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Objective:To discuss the clinical and pathological features of the patients with renal oncocytoma.Methods:Making a retrospective analysis of the clinical data of 35 patients with renal oncocytoma who were admitted to the department of urology in the First affiliated Hospital of China Medical University from January 2013 to August 2020, discussing their clinical features, pathological characteristics, treatment and prognosis. The age range of the 35 patients was 35-79 years, with an average age of (59.0±11.3) years, there were 15 males and 20 females. The tumors of the 35 patients were unilateral, concluded 22 cases on the left side and 13 cases on the right side.Among the 35 patients, the tumors of 7 cases located in the upper pole, 14 in the middle pole, and 14 in the lower pole. At the time of admission, 5 patients complained with flank pain, 3 patients had gross hematuria, and the other patients were found during physical examination or examination due to other diseases. In the imaging examination, there were 33 cases of ultrasound data, including 18 cases of hypoechoic, 10 cases of hyperechoic, 3 cases of isoechoic and 2 cases of mixed echo. The data of CT were collected in 30 cases. The tumors showed isointense or slightly hypointense on plain scan, after enhancement, it showed low enhancement with clear boundary to the renal parenchyma and 12 patients had typical central stellate scar sign. All patients accepted surgical treatment, including 23 cases of retroperitoneal laparoscopic surgery and 12 cases of open surgery, but only 12 cases had partial nephrectomy.Results:The tumors were incised after the operation, the range of the tumors’diameter was 1.3-14.0 cm, with an average of (4.0±2.3) cm. The color of the cross-section was tawny in 14 cases, mahogany in 19 cases and 2 cases of other colors. The typical features of tumor cell under microscope were arranged in nests, alveolar or tubular shapes, the cells were round or polygonal.The cell size was uniform, the cytoplasm was rich in eosinophilic granules, the nuclei was deeply stained and the nucleoli was small. There are 9 indicators reach to 20 cases in immunohistochemical stain, and the positive rates of each indicator are respectively EMA 100.0%(23/23), E-cadherin 100.0%(20/20), CK 96.2%(25/26), CD117 95.5%(21/22), p504S(AMACR)35.0%(7/20), CD10 33.3%(9/27), CK7 31.0%(9/29), Vimentin 17.2%(5/29), Ki-67(0/28). Thirty-five patients were followed up after surgery, 4 patients were lost to follow-up, and the follow-up time of the other 31 patients ranged from 7 to 90 months, with an average of (46.9±25.0) months. All patients had a good prognosis without recurrence or metastasis. Among them, 3 patients had mild renal insufficiency in a short time after operation, and they have all recovered. Three patients with gross hematuria before the operation disappeared after the operation. In 5 patients with low back pain, only two patients felt significant improvement, and the other three still felt intermittent episodes of dull lumbar pain.Conclusions:Renal oncocytoma is a relatively rare benign tumor of the kidney. Because of the lack of effective diagnostic methods, it is difficult to differentiate from renal malignant tumors preoperatively. Pathological results are the golden standard for the diagnosis and differential diagnosis of renal oncocytoma. The main treatment of renal oncocytoma is surgery, and after surgery, the patient's prognosis is good, but renal oncocytoma has the possibility of recurrence and metastasis, regular follow-up and surveillance are still required.
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Clinical scientific research is based on clinical reality, through organized scientific behavior, to answer the difficult questions encountered in clinical work, so as to improve the level of clinical diagnosis and treatment. After 35 years of medical work, I have gotten some insights in the practice of clinical scientific research. First, in order to do a good job in clinical scientific research, we have to be good at finding problems in clinical practice and pay attention to the collection of clinical data. Second, we should be diligent in learning and good at thinking. Young doctors should deal with the problems encountered in clinical work, combine with learning and think repeatedly, determine new problems, and then look for literature to study, in order to find out clinical research topics. Third, we should have a clear theme and continue to dig in depth. When having a clear research direction, it is suggested to carry out in-depth research from clinical practice to clinical basis, gradually form a scientific research system, and improve young doctors’own professional ability and professional quality. Clinical research should be the starting point and lasting driving force for success of young doctors.
