Application of holographic image navigation in urological laparoscopic and robotic surgery / 中华泌尿外科杂志

Objective To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery.Methods The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan.2019 to Dec.2019 in Beijing United Family Hospital and other 18 medical centers,including 78 cases of renal tumor,2 cases of bladder cancer,2 cases of adrenal gland tumor,1 cases of renal cyst,1 case of prostate cancer,1 case of sweat gland carcinoma with lymph node metastasis,1 case of pelvic metastasis after radical cystectomy.All the patients underwent operations.In the laparoscopic surgery group,there were 27 cases of partial nephrectomy,1 case of radical prostatectomy,2 cases of radical cystectomy and 2 cases of adrenalectomy.In the da Vinci robotic surgery group of 54 cases,there were 51 cases of partial nephrectomy,1 case of retroperitoneal lymph node dissection,1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis.There were 41 partial nephrectomy patients with available clinical data for statistic,with a median age of 53.5 years (range 24-76),including 26 males and 15 females.The median R.E.N.A.L score was 7.8 (range 4-11).Before the operation,the engineers established the holographic image based on the contrast CT images and reports.The surgeon applied the holographic image for preoperative planning.During the operation,the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen.Results All the procedures had been complete uneventfully.The holographic images helped surgeon in understanding the visual three-dimension structure and relation of vessels supplying tumor or resection tissue,lymph nodes and nerves.By manipulating the holographic images extracorporeally,the fused image guide surgeons about location vessel,lymph node and other important structure and then facilitate the delicate dissection.For the 41 cases with available clinical data including 23 cases of robotic-assisted partial nephrectomy and 18 cases of laparoscopic nephrectomy,the median operation time was 140 (range 50-225) min,the median warm ischemia time was 23 (range 14-60) min,the median blood loss was 80(range 5-1 200) ml.In the robotic surgery group,the median operation time was 140 (range 50-215)min,the median warm i schemia time was 21 (range 17-40)min,the median blood loss was 150(range 30-1 200)ml.In the laparoscopic surgery group,the median operation time was 160(range 80-225)min,the median warm ischemia time was 25 (range 14-60)min,the median blood loss was 50 (range 5-1 200) ml.All the patients had no adjacent organ injury during operation.There were 2 cases with Clavien Ⅱ complications.One required transfusion and the other one suffered hematoma post-operation.However,the tumors were located in the renal hilus for these 2 cases and the R.E.N.A.L scores were both 11.Conclusions Holographic image navigation can help location and recognize important anatomic structures during the surgical procedures..This technique will reduce the tissue injury,decrease the complications and improve the success rate of surgery.

Analysis of the clinical characteristics of pheochromocytoma crisis / 中华内分泌外科杂志

Objective@#To analyze the clinical characteristics of pheochromocytoma crisis (PCC) .@*Methods@#Data of 123 cases of pheochromocytoma and paraganglioma (PPGL) admitted from Apr. 2011 to Feb. 2017 were retrospectively analyzed and they were divided into crisis group and noncrisis group according to the patients with or without haemodynamic instability and end-organ damage. The differences of demographics characteristics, presentations, laboratory tests, imaging findings, perioperative clinical conditions and pathological features were compared between the two groups.@*Results@#①16 cases were enrolled into crisis group, among whom 5 were misdiagnosed, while 107 cases were enrolled into noncrisis group. ②Compared with noncrisis group, the incidence of headache, palpitation, sweating, the classic triad, other presentations of PPGL, severe hypertension and hypotension were higher, and more patients had paroxysmal hypertension and admitted to our hospital for paroxysmal presentations in crisis group (P<0.05) . ③Leukocyte, fasting blood glucose, liver transaminases, troponin and D-dimmer were higher, while estimated glomerular filtration rate (eGFR) was lower, more tumors located in the left of adrenal in crisis group (P<0.05) . ④ Patients in crisis group had higher plasma free metanephrines (MNs) , larger maximal tumor diameter, higher enhanced CT value in each period, more benign tumors and hemorrhage or necrosis in the tumors, but all the differences were not significant when compared with the noncrisis group. ⑤Patients in crisis group were more likely to undergo elective surgery. However, there was no difference in the preoperative time of α-blockade, type of surgery, intraoperative and postoperative complications, mortality among the two groups.@*Conclusions@#PCC is a rare endocrinological emergency with a highly variable manifestations, which commonly presents with typical triad, with higher incidence of hemodynamic instability and end-organ damage. Although biochemical and imaging examinations are relatively effective in the diagnosis of PCC, the misdiagnosis remains inappropriate high. Once the diagnosis is established, clinicians should timely start drug preparation while surgical resection is the key to the treatment of PCC.

