Analysis of the diagnosis and treatment of 68 cases of iatrogenic ureteral stricture / 现代泌尿外科杂志

【Objective】 To investigate the common etiology, characteristics and treatment of iatrogenic ureteral stricture. 【Methods】 The clinical data of 226 patients with ureteral stricture repaired during May 2019 and Mar. 2022 were retrospectively analyzed, including 68 cases of iatrogenic ureteral stricture. According to the etiology, the patients were divided into urinary group and non-urinary group. 【Results】 There were 42 females and 26 males, aged 25 to 67 (average 49.0±10.4) years. Upper ureteral stricture was detected in 24 (35.3%) cases, who received oral mucosal repair of the ureter. Middle ureteral stricture was detected in 12 (17.6%) cases, who underwent ileal ureterography. Lower ureteral stricture was observed in 24 (35.3%) cases, who were treated with vesical wall flap ureteroplasty. Full-length stricture was observed in 8 (11.8%) cases,who were treated with ileal ureterography. There were significant differences in age, gender, stenosis side, stenosis location and length, surgical methods and types between patients in the urinary group and non-urinary group (P<0.05). During the follow-up of 8 to 20 (average 12.3±5.6) months, the symptoms and renal function of all patients improved, and no recurrence occurred. 【Conclusion】 Invasive endourological surgery is the most common cause of iatrogenic ureteral stenosis. Different treatment strategies should be adopted according to patients’ condition, time of diagnosis and location and length of ureteral injury.

Analysis of the feasibility and safety of repair of ureteral stricture with oral mucosal graft / 中华泌尿外科杂志

Objective:To summarize and analyze the current application status of oral mucosal graft (OMG) technique in the repair of ureteral strictures in China, and clarify the feasibility, safety and effectiveness of this technique.Methods:The 175 patients who underwent repair of ureteral stricture using oral mucosal patches from June 2015 to February 2022 were etrospectively analyzed in 14 medical centers in China, including 49 cases in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 32 cases in Affiliated Seventh Medical Center of PLA General Hospital, 3 cases in The Second Hospital of Anhui Medical University, 6 cases in The First Affiliated Hospital of Zhengzhou University, 56 cases in Peking University First Hospital, 3 cases in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 cases in Shanghai Sixth People' s Hospital, 4 cases in General Hospital of Estern Theater Command, 4 cases in Lanzhou University Second Hospital, 2 cases in Guizhou Province People 's Hospital, 2 cases in Peking University People' s Hospital, 5 cases in Jinzhou First People's Hospital, 5 cases in The First Affiliated Hospital of Wannan Medical College, 1 case in Shandong Provincial Hospital. In this study, 127 patients (72.6%) used lingual mucosal patches, 32(18.3%) labial mucosa, and 16(9.1%) buccal mucosa. The surgical approach for OMG ureteral reconstruction was mainly minimally invasive, with robot-assisted laparoscopy in 84 patients (48.0%), traditional laparoscopic surgery in 87 patients (49.7%), and open surgery in only 4 patients (2.3%). There were 133 males and 42 females with an average age of (35.0±17.2) years. The mean body mass index (BMI) and stenosis length were (23.1±4.1) kg/m 2 and (4.7±1.8) cm, respectively. The stricture was located in the left ureter in 116 patients, right ureter in 58 case and bilateral ureter in 1 case. The most common causes of ureteral stricture were endoscopic surgery in 88(50.3%)patients, congenital stricture in 55(31.4%)patients, failed ureteroplasty in 29(16.6%)patients, history of extracorporeal shock wave lithotripsy in 13(7.4%)patients, radiotherapy history in 3(1.7%)patients and other causes in 6(3.4%)patients. Strictures were mainly located in the upper ureter, accounting for 61.7% (108/175 cases), followed by 36.0% (63/175) at the ureteropelvic junction and 2.3%(4/175)in the middle ureter. According to the surgical methods, the patients were divided into robot-assisted laparoscopic surgery group ( n=84), traditional laparoscopic surgery group ( n=87)and open surgery group ( n=4). Subgroup analysis of patients in robot-assisted laparoscopic and traditional laparoscopic surgery groups was performed. There were no significant difference in preoperative data between the two groups except for age (32.0±18.3) years vs.(37.0±15.9)years, P=0.040], BMI[(22.5±4.3)kg/m 2 vs. (23.7±3.6)kg/m 2, P=0.028], and etiology of stenosis [endoscopic injury, 34(40.5%) vs. 53(60.9%), P=0.012]. Preoperative hydronephrosis and stricture length were assessed by CTU and ureterography. Ureterography 7-9 weeks after surgery showed patency of the reconstructed segment, or no recurrence of hydronephrosis was judged as success. Evaluate the operation method, operation time, success rate, length of OMG in repairing ureteral stricture between laparoscopic and robot-assisted groups. Results:The overall success rate of oral mucosal graft repair surgery reached 97.7%(171/175). The success rate of ureteral reconstruction in the two groups were 96.4%(81/84)and 98.9%(86/87), respectively ( P=0.351), and the difference was not statistically significant. There was no significant difference for operation time, intraoperative blood loss, and mean oral mucosal length between the robotic and laparoscopic groups[(244.7±85.8) min and (222.7±83.5)min ( P=0.116), (58.9±38.6) ml and (68.4±45.5) ml ( P=0.217), (5.0±2.0) cm and (4.6±1.5) cm ( P=0.350)], respectively.Postoperative complications were reported in 23 (13.1%) patients, such as fever, urinary leakage, lymphatic leakage, infection, but only 2 (1.4%) cases patients had complications of Clavien-Dindo score ≥ Ⅲ. The two patients developed urinary stricture after surgery with failed conservative treatment, and no urinary stricture occurred following endoscopic treatment.The short-term (three months after surgery)incidence of complications in the site where the oral mucosa was taken, such as difficulty in opening mouth, pain, and swelling, was 12.0% (21/175), and there was no significant difference for oral complications between patients harvesting different length of mucosal graft. Conclusions:Ureteroplasty with oral mucosal graft is a safe, feasible and reliable technique for ureteral reconstruction. At present, minimally invasive technology is the main surgical approach for ureteroplasty, and there is no significant difference in operation time and success rate between robotic surgery and laparoscopic surgery.

