Bioinspired Hydroxyapatite Coating Infiltrated with a Graphene Oxide Hybrid Supramolecular Hydrogel Orchestrates Antibacterial and Self-Lubricating Performance.

Hydroxyapatite (HA) bioceramic coating has been extensively applied for the modification of metallic implants to improve their biocompatibility and service life after implantation. Unfortunately, HA coating often suffers from high friction, severe wear, and bacterial invasion, which restrict its application in artificial joints. According to a bioinspired soft/hard combination strategy, a novel HA composite coating that is infiltrated with a vancomycin-loaded graphene oxide (GO) hybrid supramolecular hydrogel is developed via vacuum infiltration and a subsequent host-guest interaction-induced self-assembly process. The holes of textured HA ceramic coating act just like a "magic pocket", offering a stable container to form and store GO hybrid hydrogels and even to recycle wear debris as well. The drug-loaded hybrid hydrogels stored in textured HA coating possess a unique shear force and/or frictional heat triggered gel-sol transition and sustained drug release behavior, acting like the extrusion of synovial fluid during articular cartilage movement, leading to a remarkable self-lubrication, anti-wear performance, and promising antibacterial property against Staphylococcus aureus. The friction coefficient and wear rate of composite coating reduced by nearly five times and three orders of magnitude compared with textured HA coating, respectively, which benefited from the synergistic lubricate effect of cyclodextrin-based pseudopolyrotaxane supramolecular hydrogel and GO lubricants.

Supramolecular hydrogel-infiltrated ceramics composite coating with combined antibacterial and self-lubricating performance.

Inspired by the structure and dynamic weeping lubricating mechanism of articular cartilage, a novel composite coating composed of a textured Y2O3-stabilized ZrO2 (YSZ) ceramics reservoir and silver nanoparticles (AgNPs) hybrid supramolecular hydrogel was developed on the basis of a soft/hard combination strategy. The precursor solution including the poly(ethylene glycol) (PEG)-modified AgNPs and α-cyclodextrins (α-CDs) could be infiltrated deep into (50-60 µm) the pores of a textured YSZ ceramics substrate by a vacuum infiltration method, in situ forming a supramolecular hydrogel within the pores through host-guest inclusion between α-CDs and PEG chains distributed onto the surface of AgNPs. The AgNPs hybrid hydrogel showed thixotropic and thermoresponsive gel-sol transition behavior, low cytotoxicity, and excellent drug-loading capacity, as well as significant antibacterial properties. The textured YSZ ceramics not only provided a hard supporting skeleton and stable reservoir to protect the supramolecular hydrogel from destruction under load-bearing or shear condition, but also allowed retaining the stimuli-responsive gel-sol transition property and drug-release capability of the infiltrated hydrogel, endowing the composite coating with excellent antibacterial properties, and self-lubrication and wear-resistance performance. The composite coating in this work brings a new insight into the design of antibacterial and self-lubricating ceramic coatings for artificial joint applications.

Electroacupuncture Inhibits Atherosclerosis through Regulating Intestinal Flora and Host Metabolites in Rabbit.

METHODS: In this study, general rabbit conditions, vascular histology, metabolites, and intestinal flora structures were analyzed. Integrated analysis of metabolomics and 16S rRNA sequencing were performed. All the rabbits were randomly divided into four groups. The rabbit model of atherosclerosis was established. The histopathological change in the common carotid artery was assessed by HE staining and the structural change in the flora by 16S rRNA sequencing. HPLC-TOF-MS and Agilent MPP 12.1 were integrated to identify and screen out differential metabolites. Correlational analyses of every differential metabolite with intestinal flora were integrated on Omicshare platform. RESULTS: Atherosclerotic rabbits showed obvious changes in general conditions, significant fibrous cap and necrotic center on carotid artery, abnormal intestinal bacteria structure, and metabolites levels. Electroacupuncture improved the conditions, reduced lipid deposition on the carotid artery wall, diversified intestinal flora, and normalized host metabolism. Integrated analysis showed that 149 altered metabolites were related to 22 intestinal flora, among which eight intestinal floras and 21 metabolites have relationships with atherosclerosis. CONCLUSION: Electroacupuncture can effectively reverse atherosclerosis through manipulating the structural feature of intestinal flora to influence the host metabolites. The possible mechanisms involved activating signal pathways through host metabolites or affecting the activity of cardiovascular-related enzymes, or regulating host lipid metabolism directly.

