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Objective:To investigate the efficacy and safety of modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy (RAPN) for patients with renal tumors.Methods:A total of 32 renal tumor patients undergoing RAPN with modified early unclamping technique between January 2019 and August 2020 were retrospectively collected, including 18 males and 14 females. The average age was (48.5±11.2) years old, average BMI was (23.8±3.7) kg/m 2, average tumor size was (4.2±1.4)cm with 18 left tumors and 14 right tumors, average R. E.N.A.L. score was 7.6±0.4, and average preoperative eGFR was (84.0±18.6)ml/(min·1.73 m 2). The control group included 66 renal tumor patients undergoing RAPN with standard unclamping technique during the same period by the same surgeon, including 42 males and 24 females. The average age was (50.2±13.8) years old, average BMI was (24.0±4.5)kg/m 2, average tumor size was (4.1±1.6)cm with 35 left tumors and 31 right tumors, average R. E.N.A.L. score was 7.5±0.5, and average preoperative eGFR was (82.8±20.2) ml/(min·1.73 m 2). There was no significant difference in above variables between two groups. Modified early unclamping technique used barbed wire to continually suture 2-3 needles in a short time to close the large space at the outer after the inner suture, and then loosen the blocking clip to restore renal blood supply. The operative time, warm ischemia time, blood loss, postoperative tube removal time, postoperative hospital stay and 3 months postoperative renal function of two groups were compared. Results:All of the 98 RAPN were performed successfully and no patient was converted to radical nephrectomy or open surgery. There was no significant difference in operation time [(120.9±22.8)vs.(111.6±25.0)min, P=0.079], postoperative tube removal time [(4.0±0.6)day vs.(3.8±0.8) day, P=0.214] and postoperative hospital stay [(5.1±0.7)day vs.(5.2±0.5) day, P=0.419] between the two groups. Compared with the standard unclamping group, the modified early unclamping group had obvious less warm ischemia time [(13.5±3.6)min vs.(21.2±4.4) min, P<0.001]. There was no difference in intraoperative estimated blood loss between two groups (110 ml vs. 100 ml, P=0.480). No blood transfusion, urine leakage, postoperative hemorrhage occurred in either group. The 3 months postoperative renal function decline of modified early unclamping group was slightly less than standard unclamping group [(10.5±7.6)ml/(min·1.73m 2)vs.(13.2±6.4) ml/(min·1.73m 2)], but did not reach statistical significance ( P=0.069). The median follow-up period was 12.4 months(4-24 months) without any recurrence or metastasis. Conclusions:The modified early unclamping technique in RAPN for patients with renal tumors is safe and feasible. Compared with the standard unclamping technique, the modified early unclamping technique could shorten the warm ischemia time without increasing blood loss and complications, and might protect the postoperative renal function, which has high value in clinical practice.
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Objective:To retrospectively analyze the pregnancy outcomes of patients with adenomyosis requiring fertility in a single center under real world condition.Methods:From June 2015 to May 2020, 231 cases of pregnancy complicated with adenomyosis diagnosed by ultrasound with fertility requirements were treated in the Women′s and Children′s Hospital Affiliated to Qingdao University with complete clinical data. And they were divided into three groups according to the treatment of adenomyosis before pregnancy: expectation group, drug group and operation group. The relevant data before pregnancy of the three groups were analyzed, and the pregnancy outcomes of the patients were summarized. According to whether the early pregnancy was treated with medication, the patients who were naturally conceived without symptoms of threatened abortion were divided into observation group and fetus protection group, and the pregnancy outcomes of the two groups were compared.Results:(1) Compared with the expectation group, the ages of patients in the drug group and the operation group were larger [(31.5±1.8) vs (34.1±3.7) vs (36.9±3.6) years old], and the difference was statistically significant ( P<0.05). Only 9 patients (11.5%, 9/78) had clinical symptoms in the expectation group, while the patients in the drug group and the operation group had a higher proportion of dysmenorrhea and increased menstrual volume. The uterine volume of the drug group and the operation group were larger than that of the expectation group [(151±46) vs (166±27) vs (97±18) cm 3], the difference was statistically significant ( P<0.05). 78.6% (33/42) of the operation group were focal adenomyosis. The proportion of natural pregnancy in the expectation group was 97.4% (76/78), and in vitro fertilization and embryo transfer was mainly used in the drug group and the operation group. (2) The abortion rates of the three groups were 48.7% (26/111), 4/17, 67.5% (27/78) respectively. Compared with the drug group and the operation group, the preterm birth rate was lower [55.9% (33/111) vs 11/17 vs 12.5% (5/78)] and the natural delivery rate was higher [44.1% (26/111) vs 4/17 vs 67.5% (27/78)] in the expectation group. (3) There were 89 cases of spontaneous pregnancy without threatened abortion symptoms, including 31 cases in the observation group and 58 cases in the fetus protection group. Compared with the observation group, the abortion rate of patients in the fetus protection group was lower [41.9% (13/31) vs 34.5% (20/58)], and the difference was statistically significant ( P<0.05). Conclusions:Patients with adenomyosis who have fertility requirements should be comprehensively evaluated and individualized treatment plans should be given. Pregnancy patients with adenomyosis have a high rate of miscarriage, and they should be included in the management of high-risk pregnant women. Active fetal protection treatment during early pregnancy might improve pregnancy outcomes.
