Radical prostatectomy plus extended lymph node dissection for locally advanced prostate cancer: 12-year experience of a single centre / 中华泌尿外科杂志

Objective To evaluate the functional and oncological outcomes of patients with locally advanced prostate cancer (PCa) treated by hormone therapy combined with extra-fascia1 laparoscopic radical prostatectomy (LRP) plus extended lymph node dissection (ePLND).Methods From January 2004 to June 2016,a total of 255 PCa cases (pT3-4NxM0) who received LRP plus ePLND were enrolled into our study.The mean age of the patients was 67 (range 44-88) years,and median PSA level was 21.2 (range 0.6-454.0) ng/ml.The patients were divided into earlier group (from January 2004 to December 2011,160 cases) and later group (from January 2012 to June 2016,95 cases) according to different treatment periods.The baseline demographics between the two groups were similar.All patients routinely received adjuvant hormone therapy (AHT) postoperatively.The patients in the later group underwent collapsin response mediator protein 4 (CRMP4) methylation study on the prostatic biopsy preoperatively.Those with a CRMP4 methylation level ＞ 15％ or rectum/bladder neck invasion,were treated by neoadjuvant hormone therapy (NHT) for 3-6 months.Positive surgical margin (PSM),progression-free survival (PFS),cancer-specific survival (CSS),overall survival (OS) and postoperative continence rates between the two groups were analyzed and compared.Results The mean operative time of the earlier and later group were (239 ±65) min and (203±51) min,mean blood loss were (109-±65) ml and (96-±44) ml,mean dissected nodes were (19 ± 5) and (21 ± 7),respectively (all P ＞ 0.05).The total PSM rate was 19.2％,and PSM rates of the two groups were 23.1％ and 12.6％ (P =0.04).All the 255 cases received AHT and 25 cases in the later group underwent NHT.The median follow-up time was 73 months (range 10-152 months).The total 5-year PFS,CSS and OS rates were 77.7％,94.3％ and 87.1％,respectively,and the rates between groups were 73.8％ vs.86.1％ (P=0.03),93.1％ vs.98.6％ (P=0.07),and 85.0％ vs.92.8％ (P =0.11),respectively.The 1-year postoperative continence rates were 91.9％ vs.97.9％ (P =0.09).Conclusions Hormone therapy combined with LRP plus ePLND represents an oncological and functional effective option in patients with locally advanced PCa,and improved PFS might be acquired by preoperative tumor staging.

Effect of cadmium chloride on the expression of KIM-1 in in vitro HK-2 cell culture / 中国职业医学

OBJECTIVE: To investigate the effect of cadmium chloride on the expression of kidney injury molecule-1( KIM-1)in human renal tubular epithelial cells( HK-2 cells). METHODS: HK-2 cells at logarithmic phase were divided into a control group and 5 treatment groups that were treated with 5. 0,10. 0,20. 0,50. 0 and 100. 0 μmol / L of cadmium chloride dissolved in phosphate buffer solution. Cell pathology observation was carried out after 24 hours of cultivation. The methyl thiazolyl tetrazolium assay was used to calculate the survival rate of HK-2 cells. The expression of KIM-1 mRNA and protein were detected by the reverse transcription-polymerase chain reaction and Western blotting analysis respectively.RESULTS: There were no cellular morphologic change in HK-2 cells in the control group,the 5. 0 and 10. 0 μmol / L groups;the HK-2 cells showed different degree of swellings or vacuoles in the 20. 0 and 50. 0 μmol / L groups; a large number of cells were found dead in the 100. 0 μmol / L group. The cell survival rates of HK-2 cells in the 20. 0,50. 0 and 100. 0μmol /L groups were lower than those of control group,the 5. 0 and 10. 0 μmol /L groups( P < 0. 05). The pairwise comparison among survival rates of the 20. 0,50. 0 and 100. 0 μmol / L groups showed significant difference( P < 0. 05).The expression levels of KIM-1 mRNA and protein in the 20. 0 and 50. 0 μmol / L groups were higher than those of control group,the 5. 0 and 10. 0 μmol / L groups( P < 0. 05). The levels of KIM-1 mRNA and protein in the 50. 0 μmol / L group were higher than those of the 20. 0 μmol / L group( P < 0. 05). CONCLUSION: Cadmium chloride at certain concentration can increase the expression of KIM-1 mRNA and protein in HK-2 cells. Therefore,the expression of KIM-1 could be used as one of the effect biomarkers for cadmium induced kidney tubule injury.