ODAM is a predictor for biomedical recurrence and inhibits the migration and invasion of prostate cancer.

Odontogenic ameloblast associated protein (ODAM) is a protein contributed to cell adhesion and has been shown to express in normal prostate tissue, but the expression and significance of ODAM in prostate cancer remain unknown. In this study, we detected the protein expressions of ODAM in 88 prostate cancer tissues with immunohistochemical staining, and found that 53 cases (60.2%) was high expression of ODAM, which was shown in the cytoplasm and paranuclear regions. Furthermore, low expression of ODAM was significantly correlated with lymph node metastasis, preoperative PSA and Gleason score, but not with mean age, follow-up duration, PSM rate and distribution of pathological T stage. Additionally, our results of multivariate analysis showed that low ODAM expression was an independent predictor of biomedical recurrence, while the positive lymph node metastasis, Gleason score, and preoperative PSA were not the independent risks for biomedical recurrence. Overexpression of ODAM did not inhibit the growth of prostate cancer cells PC3, but significant suppressed their invasion and migration with decrease of the protein levels of MMP-2. These results suggest that ODAM is a predictor for biomedical recurrence and inhibits the migration and invasion of prostate cancer.

ERG rearrangement as a novel marker for predicting the extra-prostatic extension of clinically localised prostate cancer.

Currently, there are no well-established preoperative clinicopathological parameters for predicting extra-prostatic extension (EPE) in patients with clinically localised prostate cancer (PCa). The transmembrane protease serine 2 (TMPRSS2)-ETS-related gene (ERG) fusion gene is a specific biomarker of PCa and is considered a prognostic predictor. The aim of the present study was to assess the value of this marker for predicting EPE in patients with clinically localised PCa. In total, 306 PCa patients with clinically localised disease, including 220 patients (71.9%) with organ-confined disease and 86 EPE cases (28.1%), were included in the study. Receiver operating characteristic curves and logistic regression were employed to establish the optimal cut-off value and to investigate whether ERG rearrangement was an independent predictor for the EPE of clinically localised PCa. A leave-one-out cross-validation (LOOCV) model was implemented to validate the predictive power of ERG rearrangement. An increase in ERG rearrangements was identified to be associate'd with EPE, and the optimal cut-off for predicting EPE was determined to be 2.25%, with a sensitivity of 70.24% [95% confidence interval (CI), 62.6-78.9%], a specificity of 80.43% (95% CI, 75.4-85.1%), and an area under the curve (AUC) of 0.781 (95% CI, 0.730-0.826). In the LOOCV model, ERG rearrangement also demonstrated good performance for predicting EPE (sensitivity, 76.923%; specificity, 71.429%; 95% CI for AUC, 0.724-0.958). In addition, a high Gleason score (≥7) and a cT2c classification upon biopsy were independent factors for EPE.

Laparoscopic Radical Prostatectomy Plus Extended Lymph Node Dissection in Combination With Immediate Androgen Deprivation Therapy for Cases of pT3-4N0-1M0 Prostate Cancer: A Multimodal Study of 8 Years' Follow-up.

PURPOSE: To investigate the functional and oncologic outcomes of patients with locally advanced or lymph node (LN) metastatic prostate cancer (PCa) treated by laparoscopic radical prostatectomy (LRP) with extended lymph node dissection (ePLND). METHODS: From June 2004 to March 2014, a total of 232 cases (pT3-4N0-1M0) including 160 locally advanced PCa and 72 LN metastatic PCa who received immediate androgen deprivation therapy after LRP plus ePLND were enrolled onto our study. The patients were followed up for 12 to 124 months. Surgical records, surgical margin status, complications, urinary continence, and oncologic outcomes were presented. RESULTS: The mean operation time and bleeding were 230 minutes and 105 mL, respectively. The rates of urinary continence were 91.4% and 94.8% at 6 and 12 months, respectively. We observed 122 biochemical recurrent cases. The 5- and 8-year biochemical relapse-free survival rates were 47.3% and 46.7%, respectively. The 5- and 8-year overall and cancer-specific survivals were 81.2%, 80.1%, 90.6%, and 90.6%, respectively. The survival analysis showed that biochemical recurrence-free survival rates were significantly lower for patients with higher Gleason score (77.3% vs. 39.6% vs. 30.8%, P = .003 log rank), higher T stage (55.7% vs. 41.4% vs. 21.4%, P = .039 log rank), positive surgical margin (51.1% vs. 29.3%, P = .000 log rank), and higher CAPRA-S score (68.6% vs. 35.0% vs. 29.2%, P = .000 log rank). There were no significant differences in biochemical relapse-free (40.9% vs. 49.3%, P = .286), overall (75.6% vs. 81.9%, P = .398), and cancer-specific (87.3% vs. 92.1%, P = .284) survival between LN-positive and -negative PCa. CONCLUSION: LRP plus ePLND in combination with immediate androgen deprivation therapy is a feasible approach to patients with pT3-4N0-1M0 PCa; favorable functional and oncologic outcomes were presented postoperatively.

