Diagnosis, treatment and prognosis of FH-deficient renal cell carcinoma with tumor thrombus / 中华泌尿外科杂志

Objective:To Explore the diagnosis, treatment and prognosis of FH-deficient renal cell carcinoma (FH-deficient RCC) with tumor thrombus, and share surgical experience.Methods:From August 2019 to October 2022, 6 cases of FH-deficient RCC with tumor thrombus were diagnosed and treated in our center, including 4 males and 2 females. The patients were aged 22 to 57 years, with 2 cases younger than 40 years, icluding 5 cases on the left and 1 case on the right. The median maximum diameter of the tumor is 8 (4.8, 14.0) cm. Operations were performed after complete examination (enhanced CT and other related examinations). One case underwent open surgery and palliative resection of the left kidney was performed because of severe adhesion of the inferior vena cava. Among the remaining 5 cases, 1 case underwent retroperitoneal laparoscopic right radical nephrectomy with inferior vena cava thrombectomy, 1 case underwent transabdominal laparoscopic left radical nephrectomy with inferior vena cava thrombectomy, and 3 cases underwent robot assisted laparoscopic left radical nephrectomy with inferior vena cava thrombectomy.Results:The median surgical time was 293 (185, 366) min, with blockage of the vena cava for 13 min and 28 min in 2 of 6 cases, respectively. The pathological report of renal tumor and tumor thrombus was FH-deficient renal carcinoma. The pathological features were as follows: the gross section of the specimen was gray yellow solid, often accompanied by necrosis, and the cystic cavity could be seen locally. Microscopically, the tumor extensively involved the renal parenchyma, with papillary, cribriform and tubular cystic structures. Immunohistochemistry showed FH (-), 2SC (+ ). The median postoperative hospital stay was 8 (4, 15) days. The median follow-up time was 13 (4, 27) months. One patient undergoing palliative resection of the left kidney underwent targeted therapy and radiotherapy after surgery (died 15 months after surgery due to gastrointestinal perforation). During the follow-up process, 4 cases experienced metastasis and received systematic treatment, with 1 death 27 months after surgery. Uterine leiomyomas were found in the remaining 1 case during follow-up.Conclusions:FH-deficient RCC with tumor thrombus is very rare. This disease is highly invasive, difficult to be diagnosed preoperatively and poor clinically prognostic. Operation combined with systemic therapy is an effective way to treat FH-deficient RCC with tumor thrombus.

Expression of PRMT5 protein in colorectal cancer tissues and its relationship with recurrence after radical resection / 中国医师进修杂志

Objective:To investigate the expression of PRMT5 protein in colorectal cancer tissues and its relationship with recurrence after curative resection.Methods:The clinical data of 154 patients with colorectal cancer who underwent radical resection in Zigong Fourth People′s Hospital from February 2016 to April 2018 were retrospectively reviewed, the colorectal cancer tissues and adjacent tissues samples of them were retained at the time of surgery. The PRMT5 protein expressions in each specimen were determined by immunohistochemistry. The recurrence status of patients during the 3-year postoperative follow-up period was counted, and they were divided into recurrence group and no recurrence group.The positive expression rates of PRMT5 protein in colorectal cancer tissues between the two group was compared, and Cox regression model analysis was used to analyze the influencing factors of recurrence after radical resection of colorectal cancer.Results:The positive expression rate of PRMT5 protein in the colorectal cancer tissues was higher than that in the adjacent tissues: 70.13%(108/154) vs. 16.23%(25/154), there was statistical difference ( χ2 = 91.16, P<0.01). Within 3 years after surgery, the recurrence rate was 20.13%(31/154), and the positive expression rate of PRMT5 protein in the recurrence group was higher than that in the no recurrence group: 93.55%(29/31) vs. 64.23%(79/123), there was statistical difference ( χ2 = 10.16, P<0.05). The results of Cox regression model analysis showed that the tumor stage, lymph node metastasis and positive expression of PRMT5 protein in colorectal cancer tissues were independent risk factors for recurrence after radical resection of colorectal cancer ( P<0.05). Conclusions:The PRMT5 protein shows high expression in colorectal cancer tissues, and it is closely related to postoperative recurrence, and its positive expression can increase the risk of postoperative recurrence in patients with colorectal cancer.

The feasibility of laparoscopic partial nephrectomy in the treatment of renal tumors with R. E.N.A.L. score of 10 / 中华泌尿外科杂志

Objective:To investigate the efficacy and safety of laparoscopic partial nephrectomy in the treatment of renal tumors with renal score of 10.Methods:From February 2016 to March 2021, 23 patients who underwent laparoscopic partial nephrectomy in Peking University Third Hospital with renal tumors of R. E.N.A.L. score of 10 was studied retrospectively, including 16 cases of male and 7 cases of female, with 11 cases on the right side and 12 cases on the left side. The patients’ age was (55.0±16.4) years, and BMI was (25.4±3.6) kg/m 2. The maximum diameter of the tumor was (3.5±1.4)cm. Laparoscopic partial nephrectomy was performed after complete examination. The observation indexes included operation time, blocking time, complications, postoperative hospital stay and the trifecta (negative surgical margin, blocking time ≤25 minutes, and no perioperative complications). Results:All operations were successfully completed, only 4 cases were converted to open surgery. The median operation time was 153 min(99-346 min). The median blocking time was 27 min(14-60min). The median postoperative hospital stay was 6 d(4-11 d). Postoperative complications occurred in 7 cases(fever in 5 cases, intestinal obstruction in 1 case, postoperative blood transfusion and leg intermuscular venous thrombosis in 1 case). 9 cases (39.1%) achieved the trifecta. 19 cases who completed by laparoscopy, their operation time was 151 min(99-303 min), blocking time was 28 min(18-60 min), postoperative hospital stay was 6 d(4-11 d), fever occurred in 4 cases, and 6 cases achieved the trifecta (31.6%). The follow-up time was 3-62 months, with a median of 32 months, and there was no recurrence or metastasis.Conclusions:Laparoscopic partial nephrectomy is safe and effective in the treatment of renal tumors with renal score of 10.Although the tumor is highly complex, it also achieves the purpose of preserving nephron to the greatest extent. If technical conditions permit, laparoscopic partial nephrectomy could be considered for the treatment of highly complex renal tumors.

