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Objective To determine the predictive parameters of impacted ureteral stones and evaluate the predictive value of ureteral wall thickness for impacted ureteral stones.Methods A total of 93 patients with proximal ureteral stones from January 2017 to December 2017 were included in the study [71 males and 22 females,aged 30-80 years,and body mass index (23.7 ± 2.7) kg/m2].Both clinical and computed tomography urography (CTU) data were compared between patients with or without impacted ureteral stone,including sex,age,body mass index,renal pelvic diameter,longitudinal size of stone,transverse size of stone,stone surface area,stone volume,hounsfield units of stone,diameter of the ureter proximal to the stone,and ureteral wall thickness at the impacted ureteral stone site.The receiver operating characteristic curve (ROC) was used to analyze the performance of each of the above-mentioned parameters for predicting the impacted ureteral stones.Multivariate logistic regression analysis was used to select the independent risk factors of impacted ureteral stones.Results Among 93 patients,38 (40.8％) patients were with impacted stones and 55 (59.1％) without impacted stones.Univariate analysis showed significant difference in ureteral wall thickness (t =6.344,P ＜ 0.001),diameter of the ureter proximal to the stone (U =607.5,P =0.001),longitudinal size of stone(U =580.5,P ＜0.001),transverse size of stone(t =4.172,P ＜0.001),stone surface area(U =508.5,P ＜ 0.001),stone volume (U =508.5,P ＜ 0.001) and hounsfield units of stone (t =6.344,P =0.006) between patients with or without impacted stones.Ureteral wall thickness(UWT)showed the largest area under curve (AUC) among those parameters (AUC =0.825,P ＜ 0.001),followed by stone surface area and stone volume.The optimal cut-off value of ureteral wall thickness was 3.16 mm,with sensitivity of 71.1％ and specificity of 85.5％.Multivariate analysis showed that ureteral wall thickness (Wald =18.709,P ＜ 0.001) and stone volume (Wald =8.391,P =0.004) were independent predictors of impacted stones.Conclusion Ureteral wall thickness was related to the presence of impacted ureteral stones and could be used for predicting impacted ureteral stones.
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Objective To assess the efficacy and side effects of intravesical instillation of BCG after transurethral resection of the bladder tumor (TURBT) in non-muscle invasive bladder cancer (NMIBC) patients.Methods The clinical data of patients treated with BCG 120 mg per course induced perfusion or more after TURBT from December 2013 to October 2016 in 18 hospitals of northeast China region,were analyzed retrospectively.The first part,data of 106 patients with moderate,high-risk NMIBC were collected.A total of 83 patients were male,while the other 23 patients were female.The average age was 66.7 years old.The clinical staging were T1 in 86(81.1％) cases,Ta in 20(18.9％) cases and carcinoma in situ in 6 (5.7％) patients.Intravesical instillation of BCG was executed after transurethral resection of the bladder tumor.The incidence rate of recurrence and progression during more than 6 months' follow-up time were observed.Multivariate analyses were done by using logistic analysis and Cox proportional hazards regression model with Kaplan-Meier method.The second part,treatment compliance of 276 patients with bladder cancer,including moderate/high-risk NMIBC in 263 cases,moderate/high-risk NMIBC followed with renal pelvis/ureteral carcinoma in 8 cases were and moderate/high-risk NMIBC with renal pelvis/ureteral carcinoma in 5 cases who treated with BCG after the surgeries,were observed.Patients consisted of 211 males and 65 females with average age of 68.3 years.Results With a median follow-up of 12 months,9 (8.5％) patients experienced tumor recurrence and 2 (1.9％) patients were found progression in the first part.The one-year cancer free recurrence rate of the patients was 91.5％.Statistically significant prognostic factors for recurrence identified by multivariable analyses were prior recurrence of the tumors (OR =3.214,95％CI0.804-12.845,P =0.099).In the second port,an incidence rate of adverse effects was 64.1％ (177/276).The Ⅲ/Ⅳ degree complications were occurred in 11 patients and satisfactory outcomes achieved with active treatment.A total of 36 patients withdrawal with the major causes were recurrence and progression of bladder tumor in 12 cases (4.4 ％),9 cases (3.3 ％) with economic reasons and 11 cases (4.0％) with serious complications.Conclusions NMIBC patients treated with intravesical BCG therapy have approving cancer free recurrence rates and acceptable adverse effects.Prior recurrence may be prognostic factor of recurrence after intravesical BCG therapy.
