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1.
Chinese Journal of Urology ; (12): 566-570, 2021.
Article in Chinese | WPRIM | ID: wpr-911073

ABSTRACT

Objective:To disiuss the application of liver free technique in renal cell carcinoma patients with Mayo Ⅱ-Ⅳ tumor thrombus.Methods:The clinical data of renal cell carcinoma patients with MayoⅡ-Ⅳ IVC tumor thrombus in our hospital from January 2014 to December 2019 were retrospectively analyzed. 25 patients underwent right part of liver or hepatic portal part dissection via open abdominal approach. There were 20 males and 5 females, aged 45-74 years (mean 61±6 years). All patients underwent urinary tract CTU or MRU examination, vena cava enhanced magnetic resonance angiography.There were left 8 cases, right 17 cases; the median length of tumor was 7 cm (3.6-12.1 cm). There were 1 case of Mayo grade Ⅱ tumor thrombus, 7 cases of Mayo grade Ⅲ tumor thrombus, and 17 cases of Mayo grade Ⅳ tumor thrombus. There were 7 cases of distant metastasis, including 6 cases of lung metastasis and 1 case of bone metastasis. After multi-disciplinary consultation (MDT), 19 patients underwent radical nephrectomy and 6 patients underwent tumor reducing nephrectomy. During the operation, the ligaments around the liver were completely dissociated and the space between the liver and kidney was opened. The bare area of the liver was fully dissociated, to expose the inferior vena cava. For Mayo grade Ⅳ tumor thrombus, 11 cases were treated with free diaphragmatic thrombus removal without thoracotomy, and 6 cases were treated with open chest cardiopulmonary bypass.Results:The median operation time was 444(258-694)min, the median intraoperative blood loss was 2 000(250-10 000)ml, and the median value of suspended red blood cell transfusion was 1 300(400-10 400)ml. The median postoperative hospital stay was 10(4-25)days.15 patients (60%) had postoperative complications, including 8 cases of liver injury, 5 cases of respiratory complications, 4 cases of kidney injury, 3 cases of anemia, 3 cases of infection and 1 case of thrombosis. Three patients died during perioperative period.Conclusions:The application of total liver free technique might obtain good exposure of surgical field, effectively control the hemorrhage of inferior vena cava, which is helpful for safe resection of tumor.

2.
Asian Journal of Andrology ; (6): 103-108, 2021.
Article in English | WPRIM | ID: wpr-879715

ABSTRACT

We aimed to confirm the predictive ability of the presence of intraductal carcinoma of the prostate (IDC-P) for prognosis and the associations between IDC-P and clinicopathological parameters. Studies were identified in PubMed, Cochrane Library, EMBASE, Web of Science, and SCOPUS up to December 1, 2019. Hazard ratios (HRs) for survival data and odds ratios for clinicopathological data with 95% confidence intervals (CIs) were extracted. Heterogeneity was evaluated by the I

3.
Chinese Medical Journal ; (24): 2647-2655, 2021.
Article in English | WPRIM | ID: wpr-921147

ABSTRACT

Cell death occurs in various tissues and organs in the body. It is a physiological or pathological process that has different effects. It is of great significance in maintaining the morphological function of cells and clearing abnormal cells. Pyroptosis, apoptosis, and necrosis are all modes of cell death that have been studied extensively by many experts and scholars, including studies on their effects on the liver, kidney, the heart, other organs, and even the whole body. The heart, as the most important organ of the body, should be a particular focus. This review summarizes the mechanisms underlying the various cell death modes and the relationship between the various mechanisms and heart diseases. The current research status for heart therapy is discussed from the perspective of pathogenesis.


Subject(s)
Apoptosis , Autophagy , Cardiovascular Diseases , Humans , Necrosis , Pyroptosis
4.
Chinese Journal of Urology ; (12): 497-502, 2020.
Article in Chinese | WPRIM | ID: wpr-869702

