Herpes zoster infection in the sacral area accounts for a considerable number of all herpes zoster cases, and cases of acute urinary retention and defecation disorders caused by herpes zoster infection in the sacral area have been reported. However, no clinical case of spontaneous bladder rupture has been reported. In this report, we describe a 77-year-old male patient with severe complications of spontaneous bladder rupture caused by herpes zoster-associated urinary retention. The patient regained complete bladder function after undergoing surgery to repair the bladder and treatment with antiviral drugs.

OBJECTIVE:To explore the pathological characteristics and significance of RET proto-oncogene screening in multiple endocrine neoplasia type 2A (MEN2A) with cutaneous lichen amyloidosis (CLA).METHODS:Clinical data of 51 members from 7 unrelated pedigrees of MEN2A-CLA were collected. Systemic clinical investigations including biochemical testing, imaging examination, germline RET variant screening and histopathological examination were carried out.RESULTS:RET gene variants were detected in 28 patients with MEN2A (C634G/F/R/S/W and C611Y) including 12 males and 16 females, with the mean age of diagnosis being (41.1 ± 18.3) years old, which were consistent with their clinical manifestations. The incidence of medullary thyroid carcinoma (MTC), pheochromocytoma (PHEO), hyperparathyroidism (HPTH) and CLA among 28 MEN2A patients were 89.3%, 28.6%, 7.1% and 28.6%, respectively. Comparison of the incidence of MTC/PHEO/HPTH and CLA between C611Y and C634G/F/R/S/W, only PHEO and CLA in C611Y were lower than those in C634G/F/R/S/W (P < 0.05; P < 0.05). Among 8 patients with CLA, the male to female ratio was 2 : 6. The clinical features included pruritus in the interscapular region and presence of dry, thickened, scaly, brown pigment, clustered or desquamate-like plaques. The mean onset age of CLA [(18.4 ± 4.6) years] versus the mean age at diagnosis of CLA or MEN2A were significantly different (P < 0.001; P < 0.001).CONCLUSION:MEN2A-CLA may be the early clinical manifestation of MEN2A and most frequently occurred along with RET-C634 variant. To facilitate the recognition of MEN2A-CLA, to combine family investigation and screening of RET variant are helpful for early diagnosis and standardized treatment, which can improve the long-term outcome of MEN2A-specific tumors.

BACKGROUND:This study sought to explore the expression pattern in prostate cancer (PCa) tissues, as well as the regulatory effects of circ_0061140 on the proliferative potential of PCa cells.METHODS:A quantitative real-time polymerase chain reaction (qRT-PCR) analysis was undertaken to detect circ_0061140 levels in 43 paired PCa tissues and adjacent normal tissues. After the knockdown of circ_0061140, changes in the proliferative potential of PCa cells and tumor growth in nude mice with PCa were detected. Finally, the relationship of circ_0061140 and miR-1193 in the development of PCa was assessed.RESULTS:The results showed that circ_0061140 was upregulated in PCa tissues. PCa patients with higher Gleason score or larger sized tumors expressed higher levels of circ_0061140. Additionally, the knockdown of circ_0061140 inhibited the proliferative potential of PCa cells. MiR-1193 was the target gene binding circ_0061140, and its level was negatively regulated by circ_0061140. Finally, rescue experiments showed that miR-1193 was regulated by circ_0061140 in the development of PCa.CONCLUSIONS:Circ_0061140 is upregulated in PCa tissues, and is closely linked to Gleason score and tumor size in PCa. Additionally, it causes PCa cells to proliferate by negatively regulating miR-1193.