Analysis of the clinical characteristics of pheochromocytoma crisis / 中华内分泌外科杂志

Objective To analyze the clinical characteristics of pheochromocytoma crisis (PCC). Meth-ods Data of 123 cases of pheochromocytoma and paraganglioma (PPGL) admitted from Apr. 2011 to Feb. 2017 were retrospectively analyzed and they were divided into crisis group and noncrisis group according to the pa-tients with or without haemodynamic instability and end-organ damage. The differences of demographics charac-teristics, presentations, laboratory tests, imaging findings, perioperative clinical conditions and pathological fea-tures were compared between the two groups. Results ①16 cases were enrolled into crisis group, among whom 5 were misdiagnosed, while 107 cases were enrolled into noncrisis group. ②Compared with noncrisis group, the incidence of headache, palpitation, sweating, the classic triad, other presentations of PPGL, severe hypertension and hypotension were higher, and more patients had paroxysmal hypertension and admitted to our hospital for paroxysmal presentations in crisis group (P<0.05). ③Leukocyte, fasting blood glucose, liver transaminases, tro-ponin and D-dimmer were higher, while estimated glomerular filtration rate(eGFR) was lower, more tumors locat-ed in the left of adrenal in crisis group(P<0.05). ④ Patients in crisis group had higher plasma free metanephrines (MNs), larger maximal tumor diameter, higher enhanced CT value in each period, more benign tumors and hem-orrhage or necrosis in the tumors, but all the differences were not significant when compared with the noncrisis group. ⑤Patients in crisis group were more likely to undergo elective surgery. However, there was no difference in the preoperative time of α-blockade, type of surgery, intraoperative and postoperative complications, mortality a-mong the two groups. Conclusions PCC is a rare endocrinological emergency with a highly variable manifesta-tions, which commonly presents with typical triad, with higher incidence of hemodynamic instability and end-organ damage. Although biochemical and imaging examinations are relatively effective in the diagnosis of PCC, the mis-diagnosis remains inappropriate high. Once the diagnosis is established, clinicians should timely start drug prepa-ration while surgical resection is the key to the treatment of PCC.

Factors influencing unplanned re-operation of pheochromocytoma and its prevention countermeasures / 中华泌尿外科杂志

Objective To analyze the main causes for unplanned re-operation of pheochromocytoma (PCC) and explore the countermeasures on reducing the re-operation rate.Methods The clinical data of 6 patients with pheochromocytoma who underwent an unplanned re-operation were analyzed retrospectively between September 2011 and December 2016 in our hospital.There were 4 males and 2 females with a mean age of 46 years,ranged from 24 to 60 years.Only 1 patient had paroxysmal hypertension and headache,and the other 5 patients had no symptoms or atypical symptoms.Tumors of 3 cases were located in adrenal,and 3 were extra-adrenal PCCs.The average size of tumors was 5.25cm,ranged from 3 to 10 cm.Among the 6 cases,2 cases were diagnosed as PCC preoperatively and underwent adequate preparationwith stable hemodynamics during the first operation,who encountered post-operative bleeding soon after the surgery.Four cases were misdiagnosed,with poor preoperative preparation and operation was aborted.One case was misdiagnosed as bladder carcinoma and underwent transurethral resection.Results All 6 re-operations were performed by urologists.The main causes for unplanned re-operation were as follows:perioperative hemodynamic unstability (50％,3/6),post-operative bleeding (33.3％,2/6),uncertainty of surgical outcome (16.7％,1/6).Conclusions A precise diagnosis and an adequate preoperative preparation are the key to prevent a second-look surgery.An appropriate surgical approach and a complete surgical hemostasis could help lowering the re-operation rate.