ABSTRACT

Objective:To explore the value of preoperative aspartate transaminase(AST) and aspartate transaminase/alanine transaminase ratio(AST/ALT)for predicting the prognosis in patients with non-metastatic renal cell carcinoma with tumor thrombus.Methods:A retrospective analysis was made of the patients with renal cell carcinoma with tumor thrombus in our institution from February 2015 to December 2018. This study included 80 patients, 56 males and 24 females with mean age of 58 years (range 15-83 years). There were 17 in Mayo level 0, 24 Mayo level I, 22 in Mayo level II, 12 in Mayo level III and 5 in Mayo level IV. All the patients received radical nephrectomy or palliative nephrectomy with tumor thrombectomy. The continuous variable of AST/ALT was collected by ROC curve. The maximum value of Youden index was taken as the critical value, and the continuous variables were adjusted to binary variables. Cancer-specific survival (CSS) was calculated according to the Kaplan-Meier analysis and compared by the log-rank test. Cox multivariate regression analysis was used to analyze the independent factors of the prognosis of patients with non-metastatic renal cancer and tumor thrombus.Results:There were 70 cases of clear cell carcinoma, 10 cases of non-clear cell carcinoma, 30 cases of low Fuhrman grade (grade 1&2), and 50 cases of high Fuhrman grade (grade 3&4). AST was 19U/L (8-226 U/L) and AST/ALT was 1.3(0.4-3.3). There was a significant difference in AST between different lymphovascular invasion groups ( P=0.04), but there was no significant difference in sex, age, Mayo classification, pathological type, Fuhrman grade and lymph node metastasis. The difference of AST / ALT between age groups was significant ( P=0.025). The average follow-up time was 14.7 months (0-44 months). During the follow-up, 11 (13.8%) patients died of tumor. Univariate analysis showed that Fuhrman grade ( P=0.007), lymph node metastasis ( P=0.019), hemoglobin ( P=0.001), alkaline phosphatase (ALP, P=0.001), AST ( P=0.004) and AST / ALT ( P=0.038) were risk factors for CSS. In terms of prognosis, considering the potential correlation between AST level and AST/ALT ratio, after excluding AST, multivariate Cox regression analysis showed that high nuclear grade ( HR=3.049, 95% CI 1.292-7.196, P=0.011), high ALP ( HR=1.018, 95% CI 1.007-1.029, P=0.001) and high AST/ALT ratio ( HR=4.094, 95% CI 1.064-15.759, P=0.04) were associated with poor CSS. After excluding AST/ALT ratio, multivariate Cox regression analysis showed that high nuclear grade ( HR=5.836, 95% CI 1.867-18.240, P=0.002) and high AST ( HR=1.040, 95% CI 1.017-1.062, P<0.001) were associated with poor CSS. Conclusions:In patients with non-metastatic renal cell carcinoma with tumor thrombus, high AST/ALT ratio and AST levels indicate poor pathological types and poor prognosis.

