DDT and titanium dioxide nanoparticle coexposure induced neurobehavioral deficits in zebrafish.

Both dichlorodiphenyltrichloroethane (DDT) and titanium dioxide nanoparticle (TiO2 NP) have worldwide-scale commercial applications, resulting in their co-pollution in the ecosystems and posing combined health risks. However, there is a lack of toxicity studies for the interactions of DDT and TiO2 NP in the environmental relevant concentrations. In this study, we characterized the coexposures using a zebrafish waterborne exposure approach and evaluated the neurotoxicity response of the treated embryos or adults. Our results showed that DDT/TiO2 NP coexposure enhanced the DDT accumulation in vivo and increased the larval locomotor. The chronic DDT/TiO2 NP coexposure did not affect the overall survival rate, sex ratio and growth. However, DDT/TiO2 NP coexposure severely affected the adult locomotor activity, social contact, shoaling and aggressive behaviors compared to single treatment groups or controls. These adult behavioral deficits were accompanied by changes in neurotransmitter acetylcholine (ACH) level in the brain and muscle tissues, as well as neural development genes expression activation of growth-associated protein 43 (gap43) and synaptic vesicle glycoprotein 2 (sv2) in the brain. The significantly increased ACH level and the activated neural genes expression in the DDT/TiO2 NP co-exposed fish may account for the observed hyperactivity and social deficits.

Feasibility and safety of laparoscopic radical cystectomy for male octogenarians with muscle-invasive bladder cancer.

This study was designed to evaluate the safety and feasibility of laparoscopic radical cystectomy (LRC) for male octogenarian patients with muscle-invasive bladder cancer (MIBC). Briefly, a total of 57 male octogenarian patients (A group) with bladder carcinoma were enrolled and underwent LRC and intracorporeal pelvic lymph node dissection with bilateral cutaneous ureterostomy from May 2016 to December 2022. Besides, 63 male patients (age < 80 years old) with bladder carcinoma undergoing LRC and 17 octogenarian male patients with bladder carcinoma undergoing open radical cystectomy (ORC) were enrolled in B and C groups as control. All perioperative clinical materials and outcomes of long-term follow-up, and complication were collected. The specific results were shown as follows. Compared with C group, the operation time and resected lymph node in A group was increased, and the estimated blood loss, the number of transfusion needed, duration of pelvic drainage and hospital stay after surgery was decreased. The death rate and ileus complication rate were higher in A group (12 cases) than in C group (15 cases). The cases of ureteral stricture in A group (13 cases) was decreased compared with that in C group. Overall, LRC and bilateral cutaneous ureterostomy are safe, feasible and better choices for the treatment of male octogenarian patients with MIBC. The octogenarian receiving cutaneous ureterostomy heals slowly and exists certain incomplete intestinal obstruction after surgery.

A retrospective analysis on the effect of single-channel minimally invasive percutaneous nephrolithotomy combined with retrograde flexible ureteroscopy using the completely lateral decubitus and semi-lithotomy positions to treat complex kidney stones.

BACKGROUND: Some types of complex kidney stones cannot be broken down and removed through single-channel percutaneous nephroscope or retrograde flexible ureteroscope. In order to be removed, these types of stones require multiple combined methods to be performed. The aim of this study was to retrospectively evaluate the clinical effect of single-channel minimally invasive percutaneous nephrolithotomy (mPCNL) combined with retrograde flexible ureteroscopy using the completely lateral decubitus and semi-lithotomy positions for treating complex renal calculi. METHODS: We selected 117 patients with complex renal calculi who were admitted to Peking University Shougang Hospital and Weifang People's Hospital from January 1, 2017, to January 31, 2021. All patients were treated with single-channel mPCNL combined with retrograde flexible ureteroscopy in the completely lateral decubitus and semi-lithotomy positions. During the operation, the patients were placed in a completely lateral decubitus position, or their lower limbs were placed in a semi-lithotomy position for a single attempt only. RESULTS: An 18-Fr percutaneous channel was successfully established in all patients. The mean operation time was 112±37 minutes, and the average blood loss was 71±31 mL. A 14-Fr renal fistula was maintained for 7 days, a urethral catheter for 2-3 days, and a ureteral stent tube for 2 weeks after each surgery. According to the results of computed tomography (CT) scans performed 3-5 days after the operation, the total lithotripsy success rate reached 100%, with a first-stage lithotripsy rate of 98.29%. Two patients were found to each have 1 residual stone, with a diameter of 4 mm, left in kidney by CT, which then was to be removed under local anesthesia. The average postoperative hospitalized time was 7±2 days, and no severe complications occurred perioperatively. CONCLUSIONS: Single-channel mPCNL combined with retrograde flexible ureteroscopy in the completely lateral decubitus and semi-lithotomy positions is a safe, feasible, and highly effective method of treating complex renal calculi, which is of benefit to save operation time and facilitate operation process, because patient's position could not need to be changed repeatedly during the surgery.

