Overexpression of LaGRAS enhances phosphorus acquisition via increased root growth of phosphorus-deficient white lupin.

The GRAS transcription factors play an indispensable role in plant growth and responses to environmental stresses. The GRAS gene family has extensively been explored in various plant species; however, the comprehensive investigation of GRAS genes in white lupin remains insufficient. In this study, bioinformatics analysis of white lupin genome revealed 51 LaGRAS genes distributed into 10 distinct phylogenetic clades. Gene structure analyses revealed that LaGRAS proteins were considerably conserved among the same subfamilies. Notably, 25 segmental duplications and a single tandem duplication showed that segmental duplication was the major driving force for the expansion of GRAS genes in white lupin. Moreover, LaGRAS genes exhibited preferential expression in young cluster root and mature cluster roots and may play key roles in nutrient acquisition, particularly phosphorus (P). To validate this, RT-qPCR analysis of white lupin plants grown under +P (normal P) and -P (P deficiency) conditions elucidated significant differences in the transcript level of GRAS genes. Among them, LaGRAS38 and LaGRAS39 were identified as potential candidates with induced expression in MCR under -P. Additionally, white lupin transgenic hairy root overexpressing OE-LaGRAS38 and OE-LaGRAS39 showed increased root growth, and P concentration in root and leaf compared to those with empty vector control, suggesting their role in P acquisition. We believe this comprehensive analysis of GRAS members in white lupin is a first step in exploring their role in the regulation of root growth, tissue development, and ultimately improving P use efficiency in legume crops under natural environments.

Prognostic differences between type Ⅰ and type Ⅱ renal papillary cell carcinoma / 现代泌尿外科杂志

【Objective】 To analyze the clinical characteristics and prognostic differences between type Ⅰ and type Ⅱ papillary renal cell carcinoma (PRCC), and identify the prognosis-related independent predictors. 【Methods】 A total of 143 PRCC patients treated during Jan.2012 and Dec.2019 were involved, including 91 type Ⅰ patients and 52 type Ⅱ patients. The prognostic factors were analyzed with univariate and multivariate Cox regression analysis. The differences in cancer-specific survival (CSS) between the two groups were analyzed with Kaplan-Meier method and log-rank test. 【Results】 The patients’ age was 53.41±13.50 years. After a mean follow-up of 63.27±26.20 months, 14 patients died, and the overall CSS was 90.2%. The prognosis of type Ⅰ patients was better than type Ⅱ patients (94.5% vs. 82.7%, P=0.020). Cox regression suggested that PRCC subtype and stage were significantly associated with prognosis. There was no difference in prognosis between type Ⅰ and type Ⅱ patients in T1/T2 subgroup (P>0.05). However, in T3/T4 subgroup, type Ⅰ patients had a significant better prognosis than type Ⅱ patients (P=0.023), while the above trends were not observed in G1/G2 and G3/G4 subgroups (P>0.05). 【Conclusion】 PRCC subtype and stage are independent prognostic predictors. The impact of PRCC subtype on prognosis is mainly manifested in the subgroup of patients with T3 or higher stage.

Rhizosheath: An adaptive root trait to improve plant tolerance to phosphorus and water deficits?

Drought and nutrient limitations adversely affect crop yields, with below-ground traits enhancing crop production in these resource-poor environments. This review explores the interacting biological, chemical and physical factors that determine rhizosheath (soil adhering to the root system) development, and its influence on plant water uptake and phosphorus acquisition in dry soils. Identification of quantitative trait loci for rhizosheath development indicate it is genetically determined, but the microbial community also directly (polysaccharide exudation) and indirectly (altered root hair development) affect its extent. Plants with longer and denser root hairs had greater rhizosheath development and increased P uptake efficiency. Moreover, enhanced rhizosheath formation maintains contact at the root-soil interface thereby assisting water uptake from drying soil, consequently improving plant survival in droughted environments. Nevertheless, it can be difficult to determine if rhizosheath development is a cause or consequence of improved plant adaptation to dry and nutrient-depleted soils. Does rhizosheath development directly enhance plant water and phosphorus use, or do other tolerance mechanisms allow plants to invest more resources in rhizosheath development? Much more work is required on the interacting genetic, physical, biochemical and microbial mechanisms that determine rhizosheath development, to demonstrate that selection for rhizosheath development is a viable crop improvement strategy.

Identification and expression analysis of phosphate transporter (PHT) gene family in Lupinus albus cluster root under phosphorus stress.