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Objective:To explore the clinical application value of limb remote ischemic postconditioning (LRIPC) in patients with acute cerebral infarction after recanalization.Methods:A total of 78 patients with acute cerebral infarction admitted to the First Affiliated Hospital of Shantou University Medical College from June 2017 to March 2019 were selected. According to the random number table method, they were divided into the observation group with 39 cases (LRIPC + conventional medical treatment) and the control group with 39 cases (conventional medical treatment). The National Institutes of Health Stroke Scale (NIHSS) and Montreal Cognitive Assessment scale (MoCA) scores, the changes of cerebral blood perfusion, cerebral infarction volume and the levels of nerve function indexes before and after the treatment were compared and analyzed.Results:After the treatment, the NIHSS scores in the observation group were lower than thosein the control group, and the MoCA scores were higher than those in the control group, the differences were statistically significant ( P<0.05). After the treatment, the mean transit time of cerebral blood flow in the observation group was shorter than that in the control group, while the regional cerebral blood flow and regional cerebral blood volume were higher than those in the control group, the differences were statistically significant ( P<0.05). After the treatment, the volume of cerebral infarction in the observation group was lower than that in the control group ( P<0.05). After the treatment, the levels of matrix metalloproteinase 9 and S-100B protein in the observation group were lower than those in the control group: (142.45 ± 36.23) mg/L vs. (176.89 ± 42.63) mg/L, (2.52 ± 0.46) μg/L vs. (3.61 ± 0.75) μg/L; and the level of nerve growth factor was higher than that in the control group: (143.49 ± 10.58) μg/L vs. (124.96 ± 13.62) μg/L, the differences were statistically significant ( P<0.05). Conclusions:LRIPC can improve the nerve functions, cognitive functions andreduce the volume of cerebral infarction by improving cerebral blood flow. It also has a good effect on alleviating the neurological functional impairment after vascular recanalization.
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To investigate the efficacy and adverse reactions of enzalutamide in the treatment of metastatic prostate cancer(mPCa). Two male patients were reported, Patient 1 was hospitalized due to elevated PSA for 6 months and fatigue for 2 weeks. Tests on the admission showed that tPSA > 1 000 ng/ml, pathological of prostate biopsy: prostate acinar carcinoma, Gleason score 4+ 4=8, imaging examination revealed multiple metastases of prostate cancer throughout the body. Patient 2 was admitted to hospital due to cough, sputum, chest tightness and difficulty in defecation for more than 20 days, and the patient had radical surgery for prostate cancer five years ago. Tests on admission showed that tPSA > 100 ng/ml, fPSA>50 ng/ml. The patient was diagnosed as postoperative local recurrence of prostate cancer with bilateral pleural effusion, and cancer lymphangitis was considered. Both patients were treated with enzalumide combined with goseraline. Both patients were followed up for 6 months, PSA decreased significantly within half a year, general condition continued to improve, and they were well tolerated, no obvious adverse reactions occurred.
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Objective:To validate gender-related differences in patients with upper tract urothelial carcinoma (UTUC).Methods:We used a method of combination of SEER database analysis and validation in our center. We selected 2 125 men (57.8%) and 1 552 (42.2%) women who underwent radical nephroureterectomy (RNU) for UTUC between 1995 and 2015 within the surveillance, Epidemiology, and End Results registries (SEER). In male cases, the median age was 71(22-99)years old, median follow-up time was 53.0 (0-227) months, 902 (89.5%) cases were Caucasian, 1 384 cases (65.1%) were located in the renal pelvis, and 810(38.1%) cases were T 3-T 4. For female cases, the median age was 73.6(25-99)years old, median follow-up time was 53.1(0-226) months, 1 417(91.3%) cases were Caucasian, 1 043 cases (67.2%) were located in the renal pelvis, and 508 (32.7%) cases were T 3-T 4. The analysis of SEER database showed that female patients were older compared to male patients ( P=0.002), the proportion of T 3-T 4 was even lower ( P=0.028). There were no statistically significant differences in race, tumor location, and follow-up time between males and females (all P>0.05). We also enrolled 131 men (55.3%) and 106 women (44.7%) who underwent RNU for non-muscle invasive (T a/T is/T 1) UTUC between January 2000 and January 2015. These patients had no history of bladder cancer, UTUC and kidney transplantation. Preoperative cystoscopy was performed to confirm the absence of bladder tumor. The male group was (65.8±12.4)years old, with history of aristolochic acid medications in 7(5.3%) cases, 98 smoking cases (74.8%), and estimated glomerular filtration rate (eGFR) of (64.2±29.4)ml/(min·1.73 m 2). In the female group, mean age was (66.7±11.9)years, 14 (13.2%) cases had history of aristolochic acid medications, 16(15.1%) had history of smoking, eGFR (56.3±27.9) ml/(min·1.73m 2). Compared with female patients, male patients tended to had less aristolochic acids exposure (5.3% vs.13.2%, P<0.001), frequent smoking (74.8% vs. 15.1%, P<0.001) and better renal function ( P=0.036). The Kaplan-Meier test was used for time-to-event analysis. Univariate and multivariate logistic regression models were adopted to examine the effect of gender on the development of T 3-T 4 tumor. Univariate and multivariate Cox regression analyses were used to assess the roles of factors on overall survival (OS) in both SEER and cases in our center, and competing-risks regression model was used to assess the roles of factors on cancer-specific survival (CSS) in both SEER and cases in our center. Results:Multivariate logistic analysis showed that gendere represented an independent risk factor of T 3-T 4 UTUC development( OR=0.86, P=0.02). Kaplan-Meier analysis showed that better OS and CSS for females only existed in the non-muscle invasive stages(5-year OS rates were 80.4% vs.87.3%, χ 2=31.0, P<0.001; 5-year CSS rates were 82.6% vs.89.2%, χ 2=31.2, P<0.001). In multivariate competing-risks regression models, no statistically significant differences in survival were observed between males and females ( HR=0.83, P=0.115). For the patients in our center, there were also no statistically significant differences existed in the non-muscle invasive stage between two genders on OS and CSS ( HR=0.93, P=0.071; HR=0.87, P=0.064). Conclusions:Females were less likely to have advanced pathological T stage. The differences on OS and CSS between males and females only existed in non-muscle invasive stage. However, after accounting for gender related factors, gender no longer had effects on UTUC prognosis.