5.
Chinese Journal of Urology ; (12): 415-420, 2020.
Article in Chinese | WPRIM | ID: wpr-869682

ABSTRACT

Objective:To investigate the safety and effectiveness of cytoreductive nephrectomy and tumor thrombectomy in patients with metastatic renal cancer with renal vein or inferior vena cava tumor thrombus.Methods:From February 2015 to May 2019, 56 cases of metastatic renal cell carcinoma with venous tumor thrombus were analyzed retrospectively, including 44 male (78.6%) and 12 female (21.4%)cases, and the average age was (59.2±10.7)(22-82). The clinical presentations covered local symptoms in 26 cases (46.4%), systemic symptoms in 8 cases (14.3%), both local symptoms and systemic symptoms in 12 cases (21.4%), and asymptomatic in 10 cases (17.9%). Among them, renal tumors were located in 35 cases (62.5%) on the right and 21 cases (37.5%) on the left. The average tumor diameter was (10.1±3.8)(1.5-21.1) cm. Forty-five cases (80.4%) scored 2 points and 11 cases (19.6%) scored 3 points by the American Society of anesthesiologists(ASA). Preoperative hemoglobin was (118.2±23.1)(72-178) g/L, and albumin was (37.9±5.6)(23-50) g/L, total protein was (67.7±6.7)(43-81) g/L, serum creatinine was (111.3±119.6)(32-958) μmol/L. There were 16 cases of Mayo 0 (28.6%), 14 cases of Mayo Ⅰ(25.0%), 17 cases of Mayo Ⅱ(30.4%), 4 cases of Mayo Ⅲ(7.1%), and 5 cases of Mayo Ⅳ(8.9%). Fourteen cases (25.0%) were in the stage of cN 0 and 42 cases (75.0%) in the stage of cN 1. Five cases (8.9%) had simple bone metastasis, 16 cases (28.6%) had simple lung metastasis, 2 cases (3.6%) had simple adrenal metastasis, 6 cases (10.7%) had simple liver metastasis, and 27 cases (48.2%) had 2 or more multiple system metastasis. According to the location of the organ system, 91 metastatic lesions were found in 56 patients. Among them, 37 cases (40.7%) had lung metastasis, 18 cases (19.8%) had liver metastasis, 21 cases (23.1%) had bone metastasis and 15 cases (16.5%) had adrenal metastasis. All 56 patients belonged to IMDC prognosis score model medium risk group. The surgical treatment of Mayo grade 0 tumor thrombus was the same as that of routine radical nephrectomy. The tumor thrombus of Mayo grade Ⅰ was removed after IVC was partially blocked by Satinsky′s forceps. The Mayo Ⅱ tumor thrombus was removed, after blocking the distal vena cava, the contralateral renal vein and the proximal vena cava. Mayo grade Ⅲ tumor thrombus needed pringer's method to block the first porta hepatis. For grade Ⅳ tumor thrombus the diaphragm could be cut directly, or the thrombus could be removed by cardiopulmonary bypass. Laparoscopic surgery was performed in 22 cases (39.3%) and open surgery in 30 cases (53.6%). Six cases (10.7%) underwent IVC wall resection because of tumor invasion. 32 cases (57.1%) underwent ipsilateral adrenalectomy because of tumor invasion or adrenal metastasis, and 23 cases (41.1%) underwent ipsilateral lymphadenectomy. In this study, there were 11 cases of solitary metastasis, 8 cases of which were operated on and 3 cases of which were not operated on. Forty-three patients were treated with sunitinib after palliative nephrectomy, 9 patients were treated with pazopanib, 3 patients were treated with acitinib, and 1 patient was treated with sorafenib. Results:The operations were successfully completed in 56 patients. Four cases (7.1%) changed from laparoscopic surgery to open surgery. The operation time was (326.8±114.9)(108-589) min. Intraoperative hemorrhage was (1 435.2±1 513.4)(20-6 000) ml, intraoperative red blood cells transfusion was (1 456.7±832.8)(400-3 600) ml in 30 cases, and intraoperative plasma transfusion was (700.0±473.6)(200-1 800) ml in 15 cases. The postoperative hospital stay was (10.6±4.6)(5-26) days. The serum creatinine one week after operation was (109.5±98.7) (47-772) μmol/L. There were 46 cases (82.1%) of renal clear cell carcinoma, 7 cases (12.5%) of papillary renal cell carcinoma and 3 cases (5.4%) of unclassified renal cell carcinoma. One case was WHO/ISUP 2016 nuclear grade 1 (1.8%), 20 cases(36.4%) was grade 2, 18 cases(32.7%)was grade 3, and 16 cases(29.1%)was grade 4. Early postoperative complications occurred in 22 cases (39.3%). Among them, 1 case of Clavien gradeⅠ was wound infection. There were 16 cases with Clavien gradeⅡ, including 5 cases who received blood transfusion due to anemia, 3 cases with chylous fistula, 4 cases with postoperative pulmonary infection, 2 cases with postoperative lower extremity venous thrombosis, 1 case with atrial fibrillation and 1 case with epididymitis. Clavien gradeⅢ a was found in 1 case with pneumothorax. Clavien gradeⅣ was found in 2 cases, including 1 case of acute cerebral infarction and 1 case of renal insufficiency.There were 2 cases with Clavien gradeⅤ with perioperative death. Among the 56 patients, 5 lost the follow-up, 2 died during the perioperative period, and the other 49 patients were followed up for 1-39 months, with a median follow-up of 14 months. The mean survival time was (25.6±2.5) months, and the median survival time was 25 months.Conclusions:It was relatively safe and effective to perform cytoreductive nephrectomy and tumor thrombectomy in patients with metastatic renal cancer with tumor thrombus. For the patients with clinical symptoms, IMDC prognosis score model medium risk group, and strong desire for surgery, the combination of cytoreductive nephrectomy with tumor thrombectomy and postoperative targeted medical therapy was recommended.

6.
Chinese Journal of Urology ; (12): 474-476, 2020.
Article in Chinese | WPRIM | ID: wpr-869674

ABSTRACT

The prognosis of metastatic renal cell carcinoma is relatively poor. With the development of molecular biology, the treatment of metastatic renal cell carcinoma is undergoing a transformation from cytokine therapy to targeted molecular therapy or immunotherapy, and the prognosis has been improved. This study summarized and discussed the treatment progress of metastatic renal cell carcinoma.

