Association of bone lesions distribution with prognosis in renal cell carcinoma bone metastasis / 中华泌尿外科杂志

Objective:To investigate the association between bone lesions distribution and survival outcome and prognostic risk stratification in renal cell carcinoma bone metastasis (RCC-BM).Methods:The data of 122 RCC-BM patients admitted to Peking University People's Hospital between January 2009 and December 2019 were retrospectively reviewed. There were 100 males and 22 females, with a baseline age of (59.87±11.33) years old. According to the Memorial Sloan-Kettering Cancer Center (MSKCC)/Motzer score, patients were stratified into different risk groups using profiles at first bone metastasis diagnosis, with 20 (16.4%), 74 (60.6%) and 28 (23.0%) patients in favorable, intermediate and poor group, respectively. The spatial distribution of bone metastasis was investigated at the first bone metastasis diagnosis. The overall distribution patterns were as follows: locoregional group (lesions only involved thoracic and/or lumbar vertebrates) in 26 cases (21.3%), stochastic group (bone lesions randomly distributed) in 69 cases (56.6%), extensive group (with concomitant visceral metastasis) in 27 cases (22.1%). Metastatic site involvement was as follows: spine in 48 cases(39.3%), pelvis in 43 cases (35.2%), upper extremities in 22 cases (18.0%), and lower extremities in 20 cases (16.4%). Half (61 cases) of the enrolled patients had synchronous bone metastasis as their first bone metastases were diagnosed simultaneously with their renal tumors. Of all the patients, 99 (81.1%) accepted radical nephrectomy, 6 (4.9%) accepted partial nephrectomy, and the other 17 patients (13.9%) accepted the treatment of ablation or embolization. Eighty-two patients (67.2%) received definitive treatment for bone metastatic lesions, respectively. Forty patients (32.8%) accepted the palliative tumor reduction therapy. Thirty-two patients (26.2%) received tyrosine kinase inhibitor (TKI) or immune checkpoint inhibitor (ICI) medication, and 12 patients (9.8%) received local radiotherapy. Distribution variation and therapeutic strategies throughout the disease course until the last follow-up were recorded. Univariate analysis (chi-squared test, Mantel-Haenszel test), Kaplan-Meier survival analysis, and multivariate ordinal logistic regression were performed for the possible association.Results:Patients from the locoregional group (30.8%, 8/26) were prone to have higher risk stratification at first diagnosis than patients in the stochastic and extensive groups ( 20.8%, 20/96, P=0.107) as the marginal difference was found. At first bone metastasis diagnosis, RCC-BM patients with spinal involvement were more likely to have higher MSKCC risk stratification than those without spinal involvement [20.3%(15/48) vs. 17.6%(13/74), P<0.05]. Multivariate ordinal logistic regression showed that after adjusting for general data, bone metastasis sites, and concomitant visceral metastasis, RCC-BM patients with spinal involvement at first bone metastasis diagnosis were 3.3 times (95% CI 1.195-9.091, P<0.05)more likely to fall into the higher MSKCC risk group than those without spinal involvement.In those 93 cases with follow-up records, 20 (21.5%), 53 (57.0%), and 20 (21.5%) cases were in the locoregional group, stochastic group, and extensive group, respectively. The median overall survival time (mOS) of patients with pelvic involvement (36 cases) throughout the disease course was 32.0 months (95% CI 6.0-58.0), which was shorter than that of patients without pelvic involvement (57 cases, mOS 49.0 months, 95% CI 20.4-77.5, P<0.05). Conclusions:Spinal involvement (especially limited to thoracic and/or lumbar vertebrates) at first bone metastasis diagnosis and pelvic involvement throughout the disease course were associated with poor prognosis.