Diagnosis value of peripheral blood TEMs percentage in the AFP negative early hepatocellular carcinoma / 中华检验医学杂志

Objective To evaluate the diagnosis value of the percentage of Tie 2-expressing monocytes(TEMs)in CD14+CD16+monocytes of peripheral blood from hepatocellular carcinoma(HCC) patients with negative AFP and tumor size≤3 cm.Methods Flow Cytometry(FCM)was used to determine the percentage of TEMs in CD14+CD16+monocytes of peripheral blood from patients with HCC(n=82), liver cirrhosis(n=29), chronic hepatitis B(n=28), and healthy controls(n=31).Abbott i2000 microparticle chemiluminescence immunoassay analyzer was used to determine the plasma alpha -fetoprotein (AFP)levels.The difference among multi groups was analyzed by the Kruskal-Wallis H test.Two independent groups were analyzed by the Mann-Whitney U test.The chi-square test was used in the rate comparison.The correlation between TEMs and AFP was analyzed by Spearman rank correlation analysis. Morever, the areas under the receiver operating characteristic curves(ROC-AUC), sensitivity and specificity of TEMs or AFP in differentiating HCC, HCC with AFP negative or tumor size≤3 cm were analyzed.Results The percentage of TEMs in CD14 +CD16 +monocytes of peripheral blood from HCC or HCC with negative AFP or HCC with tumor size≤3 cm was significantly higher than that in patients with liver cirrhosis,chronic hepatitis B and healthy controls(P<0.05).ROC-AUC of TEMs and AFP in the diagnosis of HCC were 0.701(95% CI 0.626-0.768)and 0.712(95% CI 0.638-0.779) respectively.When the cut-off values of TEMs and AFP were 4.95%and 20 μg/L,the sensitivities of TEMs and AFP were 71.95%and 45.12%,and the specificities of TEMs and AFP were 70.45%and 85.23%. The sensitivity of TEMs in the diagnosis of HCC was significantly higher than that of AFP(χ2=12.16,P=0.000).The specificity of AFP was significantly higher than that of TEMs(χ2=5.57,P=0.018).There was a highest sensitivity(89.02%)in TEMs/AFP method,and there was a highest specificity(93.18%) in TEMs+AFP method in the diagnosis of HCC.There was no significant difference between the ROC-AUC for the TEMs and the AFP in the diagnosis of 26 patients with tumor size≤3 cm HCC(0.776 vs 0.645,Z=1.805,P=0.071),TEMs/AFP had the highest sensitivity(84.62%),while TEMs+AFP had the highest specificity(93.18%)in the diagnosis of tumor size≤3cm HCC.The ROC-AUC for the TEMs in the diagnosis of 45 patients with AFP negative HCC was 0.739(95%CI 0.648-0.829).The sensitivity and specificity of TEMs were 80.0% and 70.45% respectively.There was no correlation between the level of plasma AFP and the percentage of TEMs(r=-0.169, P=0.129)determined by Spearmans rank correlation coefficient.Conclusions TEMs is valuable in the diagnosis of HCC with negative AFP and tumor size≤3cm,and the two tests of TEMs and AFP can complement each other in the diagnosis of patients with HCC.

Transurethral columnar balloon dilation of prostate for benign prostatic hyperplasia in middle-aged and high-risk patients / 重庆医学

Objective To analyze and summarize the short-term clinical efficacy and surgical points of transurethral columnar balloon dilation of prostate for middle-aged and high-risk prostatic hyperplasia patients.Methods A total of 30 patients with benign prostatic hyperplasia(BPH) admitted to our department from March 2016 to December 2016 was retrospectively analyzed,including 9 middle-aged patients(less than 60 years old) and 21 high-risk patients with various underlying diseases(more than 80 years old).Transurethral columnar balloon dilation of prostate was adopted and performed in accordance with standard operation process.Results All 30 patients were operated successfully by extending their prostate at the direction of 12 o'clock to the fat layer with short operation time and less amount of bleeding.The complication rate was 6.7％ (2/30),and the catheter was removed smoothly after the operation.After 1 month and 6 months follow-up,the international prostate symptom score(IPSS),quality of life score(QOL),maximum urinary flow rate(Qmax),residual urine(RUV) and other indicators were analyzed and were statistically significant(P＜0.05).Conclusion Transurethral columnar balloon dilation of prostate is an effective and supplemental method for the treatment of BPH in middle-aged and high-risk patients.

