Research on the metabolic regulation mechanism of Yangyin Qingfei decoction plus in severe pneumonia caused by Mycoplasma pneumoniae in mice.

Introduction: With amazing clinical efficacy, Yangyin Qingfei Decoction Plus (YQDP), a well-known and age-old Chinese compound made of ten Chinese botanical drugs, is utilized in clinical settings to treat a range of respiratory conditions. This study examines the impact of Yangyin Qingfei Decoction (YQDP) on lung tissue metabolic products in severe Mycoplasma pneumoniae pneumonia (SMPP) model mice and examines the mechanism of YQDP in treating MP infection using UPLC-MS/MS technology. Methods: YQDP's chemical composition was ascertained by the use of Agilent 1260 Ⅱ high-performance liquid chromatography. By using a nasal drip of 1010 CCU/mL MP bacterial solution, an SMPP mouse model was created. The lung index, pathology and ultrastructural observation of lung tissue were utilized to assess the therapeutic effect of YQDP in SMPP mice. Lung tissue metabolites were found in the normal group, model group, and YQDP group using UPLC-MS/MS technology. Using an enzyme-linked immunosorbent test (ELISA), the amount of serum inflammatory factors, such as interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α), was found. Additionally, the protein expression of PI3K, P-PI3K, AKT, P-AKT, NF-κB, and P-NF-κB was found using Western blot. Results: The contents of chlorogenic acid, paeoniflorin, forsythrin A, forsythrin, and paeonol in YQDP were 3.480 ± 0.051, 3.255 ± 0.040, 3.612 ± 0.017, 1.757 ± 0.031, and 1.080 ± 0.007 mg/g respectively. YQDP can considerably lower the SMPP mice's lung index (p < 0.05). In the lung tissue of YQDP groups, there has been a decrease (p < 0.05) in the infiltration of inflammatory cells at varying concentrations in the alveoli compared with the model group. A total of 47 distinct metabolites, including choline phosphate, glutamyl lysine, L-tyrosine, 6-thioinosine, Glu Trp, 5-hydroxydecanoate, etc., were linked to the regulation of YQDP, according to metabolomics study. By controlling the metabolism of porphyrins, pyrimidines, cholines, fatty acids, sphingolipids, glycerophospholipids, ferroptosis, steroid hormone biosynthesis, and unsaturated fatty acid biosynthesis, enrichment analysis suggested that YQDP may be used to treat SMPP. YQDP can lower the amount of TNF-α and IL-6 in model group mice as well as downregulate P-PI3K, P-AKT, and P-NF-κB expression (p < 0.05). Conclusion: A specific intervention effect of YQDP is observed in SMPP model mice. Through the PI3K/Akt/NF-κB signaling pathways, YQDP may have therapeutic benefits by regulating the body's metabolism of α-Linoleic acid, sphingolipids, glycerophospholipids, arachidonic acid, and the production of unsaturated fatty acids.

Integrating spatial transcriptomics and single-cell RNA-sequencing reveals the alterations in epithelial cells during nodular formation in benign prostatic hyperplasia.

OBJECTIVE: Proliferative nodular formation represents a characteristic pathological feature of benign prostatic hyperplasia (BPH) and serves as the primary cause for prostate volume enlargement and consequent lower urinary tract symptoms (LUTS). Its specific mechanism is largely unknown, although several cellular processes have been reported to be involved in BPH initiation and development and highlighted the crucial role of epithelial cells in proliferative nodular formation. However, the technological limitations hinder the in vivo investigation of BPH patients. METHODS: The robust cell type decomposition (RCTD) method was employed to integrate spatial transcriptomics and single cell RNA sequencing profiles, enabling the elucidation of epithelial cell alterations during nodular formation. Immunofluorescent and immunohistochemical staining was performed for verification. RESULTS: The alterations of epithelial cells during the formation of nodules in BPH was observed, and a distinct subgroup of basal epithelial (BE) cells, referred to as BE5, was identified to play a crucial role in driving this progression through the hypoxia-induced epithelial-mesenchymal transition (EMT) signaling pathway. BE5 served as both the initiating cell during nodular formation and the transitional cell during the transformation from luminal epithelial (LE) to BE cells. A distinguishing characteristic of the BE5 cell subgroup in patients with BPH was its heightened hypoxia and upregulated expression of FOS. Histological verification results confirmed a significant association between c-Fos expression and key biological processes such as hypoxia and cell proliferation, as well as the close relationship between hypoxia and EMT in BPH tissues. Furthermore, a strong link between c-Fos expression and the progression of BPH was also been validated. Additionally, notable functional differences were observed in glandular and stromal nodules regarding BE5 cells, with BE5 in glandular nodules exhibiting enhanced capacities for EMT and cell proliferation characterized by club-like cell markers. CONCLUSIONS: This study elucidated the comprehensive landscape of epithelial cells during in vivo nodular formation in patients, thereby offering novel insights into the initiation and progression of BPH.

