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Objective:To determine the 50% effective concentration (EC 50) of ropivacaine plus sufentanil for labor analgesia using the dural puncture epidural technique. Methods:Using the method of prospective study, sixty parturients requiring labor analgesia in Dalian Women and Children′s Medical Group from May 2021 to May 2022 were divided into six groups using a random number table and administered 0.3 mg/L sufentanil and ropivacaine at different concentrations: 0.05% (group D1), 0.06% (group D2), 0.07% (group D3), 0.08% (group D4), 0.09% (group D5), and 0.1% (group D6). A probit model was constructed to compute the EC 50 values and 95% confidence intervals (95% CI) of ropivacaine plus sufentanil in dural puncture epidural analgesia (DPEA) for labor. The pain intensity of uterine contractions before labor analgesia and 30 min after administration was recorded and assessed on a numeric rating scale (NRS), and decreases in blood pressures and heart rates, vomiting and nausea, postpartum headaches, and fetal bradycardia were documented. Results:When using ropivacaine plus sufentanil for labor analgesia via DPE, the EC 50 was 0.061%, and the 95% CI ranged from 0.051 to 0.067; the 90% effective concentration (EC 90) was 0.081%, and the 95% CI was between 0.074 and 0.098. Among the six groups, there was one case of fetal bradycardia in group D3 and one case of decreased heart rates in group D4. No decreased blood pressure, vomiting and nausea, or postpartum headaches were reported. Conclusions:In DPEA for labor, ropivacaine plus sufentanil has an EC 50 of 0.061%, with the 95% CI falling between 0.051 and 0.067, similar to the EC 50 value in epidural analgesia.
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Objective To compare the analgesic effect and adverse reactions of oxycodone versus morphine after transcervical resection of adhesions (TCRA). Methods Sixty patients undergoing hysteroscopic TCRA under general anesthesia in Dalian Municipal Woman and Children′s Medical Center were randomly assigned to the test group or control group with 30 patients in each group; the test group received oxycodone 0.1 mg/kg (Q group), and the control group received morphine 0.1 mg/kg (M group). Both group was followed by propofol 2—3 mg/kg, as well as laryngeal mask airway (LMA) insertion after loss of consciousness to maintain ventilation. Propofol 6—10 mg/kg/h and remifentanil 0.1—0.2 μg/kg min were administered intraoperatively to maintain anesthesia. The visual analogue scale (VAS) score, sedation score and number of rescue medications were recorded immediately and 1 h, 2 h after the patient was sent to postoperative recovery room. The incidences of body movement, nausea and vomiting and pruritus after LMA insertion were recorded. Results There were no statistically significant differences between the two groups in VAS score, sedation score ,nausea and vomiting, itchy skin or the number of rescue medications at any post-recovery time point (P > 0.05); the incidence of body movements during LMA insertion was lower in M group: 13.3%(4/30) vs 36.7%(11/30), with statistically significant difference (P < 0.05). Conclusions Oxycodone could provide favorable postoperative analgesia for patients with intrauterine adhesion, with low incidence of adverse reactions.
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Objective To assess the median effective dose (ED50) of patient- controlled intravenous remifentanil labor analgesia. Methods Forty primiparas were selected and randomly divided into 5 groups with 8 cases in each group. Patient-controlled intravenous administration of remifentanil was performed among the 5 groups with differrent doses:0.80μg/kg(R1 group), 0.67μg/kg (R2 group), 0.56μg/kg (R3 group), 0.47μg/kg (R4 group), and 0.39μg/kg(R5 group). Probit regression method was adopted to calculate the ED50 and 95% confidence interval of the patient-controlled intravenous remifentanil labor analgesia. The visual analogue scales (VAS) scores following the labor analgesia, pulse oxygen saturation, maternal heart rate, sedation scores and newborn Apgar scores were recorded. Results The ED50 remained at 0.576 μg/kg and the 95% confidence interval was 0.390-0.701μg/kg. The blood pressure and heart rate remained at normal limits, and there were no significant differences among five groups (P>0.05). The newborn 1, 5 min Apgar scores and umbilical arterial pH were no significant differences among five groups (P>0.05). The second stage of labor time, rate of using oxytocin were showed no significant differences among five groups (P>0.05). The VAS scores and sedation scores were no significant differences among five groups (P>0.05). Conclusion The ED50 of patient-controlled intravenous remifentanil labor analgesia is 0.576 μg/kg, and the 95% confidence interval remains at 0.390-0.701μg/kg.
