Functional Shoulder Evaluation after Osteosynthesis of Greater Tuberosity Fracture: Is There any Influence of Glenohumeral Dislocation? / Avaliação funcional do ombro após osteossíntese da fratura da tuberosidade maior: Há influência da luxação glenoumeral?

Abstract Objective To evaluate the postoperative functional and radiographic outcomes of the shoulder of patients submitted to transosseous suturing of a greater tuberosity fracture (GTF) through an anterolateral route and the influence of the glenohumeral dislocation on these outcomes. Methods We conducted a retrospective study and functional assessment using the Constant-Murley score. The distance between the greater tuberosity and the joint surface of the proximal humerus (in true anteroposterior radiographs) after the union was calculated. We used the Fisher exact test for the categorical independent variables, and the Student t or Mann-Whitney test for the non-categorical variables. Results In total, 26 patients met the inclusion criteria, and 38% of the sample presented an association between glenohumeral dislocation and GTF. The mean Constant-Murley score was of 82.5 + 8.02 points. The presence of an associated dislocation did not alter the functional outcome. The mean distance between the greater tuberosity of the humerus and the joint surface of the humeral head after the union was of 9 + 4.3 mm below the articular line of the humeral head. The dislocation led to a lower level of reduction, but this did not influence the Constant-Murley score. Conclusion The cases of GTF submitted to surgical treatment with transosseous sutures had good functional outcomes. The presence of dislocation made the anatomical reduction of the greater tuberosity difficult. However, it did not influence the Constant-Murley score.

Resumo Objetivo Avaliar os resultados funcional e radiográfico pós-operatórios do ombro, em pacientes submetidos a sutura transóssea de fratura da tuberosidade maior (FTM) por acesso anterolateral, e a influência da luxação glenoumeral nesses resultados. Métodos Realizou-se estudo retrospectivo e avaliação funcional (pela escala de Constant-Murley). Calculou-se a distância entre a tuberosidade maior e a superfície articular do úmero proximal (por meio de radiografia em incidência anteroposterior verdadeira) após a consolidação. Usou-se o teste Exato de Fisher para as variáveis independentes categóricas, e os testes tde Student ou de Mann-Whitney para as não categóricas. Resultados Ao todo, 26 pacientes preencheram os critérios de inclusão. A associação de luxação glenoumeral com FTM foi observada em 38% da amostra. A média da pontuação na escala de Constant-Murley foi de 82,5 + 8,02. A presença de luxação associada não alterou o resultado funcional. A distância média da consolidação da tuberosidade maior do úmero em relação à superfície articular da cabeça umeral foi de 9 + 4,3 mm abaixo da linha articular da cabeça umeral. Pacientes com luxação associada evoluíram com redução menor, mas isso não influenciou na pontuação na escala de Constant-Murley. Conclusão As FTMs submetidas ao tratamento cirúrgico com sutura transóssea evoluíram com bom resultado funcional. A presença de luxação dificultou a redução anatômica da tuberosidade maior. Entretanto, isso não influenciou na pontuação na escala de Constant-Murley.

The effect of the extracellular vesicle loaded polylactic acid microspheres in promoting hepatocyte proliferation / 中国热带医学

@#Abstract: Objective　To prepare a microparticle delivery system that regulates the release rate of extracellular vesicles (EVs), and to exert long-term enhancement of liver cell proliferation after only one intervention. Methods EVs was extracted by differential centrifugation. The structure of the EVs was observed by transmission electron microscopy and the membrane marker protein of EVs was detected by Western blotting. EVs-PLA microspheres with "core-shell" structure were prepared by emulsion-solvent evaporation method. Scanning and transmission electron microscopy were used to detect the morphology of EVs-PLA microspheres and EVs. The release test detected the release behavior of EVs in EVs-PLA microspheres. Scanning electron microscopy was used to detect the morphological changes of EVs-PLA microspheres at 8 weeks of release. EVs-PLA microspheres were co-cultured with hepatocytes, and Phalloidin/DAPI staining was used to observe the cell morphology and evaluate the cytotoxicity of the microspheres. CCK8-test was used to evaluate the cell proliferation activity. Western blot analysis was used to detect extracellular vesicles membrane marker protein expression. Results Comparing the ability of hepatocyte proliferation in the group treated with EVs-PLA microspheres and the control group, it was found that EVs-PLA microspheres did not cause cell apoptosis and mutation in cell structure, had biocompatibility and no cytotoxicity. The EVs-PLA microspheres with "core-shell" structure regulated the release behavior of EVs, which can continuously release EVs, exerting a continuous biological role in promoting hepatocyte proliferation after a single intervention. Conclusions The EVs-PLA microspheres can control-release EVs and promote hepatocyte proliferation continuously after a single intervention, providing a reference for further exploration of EVs-loaded delivery systems in promoting liver regeneration.

Risk factors of incidental prostate cancer in patients undergoing radical cystoprostatectomy / 现代泌尿外科杂志

【Objective】 To investigate the risk factors and clinical significance of incidental prostate cancer (IPCa) in patients undergoing radical cystoprostatectomy (PCR). 【Methods】 The clinicopathological data of 260 patients undergoing RCP in our hospital during Jan. 2010 and Jan. 2022 were retrospectively analyzed, including 39 cases of IPCa detected with postoperative pathology, and 221 non-IPCa cases. 【Results】 The detection rate of IPCa was 15%. Univariate logistic regression analysis showed age (P<0.001), smoking (P<0.05), T stage (P<0.05), number of tumors (P<0.05), involvement of trigone (P<0.05), prostate volume (P<0.05), and preoperative total prostate-specific antigen (tPSA) (P<0.05) were influencing factors of prostate cancer. Multivariate logistic regression analysis showed that age (OR=1.061, 95%CI: 1.021-1.107, P=0.004), smoking (OR=2.852, 95%CI: 1.296-6.677, P=0.012), involvement of trigone(OR=2.967, 95%CI: 2.365-3.657, P=0.019) and preoperative tPSA (OR=1.109, 95%CI: 1.011-1.223, P=0.030) were independent risk factors of IPCa. 【Conclusion】 Advanced age, smoking, bladder tumor in trigone and preoperative PSA abnormality are risk factors for incidental prostate cancer in bladder cancer patients.

