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OBJECTIVE@#To explore the surgical strategy and experience of reoperation for pheochromocytoma and paraganglioma which is very challenging.@*METHODS@#The clinical data of 7 patients with pheochromocytoma and paraganglioma who underwent reoperation in Department of Urology, Peking University Third Hospital from August 2016 to February 2021 were analyzed retrospectively. There were 4 males and 3 females, with an average age of (44.1±11.5) years (28-60 years), 6 cases on the right side and 1 case on the left side. The causes of the operations included: (1) 2 cases of tumor recurrence after resection; (2) The primary operations failed to completely remove the tumors in 3 cases, because the tumors were large and closely related to blood vessels. (3) Pheochromocytoma and paraganglioma wasn't diagnosed before primary operation, therefore, drug preparation wasn't prepared. Two cases were interrupted by severe blood pressure fluctuations during the primary operations. Imaging evaluation, catecholamine biochemical examination and adequate adrenergic α receptor blockers were administrated in all the cases. The surgical approaches included open transperitoneal surgery in 4 cases, robot-assisted laparoscopy in 1 case and retroperitoneal laparoscopy in 2 cases. The innovative techniques included mobilization of the liver, inferior vena cava transection and anastomosis, and transection of left renal vein.@*RESULTS@#The average tumor size was (8.0±3.2) cm (3.6-13.9 cm). The median interval between the reoperation and the primary operation was 9 months (IQR: 6, 19 months). The median operation time was 407 min (IQR: 114, 430 min) and the median blood loss was 1 500 mL (IQR: 20, 3 800 mL). Operations of 5 cases were performed successfully, and 1 case failed only by exploration during the operation. One case died perioperatively. There were 5 cases of intraoperative blood transfusion, the median transfusion volume of red blood cells was 800 mL (IQR: 0, 2 000 mL). One case experienced postoperative lymphorrhagia, and recovered after conservative treatment. The renal function was normal in 2 cases after resection and anastomosis of inferior vena cava or transection of left renal vein. The average postoperative hospital stay was (7.2±3.3) d (4-13 d). The median follow-up time of 6 patients was 33.5 months (IQR: 4.8, 48.0 months). The case who failed in the reoperation still survived with tumor and there was no recurrence in the rest of the patients.@*CONCLUSION@#The reoperation of pheochromocytoma and paraganglioma, which can not be resected in the primary operation or recurred postoperatively, is difficult with high risk of hemorrhage, and there is a risk of failure and perioperative death. Different surgical approaches and strategies need to be adopted based on the different situation.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Adrenal Gland Neoplasms/surgery , Laparoscopy , Neoplasm Recurrence, Local , Paraganglioma/surgery , Pheochromocytoma/surgery , Reoperation , Retrospective StudiesABSTRACT
OBJECTIVE@#To evaluate the relationship between recovery of urinary continence after laparoscopic radical prostatectomy (LRP) and preoperative prostate apex depth (PAD) on magnetic resonance imaging (MRI).@*METHODS@#We retrospectively analyzed 184 patients with pathologic confirmed prostate carcinoma who underwent LRP in Department of Urology, Peking University Third Hospital. All the patients received MRI examination before surgery. Membranous urethral length (MUL) was defined as the distance from the apex of prostate to the level of the urethra at penile bulb on the coronal image. PAD was defined as the distance from the apex of prostate to the suprapubic ridge line on sagittal MRI. PAD ratio (PADR) was defined as PAD/pubic height. All the patients received extraperitoneal LRP. The patients' reporting freedom from using safety pad (0 pad/d) were defined as urinary continence. Univariate and multivariate regression analyses were used to identify independent predictors of early continence recovery after LRP. Kaplan-Meier analyses and log-rank test were used to compare time to continence recovery between the groups.@*RESULTS@#For all the 184 patients, the average age was (69.0±7.7) years, the ave-rage mass index(BMI) was (25.07±3.29) kg/m2, and the pre-biopsy PSA was (16.80±21.99) g/L. For all the patients who underwent MRI preoperatively, the mean PV was (39.35±25.25) mL and the mean MUL was (14.0±3.7) mm. The mean PAD was (24.52±4.97) mm and the mean PADR was 0.70±0.14. The continence rate for all the patients after LRP was 62.0% and 96.2% in three months and one year. The patients achieving early continence recovery had significant smaller PV (P=0.049), longer MUL (P < 0.001) and higher PADR (P=0.005). Multivariate analysis revealed MUL (P < 0.001) and PADR (P=0.032) were predictors of continence recovery after LRP. Kaplan-Meier analyses and Log-rank test revealed that MUL (≥14 mm vs. < 14 mm, P < 0.001) and PADR (≥0.70 vs. < 0.70, P < 0.001), PV(< 50 mL vs. ≥50 mL, P=0.001) were all significantly associated with continence recovery.@*CONCLUSION@#MUL and PADR are independent predictors of early continence recovery after LRP. MUL, PADR and PV are significantly associated with recovery of urinary continence.