Surgical technique and clinical experience of robotic-assisted laparoscopic nephrectomy with Mayo 0-Ⅲ inferior vena cava thrombectomy / 中华泌尿外科杂志

Objective:To summarize the surgical technique and clinical experience of robotic-assisted laparoscopic radical nephrectomy (RN) + venous tumor thrombectomy (VTTE) approach for renal tumor with Mayo grade 0-Ⅲ tumor thrombus, and to discuss its safety and efficacy.Methods:A retrospective analysis of the clinical data of 26 patients with renal tumor associated with Mayo 0-Ⅲ thrombus admitted to Peking University Third Hospital from October 2020 to September 2021. There were 17 male cases and 9 female cases. The mean age was (56.9±13.9) years. The mean body mass index (BMI) was (25.8±3.5) kg/m 2. The renal tumors were located on the left side in 12 cases and on the right side in 14 cases, with a mean tumor diameter of (7.8±2.9) cm. The tumors were graded by Mayo: Mayo 0 in 10 cases, Mayo Ⅰ in 3 cases, Mayo Ⅱ in 11 cases and Mayo Ⅲ in 2 cases. The American Society of Anesthesiology (ASA) graded 23 cases as grade 2 and 3 cases as grade 3. All 26 patients were treated by robotic-assisted laparoscopic approach with RN+ VTTE. Mayo 0 tumor thrombus was treated in the same way as radical nephrectomy. For Mayo Ⅰ tumor thrombus, the lateral wall of the IVC at the inferior vena cava (IVC) where the renal vein joins was clamped to partially block the IVC flow and then the thrombus was removed. For Mayo Ⅱ tumor thrombus, after blocking the flow in the IVC with three blocking bands, the wall of the IVC was dissected and the thrombus was removed. For Mayo Ⅲ tumor thrombus: cut the short hepatic vein, free the liver, expose the posterior IVC and follow the same procedure as for Mayo Ⅱ tumor thrombus. Results:All 26 patients in this group were successfully operated on, 1 of which was converted to open surgery. The median operative time was 148.5 (77.0-399.0) min, and the median intraoperative estimated bleeding volume was 300 (10-2000) ml. Postoperative pathological diagnosis: 18 cases of renal clear cell carcinoma, 2 cases of papillary renal cell carcinoma type Ⅱ, 2 cases of TEF gene fusion-related renal carcinoma, 1 case of unclassified renal cell carcinoma, 1 case of uroepithelial carcinoma and 2 cases of AML. In 2 of the 26 cases, segmental resection of the IVC was performed because the right renal VTT had extensively invaded the wall of the IVC. Due to the residual wall thrombus at the head of the tumour thrombus, 1 case underwent inferior vena cava dissection and the inferior vena cava was cut obliquely to preserve the left renal venous return. 6 patients underwent intraoperative lymph node dissection of the hilum, three of which had pathology suggestive of lymph node metastasis. 1 patient underwent adrenalectomy for tumor invasion of the ipsilateral adrenal gland. The median postoperative hospital stay was 7.2(4.0-22.0)d. According to the modified Clavien classification, there were 18 grade Ⅰ and 8 grade Ⅱ postoperative complications. 26 patients were followed up for 1-11 months, with a median follow-up time of 5.5 months. 3 cases developed distant metastases, including 1 case with tumour-specific death due to multiple metastases in the liver and retroperitoneum at 4 months of follow-up.Conclusions:Robotic-assisted laparoscopic RN+ VTTE is a safe and effective procedure for the treatment of renal tumours with Mayo 0 to Ⅲ tumour thrombus, with the advantages of delicate operation, minimal trauma and low incidence of serious postoperative complications.

Efficacy and safety study of Chinese botulinum toxin A 100U in patients with overactive bladder: a prospective, multicenter, double-blind and randomized controlled trial / 中华泌尿外科杂志

Objective:To assess the efficacy and safety of 100 units of botulinum toxin A (BTX-A) intradetrusor injection in patients with overactive bladder.Methods:From April 2016 to December 2018, 17 tertiary hospitals were selected to participate in this prospective, multicenter, randomized, double-blind, placebo-controlled study. Two phases of study were conducted: the primary phase and the extended phase. This study enrolled patients aged 18 to 75 years who had been inadequately managed by anticholinergic therapy (insufficient efficacy or intolerable side effects) and had spontaneous voiding with overactive bladder. Exclusion criteria included patients with severe cardiac, renal and hepatic disorders, patients with previous botulinum toxin treatment for 6 months or allergic to BTX-A, patients with urinary tract infections, patients with urinary stones, urinary tract tumors, diabetes mellitus, and bleeding tendency. Eligible patients were randomly assigned to BTX-A group and placebo control group in a ratio of 2∶1. Two groups of patients received 20 intradetrusor injections of BTX-A 100U or placebo at the depth of the submucosal muscle layer respectively under cystoscope, including 5 injections at the base of the bladder, 3 injections to the bladder triangle, 5 injections each to the left and right walls and 2 injections to the top, sparing the bladder neck. As a placebo control group, patients received same volume of placebo containing no BTX-A and only adjuvant freeze-dried preparations for injection with the same method. A combination of gelatin, sucrose, and dextran served as adjuvants. Average micturition times per 24 hours, urinary incontinence (UI) episodes per day, average micturition volume per day, OAB symptom score(OABSS), and quality of life (QOL) score were recorded at baseline and the 2nd, 6th and 12th week after treatment. The primary efficacy endpoint was the change from baseline in the average micturition times per 24 hours at the 6th week after treatment. The secondary efficacy endpoints included the change from baseline in the average micturition times per 24 hours at 2nd and 12th week, as well as the change from baseline in the OABSS, QOL score, average frequency of urgency and UI episodes per day, urgency score, average micturition volume per day at 2nd, 6th and 12th week after treatment. Patients were followed for 12 weeks to assess adverse events (AEs). After assessed at week 12, if the micturition times has decreased less than 50% compared to baseline and the patient is willing to receive retreatment, then patients could enter the extended trial phase. In that phase, patients in both groups were injected with 100 units BTX-A from 12th week onwards and then followed up the same indicators for 12 weeks.Results:216 patients were enrolled in this trial (144 cases in the BTX-A group and 72 cases in the placebo control group). Baseline characteristics such as age (47.75±14.20 in the BTX-A group and 46.39±15.55 in the control group), sex (25 male/117 female in the BTX-A group and 10/61 in the control group), and disease duration (0.51 years in the BTX-A group and 0.60 years in the control group) were balanced between the two groups( P>0.05). A marked reduction from baseline in average micturition times per 24 hours was observed in all treatment groups at the 6th week and the reduction of the two groups was statistically different ( P<0.001 and P=0.008 respectively). Compared with the baseline, the average micturition times per 24 hours at the 6th week decreased from baseline by 2.40(0.70, 4.60)times for the BTX-A group and 0.70(-1.00, 3.30) times for the placebo control group respectively, and the difference between the two groups was considered to be statistically significant ( P=0.003). The change rates of average micturition times per 24 hours from baseline at the 6th week of the two groups were (16±22)% and (8±25)% respectively, and the difference between the two groups was statistically significant ( P=0.014). Compared with the baseline, the average micturition times per 24 hours at 2nd and 12th week decreased by 2.00(0.00, 4.00)and 3.30(0.60, 5.03)for the BTX-A group, 1.00(-1.00, 3.00)and 1.70(-1.45, 3.85)for the placebo control group respectively. The difference between two groups was considered to be statistically significant ( P=0.038 and P=0.012); the changes of average urgency times per day for the BTX-A group and the control group at the 2nd, 6th and 12th week were 2.00(0.00, 4.30)and 2.40(0.30, 5.00), 3.00(0.30, 5.70)and 0.70(-1.30, 2.70), 0.70(-1.30, 3.00) and 1.35(-1.15, 3.50), respectively. There were significant differences between two groups at the 2nd, 6th and 12th week, ( P=0.010, P=0.003 and P=0.025, respectively). The OABSS of the BTX-A group and the control group at the 6th week decreased by 1.00(0.00, 4.00)and 0.50(-1.00, 2.00) compared with the baseline, and the difference between the two groups was statistically significant ( P=0.003). 47 cases of BTX-A group and 34 cases of placebo control group entered the extended trial phase, and 40 and 28 cases completed the extended trial phase, respectively. The average micturition volume per 24 hours changed by -16.60(-41.60, -0.60)ml and -6.40(-22.40, 13.30)ml, (-35.67±54.41)ml and(-1.76±48.69)ml, (-36.14±41.51)ml and (-9.28±44.59)ml, (-35.85±43.35)ml and(-10.41±40.29)ml for two groups at the 12th, 14th, 18th and 24th week, and the difference between two groups was statistically significant at each follow-up time ( P=0.01, 0.006, 0.012 and 0.016, respectively). There was no significant difference in other parameters( P>0.05). However, adverse reactions after intradetrusor injection included increased residual urine volume (27 in the BTX-A group and 3 in the control group), dysuria (21 in the BTX-A group and 6 in the control group), urinary infection (19 in the BTX-A group and 6 in the control group), bladder neck obstruction (3 in the BTX-A group and 0 in the control group), hematuria (3 in the BTX-A group and 1 in the control group), elevated alanine aminotransferase (3 in the BTX-A group and 0 in the control group), etc. During the follow-up period, there was no significant difference in the other adverse events between two groups except the increase of residual urine volume( P<0.05). In the primary trial phase, among the 27 cases with increased residual urine volume in BTA group, only 1 case (3.70%) with PVR more than 300 ml; the PVR of 3 patients in the placebo group was less than 100 ml. The increase of residual urine volume caused by the injection could be improved or disappeared with the passage of time. Conclusions:Intradetrusor injection of Chinese BTX-A improved the average micturition times per 24 hours, the average daily urgent micturition times, OABSS, and average micturition volume per time, and reduced the adverse effects in patients with overactive bladder.Chinese BTX-A at dose of 100U demonstrated durable efficacy and safety in the management of overactive bladder.