Prognostic value of tumour contour irregularity on surgical strategies for T1bN0M0 renal cell carcinoma: A multi-institutional study.

PURPOSE: To determine the prognostic value of tumour contour irregularity degree (CID) in surgical strategy options for T1bN0M0 renal cell carcinoma (RCC). MATERIALS AND METHODS: We performed a retrospective multi-institutional review of 489 patients with T1bN0M0 RCC treated between January 2009 and June 2019. Cox regression and Kaplan-Meier analyses were performed to analyse the impact of CID on disease-free survival (DFS). RESULTS: The median follow-up time was 55 months (interquartile range, 40-81 months) for 55 (11.2 %) patients with metastasis or recurrence. Logistic analysis indicated that CID was associated with World Health Organization/International Society of Urological Pathology (WHO/ISUP) grades III-IV (odds ratio, 1.015; 95 % confidence interval [CI], 1.008-1.023; p < 0.001). After being classified into high CID (≥50 %) and low CID (<50 %) groups, those with a high CID showed a significantly higher ratio of WHO/IUSP grades III-IV (74/277 [26.7 %] vs 25/212 [11.8 %]) and shorter DFS than the low CID group (p < 0.001). Multivariable Cox regression showed that partial nephrectomy (PN; hazard ratio [HR], 1.889; 95 % CI, 1.020-3.499; p = 0.043), high CID (HR, 6.685; 95 % CI, 2.776-16.100; p < 0.001), and WHO/ISUP grade III-IV (HR, 1.950; 95 % CI, 1.100-3.458; p = 0.022) were independent prognostic factors for DFS. The Kaplan-Meier plot showed that PN had a DFS rate comparable to that of radical nephrectomy (RN; p = 0.994). In the low CID group, patients who underwent PN showed comparable DFS to those who underwent RN (p = 0.903). Furthermore, patients with a high CID tended to have worse DFS in the PN versus RN group (p = 0.044). Multivariable Cox regression showed that PN (HR, 2.049; 95 % CI, 1.065-3.942; p = 0.032) and WHO/ISUP grade III-IV (HR, 2.148; 95 % CI, 1.189-3.881; p = 0.011) were independent prognostic factors of DFS in the high CID group. CONCLUSIONS: CID is a reliable preoperative parameter which is positively correlated with WHO/ISUP grade and can help with surgical decision-making in patients with T1bN0M0 RCC.

Predictive value of renal tumor contour irregularity score in pathological T3a upstaging of clinical T1 renal cell carcinoma: A multi-institutional study.