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Objective To explore the clinicopathological significance of the presence of lymphovascular invasion (LVI) in the high-grade stage pT1 bladder cancer (BC) after first transurethral resection of bladder tumor (TURBT).Methods The retrospective study was performed with 27 patients of high-grade stage pT1 BC after first TURBT from January 2006 to December 2011,and another 54 patients were matched as negative control in terms of gender,age,pathological pattern,grading and staging.All the data were calculated by using SPSS17.0 software.Qualitative variables were compared by using chi-square test.The Kaplan-Meier method was used to calculate total survival and cancer-specific survival and differences were assessed with the Log-rank statistic.Results Twenty-four patients (89％) experienced cancer recurrence in LVI group,while 19 cases (35％) experienced recurrence in control group.Progress developed in 56％ (15/27) and 24％ (13/54) in the 2 groups respectively.LVI was detected to be a prognostic factor for overall recurrence (x2 =20.845,P＜0.001) and progress (x2 =7.887,P =0.005) in patients with high-grade T1 stage BC.Furthermore,overall survival and recurrence-free survival according to the presence or absence of LVI was 54±6 months and 84±3 months,17±5 months and 67±5 months,respectively.LVI was proved to be associated with worse overall survival (x2=13.443,P＜0.001) and recurrence free survival (x2=33.094,P＜0.001).Conclusion In patients with high-grade T1 stage BC,LVI in first TURBT specimens predicts disease recurrence,progression and overall recurrence and recurrence free survival.
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HGK is a germinal center kinase (GCK)-Ⅳand is involved in controlling cellular processes, such as cell motility, cy-toskeleton rearrangement, and cell proliferation. HGK is involved in a very complex network of signaling pathways and interactions in-volved in diseases, such as diabetes or cancer. HGK was determined to be highly overexpressed in different types of cancers, such as ovarian cancer, hepatocellular carcinoma, lung cancer, pancreatic cancer, and prostate cancer. Recent findings have shown that HGK is a novel target that may provide insight into new therapies to prevent or even treat many metabolic diseases, such as diabetes or even co-lon cancer, prostate cancer, breast cancer, ovarian cancer, pancreatic cancer, or hepatic cancer.
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Objective To observe the effect of MAP4K4 targeted shRNA on biological characteristics such as proliferation,invasiveness,and apoptosis in human bladder cancer cell.Methods Differentially expressed genes was screened out through cDNA microarray analysis in 5 pairs of fresh-frozen muscle-invasive bladder cancer(MIBC) and adjacent normal tissue obtained from radical cystectomy.Combining the results of genechip and literature review,MAP4K4 was picked up for further analysis.To verify the result of microarray analysis,16 pairs of fresh muscle-invasive bladder cancer (MIBC) and adjacent tissues were assessed for the expression of MAP4K4 mRNA and protein through RT-PCR,qRT-PCR and Western-blot.T24 cell line was stably trasfected with MAP4K4 targeted shRNA and control shRNA,respectively.The effects of MAP4K4 silencing on proliferation,invasiveness and apoptosis of T24 cells transfected with MAP4K4 targeted shRNA and control shRNA were assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT),transwell and flowcytometry (FCM) assay.Results MAP4K4 was overexpressed in muscle invasive bladder cancer than in normal tissue.Down regulation of MAP4K4 expression decreased bladder cancer cell proliferation(MAP4K4-targeted versus control,P＜0.001),invasiveness(MAP4K4-targeted versus control,P=0.004)and promoted cell apoptosis(MAP4K4-targeted versus control,P=0.023).Conclusions MAP4K4 is overexpressed in muscle invasive bladder cancer than in normal tissue.Down-regulation of MAP4K4 expression inhibits the invasive ability of bladder cancer.Therefore,MAP4K4 might be a potential therapeutic target for bladder cancer.