Safety and Efficacy of Flexible Ureteroscopy in Combination with Holmium Laser Lithotripsy for the Treatment of Bilateral Upper Urinary Tract Calculi.

OBJECTIVE: To retrospectively evaluate the safety and efficacy of flexible ureteroscopy (FURS) in combination with holmium laser lithotripsy for the treatment of bilateral upper urinary calculi. MATERIALS AND METHODS: The stone-free status was defined as the absence of any stones or asymptomatic status, or the presence of clinically insignificant residual fragments <4 mm, and was assessed by plain kidney, ureter, and bladder X-ray. The operative time, stone-free rates (SFRs), serum creatinine (SCr), and complications were recorded. RESULTS: During the operation, there was no bleeding, ureteral perforation, avulsion, and rupture. Postoperative hematuria was observed in 2 patients. SCr increased significantly on the first day after the procedure compared with the preoperative SCr, but after 4 weeks, the renal function significantly improved (p < 0.05). The SFR was 71.6% (63/88) on the first day after the first surgical procedure; it then increased to 86.4% (76/88) in the fourth week, and rose to 97.4% (76/78) after the second operation. CONCLUSION: The results demonstrated that FURS in combination with holmium laser lithotripsy represented a favorable less-invasive alternative with high SFR and acceptable complication rates in the treatment of bilateral upper urinary tract calculi.

MicroRNA-21 in peripheral blood mononuclear cells as a novel biomarker in the diagnosis and prognosis of prostate cancer.

OBJECTIVE: To evaluate the effects of microRNA-21 (miR-21) in peripheral blood mononuclear cells (PBMC) in the diagnosis and prognosis of prostate cancer (PCa). METHODS: Proved by pathologic biopsy, 92 patients diagnosed with PCa and also underwent resection operation and 85 patients with benign prostatic hyperplasia (BPH) were selected in this study, as well as 97 healthy volunteers were chosen as the control group. PBMC were extracted to examine the relative expression of miR-21 by real time reverse transcriptase-polymerase chain reaction (RT-PCR). The relative operating characteristic (ROC) curves were drew to analyze the diagnosis value of PCa. The survival function curves were made by Kaplan-Meier method to show the miR-21 expression levels of PCa patients. The Log-rank test was adopted to compare the differences among the different groups. The Cox proportional hazard risk regression analysis was used to screen the independent factors affected the PCa patients. RESULTS: The expression levels of miR-21 in PCa group were increased compared to BPH and control group (P < 0.05). The expression of miR-21 was significantly correlated with the Gleason score, clinical stages, bone metastasis and tumor recurrence (all P < 0.05). ROC curves demonstrated that the area under the curve of PCa and BPH distinguished by the miR-21 were 0.974 and 95% confidence intervals (95% CI) were 0.956∼ 0.993. The sensitivity and specificity were 93.5% and 92.9%. ROC curves demonstrated that the area under the curve of PCa and control group distinguished by the miR-21 were 0.984 and 95% CI were 0.972∼ 0.997. The sensitivity and specificity were 94.6% and 92.8%. The results of Kaplan-Meier Method demonstrated that the miR-21 expression levels were related to the prognosis of PCa (all P < 0.05). The results of the COX analysis suggested that the miR-21 expression level, tumor recurrence and bone metastasis could be the independent factors affected the prognosis of PCa patients (all P < 0.05). CONCLUSION: miR-21 is highly expressed in the PCa patients, which could be the molecule biomarker of diagnosis and prognosis of PCa.

A Large Bladder Tumor Covered With a Thick "Shell" of Necrotic Material: Misdiagnosis of a Patient With Spina Bifida.

Bladder tumor arising in a spina bifida patient is rare and may be clinically latent. We report the case of a 61-year-old female patient with spina bifida, neurogenic bladder, and a history of recurrent urinary tract infections. A B-ultrasound and non-contrast computed tomography scan did not reveal any bladder mass, but an unexplained "well-filled" bladder was observed, which was confusing as the catheter was present and open. However, a subsequent cystoscopic evaluation revealed a large bladder mass measuring 9.5 × 9.0 × 6.5 cm³, which almost filled the entire bladder. The mass had coarse and flocculent surface and seemed to be free from each observed wall of the urinary bladder. It was diagnosed as an infectious necrotic mass based on its appearance. During transurethral resection of the mass, a bladder tumor was suspected as small blood vessels and bleeding appeared within the inner layer of the mass. Pathological examination revealed necrotic material, inflammatory cells, and urothelial carcinoma cells. Then, a radical cystectomy was performed, and the pathological results indicated stage pT3bN0M0 transitional cell carcinoma. In the gross specimen, the base of the tumor measured 3 × 3 cm² on the top of the back wall of the bladder. Bladder tumors may have atypical presentations in patients with spina bifida. Regular screening is helpful for earlier detection and improving outcomes of bladder tumors in such patients.

