LncRNA SNHG1 regulates immune escape of renal cell carcinoma by targeting miR-129-3p to activate STAT3 and PD-L1.

Immune escape of renal cell carcinoma (RCC) impacts patient survival. However, the molecular mechanism of long noncoding RNA (lncRNA) small nucleolar RNA host gene 1 (SNHG1) in RCC immune escape remains unclear. Quantitative real-time PCR and western blotting results revealed that the expression of lncRNA SNHG1 and STAT3 were upregulated in RCC tissues and cells and that the expression of miR-129-3p was downregulated. Enzyme-linked immunosorbent assay results revealed the increased levels of immune-related factors (interferon-γ, tumour necrosis factor α, and interleukin-2) in RCC tissues. SNHG1 knockdown or miR-129-3p overexpression inhibited the proliferation and invasion of A498 and 786-O cells, while the proliferation and cytotoxicity of CD8+ T cells increased, which promoted the secretion of immune-related factors. STAT3 overexpression decreased the protective effect of miR-129-3p overexpression on RCC cell immune escape. In addition, miR-129-3p knockdown and STAT3 overexpression decreased the protective effect of lncRNA SNHG1 knockdown on RCC cell immune escape. In addition, PD-L1 expression was downregulated after lncRNA SNHG1 knockdown but upregulated after miR-129-3p knockdown and STAT3 overexpression. Dual-luciferase assays showed that lncRNA SNHG1 targets miR-129-3p, and miR-129-3p targets STAT3. RNA pull-down and RNA immunoprecipitation assays verified the regulatory relationship between SNHG1 and STAT3. In vivo, shSNHG1 prolonged the overall survival of RCC tumour model mice and inhibited RCC tumour growth and immune escape but increased CD8+ T cell infiltration in mice. Our findings provide an experimental basis for elucidating the molecular mechanisms of immune escape by RCC and reveal a novel target to treat this disease.

Angiopoietin-2 induces angiogenesis via exosomes in human hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is a highly vascularized solid tumor. Angiopoietin-2 (ANGPT2) has been described as an attractive target for antiangiogenic therapy. Exosomes are small extracellular vesicles secreted by most cell types and contribute to cell-to-cell communication by delivering functional cargo to recipient cells. The expression of ANGPT2 in tumor-derived exosomes remains unknown. METHODS: We detected the ANGPT2 expression in HCC-derived exosomes by immunoblotting, enzyme-linked immunosorbent assay and immunogold labeling, then observed exosomal ANGPT2 internalization and recycling by confocal laser scanning microscopy, co-immunoprecipitation and immunoblotting. We used two HCC cell lines (Hep3B and MHCC97H) to overexpress ANGPT2 by lentivirus infection or knockdown ANGPT2 by the CRISPR/Cas system, then isolated exosomes to coculture with human umbilical vein endothelial cells (HUVECs) and observed the angiogenesis by Matrigel microtubule formation assay, transwell migration assay, wound healing assay, cell counting kit-8 assay, immunoblotting and in vivo tumorigenesis assay. RESULTS: We found that HCC-derived exosomes carried ANGPT2 and delivered it into HUVECs by exosome endocytosis, this delivery led to a notable increase in angiogenesis by a Tie2-independent pathway. Concomitantly, we observed that HCC cell-secreted exosomal ANGPT2 was recycled by recipient HUVECs and might be reused. In addition, the CRISPR-Cas systems to knock down ANGPT2 significantly inhibited the angiogenesis induced by HCC cell-secreted exosomal ANGPT2, and obviously suppressed the epithelial-mesenchymal transition activation in HCC. CONCLUSIONS: Taken together, these results reveal a novel pathway of tumor angiogenesis induced by HCC cell-secreted exosomal ANGPT2 that is different from the classic ANGPT2/Tie2 pathway. This way may be a potential therapeutic target for antiangiogenic therapy. Video Abstract.

