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1.
Chinese Medical Journal ; (24): 1166-1174, 2020.
Article in English | WPRIM | ID: wpr-827631

ABSTRACT

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.

2.
Chinese Medical Journal ; (24): 1780-1787, 2019.
Article in English | WPRIM | ID: wpr-802697

ABSTRACT

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.

3.
Chinese Medical Journal ; (24): 928-934, 2019.
Article in English | WPRIM | ID: wpr-772174

ABSTRACT

BACKGROUND@#Positive surgical margins are independent risk factor for biochemical recurrence, local recurrence, and distant metastasis after radical prostatectomy. However, limited predictive tools are available. This study aimed to develop and validate a preoperative nomogram for predicting positive surgical margins after laparoscopic radical prostatectomy (LRP).@*METHODS@#From January 2010 to March 2016, a total of 418 patients who underwent LRP without receiving neoadjuvant therapy at Peking University Third Hospital were retrospectively involved in this study. Clinical and pathological results of each patient were collected for further analysis. Univariable and multivariable logistic regression (backward stepwise method) were used for the nomogram development. The concordance index (CI), calibration curve analysis and decision curve analysis were used to evaluate the performance of our model.@*RESULTS@#Of 418 patients involved in this study, 142 patients (34.0%) had a positive surgical margin on final pathology. Based on the backward selection, four variables were included in the final multivariable regression model, including the percentage of positive cores in preoperative biopsy, clinical stage, free prostate specific antigen (fPSA)/total PSA (tPSA), and age. A nomogram was developed using these four variables. The concordance index (C-index) of the nomogram was 0.722 in the development cohort and 0.700 in the bootstrap validations. The bias-corrected calibration plot showed a limited departure from the ideal line with a mean absolute error of 2.0%. In decision curve analyses, the nomogram showed net benefits in the range from 0.2 to 0.7.@*CONCLUSION@#A nomogram to predict positive surgical margins after LRP was developed and validated, which could help urologists plan surgical procedures.


Subject(s)
Aged , Humans , Laparoscopy , Methods , Male , Margins of Excision , Middle Aged , Nomograms , Prostatectomy , Methods , Prostatic Neoplasms , General Surgery , ROC Curve , Retrospective Studies
4.
Chinese Medical Journal ; (24): 1780-1787, 2019.
Article in English | WPRIM | ID: wpr-771149

ABSTRACT

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.

5.
Chinese Medical Journal ; (24): 956-962, 2015.
Article in English | WPRIM | ID: wpr-350372

ABSTRACT

<p><b>BACKGROUND</b>Phloroglucinol plays an important role in oxidative stress and inflammatory responses. The effects of phloroglucinol have been proven in various disease models. The aim of the present study was to investigate the efficacy and possible mechanisms of phloroglucinol in the treatment of interstitial cystitis (IC).</p><p><b>METHODS</b>Thirty-two female Sprague-Dawley (SD) rats were used in this study. IC was induced by intraperitoneal injection of cyclophosphamide (CYP). Rats were randomly allocated to one of four groups (n = 8 per group): A control group, which was injected with saline (75 mg/kg; i.p.) instead of CYP on days 1, 4, and 7; a chronic IC group, which was injected with CYP (75 mg/kg; i.p.) on days 1, 4, and 7; a high-dose (30 mg/kg) phloroglucinol-treated group; and a low-dose (15 mg/kg) phloroglucinol-treated group. On day 8, the rats in each group underwent cystometrography (CMG), and the bladders were examined for evidence of oxidative stress and inflammation. Statistical analysis was performed by analysis of variance (ANOVA) followed by least square difference multiple comparison post-hoc test.</p><p><b>RESULTS</b>Histological evaluation showed that bladder inflammation in CYP-treated rats was suppressed by phloroglucinol. CMG revealed that the CYP treatment induced overactive bladder in rats that was reversed by phloroglucinol. Up-regulated tumor necrosis factor-α and interleukin-6 expression in the CYP-treated rats were also suppressed in the phloroglucinol treated rats. CYP treatment significantly increased myeloperoxidase activity as well as the decreased activities of catalase of the bladder, which was reversed by treatment with phloroglucinol.</p><p><b>CONCLUSIONS</b>The application of phloroglucinol suppressed oxidative stress, inflammation, and overactivity in the bladder. This may provide a new treatment strategy for IC.</p>


