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【Objective】 To investigate the clinical characteristics and treatment strategy of giant multilocular prostatic cystadenoma(GMPC). 【Methods】 The clinical data of a GMPC patient treated in our hospital in July 2021 were retrospectively analyzed. The patient was 73 years old. The clinical manifestations were urgent urination and frequent urination. The prostate specific antigen (PSA) increased slightly. MRI showed giant cystic solid space occupying lesion of the prostate. Domestic and foreign cases of prostate cystadenoma from 2000 to 2021 were retrieved for literature review. 【Results】 Transabdominal laparoscopic radical prostatectomy was performed successfully. The postoperative pathological diagnosis was GMPC. Two weeks after operation, the urinary catheter was removed, and there was no discomfort such as urinary frequency or urinary incontinence. After follow-up for more than 8 months, there was no tumor recurrence or metastasis. 【Conclusion】 There are still some disputes about the oncological characteristics and diagnosis and treatment of GMPC, and there is a lack of long-term follow-up results. Laparoscopic prostatectomy is safe and feasible. Most patients have a good prognosis after surgical treatment. It is necessary to formulate an individualized standard treatment plan based on surgery combined with different patients’ conditions to actively improve the prognosis.
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With the continuous development of kidney transplantation technique, the survival time after kidney transplantation is gradually prolonged. Thus, the malignant tumor has been the important influencing factor on the long-term survival for kidney transplantation patients. Renal cell carcinoma is a relatively common tumor after kidney transplantation. Besides, clear cell renal cell carcinoma and papillary renal cell carcinoma are the relatively common pathological types for renal cell carcinoma following kidney transplantation. However, bilateral renal cell carcinoma following kidney transplantation is comparatively rare. In this article, we presented a case of bilateral papillary renal cell carcinoma, which occurred after kidney transplantation. And the diagnosis and treatment were introduced in detail. The patient was 37 years old, and he underwent kidney transplantation 13 years ago in our hospital, because of kidney failure. After kidney transplantation, he had regular medical check-up every year. In this year, his urological ultrasound results indicated bilateral renal tumors. And then, he received abdominal and pelvic computed tomography, and the result also showed bilateral renal tumors, which were likely to be malignant tumors. After adequate consultation, the patient chose surgical treatment. The patient received long-term immunosuppressive therapy, because of kidney transplantation. Considering this, the surgeon decided to choose a staging surgical treatment, in order to reduce the bad influence of one-stage surgery. Then, the patient first underwent retroperitoneal laparoscopic radical nephrectomy for right renal tumor in our hospital, and he had no complications after operation. The pathological results showed papillary renal cell carcinoma. He was discharged successfully. He underwent retroperitoneal laparoscopic radical nephrectomy for left renal tumor in our hospital one month later, and he had no complications after operation. The pathological results also showed papillary renal cell carcinoma. He was discharged successfully two days after surgery. In the 3-month follow-up, the patient was recovering well. To sum up, the incidence of bilateral renal cell carcinoma following kidney transplantation is relatively rare, and bilateral radical nephrectomy is effective and safe treatment. Above all, it is the patient's condition that determines the choice of staging surgery or simultaneous surgery.