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Objective To assess the efficacy and side effects of intravesical instillation of BCG after transurethral resection of the bladder tumor (TURBT) in non-muscle invasive bladder cancer (NMIBC) patients.Methods The clinical data of patients treated with BCG 120 mg per course induced perfusion or more after TURBT from December 2013 to October 2016 in 18 hospitals of northeast China region,were analyzed retrospectively.The first part,data of 106 patients with moderate,high-risk NMIBC were collected.A total of 83 patients were male,while the other 23 patients were female.The average age was 66.7 years old.The clinical staging were T1 in 86(81.1％) cases,Ta in 20(18.9％) cases and carcinoma in situ in 6 (5.7％) patients.Intravesical instillation of BCG was executed after transurethral resection of the bladder tumor.The incidence rate of recurrence and progression during more than 6 months' follow-up time were observed.Multivariate analyses were done by using logistic analysis and Cox proportional hazards regression model with Kaplan-Meier method.The second part,treatment compliance of 276 patients with bladder cancer,including moderate/high-risk NMIBC in 263 cases,moderate/high-risk NMIBC followed with renal pelvis/ureteral carcinoma in 8 cases were and moderate/high-risk NMIBC with renal pelvis/ureteral carcinoma in 5 cases who treated with BCG after the surgeries,were observed.Patients consisted of 211 males and 65 females with average age of 68.3 years.Results With a median follow-up of 12 months,9 (8.5％) patients experienced tumor recurrence and 2 (1.9％) patients were found progression in the first part.The one-year cancer free recurrence rate of the patients was 91.5％.Statistically significant prognostic factors for recurrence identified by multivariable analyses were prior recurrence of the tumors (OR =3.214,95％CI0.804-12.845,P =0.099).In the second port,an incidence rate of adverse effects was 64.1％ (177/276).The Ⅲ/Ⅳ degree complications were occurred in 11 patients and satisfactory outcomes achieved with active treatment.A total of 36 patients withdrawal with the major causes were recurrence and progression of bladder tumor in 12 cases (4.4 ％),9 cases (3.3 ％) with economic reasons and 11 cases (4.0％) with serious complications.Conclusions NMIBC patients treated with intravesical BCG therapy have approving cancer free recurrence rates and acceptable adverse effects.Prior recurrence may be prognostic factor of recurrence after intravesical BCG therapy.
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Objective To investigate the diagnosis and therapy by improving the further understanding of adrenal hemorrhage.Methods The clinical data of 12 cases of adrenal hemorrhage confirmed by pathology admitted to the First Hospital of China Medical University from October 2006 to October 2017 were retrospectively analyzed.Observe the patient's clinical manifestations,imaging features,treatment methods and prognosis.Results All 12 cases were unilateral adrenal hemorrhage,8 cases manifested lumbago in troubled side,2 cases manifested abdominal pain,and 2 cases were found during physical examination incidentally with no obvious symptoms.Ultrasound-B was performed in 10 cases,revealed low echo of masses in 5 cases,mixed echo of masses in 2 cases,cystic echo of masses in 2 cases,and no abnormality in 1 case.All 12 cases were scanned by CT,9 cases showed cystic masses with mixed density,and 3 cases showed solid masses.The value of plain CT ranged from 31 HU to 77 HU,no obvious enhancement was found in enhanced scan.One case was scanned by MRI,showed round mass in left adrenal gland,with uneven signal.The main signal was iso-signal in T1-weighted and T2-weighted.Six cases underwent adrenal and mass resection through the 11th rib,3 cases underwent retroperitoneoscopic adrenalectomy,2 cases underwent abdominal exploration and accepted adrenalectomy and hematoma removal,and 1 case was discharged after conservative treatment because of surgery contraindication.11 cases of the pathology of postoperation were adrenal hemorrhage.Conclusions Preoperative diagnosis of adrenal hemorrhage is relatively difficult,ultrasound-B,CT,and MRI examination can help diagnose.Surgical treatment should be performed for patients who can tolerate surgery and with larger hematoma (＞5 cm).
