Transfemoral Venous Access Facilitates Upper Extremity Dialysis Interventions: Procedural Success and Clinical Outcomes

PURPOSE

To report technical success and clinical outcomes of transfemoral venous access for upper extremity dialysis interventions.

MATERIALS AND METHODS

A total of 15 patients underwent a transfemoral venous approach for fistulography (n = 4; 27%) or thrombectomy (n = 11; 73%) over a 14-month period. Access characteristics, sheath size, thrombectomy method, angioplasty site, fluoroscopy time, radiation dose, technical and clinical success, complications, and post-intervention primary and secondary patency rates were recorded.

RESULTS

Access type included arteriovenous fistulas (n = 10; 67%) and grafts (n = 5; 33%). The most common configuration was brachio-brachial (n = 6; 38%). Mean age of access was 37 months. Mean prior interventions were 4. Right CFV access was used in all patients using 6-8-French (most common: 7-French [n = 10; 67%]) sheaths. Most thrombectomies (n = 11; 73%) required both pharmacologic and mechanical maceration (n = 9; 82%). All accesses required angioplasty to treat underlying stenosis at the outflow vein (n = 12; 80%) or arteriovenous anastomosis (n = 9; 90%). Mean fluoroscopy time was 26.43 min. Air kerma and dose area product were 178.06 ± 225.77 mGy and 57,768.83 ± 87,553.29 μGym², respectively. Procedural and clinical success rates were 93% and 80%, respectively. Technical failure was due to persistent stenosis in one patient. Clinical failure was due to unsuccessful dialysis immediately following intervention in three patients. Mean post-intervention primary patency and secondary patency durations were 2.8 and 4.8 months, respectively. Primary patency rates at 1 and 3 months were 50% and 35%, respectively. Secondary patency rates at 1 and 3 months were 58% and 30%, respectively.

CONCLUSION

A transfemoral venous approach for intervention of upper extremity dialysis accesses may be a valuable adjunct to traditional approaches.

Immune Checkpoint Human Endogenous Retrovirus-H Long Terminal Repeat-Associating Protein 2 is Upregulated and Independently Predicts Unfavorable Prognosis in Bladder Urothelial Carcinoma

BACKGROUND/AIMS

human endogenous retrovirus-H long terminal repeat-associating protein 2 (HHLA2) is highly expressed in multiple solid malignant tumors, making it a potential biomarker for tumorigenesis and invasion. However, the expression and clinical significance of HHLA2 in bladder urothelial carcinoma (BUC) have not been extensively studied. This study aimed to investigate the relationship between HHLA2 expression and clinicopathological characteristics of BUC.

METHODS

A total of 212 patients pathologically diagnosed with BUC were included in this study. HHLA2 expression was analyzed by immunohistochemical staining and qRT-polymerase chain reaction. Correlations of HHLA2 expression and pathological characteristics, including 5-year recurrence-free survival (RFS) and overall survival (OS) were examined, and the diagnostic value of HHLA2 was estimated by using the receiver operating characteristic (ROC) curve.

RESULTS

Immunohistochemical staining showed that the expression of HHLA2 was significantly upregulated in BUC tissues compared with normal bladder tissues. In BUC tissues, HHLA2 expression was significantly associated with tumor size, tumor stage, tumor grade, and lymph node metastasis (all p < 0.05). HHLA2 expression was an independent prognostic factor of tumor metastasis (p < 0.05). The Kaplan-Meier survival curve revealed that high HHLA2 expression was significantly correlated with the poor RFS and OS of BUC patients (both p < 0.05), and the ROC curve showed HHLA2 could be a good diagnostic marker.

CONCLUSIONS

HHLA2 can independently predict unfavorable prognosis in BUC.

Diastereoselective construction of 3-aryl-substituted indolines via annulation of in situ generated p-quinone methides

A highly diastereoselective [4 + 1] annulation reaction of in situ generated p-quinone methides for the synthesis of 3-aryl-substituted indolines has been developed.

Causes of Visual Impairment and Blindness in the 2006 and 2014 Nine-Province Surveys in Rural China

PURPOSE

To investigate the primary causes of visual impairment and blindness in rural China.

DESIGN

Population-based, cross-sectional study.

METHODS

Geographic cluster sampling was used in randomly selecting residents from a rural county/district within 9 provinces in the East Coast, Inland Middle, and West regions of mainland China. Persons aged 50 years or older were enumerated through household visits and invited to examination sites for visual acuity testing and ocular examination. Causes of vision impairment and blindness in 2014 were compared with data from an earlier 2006 survey.