Subject(s)
Aged , Humans , Male , Middle Aged , Laparoscopy , Prostate/surgery , Prostatectomy , Prostatic Neoplasms/surgery , Recovery of Function , Retrospective Studies , Urinary Incontinence/etiologyABSTRACT
BACKGROUND@#Radical nephrectomy and thrombectomy is the standard surgical procedure for the treatment of renal cell carcinoma (RCC) with tumor thrombus (TT). But the estimation of intra-operative blood loss is only based on the surgeon's experience. Therefore, our study aimed to develop Peking University Third Hospital score (PKUTH score) for the prediction of intra-operative blood loss volume in radical nephrectomy and thrombectomy.@*METHODS@#The clinical data of 153 cases of renal mass with renal vein (RV) or inferior vena cava tumor thrombus admitted to Department of Urology, Peking University Third Hospital from January 2015 to May 2018 were retrospectively analyzed. The total amount of blood loss during operation is equal to the amount of blood sucked out by the aspirator plus the amount of blood in the blood-soaked gauze. Univariate linear analysis was used to analyze risk factors for intra-operative blood loss, then significant factors were included in subsequent multivariable linear regression analysis.@*RESULTS@#The final multivariable model included the following three factors: open operative approach (P < 0.001), Neves classification IV (P < 0.001), inferior vena cava resection (P = 0.001). The PKUTH score (0-3) was calculated according to the number of aforementioned risk factors. A significant increase of blood loss was noticed along with higher risk score. The estimated median blood loss from PKUTH score 0 to 3 was 280 mL (interquartile range [IQR] 100-600 mL), 1250 mL (IQR 575-2700 mL), 2000 mL (IQR 1250-2900 mL), and 5000 mL (IQR 4250-8000 mL), respectively. Meanwhile, the higher PKUTH score was, the more chance of post-operative complications (P = 0.004) occurred. A tendency but not significant overall survival difference was found between PKUTH risk score 0 vs. 1 to 3 (P = 0.098).@*CONCLUSION@#We present a structured and quantitative scoring system, PKUTH score, to predict intra-operative blood loss volume in radical nephrectomy and thrombectomy.
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BACKGROUND@#Renal cell carcinoma (RCC) has the propensity to lead to venous tumor thrombus (VTT). Nephrectomy with tumor thrombectomy is an effective treatment option but is a technically challenging surgical procedure that is accompanied by a high rate of complications. The aims of this study were to investigate pre-operative imaging parameters for the assessment of inferior vena cava (IVC) wall invasion due to a tumor thrombus in patients with RCC and to identify predictors from the intra-operative findings.@*METHODS@#Clinical and imaging data were collected from 110 patients who underwent nephrectomy with IVC tumor thrombectomy (levels I-IV) for RCC and IVC tumor thrombus at the Peking University Third Hospital between May 2015 and March 2018. Univariable and multivariable logistic regression and receiver operating characteristic curves were used to assess the correlations between pre-operative imaging features and intra-operative macroscopic invasions of the IVC wall by tumor thrombus.@*RESULTS@#Among the 110 patients, 41 underwent partial or segmental resection of IVC. There were univariate associations of pre-operative imaging parameters that could be used to predict the need for IVC resection, including those of the Mayo classification, maximum anterior-posterior (AP) diameter of the renal vein at the renal vein ostium (RVo), maximum AP diameter of the VTT at the RVo and IVC occlusion. For the multivariable analysis, the AP diameter of the VTT at the RVo and IVC occlusion were associated with a significantly increased risk of invasion of the IVC wall by tumor thrombus. The optimum imaging thresholds included an AP diameter of the VTT at the RVo larger than 17.0 mm and the presence of IVC occlusion, with which we predicted invasions of the IVC wall requiring IVC resection. The probabilities of intra-operative IVC resection for patients without both independent factors, with an AP diameter of the VTT at the RVo larger than 17.0 mm, with IVC occlusion, and with both concurrent factors were 5%, 23%, 56%, and 66%, respectively.@*CONCLUSION@#An increase in the AP VTT diameter at the RVo and the presence of complete occlusion of the IVC are independent risk factors for a high probability of IVC wall invasion by tumor thrombus.
