Characterization of progression-related alternative splicing events in testicular germ cell tumors / 亚洲男科学杂志(英文版)

Accumulating evidence supports the significance of aberrant alternative splicing (AS) events in cancer; however, genome-wide profiling of progression-free survival (PFS)-related AS events in testicular germ cell tumors (TGCT) has not been reported. Here, we analyzed high-throughput RNA-sequencing data and percent-spliced-in values for 150 patients with TGCT. Using univariate and multivariate Cox regression analysis and a least absolute shrinkage and selection operator method, we identified the top 15 AS events most closely associated with disease progression. A risk-associated AS score (ASS) for the 15 AS events was calculated for each patient. ASS, pathological stage, and T stage were significantly associated with disease progression by univariate analysis, but only ASS and pathological stage remained significant by multivariate analysis. The ability of these variables to predict 5-year progression was assessed using receiver operating characteristic curve analysis. ASS had stronger predictive value than a combination of age, pathological stage, and T stage (area under the curve = 0.899 and 0.715, respectively). Furthermore, Kaplan-Meier analysis of patients with low and high ASS demonstrated that high ASS was associated with significantly worse PFS than low ASS (P = 1.46 × 10

Conditional Knockout of Src Homology 2 Domain-containing Protein Tyrosine Phosphatase-2 in Myeloid Cells Attenuates Renal Fibrosis after Unilateral Ureter Obstruction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Src homology 2 domain-containing protein tyrosine phosphatase-2 (SHP-2) is a kind of intracellular protein tyrosine phosphatase. Studies have revealed its roles in various disease, however, whether SHP-2 involves in renal fibrosis remains unclear. The aim of this study was to explore the roles of myeloid cells SHP-2 in renal interstitial fibrosis.</p><p><b>METHODS</b>Myeloid cells SHP-2 gene was conditionally knocked-out (CKO) in mice using loxP-Cre system, and renal interstitial fibrosis was induced by unilateral ureter obstruction (UUO). The total collagen deposition in the renal interstitium was assessed using picrosirius red stain. F4/80 immunostaing was used to evaluate macrophage infiltration in renal tubular interstitium. Quantitative real-time polymerase chain reaction and enzyme linked immunosorbent assay were used to analyze the production of cytokines in the kidney. Transferase-mediated dUTP nick-end labeling stain was used to assess the apoptotic renal tubular epithelial cells.</p><p><b>RESULTS</b>Src homology 2 domain-containing protein tyrosine phosphatase-2 gene CKO in myeloid cells significantly reduced collagen deposition in the renal interstitium after UUO. Macrophage infiltration was evidently decreased in renal tubular interstitium of SHP-2 CKO mice. Meanwhile, the production of pro-inflammatory cytokines was significantly suppressed in SHP-2 CKO mice. However, no significant difference was observed in the number of apoptotic renal tubular epithelial cells between wild-type and SHP-2 CKO mice.</p><p><b>CONCLUSIONS</b>Our observations suggested that SHP-2 in myeloid cells plays a pivotal role in the pathogenesis of renal fibrosis, and that silencing of SHP-2 gene in myeloid cells may protect renal from inflammatory damage and prevent renal fibrosis after renal injury.</p>