Evaluation of the effect of self-management model in diabetic patients in community under the guidance of general practitioners / 中华健康管理学杂志

Objective:To evaluate the effect of self-management model of community diabetes patients under the guidance of general practitioners.Methods:A total of 22 communities in Hangzhou were selected as intervention pilot from 2016 to 2017, and 10-15 diabetic patients were recruited to form a self-management team in each community. Relying on the construction of medical alliance and there sources of contracted service of family doctors, intervention teams were set up to conduct regular, personalized and continuous self-management interventions on patients. Intervention continued for 4-6 months. Before, after and 6 months after the intervention, the basic information of patients, knowledge of diabetes, faith in managing disease, self-management behavior, self-management ability of patients, and quality of life were collected through questionnaire survey, body mass index (BMI), 2-hour postprandial blood glucose and glycosylated hemoglobin were detected uniformly, and statistical analysis was conducted.Results:A total of 292 patients were involved in the self-management group, the average age was (66.38±7.90) years old, most of them were female (64.73%). Six months after the intervention, the awareness rate of basic knowledge, risk factors and prevention and treatment knowledge about diabetes in patients (68.64%, 78.75%, 63.41%) were significantly higher than those before the intervention (28.08%, 48.29%, 39.38%), the proportion of patients with reasonable diet, moderate exercise, active problem-solving, management plan making and action according to the plan increased (from 65.41%, 28.76%, 39.04%, 31.85%, 27.74% to 86.76%, 60.28%, 65.16%, 78.05%, 73.17%)(all P<0.05).In terms of time effect, the scores of physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health in SF-36 after intervention and 6 months after intervention were all increased step by step (all P<0.05). Before the intervention, BMI, 2-hour postprandial blood glucose and glycosylated hemoglobin were (24.20±3.11) kg/m 2, (9.29±2.23) mmol/L, (6.81±1.01)% respectively. After the intervention, the three indexes all showed a downward trend, which were (22.89±2.98) kg/m 2, (8.81±1.61) mmol/L, (6.57±0.76)% respectively ( F=14.832, 6.828, 9.667; all P<0.05). Conclusion:Under the guidance of general practitioners, the self-management model of community diabetes patients can effectively improve the level of recognition, belief and behavior of patients, improve their self-management ability and quality of life, and improve BMI and blood glucose control level.

Effect of Different Purification Technologies on Saponins Water Extract of Anemarrhena Asphodeloides / 中国药师

Objective:To explore the macroporous resin adsorption and the membrane separation technologies for the purification of saponins water extract of Anemarrhena asphodeloides. Methods:Ten-fold amount of water was used to extract twice for 120 min each time to extract saponins from Anemarrhena asphodeloides. The macroporous resin adsorption(HP-20,HPD-600,D101,AB-8) and the membrane separation technologies (ceramic microfiltration membranes 0.8 μm and 0.05 μm, and hollow fiber ultrafiltration mem-branes 50,10 and 6 kDa) were adopted to purify the saponins water extract liquid. The physicochemical parameters including electri-cal conductivity,viscosity and turbidity were measured,as well as the contents of total saponins,proteins and polysaccharides were de-termined. Results:The viscosity and turbidity decreased,the value of pH increased and the electrical conductivity of the saponins puri-fication liquid changed irregularly after the membrane filtration. The microfiltration membrane was more advantageous than the ultrafil-tration membrane in removing macromolecular substances. The smaller the pore diameter of microfiltration membrane, the smaller the intercepted molecular weigh,the higher the removal ratio of proteins and the higher the penetration rate of the total saponins,while the polysaccharides content was stable, which was consistent with the results of physicochemical parameters. The ceramic microfiltration membrane could obtain clearer extract,while the ultrafiltration membrane was more suitable for the enrichment of saponins when the in-tercepted molecular weight was 6 kDa. The macroporous resin HPD-600 was the best for the purification of timosaponin water extraction liquid.Conclusion:The selection of membrane for the separation and purification of different substances is particularly important. The change of physicochemical parameters and the content decrease of macromolecular substances have obvious corresponding relationship. Ultrafiltration membrane is better than microfiltration membrane for the purification of timosaponin water extract liquid.