Laparoscopic Radical Prostatectomy after Previous Transurethral Resection of the Prostate in Clinical T1a and T1b Prostate Cancer: A Matched-Pair Analysis.

PURPOSE: To analyze and compare surgical, oncological and functional outcomes of laparoscopic radi­cal prostatectomy (LRP) in patients with and without previous transurethral resection of the prostate (TURP). MATERIALS AND METHODS: In total, 785 men underwent LRP at our institution from January 2002 to December 2012. TURP had been performed previously in 35 of these patients (TURP group). A matched-pair analysis iden­tified 35 additional men without previous TURP who exhibited equivalent clinicopathological characteristics to serve as a control group. Perioperative complications and surgical, functional, and oncological outcomes were compared between the two groups. RESULTS: The groups were similar in age, body mass index, serum prostate-specific antigen level, and pre- and post-operative Gleason scores. Patients in the TURP group had greater blood loss (231 vs. 139 mL), longer opera­tive times (262 vs. 213 min), a greater probability of transfusion (8.6% vs. 0%), and a higher rate of complications (37.1% vs. 11.4%) compared with the control group. The positive surgical margin rate was higher in the TURP group, but this difference was not statistically significant (P = .179). The continence rates at one year after surgery were similar, but a lower continence rate was identified in the TURP group (42.9% vs. 68.6%) at 3 months. Bio­chemical recurrence developed in 17.1% and 11.4% of the patients in the TURP and control groups, respectively, after a mean follow-up of 57.6 months. CONCLUSION: LRP is feasible but challenging after TURP. LRP entails longer operating times, greater blood loss, higher complication rates and worse short-term continence outcomes. However, the radical nature of this cancer surgery is not compromised.

Predictors of urinary continence recovery after modified radical prostatectomy for clinically high-risk prostate cancer.

PURPOSE: To retrospectively determine predictors of urinary continence (UC) recovery in clinically high-risk prostate cancer (PCa) patients treated with modified radical prostatectomy (RP). MATERIALS AND METHODS: A total of 184 patients with clinically high-risk PCa who underwent modified RP in a single Chinese center were retrospectively reviewed. Pelvic floor muscle training with biofeedback was routinely performed after catheter removal. UC was defined as wearing 0 or 1 protective pad daily. Univariate and multivariate Cox regression analyses were performed to determine the predictors of UC recovery. RESULTS: The median age at surgery was 69.5 years (range 48-82), and the median follow-up duration was 40 months (range 12-111). Only 40 patients (21.7%) received a nerve-sparing procedure. For patients with restored UC, the median time to continence was 1 month (range 1-24). UC recovery at 1 month, 6 months, 12 months and the most recent follow-up was observed in 99 (53.8%), 158 (85.9%), 171 (92.9%) and 174 (94.6%) patients, respectively. Multivariate Cox regression analysis showed that patient age < 70 years (hazard ratio 1.684, P = .003) and smaller prostate volume (hazard ratio 0.989, P = .036), but not the surgical approach or treatment with a nerve-sparing procedure, independently predicted UC recovery. CONCLUSION: Age < 70 years and smaller prostate volume were independent predictors of UC recovery in clinically high-risk PCa patients. The adverse factors of high-risk disease were not significantly associated with UC recovery. These results may help surgeons preoperatively counsel patients regarding expected UC outcomes following RP. 

[Effects of age, gender and urinary diversion category on perioperative complications of radical cystectomy].