PURPOSE: To explore the predictive value of renal tumor contour irregular degree (CID) in pathological T3a upstaging of clinical T1 renal cell carcinoma (RCC). MATERIALS AND METHODS: We performed a retrospective multi-institutional review of 1,487 patients with clinical T1N0M0 RCC between January 2009 and June 2019. Kaplan-Meier survival curve and Cox regressions were used to analyze the prognostic factors of disease-free survival (DFS). Logistic regressions were performed to determine predictors of pathological T3a upstaging in clinical T1 RCC. RESULTS: Among 1,487 patients with cT1 RCC, 96 (6.5%) were pathological T3a upstaging. Multivariable logistic regression analysis showed that age (odds ratio [OR] = 1.022, 95% confidence interval [CI] = 1.001-1.042, P = 0.036), tumor maximum diameter(OR = 1.242, 95% CI = 1.042--1.480, P = 0.015) and CID (OR = 1.067, 95% CI = 1.051-1.083, P < 0.001) were independent predictors of pathological T3a upstaging. The area under the curve (AUC) of the prediction model that included the CID was 0.846, while the AUC of the prediction model that did not include CID was only 0.741, the difference was statistically significant (P < 0.001). Kaplan-Meier survival curve showed that patients with pathological T3a upstaging had significantly worse DFS than patients without pathological T3a upstaging (P < 0.001). Multivariable Cox analysis showed that pathological T3a upstaging (HR = 1.836, 95% CI = 1.013-3.329, P = 0.002) is an independent prognostic factor for DFS in patients with cT1N0M0 RCC. CONCLUSIONS: The predictive model of CID combined with tumor maximum diameter and age significantly improved the ability to predict pathological T3a upstaging in clinical T1 RCC, compared with the prediction model of tumor maximum diameter combined with age. The predictive model of CID combined with tumor maximum diameter and age may be applicable to patients considering partial vs. radical nephrectomy.

Fully Optical Modulation of the Two-Dimensional Electron Gas at the γ-Al2O3/SrTiO3 Interface.

Two-dimensional electron gas (2DEG) formed at the heterointerface between two oxide insulators hosts plenty of emergent phenomena and provides new opportunities for electronics and photoelectronics. However, despite being long sought after, on-demand properties controlled through a fully optical illumination remain far from being explored. Herein, a giant tunability of the 2DEG at the interface of γ-Al2O3/SrTiO3 through a fully optical gating is discovered. Specifically, photon-generated carriers lead to a delicate tunability of the carrier density and the underlying electronic structure, which is accompanied by the remarkable Lifshitz transition. Moreover, the 2DEG can be optically tuned to possess a maximum Rashba spin-orbit coupling, particularly at the crossing region of the sub-bands with different symmetries. First-principles calculations essentially well explain the optical modulation of γ-Al2O3/SrTiO3. Our fully optical gating opens a new pathway for manipulating emergent properties of the 2DEGs and is promising for on-demand photoelectric devices.

Isolation and Identification of a Large Green Alga Virus (Chlorella Virus XW01) of Mimiviridae and Its Virophage (Chlorella Virus Virophage SW01) by Using Unicellular Green Algal Cultures.

Virophages are a group of small double-stranded DNA viruses that infect protist hosts and parasitize the viral factory of host giant/large viruses to propagate. Here, we discover a novel cell-virus-virophage (CVv) tripartite interaction system by using unicellular micro-green algae (Chlorella sp.) as eukaryotic hosts for the first time. Viral particles, resembling known virophages and large alga viruses, are detected in culture supernatants and inside algal cells. Complete genomic sequences of the virophage (Chlorella virus virophage SW01 [CVv-SW01]; 24,744 bp) and large virus (Chlorella virus XW01 [CV-XW01]; 407,612 bp) are obtained from the cocultures. Both genomic and phylogenetic analyses show that CVv-SW01 is closely related to virophages previously found in Dishui Lake. CV-XW01 shares the greatest number of homologous genes (n = 82) with Cafeteria roenbergensis virus (CroV) and phylogenetically represents the closest relative to CroV. This is the first report of a large green alga virus being affiliated with a heterotrophic zooplankton-infecting Cafeteriavirus of the family Mimiviridae. Moreover, the codon usage preferences of CV-XW01 and CVv-SW01 are highly similar to those of CroV and its virophage Mavirus, respectively. The discovery of such a novel CVv system with the green alga Chlorella sp. as the single cellular eukaryotic host paves a way to further investigate the potential interaction mechanism of CVv and its significance in the ecology of green algae and the evolution of large/giant viruses and their parasitic viruses. IMPORTANCE Parasitic virophages are small unicellular eukaryotic dsDNA viruses that rely on the viral factories of coinfecting giant/large dsDNA viruses for propagation. Presently, the identified eukaryotic hosts of isolated virophages were restricted to a free-living amoeba, Acanthamoeba polyphaga, and a widespread marine heterotrophic flagellate, Cafeteria roenbergensis. In this study, we successfully discovered and identified a novel tripartite interaction system comprised of a micro-green alga (Chlorella sp.), Mimiviridae large green alga virus, and virophage at the coculture level, with Chlorella sp. as the eukaryotic host, based on combination analysis of infection, morphotype, genome, and phylogeny. The large green alga virus CV-XW01 represents the closest relative to the Mimiviridae giant virus Cafeteria roenbergensis virus, host virus of the virophage Mavirus, as well as a novel large virus of Mimiviridae that infects a non-protozoan protist host. The virophage CVv-SW01 highly resembles Mavirus in its codon usage frequency and preference, although they are phylogenetically distantly related. These findings give novel insights into the diversity of large/giant viruses and their virophages.

