Current status and prospect of surgical technique of liver transplantation / 器官移植

Along with the increasing quantity of patients with end-stage liver diseases year by year, as an efficacious treatment, the safety and efficacy of liver transplantation are critical issues to be considered. In addition, liver transplant techniques have become a new research hot spot. In recent years, liver transplant techniques are constantly innovating and developing with the unremitting efforts of researchers. Researchers have successively developed multiple liver transplant techniques, such as split liver transplantation, ischemia-free liver transplantation, liver xenotransplantation, domino liver transplantation, delayed total hepatectomy combined with liver resection and segment Ⅱ-Ⅲ liver transplantation, heterotopic auxiliary liver transplantation on splenic fossa and magnetic anastomosis. It has laid a foundation for expanding the donor pool, improving clinical efficacy of liver transplantation and enhancing the quality of life of liver transplant recipients. In this article, the exploration, development, innovation and improvement of liver transplant techniques were reviewed and prospected, aiming to provide reference for clinical application of liver transplantation.

Current status and progress of treatment for hepatocellular carcinoma with portal vein tumor thrombus / 中华消化外科杂志

Hepatocellular carcinoma (HCC) is the fifth most common cancers worldwide, which ranks as the second of cancer-related death. Each year, more than half of the new and death cases occur in China. Vascular invasion is one of the important biological characteristics of HCC. HCC with portal vein tumor thrombus is closely related to the prognosis of patients, but there is no consensus on the best treatment method.Based on domestic and foreign literatures, the authors discuss the current status and progress of treatment for HCC with portal vein tumor thrombus, in order to explore the optimal treatment.

Research progress in diagnosis and treatment of cystitis glandularis / 国际外科学杂志

Cystitis glandularis is a hyperplastic disease originated from the bladder mucosa, cystitis glandularis is a rare clinical disease, there is no standard diagnosis and treatment. The etiology and pathogenesis of cystitis glandularis are still unknown, it can be diagnosed according to clinical manifestations, laboratory and auxiliary examinations, and the diagnosis of cystitis glandularis mainly depends on pathological results. Cystitis glandularis has a cancerous tendency. The clinical treatment methods of cystitis glandularis include conservative treatment, surgical treatment and surgical combined with drug therapy, but different types of treatment methods are different, and most patients are treated by surgery combined with drug perfusion of the bladder.This article will review the research progress in diagnosis and treatment of cystitis glandularis.

Progress in the diagnosis and treatment of adrenal metastatic carcinoma / 国际外科学杂志

Adrenal gland is one of the most common metastases from malignant tumors. Most adrenal metastases have not completely destroyed adrenal tissue, so most patients have no clinical symptoms. The main methods for the diagnosis of adrenal metastases are CT, magnetic resonance imaging and positron emission tomography. At present, there is still controversy about the treatment of adrenal metastasis of all kinds of adrenal metastases. Non-surgical treatment mainly includes chemical drug therapy, radiotherapy, interventional therapy and so on. With the development of cognition and technology, the mode and indication of surgical treatment have also changed. In this paper, the diagnosis and treatment of adrenal metastases in recent years are reviewed.

Construct a predictive model to avoid excessive biopsy screening in patients with PI-RADs v2 3 / 国际外科学杂志

Objective@#Assist in clinical decision making by building models to predict the probability of clinically significant prostate cancer (CSPCa) with prostate imaging reporting and data system version 2 (PI-RADs v2) 3 and avoid unnecessary biopsy.@*Methods@#It’s a retrospective study which maintained database of 218 consecutive men who received prostate biopsy and with PI-RADs v2 category 3 in Capital Medical University, Beijing Friendship Hospital between January 2012 to July 2018, the average age was 70.7 years, and the age range was 63-77 years. Among them, 137 patients with benign diseases, 30 patients with clinically insignificant prostate cancer (CIPCa), and 51 patients with CSPCa. Models were established based on clinical variables. The measurement data were expressed as the median (interquartile range) [M(P25, P75)], and the rank sum test was used for comparison between groups; the Chi-square test was used for comparison between the count data groups. The decision curve was used to determine the clinical net benefit unilateral factors generated by the application of the model, univariate and multivariate logistic regression analysis to determine the predictors of positive outcomes. The diagnostic performance of the predictive model was evaluated by the area under the curve (AUC) of receiver operating curve, which was used to assess the overestimation or underestimation of the model, and the decision curve was used to determine the clinical net gain from the application of the model.@*Results@#Detection of prostate caner (PCa) and CSPCa in the PI-RADs v2 cohort were 37.2% (81/218) and 23.4% (51/218). The median prostate specific antigen of CSPCa patients was 12.1 ng/ml, which was higher than CIPCa (9.5 ng/ml) and benign (10.5 ng/ml) patients. The median prostate volume of CSPCa patients was 41.2 ml, lower than CIPCa (45.8 ml) and benign (57.3 ml) patients. The median prostate special antigen density (PSAD) was 0.28 ng/ml2, higher than CIPCa (0.20 ng/ml2) and benign (0.15 ng/ml2) patients. The predictive power of the developed model, based on age, PSAD, lesion region and ADC value, showed a higher AUC than that of parameters alone. Internally validated calibration curves showed that the nomogram might overestimate the risk of PCa when the threshold was above 35%. As for CSPCa, the predicted risk was closer to actual probability when the threshold was above 60%. Decision curves showed that a better net benefit was met when the model was used to guide clinical practice.@*Conclusions@#The models based on age, PSAD, lesion region and ADC value showed internally validated high predictive value for both PCa and CSPCa. It could be used to improve the detection rate of CSPCa and avoid unnecessary biopsy.