OBJECTIVE: To explore the association of age, gender and urinary diversion category with postoperative complications of radical cystectomy. METHODS: A total of 374 patients with bladder cancer undergoing modified radical cystectomy and urinary diversion between March 2000 and June 2011 were retrospectively reviewed. Their demographic, perioperative and complication data were recorded. And multivariable Logistic regression was used to investigate the predictors of perioperative complications. RESULTS: Among them, 38.8% (145/374) received ileal conduit, 47.9% (179/374) orthotopic ileal neobladder and 13.4% (50/374) orthotopic colonic neobladder. The overall perioperative complication rate was 37.4% (140/374). And 21.4% (80/374) experienced at least one complication within Day 90 postoperation while 16.3% (61/374) had the long-term complications (> Day 90). There was no significant association between patients age (P = 0.15) and perioperative complications or between gender (P = 0.16) and complication. Urinary diversion (OR = 0.26, 95%CI: 0.16 - 0.43) was the only variable significantly associated with the perioperative urinary complications. CONCLUSION: The categories of urinary diversion may be used as a single predictor for complications after radical cystectomy.

Reassessment of the predictive role of perivesical fat invasion in invasive bladder cancer prognosis in 151 Chinese patients.

BACKGROUND: Perivesical fat invasion is considered as an important prognostic factor for bladder cancer. However, the predictive role of perivesical fat invasion in invasive bladder cancer prognosis has never been reported in Chinese patients. The aim of the study was to assess the predictive value of perivesical fat invasion for prognoses of T2 and T3 bladder cancer in Chinese patients. METHODS: One hundred and fifty-one patients who underwent radical cystectomy for pT2-3N0M0 invasive bladder cancer from 2001 to 2007 were studied. Cancer-specific survival rate (CSS) and recurrence-free survival rate (RFS) were compared between the pT2 and pT3 patient groups. Other clinicopathological parameters were also retrospectively analyzed by univariate and multivariate analyses to identify the independent predictor for the prognoses of this cohort. RESULTS: Average patient age at surgery was 58 years. Ninety (60.3%) patients had grade I and II disease. During follow-up (median 66 months), 27 patients (17.9%) had tumor recurrence and 18 (11.9%) died of bladder cancer. In the univariate analysis, the CSS and RFS curves between T2 and T3 patients showed no significant difference (P = 0.756 and 0.354, respectively). Multivariate Cox regression showed that histological classification and grade were independent predictors for CSS, while grade was the sole independent predictor for RFS. CONCLUSIONS: For this group of Chinese patients, perivesical fat invasion did not demonstrate a statistically significant difference in prognosis between T2 and T3 patients. Nontransitional cell carcinoma (non-TCC) and high-grade patients had short CSS, and patients with high-grade tumor had higher recurrent risk.

[Clinical outcomes of nephron sparing surgery for T1 renal cell carcinoma].

OBJECTIVE: To investigate the safety and effect of nephron-sparing surgery (NSS) in treatment of T1a and T1b renal cell carcinoma. METHODS: Retrospective analyzed the clinical data of 101 patients with T1 renal cell carcinoma underwent NSS from November 1999 to December 2009.Including 79 male and 22 female with the mean age of 52.3 years (ranged 28 to 79 years). Based on tumor pathologic diameter, 101 patients were divided into T1a group with 62 patient and T1b group with 39 cases. Demographic, intraoperative, postoperative and follow-up data were compared between the 2 groups. RESULTS: The operation were performed successfully in all the 101 cases. The mean operation time was (151 ± 80) min in group T1a and (158 ± 50) min in group T1b with no statistical difference (P = 0.32). The mean blood loss was (322 ± 596) ml in group T1a and (308 ± 239) ml in group T1b (P = 0.45). Postoperative follow-up ranged from 8 to 102 months with a mean of 38.4 months. One patient in T1b group died of distant metastasis 36 months after operation. Others were no tumor recurred. CONCLUSION: Nephron-sparing surgery is safe and effective for the treatment of T1a and T1b renal cell carcinoma.

Primary adult intratesticular rhabdomyosarcoma: results of the treatment of six cases.

