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【Objective】 To investigate the predictive factors of clinical T1 (cT1) stage renal cell carcinoma (RCC) escalation to T3a (pT3a), hoping to identify high-risk patients with occult pT3a features. 【Methods】 A total of 666 patients with cT1 RCC who underwent radical or partial nephrectomy were involved and divided into upstaging group and non-upstaging group. The independent predictive factors of cT1 to pT3a stage were determined with univariate and multivariate logistic regression analyses. A model was established. The area under the receiver operator characteristic (ROC) curve (AUC) and calibration plot were used to assess the predictive model’s discrimination and calibration. 【Results】 The upgrading rate was 11.4% (n=76). The RENAL score, neutrophil-to-lymphocyte ratio (NLR), prognosis nutrition index (PNI) and Cystatin C (Cys C) were correlated to pT3a upgrading. Our model exhibited good discrimination (AUC=0.726, 95%CI:0.662-0.791) and decent calibration. In the internal validation, the high C-index value of 0.717 was still attainable. 【Conclusions】 RENAL score, NLR, PNI, and Cys C can be used to predict the risk of postoperative pT3a stage escalation in patients with cT1 stage renal cancer. Urologists can complete risk stratification and treatment based on these indicators.
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Objective:To explore the effect of the interval of radical prostatectomy after prostate puncture on the perioperative period and prognosis of patients.Methods:Patient’s data from September 2016 to September 2018 whom performed laparoscopic radical prostatectomy at the Affiliated Hospital of Xuzhou Medical University were collected and retrospectively analyzed. All prostate biopsy confirmed prostate cancer and 66 patients underwent laparoscopic radical prostatectomy. The average age was (70.11 ± 5.01) years, ranged from 60 to 79 years. The patients were divided into two groups according to the interval time from prostate biopsy to laparoscopic radical prostatectomy: <7 d group ( n=32) and 6-8 weeks group ( n= 34). The operation time, intraoperative blood loss, postoperative hospital stays, positive rate of incisional margin, postoperative urinary incontinence rate and the rate of urinary incontinence 6 months after operation, rate of postoperative erectile dysfunction and bone metastasis were compared and analyzed between the two groups. When the data conformed to the normal distribution, the data were expressed in Mean±standard deviation ( Mean± SD), and the independent sample t-test was used to evaluate the statistical significance between groups. When the data did not conform to the normal distribution, the measurement data was expressed as Median (interquartile range) [ M( P25, P75)], and the Mann-Whitney U test was used for the comparison between groups. Count data comparison between groups using Chi-square test or Fisher exact probability method. Unconditional multivariate Logistic regression was used to analyze the relationship between outcome and exposure. Results:All the 66 patients successfully underwent surgery, the surgery success rate was 100%. The average operation time of <7 d group and group 6-8 weeks group was [185.00(174.50, 193.50)] min and [183.00(175.00, 187.50) min], respectively, the difference was not statistically significant ( P=0.685 8, U=512.0). The average intraoperative blood loss of group <7 d group and 6-8 weeks group was [185.50(177.75, 205.25)]ml, [189.00(180.75, 206.00)] ml, respectively, the difference was not statistically significant ( P=0.685 9, U=512.0). The average postoperative hospital stays of <7 d group and 6-8 weeks group was [14.00(11.75, 16.00)] d, [13.50(12.00, 15.00)] d, respectively, the difference was not statistically significant ( P=0.785 7, U=522.5). The positive rate of incisal margin of<7 d group and 6-8 weeks group was 18.75%, 14.71%, respectively, the difference was not statistically significant ( P=0.659 5, χ2=0.194). The postoperative urinary incontinence rate of <7 d group and 6-8 weeks group was 6.25% and 8.82%, respectively, the difference was not statistically significant ( P=1.000 0). The urinary control after follow-up for six months of <7 d group and 6-8 weeks group was 6.25% and 2.94%, respectively, the difference was not statistically significant ( P=0.607 7). The postoperative erectile dysfunction rate of<7 d group and group 6-8 weeks group was 9.38% and 8.82%, respectively, the difference was not statistically significant ( P=1.000 0). The postoperative bone metastasis rate of group<7 d and 6-8 weeks group was 6.25% and 5.88%, respectively, the difference was not statistically significant ( P=1.000 0). Conclusions:Performing laparoscopic radical prostatectomy within 7 days following prostate biopsy did not adversely affect the postoperative outcomes and prognosis, also not increased postoperative complications, can shorten the patient′s treatment cycle.