Environmental and psycho-social factors related to prostate cancer risk in the Chinese population: a case-control study / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To study the risk environmental and psycho-social factors associated to prostate cancer (PCa) in Chinese population.</p><p><b>METHODS</b>250 PCa patients and 500 controls were enrolled in this case-control study. Information was collected and logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI) for relationship between lifestyle, eating habits and psycho-social factors with PCa risk.</p><p><b>RESULTS</b>Green vegetables and green tea were associated with a decreased risk of PCa (OR=0.39, 95% CI: 0.28-0.53; OR=0.59, 95% CI: 0.40-0.87, respectively). Family history of PCa (OR=7.16, 95% CI: 2.01-25.49), history of prostate diseases (OR=2.28, 95% CI: 1.53-3.41), alcohol consumption (OR=1.97, 95% CI: 1.33-2.90), red meat consumption (OR=1.74, 95% CI: 1.20-2.52), barbecued (OR=2.29, 95% CI: 1.11-4.73) or fried (OR=2.35, 95% CI: 1.24-4.43) foods were related with increased PCa risk. Negative psycho-social factors including occupational setbacks (OR=1.61, 95% CI: 1.00-2.59), marital separation (OR=1.94, 95% CI: 1.29-2.91), self-contained suffering (OR=2.37, 95% CI: 1.58-3.55), and high sensitivity to the personal comments (OR=1.73, 95% CI: 1.18-2.54) were related to PCa.</p><p><b>CONCLUSION</b>Regular consumption of green vegetables and green tea may suggest protective effects on PCa. Alcohol consumption, red meat consumption and barbecued or fried foods were associated with PCa. Negative psycho-social factors may also play a role in the incidence of PCa in Chinese population.</p>

Holmium laser versus conventional transurethral resection of the bladder tumor / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Transurethral resection of the bladder tumor (TURBT) remains the gold standard for non-muscle-invasive bladder cancer (NMIBC). Laser techniques have been widely used in urology. This analysis aimed to assess the safety and efficacy of holmium resection of the bladder tumor (HoLRBT) vs. TURBT.</p><p><b>METHODS</b>A systemic search of MEDLINE, Embase, Web of Science, and The Cochrane Library as well as manual bibliography searches were performed to identify the relevant studies. The pooled estimates of operation time, obturator nerve reflex rate, bladder perforation rate, bladder irrigation rate, catheterization time, hospital stay, and one- and two-year recurrence free survivals were calculated.</p><p><b>RESULTS</b>Five studies were enrolled into our meta-analysis. No significant difference was observed in the operation time between groups (weighted mean difference (WMD) 1.01, 95% confidential interval (95% CI) -3.52 - 5.54, P = 0.66). The significant difference in the obturator nerve reflex (OR 0.05, 95% CI 0.01 - 0.04, P = 0.004), bladder perforation (OR 0.14, 95% CI 0.03 - 0.61, P = 0.009), bladder irrigation (OR 0.13, 95% CI 0.04 - 0.45, P = 0.001), catheterization time (WMD -0.96, 95% CI -1.11 to -0.82, P < 0.00001), and hospital stay (WMD -1.46, 95% CI -1.65 to -1.27, P < 0.00001) showed advantages of HoLRBT over TURBT. The 2-year recurrence free survival rate favors the HoLRBT group (OR 1.46, 95% CI 1.02 - 2.11, P = 0.04).</p><p><b>CONCLUSIONS</b>As a promising technique, HoLRBT is safe and efficient, and showed several advantages over TURBT. HoLRBT can be used as an alternative procedure for TURBT in terms of low-grade papillary urothelial carcinoma or low-grade early TNM-stage urothelial carcinoma.</p>

Adrenocorticotropic hormone-producing pheochromocytoma: a case report and review of the literature / 中华医学杂志(英文版)

Ectopic Cushing’s syndrome caused by pheochromocytoma is rare. We reported a 15-year-old female patient who was admitted to hospital with typical Cushing’s syndrome. She had not started menstruation. Her plasma adrenocorticotropic hormone (ACTH) and 24-hour urinary free cortisol levels were extremely high. Gonadal and progestational hormone levels were also abnormal. Abdominal computed tomography scans and enhanced scans revealed multiple irregular tumors in the right adrenal. Pelvic echogram showed an infantile uterus, while the ovaries were at an immature stage of development. Retroperitoneal laparoscopic right adrenalectomy was performed without intraoperative complications. Histology and immunohistochemistry of the tumor were consistent with pheochromocytoma. Retroperitoneal laparoscopic adrenalectomy is a safe procedure with satisfactory outcomes and allows for rapid recovery.

