Risk factors of the bladder cancer occurrence after radical nephroureterectomy of the upper tract urothelial carcinoma / 中华泌尿外科杂志

Objective To study the clinic features and risk factors of bladder cancer occurrence after radical nephroureterectomy of urothelial carcinoma of the upper tract.Methods 61 cases of urothelial carcinoma of the upper tract from March 2013 to December 2013 in Beijing Friendship Hospital are retrospectively studied.31 patients are male,while the other 30 patients are female.Age of them ranges from 43 to 90 years old,and the average age is 69 years old.17 patients are accompanied with diabetes.32 patients are accompanied with hypertension.12 patients have the history of chronic nephrosis.7 patients have the history of renal transplation operation.47 patients have the symptom of hematuresis.16 patients have the symptom of lumbago.Body mass index ＜ 18.5 kg/m2 2 cases,18.5 ～ 22.9 kg/m2 25 cases,23.0 ～ 24.9 kg/m2 10 cases,25.0 ～ 29.9 kg/m2 20 cases,≥ 30.0 kg/m2 4 cases.25 patients' serum creatinine is abnormal,while the other 36 patients'is normal.36 patients have left tumors,while the other 25 patients have right tumors.39 patients have hydronephrosis before operation.25 patients go through ureteroscopy.11 patients have the concurrence of bladder cancer preoperatively.25 patients have renal pelvic carcinoma,while the other 36 patients have carcinoma of ureter.14 patients have multiple tumors,while the other 47 patients just have single tumors.The size of tumor ranges from 0.5cm to 8.0cm,and the average size is 2.9cm.27 patients have the cauliflower-like tumors,while the other 34 patients have other shaped tumors.28 cases have the positive results of cytology,while the other 33 cases donl have.6 patients go through cystoscopic operation of ureterovesical junction,while the other 55 patients go through open operation of ureterovesical junction.Kaplan Meier analysis is used to find univariate risk factors of the bladder cancer occurrence postoperatively,and Log-rank test is used after that.Cox regression analysis is used to identify the independent risk factor from all the univariate risk factors.Results Time of surgery ranges from 2.0 hours to 7.5 hours,and the average time is (4.9 ± 1.2) hours.39 patients' tumors are equal or greater than T2 stage,while the other 22 patients'tumors are less than T2 stage.2 patients have Ⅰ grade tumors,40 patients have Ⅱ grade tumors,and the other 19 patients have Ⅲ grade tumors.12 patients go through systematic chemotherapy,while the other 49 patients don l.23 patients go through intravesical instillation postoperatively,while the other 38 donl.Follow-up time of 61 cases ranges from 22 months to 31 months,and the average time is (27.3 ± 2.7) months.3 to 30 months after radical nephroureterectomy,21 cases(34.4％) have bladder cancer occurrence.4 of patients who have concurrence of bladder cancer preoperatively go through the occurrence of bladder cancer(57.1％,4/7),and 17 of patients who dont have concurrence of bladder cancer preoperatively go through the occurrence of bladder cancer(3 1.5％,17/54).8 of patients with multiple tumors go through the occurrence of bladder cancer(57.1％,4/7),while 13 of patients with a single tumor go through the occurrence of bladder cancer(27.7％,13/47).18 of patients who have tumors equal or greater than T2 stage have the occurrence of bladder cancer(46.2％,18/39),while 3 of patients who have tumors less than T2 stage have the occurrence of bladder cancer(13.6％,3/ 22).3 of patients with postoperative intravesical instillation have the occurrence of bladder cancer(13.0％,3/23),while 18 of patients without postoperative intravesical instillation have the occurrence of bladder cancer(47.4％,18/38).Single factor analysis shows that preoperative concurrence of bladder cancer(P =0.003),multiple tumors (P =0.044),T stage (P =0.023) and postoperative intravesical instillation (P =0.002) have significant influence on the occurrence of bladder cancer.And Cox proportional hazards regression model analysis shows that the preoperative concurrence of bladder cancer (RR =2.860,P =0.024,regression coefficient =1.051) and postoperative intravesical instillation (RR =0.201,P =0.011,regression coefficient =-1.065) are significantly related to the occurrence of bladder cancer after radical nephroureterectomy.Conclusions The preoperative concurrence of bladder cancer and postoperative intravesical instillation are the independent risk factors of the bladder cancer occurrence after radical nephroureterectomy.And the preoperative concurrence of bladder cancer is a risk factor,while the postoperative intravesical instillation is a protective factor.