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Objective@#To improve the diagnosis and treatment of primary adrenal cortical carcinoma.@*Methods@#The clinical and pathological data of 11 patients who diagnosed as primary adrenal cortical carcinoma by pathology were retrospectively analyzed.The median age was 43 years, including 6 males, 5 females.7 cases(63.6%) got the tumor on the left.9 cases(81.8%) presented the maximum diameter of tumor more than 6 cm, and the average maximum diameter was 12.9 cm.All cases had CT or MRI imaging examination.Among most of them, CT showed mixed density lesions, or MRI showed mixed signal.Only 3 cases(27.3%) were considered adrenal cortical cancer through preoperative examinations.@*Results@#11 patients were treated with surgical treatment.Of them, 9 cases(81.8%) had complete resection of tumor.3 cases were lost to follow-up, while other 8 cases were followed up for 5-58 months.3 cases presented tumor-specific death at 5-15 months after surgery, with each 1 case in AJCC stage Ⅱ, Ⅲ and Ⅳ, respectively.Survive were in 5cases, and 3cases of them were tumor-free survival, while the other 2 cases of them had local recurrence.@*Conclusion@#Adrenal cortical carcinoma is very difficult to diagnose preoperatively.Adrenal cortical cancer should be considered when tumor size more than 4cm and tumor presenting inhomogeneous enhancement.Then, the surgical treatment should be performed as soon as possible, and as appropriate, chemotherapy and other comprehensive treatment should be given subsequently.Clinical and basic research such as genes test may provide more treatment options for advanced tumors in future.
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Wilms' tumor is the most common kidney tumor in childhood.MicroRNAs (miRNAs) are about the size of 19-22 nucleotide sequences that exist widely in the non-coding RNA in eukaryotes,function primarily through combination with mRNA target base pairing causing target mRNA degradation or inhibition of translation,and then develop his inhibiting or promoting the role of tumor.Abnormal expressions of miRNAs can cause a lot of kidney diseases,such as chronic kidney disease,polycystic kidney disease,renal fibrosis and renal cancer.Wilms'tumor,abnormal expression of key genomes,such as miR-17-92,miR-185,miR-204,miR-48 anomalies and tumors are closely related.Paper of miRNAs in incidence of Wilms'tumor expression,and the possible role for future targeted gene targeted drug sites are reviewed.
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Objective To explore the expression and clinical value of major histocompatibility complex class-Ⅰ related chain A (sMICA) molecule in serum of patients with renal tumor.Methods From March 2013 to July 2013,60 patients with renal tumor,including 37 male patients and 23 female patients were enrolled in this study as experimental group.The mean age was 46 years (range 34-76 years).The pathological diagnosis included renal cell carcinoma in 48 cases and renal angiomyolipoma in 12 cases.The stage classification included T1 stage in 20 cases,T2 stage in 14 cases,T3 stage in 10 cases and T4 stage in 4 cases.Lymphatic metastases were found in 11 cases and metastases in other organs were found in 4 cases.Another 20 healthy volunteers were enrolled as control group,including 10 male and 10 female.The mean age was 31 years (range 24-50 years).The ELISA method was used to detect the soluble MICA's (sMICA) level in serum.And the results were compared with tumor's malice,TNM pathology stages,metastasis.In 15cases with renal cell carcinoma,the expression of MICA molecule in tumor masses and paraneoplastic masses was measured by immunohistochemical (IHC) method.The quantitative expression of MICA-mRNA was detected by RT-PCR in 9 tumor masses and 3 paraneoplastic masses.Results The level of sMICA in renal malignant tumor group was (348.5±32.5) pg/ml,while the sMICA's level in benign renal tumor groups was (289.3±30.4) pg/ml and that in the control group was (168.4±43.2) pg/ml.The level of sMICA in malignant group is statistically higher than that in benign group and control group (P＜0.05).The level of sMICA in T1 、T2 、T3 and T4 stage was (304.3±27.4),(308.4±26.8),(368.3±33.4),(378.4±43.4) pg/ml,respectively.Insignificant difference only demonstrated between T1 and T2 stage.The level of sMICA in those patients with and without lymphatic metastasis was (326.2±32.4),(319.4±32.5) pg/ml,respectively (P＞0.05).Significant difference in the sMICA level could also be observed between patients with other organ metastasis (373.4±45.4) pg/ml and those without metastasis (346.4±31.5) pg/ml (P＜0.05).The IHC results revealed that high expression of MICA molecule in tumor cell.However,this oppsite result was demonstrated in cells located in paraneoplastic tissues.In the results of RT-PCR,the MICA-mRNA level (2.03) in tumor masses was significantly higher than that in pareneoplastic masses (0.77) (P＜0.05).Conclusions MICA highly expressed in renal tumor,and its expression correlates with tumor's malice,TNM pathologic stages,and metastasis.