Clinical analysis on four cases of occupational chronic toxic peripheral neuropathy caused by 1-bromopropane / 中国职业医学

OBJECTIVE: To analyze the clinical features of occupational chronic toxic peripheral neuropathy caused by1-bromopropan( 1-BP). METHODS: Clinical data of 4 patients who suffered from occupational chronic toxic peripheral neuropathy caused by 1-BP were collected for retrospective analysis. RESULTS: The 4 male patients were ultrasonic cleaning operation workers in a hardware vacuum coating enterprise. They were exposed to high levels of 1-BP for 9-11 months. The main clinical manifestations were varying degrees of sensory disorder and dyskinesia. The main symptoms were progressive increase of numbness and fatigue in the lower extremities. These symptoms might be accompanied by unsteady gait.Physical examination showed muscle strength weakness in the double lower limbs. The hypalgesia,pselaphesia,topesthesia and pallesthesia decreased in the double lower limbs or 4 limbs. The bilateral achilles tendon reflex mainly showed reduced or disappeared. One case had sensory ataxia. Electroneuromyography examination showed different levels of peripheral nerve damage among the cases. The motor nerve conduction velocity and sensory nerve conduction velocity reduced commonly. The axon and myelin sheath damage were visible. On the basis of GBZ / T 247-2013 Diagnosis of Occupational Chronic Toxic Peripheral Neuropathy Caused by Chemicals,these cases were diagnosed as occupational chronic toxic peripheral neuropathy caused by 1-BP. CONCLUSION: Long-term exposure to high level 1-BP can lead to chronic poisoning with peripheral nervous system damage. The diagnosis can be made based on the 1-BP exposure history,clinical features and the neurogenic damage found in electroneuromyography examination.

The significance of monitoring procalcitonin when applying antibiotics to trichlorethylene dermatitis / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To investigate the significance of monitoring procalcitonin (PCT) when applying antibiotics to trichlorethylene (TCE)-induced dermatitis.</p><p><b>METHODS</b>One hundred and two patients who were hospitalized and recovered from TCE-induced dermatitis in our hospital from 2006 to 2013 were enrolled as subjects. Based on whether the PCT level was monitored or not, we divided patients into regular group and PCT group. For the regular group, we applied antibiotic treatment and determined the course of treatment based on clinical symptoms, laboratory test results, medical imaging results, and bacterial culture. For the PCT group, in addition to the above treatments, antibiotic treatment was applied when the PCT level was not lower than 0.25 ng/ml and stopped when the PCT level was lower than 0.25 ng/ml. The distribution of bacterial infection sites, type of bacteria, type of antibiotics, average period of hospitalization, and course of antibiotic treatment were compared between the two groups.</p><p><b>RESULTS</b>There were no significant differences in the distribution of bacterial infection sites, type of bacteria, type of antibiotics, and average period of hospitalization between the two groups (P > 0.05). The course of antibiotic treatment for the PCT group was significantly shorter than that for the regular group (25.37 ± 11.66 vs 20.58 ± 7.53 d, P < 0.05).</p><p><b>CONCLUSION</b>Under similar conditions of bacterial infection, antibiotic treatment of TCE-induced dermatitis based on the serum PCT level can significantly shorten the course of treatment and avoid the abuse of antibiotics.</p>

Role of co-expression of c-Myc, EZH2 and p27 in prognosis of prostate cancer patients after surgery / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>c-Myc, EZH2 and p27 were defined to modulate the behavior of prostate cancer with pro-tumoral or anti-tumoral effects and had ability in predicting prostate cancer progression, but the research of their co-expression value of prognosis is rarely. This study aimed to investigate the prognostic value of combining tri-marker together in patients with intermediate-risk prostate cancer after surgery.</p><p><b>METHODS</b>Expression levels of c-Myc, EZH2 and p27 in 129 patients with intermediate-risk prostate cancer were assessed using immunohistochemistry in a semi-quantitative manner. The expression profiles of these three markers were analyzed and investigated for association with biochemical recurrence.</p><p><b>RESULTS</b>In all, fifty of 129 cases experienced biochemical recurrence during a median follow-up time of 31 months (range, 6 - 60 months). Of these relapse patients, one case without and 10 cases with any single positive marker were observed; 39 cases were detected with any two or all three positive markers (22 cases with any two and 17 cases with all three positive markers). Survival analysis showed that patients with over-expression of c-Myc or EZH2, and lower expression of p27 manifested significantly higher biochemical recurrence rates. Subsequent multivariate analysis revealed that c-Myc, EZH2 and p27 expression statuses showed potential in predicting relapse, respectively. Notably, combining three markers together as a "composite index" (0 or 1, vs. 2 or 3 positive markers) provided powerful prognostic value (HR 6.57, 95% CI 3.02 - 14.31, P < 0.001). There was a significant difference between the patient subgroups with 0 or 1 and those with 2 or 3 positive markers expression statuses, and tri-marker composite index was an independent risk factor for predicting relapse in patients with intermediate-risk prostate cancer after surgery.</p><p><b>CONCLUSION</b>Composite index of c-Myc, EZH2, and p27 can be valued as powerful prognosis parameter for intermediate-risk prostate cancer patients after the surgery, and postoperative adjuvant therapy can be adopted accordingly.</p>