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Objective:To explore the attitude and behavior of scientific research in professional postgraduates majoring in stomatology in Peking University, proposing suggestions to improve the quality of scientific research training.Methods:150 professional postgraduates of stomatology including the 8-year program stomatological students (the postgraduate stage) of Peking University School of Stomatology were involved in the survey, information including the types of and attitudes to scientific research, the evaluation of research environments, the understanding of the relationship with their mentors, and the expected working institutions after graduation was collected by questionnaires.Results:A total number of 131 valid questionnaires were collected, with an effective rate of 87.3%. In terms of the type of research work, 70 (53.4%) were engaged in basic research and 30 (22.9%) in clinical research. In terms of attitudes towards scientific research training, 69 (52.7%) respondents agreed that scientific research and clinical practice promoted each other. The Likert scores of scientific research interest, ability, and pressure were 3.13 ± 0.84, 3.04 ± 0.84, and 4.14±0.71. The evaluation of laboratory conditions (3.30±0.92), scientific research funding (3.54±1.06), scientific research atmosphere (3.89±0.85), and reward and punishment mechanisms (3.82±0.76) were positive. The evaluations of scientific research training courses (2.89±0.88) and scientific training time (2.79±0.94) were negative. The average score of the rapport level between postgraduates and their mentors was 4.29±0.77, and 111 respondents (84.7%) had a correct understanding of the guiding relationship. Sixty-six respondents (50.4%) expected to engage in clinical and scientific research in stomatological schools and 61 (46.6%) expected to engage in clinical work only, after graduation.Conclusions:The scientific research for graduate students of stomatology in Peking University is mainly basic research, and the research pressure is relatively high. It is recommended to choose research topics in combination with clinical practice, clarify the significance of scientific research, optimize the scientific research environment and facilities, strengthen the tailored guidance of mentors, and to fulfill the " holistic training (Three All-round Education)" in professional postgraduate training.
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Objective@#To evaluate the value of Prostate Imaging Reporting and Data System Version 2 (PI-RADS ) based biparametric magnetic resonance imaging (bpMRI) for predicting prostate biopsy results in patients with elevated prostate specific antigen (PSA).@*Methods@#The bpMRI from 539 patients who took transperineal template saturate biopsy from January 2015 to October 2017 were assessed retrospectively. The average age was 69.5 years old (44-88 years), with tPSA level of 7.23 ng/ml (4-10 ng/ml), f/t PSA of 0.183( 0.016-0.504), PSAD of 0.126 ng/ml2 ( 0.025-0.534 ng/ml2) , PV of 72.42 ml ( 18.71-199.51 ml). The age, PSA level, free/total PSA ratio, PSA density, prostate volume, and PI-RADS score of enrolled patients were analyzed for univariate analysis and their difference was compared by chi-square test, t-test. The multivariate logistic regression analysis was also performed through SPSS to select the independent risk factors for prostate cancer (PCa) and clinically significant cancer (csPCa). The receiver operating characteristic curves were also constructed to analyze the sensitivity and specificity of PI-RADS in PCa to explore the best cut-off value for the diagnosis of PCa and csPCa.@*Results@#A total of 539 patients were included in our study with 244 cases being positive and 295 cases being negative. In patients with positive results, 59 patients were diagnosed csPCa. According to univariate analysis results, the age(P<0.001) and PI-RADS score (P<0.001) of the positive patients were higher than the negative patients, and the difference was statistically significant. The age of the csPCa patients (P=0.023), PSAD (P=0.048) and PI-RADS scores (P<0.001) were higher than those of InsPCa patients, and f/t PSA (P=0.027) was lower than that of InsPCa patients with statistically significance. Multivariate logistic regression analysis demonstrated that f /t PSA (OR=2.283, P=0.049) and PI-RADS score (OR=9.046, P<0.001) were independent risk factors for positive biopsy results, while PSAD (OR=4.54, P=0.038) and PI-RADS score (OR=8.254, P<0.001) were independent risk factor for csPCa. The Yoden index analysis of different thresholds for prostate cancer detection indicated that PI-RADS 3 was the optimal threshold for the diagnosis of PCa, and PI-RADS 4 was the optimal threshold for the diagnosis of csPCa. Based on the combination of the above factors, the positive rate of prostate cancer was relatively high in patients with PI-RADS score ≥3 and f/t PSA<0.2 , which accounted for 86.6%(181/209). In contrast, the positive rate in patients with a PI-RADS score of ≤2 and f/t PSA≥0.2 was low, which accounted for 10.7%(6/56). The positive rate of csPCa was relatively high in patients with PI-RADS score≥4 and PSAD≥0.15 ng/ml2, which accounted for 76.0%(38/50). The positive rate of csPCa detected in patients with ≤3 and PSAD<0.15 ng/ml2 was low, which accounted for 0(0/359).@*Conclusions@#PI-RADS score could be used to reduce the unnecessary prostate biopsies in patients with elevated PSA when combined with other PSA related markers. Patients with a PI-RADS score of ≤3 and a PSAD ratio <0.15 ng/ml2 could avoid unnecessary biopsies.