Application of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma patients with intermediate risk PADUA score / 中华外科杂志

<p><b>OBJECTIVE</b>To study the application of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma patients with intermediate risk PADUA score.</p><p><b>METHODS</b>From April 2005 to June 2011, 79 cases (48 males and 31 females) of intermediate risk PADUA score (range from 8 to 9 score) renal cell carcinoma were retrospectively analyzed. Mean age was (54 ± 9) years, mean tumor size was (2.8 ± 0.8) cm in diameter, with 37 cases on the left side and 42 cases on the right side. Tumor located anteriorly in 35 cases, and 44 cases were located posteriorly. Preoperative imaging examinations showed tumor invasion of the collecting system was dislocated or infiltrated by tumor invasion were in 13 cases, renal sinus were involved in 5 cases, tumor located near the renal hilum were in 10 cases. All of the 79 patients received retroperitoneal laparoscopic partial nephrectomy.</p><p><b>RESULTS</b>The 79 cases were operated successfully without conversion to open surgery, no severe perioperative complications. The mean operation time was (105 ± 24) minutes, and the median of operation time was 115 minutes (range from 80 - 180 minutes), and mean warm ischemia time (WIT) was (20 ± 5) minutes, and mean blood loss was (24 ± 8) ml; mean postoperative hospital stay was (5.2 ± 1.5) days. Postoperative urinary leakage in 3 cases, symptoms disappeared one week after indwelling catheterization and ureteral catheter. Serum creatinine transient increased in 7 cases after surgery, and fell to normal range within 6 weeks. In a mean follow up for (34 ± 12) months (range from 10 to 84 months), estimated glomerular filtration rate (eGFR) 6 months after operation was no statistical significance compared with preoperation in 77 cases, another 2 patients' eGFR decreased by 30% and 35%. Postoperative renal function remained in CKD3 period and CKD2 period were in 2 cases respectively, none of these cases were treated with hemodialysis, and the remaining patients with normal renal function after surgery, no tumor recurrence and metastasis during follow-up in all cases.</p><p><b>CONCLUSIONS</b>Treatment of retroperitoneal laparoscopic partial nephrectomy in renal carcinoma patients with intermediate risk PADUA score is safe and effective, but its long-term effects still need to study with large samples compare and long-term follow-up.</p>

Evaluating the oncologic outcomes in 152 patients undergoing extraperitoneal laparoscopic radical prostatectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Although many midterm oncologic data have been reported for extraperitoneal laparoscopic radical prostatectomy (ELRP) in western countries, few oncologic data of the extraperitoneal procedure was published in China. The aim of the study was to evaluate the oncologic outcomes of patients treated with ELRP in China.</p><p><b>METHODS</b>From January 2005 to March 2010, a total of 152 consecutive patients diagnosed with clinically localized prostate cancer were included in this study and treated with ELRP. The patients were staged according to the TNM (tumor, nodes, metastases) system. Median and mean postoperative follow-up were 28.1 months and 27.0 months, respectively. The patients were retrospectively analyzed for progression-free survival.</p><p><b>RESULTS</b>One hundred and twelve cases (73.7%) were postoperatively diagnosed as pT2 in, and 40 cases (26.3%) as pT3. Positive lymph nodes were shown in 5 patients (3.3%). Gleason score was < 7 in 49 men (32.2%), 7 in 69 men (45.4%), and > 7 in 34 men (22.4%). Positive surgical margins (PSM) were observed in 15 patients (9.9%), which included 32.0% of all pT3a cases and 46.7% of all pT3b cases, respectively. The overall prostate-specific antigen recurrence-free survival rate was 86% in all patients. The recurrence-free survival rates were 91.8% and 62.2% in pT2N0 patients and pT3N0 patients, respectively. Preoperative prostate-specific antigen, surgical margins, tumor stage, and lymph nodal status were identified as independent predictors of biochemical recurrence-free survival using multivariate Cox proportional hazard model.</p><p><b>CONCLUSIONS</b>ELRP is a precise, safe and effective procedure at this particular Chinese institution. The prognostic power of prostate-specific antigen relapse after ELRP is not identical to that described previously with transperitoneal or open retropubic approaches.</p>