Correlation between molecular biomarkers and risk factors for the clinical progression of benign prostatic hyperplasia using tissue microarray immunostaining.

BACKGROUND: The pathogenesis of benign prostatic hyperplasia (BPH) has been widely studied, and several biomarkers are known to play roles in its development. This study aimed to investigate the possible role of cysteine-rich protein 61 (CYR61), vascular endothelial growth factor (VEGF), androgen receptor (AR), interleukin-6 (IL-6), cytochrome c, caspase-3, and proliferating cell nuclear antigen (PCNA) in the clinical progression of BPH. METHODS: Tissue specimens from 96 BPH cases who underwent transurethral resection of the prostate were processed and transferred to tissue microarrays. Patient age, prostate volume, serum prostate-specific antigen (PSA) level, and International Prostate Symptom Score (IPSS) of all BPH cases were collected before surgery. The expression of CYR61, VEGF, AR, IL-6, cytochrome c, caspase-3, and PCNA was examined by immunostaining in the BPH specimens, and any possible correlation between the different biomarkers and risk factors for BPH clinical progression was analyzed. RESULTS: The expression of CYR61, VEGF, AR, IL-6, cytochrome c, caspase-3, and PCNA in the BPH cases was 68.8% (66/96), 77.1% (74/96), 43.8% (42/96), 31.3% (30/96), 35.4% (34/96), 56.3% (54/96), and 29.2% (28/96), respectively. The expression of both CYR61 and VEGF was positively correlated with patient age, prostate volume, and serum PSA level (P < 0.05). Furthermore, cytochrome c and caspase-3 expression were inversely related to prostate volume (P < 0.05), and AR expression was positively related to serum PSA level (P < 0.05). CONCLUSION: CYR61 and VEGF expression might serve as biomarkers for predicting the clinical progression of BPH due to effects on stromal cell proliferation and angiogenesis.

[An efficient method for isolation of mitochondrial DNA in wheat].

An efficient method for isolation of mitochondrial DNA (mtDNA) from etiolated tissues of wheat was developed. The protocol consists of mitochondria isolation with differential centrifugation, Dnase I treatment, lysis with SDS and proteinase K, removing protein by TE-saturated phenol/chloroform extraction and a final RNase A treatment for obtaining mtDNA. The mtDNA samples were tested using spectrophotometry and agarose gel electrophoresis. It was proved that the mtDNA isolated by this method not only have the high yield but also structural complete, and contains no impurities, such as nuclear DNA, RNA and protein. The result showed that this high quality mtDNA can be successfully used in PCR and other genetic studies. In addition, it was found that adjusting the lysis temperature has a noticeable effect on the mtDNA yield.

[Causes of delaying diagnosis of primary hyperaldosteronism with adrenal adenoma and strategy therefore].

OBJECTIVE: To analyze the causes of delaying diagnosis of primary hyperaldosteronism with adrenal adenoma and discuss corrective strategies. METHODS: The clinical data of 267 patients of primary hyperaldosteronism with adrenal adenoma confirmed by operation 1995 - 2005 were analyzed. RESULTS: Confirmed diagnosis was made after a duration of (92 +/- 64) months (3 - 40 years) after the first visit. 78.3% of the hospitals where the patients with hypertension made their first visits were grade II hospitals, and 21.3% of them were grade III hospitals. 95.9% of the patients were diagnosed as with primary hypertension at the first visit without receiving relevant imaging examination of adrenal and endocrine examination. 87.3% of the patients with extremity weakness numbness of finger tips were diagnosed as with hypokalemia and more than 10% of them failed to receive examination of blood potassium. Adrenal adenoma was discovered by computed tomography with thin coat screening in 267 patients and by ultrasonography in 151 patients. CONCLUSION: Primary hyperaldosteronism should be considered and screened in all young patients with hypertension. Plasma aldosterone/rennin ratio is an effective mark in screening. The first choice diagnostic means for primary hyperaldosteronism should be computed tomography with screening by coat 2 - 4 mm thin.

Clinical diagnosis and treatment of nonfunctioning pheochromocytomas in 14 patients.

