Diagnostic and Prognostic Value of Neutrophil-Lymphocyte Ratio in Adrenocortical Carcinoma.

BACKGROUND: The aim was to explore the value of neutrophil-lymphocyte ratio (NLR) as a biomarker for predicting the prognosis or diagnosis in adrenocortical carcinoma (ACC). METHODS: We identified 262 patients with adrenal gland disease who underwent operation at our institution between 2013 and 2018. According to postoperative pathology, patients were divided into 2 groups: ACC and non-ACC groups. The neutrophil and lymphocyte count of patients were recorded. Within the intergroup comparison, data obtained from ACC and non-ACC groups were evaluated using ANOVA test. The cut-off values of NLR for the prognosis in ACC were determined according to 3 methods. RESULTS: The NLR values of ACC and non-ACC groups were 5.36 ± 5.30 and (1.73 ± 0.26) ∼ (2.56 ± 1.35), respectively (P < .001). NLR carry a differential property was evaluated with ROC curve to distinguish the above 2 groups. The cut-off value of NLR was estimated as 2.65 according to the Youden index. With this value, sensitivity was found as 67.5%, specificity was 83.8% and AUC was 0.749 (P < .001, confidence interval = 0.638-0.860). In ACC, the higher NLR group was not shown significantly poorer overall survival than the lower NLR group (NLR ≥2.65 vs. NLR < 2.65, NLR ≥5 vs. NLR <5, NLR ≥5.36 vs. NLR <5.36) (P > .05). CONCLUSION: According to the data in this study, it can be said that adrenocortical tumors are likely to be malignant by 67.5% if the NLR value is greater than 2.65. When we use the NLR to predict the prognosis of ACC, there is not statistically significant.

Long non-coding RNA MEG3 functions as a competing endogenous RNA of miR-93 to regulate bladder cancer progression via PI3K/AKT/mTOR pathway.

BACKGROUND: Maternally expressed gene 3 (MEG3) is a long non-coding RNA (lncRNA) and involved in progression of various human tumors. However, its underlying regulatory mechanism in tumorigenesis of bladder cancer (BC) remains unclear. To demonstrate effects of MEG3 on BC cell proliferation and elaborate its regulatory mechanism in BC. METHODS: Aberrant expressions of MEG3 and miR-93-5p were induced by cell transfection. The mRNA and protein expression were analyzed using qRT-PCR and western blot. Cell proliferation was examined by CCK-8 assay and EdU staining. The targeted regulation effect of MEG3 on miR-93-5p was confirmed by luciferase reporter assay. The number of LC3 punctated cells was detected by immunofluorescence. Xeno-graft mouse model was constructed for in vivo validation. RESULTS: MEG3 was down-regulated with increased expression of miR-93-5p in BC cells and tissues. Luciferase reporter assay showed that miR-93-5p was a direct target of MEG3 and was negatively regulated by MEG3. MEG3 overexpression inhibited cell proliferation and the expression of proliferation-, apoptosis- and autophagy-related proteins. The activation of PI3K/AKT/mTOR pathway was also suppressed with elevated cell apoptosis. miR-93-5p overexpression counteracted these results. In vivo experiments, we confirmed that miR-93-5p overexpression reversed the MEG3 overexpression-mediated suppression on tumor growth and protein expression. CONCLUSIONS: lncRNA MEG3 could function as a competing endogenous RNA of miR-93 to regulate the tumorigenesis of BC via PI3K/AKT/mTOR pathway. The present research provided a new perspective to understanding the pathogenic mechanism of BC, and an effective therapeutic target for BC.

The utility of adrenal and ovarian venous sampling in a progesterone-producing adrenal tumor and review of the literature.

PURPOSE: A clinical case presenting secondary amenorrhea accompanied by an adrenal adenoma and hyperprogesteronemia is described in this study. METHODS: Selective catheterization and sampling of adrenal and ovarian veins were performed. RESULTS: The source of hyperprogesteronemia was located in the right adrenal gland. A progesterone-producing tumor in the right adrenal gland was diagnosed and removed. Twenty-six days after tumor resection, menstruation occurred. CONCLUSIONS: Progesterone-producing tumors should be considered with the presence of an adrenal mass and hyperprogesteronemia. Combined adrenal and ovarian venous sampling may help to identify the source of progesterone secretion.