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Objective To compare the curative effect of three different surgical methods:peritoneal varicocele ligation,peritoneal single-port laparoscopy and microscopy on varicocele.Methods Retrospective analysis of the case data of 150 patients with varicocele treated in the Affiliated Hospital of Xuzhou Medical University from September 2016 to September 2018.The average age was 24.5 years,and the age range was 22-30 years.The patients were divided into three groups according to different surgical methods:open group,laparoscopy group and microscope group,with 50 cases in each group.Patients in the open group were treated with retroperitoneal spermatic cord ligation.Patients in the laparoscopic group were treated with single-hole laparoscopic laparoscopic surgery.Patients in the microscope group were treated with microscope surgery.Operation time,postoperative hospitalization time,hospitalization cost reserved arteries,surgical complications (such as testicular hydrocele,scrotal edema,epididymitis,testicular atrophy),recurrence,and semen quality improvement were compared between three groups.Measurement data were expressed as mean ± standard deviation(Mean ± SD),the two comparisons used the t test,the comparison between the three groups used the analysis of variance,and the comparison between the count data groups using the Chi-square test.Results The operation time of the patients in the microscope group [(52.52 ± 4.29) min] was longer than that of the open group [(36.60 ± 3.69) min] and the laparoscopic group [(39.54 ± 2.87) min].The difference between the two groups was statistically significant (P ＜ 0.05);but the postoperative hospitalization time and hospitalization cost of patients in the microscope group [(2.16±0.95) d,(5251 ± 300) yuan] were higher than those in the open group [(3.80±0.78) d,(64 75 ±415) yuan)] and the laparoscopic group [(3.28 ± 1.01) d,(7 379 ± 273) yuan].The results of pairwise comparison showed that the difference between the microscope group,the open group and the laparoscopic group was statistically significant (P ＜0.05).Arterial preservation in the microscope group [47(94.0％)] were compared with the open group [35 (70.0％)],and laparoscopic group [30(60.0％)] had obvious advantages.Pairwise comparison results showed that the comparison between the microscope group and the open group and the laparoscopic group was statistically significant (P ＜ 0.05).After follow-up for six months,2 cases were lost to follow-up in the microscope group,1 cases were lost to the open group,and 5 case was lost to the unilateral laparoscopic group.2(4.2％) patients had complications in the microscope group,and 14 (28.6％) patients had complications in the open group;9 (20.0％) patients had complications in the laparoscopic group,and the total incidence of complications showed a pairwise comparison,the difference between the microscope group,the open group and the laparoscopic group was significant (P ＜ 0.05).The recurrence rate in the microscope group was 2.1％ (1/48),the recurrence rate in the open group was 18.4％ (9/49),and the recurrence rate in the laparoscopic group was 13.3％ (6/45);the recurrence rate was compared in pairs,the difference between the microscope group,the open group and the laparoscopic group was significant (P ＜ 0.05).The improvement rate of semen quality in the microscope group was 68.8％ (33/48),the open group was 42.9％ (21/49),the laparoscopic group was 55.6％ (25/45),pairwise comparison results showed that the microscope group compared with the open group and laparoscopy group,the difference were statistically significant (P ＜ 0.05).Conclusions Microscopic surgery has less trauma,faster postoperative recovery,shorter operation cost and hospitalization time.Postoperative complications and recurrence,and improved semen quality are all superior to open spermatic vein ligation and single-hole umbilical laparoscopic surgery,it is a safe and effective way to treat varicocele.