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OBJECTIVE@#To study the percentage of the measured values of the main pulmonary ventilation function parameters in their predicted values based on Zapletal equation among healthy children aged 5-14 years in Kunming, China, and to provide a basis for accurate judgment of pulmonary ventilation function in clinical practice.@*METHODS@#A total of 702 healthy children aged 5-14 years (352 boys and 350 girls) from Kunming were enrolled. The Jaeger spirometer was used to measure the nine indices:forced vital capacity (FVC), forced expiratory volume in one second (FEV1), ratio of forced expiratory volume in one second to forced vital capacity (FEV1/FVC), maximal mid-expiratory flow (MMEF), forced expiratory flow at 25% of forced vital capacity (FEF25), forced expiratory flow at 50% of forced vital capacity (FEF50), forced expiratory flow at 75% of forced vital capacity (FEF75), peak expiratory flow (PEF), and maximal voluntary ventilation (MVV). The values obtained from the Zapletal equation of predicted values provided by the spirometer were used as the predicted values of children, and the percentage of measured values in predicted values was calculated.@*RESULTS@#In the 702 children, the percentages of the measured values of the main pulmonary ventilation function parameters PEF, FVC, FEV1, FEV1/FVC, and MVV in their predicted values fluctuated from 102% to 114%, 94% to 108%, 98% to 113%, 98% to 107%, and 141% to 183% respectively. As for the main airway velocity parameters, the percentages of the measured values of FEF25, FEF50, FEF75, and MMEF in their predicted values fluctuated from 98% to 116%, 85% to 102%, 71% to 98%, and 83% to 100% respectively. The percentages of the measured values of PEF, FVC, FEV1, FEV1/FVC, MVV, FEF25, FEF50, FEF75, and MMEF in their predicted values had the lower limits of normal of 88.2%, 88.4%, 92.0%, 94.4%, 118.5%, 82.9%, 70.0%, 62.1%, and 70.1% respectively.@*CONCLUSIONS@#There are differences between pulmonary ventilation function parameter levels and normal values provided by Zapletal equation in healthy children aged 5-14 years in Kunming. As for the pulmonary ventilation function parameters of PEF, FVC, FEV, FEV1/FVC, MVV, FEF25, FEF50, FEF75, and MMEF in these children, the lower limits of normal of measured values in predicted values may be determined as 88.2%, 88.4%, 92.0%, 94.4%, 118.5%, 82.9%, 70.0%, 62.1%, and 70.1% respectively.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Male , China , Forced Expiratory Volume , Lung/physiology , Pulmonary Ventilation , Reference Values , Vital CapacityABSTRACT
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
Background@#Radical nephrectomy with thrombectomy is one of the most difficult and complicated urological operations. But the roles of renal tumor volume and thrombus level in surgical complexity and prognostic outcome are not clear. This study aimed to evaluate the surgical complexity and prognostic outcome between the volume of renal cell carcinoma (RCC) and the level of venous tumor thrombus.@*Methods@#The clinical data of 67 RCC cases with renal vein or inferior vena cava (IVC) tumor thrombus from January 2015 to May 2018 were retrospectively analyzed. Among these 67 cases, 21 (31.3%) were small tumors with high-level thrombus (tumor ≤7 cm in diameter and thrombus Neves Level II–IV), while 46 (68.7%) were large tumors with low-level thrombus group (tumor >7 cm in diameter and thrombus Level 0–I). Clinical features, operation details, and pathology data were collected. Univariable and multivariable logistic regression analyses were applied to evaluate the risk factors for small tumor with high-level thrombus.@*Results@#Patients with small tumors and high-level thrombus were more likely to have longer operative time (421.9 ± 135.1 min vs. 282.2 ± 101.9 min, t = 4.685, P < 0.001), more surgical bleeding volume (1200 [325, 2900] mL vs. 500 [180, 1000] mL, U = 270.000, P = 0.004), more surgical blood transfusion volume (800 [0, 1400] mL vs. 0 [0, 800] mL, U = 287.500, P = 0.004), more plasma transfusion volume (0 [0, 800] mL vs. 0 [0, 0] mL, U = 319.000, P = 0.004), higher percentage of open operative approach (76.2% vs. 32.6%, χ2 = 11.015, P = 0.001), higher percentage of IVC resection (33.3% vs. 0%, χ2 = 17.122, P < 0.001), and higher percentage of post-operative complications (52.4% vs. 19.6%, χ2 = 7.415, P = 0.010) than patients with large tumors and low-level thrombus. In multivariate analysis, decreased hemoglobin (Hb) (odds ratio [OR]: 0.956, 95% confidence interval [CI]: 0.926–0.986, P = 0.005) and non-sarcomatoid differentiation (OR: 0.050, 95% CI: 0.004–0.664, P = 0.023) were more likely to form small tumors with high-level tumor thrombus rather than large tumor with small tumor thrombus. The estimated mean cancerspecific survival times of small tumor with high-level thrombus and large tumor with low-level thrombus were 31.6 ± 3.8 months and 32.5 ± 2.9 months, without statistical significance (P = 0.955). After univariate and multivariate Cox proportional hazard survival regression analyses, only distant metastasis (hazard ratio [HR]: 3.839, P = 0.002), sarcomatoid differentiation (HR: 7.923, P < 0.001), alkaline phosphatase (HR: 2.661, P = 0.025), and severe post-operative complications (HR: 10.326, P = 0.001) were independent predictors of prognosis.@*Conclusions@#The level of the tumor thrombus was more important than the diameter of the primary kidney tumor in affecting the complexity of surgery. In the same T3 stage, neither the renal tumor diameter nor the tumor thrombus level was an independent risk factor for prognosis.