Structural components of Chinese medicine and pharmacology network: systematical overall regulation on pathological network / 中国中药杂志

Development of the disease is the result of several factors involved in biological network changes. The nature of drug intervention is to regulate these pathological changes to the normal range. Advantages of traditional Chinese medicine (TCM) are to integrally and systematically regulate this biological networks and systematic pathology through multi-targets, multi-levels, multi-channels. Structural components TCM provides the controlled and precise basis "substance" for this regulation and also to clarify the "truth" of the nature of the regulation by the network pharmacology. Network pharmacology provides new strategy for the research on mechanism of structural components TCM. This study not only reflects the overall characteristics of the development of the disease, but also fully embodies the essence of TCM for preventing and treating diseases through changing traditional model on "one drug, one gene, one disease". This paper explores systematically the integration essence, features and research strategies of structural components TCM and the network pharmacology, understand the interaction of structural components TCM and body from the perspective of the overall concept of improving or restoring the balance of.biological networks. It is effective measure to reveal the structure of a multi-component for regulating biological networks mechanisms, and also provide new ideas and methods for further scientific research and innovation of structural component TCM.

Effect of different composition structures of total paeony glycoside component and total phenolic acid component of Chuanxiong Rhizome on human umbilical vein endothelial cells with hypoxic injury / 中国中药杂志

<p><b>OBJECTIVE</b>To study the effect of different composition structures of total paeony glycoside (TPG) component and total phenolic acid of Ligusticum chuanxiong ( TLPA) on sodium dithionite (Na2S2O4) -induced human umbilical vein endothelial cells (HUVEC) hypoxic injury. The baseline geometric proportion was used to design different components structure. And then the best structure of components by cell injury model were optimized.</p><p><b>METHOD</b>A HUVEC hypoxic injury model was established by being induced of Na2S2O4. Cell viability was measured by MTI colorimetric method, intracellular superoxide dismutase (SOD) activity, malondialdehyde (MDA), lactate dehydrogenase( LDH) levels, nitric oxide (NO) contents were measured by kits. At last, Western blot analysis was used to detect the expression of two proteins, Bcl-2 and Bax.</p><p><b>RESULT</b>Compared with the model group, TPG component, TLPA component at different composition structures can significantly increase SOD activity and decrease MDA, LDH, NO levels (P < 0.01, P < 0.05). Paeoniae Radix Rubra and Chuanxiong Rhizoma components can downregulate the expression of Bax protein and upregulate the expression of Bcl-2 protein. The ratio of Bcl-2 and Bax was significantly increased (P < 0 01, P < 0 05), it means that cell apoptosis was inhibited. The results indicate that among all the component composition structures, TPG and TLPA component at the proportion of 8: 2 had the best protection on hypoxic injury of endothelial cells.</p><p><b>CONCLUSION</b>TPG component and TLPA component can resist HUVEC hypoxia injury, the protective effect was the most evident under the structure of 8: 2, which may be due to the inhibition of intracellular lipid peroxidation and cell apoptosis.</p>

Changes in dendritic cells and dendritic cell subpopulations in peripheral blood of recipients during acute rejection after kidney transplantation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Advances in transplantation immunology show that the balance between dendritic cells (DCs) and their subsets can maintain stable immune status in the induction of tolerance after transplantation. The aim of this study was to investigate if DCs and DC subpopulations in recipient peripheral blood are effective diagnostic indicators of acute rejection following kidney transplantation.</p><p><b>METHODS</b>Immunofluorescent flow cytometry was used to classify white blood cells (WBCs), the levels of mononuclear cells and DCs (including the dominant subpopulations, plasmacytoid DC (pDC) and myeloid DC (mDC)) in peripheral blood at 0, 1, 7, and 28 days and 1 year after kidney transplantation in 33 patients. In addition, the blood levels of interleukin-10 (IL-10) and IL-12 were monitored before and after surgery. Fifteen healthy volunteers served as normal controls. Patients were undertaking hemodialysis owing to uremia before surgery.</p><p><b>RESULTS</b>The total number of DCs, pDC, and mDC in peripheral blood and the pDC/mDC ratio were significantly lower in patients than controls (P < 0.05). Peripheral DCs suddenly decreased at the end of day 1, then gradually increased through day 28 but remained below normal levels. After 1 year, levels were higher than before surgery but lower than normal. The mDC levels were higher in patients with acute rejection before and 1 day after surgery (P < 0.005). There was no significant difference in IL-10 and IL-12 levels between patients with and without acute rejection.</p><p><b>CONCLUSION</b>The changes in DCs and DC subpopulations during the acute rejection period may serve as effective markers and referral indices for monitoring the immune state, and predicting rejection and reasonably adjusting immunosuppressants.</p>