Construct a predictive model to avoid excessive biopsy screening in patients with PI-RADs v2 3 / 国际外科学杂志

Objective Assist in clinical decision making by building models to predict the probability of clinically significant prostate cancer (CSPCa) with prostate imaging reporting and data system version 2 (PI-RADs v2) 3and avoid unnecessary biopsy.Methods It's a retrospective study which maintained database of 218 consecutive men who received prostate biopsy and with PI-RADs v2 category 3 in Capital Medical University,Beijing Friendship Hospital between January 2012 to July 2018,the average age was 70.7 years,and the age range was 63-77 years.Among them,137 patients with benign diseases,30 patients with clinically insignificant prostate cancer (CIPCa),and 51 patients with CSPCa.Models were established based on clinical variables.The measurement data were expressed as the median (interquartile range) [M(P25,P75)],and the rank sum test was used for comparison between groups;the Chi-square test was used for comparison between the count data groups.The decision curve was used to determine the clinical net benefit unilateral factors generated by the application of the model,univariate and multivariate logistic regression analysis to determine the predictors of positive outcomes.The diagnostic performance of the predictive model was evaluated by the area under the curve (AUC) of receiver operating curve,which was used to assess the overestimation or underestimation of the model,and the decision curve was used to determine the clinical net gain from the application of the model.Results Detection of prostate caner (PCa) and CSPCa in the PI-RADs v2 cohort were 37.2％ (81/218) and 23.4％ (51/218).The median prostate specific antigen of CSPCa patients was 12.1 ng/ml,which was higher than CIPCa (9.5 ng/ml) and benign (10.5 ng/ml) patients.The median prostate volume of CSPCa patients was 41.2 ml,lower than CIPCa (45.8 ml) and benign (57.3 ml) patients.The median prostate special antigen density (PSAD) was 0.28 ng/ml2,higher than CIPCa (0.20 ng/ml2) and benign (0.15 ng/ml2) patients.The predictive power of the developed model,based on age,PSAD,lesion region and ADC value,showed a higher AUC than that of parameters alone.Internally validated calibration curves showed that the nomogram might overestimate the risk of PCa when the threshold was above 35％.As for CSPCa,the predicted risk was closer to actual probability wben the threshold was above 60％.Decision curves showed that a better net benefit was met when the model was used to guide clinical practice.Conclusions The models based on age,PSAD,lesion region and ADC value showed internally validated high predictive value for both PCa and CSPCa.It could be used to improve the detection rate of CSPCa and avoid unnecessary biopsy.

Gene therapy with induced pluripotent stem cells:a hope for beta thalassemia? / 中国组织工程研究

BACKGROUND: Beta thalassaemia is a monogenic disease, which lacks effective clinical treatments. Hematopoieticstem cell transplantation currently is the only radical treatment for beta thalassaemia, but the limits of suitable donor and costs minimize its clinical application. Given the technology of reprogramming using somatic cells is well established,gene therapy using induced pluripotent stem cells has become the new direction of beta thalassaemia treatment.OBJECTIVE: To put forward the advantages of CRISPR/Cas9 technology in gene therapy of beta thalassaemia in thefuture by summarizing the mechanisms of three kinds of gene editing technologies and the preliminary experimentalresults in animal models.METHODS: In order to search relevant articles about beta thalassaemia, the first author retrieved PubMed database andCNKI (from 1989 to 2015) using the key words of beta thalassemia, genetic therapy, genome editing, homologousrecombination, iPSCs in English and Chinese, respectively. After eliminating literatures which were irrelevant toresearch purpose or containing a similar content, 67 articles were chosen for further analysis.RESULTS AND CONCLUSION: Gene editing technology has made considerable progress and three kinds of directedgene editing technologies have been developed, including ZFNs, TALENs, CRISPR/Cas technology. By targeting inducedpluripotent stem cells from thalassemi patients, these three kinds of gene editing technologies have been expected tocorrect pathogenic genes of thalassemia. The CRISPR/Cas system is more simple, rapid, safe and efficient than the others.The CRISPR/Cas9 system is expected to repair β-globin genes in the induced pluripotent stem cells, germ cells, fertilizedeggs and embryos from beta thalassaemia patients, laying the foundation for future clinical application.