According to global estimation, 5.7 billion hectares of agricultural land contain limited phosphorus (P) availability leading to insufficient plant growth and productivity. Internal phosphate transporters play an essential role in mediating P mobilization and uptake from the soil. White lupin (Lupinus albus) is a cluster root (CR) forming crop with great potential to survive under P limited soil. However, it is imperative to identify and characterize the phosphate transporter (PHT) gene family in plants to validate their involvement in solving P deficiency problems. The recent availability of white lupin high-quality genome allowed us an exhaustive searches in the whole genome and identified five phosphates transporters subfamilies, including 35 putative genes that are unevenly distributed on 16 chromosomes. The LaPHT1 subfamily contained eight genes, LaPHT2 subfamily have three, LaPHT3 subfamily have eight, LaPHT4 subfamily have nine, and LaPHO subfamily has seven. Gene structure and duplication were also examined in detail. Syntenic analysis revealed that white lupin PHT family members had maximum the collinear relationship with those in L. angustifolius followed by Phaseolus vulgaris but showed the least collinear relationship with those in Arabidopsis. Gene ontology (GO) analysis revealed that the in white lupin PHT genes were enriched in functions regulated P uptake, transport, and recycling mechanisms. RT-qPCR was performed to evaluate the transcript levels of LaPHT genes in different parts of CR under P deficient hydroponic culture. Our study would provide better understanding the genetic evolution and expression phosphate of phosphate transporters in L. albus CR under P deficiency. It will also be helpful for further functional-based studies to solve P deficiency-related issues and mitigate P stress responses.

Feasibility of deep learning for renal artery detection in laparoscopic video / 中华泌尿外科杂志

Objective:To explore the feasibility of deep learning technology for renal artery recognition in retroperitoneal laparoscopic renal surgery videos.Methods:From January 2020 to July 2021, the video data of 87 cases of laparoscopic retroperitoneal nephrectomy, including radical nephrectomy, partial nephrectomy, and hemiurorectomy, were retrospectively analyzed. Two urological surgeons screened video clips containing renal arteries. After frame extraction, annotation, review, and proofreading, the labeled targets were divided into training set and test set by the random number table in a ratio of 4∶1. The training set was used to train the neural network model. The test set was used to test the ability of the neural network to identify the renal artery in scenes with different difficulties, which was uniformly transmitted to the YOLOv3 convolutional neural network model for training. According to the opinion of two senior doctors, the test set was divided into high, medium, and low discrimination of renal artery and surrounding tissue. High identification means a clean renal artery and a large exposed area. For middle recognition degree, the renal artery had a certain degree of blood immersion, and the exposed area was medium. Low identification means that the exposed area of the renal artery was small, often located at the edge of the lens, and the blood immersion was severe, which may lead to lens blurring. In the surgical video, the annotator annotated the renal artery truth box frame by frame. After normalization and preprocessing, all images were input into the neural network model for training. The neural network output the renal artery prediction box, and if the overlap ratio (IOU) with the true value box was higher than the set threshold, it was judged that the prediction was correct. The neural network test results of the test set were recorded, and the sensitivity and accuracy were calculated according to IOU.Results:In the training set, 1 149 targets of 13 videos had high recognition degree, 1 891 targets of 17 videos had medium recognition degree, and 349 targets of 18 videos had low recognition degree. In the test set, 267 targets in 9 videos had high recognition degree, 519 targets in 11 videos had medium recognition degree, and 349 targets in 18 videos had low recognition degree. When the IOU threshold was 0.1, the sensitivity and accuracy were 52.78% and 82.50%, respectively. When the IOU threshold was 0.5, the sensitivity and accuracy were 37.80% and 59.10%, respectively. When the IOU threshold was 0.1, the sensitivity and accuracy of high, medium and low recognition groups were 89.14% and 87.82%, 45.86% and 78.03%, 32.95%, and 76.67%, respectively. The frame rate of the YOLOv3 algorithm in real-time surgery video was ≥15 frames/second. The false detection rate and missed detection rate of neural network for renal artery identification in laparoscopic renal surgery video were 47.22% and 17.49%, respectively (IOU=0.1). The leading causes of false detection were similar tissue and reflective light. The main reasons for missed detection were image blurring, blood dipping, dark light, fascia interference, or instrument occlusion, etc.Conclusions:Deep learning-based renal artery recognition technology is feasible. It may assist the surgeon in quickly identifying and protecting the renal artery during the operation and improving the safety of surgery.

Clinical value of remnant lipoproteins and low density lipoprotein cholesterol particle concentration detected by vertical auto profile on the diagnosis of carotid plaque / 中华检验医学杂志