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Objective To compare the different pathological type of renal tumor,clinical epidemiology,imaging and pathological features,summarize its value in the diagnosis of renal tumor.Methods The clinical data of 2198 patients who underwent surgical treatment in our hospital due to renal tumors from January 2010 to January 2019 were retrospectively analyzed.There were 1 404 males and 794 females with an average age of (56.5 ± 11.7) years old.The clinical epidemiology,image features and pathological features were compared.Results Among them,the pathological results concluded 1 891 cases of renal clear cell carcinoma (86.0％),112 cases of papillary renal cell carcinoma (5.1％),76 cases of chromophobe cell carcinoma (3.5％),23 cases of multilocular cystic renal tumors with low malignant potential (1.0％),13 cases of Xp11.2 translocation carcinoma (0.6％),4 cases of collecting duct carcinoma (0.2％),58 cases of anadipotic angiomyolipoma (2.6％),18 cases of acidophiloma (0.8％),and 3 cases of metanephric adenoma (0.1％).The overall differences in age and gender among patients with renal tumors of different pathological types were statistically significant (F =13.8,P ＜ 0.05;x2 =20.5,P ＜ 0.05),Xpl 1.2-translocated carcinoma had the lowest mean age of onset,which was (44.9 ± 17.1 years old).The percentage of women with anadipotic angiomyolipoma was higher (41,70.7％),and the percentage of men with clear cell carcinoma and papillary renal cell carcinoma was higher (1 253,66.3％) and(77,68.8％).There was no statistically significant difference in side sex and clinical manifestations among patients with different pathological types of renal tumors (x2 =16.27,P ＞ 0.05).No significant difference in the distribution of left and right side,the clinical manifestations were mainly sporadic (x2 =19.63,P ＞ 0.05).The results of renal tumors ultrasound ith different pathological types showed statistically significant difference (x2 =67.l,P ＜ 0.05).Hyperechoic (20,34.5％) and mixed echogenicity (16,27.6％) were the main manifestations of lipoma.Multilocular cystic renal tumors with low malignant potential were mostly cystic and solid mixed echogenicity (14,60.9％).CT values of renal tumors of different pathological types at all stages showed statistically significant differences (P ＜ 0.05).The CT values of clear cell carcinoma at the arterial phase of CT enhanced scan were significantly higher than those of other types of tumors (F =11.6,P ＜ 0.05),but decreased significantly in the parenchymal phase,showing the enhancement characteristics of "fast in and fast out".The CT values of papillary cell carcinoma in the third phase of enhanced scan were all lower than those of clear cell carcinoma and chromophobe cell carcinoma (P ＜ 0.05),showing a "progressive enhancement".The enhancement effect of chromophobe cell carcinoma is somewhere in between.The CT value on plain scan of anadipotic angiomyolipoma was higher than that of clear cell carcinoma,and the enhancement was followed by continuous enhancement,showing the characteristics of "fast in and slow out".The majority of clear cell carcinoma and papillary cell carcinoma were tan section (1 235,72.55％;51,52.13％).The grey-white section was the most common type of adipogenic angiomyolipoma (21,40.4％).Conclusions The epidemiological characteristics,imaging and pathological features of renal tumors of different pathological types have certain characteristics,especially the enhanced CT features of renal clear cell carcinoma,papillary renal cell carcinoma,chromophobe cell carcinoma and anadipotic angiomyolipoma,which are of certain value for the differential diagnosis of renal tumors of different pathological types.
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Histone deacetylase 9 (HDAC9) belongs to the IIa subtype of HDACs. It is responsible for changing the structure of chromo-somes and regulating the transcription of genes by catalyzing the deacetylation of H3, H4, and non-histone proteins in vivo. Emerging studies have demonstrated that HDAC9 is closely related to tumors, but their expression and function in different tumors is not the same. This could ultimately lead to the opposite effect of promoting or suppressing tumorigenesis; unfortunately, the mechanisms are not clear. Recently, epigenetic treatment with HDAC deacetylases inhibitors (HDACIs) has become a hot topic and the development of selective HDACIs in combination with chemotherapy, radiotherapy, and immunotherapy has gained traction. However, studies target-ing HDAC9 are limited. This review summarizes the recent studies about HDAC9 in tumors.
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Objective To analyze the clinicopathological features and prognostic factors of chromophobe renal cell carcinoma.Methods The clinical data of 107 patients with pathologically diagnosed chromophobe cell carcinoma in our hospital from January 2010 to December 2017 were retrospectively analyzed.There were 50 males and 57 females.The age was 16-81 years,with a median age of 53 years.The diameter of the tumor was 1.6-30.0 cm and the median value was 5.0cm.The tumor was located on the right side in 55 cases,on the left side in 51 cases,and bilateral in 1 case.The clinical parameters of different types of renal chromophobe cancer were compared by the Chi square test.The survival analysis was carried out by Kaplan-Meier,and the risk factors were evaluated by single factor and multiple factor Cox proportional risk regression model.Results One hundred and six patients underwent operation,with 55 by open surgery,and 51 by endoscopic surgery,including 89 radical surgery and 17 nephron-sparing surgery.One patient was treated with Sorafenib.Pathological stage T1 stage was 74 cases (69.2％),T2 stage 28 cases (26.2％),T3 stage 3 cases (2.8％),T4 stage 2 cases (1.9％).There were 102 cases of type Ⅰ chromophobe cell carcinoma (95.3％),and 5 cases of type Ⅱ chromophobe cell carcinoma (4.7％).There was no significant difference in gender,age,tumor side,first symptom and T staging in patients with type Ⅰ and Ⅱ chromophobe cell carcinoma (P ＞ 0.05).One hundred and seven patients were followed up for 4-95 months,with the median time of 40 months.Four cases were missed and 5 cases died.The 5 year survival rate was 93.1％.Cox univariate and multivariate regression analysis showed that different T staging and metastasis were independent prognostic factors (all P ＜ 0.05).Conclusions Renal chromophobe cell carcinoma is rare and its diagnosis mainly depends on pathology.Surgery is the main method for the treatment.The malignant grade is low,progress is slow,and the prognosis is good.