RESULTS

Mild visual impairment (20.4% prevalence) was caused by uncorrected refractive error in two thirds of cases and by cataract in nearly another one fourth; moderate-to-severe visual impairment (10.3% prevalence) was caused by cataract in over onec half of cases and by uncorrected refractive error in another one fifth; blindness (1.66% prevalence) was caused by cataract in approximately one half of cases and in another one fourth by retinal disease. Primary causes of visual impairment and blindness in cataract-operated eyes were uncorrected refractive error, posterior capsule opacity, and retinal disease. From 2006 to 2014, the proportion of visual impairment caused by uncorrected refractive error increased, but rates for unoperated cataract were reduced.

CONCLUSIONS

Uncorrected refractive error and unoperated cataract are the 2 primary causes of mild, moderate, and severe visual impairment in rural China, with unoperated cataract and retinal diseases primary causes for blindness. An effective public health strategy to increase service delivery for these causes would lead to substantial reduction in vision impairment and blindness.

Ruthenium(ii)-catalyzed C–O/C–S cyclization for the synthesis of 5-membered O-containing and S-containing heterocycles

An efficient and convenient method for the synthesis of oxazole derivatives from enamides has been established via a ruthenium-catalyzed C–O cyclization.

Sensitive and simultaneous determination of nine anticoagulant rodenticides in human blood by UPLC-MS-MS with phospholipid removal pretreatment

A sensitive and rapid method for the simultaneous determination of nine anticoagulant rodenticides (ARs) in human blood is reported herein. The method involves phospholipid removal pretreatment for reduced matrix effect (ME) and detection with ultra-performance liquid chromatography coupled with tandem mass spectrometry. Satisfactory recoveries were achieved ranging from 80.6% to 113.1% for the nine analytes, with the intra-day relative standard deviations (RSDs) in the range of 3.4-7.9% and inter-day RSDs in the range of 4.1-8.3%, indicating good precision. Linear relationships with correlation coefficients above 0.998 (n = 6) were found in the range of 1-2,000 ng/mL. High sensitivity was achieved with limits of detection ranging from 0.02 to 0.3. The application of phospholipid removal step significantly optimized the ME, and the reduction of ME ranged from 6.1% to 15.5%. This method was successfully applied to the determination of ARs for blood samples from real forensic cases. These results prove that this method is reliable for rapid forensic and clinical diagnosis. The removal capabilities for five representative phospholipids that are abundant in blood were evaluated individually with Phree™ phospholipid removal plates. While significant capabilities for phospholipid removal were confirmed, the results showed that the removal capability for certain phospholipid could be improved.

Multicolor Emission from Non-conjugated Polymers Based on a Single Switchable Boron Chromophore

Multicolor emissive and responsive materials are highly attractive owing to their potential applications in various fields, and polymers are preferred for their good processability and high stability. Herein, we report a series of new polymers based on a methacrylate monomer containing a switchable boron chromophore. In spite of their unconjugated nature, interestingly, the homopolymers from this monomer display rare multicolor fluorescence in solution that is highly dependent on the degree of polymerization (DP). With an increasing DP, the local concentration of the chromophore increases, leading to a higher propensity for switching the blue-emitting tricoordinate boron chromophore to the red-emitting tetracoordinate one. The homopolymers also display temperature- and solvent-dependent emission color change. Furthermore, pure white-light emission could be achieved in various solvents by precisely tuning the homopolymer molecular weight, or in films/solid state by copolymerizing the emissive boron monomer with non-emissive monomers in an appropriate ratio.

An Investigation of Surface Corrosion Behavior of Inconel 718 after Robotic Belt Grinding

Surface corrosion resistance of nickel-based superalloys after grinding is an important consideration to ensure the service performance. In this work, robotic belt grinding is adopted because it offers controllable material processing by dynamically controlling process parameters and tool-workpiece contact state. Surface corrosion behavior of Inconel 718 after robotic belt grinding was investigated by electrochemical testing in 3.5 wt % NaCl solution at room temperature. Specimens were characterized by morphology, surface roughness and residual stress systematically. The potentiodynamic polarization curves and electrochemical impedance spectroscopy (EIS) analysis indicate the corrosion resistance of the specimen surface improves remarkably with the decrease of abrasive particle size. It can be attributed to the change of surface roughness and residual stress. The energy dispersive X-ray spectroscopy (EDS) indicates that niobium (Nb) is preferentially attacked in the corrosion process. A plausible electrochemical dissolution behavior for Inconel 718 processed by robotic belt grinding is proposed. This study is of significance for achieving desired corrosion property of work surface by optimizing grinding process parameters.