Single plus one port laparoscopic radical prostatectomy: a report of 8 cases in one center / 中华医学杂志(英文版)

Laparoscopic radical prostatectomy is considered the first treatment of choice for local prostate cancer due to its minimal invasion advantage. To further achieve the goal of minimal invasion, single port laparoscopic radical prostatectomy has been developed to minimize the complications associated with puncture tracks. The aim of this study was to illustrate the technique for single port laparoscopic radical prostatectomy and evaluate its efficacy and safety. We reported 8 cases of radical prostatectomy with excellent early outcome carried out in Shanghai Changzheng Hospital from June 2009 to August 2009 using a home-made multiple instrument access port and adding an additional small incision at McBurney point.

Constructing of PSA-specific dendritic cell vaccine and its in vitro immune activity / 第二军医大学学报

Objective: To construct of PSA-specific dendritic cell (DC) vaccine and to observe its in vitro anti-tumour activity, so as to pave a way for future study. Methods: Bone marrow precursors were isolated and bone marrow derived DCs were prepared. Mature DCs were pulsed by PSA, Lysate of cancer cells, OVA and PBS to yield PSA-DC, Lys- DC, Ova-DC, and Non DC, respectively. After primed by antigen, the changes of IL-12 p70 and IL-1β in the supernatant of dendritic cells were assessed by ELISA. The antigen-specific proliferation and cytotoxicity activity of T cell-primed by PSA-pulsed DCS were observed and the results were compared with those by Lys-, Ova- and PBS-pulsed DCs. Results: Mature DCs were successfully derived from bone marrow cells with a purity higher than 95%. ELISA assay showed PSA-DC, Lys-DC and Ova-DC group secreted high levels of IL-12 p70 and IL-1β than Non-DC group (P < 0.05). In addition, PSA-DCs and Lys-DCs had significantly stronger ability to stimulate the proliferation of CD4+ T cells in 3-day classic mixed lymphocyte reaction (MLR) compared with Ova-DCs and Non-DCs (P<0.01). Higher levels of IFN-γ and IL-2 were detected in PSA-DCs and Lys-DCs groups compared with the other two groups (P<0.01), whereas the levels of IL-10 and IL-4 were lower than the other two groups (P<0.05). Moreover, PSA-DCs and Lys DCs enhanced DTH responses of C57BL/6 mice after antigen immunization; the third antigen and control did not show the enhancement effect (P<0.05). To observe the in vitro anti-PSA CTL reactions induced by PSA-DCs and Lys-DCs, the LNCaP cell line (PSA specific) was used as syngeneic target and the E. G7 cell line (H-2b) was used as Ova-specific target cells. Compared with Ova-DCs and Non-DCs, CTL cells induced by PSA DCs, Lys-DCs had significantly enhanced antigen-specific CTL activity to LNCall cells (P<0.05). Conclusion: DC-based PSA-epitope vaccine can be prepared by pulsing DCs with PSA protein; the prepared vaccine has strong in vitro immune activity and can kill LNCaP cells.

Single incision for trans-peritoneal laparoscopic adrenalectomy in treatment of adrenal tumors / 第二军医大学学报

Objective: To perform trans-peritoneal laparoscopic adrenalectomy via a single incision in treatment of adrenal tumors, and to discuss its clinical outcome and safety. Methods: Single incision trans-peritoneal laparoscopic adrenalectomy was used in treatment of three patients with adrenal tumors. The incision was made 3 cm below the costal margin of anterior axillary line; three Tocars were placed in the cut. The instruments used included single port access, CUSA, Hem-o-lok, etc.. Results: The three operations were all successful, and there were no conversion to open procedure or a need for extra Ttrocars. The operating time periods were 75, 116, and 135 min, with a mean of (108.7±30.7) min. The perioperative blood losses were 10, 20, and 30 ml, with a mean of (20±10) ml. The gastric canal and ureteral catheter were withdrew one day after operation, and the drainage tube was withdrew 3 d after operation. The mean postoperative hospital stay was 4 d. Conclusion: Single incision trans-peritoneal laparoscopic adrenalectomy has the advantage of little trauma, less blood loss, satisfactory safety, and prompt postoperative recovery, but is difficult to manage.