Subject(s)
Adult , Humans , Male , Carcinoma, Renal Cell/surgery , Kidney , Kidney Neoplasms/surgery , Kidney Transplantation/adverse effects , NephrectomyABSTRACT
Mitochondria as a signaling platform play crucial roles in deciding cell fate. Many classic anticancer agents are known to trigger cell death through induction of mitochondrial damage. Mitophagy, one selective autophagy, is the key mitochondrial quality control that effectively removes damaged mitochondria. However, the precise roles of mitophagy in tumorigenesis and anticancer agent treatment remain largely unclear. Here, we examined the functional implication of mitophagy in the anticancer properties of magnolol, a natural product isolated from herbal
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Objective:To explore the value of preoperative aspartate transaminase(AST) and aspartate transaminase/alanine transaminase ratio(AST/ALT)for predicting the prognosis in patients with non-metastatic renal cell carcinoma with tumor thrombus.Methods:A retrospective analysis was made of the patients with renal cell carcinoma with tumor thrombus in our institution from February 2015 to December 2018. This study included 80 patients, 56 males and 24 females with mean age of 58 years (range 15-83 years). There were 17 in Mayo level 0, 24 Mayo level I, 22 in Mayo level II, 12 in Mayo level III and 5 in Mayo level IV. All the patients received radical nephrectomy or palliative nephrectomy with tumor thrombectomy. The continuous variable of AST/ALT was collected by ROC curve. The maximum value of Youden index was taken as the critical value, and the continuous variables were adjusted to binary variables. Cancer-specific survival (CSS) was calculated according to the Kaplan-Meier analysis and compared by the log-rank test. Cox multivariate regression analysis was used to analyze the independent factors of the prognosis of patients with non-metastatic renal cancer and tumor thrombus.Results:There were 70 cases of clear cell carcinoma, 10 cases of non-clear cell carcinoma, 30 cases of low Fuhrman grade (grade 1&2), and 50 cases of high Fuhrman grade (grade 3&4). AST was 19U/L (8-226 U/L) and AST/ALT was 1.3(0.4-3.3). There was a significant difference in AST between different lymphovascular invasion groups ( P=0.04), but there was no significant difference in sex, age, Mayo classification, pathological type, Fuhrman grade and lymph node metastasis. The difference of AST / ALT between age groups was significant ( P=0.025). The average follow-up time was 14.7 months (0-44 months). During the follow-up, 11 (13.8%) patients died of tumor. Univariate analysis showed that Fuhrman grade ( P=0.007), lymph node metastasis ( P=0.019), hemoglobin ( P=0.001), alkaline phosphatase (ALP, P=0.001), AST ( P=0.004) and AST / ALT ( P=0.038) were risk factors for CSS. In terms of prognosis, considering the potential correlation between AST level and AST/ALT ratio, after excluding AST, multivariate Cox regression analysis showed that high nuclear grade ( HR=3.049, 95% CI 1.292-7.196, P=0.011), high ALP ( HR=1.018, 95% CI 1.007-1.029, P=0.001) and high AST/ALT ratio ( HR=4.094, 95% CI 1.064-15.759, P=0.04) were associated with poor CSS. After excluding AST/ALT ratio, multivariate Cox regression analysis showed that high nuclear grade ( HR=5.836, 95% CI 1.867-18.240, P=0.002) and high AST ( HR=1.040, 95% CI 1.017-1.062, P<0.001) were associated with poor CSS. Conclusions:In patients with non-metastatic renal cell carcinoma with tumor thrombus, high AST/ALT ratio and AST levels indicate poor pathological types and poor prognosis.
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Objective:To investigate the safety and effectiveness of cytoreductive nephrectomy and tumor thrombectomy in patients with metastatic renal cancer with renal vein or inferior vena cava tumor thrombus.Methods:From February 2015 to May 2019, 56 cases of metastatic renal cell carcinoma with venous tumor thrombus were analyzed retrospectively, including 44 male (78.6%) and 12 female (21.4%)cases, and the average age was (59.2±10.7)(22-82). The clinical presentations covered local symptoms in 26 cases (46.4%), systemic symptoms in 8 cases (14.3%), both local symptoms and systemic symptoms in 12 cases (21.4%), and asymptomatic in 10 cases (17.9%). Among them, renal tumors were located in 35 cases (62.5%) on the right and 21 cases (37.5%) on the left. The average tumor diameter was (10.1±3.8)(1.5-21.1) cm. Forty-five cases (80.4%) scored 2 points and 11 cases (19.6%) scored 3 points by the American Society of anesthesiologists(ASA). Preoperative hemoglobin was (118.2±23.1)(72-178) g/L, and albumin was (37.9±5.6)(23-50) g/L, total protein was (67.7±6.7)(43-81) g/L, serum