Comparison of the Effects of Essential Oil Obtained from the Crude and Bran-Processed Atractylodes lancea on Lipopolysaccharide-Induced Inflammatory Injury of Human Colonic Epithelial Cells by Downregulating the IKK/NF-κB Signaling Pathway.

BACKGROUND: Atractylodes lancea (AL) has been used in traditional Chinese medicine for the treatment of various diseases including digestive disorders. Ulcerative colitis (UC) is a common digestive system disease with a low cure rate and easy recurrence. However, it is still not clear whether AL is suitable for UC treatment. Currently, stir-baking with wheat bran is most commonly used to process AL. Here, we aimed to address the effects of the crude and bran-processed AL on UC in vitro and uncover the underlying mechanism based on regulating the IKK/NF-kappa B signaling pathway. METHODS: Human colonic epithelial cells (HCoEpiC) were treated with lipopolysaccharide (LPS) to mimic the inflammatory injury of UC in vitro. The essential oil from crude and bran-processed AL was used to treat LPS-induced HcoEpiC cells. The cell viability was detected by an MTT assay. The levels of IL-4, IL-6, IL-8, IL-12, IL-1-ß, TNF-α, and NO were determined by ELISA, and the mRNA expressions of IKK-α, NF-κB, IL-4, IL-6, IL-8, and TNF-α were determined by RT-PCR. Meanwhile, the expressions of IKK-α, p-IKK-α, p-IKK-ß, NF-κB, IL-6, and IL-8 proteins were determined by Western blot. RESULTS: The essential oil of AL, whether it was from crude or bran-processed AL, could significantly increase the viability of LPS-induced HCoEpiC cells. The treatment of AL essential oil also notably inhibited the productions of IL-6, IL-8, IL-12, IL-1-ß, TNF-α, NO, p-IKK-α, p-IKK-ß, and NF-κB and downregulated the mRNA expressions of NF-κB, IL-6, IL-8, and TNF-α. Meanwhile, IL-4 protein and mRNA expression were significantly stimulated by AL essential oil. Moreover, the essential oil from bran-processed AL was more effective than that from crude AL. CONCLUSION: Both kinds of AL essential oil had the anti-inflammatory effect on LPS-induced HCoEpiC, and the essential oil from bran-processed AL was more effective. The mechanism could be through the IKK/NF-κB signaling pathway in vitro.

Association of gene polymorphisms of KLK3 and prostate cancer: A meta-analysis.

