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PURPOSE: This study aimed to evaluate the prognostic impact of lymphovascular invasion (LVI) in patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: We collected data from 180 patients who were treated with RNU from 2005 to 2013 at our institution. The Kaplan-Meier method with log-rank test and Cox proportional hazards regression models were used for univariate and multivariate analyses. RESULTS: LVI was present in 28 patients (15.6%), which was associated with higher pathological tumor stage (p < 0.001), tumor necrosis (p=0.012), lymph node metastasis (p=0.017) and multifocality (p=0.012). On multivariate analysis, LVI was an independent prognostic factor of recurrence-free survival [RFS: hazard ratio (HR)=2.954; 95% confidence interval (CI)=1.539–5.671; p=0.001] and cancer-specific survival (CSS: HR=3.530; 95% CI=1.701–7.325; p=0.001) in all patients. In patients with node-negative UTUC, LVI was also a significant predictor of RFS (HR=3.732; 95% CI 1.866–7.464; p < 0.001) and CSS (HR=3.825; 95% CI=1.777–8.234; p=0.001). CONCLUSION: LVI status was an independent predictor in patients with UTUC who underwent RNU. The estimate of LVI could help physicians identify high-risk patients and make a better medication regimen of adjuvant chemotherapy.
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Humans , Carcinoma, Transitional Cell , Chemotherapy, Adjuvant , Lymph Nodes , Methods , Multivariate Analysis , Necrosis , Neoplasm Invasiveness , Neoplasm Metastasis , Prognosis , Urinary TractABSTRACT
Objective To investigate the correlation between ultrasound findings and clinical pathological types of adrenal cortical tumors(ACT).Methods The clinical data and ultrasonographic finding of 138 ACT patients undergoing surgical treatment in Affiliated Hospital of Qingdao University from January 2006 to December 2015 were retrospectively reviewed.The correlation between ultrasonic signs and pathological types of ACT was analyzed with Spearman method.Results There were 65 males and 73 females aged 18-71 years old.Among 138 cases,90 patients were characterized by hypertension,Cushing signs,Coon signs and abnormal sexual character, with the clinical diagnosis of adrenal cortical hyperplasia or adenoma;while 48 asymptomatic patients were first detected by ultrasonography.The coincidence rate of ultrasound and clinical pathological diagnosis was 92.0%(127/138),and 11 cases were misdiagnosed.The coincidence rate of ultrasound and surgical diagnosis was 94.2%(130/138), and 8 cases were misdiagnosed.The coincidence rate for no functional adenoma was 95.8%(46/48), for cortisol cortical adenoma was 94.1%(32/34),for aldosterone cortical adenoma was 93.6%(29/31),for cortical cysts was 9/10,for no functional adenocarcinoma was 5/6,for sexual abnormal cortical adenocarcinoma was 3/4,for cortisol cortical adenocarcinoma was 2/3,for mucous cortical adenoma was 1/2.The diameter of ACT was 0.6-11.5 cm.The low echo nodules of the adrenal region with a diameter <2.0 cm were associated with aldosterone cortical adenomas(r=0.485, P=0.01); the low echo or isoechoic nodules with a diameter 2.0-5.0 cm were associated with cortical adenomas or non-functional adenomas(r=0.567,0.452,P=0.01),and the circular non-echo nodules were associated with cortical cysts(r=0.483, P=0.01); the irregular nodules with a diameter >5.0 cm were associated with cortical adenocarcinoma(r=0.595, P=0.01).Conclusion The ultrasound image of ACT is related to different clinical pathological types,which can provide important information for clinical diagnosis and selection of surgical modalities.