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Objective To evaluate effectiveness of the applying pelvic double-slice retractor in the division of bladder and prostate pedicles in male patients with previous surgery history during radical cystectomy (RC) and anterograde radical prostatectomy (ARP). Methods The pelvic double-slice retractor was used to expose the bladder and prostate pedicles in 43 RC (30 cases with BMI ＞ 28 kg/m2,16 cases had previous partial cystectomy) and 37 ARP ( all cases with BMI ＞ 28 kg/m2 ). Results The pelvic double-slice retractor provided excellent exposure for the division of bladder and prostate pedicles.The handling of bladder and prostate pedicles became easy and safe without unnecessary bleeding and injury to the rectum.The median operating time to control the pedicles during RC and ARP were 12 min and 7 min,and the average blood loss were 30 ml and 20 ml,respectively. Conclusion The use of pelvic double-slice retractor for the exposure of the bladder and prostate pedicles is simple and effective in male patients with complicated pelvic anatomy during RC and ARP.
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ObjectiveTo report a series of female patients with bladder cancer who underwent gynecologic-tract sparing radical cystectomy with long term follow-up.MethodsFifty-five female patients between the ages of 25 and 82 years who underwent gynecologic-tract sparing radical cystectomy between 1990 and 2010 were reviewed retrospectively.Pathologic characteristics and survival ( overall and cancerspecific) were reported.Survival was estimated using Kaplan-Meier methods,and Cox proportional hazards regression analyses were performed to determine factors associated with mortality.ResultsFive patients were lost in follow up.Fifty-five women with a mean follow-up of 55.2 months were analyzed.The 3,5 and 10-year cancer specific survival (CSS) was 65％,61％ and 61％,respectively,and the corresponding overall survival (OS) was 61％,54％ and 42％,respectively.For patients with organ confined disease ( ≤ pT2N0M0) the 5-year CSS and OS was 84％ and 72％,while for those with non organ confined disease ( ≥pT3N0M0) the 5-year CSS and OS reduced to 29％ and 29％.Pathologic lymph node status (HR =3.877,P =0.019) and pathologic staging ( HR =3.992,P =0.011 ) were the only clinical or pathologic characteristics significantly associated with survival.ConclusionsFor patients with pathologically organ-confined bladder cancer ( ≤ pT2 N0 M0 ),gynecologic-tract sparing radical cystectomy is an oncologically safe treatment modality,while for those with ≥ pT3N0M0 or positive pelvic lymph nodes,gynecologic-traet sparing radical cystectomy may need large scale randomized control trials to justify its validity,pathological stage and lymph node status are the most important key points when choosing appropriate patients.
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Objective To find out if an unique blood mode-vasculogenic mimicry (VM) exist in prostate cancer and analyze its relationship with prognosis. Methods The age of the patients was 59 to 72 years,with a mean age of (66.7 ± 11.0) years.All had been confirmed as prostate cancer by biopsy.The level of serum PSA was 15.6 to 76.7 μg/L,with a mean level of (34.6 ± 1.7 ) μg/L.A histochemical and immunohistochemical dual staining method for PAS-CD31 and MMP-2 in 96 prostatic adenocarcinomas were conducted to explore if VM exist in prostate cancer,describe its morphology and distribution.The different expression of MMP-2 in VM positive and VM negative tissue were.The clinical data were collected and analyzed to explore the relationship between disease progression and VM. Results Among 96 cases,24 cases were found VM positive,the others were negative.The boundary membrane of VM was PAS positive,which was continuous or incontinuous. A positive correlation between VM density and high Gleason score were found.The tPSA were higher in the VM positive cases than that in VM negatives.The VM positive patients had poorer prognosis than that of the negatives.The MMP-2 expression was found correlated with VM positive (rs =0.60,P ＜ 0.01 ). Conclusions VM exists in the prostate cancer as an independent structure,and it is more common in the high-grade cancer.The progression-free survival of VM positive patients could be worse than the negative.MMP-2 and VM could be the indicators of poor prognosis.
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Objective To investigate the effects of preserving continence important structures during Studer pouch surgery. Methods Radical cystectomy and Studer orthotopic neobladder surgeries were performed on 68 male patients with muscle invasive bladder cancer.The anatomic configuration of the rhabdosphincter complex,pudendal nerve supply,and musculofascial support system to the proximal urethra were carefully preserved.The neobladder functions were then evaluated. Results The pathological classification of the 68 patients was as follows:T3a N0M0 in 20 cases and T2N0M0 in 48 cases.The patients were followed up for 6 to 36mon(mean 12 mon).Complete urinary continence was achieved in 67 patients 24 hours a day and the remained one had nocturnal incontinence.Of these patients,59 patients could urinate well without residual urine and the other 9 patients had residual urine of 20 to 30 ml. Conclusions A well-performed Studer pouch should pay specific attention to the anatomic configuration of the rhabdosphincter complex,pudendal nerve supply,and musculofascial support system to the proximal urethra to achieve the goal of maximizing continence preservation.