Image characteristics and early diagnosis of renal pelvic carcinoma:report of 69 cases / 重庆医学

Objective To analyze the typical clinical manifestations and imaging characteristics of renal pelvic carcinoma.Methods The clinical data in 69 cases of renal pelvic carcinoma verified by postoperative pathology in this department of the hospital from July 2013 to November 2016 were retrospectively summarized to analyze its typical clinical manifestations,imaging features and treatment regimens.Results All the cases were hospitalized due to hematuria and presented gross hematuria.The detectable rate of B-ultrasonic examination was 71.43 ％,which of computed tomography urography(CTU) was 84.21％ and which of intravenous urography(IVU) + kidney ureter bladder(KUB) was 70.27 ％,which of retrograde pyelography(RP) was 90.32 ％,which of flexible ureteroscope(FU) was 91.67 ％,the pathological detection rate of biopsy tissue by this method was 58.33 ％ and detection rate of fluorescence in situ hybridization was 79.07 ％.Sixty-nine cases all were performed the retroperitoneal laparoscopy combined with hypogastric incision renal pelvic carcinoma radical operation,postoperative pathological examination verified renal pelvis carcinoma.Conclusion Flexible ureteroscope examination has the highest definite diagnosis rate of renal pelvic carcinoma,but the pathological positive rate of biopsy tissue by this method is not ideal;the definite diagnosis rate of RP and CTU were secondary,urinary system B-ultrasonic examination,FISH and KUB+IVP can serve as the preliminary screening and postoperative re-examination means of renal pelvic carcinoma.

Renal malignant solitary fibrous tumor: 1 case report and literature review / 重庆医学

Objective To investigate the clinicalmanifestations,imaging features,diagnosis and differential diagnosis,treatment and prognosis of renal malignant solitary fibrous tumor(SFT).Methods The clinical data in 1 case of rare renal malignant SFT were retrospectively analyzed.Referring to related literatures,the histological origin,pathological features,differential diagnosis,treatment and follow-up of renal malignant SFT were analyzed.Results The patient was preoperatively diagnosed as right renal clear cell carcinoma.Postoperative pathological examination diagnosed as low grade malignant SFT of right kidney.And immunohistochemistry indicated CD34+,BCL-2 +,CD68+,CD99+,vimentin,Ki-67 5％ +,SMA focal weakly positive.No recurrence or metastasis occurred after 4-month follow-up period.Conclusion Malignant SFT of the kidney is very rare,its diagnosis and differential diagnosis depend on postoperative pathological and immunohistochemical examination.Radical nephrectomy is the main option for malignant SFT of the kidney with good prognosis.

Xanthogranulomatous cystitis with pelvic lymph node hyperplasia case report and literature review / 重庆医学

Objective To decrease the error and missed diagnosis of xanthogranulomatous cystitis(XC) .Methods Combined with laboratory and imaging examnation ,we considered the diagnosis of urachal carcinoma complicated by urinary track infection . Anti-infection treatment before surgery ,we removaled of the pathological tissues ,and the final diagnosis was XC .Results The clin-ical symptoms of XC was not typical ,and this case was similar to that of urachal carcinoma .Cystoscope and imaging examination had no specificity .There were not frequent micturition ,the the urgency of urination and low back pain of patiut of the patient by one year follow-up .Conclusion XC is very rarely ,and it is hard to differentiate from other bladder diseases ,tumor of the urachus .The final diagnosis may still depends on histopathological examination .

Relationships between Prostatic Volume and Intravesical Prostatic Protrusion on Transabdominal Ultrasound and Benign Prostatic Obstruction in Patients with Lower Urinary Tract Symptoms

<p><b>INTRODUCTION</b>The objective of this study is to determine the relationships between prostatic volume (PV) and intravesical prostatic protrusion (IPP) with benign prostatic obstruction (BPO).</p><p><b>MATERIALS AND METHODS</b>A total of 408 males (aged 50 years and above) who presented with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) were recruited. All had International Prostate Symptoms Score (IPSS), quality of life (QOL) index, uroflowmetry (Qmax) and postvoid residual urine (PVR) measured by transabdominal ultrasonography (TAUS). The PV and the degree of IPP were also measured by TAUS in the transverse and sagittal planes respectively. The PV is classified as Grade a, (20 ml or less), Grade b, (more than 20 ml to 40 ml) and Grade c, (more than 40 ml), while the IPP is graded as Grade 1 (5 mm or less), Grade 2 (more than 5 mm to 10 mm) and Grade 3 (more than 10 mm).</p><p><b>RESULTS</b>There was a fair positive correlation between the PV and IPP (Spearman, r(s) = 0.62, P <0.001) with important clinical exceptions. There was negative correlation between the PV and Qmax (rs = -0.20, P = 0.022), IPP and Qmax (r(s) = -0.30, P <0.001). PV and IPP were good predictors of BPO. However, IPP was slightly better (r(s) of -0.30 vs -0.20) than PV.</p><p><b>CONCLUSION</b>PV is related to IPP with important clinical exceptions. IPP is a better predictor of BPO than PV.</p>

