Radical nephrectomy for a giant chromophobe renal cell carcinoma diagnosed > 17 years previously: a case report and literature review.

Early diagnosis of renal cell carcinoma relies on imaging tests such as ultrasound, computed tomography, or magnetic resonance imaging. Since surgery is associated with a favorable prognosis, the standard treatment for clinically limited renal cell carcinoma remains surgical resection. Among asymptomatic patients with localized renal cell carcinoma, a small number refuse surgical treatment and survive. We report a case involving a 59-year-old female who underwent a difficult radical nephrectomy 17 years after being diagnosed with malignant tumors due to primary renal cell carcinoma.

Post-infectious inflammatory response syndrome in an HIV-negative patient after Cryptococcus gattii meningoencephalitis: a case report and review of the literature.

BACKGROUND: Cryptococcal meningitis (CM) is an inflammatory mycosis of the central nervous system caused by meninge infection or brain parenchyma with Cryptococcus species. It is associated with high morbidity and mortality, and patients with acquired immune deficiency syndrome are particularly susceptible. There have been increasing reports of CM in HIV-negative patients in China over the last few years. CASE PRESENTATION: A 31-year-old healthy Chinese male presented with fever and gradually developed headache, projectile vomiting, and other manifestations that were later confirmed as Cryptococcus gattii meningoencephalitis. However, multiple disease changes occurred during the course of treatment, and the regimen was accordingly modified after the diagnosis of post-infectious inflammatory response syndrome (PIIRS). The patient eventually recovered. CONCLUSION: There has been a growing trend in the incidence of C. gattii meningoencephalitis in HIV-negative patients. It shows rapid onset and severe prognosis. This case report can provide a reference to treat PIIRS following CM in HIV-negative patients.

Perineal nerve block versus periprostatic block for patients undergoing transperineal prostate biopsy (APROPOS): a prospective, multicentre, randomised controlled study.

Background: We aimed to investigate perineal nerve block versus periprostatic block in pain control for men undergoing a transperineal prostate biopsy. Methods: In this prospective, randomised, blinded and parallel-group trial, men in six Chinese hospitals with suspected prostate cancer were randomly assigned (1:1) at the point of local anaesthesia to receive a perineal nerve block or periprostatic block and followed by a transperineal prostate biopsy. Centres used their usual biopsy procedure. Operators who performed anaesthesia were trained in both techniques before the trial and were masked to the randomised allocation until the time of anaesthesia and were not involved in the subsequent biopsy procedure and any assessment or analysis. Other investigators and the patients were masked until trial completion. The primary outcome was the level of the worst pain experienced during the prostate biopsy procedure. Secondary outcomes included pain (post-biopsy at 1, 6 and 24 h), changes in blood pressure, heart rate and breathing rate during the biopsy procedure, external manifestations of pain during biopsy, anaesthesia satisfaction, the detection rate of PCa and clinically significant PCa. This trial is registered on ClinicalTrials.gov, NCT04501055. Findings: Between August 13, 2020, and July 20, 2022, 192 men were randomly assigned to perineal nerve block or periprostatic block, 96 per study group. Perineal nerve block was superior for the relief of pain during the biopsy procedure (mean 2.80 for perineal nerve block and 3.98 for periprostatic block; adjusted difference in means -1.17, P < 0.001). Although the perineal nerve block had a lower mean pain score at 1 h post-biopsy compared with the periprostatic block (0.23 vs 0.43, P = 0.042), they were equivalent at 6 h (0.16 vs 0.25, P = 0.389) and 24 h (0.10 vs 0.26, P = 0.184) respectively. For the change in vital signs during biopsy procedure, perineal nerve block was significantly superior to periprostatic block in terms of maximum value of systolic blood pressure, maximum value of mean arterial pressure and maximum value of heart rate. There are no statistical differences in average value of systolic blood pressure, average value of mean, average value of heart rate, diastolic blood pressure and breathing rate. Perineal nerve block was also superior to periprostatic block in external manifestations of pain (1.88 vs 3.00, P < 0.001) and anaesthesia satisfaction (8.93 vs 11.90, P < 0.001). Equivalence was shown for the detection rate of PCa (31.25% for perineal nerve block and 29.17% for periprostatic block, P = 0.753) or csPCa (23.96% for perineal nerve block and 20.83% for periprostatic block, P = 0.604). 33 (34.8%) of 96 patients in the perineal nerve block group and 40 (41.67%) of 96 patients in the periprostatic block group had at least one complication. Interpretation: Perineal nerve block was superior to periprostatic block in pain control for men undergoing a transperineal prostate biopsy. Funding: Grant 2019YFC0119100 from the National Key Research and Development Program of China.

Efficacy of Kegel exercises combined with electrical stimulation on the restoration of postpartum pelvic floor muscle function.