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Objective To investigate the value of the application of the fresh first morning midstream urine in cytological study of bladder cancer patients. Methods The results of the fresh first and second morning midstream urine cytological studies for 52 bladder cancer patients were analyzed.Continual three urine samples and single urine sample were treated as study objects respectively. The positive rates in different tumor stages and grades were evaluated. Results The positive rate of overall 52 patients was 78. 8 % (41/52) in fresh first morning midstream urine and 80. 8% ( 42 / 52) in the fresh second morning midstream urine. While in 156 single urine samples, the positive percentages were 56.4%(88/156) and 60. 9% (95/156). The positive rates of the fresh first and second morning midstream urine were 69.7% (23/33) and 72.7% (24/33) respectively in grade 1- 2 patients, and 44.4 % (44/99) and 48. 5 % (48/99) in 99 single urine samples. The positive rates of 42 non-muscle invasive bladder cancer patients were 73. 8% (31/42) and 76.2% (32/42) in the fresh first and second morning midstream urine, while in 126 single urine samples, the positive rates were 54.8% (69/126)and 57.1% (72/126). There were no significant differences between positive rate of the fresh first and second morning midstream urine in diagnosis of bladder cancer, low grade bladder cancer and nonmuscle invasive bladder cancer. Conclusion The fresh first morning midstream urine can be used for urine cytological study in the diagnosis of bladder cancer, even in the diagnosis of low stage and low grade bladder cancer.
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Objective To evaluate the feasibility and clinical effect of Argon plasma coagulator in simple enucleation for small renal cell carcinoma. Methods On the basis of successful performing the animal experience of coagulating therapy on the wound tissue during partial nephrectomy with Argon plasma coagulator in rabbit models, 10 cases of simple enucleation for small renal cell carcinoma with Argon plasma coagulator were accomplished. Results Both with the standard of stopping bleeding of wound tissue by Argon plasma coagulator and with the standard of re-spraying the wound tissue for 2 s after stopping bleeding using Argon plasma coagulator, the depth of wound tissue necrosis without blocking the renal pedicle is deeper than that with blocking the renal pedicle(P=0. 012 and P=0. 002, respectively).If the wound tissue was re-sprayed for 2 s after stopping bleeding by Argon plasma coagulator, the depth of the wound tissue necrosis without blocking the renal pedicle was deeper than that just with blocking the renal pedicle(P=0. 007 and P=0. 002,respectively). In the part of application in clinical, all procedures were successfully completed. The mean operative time was 163 min (range, 100-210 min) and mean blood loss was 230 ml (range, 100-400 ml). Drainage tube was pulled out 1 month after operation in 1 case for being allergic to absorbable hemostatic gauze, and the mean pulling drainage tube out time in others was 4. 2 d (range, 3-5 d). During a mean follow-up of 22 months (range, 10-38 months), no local tumor recurrence and distant metastasis was found. Conclusion Argon plasma coagulator can be used in simple enucleation for small renal cell carcinoma, and the clinical effectiveness is ideal.
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Objective To evaluate the contribution of puboprostatic ligament-sparing technique in urinary continence after radical retropubic prostatectomy (RRP). Methods A total of 74 men with clinically localized prostate cancer underwent RRP. Of whom, 50 patients were performed pubo-prostatic ligament-sparing technique(group A), while 24 patients were not(group B). Patients were evaluated by independent observer questionnaire to determine their urinary continence status. Results Mean patient age [(61.3±2.4) vs (60.8±2.1)years], serum prostate-specific antigen (PSA) values [14.3±1.2)ng/ml vs (14.7±1.3) ng/ml], operative time [(110.5±10.4)min vs (109.7±10.6) mini, estimated blood loss [(250.5±23.4) ml vs (253.4±22.3) ml], and positive surgical margin rate (6% vs 8%) were not significantly different between group A and B(P>0.05). The urinary con-tinence rate with the puboprostatic ligament-sparing technique at 1-year follow-up was significantly higher than that of the control group (P<0.05). Concision The puboprostatic ligament-sparing technique significantly enhances post-operative urinary continence after RRP.