Objective: We investigated the clinical value of the Controlling Nutritional Status score in evaluating the prognosis of patients with non-muscle invasive bladder cancer. Methods: We conducted a retrospective analysis of the clinical data of 88 patients with non-muscle invasive bladder cancer who underwent transurethral resection of bladder tumor or partial cystectomy between January 2011 and May 2015 in a single center. The patients were divided into groups base on high (>1) and low (≤1) Controlling Nutritional Status score. Results: Clinical and demographic data of the patient groups were analyzed using the Kaplan-Meier method and log-rank test to generate survival curves. Univariate and multivariate analyses were conducted using the Cox proportional hazard model. Among the participants, the male-to-female ratio was 70:18 and median age was 64.5 years (range, 25-84 years). The numbers of patients with Controlling Nutritional Status score of 0, 1, 2, 3, 4, 5, and 6 were 26 (29.55%), 21 (23.86%), 20 (22.73%), 12 (13.64%), 5 (5.68%), 1 (1.14%), and 3 (3.41%), respectively. The 5-year recurrence rate was 29 out of 88 patients (32.95%). The recurrence-free survival of the high-score group was significantly lower than that of the low-score group (P < 0.001). On univariate analysis, age, smoking history, Controlling Nutritional Status score, depth of tumor invasion, pathological grade, and tumor diameter were related to the prognosis of patients with non-muscle invasive bladder cancer. On multivariate analysis, the Controlling Nutritional Status score (hazard ratio, 4.938; 95% confidence interval, 1.392-17.525; P = 0.013) was an independent factor affecting the recurrence-free survival of patients with non-muscle-invasive bladder cancer. Conclusion: Therefore, the Controlling Nutritional Status score could be a simple, cost-effective, and reliable predictor of prognoses among of patients with non-muscle-invasive bladder cancer.

BACKGROUND:Bladder cancer is the second most prevalent neoplasm in the urogenital system in terms of morbidity and mortality, and there is an urgent need for a more accurate assessment of individual prognosis in patients with primary non-muscle-invasive bladder cancer (NMIBC). The Controlling Nutritional Status (CONUT) score is an emerging biomarker score which has been confirmed to have prognostic value in various malignant tumors. The study attempted to systematically identify the prognostic role of preoperative CONUT score on posttreatment recurrence-free survival (RFS) in patients with NMIBC, and determine the predictive value and feasibility of the new prognostic prediction model. METHODS:A total of 94 patients with NMIBC were analyzed retrospectively between January 2011 and December 2015. Statistical analysis was conducted using the nonparametric method. The Kaplan--Meier method was used to assess recurrence-free survival (RFS), and Log rank tests was used to analyze the equivalences of survival curves. We used univariate and multivariate Cox proportional hazards regression model to identify important predictors of RFS. Discrimination of nomogram was measured by the concordance index. Predictive accuracy of the model was evaluated using the internal validation. RESULTS:In univariate analysis, age, history of smoking, pathological T stage, tumor grade, tumor size, and CONUT score were significantly correlated with RFS. Multivariate analysis indicated that CONUT score (HR =3.855, 95% CI 1.242-11.970, p=0.020) was an independent predictor of RFS in patients with NMIBC. Based on significant parameters in multivariate analysis and reliable recurrence predictors determined in predictive models and relevant guidelines, a new age-, history of smoking-, pathologic factors- and the CONUT score-based scoring model was developed to predict recurrence of NMBIC. In addition, we internally validated the nomogram using the consistency index and calibration plots, which demonstrated that the model has high prediction accuracy (c-index= 0.851). CONCLUSION:The development of a new nomogram based on CONUT score could increase the accuracy of recurrence prediction and improve individualized treatment plans for patients with NMIBC.

1Department of Urology, School of Medicine, Hangzhou Normal University, Hangzhou, 311121, Zhejiang Province, People’s Republic of China; 2Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, 311202, Zhejiang Province, People’s Republic of China; 3Department of Urology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, People’s Republic of China

目的 评价托特罗定联合膀胱内注射A型肉毒素治疗女性膀胱过度活动症(OAB)的临床疗效及其安全性.方法 2016年6月至2018年10月OAB女性患者72例,随机分为4组,各18例.A组:口服安慰剂、B组:口服托特罗定片2mg,1次/d,共4周,C组:膀胱内注射A型肉毒素,D组:膀胱内注射A型肉毒素后并立即开始服用托特罗定片2mg,1次/d,分别记录治疗前后4周平均每日日间排尿次数、平均每次排尿量、夜尿次数、尿急次数、初始尿意膀胱容量、最大膀胱容量、OABSS评分、QOL评分情况.结果 治疗后D组平均每日日间排尿次数、平均每次排尿量、夜尿次数、尿急次数、初始尿意膀胱容量、最大膀胱容量、OABSS评分、QOL评分均较其他组有明显改善.结论 口服托特罗定联合膀胱内注射A型肉毒素治疗OAB疗效确切,安全性高.