Laparoscopic duodenum-preserving total pancreatic head resection: a novel surgical approach for benign or low-grade malignant tumors.

BACKGROUND: Duodenum-preserving total pancreatic head resection (DPPHRt) is an accepted alternative surgical procedure for benign or low-grade malignant tumors of the pancreatic head by preserving the duodenum with its intact blood supply from the pancreatic duodenal arterial arcade. This study describes our experience in laparoscopic DPPHRt (LDPPHRt). To our knowledge, this is the first description of this novel minimally invasive operation. METHODS: From August 2016 to May 2017, all consecutive patients who underwent LDPPHRt for pancreatic head lesions at the HPB Surgery Department, Sun Yat-Sen Memorial Hospital in Guangzhou, China were enrolled into this retrospective study. RESULTS: There were ten women and two men. The average age was 37.3 years (range 8-61 years). The average diameter of the pancreatic head lesions on pre-operative CT/MR was 3.7 cm (range 2-4.8 cm). All the LDPPHRt procedures were performed successfully. There was no peri-operative death. The average operative time was 272.5 min (range 210-320 min). The average blood loss was 215 ml (range 50-450 ml). Post-operative complications included pancreatic fistula grade B (two patients, or 16.7%) and biliary fistula (two patients, or 16.7%). All the complications responded well to conservative treatment. The mean post-operative hospital stay was 11.5 days (range 6-25 days). CONCLUSIONS: LDPPHRt provided a minimally invasive approach with good organ-preservation for benign or low-grade malignant tumors of the pancreatic head. The long-term oncological outcomes, and the exocrine and endocrine pancreatic functions after this operation require further studies.

Vps4A functions as a tumor suppressor by regulating the secretion and uptake of exosomal microRNAs in human hepatoma cells.

UNLABELLED: The deregulation of microRNAs (miRNAs) plays an important role in human hepatocarcinogenesis. In this study, we highlight exosomes as mediators involved in modulating miRNA profiles in hepatocellular carcinoma (HCC) cells. First, we examined the different miRNA expression profiles in HCC cells and HCC cell-derived exosomes. Next, coculture experiments indicated that HCC cell-derived exosomes promoted the cell growth, migration, and invasion of HCC cells and had the ability to shuttle miRNAs to recipient cells. Further, our data showed that Vps4A, a key regulator of exosome biogenesis, was frequently down-regulated in HCC tissues. The reduction of Vps4A in HCC tissues was associated with tumor progression and metastasis. In vitro studies revealed that Vps4A repressed the growth, colony formation, migration, and invasion of HCC cells. We further investigated the role and involvement of Vps4A in suppressing the bioactivity of exosomes and characterized its ability to weaken the cell response to exosomes. By small RNA sequencing, we demonstrated that Vps4A facilitated the secretion of oncogenic miRNAs in exosomes as well as accumulation and uptake of tumor suppressor miRNAs in cells. A subset of Vps4A-associated miRNAs was identified. Kyoto Encyclopedia of Genes and Genomes pathway analysis indicated that the phosphatidylinositol-3-kinase/Akt signaling pathway was the most likely candidate pathway for modulation by these miRNAs. Indeed, we proved that the phosphatidylinositol-3-kinase/Akt pathway was inactivated by Vps4A overexpression. CONCLUSION: Exosome-mediated miRNA transfer is an important mechanism of self-modulation of the miRNA expression profiles in HCC cells, and Vps4A may function as a tumor suppressor, which utilizes exosomes as mediators to regulate the secretion and uptake of miRNAs in hepatoma cells; these observations provide new insights into the development of HCC.

[Effect of downregulation of prostate cancer antigen-1 expression on malignant biological behavior of prostate cancer LNCaP cells].