Autophagy enhanced by curcumin ameliorates inflammation in atherogenesis via the TFEB-P300-BRD4 axis

Disturbance of macrophage-associated lipid metabolism plays a key role in atherosclerosis. Crosstalk between autophagy deficiency and inflammation response in foam cells (FCs) through epigenetic regulation is still poorly understood. Here, we demonstrate that in macrophages, oxidized low-density lipoprotein (ox-LDL) leads to abnormal crosstalk between autophagy and inflammation, thereby causing aberrant lipid metabolism mediated through a dysfunctional transcription factor EB (TFEB)-P300-bromodomain-containing protein 4 (BRD4) axis. ox-LDL led to macrophage autophagy deficiency along with TFEB cytoplasmic accumulation and increased reactive oxygen species generation. This activated P300 promoted BRD4 binding on the promoter regions of inflammatory genes, consequently contributing to inflammation with atherogenesis. Particularly, ox-LDL activated BRD4-dependent super-enhancer associated with liquid-liquid phase separation (LLPS) on the regulatory regions of inflammatory genes. Curcumin (Cur) prominently restored FCs autophagy by promoting TFEB nuclear translocation, optimizing lipid catabolism, and reducing inflammation. The consequences of P300 and BRD4 on super-enhancer formation and inflammatory response in FCs could be prevented by Cur. Furthermore, the anti-atherogenesis effect of Cur was inhibited by macrophage-specific Brd4 overexpression or Tfeb knock-out in Apoe knock-out mice via bone marrow transplantation. The findings identify a novel TFEB-P300-BRD4 axis and establish a new epigenetic paradigm by which Cur regulates autophagy, inhibits inflammation, and decreases lipid content.

Application of modified upper urinary tract video urodynamics in evaluating the surgical effect and guiding the treatment after ureteral reconstruction / 中华泌尿外科杂志

Objective:To explore the clinical value of modified upper urinary tract video urodynamics in evaluating the surgical effect and guiding the follow-up treatment after ureteral reconstruction.Methods:From December 2018 to November 2020, sixty-nine patients underwent upper urinary tract reconstruction and received modified video urodynamics at the time of nephrostomy removal 3 months after the surgery in the RECUTTER database (29 cases in Peking University First Hospital, 22 cases in Emergency General Hospital, and 18 cases in Beijing Jiangong Hospital). There were 39 males and 30 females, with an average age of (40.4±12.7)years. The stricture was located in left in 34 patients, right side in 27 patients, and bilateral sides in 8 patients. The upper, middle, and lower thirds of the ureter were affected in 26, 10, and 33 cases, respectively. The preoperative creatinine was (92.3±26.9)μmol/L, and the estimated glomerular filtration rate (eGFR) was (85.1±23.2)ml/(min·1.73m 2). The upper urinary tract reconstruction included ileal replacement of ureter in 25 cases (36.2%), pyeloplasty in 8 cases (11.6%), ureteroneocystostomy in 9 cases (13.0%), boari flap in 6 cases (8.7%), lingual mucosal graft ureteroplasty in 9 cases (13.0%), appendiceal onlay ureteroplasty in 3 cases (4.3%), ureteroureterostomy in 3 cases (4.3%), and balloon dilation in 6 cases (8.7%). Based on the pressure and imaging, the results could be divided into three types, type Ⅰ, the pressure difference remained stable near baseline, and the renal pelvis pressure was below 22 cmH 2O(1 cmH 2O=0.098 kPa), and the reconstructed ureter is well visualized during the whole perfusion process; type Ⅱ, the pressure difference increases with the perfusion, but it can decrease to a normal level with the ureteral peristalsis; type Ⅲ, the pressure difference exceeds 15 cmH 2O, and the ureteral peristalsis is weak or disappears at the same time. The management strategies and treatment effects of different subtypes were analyzed. Successful treatment was defined as no further treatment required, the absence of hydronephrosis-related symptoms, and the improved or stabilized degree of hydronephrosis. Results:All 69 patients successfully completed upper urinary tract video urodynamics. The pressure difference was higher than 15 cmH 2O in 8 patients, and the median pressure difference was 37(19-54)cmH 2O. The renal pelvis pressure exceeded 22 cmH 2O in 10 patients, and the median pressure was 63.5 (24-155) cmH 2O. Video urodynamic results of upper urinary tract were classified as type Ⅰ in 60 cases, type Ⅱ in 5 cases, and type Ⅲ in 4 cases. Patients in type Ⅰ do not require other treatment after nephrostomy tube removal. Patients in type Ⅱ should avoid holding urine after the removal of nephrostomy and D-J tubes. All patients in type Ⅲ received further treatment, of which 2 patients replaced D-J tube regularly, 1 patient underwent long-term metal ureteral stent replacement, and 1 patient underwent ureteroscopic balloon dilation. The median follow-up time was 24 (18-42) months. All patients in type Ⅰ met the criteria for surgical success, The pre-and postoperative creatinine in type Ⅰ patients were (88.71±23.09)μmol/L and (88.75±23.64)μmol/L ( P=0.984), and eGFR were (88.06±22.66)ml/(min· 1.73m 2)and (87.97±23.01)ml/(min·1.73m 2), respectively( P=0.969). For type Ⅱ patients, ultrasound showed that the degree of hydronephrosis improved in 3 cases and remained stable in 2 cases. The pre-and postoperative creatinine were (105.97±7.75)μmol/L and (97.63±7.56)μmol/L ( P=0.216), and eGFR were (69.08±14.74)ml/(min·1.73m 2)and (75.95±14.02)ml/(min·1.73m 2)( P=0.243), respectively. For type Ⅲ patients, ultrasound showed that the degree of hydronephrosis remained stable. The pre-and postoperative creatinine were (105.14±44.34)μmol/L and (101.49±57.02)μmol/L ( P=0.684), and eGFR were (65.32±19.85)ml/(min·1.73m 2) and (73.42±27.88) ml/(min·1.73m 2), respectively( P=0.316). Conclusions:The pressure and imaging results of modified upper urinary tract video urodynamics can assist in evaluating the surgical effect of ureteral reconstruction, and the classification has certain guiding significance for further treatment.