ObjectiveTo study the effect of entecavir on the reproductive function of male patients with chronic hepatitis B (CHB).METHODSThis study included 56 CHB male patients (aged 18－45 ［33.14 ± 5.38］ years) initially treated with entecavir at 0.5 mg/d for 24 weeks from 2015 to 2018 and another 24 healthy fertile male volunteers (aged 21－45 ［32.62 ± 5.94］ years) as normal controls. We obtained the body mass index (BMI), reproductive hormone levels, semen parameters and IIEF-5 scores from the subjects and compared them between the two groups before and after treatment.RESULTSThere were no statistically significant differences between the CHB and normal control groups in age, BMI, lifestyle and baseline reproductive hormone levels except in the levels of FSH (［3.92 ± 1.29］ vs ［3.08 ± 0.85］ mIU/ml, P = 0.003) and E2 (［35.79 ± 7.49］ vs ［28.25 ± 7.09］ pg/ml, P < 0.01). The semen parameters were significantly lower in the CHB patients than in the normal controls, including total sperm motility (［37.75 ± 13.33］% vs ［49.58 ± 9.27］%, P = 0.004), the percentage of progressively motile sperm (PMS) (［30.70 ± 10.03］% vs ［42.46 ± 8.90］%, P < 0.01), sperm concentration (［51.51 ± 19.50］ vs 70.33 ± 30.62) ×10⁶/ml, P = 0.007), and total sperm count (［160.2 ± 51.8］ vs ［225.91 ± 97.97］ ×106, P = 0.002), and so were the IIEF-5 scores (19.32 ± 2.34 vs 21.25 ± 2.35, P = 0.0006). After 24 weeks of entecavir treatment, the CHB patients showed no significant difference from the baseline in the semen volume, semen pH and days of abstinence, but remarkable improvement in total motility (［37.75 ± 13.33］ vs ［44.1 ± 11.89］%, P = 0.004), PMS (［30.70 ± 10.03］ vs ［38.30 ± 7.42］%, P < 0.01), sperm concentration (［51.51 ± 19.50］ vs ［62.00 ± 24.64］ ×10⁶/ml, P = 0.007), total sperm count (［160.21 ± 51.8］ vs ［207.65 ± 81.69］ ×106, P = 0.0002), and IIEF-5 score (20.13 ± 1.82 vs 19.32 ± 2.34, P = 0.02).CONCLUSIONSCHB patients have lower sexual function and semen quality than normal males. Entecavir can significantly improve the liver function, sexual function and semen quality of the CHB patients, but whether it directly improves the sexual function and semen quality of the patients or indirectly through liver function improvement needs to be further studied.

目的:观察排石汤辅助输尿管镜钬激光碎石术治疗输尿管上段结石的临床效果.方法:选取120例在本院行输尿管镜钬激光碎石术治疗的输尿管上段结石患者120例为研究对象,按随机数字表法分为观察组和对照组,每组60例.2组均采用输尿管镜钬激光碎石术治疗,观察组术后给予排石汤辅助治疗.对比2组术后结石残留率,检测2组手术前后的肾功能指标,统计并发症发生率.结果:术后2天,2组结石残留率比较,差异无统计学意义(P＞0.05).术后1月及术后3月,观察组结石残留率分别为11.67％和1.67％,低于对照组的26.67％和11.67％,差异均有统计学意义(P＜0.05).术后3月,2组尿素氮(BUN)、血肌酐(SCr)、β2-微球蛋白(β2-MG)水平均较术前降低,差异均有统计学意义(P＜0.05);观察组BUN、SCr、β2-MG水平均低于对照组,差异均有统计学意义(P＜0.05).观察组并发症发生率15.00％,对照组并发症发生率8.33％,2组比较,差异无统计学意义(P＞0.05).结论:排石汤辅助输尿管镜钬激光碎石术治疗输尿管上段结石可获得较好的临床效果,能促进术后残留结石排出,改善患者的肾功能,且并发症发生率较低,值得临床推广应用.

