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Objective To observe the clinical effect of the method of Shugan-Yiqi-Yangyin treatment for the steroid-resistant nephrotic syndrome (SRNS). Methods A total of 80 patients with SRNS were divided into 2 groups by random number table method, 40 in each group. The control group received glucocorticoids combined with Tripterygium Glycosides;and the treatment group received Shugan-Yiqi-Yangyin on the basis of the control group, 3 month as a course. The 24 h urine protein quantitative (propagated), plasma albumin, blood lipid (total cholesterol, triglycerides), hemorrheology, blood urea nitrogen (BUN), creatinine (Cr), urinary inhibition C (Cys C) were detected before and after the treatment of two groups, and the clinical effect was compared. Results The total effective rate of the treatment group was 92.50% (37/40) and 82.50% (33/40) in the control group, and the difference was statistically significant (Z=-1.966, P<0.05). After the treatment, the 24 hPRO (1.03 ± 0.64 mg vs.2.81 ± 1.43 mg,t=3.025),Cys C(0.35 ± 0.41 mg/L vs.0.76 ± 0.51 mg/L, t=3.058) of the treatment group was significantly lower than those of the control group(P<0.05).The Alb(34.88 ± 2.17 mg vs. 31.69 ± 2.05 mg, t=2.986) of the treatment group was significantly higher than this of the control group (P<0.05), After treatment,the whole blood high shear viscosity(7.84 ± 1.42 mPa?s vs.8.94 ± 1.38 mPa?s,t=3.160),the whole blood low shear viscosity(4.55 ± 0.37 mPa?s vs.5.02 ± 0.44 mPa?s,t=3.825),plasma viscosity(1.33 ± 0.10 mPa?s vs.1.95 ± 0.26 mPa?s,t=2.981),hematocrit(0.28 ± 0.03 vs.0.34 ± 0.03,t=2.993),fibrinogen(3.96 ± 0.57 g/L vs.4.52 ± 0.47 g/L,t=4.863)of the treatment group were significantly lower than those of the control group(P<0.05).The TC(5.04 ± 1.72 mmol/L vs.6.99 ± 1.06 mmol/L,t=3.67),TG(1.4 ± 0.64 mmol/L vs.2.02 ± 0.31 mmol/L, t=3.040) of the treatment group were significantly lower than those of the control group (P<0.05). Conclusions The Shugan-Yiqi-Yangyin treatment for SRNS can obviously improve the symptoms,reduce the side effects of hormone of antagonism. The possible mechanisms are to restore kidney function, improve blood viscosity and lower blood lipid levels.
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Objective To summarize the relationship between metabolic syndrome (MS),its components and T1 stage with high grade urothelial carcinoma (HGUC) of the Bladder.Methods The clinical data of 200 patients with T1 high grade bladder cancer who were admitted to our hospital from January 2010 to June 2014 were retrospectively analyzed,including 155 males and 45 females.Ages were 24 to 86 years old,average 66 years old.Based on the history or blood glucose levels,patients were divided into diabetic group (n =41) (20.5％) and non diabetes group 159 cases (79.5％);According to the body mass index (BMI) were divided into obese group (≥25 kg / m2) of 98 cases (49.0％) and non obese group (＜ 25 kg / m2) of 102 cases (51.0％).According to the blood pressure level,71 cases (35.5％) were divided into hypertension group and 129 cases of non hypertension group (64.5％).MS and its components and the relationship between the recurrence and progress of bladder cancer were analyzed.The Kaplan Meier method was used to assess MS and its components division of tumor progression free survival (progress-free survival,PFS) and recurrence free survival (recurrence-free survival,RFS) influence.Cox regression model of multi factor analysis were used to evaluate the PFS and RFs of MS and its components with bladder cancer.Results Of the 200 cases,16 cases (8.0％) were MS.Tumor recurrence occurred in 121 cases (60.5％),and 84 patients (42.0％) were in progress.Diabetes and non diabetes groups the average RFs were 21.7 and 29.3 months respectively,and the difference was statistically significant (x2 =10.115,P =0.001);The median PFS were 32.8 and 39.8 months respectively,the difference has statistical significance (x2 =14.760,P ＜0.001).Obese group and non obese group average RFs were 34.7 and 42.0 months respectively,and the difference were statistically significant (x2 =16.077,P ＜ 0.001);The median PFS were 22.8 and 32.6 months respectively,the difference was statistically significant (x2 =16.174,P＜0.001).The average RFS of MS group and non MS group were 21.5 and 28.4 months respectively,the difference was statistically significant (x2 =5.429,P =0.02);the average PFS was 35.1 and 38.7 months respectively,and the difference was statistically significant (x2 =3.854,P ＜ 0.05).Cox multivariate survival analysis showed that diabetes and obesity can increase the risk of recurrence and progression of T1 advanced stage bladder cancer (HR =1.792,P =0.013,HR =2.498,P ＜ 0.001;HR =0.559,P ＜ 0.001;HR =0.492,P ＜ 0.001).Conclusions Diabetes mellitus and obesity are high risk factors for the recurrence and progression of T1 advanced stage bladder cancer,but MS is not related to the prognosis of T1 patients with advanced bladder cancer.