"Clinical application of retroperitoneal laparoscopic surgery combined with mini-flank incision ""hybrid surgery"" for partial nephrectomy of complex renal tumors" / 北京大学学报(医学版)

Objective: To evaluate the clinical effect and safety of retroperitoneal laparoscopic surgery combined with mini-flank incision hybrid surgery for partial nephrectomy of complex renal tumors.Methods: Between April 2015 and December 2016, the clinical data from 16 patients with complex renal tumors who underwent the hybrid surgery, including 10 males and 6 females, were retrospectively reviewed.The average age was (50.2±10.7) years, 9 cases were located in the left side and 7 cases in the right side, the mean tumor size was (6.1±1.0) cm, and the mean R.E.N.A.L.nephrometry score was 9.3±1.3.All the patients received the hybrid surgery, the first step was to adequately mobilize the kidney and tumor, prepared the renal artery by retroperitoneal laparoscopy, and then the incision about 10-12 cm was done under the twelve rib to convert to open surgery.After the renal artery was clamped, the tumor was removed and the wound was closed under direct vision.The operative time, ischemia time, estimated blood loss, intraoperative and postoperative complications and short-term renal function were recorded.Results: All the 16 patients'' hybrid surgeries were successfully performed.The mean operative time was (164.9±23.6) min, mean ischemia time was (32.4±6.2) min, and mean estimated blood loss was (204.0±125.1) mL.The mean drainage tube removal time was (4.1±1.0) d, and the mean postoperatively hospital stay was (6.9±1.5) d.There were 2 patients with Clavien Ⅲ grade complications.One patient was injured with collecting system, and 1 patient received a second emergency surgery for acute postoperative bleeding.The mean 1 day postoperative serum creatinine level was (126.3±26.4) μmol/L, which was statistically significant (P0.05) in comparing the 1 month postoperative serum creatinine level(92.6±18.2) μmol/L, 3 months postoperative serum creatinine level (80.8±18.4) μmol/L with the preoperative serum creatinine level.During 3 to 20 months follow-up periods, no local recurrence or distant metastasis occurred.Conclusion: This hybrid surgery combined retroperitoneal laparoscopic surgery with mini-flank incision for partial nephrectomy is safe and effective.It could decrease the operative difficulty and be worthy of further application for some selected complex renal tumor patients.

Anti-tumor components from Lysimachia christinae Hance / 军事医学

Objective To isolate and identify anti-tumor constituents from Lysimachia christinae Hance.Methods The compounds were isolated and purified by chromategraphy on AB-8 macroporous resin, silica gel, Sephadex LH-20, ODS and preparative HPLC.Their structures were elucidated using chemical and spectroscopic methods.All thecompounds obtained were evaluated on their growth inhibitory effects in vitro using the MTT method.Results Eleven compounds were isolated from the whole plant of L.christinae Hance and were identified as 3,3'-dimethoxy-6,6'-di[(Z)-pentadec-10-en-1-yl]-[1,1'-bi(cyclohexane)]-3,3',6,6'-tetraene-2,2',5,5'-tetraone(1),physcion(2),munjistin(3), 9,16-dioxooctadec-10,12,14-trienoic acid(4),cyclamiretinA-3-O-{β-D-xylopyranosyl-(1→2)-β-D-glucopyranosyl-(1→2)-[β-D-glucopyranosyl-(1→4)]-α-L-arabinopyranoside(5),lysikoianoside(6),quercetin-3-O-glucopyranoside(7),isorhamnetin3-O-β-D-galactopyranoside(8),3',4',5',5,7-pentahydroxyflavone(9), rutin(10), and quercetin(11).The screening results of antitumor activity in vitro showed that IC50 of compound 5 for human cervical carcinoma cells HeLa, human osteosarcoma cells U20S, human lung adenocarcinoma cells PC-9,and human colorectal carcinoma cells CT-26 was 2.29, 1.22, 1.43, and 1.29 μmol/L respectively.Conclusion Compound 1 is a new compound and compounds 2-4 are isolated from the plants of Lysimachia for the first time.Compound 5 shows obvious inhibitory effects on tumor cell growth in vitro.

