Application of laparoendoscopic single-site combined with transurethral approach for unilateral retrograde nephroureterectomy / 中华泌尿外科杂志

Objective:To investigate the feasibility and safety of laparoendoscopic single-site combined with transurethral approach for unilateral retrograde nephroureterectomy in the treatment of upper urinary tract epithelial carcinoma.Methods:The clinical data of 12 patients from January 2018 to November 2019 with unilateral retrograde nephroureterectomy were analyzed retrospectively. There were 7 males and 5 females with an average age of 65.9 years, the age ranged from 50 to 78 years.There were 8 cases with left ureteral tumor, 6 cases with left renal pelvis tumor, 4 cases with right tumor(2 cases of right ureteral tumor and 2 cases of right renal pelvis tumor). Surgical methods: 1470 laser sleeve was used to remove the inner segment of the ureter bladder wall after the lower ureter was clipped through abdominal approach, and the urethra was inserted under the guidance of zebra guide wire.The operation time, intraoperative blood loss, intraoperative auxiliary cannula, postoperative hospital stay, postoperative drainage tube removal time, intraoperative and postoperative complications, postoperative pathology were recorded.Results:All of the operations were successful. The mean operation time was 194(135-260)min, the mean estimated blood loss was 50(25-100) ml, and the mean hospitalization time was 11.6(5-24)d. Among the 12 patients, 8 patients had abdominal drainage tube after operation. The mean time for drainage was 6.8(3-11)d. One patient added a 5 mm ancillary port.One patient had urinary leakage at the bladder anastomotic site, the catheter was removed 3 weeks later. The other patients had no postoperative incision infection, fever, bleeding, venous thrombosis and other related complications.No patient received blood transfusion and the pathological margin was negative. The median follow-up time was 12 months (5-15 months). One patient died of lumbar metastasis 8 months after operation, and others were neither tumor recurrence nor distant metastasis.Conclusions:The application of laparoendoscopic single-site combined with transurethral approach for unilateral retrograde nephroureterectomy in the treatment of upper urinary tract epithelial carcinoma is safe, accurate and effective, with less trauma and less bleeding. It is worth applying in clinical practice.

Clinical application of intra-abdominal exposure instruments in laparoendoscopic single-port nephrectomy / 中华泌尿外科杂志

Objective To evaluate the feasibility and clinical efficacy of intra-abdominal exposure instruments in laparoendoscopic single-port nephrectomy(LESS-N).Method From February 2012 to July 2016,61 cases of LESS-N were performed in our center.There were 34 males and 27 females with a mean age of (60.3 ± 9.4) years old (ranging 36-72 years old).There were thirty-nine cases of renal tumors and twenty two cases of nonfunctioning kidney.The patients were divided into two groups.Group A included 39 cases that underwent conventional LESS-N (22 radical nephrectomy/17 simple nephrectomy).Group B included 22 cases that underwent intra-abdominal exposure instruments assisted LESS-N (17 radical nephrectomy/5 simple nephrectomy).The perioperative and postoperative data were collected and analyzed retrospectively.Results All the procedures of these two groups were completed successfully.In Group A,four patients were added one 5 cm additional trocar and two patients were converted to open surgery.No additional trocars or conversion to open surgery were needed in Group B.For LESS radical nephrectomy,there were no significant differences of mean tumor diameter (5.7cm vs.5.4 cm,P =0.65) between two groups.The average operative time was (95.1 ± 43.9) min in Group B which was lower than that in Group A (127.4 ± 61.9) min (P ＜ 0.01).The mean renal vascular processing time was declined from (25.4 ± 10.1)rmin in Group A to (18.8 ± 8.9)min in Group B (P ＜ 0.05).The mean estimated blood loss was (128.6 ± 51.1) ml in Group A and (98.7 ±-57.6) ml in Group B (P ＜ 0.05).No severe intraoperative and postoperative complications occurred in both group.Conclusions Intra-abdominal exposure instruments are feasible and effective for LESS-N.This system may shorten the operation time,reduce the amount of bleeding and improve surgical accuracy.

High-bone-turnover Osteoporosis and Aortic Calcification in Opg Knockout Mice / 生物化学与生物物理进展

Bone turnover is regulated by local concentrations of cytokines such as osteoprotegerin (OPG) and receptor activator of nuclear factor kappaB ligand (RANKL). To explore the in vivo biological function of Opg and the mechanism of osteoporosis due to deficiency of Opg, Opg knockout mice have been generated through homologous recombination. Opg-/- mice exhibit a sharply decrease in bone density and strength as expected. The number of osteoclasts in Opg-/- mice significantly increases. Morphologically, osteoclasts appear more cuboidal in shape in Opg-/- mice than those of wt mice, suggesting that active osteoclastogenesis occurs in the absence of Opg. In consistent with this finding, an increase of osteoblast activity was also observed with accelerated mineral accumulation rate by histomorphometric measurement and elevated serum alkaline phosphatase activity (ALP) in Opg-/- mice. Interestingly, more than 50% of 2-month-old Opg-/- mice manifest medial calcification of aorta with comparable serum concentrations of calcium and phosphorus to wt mice. In conclusion, Opg-/- mice have a high-bone-rurnover type osteoporosis. The aortic calcification in Opg-/- mice is not due to abnormality of calcium and phosphorus metabolism. The mechanism underlying aortic calcification in Opg-/- mice needs to be further investigated.

Generation of Adiponectin Gene Knock-out and LacZ Gene Knock-in Mouse Model / 生物化学与生物物理进展

Adiponectin is an adipocyte-derived secretory protein. It was found to be associated with insulin resistance, inflammation and arteriosclerosis. To further study the biological function and expression of adiponection in vivo, adipoenctin gene knock-out and LacZ gene knock-in mouse model was constructed. Gene targeting strategy was designed to replace part of exon 2 and exon 3 of adiponectin gene with full length LacZ gene in frame with remaining upstream ATG and signal peptide sequence of exon 2. The targeting vector (Adipo-LacZ-XpPNT) was constructed and verified by restriction enzyme digestion and sequencing. CJ7 ES cells were transfected with targeting vector linearized by NotⅠ digestion, selected in the medium containing both G418 and ganciclovoir. Resistant clones were screened by PCR and further confirmed by Southern blot for correct homologous recombinants. Chimera mice were obtained by routing microinjection of homologous recombined ES cells into blastocysts. After mating, mice heterozygous and further homozygous for adiponectin knockout and LacZ gene knock-in were established. Expression of both endogenous adiponectin and exogenous LacZ gene in mouse tissues and sera were detected by RT-PCR, Northern-blot, Western blot and ELISA. The results show that adiponectin was disrupted at both mRNA and protein levels. LacZ gene is expressed exclusively in adipose tissue of mutant mice. Its expression profile is identical to endogenous adiponection. Unexpectedly, LacZ activity could not be detected in both adipose tissue and serum although LacZ protein can be detected in adipose tissue but not in serum of mutant mice. In conclusion, mice homozygous for adiponectin knockout and LacZ gene knock-in have been successfully constructed. Mutant mice display LacZ expression profile identical to endogenous adiponectin albeit neither LacZ activity nor protein can be detected in serum of mutant mice.