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Objective To investigate the accumulation of mutations and single nucleotide polymorphisms ( SNPs) in the displacement loop ( D-loop ) of mitochondrial DNA ( mtDNA ) might be associated with cancer risk and disease outcome.Methods We obtained cancerous and noncancerous liver tissues from 49 HBV-related HCC patients at the Fourth Hospital of Hebei Medical University.mtDNA of the liver tissues was extracted with Mitochondrial DNA Extraction Kit.Mutation and polymorphism were confirmed by repeated analysis.We assessed the prediction power of D-loop SNPs in hepatocellular carcinoma ( HCC) patients.Results No mutation in these HCC patients had prediction power for post-operational survival, whereas one SNP site ( nucleotide 150 C/T ) was identified by the log-rank test for statistically significant prediction of HCC survival.In an overall multivariate analysis, allele 150 was identified as an independent predictor of HCC outcome.The length of survival of patients with allele 150C was significantly shorter than that of patients with allele 150T (relative risk, 0.246;95% CI, 0.070–0.861; P=0.028).Conclusions The analysis of genetic polymorphisms in the mitochondrial D-loop helps to identify patient subgroups at high risk of a poor disease outcome.
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Objective To evaluate the relationship between metabolic syndrome , its components and the histopathological findings in bladder cancer patients .Methods The data of 326 patients in our department between October 2010 and October 2013 were retrospectively analyzed.Age, gender, stature, weight, histologic stage, grade, and the presence of hypertension , diabetes mellitus, body mass index ( BMI) were evaluated.There were 64 females, 262 males, aged 23-89 years, including 241 low stage, 85 high stage, 155 low grade, and 171 high grade, respectively.There were 117 cases with hypertension, 95 cases with diabetes mellitus , 139 cases with BMI ≥25 kg/m2 and 49 cases with metabolic syndrome.The TNM classification was used , with Ta and T1 tumor accepted as low stage , T2 , T3 and T4 tumor as high stage bladder cancer.In addition, the pathological grading system adopted by the 2004 World Health Organization was applied.Non-invasive papillary urothelial neoplasms of low malignant potential were regarded as low grade.Analyses were completed using Chi-square tests to evaluate the correlation of diabetes mellitus , hypertension and obesity with the pathologic stage and grade .Moreover , the pathologic stage , grade and recurrence were compared between metabolic syndrome and non-metabolic syndrome groups . Results Metabolic syndrome was significantly associated with histological grade and stage (P=0.001, P=0.011). Diabetes mellitus and obesity were also associated with histological grade and stage (P=0.006, P<0.01). Conclusions Patients with metabolic syndrome were found to have significant higher T stage and grade of bladder cancer .Diabetes mellitus and obesity may promote the grading and staging of bladder cancer .