A study of sympathetic skin response to the damage of autonomic nerves function in patients with chronic N-hexane poisoning / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To study the sympathetic skin response (SSR) to the effects of N-hexane on autonomic nerves function in patients with chronic N-hexane poisoning.</p><p><b>METHODS</b>The subjects in present study included 30 controls and 37 cases with chronic N-hexane poisoning. Also 37 patients were divided into 3 subgroups (mild, moderate and severe poisoning) according to diagnostic criteria of occupational diseases. All subjects were examined by SSR test and nerve conduction velocity (NCV) test. All patients were reexamined by SSR and NCV every 1 ∼ 2 months. The differences in SSR parameters (latency, amplitude) among groups were observed. In the severe poisoning subgroup, the changes of SSR and NCV parameters (conduction velocity, amplitude) in different poisoning stages were observed.</p><p><b>RESULTS</b>There were significant differences in SSR latency of upper extremity among groups and the significant differences in SSR amplitude of upper and lower extremity among groups (P < 0.05). No significant differences in SSR parameters were found between the adjacent groups (P > 0.05). There were significant differences in SSR latency of upper extremity during different periods and the significant differences in SSR amplitude of upper and lower extremity during different periods among all groups (P < 0.05). The change of SSR parameters consistent with that in NCV. The longest SSR latency of upper extremity and the smallest SSR amplitudes of upper and lower extremity appears 1 - 2 months earlier than that of the smallest action potential amplitude.</p><p><b>CONCLUSION</b>The damage of autonomic nerves induced by N-hexane increased with poisoning progresses. The damage of autonomic nerves corresponded with the damage of myelin sheath of large myelinated nerves, but which appeared 1 - 2 months earlier than the damage of axon of large myelinated nerves. SSR test may serve as a method to detect the damage of autonomic nerves function in patients with chronic N-hexane poisoning.</p>

Transvesical approach laparoendoscopic single-site radical prostatectomy: for organ-confined prostate cancer: report of 8 cases / 中华泌尿外科杂志

Objective　To investigate the feasibility of applying transvescal approach laparoendoscopic single-site radical prostatectomy (TVSSLRP) and assess the oncological and functional outcomes.Methods　Eight patients with clinically localized prostate cancer (PCa) of low risk underwent TVSSLRP.Demographic data were accrued including patient age,body mass index (BMI),preoperative PSA level,the International Index of Erectile Function 5,biopsy Gleason score,clinical TNM stage and D'Amico risk classification.One surgeon performed all TVSSLRP procedures.A homemade triple-port was introduced percutaneouly into the bladder to establish pneumovesicum through a 4 cm incision.The major steps of the surgery were described as follows:initial incision was made along posterior margin of the bladder neck to expose bilateral vas deference and spermatic vesicle.After opening Denonvilliers' fascia and extending the space to lateral prostatic pedicles,an intra-fascial nerve sparing procedure was performed.The puboprastatic ligaments were then separated close to the prostate surface and the dorsal vein complex was cautiously swept off.Subsequently,careful apical dissection and urethral transection was sequentially conducted. To reduce the tension of vesico-urethral anastomosis,3 additional incisions parallel to vesio-urethral margin were created and a novel tension - reduced V-LocTM barbed polydioxanone sutures was used.　Results　All the operations were successfully performed and there was no conversion to standard laparoscopic approach or open surgery.The total operative time range was 75 - 180 min with mean time of 125 min.The blood loss was 85 -450 ml with mean 140 ml and no blood transfusion was required.The catheter was removed after a mean (range) of 14 (9 -16) days.No intra-operative complications occurred. No patient had positive surgical margins.The mean (range) hospital stay was 17 (13 -25) days after surgery. All the cases were continent after removal of the catheter.No cases demonstrated vesico-urethral stricture and biochemical recurrence on 12 - 18 months follow up postoperatively.　Conclusions　TVSSLRP is technically feasible for cases with organ-confined prostate cancer with good oncological and functional results.