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Objective To evaluate the value of Prostate Imaging Reporting and Data System Version 2 (PI-RADS) based biparametric magnetic resonance imaging (bpMRI) for predicting prostate biopsy results in patients with elevated prostate specific antigen (PSA).Methods The bpMRI from 539 patients who took transperineal template saturate biopsy from January 2015 to October 2017 were assessed retrospectively.The average age was 69.5 years old (44-88 years),with tPSA level of 7.23 ng/ml (4-10 ng/ml),f/t PSA of 0.183(0.016-0.504),PSAD of 0.126 ng/ml2 (0.025-0.534 ng/ml2),PV of 72.42 ml (18.71-199.51 ml).The age,PSA level,free/total PSA ratio,PSA density,prostate volume,and PI-RADS score of enrolled patients were analyzed for univariate analysis and their difference was compared by chi-square test,t-test.The multivariate logistic regression analysis was also performed through SPSS to select the independent risk factors for prostate cancer (PCa) and clinically significant cancer (csPCa).The receiver operating characteristic curves were also constructed to analyze the sensitivity and specificity of PI-RADS in PCa to explore the best cut-off value for the diagnosis of PCa and csPCa.Results A total of 539 patients were included in our study with 244 cases being positive and 295 cases being negative.In patients with positive results,59 patients were diagnosed csPCa.According to univariate analysis results,the age(P ＜ O.001) and PI-RADS score (P ＜ 0.001) of the positive patients were higher than the negative patients,and the difference was statistically significant.The age of the csPCa patients (P =0.023),PSAD (P =0.048) and PI-RADS scores (P ＜ 0.001) were higher than those of InsPCa patients,and f/t PSA (P =0.027) was lower than that of InsPCa patients with statistically significance.Multivariate logistic regression analysis demonstrated that f/t PSA (OR =2.283,P =0.049) and PI-RADS score (OR =9.046,P ＜ 0.001) were independent risk factors for positive biopsy results,while PSAD (OR =4.54,P =0.038) and PI-RADS score (OR =8.254,P ＜ 0.001) were independent risk factor for csPCa.The Yoden index analysis of different thresholds for prostate cancer detection indicated that PI-RADS 3 was the optimal threshold for the diagnosis of PCa,and PI-RADS 4 was the optimal threshold for the diagnosis of csPCa.Based on the combination of the above factors,the positive rate of prostate cancer was relatively high in patients with PI-RADS score ≥3 and t/t PSA ＜ 0.2,which accounted for 86.6％ (181/209).In contrast,the positive rate in patients with a PI-RADS score of ≤2 and f/t PSA≥0.2 was low,which accounted for 10.7％ (6/56).The positive rate of csPCa was relatively high in patients with PI-RADS score≥4 and PSAD≥0.15 ng/ml2,which accounted for 76.0％ (38/50).The positive rate of csPCa detected in patients with ≤ 3 and PSAD ＜ 0.15 ng/ml2 was low,which accounted for 0 (0/359).Conclusions PI-RADS score could be used to reduce the unnecessary prostate biopsies in patients with elevated PSA when combined with other PSA related markers.Patients with a PI-RADS score of ≤ 3 and a PSAD ratio ＜0.15 ng/ml2 could avoid unnecessary biopsies.
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Objective To investigate the expression of proline rich tyrosine kinase 2 (Pyk2) in non-muscle invasive bladder cancer,and analyze its correlation to clinicopathologic features and prognosis of non-muscle invasive bladder cancer.Methods 114 surgical specimens and 50 normal bladder mucosa specimens were collected from 114 non-muscle invasive bladder cancer patients who underwent TURBT at our hospital,from June 2013 to March 2018.Of the 114 patients,63 were male and 51 were female,aged 42-87 years,average age of (63.6 ± 13.8) years,73 cases of tumor ＜3 cm,41 cases of tumor ≥3 cm,83 cases were single and 31 cases were multiple tumor,53 cases were high grade and 61 cases were low grade,59 cases were Ta and 55 cases were T1 stage.Pyk2 protein expression was detected by immunohistochemistry and western blot.The correlation of the expression of Pyk2 with clinicopathologic features,including gender,age,tumor size,the number of tumors,histological grade and clinical stage were analyzed.Survival analysis was calculated by using the Kaplan-Meier method,and the difference in survival curve was analyzed by using the log-rank test.Association of Pyk2 expression with prognosis of non-muscle invasive bladder cancer analyzed by using the Cox proportional hazards regression model.Results Compared with normal bladder tissues,expression of Pyk2 protein was increased in bladder cancer tissue significantly(0.571 ±0.230 vs.0.253 ± 0.152,P ＜0.01).The expression of Pyk2 protein was closely related to clinical stage(P =0.027) and grade(P =0.010),rather than gender (P =0.275),age (P =0.419),tumor size (P =0.317),and tumor number(P =0.208).The recurrence rate in the Pyk2 positive group and negative group were 46.1％ (35/76)and 28.9％ (11/38)respectively.The progression rate in the Pyk2 positive group and negative group were 35.5％ (27/76) and 10.5 ％ (4/38) respectively.Survival analysis suggested expression of Pyk2 in non-muscle invasive bladder cancer had a significant relation to recurrence-free survival rate(P ＜0.001) and progression-free survival rate(P =0.003).In the multivariable Cox analysis,we found that Pyk2 protein was an independent predictor of recurrence-free survival rate(HR 0.245,95％ CI 0.078-0.768,P =0.016) and progression-free survival rate (HR 0.095,95％ CI 0.012-0.764,P =0.027).Conclusions The expression of Pyk2 in non-muscle invasive bladder cancer was significantly increased.The expression of Pyk2 has a significant relation to recurrence and progression of non-muscle invasive bladder cancer.High Pyk2 expression is an independent prognostic factor in non-muscle invasive bladder cancer.