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Objective To investigate the clinicopathological features, treatment modalities, and prognostic factors for survival in patients with urinary tract small cell carcinoma (UT-SCC).Methods A total of 25 patients treated from June 2000 to December 2014 were included in the retrospective study.The data included age, gender, primary tumors origins, stage, treatment modalities, progression-free survival (PFS), overall survival (OS), pathology and immunohistochemistry.Of these cases, 22 were male, and the other was female, whose age was 45-79 years (mean age 67).20 cases small cell carcinoma of bladder patients and 2 small cell carcinoma of prostate cancer patients were included.The number of small cell carcinoma in pelvis,ureter and retroperitoneal was 1 respectively.The patients with small cell carcinoma of the urinary tract were classified as disease and extensive disease.17 bladder small cell carcinomas were limited disease and 3 cases were extensive disease;Prostate small cell carcinomas were both extensive disease;The small cell carcinomas in pelvis, ureter were limited disease;The small cell carcinoma in retroperitoneal was extensive disease.10 bladder small cell carcinomas which were limited disease received radical cystectomy.6 of 10 patients received etoposide and cisplatnum (EC).4 of 10 patients received gemcitabine and cisplatnum (GC).7 bladder small cell carcinomas patients who with limited disease refused to receive radical cystectomy in which 2 patients received TURBT and 5 patients received TURBT followed chemotherapy.Both prostate small cell carcinomas received chemoradiotherapy.2 small cell carcinomas in upper urinary tract (pelvis and ureter) received radical nephroureterectomy with bladder cuff resection.The patient of retroperitoneal small cell carcinoma received percutaneous nephrostomy after biopsy.The progression-free survival (PFS) and overall survival (OS) of these patients are analyzed;the influence of TURBT with adjuvant chemotherapy and clinicopathologic characteristics were analyzed in median PFS and OS.PFS and OS were compared between groups as a function of time, using a Kaplan-Meier survival curve analysis and the log-rank significance test.All statistical tests were two-sided, and P values ＜ 0.05 were considered statistically significant.Results 25 patients with a pathologic confirmation of UT-SCC,either by biopsy or surgery,were finally included.These patients were classified as pure UT-SCC (14) and Mixed UT-SCC (11).Mixed UT-SCC was defined as tumors containing both SCC and non-SCC components,regardless of the proportion of the latter.13 cases were strongly positive and 3 cases were weakly positive in neuron specific enolase (NSE) level.8 cases were strongly positive and 2 cases were weakly positive in CgA level.Patients with limited disease experienced a significant longer PFS and OS compared with extensive disease subjects (PFS 13.2 vs.7.8 x2=13.53 P＜0.01;OS27.2 vs.12.7x2=19.88 P＜0.01).Patients with bladder SCC showed a significantly higher median PFS and OS compared with patients with SCC of other parts of urinary tract (PFS 12.8 vs.8.2 x2 =12.00, P =0.001;OS 26.3 vs.13.2 x2 =14.45,P ＜0.01) .The two different chemotherapy regimens (GC and EC) have no influence on survival (PFS: 16.3 vs.12.5,x2 =3.34, P =0.07;OS 29.5 vs.22.8, x2 =1.66, P =0.198).TURBT followed by adjuvant therapy have no influence on survival (PFS 14.5 vs.12.0 t =1.30 P =0.251;OS 24.5 vs.28.4 t =0.50,P =0.636).Conclusions The primary tumors origins and stage may have influence on survival in patients with UT-SCC.Patients with bladder small cell carcinoma and limited disease experienced a longer survival.
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Objective To analyze the diagnosis,treatment and prognosis of small cell carcinoma of bladder (SCCB) in order to improve the understanding of it.Methods The pathological and clinical data of 5 cases of SCCB were retrospectively analyzed.All patients were male,aged 50 to 78 years (mean age,64 years).Clinical manifestations of 4 cases were gross hematuria,the other case was found by health examination.Ultrasonography results of 3 cases were medium echo tumors,the other 2 cases were hypoecho tumors.The diameter of the tumor was 2.1 to 4.0 cm (mean,3.0 cm).There were 3 patients accepted CT scan.One of them was found of hydronephrosis and multiple pelvic lymph nodes.All patients accepted diagnostic TURBT.Three of them accepted postoperative chemotherapy (1 cycle) without other surgery.Two patients accepted radical cystectomy with postoperative chemotherapy (3 cycles) after bladder tumor biopsy.Results Pathological findings showed that tumor cells were small,round and sheet in arrangement.These hyperchromatic nuclei showed limited cytoplasm with lack of nesting character.Neuron specific enolase,chromogranin A and synaptophysin were positive in immunohistochemistry.The final diagnosis was SCCB'.Two of the three patients who accepted TURBT with postoperative chemotherapy died 7 and 8 months postoperatively,the other one was alive for 32 months.Another two patients who accepted radical cystectomy with postoperative chemotherapy were alive for 16 and 26 months.Conclusions SCCB is a rare tumor which has high malignancy and poor prognosis.Radical cystectomy in combination with postoperative chemotherapy is the main treatment.Retained bladder surgery with chemotherapy is an alternative choice.
