnervate the rectum by nerve transfer.

Antibiotic Susceptibility and Molecular Characterization of Escherichia coli O157 Isolates from Urinary Tract Infections.

BACKGROUND: Escherichia coli O157 is an important food-borne pathogen that can cause diarrhoea, hemorrhagic colitis, and hemolytic uraemic syndrome. Enterobacterial repetitive intergenic consensus sequence PCR (ERIC-PCR) and multilocus sequence typing (MLST) are good methods for molecular typing and the extensive use of antibiotics is a contributing factor to the increasing incidence of antimicrobial-resistant for these strains. OBJECTIVES: The aim of this study was to determine the prevalence, antimicrobial resistance, and genetic diversity of E. coli O157 based on the prevalence of urinary tract infection (UTI) in Hubei, China. RESULTS: We obtained 23 (8.07%) E. coli O157 isolates from 285 UTI patients in Hubei, China. All isolates were subjected to antibiotic susceptibility analysis, and molecular typing was performed using ERIC-PCR and MLST. Antimicrobial susceptibility results indicated that most strains were resistant to penicillin (95.65%), chloramphenicol (73.91%), and ampicillin (69.57%). All isolates were discovered to be multiresistant (resistance to more than 3 antibiotics). Genetic variability analysis showed that all of the isolates were grouped into 4 clusters both by ERIC-PCR and MLST. CONCLUSION: Our findings demonstrated the presence of E. coli O157 in UTIs, provided insights into the dissemination of antibiotic-resistant strains, and improved our knowledge of E. coli O157 risk assessment in UTIs.

Detection of low-abundance point mutations by competitive strand assisted endonuclease IV signal amplification system.

Genetic mutations are important molecular biomarkers for cancer diagnosis and surveillance. Therefore, the development of methods for mutation detection characterized with straightforward, highly specific and sensitive to low-level mutations within various sequence contexts is extremely needed. Although some of the currently available methods have shown very encouraging results, their discrimination efficiency is still very low. Herein, we demonstrate a fluorescent probe coupled with blocker and property of melting temperature discrimination, which is able to identify the presence of known or unknown single-base variations at abundances down to 0.1% within 20 min. The discrimination factors between the perfect-match target and single-base mismatched target are determined to be 10.15-38.48. The method is sequence independent, which assures a wide range of application. The new method would be an ideal choice for high-throughput in vitro diagnosis and precise clinical treatment.

Detection of Low-abundance Point Mutations by Competitive Strand Assisted Endonuclease Ⅳ Signal Amplification System / 华中科技大学学报（医学）（英德文版）

Genetic mutations are important molecular biomarkers for cancer diagnosis and surveillance.Therefore,the development of methods for mutation detection characterized with straightforward,highly specific and sensitive to low-level mutations within various sequence contexts is extremely needed.Although some of the currently available methods have shown very encouraging results,their discrimination efficiency is still very low.Herein,we demonstrate a fluorescent probe coupled with blocker and property of melting temperature discrimination,which is able to identify the presence of known or unknown single-base variations at abundances down to 0.1％ within 20 min.The discrimination factors between the perfect-match target and single-base mismatched target are determined to be 10.15-38.48.The method is sequence independent,which assures a wide range of application.The new method would be an ideal choice for high-throughput in vitro diagnosis and precise clinical treatment.

Functional Restoration of Erectile Function Using End-to-side Autonomic-to-somatic Neurorrhaphy in Rats.