OBJECTIVE: To investigate the efficacy of Kegel exercises combined with electrical stimulation on the restoration of postpartum pelvic floor muscle (PFM) function. METHODS: Data of 120 parturients with full-term singleton pregnancy who delivered vaginally in the Guang'an People's Hospital were retrospectively analyzed, and the study subjects were grouped into a Kegel exercise group (n=40, receiving Kegel exercise alone), an electrical stimulation group (n=40, receiving electrical stimulation alone) and a combined group (n=40, receiving Kegel exercises combined with electrical stimulation) according to the treatments received. All three groups received intervention for 3 months. The overall response rates (ORRs) at 3 months, changes in PFM strength and vaginal pressure during treatment, the scores of International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF), the incontinence quality of life questionnaire (I-QOL), and the incidence rates of pelvic floor dysfunction (PFD) were evaluated in the three groups. RESULTS: ORR in the combined group (100.00%) was higher than that of the Kegel exercises group (87.50%) and the electrical stimulation group (85.00%) (P < 0.05). At 1, 3, and 6 months after intervention, the combined group was superior to the Kegel exercises and the electrical stimulation groups in systolic blood pressure (SBP) of pelvic floor, and the continuous SBP of type I and II muscle fibers (P < 0.05). After 6 months of follow-up, the scores of ICIQ-UI SF and I-QOL in the combined group were higher than those in the Kegel exercises and electrical stimulation groups (P < 0.05). The score of satisfaction in the combined group was higher than in Kegel exercises and electrical stimulation groups (P < 0.05). CONCLUSION: Kegel exercises combined with electrical stimulation have a good therapeutic effect on postpartum pelvic floor dysfunction, which can markedly improve PFM strength and vaginal pressure.

Association of angiotensin-converting enzyme insertion/deletion (ACE I/D) gene polymorphism with susceptibility to prostate cancer: an updated meta-analysis.

OBJECTIVE: This meta-analysis aims to explore the association between angiotensin-converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism and susceptibility to prostate cancer (PCa). METHODS: We searched studies related to ACE I/D polymorphism and susceptibility to PCa through PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases from inception to June 1, 2022. Five gene models, including allelic, dominant, recessive, homozygote, and heterozygote models, were analyzed. The pooled odds ratio (OR) was calculated using Stata 15.0 software. Publication bias was judged by the funnel plot and Egger's test, with the robustness of the findings verified by sensitivity analysis. RESULTS: Eight published articles (including ten studies) were identified. The pooled results showed that ACE I/D locus polymorphism was significantly correlated with the risk of PCa under all gene models except for the heterozygous model (D vs. I: OR= 1.58, 95% CI: 1.14-2.21; DD vs. DI+II: OR=1.68, 95% CI: 1.11-2.54; DD+DI vs. II: OR=1.76, 95% CI: 1.11-2.80; DI vs. II: OR= 1.44, 95% CI: 0.99-2.10; DD vs. II: OR= 2.12, 95% CI: 1.15-3.93). Subgroup analysis based on genotype frequencies in the control group meeting Hardy-Weinberg equilibrium showed statistically significant differences in all gene models. The funnel plot and Egger's test indicated no publication bias. The sensitivity analysis verified the robustness of the conclusions obtained in this meta-analysis. CONCLUSION: ACE I/D locus polymorphism correlates to PCa risk. Allele D, genotype DD+DI, and DD at the ACE I/D locus increase susceptibility to PCa and can therefore serve as a potential diagnostic and screening molecular marker for PCa patients.

Retroperitoneal laparoscopic renorrhaphy for post-percutaneous nephrolithotomy hemorrhage: a case report.

Percutaneous nephrolithotomy is the preferred treatment for large renal calculi; however, postoperative hemorrhage is a dangerous complication. The three main causes of hemorrhage after percutaneous nephrolithotomy are pseudoaneurysms, arteriovenous fistulas, and arterial lacerations. The preferred treatment for acute hemorrhage is superselective angioembolization. However, in a few cases, angiography reveals no abnormal findings pertaining to hemorrhage. We herein present a clinical case of a 48-year-old man who presented with multiple complex right renal calculi and was managed with percutaneous nephrolithotomy in the prone position. Massive hemorrhage occurred 6 days postoperatively, and renal angiography was immediately performed. However, while the bleeding was still occurring, no extravasation was observed on renal angiography. We performed retroperitoneal laparoscopic renorrhaphy, which successfully stopped the bleeding and consequently preserved the kidney. We suggest that retroperitoneal laparoscopic renorrhaphy can be effective in patients who have undergone failed renal arterial embolization or are reluctant to undergo renal arterial embolization.