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Objective To compare the clinical efficacy of laparoscopic surgery and open surgery for intraperitoneal bladder rupture.Methods From January 2004 to August 2013,the clinical data and therapeutic methods of 50 patients with intraperitoneal bladder rupture were retrospectively reviewed,inclu-ding 26 cases of laparoscopic surgery and 24 cases of open surgery.The operative time,intraoperative blood loss,postoperative intestinal recovery,hospital stay,analgesic use rate and complication ratio were com-pared between the two groups.Results All surgeries were successfully performed.There were significant differences in intraoperative blood loss [(54.24 ±5.38)ml vs(89.35 ±12.17)ml],intestinal recovery time [(23.24 ±2.39)h vs(38.42 ±6.98)h],hospital stay [(4.64 ±1.42)d vs(7.04 ±1.29)d]and analgesic use rate [38.64%(10 /26)vs 75.00%(18 /24)]between laparoscopy group and open surgery group,respectively(P 0.05).Conclusion Laparoscopic treatment of intraperitoneal bladder rupture has the advantages of mini-invasion and rapid re-covery compared with traditional open surgery.
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Objective To explore renal transplantation model in non-human primate cynomolgus monkeys.Methods 50 non-human primates' kidneys were transplanted into the lower part of the abdomen with end-to-side anastomosis of renal artery to aorta and renal vein to inferior vena eava,and with end-to-end anastomosis of ureter to bladder.Results In the 50 cases,1 case death as accident of anesthesia;7 cases with postoperative complications,and all with creatinine sudden rise,after ultrasonic examinations showed that 2 cases with renal vein thrombosis,and 5 cases appeared urinary leakage.All animal models were without surgical infections,and with normal serum creatinine,urine output.Conclusion Non-human primate animal kidney transplantation model establishment method is reliable,but should pay attention to the the surgical technique training,complications prevention.The model is valuable for application in the research of immune tolerance,heterogeneous transplant.
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Objective To evaluate the safety and efficacy of colour doppler in guiding the percutaneous nephrolithotomy(PCNL) for Staghom calculi.Methods The clinical records of 46 patients with renal calculi who underwent PCNL were retrospectively analyzed.Patients' mean age was 43 years old,and the range of diameter of stone was 3.0 -7.5 cm.Among these cases,29 cases had complete staghorn calculus.One case had isolated kidney stone.And the other 6 patients had open surgery history.Using Colour Doppler guidance,the percutaneous nephrolithotomy for renal calculi was conducted.Results F22 percutaneous channel was successfully established in 55 sides of 46 patients,with the first and the second phase surgeries of 41 and 14 sides respectively.Single-,double- and three-channel PCNL were performed in 38,16,and 1 sides respectively.Abdominal x-ray conducted at 3 -4 days post operation revealed residual stones on 18 sides,with the range of 0.4 -2.0 cm in diameter.Second-phase lithotripsy was conducted on 14 sides of patients.After the first and the second phases of surgery,4 sides having residual stones ranging 0.6 - 1.0 cm,underwent extracorporeal shock wave lithotripsy.Ater the third-phase surgery,the diameters of residual stones were much less than 0.5 cm and patients were treated with medication.The total rate of clearance was 87.0％ (48/55).The duration of surgery was 65 - 160 minutes and 95 minutes on average.One patient having delayed bleeding was cured with selective renal artery embolization.There were no complications such as nephrectomy,deaths,pleural or intestinal damage during the period of study.Patients were followed up for 3 to 18 months.Six of 9 patients with renal insufficiency recovered after surgery.The serum creatinine in the remaining 3 patients ranged 185 -220 μmol/L Conclusion Colour Doppler-guided percutaneous nephrolithotomy for renal calculi is safe and effective.
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Objective To evaluate the prognostic significance of carbonic anhydrase IX (CA IX) expression in patients with clear cell renal cell carcinoma (ccRCC). Methods CA IX expression in a cohort of 120 patients with ccRCC was evaluated by P-V immunohistochemistry with a rabbit CA IX polyclonal antibody. Twenty-five normal kidney tissues were used as a control. The relationship between CA IX expression and prognosis was analyzed by univariate and multiple-factor analysis (Cox regression model). The primary end point was cancer specific survival. Results One hundred and twelve (93.3%) patients were followed up with the median follow-up time of 45 months (range, 6 to 94 months). Seventy-five patients survived without evidence of tumor recurrence, 3 patients survived with tumor recurrence, and 34 patients died, 28 of the 34 died of cancer. CA IX expression was negative in all normal renal tissue. High CA IX expression was observed in 89 (74.2%) patients, among which 82 patients were followed up, and the disease free survival was 75.6% (62/82). Two (2.4%) patients survived with tumor recurrence, and 18 (22.0%) patients died, of which 13 (15.9%) died of cancer. Tumor recurrence and (or) metastasis occurred in 9 (11.0%) patients, with a median survival of 92 months in this high expression group. Low CA IX expression was observed in 31 (25.8%) patients, among which 30 patients were followed up, and the disease free survival was 43.3% (13/30). One (3.3%) patient survived with tumor recurrence, and 16 (53.3%) patients died, of which 15 (50.0%) died of cancer. Tumor recurrence and (or) metastasis occurred in 8 (26.7%) patients with a median survival of 53 months in this low expression group. Cancer specific survival between CA IX high expression group and low expression group was significantly different (P=0.000, χ2=15.950), and tumor relapse and (or) metastasis rates were significantly different (P=0.040, χ2=4.200). The 1, 3, 5 and 7 year cancer specific survival rates were 95.2%, 83.9%, 81.2% and 78.2% respectively in the high CA IX expression group, and 89.5%, 63.9%, 46.8% and 40.1% respectively in the low expression group. Multivariate analysis with Cox regression model showed that CA IX expression was a prognostic factor (RR=0.186). Conclusions High CA IX expression is negatively correlated with postoperative mortality, relapse and (or) metastasis in ccRCC. CA IX expression could be used as a prognostic biomarker in ccRCC.