Objective:To explore the clinical value of peripheral remnant lipoproteins (RLP), low density lipoprotein cholesterol particle (LDL-P) and sdLDL particle (sdLDL-P) measurement in the diagnosis of carotid plaque, so as to provide practical basis for the accurate diagnosis of carotid plaque and the control of carotid plaque related cardiovascular and cerebrovascular diseases.Methods:People who underwent carotid plaque ultrasound examination in Xingtai Third Hospital , from January 2020 to June 2021 were selected as the research object. According to the ultrasound results, they were divided into carotid plaque group ( n=146) and control group without carotid plaque ( n=149). The fasting RLP, LDL-P and sdLDL-P of the two groups were measured by vertical auto profile (VAP) centrifugal separation phase, and the fasting TG and LDL-C were detected by routine mixed phase method. The indexes were compared between the two groups and the true positive rate, true negative rate, false positive rate and false negative rate of the diagnosis of carotid plaque were analyzed. The receiver operating characteristic curve of each test index was drawn, and AUC was used to evaluate the clinical diagnostic value of each test index for carotid plaque. Results:The levels of RLP, LDL-P and sdLDL-P in carotid plaque group were significantly higher than those in non-carotid plaque group ([1.07±0.36] mmol/L vs [0.59±0.17] mmol/L,[1 300±370] nmol/L vs [781±215] nmol/L,[435±139] nmol/L vs [156±59] nmol/L, all P<0.01). The true positive rate (78.08% [114/146],81.51% [119/146]) and true negative rate (84.56% [126/149], 86.58%[129/149]) of serum RLP and LDL-P for the diagnosis of carotid plaque were significantly higher than TG (58.90%[86/146], 43.62%[65/149]) and LDL-C (59.59% [87/146], 46.98% [70/149]), and the false positive rate (15.44% [23/149], 13.42% [20/149]) and false negative rate (21.92% [32/146], 18.49% [27/146]) were significantly lower than TG (56.38% [84/149], 41.10% [60/146]) and LDL-C (53.02% [79/149], 40.41% [59/146], all P<0.01). The AUC of the ROC curve of RLP (0.890), LDL-P (0.902) and sdLDL-P (0.973) for the diagnosis of carotid plaque was higher than TG (0.682) and LDL-C (0.712). The AUC of ROC curve of the RLP combined with sdLDL-P (0.977) for the diagnosis of carotid plaque was higher than the RLP and sdLDL-P (all P<0.01). Conclusion:The serum RLP, LDL-P and sdLDL-P can be used as indicators of carotid plaque, and their clinical diagnostic value are superior to TG and LDL-C; the combined diagnostic effect of lipoprotein subclass is better than that of single index alone.

Abscisic Acid Mediates Drought-Enhanced Rhizosheath Formation in Tomato.

The rhizosheath, commonly defined as soil adhering to the root surface, may confer drought tolerance in various crop species by enhancing access to water and nutrients under drying stress conditions. Since the role of phytohormones in establishing this trait remains largely unexplored, we investigated the role of ABA in rhizosheath formation of wild-type (WT) and ABA-deficient (notabilis, not) tomatoes. Both genotypes had similar rhizosheath weight, root length, and root ABA concentration in well-watered soil. Drying stress treatment decreased root length similarly in both genotypes, but substantially increased root ABA concentration and rhizosheath weight of WT plants, indicating an important role for ABA in rhizosheath formation. Neither genotype nor drying stress treatment affected root hair length, but drying stress treatment decreased root hair density of not. Under drying stress conditions, root hair length was positively correlated with rhizosheath weight in both genotypes, while root hair density was positively correlated with rhizosheath weight in well-watered not plants. Root transcriptome analysis revealed that drought stress increased the expression of ABA-responsive transcription factors, such as AP2-like ER TF, alongside other drought-regulatory genes associated with ABA (ABA 8'-hydroxylase and protein phosphatase 2C). Thus, root ABA status modulated the expression of specific gene expression pathways. Taken together, drought-induced rhizosheath enhancement was ABA-dependent, but independent of root hair length.

Preliminary results of five cases of laparoscopic adrenalectomy assisted by domestic robotic surgery system / 中华泌尿外科杂志

Objective:To investigate the safety and efficacy of domestic Kangduo robotic surgery system in adrenalectomy.Methods:This study summarized the clinical data of patients with adrenal adenoma who were operated by domestic kangduo robot from November 2020 to April 2021. This study was approved by the hospital ethics committee, and the clinical trials of medical devices were filed. Inclusion criteria: age 18-75 years old; all of them in accordance with the indication of adrenalectomy; tumor volume≤6 cm; agree to sign the informed consent, follow the doctor's advice and follow up regularly. Exclusion criteria: patients with ipsilateral upper abdominal surgery history; patients with severe uncontrolled disease or acute infection; patients with cardiovascular and cerebrovascular diseases, blood system diseases and immune system diseases that are not controlled and can not reach the operation standard; pregnant or lactating women. All patients underwent robot assisted adrenalectomy. The general information and perioperative data of the patients were summarized.Results:Five patients were included in this study, including 1 male and 4 female. The average age was 49 (34-61)years old. There were 2 cases on the left and 3 cases on the right. The average diameter of tumor was 2.2 (1.1-3.7) cm. All patients showed adenoma by CT examination. Two cases were diagnosed as primary aldosteronism, one as Cushing's syndrome, and two as nonfunctional adenoma. All the operations were successfully completed in 5 cases, including 4 cases via retroperitoneal approach and 1 case via peritoneal approach. The average docking time was 3.8 (3-6) min, the average operation time was 56.2 (21-92) min, and the average blood loss was 34 (20-50) ml. The postoperative pathology was adrenal cortical adenoma. The average postoperative hospital stay was 3.6 (3-5) days. No postoperative complications occurred in 5 cases. Two patients with primary aldosteronism had hypertension and hypokalemia before operation, and they needed oral antihypertensive drugs to control them. They did not need medication after operation, and their blood pressure and potassium were maintained at normal levels. All patients were followed up for average 1.5(0.5-5.0)months.Conclusions:Domestic robot assisted laparoscopic adrenalectomy has the advantages of few blood loss, short operation time, few complications. It’s a safe and effective operation, but the conclusion needs to be further verified by large sample and multi-center study.