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BACKGROUND@#Radical nephrectomy with thrombectomy is one of the most difficult and complicated urological operations. But the roles of renal tumor volume and thrombus level in surgical complexity and prognostic outcome are not clear. This study aimed to evaluate the surgical complexity and prognostic outcome between the volume of renal cell carcinoma (RCC) and the level of venous tumor thrombus.@*METHODS@#The clinical data of 67 RCC cases with renal vein or inferior vena cava (IVC) tumor thrombus from January 2015 to May 2018 were retrospectively analyzed. Among these 67 cases, 21 (31.3%) were small tumors with high-level thrombus (tumor ≤7 cm in diameter and thrombus Neves Level II-IV), while 46 (68.7%) were large tumors with low-level thrombus group (tumor >7 cm in diameter and thrombus Level 0-I). Clinical features, operation details, and pathology data were collected. Univariable and multivariable logistic regression analyses were applied to evaluate the risk factors for small tumor with high-level thrombus.@*RESULTS@#Patients with small tumors and high-level thrombus were more likely to have longer operative time (421.9 ± 135.1 min vs. 282.2 ± 101.9 min, t = 4.685, P < 0.001), more surgical bleeding volume (1200 [325, 2900] mL vs. 500 [180, 1000] mL, U = 270.000, P = 0.004), more surgical blood transfusion volume (800 [0, 1400] mL vs. 0 [0, 800] mL, U = 287.500, P = 0.004), more plasma transfusion volume (0 [0, 800] mL vs. 0 [0, 0] mL, U = 319.000, P = 0.004), higher percentage of open operative approach (76.2% vs. 32.6%, χ = 11.015, P = 0.001), higher percentage of IVC resection (33.3% vs. 0%, χ = 17.122, P < 0.001), and higher percentage of post-operative complications (52.4% vs. 19.6%, χ = 7.415, P = 0.010) than patients with large tumors and low-level thrombus. In multivariate analysis, decreased hemoglobin (Hb) (odds ratio [OR]: 0.956, 95% confidence interval [CI]: 0.926-0.986, P = 0.005) and non-sarcomatoid differentiation (OR: 0.050, 95% CI: 0.004-0.664, P = 0.023) were more likely to form small tumors with high-level tumor thrombus rather than large tumor with small tumor thrombus. The estimated mean cancer-specific survival times of small tumor with high-level thrombus and large tumor with low-level thrombus were 31.6 ± 3.8 months and 32.5 ± 2.9 months, without statistical significance (P = 0.955). After univariate and multivariate Cox proportional hazard survival regression analyses, only distant metastasis (hazard ratio [HR]: 3.839, P = 0.002), sarcomatoid differentiation (HR: 7.923, P < 0.001), alkaline phosphatase (HR: 2.661, P = 0.025), and severe post-operative complications (HR: 10.326, P = 0.001) were independent predictors of prognosis.@*CONCLUSIONS@#The level of the tumor thrombus was more important than the diameter of the primary kidney tumor in affecting the complexity of surgery. In the same T3 stage, neither the renal tumor diameter nor the tumor thrombus level was an independent risk factor for prognosis.
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BACKGROUND: Antagonism of bone sclerosis protein can stimulate osteogenesis and increase bone synthesis and metabolism through the Wnt/β-catenin signaling pathway. OBJECTIVE: To investigate the effects of sclerostin-single chain antibody fragment (Scl-scFv) on the proliferation and osteogenic differentiation of C57BL/6 mouse bone marrow mesenchymal stem cells (BMSCs). METHODS: BMSCs were isolated from C57BL/6 mice using whole bone marrow adherence method. Alizarin red staining was performed at the 14thday of osteogenic induction, and oil red O staining performed at the 7thday of adipogenic induction. Passage 3 BMSCs were cultured with α-MEM complete medium with (experimental) or without (control) 50 μg/L Scl-scFv aScl-scFv. Real-time PCR was used to detect type 1 collagen, alkaline phosphatase, RUNX2, osteopontin, osteocalcin at the 7thday of culture and meanwhile, alkaline phosphatase staining was done; western blot assay was used to detect expression of type 1 collagen and osteopontin proteins, and ELISA was used to detect the level of osteocalcin in the cell supernatant at 4, 7, 10 days of culture. RESULTS AND CONCLUSION: Formation of calcium nodules and orangered oil droplets was obviously visible in the BMSCs after osteogenic and adipogenic induction, respectively. Over time, the absorbance value showed no difference between the experimental and control group. Compared with the control group, the experimental group showed significant increases in mRNA and protein expression of type 1 collagen and osteopontin as well as in protein expression of alkaline phosphatase, RUNX2 and osteocalcin (P < 0.05). Moreover, stronger alkaline phosphatase staining was found in the experimental group relative to the control group. These findings indicate that Scl-scFv has no effect on BMSCs proliferation,but can promote the osteogenic capacity of BMSCs in vitro.