7.
Article in Chinese | WPRIM | ID: wpr-868772

ABSTRACT

Objective To study protective and therapeutic measures to improve perioperative safety in extremely elderly patients with biliary diseases.Methods A retrospective case-control study was conducted.The clinical data of elderly patients with biliary diseases treated at the Department of General Surgery,Beijing Electric Power Hospital,from July 2013 to December 2018,were collected.According to age,the patients were divided into the high age (HA) group (≥80.0 years) and the middle-low age (MLA) group (60.0~79.0 years).The related indexes of perioperative safety such as preoperative coexisting diseases,functions of liver,kidney,heart and lung,surgical procedures,intraoperative blood loss,operation time,postoperative hospital stay and postoperative hospital stay were analyzed and compared between the two groups.Results Of the 372 included patients,there were 168 males and 204 females,aged 60.0 to 96.0 (72.0 ± 8.6) years.There were 69 elderly patients (37 males and 32 females) aged 80.0 to 96.0 (84.4 ±3.8) years in the HA group.There were 303 patients in the middle and lower age group (131 men and 172 women),aged 60.0 to 79.0(68.4 ±5.8) years (MLA group).(1) Preoperative coexisting diseases were significantly increased in the HA compared with the MLA group (all P < 0.05),including the proportion of coexisting coronary heart disease [34.8% (24/69) vs.18.5% (56/303)],hypertension [68.1% (47/69)vs.46.9% (142/303)],chronic bronchitis with emphysema [17.4% (12/69) vs.3.6% (11/303)],hypoproteinemia [39.1% (27/69) vs.26.7% (81/303)],and anemia [42.0% (29/69) vs.11.9% (36/303)].(2) Laboratory examinations:the functions of liver,kidney,heart,lung and blood coagulation were significantly worse in the HA compared with the MLA group (P < 0.05).(3) Surgical procedures:the proportion of open cholecystectomy with transcystic common bile duct exploration (OC + OTCBDE) was higher [17.4% (12/69) vs.6.9% (21/303)],while laparoscopic cholecystectomy (LC) was lower [43.5% (30/69) vs.62.7% (190/303)],in the HA compared with the MLA group (P <0.05,totally).(4) Operative effects:the intraoperative blood loss [30.0 (20.0,75.0) ml vs.20.0 (10.0,30.0) ml],operation time [90.0(72.5,137.5) min vs.77.0(55.0,115.0) min],postoperative hospital stay [10.0(6.0,18.0) d vs.7.0(4.0,11.0) d],and length of hospitalization [17.0(11.5,23.0) d vs.13.0(9.0,19.0) d] were significantly increased or prolonged in the HA compared with the MLA group (all P <0.05).(5) Postoperative complications:the incidence of postoperative complications was significantly higher [30.4% (21/69) vs.12.2% (37/303)] in the HA compared with the MLA group (P < 0.05).(6) Therapeutic outcomes:there was a cure rate of 95.7% (66/69) in the HA group,and 97.7% (296/303)in the MLA group.No significant difference in the therapeutic effects was found between the two groups (P > 0.05).Conclusions Operation in extremely elderly patients with biliary diseases is safe and feasible.The key is to take measures such as actively treating preoperative coexisting diseases,strictly mastering operative indications,reasonably selecting surgical procedures,accurately carrying out precise operation,strictly monitoring and dealing with intraoperative emergency,timely preventing and treating postoperative complications,and especially focusing on maintaining cardiopulmonary function during the perioperative period.

8.
Article in Chinese | WPRIM | ID: wpr-863110

ABSTRACT

Objective:To investigate the clinical and imaging characteristics of deep cerebral vein thrombosis (DCVT).Methods:From December 2006 to December 2019, patients with DCVT admitted to Nanjing Drum Tower Hospital were enrolled retrospectively. The clinical manifestations, imaging examinations, treatment and prognosis of the patients were analyzed.Results:A total of 11 patients with DCVT were enrolled in the study, including 4 females and 7 males. Their average age of onset was 41.6 years. Their most common clinical manifestations were acute or subacute onset headache (11/11, 100%), disturbance of consciousness (5/11, 45.5%), and seizures (4/11, 36.4%). All 11 patients involved straight sinus, 9 involved the great cerebral vein, 5 involved the internal cerebral vein, and 1 involved the basilar vein. All patients were complicated with other venous sinus thrombosis, and 3 were complicated with superficial cortical venous thrombosis. Early CT plain scan (within 1 week of onset) of 8 patients (72.3%) showed high-density point sign of great cerebral vein or cord sign of straight sinus. Head MRI showed that 90.9% (10/11) of patients had brain parenchymal damage, thalamic involvement (5/11, 45.5%) was the most common, followed by deep white matter (4/11, 36.4%). One patient received urokinase interventional thrombolysis and died on the 6 th day of onset. The remaining 10 patients improved after receiving anticoagulant therapy. Follow up of 4 months to 13 years showed that 4 patients left with mild to moderate disability (the modified Rankin scale score 1-3), and 6 returned to normal. Conclusions:Headache, disturbance of consciousness and seizures are common clinical manifestations of DCVT. Imaging examination shows that the possibility of DCVT should be warned when the thalamus or deep white matter is involved. It is necessary to pay attention to the high-density thrombus spot sign and cord sign on early CT plain scan. DCVT patients with cortical venous thrombosis progressed rapidly in the acute phase, and the outcomes were poor.