Mortality relevant factors of COVID-19 infection in kidney transplantation recipients: a systematic review and Meta-analysis / 中华器官移植杂志

Objective:To assess the evidence for relevant factors associated with mortality in COVID-19 kidney transplantation recipients(KTR) through Meta-analysis.Methods:A complete search of PubMed, Web of Science, Medline, Scopus, Cochrane Library, CNKI and Wanfang Database were performed to search for eligible studies on 18 August 2022.Results:twenty-nine studies involving 7 978 Cases were included in our Meta-analysis.Patients with mean age ≥60 years( OR=1.09, 95% CI: 1.06-1.13), Comorbidities including diabetes mellitus( OR=1.49, 95% CI: 1.26-1.76), cardiovascular disease( OR=1.88, 95% CI: 1.33-2.65), and acute kidney injury( OR=3.46, 95% CI: 1.35-8.89) significantly increased mortality risk.KTR with dyspnea ( OR=2.17, 95% CI: 1.38-3.42), higher Hemoglobin ( OR=1.09, 95% CI: 1.00-1.19), Use of mycophenolic ( OR=1.18, 95% CI: 1.02-1.37) and Antibiotics( OR=7.26, 95% CI: 2.11-25.07) at presentation were at higher mortality risk, while diarrhea( OR=0.57, 95% CI: 0.34-0.96) and higher eGFR( OR=0.95, 95% CI: 0.92-0.98) decreased the risk.Overall in-hospital mortality in COVID-19 KTR was 19%, 95% CI: 15%-23%. Conclusions:Our systematic review and -analysis results suggest that overall in-hospital mortality in COVID-19 KTR declined progressively over time.KTR with these risk factors should receive more intensive monitoring and early therapeutic interventions to optimize health outcomes.

Reprt of the short-term efficacy of a new type of ileal orthotopic cystectomy / 中华泌尿外科杂志

In this study, a new ileal orthotopic bladder (Urumqi Bladder) modified by our center based on the ileal "W" type orthotopic bladder and Studer bladder was used on 8 patients with invasive bladder cancer. All of patients were male and aged between 54 and 66 years. The history of disease ranged from 1 month to 3 years, including 5 patients with initial onset, 3 patients with ≥2 TURBT history. 6 patients had multiple tumors, tumor size from 0.5 cm to 2.5cm. There were 2 patients with single tumor. Preoperative PET-CT examination showed no distant metastasis and pelvic lymph node enlargement, no urinary tract hydronephrosis, and cystoscopy showed no suspected tumor in the urethra. Preoperative pathological results: high-grade invasive urothelial carcinoma was found in 6 cases and muscular invasive urothelial carcinoma in 2 cases. In 8 patients, 50cm ileum was taken from 15cm away from ileocecum after radical cystectomy, which was crimped clockwise inward from the right end into a nearly circular shape, with 10cm left at the left end. The remaining 40cm ileum was formed into 3 sections of about 13cm each, which were decanted to form a storage capsule. The last 10cm intestinal tube was crossed from the front of sigmoid colon. The end of intestine was anastomosed with the left ureter. The right ureter was anastomosed with the top of the right intestine pouch, and the urethra was anastomosed with the pouch to complete the diversion of urine flow. During 3-12 months of postoperative follow-up, 4 patients had short-term mild urinary incontinence. All had complete urinary control at 12 months. 1 patient still had mild left ureter reflux 12 months after surgery, and the other 7 patients had no ureter reflux. In this group of 8 patients, postoperative excretory cystography showed satisfactory effect of bladder voiding, residual, and bladder capacity. Follow-up review of chest CT, urinary CT and abdominal ultrasound showed no hydronephrosis, and no tumor recurrence or distant metastasis.

Programa de Mentoria da Faculdade de Medicina da Universidade Federal de Alfenas: relato de experiência / Mentoring Program at the Medical School of the Federal University of Alfenas: experience report

Resumo: Introdução: O Programa de Mentoria do curso de Medicina da Universidade Federal de Alfenas (Unifal) foi inspirado em programas de mentoring implantados em escolas médicas brasileiras desde a década de 1990, reconhecendo que a formação do futuro médico é marcada por intenso estresse acadêmico e emocional. Relato de experiência: O Programa de Mentoria tem papel preventivo e de suporte para o desenvolvimento pessoal e profissional dos estudantes de Medicina. As ações visam acompanhar o estudante longitudinalmente para proporcionar momentos de reflexão, tomada de consciência e desenvolvimento de competências para enfrentar os meios acadêmico, social e profissional. O mentor provê ao estudante uma figura-modelo que atua como suporte para auxiliá-lo nas vicissitudes do processo de ser médico. Discussão: Segundo os participantes, o Programa de Mentoria permite troca de experiências, aprendizagem e reflexão sobre temas relevantes da profissão e da vida acadêmica, atendendo às exigências das Diretrizes Curriculares Nacionais para os Cursos de Medicina para uma formação geral, humanista, crítica, reflexiva e ética. Conclusão: O Programa de Mentoria é exemplo de intervenção possível para prevenção de doenças e promoção da saúde durante a formação médica e contribui para o desenvolvimento de habilidades nos contextos pessoal e profissional.