Application of laparoscopic ultrasonography in laparoscopic partial nephrectomy / 中华全科医师杂志

Seven cases of renal tumor treated at our hospital from May 2009 to November 2011 were assigned to undergo laparoscopic ultrasonography assisted laparoscopic partial nephreetomy.The mean operative duration was 109 minutes (range:102-121).And the mean volume of blood loss was 82 ml (range:60-120).All patients had confirmed negative margins.Renal clear cell carcinoma was definitely diagnosed in all cases.Laparoscopic ultrasonography could provide more precise information of renal tumor within renal capsule.Thus it may be used to guide the operation so that tumors are excised more completely,residual tumor tissues avoided and normal renal tissues protected.

Clinical analysis of 13 cases of urachal carcinoma / 国际外科学杂志

Objective To summarize the author' s clinical experiences in the diagnosis and treatment of urachal carcinoma.Methods Thirteen cases with urachal carcinoma from 1990-2011 at Beijing Friendship Hospital affiliated to Capital Medical University were retrospectively reviewed and analyzed.Results The most common complaint was hematuria;B ultrasonic or CT scan demonstrated a parenchyma or vesica between the bladder dome and abdominal wall.Nine patients underwent extensive pattical excision of the bladder,3 paitents underwent radical resection,and 4 patients received comprihensive chemotherapy.The five-year survival rate was 30.7％.Conclusion Extensive partial excision of the bladder is recommended for urachal carcinoma.

Impact of surgery and epirubicin intravesical chemotherapy on peripheral blood dendritic cell subsets in patients with superficial urothelial carcinoma of the bladder / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Superficial urothelial carcinoma (SUC) of the bladder is a common urinary tract tumor in China. There is a high recurrence rate of this tumor even after surgery and intravesical instillation. Previous reports have described a suppression of the immune system in cancer patients. Dendritic cells (DCs) play a pivotal role in the induction of an effective antitumor immune response. The aim of this study was to investigate the effects of surgery and epirubicin intravesical chemotherapy (IC) on peripheral blood DCs in subsets of patients with bladder SUC.</p><p><b>METHODS</b>A total of 66 SUC patients and 38 healthy controls were enrolled in this study. All the patients had undergone transurethral resection (TUR) of their cancer and adjunctive IC after tumor removal. The patients were divided into a non-recurrence group (n = 40) and a recurrence group (n = 26) based on the presence or absence of tumor recurrence. Blood samples were taken preoperatively (PreOP), on postoperative days (POD) 1 and 7, and at postoperative month (POM) 3. Flow cytometric analysis was used for the determination and quantitation of the surface markers CD80 and CD86 in circulating DC subsets.</p><p><b>RESULTS</b>The preoperative percentages of myeloid dendritic cells (mDCs) and expression of CD80 and CD86 were impaired in SUC patients compared to healthy controls (P < 0.05). The percentages of mDCs and these surface markers decreased significantly on POD 1 and increased on POD 7, remaining higher than the preoperative values in POM 3 (P < 0.05). The percentages of mDCs, and CD80 and CD86 in the non-recurrence group on PreOP, POD 7, and POM 3 were higher than those in recurrence group.</p><p><b>CONCLUSIONS</b>Surgical removal of SUC and adjunctive IC were associated with improved circulating mDC counts and function. Persistent depression of mDC counts and function after treatment in recurrence patients indicated lower antitumor immunity that may lead to tumor recurrence.</p>

Dynamic changes of dendritic cells subsets in kidney transplantation recipients / 中华器官移植杂志