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Objective To evaluate transurethral fulguration with intravesical instillation of heparin and alkalinized lidocaine for the treatment of interstitial cystitis/bladder pain syndrome (IC/BPS).Methods Data from the chnical records of 31 patients (30 female and 1 male) with IC/BPS were analyzed retrospectively.Transurethral fulguration and biopsy were performed.Intravesical instillation of heparin and alkalinized lidocaine (25 000 units of hepmin,10 mL of 2％ lidocaine,and 5 mL of 5％ sodium bicarbonate) was administered weekly for 8 weeks.Thereafter,intmvesical instillation treatment was administered twice a month.The interstitial cystitis symptom index and problem index (O'Leary-Sant index),visual analog scale score for pain,quality-of-life index,voiding frequency,bladder capacity,and side effects of intravesical instillation were recorded preoperatively and at the first and sixth month follow-ups postoperatively.Results The follow-up period was 6 to 24 months.The interstitial cystitis symptom index and problem index,visual analog scale score for pain,quality-of-life index,daily voiding time,and maximal bladder volume improved significantly in 28 cases (90.32％;P ＜ 0.01),and no significant adverse effects were observed.Two patients underwent cystectomy,and the symptoms disappeared after the operation.Carcinoma in situ was detected on histopathological examination in one patient.Conclusion Transurethral fulguration with intravesical instillation of heparin and alkalinized lidocaine is a safe and effective therapy for IC/BPS.
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Objective Investigating the CT features and related prognostic factors of high-grade renal clear cell carcinoma.Methods The data of 141 patients with renal clear cell carcinoma treated by radical nephrectomy in our hospital from November 2012 to April 2017 were analyzed retrospectively.There were 102 males and 39 females.Age from 30 to 86 years old.The tumors were located in the left side in 73 cases and 68 in the right.The tumor size ranged from 1.6 cm to 12.7 cm.50 cases of clinical stage T1a,stage T1b 67 cases,24 cases above T2.All patients had CT examination before operation.According to the postoperative pathological nuclear grade,patients were divided into high grade group (Ⅲ-Ⅳ) and low grade group (grade Ⅰ-Ⅱ),clinical data and CT findings were compared between the two groups (tumor size,capsule,CT,with or without leafs,with or without hemorrhagic necrosis),survival situation after the operation.Result The results of CT examination of 141 cases of this study indicated there were 109 cases of complete capsule,85 cases of tumor showed lobulation,102 cases of tumor showed hemorrhagic necrosis,the average CT value is 10-72 HU,35.4 HU in average;enhanced CT value is 32-308 HU,102.1 HU in average.After pathological examination,the nuclear classification was 66 cases in high grade group and 75 cases in low grade group.The CT examination in thc high grade group and the low grade group showed the number of cases with complete capsule [44 cases (33.3％) vs.65 cases (13.3％)] and plain CT scan value [(38.9 ± 1.1) HU) vs.(32.3 ± 1.1) HU],the difference was statistically of significance (P ＜0.01).The high level of patients in group T1 and group above T2 stage were 46 cases and 20 cases.And the cases of low grade group were 71 cases and 4 cases,there was significant difference between two groups (P ＜ 0.01).The 141 cases were followed up for 2-58 months,with an average of 26.4 months.There was statistical significance difference between the two groups of T1 patients and patients above T2 (P ＜ 0.01).The results of CT examination were compared.There were significant differences in the case of intact capsule and the value of CT scan (P ＜ 0.01).The overall survival rate between the two groups was statistically significant (P ＜ 0.05).Conclusions The CT examination of high-grade renal cell carcinoma shows that most of the capsule is not complete and the CT value of the scan is much higher.The pathological grading of renal cell careinoma indicates the malignancy of tumor cells,which is closely related to prognosis.