OBJECTIVE: To detect the expression of prostate cancer antigen-1 (PCA-1) in prostate cancer, and to analyze the effects of downregulation of PCA-1 expression on malignant biological behavior of prostate cancer LNCaP cells, and to explore their possible molecular mechanisms. METHODS: PCA-1-siRNA and control siRNA were transfected into LNCaP cells with lipofectamine 2000. The cell cycle, proliferation and migration were determined by methyl thiazolyl tetrazolium (MTT) assay, flow cytometry and Transwell chambers, respectively. Western blotting was used to detect the expression of cyclin E, matrix metallopeptidase 9 (MMP-9) and p21. Immunohistochemistry was used to detect the expression of PCA-1 protein in 126 cases of prostate cancer and 88 cases of benign prostatic hyperplasia (BPH). RESULTS: The positive rate of PCA-1 expression was 77.8% (98/126) in prostate cancer, and 10.2% (9/88) in BPH, and its expression was not significantly related to age, prostate specific antigen (PSA), Eastern Cooperative Oncology Group (ECOG) score (P > 0.05), and was associated with Gleason score, TNM staging and bone metastasis (P < 0.05). Downregulation of PCA-1 expression inhibited cell proliferation, arrested cell cycle at S phase and decreased cell migration of LNCaP cells. The downregulation of PCA-1 expression decreased the expression of Bcl-xl, cyclin E and MMP-9 proteins, but increased the expression of p21 proteins. CONCLUSIONS: PCA-1 may play an important role in the development of prostate cancer. The downregulation of PCA-1 expression can lead to changes in the proliferation, cell cycle and migration of prostate cancer LNCaP cells, and these effects may be associated with the decrease of Bcl-xl, cyclin E and MMP-9 proteins and increase of p21 protein.

Osteoinductive activity of bisdemethoxycurcumin and its synergistic protective effect with human amniotic mesenchymal stem cells against ovariectomy-induced osteoporosis mouse model.

Osteoporosis is a common disease characterized by skeletal fragility and microarchitectural deterioration. However, existing conventional drugs exhibit limited efficacy and can elicit severe adverse effects; moreover, and novel stem cell-based therapies have not exhibited sufficient therapeutic efficacy. Our hypothesis is that an appropriate osteogenic inducer may improve their therapeutic efficacy. In this study, we found that bisdemethoxycurcumin (BDMC) stimulates the differentiation of human amniotic mesenchymal stem cells (hAMSCs) into osteoblasts without inducing cytotoxicity. Here BDMC enhances calcium deposition in hAMSCs, while promoting the expression of early and late markers of osteoblast differentiation, including ALP, runt-related transcription factor 2, osterix, COL1-α1, osteocalcin, and osteopontin at the transcriptional and translational levels. Mechanistically, BDMC was found to activate the JAK2/STAT3 pathway; whereas AG490 (JAK2/STAT3 pathway inhibitor) inhibited BDMC functioning. Subsequently, we found that the combinatorial therapy of BDMC and hAMSC had a positive synergistic effect on osteoporotic mouse model induced by bilateral ovariectomy, including inhibiting bone loss and bone resorption and improving bone micro-architecture. Moreover, BDMC inhibited production of the bone resorption markers C-terminal telopeptide of type I collagen, and tartrate resistant acid phosphatase, while promoting serum levels of bone formation markers OCN, and procollagen I N-terminal propeptide. BDMC also improved liver and kidney function in osteoporotic mouse model. Collectively, BDMC improved osteoporosis by enhancing hAMSC osteogenesis and exhibited a protective effect on liver and kidney function in an osteoporotic mouse model. Hence, BDMC may serve as an effective adjuvant, and combined therapy with hAMSCs is a promising new approach toward osteoporosis treatment.

Urodynamic parameters development and complications of clean intermittent self-catheterization in Chinese schoolchildren with neurogenic underactive bladder.