Learning curve for robotic assisted laparoscopic partial nephrectomy: a single operator experience / 中华泌尿外科杂志

Objective:To present the learning curve of robotic assisted laparoscopic partial nephrectomy by a single surgeon.Methods:The clinical data of 100 patients with renal tumor who underwent robot assisted laparoscopic partial nephrectomy in Peking Union Medical College Hospital from February 2016 to April 2018 were retrospectively analyzed. There were 64 males and 36 females. The average age was 51.5(18-79) years. The average body mass index (BMI) was 24.9(19-31)kg/m 2. TNM stage was T 1N 0M 0, which indicated partial nephrectomy. The tumors were located on the left in 38 cases and on the right in 62 cases. The average maximum diameter of tumor was 3.9(1.0-6.7) cm, and the average R. E.N.A.L. score was 6.7(4-11). All operations were performed by a single surgeon. This group of operations were the first 100 robot cases for this surgeon. The mean machines docking time was 14(10-30) min, the mean operation time was 119.2(60-240) min, the mean warm ischemia time was 16.7(0-45) min, and the estimated mean blood loss was 105.2(30-500) ml. There was no conversion to open surgery or laparoscopic radical nephrectomy. No serious complications occurred (Dindo calvein grade ≥ grade Ⅲ). There were 1 case of lower extremity intramuscular venous thrombosis, 1 case of urinary fistula, 1 case of pulmonary infection and 1 case of peri-kidney hematoma after operation. All patients were cured after conservative treatment without further operation or intervention. Cumulative Sum (CUSUM) test was used to fit the learning curve of docking time and operation time, and to judge the three different learning stages of robot surgery according to the inflection of the curve (CUSUM stop rising, and CUSUM begin to decline). The characteristics of patients and perioperative data of different learning stages were compared. Result:According to the CUSUM, the learning curve of robot assisted laparoscopic partial nephrectomy was 19 cases. According to the inflection point of operation time learning curve, 100 cases could be divided into three stages, 1st-19th cases were learning stage, 20th-43rd cases were mastering stage and 44th-100th cases are proficient stage. There were no significant differences in age, gender, tumor side, intraoperative bleeding volume, postoperative pathological type, total cost of hospitalization and incidence of complications among the three stages ( P>0.05). The median BMI in the learning stage was significantly lower than that in the mastery stage and the proficiency stage (23 kg/m 2, 26 kg/m 2, 25 kg/m 2, P=0.02). The median docking time(20 min, 12 min, 12 min), median operation time (150 min, 120 min, 100 min) and median warm ischemia time (21 min, 18 min, 15 min)were gradually shortened in the learning stage, mastering stage and proficient stage ( P<0.001). The median length of postoperative hospital stay in mastering stage and proficient stage was shorter than that in learning stage (7 d, 6 d, 6 d, P=0.011). The median maximum diameter of tumor (3.7 cm, 3.9 cm, 4.0 cm)and median R. E.N.A.L. score (6, 7, 7)increased gradually in learning stage, mastering stage and proficient stage, but the difference was not statistically significant( P=0.75, P=0.16). Conclusions:The learning curve of robotic assisted laparoscopic partial nephrectomy for an experienced surgeon is about 19 cases. After the completion of the learning curve, the docking time, operation time, warm ischemia time and postoperative hospital stay of patients can be significantly shortened than the initial period, and more difficult renal tumor operations can be accomplished.

Comparison of the Clinical Effect of Uniportal Video-assisted Thoracoscopic Lobectomy and Biportal Video-assisted Thoracoscopic Lobectomy in the Treatment of Lung Cancer / 中国肺癌杂志