[Diagnosis and treatment of adrenal medullary hyperplasia].

OBJECTIVE: To explore the clinical characters of adrenal medullary hyperplasia (AMH). METHODS: The clinical data of 7 cases of AMH admitted from 1996 to 2013 were analyzed with a review of literature. RESULTS: There were 3 males and 4 females with a median age of 36 (23-69) years. All had hypertension at first diagnosis and 2 were paroxysmal. Computed tomography (CT) scan revealed unilateral adrenal nodule in all cases, including left (n = 5) and right (n = 2) side. The diameter of nodules was 0.9 cm to 3.0 cm.Hypokalemia was found in 2 cases. And 24-hour output of urine catecholamine was higher than normal level in 2 cases. An abnormal rise of 24-hour output of urine free cortisol was found in 1 case with a lower level of adrenocorticotropic hormone (ACTH) simultaneously while a lower level of plasma renin activity in vertical position was found in another case. Three patients received (131)I-meta-iodobenzylguanidine scan and one had positive result. Pre-operative diagnosis included pheochromocytoma (n = 2), adrenocortical adenoma (n = 3) (2 aldosterone-producing adenomas, 1 Cushing adenoma) and undetermined adrenal tumor (n = 2). All underwent surgery, including unilateral adrenalectomy (n = 4) and resection of adrenal disease (n = 3). All cases had a pathologic diagnosis of AMH. One had concurrent Cushing adenoma while another with cortical hyperplasia.One case achieved normotension postoperatively while others showed varying decreases of blood pressure, but remained hypertensive. CONCLUSION: With a common feature of hypertension, AMH is difficult to diagnose preoperatively. CT scan has a certain diagnostic significance and a definite diagnosis depends on pathological examination; because of inaccurate preoperative and intraoperative diagnosis, the extent of surgery may be incomplete and results in unsatisfied outcomes.

[Complications of laparoscopic surgery: a 11-year single institute experience].

OBJECTIVE: To analyze the complications of laparoscopic surgery for the past 11 years in the Urology Department of Peking Union Medical College Hospital. METHODS: The laparoscopic surgery of 5 386 cases from Jan. 2002 to Dec. 2012 was statistically analyzed. The patient's gender, age, surgery mode, blood loss, complications, total length of hospital stay, postoperative hospital stay and other data were analyzed. RESULTS: There were 5 386 cases in this group aged 8-86 years (the mean age: 49.0 years; 2 651 cases were male and 2 735 female). Of all the cases, 2 411 were of adrenal surgery, accounting for 44.7%, 167 of retroperitoneal tumor resection , accounting for 3.1%, 763 of radical nephrectomy surgery, accounting for 14.2%, 441 of partial nephrectomy surgery, accounting for 8.2%, 784 of renal cyst surgery, accounting for 14.6%; 279 of semi-urinary tract resection, accounting for 5.2%; 74 of renal pelvis and ureter plasty, accounting for 1.4%; 141 of radical prostatectomy surgery, accounting for 2.6%, 71 of cystectomy surgery, accounting for 1.3% and 255 of other surgery, accounting for 4.7%. The blood loss was 10-3 000 mL (average: 97.5 mL ) and the surgery requiring blood transfusion treatment involved 270 patients. The total hospital stay was 3-133 days (average: 18 days) and postoperative hospital stay was 2-35 days (average: 6.3 days). All kinds of complications occured in 346 cases (6.42%), of which 198 were of peritoneal injury, 12 of pleural injury; 72 of subcutaneous emphysema, 24 of urinary fistula, 15 of inferior vena cava injury, 6 of pancreatic fistula 10,of lymphatic fistula, 8 of wound delayed healing and 1 of, intestinal fistula. The incidence of the complications and blood transfusion showed a downward trend according to stratified analysis each year. CONCLUSION: The laparoscopic surgery coveres almost all treatment of urological diseases. The complications are different in different types of surgery at different times, but generally no serious complications occurr. The incidence of complications is in a downward trend as the laparoscopic technique level improves.

Surgical management and clinical prognosis of adrenocortical carcinoma.