OBJECTIVE: To evaluate the urodynamic parameters, development of bladder function and complications of clean intermittent self-catheterization (CIC) in Chinese schoolchildren with neurogenic underactive bladder. METHODS: Ninety-three children with neurogenic underactive bladder were successfully treated with CIC or combined with oxybutynin for two years follow-up. According to bladder compliance before CIC, they were subdivided into a normal bladder compliance (NBC) group and a low bladder compliance (LBC) group. Urodynamic parameters and complications were recorded. RESULTS: At follow-up, the incidence of neurogenic detrusor overactivity was found to have significantly decreased in both groups. Moreover, maximum cystometric capacity (CC) and relatively safe CC in the NBC group was significantly higher than those before CIC. However, relatively safe CC was significantly lower than that before CIC, and detrusor leakage point pressure was significantly higher than that before CIC in the LBC group. The incidences of bacteriuria, vesicureteral reflux (VUR), febrile urinary tract infections (UTI) and macroscopic hematuria were, respectively, 62, 13, 25 and 15%, and those of VUR and febrile UTI in the LBC group were significantly higher than those in the NBC group. CONCLUSION: For these cases, the complications of CIC are rare, and bladder compliance seems to be correlated with the development of bladder function and complications during CIC.

Corticostriatal control of defense behavior in mice induced by auditory looming cues.

Animals exhibit innate defense behaviors in response to approaching threats cued by the dynamics of sensory inputs of various modalities. The underlying neural circuits have been mostly studied in the visual system, but remain unclear for other modalities. Here, by utilizing sounds with increasing (vs. decreasing) loudness to mimic looming (vs. receding) objects, we find that looming sounds elicit stereotypical sequential defensive reactions: freezing followed by flight. Both behaviors require the activity of auditory cortex, in particular the sustained type of responses, but are differentially mediated by corticostriatal projections primarily innervating D2 neurons in the tail of the striatum and corticocollicular projections to the superior colliculus, respectively. The behavioral transition from freezing to flight can be attributed to the differential temporal dynamics of the striatal and collicular neurons in their responses to looming sound stimuli. Our results reveal an essential role of the striatum in the innate defense control.

[Treatment of thymic diseases by bilateral video thoracoscopes].

OBJECTIVE: To explore the therapeutic efficacy of thymic diseases by bilateral video-assisted thoracoscopes. METHODS: A total of 46 cases with thymic diseases, including benign or malignant thymoma and myasthenia gravis (MG), were operated by bilateral video-assisted thoracoscopes. It was compared with 33 cases undergoing traditional thymic operations. RESULTS: The resection rate was 100%. There was no perioperative mortality. All cases were followed up for 3 years. The 1, 3-year survival rates were 95.7% (44/46) and 91.3% (42/46) versus 93.9% (31/33) and 90.9% (30/33) for a traditional thymic operation respectively. And the difference was insignificant (P > 0.05). The effective remission rate of MG was 91.7% (11/12) versus 92.9% (13/14) for a traditional thymic operation. And the difference was insignificant (chi(2) = 0.17, P > 0.05). CONCLUSION: The treatment of thymic diseases by bilateral video-assisted thoracoscopes can achieve a comparable clinical efficacy of employing a traditional thymic operation. But it is superior in terms of surgical trauma and postoperative recovery.

The effect of familial aggregation on the children with primary nocturnal enuresis.

OBJECTIVE: To evaluate the effect of familial aggregation on the children with PNE by evaluating nocturnal urine output, bladder, and arouse function. PATIENTS AND METHODS: According to whether relatives of family of probands over three generations were affected by PNE, forty-five children with familial aggregation PNE (FPNE), seventy children with sporadic PNE (SPNE) and ten children with normal lower urinary tract function but waiting for operation (control group) were included. Questionnaire of arousal from sleep (AS scores), bladder diary and daytime urodynamic studies were performed in all patients. RESULTS: The incidences of severe PNE and nonmonosymptomatic PNE in FPNE group were significantly higher than those in SPNE group. The nocturnal urine output and AS scores in both PNE groups was significantly higher, maximal voided volume significantly smaller than those in control group. Moreover, the incidences of small bladder in FPNE group was 44%, significantly higher than that in SPNE group (21%), but no significantly difference was found in nocturnal polyuria and arousal AS scores between two PNE groups. There were 53% patents with daytime detrusor overactivity and 60% patents with urodynamic functional bladder outflow obstruction in FPNE group, significantly higher than those in SPNE group (19% and 37%). Maximum cystometric capacity significantly decreased from control group to FPNE group. CONCLUSION: Familial aggregation has significant effects on the children with PNE, and FPNE are more likely to be severe symptoms and bladder dysfunction. It would be beneficial to have an urodynamic study for their diagnosis and treatment. Neurourol. Urodynam. 28:423-426, 2009. (c) 2008 Wiley-Liss, Inc.