Abstract: Introduction: The Mentoring Program of the Medical School at UNIFAL-MG was inspired by Mentoring Programs implemented in Medical Schools in Brazil since the 1990s, recognizing that training to be a physician is marked by intense academic and emotional stress. Experience report: The Mentoring Program has a preventive and supportive role for the personal and professional development of medical students. The actions aim to accompany the student longitudinally to provide moments of reflection, awareness, and the skills to face the academic, social and professional environment. The mentor represents a supportive model figure for the student, to help him overcome the difficulties in the process of being a physician. Discussion: According to the participants, the Mentoring Program allows the exchange of experiences, learning and reflection on relevant topics of the profession and academic life, meeting the requirements of the National Curriculum Guidelines for Medical Courses for general, humanistic, critical, reflective and ethical training. Conclusion: The Mentoring Program exemplifies a method of intervention for prevention and health promotion during medical training and contributes to the development of skills in both a personal and professional setting.

Analysis of risk factors for clinical cure and biochemical recurrence in patients after radical prostatectomy / 中华泌尿外科杂志

Objective:To evaluate the risk factors of clinical cure and biochemical recurrence (BCR) after radical prostatectomy (RP).Methods:The clinical data of 896 patients who underwent RP at Peking University First Hospital from April 2001 to December 2020 were retrospectively analyzed. Average age was (65.90±6.3) years, median preoperative prostate specific antigen (PSA) was 10.75 (0.36-264.20) ng/ml, median prostate volume was 40.0 (12.0-220.9) ml, median PSA density (PSAD) was 0.27 (0.02-3.42) ng/(ml·g). Clinical staging: 432 cases in T 1c stage, 333 cases in T 2a/bstage, 76 cases in T 2c stage, and 55 cases in ≥T 3 stage. Preoperative Gleason score of biopsy: 193 cases in 3+ 3, 315 cases in 3+ 4, 162 cases in 4+ 3, 226 cases in ≥8. The RP surgery was operated by open or laparoscopic or robot-assisted approach. Clinical cure and BCR were used as the end points for analysis. Clinical cure was defined as a decrease in serum PSA level below 0.03 ng/ml 6 weeks after surgery. BCR was defined as the 2 consecutive serum PSA >0.2ng/ml during the follow-up after RP. Multivariate logistic regression was used to analyze the independent risk factors of clinical cure. The Kaplan-Meier method was used to draw the biochemical recurrence-free survival curve, the log-rank method was used for univariate analysis of BCR, and the Cox regression analysis was used for multivariate analysis. Results:All 896 patients were followed-up for 58 (5-241) months, 678 cases (75.7%) achieved clinical cure. Based on univariate analysis and multivariate analysis, among the preoperative indicators, whether the proportion of positive biopsy needles ≥33% ( P=0.007) and preoperative Gleason score of biopsy ( P=0.041) were independent risk factors of clinical cure. A total of 890 cases were included in the analysis of risk factors of BCR, of whom 172 cases (19.3%) had BCR. The 1-, 5-, and 10-year biochemical recurrence-free survival(BFS)rates were 98.1%, 83.1% and 68.4% respectively. The median BFS has not been reached, and the average BFS was 181 months (95% CI 172-189). The results of univariate and multivariate analysis showed that whether achieved clinical cure ( P=0.001) and postoperative pathological staging ( P<0.001) were independent risk factors of BCR. Conclusions:Whether the proportion of positive biopsy needles≥33% and preoperative Gleason score of biopsy were independent risk factors of clinical cure. Postoperative pathological staging and whether achieved clinical cure may be independent risk factors of BCR.

Effect of maximum TURBT before radical cystectomy on the prognosis of multiple bladder tumors / 中华泌尿外科杂志