The expression of sex determining region Y-box 18 in prostate cancer and its impact on prostate cancer cell function / 中华泌尿外科杂志

Objective To explore the expression of sex determining region Y-box 18 (SOX18) in prostate cancer(PCa) and its role on prostate cancer cells.Methods The expression of SOX18 in 98 PCa tissues and 81 adjacent non-tumor tissues was detected by immunohistochemistry.The expression of SOX18 mRNA and protein in PCa cell lines were detected by q-PCR and Western blotting analysis,respectively.After knocking down SOX18 with si-RNA,the proliferation,migration and invasion of PCa cells were analyzed by CCK8,Transwell and Matrigel assays in vitro.Results The rate of high SOX18 expression in prostate cancer tissues was 73.5％ (72/98),which was higher than that in adjacent normal tissues (43.2％,35/81) (P ＜ 0.01).In addition,the rates of high SOX18 expression in clinical stage Ⅲ-Ⅳ [83.7 ％ (36/43) vs.65.5 ％ (36/55),x2 =4.131,P =0.042],pathological grading G3-4 [88.6％ (39/ 44) vs.61.7％ (33/54),x2 =9.424,P =0.002] and Gleason scores ≥ 8 [85.0％ (34/40) vs.65.0％ (38/58),x2 =4.610,P =0.032] groups were higher than those in clinical stage Ⅲ-Ⅳ,pathological grading G1-2 and Gleason scores ≤7 groups.However,there were no differences in the rate of high SOX18 expression in different age groups [77.3％ (38/54) vs.70.4％ (34/44),x2 =0.539,P =0.441].Knockdown of SOX18 notably suppressed the proliferation,migration and invasion of prostate cancer cells.Conclusions SOX18 is over-expressed in prostate cancer,and could promote the proliferation,migration and invasion ability of prostate cancer cells.

Content Determination of 3 Components in Sangju Ganmao Pills by HPLC-MS/MS / 中国药房

OBJECTIVE:To establish the method for simultaneous determinations of rutin,forsythin and platycodin D in Sangju ganmao pills.METHODS:HPLC-MS method was adopted.The determination was performed on Waters Atlantis C18 column with mobile phase consisted of acetonitrile-0.1％ formic acid (gradient elution) at the flow rate of 0.2 mL/min.The column temperature was set 35 ℃,and sample size was 10 μL.The ionization mode was electrospray ion,and the reaction mode was multi-reaction monitoring.By positive ion detection mode,the drying gas and nebuliser gas were all high purity nitrogen.The drying gas temperature was 270 ℃.The drying gas flow rate was 25 L/min.The sheath gas flow rate was 10 L/min.The capillary voltage was 4 500 V.The nozzle voltage was 2 000 V and the scanning time was 0.1 s.RESULTS:The linear range of rutin,forsythin and platycodin D were 0.010 82-2.164 μg/mL (r=0.999 7),0.010 18-2.036 μg/mL (r=0.999 4),0.010 27-2.054 μg/mL (r=0.999 7),respectively The limits of quantification were 1.250,0.260,2.720 ng/mL,and the limits of detection were 0.380,0.078,0.820 ng/mL.RSDs of precision,stability and reproducibility tests were all no more than 3.0％.The recoveries were 97.88％-99.88％ (RSD=0.72％,n=6),98.48％-103.13％ (RSD=1.91％,n=6),98.79％-101.41％ (RSD=1.05％,n=6).CONCLUSIONS:This method is simple,precise,stable and reproducible,and can be used for simultaneous determination of rutin,forsythin and platycodin D in Sangju ganmao pills.