Short-term efficacy after laparoscopic radical cystectomy:comparison of ileal conduit to orthotopic ileal neobladder / 重庆医学

Objective To summary the experience of laparoscopic cystectomy ileal conduit (Bricker) and orthotopic ileal neo‐bladder (Hautmann) and compare the short‐term efficacy of the two types of urinary diversion for invasive bladder cancer . Methods Retorspective analysis of the patients in our hospital who accepted laparoscopic radical cystectomy from 2010 to 2014 was performed ,74 of them accepted ileal conduit ,and 30 of them accepted orthotopic ileal neobladder .The general clinical data ,postop‐erative recovery ,postoperative complications and Oncology feature were analyzed and compared between the two groups .Results There was no demonstrable difference was found in operation time ,blood loss ,intraoperative blood transfusion rate ,the number of removed lymph node ,average hospital stay ,specimens positive margin rate and postoperative pathology results between the two groups (P>0 .05) .But there were significant difference in postoperative intestinal function recovery time[(4 .2 ± 1 .4)d ,(5 .3 ± 2 .2)d] ,(P=0 .002) ,and the complication rates 31 .9% (23 cases)vs .53 .3% (16 case) ,P=0 .043 .After 6 months ,the daytime and nighttime urinary control were 76 .9% ,57 .7% ,after 12 months ,the daytime and nighttime urinary control increased to 90 .9% , 81 .8% .2 cases(7 .7% ) were diagnosed with recurrence or metastasis during follow‐up in Hautmann group ,while 9 cases(14 .1% ) were diagnosed with recurrence or metastasis in Bricker group .Conclusion Two kinds of surgical procedures both have the similar therapeutic effect ,but the postoperative quality of life is better for Hautmann orthotopic neobladder patients .

Clinical research on oxaliplatin or irinotecan plus capecitabine for colorectal liver metastasis treatment / 中国肿瘤临床

Objective:This study aims to evaluate the clinical effect and adverse reactions of oxaliplatin or irinotecan plus capecitabine treatment for colorectal liver metastases. Methods:Data from 125 cases of colorectal liver metastasis patients were continuously enrolled and randomized into two groups, i.e., 63 in group one (treatment group) and the other 62 in group two (the control group). Capecitabine was administered at 1 000 mg/m2 doses, twice a day from d1 to d14, to all patients. Irinotecan was administered at 150 mg/m2 in d1 to group one, and oxaliplatin was administered at 130 mg/m2 in d1 to group two. The drug administration cycle lasted for 21 days in both regimens, with at least 6 administration cycles. The total course was for 6 months at most. The therapeutic efficacy, median progression-free survival time, median survival time, short-term clinical effect, and adverse drug reaction were monthly determined. Results:The overall response rates and disease control rates were 33.3%and 66.7%in group one, respectively, and 35.5%and 70.9%in group two, respectively, with no significant differences between the groups (P>0.05). The median survival time and median progression-free survival time were 14 months and 5 months in group one, respectively, and 12 months and 5 months in group two, with no significant differences between the two groups (P>0.05). The level-Ⅲand-Ⅳadverse drug reactions mainly include hematological toxicity, gastrointestinal reactions, and hand-foot syndrome. The diarrhea frequency is obviously higher in group one than in group two, and the difference between the two groups is sta-tistically significant (P0.05). Conclusion:The Oxaliplatin or Irinotecan plus Capecitabine treatment is effective for colorectal liver metastases, which enhances survival rate and reduces patient suffering because of it has less side effects and good tolerance. The treatment must be further generalized and clinically applied.