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Objective To explore clinical value of the color Doppler ultrasonic(CDU)and TNM staging of renal cell carcinoma.Methods 265 cases of renal cell carcinoma(RCC)confirmed by surgical pathology were retro-spectively analyzed.According to the WHO 2004 pathological types of classification standards and the American Joint Committee on Cancer(AJCC)cancer staging manual/6th TNMstaging criteria.The analyzed application of a CDFI to TNMstaging of renal cell carcinoma,and surgical pathology results werecompared.Results 265 cases of RCC and right kidney in 136 cases,129 cases of left kidney;Diameter of 1.5 -12.8cm;Pathological diagnosis of renal clear cell carcinoma in 226 cases(85.28%),28 cases of papillary renal cell carcinoma(10.57%),renal too color cell car-cinoma in 5 cases(1.89%),4 cases of multilocular cystic renal cell carcinoma(1.51%),Bellini duct carcinoma in 2 cases(0.75%).Diagnosis results of CDU and pathological in 250 cases(94.34%),CDU misdiagnosis leakage 15 cases(5.66%).Within the kidney showed low echo or high echo,and mixed echo lumps,and invasive growth to the surrounding tissues or organs sign for it.CDU showed the various blood flow signals were given priority to with renal clear cell carcinoma;CDU and surgical pathology TNMstaging coincidence rate was 90.40%(226 /250),inclu-ding T1 N0 -1 M0 ,T2 N0 -1 M0 ,T3 N0 -2 M0 -1 and T4 N0 -2 M0 -1 of coincidence rate were 92.12%(152 /165),85.71%(36 /42),82.14%(23 /28)and 100.00%(15 /15).Conclusion CDU can be used as the preferred method of diag-nosis and evaluation of renal cell carcinoma,which can can provide valuable information for TNMstaging.
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Objective To understand the application and effect of problem based,case based and evidence based (PCE) combined teaching method in urology surgery clinical teaching.Methods A total of 50 clinical medicine students were selected.PCE combined teaching method was applied in urology surgery clinical teaching and the teaching effect was evaluated.Results The ratios of student who thought PCE combined teaching method could stimulate learning enthusiasm,improve learning efficiency and improve the abilities of logical thinking,inductive analysis,practical application,self-study,literature retrieval,innovation and team cooperation were 96％,94％,95％,94％,100％,88％,100％,96％ and 95％ respectively.All students thought this new teaching method could be extended in other subjects.Conclusions Application of PCE combined teaching method in urology surgery clinical teaching can achieve good teaching effect and it is worth recommending in clinical teaching.
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Objective To study efficacy and safety of large dose of pamidronate disodium in treatment for patients with painful bone metastasis of prostate cancer. Methods A total of 100 patients with painful bone metastasis of prostate cancer were randomized into large dose group and conventional dose group, with 50 cases each. Pamidronate disodium was administered by intravenous infusion, 90 mg on the first day and 60 mg on the second day for large dose group, and 60 mg on the first day and 30 mg on the second day for conventional dose group, respectively, every 4 weeks for two courses. Changes of pain,mobility, quality of life and adverse effect in patients before and after treatment were observed. Results After treatment, pain was relieved in 43 of 50 patients ( 86% ) in large dose group, significantly more than that in conventional dose group (21/50, 42% ) (χ2 = 22.79, P ＜ 0. 01 ). Both mobility and quality of life were improved in 39 and 33 patients ( 87% and 66% ), respectively in large dose group and 21 and 18 (46% and 36% ), respectively in conventional dose group (χ2 = 17.04 and 9. 00, P ＜0. 01 ). No severe adverse effect in both groups was observed. Conclusions Pain in patients with bone metastasis of prostate cancer can be significantly relieved with large dose of pamidronate disodium, as well as their quality of life improved.
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OBJECTIVE To observe the effect of voriconazole on pulmonary fungals infection after renal transplantation.METHODS Nine cases of pulmanory fungals infection after renal transplantation were analyzed to evaluate the therapeutic effect of voriconazole.RESULTS Treated with voriconazole,seven in nine patients were cured,while the other two died.CONCLUSIONS For patients with pulmanory fungals infection after renal transplantation,the application of voriconazole can receive satisfactory effect.
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AIM To explore the effect of tacrolimus on maturity and allostimulatory activity of cultured dendritic cells (DC) in vitro. METHODS Twenty rats were randomly divided into 4 groups: control, tacrolimus, LPS, and tacrolimus+LPS groups. The bone marrow cells of rats were cultured with granulocyte-macrophage colony-stimulating factors and interleukin-4 (IL-4) for 6 d and the DC which adhered to the wall were harvested. No other extraneous reagents were used in control group. Tacrolimus 10 μg·L-1 was added to tacrolimus group at the beginning of culture. Lipopolysaccarides (LPS) 100 μg·L-1 were administered 18 h beforeharvest in LPS group. In tacrolimus+LPS group, tacrolimus and LPS were used in accordance with tacrolimus and LPS groups. The immunophenotypes of DC were analyzed with flow cytometry and the level of IL-12 secreted by DC was detected by ELISA. The allostimulatory activity of DC on allogeneic T cells was assessed with mixed lymphocyte reaction. RESULTS Compared with control group, LPS increased CD80 and CD86 expressions, IL-12 secretion and allostimulatory activities of DC. Compared with control and LPS groups, tacrolimus cut down the expressions of CD80 and CD86, decreased the secretion of IL-12 and reduced the allostimulatory activity of cultured DC. CONCLUSION Tacrolimus exerts a negative effect on the maturation and allostimulatory activity of cultured DC in vitro.
