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Objective:To investigate the feasibility and accuracy of transperineal prostate targeted biopsy guided by holographic image.Methods:Clinical data of 10 patients with transperineal prostate targeted biopsy guided by holographic image in Peking University Shougang Hospital between May and September 2020 were analyzed retrospectively. The average age was (70.9±10.3) years old, the median PSA was 15.1(6.02-1110.14) ng/ml, prostate MRI were performed before biopsy and the PI-RADS scores were all ≥ 3, and the number of suspicious target lesions was 1.4±0.5. CT examinations of urinary system were performed on the premise of mild lithotomy position and positioning stickers pasted on the skin of perineum and lower abdomen. The original data of CT and MRI were obtained, holographic image models were firstly made separately and then fused into a complete model, and the puncture paths were planned for the target lesions. At the time of puncture, the patient took the same body position as in CT scan, the operator wore a mixed reality head mounted display (HoloLens glasses), and the skin positioning stickers were used for visual registration between the holographic model and the real human body. Then under the guidance of the virtual puncture path, the puncture biopsy gun was placed, fired after reaching the predetermined depth, a transrectal ultrasound probe was placed to clarify the position of the puncture needle, and the objective accuracy of puncture was judged by comparison of ultrasound and MRI images. If the first shot was judged to be inaccurate, it was allowed to make a supplementary shot after adjusting the angle. After holographic guided biopsies, cognitive fusion targeted biopsies and 12-needle systematic biopsies were performed routinely, and the proportion of positive needles of the three different biopsy methods were calculated respectively.Results:All the 10 cases were successfully completed, including 16 holographic image guided shots, 28 cognitive fusion targeted shots and 116 systematic shots. The objective accuracy of holographic image guided biopsy after first shot judgments was 68.8% (11/16), while it raised to 87.5% (14/16) after supplementary shots. The proportion of positive needles in the three puncture methods were 56.3% (9/16), 42.9% (12/28) and 19.8% (23/116), respectively ( P=0.002). The results of subjective questionnaire showed that holographic model was helpful to improve the spatial understanding of lesions. The satisfaction of intraoperative holographic registration and guided puncture were 90% and 60%, respectively. No puncture related complication occurred in this group. Conclusion:The study preliminarily confirmed the feasibility of holographic image-guided prostate targeted biopsy. This new puncture method has better objective accuracy, and the proportion of positive needles is significantly better than systematic biopsy.
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Objective@#To investigate clinical characteristics of urodynamics in elderly male patients with indwelling urinary catheterization.@*Methods@#Clinical urodynamics of 497 male patients with indwelling urinary catheterization aged 60 years and over from December 2010 to April 2019 in our center were retrospectively analyzed and divided into 3 groups: 60-69-year-old group(n=114), 70-79-year-old group(n=220), and 80-111-year-old group(n=163). According to the catheter indwelling time, the patients were divided into 3 groups: 1-2 weeks group(n=262), 2-4 weeks group(n=47)and over 4 weeks group(n=188). The cause of indwelling urinary catheterization, bladder outlet obstruction, acontractile detrusor and other indicators were observed.@*Results@#The main cause of indwelling urinary catheterization in elderly men was acute urinary retention(55.1%, 274 cases), in that the most common diagnosis was benign prostatic hyperplasia(90.3%, 449 cases). No statistically significant difference in the different catheter indwelling time-related urodynamics between the different age groups was found(χ2=1.606, 0.199 and 2.477, all P>0.05). There were statistically significant differences both in the incidences of bladder outlet obstruction between the 1-2 weeks vs.2-4 weeks vs.over 4 weeks groups[56.9%(149/262)vs.55.3%(26/47) vs.42.6%(80/188), χ2=9.315, P<0.05)], and in the incidences of acontractile detrusor between the 1-2 weeks vs.2-4 weeks vs.over 4 weeks groups[15.6%(41/262)vs.12.8%(6/47)vs.29.8%(56/188), χ2=15.319, all P<0.05)]. There was no statistically significant difference in catheter indwelling time-related urodynamics between two groups with normal detrusor muscle function and weak detrusor muscle function(P>0.05). Clinical urodynamics had no statistically significant in different age groups(P>0.05).@*Conclusions@#Bladder outlet obstruction is the main cause of indwelling urinary catheterization in elderly men.Urodynamic examination can be performed 1-2 weeks after indwelling urinary catheterization.Age has no significant effect on the catheter indwelling time-related urodynamics.The duration of indwelling urinary catheterization has little effect on the urodynamic diagnosis in patients with normal or weak detrusor muscle contractile strength.The elderly patients may have acontractile detrusor if the duration of indwelling urinary catheterization is more than 4 weeks.