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Objective ToexplorethevalueofCTtargetreconstructionforpureground-glassnodules(pGGN)onidentifyingthe invasivenessofthelungadenocarcinoma.Methods ThepGGNs weredividedintopre-invasivegroup[atypicaladenomatoushyperplasia (AAH),andadenocarcinomainsitu(AIS)]andinvasivegroup[minimallyinvasiveadenocarcinoma(MIA),andinvasiveadenocarcinomas(IA)] accordingtothepathologicresults.ThemorphologicfeaturesofpGGNonCTincludedthelargestdiameters,CTvalue,pleuralindentation,air bronchogram,bubblelucency,vesselconvergence,vesseldilatation,lobulationandspeculation.Twodiagnosticiansevaluatedthemorphologic featuresofpGGNonCT.Binary L o g istic regressionwasusedtoassesstheassociationbetweenCTfindingsandhistopathological classification.ROCcurveanalysiswasusedindiameterandCTvalue.Results Betweenpre-invasiveandinvasivegroup,therewere significantdifferencesindiameter,CTvalue,spiculationandvesseldilatation(P<0.05).Nodifferencewasfoundinlobulated-margin,bubble lucency,airbronchogram,vascularconvergenceorpleuralindentationbetweenthetwogroups(P>0.05).Thediagnosticthresholds forpredictingpGGOinfiltrationwere8.75mminmaximumdiameterand-605HUinCTvaluerespectively.Conclusion ThepGGNwitha diametermorethan87.5mm,theCTvaluemorethan-605HU,andpresencesofspiculationandvesseldilatationsuggeststhatpGGOisinvasive.
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BACKGROUND@#The blocking of the programmed cell death protein (PD-1)/programmed death-ligand 1 (PD-L1) axis has been found to have an anticancer activity against various types of cancer by enhancing T cell immunity, while there are no studies linking the PD-1/PD-L1 axis to chemotherapy drugs in osteosarcoma (OS). The present study aimed to investigate the effects of blocking PD-1/PD-L1 axis on the cisplatin chemotherapy in OS in vitro and in vivo.@*METHODS@#Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was applied to detect PD-L1 mRNA in OS tissues. Cell proliferation and apoptosis were measured by Cell Counting Kit-8 (CCK-8) and flow cytometry assays, respectively. In vivo, the syngeneic mice were treated with cisplatin and anti-PD-1 antibody alone or jointly.@*RESULTS@#In this study, it revealed that PD-L1 mRNA was highly expressed in OS tissues. Further inhibitory evaluation showed that the K7M2-LV cells (PD-L1 overexpression) co-cultured with PD-1 lymphocytes could promote K7M2 cell proliferation. Meanwhile, the combination of anti-PD-1 antibody and cisplatin significantly decreased the proliferation and increased the apoptosis of K7M2 cells in a co-culture system. In vivo, the combination of anti-PD-1 antibody and cisplatin significantly inhibited tumor growth, while the mechanisms did not involve regulatory T cells.@*CONCLUSION@#The present data suggested that the blocking of PD-1/PD-L1 axis had a positive prognostic value, which can enhance the chemotherapeutic effect of cisplatin in OS. These findings provide a rationale for utilizing PD1/PD-L1 blocking antibodies as a single agent to cure refractory OS in patients receiving cisplatin treatment.
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Objective To investigate the correlation between serum lipoprotein (a) (Lp(a)) level andischemic stroke and its etiological subtypes. Methods The consecutive inpatients with acute ischemic stroke (case group) and age-and sex-matched healthy subjects (control group) over the same period were enrolled retrospectively. The demographic and baseline clinical data, as well as fasting blood glucose, fibrinogen,homocysteine, total cholesterol, triacylglycerol, high-densitylipoprotein cholesterol, low -density lipoprotein cholesterol, and Lp(a) concentration of the case group and the control group were collected. According to TOAST classification criteria, the patients in the case group were divided into large artery atherosclerosis (LAA), small artery occlusion (SAO) and cardioembolism (CE), and the patients with other determined etiology and undetermined etiology were excluded. Multivariate logistic regression analysis was used to make clear the correlation between serum Lp(a) and acute ischemic stroke and its etiological subtypes. Results A total of 214 patients with ischemic stroke were enrolled. Ninety-seven had LAA (45.33%), 64 (29.91%) had SAO, and 53 (24.77%) had CE. There were 118 subjects in the control group. There were significant differences in the proportions of hypertension, diabetes, hyperlipidemia, atrial fibrillation and alcohol consumption, as well as systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol, low -density lipoprotein cholesterol, Lp(a), fibrinogen, and homocysteine between the case group and the control group (all P <0.001). Multivariate logistic regression analysis showed that after adjustment for age and sex, Lp(a) is an independent risk factor for ischemic stroke (odds ratio [OR] 2.014, 95% confidence interval [CI ] 1.273-3.092, P = 0.036). The independent risk factors for LAA included hypertension (OR 3.353, 95% CI 1.714-6.558, P = 0.001), systolic blood pressure ( OR 2.786, 95% CI 1.136-5.538, P =0.016), homocysteine ( OR 1.108, 95% CI 1.031-2.191, P = 0.005), total cholesterol (OR 2.169, 95% CI 1.599-4.943, P = 0.001), low -density lipoprotein cholesterol ( OR2.782, 95% CI 1.093-5.238, P =0.024), and Lp(a) (OR 3.072, 95% CI 1.907-8.064, P =0.001). Theindependent risk factors for SAO included hypertension ( OR 7.042, 95% CI 3.189-25.55, P =0.001), diabetes mellitus (OR 5.162, 95% CI 2.372-11.23, P =0.001), fibrinogen (OR 1.667, 95% CI 1.434-2.025, P = 0.045), and homocysteine (OR 1.967, 95% CI 1.859-1.995, P =0.036). The independent risk factors for CE included atrial fibrillation (OR 13.340, 95% CI 4.637-39.20, P = 0.001), fibrinogen (OR 2.365, 95% CI 1.147- 4.904, P =0.029), and Lp(a) (OR 1.656, 95% CI 1.996-3.001, P = 0.035). Conclusions Lp(a) is an independent risk factor for ischemic stroke, and can be used as a serum biomarker for predicting the risk of the onset of ischemic stroke. There are differences in independent risk factors between the different stroke etiological subtypes. Lp(a) is independently associated with LAA and CE; however, it has no independent correlation with SAO.