Changes of sTim-3/HMGB1 and Spot forming cells of TGF-β secreting from peripheral blood mononuclear cell in patients infected with brucella / 中国免疫学杂志

Objective:To investigate the changes of sTim-3,HMGB1 and TGF-β in the brucellosis patients and to analyse the relationship between the changes of these molecules and brucella infection. Methods:28 cases of brucellosis patient untreated and 28 healthy control cases in the age and gender matched with brucellosis cases were collected. The serum levels of sTim-3 and HMGB1 were detected by ELISA,and the levels of Spot forming cells secreting TGF-β were measured by ELISPOT in patients and healthy control group. Results: Compared with healthy controls, sTim-3/HMGB1 expression levels and Spot forming cells secreting TGF-β were significantly increased in the brucellosis patients ( P<0. 01 ) . The changes of Spot forming cells secreting TGF-β were positively correlated with the levels of HMGB1 (P<0. 05). Conclusion:The serum levels of sTim-3/HMGB1 and Spot forming cells of secreting TGF-β from peripheral blood mononuclear cell are significantly increased in the brucellosis patients. Those molecules may be involved in the process of brucella infection and may play a significant role in the immune escape of patients infected with brucella.

MicroRNA-133a antagonizes phenylephrine-induced hypertrophy of neonatal rat cardiomyocytes in vitro / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the mechanism of miR-133a in reversing neonatal rat cardiomyocyte hypertrophy induced by phenylephrine.</p><p><b>METHODS</b>A miR-133a precursor cDNA was used to construct an adenovirus vector, which was transfected into 293 cells to harvest miR-133a-containing virus. Neonatal rat cardiac myocytes treated by phenylephrine were exposed to miR-133a adenovirus, and the changes in cell area was measured; the expression levels of miR-133a and Acta1, Actc1, Actb, Myh6, Myh7, and BNP mRNAs were detected by quantitative RT-PCR.</p><p><b>RESULTS</b>Phenylephrine treatment increased the area of cardiomyocytes by more than 3 folds and significantly enhanced the expression levels of Acta1, Actc1, Actb, Myh6, Myh7 and BNP mRNAs. All these changes were obviously reverse by miR-133a treatment.</p><p><b>CONCLUSION</b>miR-133a is an important regulator of phenylephrine-induced cardiomyocyte hypertrophy and negatively regulates this process.</p>

Management of advanced renal cell carcinoma / 国际外科学杂志

Radiotherapy and chemotherapy have little or no effect on advanced renal cell carcinoma, leading to a poor prognosis. Several factors couLd affect the survival rate of RCC. Some RCC patients could partly respond to immunotherapy.The newly emerging targeted therapy has a dramatic tuning point in improving outcomes for RCC. Further understanding of the anti-RCC mechanisms involves in chemokine-mediated angiogenesis and RCC cell proliferation. These new agents include Sorafenib, Sunitinib, Temsirolimus, Bevacizumab, etc. Combination treatment with immunotherapy may lead to improved outcomes in this disease.

Analysis of demethylation drug 5-aza-2'-deoxycytidine in growth inhibition on bladder tumor cell / 中华泌尿外科杂志

Objective To study the growth suppressive effect of demethylation drug 5-aza-2'-deoxycytidine on bladder tumor cells. Methods The growth suppressive effect of DAC on 4 transitional cell carcinoma (TCC) cell lines was measured using the Cell Proliferation Reagent WST-1 assay.The effects of DAC on apoptosis induction and cell cycle arrest were analyzed by flow cytometric analysis. Caspase 3, 9 activities were analyzed by APOPCYTO Caspase Colorimetric Assay Kit and PCNA expression was also investigated by Western blot to clarify the mechanism of DAC against TCC. Results DAC inhibited the growth of all TCC cell lines tested in a dose-dependant manner, however,growth suppressive effect of DAC was independent of p53 status in TCC. DAC inhibited proliferation via inducing G2/M cell cycle arrest but not via inducing apoptosis. After treated with 0, 1 and 8 μmol/L DAC, cells of RTl 12 in G2/M phase was (36.3 ± 3.4) %, (46.2 ± 4.6) % and (56.5 ±6.2) %, TCCsup was (37.5 ± 3.8) %, (48.4 ±4.9) % and (60.1 ± 6.7) %, respectively. The expression of PCNA was decreased by DAC, but caspase3, 9 activities were not activated. Conclusion DAC could suppress the growth of TCC cells and might be a new strategy to treat bladder malignancy in the future.