creatinine was (111.3±119.6)(32-958) μmol/L. There were 16 cases of Mayo 0 (28.6%), 14 cases of Mayo Ⅰ(25.0%), 17 cases of Mayo Ⅱ(30.4%), 4 cases of Mayo Ⅲ(7.1%), and 5 cases of Mayo Ⅳ(8.9%). Fourteen cases (25.0%) were in the stage of cN 0 and 42 cases (75.0%) in the stage of cN 1. Five cases (8.9%) had simple bone metastasis, 16 cases (28.6%) had simple lung metastasis, 2 cases (3.6%) had simple adrenal metastasis, 6 cases (10.7%) had simple liver metastasis, and 27 cases (48.2%) had 2 or more multiple system metastasis. According to the location of the organ system, 91 metastatic lesions were found in 56 patients. Among them, 37 cases (40.7%) had lung metastasis, 18 cases (19.8%) had liver metastasis, 21 cases (23.1%) had bone metastasis and 15 cases (16.5%) had adrenal metastasis. All 56 patients belonged to IMDC prognosis score model medium risk group. The surgical treatment of Mayo grade 0 tumor thrombus was the same as that of routine radical nephrectomy. The tumor thrombus of Mayo grade Ⅰ was removed after IVC was partially blocked by Satinsky′s forceps. The Mayo Ⅱ tumor thrombus was removed, after blocking the distal vena cava, the contralateral renal vein and the proximal vena cava. Mayo grade Ⅲ tumor thrombus needed pringer's method to block the first porta hepatis. For grade Ⅳ tumor thrombus the diaphragm could be cut directly, or the thrombus could be removed by cardiopulmonary bypass. Laparoscopic surgery was performed in 22 cases (39.3%) and open surgery in 30 cases (53.6%). Six cases (10.7%) underwent IVC wall resection because of tumor invasion. 32 cases (57.1%) underwent ipsilateral adrenalectomy because of tumor invasion or adrenal metastasis, and 23 cases (41.1%) underwent ipsilateral lymphadenectomy. In this study, there were 11 cases of solitary metastasis, 8 cases of which were operated on and 3 cases of which were not operated on. Forty-three patients were treated with sunitinib after palliative nephrectomy, 9 patients were treated with pazopanib, 3 patients were treated with acitinib, and 1 patient was treated with sorafenib. Results:The operations were successfully completed in 56 patients. Four cases (7.1%) changed from laparoscopic surgery to open surgery. The operation time was (326.8±114.9)(108-589) min. Intraoperative hemorrhage was (1 435.2±1 513.4)(20-6 000) ml, intraoperative red blood cells transfusion was (1 456.7±832.8)(400-3 600) ml in 30 cases, and intraoperative plasma transfusion was (700.0±473.6)(200-1 800) ml in 15 cases. The postoperative hospital stay was (10.6±4.6)(5-26) days. The serum creatinine one week after operation was (109.5±98.7) (47-772) μmol/L. There were 46 cases (82.1%) of renal clear cell carcinoma, 7 cases (12.5%) of papillary renal cell carcinoma and 3 cases (5.4%) of unclassified renal cell carcinoma. One case was WHO/ISUP 2016 nuclear grade 1 (1.8%), 20 cases(36.4%) was grade 2, 18 cases(32.7%)was grade 3, and 16 cases(29.1%)was grade 4. Early postoperative complications occurred in 22 cases (39.3%). Among them, 1 case of Clavien gradeⅠ was wound infection. There were 16 cases with Clavien gradeⅡ, including 5 cases who received blood transfusion due to anemia, 3 cases with chylous fistula, 4 cases with postoperative pulmonary infection, 2 cases with postoperative lower extremity venous thrombosis, 1 case with atrial fibrillation and 1 case with epididymitis. Clavien gradeⅢ a was found in 1 case with pneumothorax. Clavien gradeⅣ was found in 2 cases, including 1 case of acute cerebral infarction and 1 case of renal insufficiency.There were 2 cases with Clavien gradeⅤ with perioperative death. Among the 56 patients, 5 lost the follow-up, 2 died during the perioperative period, and the other 49 patients were followed up for 1-39 months, with a median follow-up of 14 months. The mean survival time was (25.6±2.5) months, and the median survival time was 25 months.Conclusions:It was relatively safe and effective to perform cytoreductive nephrectomy and tumor thrombectomy in patients with metastatic renal cancer with tumor thrombus. For the patients with clinical symptoms, IMDC prognosis score model medium risk group, and strong desire for surgery, the combination of cytoreductive nephrectomy with tumor thrombectomy and postoperative targeted medical therapy was recommended.
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The prognosis of metastatic renal cell carcinoma is relatively poor. With the development of molecular biology, the treatment of metastatic renal cell carcinoma is undergoing a transformation from cytokine therapy to targeted molecular therapy or immunotherapy, and the prognosis has been improved. This study summarized and discussed the treatment progress of metastatic renal cell carcinoma.