Relationship between defense style and family environment among male prisoners of different terms of imprisonment / 四川精神卫生

ObjectiveTo explore the psychological defense styles and family environment among male prisoners of different terms of imprisonment， and to analyse the relationship between their psychological defense styles and family environment. MethodsA total of 200 male prisoners in a prison in Guangdong were randomly selected from April to June 2015， and they were classified into less than 5 years of imprisonment group （n=108） and 5 years or more imprisonment group （n=92）. Their defense style and family environment were evaluated by Defense Style Questionnaire （DSQ） and Family Environment Scale-Chinese Version （FES-CV）. Pearson correlation analysis was used to test the correlation between each scale score. ResultsThe factor scores of immature defense mechanism and intermediate defense mechanism of DSQ in the group with less than 5 years of imprisonment were lower than those in the group with 5 years or more imprisonment， with statistically significant differences （t=4.198， 1.137， P<0.01）. The scores of FES-CV family intimacy， emotional expression and organizational factors in less than 5 years of imprisonment group were higher than those in 5 years or more imprisonment group （t=3.122， 2.993， 2.203， P<0.01）， and the scores of contradiction factors were lower than those in 5 years or more imprisonment group （t=-3.682， P<0.01）. The scores of DSQ immature， intermediate defense mechanism and concealment factor of male prisoners were negatively correlated with the scores of FES-CV family intimacy and emotional expression factor （r=-0.428~-0.172， P<0.05 or 0.01）， and the scores of 4 factors in DSQ were all positively correlated with the scores of contradiction factor in FES-CV （r=0.175~0.384， P<0.05 or 0.01）. ConclusionCompared with male prisoners with less than 5 years of imprisonment， those with 5 years or more are prone to adopt immature and intermediate defense mechanisms， and their family environments are characterized by apparent contradiction and a lack of family intimacy， emotional expression and organization. Furthermore， the defects of psychological defense mechanism of prisoners are related to their family environment.

Initial clinical application of domestic endoscopic surgical robot system for partial nephrectomy / 中华泌尿外科杂志

Objective:To evaluate the safety and effectiveness of Kangduo endoscopic surgical robot system for partial nephrectomy.Methods:Consecutive patients with stage T 1 renal tumor meeting the inclusion criteria from the Department of Urology, Peking University First Hospital from December 2020 to February 2021 were prospectively enrolled. All patients underwent partial nephrectomy with the Kangduo endoscopic surgical robot system after signing the informed consent. Clinical data including preoperative, perioperative and postoperative pathology and follow-up were collected. Results:Among the 26 patients, there were 16 males and 10 females, with a median age of 53(33-74) years, and a median body mass index of 25.99(20.90-32.91) kg/m 2. There were 12 cases of left kidney tumor and 14 cases of right kidney tumor. The median tumor diameter was 2.2(1.0-3.5) cm. The median time of warm ischemia was 17.7(7.1-29.2) minutes, and all of them were less than 30 minutes. The median docking time was 4.7(2.3-9.9) minutes, and the median time of robotic arm operation was 65.0 (37.0-155.0) minutes. The median National Aeronautics and Space Administration Task Load Index (NASA-TLX) score was 5.3 (2.0-28.0), and no instrument-related adverse events occurred intraoperatively. The median postoperative hospital stay was 4 (4-5) days. All tumor margins were negative on pathologic reports. No Clavien Ⅱ stage operative complications occurred in all patients during perioperative period and 1 month after the surgery. Conclusions:The partial nephrectomy using the kangduo endoscopic surgical robot system were completed successfully, and no instrument-related adverse events and complications occurred, showing that this surgical system used for partial nephrectomy is safe and effective.