Evolutional conservation of molecular structure and antiviral function of a type I interferon, IFN-kappa, in poultry

IFN-kappa (IFN-κ) is a type I IFN expressed by keratinocytes, monocytes and dendritic cells with important roles during the innate immune response period. This research was conducted to elaborate the evolution and characteristics of IFN-κ in poultry. Chicken IFN-κ is located on the sex-determining Z chromosome, which is greatly different from mammals. Poultry IFN-κ cluster together in a species-specific manner through positive selection pressure and share only 19-33% homology with mammalian IFN-κ and poultry other type I IFN. Both chicken and duck IFN-κ was constitutively expressed in spleen, skin, lung, and peripheral blood mononuclear cells (PBMC), as well as being significantly induced after treatment with virus in PBMC. Biologically, poultry IFN-κ has antiviral activity against VSV in chicken embryonic fibroblasts and duck embryonic fibroblasts (CEF and DEF) cells, and induces the expression of IFN stimulated genes (ISGs). After treatment with JAK1 inhibitor, the ISGs expression can be down-regulated. Overall, our research on poultry IFN-κ not only enriches the knowledge about IFN-κ but also facilitates further research on the role of type I IFNs in antiviral defense responses in poultry.

[Comparison of parameters for diffusion-weighted intravoxel incoherent motion imaging in lung cancer patients with different histopathological subtypes]

Objective: To explore the intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) model in lung cancer patients with different histopathological subtypes. Methods: A total of 105 patients were recruited, including 68 cases of adenocarcinoma, 22 cases of squamous carcinoma and 15 cases of small cell carcinoma. All patients underwent magnetic resonance examination consisting of axial IVIM-DWI sequence on a 3.0 T whole body scanner, then the standard ADC (sADC), diffusion coefficient (D), pseudo-diffusion coefficient(D(*)), perfusion fraction (f), distributed diffusion coefficient (DDC) and water diffusion heterogeneity index (α) were calculated for each lesion within the IVIM-DWI model. Results: Mean sADC values were (1.45±0.26) ×10(-3)mm(2)/s, (1.36±0.48) ×10(-3)mm(2)/s and (1.35±0.40) ×10(-3)mm(2)/s for adenocarcinoma, squamous carcinoma and small cell carcinoma, respectively. Mean f values were (59.75±16.37) %, (47.41±18.69) % and (48.96±19.88) % for adenocarcinoma, squamous carcinoma and small cell carcinoma, respectively. Mean α values were 0.72±0.13 for adenocarcinoma, 0.62±0.12 for squamous carcinoma, and 0.63±0.11 for small cell carcinoma, respectively. Statistical analyses indicated that the sADC, f and α values among different histopathological subtypes were significantly different (P<0.05), while there was no significant difference in D, D(*) and DDC values (P>0.05). Furthermore, the comparison showed that the sADC, f and α values of patients with adenocarcinoma were significantly higher than those with squamous carcinoma or small cell carcinoma (P<0.05), whereas there was no significant difference between squamous carcinoma group and small cell carcinoma group (P>0.05). Conclusions: The sADC, f and α values derived from the IVIM-DWI model can be used for comprehensive non-invasive evaluation of diffusion, perfusion and heterogeneity of microenvironment in lung cancer patients. And the IVIM-DWI model may be a promising tool for predicting histopathological subtypes of lung cancer.

[Pleural amoebic empyema: a case report]

In this paper, a case of pleural amoebic empyema and its diagnosis and treatment were reported.

Physiological and metabolome changes during anther development in wheat (Triticum aestivum L.)