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Objective To summarize the relationship between metabolic syndrome (MS),its components and T1 stage with high grade urothelial carcinoma (HGUC) of the Bladder.Methods The clinical data of 200 patients with T1 high grade bladder cancer who were admitted to our hospital from January 2010 to June 2014 were retrospectively analyzed,including 155 males and 45 females.Ages were 24 to 86 years old,average 66 years old.Based on the history or blood glucose levels,patients were divided into diabetic group (n =41) (20.5％) and non diabetes group 159 cases (79.5％);According to the body mass index (BMI) were divided into obese group (≥25 kg / m2) of 98 cases (49.0％) and non obese group (＜ 25 kg / m2) of 102 cases (51.0％).According to the blood pressure level,71 cases (35.5％) were divided into hypertension group and 129 cases of non hypertension group (64.5％).MS and its components and the relationship between the recurrence and progress of bladder cancer were analyzed.The Kaplan Meier method was used to assess MS and its components division of tumor progression free survival (progress-free survival,PFS) and recurrence free survival (recurrence-free survival,RFS) influence.Cox regression model of multi factor analysis were used to evaluate the PFS and RFs of MS and its components with bladder cancer.Results Of the 200 cases,16 cases (8.0％) were MS.Tumor recurrence occurred in 121 cases (60.5％),and 84 patients (42.0％) were in progress.Diabetes and non diabetes groups the average RFs were 21.7 and 29.3 months respectively,and the difference was statistically significant (x2 =10.115,P =0.001);The median PFS were 32.8 and 39.8 months respectively,the difference has statistical significance (x2 =14.760,P ＜0.001).Obese group and non obese group average RFs were 34.7 and 42.0 months respectively,and the difference were statistically significant (x2 =16.077,P ＜ 0.001);The median PFS were 22.8 and 32.6 months respectively,the difference was statistically significant (x2 =16.174,P＜0.001).The average RFS of MS group and non MS group were 21.5 and 28.4 months respectively,the difference was statistically significant (x2 =5.429,P =0.02);the average PFS was 35.1 and 38.7 months respectively,and the difference was statistically significant (x2 =3.854,P ＜ 0.05).Cox multivariate survival analysis showed that diabetes and obesity can increase the risk of recurrence and progression of T1 advanced stage bladder cancer (HR =1.792,P =0.013,HR =2.498,P ＜ 0.001;HR =0.559,P ＜ 0.001;HR =0.492,P ＜ 0.001).Conclusions Diabetes mellitus and obesity are high risk factors for the recurrence and progression of T1 advanced stage bladder cancer,but MS is not related to the prognosis of T1 patients with advanced bladder cancer.
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Objective To analyze the diagnosis,treatment and prognosis of small cell carcinoma of bladder (SCCB) in order to improve the understanding of it.Methods The pathological and clinical data of 5 cases of SCCB were retrospectively analyzed.All patients were male,aged 50 to 78 years (mean age,64 years).Clinical manifestations of 4 cases were gross hematuria,the other case was found by health examination.Ultrasonography results of 3 cases were medium echo tumors,the other 2 cases were hypoecho tumors.The diameter of the tumor was 2.1 to 4.0 cm (mean,3.0 cm).There were 3 patients accepted CT scan.One of them was found of hydronephrosis and multiple pelvic lymph nodes.All patients accepted diagnostic TURBT.Three of them accepted postoperative chemotherapy (1 cycle) without other surgery.Two patients accepted radical cystectomy with postoperative chemotherapy (3 cycles) after bladder tumor biopsy.Results Pathological findings showed that tumor cells were small,round and sheet in arrangement.These hyperchromatic nuclei showed limited cytoplasm with lack of nesting character.Neuron specific enolase,chromogranin A and synaptophysin were positive in immunohistochemistry.The final diagnosis was SCCB'.Two of the three patients who accepted TURBT with postoperative chemotherapy died 7 and 8 months postoperatively,the other one was alive for 32 months.Another two patients who accepted radical cystectomy with postoperative chemotherapy were alive for 16 and 26 months.Conclusions SCCB is a rare tumor which has high malignancy and poor prognosis.Radical cystectomy in combination with postoperative chemotherapy is the main treatment.Retained bladder surgery with chemotherapy is an alternative choice.