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Objective To develop and evaluate a porcine model for training the single needle running suture method of laparoscopie urethrovesical anastomosis(LUA). Methods Twenty minipigs with mean weight of 30kg were general anaesthetized with Sumianxin solution 0. 1 ml/kg intramuscularly. Pneumoperitoneum was created by insufflation of carbon dioxide by a veress needle inserted through the umbilicus. One 10mm port and two 5mm ports were positioned after the establishment of pneumoperitoneum. The intestine was used as "bladder". The procedures were completed with the single needle running suture method of laparoscopic urethrovesical anastomosis. Six trainees performed the LUA procedure based on the models during a laparoscopic training course, following the technique used in the operation room. The learning curve was analyzed by operative time. Results The porcine model for laparoscopic training was established successfully and 3 LUAs could be performed on each pig. Each trainee performed 10 LUAs based on the models during the training course of laparoscopic urology. The operative time declined from (55.3±10. 4)min initially to (22.4±4.8)min (P＜0. 01) after the training course. At the end of training, all trainees could accomplish a watertight LUR procedure on the model. Conclusions The establishment of the training model is feasible. The trainees could acquire the skills necessary to perform LUA in vivo based on this model. The model provides a platform for training the basic techniques of LUA procedures.
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Objective To investigate the treatment of recipients carrying hepatic virus after renal transplantation. Methods Of the 14 patients, 8 carried HBV and 4 HCV, and the other 2 both HBV and HCV. HBV DNA or RNA was negative before transplantation.Results During the follow-up period of 3 to 20 months, 10 patients had liver dysfunction with higher ALT and AST, but negative for HBV DNA and/or HCV RNA. After adjusting the dosage of immunosuppressants and treatment of liver protection, liver function of these patients all restored to normal level.Conclusion In the hepatic virus carriers receiving renal transplantation, liver dysfunction caused by drug-induced liver damage or hepatic viral injury should be distinguished and corresponding treatment should be given in time.
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Objective To investigate the expression of complement split product C4d and its significance in renal allograf tissue of chronic rejection in rats.Methods The healthy closed population Wister rats and SD rats were used as donator and acceptor in renal transplantation.The chronic rejection model of renal transplant in rats was established and the rats were divided into 2 groups.The rats in experimental group were given Mycophenolate mofetil(MMF)(10 mg/kg) and those of the control group were given nothing except CsA(5 mg?kg~(-1)?d~(-1)) for 10 days.At the 12th week of renal transplantation,the allograft was tested by light microscope,and the pathological changes of renal grafts and the expression of C4d in peritubular capillaries were observed.Results On the 12th week of renal transplantation,the morphology changes of chronic rejection was observed in the experimental group and obvious C4d deposition was detected in peritubular capillaries of renal allograft tissue,with significant difference compared with those of the control group(all P
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Objective To explore the significance of complement split product C4d in monitoring chronic rejection of renal allografts in rats.Methods Healthy closed population rats were used as donors and SD rats as recipients. The Wistar to SD model of graft rejection was developed. All the 42 recipients were randomly divided into 2 groups: group A receiving nothing except CsA (5mg?kg~ -1 ? d~ -1 ) in the first 10 days after operation, and group B receiving MMF (10 mg/kg) and CsA after operation. On the 3rd, 5th and 10th week, all the allografts were tested by light microscopy and immunofluorescence. Pathological changes of the kidneys and the expression of C4d in allograft tissue were observed.Results From the 3rd week, the rats in group A showed light pathological changes of chronic rejection and they became more and more obvious as time increased. Pathological changes occurred in group B at the 5th week and lighter than in group A. At the same time, C4d deposition in PTC was obviously observed on the 3rd week in group A, and on the 10th week C4d widespread deposition in allografts.Conclusion The deposition of complement split product C4d in allografts appears earlier than pathological change of chronic rejection, which can be regarded as a significant indicator to predict chronic rejection of renal allografts.