A long-term clinical report of a modified unilateral cutaneous ureterostomy in bladder cancer patients receiving radical cystectomy / 中华泌尿外科杂志

Objective:To explore the long-term efficacy of a modified unilateral cutaneous ureterostomy in bladder cancer patients receiving radical cystectomy.Methods:The medical data of 104 bladder cancer patients who underwent ureterostomy in our hospital from Janurary 2013 to December 2020 were retrospectively analyzed. The patients were divided into unilateral and bilateral group. The unilateral group contained 66 cases, with 53 males and 13 females, average age (71.8±9.8) years, body mass index (BMI)(23.3±3.2)kg/m 2. The bilateral group contained 38 cases, with 33 males and 5 females, average age (75.1±10.8) years; BMI (22.7±3.0)kg/m 2. There was no significant difference in the above characteristics between the two groups ( P>0.05). The pathology, survival status, long-term complications between the two groups were compared. Quality of life was assessed during follow-up using the European Core Questionnaire for Quality of Life in Cancer Patients (EORTC QLQ-C30). Results:The unilateral group contained 46(69.7%) muscle invasive bladder cancer (MIBC) cases, 15 (22.7%) cases with lymph node metastasis, 7 (10.6%) cases with distant metastasis. The bilateral group contained 24(63.2%) muscle invasive bladder cancer(MIBC) cases, 6 (15.8%) cases with lymph node metastasis, 2 (5.3%) cases with distant metastasis. There was no significant difference in disease specific survival between the two groups ( P>0.05). During the follow-up, the incidence of overall complication rate in the unilateral group was significantly lower than that in the bilateral group [43.9% (29/66) vs. 63.2% (24/38), P<0.001]. The incidence of pyelonephritis in unilateral group was significantly lower than that in the bilateral group [16.6%(11/66) vs. 42.1%(16/38), P=0.006]. There was no statistical significance in terms of quality of life before operation in the two groups. After operation, both physical function score[(54.9±7.1) vs.(49.2±6.7)] and emotional function score [(63.1±6.4) vs.(59.9±6.7)] in unilateral group were higher than that in bilateral group ( P<0.05). Conclusions:The modified unilateral cutaneous ureterostomy could achieve relatively low complication rate, and improve the quality of life to some extent compared with bilateral ureterostomy.

The experience of surgical treatment in T 4 stage prostate cancer / 中华泌尿外科杂志

Objective:To investigate the effectiveness of surgical treatment for patients with T 4 stage prostate cancer. Methods:The clinical data and prognosis of 18 patients with T 4 stage prostate cancer treated in Shanghai Tenth People's Hospital from July 2013 to December 2019 were retrospectively analyzed. The average age of these 18 patients was 68.3 (53-81)years. 10 patients were castration resistant prostate cancer (CRPC) and 8 patients were hormone-sensitive prostate cancer (HSPC). 10 CRPC patients were treated with surgical treatment due to bladder clot packing and/or lower urinary tract obstruction. 8 HSPC patients had severe hematuria, severe dysuria and local symptoms. The KPS scores of all patients were ≥80 points with an average score of 84 (80-90). The average QOL score of 18 patients was 28 (21-32). 2 cases in 18 patients underwent total pelvic resection for rectal invasion (one CRPC and one HSPC). 7 cases underwent radical cystoprostatectomy for ureteral invasion (5 cases of CRPC, 2 cases of HSPC), 9 cases underwent bladder preservation surgery for bladder neck invasion (4 cases of CRPC, 5 cases of HSPC), of which 4 cases of enlarged lymph node dissection were all HSPC patients. Results:All cases of T 4 stage prostate cancer patients operation were successfully completed, the average operation time was 256 (219-310)min and the median intraoperative blood loss was about 300 (250-350)ml. Four of them (3 cases of CRPC and 1 case of HSPC) received blood transfusion after operation. The average postoperative hospital stay was 21(11-37) days. All 18 cases were followed up and the median follow-up time was 23.8 months. There was no perioperative death, and no bladder-preserving patients had true urinary incontinence or bladder outlet stenosis.2 CRPC cases died 8 and 15 months after surgery respectively, 7 patients were PSA relapse treated with docetaxel or abiterone therapy, and 1 HSPC patient with rectal invasion was followed up for 58 months after total pelvic resection, the PSA level was still 0.003ng/ml, no distant metastasis was found. 8 cases of hormone-sensitive patients were treated with endocrine therapy, and PSA was less than 0.2 ng/ml. The average QOL of 18 patients 3 months after operation was 37 points (25-45), which was significantly higher than that before operation. The average maximum urine flow rate of patients with bladder preservation was 23(19-25)ml/s. Conclusions:For T 4 stage prostate cancer, surgical treatment is feasible and safe for doctors with extensive surgical experience. For CRPC patients, the surgery can significantly improve short-term symptoms and quality of life, and long-term benefits need to be further evaluated with a large sample. For HSPC patients, it can not only improve clinical symptoms and QOL of patients, but also provide long-term benefits.