Laparoscopic radical prostatectomy via single incision in treatment of early localized prostate cancer: A report of 5 cases / 第二军医大学学报

Objective: To summarize our experience on laparoscopic radical prostatectomy via single incision in treatment of early localized prostate cancer. Methods: From June 2009 to August 2009, five patients with localized prostate cancer(T1c) received laparoscopic radical prostatectomy via single incision. A home-made multichannel port was inserted extraperitoneally through a 3 cm incision under the umbilicus. A 10 mm TROCAR and two 5 mm TROCAR were inserted. The prostate was isolated and excised, then the bladder urethral anastomosis was performed. Results The procedures were successful in all the five cases with no transversion to open or standard laparoscopic approach. The mean operating time, the mean operative time for prostate excision, and the mean time for urethrovesical anastomosis were (167±31. 5) min(ranging 135-210 min), (115±26) min (ranging 90-150 min), and (52±5. 7) min(ranging 45-60 min), respectively. The estimated blood loss averaged (90±62) ml (ranging 50-200 ml). Positive margin occurred in one case. Transient incontinence occurred in two cases after the catheter was removed one week later. All patients had a prostate-special antigen level < 0. 2 μg/L during a follow-up of 4-12 weeks. Conclusion: Laparoscopic radical prostatectomy via single incision is feasible and safety. Excellent instruments and skilled surgeon are the keys for the success of the operation.

Single port laparoscopic ureterolithotomy: An initial report of 6 cases / 第二军医大学学报

Objective: To summarize our initial experience on single-incision laparoscopic ureterolithotomy in 6 patients, and to evaluate the efficacy and safety of this procedure. Methods: From Jun. 2009 to Jul. 2009, single-incision laparoscopic ureterolithotomies were performed in 6 patients who had a ureteral calculus. The clinical data and operative results were summarized retrospectively. Results: All 6 operations were performed successfully, with no conversion to an open procedure; neither an extra trocar for assistance was needed. No intraoperative complications were noticed. The average operative time was (93.5±30.4) min, the average estimated blood loss was (28.5±16.2) ml, and the average postoperative hospital stay was (5.4±1.1) d. Conclusion: Single-incision ureterolithotomy appears to be safe and effective, and has less trauma and better cosmetic outcomes; but it seems to be more difficult for the surgeon to operate.