Preoperative AST and AST/ALT ratio predict clinical outcome in patients with non-metastatic renal cell carcinoma with tumor thrombus / 中华泌尿外科杂志

Objective:To explore the value of preoperative aspartate transaminase(AST) and aspartate transaminase/alanine transaminase ratio(AST/ALT)for predicting the prognosis in patients with non-metastatic renal cell carcinoma with tumor thrombus.Methods:A retrospective analysis was made of the patients with renal cell carcinoma with tumor thrombus in our institution from February 2015 to December 2018. This study included 80 patients, 56 males and 24 females with mean age of 58 years (range 15-83 years). There were 17 in Mayo level 0, 24 Mayo level I, 22 in Mayo level II, 12 in Mayo level III and 5 in Mayo level IV. All the patients received radical nephrectomy or palliative nephrectomy with tumor thrombectomy. The continuous variable of AST/ALT was collected by ROC curve. The maximum value of Youden index was taken as the critical value, and the continuous variables were adjusted to binary variables. Cancer-specific survival (CSS) was calculated according to the Kaplan-Meier analysis and compared by the log-rank test. Cox multivariate regression analysis was used to analyze the independent factors of the prognosis of patients with non-metastatic renal cancer and tumor thrombus.Results:There were 70 cases of clear cell carcinoma, 10 cases of non-clear cell carcinoma, 30 cases of low Fuhrman grade (grade 1&2), and 50 cases of high Fuhrman grade (grade 3&4). AST was 19U/L (8-226 U/L) and AST/ALT was 1.3(0.4-3.3). There was a significant difference in AST between different lymphovascular invasion groups ( P=0.04), but there was no significant difference in sex, age, Mayo classification, pathological type, Fuhrman grade and lymph node metastasis. The difference of AST / ALT between age groups was significant ( P=0.025). The average follow-up time was 14.7 months (0-44 months). During the follow-up, 11 (13.8%) patients died of tumor. Univariate analysis showed that Fuhrman grade ( P=0.007), lymph node metastasis ( P=0.019), hemoglobin ( P=0.001), alkaline phosphatase (ALP, P=0.001), AST ( P=0.004) and AST / ALT ( P=0.038) were risk factors for CSS. In terms of prognosis, considering the potential correlation between AST level and AST/ALT ratio, after excluding AST, multivariate Cox regression analysis showed that high nuclear grade ( HR=3.049, 95% CI 1.292-7.196, P=0.011), high ALP ( HR=1.018, 95% CI 1.007-1.029, P=0.001) and high AST/ALT ratio ( HR=4.094, 95% CI 1.064-15.759, P=0.04) were associated with poor CSS. After excluding AST/ALT ratio, multivariate Cox regression analysis showed that high nuclear grade ( HR=5.836, 95% CI 1.867-18.240, P=0.002) and high AST ( HR=1.040, 95% CI 1.017-1.062, P<0.001) were associated with poor CSS. Conclusions:In patients with non-metastatic renal cell carcinoma with tumor thrombus, high AST/ALT ratio and AST levels indicate poor pathological types and poor prognosis.