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OBJECTIVE@#To detail a novel technique for marking renal tumors with intravenous indocyanine green (ICG) during laparoscopic partial nephrectomy, and to investigate the feasibility and safety of this technique with the use of near-infrared fluorescence imaging.@*METHODS@#Between July 2019 and January 2020, 25 consecutive cases with renal masses underwent intraoperative ICG tumor marking laparoscopic partial nephrectomy, at the department of urology in Peking University Third Hospital by the same surgeon. The key benefits included quick intraoperative identification of the mass with improved visualization and real-time control of resection margins by the ICG Immunofluorescence imaging technique. Clinical data were prospectively collected in our institutional database. Perioperative, pathological, and clinical outcomes of the partial nephrectomy were assessed. Measurement data with normal distribution and count data were respectively described as M(range) and percentage. Among these cases, 16 cases were male and 9 cases female, The median body mass index was 25.4 (20.0-35.4) kg/m2. The average age was 54 (29-77) years. The maximum tumor diameter was 2.75(1.30-5.20) cm. The R.E.N.A.L score was 7.5 (5.0-10.0).The tumor locations were distributed with upper pole (11, 42%), middle (6, 23%), and lower pole (9, 35%).The clinical stages of the tumor were described as follows: T1aN0M0 (23, 88.5%), T1bN0M0(2, 7.7%), T2aN0M0 (1, 3.8%).@*RESULTS@#All the 25 cases were performed 26 times with intraoperative ICG tumor marking laparoscopic partial nephrectomy. There were no allergy, infection and other complications with intravenous indocyanine green. The surgical procedure was successful in all the patients. No conversion and blood transfusion were needed. All the cases of the surgical margin were negative. Overall the operative time was 136 (50-247) min and warm ischemia time was 14 (7-30) min.The estimated blood loss was 50 (10-400) mL and the hospital stay was 5.5 (3.0-31.0) days. One case with perirenal hematoma, one case with urine leak, one with respiratory failure and deep venous thrombosis. All of these cases were cured by the corresponding treatment. The others had no severe complications. There was no tumor recurrence and metastasis during the follow up with 4 to 10 months.@*CONCLUSION@#ICG marking and near-infrared fluorescence imaging technology has now emerged as a safe, feasible and useful tool that may facilitate laparoscopic partial nephrectomy.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Indocyanine Green , Kidney Neoplasms , Laparoscopy , Neoplasm Recurrence, Local , Nephrectomy , Retrospective StudiesABSTRACT
Objective@#To learn the current situation of smoking among permanent residents aged 15 years and over in Hangzhou,so as to provide evidence for further smoking control.@*Methods@#From March to June of 2017,multi-stage random sampling method was used to select residents aged 15 years and over in Hangzhou from district (county),town (street),village (residential committee) and then residential groups. The global Adult Tobacco Survey (part of China) questionnaire was used to investigate smoking,second-hand smoking and smoking cessation status of residents. Logistic regression model was used to analyze the influencing factors for smoking and quitting behaviors.@*Results@#A total of 1 440 questionnaires were sent out and 1 434 valid ones were recovered,with an response rate of 99.58%. There were 359 (25.03%) current smokers and 333 (23.22%) daily smokers. The median number was 15 cigarettes per day in daily smokers,and the median age of starting daily smoking was 21 years old. There were 670 (62.33%) people exposed to second-hand smoking. There were 137 (27.62%) people successfully quitting smoking. The results of multivariate logistic regression analysis showed that men (OR=73.459,95%CI:38.970-138.458), 50 years old or above (OR:1.646-2.632,95%CI:1.020-4.710),primary school education (OR=3.267,95%CI: 1.586-6.732),high school or vocational school education (OR=1.902,95%CI: 1.109-3.261),awareness of second-hand smoking hazards (OR=2.485,95%CI:1.735-3.559) were the influencing factors for current smoking;men (OR=64.454,95%CI:29.031-138.691),50-59 years old (OR=0.281,95%CI:0.095-0.827),primary school education (OR=0.211,95%CI:0.053-0.841) were the influencing factors for quitting smoking.@*Conclusions@#The rates of current smoking and second-hand smoking of permanent residents aged 15 years and over in Hangzhou were 25.03% and 62.33%,respectively. Gender,age and education level were associated with current smoking and quitting smoking.