Neuropeptide oxytocin and male infertility / 中华男科学杂志

<p><b>OBJECTIVE</b>To analyze the level of the oxytocin (OT) and the expression of oxytocin receptor (OTR) in males with idiopathic infertility.</p><p><b>METHODS</b>Sixty-five infertile males aged 20 -45 years were divided according to their semen parameters into an idiopathic oligozoospermia group (OG, n = 20), an idiopathic asthenozoospermia group (AG, n = 25), and an idiopathic oligoasthenozoospermia group (OAG, n = 20). Another twenty 20-45 years old healthy male volunteers with a natural childbearing history were included in the control group (CG). All the subjects were detected for the contents of luteinizing hormone (LH), follicle stimulating hormone (FSH) , testosterone (T) and OT, and analyzed for the expression of OTR by sequencing the functional region of the OTR promoter (OTRP), OTR-mRNA, and OTR-COOH terminus. The gene sequences were compared using DNASTAR-MegAlign, Western blot values changed into enumeration data, and all the data analyzed by one-way ANOVA and Dunnette's multiple range t-test.</p><p><b>RESULTS</b>A significantly lower content of OT was observed in CG ( [79.30 +/- 3.83] pg/ml) than in OG ([118.53 +/- 7.69] pg/ml, AG ([108.81 +/- 5.66] pg/ml) and OAG ([103.71 +/- 4.54] pg/ml) (F(0.05/2[2,82]) = 8.29, P < 0.01). The content of LH was significantly lower in AG ([4.26 +/- 0.31] IU/L) and OAG ([4.55 +/- 0.40] IU/L) than in OG ([6.77 +/- 0.57] IU/L) and CG ([7.19 +/- 0.50] IU/L) (F(0.05/2 [2,82]) = 11.64, P < 0.01), and so was the content of FSH in AG ( [5.02 + 0.39] IU/L) than in CG ([8.91 +/- 0.91] IU/L), OG ([11.86 +/- 1.76] IU/L) and OAG ([8.82 +/- 1.03] IU/L) (F(0.05/[2,82]) = 7.22, P < 0.01). There were no significant differences in the T content among the four groups (F(0.05/2[2,82] = 0.42, P = 0.739). No evident gene mutation was found in OTRP and OTR-mRNA gene sequencing. Human OTRs in the lymphocytes were monomers and oligomers, mostly tetramers and hexamers. There were obviously more monomers in AG (0.41 +/- 0.03) and OAG (0.13 +/- 0.01) than in OG (0.05 +/- 0.004) and CG (0.05 +/- 0.003) (F(0.05/2[2,82]) = 115.50, P < 0.01), while the number of oligomers was markedly decreased in 20% of the cases in AG.</p><p><b>CONCLUSION</b>Significant differences in the content of OT and expression of OTR between fertile and infertile men suggested an association of OT with male infertility. The decreased expression of OTR oligomers and increased expression of monomers may be related to idiopathic asthenozoospermia, which has provided a new insight into the pathogenesis and treatment of male infertility.</p>

Treatment of 58 cases of penile squamous cell carcinoma / 中华男科学杂志

<p><b>OBJECTIVE</b>To search for rational and effective treatments for penile squamous cell carcinoma (PSCC).</p><p><b>METHODS</b>We retrospectively analyzed the clinical data of 58 cases of pathologically confirmed PSCC, focusing on the treatment methods.</p><p><b>RESULTS</b>Based on Jackson Staging, 25 of the 58 cases fell into stage I, 18 stage II, 11 stage III, and 4 stage IV. Fifty-three of the patients were treated by surgery, of whom 43 underwent limited resection of the tumor or partial amputation of the penis, and the other 10 received total penis amputation plus perineal urethrostomy and clearance of lymphoglandulae iliacae and inguinal lymph nodes, with the lymphoglandulae iliacae positive in 1 case and the inguinal lymph nodes positive in all. Thirty-seven cases received neoadjuvant hormonal therapy (thermotherapy plus chemotherapy) and combined postoperative chemotherapy, 12 postoperative chemotherapy only, and 4 merely surgery. Five of the total number underwent chemotherapy and/or radiotherapy without surgery. The 2-5 years follow-up of 48 patients found recurrence in 4 cases of partial penis amputation within 2 years, 4 deaths within 2 years, 7 deaths from 2 to 5 years. The 2- and 5-year survival rates were 91.7% and 77.1%, respectively. Ten of the cases were lost in follow-up.</p><p><b>CONCLUSION</b>Surgery + neoadjuvant hormonal therapy + postoperative chemotherapy and/or radiotherapy is an effective method for PSCC, but whether it can reduce the recurrence of PSCC and improve the survival of the patients remains to be further studied.</p>

Transurethral ureteroscopy in the diagnosis and treatment of hemospermia / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the clinical application value of transurethral ureteroscopy in the diagnosis and treatment of hemospermia.</p><p><b>METHODS</b>We summed up and analyzed the experience in the diagnosis and treatment of 43 hemospermia patients by transurethral ureteroscopy and douching therapy.</p><p><b>RESULTS</b>The disease causes were clearly determined and the therapeutic procedures successfully accomplished in all the cases. The mean surgical time was 20 (18 -45) minutes. No significant complications developed either intraoperatively or postoperatively. The patients were followed up for 1 -24 months, during which hemospermia symptoms completely disappeared in 35 and were relieved in 6 of the cases, but the other 2 remained unimproved. All the patients had normal sexual life and none experienced retroinfection postoperatively.</p><p><b>CONCLUSION</b>Transurethral ureteroscopy, advantageous for its safety, high rate of detection, good effect of treatment and fewer complications, deserves to be popularized in the clinical diagnosis and treatment of hemospermia.</p>