Clinical experience of surgical treatment in metastatic renal cell carcinoma with venous tumor thrombus / 中华泌尿外科杂志

Objective:To investigate the safety and effectiveness of cytoreductive nephrectomy and tumor thrombectomy in patients with metastatic renal cancer with renal vein or inferior vena cava tumor thrombus.Methods:From February 2015 to May 2019, 56 cases of metastatic renal cell carcinoma with venous tumor thrombus were analyzed retrospectively, including 44 male (78.6%) and 12 female (21.4%)cases, and the average age was (59.2±10.7)(22-82). The clinical presentations covered local symptoms in 26 cases (46.4%), systemic symptoms in 8 cases (14.3%), both local symptoms and systemic symptoms in 12 cases (21.4%), and asymptomatic in 10 cases (17.9%). Among them, renal tumors were located in 35 cases (62.5%) on the right and 21 cases (37.5%) on the left. The average tumor diameter was (10.1±3.8)(1.5-21.1) cm. Forty-five cases (80.4%) scored 2 points and 11 cases (19.6%) scored 3 points by the American Society of anesthesiologists(ASA). Preoperative hemoglobin was (118.2±23.1)(72-178) g/L, and albumin was (37.9±5.6)(23-50) g/L, total protein was (67.7±6.7)(43-81) g/L, serum creatinine was (111.3±119.6)(32-958) μmol/L. There were 16 cases of Mayo 0 (28.6%), 14 cases of Mayo Ⅰ(25.0%), 17 cases of Mayo Ⅱ(30.4%), 4 cases of Mayo Ⅲ(7.1%), and 5 cases of Mayo Ⅳ(8.9%). Fourteen cases (25.0%) were in the stage of cN 0 and 42 cases (75.0%) in the stage of cN 1. Five cases (8.9%) had simple bone metastasis, 16 cases (28.6%) had simple lung metastasis, 2 cases (3.6%) had simple adrenal metastasis, 6 cases (10.7%) had simple liver metastasis, and 27 cases (48.2%) had 2 or more multiple system metastasis. According to the location of the organ system, 91 metastatic lesions were found in 56 patients. Among them, 37 cases (40.7%) had lung metastasis, 18 cases (19.8%) had liver metastasis, 21 cases (23.1%) had bone metastasis and 15 cases (16.5%) had adrenal metastasis. All 56 patients belonged to IMDC prognosis score model medium risk group. The surgical treatment of Mayo grade 0 tumor thrombus was the same as that of routine radical nephrectomy. The tumor thrombus of Mayo grade Ⅰ was removed after IVC was partially blocked by Satinsky′s forceps. The Mayo Ⅱ tumor thrombus was removed, after blocking the distal vena cava, the contralateral renal vein and the proximal vena cava. Mayo grade Ⅲ tumor thrombus needed pringer's method to block the first porta hepatis. For grade Ⅳ tumor thrombus the diaphragm could be cut directly, or the thrombus could be removed by cardiopulmonary bypass. Laparoscopic surgery was performed in 22 cases (39.3%) and open surgery in 30 cases (53.6%). Six cases (10.7%) underwent IVC wall resection because of tumor invasion. 32 cases (57.1%) underwent ipsilateral adrenalectomy because of tumor invasion or adrenal metastasis, and 23 cases (41.1%) underwent ipsilateral lymphadenectomy. In this study, there were 11 cases of solitary metastasis, 8 cases of which were operated on and 3 cases of which were not operated on. Forty-three patients were treated with sunitinib after palliative nephrectomy, 9 patients were treated with pazopanib, 3 patients were treated with acitinib, and 1 patient was treated with sorafenib. Results:The operations were successfully completed in 56 patients. Four cases (7.1%) changed from laparoscopic surgery to open surgery. The operation time was (326.8±114.9)(108-589) min. Intraoperative hemorrhage was (1 435.2±1 513.4)(20-6 000) ml, intraoperative red blood cells transfusion was (1 456.7±832.8)(400-3 600) ml in 30 cases, and intraoperative plasma transfusion was (700.0±473.6)(200-1 800) ml in 15 cases. The postoperative hospital stay was (10.6±4.6)(5-26) days. The serum creatinine one week after operation was (109.5±98.7) (47-772) μmol/L. There were 46 cases (82.1%) of renal clear cell carcinoma, 7 cases (12.5%) of papillary renal cell carcinoma and 3 cases (5.4%) of unclassified renal cell carcinoma. One case was WHO/ISUP 2016 nuclear grade 1 (1.8%), 20 cases(36.4%) was grade 2, 18 cases(32.7%)was grade 3, and 16 cases(29.1%)was grade 4. Early postoperative complications occurred in 22 cases (39.3%). Among them, 1 case of Clavien gradeⅠ was wound infection. There were 16 cases with Clavien gradeⅡ, including 5 cases who received blood transfusion due to anemia, 3 cases with chylous fistula, 4 cases with postoperative pulmonary infection, 2 cases with postoperative lower extremity venous thrombosis, 1 case with atrial fibrillation and 1 case with epididymitis. Clavien gradeⅢ a was found in 1 case with pneumothorax. Clavien gradeⅣ was found in 2 cases, including 1 case of acute cerebral infarction and 1 case of renal insufficiency.There were 2 cases with Clavien gradeⅤ with perioperative death. Among the 56 patients, 5 lost the follow-up, 2 died during the perioperative period, and the other 49 patients were followed up for 1-39 months, with a median follow-up of 14 months. The mean survival time was (25.6±2.5) months, and the median survival time was 25 months.Conclusions:It was relatively safe and effective to perform cytoreductive nephrectomy and tumor thrombectomy in patients with metastatic renal cancer with tumor thrombus. For the patients with clinical symptoms, IMDC prognosis score model medium risk group, and strong desire for surgery, the combination of cytoreductive nephrectomy with tumor thrombectomy and postoperative targeted medical therapy was recommended.

The treatment for metastatic renal cell carcinoma / 中华泌尿外科杂志

The prognosis of metastatic renal cell carcinoma is relatively poor. With the development of molecular biology, the treatment of metastatic renal cell carcinoma is undergoing a transformation from cytokine therapy to targeted molecular therapy or immunotherapy, and the prognosis has been improved. This study summarized and discussed the treatment progress of metastatic renal cell carcinoma.