BACKGROUND@#In recent years, the technique of uniportal video-assisted thoracoscopic surgery has been developed. As a new surgical method, its feasibility and safety have not been generally recognized. The aim of this study is to review the technology in the treatment of lung cancer patients in stage I to part of stage IIIa.@*METHODS@#The clinical data of patients accepted thoracoscopic resection of lung cancer by a same medical group from May 2018 to March 2019 in The First Affiliated Hospital of Soochow University were retrospectively analyzed. After remove of cases that did not meet the requirements, the patients were divided into uniportal group (55 cases) and biportal group (87 cases). The clinical data of the two groups were collected and statistically analyzed.@*RESULTS@#All the 142 patients underwent lobectomy and systemic lymph node dissection. There is no perioperative death in both groups. There was no significant difference in age, location of tumors, pathological type, size of tumors and pathological tumor-node-metastasis (pTNM) staging between uniportal group and biportal group (P>0.05). The operation time [(167.65±43.85) min vs (181.71±51.28) min], the intraoperative bleeding volume [(57.45±50.19) mL vs (87.47±132.54) mL], the indwelling time of drainage tube [(4.82±2.82) d vs (5.84±3.43) d] and the hospital stay [(6.91±3.88) d vs (7.74±3.87) d] were less in uiportal group compared to biportal group, though no significant difference occurred (P>0.05 ). The total drainage volume of uniportal group was significantly lower than that of biportal group [(1,064.82±776.38) mL vs (1,658.71±1,722.38) mL], and the visual analogue score of 24 hours and 72 hours after operation [(4.73±0.73) points vs (5.25±0.74) points; (2.16±0.71) points vs (2.55±0.86) points] were lower in uniportal group (P<0.05).@*CONCLUSIONS@#Uniportal video-assisted thoracoscopic radical resection of lung cancer is safe and feasible for stage I to part of stage IIIa lung cancer patients.

The efficacy of radiofrequency ablation combined with splenectomy in treatment of hepatocellular carcinoma with liver cirrhosis and hypersplenism / 中华肝胆外科杂志

Objective To study the efficacy and safety of radiofrequency ablation combined with splenectomy in treatment of primary liver cancer with liver cirrhosis and hypersplenism.Methods Thirty patients with hepatocellular carcinoma complicated with liver cirrhosis and hypersplenism were treated in Fuyang People's Hospital from January 2016 to December 2017.These patients were randomly divided into the observation group (n =15) and the control group (n =15).Surgical liver resection combined with splenectomy was performed in the control group,and radiofrequency ablation combined with splenectomy was performed in the observation group.The time of thermal ischemia,operation time,intraoperative blood loss,blood transfusion volume,length of hospital stay,platelet level and liver function 1 week after surgery,and the incidences of postoperative complications and the overall survival rates 2 years after surgery were compared between the two groups.Results The operation times of the observation group and the control group were (89.1 ± 18.4 vs.118.9 ± 33.6) rin,blood loss (228.4 ± 120.5 vs.362.2 ± 159.5) ml,blood transfusion (192.3±112.4 vs.503.8±196.2) ml,and length of hospital stay (13.5±6.0 vs.21.9±11.6) d (all P＜0.05).After a week of operation,the indicators in the observation group were significantly better than the control group (all P＜0.05).The postoperative two-years complication rate in the observation group was 13.3％,which was significantly lower than the control group (46.7％,P＜0.05).There was no significant difference in the survival rates between the two groups two years after surgery.Conclusions Radiofrequency ablation combined with splenectomy for treatment of liver cancer with cirrhosis and hypersplenism effectively reduced postoperative complications,preserved liver function,increased platelet levels,improved hypersplenism,and was safer.It is a surgical method worthy of generalization.

Analysis of clinical characteristics for hypertensive attack during pheochromocytoma and paraganglioma operation:a single center case report of 219 cases / 中华泌尿外科杂志

Objective To analyze the clinical characteristics for hypertensive attack during operation and clinical experience of preoperative evaluation and preparation in patients with pheochromocytoma and paraganglioma(PHEO/PGL).Methods A total 219 PHEO/PGL cases from September 2016 to September 2018 were retrospectively reviewed.It included 99 males and 120 females,aged 13 to 76 (average 47) years old.The mean diameter of tumor was 5.3 cm (1.5-18.0 cm).140 cases were unilateral PHEO,6 cases were bilateral PHEO,68 cases were PGL(jugular,mediaphragm,heart,retroperitoneum,pelvic and bladder) and 5 cases were PHEO combined with PGL.Preoperative highest systolic blood pressure (SBP)was 240 mmHg(1 mmHg-0.133 kPa) and highest diastolic blood pressure (DBP) was 160 mmHg.20 cases were occult PHEO without hypertension.217 cases accepted preoperative preparation of alpha-blocker [phenoxy-benzamine,dosage ranging from 5 mg Q12h to 40 mg Q8h,maximum dosage not exceeding 1 mg/(kg· 24 h)].2 cases did not accept preoperative preparation.All cases accepted open or endoscope surgery.The patients were divided into 2 groups depending on the presence or absence of hypertensive attack at the time of surgery.Patient demographic characteristics and preoperative evaluations were assessed for their prognostic relevance with respect to hypertensive attack.Results Histopathological results showed that all cases were PHEO or PGL,while 205 cases were benign,14 cases were malignant.Hypertensive attack were recorded in 112 cases(51％).The diameter of tumors in the hypertensive attack group were larger than that in the non-hypertensive attack group[(6.70 ± 2.95)cm vs.(3.95 ± 1.70) cm,P =0.005].There was no significant difference between the two groups among age [(51.0 ± 10.8) years vs.(38.5 ± 17.6) years,P =0.105],preoperative catecholamine level [norepinephrine (111.20 ± 41.49) μg/24 h vs.(419.15 ± 154.81) μg/24 h,P =0.075],time of use of alpha blockers [(53.0 ± 7.5) d vs.(38.0 ± 6.4) d,P =0.139],daily dosage of alpha blocker [(40.0 ±7.2)mg vs.(27.1 ± 1.8) mg,P =0.111] and blood pressure at diagnosis[(173.75 ± 26.69) mmHg vs.(155.0 ± 20.75) mmHg,P =0.139].Among 219 cases,2 case had emergency hemostasis after operation,1 case had catecholamine cardiomyopathy after operation for occult pheochromocytoma,and no perioperative death occurred.Conclusions Patients with large tumor tend to have hypertensive attack during operation so that should be better prepared.