Effect of nonalcoholic fatty liver disease on glucose and lipid metabolism during pregnancy / 中华内分泌代谢杂志

Objective:To investigate the effect of nonalcoholic fatty liver disease (NAFLD) on glucose and lipid metabolism during pregnancy.Methods:A retrospective analysis was performed in women who gave birth in Minhang Hospital Affiliated to Fudan University from January 2013 to June 2020. The data on demographic, clinical examination, and delivery were obtained via electronic medical record abstraction. According to the ultrasound imaging, all pregnant women were divided into NAFLD group and control group. The difference of glucose and lipid metabolism indexes, incidence of gestational diabetes mellitus, and gestational hypertension between two groups were compared. Logistic regression model was used to examine potential associations between NAFLD and metabolic related adverse pregnancy outcomes.Results:A total of 14 708 pregnant women with a mean age of (29.1±4.7) years and a mean body mass index of (21.0±2.8) kg/m 2 were included in our study. Of those eligible women, 554 (3.8%) were confirmed by ultrasound as NAFLD. Pregnant women with NAFLD presented higher circulating levels of fasting glucose [(4.2±0.5)mmol/L vs (4.1±0.5)mmol/L, P<0.01], 1 h plasma glucose [(7.4±1.7)mmol/L vs (6.6±1.6)mmol/L, P<0.01] and 2 h plasma glucose [(6.2±1.4)mmol/L vs (5.7±1.3)mmol/L, P<0.01] after glucose loading, HbA 1C [(5.2±0.4)% vs (5.1±0.5)%, P<0.01], triglyceride [(2.1±1.1)mmol/L vs (1.6±0.7)mmol/L, P<0.01], total cholesterol [(4.8±0.8)mmol/L vs (4.7±0.9)mmol/L, P<0.01], low density lipoprotein-cholesterol [(2.6±0.7)mmol/L vs (2.5±0.7)mmol/L, P<0.01], uric acid [(224.1±51.8)μmol/L vs (203.0±45.9)μmol/L, P<0.01] level. After adjusting for potential confounders, NAFLD significantly increased the risk of gestational diabetes mellitus ( OR=1.722, 95% CI 1.079-2.747, P=0.023) and gestational hypertension ( OR=3.845, 95% CI 2.247-6.582, P<0.001). Conclusions:Compared to non NAFLD, women with a diagnosis of NAFLD had more significant glucose and lipid metablic aberrations during pregnancy and increased incidence of gestational diabetes and gestational hypertension. Pregnant women with NAFLD should be closely monitored on glucose and lipid metabolism and blood pressure to prevent gestational diabetes mellitus and hypertension.

Establishment and practical effect of comprehensive clinical management for out patients with orthotopic new bladder based on doctor-nurse cooperation / 中国实用护理杂志

Objective:To build a comprehensive clinical management of outpatient with orthotopic neobladder based on doctor-nurse cooperation to provide overall service to patients.Methods:The comprehensive clinical management was established in October 2018, 32 patients were collected retrospectively from January 2009 to before the establishment of the clinic, and 14 patients were collected from the establishment of the clinic to January 2020. After the establishment of the clinic, the comprehensive management mode was adopted, including the medical team implementing management from the aspects of implementing doctor-patient joint decision-making, guiding patients to carry out pelvic floor muscle rehabilitation training, teaching family members to carry out new bladder irrigation, and establishing patients′ records. Before the establishment of the clinic, there was no specialized personnel for unified management, and the doctor for new bladder irrigation and so on.Results:The rate of complete urinary control in the 46 patients with orthotopic neobladder was 82.6%(38/46) in the day and 71.7%(33/46) in the night. The rates of complete urine control of patients in the day and night were 12/14 and 9/14 after the establishment of the clinic. The length of stay which was (13.36 ± 9.44) d, and feeding time which was (5.00 ± 2.11) d of the patients after the establishment of the clinic were both less than those of the patients before the establishment of the clinic, which were (17.28 ± 9.98) d and (5.78 ± 2.90) d, but the differences were not statistically significant ( t values were -1.247 and -0.905 respectively, both P>0.05). However, for diurnal and night-time urine control, the proportion of people with more than one diaper was better after the establishment of outpatient clinic than before. Conclusions:The establishment of the comprehensive clinical management meets the needs of patients with orthotopic neobladder, enables patients to get the function of continence and urination sooner, and contributes to improve the clinical outcome of patients.

Clinical study on the treatment of depression with venlafaxine under the guidance of pharmacogenomics testing / 四川精神卫生

ObjectiveTo investigate the efficacy and safety of venlafaxine in the treatment of depression under the guidance of pharmacogenomics testing， and to provide references for individualized medication. MethodsA total of 66 patients who met the diagnostic criteria of International Classification of Diseases， tenth edition （ICD-10） for depressive episode were included in the study. Patients who were recommended to be treated with venlafaxine in the pharmacogenomics testing report were divided into study group （n=32）， and those who were decided to be treated with venlafaxine by doctors after consultation with patients were divided into control group （n=34）. At the baseline and the end of the 2nd， 4th， 6th and 8th weekend of treatment， Hamilton Depression Scale-24 item （HAMD-24） was adopted to evaluate the clinical efficacy. Meanwhile， Sheehan Disability Scale （SDS） was applied to measure the social function of patients at the baseline and the end of the 8th weekend of treatment. After treatment， Treatment Emergent Symptom Scale （TESS） was used to assess the incidence of adverse reactions. ResultsAt the end of the 4th， 6th and 8th weekend of treatment， HAMD-24 scores in the study group were all lower than those in the control group， with statistical differences （t=2.344， 4.316， 5.760， P<0.05 or 0.01）. At the end of the 8th weekend of treatment， SDS score of the study group was lower than that of the control group， with statistical difference （t=2.173， P<0.05）. The adverse reaction rate in the study group was lower than that in the control group， with statistical difference （χ2=5.720， P<0.05）. ConclusionTreatment of depression with venlafaxine based on pharmacogenetic testing is an effective and safe way to alleviate the depression symptoms in patients.