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BACKGROUND: Immune tolerance is regarded as the most effective measure to overcome rejection. For the past few years, the important effect of immature dendritic cells (imDCs) on immune tolerance has drawn close attention. OBJECTIVE: To study the effect of imDCs treated with tacrolimus (FK506) on imlnune tolerance in rat allograft organ transplantation and to investigate the mechanism of immune tolerance induced by imDCs. DESIGN: A randomized and controlled animal experiment. MATERIALS: The experiment was carried out at the Experimental Animal Center, the Affiliated Hospital of Medical College. Qingdao University from April 2006 to December 2006.Cervical heart transplantations were performed in which 45Wister rats were used as donors and45 SD rats as allograft recipients. The ratswere randomly divided into three groups with 15 for each. METHODS: Normal sodium, imDes. and imDCs treated with FK506 were injected via vena caudalis seven. days before the operations respectively. Mixed lymphocyte reaction (MLR) was meas ured on SD, Wistar, and Lewis rats. MAIN OUTCOME MEASURES: Heart allografi survival was monitored and one-way MLR, heart pathology and the levels of interleukin-2(IL-2),IL-4,IL-10,and interferon-Y(IFN-Y)in the serum were detected. RESULTS: In treatment group without FK506.heart allografl survival were prolonged after imDC injection(P＜0.01);while their survival were prolonged further in treatment group with FK506(P＜0.05).MLR showed that the tolerance was donor specific. Analysis of variance showed that tere was high significant difference for serum concentrations of IL-2,IFN-Y,IL-4,and IL-10 in the three groups(P＜0.01).The concentrations of IL-2 and IFN-Y expressing on Th1 were lower. and that of IL-4 and IL-10 expressing on Th2 were obviously higher in the latter two groups. CONCLUSION: ImDCs can induce immune tolerance in rat heterotopic heart transplantation successfully; ImDCs treated with FK506 can enhance the tolerance which is donor specific.ImDCs may induce the immnune tolerance bymeans of modifying the immune response type of T cells (immune deflection from Th1 to Th2), mediating the generation of regulatory T cells (T-reg)and inducing T cells disenabling.
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Objective To investigate the protective effect of recombinant mouse OP 1 (rmOP 1) on renal ischemia reperfusion injury. Methods The full length open reading frame of mouse OP 1 was cloned by RT PCR. The rmOP 1 was prepared and its osteogenesis was assayed in vitro. Thirty Wistar rat models of renal ischemia reperfusion were randomly divided into 3 groups: preventive group, therapeutic group and control group. The former two groups were administered with rmOP 1 (250 ?g/kg) via the superior mesenteric vein at different time points. The renal function and structure were assessed by serum BUN, Cr, histological findings and the modified Miller's scoring. Results rmOP 1 showed osteoinductive activities in vitro. The level of serum BUN, Cr and Miller's scoring were higher in control group than the others ( P 0.05 ). Histological finding showed that rmOP 1 minimized the cell necrosis. Conclusion rmOP 1 has an protective effect on renal function and structure.
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Sequential monitoring of the levels of serum interleukin-2(IL-2),soluble interleukin-2 receptor(sIL-2R)and interleukin-6(IL-6)were conducted in 60 patients for 2 months after renal transplantation.The results showed that the levels of serum IL-2,sIL-2R and IL-6 were increased significantly several days prior to the clinical diagnosis in the patients with acute rejection,which were much higher than those in CsA-induced nephrotoxicity group.The levels of IL-2,slL-2R and IL-6 in the patients with rejection sensible to methylprednisolone came down to the pre-rejection levels several days after the treatment.It was concluded that sequential monitoring of serum IL-2,sIL-2R and IL-6 of renal allograft recipients are helpful for the early diagnosis and differential diagnosis of acute rejection as well as the evaluation of methylprednisolone in the treatment of antirejection.