Objective To evaluate the clinical effects of bladder perfusion combined with deep hyperthermia on preventing postoperative recurrence of non-muscle invasive bladder cancer.Methods Choose 98 patients with NMIBC who were treated with transurethral bladder cancer resection,and randomly divide them into two groups,research group and control group,49 cases in each.Giving MMC bladder perfusion chemotherapy to the control group,and added deep hyperthermia to the research group on the basis of bladder peffusion.Contrast the relapse rates and condition of adverse events during treatment.Resnits The relapse rates of research group when treatment was continued for 6,9,12,15,18 months were significantly lower than that of control group(4.08％ VS 10.20％,6.12％ VS 12.24％,10.20％ VS 18.37％,10.20％ VS 20.41％,14.29％ VS 24.50％,all P ＜ 0.05).No statistical significance in adverse events between each group was observed (P ＞ 0.05).Conclusion MMC bladder perfusion combined with deep hyperthermia therapy has great clinical value,as it can reduce the rates of postoperative recurrence of NMIBC,as well as not increase the AEs of bladder perfusion.

Aim: The aim of this study was to explain the Numb anti-cancer effects in the prostatic cancer. Methods: Collecting the 20 prostatic cancer patients and analyzing the correlation between Numb and Glease score. Transfection Numb into DU-145 and PC-3 cells, measuring the proliferation rate of difference groups by MTT assay, evaluating the cell apoptosis and cell cycle of difference group by Flow cytometry; measuring the invasion and migration abilities by transwell and wound healing assays. In the nude mice experiment, establish prostatic cancer nude mouse subcutaneous planting tumor model by DU-145 cells, Injection the Numb from tail vein. Evaluating the tumor volume and weight. Results: The Numb protein expression was decreased with Glease score increasing. The proliferation rate of Numb groups were significantly decreased compared with NC groups (P < 0.05, respectively). The apoptosis and G1 phase rates of Numb groups were significantly enhanced compared with NC groups (P < 0.05, respectively). The invasion and migration abilities of Numb group cells were significantly weaken compared with NC groups (P < 0.05, respectively). In the WB assay, The relative proteins (Numb, P53, Cyclin D1, Rac1, MMP-2 and MMP-9) expression were significantly differences between NC and Numb groups (P < 0.05, respectively). In the vivo experiment, the tumor volume and weight of Numb group was significantly lighter than NC group (P < 0.05, respectively). Conclusion: Overexpression Numb had anti-cancer effects to prostatic cancer in vitro and vivo experiments, the mechanism might be P53/Cyclin D1 and Rac1/MMP-2/-9 signaling pathway. (C) 2017 Published by Elsevier Masson SAS.

Spindle and kinetochore-associated protein 1 is a microtubule-binding subcomplex of the outer kinetochore that is essential for proper chromosome segregation. Recently, spindle and kinetochore-associated protein 1 has been highlighted as a biomarker in various cancers; however, the precise role of spindle and kinetochore-associated protein 1 in prostate cancer remains unknown. This study aims to evaluate whether spindle and kinetochore-associated protein 1 affects the biological behaviors of prostate cancer. We investigated the expression of spindle and kinetochore-associated protein 1 in a series of prostate cancer tissues as well as in a panel of prostate cancer cell lines. Cell proliferation, migration, and invasion were evaluated in spindle and kinetochore-associated protein 1 knockdown prostate cancer cell lines by MTT and Transwell assays. Our results showed that the expression of spindle and kinetochore-associated protein 1 was remarkably upregulated in prostate cancer at both messenger RNA and protein levels compared with non-cancerous tissue. Knockdown of spindle and kinetochore-associated protein 1 repressed the ability of cell proliferation, migration, and invasion of prostate cancer cells. Moreover, inhibition of spindle and kinetochore-associated protein 1 could inhibit the activity of AKT and ERK pathway. In conclusion, our findings suggest that spindle and kinetochore-associated protein 1 could serve as a potential therapeutic target in prostate cancer patients.