9.
Article in Chinese | WPRIM | ID: wpr-863077

ABSTRACT

Objective:To investigate the clinical and imaging characteristics of isolated cortical vein thrombosis (ICVT) in order to improve the understanding of this rare disease.Methods:From December 2013 to September 2019, patients with ICVT admitted to Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were collected retrospectively. Their clinical manifestations, imaging examination, treatment and prognosis were analyzed.Results:A total of 6 patients with ICVT were enrolled in the study, including 3 males and 3 females, with an average age of 37 years. The main clinical manifestations were acute seizures (5/6, 83.3%), focal neurological deficits (3/6, 50.0%), and headache (3/6, 50.0%). In the imaging examination, the direct signs of ICVT were spot sign and cord sign, and the indirect signs were cerebral lobe hemorrhage, infarction, or edema.Conclusions:Seizures, focal neurological deficits and headaches are common manifestations of ICVT. Multimodality imaging examinations are helpful for early diagnosis of the disease.

10.
Article in Chinese | WPRIM | ID: wpr-870639

ABSTRACT

Ten patients with allergic granulomatosis with polyangiitis (AGPA) were admitted in Nanjing Drum Tower Hospital during January 2013 to August 2019, among whom 5 cases with neurologic involvement. The clinical features, laboratory findings and clinical outcome of the 5 patients were analyzed and literature review was performed. Among 5 cases of AGPA with neurologic involvement, 3 presented with peripheral neuropathy as the initial symptom, 2 had multiple mononeuropathy, 3 had distal asymmetric or symmetric polyneuropathy. All five patients had acute or subacute onset, and the symptoms of limb numbness or pain were prominent. Electrophysiological examination showed that sensory and motor conduction amplitude significantly decreased or disappeared. Eight of the 10 AGPA patients were treated with corticosteroid combined with immunosuppressants, 2 were treated with corticosteroid alone. Eight patients had good prognosis and 2 patients died. The results suggest that peripheral neuropathy is common in AGPA. When the patients present with acute or subacute onset of axonal impairment of peripheral neuropathy and elevated eosinophils, AGPA should be considered.

11.
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.

12.
Chinese Medical Journal ; (24): 2612-2620, 2019.
Article in English | WPRIM | ID: wpr-803155

ABSTRACT

Background@#Gestational diabetes mellitus (GDM) is a common complication during pregnancy. Obesity and overweight are closely related to metabolic diseases and diabetes. However, the role of adipose tissue in the pathogenesis of GDM remains to be studied. The aim of this study was to investigate the correlation of vitamin D (VD) levels, VD receptor (VDR), and peroxisome proliferatoractivated receptor γ (PPARγ) expression with GDM in overweight or obese women.@*Methods@#One hundred and forty pregnant women with full-term single-birth cesarean-section were selected as the study subjects and grouped (70 GDM women, including 35 non-overweight/non-obese women [group G1] and 35 women with overweight or obesity [group G2]; 70 pregnant women with normal glucose tolerance, including 35 non-overweight/non-obese women [group N1] and 35 overweight/obese women [group N2]). The levels of serum VD, blood biochemistry, and adiponectin were compared in these women. Subcutaneous adipose tissue was isolated from the abdominal wall incision. VDR and PPARγ messenger RNA (mRNA) transcript levels in these adipose tissues were quantified by real-time polymerase chain reaction. The differences between the levels of PPARγ protein and phosphorylated PPARγ Ser273 were detected by Western blotting.@*Results@#The serum VD level of GDM women was lower in comparison to that of women with normal glucose tolerance (G1 vs. N1: 20.62 ± 7.87 ng/mL vs. 25.85 ± 7.29 ng/mL, G2 vs. N2: 17.06 ± 6.74 ng/mL vs. 21.62 ± 7.18 ng/mL, P < 0.05), and the lowest in overweight/obese GDM women. VDR and PPARγ mRNA expression was higher in the adipose tissues of GDM women in comparison to that of women with normal glucose tolerance (VDR mRNA: G1 vs. N1: 210.00 [90.58-311.46] vs. 89.34 [63.74-159.92], G2 vs. N2: 298.67 [170.84-451.25] vs. 198.28 [119.46-261.23], PPARγ mRNA: G1 vs. N1: 100.72 [88.61-123.87] vs. 87.52 [66.37-100.04], G2 vs. N2: 117.33 [100.08-149.00] vs. 89.90 [76.95-109.09], P < 0.05), and their expression was the highest in GDM+ overweight/obese women. VDR mRNA levels positively correlated with the pre-pregnancy body mass index (BMI), pre-delivery BMI, fasting blood glucose (FBG), homeostasis model assessment of insulin resistance (HOMA-IR), and PPARγ mRNA while it negatively correlated with the VD and the adiponectin levels (r = 0.395, 0.336, 0.240, 0.190, 0.235, -0.350, -0.294, respectively, P < 0.05). The degree of PPARγ Ser273 phosphorylation increased in obese and GDM pregnant women. PPARγ mRNA levels positively correlated with pre-pregnancy BMI, pre-delivery BMI, FBG, HOMA-IR, serum total cholesterol, triglyceride, free fatty acid, and VDR mRNA, while it negatively correlated with the VD and adiponectin levels (r = 0.276, 0.199, 0.210, 0.230, 0.182, 0.214, 0.270, 0.235, -0.232, -0.199, respectively, P < 0.05).@*Conclusions@#Both GDM and overweight/obese women had decreased serum VD levels and up-regulated VDR and PPARγ mRNA expression in adipose tissue, which was further higher in the overweight or obese women with GDM. VD may regulate the formation and differentiation of adipocytes through the VDR and PPARγ pathways and participate in the occurrence of GDM.