Investigation of the family environment of senior high school students with psychological problems / 四川精神卫生

ObjectiveTo discuss the family environment characteristics of senior high school students with psychological problems， and to provide references for realizing management of senior high school students' mental health. MethodsA total of 1 917 senior high school students in Foshan No. 2 Middle School were enrolled， and assessed using Middle School Student Mental Health Scale （MSSMHS-60） and a self-compiled family environment questionnaire. Then the family environment characteristics of senior high school students with psychological problems were analyzed. ResultsThe total score of MSSMHS-60 was （1.83±0.49） in 1 917 senior high school students， and was （2.40±0.36） in 602 （31.40%） students with psychological problems. The detection rate of psychological problems demonstrated significant difference among senior high school students with different status of companionship， household finance， parental rearing style and kinship （χ2=16.951， 38.142， 90.545， 59.448， P<0.05 or 0.01）. Binary Logistic regression analysis showed that the presence of frequent parental quarrels was a risk factor for senior high school students' mental health （OR=3.120， P<0.01）. ConclusionThe detection rate of psychological problems is high among senior high school students in Foshan City， and family disputes is a risk factor for psychological problems.

Surgical resection of locally recurrent renal cell carcinoma after radical or partial nephrectomy: feasibility and prognostic analysis / 中华泌尿外科杂志

Objective:To evaluate the feasibility and prognostic features of surgical resection of locally recurrent renal cell carcinoma patients after initial radical or partial nephrectomy.Methods:The data of the patients treated for postoperative locally recurrent renal cell carcinoma from Jan 2005 to Dec 2019 in the Department of Urology, Peking University First Hospital, were analyzed retrospectively. Postoperative locally recurrent of renal cell carcinoma is defined as disease recurring in the remnant kidney, renal fossa, adjacent abdomen, ipsilateral adrenal or retroperitoneal lymph nodes. Secondary surgery includes radical nephrectomy, partial nephrectomy, recurrent mass resection or radiofrequency ablation. The adjuvant therapy and prognostic information after secondary surgery were obtained and analyzed. Ninety-five patients were included in the study, with the median age of 56 years old (14-82 years old). The overall median recurrent interval was 25 months (2-164 months) and the median recurrent interval for radical and partial nephrectomy patients were 30 months and 25 months, with no significant difference. As for the secondary surgery, 63 patients underwent open surgery, 22 patients with laparoscopic surgery and 10 patients with radiofrequency ablation therapy.Result:The median operation time of secondary surgery was 148 minutes (35-330 minutes) and median intraoperative blood loss of 150 ml (20-3 000 ml). There were 8 cases of stage Ⅰ or stage Ⅱ postoperative complication, including wound infection and anemia. A stage Ⅲ complication of postoperative hematuria occured. The patient underwent renal artery embolization to control the hematuria. Eight patients suffered local recurrence and 10 patients experienced distant metastasis after the secondary surgery. During the follow-up, 6 patients died. The overall 3-year, 5-year disease free survival rate was 85.8% and 53.3%, respectively. The median survival time of patients with remnant kidney, renal fossa, and adjacent abdomen recurrence was 78 months, while 49 months for patients with ipsilateral adrenal and retroperitoneal lymph nodes recurrence ( P=0.141). Conclusions:With sufficient evaluation and preparation, the resection of the recurrent mass could be feasible and safe. With completion resection and negative surgery margin, patients could obtain relative long-term survival.

The application of adjuvant radiotherapy after radical nephroureterectomy in the treatment of upper tract urothelial carcinoma / 中华泌尿外科杂志

Urothelial carcinoma (UC) is the second most commonly diagnosed genitourinary tumor, and upper tract urothelial carcinoma (UTUC) accounts for 5% of UC in USA. It may be more in Asia. Senventy-eight percent of UTUC may be invasive when diagnosed. The radical nephroureterectomy (RNU) with bladder cuff is the golden standard treatment. In recent years, as the development of radiotherapy, adjuvant radiotherapy (ART) after RNU has been used to treat UTUC patients, but its efficacy is still a controversy. We did this review focusing on ART’s efficacy after RNU to guide and help the clinical practice.