Markers of renal cell carcinoma stem cells / 国际肿瘤学杂志

The renal cell cancer stem cells determine the growth and proliferation of renal cell carcino-ma.So far some possible markers have been identified in renal cell carcinoma,including octamer binding factor 4 (Oct4),CD133,CD105,ATP-binding cassette subfamily B member 1 transporter gene (ABCB1),CXC chemokine receptor 4 (CXCR4),but these markers are still controversial.Therefore,for the more effective treatments of metastatic renal cell carcinoma,studying a generally applicable marker for renal cell carcinoma is necessary.

Meta-analysis of effect comparison between video endoscopic inguinal lymphadenectomy and open inguinal lymphadenectomy / 重庆医学

Objective To evaluate the effects between video endoscopic inguinal lymphadenectomy (VEIL ) and open inguinal lymphadenectomy(OIL) to provide the evidence-based basis for the selection of the clinical therapy schemes .Methods The related clinical controlled trial literature on the effective comparison of VEIL and OIL were retrieved from the databases of PubMed ,Co-chrane library ,Elsevier ,CNKI and Wanfang database .The screening was independently performed by 2 reviewers according to the including and excluding criteria .The related data were extracted and performed the meta analysis by the RevMan 5 .2 software .Re-sults A total of 4 trials were included .There were 146 cases of inguinal lymphadenectomies ,in which 61 cases were VEIL and 85 cases were OIL .The meta-analysis results showed that there were no statistical differences between the two operation modes in terms of the operative time(WMD=32 .33 ,95% CI -25 .70-90 .36 ,P=0 .27) ,intraoperative blood loss(WMD=9 .10 ,95% CI -76 .03-94 .23 ,P=0 .83) ,number of removed lymph nodes(WMD=0 .77 ,95% CI -1 .66-3 .20 ,P=0 .53) ,number of positive re-moved lymph nodes(WMD=0 .08 ,95% CI -0 .23-0 .40 ,P=0 .61) ,postoperative drainage time(WMD= -1 .30 ,95% CI -6 .40 -3 .80 ,P=0 .62) ,postoperative hospital stay (WMD= -4 .02 ,95% CI -10 .19-2 .15 ,P=0 .20) ,but the difference between VEIL and OIL in term of surgical complications had statistical significance (OR=0 .08 ,95% CI 0 .03-0 .26 ,P<0 .01) .Conclusion VEIL has equivalent efficacy to OIL ,but has less surgical complications .

Meta-analysis of laparoscopic versus open partial nephrectomy / 中华泌尿外科杂志

Objective To provide Meta-analysis evidence of laparoscopic partial nephrectomy (LPN) vs open partial nephrectomy (OPN) in assisting clinical decision making.Methods By searching CHKD,PUBMED,Wanfang and VIP database self-built library up to June 30,2012,both Chinese and English literatures of LPN and OPN efficacy in controlled study were included with strict exclusion criteria by two independent screenings of the literature.Data extraction and quality assessment were done by using the RevMan 5.1 META analysis software.Results A total of four English and six Chinese literature were included in this Meta-analysis.There were 1636 cases of partial nephrectomies.Of these patients,794 cases were treated with LPN,842 cases were treated with OPN.Meta analysis results showed that:in terms of operative time (SMD =0.10,95％ CI-O.40-0.59,P =0.70),surgical complication (OR =1.03,95％ CI0.73-1.44,P =0.88),positive surgical margin (OR =1.64,95 ％ CI0.83-3.23,P =0.16),warm ischemia time (SMD =1.07,95％ CI-0.02-2.16,P =0.05),postoperative tumor recurrence (OR =0.58,95％ CI 0.26-1.30,P =0.18),there was no significant difference.But in terms of intraoperative blood loss (SMD=-1.08,95％CI-1.57--0.59,P＜0.01),postoperative hospital stay (SMD=-0.81,95％CI-0.97--0.65,P ＜0.01),the differences were significant in favor of LPN.Conclusion Comparing with OPN,LPN has advantages in intraoperative blood loss and post-operative hospital stay,no obvious advantages in operative time,surgical complications,positive surgical margin,warm ischemia time and tumor recurrence.