The rs13347 Polymorphism of the CD44 Gene Is Associated with the Risk of Kidney Stones Disease in the Chinese Han Population of Northeast Sichuan, China.

OBJECTIVE: To investigate the association between the rs13347 polymorphism of the CD44 gene and the risk of kidney stone disease (KSD) in the Han population of northeast Sichuan, China, so as to provide a theoretical basis for the treatment of KSD. METHODS: We used PCR-restriction fragment length polymorphism (RFLP) technique to perform genotyping at rs13347 locus of the CD44 gene in the KSD group and the gontrol group. SNP Hardy-Weinberg equilibrium (HWE) testing was used to confirm the balance of genetic inheritance. Multivariate logistic regression analysis was used for the assessment of rs13347 polymorphism and the risk of developing KSD and to compare the relationship between the polymorphism of rs13347 and clinical characteristics of patients with KSD. RESULTS: Genotypic results of rs13347 locus of the CD44 gene in the two groups were consistent with the SNP-HWE test, indicating the genetic balance. At the same time, multivariate logistic regression analysis indicated that subjects with CT and TT genotypes at rs13347 in the CD44 gene were more likely to have KSD, and there was a higher prevalence rate in males. Furthermore, carrying allele T at rs13347 was also a risk factor for KSD. In addition, people carrying CT and TT genotypes at rs13347 also have a significantly increased risk of relapsing KSD. CONCLUSION: The rs13347 polymorphism of the CD44 gene may be associated with the risk of KSD in the Han population of northeast Sichuan in China, and the recurrence rate of KSD in the carriers of CT and TT genotypes is higher.

A study of the development path of key disciplines in the Guang'an hospital based on construction of west China's compact medical consortium hospitals.

OBJECTIVE: To investigate the development path of key disciplines in Guang'an Hospital based on the construction of West China's compact medical consortium hospitals. METHODS: The urological medical staff and facilities in Guang'an Hospital were selected as the study subjects. The urological medical staff were interviewed, and a detailed investigation and analysis of the current development of urology and the allocation of experts and medical equipment and resources were performed, so as to promote the development of key disciplines in Guang'an Hospital. RESULTS: We aim to focus on the operational targets of the compact medical consortium while remaining committed to the construction of disciplines of urology. Meanwhile, the relationship between patients and health care providers was coordinated in regard to health care services. The mean of compactness of the dimensions involved in the targets of the operational body of patients was 4.71, while that of the improvement of the medical and health environment was 4.88. The allocated proportion of healthcare resources was optimized, and the operational efficiency was improved. If an excellent medical service experience was provided, the obtained data are statistically significant. CONCLUSION: Based on the medical consortium, the assessment model of scientific experimental methods, and with the goal of improving the quality of medical treatment regarding urology, the responsibilities of urologists are further defined. A standardized training plan was conducted, with assessment systems of disciplines and better access systems of urologists are formulated and improved, and therefore the construction of key disciplines is promoted, thereby providing more references for the construction and development of key disciplines of urology.

Efficiency of C-reactive protein in prognosis evaluation of prostate cancer: a systematic review and meta-analysis.

BACKGROUND: Tumor markers can be diagnostically suggestive and are sometimes even related to prognostic prediction certain diseases. Multiple studies have shown the effectiveness in the prediction of prostate cancer (PCa) by the use of C-reactive protein (CRP). This meta-analysis was conducted to facilitate a conclusion regarding the values of CRP in the prediction of survival rate in patients with PCa. METHODS: Manuscripts were searched, identified, and collected from different databases; quality evaluation was performed according to the different search strategies involved. Information including the comparison between overall survival (OS) and cancer-specific survival (CSS) rate were retained from different studies in patients with evaluated or lowered CRP levels. Progression-free survival (PFS) was also recorded in relation to the log of CRP. Level of relevance was assessed using hazard ratio (HR) and 95% confidence interval (CI). Heterogenicity testing was performed by using Cochran's Q test and Higgins I2 statistics. When P value <0.05, the outcome was considered statistically significant. RESULTS: A total 12 of manuscripts were included and evaluated from the 1,523 initially identified studies. The results of OS and PFS were 1.57 (95% CI: 1.34 to 1.85) and 1.50 (95% CI: 1.25 to 1.81), respectively. For CSS, the combined HR and 95% CI was 1.92 (95% CI: 1.36 to 2.70), which revealed a significant correlation between increased level of CRP and CSS in PCa patients. CONCLUSIONS: This meta-analysis revealed that CRP value could be one of the critical indicators to predict the survival rate of PCa patients.

ß-Adrenoceptors regulate matrix metalloproteinase expression in human urothelial cells under hydrostatic pressure.