Clinical Observation of Tegafur Gimeracil and Oteracil Potassium and Capecitabine Synchronous Radio-therapy in the Treatment of Recurrence after Radical Resection of Colon Cancer / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of capecitabine and tegafur gimeracil and oteracil potassium synchronous radiotherapy in the treatment of recurrence after radical resection of colon cancer. METHODS:A total of 150 patients with recurrent after radical resection of colon cancer in our hospital during Jan. 2012-Dec. 2012 were divided into group A and B ac-cording to random number table,with 75 cases in each group. Both groups received three-dimensional conformal radiotherapy. Group A was additionally given capecitabine 2.5 g. Group B was additionally given tegafur gimeracil and oteracil potassium,40 mg,bid for body surface area <1.25 m2,50 mg,bid for body surface area ranged 1.25-1.50 m2 and60mg,bid for body surface ar-ea<1.50 m2. Clinical efficacies of 2 groups were compared;1-year,2-year,3-year survival andⅢ-Ⅳdegree toxic effect were fol-lowed up. RESULTS:The total response rate of group B was 86.67％,which was significantly higher than 66.67％ of group A, with statistical significance(P<0.05). 1-year,2-year,3-year survival rates of group B were 93.335,72.00％,58.67％,which was significantly higher than 74.67％,53.33％,41.33％,with statistical significance(P<0.05). The median disease progression time of group A was 8.0 months,which was significantly shorter than 9.5 months of group B,with statistical significance (P<0.05). There was no statistical significance in Ⅲ-Ⅳ degree toxic effect between 2 groups (P<0.05). CONCLUSIONS:Compared with capecitabine,tegafur gimeracil and oteracil potassium combined with three-dimensional conformal radiotherapy show significant therapeutic efficacy for recurrence after radical resection of colon cancer,can control disease progression,prolong the survival time and don't increase the risk of toxic effects.

Effect of Different Purification Technology on Physical and Chemical Properties of Water Extract of Ophio-pogonin / 中国药师

Objective:To explore the effect of different separation and purification technology on the physical and chemical proper-ties of water extract of ophiopogonin. Methods:The water extraction process of total ophiopogon saponins was optimized by an orthogo-nal test. The macroporous resin adsorption and membrane separation technology were adopted to purify the ophiopogonin water extract. The physical and chemical parameters, such as electrical conductivity, pH value, viscosity and turbidity, and the contents of total sap-onins, proteins, tannins and polysaccharides were determined. Results:The optimum water extraction technology of total saponins was as follows:6-fold amount of water was added, boiling 3 times with 90 min for each time. The electrical conductivity, pH value and vis-cosity of different purified liquid of total saponins had no significant differences, while the contents of total saponins and the three kinds of macromolecules showed significant differences. Conclusion: The content of macromolecules can be used as the reference index of purification process of total saponins water extract. Compared with macroporous resin separation, membrane separation technology is more suitable for the separation and purification of total saponins water extract.

Analysis of metabolic factors and relevance with the grade and stage in patients with renal cell carcinoma / 北京大学学报(医学版)

Objective:To investigate the association between metabolic factors,such as obesity,blood pressure,blood glucose,serum lipid profile,and the histopathological characteristics of renal cell carci-noma.Methods:The medical records of 382 consecutive renal cell carcinoma patients who underwent radical or partial nephrectomy at Peking University People’s Hospital from January 2009 to January 2015 were retrospectively reviewed.Metabolic factors were collected from the records,including weight,body mass index,waist circumstance,blood pressure,fasting blood glucose,serum total triglyceride,serum total cholesterol,serum low-density lipoprotein-cholesterol and serum high-density lipoprotein-cholesterol. The patients were divided into different groups according to tumor grade,stage and diameter.Statistics analysis,such as t test,Mann-Whitney U test and Logistic analysis,were performed to investigate the as-sociation between metabolic factors and grade,stage and tumor diameter of renal cell carcinoma.Re-sults:A total of 80 (20.94%)of the tumors were classified as high grade disease,63 (16.49%)were classified as advanced disease and 153 (40.05%)tumor diameter more than 4 cm.The patients in high grade group were found to have lower high-density lipoprotein-cholesterol level than in low grade group (P =0.015),body mass index,total cholesterol and high-density lipoprotein-cholesterol were found to be lower in advanced disease than in localized disease (P =0.022,P =0.005 and P =0.006,respec-tively),and low-density lipoprotein-cholesterol was found to be lower in larger tumors (P =0.030). Other factors were comparable between the different groups.The results of Logistic analyses showed that, body mass index (OR =0.906,95%CI:0.852 -0.986,P =0.023)and total cholesterol (OR =0.660,95%CI:0.492 -0.884,P =0.005)were associated with the tumor stage,high-density lipopro-tein-cholesterol level was significantly associated with tumor grade (OR =0.293,95% CI:0.108 -0.797,P =0.016)and stage (OR =0.204,95%CI:0.065 -0.635,P =0.006),and low-density lipoprotein-cholesterol level was significantly associated with tumor diameter (OR =0.756,95% CI:0.586 -0.975,P =0.031).Conclusion:The results of our study indicate that metabolic factors,espe-cially obesity and serum lipid profile,are closely related with the histopathological characteristics of renal cell carcinoma.