Objective:to investigate the effect of maximum transurethral cystectomy ((TURBT)) before radical cystectomy on the prognosis of patients with multiple bladder tumors.Methods:the clinical data and follow-up records of 90 patients with multiple bladder tumors treated in our hospital from August 2010 to August 2018 were analyzed retrospectively. There were 72 males and 18 females. The age ranged from 20 to 84 years old, with an average of (64.6 ±11.7) years. There were 50 cases of age <60 years old and 40 cases of ≥60 years old. The median age of male was 68 years old and that of female was 69 years old. The diameter of Tumor was ≥3 cm in 52 cases and <3 cm in 38 cases. There were 53 cases with 2 lesions and 37 cases with more than 2 lesions. According to the extent of TURBT resection, 55 patients (61.1%) were divided into maximum TURBT group, 42 males and 13 females, with an average age of (56.2±12.0) years. Tumor diameter ≥3 cm(n=29) and <3 cm(n=26). There were 35 cases (38.9%) in the non-maximal TURBT group, including 30 males and 5 females, with an average age of (59.8±13.4) years. In the non-maximum TURBT group. The diameter of tumor was ≥3 cm in 23 cases and <3 cm in 12 cases. There was no significant difference in preoperative data between the two groups ( P > 0.05). In the maximum TURBT group, all the tumors visible to the naked eye were completely removed, and the tissues were taken from the base and surrounding mucosa for pathological examination. Diagnostic TURBT group: multiple tumors in the bladder were found during the operation, the surface was rough, and there were no ureteral orifices on both sides. Samples of ureteral orifice and surrounding mucosal tissues were taken for biopsy, and the bladder tumor was not completely removed. Radical cystectomy was performed in both groups. The relationship between two different surgical methods and clinicopathological factors was analyzed. After that, the recurrence-free survival time (RFS) and overall survival time (OS) of patients were analyzed by Kaplan-Meier method, and the statistical difference of survival curve was analyzed by Log-rank method. Univariate Log-rank and multivariate Cox regression analysis were used to analyze the influencing factors of RFS and OS. Results:In this study, 90 cases of radical cystectomy were completed successfully. The postoperative follow-up time was 7-60 months, 1 case lost follow-up, and the median follow-up time was 30 (15-46) months. There was no significant difference in all data between maximum TURBT group and diagostic TURBT group ( P>0.05). Urethral recurrence occurred in 6 (6.7%) cases and pelvic recurrence in 9 (10%) cases after RC. 15 (16.7%) cases died, of which 8 cases died of postoperative pelvic recurrence, 3 cases died of myocardial infarction, 2 cases died of bone metastasis and 2 cases died of pulmonary metastasis. The results of Kaplan-Meier method showed that the 1-, 3-and 5-year overall survival rates of patients with RC after maximum TURBT were 96.67%, 86.05% and 80.86%, respectively, and the 1-, 3-and 5-year relapse-free survival rates were 89.97%, 76.93% and 71.41%, respectively. Univariate Log-rank results showed that pathological stage ( P=0.018), urethral recurrence ( P<0.01), pelvic recurrence ( P<0.01) and maximum TURBT ( P<0.01) were the risk factors of OS and RFS. The risk of death in patients with pelvic recurrence was higher than that in patients without pelvic recurrence ( HR=41.850, 95% CI 12.597-139.036, P<0.01). The risk of death in patients with urethral recurrence was higher than that in patients without urethral recurrence ( HR=8.128, 95% CI 1.551-42.606, P<0.01). The risk of death in patients with RC after maximum TURBT was lower than that in patients with diagnostic TURBT ( HR=0.164, 95% CI 0.036-0.746, P<0.01). Among them, there were only 2(3.9%) pelvic recurrence in patients with maximum TURBT combined with RC, 7(6.1%) pelvic recurrence and 6(6.7%) urethral recurrence in patients without maximum TURBT combined with RC, and there was significant difference between patients without maximum TURBT and patients without maximum urethral recurrence. Multivariate Cox analysis showed that urethral recurrence ( HR=8.128, 95% CI 1.551-42.606, P=0.013, P<0.01) and pelvic recurrence ( HR=41.850, 95% CI: 12.597-139.036, P<0.01) were independent risk factors for OS, and urethral recurrence ( HR=18.637, 95% CI 5.443-63.817, P<0.01) and pelvic recurrence ( HR=22.94, 95% CI 8.635-60.973, P<0.01) were independent risk factors for RFS. The maximum TURBT was the independent protective factor of OS ( HR=0.164, 95% CI 0.036-0.746 P<0.01) and RFS ( HR=0.153, 95% CI 0.048-0.493, P<0.01). Conclusions:For patients with multiple bladder tumors, radical cystectomy with maximum TURBT before radical cystectomy might reduce urethral and pelvic recurrence after radical cystectomy, and might improve the prognosis of patients with multiple bladder cancer. Maximum TURBT is an independent protective factor for OS and RFS. Urethral recurrence and pelvic recurrence are independent risk factors for OS and RFS.

Clinical features and prognosis of renal malignant mesenchymal tumors / 中华泌尿外科杂志

Objective:To discuss the clinical features, treatment and prognosis of renal mesenchymal malignancy.Methods:Retrospective analysis was performed on the clinical data of 48 patients with renal mesenchymal malignancies admitted from January 2005 to June 2019.The patients' age ranged from 16-79 years, including 29 males and 19 females. There were 21 cases of Han nationality and 27 cases of ethnic minorities. The main complained of lumbago were 31 cases, bloating 8 cases, blood urine 2 cases, and 6 cases by physical examination. And one case was seen in orthopedics due to upper arm pain. The patient's completion of the examination indicated a tumor of kidney origin. CT examination mostly showed renal space-occupying lesions. After enhancement, the tumor was irregularly enhanced, with unclear edges, which was difficult to distinguish from renal carcinoma. The tumors were on the left in 30 cases and on the right in 18 cases. All patients perfected preoperative blood routine, biochemical, coagulation and other examinations. Prothrombin time was normal in 39 cases. Clinical staging was conducted according to the imaging results at the time of initial diagnosis. 7 were in clinical Stage T 1, 16 were in Stage T 2, 20 were in stage T 3, and 5 were in stage T 4.Distant metastases were found in 8 cases, including 4 lung metastases, 2 retroperitoneal metastases, and 2 bone metastases. 13 patients underwent needle biopsy to confirm the diagnosis. Among the 48 cases in this group, 29 cases were diagnosed as renal tumor, 12 cases were diagnosed as renal space occupying lesions, and 7 cases were diagnosed as retroperitoneal space occupying. 17 underwent radical nephrectomy, 22 underwent partial nephrectomy, and 9 did not receive surgical treatment after needle biopsy. Results:Among the 48 patients, Conventional pathology confirmed 17 cases as leiomyosarcoma, 17 cases as liposarcoma, and 14 cases as other types of mesenchymal malignancies. Follow-up ranged from 7 to 180 months, with an average follow-up of 38.8 months. Thirty patients died, and the average survival time was 39 months. The 5-year survival rates of leiomyosarcoma, liposarcoma and other types of tumors were 18.2%, 30.8% and 50.1%, and the difference was statistically significant ( P=0.047). The 5-year survival rates of patients with normal and abnormal prothrombin time were 36.8% and 11.0%, the difference was statistically significant ( P=0.018). The 5-year survival rates of radical surgery and partial nephrectomy were 44.6% and 29.8%, and the difference was statistically significant ( P<0.05). The 5-year survival rates of T 1, T 2, T 3 and T 4 patients were 40.0%, 31.6%, 35.4% and 0, and the differences were statistically significant ( P=0.020). Multivariate analysis showed that preoperative prothrombin time ( P=0.013), clinical T stage ( P=0.030) and surgical method ( P=0.006) were independent factors affecting the prognosis of patients with RMM. Conclusions:Renal mesenchymal malignant tumor is rare, and highly malignant. Preoperative needle biopsy did not affect the prognosis of RMM. Patients with normal prothrombin time, early clinical staging and radical surgery had better prognosis. Renal liposarcoma has a better prognosis than renal leiomyosarcoma.