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Objective@#To investigate the operating key steps and the initial experience of IUPU (Institute of Urology, Peking University) modified extraperitoneal laparoscopic VIP (Vattikuti institute prostatectomy) technique and the initial follow-up outcomes.@*Methods@#46 patients of prostate cancer underwent the modified extraperitoneal laparoscopic VIP and were reviewed from November 2017 to September 2018. Patients aged 54 to 77 years, with mean age of 65.5 years old. Their preoperative PSA was 0.15 to 69.76 ng/ml with an average of 13.4 ng/ml. All patients were diagnosed by prostate biopsy and Gleason score was 6 to 10 with an average of 7.5. MRI was used to assess their clinical stage before operation. All the modified laparoscopic VIP were done through the extraperitoneal approach by a single surgeon and the follow-up by telephone for the PSA level and continence recovery (urine pad test). The major differences between modified laparoscopic VIP and the routine steps of radical prostatectomy are as follows: use of extraperitoneal approach and traditional laparoscopic operation; after the setup of the extraperitoneal cavity, the bladder neck is separated, isolated and cut down first; the management of DVC: Cut down the super-facial and deep layers of DVC just along the capsule of the prostate apex and it’s unnecessary to suture it. Perioperative data of these patients were collected retrospectively, including operation time, intraoperative blood loss, length of hospital stay, postoperative pathology, and continence outcome after surgery.@*Result@#All 46 patients underwent the IUPU modified extraperitoneal laparoscopic VIP successfully without converting to open surgery. The operation time was 69-143 min with an average of 95.7 min and the estimated blood loss was 20-200 ml with an average of 81.5 ml. It was 3-17 days for the average time to remove the retropubic drainage tube postoperatively, with an average of 4.3 days. The postoperative hospital stay was 3-17 days with an average of 5.3 days. The Foley catheter was removed 14 days postoperatively. Five patients suffered from urine leakage and were managed successfully with conservative treatment. For the postoperative pathological stage, 1 patient was pT2a, 12 patients were pT2c, 12 patients were pT3a and 21 patients were pT3b. The postoperative Gleason score was 6-9 with an average of 7.7. The postoperative follow-up time was 1-11 months with an average of 6.3 months. The PSA was 0.001-0.966 ng/ml with an average of 0.181 ng/ml 1 month postoperatively and the continence rate was 54%(25/46) and 89%(34/38) 1 month and 3 months after operation respectively.@*Conclusions@#The IUPU modified extraperitoneal laparoscopic VIP might be a safe and feasible for the radical prostatectomy. It’s simplified for the operative steps, unnecessary to isolate and suture DVC and doesn’t increase the blood loss. It’s almost left intact for the surrounding tissues of the prostate apex and satisfactory for the early urinary continence. The oncological outcomes are needed to followup further.
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Objective@#To evaluate the efficacy and safety of Institution Urology of Peking University modified technique for transperitoneal laparoscopic pyeloplasty combined with deflectable tip rigid ureteroscope(the Sun's ureteroscope) in ureteropelvic junction obstruction(UPJO) complicated with renal calculi.@*Methods@#From January 2018 to September 2018, eight patients, including five males and three females, were diagnosed as UPJO with coexistent ipsilateral renal calculi in Peking University First Hospital and Changzheng Hospital of Second Military Medical University. The age ranged from 14 to 50 years(mean 28 years). Four patients had flank pain and one patient had flank pain with hematuria, while the other three patients came without clinical symptom.The BMI ranged from 16.8 to 26.2 kg/m2(mean 22.0 kg/m2). The lesion located on the left side in 4 cases and on the right side in 4 cases. One patient suffered with multiple pelvis stones. Four patients suffered with multiple lower calyceal stones, and 3 patients had solitary lower calyceal stone. The stone size ranged from 2 mm to 10 mm (mean 6.4 mm). 