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Objective To investigate clinical characteristics of urodynamics in elderly male patients with indwelling urinary catheterization.Methods Clinical urodynamics of 497 male patients with indwelling urinary catheterization aged 60 years and over from December 2010 to April 2019 in our center were retrospectively analyzed and divided into 3 groups:60-69-year old group(n=114),70-79-year-old group (n =220),and 80-111-year-old group (n =163).According to the catheter indwelling time,the patients were divided into 3 groups:1-2 weeks group(n=262),2 4 weeks group(n=47)and over 4 weeks group (n =188).The cause of indwelling urinary catheterization,bladder outlet obstruction,acontractile detrusor and other indicators were observed.Results The main cause of indwelling urinary catheterization in elderly men was acute urinary retention(55.1％,274 cases),in that the most common diagnosis was benign prostatic hyperplasia(90.3％,449 cases).No statistically significant difference in the different catheter indwelling time related urodynamics between the different age groups was found(x2 =1.606,0.199 and 2.477,all P＞0.05).There were statistically significant differences both in the incidences of bladder outlet obstruction between the 1-2 weeks vs.2-4 weeks vs.over 4 weeks groups [56.9％ (149/262) vs.55.3％ (26/47) vs.42.6％ (80/188),x2=9.315,P＜0.05)],and in the incidences of acontractile detrusor between the 1-2 weeks vs.2-4 weeks vs.over 4 weeks groups[15.6％ (41/262)vs.12.8％(6/47)vs.29.8％ (56/188),x2 =15.319,all P＜ 0.05)].There was no statistically significant difference in catheter indwelling time-related urodynamics between two groups with normal detrusor muscle function and weak detrusor muscle function(P＞0.05).Clinical urodynamics had no statistically significant in different age groups (P＞0.05).Conclusions Bladder outlet obstruction is the main cause of indwelling urinary catheterization in elderly men.Urodynamic examination can be performed 1-2 weeks after indwelling urinary catheterization.Age has no significant effect on the catheter indwelling time-related urodynamics.The duration of indwelling urinary catheterization has little effect on the urodynamic diagnosis in patients with normal or weak detrusor muscle contractile strength.The elderly patients may have acontractile detrusor if the duration of indwelling urinary catheterization is more than 4 weeks.
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Objective@#To explore the effect of neutrophil-to-lymphocyte ratio (NLR) in peripheral blood on the survival of patients with multiple myeloma (MM).@*Methods@#The clinical data of 195 patients with MM who were diagnosed in Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2007 to December 2015 were retrospectively analyzed. According to NLR, the patients were divided into the low NLR group (NLR<3) or high NLR group (NLR≥3). The relationship between NLR and the parameters including clinical indicators, treatment response and overall survival of the patients was detected.@*Results@#There were 61 cases in the high NLR group and 134 cases in the low NLR group. Compared with the low NLR group, creatinine and serum calcium in the high NLR group were higher (all P < 0.05). Complete remission rate after initial induction therapy in the low NLR group (32.1%, 43/134) was higher than that in the high NLR group (16.4%, 10/61), and there was a statistically significant difference (χ2=5.218, P=0.022). Median survival time in the low NLR group (38 months) was longer than that in the high NLR group (27 months), with a statistically significant difference (P=0.022). Cox univariate and multivariate analysis showed NLR≥3 was a risk factor (P=0.024), but not an independent risk factor (P=0.064).@*Conclusion@#NLR is associated with creatinine and serum Ca, which can be used to evaluate the overall survival time and inductive treatment response in patients with MM.