Comparison of three surgical methods of ureteropelvic junction obstruction in therapeutic effect and complication / 北京大学学报(医学版)

Objective:To compare various data of open pyeloplasty,laparoscopic pyeloplasty and en-dopyelotomy as a treatment of ureteropelvic junction obstruction(UPJO),and to investigate and discuss the feasibility and effect of the three methods.Methods:In the study,109 cases of UPJO treated by dif-ferent surgical approaches in Peking University People’s Hospital from January 2004 to December 2014 were retrospectively investigated.The patients were divided into three groups according to the treatment they received:open peyloplasty group (32 cases),laparoscopic peyloplasty group (31 cases)and en-dopyelotomy group (46 cases).We compared the data of the operative time,intraoperative blood loss, perioperative complications and post-operative hospital stay among the three groups.The mean follow-up time was(51.9 ±40.1 )months (6 -132 months).Results:None of the laparoscopic peyloplties was converted to open peyloplasty.All endpyelotomies were successfully completed.The operative time was as follows:laparoscopic peyloplasty group (195.97 ±55.22)min,open peyloplasty group (121.19 ± 33.95)min and endopyelotomy group (74.04 ±33.95 )min,and there were significant differences among the three groups respectively(P 0.05).Conclusion:The laparoscopic peyloplasty group had a longer operative time than open peyloplasty group,while its post-operative stay was shorter. There was no significant difference on the operative blood loss between open peyloplasty group and laparo-scopic peyloplasty group.Although the success rate of endopyelotomy was lower than those of the other two groups,it had advantages over the aspect of operative time,operative blood loss and post operative stay.

Optimization of Water Extraction Process for Glycyrrhiza by Central Composite Design/Response Surface Methodology / 中国药师

To optimize the water extraction process for glycyrrhiza. Methods: HPLC was used to determine the con-tents of glycyrrhizic acid and liquiritin. The comprehensive index included the contents of glycyrrhizic acid and liquiritin and the yield of dry extract. The water amount and the extraction time were selected as the independent variables, and the comprehensive index was set as the dependent variable. Design-expert 8. 06 software was used to fit multivariate linear or quadratic multinomial models for the experimental values. Response surface methodology was used to optimize the water extraction process. The prediction was carried out through comparing the observed and predicted values. Results:The regression coefficient of binomial fitting complex model was as high as 0. 979 7. The optimum conditions of extraction process were as follows:12-fold amount of water, extracting 3 times with 90 min for each time. The deviation between the observed and predicted values was -1. 72%. Conclusion: Central composite design-response surface methodology is convenient and highly predictive in optimizing the water extraction process for glycyrrhiza, which can be applied in the further membrane separation and purification.

Nephron-sparing surgery for renal angiomyolipoma in middle aged and elderly patients / 中华老年医学杂志

Objective To evaluate the effcacy and safety of nephron-sparing surgery(NSS) in the treatment of renal angiomyolipoma(AML) in middle-aged and elderly patients.Methods From September 2002 to September 2011,NSS was performed in 12 cases with renal AML in our hospital.Renal function was observed before and after surgery.Tumor size,pathological findings,surgical complications and prognosis were retrospectively analyzed.Clinical features were summarized.Results The age of patients ranged from 45 to 65 years(median 60.2 years).There were 2 males and 10 females in this study,including 1 eases with solitary kidney.Open NSS were performed in 2 cases and laparoscopic surgery in 10 cases.Tumor diameter was(6.8 ±3.3) cm on average,ranged from 3.5 cm to 12.0 cm.Intraoperative findings showed that diameters of AML in the basal kidney were small,similar to themushroom in shape,and the depth of tumor invasion into the renal parenchyma was superficial.Pathologic results showed that pathologically classic AML was found in 9 cases,epithelial-like type in 2 cases,leiomyoma type in 1 case.Mean intraoperative blood loss was 250 ml(100-750 ml).Postoperative retroperitoneal hematoma occurred in 1 case.Serum creatinine level showed no statistically significant difference between pre-surgery and 10 days after surgery [(87 ±34) mmol/L vs.(92±37) mmol/L,t=2.073,P＞0.05].During mean follow-up of 26.5 months (12-48 months),no renal insufficiency was found.Conclusions NSS is an effective and safe treatment for renal AML in middle-aged and elderly patients.