Surgical treatment of renal angiomyolipoma with inferior vena cava tumor thrombus: case report and literature review / 中华泌尿外科杂志

Objective@#To explore the clinical characteristics of renal angiomyolipoma (AML) with inferior vena cava (IVC) tumor thrombus and to improve the diagnosis and treatment of the disease.@*Methods@#The clinical data of 3 patients with renal AML and inferior vena cava tumor thrombus was retrospectively reviewed. The patients were all female, aged 19 to 70 years. Among them, 2 patients presented with lumbago on the right side, and the other one was diagnosed by physical examination. The body mass index ranged from 18.4 to 24.6 kg/m2, with a median value of 20.4 kg/m2. According to the American Society of Anesthesiologists (ASA), they were classified as grade Ⅱ. Color doppler ultrasound examination of the kidney and IVC was performed in all the 3 patients, all of which showed hyperechoic solid mass in the right kidney. Color doppler ultrasound of IVC showed hyperechoic band in the IVC, indicating blood flow signals and the tumor thrombus. All the 3 cases showed irregular fat density or mixed density in the right kidney and multiple irregular fat density were observed in the right renal vein and inferior vena cava on CT. Two of them received MRI examination of IVC, which showed irregular lesions in the right kidney, short T1 and long T2 signals, low lipids, and no definite limited diffusion on DWI. Irregular fat signal were seen in the right renal vein and inferior vena cava. All 3 patients were diagnosed with right renal mass with IVC tumor thrombus, with 1 patient of Mayo grade Ⅲ tumor thrombus and the other 2 of Mayo gradeⅡtumor thrombus. One underwent laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy, another one underwent open right partial nephrectomy and tumor thrombectomy, and the third one suffered preoperative AML rupture, undergoing open radical nephrectomy and tumor thrombectomy.@*Results@#The operation time was 168 to 659 min, with median of 220 min. Intraoperative blood loss ranged from 50 to 300 ml, with the median of 50 ml. Postoperative indwelling time of drainage tube was 5 to 11 days, with the median of 6 days. Postoperative hospital stay ranged from 7 to 14 days, with a median of 8 days. Postoperative follow-up ranged from 12 to 16 months, with a median follow-up of 13 months. All the three patients underwent operation without postoperative complications. Postoperative pathology proved to be right renal angiomyolipoma. After 3 months of follow-up, the patients showed no tumor recurrence or metastasis.@*Conclusions@#Renal AML is a benign lesion, which is rarely concurrent with inferior vena cava cancer thrombus. Enhanced CT examination is the main diagnostic method, surgical resection of the lesion is the preferred treatment, partial nephrectomy combined with thrombectomy can be performed in patients with AML, if permitted, and postoperative prognosis turns out to be propitious.

Application of three-dimensional printing technology combined with PACS imaging system in phase Ⅱ standardized training of residents in urology / 中华医学教育探索杂志

This study explores the application of three-dimensional(3D) printing technology combined with PACS in the standardized training of residents in urology.For the residents who received phase Ⅱ standardized training,they were guided to observe and analyze CT images,3D CT reconstruction data,and 3D printing entity during teaching;with reference to the cases of kidney tumors,the 3D printing entity model was explained to help the trainees learn the characteristics of the disease and formulate the operation plan of partial nephrectomy;an explanation of the actual surgical procedure gave them a deeper understanding of the anatomical characteristics and treatment regimens of the disease.The preliminary results of practice show that the application of 3D printing technology combined with PACS can enable residents to grasp the anatomical characteristics of renal tumors within a short time and deepen their understanding of surgical procedures and techniques.This teaching method holds promise for application in clinical specialties.

Surgical treatment of renal angiomyolipoma with inferior vena cava tumor thrombus: case report and literature review / 中华泌尿外科杂志

Objective To explore the clinical characteristics of renal angiomyolipoma (AML) with inferior vena cava (IVC) tumor thrombus and to improve the diagnosis and treatment of the disease.Methods The clinical data of 3 patients with renal AML and inferior vena cava tumor thrombus was retrospectively reviewed.The patients were all female,aged 19 to 70 years.Among them,2 patients presented with lumbago on the right side,and the other one was diagnosed by physical examination.The body mass index ranged from 18.4 to 24.6 kg/m2,with a median value of 20.4 kg/m2.According to the American Society of Anesthesiologists (ASA),they were classified as grade Ⅱ.Color doppler ultrasound examination of the kidney and IVC was performed in all the 3 patients,all of which showed hyperechoic solid mass in the right kidney.Color doppler ultrasound of IVC showed hyperechoic band in the IVC,indicating blood flow signals and the tumor thrombus.All the 3 cases showed irregular fat density or mixed density in the right kidney and multiple irregular fat density were observed in the right renal vein and inferior vena cava on CT.Two of them received MRI examination of IVC,which showed irregular lesions in the right kidney,short T1 and long T2 signals,low lipids,and no definite limited diffusion on DWI.Irregular fat signal were seen in the right renal vein and inferior vena cava.All 3 patients were diagnosed with right renal mass with IVC tumor thrombus,with 1 patient of Mayo grade Ⅲ tumor thrombus and the other 2 of Mayo grade Ⅱ tumor thrombus.One underwent laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy,another one underwent open right partial nephrectomy and tumor thrombectomy,and the third one suffered preoperative AML rupture,undergoing open radical nephrectomy and tumor thrombectomy.Results The operation time was 168 to 659 min,with median of 220 min.Intraoperative blood loss ranged from 50 to 300 ml,with the median of 50 ml.Postoperative indwelling time of drainage tube was 5 to 11 days,with the median of 6 days.Postoperative hospital stay ranged from 7 to 14 days,with a median of 8 days.Postoperative follow-up ranged from 12 to 16 months,with a median follow-up of 13 months.All the three patients underwent operation without postoperative complications.Postoperative pathology proved to be right renal angiomyolipoma.After 3 months of follow-up,the patients showed no tumor recurrence or metastasis.Conclusions Renal AML is a benign lesion,which is rarely concurrent with inferior vena cava cancer thrombus.Enhanced CT examination is the main diagnostic method,surgical resection of the lesion is the preferred treatment,partial nephrectomy combined with thrombectomy can be performed in patients with AML,if permitted,and postoperative prognosis turns out to be propitious.

Effects of Edaravone on protein expression of the mitogen-activated protein kinase/extracellular signal-regulated protein kinase signaling pathway in elderly patients with acute ischemic stroke / 中华老年医学杂志

Objective To investigate the effects of Edaravone on cognitive dysfunction and on protein expression of the mitogen-activated protein kinase/extracellular signal-regulated protein kinase (MAPK/ERK)signaling pathway in elderly patients with acute ischemic stroke. Methods A total of 100 elderly patients with acute ischemic cerebral stroke admitted to our hospital from January 2011 to December 2015 were enrolled in this study.During the corresponding period ,100 healthy individuals receiving regular check-ups were selected as the control group. The effects of Edaravone on cognitive function in elderly patients with acute ischemic cerebral stroke were assessed.Serum proteins related to the MAPK/ERK signaling pathway were assayed. Results Elderly patients with acute ischemic stroke showed obvious cognitive dysfunction ,and scores on memory ,orientation ,attention ,calculation language and recall significantly decreased(P＜0.01)but returned to normal after Edaravone treatment (P＜0.01).Compared with the control group ,serum protein expression of rat sarcoma (Ras) ,rapidly accelerated fibrosarcoma(Raf) ,hypoxia inducible factor-1α(HIF-1α) ,connective tissue growth factor (CTGF),extracellular signal-regulated protein kinase(ERK1),ERK2 ,MAPK/ERK kinase(MEK), interleukin-1(IL-1) ,tumor necrosis factor-α(TNF-α) ,vascular endothelial growth factor (VEGF) , tissue inhibitor of metalloproteinase (TIMP) ,nerve growth factor (NGF)and its receptors was significantly downregulated(P＜0.01) ,while expression of leptin and its receptors was upregulated in elderly patients with acute ischemic cerebral stroke ( P ＜ 0.01 ). Expression levels of the above downregulated proteins clearly recovered after Edaravone treatment ( P ＜ 0.01 ). Conclusions Edaravone has favorable effects on cognition dysfunction in elderly patients with acute ischemic cerebral stroke ,which may be related to the regulation of the MAPK/ERK signaling pathway.