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Objective To study the surgical treatment of adrenocorticotropic hormone independent macronodular adrenal hyperplasia (AIMAH).Methods The clinical data of 12 AIMAH patients were analyzed retrospectively.There were 3 males and 9 females, with an average age of 55 years (range, 39-67 years).10 cases had typical clinical features of Cushing syndrome.Endogenous hypercortisolism was confirmed on the basis of loss of circadian rhythm of serum cortisol, high late-night serum cortisol level and inadequate cortisol suppression after overnight low-dose dexamethasone suppression test.ACTH independence was established on the basis of suppressed serum ACTH levels and inadequate cortisol suppression after overnight high-dose dexamethasone suppression test.CT scan showed bilateral enlargement of the adrenal glands with multiple macronodules.Steroid supplement was given after operation.Results Surgical intervention was performed in all the patients.Seven patients underwent bilateral adrenalectomy,and unilateral adrenalectomy was performed in 5 patients, one of whom had the history of contralateral adrenalectomy.Pathological examination confirmed multinodular hyperplastic adrenal enlargement.The average duration of postoperative follow-up was 50 months (range, 1-105 months).One patient undergoing bilateral adrenalectomy died from respiratory failure and pulmonary infection one month after operation.Remission of Cushing syndrome symptoms was obtained after surgery in other 11 patients.For these 11 cases,the serum cortisol declined into normal ranges, but suppressed serum ACTH levels and inadequate cortisol suppression after overnight low-dose dexamethasone suppression test were still present.Two patients received contralateral adrenalectomy due to recurrent overt Cushing syndrome after one year and 5 years, respectively.Conclusions Unilateral adrenalectomy might be an effective and safe treatment modality for AIMAH, but subclinical hypercortisolism would be present postoperatively.Contralateral adrenalectomy may be performed in case of the recurrence of overt Cushing syndrome.
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Objective To study the clinical features,diagnosis and management of small cell carcinoma of the bladder (SCCB).Method The clinical data of 18 cases of patients with small cell carcinoma of the bladder were analyzed retrospectively and the literature were reviewed.There were 16 males and 2 females,ages 54 to 81 years (median age,61 years).Clinical manifestations included gross hematuria in 11 cases,urgency in 2 cases,dysuria in 2 cases and postoperative review after TURBT of bladder urothelial carcinoma in 3 cases.The median tumor size was 3.35cm (ranged,1.0 to 6.0 cm).2 cases underwent TURBT and intravesical chemotherapy regularly were followed after surgery.3 cases underwent partial cystectomy,intravenous chemotherapy combined with radiotherapy was followed in one case,the other 2 cases refused the following therapy.13 cases underwent radical cystectomy,intravenous chemotherapy was followed in 2 cases,pelvic radiotherapy was followed in 2 csaes and intravenous chemotherapy combined with radiotherapy was followed in 2 cases,the other 7 cases refused the following therapy.Results 11 cases were pure SCCB,7 cases were mixed SCCB,all with urothelial carcinoma.T1N0M0 in 3 cases,T2N0.1M0 in 4 cases,and T3N0-2M0 in 11 cases.The duration of follow-up was from 5 to 35 months after surgery.9 cases died of tumor metastasis,9 cases are still alive,except 1 case with lymph node metastasis,the other 7 cases are free of tumor recurrence or metastasis.Conclusions SCCB is rare,with high malignant degree and poor prognosis.The prognosis of the pure SCCB may be worse than the mixed SCCB.The diagnosis depends on pathology examination.Radical cystectomy is the main treatment method,the strategy of bladder-preserving may be an attempt for proper SCCB patients.Adjuvant therapy plus surgery may be better.