LncRNA Xist Promotes Proliferation and Migration of Rat BMSC by Regulating CXCR4 Expression / 中山大学学报(医学科学版)

@#【Objective】To explore the role of lncRNA Xist in proliferation and migration of rat bone marrow mesenchymal stem cells（BMSC）and its possible mechanism.【Methods】BMSC were isolated，cultured and identified from the femur and tibia of 3 weeks old SD female rats in vitro. SiRNAs was designed and screened to acquire a high silencing efficiency siRNA. Lipo2000 was used to transfected si- Xist and si- NC into BMSC of the experimental group（si- Xist group）and the control group（si-NC group）. BMSC proliferation capacity was determined by CCK-8 assay. The transverse and longitudinal mobility of BMSC were measured by wound healing assay and transwell migration assays. QPCR was performed to verify the silencing efficiency of lncRNA Xist and detect the expression levels of SDF- 1 and CXCR4 mRNA. Western blot was used to quantify the expression of CXCR4 protein.【Results】The P3 generation BMSC shows shuttle- like or whirlpool-like，and flow cytometry showed CD11b（-），CD34（-），CD45（-），CD44（+），CD90（+），CD105（+）. When siRNAs were used to interfere with the expression of lncRNA Xist in BMSC ，the silencing efficiency of three siRNAs was 67.92% ，68.72% and 98.32% ，respectively. CCK- 8 assay showed that the OD450 value of si- Xist group decreased compared with si-NC group at 24 h and 48 h（P < 0.001，P < 0.01，respectively）and had no statistical difference at 12 h（P > 0.05）. Wound healing assay showed that the wound healing percentage of si-Xist group was lower than that of si-NC group（P < 0.05）；and the transwell migration assay showed that，compared with si- NC group，the cells that migrated through the polycarbonate membrane were obviously decreased at 6 h（P < 0.001）. QPCR experiment showed that CXCR4 expression in si-Xist group was lower than that in si-NC group at mRNA level（P < 0.05），while SDF-1 expression showed no significant statistical difference（P > 0.05）. Western blotting confirmed that CXCR4 expression in si- Xist group was lower than that in si-NC group（P < 0.05）.【Conclusions】LncRNA Xist promotes proliferation and migration of rat BMSC by regulating CXCR4 expression.

Comparison of efficacy between extended pelvic lymph node dissection and standard pelvic lymph node dissection in open radical cystectomy / 中华泌尿外科杂志

Objective To compare the efficacy of extended pelvic lymph node dissection (ePLND) and standard pelvic lymph node dissection (sPLND) in open radical cystectomy.Methods We retrospectively analyzed the clinical data of 139 patients with bladder cancer cases in our hospital from January 2007 to January 2017,who underwent open radical cystectomy and pelvic lymph node dissection performed by the same group of surgeons.There were 117 males and 22 females,aged from 20 to 84 years old,with an average of (64.6 ± 11.7) years,91 patients were underwent ePLND group and 48 patients were underwent sPLND group.The preoperative anemia-free patients was compared between the ePLND group and the sPLND group [24 (50.0％)] vs.58 (54.9％),respectively],the patients with anemia were [24 (50.0％) vs.41 (45.1％)].The range of ePLND is:sway to the common iliac artery and the lower aortic (unreaching the inferior mesenteric artery);the lateral boundary to the reproductive femoral nerve;the distal end of the iliac artery at the groin level,the posterior border to the iliac vessels and closure,which contains the anterior tibial lymph nodes between the two sides.The range of sPLND is below the level of the common iliac artery bifurcation,and the rest of the range is the same as ePLND.The average operative time,average intraoperative blood loss,intraoperative blood transfusion,intraoperative and postoperative complications,postoperative eating time,postoperative activity time,postoperative exhaust time,postoperative hospital stay,mean gastric tube indwelling time,average pelvic drainage tube indwelling time,lymph nodes positive rate,lymph node density,and cancer-free survival were evaluated.Results All 139 patients underwent surgery successfully.The average operative time in the ePLND group and the sPLND group were [(351.2 ±79.5)min vs.(342.5 ± 69.3) min],average intraoperative blood loss [(314.6 ± 120.6) ml vs.(298.3 ± 126.3)ml],intraoperative blood transfusion [(702.9 ± 645.7) ml vs.(936.9 ± 818.1) ml],no intraoperative complications,postoperative complications [29 cases (31.9 ％) vs.18 cases (37.5 ％)],postoperative eating time [(5.4 ± 1.9) d vs.(4.8 ± 2.1) d],postoperative activity time [(2.1 ± 0.9) d vs.(1.9 ± 0.8) d],postoperative exhaust time [(3.8 ± 0.9) d vs.(3.6 ± 1.0) d],postoperative hospital stay [(14.9 ± 7.8) d vs.(15.5 ± 6.9) d],average gastric tube indwelling time [(4.8 ± 2.6) d vs.(4.53 ± 1.9) d],average pelvic drainage tube indwelling time [(11.1 ± 4.9) d vs.(10.9 ± 4.9) d],the difference was not statistically significant (P ＞ 0.05).A total of 2 359 lymph nodes were dissected from the two groups.The number of lymph nodes dissected in each of the ePLND group and the sPLND group was [(20.3 ± 3.8) vs.(10.6 ± 3.1),P ＜ 0.01],and the average number of positive lymph nodes was [(0.6 ± 1.3) vs.(0.3 ±1.0),P =0.034],the ratio of lymph node positive patients was [33 (36.3％) vs.9 (18.8％),P =0.026],and the lymph node density was [7.9％ (146/1848) vs.4.1％ (21/511)],the difference was statistically significant (P ＜ 0.05).In regard to prognosis,the disease-free survival rate (DFS) of ePLND group was 94.5％,91.0％,84.4％,81.1％,75.3％ at 1,2,3,4 and 5 years follow-up respectively.The other group was 70.5％,63.5％,57.8％,51.4％,41.1％ respectively.DFS of ePLND group tended to be higher than that of sPLND group in lymph node positive subgroups.The difference between the two groups was statistically significant (P ＜ 0.001).Conclusions In open radical cystectomy,ePLND and sPLND have similar surgical safety,but expanded lymph node dissection can improve disease-free survival in patients and improve the prognosis by increasing the detection range of positive lymph nodes.