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<p><b>BACKGROUND</b>The mitochondrial displacement loop (D-loop) accumulates mutations and single nucleotide polymorphisms (SNPs) at a higher frequency than other regions of mitochondrial DNA (mtDNA). We previously identified disease risk-associated SNPs in the D-loop of chronic kidney disease (CKD) patients; in this study, we investigated the association of age-at-onset and D-loop SNPs in CKD patients.</p><p><b>METHODS</b>The D-loop region of mtDNA was sequenced in 119 CKD patients attending the Fourth Hospital of Hebei Medical University between 2002 and 2008. The age-at-onset curve of the CKD patients was calculated using the Kaplan-Meier method at each SNP site, and compared using the log-rank test.</p><p><b>RESULTS</b>The mean age of 119 CKD patients was (55.6±14.2) years, and 56.3% were males. The mean estimated glomerular filtration rate (eGFR) was (81.2±12.4) ml×min(-1)×1.73 m(-2), with 79.8% (n = 95) of patients having an eGFR <60 ml×min(-1)×1.73 m(-2). All participants had an eGFR >30 ml×min(-1)×1.73 m(-2). The age-at-onset for CKD patients who smoked was significantly lower than that of non-smoking CKD patients. The SNP sites of nucleotides 150C/T were identified for their association with age-at-onset using the log-rank test. The age-at-onset of patients with the minor allele T genotype was significantly lower than that of patients with the C genotype at the 150 SNP site (P = 0.010).</p><p><b>CONCLUSIONS</b>Genetic polymorphisms in the D-loop appear to be predictive markers for age-at-onset in CKD patients. Accordingly, the analysis of genetic polymorphisms in the mitochondrial D-loop may help identify CKD patient subgroups at high risk of early onset disease.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , DNA, Mitochondrial , Genetics , Kaplan-Meier Estimate , Polymorphism, Single Nucleotide , Genetics , Renal Insufficiency, Chronic , GeneticsABSTRACT
Objective To summarize the diagnosis and treatment strategy of the retroperitoneal fibrosis(RPF)associated with hydronephrosis.Methods The clinical data of 26 RPF cases treated from Jan.2005 to Mar.2012 were analyzed retrospectively.Early symptoms mainly included lumbar,flank,abdominal pain,nausea and vomit.Retroperitoneal mass was found in 12(46.2％)cases by ultrasonography,while in 23(88.5％)cases by CT.Results Ureterolysis with intra-peritoneal transposition was underwent in 10 cases who were followed up for 6-25 months,and no relapse was found.Ureterocystostomy was underwent in 1 cases for difficulty in ureterolysis who was followed up for 45 months,and no relapse was found.D-J stent inter-ureter drainage was performed in 15 cases,all of whom had replaced the D-J stent discontinuously except that 2 cases had ceased replacement successfully,and all of the obstruction were relieved during the follow-up period for 16-84 months post-operatively.Conclusions Retroperitoneal mass can be found by CT of abdomen effectively.The therapeutics should depend on the pathological condition of the retroperitoneal mass.Obstruction can be relieved effectively by both ureterolysis with intraperitoneal transposition and D-J stent inter-ureter drainage and replacement.The complication occurred in the replacement of D-J can be relieved or eliminated by all kinds of measures.The unimpaired kidney drainage should be paid attention in the follow-up.