13.
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.

14.
Chinese Journal of Urology ; (12): 732-736, 2019.
Article in Chinese | WPRIM | ID: wpr-796744

ABSTRACT

Objective@#To explore the clinical characteristics of renal angiomyolipoma (AML) with inferior vena cava (IVC) tumor thrombus and to improve the diagnosis and treatment of the disease.@*Methods@#The clinical data of 3 patients with renal AML and inferior vena cava tumor thrombus was retrospectively reviewed. The patients were all female, aged 19 to 70 years. Among them, 2 patients presented with lumbago on the right side, and the other one was diagnosed by physical examination. The body mass index ranged from 18.4 to 24.6 kg/m2, with a median value of 20.4 kg/m2. According to the American Society of Anesthesiologists (ASA), they were classified as grade Ⅱ. Color doppler ultrasound examination of the kidney and IVC was performed in all the 3 patients, all of which showed hyperechoic solid mass in the right kidney. Color doppler ultrasound of IVC showed hyperechoic band in the IVC, indicating blood flow signals and the tumor thrombus. All the 3 cases showed irregular fat density or mixed density in the right kidney and multiple irregular fat density were observed in the right renal vein and inferior vena cava on CT. Two of them received MRI examination of IVC, which showed irregular lesions in the right kidney, short T1 and long T2 signals, low lipids, and no definite limited diffusion on DWI. Irregular fat signal were seen in the right renal vein and inferior vena cava. All 3 patients were diagnosed with right renal mass with IVC tumor thrombus, with 1 patient of Mayo grade Ⅲ tumor thrombus and the other 2 of Mayo gradeⅡtumor thrombus. One underwent laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy, another one underwent open right partial nephrectomy and tumor thrombectomy, and the third one suffered preoperative AML rupture, undergoing open radical nephrectomy and tumor thrombectomy.@*Results@#The operation time was 168 to 659 min, with median of 220 min. Intraoperative blood loss ranged from 50 to 300 ml, with the median of 50 ml. Postoperative indwelling time of drainage tube was 5 to 11 days, with the median of 6 days. Postoperative hospital stay ranged from 7 to 14 days, with a median of 8 days. Postoperative follow-up ranged from 12 to 16 months, with a median follow-up of 13 months. All the three patients underwent operation without postoperative complications. Postoperative pathology proved to be right renal angiomyolipoma. After 3 months of follow-up, the patients showed no tumor recurrence or metastasis.@*Conclusions@#Renal AML is a benign lesion, which is rarely concurrent with inferior vena cava cancer thrombus. Enhanced CT examination is the main diagnostic method, surgical resection of the lesion is the preferred treatment, partial nephrectomy combined with thrombectomy can be performed in patients with AML, if permitted, and postoperative prognosis turns out to be propitious.

