Anomalous left coronary artery from the pulmonary artery (ALCAPA), also known as Bland-White-Garland syndrome, is a rare congenital coronary artery anomaly with an incidence of approximately 1 in 300,000 live births, accounting for 0.25%-0.5% of all congenital heart diseases. Without surgical correction, approximately 90% of affected infants die within the first year of life due to myocardial ischemia and heart failure. However, a small subset of patients with well-developed collateral circulation may survive into adulthood without marked symptoms. We report an incidentally diagnosed case of ALCAPA in a 76-year-old man who was admitted for benign prostatic hyperplasia and urinary retention and underwent cardiovascular evaluation before non-cardiac surgery. Electrocardiography showed sinus bradycardia and complete right bundle branch block, and ambulatory celectrocardiography documented frequent supraventricular premature beats and short supraventricular tachycardia runs without significant ST-T abnormalities. Echocardiography showed a dilated right coronary artery, a suspected coronary fistula, mild chamber enlargement, preserved left ventricular systolic function, and no typical resting segmental wall-motion abnormality. Coronary CT angiography (CTA), performed after cardiology consultation, demonstrated the left main coronary artery arising from the pulmonary trunk, a markedly dilated and tortuous right coronary artery, extensive collateral circulation among the right coronary artery, left coronary system, and bronchial arteries, and a high coronary artery calcium score of 941.74 Agatston units. Cardiac enzymes were not elevated, but formal stress testing and cardiac magnetic resonance imaging were not performed during the index admission. The management decision was therefore framed as individualized conservative follow-up rather than evidence that conservative treatment is generally safe in adult ALCAPA. This case illustrates the diagnostic value of CTA for defining coronary anatomy in late adult ALCAPA, the need for functional ischemia and scar assessment when feasible, and the therapeutic tension between guideline-based surgical recommendations and individualized decision-making in elderly patients with preserved resting ventricular function.

Benign prostatic hyperplasia (BPH) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) are common benign prostatic diseases in middle-aged and older men. The prevalence of BPH increases with age, affecting approximately 45% of men older than 45 years and nearly 80% of those older than 70 years. CP/CPPS predominantly affects men aged 30-50 years, with a global prevalence of approximately 8%. Conventional pathogenic models emphasize androgen metabolism, chronic inflammation, aging, and genetic susceptibility; however, these factors do not fully explain the marked clinical heterogeneity of these disorders. Recent evidence suggests that the gut microbiota may influence prostatic inflammation and hyperplasia through microbial metabolites, immune regulation, and neuroendocrine pathways, giving rise to the concept of a gut-prostate axis. Animal experiments and clinical association studies have reported significant differences in gut microbial composition between patients with BPH or CP/CPPS and healthy controls, and some studies have suggested that microbiota-directed interventions, such as fecal microbiota transplantation, may have potential for alleviating pelvic pain. This narrative review selectively synthesizes evidence from published systematic reviews and original studies to discuss the relationship between the gut microbiota and BPH and CP/CPPS, evaluate the proposed mechanisms and current controversies, and outline future research directions and translational prospects.

To investigate the efficacy and safety of a modified transurethral diode laser four-troughs vaporesection in treating benign prostatic hyperplasia (BPH). The clinical data of BPH patients who underwent prostatic surgery between January 2023 and June 2025 at Guangdong Provincial People's Hospital, Southern Medical University were retrospectively included. The patients were divided into two groups according to the surgical methods: the four-troughs group (patients who underwent modified four-troughs vaporesection of the prostate using a 1 470 nm diode laser), and the enucleation group (patients who underwent 1 470 nm diode laser enucleation of the prostate). The patients were followed up to 6 months after surgery. Independent sample t test, Mann-Whitney U test and analysis of covariance were used to compare perioperative related indicators between the two groups, including prostate volume, International Prostate Symptom Score (IPSS), quality of life score (QoL), maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), duration of surgery, hemoglobin drop level, length of hospital stay, bladder irrigation time and postoperative complications. A total of 103 male patients, aged of (70±6) years, were included. Fifty-five patients were included in the four-troughs group and 48 patients in the enucleation group. The follow-up duration [M (Q1, Q3)] was 3 (2, 5) months. The operative time [(109±36) vs (124±35) min, P=0.024] and hospital stay [(9.4±3.6) vs (11.5±3.4) days, P=0.010], hemoglobin drop level [(6.6±7.8) vs (11.7±8.3) g/L, P=0.002] of the four-troughs group were lower than those of the enucleation group. There were no statistically significant differences in prostate volume, Qmax, PVR, preoperative or postoperative IPSS and QoL between the two groups. (all P>0.05). A total of 5 patients developed mild postoperative complications (2 in the four-troughs group and 3 in the enucleation group), and all improved after symptomatic treatment. The modified transurethral 1 470 nm diode laser four-troughs vaporesection is easy to operate, which is associated with less reduction in hemoglobin level and a shorter operative time. Its short-term therapeutic efficacy and safety are comparable to those of enucleation.