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OBJECTIVE@#To investigate the safety and feasibility of laparoscopic treatment for renal carcinoma with Mayo 0-2 level venous thrombosis.@*METHODS@#From January 2015 to February 2018, 58 renal carcinoma cases with venous thrombus underwent laparoscopic radical nephrectomy with inferior vena cava thrombectomy in Department of Urology, Peking University Third Hospital, of which, 51 cases were male, and 7 female, aged 29-82 years. According to the Mayo grade classification, 20 cases were level 0, 20 cases were level 1, and 18 cases were level 2, with left side being 22 cases, and right side 36 cases. The patients except for those complicated with hemorrhagic diseases, cardiac and pulmonary insufficiency, or those who could not tolerate anesthesia and surgical contraindications, underwent the operation after comprehensive examinations.@*RESULTS@#The 58 cases of renal tumor with venous tumor emboli were successfully completed with the surgeries, including 50 cases of totally laparoscopic surgery, 8 cases of laparoscopy surgery from convert to open (among the patients who were converted to open surgery, 7 were complicated with grade 2 tumor thrombus and 1 with grade 1 tumor thrombus). The main reasons for converting to open surgery were huge tumors (the largest of which was about 16 cm in diameter), severe adhesion and difficulty of separation. For different patients, different surgical methods and procedures were adopted according to the tumor direction and the different grade of tumor thrombus. Radical nephrectomy combined with vena cava tumor thrombus removal was performed in 55 cases and segmental resection of vena cava in 3 cases. The operation time was 132-557 min, and blood loss was 20-3 000 mL. Post-operative pathological types: 51 cases were clear cell carcinoma, 5 cases were type 2 of papillary carcinoma, 1 case was squamous cell carcinoma, and 1 case was chromophobe cell tumor. In the study, 47 cases were followed up for 1-36 months, and 4 cases died (the survival time was 5-15 months, with an average of 10.2 months).@*CONCLUSION@#Laparoscopic radical nephrectomy with inferior vena cava thrombectomy is a reasonable choice for renal tumor with Mayo 0-2 level venous thrombosis. For different tumor directions and different grades of tumor thrombus, an appropriate operation plan can give the maxim benefit to the patients with skillful surgeons.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Carcinoma, Renal Cell , Kidney Neoplasms/complications , Laparoscopy , Nephrectomy/methods , Retrospective Studies , Thrombectomy/methods , Thrombosis/surgery , Vena Cava, InferiorABSTRACT
OBJECTIVE@#To assess the perioperative outcome, continence recovery and oncologic outcome of Chinese patients aged 80 years or older treated with radical prostatectomy for prostate cancer.@*METHODS@#We retrospectively evaluated the octogenarian patients who recieved biopsy for prostatic carcinoma and underwent laparoscopic radical prostatectomy from 2007 to 2016. We collected the data of clinical variables, perioperative parameters and postoperative pathological results for the octogenarian patients. We recorded and analyzed the recovery of urinary continence of the patients 3 months, 6 months and 1 year after surgery. Biochemical progression was defined as postoperative prostate specific antigen (PSA) greater than 2 μg/L for 2 times. We evaluated the non-biochemical recurrence survival rate and overall survival rate by Kaplan-Meier survival curve analysis for the patients aged 80 years or older. Multivariable COX regression analyses were used for evaluating the influence factors of biochemical recurrence after laparoscopic radical prostatectomy.@*RESULTS@#For all the 51 patients, the average age was (81.6±1.6) years,and prebiopsy PSA was (15.19±13.68) μg/L. There were 14 cases (27.5%), 19 cases (37.3%) and 18 cases (35.3%) for biopsy Gleason score 6, 7 and ≥8. There were 6 patients (11.8%) with clinical stage T1, 31 patients (60.8%) with clinical stage T2 and 14 patients (27.5%) with clinical stage T3. According to American Society of Anesthesiologists (ASA) classification, grade I was in 6 patients and grade II in 45 patients. All the octogenarian patients received extra-peritoneal laparoscopic radical prostatectomy. The average operation time was (189.6±69.1) min, the estimated blood volume was (169.9±163.5) mL, and 11 patients (21.6%) had perioperative complications. There were 29 cases (56.9%) and 22 cases (43.1%) staged for pT2 and pT3 based on postoperative pathological test. Of the pT3 patients, 18 (35.3%) and 4 (7.8%) were pT3a and pT3b. Eight cases (15.7%) presented Gleason score 6,21 cases (41.1%) 7 and 22 cases(43.1%) ≥8. Fourteen cases were positive surgical margin patients after surgery. Overall, the median follow up was 42 months. The continence rate of the octogenarian patients was 64.7%, 82.4% and 92.2% for 3 months, 6 months and 12 months after the surgery. Twelve cases (23.5%) had biochemical recurrence and 4 cases (7.8%) died in the follow up. There was 1 patient who died of prostate cancer progression and 3 died for other reasons. PSA (P=0.019), pT≥T3 (P=0.017) and positive surgical margin (P=0.020) were independent risk factors for biochemical recurrence of the octogenarian prostate cancer patients according to multivariable COX regression analysis.@*CONCLUSION@#For well selected octogenarian prostate cancer patients, laparoscopic radical prostatectomy was a feasible treatment option. Octogenarian patients who received laparoscopic radical prostatectomy showed good oncologic outcome. PSA, pT≥T3 and positive surgical margin were independent risk factors for biochemical recurrence of octogenarian prostate cancer patients.