Retroperitoneal laparoscopic nephropexy: a report of 28 cases / 第二军医大学学报

Objective: To discuss the procedure and clinical effect of retroperitoneal laparoscopic nephropexy (RLN).Methods: From August 2001 to June 2006, RLN was performed on 28 female patients aged 26-45 years old (mean, 34±2.5) with symptomatic nephroptosis, including 15 with the right kidney, 12 with the left, and 1 with both. The preoperative complaint of patients included subjective symptoms (constant and recurring pain in 28 patients) and objective symptoms (upper urinary infections in 16, hematuria in 12, and upper tract obstruction in 12). One patient underwent nephropexy via the transperitoneal approach and the others underwent nephropexy via the retroperitoneal approach. A retroperitoneoscopic procedure was performed after positioning the patients in the flank position. Digital preparation of the retroperitoneal space was made and standardized trocar was placed. The key step of the surgery was complete exposure of the kidney within Gerota' fascia, which was aimed to separate the potential adhesions between the colon and kidney or between the inferior blood vessels of the kidney. Nephropexy was performed between the fibrous capsule at the lower pole of the kidney and the dissected psoas muscle, using three sutures placed by intracorporeal technique or the percutaneous needle both for introduction and removal of the suture; the sutures were separately tied over the sacrospinalis fascia. Results: The mean operative time was (125±9) min (ranging 115-240 min); the mean postoperative hospital stay was (9±1.2) days, largely owing to the required 5-12 days' bed rest. During a mean follow-up of (24±4.2) months(ranging 3 to 70 months), 3 patients had paresthesia, 5 had constant and recurrent ache, 20 were completely free of pain, and 4 had micro-hematuria. One patient had further episodes of pyelonephritis and upper tract obstruction after operation. Intravenous pyelogram(IVP) revealed that the ptosis incorporated into more than one vertebral body in 2 patients. Postoperative renal function test showed an improvement in renal function. Conclusion: RLN is mini-invasive and has less complication. The procedure should be considered as one of the optimal therapy for nephroptosis.

Retroperitoneal laparoscopic nephropexy: a report of 28 cases / 第二军医大学学报

Objective: To discuss the procedure and clinical effect of retroperitoneal laparoscopic nephropexy (RLN).Methods: From August 2001 to June 2006, RLN was performed on 28 female patients aged 26-45 years old (mean, 34±2.5) with symptomatic nephroptosis, including 15 with the right kidney, 12 with the left, and 1 with both. The preoperative complaint of patients included subjective symptoms (constant and recurring pain in 28 patients) and objective symptoms (upper urinary infections in 16, hematuria in 12, and upper tract obstruction in 12). One patient underwent nephropexy via the transperitoneal approach and the others underwent nephropexy via the retroperitoneal approach. A retroperitoneoscopic procedure was performed after positioning the patients in the flank position. Digital preparation of the retroperitoneal space was made and standardized trocar was placed. The key step of the surgery was complete exposure of the kidney within Gerota' fascia, which was aimed to separate the potential adhesions between the colon and kidney or between the inferior blood vessels of the kidney. Nephropexy was performed between the fibrous capsule at the lower pole of the kidney and the dissected psoas muscle, using three sutures placed by intracorporeal technique or the percutaneous needle both for introduction and removal of the suture; the sutures were separately tied over the sacrospinalis fascia. Results: The mean operative time was (125±9) min (ranging 115-240 min); the mean postoperative hospital stay was (9±1.2) days, largely owing to the required 5-12 days' bed rest. During a mean follow-up of (24±4.2) months(ranging 3 to 70 months), 3 patients had paresthesia, 5 had constant and recurrent ache, 20 were completely free of pain, and 4 had micro-hematuria. One patient had further episodes of pyelonephritis and upper tract obstruction after operation. Intravenous pyelogram(IVP) revealed that the ptosis incorporated into more than one vertebral body in 2 patients. Postoperative renal function test showed an improvement in renal function. Conclusion: RLN is mini-invasive and has less complication. The procedure should be considered as one of the optimal therapy for nephroptosis.