Experience of diagnosis and treatment for renal multiple malignant tumors / 中华泌尿外科杂志

Objective To investigate the diagnosis and treatment of ipsilateral multiple renal malignant tumors.Methods 4 patients with multiple renal malignant tumors were retrospectively reviewed from May 2013 to November 2017.All cases were males,with average age of 64 years old (ranging 54-82 years old).Two cases were found thai tumor located in right side.The duration of disease ranged from 7 days to 6 months,with an average of 2 months.One case was found the tumor due to the complaining of lumbar discomfort,and other 3 cases were found by physical examination.The number of tumors was 2 in 1 case,and 3 in 3 cases.The sonographic features of the tumors were iso-echoic nodules.CT showed irregular soft tissue shadow,partially prominent outside the kidney,and heterogeneous enhanced after enhancement.3 cases were undergone laparoscopic radical nephrectomy and 1 case which was solitary kidney,was undergone laparoseopic partial nephrectomy.Results All operations were performed successfully.3 cases were undergone laparoscopic radical nephrectomy,which the operative time was 189-271 min (average,230 min),and blood loss was 50-100 ml (mean 83 ml).Postoperative hospitalization time was 5-14 days,average 9.7 days.1 case occurred intestinal obstruction after surgery,which was improved after treatment.1 case was found the close distance of 3 tumors during the laparoscopic surgery.In order to short the ischemic duration,open surgery conversion was performed in this case.The total operation time was 207min.The ischemic time was 15min and blood loss was 50 ml.The postoperative hospital stay was 6 days.Pathological reported that 3 cases were clear cell carcinoma,another 1 case was clear cell carcinoma with papillary carcinoma.All patients were followed up for 2-55 months (mean 38 months).No recurrence sign was recorded in all cases.Conclusion Ipsilateral multiple renal malignant tumors are rare,laparoscopic radical nephrectomy is effectie.Meanwhile,partial nephrectomy can also be chosen in some optimal cases.

Large cell neuroendocrine carcinoma of urinary bladder and ureter: a case report and review of the literature / 中华泌尿外科杂志

Objective To investigate the clinicopathological features,diagnosis,treatment and prognosis of a case of large cell neuroendocrine carcinoma (LCNEC) in urinary bladder and ureter.Methods The clinical pathological data of a patient with LCNEC in urinary bladder and ureter was retrospectively analyzed and the related literatures were reviewed.It was a male patient,78 years old,presenting with total painless gross hematuria.The ultrasonography showed nodules on the left lateral wall of bladder.Cystoscopy showed 2 cm cauliflower-like mass on the left lateral wall of bladder,and pathologic biopsy showed bladder urothelial carcinoma.Results Transurethral resection of bladder tumor was performed.The tumor cells were large in size,with vesicular nuclei,prominent nucleoli and nested/trabecular architecture.Immunohistochemical analysis demonstrated that tumor cells were positive for synaptophysin,chromogranin A and CD56.The proliferation index evaluated with Ki-67 was about 80％.The pathology report revealed a large cell neuroendocrine bladder tumor with focal areas of high-grade urothelial carcinoma.After intravesical instillation therapy for 2 months,tumor recurrence was detected by CT.Laparoscopic radical cystectomy and ureteral segmental resection was performed.The pathology report revealed a LCNEC with focal areas of highgrade invasive urothelial carcinoma in the bladder and ureter.CT showed tumor recurrence with liver metastasis 1 month after the operation.The overall survival was 9 months.Conclusions The clinical and imaging findings of LCNEC in bladder and ureter are nonspecific.Diagnosis must depend on the pathological and immunohistochemical staining.The tumor is aggressive with high risk of recurrence and metastasis and has a poor prognosis.It is mainly treated with radical resection combined with chemotherapy.

Survey on anti-Pneumocystis jirovecii recombinant antigen IgG and IgM antibodies in children under 14 years of age / 中华实验和临床病毒学杂志

Objective@#To obtain recombinant major surface glycoprotein(rMsg)of Pneumocystis jirovecii(Pj) and survey anti-Pj rMsg IgG and IgM antibodies using enzyme-linked immunosorbent assay (ELISA) among randomly selected sera from Beijing local children under 14 years of age.@*Methods@#ELISA method were established to detect anti-Pj rMsg IgG and IgM antibodies. We randomly selected sera of 201 cases who were under 14 years of age were screened.@*Results@#There were 78 cases in the age group of 1 day to 30 days, 33 cases in the group of 1 month to 12 months, and 90 cases in the group of 1 year to 14 years. The positive rates of anti-Pj rMsg IgG antibody in these three age groups were 10.3%(8/78), 21.2%(7/33), and 41.1%(37/90)respectively(χ2=21.190, P=0.000). The positive rates of anti-Pj rMsg IgM antibody were 6.4%(5/78), 39.4%(13/33), and 76.7%(69/90)respectively(χ2=84.260, P=0.000). The overall positive rates of anti-Pj rMsg IgG and IgM antibodies were 25.9%(52/201)and 43.3%(87/201)respectively(χ2=53.463, P=0.000). Among these, simultaneously IgG positive IgM positive, IgG positive IgM negative, IgG negative IgM positive and IgG negative IgM negative rates were 22.4%(45/201), 3.5%(7/201), 20.9%(42/201), and 53.2%(107/201)respectively.@*Conclusions@#The overall serological response rate after Pj exposure, either anti-Pj IgG or IgM antibody positive, was as high as 46.8% in children under 14 years of age in Beijing area. The positive rates of anti-rMsg IgG and IgM antibodies increased with age, with highest rate in age group of more than one years old.