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Objective@#To compare the curative effect of three different surgical methods: peritoneal varicocele ligation, peritoneal single-port laparoscopy and microscopy on varicocele.@*Methods@#Retrospective analysis of the case data of 150 patients with varicocele treated in the Affiliated Hospital of Xuzhou Medical University from September 2016 to September 2018. The average age was 24.5 years, and the age range was 22-30 years. The patients were divided into three groups according to different surgical methods: open group, laparoscopy group and microscope group, with 50 cases in each group. Patients in the open group were treated with retroperitoneal spermatic cord ligation. Patients in the laparoscopic group were treated with single-hole laparoscopic laparoscopic surgery. Patients in the microscope group were treated with microscope surgery. Operation time, postoperative hospitalization time, hospitalization cost reserved arteries, surgical complications (such as testicular hydrocele, scrotal edema, epididymitis, testicular atrophy), recurrence, and semen quality improvement were compared between three groups. Measurement data were expressed as mean ± standard deviation(Mean±SD), the two comparisons used the t test, the comparison between the three groups used the analysis of variance, and the comparison between the count data groups using the Chi-square test.@*Results@#The operation time of the patients in the microscope group [(52.52 ± 4.29) min] was longer than that of the open group [(36.60±3.69) min] and the laparoscopic group [(39.54±2.87) min]. The difference between the two groups was statistically significant (P<0.05); but the postoperative hospitalization time and hospitalization cost of patients in the microscope group [(2.16±0.95) d, (5 251 ± 300) yuan] were higher than those in the open group [(3.80±0.78) d, (64 75±415) yuan)]and the laparoscopic group [(3.28±1.01)d, (7 379±273) yuan] . The results of pairwise comparison showed that the difference between the microscope group, the open group and the laparoscopic group was statistically significant (P<0.05). Arterial preservation in the microscope group [47(94.0%)] were compared with the open group [35 (70.0%)], and laparoscopic group [30(60.0%)] had obvious advantages. Pairwise comparison results showed that the comparison between the microscope group and the open group and the laparoscopic group was statistically significant (P<0.05). After follow-up for six months, 2 cases were lost to follow-up in the microscope group, 1 cases were lost to the open group, and 5 case was lost to the unilateral laparoscopic group. 2(4.2%) patients had complications in the microscope group, and 14 (28.6%) patients had complications in the open group; 9 (20.0%) patients had complications in the laparoscopic group, and the total incidence of complications showed a pairwise comparison, the difference between the microscope group, the open group and the laparoscopic group was significant (P<0.05). The recurrence rate in the microscope group was 2.1% (1/48), the recurrence rate in the open group was 18.4% (9/49), and the recurrence rate in the laparoscopic group was 13.3% (6/45); the recurrence rate was compared in pairs, the difference between the microscope group, the open group and the laparoscopic group was significant (P<0.05) . The improvement rate of semen quality in the microscope group was 68.8% (33/48), the open group was 42.9%(21/49), the laparoscopic group was 55.6%(25/45), pairwise comparison results showed that the microscope group compared with the open group and laparoscopy group, the difference were statistically significant (P<0.05).@*Conclusions@#Microscopic surgery has less trauma, faster postoperative recovery, shorter operation cost and hospitalization time. Postoperative complications and recurrence, and improved semen quality are all superior to open spermatic vein ligation and single-hole umbilical laparoscopic surgery, it is a safe and effective way to treat varicocele.