Application of laparoscopic surgery in urology: An experience with 509 cases / 第二军医大学学报

The last ten years have witnessed a rapid development in laparoscopic surgery for urology, but there are still many specific problems need to be discussed concerning the operation procedures. From October 1998 to August 2006, 509 patients have received laparoscopic surgery in our department. Our experience is summarized as following: (1) Compared with the peritoneal approach, the retroperitoneal approach is faster in exposing the operative field and more experience from the open operation could be used, so retroperitoneal approach should be recommended unless for a few difficult cases or cases need to be treated bilaterally. (2) In radical nephrectomy, the kidney should be completely removed including the lymph nodes. Open operation should be considered if the diameter of the tumor is more than 10 cm. Adrenal gland resection should not be considered unless the tumor locates in the upper pole. In radical resection of the renal pelvic carcinoma, attention must be paid to prevent tumor metastasis into the ureter. The kidney vessels must be separated in the nephrectomy operation and the use of hemo-lock is recommended to block the kidney artery. (3) Laparoscopy is a golden standard for adrenalectomy; the operation procedure should be chosen according to the property, location, involvement, and blood supply of the tumors. (4) Whether to use laparoscopic surgery or not for patients warranting difficult surgeries such as radical prostatectomy should be decided considering the general condition of the patients and the skills of the surgeons. As for operations for varicocele, we do not recommend laparoscopic surgery because it can be readily treated with open operation.

Severe post-renal transplantation infection: its etiology and clinical charact eristics / 第二军医大学学报

Objective: To probe into the etiology of the sever e post-renal transplantation infection and its diagnosis and t reatment. Methods: A retrospective analysis was made on the seve re infected cases among 1 504 renal transplantation cases. Results: (1)The infected rate in the whole group was 23.74%,and 14.01% of the infecti on cases was severely involved. (2) About 86% of the severe infection occurred within 6 months after operation and as high as 82% of the patients were successf ully rescued by various etiological treatment. (3) The main etiological causes according to their frequency and type were: Bacteria(Mycobacterium tub erculosis, Pseudomonas, Aureus staphylococcus, Bacillus cloacae, etc.); Fungus (Candida albians, Candida tropicals, Penicillum patulum). Cytomegalo virus also often appeared. Conclusion: (1) Infection is one of t h e common complications after renal transplantation and severe infection is an im portant cause of death. (2) Correct diagnosis and combined therapy in time may improve its success rate. (3) Characterized germ spectrum exists in severe post -renal transplantation infection and its role is of great importance to clinica l management.

Severe post-renal transplantation infection: its etiology and clinical charact eristics / 第二军医大学学报

Objective: To probe into the etiology of the sever e post-renal transplantation infection and its diagnosis and t reatment. Methods: A retrospective analysis was made on the seve re infected cases among 1 504 renal transplantation cases. Results: (1)The infected rate in the whole group was 23.74%,and 14.01% of the infecti on cases was severely involved. (2) About 86% of the severe infection occurred within 6 months after operation and as high as 82% of the patients were successf ully rescued by various etiological treatment. (3) The main etiological causes according to their frequency and type were: Bacteria(Mycobacterium tub erculosis, Pseudomonas, Aureus staphylococcus, Bacillus cloacae, etc.); Fungus (Candida albians, Candida tropicals, Penicillum patulum). Cytomegalo virus also often appeared. Conclusion: (1) Infection is one of t h e common complications after renal transplantation and severe infection is an im portant cause of death. (2) Correct diagnosis and combined therapy in time may improve its success rate. (3) Characterized germ spectrum exists in severe post -renal transplantation infection and its role is of great importance to clinica l management.