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Objective To investigate the relationship between the interleukin-17 (IL-17),interleukin23 (IL-23) and carotid artery sclerosis in patients with cerebral infarction.Methods One hundred and twentyfive cerebral infarction patients in the first affiliated hospital of Shantou University medical college from June 2010 to June 2012 were recruited.All the subjects were examined with carotid ultrasonography.According to the results of carotid ultrasonography,all patients were divided into carotid atherosclerosis group(86 cases) and non carotid atherosclerosis group(39 cases).Patients with carotid atherosclerosis were divided into soft plaque group (35 cases),hard plaque group (21 cases),mixed plaque group (30 cases) based on plaque feature.Carotid atherosclerosis patients with cerebral infarction plaque determined by semi-quantitative method were grouped into Ⅰ grade(29 cases),Ⅱ grade (43 cases),Ⅲ grade (14 cases) according to the severity atherosclerosis.Serum levels of IL-17 and IL-23 were measured.Results The levels of IL-17 and IL-23 in patients with carotid atherosclerosis group were (31.42 ± 8.73) μg/L and(21.79 ± 9.34) μg/L,higher than that of non-carotid atherosclerosis group((22.81 ±6.52) μg/L,t =5.15,P ＜0.01 ; (14.33 ±6.21) μg/L,t =4.99,P ＜0.01).The IL-17 and IL-23 levels in patients with soft plaque,hard plaque and mixed plaque group were significant different (F =10.181,3.835,P ＜0.05).Serum IL-17 in soft plaque and mixed plaque expression group was higher than that of hard plaque group (P =0.001,P=0.007).IL-23 level in soft plaque group was higher than mixed plaque and hard plaque groups(P =0.017;P =0.045).The IL-17 and IL-23 levels in Ⅰ,Ⅱ,Ⅲ level group were markedly different (F =41.046,3.739 ; P ＜ 0.05),and there was significant difference between Ⅱ,Ⅲ and Ⅰ group(P ＜0.01,P ＜0.05).The correlation between IL-17 and IL-23 levels in Ⅰ,Ⅱ,Ⅲ level group were 0.892 and 0.420 (P =0.000 ; P =0.041).Conclusion IL-17 and IL-23 play important roles in the pathologic progress of artery sclerosis and are helpful for early diagnosis of the disease.
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Objective To investigate the imbalance of T helper 17 (Th17) / CD4 + CD25 + regulatory cell (Treg) in HAM/TSP patients.Methods Enzyme linked immunosorbent assay (ELISA) was performed to measure the levels of interleukin (IL-17) and IL-10 in CSF,and flow cytometry to determine the percentage of Th17 and Treg cells in peripheral blood of patients with HAM/TSP.Results There was a significant increase in the level of IL-17 [(4.58 ± 0.70)pg/ml vs (0.76 ± 0.17)pg/ml,P ＜ 0.01] in CSF and the percentage of Th17 cells [(2.00 ± 0.64) ％ vs (0.41 ± 0.24) ％,P ＜ 0.01],but a decrease in the level of IL-10 in CSF and the percentage of Treg cells in peripheral blood of patients with HAM/TSP compared with the control group.The ratio of Th17/Treg cell (0.55 ±0.10 vs 0.06 ±0.03) in the peripheral blood of patients with HAM/TSP increased significantly compared with control group (t =12.11,P ＜0.01).Conclusions The imbalance between Thl7 and Treg cells may play an important role in the pathogenesis of the disease.
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Objective To investigate the clinical feature,diagnosis,treatment and prognosis of endometriosis of the bladder.Methods A retrospective study was conducted to review the clinical data of 10 patients with bladder endometriosis.Patient's age ranged from 30 to 48 years (with mean age of 38 years).Eight cases were admitted to hospital with urinary tract irritating symptoms during the menstrual period and 6 cases with hematuria; 2 patients without any symptoms were found through examination.The course of disease was 1-36 months (with mean of18 months).Ultrasound shows with low echo,single,wide base and no significant blood flow mass whose boundaries are less clear within the bladder wall.CT reveals soft-mass protruding into the bladder.Results Eight of the 10 patients were undergone partial cystectomy.And 2 cases was treated with transurethral resection.All cases were pathologically confirmed to be bladder endometriosis.Recurrence and ectopic lesion had not be found during follow-up period from 10 to 72 months (with mean of 30 ± 5.6 mon).Conclusions Endometriosis is a common disease in females in their reproductive years,but thebladder endometriosis is rare.The initial diagnosis needs to be made combining with imaging studies.It is confirmed by cystoscopy and pathological biopsy.Surgery is the option for the treatment of bladder endometriosis.
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Objective To discuss the indication for kidney-sparing surgery (KSS) on primary urothelial carcinoma of the distal ureter.MethodsClinical data of 108 patients with primary urothelial carcinoma of the distal ureter in our hospital from 2001 to 2009 were analyzed retrospectively.There were 75 males and 33 females with mean age of 62 ( range from 42 to 85 ) years old in this study.The patients were divided into KSS group and RNU group according to the operation methods.The recurrence rate of radical nephroureterectomy (RNU) and KSS were evaluated.Results The recurrence was seen none with T,stage,1 (12.5％) with T1 stage,4 (36.4％) with T2 stage and 4 (80％) with T3 stage in KSS group.In RNU group,there was none with Ta stage,4 ( 15.4％ ) with T1 stage,10 (33.3％) with T2 stage and 7 (36.8％) with T3 stage recurred.There was no difference between patients with Ta to T2 stages in KSS and RNU group (P ＞0.05 ) on recurrence,but there was a significant difference between patients with T3 stage (P＜0.05).There was 1 (33.3％) case with G1 grade,3 (18.8％) with G2 grade and 5 (62.5％) with G3 grade recurred in KSS group,while 2 (22.2％) cases with G1 grade,9 (20％) with G2 grade and 10 (37.0％) with G3 grade recurred in RNU group.There was no difference between patients with G1 to G2 grades in KSS and RNU group (P＞0.05),but there was a significant difference between patients with G3 stage in the two groups ( P ＜ 0.05 ).Conclusion KSS seems to be safe for patients with low stage and low grade primary urothelial carcinoma of the distal ureter.