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Objective To study the diagnosis and surgical outcomes of renal cell carcinoma with inferior vena cava tumor thrombus.Methods The clinical data from 31 cases of renal cell carcinoma with inferior vena cava tumor thrombus were retrospectively reviewed from January 2000 to December 2014.Among them,21 cases were male and 10 cases were female.The mean age ranged from 38 to 79 years,mean 57 years.The location of tumor included right renal in 29 cases and left renal in 2 cases.The distribution of the tumor thrombus was recorded as follow:level Ⅰ in 20 cases,level Ⅱ in 8 cases and level Ⅲ in 3 cases.All patients received radical nephrectomy and tumor thrombectomy.Ipsilateral subcostal oblique incision was chosen in 20 cases.Transrectus incision was chosen in 10 cases.And abdominal transperitoneal L shaped incision was chosen in 1 case.Three patients were given neoadjuvant molecular targeted therapies before operation.Results All patients accepted the operation successfully.There was no death during perioperative period.The pathological diagnosis showed clear cell carcinoma in 30 cases and chromophobe cell tumor in 1 case.The Fuhrman grading showed that 17 cases were grade Ⅱ,8 cases were grade Ⅲ and 5 cases were grade Ⅳ.Among them,the lymphatic metastasis in the renal hilum was found in 5 cases.After operation,16 patients received molecular targeted therapies,including sorafenib in 10 cases and sunitinib in 6 cases.Six patients were given autologous tumor lysate-pulsed dendritic cells co-cultured with cytokine induced killer cells treatment.The median overall survival was 44 months (range 4-60 months).The 1-,3-,and 5-year overall survival rates for all patients were 100％,52％,and 39％,respectively.There were significant differences of the overall survival rates between level Ⅰ / Ⅱ and level Ⅲ tumor thrombi(81.5％ vs 0) (P =0.012).Similar difference was noticed between Fuhrman grade Ⅱ and grade Ⅲ/Ⅳ (94.1％ vs 46.2％)(P =0.003).There was also significant difference between those with or without lymph node metastases (40.0％ vs 80.8 ％) (P =0.0 1 6).Conclusions Radical nephrectomy and tumor thrombectomy could improve the survival of patients of renal cell carcinoma with inferior vena cava tumor thrombus.The overall survival rate might be related to the tumor thrombus level,tumor grade,and local lymph node metastasis.
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<p><b>BACKGROUND</b>Overactive bladder (OAB) is a series of symptoms with high prevalence in elderly people. This study was conducted using the overactive bladder symptom score (OABSS) to evaluate the efficacy of solifenacin succinate for the treatment of OAB.</p><p><b>METHODS</b>This was a prospective, multicenter, single-arm, 12-week study that enrolled 241 OAB patients. The patients received 5-10 mg/day solifenacin. Changes in OABSS, symptoms from voiding diary, perception of bladder condition (PPBC) score, international prostate symptom score (IPSS) and quality of life (QOL) were evaluated at weeks 0, 4, and 12. The relationship between OABSS and PPBC score or parameters of voiding diary was also evaluated.</p><p><b>RESULTS</b>At baseline, the mean OABSS for all patients was 9.41 ± 2.40, and was reduced significantly at week 12 (-3.76 points; 61.21%, P < 0.0001). The OABSS subscore, PPBC score, IPSS, and QOL were also significantly reduced during the study (P < 0.0001). The overall incidence of adverse events was 19.91% (44 cases). The gastrointestinal system was the most commonly affected (11.31%). Around 5.88% of the cases had adverse events related to the genitourinary system. There was a strong correlation between OABSS and urinary symptoms that was recorded in the 3-day voiding dairy.</p><p><b>CONCLUSIONS</b>We showed that solifenacin was clinically effective for relieving OAB symptoms, considering the balance between efficacy, patients' well-being, and tolerability. OABSS integrates four OAB symptoms into a single score and can be a useful tool for research and clinical practice.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Muscarinic Antagonists , Therapeutic Uses , Prospective Studies , Quality of Life , Quinuclidines , Therapeutic Uses , Solifenacin Succinate , Tetrahydroisoquinolines , Therapeutic Uses , Treatment Outcome , Urinary Bladder, Overactive , Drug TherapyABSTRACT
Objective To evaluate the safety,efficacy,experience and techniques of percutaneous nephrostolithotomy (PCNL) in treating renal staghorn calculi.Methods The clinical data of 60 patients with staghorn renal stone who underwent PCNL were analyzed retrospectively.Results The stone free rate was 68.3％(41/60) in the first procedure.Three patients were performed a secondary procedure.The stone free rate was 73.3％ (44/60) in the second procedure.The total stone free rate was 93.3％(56/60) after the procedure of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic lithotripsy (URL).Conclusions PCNL is a safe and effective method for the staghorn renal calculi.The stone free rate may be improved with skilled operation experience and combination with ESWL and/or URL.