OBJECTIVE: To investigate the feasibility of erectile function rehabilitation using end-to-side autonomic-to-somatic neurorrhaphy in rats. MATERIALS AND METHODS: Thirty-six adult male Sprague-Dawley rats were divided into 3 groups (n = 12 per group): in the end-to-side coaptation group, the left L6 and S1 spinal nerves were transected, and the distal stump of L6 ventral root was sutured to L4 ventral root through end-to-side neurorrhaphy; in the no-coaptation group, the rats did not undergo coaptation; and in the control group, the left L6 and S1 spinal nerves were transected, but L6 ventral root was preserved. After 4 months, retrograde tracing, histomorphological technique, mating test, and evaluation of functional properties of the regenerated nerve were performed. RESULTS: Mating test showed a significantly higher intromission behavior rate in the end-to-side coaptation group (41.7%) and control group (58.3%) than in the no-coaptation group (0%) (P < .001). Intracavernous pressure in end-to-side coaptation group was 31.6 ± 12.0 mmHg, significantly higher than in the no-coaptation group (3.1 ± 1.4 mmHg), but lower than in the control group (67.9 ± 18.0 mmHg) (P < .0001). Retrograde tracing indicated the establishment of the new neural pathway. Axon counting and ultrastructure observation confirmed axonal regeneration in the end-to-side coaptation group. The bilateral tibialis anterior muscles wet weight in the end-to-side coaptation group were 0.6686 ± 0.0427 g and 0.6707 ± 0.0515 g (P = .93). The wet weight and morphology of the tibialis anterior muscles revealed no detrimental effect on the donor nerve. CONCLUSION: Nerve regeneration can be achieved using end-to-side autonomic-to-somatic neurorrhaphy, and erectile function can be restored without the functional impairment of the donor somatic nerve.

Renovascular morphological changes in a rabbit model of hydronephrosis.

Obstructive nephropathy ultimately leads to end-stage renal failure. Renovascular lesions are involved in various nephropathies, and most renal diseases have an ischemic component that underlies the resulting renal fibrosis. The aim of this study was to investigate whether morphological changes occur in the renal vasculature in hydronephrosis and the possible mechanisms involved. A model of complete unilateral ureteral obstruction (CUUO) was used. Experimental animals were divided into five groups: a normal control group (N) and groups of animals at 1st week (O1), 2nd week (O2), 4th week (O4) and 8th week (O8) after CUUO. Blood pressure was measured, renal arterial trees and glomeruli were assessed quantitatively, and renovascular three-dimensional reconstruction was performed on all groups. Glomerular ultrastructural changes were examined by transmission electron microscopy. The results showed that the systolic blood pressure was significantly increased in the obstructed groups (O1, O2, O4 and O8). Three-dimensional reconstruction showed sparse arterial trees in the O8 group, and a tortuous and sometimes ruptured glomerular basement membrane was found in the O4 and O8 groups. Furthermore, epithelial media thickness and media/lumen ratio were increased, lumen diameters were decreased, and the cross-sectional area of the media was unaltered in the segmental renal artery, interlobar artery and afferent arterioles, respectively. In conclusion, renal arterial trees and glomeruli were dramatically altered following CUUO and the changes may be partially ascribed to vascular remodeling. Elucidation of the molecular mechanisms of renovascular morphological alterations will enable the development of potential therapeutic approaches for hydronephrosis.

Successful removal of metal objects causing penile strangulation by a silk winding method.

Penile strangulation is a challenge to urologists. The decompression of the penis is required to prevent long-term complications. Metal objects are difficult to remove. Cutting is the most common method described. Appropriate cutting tools may be difficult to obtain, and the process may be time-consuming with the possibility of iatrogenic penile injury. In this paper, we will present a simple method to remove such objects by use a silk winding method and subcutaneous puncture.

Rapamycin regulates Akt and ERK phosphorylation through mTORC1 and mTORC2 signaling pathways.

Numerous studies have shown that mammalian target of rapamycin (mTOR) inhibitor activates Akt signaling pathway via a negative feedback loop while inhibiting mTORC1 signaling. In this report, we focused on studying the role of mTORC1 and mTORC2 in rapamycin-mediated Akt and ERK phosphorylation, and the antitumor effect of rapamycin in cancer cells in combination with Akt and ERK inhibitors. Moreover, we analyzed the effect of mTORC1 and mTORC2 on regulating cell cycle progression. We found that low concentrations rapamycin increased Akt and ERK phosphorylation through a mTORC1-dependent mechanism because knockdowned raptor induced the activation of Akt and ERK, but higher doses of rapamycin inhibited Akt and ERK phosphorylation mainly via the mTORC2 signaling pathway because that the silencing of rictor led to the inhibition of Akt and ERK phosphorylation. We further showed that mTORC2 was tightly associated with the development of cell cycle through an Akt-dependent mechanism. Therefore, we combined PI3K and ERK inhibitors prevent rapamycin-induced Akt activation and enhanced antitumor effects of rapamycin. Collectively, we conclude that mTORC2 plays a much more important role than mTORC1 in rapamycin-mediated phosphorylation of Akt and ERK, and cotargeting AKT and ERK signaling may be a new strategy for enhancing the efficacy of rapamycin-based therapeutic approaches in cancer cells.