Clinicopathological features and prognosis of chromophobe renal cell carcinoma and papillary renal cell carcinoma / 中华泌尿外科杂志

Objective To analyze the clinicopathological features and prognostic factors of common subtypes of non-transparent renal cell carcinoma.Methods Retrospective analysis of 115 patients with pathologically confirmed non-transparent renal cell carcinoma from January 2003 to December 2017,including 67 males and 48 females,with a male to female ratio of 1.4∶ 1.The average age is (51.2 ± 13.4)years old.71 cases were asymptomatic renal cancer,44 cases had clinical symptoms,including 10 cases of gross hematuria,28 cases of low back pain,4 cases of hematuria with low back pain,and 2 cases of abdominal mass.There were 49 open surgery and 66 laparoscopic surgery.58 patients underwent radical nephrectomy and 57 underwent partial nephrectomy.Of the 115 patients,17 (14.9％) had abnormal hemoglobin (Hb),22 (19.1％) had abnormal platelet (PLT) count,18 (15.7％) had abnormal alkaline phosphatase,and abnormal lactate dehydrogenase 16 cases (13.9％).The Kaplan-Meier survival analysis method was used to calculate the survival rate of patients,and the Cox proportional regression risk model was used to analyze the prognostic factors.Results The postoperative pathological stage was 57 cases in T1a stage,38 cases in T1b stage,12 cases in T2a stage,8 cases in T2b stage,2 cases of regional lymph node positive,and 113 cases negative;no distant metastasis.Pathological types:42 cases of renal chromophobe cell carcinoma,37 cases of papillary renal cell carcinoma type Ⅰ,36 cases of type Ⅱ.The average follow-up time was 38.6 months,and the rate of loss of follow-up was 3.5％ (4/115).The 1,3,and 5 year overall survival rates of 115 patients with common subtypes of non-transparent renal cell carcinoma were 99.1％,95.8％,and 81.1％,respectively.Multivariate Cox regression analysis found that the pathological type (OR =4.625,P =0.014),four indicators ≥ 3 abnormalities (OR =30.853,P =0.024),lymph node metastasis (OR =35.663,P =0.006) were the group.An independent factor in the survival time of patients with common subtypes of non-transparent renal cell carcinoma.Conclusions Compared with papillary renal cell carcinoma type Ⅰ and renal chromophobe cell carcinoma,papillary renal cell carcinoma type Ⅱ has a higher degree of malignancy and a poor prognosis.The pathological types of the common subtypes of nontransparent renal cell carcinoma,four indicators (Hb,PLT count,alkaline phosphatase,and lactate dehydrogenase) ≥3 abnormalities and lymph node metastasis are independent prognostic factors for overall survival.

Growth and proliferation of human urine derived stem cells in three kinds of culture media / 中国组织工程研究

BACKGROUND: Little is reported on human urine derived stem cells, and there is still no stable and efficient culture method until now. OBJECTIVE: To compare the effects of three kinds of culture media on the growth and proliferation of human urine derived stem cells, and to optimize the culture methods. METHODS: Human urine derived stem cells were isolated and purified using centrifugation method, and then cultured using adherent method in keratinocyte serum-free medium, progenitor cell culture medium, and urinary cell culture medium (equal-proportion mixture of keratinocyte serum-free medium and progenitor cell culture medium). Cell morphology was observed, and cell proliferation was detected by MTT method to draw a cell growth curve.RESULTS AND CONCLUSION: Human urine derived stem cells could be successfully cultured in these three kinds of culture media, which grew slowly in the keratinocyte serum-free medium, grew rapidly in the progenitor cell culture medium, and grew best in the urinary cell culture medium. To conclude, the urinary cell culture medium which can rapidly and efficiently culture target cells is the best choice for the growth of human urine derived stem cells.

Isolation, culture and biological characteristics of human urine-derived stem cells / 中国组织工程研究

BACKGROUND: As an emerging stem cell family, urine-derived stem cells have attracted more and more attentions in the tissue engineering construction. OBJECTIVE: To study the culture method of urine-derived stem cells, and to identify the biological characteristics of urine-derived stem cells. METHODS: Cleaning urine samples were harvested and centrifuged, and urine-derived stem cells were isolated from the urine samples and extensively expanded in vitro.Cell growth curve was measured by MTT method,and cell surface markers were detected by flow cytometry. Meanwhile, the cells were subjected to osteogenic and adipogenic induction. RESULTS AND CONCLUSION: Urine-derived stem cells were successfully isolated from the urine samples, which grew and proliferated rapidly. After subculture, the cells exhibited an S-shaped growth. The isolated urine-derived stem cells expressed CD29, CD44, CD73 and CD90, indicating that the cells maintained the activity of stem cells. Moreover, the isolated cells had the ability of osteogenic and adipogenic differentiation. To conclude, urine-derived stem cells have strong proliferation and differentiation potentials, as a kind of economic, convenient, non-invasive source of cells, which can provide great convenience for urethral defect repair and organ reconstruction.