Expression and significance of Yes-associated protein and large tumor suppressor gene 1 in renal clear cell carcinoma / 中华泌尿外科杂志

Objective To explore the expressions and significance of Yes-associated protein (YAP) and large tumor suppressor gene 1 ( LATS1 ) in renal clear cell carcinoma (RCCC).Methods There are 30 cases of RCCC,15 males and 15 females.The median age was 63 (36 - 77) years.There were 17 cases of stage Ⅰ - Ⅱ,13 cases of stage Ⅲ - Ⅳ.There were 8 cases well differentiated,13 cases moderately differentiated and 9 cases low differentiated.The expressions of YAP,LATS1 mRNA and proteins in 30 cases of RCCC and normal renal tissues were tested by RT-PCR and immunohistochemistry,and were analyzed with clinical data.ResultsThe expression level of YAP mRNA in RCCC was higher than that in normal renal tissues (0.569 ± 0.066 vs 0.515 ±0.068,P =0.003 ),and the level of LATS1 mRNA in RCCC was lower than that in normal renal tissues (0.454 ± 0.115 vs 0.514 ± 0.093,P =0.029 ).Thepositive rate of YAP proteins in RCCC was obviously higher than that in normal renal tissues (63.3％ vs 33.3％,P =0.020),and the positive rate of LATS1 proteins in RCCC was lower than that in normal renal tissues (46.7％ vs 76.7％,P =0.017).The positive rate of YAP proteins was 33.3％ in well differentiated tissues,61.5％ in moderately differentiated tissues and 88.9％ in low differentiated tissues ( P =0.018),and the positive rate of LATS1 proteins was 75.0％ in well differentiated tissues,53.8％ in moderately differentiated tissues and 11.1％ in low differentiated tissues (P =0.024).The positive rate of YAP proteins was 47.1％ in stage Ⅰ - Ⅱ and 84.6％ in stage Ⅲ - Ⅳ ( P =0.034 ),and the positive rate of LATS1 proteins was 64.7％ in stage Ⅰ - Ⅱ,23.1％ in stage Ⅲ - Ⅳ ( P =0.024 ).ConclusionYAP and LATS1 play important roles in the development of renal clear carcinoma,and may become new targets in the treatment of RCCC.

Multidisciplinary treatment for renal cell carcinoma involving inferior vena cava / 中华泌尿外科杂志

Objective To evaluate the surgical treatment for renal cell carcinoma with inferior vena cava tumor thrombus and the clinical significance of multidisciplinary treatment. Methods Two cases of renal cell carcinoma with inferior vena cava thrombus diagnosed by Doppler ultrasonography and CT were included in this retrospective analysis. The tumor thrombus was in level Ⅱ in one case and in level Ⅳ in the other. Coagulation test and complete blood count were done again before surgery. Human albumin, fibrinogen, prothrombin complex, plasma, platelet, UW and irrigating solution were prepared before the operation.Under general anesthesia, surgery was performed using abdomen inverted Y shaped incision. Right radical nephrectomy was finished by the urological surgeon; the vena cava was completely dissected from the renal vein level to the secondary porta of the liver by the hepatobiliary surgeon, the vena cava and the surrounding branch vein were blocked in the upper and lower vena cava tumor thrombus; tumor thrombus was removed completely by the vascular surgeon. In one case (patient with level Ⅳ thrombus ) where the tumour thrombus invaded the wall of the vena cava, the thrombus was found to be extending to the cavo-atrial junction but not into the right atrium. The left femoral venous-right atrial bypass was established, the cardiopulmonary bypass lasted for 241 mia, and the aorta was blocked for 18 min. Salvage autotransfusion was used during surgery, and the hepatic vein of the secondary liver porta was anastomosed to artificial vascular graft.The data for surgical indication, operation time, operative blood loss and postoperative hospital stay were analyzed. Results Right radical nephrectomy and inferior vena cava thrombectomy were performed successfully, and the two patients were discharged on the 15th and 27th day after surgery, respectively. The two patients were followed up for 1 and 16 months after surgery, respectively, and both survived without local recurrence and distant metastasis. Conclusion Radical nephrectomy and inferior vena cava thrombectomy is the preferred method for patients without metastasis, and multidisciplinary cooperation could shorten the operation time, reduce the tumor recurrence and increase the survival rate of patients.