3 cases had slight hydronephrosis and 5 cases had moderate hydronephrosis. Two patients combined with crossing vessels. All patients underwent modified transperotoneal laparoscopic dismembered pyeloplasty with pyelolithotomy. In cases with left lesion, an incision was made for the veress needle 5mm inferior to the costal margin in the left midclavicular line to establish pneumoperitoneum . A 12-mm camera port was placed 30 mm inferior to the umbilicus and 10 mm lateral to the border of left rectus muscle. Then, a 5 mm operative trocars was inserted at 30mm superior to the umbilicus 10 mm lateral to the border of left rectus muscle. Another 12 mm operative trocar was inserted at the opposite McBurney point. The last 5 mm operative trocar was placed at the veress needle point. After visualizing the pelvis and the proximal ureter at the lower pole of the kidney, a 1.0 cm transverse incision on the lower pole of the pelvis above the obstruction site was made. The Sun’s ureteroscope was introduced into the renal pelvis through the 1.0 cm transverse incision via the 12-mm trocar below the umbilicus. Stones in the renal pelvis and calyces were extracted with basket catheters and removed via the port. After the pyelo-nephroscopy, a modified transperitoneal laparoscopic pyeloplasty was made. A F6 double-J stent was inserted into the ureter during the surgery.@*Result@#All surgeries were finished successfully without conversion. The surgical duration ranged from 111 to 185 min(mean 135 min). The estimated blood ranged from 10 to 50 ml(mean 38.8 ml). The hospital stay ranged from 3 to 7 days(mean 4 days). The intraoperative stone free rate was 100%(8/8). No perioperative complications occured. With the follow-up from 6 to 14.4 months(mean 8.9 months), there was no evidence of obstruction in all patients, as confirmed by symptoms or radiological improvement of hydronephrosis, and two patients found recurrence of renal calculi.@*Conclusions@#Our modified technique for transperitoneal laparoscopic pyeloplasty combined with deflectable tip rigid ureteroscope(the Sun′s ureteroscope) is a safe, effective method to manage ureteropelvic junction obstruction with renal calculi.
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Objective To evaluate the efficacy and safety of Institution Urology of Peking University modified technique for transperitoneal laparoscopic pyeloplasty combined with deflectable tip rigid ureteroscope(the Sun's ureteroscope) in ureteropelvic junction obstruction (UPJO) complicated with renal calculi.Methods From January 2018 to September 2018,eight patients,including five males and three females,were diagnosed as UPJO with coexistent ipsilateral renal calculi in Peking University First Hospital and Changzheng Hospital of Second Military Medical University.The age ranged from 14 to 50 years(mean 28 years).Four patients had flank pain and one patient had flank pain with hematuria,while the other three patients came without clinical symptom.The BMI ranged from 16.8 to 26.2 kg/m2 (mean 22.0 kg/m2).The lesion located on the left side in 4 cases and on the right side in 4 cases.One patient suffered with multiple pelvis stones.Four patients suffered with multiple lower calyceal stones,and 3 patients had solitary lower calyceal stone.The stone size ranged from 2 mm to 10 mm (mean 6.4 mm).3 cases had slight hydronephrosis and 5 cases had moderate hydronephrosis.Two patients combined with crossing vessels.All patients underwent modified transperotoneal laparoscopic dismembered pyeloplasty with pyelolithotomy.In cases with left lesion,an incision was made for the veress needle 5mm inferior to the costal margin in the left midclavicular line to establish pneumoperitoneum.A 12-mm camera port was placed 30 mm inferior to the umbilicus and 10 mm lateral to the border of left rectus muscle.Then,a 5 mm operative trocars was inserted at 30mm superior to the umbilicus 10 mm lateral to the border of left rectus muscle.Another 12 mm operative trocar was inserted at the opposite McBurney point.The last 5 mm operative trocar was placed at the veress needle point.After visualizing the pelvis and the proximal ureter at the lower pole of the kidney,a 1.0 cm transverse incision on the lower pole of the pelvis above the obstruction site was made.The Sun's ureteroscope was introduced into the renal pelvis through the 1.0 cm transverse incision via the 12-mm trocar below the umbilicus.Stones in the renal pelvis and calyces were extracted with basket catheters and removed via the port.After the pyelo-nephroscopy,a modified transperitoneal laparoscopic pyeloplasty was made.A F6 double-J stent was inserted into the ureter during the surgery.Result All surgeries were finished successfully without conversion.The surgical duration ranged from 111 to 185 min(mean 135 min).The estimated blood ranged from 10 to 50 ml(mean 38.8 ml).The hospital stay ranged from 3 to 7 days(mean 4 days).The intraoperative stone free rate was 100％ (8/8).No perioperative complications occured.With the follow-up from 6 to 14.4 months(mean 8.9 months),there was no evidence of obstruction in all patients,as confirmed by symptoms or radiological improvement of hydronephrosis,and two patients found recurrence of renal calculi.Conclusions Our modified technique for transperitoneal laparoscopic pyeloplasty combined with deflectable tip rigid ureteroscope (the Sun's ureteroscope) is a safe,effective method to manage ureteropelvic junction obstruction with renal calculi.