The feasibility and efficacy of total laparoscopic radical cystectomy with intracorporeal Xing's orthotopic neobladder / 中华泌尿外科杂志

Objective To explore the feasibility and clinical effect of laparoscopic radical cystectomy with intracorporeal Xing's orthotopic neobladder.Methods Forty-one patients who underwent laparoscopic radical cystectomy with intracorporeal Xing's orthotopic neobladder from July 2013 to August 2019.There were 31 cases performed in Beijing Chaoyang hospital and 10 cases in National Cancer Center.Mean age was 59 (range 44-78) years,mean BMI was 25.3 (range 20.1-34.7) kg/m2,and mean CCI was 3 (range 2-6).No urethral stricture or urinary incontinence was found by preoperative examination.No distant metastasis was identified by bone scans,chest X-ray and sonography.Cystoscopy or TURBT was performed on all patients and biopsy was taken to confirm the diagnosis.Preoperative pathology showed 30 cases (73.2％) of MIBC,9 cases of NMIBC (22.0％) and 2 cases (4.9％) of in-situ cancer.Laparoscopic radical cystectomy and lymphadenectomy were performed under general anesthesia.Urinary diversion was completed in the peritoneal cavity,by intercepting the terminal ileum about 60 cm,and taking the proximal ileum 10 cm as input loop on the right side with proximal to distal way,and the middle 40 cm ileum was detubated.After u-shaped suture,the ileum was folded back and stitched into a sphere building a novd orthotopic neobladder with bilateral isoperistaltic afferent limbs.The prognosis of perioperative data and postoperative satisfaction regarding continence were analyzed,continence was defined as 0-1 pad/day.The 41 patients were divided into two groups to compare the difference in term of operation time and blood loss between the first 21 patients and the last 20 patients.Results Mean total operative time was 324.9 mins (range 210-480) mins,and mean estimated blood loss was 177.6(range 50-700) ml.There were significant statistical differences in term of total operation time,construction time and blood loss between the first 21 patients and the next 20 patients (P ＜ 0.05).Postoperative pathological results were urothelial carcinoma in 40 cases (2 in situ carcinoma) and small cell carcinoma in 1 case.Mean number of dissected lymph nodes was 19 (range 11-58),with 7 cases(17.1％)of positive lymph nodes,and 3 cases(7.3％) had positive surgical margin.At a mean follow up of 17.6 (range 2-64) months,36 patients (87.8％) survived,including 2 patients (4.9％) with metastasis and 1 patient (2.4％) with recurrence,and 5 cases (12.2％)died.All patients were able to urinate without catheterization.Thirty-seven patients (90.2％) were satisfied with voiding control during the daytime (0-1 urinal pad),and 29 patients (70.7％) were satisfied with voiding control at nighttime (0-1 urinal pad) by the follow-up 12 months after the operation.Conclusions Total laparoscopic radical cystectomy combined with Xing's orthotopic ileum neobladder is a simple method with fewer postoperative complications and a satisfactory continence rate.

A clinical study on laparoscopic hepatic vein-guided anatomical hepatectomy for hepatocellular carcinoma / 中华肝胆外科杂志

Objective:To study the use of laparoscopic hepatic vein guided anatomic hepatectomy in the treatment of hepatocellular carcinoma.Methods:The clinical and follow-up data of 62 patients who underwent laparoscopic anatomic hepatectomy at the Department of Hepatobiliary Surgery of Southwest Hospital of the Army Medical University from January 2015 to February 2018 and met the inclusion criteria of the study were retrospectively analyzed. The operation procedure as to whether the main hepatic vein was exposed or not was determined. The patients were divided into the hepatic vein-oriented hepatectomy (HVOH) group when the main hepatic vein was exposed, and the traditional anatomic hepatectomy (TAH) group when the main hepatic vein was not shown. The perioperative and follow-up data of the two methods were compared.Results:A total of 31 cases were included in the HVOH group, there were 28 males and 3 females, age ranged from 29.0-70.0 (49.9±11.2) years. A total of 31 cases were included in the TAH group, there were 27 males and 4 females, age ranged from 22.0-73.0 (51.4±12.1) years. There were no significant differences in operation time, intraoperative blood loss, postoperative hospital stay, intraoperative conversion to open, and perioperative blood transfusion rates between the two groups ( P>0.05). The incidence of postoperative complication was significantly lower in the HVOH group than in the TAH group [9.7% (3/31) vs. 32.2% (10/31)] ( P<0.05), but no serious complications occurred (Clavein Level IV) in this study. The one-year tumor-free survival rate in the HVOH group was significantly higher than that in the TAH group (77.4% vs. 51.6%), ( P<0.05). There were no significant differences in the 1- and 3-year overall survival rates and tumor-free survival rates between the two groups ( P>0.05). Conclusion:Laparoscopic hepatic vein-guided anatomic hepatectomy for hepatocellular carcinoma had the potential advantages in reducing the perioperative complication rate, and enhanced the early tumor-free survival rates.

Research progress on the relationship between inflammation and neuropathic pain / 中国医师杂志

Neuropathic pain (NP) is pain triggered or caused by primary damage and dysfunction of the nervous system.It belongs to a kind of chronic pain,which is manifested as spontaneous pain,hyperalgesia,abnormal pain,paresthesia and other clinical characteristics.Because the pathogenesis is not clear,the therapeutic effect is not satisfactory.After nerve injury,the glial cells in the injured site and dorsal root ganglia (DRG) release various inflammatory mediators to participate in the regulation of the transmission of damaging information.The inflammatory process of neuropathic pain may be accomplished through some signaling pathways.This article reviews the current research on the relationship between inflammation and neuropathic pain.