OBJECTIVE: To study the relationship between surgical management and prognosis of adrenocortical carcinoma (ACC) in order to guide the surgical management of ACC. METHODS: Clinical data of 45 cases of ACC treated in our hospital were retrospectively analyzed. The 45 cases included 3 cases in stage I, 12 cases in stage II, 7 cases in stage III, and 23 cases in stage IV. 17 cases underwent complete excision, 14 cases underwent palliative excision, 8 cases had non-operative treatment and 6 cases gave up treatment. All patients were followed up from 2 to 141 months. RESULTS: The average survival time of 31 patients with surgery was 32.46 months, and the average survival time of 14 patients without surgery was 4.75 months. There were statistically significant differences between the two groups (p < 0.01). There were no statistically significant differences between the two groups in survival time in stage III and stage IV (p > 0.05). CONCLUSIONS: Surgery is considered to be the only method to cure ACC. For ACC in stage I and II, tumor resection is the most effective treatment, and second surgical operation is recommended for local recurrence. For ACC in stage III, extensive surgical operation is recommended, and for ACC in stage IV, surgical operation has no effect on the prognosis.

Open partial nephrectomy in solitary kidney with multiple renal cell carcinoma: a case report / 中国医学科学杂志(英文版)

Renal cell carcinoma (RCC) in a solitary kidney presents a unique clinical challenge to urological surgeons. Partial nephrectomy (PN) or nephron-sparing surgery in this condition provides good oncological and renal functional outcomes with an acceptable complication rate. Long-term renal function remains stable in most patients with solitary kidneys after a reduction of more than 50% in renal mass.PN is a surgical procedure reserved for patients with a tumor in a solitary kidney, bilateral renal tumors, or renal function impairment. The challenge of preserving renal parenchyma is significantly complicated with the discovery of multiple masses in a solitary kidney because any subsequent complications may result in a significant decline in quality of life. Particularly in the case of postoperative renal failure, dialysis becomes necessary.

[Clinical features of urological malignancies with paraneoplastic syndromes].

OBJECTIVE: To investigate the clinical features of paraneoplastic syndromes (PNS) in patients with renal, prostate and bladder cancer and conduct a brief prognostic analysis. METHODS: From 2008 to 2010, 464 patients of renal cell carcinoma (RCC) confirmed by operation and pathology were reviewed retrospectively. And 562 cases of patients with prostate cancer and 647 with bladder cancer from 2005 to 2010 were also analyzed respectively. RESULTS: Among all cases, 156(33.6%)patients were diagnosed with PNS manifesting with anemia, hypertension, fever, polycythemia, Stauffer's syndrome, fatigue, weight loss, anorexia, leukocytosis and hypercalcemia, etc. Two prostate cancer patients had the elevated levels of calcemia and blood glucose respectively. However, no specific clinical presentation in bladder cancer was found to be associated with PNS in this study. CONCLUSION: RCC is the most frequent urological malignancy with PNS. But prostate cancer with PNS is very uncommon and bladder cancer is extremely rare. Most paraneoplastic signs predicate a poor prognosis for the patients.

[Occurrence, types, and therapies of malignant tumors in recipients of renal transplantation].

OBJECTIVE: To investigate the types and therapies of malignancies in renal allograft recipients. METHODS: We retrospectively analyzed the occurrence, types, and therapies of malignancies in 498 renal allograft recipients who had received operations in Peking Union Medical College Hospital from May 1986 to October 2008. RESULTS: Among 498 renal allograft recipients, 18 patients (3.6% ) were diagnosed with malignancies, which included bladder cancer (n = 5), renal pyloric cancer or ureteric cancer (n = 4), leukemia or lymphoma (n = 3), hepatic cancer (n = 2), skin cancer, rectum carcinoma, pulmonary carcinoma and thymoma (n = 1 each). Surgical operations were performed in 10 cases, 6 of whom survived with normal renal function and had no rejection of transplanted kidneys. Three patients with bladder cancer and one patient with ureteric cancer experienced recurrences 7 to 15 months after operations; among them one bladder cancer patient died. One hepatic carcinoma patient died of pulmonary metastasis 8 months after operation. One non-Hodgkin's lymphoma patient died 11 months after chemotherapy. Five cases with advanced unresectable malignancies died 8 to 17 months after the diagnosis. CONCLUSIONS: The incidences of malignancies, especially urological epithelial carcinoma, are high in renal allograft recipients. Radical surgery of the solid malignancies is a preferred option.

[Diagnosis and treatment of primary pigmented nodular adrenocortical disease report of 4 cases].