Study on serum markers of prostate cancer by nuclear magnetic resonance-based metabolomics / 中华泌尿外科杂志

Objective To investigate the clinical value of serum metabolomic profile of prostate cancer using nuclear magnetic resonance-based metabolomics.Methods The retrospective case control study was adopted.The clinical data of 31 patients with prostate cancer,28 patients of prostatic hyperplasia and 31 healthy volunteers were enrolled in this study from May 2016 to May 2017 at the first affiliated hospital of Xinjiang medical university.In PCa group,the mean age was 66.3 years old,ranging 53-80 years old.In BPH group,the mean age was 59.3 years old,ranging 46-75 years old.In volunteer group,the mean age was 47.8 years old,ranging 35-62 years old..The serum of the 3 groups was measured by 1H-NMR spectroscopy.Multivariate statistical analysis was used to analyze the serum differential metabolism of the 3 groups,including principal components analysis (PCA),partial least squares discriminant analysis (PLS-DA) and orthogonal partial least squares discriminant analysis (OPLS-DA).Results The multivariate statistical analysis of PCA that the rate of the first principal component 1 (PC1) was 53.24％,the second principal component 2 (PC2) was 25.31％ and the cumulative contribution rate was 78.55 ％.Results of PLS -DA showed that partial data overlap of the three groups,but the separation trend was appeared.The variance of X(R2X) and Y(R2Y) matrixes and predictive value Q2 were 0.67,0.60,and 0.42.The results of OPLS-DA showed that the difference among the PCa group and BPH group,healthy group were obvious.The separation trend were appeared and the differential metabolites could be screened effectively.The R2X、R2Y and Q2 was 0.24,0.57,0.21 and 0.30,0.65,0.36.26 different serum metabolites were detected in the 3 groups,including citric acid,arginine,threonine,citrulline,glutamine,lactic acid,alanine,unsaturated fats,glycoprotein etc.Conclusions Compared with BPH group and healthy group,the serum of prostate cancer patients showed significant differences in metabolism.Nuclear magnetic resonance metabolomics analysis can effectively distinguish these serum metabolic differences.

Efficacy of totally thoracoscopic surgery in repair of ventricular septal defect / 中国胸心血管外科临床杂志

@#Objective    To analyze the clinical efficacy of totally thoracoscopic surgery and conventional thoracotomy in repair of ventricular septal defect (VSD). Methods    We retrospectively reviewed the clinical data of 50 VSD patients admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2015 to January 2017. According to the surgical pattern, they were divided into two groups: a totally thoracoscopic surgery group (21 patients, 13 males, 8 females, aged 38.36±10.02 years), and a thoracotomy group (29 patients, 18 males, 11 females, aged 42.36±13.02 years). The operation time, hospital stay, ventilator-assisted time and thoracic drainage were compared between the two groups. Results    There was no death in two groups. In the thoracoscopic group the duration of cardiopulmonary bypass (CPB) time and the aortic clamping time were longer than those of the thoracotomy group (P<0.05), but postoperative drainage, patients with postoperative use of blood products and postoperative hospital stay were less (P<0.05). There was no statistically significant difference between the two groups in operation time, postoperative ventilator-assisted time or duration of ICU stay. Conclusion     Compared with the conventional thoracotomy, totally thoracoscopic VSD repair with less trauma, quicker recovery and less blood use, is safe and reliable and can be used as a preferred surgical intervention.

A study on the etiology and epidemiological characteristics of fever and rash syndrome among children under the age of five years in Northwest China from 2009 to 2015 / 中华疾病控制杂志

Objective To explore the etiology and epidemiological characteristics of fever and rash syndrome a mong children under the age of five years in Northwest China from 2009 to 2015.Methods Descriptive epidemiological analysis was conducted based on the monitoring data in sentinel hospitals,which was from the information management system of national infectious disease monitoring from 2009 to 2015 in Gansu,Qinghai,Inner Mongolia and Xinjiang.Results The results showed that the major pathogens of fever and rash syndrome among children under the age of five years were enterovirus,measles virus,varicella-zoster virus (VZV) and rubella virus.The major pathogens among children in the age group of 0-years and in the age group of 1-5 years were measles virus and enteroviruses,respectively.Among the positive cases of enterovirus,the positive detectable rates of human enterovirus 71 (EV71) and coxsackie A16 (CA16) were 47.18％ and 45.59％,respectively.The incidences of enterovirus and measles virus infection were mainly concentrated on May to July and March to May,respectively.Conclusions The major pathogens of fever and rash syndrome among children under the age of five years in Northwest china were enterovirus and measles virus with seasonal epidemic characteristics.Therefore,the prevention and control of measles and hand-foot-mouth disease should be strengthened.