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Objective To assess the efficacy and safety of oral fosfomycin trometamal in patients with lower urinary tract infections ( UTIs) caused by multi drug resistant ( MDR) bacteria in the clinical setting in China.Methods Multicenter study was conducted from January 2011 to December 2011 in 12 hospitals in China.Three hundred and fifty-six patients with non-fever lower UTls were treated by fosfomycin trometamal 3 g once daily.Three hundred and fifty cases with complete data were further evaluated .One hundred and twenty ( 34.3%) were male and 230 ( 65.7%) were female.The average age was ( 49.9 ± 16.6) years.Depending of the results of urine culture at the first visit ,142 patients with E.coli, Klebsiella pneumonia, proteus, Staphylococcus aureus, Staphylococcus epidermidis and entercocous were analyzed.The susceptibility of MDR bacteria to fosfomycin trometamol were calculated . The clinical efficacy , bacteriological efficacy of fosfomycin trometamol to these patients was evaluated .Results For the gram-negative bacteria detected by culture , among the E.coli, Klebsiella pneumonia and proteus, 50%(52/104) were Extended-Spectrum β-lactamases producing organisms . For the gram-positive bacteria ( n =38 ) detected by culture, methicillin-resistant staphylococcus accounts for 55%(11/20) of all the Staphylococcus and the other gram-positive bacteria were Enterococcus ( n=18 ) .Higher susceptibility rates to fosfomycin trometamol were observed among MDR bacteria (85.7%) and the clinical effective rate and bacteriological effective rate of fosfomycin trometamol were 96.4%( 53/55 ) and 87.5%( 42/48 ) , respectively .The incidence of drug-related adverse events (AEs) was 5.6%(20/356).The most common AE was diarrhea. No drug-related serious adverse events were found .Conclusions The distributions of uropathogens in China are complicated. The detection rate of MDR uropathogens is high . The dosing regimen of fosfomycin trometamal 3 g once daily is effective and tolerable for the patients with lower UTIs caused by MDR bacteria . It may represent good options for the empiric therapy for the patients with lower UTIs .
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Objective To investigate the efficacy of using three-dimensional (3D) printing technique on surgical planning and its function in enhancing the physician-patient rapport before surgery.Methods From June 2013 to January 2014,10 patients with T1 renal tumors,who were received laparoscopic partial nephrectomy,were selected in study.Left renal tumor was found in 3 cases and right renal tumor was found in 7 cases.The location of tumor included upper part of kidney in 5 cases,lower part of kidney in 3 cases and renal hilum in 2 cases,4 cases were diagnosed as T1a stage and 6 cases were diagnosed as T1b stage.64-slice enhanced CT scan was performed preoperatively.Data of DICOM format was sent for post processing.The final data was then output to 3 d printer for generating kidney models using thermoplastic plastics.After generating the model,different colors were put on the model,including pink in kidney,yellow in pelvis and ureter,red in renal artery and blue in renal vein.Plotted questionnaires were designed for medical professionals and patients,respectively.4 urological experts make the scores by this questionnaire in order to evaluate the efficacy and fidelity of the model.2 surgeons evaluated the efficacy of model after operation by comparing the actual tumor size with that measured on the models.Meanwhile,the model was used for conversation before operation.The questionnaires were also used for evaluating the effectiveness of conversion.Results 10 kidney models fabricated successfully with 3D-printing.The tumor size,position,renal vascular and collecting system could be clearly presented.Being evaluated by 4 experts and 2 performing urologists,and the mean scores was 7.8 ± 0.7.Intraoperative correlation was advocated by the performing urologists.The mean evaluation score was 7.5.The bias between real diameter of renal carcinoma and that of 3 d model was 3.4± 1.3 mm.Patients and family members preferred the demonstration of the disease and the procedure with a visual and tactilediseased organ.The scores of satisfactory were 9.0 ± 0.8.Conclusions The 3d printed model could exhibit the relationship between tumor and renal,clearly.It can help the urologists in making surgical plan,effectively.Patients' Understandings from patients and family members of the disease and the procedure to be used can be upgraded with this novel technology.