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ObjectiveTo discuss the diagnostic value of MRI in female patients with stress urinary incontinence (SUI).Methods All SUI patients underwent pelvic MRI examination.The 16 patients mean age was 58 years (range,48 -66 years),disease course was 6 years (range,2 -15 years).All patients underwent transobturator tension-free tape (TOT) procedures.The 28 volunteers with no pelvic diseases were set as control,Mean age was 45 years (range,30 -55 years).Results28 Volunteers' urethral support ligaments appeared as low signal intensity broad linear structures in both T1 WI and T2WI images.Display rate:periurethral ligament was 89％ (25 cases) ; paraurethral ligament was 75％ (21 cases),unilateral 25％ (7 cases) ; pubourethral ligament,in each distal 100％ (near,28 cases),10％(medium,3 cases),7％ (distal,2 cases); suburethral ligament was 100％(28 cases). Levator ani muscle in T1WI,T2WI showed Moderate- intensity signal and the display rate was 100％.16 SUI patients showed varyious degrees of laxity and rupture of urethral supporting ligaments which occurred in one group (4 cases) or multi-group (12 cases) ligaments.The ligament laxity showed that periurethral ligament 14 cases,paraurethral ligament 2 cases and proximal pubourethral ligament 10 cases.The ligament rupture was seen in periurethral ligament 2 cases,paraurethral ligament 5 cases,pubourethral ligament 6 cases and suburethral ligament 7 cases.16 patients showed a relaxation of the levator ani muscle changes,including 4 cases with cervical and vaginal wall prolapsed.Conclusions MRI could clearly show the weak of support structures around the urethra in female SUI patients,and showed the cervical and vaginal prolapsed.Therefore,MRI may provide imaging evidence for clinical diagnosis and treatment.
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ObjectiveTo examine the effects of temsirolimus, an inhibitor of mammalian target of rapamycin, on bladder cancer cell lines T24 and BIU-87 in vitro and in vivo for purpose of evaluating the probability of mTOR targeted therapy for bladder cancer.MethodsAfter being treated by a different concentration of temsirolimus, T24 and BIU-87 cells were tested by MTT assay for cell proliferation activity.Cell cycle and apoptosis analysis were performed with flow cytometer. Wound scratch assay was used for cell migration activity and transwell motility assay. Western blot analysis was used to test the mTOR phosphorylation. Subcutaneous inoculation of 6-week-old nude mice was performed using 1 × 106 T24 cells in 50％ matrigel for both control (n = 10) and temsirolimus (n = 10) groups. The volume of tumors was examined and then the expression of Ki-67 was detected by immunohistochemistry.ResultsTemsirolimus significantly inhibited proliferation of T24 and BIU-87 cells in a dose- and time-dependent manner. After administration of temsirolimus on T24 and BIU-87 cell lines for 24 h, the rate of wound healing in 0 nmol/L groups were (88.9 ± 14. 1 ) ％ and ( 83.6 ± 16.3)％ , which were higher than in the 5 nmol/L groups, which were (42.7 ± 11.6) ％ and ( 36.9 ± 9.7 ) ％ ( P ＜ 0.05 ). In the transwell motility assay, the number of cells in the 0 nmol/L group was 26.5 ± 5.8 and 28.2 ± 4.6, which was higher than in the 5 nmol/L group ( 19.0 ±3. 8 and 21.3 ± 5.1, respectively) (P ＜ 0. 05). When temsirolimus was administered on T24 and BIU-87 cell lines for 48 h the percentages of cells delayed in phase G0/G1 in 5 nmol/L group were ( 77.46 ±6.11)％ and (73. 39 ± 4. 94)％ respectively, and higher than in the 0 nmol/L group, which were (65.99 ±5.01 )％ 、(60.15 ±3.98)％ (P ＜0.05). There was no statistically significant difference in the apoptosis rate between the two groups (P ＞ 0.05 ). In Western blot analysis, the ratios of p-mTOR/β-actin were 0.92 ±0.09 and 1.01 ± 0.08 in 0 nmol/L group, and higher than in the 5 nmol/L group (0.47 ±0.05、0.04 ±0. 01 ) (P ＜ 0.05 ). After administration of temsirolimus for 21 days, the tumor volume in nude mice in the control group were 351.1 ± 139.9 mm3 , which was larger than 351.1 ± 139.9 mm3 in the temsirolimus group ( P ＜ 0.05 ). The positive rate of Ki-67 expression was ( 67.3 ± 8.4 ) ％ in the control group, which was higher than in the temsirolimus group ( 35.5 ± 6.7 ) ％ ( P ＜ 0.05 ).ConclusionsThis study provides in vitro and in vivo evidence that temsirolimus may inhibit the viability of bladder cancer cells and temsirolimus could be exploited as a potential therapeutic strategy in bladder cancer.