Modified extraperitoneal laparoscopic VIP (Vattikuti institute prostatectomy) for prostate cancer:initial experience / 中华泌尿外科杂志

Objective To investigate the operating key steps and the initial experience of IUPU (Institute of Urology,Peking University) modified extraperitoneal laparoscopic VIP (Vattikuti institute prostatectomy) technique and the initial follow-up outcomes.Methods 46 patients of prostate cancer underwent the modified extraperitoneal laparoscopic VIP and were reviewed from November 2017 to September 2018.Patients aged 54 to 77 years,with mean age of 65.5 years old.Their preoperative PSA was 0.15 to 69.76 ng/ml with an average of 13.4 ng/ml.All patients were diagnosed by prostate biopsy and Gleason score was 6 to 10 with an average of 7.5.MRI was used to assess their clinical stage before operation.All the modified laparoscopic VIP were done through the extraperitoneal approach by a single surgeon and the follow-up by telephone for the PSA level and continence recovery (urine pad test).The major differences between modified laparoscopic VIP and the routine steps of radical prostatectomy are as follows:use of extraperitoneal approach and traditional laparoscopic operation;after the setup of the extraperitoneal cavity,the bladder neck is separated,isolated and cut down first;the management of DVC:Cut down the super-facial and deep layers of DVC just along the capsule of the prostate apex and it's unnecessary to suture it.Perioperative data of these patients were collected retrospectively,including operation time,intraoperative blood loss,length of hospital stay,postoperative pathology,and continence outcome after surgery.Result All 46 patients underwent the IUPU modified extraperitoneal laparoscopic VIP successfully without converting to open surgery.The operation time was 69-143 min with an average of 95.7 min and the estimated blood loss was 20-200 ml with an average of 81.5 ml.It was 3-17 days for the average time to remove the retropubic drainage tube postoperatively,with an average of 4.3 days.The postoperative hospital stay was 3-17 days with an average of 5.3 days.The Foley catheter was removed 14 days postoperatively.Five patients suffered from urine leakage and were managed successfully with conservative treatment.For the postoperative pathological stage,1 patient was pT2a,12 patients were pT2c,12 patients were pT3a and 21 patients were pT3b.The postoperative Gleason score was 6-9 with an average of 7.7.The postoperative follow-up time was 1-11 months with an average of 6.3 months.The PSA was 0.001-0.966 ng/ml with an average of 0.181 ng/ml 1 month postoperatively and the continence rate was 54％ (25/46) and 89％ (34/38) 1 month and 3 months after operation respectively.Conclusions The IUPU modified extraperitoneal laparoscopic VIP might be a safe and feasible for the radical prostatectomy.It's simplified for the operative steps,unnecessary to isolate and suture DVC and doesn't increase the blood loss.It's almost left intact for the surrounding tissues of the prostate apex and satisfactory for the early urinary continence.The oncological outcomes are needed to followup further.

Recent research on percutaneous endoscopic treatment of lumbar disc herniation in adolescents / 中国医师杂志

Lumbar disc herniation (LDH) is one of the most common degenerative spinal diseases in adults and less common in adolescents.The age of onset is less than 21 years old and is defined as adolescent lumbar disc herniation (ALDH).The incidence of ALDH is only 1％-5％.However,with the accelerated pace of life,the incidence of ALDH is increasing.In recent years,the rapid development of endoscopic technology has been widely used in spinal surgery.ALDH's percutaneous endoscopic technique has achieved good results.Compared with open surgery,percutaneous endoscopic treatment can preserve more normal lumbar structures,such as ligaments,muscles,lamina and facets,minimizing the impact on pubertal growth.This article reviews the characteristics of ALDH and endoscopic treatment as an entry point.

Recent research on percutaneous endoscopic treatment of lumbar disc herniation in adolescents / 中国医师杂志

Lumbar disc herniation (LDH) is one of the most common degenerative spinal diseases in adults and less common in adolescents. The age of onset is less than 21 years old and is defined as adolescent lumbar disc herniation (ALDH). The incidence of ALDH is only 1%-5%. However, with the accelerated pace of life, the incidence of ALDH is increasing. In recent years, the rapid development of endoscopic technology has been widely used in spinal surgery. ALDH's percutaneous endoscopic technique has achieved good results. Compared with open surgery, percutaneous endoscopic treatment can preserve more normal lumbar structures, such as ligaments, muscles, lamina and facets, minimizing the impact on pubertal growth. This article reviews the characteristics of ALDH and endoscopic treatment as an entry point.

Modified extraperitoneal laparoscopic VIP (Vattikuti institute prostatectomy) for prostate cancer: initial experience / 中华泌尿外科杂志