Previous studies have suggested that prostate-specific antigen (PSA) plays a role in the etiology of prostate cancer (PCa), and that polymorphisms of KLK3 may be associated with PCa. However, these results were conflicting. Therefore, we performed a meta-analysis to illuminate this problem. We searched the PubMed and Web of Science databases. Ten single nucleotide polymorphisms (SNPs) were involved in this meta-analysis. The pooled results showed that the minor alleles of rs1058205, rs2735839, rs174776, rs17632542, rs266849, rs266878, and rs2569735 were significantly associated with PCa. Compared to genotypes of the common homozygotes, the heterozygous genotypes of rs1058205, rs2735839, rs174776, rs17632542, rs266849, and rs266878 were significantly associated with PCa, as well as the homozygous genotypes of rs1058205, rs2735839, rs17632542, rs266878, rs266876, and rs2569735. Only rs2735839 was involved in the Gleason score (GS). The pooled results showed that when compared with GS ≥ 8 PCa, the A-allele was the protective factor for GS < 7 PCa. It was also a protective factor for GS ≥ 4+3 when compared to GS ≤ 3+4 PCa. A strong association was observed between PCa and rs1058205, rs2735839, rs266882, rs174776, rs17632542, rs266849, rs266878, rs266876, rs1058274, and rs2569735. The G-allele of rs2735839 was a risk factor for GS < 7 PCa when compared with the GS ≥ 8 PCa, as well as for the GS ≥ 4+3 when compared to the GS ≤ 3+4 PCa. Therefore, these SNPs may be valuable as biomarkers for PCa in the future.

[Status of antibiotic use in hospitalized children with community-acquired pneumonia in multiple regions of China].

OBJECTIVE: To investigate the use of antibiotics in children with community-acquired pneumonia (CAP) in multiple regions of China, and to provide a reference for CAP standard treatment and rational antibiotic use in children. METHODS: The medical data of 1 383 children with CAP who were hospitalized in the department of pediatrics in 10 grade A tertiary hospitals from 9 cities between April 14, 2014 and January 1, 2016 were reviewed, to analyze the status of antibiotic use in hospitalized children in North China, Northeast China, East China, and South China. RESULTS: The overall rate of antibiotic use in children with CAP was 89.08%, with 88.7% in North China, 95.5% in Northeast China, 83.3% in East China, and 86.6% in South China. The main types of antibiotics used were cephalosporins, macrolides, compound preparations of ß-lactam antibiotics, polyphosphoric broad-spectrum antibiotics and other ß-lactam antibiotics. The selection of antibiotics was generally rational, but antibiotics were still used in some patients with viral infection alone or a combined use of ≥2 kinds of antibiotics were noted in some patients with infection caused by one kind of pathogen. Irrational antibiotic use was observed in 131 children (10.63%). CONCLUSIONS: There are high rates of antibiotic use and irrational use of antibiotics among children with CAP. Standard management of antibiotic use in children with CAP should be strengthened.

Antitumor effects of emodin in CACO-2 human colon carcinoma cells are mediated via apoptosis, cell cycle arrest and downregulation of PI3K/AKT signalling pathway.

PURPOSE: Emodin is an important constituent of Rheum emodi, an important medicinal herb. Emodin has been reported to exhibit significant pharmacological potential. Several activities such as anticancer activity have been attributed to emodin. However, the anticancer effects of emodin on colon cancer cells have not been fully studied. Therefore, the present study was designed to investigate the anticancer activity of emodin against the CACO-2 colon carcinoma cells. METHODS: The anti-proliferative activity of emodin was assessed by MTT assay. Apoptosis, and cell cycle analysis were carried out by flow cytometry using different fluorescent probes. Expression of proteins was examined by western blotting. RESULTS: The results indicated that emodin reduced the viability of CACO-2 colon cancer cells. The observed IC50 for emodin was 30 µM at 24 hrs of incubation. Furthermore, the anticancer effects of emodin were found to be due to induction of apoptosis. Mitochondrial membrane potential (MMP) determination and Bax/Bcl-2 ratio indicated that emodin-induced apoptosis followed the mitochondrial pathway. Emodin could also trigger cell cycle arrest in CACO-2 colon carcinoma cells in a dose-dependent manner. Evaluation of the effect of emodin in PI3/AKT signalling pathway revealed that emodin could inhibit this signalling cascade indicating the potential of emodin as anticancer drug for the treatment of colon cancer. CONCLUSION: Emodin exhibited potent anticancer effects in CACO-2 human colon carcinoma cells by inducing apoptosis, cell cycle arrest and inhibition of PI3K/AKT signalling pathway.