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Objective To investigate the operating key steps and the initial experience of IUPU (Institute of Urology,Peking University) modified extraperitoneal laparoscopic VIP (Vattikuti institute prostatectomy) technique and the initial follow-up outcomes.Methods 46 patients of prostate cancer underwent the modified extraperitoneal laparoscopic VIP and were reviewed from November 2017 to September 2018.Patients aged 54 to 77 years,with mean age of 65.5 years old.Their preoperative PSA was 0.15 to 69.76 ng/ml with an average of 13.4 ng/ml.All patients were diagnosed by prostate biopsy and Gleason score was 6 to 10 with an average of 7.5.MRI was used to assess their clinical stage before operation.All the modified laparoscopic VIP were done through the extraperitoneal approach by a single surgeon and the follow-up by telephone for the PSA level and continence recovery (urine pad test).The major differences between modified laparoscopic VIP and the routine steps of radical prostatectomy are as follows:use of extraperitoneal approach and traditional laparoscopic operation;after the setup of the extraperitoneal cavity,the bladder neck is separated,isolated and cut down first;the management of DVC:Cut down the super-facial and deep layers of DVC just along the capsule of the prostate apex and it's unnecessary to suture it.Perioperative data of these patients were collected retrospectively,including operation time,intraoperative blood loss,length of hospital stay,postoperative pathology,and continence outcome after surgery.Result All 46 patients underwent the IUPU modified extraperitoneal laparoscopic VIP successfully without converting to open surgery.The operation time was 69-143 min with an average of 95.7 min and the estimated blood loss was 20-200 ml with an average of 81.5 ml.It was 3-17 days for the average time to remove the retropubic drainage tube postoperatively,with an average of 4.3 days.The postoperative hospital stay was 3-17 days with an average of 5.3 days.The Foley catheter was removed 14 days postoperatively.Five patients suffered from urine leakage and were managed successfully with conservative treatment.For the postoperative pathological stage,1 patient was pT2a,12 patients were pT2c,12 patients were pT3a and 21 patients were pT3b.The postoperative Gleason score was 6-9 with an average of 7.7.The postoperative follow-up time was 1-11 months with an average of 6.3 months.The PSA was 0.001-0.966 ng/ml with an average of 0.181 ng/ml 1 month postoperatively and the continence rate was 54％ (25/46) and 89％ (34/38) 1 month and 3 months after operation respectively.Conclusions The IUPU modified extraperitoneal laparoscopic VIP might be a safe and feasible for the radical prostatectomy.It's simplified for the operative steps,unnecessary to isolate and suture DVC and doesn't increase the blood loss.It's almost left intact for the surrounding tissues of the prostate apex and satisfactory for the early urinary continence.The oncological outcomes are needed to followup further.
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We aimed to investigate the prognostic value of chromogranin A (CgA) in castration-resistant prostate cancer (CRPC). We conducted a systematic literature search of PubMed, Web of Science, and EMBASE for citations published prior to September 2017 that described CgA and CRPC and performed a standard meta-analysis on survival outcomes. Our meta-analysis included eight eligible studies with 686 patients. The results were as follows: progression-free survival (PFS) was associated with CgA level (hazard ratio [HR] = 2.47, 95% confidence interval [CI]: 1.47-4.14, P = 0.0006); PFS was relative to CgA change (HR = 9.22, 95% CI: 3.03-28.05, P < 0.0001); and overall survival (OS) was relative to CgA level (HR = 1.47, 95% CI: 1.15-1.87, P = 0.002). When we divided the patients into two groups according to therapy status, the result for OS relative to CgA level was an HR of 1.26 (95% CI: 1.09-1.45, P = 0.001) in the first-line hormonal therapy group, and an HR of 2.33 (95% CI: 1.40-3.89, P = 0.001) in the second-line hormonal therapy or chemotherapy group. This meta-analysis indicated that a high CgA level had a negative influence on OS and PFS in CRPC patients. In addition, CRPC patients with a rising CgA had a shorter PFS. Further studies are needed to verify the prognostic value of CgA in CRPC.