The aim of the present study was to assess the treatment outcomes in a cohort of adult patients with intratesticular rhabdomyosarcoma. Between 1999 and 2008, 296 patients underwent radical orchiectomy for intrascrotal mass. A retrospective chart review was carried out for adult patients diagnosed with intratesticular rhabdomyosarcoma. Overall, six patients (mean age 21 years, range 17-23) were included: five had embryonic rhabdomyosarcoma and one had pleomorphic rhabdomyosarcoma. Four patients underwent retroperitoneal lymph node dissection and five patients had postoperative chemotherapy. The mean length of follow up was 28 months (range 12-51 months). One patient was lost to follow up after 26 months, five cases remained alive at the end of the study. Surgical resection with chemotherapy was an effective way to achieve favorable outcomes and long-term survival in adult patients with metastases from intratesticular rhabdomyosarcoma.

Oncological outcome of surgical treatment in 336 patients with renal cell carcinoma.

BACKGROUND AND OBJECTIVE: The most effective therapy against renal cell carcinoma (RCC) is surgical treatment; however, there have been few large-scale studies that focused on the oncological outcome of this disease in China. The aim of the current study was to report the clinicopathological results and cancer-specific survival (CSS) rate in RCC patients after surgical treatment in our center. METHODS: We retrospectively analyzed the clinicopathological data of 336 RCC patients who underwent radical or partial nephrectomy between 1999 and 2006. Of the 336 patients, 226 were male and 110 were female; the median age was 51 years. Univariate and multivariate analyses were conducted to identify the independent prognostic predictors for this cohort of RCC patients. RESULTS: During follow-up, the overall 5-year CSS rate was 81.4%. The 5-year CSS rates for patients with stage-I, -II, -III, and -IV RCC were 94.7%, 88.9%, 68.8%, and 19.3%, respectively. The patients with T1N0M0 (T1) and T2N0M0 (T2) tumors had similar survival curves. For patients with T1 category tumor, the survival rate did not differ significantly between the radical nephrectomy and nephron-sparing surgery groups. For the 21 patients with metastasis confined to the local lymph nodes, the 5-year survival rate was 31.6% after radical nephrectomy and lymph node dissection. For the 15 patients with vena caval tumor thrombus, the 5-year survival rate was 52.5% after radical nephrectomy and tumor thrombus extirpation. Multivariate Cox regression showed that stage was an independent predictor for CSS (hazard ratio, 3.359; P < 0.001). CONCLUSIONS: For localized RCC, the oncological outcome of this cohort is comparable to that reported in the Western literature. For some patients with locally advanced RCC, aggressive surgical treatment can lead to better long-term survival. However, the prognosis of the patients with metastasis still needs to be improved.

Benign pathological findings in 303 Chinese patients undergoing surgery for presumed localized renal cell carcinoma.

OBJECTIVE: To analyze the incidence of benign lesions in Chinese patients undergoing nephrectomies for renal masses identified as localized renal cell carcinoma (RCC) in preoperative imaging. METHODS: Between 1999 and 2007, 303 patients (112 female, 191 male) with presumed localized RCC underwent nephrectomy (234 radical nephrectomies and 69 partial nephrectomies). Preoperative computed tomography images and pathological findings were reviewed and analyzed. RESULTS: Pathological examinations revealed 31 (10.2%) benign lesions in the 303 patients. Among these 31 benign lesions, 15 (5.0%) were angiomyolipomas (AML) and only four (1.3%) were oncocytomas. Significantly, 20 (17.9%) of the 112 female patients had benign lesions compared with 11 (5.8%; P = 0.001) male patients. Benign renal lesions were found in five (25.0%) of the 20 patients with renal masses smaller than 2 cm, 13 (13.0%) of the 100 patients with renal masses 2-4 cm in size and 13 (7.1%) of the 183 patients with renal masses larger than 4 cm. CONCLUSIONS: Patients in the present study population show a low incidence of benign renal lesions, approximately half of them being AML. Female patients and patients with renal masses smaller than 4 cm are more likely to have benign renal lesions.

Modified technique to prevent complications related to stoma and ileoureteral anastomosis in patients undergoing ileal conduit diversion.