Laparoscopic Extravesical Submucosal Tunneling Ureteroneocystostomy Combined with Psoas Hitch for Medium-Length Distal Ureteral Defects in Adults.

OBJECTIVE: This study aims to describe the technique and feasibility of laparoscopic submucosal tunneling ureteroneocystostomy in combination with psoas hitch to restore urinary tract continuity in patients showing medium-length distal ureteral defects. MATERIALS AND METHODS: From January 2012 to April 2016, a total of 13 patients (4 males and 9 females) with a mean age of 37 years were performed with the laparoscopic operation of ureteral submucosal tunneling reimplantation combined with psoas hitch. The mean defective length was 5.5 cm (range 4-8 cm). The etiologies included ureteral strictures secondary to endoscopic laser lithotripsy in 2 patients, previous gynecological surgeries in 4, infiltrative ureteral endometriosis in 3, as well as ureteral strictures without obvious causes in the remaining 4. RESULTS: The operations were successfully performed in all patients. The mean operating time was 179 min (range 150-230 min). The mean estimated blood loss was 32 mL (range 15-80 mL). The mean drainage time was 5.8 days (range 4-8 days). No major complications occurred during the perioperative period. The mean follow-up time was 25 months. All patients experienced symptomatic relief and showed good urine drainage. CONCLUSION: Extravesical submucosal tunneling ureteroneocystostomy combined with psoas hitch under laparoscopy is a feasible and effective option for medium-length distal ureteral defects in selected patients.

Polymorphisms of vitamin D receptor gene TaqI susceptibility of prostate cancer: a meta-analysis.

OBJECTIVE: Many studies have investigated the association of the vitamin D receptor gene TaqI polymorphism with prostate cancer (PCa) risk. However, the evidence is inadequate to draw robust conclusions. To shed light on these inconclusive findings, we conducted a meta-analysis. MATERIALS AND METHODS: We searched PubMed for eligible articles. The relevant data were abstracted by two independent reviewers with the Stata 11.0 software. RESULTS: A total of 27 studies were included. The pooled outcomes indicated that the TaqI genetic polymorphisms were significantly associated with the risk of PCa (T vs t allele: odds ratio [OR] =1.11, 95% confidence interval [CI] =1.03-1.21, P=0.008; TT vs tt: OR =1.19, 95% CI =1.01-1.42, P=0.040; TT + Tt vs tt: OR =1.18, 95% CI =1.02-1.38, P=0.031), especially in the Asian population (T vs t allele: OR =1.11, 95% CI =1.03-1.21, P=0.008; TT/Tt vs tt: OR =1.93, 95% CI =1.02-3.66, P=0.043). In the tumor stage stratified analyses, the pooled results showed no significant difference in genetic polymorphisms between the local tumor group and the control group or between the local tumor group and the advanced tumor group. However, the genotypes TT and TT/Tt were significantly higher in the advanced PCa group compared to the control group (T vs t allele: OR =1.20, 95% CI =1.01-1.42, P=0.040; TT vs tt: OR =1.34, 95% CI =1.08-1.67, P=0.009; TT/Tt vs tt: OR =1.28, 95% CI =1.05-1.56, P=0.015). CONCLUSION: The vitamin D receptor gene TaqI allele polymorphism might be associated with a PCa risk, especially in Asians, which might provide new clues for the pathogenesis research and clinical diagnosis of PCa in the future.

Association of low expression of notch-1 and jagged-1 in human papillary bladder cancer and shorter survival.