[Comparison of three different methods of anesthesia during transrectal ultrasound guided prostate biopsy: a prospective, double-blind, randomized trial.].

OBJECTIVE: To assess the clinical efficacy and safety of three different methods of anesthesia during transrectal ultrasound guided prostate biopsy. METHODS: From July 2006 to October 2008, a total of 120 patients who underwent 12-core prostate biopsy with transrectal ultrasound guidance because of elevated prostate specific antigen and/or abnormal digital rectal examination were randomized into 4 groups, each group consisted of 30 patients. Group A received no anesthesia. Group B received an injection of 10 ml dose of 1% lidocaine (5 ml per side) into the region of the prostatic vascular pedicle at the prostate base just lateral to the junction between the seminal vesicle and prostate on each side for periprostatic nerve block (PNB). Group C received intrarectal lidocaine gel plus PNB. Group D received an injection of 4 ml dose of 1% lidocaine (2 ml per side) into 2 sites of the right and left sides of prostate for intraprostatic anesthesia plus PNB. The efficiency of anesthesia was assessed by a visual analog pain scale (VAS). All patients were followed up within one week for the evaluation of complications. RESULTS: The combination of intraprostatic anesthesia and PNB provided significantly better pain control than PNB alone. According to VAS, only group C (2.7 +/- 1.1) scores showed significantly better pain control than other groups (P < 0.05) during probe insertion, and only group D (3.9 +/- 1.3) scores showed significantly better pain control than other groups (P < 0.05) during biopsy. No difference was observed regarding the complications rate in the 4 groups (P > 0.05). CONCLUSIONS: Combination of intraprostatic anesthesia and PNB is effective and safe technique during transrectal ultrasound guided prostate biopsy without increasing the incidence of complications. PNB or PNB plus intrarectal lidocaine gel couldn't significantly reduce pain during biopsy.

Prostate cancer antigen-1 as a potential novel marker for prostate cancer.

AIM: To examine the expression of prostate cancer antigen-1 (PCA-1) in prostate cancer (PCa) and to validate it as a potential marker for diagnosis of PCa. METHODS: In situ hybridization analysis of PCA-1 mRNA expression was performed on 40 benign prostate hyperplasia (BPH), 16 high-grade prostatic intraepithelial neoplasm (HG-PIN), 74 PCa and 34 other malignant carcinoma specimens. The level of PCA-1 expression was semiquantitatively scored by assessing both the percentage and intensity of PCA-1 positive staining cells in the specimens. We then compared the PCA-1 expression between BPH, HG-PIN and PCa and evaluated the correlation of PCA-1 expression level with clinical parameters of PCa. RESULTS: PCA-1 mRNA was expressed in the majority of both PCa and HG-PIN specimens but not in BPH and other malignant carcinoma. The expression level of PCA-1 increased along with a high Gleason score (P < 0.05), and was unrelated to other clinical parameters of PCa (all P > 0.05). CONCLUSION: The data suggest that PCA-1 might be a novel diagnostic marker for PCa, and that increased PCA-1 expression might denote more aggressive variants of PCa.

[Expression of prostate cancer antigen-1 in prostate cancer and its clinical significance].