OBJECTIVE: To analyze the clinical characteristics of nonfunctioning pheochromocytoma, and to evaluate the efficacy of 131I-metaiodobenzylguanidine (MIBG) scan in the diagnosis and perioperative treatment of nonfunctioning pheochromocytoma. METHODS: The clinical data of 14 patients with nonfunctioning pheochromocytoma were analyzed retrospectively. Plasma free corticoid, renin, aldosterone, and urine catecholamines levels were estimated. B-mode ultrasonography, computed tomography scan, thoracic X-ray and 131I-MIBG were used. RESULTS: All patients with nonfunctioning pheochromocytoma had no hypertension and the tumors were found incidentally. The 24 hours urine catecholamines levels in 80% (8/10) patients were normal. The positive rate of 131-MIBG was 80% (8/10) and the specificity was 100%. All patients underwent surgical operation of tumor resection. No preoperative volume expansion was given to all patients. All tumors were resected completely, and no death accident happened. There was no recurrence and metastasis after operation by long-term follow-up. CONCLUSION: 131I-MIBG scan is the first choice technique for the diagnosis of nonfunctioning pheochromocytoma. Blood volume expansion is unnecessary before resection of pheochromocytoma.

[Effects of doxazosin mosylate and phenoxybenzamine in preoperative volume expansion of pheochromocytoma: a comparative study in 38 cases].

OBJECTIVE: To compare the effects of doxazosin mosylate and phenoxybenzamine in preoperative volume expansion of pheochromocytoma. METHODS: Phenoxybenzamine 30-240 mg/d was given orally to 38 patients of pheochromcytoma for 3 weeks. After the blood pressure was restored to the primary level before taking phenoxybenzamine, doxazosin mosylate 2-8 mg/d was given orally for three weeks. If the maximum dose of doxazosin mosylate (16 mg/d) still failed to achieve efficient blood volume expansion then phenoxybenzamine was added till completely efficient blood volume expansion was achieved. The effect in volume expansion and side effects were observed with the criteria including decrease of blood pressure to less than 120/80 mm Hg and restoration of the microcirculation imaging to normal. RESULTS: All the patients got complete volume expansion after taking phenoxybenzamine with tachycardia occurring in 23 of them and postural hypotension in 13 patients. In the 25 cases mainly with increase of norepinephrine before medical treatment doxazosin mosylate was completely effective in 18 cases with their blood pressure < 180/140 mm Hg; and was partially effective in the other 7 cases with their blood pressure > 180/140 mm Hg of which 2 suffered from postural hypotension. Doxazosin mosylate was partially effective in the other 13 cases mainly with increase of both norepinephrine and epinephrine. The total efficiency rate of these two medicines was not significantly different (chi(2) = 18.05, P > 0.05). The side-effect rate of doxazosin mosylate was significantly lower than that of phenoxybenzamine (chi(2) = 324, P < 0.01). CONCLUSIONS: Doxazosin mosylate has a lower complete volume expansion rate and side-effect rate as well for patients of pheochromocytoma. Pheochromocytomas with mild or moderate level of blood pressure are indicative of the use of doxazosin mosylate.

[The discussion of standards for clinical functional gradation and preoperative preparation of pheochromocytoma].

OBJECTIVE: To discuss the standards for clinical functional gradation and preoperative preparation of pheochromocytoma. METHODS: According to the preoperative clinical manifestations and 24 hr urine catecholamine, 172 cases of pheochromocytomas were divided into 4 grades. Functionary grade 0 including 22 patients was given no volume expansion. Functionary Grade 1 consisted of 17 cases, 10 of which were given phenoxybenzamine orally 5 - 10 mg/d for 1 week (therapeutic group), the rest were control group; the results were analyzed by the chi(2) test. Functionary Grade 2 including 120 patients had phenoxybenzamine orally 30 - 240 mg/d for 4 weeks, hemodynamics and microcirculation image were standards for evaluating volume expansion. Functionary Grade 3 consisted of 13 patients including 1 with acute heart failure, 2 and 10 patients with past history of cerebral hemorrhage and hypertensive crisis respectively, they were treated with enough phenoxybenzamine and other emergent measures. RESULTS: The perioperative blood pressure of Functionary Grade 0 had no fluctuation. The blood pressure of therapeutic group of Functionary Grade 1 had small range fluctuation (< 20 mm Hg), that of the control group was large (> 40 mm Hg). Chi(2) = 13.12, P < 0.01. The hemodynamics of Functionary Grade 2 and Grade 3 recovered within 24 hours postoperatively and no complications occurred. CONCLUSION: According to the function of pheochromocytoma, it is safe and efficient to use different preoperative preparations. Hemodynamics and microcirculation image are golden standards for evaluating preoperative preparations.