Prostate cancer detected in the specimen of radial cystoprostatectomy for bladder cancer and its prognostic impact / 中华泌尿外科杂志

Objective To study the incidence rate of prostate cancer detected in the specimen of radial cystoprostatectomy for bladder cancer and to evaluate its effect on the prognosis.Methods From June 2012 to June 2017,the clinical data of 132 patients with bladder cancer undergoing radical cystectomy (RCP) were analyzed retrospectively.The average age of 132 patients with bladder cancer was 61.2 years (37-89 years old).The serum of PSA of 89 cases out of 132 patients was examined before operation,21 cases 4 ng/ml ＜ tPSA ＜ 10 ng/ml,1 case tPSA 17 ng/ml and 67 cases tPSA ＜ 4 ng/ml.The pathology of bladder and prostate,the location and range of prostate cancer and Gleason score and the prognostic effect of prostate cancer was evaluated.Results The 132 patients with bladder cancer,116 cases (87.9％) were high grade urothelial carcinoma,8 cases (6.0％) were bladder carcinoma in situ,6 cases (4.5％) were low grade urothelial carcinoma,1 case was neuroendocrine bladder carcinoma and 1 case was signet ring cell carcinoma.The 21 cases of prostate cancer were combined with Gleason score,among which 3 + 2 score in 1 cases,3 +3 score in 17 cases,4 +3 and 3 +4 in 1 cases,and 4 +5 score in 1 cases.The lesions were unilateral in 14 cases and bilateral in 7 cases.The lesions were ＜0.5 ml in 3 cases,0.5-0.7 ml in 14 cases and 0.7-1.0 ml in 4 cases.The average age of 21 cases with prostate cancer was 67.5 years old (41-89 years).Of the 21 cases of prostate cancer,the serum tPSA was abnormal in 4 cases with an average of 8.8 ng/ml (4.2-17.0 ng/ml),the serum tPSA was normal in 12 cases with an average of 2.5 ng/ml (1.3-3.7 ng/ml),and the serum PSA in 5 cases was not detected before operation.Three cases of prostate cancer aged less than 60 years old with the detection rate of 9.6％ (3/31);18 cases were equal or older than 60 years old with the detection rate of 17.8％ (18/101).Multi parameter analysis showed that the incidence of prostate cancer increased with the age of the patients (OR =1.36,P =0.048).Followed up for 5 to 51 months,no PSA relapse was found and no patient receiving related treatment.Conclusions The detection rate of prostate cancer is very high in the specimen of radial cystoprostatectomy for bladder cancer.The clinical manifestation of the prostatic involvement is concealed.Radical resection of the prostate is necessary in radical resection of bladder cancer.

Surgery treatment of ectopic adrenocorticotrophic hormone syndrome / 北京大学学报(医学版)

Objective: To investigation the diagnosis and treatment of ectopic adrenocorticotrophic hormone (ACTH) syndrome.Methods: The clinical characters of 57 cases of ecotopic ACTH syndrome from Jan.1996 to Dec.2016 were collected and analyzed.The 57 cases included 32 males and 25 females.The age ranged from 11 to 68 years (average 32 years).ACTH levels significantly increased from 16.5 to 365.6 pmol/L, with average 77.6 pmol/L (normal range <10.1 pmol/L).The pituitary MRI did not found lesions.The CT showed that their bilateral adrenal glands diffused small nodular changes or nodular hyperplasia.The 57 cases were divided into 3 groups according to different treatment options.In the study, 25 ectopic ACTH syndrome cases (44%) were group A, without identified source of ectopic hormone, were treated with bilateral or unilateral adrenalectomy due to the severity of the disease and difficulty of operation.Group B was composed of 16 cases (28%) diagnosed as ectopic ACTH syndrome by finding ectopic ACTH tumors and surgical resection.Group C included 16 cases (28%) with nonsurgical therapy.Different treatment results and prognosis were analyzed.Results: In the study, 40 cases of the 57 had been followed up for 6 months to 10 years.In group A, of the 25 cases with bilateral or unilateral adrenalectomy, 4 died of diabetes and severe pulmonary infection, 18 survived, and 3 were lost to the follow-up, and the survival rate was 81% (18/22).In group B, of the 16 cases with radical tumor resection, 5 died of tumor recurrence 0.5-6.0 years after operation, 3 survived, and 8 were lost to the follow-up, and the survival rate was 37.5% (3/8).In group C, of the 16 non-operation patients, 4 with radiotherapy and chemotherapy died of metastases, diabetes or pulmonary infection, 6 with chemotherapy died of pulmonary infection within 1 year and the others were lost to the follow-up, and the survival rate was 0.Conclusion: Ectopic ACTH syndrome is difficult to treat.Adrenalectomy is effective for the management of ectopic ACTH syndrome, especially for those patients with severe Cushing''s syndrome, but the primary tumor can not be located.