Subject(s)
Aged, 80 and over , Humans , Male , Neoplasm Recurrence, Local , Neoplasm Staging , Prognosis , Prostate-Specific Antigen , Prostatectomy , Prostatic Neoplasms/surgery , Retrospective StudiesABSTRACT
OBJECTIVE@#To assess the relationship between recovery of urinary continence after laparoscopic radical prostatectomy (LRP) and prostatic volume (PV) and intravesical prostatic protrusion length (IPPL) on preoperative magnetic resonance imaging (MRI).@*METHODS@#88 patients with pathologic confirmed prostate carcinoma who were underwent LRP were included in this study. MRI examination was performed in 1 week before the biopsy. The patients were divided into two groups according to PV (<50 mL, ≥50 mL) on preoperative MRI. The patients were divided into two groups according to IPPL (<5 mm, ≥5 mm), IPPL was measured on MRI as the vertical distance from the tip of the protruding prostate to the base of the urinary bladder. After surgery we recorded and analyzed recovery of urinary continence of the patients for one year.@*RESULTS@#All the 88 patients received extra-peritoneal LRP successfully. The average operation time was (155±67) min, and the estimated blood volume was (145±159) mL. There was a significant difference between group PV<50 mL and ≥50 mL in the operation time (P=0.045). All the patients who underwent MRI preoperatively showed that their mean PV was (44.54±26.58) mL and mean IPPL was (5.2±5.7) mm. The continence rate for all the patients after LRP was 53.4%, 84.1% and 94.3% in their follow-up of 3, 6 and 12 months. Three months after LRP, the continence rate for group PV<50 mL and ≥50 mL were 61.5% and 30.4%, which were completely continent (P=0.010). Six or twelve months after surgery, the continence rate was 87.7% and 73.9% (P=0.120), 96.9% and 87.0% (P=0.076) for group PV<50 mL and ≥50 mL separately. Three months after LRP, the continence rate for group IPPL<5 mm and ≥5 mm were 66.1% and 31.3%, which were completely continent (P=0.002). Six months after surgery, the continence rate was 92.6% and 68.8% (P=0.003), and one year after surgery, the continence rate was 98.2% and 87.5% for group IPPL<5 mm and ≥5 mm separately (P=0.037). There was a significant difference between group PV<50 mL and ≥50 mL in the urinary continence curve (P=0.017), and the same significant difference between group IPPL<5 mm and ≥5 mm (P=0.001).@*CONCLUSION@#The PV and IPPL on preoperative MRI were associated with significantly slower return of urinary continence, especially for early recovery (3 months) of continence after LRP.
Subject(s)
Humans , Male , Laparoscopy , Prostatectomy/adverse effects , Prostatic Neoplasms/surgery , Recovery of Function , Urinary IncontinenceABSTRACT
BACKGROUND:Sclerostin has been shown to promote bone formation and decrease bone resorption,which provides a new idea for the treatment of osteoporosis.OBJECTIVE:To review the literatures related to sclerostin and osteoporosis,thereby providing theoretical basis for sclerostin applied in the treatment and prevention of osteoporosis,so as to improve the diagnosis and curative efficacy of osteoporosis.METHODS:PubMed database was searched using the keywords of "osteoporosis,sclerostin,sclerosteosis,Wnt/β-catenin,LRP5/6,sclerostin antibody,sclerostin and expertise,romosozumab,blosozumab".Finally,58 pertinent articles were enrolled for analysis.RESULTS AND CONCLUSION:Sclerostin inhibits bone formation,so anti-sclerostin antibody is utilized,and animal experiments and clinical trials have shown that it can promote bone formation and inhibit bone reaorption.Phase Ⅲ trial results potentially signify a significant step in achieving market approval,which support the preclinical and clinical emergence of sclerostin antibody therapies for both osteoporosis and alternative applications.The serum level of sclerostin is found to be closely related to lifestyle,but still need to be studied in depth.Increasing trial results show that sclerostin is the promising therapeutic candidate,which provides a new direction in the prevention and treatment of osteoporosis.