尽管微创治疗发展迅速，经尿道前列腺电切术（transurethral'resection'of'the'prostate，TURP）仍然被认为是手术治疗良性前列腺增生（benign' prostatic' hyperplasia，BPH）的金标准[1]。2005年铥激光进入临床实践，其具有两个优势：铥激光发出连续波可最大程度的止血和凝血；铥激光的中心波长在组织中能准确匹配1.92'um的最大吸水率，使其更有效地切割和汽化前列腺组织[2，3]。本次研究比较经尿道铥激光前列腺切除术（transurethral'thulium'laser'resection' of'the'prostate， TmLRP）与TURP的效果，报道如下。

目的:探讨膀胱憩室癌的临床特点及腹腔镜全膀胱切除术治疗膀胱憩室癌的可行性与安全性.方法:回顾分析2015年1月前4例因膀胱憩室癌行腹腔镜膀胱憩室癌根治术患者的临床资料,其中男3例,女1例,中位年龄62岁,术前均行膀胱镜成功活检,病理提示均为肌层浸润性膀胱憩室癌.B超、胸部CT、ECT等检查未发现远处脏器及骨转移,CT尿路成像提示双侧上尿路成像正常,无肾积水、囊肿及肿瘤.4例患者均行腹腔镜全膀胱切除术,其中3例行回肠代膀胱尿流改道术,l例行双侧输尿管皮肤造口术.结果:手术均获成功,无中转开放手术.术后病理结果均为尿路上皮癌,分级分别为G1级1例,G2级2例,G3级1例.4例患者术后中位随访时间为39个月,其中1例于术后31个月死于远处肿瘤转移,余3例患者均无瘤生存.结论:影像学、膀胱镜检查及病理活检是确诊膀胱憩室癌的重要方法.对于肌层浸润的膀胱憩室癌的治疗应采取根治性切除,腹腔镜全膀胱切除术治疗膀胱憩室癌安全、有效.

OBJECTIVE To analyze the situation and causes of urinary tract infections after transurethral resection of bladder tumorr (TURBT ) ,so as to provide help for the clinical prevention and treatment of urinary tract infections after TURBT .METHODS The relative data of inpatients received TURBT from Jan .2009 to Dec .2012 were analyzed retrospectively ,including clincial data ,the incidence and influence factors of urinary tract infection and the pathogenic bacteria distribution ,with statistical software SPSS17 .0 .RESULTS There were 60 cases in urinary tract infections out of 213 patients who accepted TURBT ,and the total incidence rate was 28 .17% ;totally 68 strains of pathogens were isolated ,including gram-negative bacteria(73 .5% ) and gram-positive bacteria (26 .5% ) .The top one species of the pathogens was Escherichia coli(51 .5% ) ,followed by K lebsiella pneumoniae (17 .6% ) and Enterococcus(4 .4% ) ,no strains of fungi detected .The risk factors of urinary tract infections after TURBT included elder than 60 years old ,multiple tumor sites ,diabetes history ,preoperative catheter indwelling , low number of white blood cells ,and use less antimicrobial drugs(P<0 .05) ,while gender ,cell classification and history of chronic bronchitis were not related to it .CONCLUSION This study confirms that infections occurr after TURBT operation ,which is mainly caused by gram-negative bacteria .Many factors are related to postoperative infections after TURBT ,while gender ,cell classification and history of chronic bronchitis are not obviously related to it .

随着腹腔镜技术的迅速发展，国外关于在腹腔镜下膀胱憩室切除的报道已有较多[1-6]。目前，我国开展的腹腔镜手术涉及了泌尿和生殖系统所有的器官，且已达到了较成熟的水平，其中膀胱手术也在其内，包括经腹腔和经腹腔外手术。近年来，浙江萧山医院应用腹腔镜技术对17例膀胱憩室患者实施了腹腔镜经腹腔膀胱憩室切除术，疗效满意，现报道如下。