15.
Chinese Journal of Urology ; (12): 732-736, 2019.
Article in Chinese | WPRIM | ID: wpr-791676

ABSTRACT

Objective To explore the clinical characteristics of renal angiomyolipoma (AML) with inferior vena cava (IVC) tumor thrombus and to improve the diagnosis and treatment of the disease.Methods The clinical data of 3 patients with renal AML and inferior vena cava tumor thrombus was retrospectively reviewed.The patients were all female,aged 19 to 70 years.Among them,2 patients presented with lumbago on the right side,and the other one was diagnosed by physical examination.The body mass index ranged from 18.4 to 24.6 kg/m2,with a median value of 20.4 kg/m2.According to the American Society of Anesthesiologists (ASA),they were classified as grade Ⅱ.Color doppler ultrasound examination of the kidney and IVC was performed in all the 3 patients,all of which showed hyperechoic solid mass in the right kidney.Color doppler ultrasound of IVC showed hyperechoic band in the IVC,indicating blood flow signals and the tumor thrombus.All the 3 cases showed irregular fat density or mixed density in the right kidney and multiple irregular fat density were observed in the right renal vein and inferior vena cava on CT.Two of them received MRI examination of IVC,which showed irregular lesions in the right kidney,short T1 and long T2 signals,low lipids,and no definite limited diffusion on DWI.Irregular fat signal were seen in the right renal vein and inferior vena cava.All 3 patients were diagnosed with right renal mass with IVC tumor thrombus,with 1 patient of Mayo grade Ⅲ tumor thrombus and the other 2 of Mayo grade Ⅱ tumor thrombus.One underwent laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy,another one underwent open right partial nephrectomy and tumor thrombectomy,and the third one suffered preoperative AML rupture,undergoing open radical nephrectomy and tumor thrombectomy.Results The operation time was 168 to 659 min,with median of 220 min.Intraoperative blood loss ranged from 50 to 300 ml,with the median of 50 ml.Postoperative indwelling time of drainage tube was 5 to 11 days,with the median of 6 days.Postoperative hospital stay ranged from 7 to 14 days,with a median of 8 days.Postoperative follow-up ranged from 12 to 16 months,with a median follow-up of 13 months.All the three patients underwent operation without postoperative complications.Postoperative pathology proved to be right renal angiomyolipoma.After 3 months of follow-up,the patients showed no tumor recurrence or metastasis.Conclusions Renal AML is a benign lesion,which is rarely concurrent with inferior vena cava cancer thrombus.Enhanced CT examination is the main diagnostic method,surgical resection of the lesion is the preferred treatment,partial nephrectomy combined with thrombectomy can be performed in patients with AML,if permitted,and postoperative prognosis turns out to be propitious.

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Chinese Journal of Oncology ; (12): 46-49, 2019.
Article in Chinese | WPRIM | ID: wpr-810382

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Objective@#To investigate the expression and clinical significance of exosomal miR-1231 in plasma of pancreatic cancer (PC) patients and pancreatic cancer cells.@*Methods@#A total of 16 patients who were diagnosed with pancreatic cancer in Hunan Cancer Hospital were collected from April 2016 to August 2017. Meanwhile, 16 healthy volunteers were recruited as the healthy control group at the same period. The plasma exosomes were extracted, and the levels of miR-1231 were detected by qRT-PCR in PC and healthy control groups. Moreover, the clinicopathological significance of exosomal miR-1231 expression was analyzed. Furthermore, the expression of exosomal miR-1231 was detected in several pancreatic cancer cells (MIA PaCa-2, PANC-1, SW1990, AsPC-1 and BxPc-3) and two normal pancreatic epithelial cells (HPDE and human primary pancreatic epithelial cell).@*Results@#qRT-PCR results showed that the expression level of miR-1231 in plasma exosomes of pancreatic cancer patients (1.06±0.46) was significantly lower than that in healthy controls (2.30±0.99; P<0.05). The levels of exosomal miR-1231 in patients with stage Ⅰ-Ⅱ (1.515±0.531), no distant metastasis (1.236±0.461) and no lymph node metastasis (1.337±0.522) were significantly higher than those with stage Ⅲ-Ⅳ (0.848±0.224), distant metastasis (0.757±0.278) and lymph node metastasis (0.838±0.261), respectively (P<0.05 for all). In addition, there were no correlation between exosomal miR-1231 expression and age, sex, smoking history, CA19-9 levels and tumor sites (P>0.05). Furthermore, the expression level of exosomal miR-1231 in pancreatic cancer cell lines (0.142±0.135) was significantly lower than that in normal epithelial cells (1.127±0.179; P<0.05).@*Conclusions@#The downregulation of exosomal miR-1231 in plasma of pancreatic cancer patients and pancreatic cancer cells suggests that it is related to the initiation and development of PC. It may be a new diagnostic and prognostic marker for PC.