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Objective To explore the effects of proteasome inhibitor bortezomib alone and in combination with chemotherapeutic agents in acute leukemia cell line HEL. Methods Tumor cell growth inhibition and apoptosis was measured by MTT assay and FACS analysis, respectively. Apoptosis- and cell cycle-associatd protein expression levels were measured by Western blotting assay. Results Bortezomib induced the suppression of tumor cell growth and apoptosis in a dose-dependent manner with an inhibitor concentration IC50 values 7.15 nmol/L in acute leukemia cell line HEL. Further combination treatment with doxorubicin or cytarabine increased tumor cell growth suppression in acute leukemia cell line, as compared to single drug treatment alone. Bortezomib caused an increase in G2/M in a time-dependent manner. Bortezomib alone and in combination with chemotherapeutic agents treatment increased the bax and p27 expression and decreased the bcl-2 expression even without influencing p53 expression levels. Conclusion Bortezomib may be an effective therapeutic drug for patients with acute leukemia. Combining bortezomib with doxorubicin might be more effective for displaying tumor cell growth inhibitor effects in acute leukemia cells through regulation of bcl-2, bax and p27 proteins and independent of p53 status.
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Objective To study the reconstitution of nature kill cell early after non-myeloablative allogeneic stem cell transplantation (NAST). Methods Cell phenotypes and in vitro immune functions were analyzed by direct immune fluorescence with FCM, T-cell activation test and MTT assay, respectively. Results The percentages of CD+3, CD+4 cells were low, (2.03±15.60) % and (22.69±12.29)%, respectively, while CD+8 lymphocytes were normal or high [(29.26±8.99)%] 1 month after NAST. Proliferative response to a T lymphocyte activator (PHA) was blunted, 94.60±44.87. The percentage of NK cells was within normal limits or high (n=7) in allotransplanted patients. It is (18.77±9.11) %. The percentage of CD+56 NK cells expressing IL-2R (CD25) was high and values obtained from transplanted patients were significantly different from control values . They are (3.71±2.23) % (t = 2.116, P = 0.044). NK cell activity in part of patients was higher than that observed in control cells (25.30±12.39) % vs (16.60±3.53) % (t = 2.135, P= 0.047). Conclusion NK cell has recovered early after transplantation and may be particularly relevant as a first line of defence in immunosurveillance against neoplastic cells or microbial infections, until a full reconstitution of T cellmediated immune response can be achieved.
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Objective To evaluate the relationship between von Hippel-Lindau (VHL) gene mutations and the prognosis of Chinese sporadic clear cell renal cell carcinoma (CCRCC). Methods VHL gene mutations were detected by polymerase chain reaction (PCR), direct DNA sequencing in 74 paired specimens of sporadic CCRCC and normal kidney. The mutation findings, pathologic fea-tures and prognostic characteristics were analyzed. Results Fifty-one patients (68.9%) were in clinical stage T1, 9 patients (12.2%) were in T2 and 14 patients (18.9%) were in T3. In the aspect of pathological grade, 15 patients (20.3%) were in G1, 50 patients (67.6%) were in G2 and 9 pa-tients (12.2%) were in G3. VHL gene mutations were detected in 40 of 74 cases (54.1%). There were no significant differences of VHL gene mutations in different pathological grade and clinical stage of CCRCC, P=0.915, P=0.237, respectively. All patients were followed up for 34 to 107 months (mean 71 months). Seven patients died of CCRCC. Another 11 patients developed CCRCC related me-tastasis. Five-year tumor-free survival was 78%. The incidence of death or metastasis of CCRCC in VHL gene mutation group (15.0%, 6/40) was significant lower than non-mutation group (35.3%,12/34), P=0.043. Logistic regression results showed that lower tumor pathological grade and stage, better patients' prognosis would be (P=0.016, P=0.024, respectively). However, VHL gene muta-tion was related with better prognosis (P=0.033). This association was stronger among patients with high grade tumors (G3, P=0.048). Conclusions There are frequent VHL gene mutations in spo-radic Chinese CCRCC. Tumors' pathological grade and clinical stage are the important parameters for prognosis. However, VHL mutations are strongly associated with better cancer specific survival for CCRCC patients. These associations are relatively stronger in patients with high grade tumors.