Video-assisted thoracosopic versus median sternotomy mitral valve replacement / 中华胸心血管外科杂志

ObjectiveStudy the effects of mitral valve replacement using video-assisted thorascoscopy compared with median sternotomy mitral valve replacement.MethodsBetween October 2003 and October 2011,72 cases suffer from mitral valve disease underwent video-assisted thorascoscopic mitral valve replacement,74 cases underwent median sternotomy procedure.CPB time,cross clamp time,ventilation time,drainage,ICU stay time and hospital stay time of the two groups were compared.Results It was longer that CPB time and cross clamp time in video-assisted thoracospic group than those of median sternotomy group.There was statistically significant difference.However there was no statistically significant differentce in ventilation time and ICU stay time between two groups.Drainage of video-assisted thoracospic group was less than median sternotomy group.And there was statistically significant difference.ConclusionAs long as strictly a good indication,mitral valve surgery can routinely be performed with video-assisted thoracospic.

Role of bone morphogenetic protein 2 and DLX5 in the differentiation of neural stem cells from anterior subventricular zone into neurons / 中国组织工程研究

BACKGROUND:Regulation of neural stem cells differentiation hampers its application,and the regulation mechanism remains poorly understood.Anterior subventricular zone(SVZa)is one of the rich zones of neural stem cells.The neural stem cells at SVZa can immigrate for a long distance with undifferentiated states and finally differentiate into intemeurons at the olfactory bulbs.Bone morphogenetic protein-2(BMP2)and DLX5 play a significant role in immigration and differentiation of neural stem cells at SVZa towards olfactory bulb.OBJECTIVE:To study the feature of construction and immigration of neural stem cells at SVZa,and to review the role of BMP2 and DLX5 in neural stem cells differentiation,in addition,to explore the regulation mechanisms of neural stern cells differentiation.METHODS:Literatures from PubMed database(http://www.ncbi.nlm.nih.gov/PubMed),CNKI database(www.cnki.net/index.htm)and WANFANG database(http://www.wanfangdata.com.cn)published between January 1997 and January 2009 were searched with the key words of"neural stem cells,SVZa,BMP2,and DLX5".The repetitive and obsolete studies were excluded.RESULTS AND CONCLUSION:A total of 121 literatures were selected and primarily collected,including 86 Chinese literatures and 35 English literatures.Finally,according to standardization,28 literatures were further analyzed.Neural stem cells of SVZa have unique construction and can immigrate for a long distance.BMP2 and DLX5 play a significant role in neuronal immigration and differentiation of the NSCs of SVZa,but the detailed mechanism of BMP2 and DLX5 in SVZa is not clear.