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Cystic fibrosis [CF] is a lifelong, inflammatory multi-organ disease and the most common lethal, genetic condition in Caucasian populations, with a median survival rate of 41.5 years. Pulmonary disease, characterized by infective exacerbations, bronchiectasis and increasing airway insufficiency is the most serious manifestation of this disease process, currently responsible for over 80% of CF deaths. Chronic dysregulation of the innate immune and host inflammatory response has been proposed as a mechanism central to this genetic condition, primarily driven by the nuclear factor KB [NF-KB] pathway. Chronic activation of this transcription factor complex leads to the production of pro-inflammatory cytokines and mediators such as IL-6, IL-8 and TNF-alpha. A20 has been described as a central and inducible negative regulator of NF-KB. This intracellular molecule negatively regulates NF-KB-driven pro-inflammatory signalling upon toll-like receptor activation at the level of TRAF6 activation. Silencing of A20 increases cellular levels of p65 and induces a pro-inflammatory state. We have previously shown that A20 expression positively correlates with lung function [FEV[1]%] in CF. Despite improvement in survival rates in recent years, advancements in available therapies have been incremental. We demonstrate that the experimental use of naturally occurring plant diterpenes such as gibberellin on lipopolysaccharide-stimulated cell lines reduces IL-8 release in an A20-dependent manner. We discuss how the use of a novel bio-informatics gene expression connectivity-mapping technique to identify small molecule compounds that similarly mimic the action of A20 may lead to the development of new therapeutic approaches capable of reducing chronic airway inflammation in CF
Subject(s)
Zinc Fingers , DNA-Binding Proteins , Nuclear Proteins , Intracellular Signaling Peptides and Proteins , Interleukin-6 , InflammationABSTRACT
<p><b>OBJECTIVE</b>To compare the stability of sacroiliac screws fixation for the treatment of bilateral vertical sacral fractures to provide reference for clinic application.</p><p><b>METHODS</b>A finite element model of Tile C pelvic ring injury (bilateral type Denis II fracture of sacrum) was produced. The bilateral sacral fractures were fixed with sacroiliac screws in 4 types of models respectively: two bidirectional sacroiliac screws fixation in the S₁ segment, two bidirectional sacroiliac screws fixation in the S₂ segment, one sacroiliac screw fixation in the S₁ segment and one sacroiliac screw fixation in the S₂ segment, two bidirectional sacroiliac screws fixation in S₁ and S₂ segments respectively. By the ABAQUS 6.9.1 software, in the case of standing on both feet, 600 N vertical load was imitated to be imposed to the superior surface of the sacrum and downward translation and backward angle displacement of the middle part of the sacral superior surface and everted angle displacement of the top of iliac bones were extracted for analysis. The stability of sacroiliac screws fixation was compared according to the principle of the better stability the smaller displacement.</p><p><b>RESULTS</b>The stability of 2 bidirectional sacroiliac screws fixation in S₁ and S₂ segments respectively was markedly superior to that of 2 bidirectional sacroiliac screws fixation in S₁ or S₂ segment and was also markedly superior to that of one sacroiliac screw fixation in S₁ segment and one sacroiliac screw fixation in S₂ segment. The vertical and everted stability (the downward translation: 0.531 mm; the everted angle displacement: 0.156° (left side), 0.163° (right side)) of sacroiliac screws fixation in two bidirectional sacroiliac screws fixation in the S₂ segment was superior to that of two bidirectional sacroiliac screws fixation in the S₁ segment (the downward translation: 0.673 mm; the everted angle displacement: 0.200° (left side), 0.232° (right side)). The rotational stability of two bidirectional sacroiliac screws fixation in the S₁ segment (the backward angle displacement: 0.269°) was superior to that of two bidirectional sacroiliac screws fixation in the S₂ segment (the backward angle displacement: 0.287°). Moreover, the rotational stability of one sacroiliac screw fixation in the S₁ segment and one sacroiliac screw fixation in the S₂ segment was inferior to that of two bidirectional sacroiliac screws fixation in the S₁ segment or two bidirectional sacroiliac screws fixation in the S₂ segment, and the vertical and everted stability of one sacroiliac screw fixation in the S₁ segment and one sacroiliac screw fixation in the S₂ segment was between that of two bidirectional sacroiliac screws fixation in the S₁ segment and two bidirectional sacroiliac screws fixation in the S₂ segment.</p><p><b>CONCLUSIONS</b>Two bidirectional sacroiliac screws fixation in S₁ and S₂ segments respectively is recommended to be utilized for fixing bilateral sacral fractures of Tile C pelvic ring injury as far as possible. It is suggested to choose sacral segments in which sacroiliac screws fixed according to vertical, rotational and everted stability degree of sacral fractures.</p>
Subject(s)