This study used cytology, cytochemistry, and non-targeted metabolomics to investigate the distribution characteristic of polysaccharides, lipids, and all the metabolites present during five wheat (Triticum aestivum L.) anther developmental stages to provide insights into wheat anther development. Anthers were collected from the tetrad through trinucleate stages, and 1.5% (w/v) acetocarmine and 4',6-diamidino-2-phenylindole staining were used to confirm the developmental stage and visualize the nuclei, respectively. Polysaccharides and lipids were detected by staining with periodic acid-Schiff and Sudan Black B, respectively. The integrated optical density of the tapetum and microspores were calculated using IPP6.0 software. Furthermore, the metabolites were identified by gas chromatograph system coupled with a Pegasus HT time-of-flight mass spectrometer (GC-TOF-MS). The results indicated that the interior and exterior surface cells of anthers are orderly. Pollen was rich in numerous nutrient substances (e.g., lipids, insoluble carbohydrates, and others), and formed a normal sperm cell that contained three nuclei, i.e., one vegetative nuclei and two reproductive nuclei in the mature pollen. Semi-thin sectioning indicated that the tapetum cells degraded progressively from the tetrad to late uninucleate stage and disappeared from the bi-to trinucleate stages. Moreover, nutrient substances (lipids and insoluble carbohydrates) accumulated, were synthesized in the pollen, and gradually increased from the tetrad to trinucleate stages. Finally, the metabolomics results identified that 146 metabolites were present throughout the wheat anther developmental stages. Principal component analysis, hierarchical cluster analysis, and metabolite-metabolite correlation revealed distinct dynamic changes in metabolites. The metabolism of organic acids, amino acids, sugars, fatty acids, amines, polyols, and nucleotides were interrelated and involved in the tricarboxylic acid (TCA) cycle and glycolysis. Furthermore, their interactions were revealed using an integrated metabolic map, which indicated that the TCA cycle and glycolysis were very active during anther development to provide the required energy for anther and pollen development. Our study provides valuable insights into the mechanisms of substance metabolism in wheat anthers and can be used for possible application by metabolic engineers for the improvement of cell characteristics or creating new compounds and molecular breeders in improving pollen fertility or creating the ideal male sterile line, to improve wheat yield per unit area to address global food security.

Computed tomography-quantified body composition predicts short-term outcomes after gastrectomy in gastric cancer

Background

Malnutrition is a common and critical problem that influences outcome in cancer patients. Body composition reflects a patient's metabolic profile and physiologic reserves, which might be the true determinant of prognosis. In the present study, which aimed to identify valuable new prognostic indicators, we investigated the association between computed tomography-quantified body composition and short-term outcomes after gastrectomy for gastric cancer.

Methods

Skeletal muscle index, mean muscle attenuation, and ratio of visceral-to-subcutaneous adipose tissue area (vsr) were calculated from preoperative computed tomography images. Low skeletal muscle index, low mean muscle attenuation, and high vsr were respectively termed "sarcopenia," "myosteatosis," and "visceral obesity." The association of body composition with postoperative complications and serum markers of nutrition and inflammation after radical gastrectomy were analyzed.

Results

The overall complication rate was significantly higher in the sarcopenia (62.5% vs. 27.3%, p = 0.001) and myosteatosis groups (38.2% vs. 4%, p = 0.002). Patients with visceral obesity had a higher incidence of inflammatory complications (20.3% vs. 6.5%, p = 0.01). Multivariate logistic regression analysis demonstrated that sarcopenia (p = 0.013), myosteatosis (p = 0.017), and low serum retinol-binding protein (p = 0.019) were independent risk factors for overall complications. Compared with control subjects, patients with sarcopenia had lower postoperative levels of serum retinol-binding protein (p = 0.007), and patients with visceral obesity had higher levels of C-reactive protein (p = 0.026).

Conclusions

Sarcopenia, myosteatosis, and visceral obesity were significantly associated with increased rates of postoperative complications and affected the postoperative nutrition and inflammation status of patients with gastric cancer.

Replacing the 238th aspartic acid with an arginine impaired the oligomerization activity and inflammation-inducing property of pyolysin

Trueperella pyogenes (T. pyogenes) is an important opportunistic pathogen. Pyolysin (PLO) importantly contributes to the pathogenicity of T. pyogenes. However, the relationship between the structure and function and the virulence of PLO is not well documented. In the current study, recombinant PLO (rPLO) and three rPLO mutants were prepared. rPLO D238R, a mutant with the 238th aspartic acid replaced with an arginine, showed impairment in oligomerization activity on cholesterol-containing liposome and pore-forming activity on sheep red blood cell membrane. Further study employing the prepared mutants confirmed that the pore-forming activity of PLO is essential for inducing excessive inflammation responses in mice by upregulating the expression levels of IL-1β, TNF-α, and IL-6. By contrast, rPLO P499F, another mutant with impaired cell membrane binding capacity, elicited an inflammation response that was dependent on pathogen-associated molecular pattern (PAMP) activity, given that the mutant significantly upregulated the expression of IL-10 in macrophages and in mice, whereas rPLO did not. Results indicated that domain 1 of the PLO molecule plays an important role in maintaining pore-forming activity. Moreover, the PLO pore-forming activity and not PAMP activity is responsible for the inflammation-inducing effect of PLO. The results of this study provided new information for research field on the structure, function, and virulence of PLO.