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Objective To investigate the expression of Netrin-1 protein in human renal clear cell carcinoma (RCCC) and the relationships between Netrin-1,pathology and prognosis.Methods Fortyeight cases of RCCC and their adjacent tissues were selected for study,including 26 males and 22 females.The median age was 62 years (range,26 to 83 years).All 48 patients were onset for the first time,confirmed by pathology.All cases had no radiotherapy,chemotherapy or biological treatment before operation.Fuhrman grade:6 cases in grade Ⅰ,6 cases,in grade Ⅱ,27 cases in grade Ⅲ and 9 cases in grade Ⅳ.The AJCC staging in 2010:20 cases in stage Ⅰ-Ⅱ],28 cases in stage Ⅲ-Ⅳ.The expression of Netrin-1 protein was detected by immunohistochemical staining and its clinical significance was analyzed.All cases were followed up for more than 5 years.Survival analysis lines were made by Kaplan-Meier method and the difference between groups was tested by the Log-rank test.Results The expression of Netrin-1 protein was higher in renal cancers [71％ (34/48)] than that in the adjacent normal tissues [17％ (8/48)] (P＜0.05).Netrin-1 protein expression rates were 42％(5/12) in Fuhrman Ⅰ-Ⅱ tumors and 81％ (29/36) in Fuhrman Ⅲ-Ⅳ tumors,while 55％ (11/20) in stage Ⅰ-Ⅱ and 82％ (23/28) in stage Ⅲ-Ⅳ,respectively (P＜0.05).The 5-year survival rate in high protein expression group and in low protein expression group was 62％ (21/ 34) and 79％ (11/14).The survival curve had different trend,with no significant difference between groups (P＞0.05).Conclusions Netrin-1 protein plays an important role in the development of RCCC.It might be a new specific tumor marker of RCCC,and might become a new target in treatment of RCCC.
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Objective To study the value of renal CT scan in evaluating split renal function.Methods 147 patients undergone CT scan from June 2009 to June 2011 were involved in this study.There were 73 cases of obstructive hydronephrosis and 74 cases of renal tumors.66 patients were males and 81 were females with a mean age of 53 years ( range 17 - 87 years).GFR detected by single-photon emission computed tomography (SPECT) was used as the reference of split renal function.The kidneys were divided into 3 groups according to the GFR:normal renal function (113 cases,GFR ≥ 34 ml/min),mildly impaired renal function (66 cases,GFR:20 -34 ml/min) and severely impaired renal function (41 cases,GFR ＜20 ml/min).One-way ANOVA and linear regression analysis were used to analyze the relationship between the results of CT scan and split renal functions. Results There were significant differences in the cortical thickness among the normal renal function,mildly impaired renal function and severely impaired renal function groups.The cortical thicknesses were (0.62 ±0.11) cm,(0.45 ±0.10) cm and (0.26 ±0.07) cm,respectively (P ＜ 0.01 ).The renal cortical thickness was strongly correlated with GFR (r =0.806,P ＜0.01 ).There were significant differences in the enhancement during the cortical phase among the 3 groups,which were (162.1 ±25.3) HU,(121.6 ±21.0) HU and (63.5 ±20.0) HU,respectively (P＜0.01).The enhancement during the cortical phase was strongly correlated with the GFR (r =0.851,P ＜ 0.01 ).The enhancement during the parenchymal phase and excretory phase was moderately correlated with the GFR ( r =0.467 and r =0.451,P ＜ 0.01 ). Conclusions The renal cortical tbickness and the enhancement during the cortical phase detected by CT scan might be useful for the clinical evaluation of split renal function.
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Objective To evaluate the efficacy of combination solifenacin and tamsulosin for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy. Methods 120 patients (male:100 female:20 age:18-67 yrs) randomly assigned to 4 groups (each group 30) with the calculi diameter range from 0.5 to 1.1 cm.All patients performed extracorporeal shock wave lithotripsy (X ray oriented).The control group did not accept any medical treatment.The solifenacin group were administered solifenacin 5 mg,once per day.The tamsulosin group were administered tamsulosin 0.2 mg,once per day.The combination group were administered solifenacin 5mg,plus tamsulosin 0.2 mg,each per day.The observation duration was set at 2 weeks. Results The stone-free rate (according to KUB) within 2 weeks were 80.0％,83.3％,93.3％ and 96.7％ in the control group,solifenacin group,tamsulosin group and combination group respectively.Statistical differences were significant among the tamsulosin group,the combination group and the control group.The stone expulsion times were (7.6 + 3.7) d,(6.3 ± 2.5) d,(4.4 + 2.3) d and (3.5 ± 2.2) d in the 4 groups respectively.Statistical differences were significant among the tamsulosin group,the combination group and the control group.The uses of analgesics were 13,5,9 and 3 in the 4 groups respectively.The bladder irrtative symptoms were 12,6,4 and 4 in the 4 groups respectively.Statistical differences were also significant for the use of analgesics and relief of bladder irritation between the solifenacin group,the combination group and the control group. Conclusions Tamsulosin and solifenacin could be safe and effective for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy.It could significantly improve the stone expulsion rate,relief the pain and improve bladder irrtative symptoms.