OBJECTIVES: To introduce a modified technique for preventing complications related to stoma and ileoureteral anastomosis in patients undergoing ileal conduit diversion. METHODS: A urinary stoma was created intracorporeally and was pulled out to the abdominal wall through a retroperitoneal tunnel. The ileal conduit was fixed by nonabsorbable sutures that incorporated all abdominal wall fascia and the bowel seromuscular layer. The terminal ureter was spatulated and anastomosed to the conduit in an end-to-side fashion by a continuous lock-stitch suture after stoma maturation and conduit fixation. A 24F multiorifice catheter was introduced into the ileal conduit as a stent, but a ureteral stent was not used. The peritoneum underlying the stoma was preserved intact, and the ureters and the conduit were completely extraperitonealized. A urine collection device was attached to the matured stoma immediately after surgery. RESULTS: The modified technique was used in 56 consecutive patients who underwent ileal conduit diversions. The median operative time was 327 minutes. No early complications, such as urine or intestinal leakage, occurred. Two patients, however, developed ileus. The median follow-up was 36 months. Forty-five patients survived disease-free, whereas 11 died during the follow-up. There were no stoma-related complications or stenosis at the ileoureteral anastomotic site. No metabolic complications were observed and renal function was normal in all patients. CONCLUSIONS: Complications related to stoma and ileoureteral anastomosis in patients undergoing ileal conduit diversion can be prevented using our modified technique. However, further clinical investigation is required to confirm the advantage and long-term effects of our modified technique.

[Experience of the treatment for clinical Stage-1 seminoma over a period of 10 years].

BACKGROUND AND OBJECTIVE: Patients with clinical stage I seminoma accounts for 70%-80% of patients with this disease. This study was to analyze the relationship between different therapeutic methods and the prognosis of this disease. METHODS: The data of all patients with clinical Stage I seminoma treated by multi-disciplinary approach from 1999 to 2008 in Sun Yat-sen University Cancer Center were analyzed. The patients were divided into 3 groups based on the treatment they received after orchiectomy: 30 patients treated with chemotherapy, 8 with radiotherapy, and 20 under surveillance. The prognosis of different treatment groups was evaluated. RESULTS: Among the 58 patients with stage I seminoma, 57 were followed up successfully. The median follow-up time was 50 months (range, 8-115 months). No relapse or metastasis was seen in the chemotherapy group. One patient relapsed in the radiotherapy group. Four patients had metastasis of retroperitoneal lymph node in the surveillance group. The disease-free survival was higher in the chemotherapy group than that in the surveillance group (P=0.005). There was no significant difference in the relapse-free survival between the surveillance group and the radiotherapy group (P=0.364). CONCLUSIONS: Chemotherapy is a safe and effective treatment for patients with Stage-1 seminoma after radical orchidectomy.

A modified technique for neourethral anastomosis in orthotopic neobladder reconstruction.

OBJECTIVES: To introduce a modified technique for urethral anastomosis in orthotopic neobladder reconstruction. METHODS: Between January 2002 and August 2008, about 141 consecutive patients (130 men and 11 women) underwent total cystectomy and orthotopic neobladder reconstruction in which a modified technique was used to anastomosed the caudal-most part of the intestinal neobladder directly to the urethral remnant. The emptying of the neobladder, the early and late complications at the urethral anastomosis was evaluated. RESULTS: Mean patient age at surgery was 58.4 years (range, 33-83) and median follow-up was 42 months (range, 4-83 months). Early urine leakage at the vesicourethral anastomosis developed in 1 patient, and was cured by extending catheter drainage. A total of 138 patients had good emptying of the neobladder, with residual urine volume < 50 mL. Three patients had residual urine volume > 100 mL, and achieved good emptying after intermittent catheterization once a week for 6-12 months. No late complications occurred at the urethral anastomosis site. Daytime continence was good or satisfactory in 97.0% of patients and night-time continence was good or satisfactory in 88.5% of patients. CONCLUSIONS: The clinical outcome of our modified technique for urethral anastomosis in orthotopic neobladder substitution was excellent, but the advantage of this technique needs prospective controlled study.

[Clinical outcomes after modified radical cystectomy in the treatment of 188 patients with invasive bladder cancer].

BACKGROUND AND OBJECTIVE: Radical cystectomy and urinary diversion is universally accepted as the most effective treatment for muscle invasive bladder cancer, but the operation is complicated, time-consuming and causes many complications. This study was to summarize our experience and clinical outcomes of modified radical cystectomy in the treatment of patients with muscle invasive bladder cancer. METHODS: In total 188 patients with invasive bladder cancer treated in the Department of Urology, Sun Yat-sen University Cancer Center from January 2000 to December 2007 with modified radical cystectomy and urinary diversion were analyzed retrospectively. Patients were followed up for 2 to 97 months, with a median of 31 months. RESULTS: The operative time was 120-525 min, with a median of 300 min. Blood transfusion was required in 39.9% of the patients. There was no operation-related death. The 5-year recurrence free and 5-year overall survival rates were 74.9% and 71.5%, respectively. The 5-year and overall survival were 82.5% and 82.8% for patients with organ-confined bladder cancer, 19.0% and 34.3% for patients with extravesical extension of bladder cancer, 82.2% and 79.1% for lymph node-negative patients, and 25.2% and 11.4% for lymph node positive patients. CONCLUSIONS: Modified radical cystectomy and urinary diversion is an effective and safe approach in treating muscle invasive bladder cancer. The efficacy of radical cystectomy is limited for the treatment of patients with extravesical extension of bladder cancer and lymph node positive patients.