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Objective To summarize the pathological and imaging features and treatment of retroperitoneal bronchogenic cyst.Methods The clinical data of 2 cases treated from October 2001 to November 2009 were summarized.The first patient was a 55-year-old woman with the chief complaint of lumbago in the left flank for 10 d.B-ultrasound showed mixed solid and cystic mass in spleen space with a diameter of 3.9 cm with thin wall and without rich blood supply.CT showed the lesion in the left adrenal gland region measured about 4 cm ×4 cm with low density with CT value of 10 HU,and enhanced scan was not obvious with CT value of 20 HU.It was diagnosed as left adrenal tumor and tumor resection was performed.The second case was a 17-year-old young man with the chief complaint of gross hematuria for 3 weeks after strenuous exercise.Ultrasonography found a 8.4 cm × 7.7 cm × 9.0 cm anechoic area surrounding the bladder.CT showed about 9.0 cm × 7.2 cm × 9.0 cm cystic lesion with thin wall,and the center density was uniformity in presacral space with CT value of8 HU.IVU showed visible semi-circular lower edge on the right edge of the bladder.The patient was diagnosed of presacral cyst and cystectomy was performed successfully.Results The pathology report of the first case:organizing wall with fibrous connective tissue,with most of the lining overlying pseudostratified ciliated columnar epithelium,goblet cells and subepithelial basement membrane.Pathological diagnosis was bronchogenic cyst,and the patient was followed up for 9 months without recurrence.The pathology report of the second case:pathological tissue fibers false wall tissue lining ciliated columnar epithelium,goblet cells seen in epithelium,fibrous tissue in the visible structure of mixed glands,a small amount of cartilage and muscle tissue.The diagnosis was bronchogenic cyst,and the patient was followed up for 2 years without recurrence.Conclusions Retroperitoneal bronchogenic cyst is rare and easily misdiagnosed.Radiology imaging can identify cystic features,while a few may be with high density without specificity.Surgical removal of retroperitoneal bronchogenic cyst with symptoms has good prognosis and may prevent malignant transformation and secondary infection.
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Objective To discuss the indication for kidney-sparing surgery (KSS) on primary urothelial carcinoma of the distal ureter.MethodsClinical data of 108 patients with primary urothelial carcinoma of the distal ureter in our hospital from 2001 to 2009 were analyzed retrospectively.There were 75 males and 33 females with mean age of 62 ( range from 42 to 85 ) years old in this study.The patients were divided into KSS group and RNU group according to the operation methods.The recurrence rate of radical nephroureterectomy (RNU) and KSS were evaluated.Results The recurrence was seen none with T,stage,1 (12.5％) with T1 stage,4 (36.4％) with T2 stage and 4 (80％) with T3 stage in KSS group.In RNU group,there was none with Ta stage,4 ( 15.4％ ) with T1 stage,10 (33.3％) with T2 stage and 7 (36.8％) with T3 stage recurred.There was no difference between patients with Ta to T2 stages in KSS and RNU group (P ＞0.05 ) on recurrence,but there was a significant difference between patients with T3 stage (P＜0.05).There was 1 (33.3％) case with G1 grade,3 (18.8％) with G2 grade and 5 (62.5％) with G3 grade recurred in KSS group,while 2 (22.2％) cases with G1 grade,9 (20％) with G2 grade and 10 (37.0％) with G3 grade recurred in RNU group.There was no difference between patients with G1 to G2 grades in KSS and RNU group (P＞0.05),but there was a significant difference between patients with G3 stage in the two groups ( P ＜ 0.05 ).Conclusion KSS seems to be safe for patients with low stage and low grade primary urothelial carcinoma of the distal ureter.
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Objective To investigate the clinical feature,diagnosis,treatment and prognosis of endometriosis of the bladder.Methods A retrospective study was conducted to review the clinical data of 10 patients with bladder endometriosis.Patient's age ranged from 30 to 48 years (with mean age of 38 years).Eight cases were admitted to hospital with urinary tract irritating symptoms during the menstrual period and 6 cases with hematuria; 2 patients without any symptoms were found through examination.The course of disease was 1-36 months (with mean of18 months).Ultrasound shows with low echo,single,wide base and no significant blood flow mass whose boundaries are less clear within the bladder wall.CT reveals soft-mass protruding into the bladder.Results Eight of the 10 patients were undergone partial cystectomy.And 2 cases was treated with transurethral resection.All cases were pathologically confirmed to be bladder endometriosis.Recurrence and ectopic lesion had not be found during follow-up period from 10 to 72 months (with mean of 30 ± 5.6 mon).Conclusions Endometriosis is a common disease in females in their reproductive years,but thebladder endometriosis is rare.The initial diagnosis needs to be made combining with imaging studies.It is confirmed by cystoscopy and pathological biopsy.Surgery is the option for the treatment of bladder endometriosis.