Abbreviations: T. pyogenes: Trueperella pyogenes; PLO: Pyolysin; rPLO: recombinant PLO; PAMP: pathogen-associated molecular pattern; CDCs: cholesterol-dependent cytolysins; PLY: pneumolysin; NLRP3: NLR family pyrin domain containing protein 3; PRRs: pattern recognition receptors; Asp: aspartic acid; TLR4: Toll-like receptor 4; Arg: arginine; Asn: asparagine; IPTG: Isopropyl-β-d-thiogalactoside; PBS: phosphate-buffered saline; sRBCs: sheep red blood cells; TEM: Transmission electron microscopy; RBCM: red blood cell membrane; SDS-PAGE: sodium dodecyl sulfate–polyacrylamide gel electrophoresis; NC membrane: nitrocellulose membrane; SDS-AGE: dodecyl sulfate agarose gel electrophoresis; MDBK cells: Madin–Darby bovine kidney cells; RPMI-1640 medium: Roswell Park Memorial Institute-1640 medium; FBS: fetal bovine serum; BMDMs: bone marrow-derived macrophages; TNF-α: tumor necrosis factor α; IL-1β: interleukin-1β; IFN-γ: interferon-γ; TGF-β: transforming growth factor-β; ELISA: enzyme-linked immunosorbent assay

Determination of the expression of three fimbrial subunit proteins in cultured Trueperella pyogenes

Background

Trueperella pyogenes is a commensal and a significant opportunistic pathogen in animals. A variety of identified or putative virulence factors are considered to significantly contribute to the occurrence of T. pyogenes infection in different species. However, these virulence factors are not fully understood.

Results

In the current study, the genes encoding putative fimbrial proteins, i.e. Fim A, Fim C, and Fim E, were cloned. Recombinant Fim A (rFim A), Fim C (rFim C), and Fim E (rFim E) were prepared and used to generate rabbit anti-rFim A, anti-rFim C, and anti-rFim E serum, respectively. Using these sera, we found that only Fim E was constitutively expressed in T. pyogenes. The expression level of Fim E in T. pyogenes peaked within 6–10 h of culture period in pH 7.5. Fim E protein expression was unaffected by anaerobic condition, but was inhibited by the microaerophilic condition. Tube agglutination tests indicated that Fim E was exhibited on the surface of T. pyogenes cells because anti-rFim E serum caused strong agglutination. Additionally, the blots for Fim A detection showed nonspecific reactions. Furthermore, the tube agglutination tests showed that anti-Fim A serum failed to cause agglutination of T. pyogenes cells, which indicated that Fim A was not, or poorly, expressed in cultured T. pyogenes. Anti-rFim C serum caused strong agglutination. However, the blots for Fim C detection showed a strong nonspecific reaction. Thus, the expression of Fim C was difficult to be determined using the current method.

Conclusions

Fim E was expressed in cultured T. pyogenes. However, Fim A was either not or poorly expressed in cultured T. pyogenes. Moreover, Fim C expression was not determined using the current strategy.

Electronic supplementary material

The online version of this article (10.1186/s13028-018-0407-3) contains supplementary material, which is available to authorized users.

[The expression of Semaphorin 5A in patients with rheumatoid arthritis and its effect on osteoclastogenesis]