[Effects of rapamycin on prostate cancer PC-3 cells].

BACKGROUND AND OBJECTIVE: The mammalian target of rapamycin (mTOR) signaling network regulates cell growth, proliferation, survival and apoptosis. This study was to investigate the effect and the underlying mechanism of rapamycin on prostate cancer PC-3 cells. METHODS: PC-3 cells were treated with 1 nmol/L rapamycin. The proliferation of PC-3 was examined by MTT. The cell cycle distribution of PC-3 was measured by FCM. The protein levels of raptor, rictor, Akt, pS6k1-T389, pAkt-s473 in PC-3 were examined by western blot. RESULTS: Rapamycin increased the proliferation of PC-3 at 24 h, however, it remarkably inhibited cell proliferation after 36 h (P<0.01), which became more obviously at 72 h. Although incubation with rapamycin slightly induced cell arrest at the S phase at 24 h, this gradually increased PC-3 cells at the G1 phase at 36 h and 48 h. Compared with the control group, the protein levels of raptor and pS6k1-T389 were significantly decreased (P<0.01), and those of rictor and Akt remained unchanged after the treatment with rapamycin for 24 h; the protein level of pAkt-s473 was significantly increased at 24 h (P<0.01), but was obviously inhibited at 36 h and almost completely inhibited at 72 h (P<0.01). CONCLUSIONS: Prolonged rapamycin treatment inhibits the proliferation of PC-3 cells. This may be caused by rapamycin-induced cell cycle arrest at the G(1) phase and inhibition of Akt phosphorylation.

[Comparison of transurethral surgical methods for treating small-size prostate hyperplasia].

OBJECTIVE: To analyze different transurethral surgical methods for the treatment of small-size benign prostate hyperplasia (BPH) in order to improve the curative effect. METHODS: The clinical data of 52 cases of small-size BPH treated by transurethral surgery were reviewed and analyzed. Of the total number, 12 underwent transurethral prostate resection (TURP), 18 TURP plus transurethral incision of the bladder neck (TUIBN) and 22 TURP plus transurethral resection of the bladder neck (TURBN). The curative effect of the three different surgical methods was evaluated by international prostate symptom score (IPSS), maximum flow rate (Qmax) and post-voiding residual urine volume (PVR). RESULTS: In the TURP group, 3 cases were complicated with contracture of the bladder neck, and the IPSS, Qmax and PVR were (12.2 +/- 3.2), (11.7 +/- 2.6) ml/s and (27.6 +/- 13.0) ml, respectively. In the TURP + TUIBN group, there was only 1 case of the complication and the three indices were respectively (8.6 +/- 3.2), (16.7 +/- 3.0) ml/s and (20.0 +/- 8.0) ml. No complication was observed in the TURP + TURBN group and the three indices were (6.2 +/- 3.0), (22.7 +/- 3.1) ml/s and (8.0 +/- 4.0) ml, respectively. No statistical difference (P > 0.05) was found in IPSS, Qmax and PVR among the three groups before the operation, but significant difference (P < 0.01) was observed after it. The curative effect was better in the TURP + TUIBN group than in the TURP, but was the best in the TURP + TURBN. CONCLUSIONS: TURP + TURBN, being more effective than TURP + TUIBN, should be used as the first option for the surgical treatment of small-size BPH. The key to the operation is to thoroughly remove not only the hyperplastic gland but also the pathological changes of the bladder neck.