Early death causes in 2349 patients who receiving heart valve replacement / 中华胸心血管外科杂志

Objective The early causes of death were analyze in 2349 patients who had undergone heart valve replacement.Methods Methods From January 1995 to December 2007,2349 patients with heart valve diseases received heart valve replacement.1109 cases were male and 1240 were female.The mean age of the patients was(41±19)years old.1962 cases had rheumatic heart valve disease,308 had congenital heart valve disease,39 had infective endocarditis,29 underwent reintervention by heart valve replacement,11 had Marfan syndrome.34 cases with coronary heart disease underwent heart valve prosthesis implantation and coronary artery bypass grafting.Mitral valve replacement(MVR)was performed in 1333 patients,aortic valve replacement(AVR)in 271,double valves replacement(DVR)in 736 and tricuspid valve replacement(TVR)in 9.There were 3075 mechanical valves and 10 bioprosthetic valves.Results From 1995 to 1999,death occurred in 16 of the 235 cases,early mortality rate was 6.81%.From 2000 to 2004,death occurred in 35 of the 1087 cases,early mortality rate was 3.22%.From 2005 to 2007,there were 29 deaths among 1027 cases,with an early mortality rate of 2.82%.Overall early mortality rate was 3.40%.The early mortality rate was 2.32%(31 in 1333 cases)in patients who underwent MVR,3.32% (9 in 271)in patients who underwent AVR,5.24%(40 in 736)in patients who underwent DVR,5.50%(7 in 127)with LVEDD≥70 mm,4.60%(14 in 304)with LVEF<0.40,2.14%(9 in 419)with NYHA class II,2.42%(37 in 1529)with NYHA class Ⅲ,and 8.48%(34 in 401)with NYHA class IV.The causes of 80 deaths were low cardiac output syndrome in 31 cases(38.8%),renal failure in 14 cases(17.5%),arrhythmia in 10 cases(12.5%),pulmonary infections in 8 cases (10.0%).cerebrovascular accidentin 5(6.3%),left ventricular rupture in 5(6.3%),multisystem and organ failure in 5(6.3%),and other cause in 2 cases(2.5%).Conclusion The causes of early death after heart valve replacement are low cardiac output syndrome,renal failure,arrhythmia,pulmonary infection,cerebrovascular accident,left ventricular rupture and multisystem and organ failure.

Application of bilateral craniotomy method in the acute encephalocele during severe head injury / 国际外科学杂志

Objective To discuss the reasons and the best treatment of the encephalocele during severe head injury. Method Retrospective analysis 26 cases of the clinical data of patients with acute encephalo-cele during severe head injury used bilateral craniotomy method. Result Good recovery in 4 patients, mod-erate disability in 5 patients, severe disability in 2 patients, vegetative state in 3 patients, death in 12 pa-tients. Conclusion Delayed intracranial hematoma and acute diffuse brain swelling are the main reasons of craniotomy brain injury in acute encephalocele, and using bilateral craniotomy can significantly increase the survival rate and quality of life.

Diagnosis and surgical treatment of 61 cases with infective endocarditis / 国际外科学杂志

Objective To summarize the diagnosis and surgical treatment of 61 cases with infective endocarditis.Methods From January 1995 to April 2008,61 cases with infective endocarditis underwent operation in our hospital.The outcomes of these patients were summarized.Results There were 4 eases of early-death.Early mortality after heart operations was 6.6%.Fifty-seven patients were followed-up for 6 months to 13 years.Five were dead.Others'cardiac function(NYHA)was as follows:classⅡin 43 cases,class Ⅲ in 9 cases.Condusion Early diagnosis,optimal surgical timing,combined internal medicine and surgical treatment are the critical factors treatment of cases with infective endocarditis.

A study of renal functional damages due to chronic cadmium intoxication in rabbits / 第三军医大学学报

Rabbits were intoxicated with hypodermic injection of 0.8% CdCl2 in normal saline every other day for 3 months,and the blood level of urea nitrogen (BUN) and creatinine (Cr) and the activities of Na/K-ATpase,Ca-ATPase,and ?-GT in the renal cortex were determined.It was found that there were no remarkable changes of BUN and Cr level but significant reduction of the activities of the 3 enzymes.It is believed that the reduction of the enzyme activities is one of the factors to initiate the functional disturbances and morphological damages of the kidneys and plays an important role in the mechanism of renal failure if it is not promptly corrected.