Objective: To investigate the clinical significance of soluble Semaphorin 5A(Sema 5A) in patients of rheumatoid arthritis(RA) and the effect of Sema 5A on osteoclastogenesis in RAW264.7 cells. Methods: (1)Soluble Sema 5A was detected in the serum of 62 RA patients, 30 osteoarthritis(OA) patients and 48 healthy controls(HC) by enzyme-linked immunosorbent assay(ELISA).The relationships between serum Sema 5A and disease activity, radiographic severity and laboratory parameters were investigated in RA patients.(2)RAW264.7 cells were treated with different concentrations of Sema 5A(0,0.5,1,2.5,5 μg/ml).After 7 days, tartrate-resistant acid phosphate(TRAP) staining was performed. The mRNA levels of TRAP, cathepsin-K and matrix metallopeptidase 9(MMP-9) were tested using real-time polymerase chain reaction (RT-PCR).(3)Bone resorption area of dentine slides cultured with RAW264.7 cells was calculated after Sema 5A(5μg/ml) treatment. Results: (1)The serum Sema 5A in RA patients[(5.24±0.59)μg/L] was significantly higher than those in healthy controls[(2.93±0.34)μg/L,P<0.01] and OA patients[(2.68±0.47)μg/L,P<0.05]. The Sema 5A level in RA patients was positively correlated with disease activity score with 28 joint using C-reactive protein(DAS28-CRP), clinical disease activity index (CDAI),C-reactive protein(CRP) and sharp scores(P<0.05 or P<0.01).In addition,the serum Sema 5A in RA patients with positive anti-cyclic citrullinated peptide(CCP) antibody was significantly greater than that of anti-CCP antibody-negative patients(P<0.05).(2)After RAW264.7 cells were treated with Sema 5A, the number of TRAP positive osteoclasts increased according to the increase of Sema 5A concentration with maximal effect at 5 μg/ml. Meanwhile, Sema 5A promoted mRNA expression of TRAP,Cathepsin-K and MMP-9.(3)Bone resorption area increased when RAW264.7 cells were treated with Sema 5A(5 μg/ml). Conclusions: Serum Sema 5A is elevated in RA patients and correlated with disease activity and radiographic severity. Sema 5A promotes osteoclastogenesis of RAW264.7 cells.

Production and characterization of a novel HPV anti-L2 monoclonal antibody panel

The major capsid protein of HPV, L1, assembles into pentamers that form a T = 7 icosahedral particle, but the location of the co-assembled minor capsid protein, L2, remains controversial. Several researchers have developed useful monoclonal antibodies targeting L2, but most react with linear epitopes toward the N-terminus. As a means to better define the virus capsid and better assess the localization and exposure of L2 epitopes in the context of assembled HPV, we have developed a panel of 30 monoclonal antibodies (mAbs) which target the N-terminus of L2 amino acids 11-200, previously defined as a broadly protective immunogen. Select mAbs were processed with enzymes and anti-L2 Fabs were generated. These new mAb/Fab probes will be beneficial in future studies to unravel the placement of L2 and to help better define the role of L2 in the HPV lifecycle and the nature of the broadly protective epitopes.

["3-step" strategy of transperineal anastomotic urethroplasty for the simple pelvic fracture urethral distraction defect in male patients]

OBJECTIVE

To evaluate the clinical effect of "3-step" strategy of transperineal anastomotic urethroplasty for the simple pelvic fracture urethral distraction defect in male patients.

METHODS

We retrospectively reviewed the clinical data of 162 male patients with simple traumatic posterior urethral stricture or stenosis admitted from January 2014 to October 2015. All had no complex complications, such as urethroperineal fistulas or urethrorectal fistulas. Before referral to Department of Urology, Beijing Jishuitan Hospital, 64 patients had undergone previous treatments: urethroplasty in 30 patients (18.5%), early urethral realignment in 17 patients (10.5%) and 17 patients (10.5%) who had undergone internal urethrotomy. The remaining 98 patients received the suprapubic cystostomy in the acute setting. All of them had received transperineal anastomotic urethroplasty with "3-step" strategy. Step 1, the bulbar urethra was circumferentially mobilized and tension-free anastomosis could be performed after the scar was completely incised and removed. Step 2, if after step 1 a tension-free anastomosis could not be achieved, were routed the distal urethra between the separated corporal bodies. Step 3, if the anastomosis still seemed to be under tension, we could perform pubectomy, partial or total removal, to get a better exposure of the apex of the prostate-membranous urethra.

RESULTS

The mean age of the patients included in this study was 36.3 years (rangingfrom 16-74 years). The mean time between incidents and operation was 13.5 months (ranging from 3-124 months) and the mean length of stricture was 2.7 cm (ranging from 0.5-6.5 cm).The mean time of operation was 92 (45-240) min and the mean evaluated blood lose was 120 (60-800) mL. Three patients (1.9%) received blood transfusing during or after the operations. The numbers of the patients who completed step 1, step 2 and step 3 were 50(30.9%), 74(45.7%) and 38(23.5%), respectively. There were 4 (2.5%) patients who needed the combined transpubic and transperineal approach for tension-free anastomosis after removing an entire wedge of anterior pubis. The mean follow-up was 19.5 months and 18 patients' strictures recurred with manifestation of decreased stream of dysuria. The overall success rate was 88.9%(144/162).

CONCLUSION

Based on the "3-step" strategy of transperineal anastomotic urethroplasty, patients with simple PFUDD can achieve a tension-free anastomosis. The present clinical data showed a successful rate of 88.9% (144/162).