Clinical analysis of maintenance hormonal treatment for patients with advanced breast cancer after response to chemotherapy / 肿瘤研究与临床

ObjectiveTo observe the efficacy of maintenance hormonal treatment after response to chemotherapy in advanced breast cancer. Methods8 patients with advanced breast cancer were treated with chemotherapy,maintenance hormonal therapy were given after response to chemotherapy.The efficacy was evaluated every 2 cycles of chemotherapy and 2 months of endocrine therapy according to RECIST standard.Results8 patients received chemotherapy for 2-8 cycles (median 4 cycles). All patients got PR, the duration of chemotherapy was 1-6 months (median 2 months), the time to failure of chemotherapy was 4 months. Until the last follow-up day (31th December 2010), the time to progression was 6-86 months (median 13.5 months).Survival was 6-86 months(median 21.5 months).Seven patients quit the chemotherapy due to severe side effects of hematologic toxicity,fatigue or nausea vomiting.One patient died because of allergy to paclitaxol.Conclusion Maintenance hormonal treatment after patients with metastatic breast cancer response to chemotherapy may prolong the duration of effective therapy and improve the QOL.

Staging of benign prostate hyperplasia is helpful in patients with lower urinary tract symptoms suggestive of benign prostate hyperplasia

<p><b>INTRODUCTION</b>We prospectively evaluated the staging of benign prostate hyperplasia (BPH) to decide transurethral resection of prostate (TURP) therapeutic modality and the final outcomes in patients with lower urinary tract symptoms (LUTS) suggestive of BPH.</p><p><b>MATERIALS AND METHODS</b>Male patients above 50 years old presented with LUTS suggestive of BPH were included in this study. The initial assessment included the International Prostatic Symptoms Score (IPSS) and the Quality of Life (QOL) index, digital rectal examination (DRE). Transabdominal ultrasound was done to measure the prostate volume, intravesical prostatic protrusion (IPP) and the post void residual (PVR) urine. BPH was classified according to the degree of IPP using grades 1 to 3. The staging of BPH was performed according to the presence or absence of bothersome symptoms (QOL ≥3) and significant obstruction (PVR >100ml). Patients with stage I BPH with no bothersome symptoms and no significant obstruction were generally observed. Those with stage II BPH, bothersome symptoms but no significant obstruction, received pharmacotherapy in the first instance, and were offered TURP if symptoms persisted or worsened. Patients with significant obstruction, persistent PVR >100ml, irrespective of symptoms would be classified as stage III, and were advised to undergo TURP as an option. Lastly, those with stage IV (complications of BPH) were strongly recommended to undergo TURP.</p><p><b>RESULTS</b>A total of 408 patients were recruited in this study and after a mean follow-up of 30 months (range, 6 to 84), 96 (24%) eventually had TURP. Sixteen (13%), 50 (21%), 28 (64%) and 2 (100%) patients who underwent TURP were initially diagnosed as stage I, II, III and IV, respectively. Eighty-seven (91%) of the 96 patients significantly improved to stage I BPH post TURP.</p><p><b>CONCLUSIONS</b>These results showed that the staging of BPH can assist in the tailoring of treatment for patients with LUTS suggestive of BPH, with good outcome in 91% post TURP.</p>

Compare and evaluate two combination regimens of vinorelbine plus gemcitabine and cisplatin pins vinorelbine for treatment of patients with advanced non-small-cell lung cancer / 肿瘤研究与临床

Objective To compare and evaluate the clinical efficacy and side effect of vinorelbine plus gemcitabine and vinorelbine plus cisplatin combinations in advanced non-small-cell lung cancer(NSCLC). Methods 56 cases with non-treated advanced NSCLC were unrandomly divided into two groups: the GN group (27patients) treated with vinorelbine plus gemcitabine, the NP group (29 patients) treated with vinorelbine plus cisplatin,1/3 weeks×2～6 cycles. Results For the GN group, the overall response rate was 37.7 %, MTTP was 5.1months,one year survival rate (1-ySR) was 40.7 %. There were no significant difference in the response rates and the survival rates for the GN group compared with the NP group (P ＞0.05); But on the side effect of toxicities, WHO grade anemia and nausea/vomiting and tiredness of the GN group was significantly milder than the NP group (P ＜ 0.05). Conclusion Vinorelbine combined Gemcitabine regimen (GN) is active and well-tolerated. It is worth to investigate GN recommended as the first line chemotherapeutic regimen for the treatment of patients with advanced NSCLC.