The bladder wall is constantly subjected to intravesical pressure during the filling and voiding cycles. An imbalance between matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) under elevated intravesical pressure contributes to pathological changes in the bladder. To investigate the changes in human urothelial cells (HUCs) under elevated intravesical pressure, this study analyzed the effect of ß-adrenoceptor signaling on the expression of MMPs and TIMPs in HUCs exposed to pathological hydrostatic pressure (HP) (70 cm H2 O) for 6 hours. Quantitative polymerase chain reaction, Western blot analysis, and cell fluorescence staining were used to explore the effect of ß-adrenoceptor signaling on the expression of MMPs and TIMPs in HUCs after agonist and/or antagonist treatment. The expression levels of ß2 - and ß3 -adrenoceptor, MMP1, and MMP2 were greatly downregulated, while the expression of TIMP1 was greatly upregulated. Formoterol and BRL 37344, which are agonists of ß2 - and ß3 -adrenoceptor, respectively, significantly increased MMP1 and MMP2 expression under 70 cm H2 O. As a classic downstream pathway of ß2 - and ß3 -adrenoceptor, protein kinase A (PKA) signaling inhibited MMP1 and MMP2 expression by regulating cAMP response element binding protein (CREB) activity. MMP1 and MMP2 expression in HUCs under 70 cm H2 O was modified by ß2 - and ß3 -adrenoceptor via the PKA/CREB pathway. This outcome suggests that MMPs likely participate in the pathological effects of elevated intravesical pressure. The underlying mechanism of ß2 - and ß3 -adrenoceptor in elevated intravesical pressure was also revealed; this mechanism constitutes a new potential therapeutic target for partial bladder outlet obstruction.

Direct Puncture Tunnel Method for Establishing the Retroperitoneal Cavity: Anatomic Confirmation and Clinical Experience.

Purpose: The feasibility and safety of the direct puncture tunnel method to establish the retroperitoneal cavity was assessed by CT and clinical experience. Materials and Methods: Ten patients who underwent retroperitoneoscopic procedure were scanned by CT in the lateral decubitus position. The distance between the lumbar fascia and psoas major muscle (L-P distance) on the puncture line was measured. The angle between the puncture line and the posterior colon margin (P-C angle) was also measured. In total, 292 patients who underwent retroperitoneoscopic procedure were used to establish the retroperitoneal cavity using the direct puncture tunnel method, and complications in these patients were evaluated. Results: The average L-P distance was 25.0 mm (left side) and 25.5 mm (right side) in the lateral decubitus position. The average P-C angle was 26.8° (left side) and 29.7° (right side). The retroperitoneal cavity was well established in all 292 patients, and no visceral or blood vessel injury occurred. Conclusions: CT scans in the lateral recumbent position indicate that there are no visceral and large blood vessels on the puncture path. The scans also provide a window for inserting the first trocar blindly into the retroperitoneum. A high success rate and low complication rate were observed clinically for the direct puncture tunnel method. We consider the direct puncture tunnel method to be a simple, effective, and safe way to establish the retroperitoneal cavity.

[The Determination of Tungsten Extracted from Prefi llable Syringes by ICP-MS].

First, simply expounded the purpose and meaning of detecting tungsten extracted from prefi lable syringes: And then, designed simulation experiment for extracting tungsten from prefi lable glass syringes. and established determination methods of tungsten content by ICP-MSL Finaly, evaluated the limit of content of tungsten ?extracting from simulation experiment.

Integrin-linked kinase functions as a tumor promoter in bladder transitional cell carcinoma.

The aim of this study was to elucidate the role of the integrin-linked kinase (ILK) gene in development of human bladder transitional cell carcinoma (BTCC). Expression of ILK protein and ILK mRNA in 56 cases of human BTCC tissue and in 30 cases of adjacent normal bladder tissue was detected by immunohistochemistry S-P and reverse transcription polymerase chain reaction (RT-PCR), respectively. Four specific miRNA RNAi vectors targeting human ILK were synthesized and transfected into BIU-87 cells by liposome to obtain stable expression cell strains. The influence of ILK on proliferation of BTCC was detected by MTT, FCM on athymic mouse tumorigenesis. The positive rate of ILK protein in BTCC tissue (53.6%) was much higher than adjacent normal bladder tissue (10.0%) (p<0.05). Similarly, expression of ILK mRNA in BTCC tissue (0.540 ± 0.083) was significantly higher than in adjacent normal bladder tissue (0.492 ± 0.070) (p<0.05). MTT showed that the proliferation ability of miRNA-ILK transfected group was clearly decreased (p<0.05), the cell cycle being arrested in G0/G1-S, an tumorigenesis in vivo was also significantly reduced (p<0.05). ILK gene transcription and protein expression may be involved in the development of BTCC, so that ILK might be the new marker for early diagnosis and the new target for gene treatment.