Adult , Female , Humans , Bone Screws , Computer Simulation , Finite Element Analysis , Fracture Fixation, Internal , Methods , Fractures, Bone , General Surgery , Sacrum , Wounds and Injuries , General SurgeryABSTRACT
<p><b>BACKGROUND</b>The coagulation function in carcinoma patients is abnormal, but in renal cell carcinoma the extent and relationships of coagulation function remain unclear. This study retrospectively investigated the relationships between coagulation function, clinical stage and metastasis in patients with renal cell carcinoma.</p><p><b>METHODS</b>A total of 350 consecutive patients admitted to our Urology Department from 2004 to 2010 were diagnosed with renal cell carcinoma by histopathologic examination and were included in this study. A total of 231 cases of renal benign tumors were considered as the control group. Fibrinogen, prothrombin time, activated partial thromboplastin time and international normalized ratio were evaluated in all subjects. Tumor size, clinical stage, lymph node metastasis, and distant metastasis were evaluated using radiologic imaging, intraoperative findings, and histological studies.</p><p><b>RESULTS</b>The preoperative plasma fibrinogen levels of patients with renal cell carcinoma ((383.9 ± 146.7) mg/dl) were significantly higher than those of the control group ((316.7 ± 62.0) mg/dl) (P < 0.01). We divided the renal cell carcinoma group into stages Ia, Ib, II, III, and IV. The fibrinogen values were (315.6 ± 64.6) mg/dl, (358.3 ± 91.1) mg/dl, (465.6 ± 164.7) mg/dl, (500.0 ± 202.1) mg/dl, and (585.8 ± 179.7) mg/dl, respectively. There were no significant differences in fibrinogen values between stage Ia and control groups. However, results of other stages showed significant differences when compared to control group values (P < 0.01). Using the cutoff value of 440 mg/dl, which defines hyperfibrinogenemia, plasma fibrinogen levels had a positive predictive value of 39.8% and a negative predictive value of 93.3% for predicting distant metastasis, with a sensitivity of 64.7% and specificity of 83.3%.</p><p><b>CONCLUSIONS</b>Preoperative plasma fibrinogen levels are elevated in patients with renal cell carcinoma with distant metastasis or lymph node metastasis. Potential metastasis is more likely if the tumor size larger than 4 cm. Increased preoperative plasma fibrinogen levels, especially hyperfibrinogenemia, may be an indicator of metastasis.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Blood Coagulation , Physiology , Carcinoma, Renal Cell , Metabolism , Pathology , Fibrinogen , Metabolism , Kidney Neoplasms , Metabolism , Pathology , Lymphatic Metastasis , Neoplasm Metastasis , Neoplasm Staging , Retrospective Studies , Thromboplastin , MetabolismABSTRACT
0.05).Quality of life in all the cases was satisfactory.Conclusions The living donor nephrectomy is feasible and safe.It is very important to examine living donor before operation,operate very carefully and perform long- term follow-up.
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Objective To report our experience with retroperitoneoscopic nephroureterectomy with excision of a bladder-cuff for renal pelvic and ureteral tumors.Methods Thirty-five patients (21 women and 14 men;mean age,67 years;age range,49 -82 years) with upper urinary tract tumors underwent retro- peritoneal laparoscopic nephrourcterectomy with excision of a bladder-cuff.Of the 35 cases,15 had pelvic tumors and 20 had ureteral tumors;19 cases had the tumors on the right side and 16 on the left.Two cases had ureteral tumors combined with bladder tumors.One case had bilateral ureteral tumors then concomitantly had bladder tumors.The needle electrode was used to circleround incise the bladder thoroughly 0.5 cm away from the ureterostoma.Three trocars in the waist were used for dissecting the kidney;and the ureter was dis- sected as far distally downward.Then an incision of 5-9 cm was created in the lower abdomen to allow dis- section of the distal ureter and bladder-cuff and intact specimen extraction.Results The operation was successful in all 35 patients.The mean operative time was 3.1 h ( range,1.5-6.0h).The mean estimated blood loss was 166 ml (range,20-1600 ml).Four cases received blood transfusion.The patient's activity re- covered in 20-32 h after operation.Postoperative pathology showed transitional cell carcinoma in 30 cases, poorly differentiated adenocareinoma in 2 (ureter),squamous cell carcinoma in 1 (ureter),leiomyosarcoma in 1 (ureter),xanthogranulomatous pyelonephritis in 1.Duodenal leakage occurred in 1 patient who had had dialysis a drainage catheter was placed on the third d after operation,and the patient died of heart failure af- ter 2 months.Postoperative vesical irrigation was performed to prevent tumor recurrence.The mean hospital stay was 11 d.During a mean follow-up of 14 months(range,1-32 months),1 patient developed pelvic me- tastasis and was alive with the tumor.The other 33 patients survived free of tumor to date.No patient had re- current transitional cell carcinoma of the bladder.Conclusions Our data demonstrate that retroperitoneo- scopic nephroureterectomy for renal pelvic and ureteral tumors has shorter incision and more rapid postopera- tive recovery compared with open surgery.Using resectoscope to resect the termination of ureter allows more complete excision of the ureter.