A novel lactone from Tripterospermum chinense / 药学学报

A novel lactone, tripterospermumcins E (1), along with four known compounds, sweroside (2), loganic acid (3), 8-epi-kingiside (4) and bergenin (5), were isolated from the aerial parts of Tripterospermum chinense. Their structures were determined by spectroscopic methods, including 1D and 2D NMR, and chemical methods. Compound 1 is rare beta-lactone with a glucoside.

Clinical analysis of 128 cases of adrenal incidentalomas / 中华泌尿外科杂志

Objective To improve the early diagnosis and differential diagnosis of adrenal incidentalomas to guide clinical management of this disease. Methods One hundred and twenty-eight cases were diagnosed as adrenal incidentalomas due to health examination or treatment of other than adrenal disease,including 60 males and 68 females,whose ages were between 20 and 75 years,with a mean age of 50 years.Tumor diamer:＜3 cm 63 cases,3-6 cm 6 cases,＞6 cm 10 cases.128 patients all had biochemical and electrolyte examination,adrenal cortex and medulla biochemical testing,abdominal ultrasound and CT examination,6 cases with MRI examination.Surgery and post operative pathological examination were performed in all patients. Results Post operative pathology finally diagnosed adrenocortical adenoma in 85 cases,pheochromocytoma in 13 cases,adrenal cyst in 8 cases,paraganglioma and myeiolipoma in 7 eases respectively,adrenal nodular hyperplasia in 4 cases,adrenocortical carcinoma in 2 cases,adrenoconical oncocytoma,cellular Schwannoma and adrenal liposarcoma in 1 case,respectively.One case of pheochromocytoma patients died of intraoperative hypotension,which is not included in the total number. Conclusions The preperative diagnosis of adrenal incidentalomas is difficult.For adrenal incidentalomas with diameter more than 6 cm and those with endocrine function,early surgicM treatment is recommended.

Investigation in nocturia prevalence, risk factors and quality of life in the Beijing population / 中华泌尿外科杂志

Objective To evaluate the prevalence, risk factors of nocturia and nocturia-related quality of life in Beijing area. Methods Age, hypertension, cardiovascular disease, diabetes mellitus, benign prostatic hyperplasia (BPH), alcohol abuse and smoking and nocturia status were analyzed using Logistic analysis. Multiple linear regression analysis was used to identify factors predicting the Nocturia-Quality of Life score. Results 1198 adults completed this query. 411 individuals (34.3%) answered that they arose for urination during night at least twice. The nocturia incidence increased with age from 8.6% in individuals younger than 40 to 67.7% in those older than 70. Hypertension (OR 2.322;95%CI:1.387,3.887) and diabetes (OR 2. 298;95%CI:1. 066,4. 954) were possible risk factors for nocturia. In male individuals, BPH (OR 3.900;95% CI: 1.890,8.049) was another risk factor. Gender was not found associated with nocturia. Increasing nocturia episodes (regression coefficient: - 2. 564; 95% CI:-3.08,-2.049) and decreasing total sleeping hours (regression coefficient: 1.738;95 %CI:0.948,2.527) were independent factors predicting a significantly lower N-QOL score. Conclusions Hypertension, diabetes and BPH are associated with nocturia, suggesting that multiple approaches are needed for the treatment of patients with nocturia. Nocturia has significant impact on N-QOL when the patient has two or more episodes per night.