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Article in Chinese | WPRIM | ID: wpr-753412

ABSTRACT

This study explores the application of three-dimensional(3D) printing technology combined with PACS in the standardized training of residents in urology.For the residents who received phase Ⅱ standardized training,they were guided to observe and analyze CT images,3D CT reconstruction data,and 3D printing entity during teaching;with reference to the cases of kidney tumors,the 3D printing entity model was explained to help the trainees learn the characteristics of the disease and formulate the operation plan of partial nephrectomy;an explanation of the actual surgical procedure gave them a deeper understanding of the anatomical characteristics and treatment regimens of the disease.The preliminary results of practice show that the application of 3D printing technology combined with PACS can enable residents to grasp the anatomical characteristics of renal tumors within a short time and deepen their understanding of surgical procedures and techniques.This teaching method holds promise for application in clinical specialties.

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Article in Chinese | WPRIM | ID: wpr-745807

ABSTRACT

Objective To compare computed tomography angiography (CTA) and digital subtraction angiography (DSA) in identifying anatomical variation of hepatic artery.Methods A retrospective analysis was made on 220 patients who underwent both CTA and DSA in our hospital.The volume rendering (VR) reconstruction of CTA images was performed.The image quality and the recognition of hepatic artery anatomic variation between CTA and DSA were compared.Results There was a significant difference in the image quality of hepatic artery between the two imaging methods (x2 =88.016,P =0.000),DSA was superior to CTA.There was no significant difference in the accuracy of hepatic artery anatomical identification between CTA and DSA (x2 =0.252,P =0.615).This study has found five other types of hepatic artery anatomical variation besides Micheles types.Conclusion The anatomical variation of hepatic artery is complex,and there are many other variations besides Micheles types.CTA,as a noninvasive method,can provide sufficient information for hepatic artery anatomy.

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Article in Chinese | WPRIM | ID: wpr-742751

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Objective:To construct and identify the monoclonal antibody of ATP synthase beta subunit (ATP5B) with high purity, and to lay foundation for further study.Methods:The ATP5Bgene was amplified by PCR and cloned into the pET28avector and transformed into E.coli BL21 (DE3) .The protein expression was induced by IPTG and then the fusion protein was purified by nickel affinity chromatography column.The protein purity was detected by SDS-polyacrylamide gel electrophoresis (SDS-PAGE) .Three female Balb/C mice were immunized with purified fusion protein and the tail vein blood was taken to detect the titer of ATP5Bantibody by indirect enzyme-linked immunosorbent assay (ELISA) .The spleen cells from the immunized mice with the highest serum titer were mixed with the SP2/0cells to establish the hybridoma cells and the fused cells were screened by indirect ELISA and monoclonally cultured.Karyotype analysis were performed in the positive cells.The hybridoma cells were intraperitoneally injected into 12weeks old BALB/C mice to estabilish the ascites models.The titer of ascites was detected by indirect ELISA.The purity of the antibody was detected by SDS-PAGE.The antibody subtype was detected by ELISA.Results:After PCR amplification, a specific band of 1 455bp was obtained, and the pET28aempty vector was ligated to obtain a recombinant pET28a/ATP5Bvector.The target protein was expressed in the IPTG-induced bacteria solution;the SDS-PAGE results showed that the protein band was found at51 000.The indirect ELISA results showed that the serum titer of the venous blood of immunized mice was up to1:64 000.In karyotype analysis, the total number of chromosomes in hybridoma cells was about the sum of myeloma cells and normal mouse spleen cells.The mouse ascites was prepared with the hybridoma cell line, and the highest titer of the antibody was 1:240 000.The subtype of the monoclonal antibody produced by the hybridoma cells was IgG1.Conclusion:The monoclonal antibody against ATP5Bprotein is successfully prepared by cloning, expressing and purifying the recombinant protein.

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Chinese Journal of Biotechnology ; (12): 2367-2385, 2019.
Article in Chinese | WPRIM | ID: wpr-781632

ABSTRACT

Nanogenerator (triboelectric nanogenerator and piezoelectric nanogenerator) has experienced a rapid development since it was proposed. This technique can covert various mechanical energies into electric energy, including human motion energy, wind energy, acoustic energy and ocean energy. The converted electricity can be used for health monitoring and physiological function regulation, such as pulse detection, bioelectrical stimulation and cardiac pacing. This review summarizes the structure, working mechanism, output performance of nanogenerator and its latest progress in circulatory system, nervous system, biological tissue, sleep and rescue system. Additionally, a further analysis was also made on the application challenge of nanogenerator in clinical treatment. In the future, nanogenerator is expected to be an auxiliary power source, or even to replace battery to power medical electronic device and realize the self-powered health monitoring and physiological function regulation of human body.


Subject(s)
Electric Power Supplies , Electricity , Humans
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