Tadalafil (Cialis) is an FDA-approved oral drug used for benign prostatic hyperplasia, pulmonary arterial hypertension, and erectile dysfunction. A fast, environmentally friendly, and reliable UPLC-MS/MS method was established to quantify tadalafil (TDF) in human liver microsomes (HLMs) and assess its in vitro metabolic stability. Unlike previously reported TDF assays, which target plasma or other biological fluids, the present method uniquely couples HLM-based metabolic-stability assessment with in silico metabolic soft-spot, toxicity, and ADME prediction and dual greenness evaluation in a single workflow. The method is linear over 1 to 4000 ng mL[-1], provides detection within 1 min, and maintains high precision and repeatability regardless of the presence of HLMs. TDF and baricitinib (internal standard) were separated using an Eclipse Plus 1.8 µm C18 column (reversed-phase; 50 mm × 2.1 mm), with a mobile phase of 0.1% HCOOH in water (45%) and in acetonitrile (55%). The approach's accuracy and precision ranged from -4.35% to 7.33% (intra-day) and -5.02% to 12.0% (inter-day). TDF's in vitro half-life was 59.65 min, with a slow intrinsic clearance (Clint) of 13.59 mL min[-1] kg[-1]. In silico results reveal that minor modifications at C28 of the 1,3-benzodioxole ring (95%) could enhance the safety and stability of the new derivatives relative to TDF.

Surgical treatments for benign prostatic hyperplasia (BPH) often impair sexual function. The 450 nm blue laser, with its high hemoglobin absorption and shallow penetration, offers rapid tissue vaporization while preserving sexual function. This study aims to evaluate the efficacy and safety of our blue laser vaporization technique, with a focus on preserving erection and antegrade ejaculation. This prospective cohort study enrolled 105 consecutive sexually active men (≥2 episodes/mo) with BPH who underwent transurethral blue laser vaporization between January 2023 and December 2023. The primary outcomes were the International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5) at 12 mo. The median age, prostate volume, and operation time were 63 yr, 44 ml, and 25 min, respectively. The IPSS decreased from 24 to 8 (p < 0.001), and the maximum urinary flow rate (Qmax) increased from 9 ml/s to 25 ml/s (p < 0.001). Erectile function was preserved (IIEF-5: 18 vs 18, p = 0.479). Although ejaculate volume decreased (2.0 ml to 1.0 ml, p < 0.001), anejaculation occurred in only 2.8% of the patients. Transient hematuria occurred in 31.4% of the patients; 1 patient (1.0%) required reoperation for hemostasis. There were no new cases of erectile dysfunction or incontinence. The blue laser vaporization technique effectively and efficiently improves voiding outcomes through rapid prostate vaporization while preserving erectile function and antegrade ejaculation.

Benign prostatic hyperplasia (BPH) is a prostate lesion, which is widely prevalent among middle-aged and elderly male individuals. Accurate segmentation of prostate structures in MRI imaging plays a critical role in aiding clinicians to assess the condition of the prostate gland. However, the boundary of the prostate gland often exhibits semantic features similar to those of adjacent connective tissues, leading to semantic confusion during prostate MRI segmentation in current methodologies. This phenomenon makes semantic ambiguity, which compromises clinicians' judgment of glandular conditions and may result in misdiagnosis of the patient's disease progression. This challenge imposes significant demands on existing prostate MRI segmentation models. Current models based on CNNs or Transformer architectures struggle to effectively capture long-range dependencies, rendering them prone to semantic confusion when processing images with indistinct boundaries. This limitation further exacerbates semantic ambiguities in the prostate MRI segmentation results. To mitigate the semantic ambiguity in prostate MRI segmentation in BPH, we propose the EScAPe, it contains Semantic Link Gates and a Cross-Layer Retro Connection. The Semantic Link Gate explicitly extracts semantic features at each point, mitigating information loss and semantic ambiguity. The Cross-Layer Retro Connection connects the initial and final layers, enabling the output to revisit the original features and preventing the loss of critical local features during sampling. We evaluate EScAPe on the MSD, NCI-ISBI 2013 and PICAI datasets compare its performance with existing Sota methods, and it achieved IoU scores of 61.66±4.99%, 80.18±%5.22, and 70.26±2.43% and Dice scores of 70.90±5.08%, 85.40±5.50%, and 81.15±2.18% on these three datasets respectively. Across most evaluation metrics, experiment shows that the EScAPe we proposed can solve the above-mentioned semantic ambiguity problem.

Benign prostatic hyperplasia (BPH) is a disease affecting the majority of aging men; 90% of men develop histological BPH by the time they reach their eighties. BPH can lead to bothersome lower urinary tract symptoms (LUTS), which may reduce quality of life. Many patients fail current treatment options and may progress to surgical intervention. Furthermore, diagnosis is reliant on symptom questionnaires and the cause of LUTS can be difficult to distinguish. Currently, BPH can only be definitively diagnosed through histological analysis of prostate tissue, which is not the standard of care. The resulting lack of clinical tissue samples is a major limitation in investigating disease pathology. Improved understanding of disease development and progression, along with objective biomarkers of disease, is needed for BPH. This investigation uses mass spectrometry (MS)-based proteomics and glycoproteomics to compare healthy prostate tissue with prostate tissue affected by BPH to address this gap in knowledge. By integrating proteomics and glycoproteomics, we identified 206 proteins and 44 glycopeptides that were significantly altered between BPH and control samples. These findings provide deeper insight into disease-associated pathways and may facilitate the identification of clinically relevant targets for further investigation.