The surgical treatment of severe ectopic adrenocorticotrophic hormone syndrome / 中华泌尿外科杂志

Objective To investigate the surgical treatment of severe ectopic adrenocorticotrophic hormone(ACTH) syndrome.Methods The clinical data of 12 cases of severe ecotopic ACTH syndrome from January 1996 to December 2016 were retrospectively analyzed.The cases include 7 males and 5 females with a mean age 38 years(range 11 to 64 years).12 cases demonstrated typical Cushing syndrome(CS),accompanied by hypertension, diabetes, hypokalemia and severe osteoporosis.9 cases were complicated with thoracolumbar compression fractures.8 cases presented with pulmonary infection and fever during operation.7 cases had cardiac dysfunction.Laboratory tests showed elevated serum cortisol(695.0 ～ 1 661.5 nmol/L,mean 1 055.7 nmol/L), high urinary free cortisol excretion (807.3 ～ 28 240.0 nmol/24 h, mean 5 270.5 nmol/24h)and high ACTH plasma levels(16.5 ～ 273.9 pmol/L, mean 80.4 pmol/L).Source of ectopic ATCH were not identified and CT showed bilateral enlargement of adrenal in 12 patients.Results We performed emergency bilateral or unilateral adrenalectomy in 12 cases.Among them, one-stage bilateral adrenalectomy were given to 6 cases, staged bilateral adrenalectomy was performed in 3 cases, and unilateral adrenalectomy were given to 3 cases.The patients were treated with hormone replacement therapy after bilateral adrenalectomy.The excised adrenal gland showed diffuse thickening and multiple nodular.Pathological diagnosis were adrenal cortical hyperplasia.They have been followed up for 1 to 8years(median 2.5 years), 9 cases survived, 2 cases died of diabetes and severe pulmonary infection, and 1 case was lost to follow-up.Conclusions Severe ectopic ACTH syndrome is difficult to treat.Emergency adrenalectomy is effective for the management of severe ectopic ACTH syndrome especially for those patients with severe Cushing syndrome but primary tumor can not be located.

Diagnosis and treatment of ureteral fibroepithelial polyp / 国际外科学杂志

Objective To improve the experience of diagnosis and evaluate the clinical efficacy and safety of the surgical management for ureteral fibroepithelial polyp.Methods The clinical date of 29 patients with ureteral polyps admitted in Peking Union Medical College Hospital during 2001 to 2014 were analysed retrospectively.The patients' age was between 1 1 to 84 years and 19 were male.Twenty patients with frank pain and two patients with hematuria were enrolled.Seven patients were found hydronephrosis.Results Twenty-nine cases were treated surgically.Fifteen cases were treated by ureteroscopic laser ablation,10 cases local resection and reanastomosis,1 case of abnormalities duplex kidney and ureter underwent local resection and ureteroplasty,2 case Partial ureterectomy including the polyps and pyeloplasty,1 cases nephroureterectomy because of giant hydronephrosis and nonfunctional kidney.No recurrences were seen during a mean follow-up of 32 months (range 10-56 mos).No ureteral stricture occurs.Conclusions Ureteral fibroepithelial polyps represent a rare pathology.Local resection is the main treatment.Endoscopic management is recommended to minimize morbidity and complications in treatment of ureteral fibroepithelial polyps.Recurrences seem to be rare in these tumors.

Microfluidic chip for tumor cell 3 D culturing establishment and its cultural conditions / 中国药理学通报

Aims To design and fabricate the 3 D cell cultural microfluidic chip for tumor cell culturing, with which to research the compatible conditions for gelatin forming and dissolving with calcium alginate as the scaffolds. To culture SMMC-7721 cells in the chip and to detect the surviving rate. Methods The microfluid-ic chip was fabricated with the software Corel Draw, the technology of soft lithography, molding, and plas-ma bonding. The applicability was tested and cells were cultured on it, on which the cell status was ob-served, their surviving rate was calculated with the help of the software IPP. Results The chip we fabri-cate was calculated is suitable for cell 3D culturing, the tumor cells showed a favorable proliferation ability in 72 h on chip, the surviving rate was ( 96. 1 ± 4. 5)%. The cells were solid and TCS appeared. Con-clusion The microfluidic chip manufactured appeared for tumor cell 3D culture, is suitable for the growth of SMMC-7721 and the cells are indubitable. They show some different status in proliferative and agminated compared with traditional 2D cell culture. With the chip and the condition found, there will be a better way to study the characteristics of tumor cells and is beneficial to the screen of anti-tumor drugs.