OBJECTIVE: To investigate the expression of prostate cancer antigen-1 (PCA-1) in different prostate tissues and analyze its correlation with the clinical parameters of prostate cancer (PCa). METHODS: The expression of PCA-1 mRNA was detected by RT-PCR in the samples from 45 cases of PCa with various clinico-pathologic characteristics, 30 cases of high-grade prostatic intraepithelial neoplasia (HG-PIN), 43 cases of BPH and 39 cases of other carcinoma tissues. The correlation of PCA-1 mRNA expression with the clinical parameters of PCa was statistically analyzed and the PCA-1 expression was examined in different samples by immunohistochemistry. RESULTS: The positive expression rate of PCA-1 mRNA was 88.9% and 60.0% and that of PCA-1 protein was 84.4% and 50.0% in the patients with PCa and HG-PIN, respectively. PCA-1 mRNA and PCA-1 proteins were not expressed in the BPH and other carcinoma tissues. The expression of PCA-1 mRNA was unrelated with the clinical parameters of PCa (P > 0.05). CONCLUSION: It is suggested that PCA-1 is a PCa-specific gene and its expression is unrelated to the clinical parameters of PCa. It might serve as a specific biomarker for the early diagnosis of PCa.

Expression of miRNA-630 in bladder urothelial carcinoma and its clinical significance.

Many studies informed that microRNAs (miRNAs) could function as diagnostic and prognostic indicators in several cancers. The aims of this study were to explore the expression of miR-630 in bladder urothelial carcinoma and its clinical significance for the evaluation of cancer prognosis. A total of 116 patients with bladder urothelial carcinoma were obtained in this retrospective study between May, 2012 and Sep. 2015. Quantitative real-time PCR (qRT-PCR) was conducted to evaluate the expression level of miR-630. The chi-square test was used to examine the associations between miR-630 expression and the clinicopathological features. The Kaplan-Meier method was conducted to explore the survival status of urothelial carcinoma patients. The log-rank test was used to analyze differences in survival rate. The results showed an obvious increase in miR-630 expression from normal bladder to bladder urothelial carcinoma (P=0.027). Additionally, patients with higher miR-630 expression had significantly shorter disease-free survival (DFS) (P=0.043) and overall survival (OS) (P=0.038) than those with lower miR-630 expression. Furthermore, multivariate analysis revealed that up-regulation of miR-630 was an independent prognostic factor for both DFS (P=0.042) and OS (P=0.046). It was demonstrated that miR-630 may be a novel and valuable prognostic factor for bladder urothelial carcinoma.

Clinicopathological significance of matrix metalloproteinase 2 protein expression in patients with renal cell carcinoma: A case-control study and meta-analysis.

BACKGROUND: Numerous previous studies explored the influence of matrix metalloproteinase 2 (MMP-2) expressions on renal cell carcinoma (RCC), yet inconsistent results were reported. OBJECTIVE: This study aims to derive a more precise estimation of the associations between MMP-2 and RCC. METHODS: A total of 115 patients with RCC were selected; meanwhile, 45 patients with traumatic rupture of renal cysts or renal calculi were recruited and normal kidney tissues were collected as control group. The expression level of MMP-2 protein was detected by using immunohistochemistry. A meta-analysis was performed by using Comprehensive Meta-analysis 2.0 (CMA 2.0). RESULTS: The positive expression rate of MMP-2 protein in the RCC tissues was evidently higher than that in the normal renal tissues (P < 0.001). The positive expression rate of MMP-2 protein in patients with tumor size > 5 cm, with lymph node metastasis (LNM), with well-differentiated RCC, and stage III-IV RCC was significantly higher, compared with the patients with tumor size ≤ 5 cm, without LNM, with moderate/low-differentiated RCC, and with stage I-II RCC, respectively (all P < 0.05). There was statistical significance in the 5-year survival rate between the patients with positive MMP-2 protein expression and those with negative MMP-2 protein expression (P = 0.037). These results were further confirmed by the meta-analysis. CONCLUSION: MMP-2 protein expression is significantly associated with historical grade, TNM stage, tumor size and LNM in RCC, suggesting that MMP-2 may serve as a biological marker for the prognosis in RCC.