Upper urinary tract dilation due to conglutination of intraluminal distal ureters after orthotopic neobladder with split-cuff nipple ureteral reimplants: early results of 8 cases.

OBJECTIVE: We reviewed our experience with dilation of the upper urinary tract caused by the conglutination of distal ureters after orthotopic neobladder reconstruction using the split-cuff nipple ureteral reimplant technique. MATERIALS AND METHODS: From January 2000 to April 2007, 250 consecutive patients underwent radical cystectomy and orthotopic neobladder reconstruction. Ureterointestinal anastomosis was performed using the split-cuff nipple technique in 291 renoureteral units. The patients from a single center were followed up for a mean period of 8 months (range 1-22) after surgery. We incised the conglutination band using a transurethral endoscope. Patient characteristics, endoscopic technique, measurement of serum creatinine levels, and results of ultrasonography, cystoscopy, and excretory urography were collected. RESULTS: Hydronephrosis was found in 8 patients (14 renoureteral units) due to the conglutination of the distal ureters to each other (n = 6) or to the neobladder wall (n = 2). After the incision procedure, seven patients had obvious improvement in renal function and hydronephrosis, and their symptoms disappeared. In 1 patient, hydronephrosis developed again because of ureteroenteric stenosis after 7 months and was resolved by open surgical revision. The hydronephrosis had improved greatly in this patient by 5 months after revision. CONCLUSION: Conglutination of the distal ureters is a cause of hydronephrosis after orthotopic neobladder reconstruction using the reimplant technique with the split-cuff nipple. Cystoscopy is mandatory in following up patients who have hydronephrosis with the split-cuff nipple ureteral reimplant technique, not only to confirm the diagnosis but to treat the complication by incising the conglutination band. Continued follow-up is required to evaluate the long-term results of this treatment.

[Local Castleman's disease: a report of 17 cases with literature review].

BACKGROUND & OBJECTIVE: Castleman's disease (CD), also named angiofollicular lymph node hyperplasia or giant lymph node hyperplasia, is an uncommon reactive lymphadenopathy with unknown causes. This study was to report clinical features and therapeutic outcomes of 17 cases of local Castleman's disease (LCD), review literatures to improve the diagnosis and management of CD. METHODS: Clinical data of 17 LCD patients, treated in Cancer Center of Sun Yat-sen University from Aug. 1995 to Jul. 2006, were reviewed. RESULTS: There were 3 cases with and 14 cases without clinical symptoms. A single lymph node or aggregation of multiple lymph nodes was observed in a single location. The longest diameters of involved lymph nodes ranged from 1.2 to 10.4 cm. The lesions were located in the neck (11 cases), mediastinum (3 cases), lung (1 case), mesentery (1 case), adrenal region (1 case). Fifteen cases were hyaline vascular type, 1 case was plasma cell type and 1 case was mixed type; all were confirmed pathologically. One hyaline vascular type LCD patient had splenomegaly, hypoalbumin (25.6 g/L), hyperglobulin (80.0 g/L) and positive fecal occult blood. One plasma cell type LCD patient had anemia (95.0 g/L), positive urine protein and positive fecal occult blood. The other 15 patients had normal laboratory results. All patients underwent complete surgical resection. The duration of follow-up ranged from 1 to 129 months with a median of 25 months. Fifteen followed-up patients were all alive without recurrence. CONCLUSIONS: LCD patients mainly have lymphadenectasis in a single location, no clinical symptoms and normal laboratory results, with a majority of hyaline vascular type. Although CT is helpful for the diagnosis of LCD, the final diagnosis depends on pathologic examination. LCD patients can live long without recurrence after complete surgical resection of the tumor.