Investigation of low and moderate stage upper urinary tumor with and without concomitant bladder cuff resection / 中华泌尿外科杂志

Objective To evaluate the necessity of concomitant bladder cuff and the possibility of distal ureter sparing surgery during radical nephroureterectomy of low-level upper urinary tract tumors. Methods Clinical data of 73 patients with low-level (Tis-T3 M0 N0 ) tumors of the proximal upper urinary transitional epithelial cancer treated in radical nephroureterectomy in our hospital from 2000 to 2007 were analyzed retrospectively. The medical charts and pathologic specimens of 35 patients with, and 38 patients without, concomitant bladder cuff were reviewed. Results In the 35 patients with concomitant bladder cuff resection, 8 cases (22.9%) recurrence was observed; in the 38 patients without concomitant bladder cuff resection, 8 cases (21.1%) recurrence was observed. There was no difference between both groups(P>0.05). In the 19 patients suffered renal pelvis tumors with concomitant bladder cuff resection, 4 cases (21.1%) recurrence was observed; In the 16 patients suffered ureter tumors with concomitant bladder cuff resection, 4 cases (25 %) recurrence was observed.There is no difference between patients of renal pelvis tumors and of ureter tumors with concomitant bladder cuff(P>0.05). In the 27 patients suffered renal pelvis tumors without concomitant bladder cuff resection, 3 cases (11.1 %) recurrence was observed; in the 11 patients suffered ureter tumors with concomitant bladder cuff, 5 cases (45.5%) recurrence was observed. There was significant different between patients of renal pelvis tumors and of ureter tumors without concomitant bladder cuff (P<0. 05). Conclusion Concomitant bladder cuff resection confers a favorable prognosis to the patients with ureter tumors, but not to the patients with renal pelvis tumors.

The inhibitive effect of siRNA on the phosphodiesterase type 5 in smooth muscle cells of human corpus cavernosum / 中华泌尿外科杂志

Objective To investigate the inhibitive effect of siRNA(small interfering RNA,siRNA) on the phosphodiesterase type 5(PDE5) in smooth muscle cells of human corpus cavernosum,and provide experimental groundwork for the gene therapy of erectile dysfunction (ED). Methods Small interfering RNAs targeting PDE5 gene were systhesized by using web design software provided by Ambion,there siRNAs and control siRNA were systhesized by Ambion. SiRNAs were transfected into smooth muscle cells of human corpus cavernosum by using siPORTTM Lipid reagent;down-regulation of PDE5 mRNA was detected by RT-PCR;the inhibitive effect of PDE5 was detected by Western Blotting. Results The results of RT-PCR indicated siRNA1、siRNA2 and siRNA3 made down-regulations of PDE5 mRNA expression in the transfected groups 58.2%、14.9% and 11.8%;the PDE5 expression decreased 70.5%、19.8% and 17.3%;however the expression did not have different in control siRNA and frank group. Conclusions The synthesized siRNAs in vitro were able to down-regulate the expression of PDE5.There were different capabilities of the specific siRNAs down-regulation.It was suggested that the siRNA technique provide not only an extremely powerful tool for the functional analysis of genome but also a new method for ED gene therapy.

Hand-assisted gasless laparoscopic nephroureterectomy for renal pelvis transitional cell carcinoma / 中国微创外科杂志

Objective To investigate the technical skill of hand-assisted gasless laparoscopic nephroureterectomy for patients with transitional cell carcinoma in renal pelvis. Methods 4 patients underwent hand-assisted gasless laparoscopic nephroureterectomy for transitional cell carcinoma in renal pelvis with homemade gasless laparoscopic device from July to November 2001. Results The average operative time was 170 minutes, and the average blood lose was 195 ml. No analgesic was prescribed postoperatively. The interval to resume normal oral intake 2 8 days. All patients had been followed up for 1 to 4 months, there was no tumor recurrence in bladder. Conclusions Hand-assisted gasless laparoscopic nephroureterectomy has the advantages of easy to learn, safer and faster to operate, less blood loss, less interference to cardiopulmonary system, as well as quicker postoperative recovery.