Radical nephrectomy and thrombectomy for Mayo clinic stage Ⅲ tumor thrombus:a surgical technique and clinical experience / 北京大学学报(医学版)

Objective: To evaluate the effectiveness and safety of radical nephrectomy and inferior vena cava thrombectomy in the treatment of patients with Mayo Ⅲ tumor thrombus, and to introduce our experience and surgical technique.Methods: The clinical data of 8 patients with Mayo Ⅲ tumor thrombus from October 2014 to September 2016 were analyzed retrospectively.Of the 8 patients, 3 were male and 5 were female.The average age was (50.8±18.7) years (18 to 77 years).The average body mass index (BMI) was (22.7±4.4) kg/m2 (15.2 to 30.8 kg/m2).Imaging suggested the right renal tumor in all the 8 cases.The average tumor size was (7.9±2.5) cm.Open radical nephrectomy and inferior vena cava thrombectomy was conducted in 5 cases and laparoscopic surgery in 3 cases, and 1 case was converted to open surgery.Results: All the 8 surgeries were completed successfully with no death case.The average surgery time was (370.3±101.6) min, ranging from 272-567 min.The average vena cava blocked time was (41.0±12.1) min, ranging from 17-55 min.The blood loss volume was (1 181.3±915.7) mL, ranging from 200-3 000 mL.During the operation, 5 cases were infused with suspended red blood cells, the amount of blood transfusion was 800-2 000 mL.3 cases were infused of plasma with 400-1 000 mL.The average hospital stay was 9-23 d, with an average of (14.1±4.0) d.In the 8 patients, 4 cases underwent inferior vena cava wall resection because of invasion by tumor thrombus.Preoperative serum creatinine was 60-101 μmol/L, with an average of (76.4±15.3) μmol/L.Serum creatinine 1 week after the operation was 74-127 μmol/L, with an average of (100.8±21.1) μmol/L.Pathological diagnosis showed 6 cases of clear cell carcinoma, 1 case of papillary carcinoma type Ⅱ, and 1 case of Ewing''s sarcoma.Among the 8 patients, early postoperative complications occurred in 5 cases.Postoperative complications were graded as level Ⅱ, according to the Clavien classifications.The 8 cases were followed up for 2 to 24 months with an average of 11.3 months.There was 1 patient who suffered from lung metastasis.Conclusion: Our initial clinical results show that radical nephrectomy and inferior vena cava thrombectomy is safe and effective for patients with Mayo Ⅲ tumor thrombus.The wide extension of grade Ⅲ vein tumor thrombus leads to the difficulty of operation technique.Sufficient preoperative preparation, rich operative experience and skills can improve the safety of operation.

Pelvic lipomatosis: urodynamic characters and clinical significance / 中华泌尿外科杂志

Objective To study the urodynamic characters of pelvic lipomatosis(PL) and its clinic significance.Methods From Sep.2013 to Feb.2016,7 patients,including 6 males and one female,were diagnosed as PL by image examinations and related lower urinary tract syndrome.Their mean age was 46 years,ranged from 30 to 52 years.All the patients(study group) have normal renal function.However,4 patients were noticed bilateral hydronephrosis.Other patients with similar LUTS but were confirmed as normal by image and urodynamic examinations were concluded in control group,which was paired designed to match the study group in visiting time,gender,age,and number of patients.The uroflowmetry and pressure/flow cystometry were performed in all patients.The urodynamic data of two groups including maximum flow rate (Qmax),time to maximum flow,post-voiding residual (PVR),first sensation capacity,first desire to void capacity,cystometric capacity,intravesical pressure at terminal of filling phase,compliance,detrusor pressure at maximum flow,detrusor opening pressure,bladder outlet obstruction index (BOOI) and bladder contractility index (BCI),were retrospectively analyized.Results There were no significant different between study aud control groups respect to Qmax [(18.71 ± 10.31) ml/min vs.(13.29 ± 6.55) ml/min],time to maximum flow [(6.71 ±2.50)s vs.(7.43±2.76)s],PVR [(28.14±27.81)ml vs.(3.14± 3.48) ml],first sensation capacity[(138.86 ± 77.01) ml vs.(142.29 ± 89.84) ml],first desire to void capacity [(203.71 ± 131.09) ml vs.(216.57 ± 72.20) ml],cystometric capacity [(271.0 ± 151.95) ml vs.(323.29± 92.87)ml],i ntravesical pressure at terminal of filling phase [(30.29 ± 16.45)cmH2O vs.(18.71 ± 9.57) cmH2 O],and compliance [(90.53 ± 126.46) cmH2O/ml vs.(129.57 ± 136.25) cmH2O/ml].The study group was significant higher than control group in terms of pressure at maximum flow [(69.57 ±25.06) cmH2O vs.(33.14 ± 11.63) cmH2O,P =0.004],opening pressure [(42.57 ± 22.16)cmH2O vs.(18.00±13.18) cmH2O,P=0.027],BOOI [(34.00±15.92)vs.(16.50±5.96),P=0.030] and BCI [(133.17 ± 27.37) vs.(87.67 ± 20.16),P =0.008],respectively.Moreover,the BCI of PL patients with hydronephrosis were significant higher compare with PL patients without hydronephrosis [(155.67 ±14.98) vs.(110.67 ± 1 1.37),P =0.014].Conclusions The urodynamic characters of PL were increased pressure at maximum flow and opening pressure,which implied obstruction.

Clinical experience of Mayo 0-Ⅳ tumor thrombus treated with radical nephrectomy and inferior vena cava thrombectomy / 中华泌尿外科杂志