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Objective To verify the efficacy and safety of intravesical instillation of Cystistat in reducing complications caused by intravesical chemotherapy after TUR-BT in non-muscle invasive bladder cancer patients. Methods One hundred and twenty patients who met the inclusion/exclusion criteria were enrolled into this multi-centered, randomized and blank controlled clinical study. Selected patients were randomized into the observation group and control group. TUR-BT was carried out in both groups followed by pirarubicin (THP) and Cystistat intravesical instillation in the observation group, and THP intravesical instillation alone in control group. Visual analog scale (VAS) was used as the primary efficacy variable. The secondary efficacy variables were assessments of hematuria and bladder irritation symptoms. Adverse events, laboratory tests and changes of vital signs before and after treatment were strictly observed during observation to evaluate the efficacy and safety of Cystistat.Results Demographics and baseline characteristics were comparable in both groups. The differences and the improvement rate of VAS score in the 2 groups were significant, both P＜0.01. The changes of VAS score and the improvement rate before and after treatment were (2. 24±1.70) and (92. 92±14.76) % in observation group and (0. 70±1.82) and (20. 59±87.34)% in control group respectively. According to the covariance analysis, there were significant differences in changes of VAS score between the observation group and the control group. Also, the improvement rate of VAS score was significant from visit 2. The urine frequency decreased from 9.06±4.09 to 6. 69±2.89 in observation group and increased from 8. 85±3. 32 to 10. 15±4.40 in control group, P＜0.01. There were also significant differences in changes of nocturia before and after treatment between these two groups (P＜0.01), the nocturia decreased from 2. 88±1.74 to 1. 47±1.62 in observation group and 3. 22±2.30 to 2.91±1.73 in control group, respectively. The changes of WHO assessment for hematuria,urgency and dysuria were not significantly different between the 2 groups. No Cystistat related adverse event was observed. Conclusions Cystistat combined instillation can significantly improve the VAS score of patients with chemotherapeutic agent instillation. Relief of bladder pain, frequency and nocturia are more rapidly and more durable in Cystistat combined instillation group. The improvement is more effective in patients with a high VAS score. Cystistat instillation with chemotherapeutics agents is both well tolerated and safe.
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Objective To detect gene expressions of Uroplakin (UP) family in interstitial cystitis (IC). Methods Gene expression of UP Ia, Ib, II, III, and III-δ4 was quantitatively measured in bladder biopsy samples from patients with IC (n=29) and control subjects (n=16) using real-time RT-PCR. Results UP III-delat4, a splicing variant of UP III, was significantly up-regulated to 4.80 in IC samples (P<0.001). When IC patients were divided into two groups, one with and one without ulcerative changes, the UP Ia, UP Ib, UP II, UP III and III-δ4 genes were significantly up-regulated to 4.99, 3.31, 2.75, 15.38, 11.48 in nonulcerative IC patients, but decreased to 0.04, 0.29, 0.09, 0.11, 0.34 in ulcerative IC patients (P<0.01). The up-regulation of UP III-δ4 was more prominent than that of UP III: 26.5-fold versus 5.6-fold compared to the median values of normal subjects. Conclusion Although the clinical implications of the over-expression of UP III and III-δ4 in non-ulcerative IC bladders remain to be clarified, from the diagnostic viewpoint, UP III-δ4 is a potential marker for identifying nonulcerative IC.
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Objective To discuss the effects of silencing of iASPP gene on human bladder cancer cells. Methods RNAi silencing of iASPP gene in bladder cancer cell 5637 and T24 cells were used by lentiviral mediated interfering short hairpin RNAs. Cell proliferation was tested by MTT assay, and rate of colony was tested by colony formation assay. Cell cycles were tested by using fluorescence-activated cell sorting. Results Down-regulation of iASPP could inhibit the growth and proliferation of human bladder cancer cells (P＜0.05). iASPP know-down could decrease the colony formation of 5637 and T24 cells (P＜0, 05). Knocking down of iASPP in 5637 and T24 cells showed cell arrested at G1. Conclusions Silencing of iASPP gene could inhibit proliferation and colony formation of bladder cancer, iASPP might be an important target for gene therapy of bladder cancer.