Objective To analyze the dynamic changes of dendritic ceils (DCs) and their subsets plasmacytoid DC (pDC) and myeliod DC (mDC) in peripheral blood of renal transplantation patients,and to confer the relationship between DCs subsets and graft rejection.Methods White blood cells (WBC) and mononuclear cells (PBMNCs) in peripheral blood of 28 renal transplantation recipients (test group) were measured before operation and at 1st,7th,28th day after operation.The number of DCs and subsets,and pDC/mDC were detected by using flow cytometry,and IL-10 and IL-12 levels were determined by using ELISA before and after operation.Ten volunteers (control group) served as controls.Results The levels of DCs,pDC and mDC before operation in test group were lower than in control group (P＜0.05),but there was no statistically significant difference in pDC/mDC ratio between two groups (P＞0.05).The number of DCs in test group was significantly decreased on the first day after operation up to the lowest level,then slowly increased,and recovered 73.7 ％ at 28th day after operation.The number of mDC and pDC was also decreased after operation,but mDC recovered faster than pDC (P＜0.05).On the day 7th after operation,the number of mDC in the recipients with graft rejection was higher than in those without graft rejection in test group (P＜0.01 ).There was no significant difference before and after operation in the levels of IL-10 and IL-12 in test group.Conclusion The number of DCs and subsets are related to the recipients' immune state,and their abnormality displays unstable immune state of recipients.The number of DCs and subsets can be used as an assistance index to diagnose graft rejection.

Analysis of demethylation drug 5-aza-2'-deoxycytidine in growth inhibition on bladder tumor cell / 中华泌尿外科杂志

Objective To study the growth suppressive effect of demethylation drug 5-aza-2'-deoxycytidine on bladder tumor cells. Methods The growth suppressive effect of DAC on 4 transitional cell carcinoma (TCC) cell lines was measured using the Cell Proliferation Reagent WST-1 assay.The effects of DAC on apoptosis induction and cell cycle arrest were analyzed by flow cytometric analysis. Caspase 3, 9 activities were analyzed by APOPCYTO Caspase Colorimetric Assay Kit and PCNA expression was also investigated by Western blot to clarify the mechanism of DAC against TCC. Results DAC inhibited the growth of all TCC cell lines tested in a dose-dependant manner, however,growth suppressive effect of DAC was independent of p53 status in TCC. DAC inhibited proliferation via inducing G2/M cell cycle arrest but not via inducing apoptosis. After treated with 0, 1 and 8 μmol/L DAC, cells of RTl 12 in G2/M phase was (36.3 ± 3.4) %, (46.2 ± 4.6) % and (56.5 ±6.2) %, TCCsup was (37.5 ± 3.8) %, (48.4 ±4.9) % and (60.1 ± 6.7) %, respectively. The expression of PCNA was decreased by DAC, but caspase3, 9 activities were not activated. Conclusion DAC could suppress the growth of TCC cells and might be a new strategy to treat bladder malignancy in the future.

RevoLix 2 micron continuous wave laser vaporesection for treatment of elderly and high risk benign prostatic hyperplasia: re-port of 36 cases / 国际外科学杂志

Objective To investigate the curative effect of RevoLix 2 micron continuous wave laser va-poresection for treatment of elderly and high risk benign prostatic hyperplasia patients. Methods Clinical data of 36 benign prostatic hyperplasia patients with medical complications aging 70 -82 years were retro-spectively analyzed. Operations were done after their complications were controlled. The RevoLix 2 μm laser system with output power of 70 W was used, and normal saline was used as rinse solution. Operations were started after positions of seminal colliculns and distances to neck of bladder were confirmed. Results Oper-ation time varied from 65 to 135 rain with a mean time of (83.6±10. 6) rain. Occasional venous hemor-rhage occurred during operation but no arterial hemorrhage was observed. No blood transfusion necessitated and no TURP syndrome was observed. Catheter was removed 2-4 days after operation. All the patients could urinate freely. No urinary incontinence was found during follow-up except 2 patients with temporary urinary incontinence. A 3-6 months follow-up showed that IPSS decreased from 24. 26 ±2. 70 to 8.47±4. 32, QOL dropped from 4. 51±0. 56 to 1.34 ± 0. 53, and Qmax increased from (6. 37 ± 1.31) mL/s to (17.24± 2. 32) mL/s. Conclusions RevoLix 2 micron continuous wave laser vaporesection is a safe and effective method with less trauma and fast recovery for treating elderly and high risk benign prostatic hyperplasia pa-tients.

Laparoscopic ureterolysis for retroperitoneal fibrosis :one case report / 国际外科学杂志