Subject(s)
Animals , Cyclophosphamide , Toxicity , Cystitis, Interstitial , Drug Therapy , Female , Inflammation , Drug Therapy , Oxidative Stress , Phloroglucinol , Therapeutic Uses , Rats , Rats, Sprague-Dawley , Urinary Bladder , Pathology
6.
Chinese Medical Journal ; (24): 2810-2814, 2013.
Article in English | WPRIM | ID: wpr-263578

ABSTRACT

<p><b>BACKGROUND</b>Living donor kidney transplantation is becoming popular in China, whereas, in clinical situations, some kidney donors may be sub-optimal, namely marginal living donor. The present study aimed to evaluate the safety and efficacy of marginal living donor kidney transplantation in a Chinese single center.</p><p><b>METHODS</b>Between January 2001 and December 2009, 888 kidney transplantations were performed in our center; 149 were living donor kidney transplantations. The living donors and recipients were followed up regularly after the operation. Of the living donors, 30 donors were marginal, who were older than 60 years or suffered from kidney anomaly or some benign diseases. Among the non-marginal living kidney transplantations, 58 donors and recipients had complete perioperative and follow-up data. We compared the marginal and non-marginal living donor kidney transplantations with regard to donor age, follow-up period, donor's serum creatinine at the last follow-up, recipient's serum creatinine at the last follow-up, and graft survival at the last follow-up.</p><p><b>RESULTS</b>The mean age of donors in the marginal and non-marginal living donors were (55 ± 9) (37-66) and (43 ± 12) (30-59) years. The mean follow-up times of the marginal and non-marginal groups were (26.4 ± 13.4) months and (28.8 ± 14.8) months. The donor and recipient serum creatinine levels at the last follow-up were (1.16 ± 0.20) mg/dl and (1.30 ± 0.24) mg/dl in the marginal group, and (1.12 ± 0.32) mg/dl and (1.34 ± 0.32) mg/dl in the non-marginal group. Three recipients in the marginal group and five recipients in the non-marginal group had acute rejection episodes during the first year. Actuarial 3-year graft survival was 96.7% in the marginal group and 100% in the non-marginal group. No significant differences were detected between the two groups with regard to these data.</p><p><b>CONCLUSION</b>Utilization of highly selective marginal living donors can be a safe, feasible, and effective way for the treatment of patients with end stage renal disease.</p>


Subject(s)
Adult , Aged , Creatinine , Blood , Donor Selection , Graft Survival , Humans , Kidney Transplantation , Living Donors , Middle Aged , Retrospective Studies , Treatment Outcome
7.
Chinese Medical Journal ; (24): 1003-1008, 2009.
Article in English | WPRIM | ID: wpr-279792

ABSTRACT

<p><b>BACKGROUND</b>Neurocysticercosis is the infection of the nervous system by the larvae of Taenia solium (T. solium). Despite continuous effort, the experimental diagnosis of neurocysticercosis remains unresolved. Since the cerebrospinal fluid (CSF) contacts with the brain, dynamic information about pathological processes of the brain is likely to be reflected in CSF. Therefore, CSF may serve as a rich source of putative biomarkers related to neurocysticercosis. Comparative proteomic analysis of CSF of neurocysticercosis patients and control subjects may find differentially expressed proteins.</p><p><b>METHODS</b>Two-dimensional difference in gel electrophoresis (2D-DIGE) was used to investigate differentially expressed proteins in CSF of patients with neurocysticercosis by comparing the protein profile of CSF from neurocysticercosis patients with that from control subjects. The differentially expressed spots/proteins were recognized with matrix-assisted laser desorption/ionization-time of flight-time of flight (MALDI-TOF-TOF) mass spectrometry.</p><p><b>RESULTS</b>Forty-four enzyme digested peptides were obtained from 4 neurocysticercotic patients. Twenty-three were identified through search of the NCBI protein database with Mascot software, showing 19 up-expressed and 4 down-expressed. Of these proteins, 26S proteosome related to ATP- and ubiquitin-dependent degradation of proteins and lipocalin type prostaglandin D synthase involved in PGD2-synthesis and extracellular transporter activities were up-expressed, while transferrin related to iron metabolism within the brain was down-expressed.</p><p><b>CONCLUSIONS</b>This study established the proteomic profile of pooled CSF from 4 patients with neurocysticercosis, suggesting the potential value of proteomic analysis for the study of candidate biomarkers involved in the diagnosis or pathogenesis of neurocysticercosis.</p>


