Association of androgen receptor gene CAG and GGN repeat polymorphism with cryptorchidism: A meta‐analysis

Researches on association between variations in the androgen receptor (AR) gene repeat polymorphisms and cryptorchidism (CO) had conflicting results. The aim of this meta‐analysis was to analyse the potential effects of AR CAG and/or GGN repeat polymorphism on CO. Studies were independently appraised by two investigators on PubMed, Web of Science, EBSCO databases and Foreign Medical Retrieval System. Case–control studies with measurement of CAG and/or GGN repeat length were included. Weighted mean difference (WMD) and 95% confidence intervals (CIs) for the CAG or GGN repeat polymorphism and CO were calculated. Five reports were included in this analysis. Overall, no difference was identified between patients and fertile men in CAG repeat length. However, when the CO was divided into unilateral and bilateral, longer CAG repeat region was significantly associated with CO in bilateral group (WMD = 0.74; 95% CI, 0.01–1.47; p < .05). In addition, GGN lengths were significantly higher in patients compared with those in controls (WMD = 1.17; 95% CI, 0.28–2.06; p < .05). No obvious effect was found in the GGN length when compared unilateral or bilateral group with control respectively. The results in this meta‐analysis indicated that AR CAG and GGN repeat polymorphisms may be an important pathogenesis of CO.     

Safety and feasibility study of holmium laser enucleation of the prostate (HOLEP) on patients receiving dual antiplatelet therapy (DAPT)

Objective

To evaluate the safety and feasibility of Holmium laser enucleation of the prostate (HoLEP) in patients receiving dual antiplatelet therapy (DAPT).

Methods

From March 2013 to August 2016, we retrospectively analyzed 1124 benign prostatic hyperplasia (BPH) patients undergoing HoLEP and divided into four groups: 56 cases receiving DAPT therapy (group A); 72 patients treated with continuous single antiplatelet (AP) therapy (group B); 41 patients treated with single AP therapy but intermittent during preoperative time (group C) and 955 cases had no AP therapy (group D). Patients’ baseline characteristics, 1-year clinical outcomes, rates of postoperative bleeding and complications were presented in this study.

Results

All patients received successful operations and no severe postoperative complications occurred. Only one patient in Group D required transfusion. The enucleation time and catheterization time for the DAPT patients were the longest among four groups (p < 0.001, respectively). The overall complications rates within 30 days were 23.2% (13/56) in Group A, 27.8% (20/72) in Group B, 19.5% (8/41) in Group C, and 27.0% (258/955) in Group D, respectively (p = 0.678). By the 12 months, the international prostate symptom scores (IPSS), quality of life scores (QOL) and residual urine volume (RUV) in all groups have been significantly improved.

Conclusion

HoLEP in patients receiving DAPT after coronary artery stunting showed similar results to those achieved in patients receiving single AP therapy or non-AP therapy. It can be a good option, which the urologists can offer to those patients with symptomatic benign prostatic hyperplasia refractory to medical treatment.

     

Mesenteric Lymphatic Vessel Density Is Associated with Disease Behavior and Postoperative Recurrence in Crohn’s Disease

Purpose

The aims of the present study were to examine the density of lymphatic vessels in the mesentery and to assess the predictive value of the mesenteric lymphatic vessel density for postoperative clinical recurrence.

Methods

Ileocolonic resection specimens were obtained from 53 patients with Crohn’s disease and 10 non-inflammatory bowel disease control subjects. Mesentery adipose tissues adjacent to the bowel wall were used for the histological quantification of lymphatic vessels using immunohistochemistry with the D2-40 antibody. The relationships between lymphatic vessel density and disease behavior, the presence of granulomas, the presence of creeping fat, and postoperative clinical recurrence were assessed.

Results

Median lymphatic vessel density in the mesentery adjacent to inflamed or non-inflamed intestine was lower in control subjects than in Crohn’s disease patients (2.13‰; interquartile range [IQR], 1.83–2.61; 8.34‰; IQR, 6.39–10.22; 4.43‰; IQR, 3.32–5.78; P ? 0.001). Increased mesenteric lymphatic vessel density was significantly associated with stricturing behavior, the presence of intestinal granulomas, the presence of creeping fat, and bowel thickness. Interestingly, patients with disease recurrence had an increased mesenteric lymphatic vessel density of the proximal mesenteric margin at the time of resection compared with those who did not have disease recurrence (6.23‰; IQR, 5.43–6.75 vs. 3.28‰; IQR, 2.93–4.29; P ? 0.001).

Conclusions

In addition to its correlation with disease behavior, bowel thickness, and the presence of intestinal granulomas and creeping fat, increased mesenteric lymphatic vessel density in the proximal margin is predictive of early clinical recurrence after surgery in patients with Crohn’s disease.

     

Alterations of gene profiles in Leydig-cell-regenerating adult rat testis after ethane dimethane sulfonate-treatment

Only occupying about 1%–5% of total testicular cells, the adult Leydig cell (ALC) is a unique endocrine cell that produces androgens. Rat Leydig cells regenerate after these cells in the testis are eliminated with ethane dimethane sulfonate (EDS). In this study, we have characterized Leydig cell regeneration and messenger ribonucleic acids (mRNA) profiles of EDS treated rat testes. Serum testosterone, testicular gene profiling and some steroidogenesis-related proteins were analyzed at 7, 21, 35 and 90 days after EDS treatment. Testicular testosterone levels declined to undetectable levels until 7 days after treatment and then started to recover. Seven days after treatment, 81 mRNAs were down-regulated greater than or equal to two-fold, with 48 becoming undetectable. These genes increased their expression 21 days and completely returned to normal levels 90 days after treatment. The undetectable genes include steroidogenic pathway proteins: steroidogenic acute regulatory protein, Scarb1, Cyp11a1, Cyp17a1, Hsd3b1, Cyp1b1 and Cyp2a1. Seven days after treatment, there were 89 mRNAs up-regulated two-fold or more including Pkib. These up-regulated mRNAs returned to normal 90 days after treatment. Cyp2a1 did not start to recover until 35 days after treatment, indicating that this gene is only expressed in ALCs not in the precursor cells. Quantitative polymerase chain reaction, western blotting and semi-quantitative immunohistochemical staining using tissue array confirmed the changes of several randomly picked genes and their proteins.     