Objective To investigate the feasibility of laparoscopic surgery for hydronephrosis caused by retroper-itoneal fibrosis.Methods Reported the diagnosis and treatment procedure and result of 1 case of hydronephrosis caused by retroperitoneal fibrosis on left side,who underwent laparoscopie surgery.Investigated the feasibility of hydronephrosis caused by retroperitoneal fibrosis with literature review.A 55-year-old female patient had interrupt-able left lower extremity swollen with nausea and vomiting for five months.The blood test showed progressive eleva-ting of creatinine and urea nitrogen.The highest creatinine value was 503 μmol/L.The computerized tomography showed renal atrophy on right side and there was a stenosis on crossing place between inferior segment on left ureter and iliac blood vessels,also there is a soft tissue image in front of aorta and around iliac blood vessels,the superior ureter was dilated.We set double J tube into left ureter before surgery with semi-reclining position toward right side,set trocar cannula through 1 era,4 em below the umbilicus as well as the same two points on lateral external oblique muscle of abdomen,set laparoscope from 1 cm below the umbilicus.We found the abdominal membrane pale and touch as tabular.There was serious eonglutination between middle segment ureter and around iliac blood vessels after we cut open retroperitoneal membrane.We carefully dissected the ureter for 9 cm and soluted the eonglutination a-round the ureter,then set the ureter into abdominal cavity and closed retroperitoneal membrane.Results The pa-tient recover well after surgery and sutured out after 5 days,pulled out the double J tube after I month.The patient had low back pain ,fever and oliguria after the double J tube was pulled out and recovered with spasmolysis,analge-sia and antibiosis treatment after 2 days.The voiding volume and renal function became normal.The B-type ultra-sound test showed hydronephrosis on left side was lessened.The ultrasound test after 3 months result showed hydro-nephrosis was significantly lessened than before surgery and renal function was normal.Conclusions The laparo-scopic ureterolysis surgery for retroperitoneal fibrosis is minimally invasive,less suffering and quick recovery.Be-cause of few case report and short follow-up time is more eases and long-term follow-up are needed to elucidate the therapeutic efficacy of this treatment.

Minimally invasive percutaneous nephrolithotomy with U100plus laser for renal calculi:report of 133 cases / 国际外科学杂志

Objective To evaluate the safety and feasibility of minimally invasive percutaneous nephro-lithotomy (mPCNL) with U100plus laser for the treatment of renal calculi. Methods From October 2006 to December 2008 ,mPCNL was performed on 133 patients suffering from renal calculi by using Wolf 8/9. 8 rig-id ureteroscope and U10Oplus laser. Results mPCNL was completed in all the 133 cases. Residual calculi were found in 7 cases after operation and use medical drags to treat. The most residual calculi were removed after 1 month and a few stones being survived. 5 cases with residual calculi were treated by ESWL. The total stone clearance was 91.0%. The operation time was 38 -65 min(mean 46 min). Nephrostomy tube was kept for a mean of 1 -2 d. The mean postoperational hospital stay was 2 -4 d. Among the patients, 133 were followed up for 1-16 months (mean 8. 3 months) , during which no recurrent renal stones were found by B ultrasonngraphy or X ray. Conclusion By using mPCNL with U100plus laser, patients with renal calculi can be treated safely and effectively.

Minimally invasive percutaneous nephrolithotomy in treatment of superior segment ureter calculi / 国际外科学杂志

Objective To evaluate mini-percutaneous nephrolithotomy in treating superior segmental ureteral calculi. Methods Two Hundred and thirty-six patients underwent mini-percutaneous nephrolithotomy with holmium laser for superior segmental ureteral calculi from May 2005 to May 2008, 133 male and 103 female. Their age ranged from 17 to 76 years old with a mean of 47. 2 years. Of the 236 patients,141 compli-cated with calculi in the left side and 88 cases in the right side,7 in the both sides. The calculi diameter ranged from 0. 7 cm to 2.2 cm and the mean diameter was 1.4 cm. One hundred and ninety-three patients had undergone ESWL from 1～6 times. Results Of the 236 patients,217 were rendered stone-free at 1 pro-cedure. Residual calculi were found in 12 cases after operation and drugs were used for treatment. The resid-ual calculi were removed after 1 month. Seven cases with residual calculi were treated by ESWL and the cal-culi were removed. The total stone clearance was 91.9%. The mean operation time was 31.3 min(rang from 19～52 min), and the mean hospital stay was 9.5 days(rang from 6 to 12 days). The main complications following operation included: durative hematuria in 25 cases relieved by haemostasis and diuresis treatment within 24 to 48 hours,pnstoperative fever in 141 cases within 24 hours of which 103 were relieved by antiin-flammatory and fluid replacement treatment within 24 to 48 hours. Thirty-eight cases were relieved by anti-inflammatory treatwent depending on urine culture results within 3 to 7 days. The postoperative pain in all patients was light. Conclusion Minimally invasive percutaneous nephrolithotomy with holmium laser under ultrasound guidance is simple,safe and effective in treating proximal ureteral calculi.