Immediate Continence Rates in RALRP: A Comparison of Three Techniques

Methods:We retrospectively analyzed the patients who underwent RALRP for localized prostate cancer by a single surgeon in our clinic from January 1, 2009–February 1, 2016. Continence was defined as no leakage or use of a safety pad for minimal leakage. The main outcome measure was continence at postoperative week 1 and months 1, 6, and 12.Results:Between 2009 and 2016, 239 patients underwent RALRP for localized prostate disease. Seventy-four patients underwent a standard approach (group 1), 88 had posterior reconstruction (group 2), and 77 had posterior reconstruction with total anatomic restoration (group 3). After 1 week, 24.3% of the patients in group 1 (18/74), 31.8% in group 2 (28/88), and 45.8% in group 3 (33/72) were continent (P = .02). One month after the surgery, continence rates for groups 1, 2, and 3 were 56.7, 67, and 75%, respectively (0.065). After 6 and 12 months, continence rates for groups 1, 2, and 3 were 72.9 and 87.8%, 81.8 and 89.7%, and 84.7 and 91.6%, respectively (P = .178 and .7484).Conclusion:Anatomic restoration improves continence rates in the early period after RALRP. Even though other parameters were higher in the total restoration group, immediate continence (at 1 week) was significantly better.     

An unexpected complication of acute pancreatitis: Intra-cardiac thrombus

Left atrial thrombus after acute pancreatitis (AP) is a rare clinical statement. Because of induction of systemic prothrombotic process by AP; some patients with underlying risk factors may develop an intra-cardiac thrombus. We present a 53 years-old-woman with moderate mitral stenosis and atrial fibrillation. However the patient was under warfarin treatment, she developed a big left atrial big thrombus which was originated from left atrial appendage after she was suffered from AP.     

Primary acute angle closure: long-term clinical outcomes over a 10-year period in the Chinese population

To investigate long-term clinical outcomes after acute angle closure in the Chinese population. A 10-year retrospective review of primary acute angle closure in Hong Kong Chinese to document patient demographics, treatment, and pre- and post-acute angle closure intraocular pressure (IOP) and visual acuity (VA). The year of attack was correlated with the timing of laser, last VA and IOP, and the number of anti-glaucoma eye drops. In 210 eyes (200 patients), 10 % had a simultaneous bilateral acute angle closure. VA improvement was noted in 68.6 % of eyes whilst 11.4 % were blinded. At 3.7 ± 2.4 years of follow-up, 49.5 % had IOP <21 mmHg with medication or surgery, 41.9 % needed anti-glaucoma eye drops, and 13.8 % had undergone trabeculectomy. The older the year of attack, the poorer the VA (r = 0.2, p = 0.03) and the longer the laser wait time (r = 0.3, p < 0.0001). VA outcome and laser promptness in acute angle closure has improved over the years. At 4 years after the attack, 50 % had normal IOP, 69 % had improved VA but 11 % were blinded.     

Effect of inflammatory cytokine expression in adenovirus vector-mediated human receptor activity modifying protein-1 after carotid artery saccule injury on proliferative intima

[目的]探讨腺病毒载体介导人受体活性修饰蛋白-1(receptor activity modifying protein-1,hRAMPI)基因对兔颈动脉粥样硬化并球囊成形术后炎性细胞因子表达的影响.[方法]建立兔动脉粥样硬化狭窄模型并行球囊损伤血管(简称血管成形术),随机抽样分为RAMP1组(n=18)和对照组(n=18),经球囊局部注射携带hRAMP1基因腺病毒载体(pAd2-GFP-RAMP1)或PBS,于注射后7、14d和28d,应用ELISA法检测肿瘤坏死因子-α(TNF-α)和C-反应蛋白(CRP)表达水平；Western blot检测局部hRAMP1目的基因表达；免疫组织化学染色测定血管局部TNF-α表达,HE染色检测血管形态学.[结果]血管成形术后不同时间点TNF-α表达增加[7d:(74.13±4.99),14d:(93.40±6.69),28d:(67.46±6.57)],外源hRAMP1注射后TNF-α表达下降[7d:(64.95±6.77),14d:(75.29±4.73),28d:(45.08±5.00),P＜O.05],病毒注射后7d和14d RAMP1组CRP水平[7d:(29.27±1.57),14d:(9.68±1.60)]与对照组比较[7d:(43.96±7.88),14d:(13.51±1.68)]显著下降(P＜0.05),28d2组间无差异性；腺病毒注射后28d损伤血管局部仍检测到hRAMP1蛋白表达,同时RAMP1组局部TNF-α表达与对照组比较明显下降,HE染色显示:RAMP1组新生内膜面积[7d:(0.07±0.18),14d:(0.15±0.05),28d:(0.35±0.05)]与对照组[7d:(0.14±0.02),14d:(0.39±0.09),28d:(0.56±0.05]比较明显降低(P＜0.05).[结论]外源hRAMPI基因调节兔动脉粥样硬化并血管成形术后CRP和TNF-α的表达,抑制血管成形术后再狭窄.