OBJECTIVE: To study the diagnosis and treatment of primary pigmented nodular adrenocortical disease (PPNAD). METHODS: The clinical data including symptom, endocrinal examination, surgical operation and prognosis of 4 cases of PPNAD hospitalized from 2000 to 2007 were analyzed respectively, relative literature were reviewed. RESULTS: 1 case received total adrenalectomy needed adrenocortical hormone postoperatively, 3 cases responded favorably to subtotal adrenalectomy and did not need adrenocortical hormone, however, 1 case was diagnosed of thyroid carcinoma 2 years after subtotal adrenalectomy. CONCLUSIONS: PPNAD is a rare subtype of ACTH-independent Cushing's syndrome, the diagnosis is depend on symptom, endocrinal examination and pathology. Total adrenalectomy is suitable to the patients with obvious symptom; subtotal adrenalectomy to the patients with mild symptom, the lesion of other endocrinal organ must be followed up postoperatively.

Analysis of HLA class I specific antibodies in patients with failed allografts.

BACKGROUND: The goals of this study are first to determine the epitope specificity of donor specific antibody (DSA) in the serum of alloimmunized transplant patients with a failed renal graft; and second to understand the correlation between the development of DSA and nondonor specific antibody (NDSA). METHODS: The sera of 35 pretransplant panel reactive antibody (PRA)-negative patients with failed allografts were examined with single-antigen (SA) luminex beads to identify human leukocyte antigen (HLA)-A and -B antibodies. Potential HLA antibody epitopes were identified by using computer software and verified by absorption and elution from single-antigen cell lines. RESULTS: Twenty-seven patients developed donor-specific HLA-A and/or -B antibodies, while the remaining eight patients had only nondonor-specific HLA-A and/or -B antibodies. The DSA-positive patients also had a long list of NDSA. Sixty-eight percent of the reactions found in 27 recipients with DSA were attributable to 66 epitopes on the mismatched donor HLA molecule. All 39 NDSA in eight patients with only NDSA shared 17 epitopes within positive allele specificities. By absorption and elution using recombinant cell lines having a single HLA specificity, we confirmed the epitopes involved in three patients. CONCLUSION: Development of most NDSA in patients with failed allografts is likely due to sharing epitopes with DSA and/or other NDSA.

[Analysis of protamine content in patients with asthenozoospermia].

OBJECTIVE: To study the significance of the change of protamine content in the management of male infertility. METHODS: Sperm nuclear proteins extracted from 199 infertile patients were analyzed by polyacrylamide gel-electrophoresis and scanning microdensitometry. RESULTS: Forty-two (21%) cases of the total number had normal sperm nuclear proteins and 157 (79%) had aberrant ones, which mainly presented the interruption of HPRR and abnormality of P2 protamine. Thirty patients were selected at random from 157 abnormal cases for clinical treatment. After the treatment, the sperm nuclear proteins were extracted and analyzed and the results demonstrated that 11 cases (36.6%) improved markedly, 5 (16.6%) restored to normal and the other 16 (46.6%) remained unchanged. CONCLUSION: There is a reduced level or selective absence or even complete selective absence of protamines in infertile patients. Protamines may act as a parameter for evaluating the treatment effect of infertile males and protamine content can be influenced by a certain or several factors.

Lung transplantation in the United States: 1990-2005.

The number of lung transplants reported to the OPTN/UNOS Registry has been increasing during the past 15 years. The increase is mainly due to a steady increase in transplants in the 50-64 age group. There is also a trend toward increasing lung transplants for older patients (> 65 yr) since 2001. Among whites, COPD, IPF, CF, alpha1-ATD, and PPH were the top 5 original diseases leading to lung transplantation; while for blacks, sarcoidosis, COPD, and IPF were the major original diseases. Recipients with IPF had significantly lower graft survival rates than COPD patients. One-year graft survival rates increased from 70% in the early 1990s to more than 80% in the most recent 3-year period, but the increase in long-term graft survival has been very limited. The negative effect of previous transplantation on graft survival was only significant within the first post transplant year; in contrast, the negative effect of HLA mismatches is more apparent on long-term graft survival. Acute rejection within the first year had a significant deleterious effect on long-term graft survival.

Role of adrenalectomy in ectopic ACTH syndrome.