目的通过在泌尿外科开展品管圈活动,降低出院患者口服药的剩余率,降低患者费用,保障患者的用药安全。方法利用品管圈的各种手法,进行原因分析,提高工作质量。结果住院患者出院时口服药剩余粒数为45.7粒/w,下降到活动后6粒/w。结论通过推行品管圈的活动,不断提高泌尿外科的质量管理,更好为患者服务。

Objective To introduce the methods and efficiency of modified Brisson operation through 20 patients who got concealed penis. Methods The operation adopted modified Brisson operation which inverted V-shaped incision in the penile ventral, releasing the penis toward the suspensory ligament until it was completely stretched and exposed, then trimed the frenulum preputii, sutured the inner plate and the prepuce after cutting the penile dorsal to an appropriate length, After all this, cut a inverted V-shaped incision in the penile ventral and suture the prepuce in the penis scrotum junction. The bandage were removed after 3-5days pressure bandaging. Results The operation duration were about 30-50 min, with a 6-12 months follow-up visit, The development and appearance of penis, were satisfied, only 1 patient got poor outcome because ofover-fat. Three patients with preputial edema, were recovered after 3 months. Conclucions The advantages of the modified Brisson operation is its simplicity, good appearance, short operative time, and rapid postoperative recovery. It is considered to be an ideal surgical method for treating patient with concealed penis.

目的:探讨特发性肾包膜下积液的病因、诊断及治疗方式.方法:回顾分析2010年3月至2013年9月收治的11例特发性肾包膜下积液患者的临床资料,其中女9例,男2例,平均(37.4±6.9)岁,单侧4例,双侧7例,均为初发,患者均于治疗前通过影像学检查排除肿瘤.结果:1例未做任何处理,予以密切随访;3例行后腹腔镜肾包膜切除术,余者行B超引导下穿刺引流术.10例患者手术顺利,围手术期无严重并发症发生.B超引导下引流的患者术后平均随访(30.6±11.7)个月2例复发,再行后腹腔镜手术.行后腹腔镜手术的患者无一例复发.结论:特发性肾包膜下积液为临床罕见疾病,目前病因不明,可通过B超、IVU及CT等影像学检查明确诊断,治疗首选肾包膜下穿刺引流术,如引流术效果不佳时,可考虑行后腹腔镜肾包膜切除术.

目的:探讨输尿管镜下应用输尿管管路封堵器联合钬激光治疗输尿管结石的安全性及有效性。方法:回顾性分析2010年11月~2013年3月采用英诺伟TMIVX-SC10输尿管管路封堵器联合钬激光治疗输尿管结石患者200例的临床资料:男123例,女77例,年龄19~67岁,平均38.1岁。左侧87例,右侧105例,双侧8例。输尿管中上段结石189例,输尿管下段结石11例。术中使用Wolf F8/9.8输尿管镜,先将管路封堵器叶片浸入生理盐水中5~10s,使管路封堵器亲水涂层润湿。然后插入输尿管镜,探及结石后将输尿管镜完全超越结石,于输尿管镜工作通道内安置输尿管管路封堵器,操作体外手柄使叶片折叠成球状,防止结石上移。将输尿管镜退到结石下方,术中采用50ml针筒注水,而后使用科瑞达钬激光以1.2~1.8J、10Hz功率完全击碎结石至直径2mm左右碎片,并使用封堵器叶片折叠球将结石碎片拖出输尿管开口。如结石较大或有息肉包裹,先用钬激光将息肉切除,从结石一侧碎出一通道,然后将输尿管镜超越结石。所有患者术后留置双J管2周。结果:术中出现结石漂移至肾脏2例,均未出现输尿管穿孔及输尿管黏膜损伤。术后出现畏寒发热1例,经抗炎补液等对症处理后好转。所有患者术后均复查血常规、肾功能,术后4周复查B超、KUB或上尿路螺旋CT平扫,发现只有3例患者存在有临床意义的残石(残石直径大于4mm),结石总清除率达91.4%。结论:输尿管管路封堵器是一种治疗输尿管结石安全有效的辅助工具,能显著减少输尿管镜碎石术中的结石漂移,同时能将碎石拖出输尿管腔道外,减少取石的进镜次数,缩短手术时间。