Objective To investigate the safety and feasibility of radical nephrectomy and Mayo 0-Ⅳ venous thrombectomy.Methods The clinical data of 52 patients with Mayo 0-Ⅳ tumor thrombus from February 2015 to January 2017 were analyzed retrospectively.Of the 52 patients,42 were male and 10 were female.The average age was (59.8 ± 13.6) years old (2.5 to 84.0 years).The renal vein tumor thrombus or inferior vena cava tumor thrombus was found in all patients,including type 0 thrombus in 12 cases,type Ⅰ thrombus in 11 cases,type Ⅱ thrombus in 15 cases,type Ⅲ thrombus in 9 cases,type Ⅳ thrombus in 5 cases (Mayo Medical Center classification).Imaging suggested the right renal tumor in 36 cases and left tumor in 16 cases.The average tumor size was (8.5 ±2.0) cm(2.0-21.1 cm).There were 2 cases of ASA Ⅰ,40 cases of ASA Ⅱ and 10 cases of ASA Ⅲ according to the American Society of Anesthesiologists (ASA).In laparoscopic radical nephrectomy and Mayo 0 venous thrombectomy,we clamped the vena cava vessel wall nearby the renal vein entrance.The vena cava blood flow was blocked partially.Then we cut the vessel wall arcuately.Mayo Ⅰ tumor thrombus requires the use of a non traumatic auricle clamp to control blood flow by the block of vena cava above thrombus,vena cava below the renal vein level,and the contralateral renal vein.Right kidney tumors with Mayo Ⅱ could be completed by retroperitoneal surgery.At the time of vascular occlusion,the distal inferior vena cava,the left renal vein and the proximal inferior vena cava were interrupted sequentially.For left renal tumors with Mayo Ⅱ,the retroperitoneal approach combined with transperitoneal approach was used.The technique of "milking" can shrink the tumor thrombus and reduced the difficulty of the operation.For Mayo Ⅲ tumor thrombus just at the hepatic vein level,we cut off 3-5 hepatic short veins,and separated inferior vena cava long enough to provide surgical field.For Mayo Ⅲ tumor thrombus much higher than the hepatic vein level,we used open surgeries to free the liver and porta hepatis.We first blocked the distal inferior vena cava,followed by the left renal vein,the hepatic artery and portal vein,at last the proximal inferior vena cava.Mayo Ⅳ tumor thrombus often required a median incision to open the chest and establish an extracorporeal circulation.Results All the 52 surgeries were completed successfully without intraoperative and perioperative mortality.Open radical nephrectomy and inferior vena cava thrombectomy was underwent in 22 cases.Pure laparoscopic surgery was under went in 30 case.Two cases were converted to open surgery.The average surgery time was(333.7 ±80.1)min(136-694 min).The average blood loss volume was (1339.0 ± 508.1) ml(20-10 000ml).During the operation,the amount of suspended red blood cells transfusion was(761.5 ± 394.8)ml(0-10 400ml).28 cases underwent regional lymph node dissection,and postoperative pathological diagnosis showed lymph metastasis in 4 cases.24 cases underwent ipsilateral adrenalectomy,and 2 cases showed tumor invasion of adrenal gland.7 cases with right tumors underwent inferior vena cava wall resection because of invasion by tumor thrombus.The average postoperative hospitalization of all 52 cases was (9.7 ± 4.7) d.Among 27 patients,early postoperative complications occurred in 18 cases (34.6％).There were 1 case of Clavien Ⅰ,12 cases of Clavien Ⅱ,1 case of Clavien Ⅲ a,2 cases of Clavien Ⅳ a and 2 cases of Clavien Ⅴ according to modified Clavien classifications.44 cases (84.6％) were followed up for 1 to 22 months with a median of 8 months.Postoperative recurrence occurred in 3 cases,and distant metastasis occurred in 9 cases.9 cases (20.5％) had tumor specific death.Conclusions Our initial clinical results show that radical nephrectomy and inferior vena cava thrombectomy is safe and effective for patients with Mayo 0-Ⅳ tumor thrombus,but the wide extension of vein tumor thrombus leads to the difficulty of operation technique.Sufficient preoperative preparation,rich operative experience and skills can improve the safety of operation.

Clinical features of imported schistosomiasis mansoni in Beijing City:a re-port of 6 cases / 中国血吸虫病防治杂志

Objective To analyze the clinical features of 6 patients with imported schistosomiasis mansoni,including the epidemic history,clinical manifestations,laboratory tests and therapeutic effect,so as to provide references for improving the levels of diagnosis and treatment of physicians. Methods The clinical data of 6 patients with imported schistosomiasis mansoni from January 2009 to July 2016 were collected and analyzed. Results All the 6 imported patients with schistosomiasis mansoni had a clear history of cercarial infested water exposure. The main manifestations were continuous fever and eosinophilia. Three (50%)patients were accompanied with diarrhea. Anti-Schistosoma japonicum IgG antibody were cross positive in 2(33.3%)pa-tients,while live eggs of S. mansoni were explored in intestinal mucosa specimens of all the patients. CD3+CD8+T cell ratio was decreased significantly but B cell ratio was elevated in all the patients,and the main immunoglobulin of the patients was IgG. Hydroperitoneum and splenomegaly signs were discovered by abdominal ultrasonography in 16.6%(1/6)of the patients. Multi-ple liver nodules and wall thickening of rectum and sigmoid colon were revealed by pelvic MR scan in 16.6%(1/6)of the pa-tients. Colitis was found in all the patients,and 66.6%(4/6)of the patients were combined with multiple colonic ulcers by the electronic colonoscopy examination. Chronic inflammation and eosinophil infiltration were found in all the patients by rectum pa-thology. All 6 patients were cured with chemotherapy named praziquantel. Conclusion Comprehensive analysis of clinical data including epidemiological history,specific manifestations,laboratory tests and intestinal mucosa pathology may be benefit of the management of schistosomiasis mansoni.

Protective effect of phloroglucinol on renal ischemia and reperfusion injury / 北京大学学报(医学版)

Objective:To investigate the effect and mechanisms of Phloroglucinol ( PG) on renal ische-mia and reperfusion injury (IRI).Methods:Forty-eight male Wistar rats were divided into 3 groups (16 rats per group):sham operated, saline-treated I/R (I/R), and PG-treated I/R (PG).I/R model:Af-ter removing the right kidney , renal I/R injury was induced by clamping the left renal artery for 45 min followed by reperfusion.The rats were administered with PG (30 mg/kg, intraperitoneally) or saline 15 min before renal ischemia .The blood and kidneys were harvested 6 and 24 h after reperfusion .Renal function and histologic changes of serum creatinine (SCr) and blood urea nitrogen(BUN)were assessed. Malondialdehyde (MDA),catalase (CAT),superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) were measured.Nuclear factor-kapa B ( NF-κB) and caspase-3 in the kidneys were also measured.Results:SCr and BUN were (103.9 ±10.4) μmol/L and (15.2 ±1.0) mmol/L in I/R group, and (81.8 ±13.4) μmol/L and (11.5 ±1.2) mmol/L in PG group 6 h after reperfusion .SCr and BUN were (154.9 ±12.1) μmol/L and (28.1 ±1.4) mmol/L in I/R group, and (103.8 ±5.9)μmol/L和(16.0 ±1.0) mmol/L in PG group 24 h after reperfusion.PG treatment significantly attenua-ted renal dysfunction and histologic damage caused by I /R injury(P<0.05).The I/R-induced elevation in kidney MDA level decreased , where as reduced kidney SOD ,CAT and GSH-Px were increased .What is more , the apoptotic tubular cells , the levels of active caspase-3 ,and active nuclear factor kappa B dra-matically decreased after PG treatment .Conclusion:PG protects murine kidney I/R injury by suppres-sing oxidative stress , inflammation , and cell apoptosis .