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Objective:To explore the clinical value of modified upper urinary tract video urodynamics in evaluating the surgical effect and guiding the follow-up treatment after ureteral reconstruction.Methods:From December 2018 to November 2020, sixty-nine patients underwent upper urinary tract reconstruction and received modified video urodynamics at the time of nephrostomy removal 3 months after the surgery in the RECUTTER database (29 cases in Peking University First Hospital, 22 cases in Emergency General Hospital, and 18 cases in Beijing Jiangong Hospital). There were 39 males and 30 females, with an average age of (40.4±12.7)years. The stricture was located in left in 34 patients, right side in 27 patients, and bilateral sides in 8 patients. The upper, middle, and lower thirds of the ureter were affected in 26, 10, and 33 cases, respectively. The preoperative creatinine was (92.3±26.9)μmol/L, and the estimated glomerular filtration rate (eGFR) was (85.1±23.2)ml/(min·1.73m 2). The upper urinary tract reconstruction included ileal replacement of ureter in 25 cases (36.2%), pyeloplasty in 8 cases (11.6%), ureteroneocystostomy in 9 cases (13.0%), boari flap in 6 cases (8.7%), lingual mucosal graft ureteroplasty in 9 cases (13.0%), appendiceal onlay ureteroplasty in 3 cases (4.3%), ureteroureterostomy in 3 cases (4.3%), and balloon dilation in 6 cases (8.7%). Based on the pressure and imaging, the results could be divided into three types, type Ⅰ, the pressure difference remained stable near baseline, and the renal pelvis pressure was below 22 cmH 2O(1 cmH 2O=0.098 kPa), and the reconstructed ureter is well visualized during the whole perfusion process; type Ⅱ, the pressure difference increases with the perfusion, but it can decrease to a normal level with the ureteral peristalsis; type Ⅲ, the pressure difference exceeds 15 cmH 2O, and the ureteral peristalsis is weak or disappears at the same time. The management strategies and treatment effects of different subtypes were analyzed. Successful treatment was defined as no further treatment required, the absence of hydronephrosis-related symptoms, and the improved or stabilized degree of hydronephrosis. Results:All 69 patients successfully completed upper urinary tract video urodynamics. The pressure difference was higher than 15 cmH 2O in 8 patients, and the median pressure difference was 37(19-54)cmH 2O. The renal pelvis pressure exceeded 22 cmH 2O in 10 patients, and the median pressure was 63.5 (24-155) cmH 2O. Video urodynamic results of upper urinary tract were classified as type Ⅰ in 60 cases, type Ⅱ in 5 cases, and type Ⅲ in 4 cases. Patients in type Ⅰ do not require other treatment after nephrostomy tube removal. Patients in type Ⅱ should avoid holding urine after the removal of nephrostomy and D-J tubes. All patients in type Ⅲ received further treatment, of which 2 patients replaced D-J tube regularly, 1 patient underwent long-term metal ureteral stent replacement, and 1 patient underwent ureteroscopic balloon dilation. The median follow-up time was 24 (18-42) months. All patients in type Ⅰ met the criteria for surgical success, The pre-and postoperative creatinine in type Ⅰ patients were (88.71±23.09)μmol/L and (88.75±23.64)μmol/L ( P=0.984), and eGFR were (88.06±22.66)ml/(min· 1.73m 2)and (87.97±23.01)ml/(min·1.73m 2), respectively( P=0.969). For type Ⅱ patients, ultrasound showed that the degree of hydronephrosis improved in 3 cases and remained stable in 2 cases. The pre-and postoperative creatinine were (105.97±7.75)μmol/L and (97.63±7.56)μmol/L ( P=0.216), and eGFR were (69.08±14.74)ml/(min·1.73m 2)and (75.95±14.02)ml/(min·1.73m 2)( P=0.243), respectively. For type Ⅲ patients, ultrasound showed that the degree of hydronephrosis remained stable. The pre-and postoperative creatinine were (105.14±44.34)μmol/L and (101.49±57.02)μmol/L ( P=0.684), and eGFR were (65.32±19.85)ml/(min·1.73m 2) and (73.42±27.88) ml/(min·1.73m 2), respectively( P=0.316). Conclusions:The pressure and imaging results of modified upper urinary tract video urodynamics can assist in evaluating the surgical effect of ureteral reconstruction, and the classification has certain guiding significance for further treatment.
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Objective To investigate the clinical efficacy and safety of 90Sr-90Y applicator combined with topical timolol maleate for infantile superficial hemangiomas.Methods A total of 59 infants with hemangiomas were randomly divided into a study group (n=33; ≤3 months,15 cases;＞3 months,18 cases) and a control group (n=26; ≤3 months,10 cases; ＞3 months,16 cases).The study group was treated with 90Sr-90Y applicator combined with timolol maleate solution (0.5％) and the control group was treated with the same dose of 90Sr-90Y applicator combined with saline.Treatment effectiveness was compared between the two groups,and x2 test was used for statistical analysis.Adverse reaction was observed and recorded.Results The effective rate was 18/18,and the cure rates were 14/15 (≤ 3 months) and 16/18 (＞3 months) in the study group.The effective rates were 8/10 (≤3 months) and 11/16 (＞3 months),and the cure rates were 6/10 (≤3 months) and 9/16 (＞3 months) in the control group.Both the effective rate and cure rate of the study group were significantly higher than those of control group (x2 =22.22 and 30.29,≤3 months; x2 =36.69 and 27.31,＞3 months; all P＜0.01).Significant adverse reaction was not found in both groups.Conclusion 90Sr-90Y applicator combined with 0.5％ solution of topical timolol maleate has a very high effective and cure rate for infantile superficial hemangiomas,without significant adverse reaction observed.
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Objective To investigate the feasibility of tissue-specific gene therapy for bladder cancer using human UroplakinⅡ(UPⅡ) promoter. Methods The recombinant adenoviruses,Ad-hUPⅡ-TNF carrying tumor necrosis factor (TNF-?) under control of the hUPⅡ,were generated.ELISA showed the production and secretion of TNF by bladder cancer cells infected with Ad-hUPⅡ-TNF.The level of TNF in urine was identified with ELISA. Results ELISA showed that production and secretion of TNF by bladder cancer cells infected with Ad-hUPⅡ-TNF was distinctly higher than by non-urothelium cells infected with Ad-hUPⅡ-TNF and MTT showed that proliferation of bladder cancer cells was obviously inhibited.Conditioned medium from bladder cancer cells apparently inhibited cells of L929 proliferation,compared with conditioned medium from non-bladder cells by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay.Intravesical inoculation of Ad-hUPⅡ-TNF also caused decreased tumor growth in orthotopic human bladder cancer model.The sustained high level of TNF in urine could be identified with ELISA. Conclusions TNF driven by hUPⅡ promoter has effective active in the inhibition of bladder cancer growth both in vivo and in vitro.These will undoubtedly yield a new approach of therapy for bladder cancer.