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Objective To discuss the clinical and pathological features of urachal carcinoma.Methods The clinical and pathological data of 7 patients diagnosed as urachal carcinoma were retrospectively analyzed,and the cIinicopathologic features,diagnosis and treatment,surgical characteristics and surgical outcomes were reviewed.There were 6 males and 1 female.Patient's age ranged from 26-75 years,with average of 52 years.Examinations before surgery included ultrasound,cystoscopy,urine cytology,CT and IVU.Six patients underwent extensive partial cystectomy and 1 patient underwent conventional partial cystectomy. Results Pathological diagnosis were 5 cases of mucinous adenocarcinoma,1 case of not classified adenocarcinoma,1 case of small cell neuroendocrine carcinoma.Clinical stages according to Sheldon staging system were 6 cases of stage ⅢA and 1 case of ⅢC.One patient died of bone metastasis 3 months after operation,1 patient experienced recurrence in bladder neck and urethra in 15 months and 24 months after operation and received TUR-Bt,the other 5 patients were alive without recurrence and metastasis with follow-up of 2-30 months. Conclusion Urachal carcinoma is a rare malignancy,and patients with this disease haye a poor prognosis.
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Objective To study the gene mutation of fibroblast growth factor receptor 3 (FGFR3) and p53 in bladder cancer tissue and to explore their relationship with tumor recurrence. Methods DHPLC and PCR direct sequence were used to detect the mutation of FGFR3 and p53 in BTCC (n=98) and normal bladder mucosa (n=10). Genomic DNA of 98 BTCC was extracted. The exon 5-8 of P53 and the exon 7, 10, 15 were amplification by PCR. The products of PCR was screened by DHPLC to detect the mutation of the production. The results of the FGFR3 and p53 mutation were analyzed by Kaplan-Meier method and no recurrence survival rate was tested by log rank test. All the analysis were aim to explore the clinical biological value of the mutation of FGFR3 and p53. Results Mutation of FGFR3 in BTCC (44. 9%) was higher than normal bladder mucosa(0, P<0.01). Mutation in T_a-T_1 was 75. 6%(33/45) ,T_2 -T_4 was 26. 6%C10/53). Mutation in G_1 was84. 6%(11/13),inG_2 was 61. 4% (27/44), in G_3 was 14. 6% (6/41), (P<0. 05). The mutation rate was lower with the higher of stage and grade. Mutation of p53 in BTCC (34. 6%) was higher than normal bladder mucosa (0%) (P<0. 01). Mutation in T_a - T_1 was 20. 0% (9/45), T_2 - T_4 was 47. 2%(25/53). Mutation in G_1 was G_1 7. 7%(1/13), in G_2 18. 2%(8/44),in G_3 58. 1%(25/41) , (P<0. 05). The mutation rate was higher in the higher stage and grade. Kaplan-Meier method results revealed that mutation of FGFR3 indicating a favorable prognosis while mutation of p53 indicating a poor prognosis. As to the analysis of genotype, the type of FGFR3mut/p53wt had a relative longer recurrent interval (P<0. 01). Conclusions Mutation of FGFR3 indicated a relative longer recurrent interval, which revealed a favorable prognosis of BTCC. Mutation of p53 indicated a relative shorter recurrent interval, which revealed a poor prognosis.
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Objective To discuss the clinicopathologic and imaging features of multilocular cystic renal eell carcinoma(MCRCC). Methods The data of 8 cases(5 men and 3 women)MCRCC classified according to 2004 WHO criteria were reviewed retrospectively.The tumor was incidentally found in 5 out of 8 cases.Renal ultrasound and CT scans were available in all 8 cases.CT or enhanced CT scans showed a well-defined cystid mass with irregular thickening wall or septa in 7 cases,without visible nodules found.For treatment,open or laparoscopic radical and partial nephrectomy was done in those cases. Results Postoperative pathological findings confirmed the diagnosis of MCRCC.The mean greatest diameter of the tumors was 5.6 cm.Microscopically,the wall and septa lined by one or several layers of clear cells were observed in all cases.The TNM stage of all 8 cases was T1 N0 M0.For pathologic grade,7 cases were G1 and 1 case was G2.Seven patients were followed up and remained tumor free during the average time of 8 months. Conclusions MCRCC is an uncommon subtype of RCC,it has a lower malignant potential and a better prognosis compared with other types of RCC according to the literature.Nephron-sparing surgery may be an appropriate treatment option for MCRCC.