Pure laparoscopic radical nephrectomy and thrombectomy for renal tumors with renal vein and vena caval thrombus / 中华泌尿外科杂志

Objective To evaluate the feasibility of using pure laparoscopic radical nephrectomy and thrombectomy to treat renal tumor with renal vein and vena caval thrombus. Methods Two ca-ses o{ right renal tumor with renal vein and vena caval thrombus were reported. Contrast-enchanced CT showed renal tumor extended into renal vein and vena cava in 1 case, and filling defect was found in right renal vein and extended to vena cava in the other. Both patients received pure laparoscopic ra-dical nephrectomy and thrombectomy through retroperitoneal approach. Four trocars were placed du-ring the operation, and the renal artery was dissected before the vena cava was mobilized circumferen-tially above and below the renal vein, a faparoscopic vessel blockage clamp was used to partly occlude the vena cava containing the thrombus. The vena cava was repaired after the intact tumor thrombus was extracted. Results The tumor thrombus extended 0.3 cm and 1.0 cm above the renal vein, re-spectively. Both patients were discharged 5 d after operation. Pathological examinations showed that tumors were epithelioid renal angiomyolipoma and grade Ⅰ-Ⅱ clear cell carcinoma separately. Both patients were free of local recurrence and metastasis 5 months after operation. Conclusion Pure la- paroscopic radical nephrectomy and thrombectomy for renal tumor with vena caval and renal vein thrombus is feasible in carefully selected patients.

A reformed ureteral stripping technique and its application in the treatment of post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidney / 中华泌尿外科杂志

Objective To evaluate the clinical outcomes of a reformed endoscope assisted ureteral stripping technique in post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidney.Methods Seven post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidneys(2 males and 5 females)with average age of 54 years old were recruited.Standard retroperitoneal laparoscopic nephrectomies were performed for all patients after placement of a 5 F ureteral stent as the ureteral stripper. After the closure of the ureter at the lower kidney pole level with metal clips, the distal ureter was separated and the ureteral muscle layer and serous membrane layer were split. The ureter muscle layer was then tied tightly to the ureteral stent tip. The ureter and the stent were pulled out through urethra. Transurethral resection around the everted ureteral orifice was performed and the ureter was removed afterwards. The graft function, operation time,complication and estimated blood loss were recorded.Results All the 7 patients successfully underwent the operations and no major complication such as ureteral disruption, stripping embarrassment and converting to open operation happened. The mean operation time was 126 min (ranging from 105 to 160 min) and the mean blood loss was 124 ml (ranging from 80 to 160 ml). Introvesical chemotherapy with farmorubine hydrochloride was performed 3 weeks after surgery. The mean preoperation and 6 months post-operation creatinine and urea nitrogen levels were 136.5μmol/L, 138. 6μmol/L and 7.42 mmol/L, 7.80 mmol/L respectively and there was no statistical difference. There was no tumor recurrence during 6 month follow-up except one case having simultaneous bladder cancer had bladder cancer relapse 3 months after operation and required another TURBt.Conclusion The reformed endoscope assisted ureteral stripping technique is minimally invasive and convenient in the treatment of post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidney.

Surgical treatment of retroperitoneal fibrosis / 中华泌尿外科杂志

Objective To evaluate the effect of surgical treatment on patients with retroperitoneal fibrosis. Methods The medical records of 24 retroperitoneal fibrosis patients (19 men and 5 women;mean age,52 years) who had been surgically treated from January 1985 to December 2003 were retrospectively analyzed.The initial clinical presentations included low back and abdominal pain in 11 cases,acute anuresis in 5 and incidental bilateral hydronephrosis in 8.Double-J inter-ureter drainage was performed in 11 cases, among whom the procedure failed in 4 cases, and then they underwent pricking pyelostomy.After their general condition improved,ureterocutaneostomy and ureterolysis were performed in 2 cases and 1 case, respectively.Of them 1 case died of acute myocardial infarction 3 months later.Thirteen cases who had good general condition at diagnosis underwent ureterolysis. Results One patient developed renal function failure due to repeated urinary infection 3 years after operation.One died of acute myocardial infarction 3 months after operation.The other 22 patients recovered well,and their mean creatinine level decreased from 450.9?mol/L before operation to 318.2 ?mol/L (1 month) and 265.2 ?mol/L (3 months),respectively,after operation. Conclusions Prompt and appropriate relief of urinary obstruction with surgical treatment can effectively protect the renal function in patients with retroperitoneal fibrosis.