Subject(s)
Cerebrospinal Fluid , Metabolism , Electrophoresis, Gel, Two-Dimensional , Female , Gene Expression Regulation, Neoplastic , Physiology , Humans , Male , Neurocysticercosis , Metabolism , Proteome , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
8.
Chinese Journal of Surgery ; (12): 1882-1884, 2008.
Article in Chinese | WPRIM | ID: wpr-275927

ABSTRACT

<p><b>OBJECTIVE</b>To present the clinical results of 51 patients of clinically localized prostate cancer treated by laparoscopic radical prostatectomy, especially recovery of urinary continence. To analysis how to improve recovery of urinary continence.</p><p><b>METHODS</b>From February 2004 to March 2008, we performed LRP on 51 patients. All patients were diagnosed by pathological result preoperatively. T1a-1b 4 cases (8%), T1c 15 cases (29%), T2a 7 cases (14%), T2b 5 cases (10%), T2c 20 cases (39%).</p><p><b>RESULTS</b>Forty-nine cases were treated by LRP successfully. There were two cases converted to open surgery. Urine leaking happened in 3 cases, but recovered without intervention. Urinary catheter duration was 14 - 45 days (mean 16 days). Six months and 12 months after LRP, incontinence happened 7/39 cases (17.9%) and 5/20 cases (25%) respectively. Complete incontinence happened in one case. The ratio of incontinence happened in the first 20 cases and the following 31 cases were 6/20 (30%) and 7/31 (22%) respectively. There were two cases had rectal injury. Both cases underwent colostomy. Duration of follow up were from 3 - 53 months (mean 17 months). Two cases recurred. One of them was treated with hormone therapy, the other one died of operation for lung metastasis. Other patients' serum total PSA were less than 0.2 microg/L.</p><p><b>CONCLUSIONS</b>Extraperitoneal laparoscopic radical prostatectomy is efficient and safe approach for localized prostate cancer. The correct handling of pubic prostatic ligaments, external urethral sphincter and neurovascular bundle are important for recovery of urinary continence. And so does the experience of LRP.</p>


Subject(s)
Aged , Aged, 80 and over , Follow-Up Studies , Humans , Laparoscopy , Male , Middle Aged , Postoperative Complications , Prostatectomy , Methods , Prostatic Neoplasms , General Surgery , Retrospective Studies , Urinary Incontinence
9.
Chinese Journal of Hepatology ; (12): 266-268, 2002.
Article in Chinese | WPRIM | ID: wpr-334232

ABSTRACT

<p><b>OBJECTIVE</b>To screen HCV NS5 mimotopes by using monoclonal antibody and phage peptide library.</p><p><b>METHODS</b>By using HCV NS5 monoclonal antibody as selective molecule, a 7 peptide phage library was biopanned and positive clones were selected by ELISA, competition assay and DNA sequencing.</p><p><b>RESULTS</b>Twelve positive clones were chosen for DNA sequencing. From the experiment and sequencing comparison results, one epitope was confirmed as the mimotope of HCV NS5.</p><p><b>CONCLUSIONS</b>HCV mimotope is obtained by phage peptide library screening. The result provides a new approach for HCV therapy and vaccine development.</p>


Subject(s)
Amino Acid Sequence , Antibodies, Monoclonal , Allergy and Immunology , Enzyme-Linked Immunosorbent Assay , Epitope Mapping , Hepatitis C , Therapeutics , Peptide Library , Viral Nonstructural Proteins , Chemistry , Genetics , Allergy and Immunology , Viral Vaccines , Allergy and Immunology
10.
Article in Chinese | WPRIM | ID: wpr-676030

ABSTRACT

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.

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