[Heme oxygenase-1 gene transfer protects rat kidney transplant from ischemia/reperfusion injury].

OBJECTIVE: To investigate the protective effect of Heme oxygenase-1 (HO-1) gene transfer on rat renal autograft against ischemia/reperfusion injury. METHODS: HO-1 recombinant adenovirus vectors were constructed and transduced into rat renal autograft by renal arterial perfusion. The renal autografts were transplanted orthotopically after store at 4 degrees C for 24 h, followed by contralateral native nephrectomy 5 d after transplantation. There were 25 rats in the control group. 5 h and 3 d after transplantation, reverse transcriptase polymerase chain reaction (RT-PCR) and immunohistochemistry were used to detect the expression of HO-1 gene; enzyme-labeled immunosorbent (ELISA) was used to measure HO-1 protein content in the homogenate of renal autograft. RESULTS: The intensity of HO-1mRNA expression at 3 h and 3 d after transplantation were 0.65 +/- 0.11, 0.86 +/- 0.17 in the experimental group and 0.09 +/- 0.01, 0.15 +/- 0.02 in the control group respectively. The differences between the two groups were significant (t = 14.38, 11.73, P < 0.05). HO-1 protein content at 3 h and 3 d after transplantation were significantly increased in the experimental group, as compared with the control group [(297 +/- 61) ng/g and (468 +/- 51) ng/g versus (98 +/- 30) ng/g and (155 +/- 31) ng/g; t = 8.27, 14.83, P < 0.05]. HO-1 transduced autografts had less renal ischemic injury and lower serum creatinine level compared with control animals (P < 0.05). CONCLUSION: Adenoviral vector can successfully transduce rat kidneys with the HO-1cDNA, which can protect rat renal autografts from ischemia/reperfusion injury.

Laparoscopic Extravascular Stent Placement for Nutcracker Syndrome: A Report of 13 Cases.

OBJECTIVE: To report our techniques and experience of laparoscopic extravascular stent placement for nutcracker syndrome. PATIENTS AND METHODS: This study included 13 nutcracker syndrome patients who were treated by laparoscopic extravascular stent placement from June 2009 to August 2013. Clinical and surgical data and short-term outcomes were analyzed retrospectively. RESULTS: The average duration of the operation was 72 minutes and the average blood loss was 30 mL. The average postoperative length of stay was 6 days. Retroperitoneal hematoma was relieved by conservative therapy in one patient. The postoperative computed tomography showed that the blood outflow of the left renal vein was smooth and the inner diameter was also decreased. The gonadal vein varices diminished in diameter in four patients. The follow-up was 8-52 months (mean 32.6); symptoms resolved in 10 patients and improved in 2 patients. One patient developed recurrent gross hematuria because of migration of the extravascular stent. CONCLUSION: Laparoscopic extravascular stent placement appears feasible and safe and it is a minimally invasive alternative to open surgery.

[Transperitoneal laparoscopic adrenalectomy for adrenal neoplasm: a report of 371 cases].

BACKGROUND AND OBJECTIVE: Open adrenalectomy has been almost replaced by mini-invasive laparoscopic surgery. There are two popular mini-invasive laparoscopic adrenalectomy approaches: retroperitoneal and transperitoneal approaches. This study was to summarize our experience in transperitoneal laparoscopic adrenalectomy. METHODS: In total 371 cases undergoing transperitoneal adrenalectomy in the First Affiliated Hospital of Zhengzhou University from February 2003 to August 2008 were reviewed retrospectively. There were 127 cases of primary hyperaldosteronism adenoma, 117 cases of Cushing's adenoma, 58 cases of phaeochromo-cytoma, 37 cases of incidentoma and 32 cases of other types. The type of adrenal diseases, operating time, blood loss, complications and prognosis were summarized and the operating method was analyzed. RESULTS: Three hundred and sixty-five out of 371 patients (98.4%) were successfully operated, five cases (1.4%) were transferred to open surgery, and one patient gave up surgery due to extensive invasion. The operating time was 40-240 min (average, 70 min). The blood loss was 20-1000 ml (average, 80 ml). Two patients suffered from diaphragm injuries, one patient had right renal vein injury and one had colon injury. The mean time of hospital stay was five days. CONCLUSION: Transperitoneal laparoscopic adrenalectomy is one of the favorable approaches for the treatment of adrenal neoplasm.