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This experiment was aimed to create A20 gene site-specific zinc finger DNA-binding protein. The sequence of A20 gene promoter was analyzed with bioinformatics means and submitted to ZF Tools Server at TSRI. Using the database of the web site, we determined the A20 gene valid target sites and designed the amino acid sequence of zinc finger protein predicted to be bound to the target site. And then, the structure of the protein sequence was analyzed and homology was modeled with various bioinformatics means. Based on the characteristic of this protein, the prokaryotic expression vector pTYB11-ZFP was constructed and expressed. Thus, the artificial zinc finger protein that recognized A20 specific sequence was designed, and expressed in Escherichia coli. The results indicate that it is feasible to design engineered artificial Zinc finger proteins by means of bioinformatics.
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Humans , Amino Acid Sequence , Base Sequence , DNA-Binding Proteins , Chemistry , Genetics , Molecular Sequence Data , Protein Binding , Protein Engineering , Methods , Transcription Factors , Chemistry , Genetics , Zinc Fingers , GeneticsABSTRACT
Objective : To investigate the mutation of VHL gene, an important tumor suppressor gene in primary sporadic human renal cell carcinoma (RCC),and analyse its relationships with pathological stage and grade of renal cell carcinoma. Methods: We analyzed 57 cases of primary sporadic Chinese renal clear carcinoma using the polymerase chain reaction (PCR) and denaturing high performance liquid chromatography(DHPLC).All positive cases in DHPLC analysis were further characterized by direct sequencing. Results: Somatic mutations were detected in 30 (53%) of 57 clear cell renal carcinomas including 13 deletions, 2 insertions, and 15 missense mutations. These mutations mainly occurred in the last one third region of exon 1, 2,and 3. Conclusion: VHL tumor suppressor gene is one of the major tumor suppressor genes in human renal cell carcinoma,and there are frequent mutations of VHL in primary sporadic Chinese renal clear cell carcinomas. The mutations of VHL gene were irrespective of the age and pathological grade and stage of patients.
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Objective To investigate the infectious complications after nonmyeloablative allogeneic peripheral blood stem cell transplantation (NASCT). Methods Ten patients with leukemia received NASCT from HLA-identical or 1-3 antigen mismatched sibling donors with conditioning regimens of Flu/Cy+BU+ALG. Five patients were acute leukemia (AL) and all of them is in complete remission (CR1). Cyclosporine in combination with methotrexate was administered for GVHD prophylaxis. Results WBC recovered to more than 0.5 ?10 9/L during postoperative 10 day to 38 day and platelet recovered to more than 20?10 9/L during postoperative 8 day to 16 day. Bacterial infections occurred in 3 patients (30 %) and cytomegalovirus (CMV) infections in 2 patients (20 %). Varicella zoster virus (VZV) infections occurred in one patient (10 %). No fungal infections were documented. No patients died as a result of infection . Conclusion NASCT is a safe and effective therapeutic method for leukemia. It reduces acute GVHD,regimen-related toxicity and early neutropenia associated with traditional allo-HSCT.