PURPOSE: We investigated the expression of Notch receptors and ligands in normal bladder transitional epithelium and transitional cell carcinoma of the bladder. We also explored its clinical and pathological implications. MATERIALS AND METHODS: The expression of Notch-1 to 3, Jagged-1 and Delta-like-1 was detected respectively in 70 cases of bladder carcinoma, 10 of normal urothelium and the 2 cell lines T24 and BIU-87 using immunohistochemistry. Reverse transcriptase-polymerase chain reaction and Western blot were used to assay the expression level of Notch-1 and Jagged-1. The predictive value of this expression for prognosis was investigated by Kaplan-Meier curves and Cox proportional hazards analysis in a multivariate model. RESULTS: All 5 kinds of Notch factors were intensively stained in normal bladder transitional epithelium immunohistochemically but expression was significantly decreased in tumor tissues. Moreover, expression of the 5 genes in papillary tumors was lower than in invasive tumors but only Notch-1 and Jagged-1 showed a statistically significant difference. Postoperative disease-free survival time in patients with low Notch-1 plus Jagged-1 expression was significantly shorter than that in patients with other expression patterns in papillary tumors (p = 0.014). Multivariate Cox proportional hazards model analysis identified Jagged-1 expression as an independent prognostic factor for disease-free survival (RR 3.09, p = 0.011). CONCLUSIONS: The Notch family expression pattern in papillary bladder transitional cell carcinoma is different from that in invasive bladder transitional cell carcinoma. Low expression of Notch-1 as well as Jagged-1 is potentially a useful marker for survival in patients with papillary bladder transitional cell carcinoma.

Retroperitoneoscopic surgery for adrenal cysts: a single-center experience of 14 cases.

PURPOSE: To evaluate the operative methods and clinical role of retroperitoneoscopic operation for adrenal cysts. PATIENTS AND METHODS: Clinical data from five male and nine female patients with a mean age of 43.5 years (range 25-68 years) who underwent retroperitoneoscopic operation for adrenal cysts from February 2000 to May 2005 were analyzed retrospectively. There were six lesions on the left side and eight on the right. The median diameter of the lesions was 8.1 cm (range 4.6-12.5 cm). RESULTS: Retroperitoneoscopy was successful in all the 14 cases and included 9 cyst decortications and 5 partial adrenalectomies. The median operative time, median blood loss, and mean postoperative hospital stay were 45.5 minutes (range 19-83 minutes), 34.5 mL (range 10-60 mL), and 4.0 +/- 0.8 days, respectively. No major postoperative complications occurred except for one case of subcutaneous emphysema and one of wound infection. The mean analgesic requirement for opioids and diclofenac sodium was 0 and 4.8 +/- 1.1 doses, respectively. With a median follow-up of 12 months (range 6-36 months), no recurrence was found. CONCLUSION: As a safe and reliable method, retroperitoneoscopic surgery can be a good treatment option for adrenal cysts.

Comparison of retroperitoneoscopic nephrectomy versus open approaches to nonfunctioning tuberculous kidneys: a report of 44 cases.

PURPOSE: We retrospectively investigated the advantages of retroperitoneoscopic nephrectomy for nonfunctioning tuberculous kidneys by comparing its clinical results, operative methods and skills with those of open nephrectomy. MATERIALS AND METHODS: Clinical data on 22 patients with nonfunctioning tuberculous kidneys who underwent retroperitoneoscopic nephrectomy, including simple and subcapsular nephrectomy, were compared with those on 22 who underwent open nephrectomy for a similar indication during the same period. Results in the 2 groups were analyzed. RESULTS: There was no statistical difference between the retroperitoneoscopy and open surgery groups with regard to patient age, sex or mean operative time +/- SD (93.0 +/- 12.6 vs 92.6 +/- 35.5 minutes). Mean blood loss was significantly less in the retroperitoneoscopy group than in the open surgery group (78.3 +/- 60.6 vs 160 +/- 120.0 ml). Mean hospital stay after operation was notably shorter in the retroperitoneoscopy group compared with the open surgery group (3.3 +/- 0.9 vs 9.1 +/- 0.8 days). The mean analgesic requirement for opioids and diclofenac sodium was also lower in the retroperitoneoscopy group than in the open surgery group (0 vs 2.1 +/- 0.9 and 5.2 +/- 1.1 vs 5.8 +/- 1.3 doses, respectively). CONCLUSIONS: Retroperitoneoscopic nephrectomy for renal tuberculosis has several advantages over open nephrectomy, namely a smaller wound, less blood loss and more rapid recovery. It may provide a safe and reliable method for treating refractory renal tuberculosis clinically.