Evaluation of adrenalectomy in patients diagnosed with ectopic ACTH syndrome was studied. Twenty-three clinical cases diagnosed with ectopic ACTH syndrome were analyzed at Chinese Academy of Medical Sciences and Peking Union Medical College Hospital (PUMCH). Cases consisted of 14 males and 9 females, with mean age of 38 years. All 23 cases had positive clinical, biochemical and radiology evidence for diagnosis of Cushing's syndrome. Sixteen of the 23 cases were treated with total adrenalectomy and the remaining 7 were treated without surgical intervention. Sixteen cases, having no identifiable source of ectopic hormone production, experienced resolution of presenting signs and symptoms after undergoing bilateral or unilateral total adrenalectomy; 1-year survival was 67%, 2-year survival 41% and 5-year survival 15%. In patients treated conservatively without surgical intervention, 1-year survival was 0%. In patients with no identifiable source of ectopic hormone production, bilateral adrenalectomy followed by hormone replacement treatment is effective.

[The evaluation of the diagnosis and treatment of 32 cases with ectopic ACTH syndrome].

OBJECTIVE: To investigate and discuss the diagnosis and treatment of ectopic ACTH syndrome. METHODS: Clinical data of 32 cases of ectopic ACTH syndrome, recruited from January 1990 to April 2003 in our hospital, was analyzed. RESULTS: All of the 32 cases presented with clinical and biochemical evidences of Cushing's syndrome. Ten cases were definitively diagnosed as ectopic ACTH syndrome by finding ectopic tumors; 4 cases were highly suspected as ectopic ACTH by blood sampling from femoral vein and infra-petrosal vein and 18 cases were suspected as ectopic ACTH by imaging examinations. Fifteen cases (47%), without identified source of ectopic hormone, were treated with bilateral or unilateral total adrenalectomy, with 1-year survival rate of 60%. Seven cases (22%), with possible source of ectopic hormone, underwent no intervention, with 1-year survival rate of 0. Ten cases underwent radical resection of tumor, 6 of which were bronchial carcinoids and 4 of which were thymic carcinoids, with 1-year survival rate of 60%. CONCLUSION: It is very difficult to localize the tumor of ectopic ACTH syndrome patients. Bilateral adrenalectomy followed by hormonal replacement is effective for most of the patients without identifying source of ectopic hormone.

[Clinic analysis of repeat prostatectomy after transurethral prostatectomy for benign prostatic hyperplasia].

OBJECTIVE: To analyze the incidence rate of repeat transurethral prostatectomy (TURP) and its probable causes after TURP for benign prostatic hyperplasia (BHP). METHODS: A retrospective study was conducted to summarize the cases who received repeat transurethral resection of prostate after TURP for benign prostatic hyperplasia in recent 20 years. The data were compared with the data of the cases who just received once TURP for BPH. RESULTS: 1225 patients received TURP for BHP from 1981 to 2001. Fifty-seven patients experienced repeat transurethral resection of the prostate after a mean interval of 3 years and 2 months with an incidence rate of 4.65%. 69.8% of which manifested repeat gross hematuria before repeat prostatectomy, with a rate significantly higher than the general gross hematuria rate and the gross hematuria rate at the first admission (P < 0.005 and P < 0.01). CONCLUSION: The incidence rate of repeat prostatectomy after TURP for BHP is 4.65%. The mean interval between the two procedures is 3 years and 2 months. Gross hematuria is one of the main causes for repeat TURP besides the low urinary tract symptoms.

[Telomerase expression in various lesions of adrenal cortex].

OBJECTIVE: To investigate the expression of telomerase in various lesions of adrenal cortex. METHODS: By autoradiography-based telomeric repeat amplification protocol, telomerase expression was detected in 36 samples of adrenocortical lesions, including 29 cases adrenocortical adenoma (8 Cushing's syndrome, 17 aldosteronism and 4 nonfunctional adenomas), 5 cases of hyperplasia of adrenal cortex (presented with Chushing' syndrome), 2 cases adrenocortical carcinoma, and 4 samples of normal adrenal cortex. RESULTS: Of the 40 samples, 2 cases of adrenocortical carcinomas had telomerase expression, and the others had no telomerase expression detected. CONCLUSIONS: No significant telomerase expression was found among different endocrine functional benign adrenocortical lesions. Telomerase expression may be used as an important marker of malignant adrenocortical tumor.