Bed-wetting in Chinese children: epidemiology and predictive factors.

AIMS: To estimate the prevalence and severity of bed-wetting in 1-18-year-old Chinese children. MATERIALS AND METHODS: A cross-sectional study of bed-wetting was performed by using 13,515 self-administered questionnaires distributed to the parents of 1-18-year-old Chinese children in Henan province. The prevalence of bed-wetting was determined. The relationship of wetting to age, gender, community characteristics (rural or urban), arousal dysfunction, associated day-time symptoms (frequency, urgency, and incontinence), and family history were analyzed. RESULTS: There was a response rate of 87% (5,978 boys and 5,786 girls). The overall prevalence of bed-wetting was 23.03% in those aged 1-4, 5.66% in those 5-12, and 1.37% in those 13-18. When a logistic regression analysis was applied to determine risk factors for the bed-wetting, a positive relationship was seen with male gender and living in rural areas. Further, living in rural areas, arousal dysfunction, and associated day symptoms were significantly related to more severe bed-wetting. Only 3.64% of the children had undergone professional evaluation. CONCLUSION: The prevalence of bed-wetting is significant in Chinese children, but lower than in most western countries, which is likely due to cultural differences. Living in rural areas, having arousal dysfunction, and having associated day-time symptoms may be predicative factors for marked bed-wetting.

Is it possible to use urodynamic variables to predict upper urinary tract dilatation in children with neurogenic bladder-sphincter dysfunction?

OBJECTIVE: To investigate the possibility of using urodynamic variables to predict upper urinary tract dilatation (UUTD) in children with neurogenic bladder-sphincter dysfunction (NBSD). PATIENTS AND METHODS: The study included 200 children with NBSD, of whom 103 had UUTD and 97 did not; they were examined using routine urological, neurological and urodynamic methods. The group with UUTD was divided into three subgroups (group 1-3, from mild to severe hydronephrosis). A urodynamic risk score (URS) was calculated, including a detrusor leak-point pressure (DLPP) of >40 cmH2O, a bladder compliance (BC) of <9 mL/cmH2O and evidence of acontractile detrusor (ACD). RESULTS: The postvoid residual urine volume (PVR), DLPP, incidences of ACD and DLPP of >40 cmH2O were greater and the BC significantly less in groups 1-3 than in the control group. Moreover, the BC decreased, while the PVR, DLPP and the incidence of DLPP of >40 cmH2O were significantly higher in group 3 than in group 2. The relative safe cystometric capacity of groups 2 and 3 were lower, respectively, than that of the control and group 1, and the relative unsafe cystometric capacity (RUCC) and relative risk rate of cystometric capacity (RRRCC) were significantly greater with the severity of UUTD. The maximum detrusor pressure on voiding or at maximum flow rate, and the Abrams-Griffiths number for voluntary contractile bladders, of the UUTD group were significantly higher than those of the control group. There was a positive correlation between URS and UUTD. CONCLUSIONS: The selective use of urodynamic variables might be valuable for predicting the risk of UUTD in children with NBSD. Decreased BC, and increased DLPP and ACD are the main urodynamic risk factors, and they reciprocally increase the occurrence and grades of UUTD. The grades of UUTD are compatible with increases in RUCC, RRRCC and URS.