Objective@#To investigate the operating key steps and the initial experience of IUPU (Institute of Urology, Peking University) modified extraperitoneal laparoscopic VIP (Vattikuti institute prostatectomy) technique and the initial follow-up outcomes.@*Methods@#46 patients of prostate cancer underwent the modified extraperitoneal laparoscopic VIP and were reviewed from November 2017 to September 2018. Patients aged 54 to 77 years, with mean age of 65.5 years old. Their preoperative PSA was 0.15 to 69.76 ng/ml with an average of 13.4 ng/ml. All patients were diagnosed by prostate biopsy and Gleason score was 6 to 10 with an average of 7.5. MRI was used to assess their clinical stage before operation. All the modified laparoscopic VIP were done through the extraperitoneal approach by a single surgeon and the follow-up by telephone for the PSA level and continence recovery (urine pad test). The major differences between modified laparoscopic VIP and the routine steps of radical prostatectomy are as follows: use of extraperitoneal approach and traditional laparoscopic operation; after the setup of the extraperitoneal cavity, the bladder neck is separated, isolated and cut down first; the management of DVC: Cut down the super-facial and deep layers of DVC just along the capsule of the prostate apex and it’s unnecessary to suture it. Perioperative data of these patients were collected retrospectively, including operation time, intraoperative blood loss, length of hospital stay, postoperative pathology, and continence outcome after surgery.@*Result@#All 46 patients underwent the IUPU modified extraperitoneal laparoscopic VIP successfully without converting to open surgery. The operation time was 69-143 min with an average of 95.7 min and the estimated blood loss was 20-200 ml with an average of 81.5 ml. It was 3-17 days for the average time to remove the retropubic drainage tube postoperatively, with an average of 4.3 days. The postoperative hospital stay was 3-17 days with an average of 5.3 days. The Foley catheter was removed 14 days postoperatively. Five patients suffered from urine leakage and were managed successfully with conservative treatment. For the postoperative pathological stage, 1 patient was pT2a, 12 patients were pT2c, 12 patients were pT3a and 21 patients were pT3b. The postoperative Gleason score was 6-9 with an average of 7.7. The postoperative follow-up time was 1-11 months with an average of 6.3 months. The PSA was 0.001-0.966 ng/ml with an average of 0.181 ng/ml 1 month postoperatively and the continence rate was 54%(25/46) and 89%(34/38) 1 month and 3 months after operation respectively.@*Conclusions@#The IUPU modified extraperitoneal laparoscopic VIP might be a safe and feasible for the radical prostatectomy. It’s simplified for the operative steps, unnecessary to isolate and suture DVC and doesn’t increase the blood loss. It’s almost left intact for the surrounding tissues of the prostate apex and satisfactory for the early urinary continence. The oncological outcomes are needed to followup further.

Initial experience of modified transperitoneal laparoscopic pyeloplasty combined with a rigid ureteroscope with a deflectable tip( Sun’s ureteroscope) for the treatment of ureteropelvic junction obstruction with renal calculi / 中华泌尿外科杂志

Objective@#To evaluate the efficacy and safety of Institution Urology of Peking University modified technique for transperitoneal laparoscopic pyeloplasty combined with deflectable tip rigid ureteroscope(the Sun's ureteroscope) in ureteropelvic junction obstruction(UPJO) complicated with renal calculi.@*Methods@#From January 2018 to September 2018, eight patients, including five males and three females, were diagnosed as UPJO with coexistent ipsilateral renal calculi in Peking University First Hospital and Changzheng Hospital of Second Military Medical University. The age ranged from 14 to 50 years(mean 28 years). Four patients had flank pain and one patient had flank pain with hematuria, while the other three patients came without clinical symptom.The BMI ranged from 16.8 to 26.2 kg/m2(mean 22.0 kg/m2). The lesion located on the left side in 4 cases and on the right side in 4 cases. One patient suffered with multiple pelvis stones. Four patients suffered with multiple lower calyceal stones, and 3 patients had solitary lower calyceal stone. The stone size ranged from 2 mm to 10 mm (mean 6.4 mm). 3 cases had slight hydronephrosis and 5 cases had moderate hydronephrosis. Two patients combined with crossing vessels. All patients underwent modified transperotoneal laparoscopic dismembered pyeloplasty with pyelolithotomy. In cases with left lesion, an incision was made for the veress needle 5mm inferior to the costal margin in the left midclavicular line to establish pneumoperitoneum . A 12-mm camera port was placed 30 mm inferior to the umbilicus and 10 mm lateral to the border of left rectus muscle. Then, a 5 mm operative trocars was inserted at 30mm superior to the umbilicus 10 mm lateral to the border of left rectus muscle. Another 12 mm operative trocar was inserted at the opposite McBurney point. The last 5 mm operative trocar was placed at the veress needle point. After visualizing the pelvis and the proximal ureter at the lower pole of the kidney, a 1.0 cm transverse incision on the lower pole of the pelvis above the obstruction site was made. The Sun’s ureteroscope was introduced into the renal pelvis through the 1.0 cm transverse incision via the 12-mm trocar below the umbilicus. Stones in the renal pelvis and calyces were extracted with basket catheters and removed via the port. After the pyelo-nephroscopy, a modified transperitoneal laparoscopic pyeloplasty was made. A F6 double-J stent was inserted into the ureter during the surgery.@*Result@#All surgeries were finished successfully without conversion. The surgical duration ranged from 111 to 185 min(mean 135 min). The estimated blood ranged from 10 to 50 ml(mean 38.8 ml). The hospital stay ranged from 3 to 7 days(mean 4 days). The intraoperative stone free rate was 100%(8/8). No perioperative complications occured. With the follow-up from 6 to 14.4 months(mean 8.9 months), there was no evidence of obstruction in all patients, as confirmed by symptoms or radiological improvement of hydronephrosis, and two patients found recurrence of renal calculi.@*Conclusions@#Our modified technique for transperitoneal laparoscopic pyeloplasty combined with deflectable tip rigid ureteroscope(the Sun′s ureteroscope) is a safe, effective method to manage ureteropelvic junction obstruction with renal calculi.