Anatomy Relationship around Internal Carotid Artery in the Endoscopic Surgery of Nasopharynx: A Study Based on Computed Tomography Angiography

Objective Anatomic knowledge is needed to avoid injury to internal carotid artery (ICA) during the endoscopic surgery around nasopharynx and its surrounding space. Design We prospectively studied the computed tomography angiography (CTA) data of 28 patients with image processing software. Special attention was given to ICA and various landmarks around nasopharynx. Results The anatomic relationship between ICA and different landmarks around nasopharynx was clearly presented in three-dimension. The fossa of Rosenmuller is the nearest point of the nasopharyngeal cavity to ICA. The opening of the Vidian canal in the middle cranial fossa could be either above, below, or at the level of the horizontal segment of petrous ICA. The pharyngeal trunk of the ascending pharyngeal artery can also be clearly identified in most reconstructed CTA images. Multiple anatomic relationships were also quantified. Conclusions Reconstructed CTA can provide key anatomic information for a safe and accurate endoscopic dissection around nasopharynx.     

Stromal vascular fraction promotes fibroblast migration and cellular viability in a hyperglycemic microenvironment through up-regulation of wound healing cytokines

Diabetic wounds have impaired healing and a propensity for further morbidity, which may result in amputations. Stromal vascular fraction (SVF) is an autologous source of heterogeneous cell population obtained from adipose tissue, which is rich in stem cells and presents little immunogenicity to the host. In this study, we hypothesized that murine fibroblasts subjected to hyperglycemic conditions co-treated with SVF exhibit greater functional activity through the colorimetric MTT assay and a cell-monolayer in-vitro scratch assay. We sought to establish the underlying mechanism of action via the utility of an ELISA chemiluminescence array on the supernatant medium of the cells. Our results demonstrate that the mean percentage gap closure at 24?h in the hyperglycemia?+?SVF group was significantly greater at 41.1%?±?1.6% compared to the hyperglycemia alone group 16.6%?±?1.5% (post-hoc Bonferroni test p?<?0.001, n?=?3) although there was no difference between the SVF and normoglycemia group. Further, this SVF group exhibited a significantly greater 2.4 fold increase in fibroblastic cell viability as compared to the hyperglycemia alone group (p?=?0.001, n?=?3). The supernatant medium of the cells upon testing with ELISA indicated that early phase wound healing cytokines including platelet-derived growth factor (p?=?0.012, n?=?3), interleukin-1 (p?=?0.003, n?=?3), basic fibroblast growth factor (p?=?0.003, n?=?3) and interleukin-10 (p?=?0.009, n?=?3) were expressed in significantly greater relative luminescent units in SVF as compared to hyperglycemia alone groups (Student t-test). Taken together and for the first time, our study shows that SVF is a promising therapeutic agent for up-regulating fibroblastic activity in a hyperglycemic microenvironment, and this result can be explained in part by the stimulation of wound-healing cytokines.     

Does Microwave Ablation of the Tumor Edge Allow for Joint-sparing Surgery in Patients With Osteosarcoma of the Proximal Tibia?

Background

Joint-sparing surgery of a patient’s native joint for osteosarcoma likely affords better function and comparable survival. However, it sometimes is challenging to resect a juxtaarticular osteosarcoma in a way that preserves the affected epiphysis because wide margins are necessary to minimize the risk of local recurrence. If there was a method to resect a tumor close to the joint and treat a potentially positive margin to prevent recurrence, it might allow salvage of a joint that otherwise might be lost.

Questions/purposes

We therefore asked (1) whether joint-preserving tumor resection could be performed for juxtaarticular osteosarcoma after microwave ablation of the tumor edge under navigation without leading to local recurrences, (2) what is the resulting function, and (3) what are the complications associated with this procedure.

Methods

Between 2009 and 2011, we treated 11 patients who had juxtaarticular osteosarcoma of the proximal tibia (mean age, 12 years; range, 9–16 years) with joint-preserving surgery by transepiphysis tumor resection after navigation-assisted microwave ablation of the tumor edge; they were followed a minimum of 37 months (mean, 48 months; range 37–62 months), and none was lost to followup. Patients were considered eligible for this procedure if they had a distance from the tumor edge to the articular surface between 10 to 15 mm, good chemotherapy responses, no pathologic fracture and no tumor involvement of major neurovascular structures. Allograft in combination with a vascularized fibula flap was used for segmental reconstruction. We recorded local tumor control, complications, and functional outcomes using the Musculoskeletal Tumor Society score, which ranges from 0 to 30, with higher scores indicating better function.

Results

There were no local recurrences. Major complications included osteonecrosis of part of the epiphysis in two patients and deep infection in one. The Musculoskeletal Tumor Society score ranged from 26 to 30 with a mean of 29.

Conclusions

In selected patients with osteosarcoma invading the epiphysis, navigated resection facilitates performing joint-sparing surgery, and in our small series, the adjuvant microwave ablation seemed to provide adequate local tumor control. Although more experience and longer followup are needed, this approach may make it possible to salvage more native joints when performing limb salvage for osteosarcoma.

Level of Evidence

Level IV, therapeutic study.