Report of 6 cases of Xp11.2 translocation renal cell carcinoma and literature review / 中华泌尿外科杂志

Objective To explore the clinical and pathological characters of Xp1 1.2 translocation renal cell carcinoma.Method We screened patients of renal cell carcinoma of PUMCH between Jan.2011 and Dec.2015,6 patients with Xp11.2 translocation renal cell carcinoma were found.There were 2 males and 4 females,with average age of 39 (ranging from 16 to 73 years old).Diameter of tumor ranged from 1.9cm to 19.0cm,and 9.6cra in average.Among which,3 cases were detected by routine physical examination,1 by severe anemia (Hb 66g/L),1 by gross hematuria,and 1 by flank discomfort.Before treatment,2 cases had local metastasis (local lymph node,renal pelvis invasion),1 had distant metastasis (pulmonary metastasis).CT examination showed that the tumors had soft tissue density / low density,with significant enhancment or uneven enhancement in enhanced scanning,and were all considered malignancy.6 patients were all treated with surgeries,of which 5 patients received radical nephrectomy,1 patient received nephron sparing surgery.Result Pathologically,most clear cells arranged in a papillary,nest like structure,with psaamoma bodies in them.Immunohistochemical examination showed that all patients were positive for TFE3.AE1/AE3,RCC,Vimentin,CD10,EMA,P504 were positive in different degree.According to pathological result,all 6 patients were proved to be Xp1 1.2 translocation renal cell carcinoma.After surgery,2 patients received immunotherapy,2 received targeted drug therapy,and 1 received local radiotherapy.The follow-up duration ranged from 9 to 56 months (average 37 months).Among which,1 patient died from tumor recurrence and multiple metastasis 22 months after surgery,1 had pulmonary metastasis 12 months after surgery,and the tumor had no significant progress after receiving targeted drug therapy.All the other patients survive without tumor recurrence.Conclusions Xp1 1.2 translocation renal cell carcinoma predominantly occurs in children and adults younger than 40 years.Arterial phase enhancement is slightly lower for Xp1 1.2 translocation renal cell carcinoma in CT scan than that of renal clear cell carcinoma.Histological features and immunohistochemical staining of TFE3 positive expression are important means of diagnosis of this disease.If necessary,gene detection could be done to make better diagnose.Surgery is preferred treatment option.Metastatic leads to poor prognosis,and need to be supplemented by targeted drug therapy.

Comparative study of transurethral 1.9 pm thulium laser resection and standard transurethral electroresection for treating superficial bladder cancer / 国际外科学杂志

Objective To compare the efficacy and safety of 1.9 μm thulium laser with transurethral resection of bladder tumor(TURBT) for the treatment of superficial bladder cancer.Methods We reviewed 53 patients with superficial bladder cancer,who were divided into 1.9 μm laser (n =25) and TURBT groups (n =28) from January 2013 to December 2015.The operation time,blood loss volume in operation,catheter indwelling time,hospital stay time,and complications,cumulative recurrence rate were compared between the two groups.Results Compared to TURBT group,1.9 μm laser group showed significantly lower rate of blood loss volume in operation (21.6 ± 4.6) min,catheter indwelling time (22.4 ± 6.4) h,hospital stay time (2.2 ± 0.7) d,less complications (12％)and recurrence(16％) (P ＜ 0.05).Conclusions 1.9 μm thulium laser is safe and effective for the treatment of patients with superficial bladder cancer.The approach has less complications than TURBT.

Effect of Daptomycin on Inflammation Indes and MRSA Matrix Metalloproteinases in Diabetes Foot Patients / 中国药房

OBJECTIVE:To analyze the effect of daptomycin on methicillin resistant Staphylococcus aureus(MRSA)infection patients with diabetic foot (DF). METHODS:179 patients with type 2 DF complicating with MRSA were randomly divided into daptomycin group (90 cases) and vancomycin group (89 cases),and both groups were included infection group. 80 DF patients without MRSA infection were included in non-infection group. All of them received DF routine treatment ;daptomycin group was additionally given intravenous injection of daptomycin 4 mg/kg,once a day,for 2 weeks;vancomycin group was additionally giv-en intravenous injection of vancomycin 4 mg/kg,once a day,for 2 weeks. RESULTS:After treatment,IL-6,IL-8,MMP-2 and MMP-9 of infection group were significantly decreased,while TIMP-1 levels increased significantly,with statistical significance, compared to before treatment (P<0.05). The effective rate of daptomycin group was 94.4%,which was significantly higher than that of vancomycin group(71.9%),with statistical significance(P<0.05). CONCLUSIONS:Daptomycin can effectively improve the inflammatory status in patients with DF complicated with MRSA infection,to restore the MMPs/TIMPs balance.