Single-port laparoscopic radical prostatectomy: initial experience and technical points to reduce its difficulties / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Laparoendoscopic single-site surgery (LESS) approaches have been reported for treating various kidney and pelvic procedures, and are feasible and effective in selected patients. In this study, we aimed to present the initial experience and evaluate the efficacy of laparoscopic radical prostatectomy performed through a single incision using a multichannel port.</p><p><b>METHODS</b>Between July 2010 and April 2011, six patients diagnosed with early stage prostate cancer underwent LESS radical prostatectomy (RP) in our institute. A multichannel port was inserted transperitoneally through a 2-cm umbilical incision. Specially articulating and flexible laparoscopic were used. Some technical tricks and points were applied during the operation to overcome the drawbacks and reduce the difficulties of this approach. Two continuous urethrovesical sutures in both sides were performed to complete both lateral aspects of anastomosis. The two ends of the suture threads were fixed by double Lapro-Clips, instead of the difficult knot-tying.</p><p><b>RESULTS</b>Total operative time was (265 ± 43) minutes. Mean blood loss was (230 ± 65) ml. All cases were completed successfully, without conversion to open surgery or adding additional abdomen ports. No patient required a blood transfusion and no intraoperative complications occurred. The Foley catheter was removed at the 14th day (range 12th - 16th) after surgery. At the 12th week of follow-up, all patients had an undetectable prostate-specific antigen level. Two patients used 2 or 1 pad for continence daily; other patients had achieved good continence.</p><p><b>CONCLUSION</b>In selected cases, LESS-RP is feasible and effective; these technic points and the flexible-articulating instruments are helpful to reduce the operation difficulties.</p>

The classification of ureter disease by the level of difficulty and risk during rigid ureteroscopic surgery / 中华泌尿外科杂志

Objective To summarize the common types and clinical characteristics of ureter disease;which can increase manipulation difficulties and adverse events during rigid ureteroscopic procedures. Methods From Jan 2001 to Dec 2010,our team performed 317 rigid ureteroscopic Drocedures for ureteroscopic examination or treatment;including 60 difficult procedures(34 male and 26 female).The mean age of the patients was 37 years (range,18 to 71).The ureteral diseases were classifted into five types according to the pathological characteristics:Type Ⅰ calculous stenosis,Type Ⅱ neoplastic stenosis;Type Ⅲ non-congenital stenosis,Type Ⅳ congenital stenosis,Type Ⅴ expansion of tortuous ureters.The operative time,complications,and conversion to open surgery were evaluated,and the therapeutic methods were analyzed. Results Of the 60 difficuhly-manipulated procedures,the mean manipulated time was 75 min (range,31 to 200).Intra-operative complications occurred in 9 procedures,including 4 cases of mucosal bleeding,2 cases of submucosaI false passage and 3 cases of ureteral perforation.Eleven procedures were converted to open surgery. In five procedures only a double J tube was inserted for drainage due to the difficulty of entering the ureter.Fiftyfive patients were followed up for 17 months (range,3 to 110);48 patients were cured,5 patients improved and 2 patients were unchanged. Conclusions The five types of ureteral disease can increase operative difficulties and risks of rigid ureteroscopic procedures.We should be cautious during surgery and should stop manipulation or convert to other surgeries if necessary.

A clinical analysis on treatment of patients who suffered from acute exa cerbations of chronic obstructive pulmonary disease (COPD) with type Ⅱ respirat ory failure / 中国实用内科杂志

Objective To study the clinical effect of noninva si ve positive pressure ventilation(NIPPV)on the treatment of acute exacerbations o f chronic obstructive pulmonary disease(COPD)with type Ⅱ respiratory failure.Methods Observe the data in arterial blood gas (pH,PaO2,PaCO2 ),the course of disease in the hospital ,the rate of endotracheal intubation ,the mortality of the patients in NIPPV and compare with those of the patients without NIPPV treatment before.Results The data in arterial blood gas had been improved signif icantly in NIPPV after 24h.The course of disease in hospital was significantly s horter,and the rate of endotracheal intubation and mortality of the patients wa s significantly lower in NIPPV than those in no NIPPV.There was remarkably diffe rence between two groups.In NIPPV,the rate of endotracheal intubation were sig nificantly lower in light and moderate respiratory failure than those in severe respiratory failure(P

Effects of dendritic cells co-cultured with CIK cells on renal carcinoma cells / 中国病理生理杂志

AIM: To study the effects of CIK cocultured with DC that pulsed with RCC antigen on renal carcinoma cells.METHODS: DC and CIK cells were generated respectively by cytokines from PBMC of healthy blood donor.Cell surface markers were analyzed by flow cytometry.Then CIK were cocultured with autologous DC that was(or not) pulsed with RCC antigen(786-0 cells).Cytotoxic activity against 786-0 or PC3 cells was measured by MTT assay under three different conditions: CIK cocultured with DC which was pulsed with 786-0 antigen(group A);CIK cocultured with DC which is not pulsed with 786-0 antigen(group B);CIK without DC(group C).RESULTS: The cytotoxic activity of three groups against 786-0 cells was(70.64?8.26)%,(53.40?7.33)%,(46.64?6.01)%,respectively(E/T=(20∶1)).Significant differences between group A and group B or between group A and group C were observed(P