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At present, chemoresistance is one of the leading causes of chemotherapy failure but there is no effective drugs or strategies to reverse the resistance of chemotherapy. In recent years, the anticancer effect of Salvia miltiorrhiza receives wide attention of researchers. The major bioactive constituents in Sal-via miltiorrhiza can be divided into two groups: liposoluble com-ponents ( tanshinoneⅠ, tanshinoneⅡA, dihydrometanoneⅠ and cryptotanshinone, etc. ) and hydrophilic components (salvianol-ic acid A, salvianolic acid B and protocatechualdehyde, etc. ). Recent studies have found that these components not only play different anti-tumor activities, but showed significant reversal re- sistance effects on drug-resistant tumor cells. Besides, with the combination of chemotherapy drugs, they have significant attenu-ated toxicity and synergistic effect. In this paper, we summarize the researches pertaining to the effects of Salvia Miltiorrhiza on the reversal of drug resistance and chemotherapy sensitization in recent years, providing references for the development of Salvia miltiorrhiza as multidrug resistance reversal agents and its ration-al application in clinic.
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The matrix metalloprotease-1 (MMP-1)/protease-activated receptor-1 (PAR-1) signal transduction axis plays an important role in tumorigenesis. To explore the expression and prognostic value of MMP-1 and PAR-1 in esophageal squamous cell carcinoma (ESCC), we evaluated the expression of two proteins in resected specimens from 85 patients with ESCC by immunohistochemistry. Sixty-two (72.9 percent) and 58 (68.2 percent) tumors were MMP-1- and PAR-1-positive, respectively, while no significant staining was observed in normal esophageal squamous epithelium. MMP-1 and PAR-1 overexpression was significantly associated with tumor node metastasis (TNM) stage and regional lymph node involvement. Patients with MMP-1- and PAR-1-positive tumors, respectively, had poorer disease-free survival (DFS) than those with negative ESCC (P = 0.002 and 0.003, respectively). Univariate analysis showed a significant relationship between TNM stage [hazard ratio (HR) = 2.836, 95 percent confidence interval (CI) = 1.866-4.308], regional lymph node involvement (HR = 2.955, 95 percentCI = 1.713-5.068), MMP-1 expression (HR = 2.669, 95 percentCI = 1.229-6.127), and PAR-1 expression (HR = 1.762, 95 percentCI = 1.156-2.883) and DFS. Multivariate analysis including the above four parameters identified TNM stage (HR = 2.035, 95 percentCI = 1.167-3.681), MMP-1 expression (HR = 2.109, 95 percentCI = 1.293-3.279), and PAR-1 expression (HR = 1.967, 95 percentCI = 1.256-2.881) as independent and significant prognostic factors for DFS. Our data suggest for the first time that MMP-1 and PAR-1 were both overexpressed in ESCC and are novel predictors of poor patient prognosis after curative resection. The MMP-1/PAR-1 signal transduction axis might be a new therapeutic target for future therapies tailored against ESCC.
Subject(s)
Aged , Female , Humans , Carcinoma, Squamous Cell/metabolism , Esophageal Neoplasms/metabolism , Matrix Metalloproteinase 1/metabolism , Neoplasm Proteins/metabolism , Receptor, PAR-1/metabolism , Immunohistochemistry , Prognosis , Signal TransductionABSTRACT
<p><b>OBJECTIVE</b>To examine the change of Smoothened (Smo) expression in the retinofugal pathway and in the growth cones during the period of embryonic day 13 (E13) to E15.</p><p><b>METHODS</b>Smo expression in the chiasm and growth cones was observed by fluorescent immunostaining and retinal explant culture.</p><p><b>RESULTS</b>On E13 and E14, Smo was expressed moderately in the retina and optic disc, and in the corner of the retina, Smo expression was especially dense. On E13, Smo expression was detected in the optic nerves and ventral diencephalon, but only in the superficial region of the optic tract on E14. Smo was also detected in the stem and filopodia of the growth cones in the retinal explant culture during this period.</p><p><b>CONCLUSION</b>Smo expression changes in different developmental phases, suggesting that Smo might play a role in signal optic axon growth during the development of the retinofugal pathway.</p>