Comparative study of totally thoracoscopic and median thoracotomy surgery in the repair of atrial septal defect / 中华胸心血管外科杂志

Objective To compare the clinical effects of totally thoracoscopic surgery and conventional median thoracoto my surgery in the repair of atrial septal defect(ASD),so as to provide reference for the clinical choice of atrial septal defect repair.Methods 131 patients with ASD from January 2015 to November 2016 in the First Affiliated Hospital of Xinjiang Medical University were divided into two groups according to operation type:totally thoracoscopic group(58 cases),median thoracotomy group.The differences in operative time,cardiopulmonary bypass time(CPB),ventilator assist time,ICU stay time,postoperative hospital stay and other aspects were compared.Results There was no death and no serious complication in the two groups.There was no statistical difference between the two groups (P ＞ 0.05) in sex,weight,age,right atrial size and cardiac function.The time of thoracoscopic surgery [(3.6 ± 1.0) h vs.(2.6 ± 0.6) h] and the duration of CPB [(98.3 ± 35.8)min vs.(32.3 ± 16.1) min] were longer than those of median thoracotomy group (P ＜ 0.05).There was no statistical difference between two groups in the time of mechanical ventilation,ICU stay,postoperative drainage and postoperative hospital stay (P ＞ 0.05).Conclusion Although ASD repair of thoracoscopic surgery is difficult and the learning curve is long,but it can be said that the totally thoracoscopic ASD repair can achieve the same results as conventional median thoracotomy does,and it is effective and safe,and thoracoscopic surgery also has less trauma and cosmetic appearance,no bone structure damage,worthy of clinical promotion.

Individualized anticoagulation versus empirical anticoagulation therapy after cardiac valve replacement in Uygur patients: A randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective    To investigate whether the individualized anticoagulation therapy based on CYP2C9 and VKORC1 gene is superior to empirical anticoagulation therapy after artificial heart valve replacement surgery in Uygur patients. Methods    From December 2012 to December 2015, 210 Uygur patients who underwent artificial heart valve replacement surgery at the First Affiliated Hospital of Xinjiang Medical University were randomly assigned to a genetic anticoagulation therapy group (group A, n=106, 41 females and 65 males, aged 44.7±10.02 years) or an empirical anticoagulation therapy group (group B, n=104, 47 females and 57 males, aged 45.62±10.01 years) according to the random number table. CYP2C9 and VKORC1 genotypes were tested in the group A and then wafarin of administration in anticoagulation therapy was recommended. Patients in the group B were treated with conventional anticoagulation. Patients in both groups were followed up for 1 month and coagulation function was regularly tested. Results    The percentage of patients with INR values of 1.8-2.5 after 4 weeks warfarin anticoagulation treatment in the group A was higher than that in the group B (47.1% vs. 32.7%, P=0.038). The rate of INR≥3.0 in the warfarin anticoagulation therapy period in the group A was lower than that in the group B (21.6% vs. 26.5%, P=0.411). The time to reach the standard INR value and the time to get maintenance dose were shorter in the group A compared with the group B (8.80±3.07 d vs.   9.26±2.09 d, P=0.031; 14.25±4.55 d vs. 15.33±1.85 d, P=0.032). Bleeding occured in one patient in the group A and three patients in the group B (P=0.293). Embolic events occured in three patients in the group A and five patients in the group B (P=0.436). Conclusion    Compared with the empirical anticoagulation, the genetic anticoagulation based on wafarin dosing model can spend less time and make more patients to reach the standard INR value. However there is no significant difference between the two groups in the ratio of INR≥3.0, bleeding and embolic events in the warfarin anticoagulation therapy.

Effect of Klotho protein on renal oxidative stress in rat with calcium oxalate nephrolithiasis / 中华泌尿外科杂志

Objective To investigate the protective effect and mechanism of Klotho protein on oxidative stress in renal tubular epithelial cells of experimental rat nodels of renal calcium oxalate stone.Methods The 30 SD rats,6-8 weeks old,were randomly divided into 3 groups (10 of each),normal control group(group A),calcium oxalate model group(group B),drug plus calcium oxalate model group (group C).Group A was established with physiological saline by garage each day,group B was established with 1％ ethylene glycol in drinking water + 2％ ammonium chloride by garage (2 ml/d),group C was established with Fosinopril 2.5mg + Valsartan 15mg aqueous solution 2 ml by gavage on the basis of group B (2 ml/d).4 weeks later,the level of malondialdehyde (MDA),superoxide dismutase (SOD),catalase (CAT) and glutathione peroxidase (GSH) in the kidney homogenate were measured by double antibody sandwich enzyme-linked immunosorbent assay (ELISA),Polymerase chain reaction (RT-PCR) was used to measure expression of Klotho and Nrf2 mRNA,and Western Blot was used to measure the expression of Klotho and Nrf2 protein.Results The level of MDA in group B [(12.43 ± 0.43) μmol/mg] was significantly increased compared to group A[(8.67 ±0.84) μmol/mg,P ＜0.05] and group C [(7.97 ±0.81) μmol/mg,P＜0.05],while group A was close to group C (P ＞0.05).In group A,B,and C,the levels of SOD were (247.89 ± 2.45),(109.54 ± 4.21),and (189.74 ± 10.47) U/mg,respectively;the levels of GSH were (38.98 ± 4.55),(26.87 ± 3.92),and (31.29± 2.54) μmol/mg,respectively;CAT were (138.47 ± 8.74),(119.87 ± 8.45),and (127.46 ± 7.45) U/mg,respectively.The levels of SOD,GSH,CAT in group B were significantly lower than that in group A and C,while those in group B were close to group A (P ＞ 0.05).The expression of Klotho and Nrf2 mRNA in group B [(0.208 ± 0.036) and (0.499 ± 0.086)] were significantly lower than group A (1.011 ± 0.174 and 1.023 ± 0.139,P ＜ 0.05)and group C(1.123 ±0.248 and 1.023 ±0.139,P ＜0.05).The expression of Klotho and Nrf2 protien were also significantly lower than that in group A and C (P ＜0.05).Conclusions Valsartan and Fosinopril could prevent the formation of renal CaOx stones by upregulating expression of low level Klotho gene induced by ethylene glycol.This effect may be involved with activation of Keapl-Nrf2-ARE signaling pathway.