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Objective To observe the efficacy of laparoscopic high ligation of spermatic vein combined with compound xuanju capsule in treating infertility caused by varicocele.Methods Retrospective analysis of 49 cases of infertility caused by varicocele admitted to the Affiliated Hospital Xuzhou Medical University from February 2015 to November 2016,average age was 27.5 years,aged 20-50 years;according to simple random method divided into experimental group (n =20) and control group (n =29).Patients in the experimental group were treated with laparoscopic high ligation of spermatic vein and compound xuanju capsule.Patients in the control group were treated with high ligation of spermatic vein.Semen quality (sperm concentration,forward motor sperm rate,sperm survival rate),peripheral blood sex hormone (follicle stimulating hormone,luteinizing hormone testosterone) were compared between the two groups before and 3 months after surgery.Pregnancy rate of the spouse 1 year after surgery were compared between the two groups.Measurement data were expressed as mean ± standard deviation (Mean ± SD),and t-test was used for comparison between groups;count data were compared by Chisquare test.Results Preoperative sperm concentration [(14.95 ± 2.35) million/ml vs (15.69 ± 3.35) million/ml,P=0.118],forward motor sperm rate [(24.35 ± 3.72)％ vs (25.10 ± 3.89)％,P =0.221],sperm survival rate [(27.90 ± 2.59) ％ vs (26.93 ± 3.20) ％,P =0.122] was not statistically significant between experimental group and control group.3 months after operation,sperm concentration [(23.45 ± 4.39) million/ml vs (20.07 ± 2.91) million/ml,P =0.001],forward motor sperm rate [(34.80 ± 3.56) ％ vs (31.62 ± 3.75) ％,P=0.001],sperm survival rate [(44.55 ± 4.29)％ vs (39.52 ± 4.49)％,P =0.001] was statistically significant between experimental group and control group.Preoperative follicle stimulating hormone [(8.97 ±0.64) IU/L vs (9.17 ± 0.96) IU/L,P =0.238] and luteinizing hormone [(6.75 ± 0.49) IU/L vs (6.64 ±0.37) IU/L,P =0.744],testosterone [(10.87 ± 1.66) nmol/L vs (9.98 ± 1.17) nmol/L,P =0.064] was not statistical significance between experimental group and control group.3 months after operation,Follicle stimulation.[(6.96 ± 0.66) IU/L vs (7.34 ± 0.77) IU/L,P =0.043],luteinizing hormone [(6.04 ± 0.39) IU/L vs (6.15 ± 0.38) IU/L,P =0.038],testosterone [(14.46 ± 1.30) nmol/L vs (12.23 ± 2.23) nmol/L,P =0.001] was statistically significant between experimental group and control group.Pregnancy rate of the spouse 1 year of the experimental group was higher than the control group [65.0％ (13/20) vs 48.3％ (14/29)],but it was not statistically significant between two groups (x2 =1.34,P =0.247).Conclusions Laparoscopic high ligation of spermatic vein combined with compound Xuanju capsule in the treatment of infertility caused by varicocele can significantly improve semen quality and sex hormone levels.From visual data,the natural pregnancy rate is also improved compared with the simple operation group.It is worthy of clinical recommendation.
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Objective@#To observe the efficacy of laparoscopic high ligation of spermatic vein combined with compound xuanju capsule in treating infertility caused by varicocele.@*Methods@#Retrospective analysis of 49 cases of infertility caused by varicocele admitted to the Affiliated Hospital Xuzhou Medical University from February 2015 to November 2016, average age was 27.5 years, aged 20-50 years; according to simple random method divided into experimental group (n=20) and control group (n=29). Patients in the experimental group were treated with laparoscopic high ligation of spermatic vein and compound xuanju capsule. Patients in the control group were treated with high ligation of spermatic vein. Semen quality (sperm concentration, forward motor sperm rate, sperm survival rate), peripheral blood sex hormone (follicle stimulating hormone, luteinizing hormone testosterone) were compared between the two groups before and 3 months after surgery. Pregnancy rate of the spouse 1 year after surgery were compared between the two groups. Measurement data were expressed as mean± standard deviation (Mean±SD), and t-test was used for comparison between groups; count data were compared by Chi-square test.@*Results@#Preoperative sperm concentration [(14.95±2.35) million/ml vs (15.69±3.35) million/ml, P=0.118], forward motor sperm rate [(24.35±3.72)% vs (25.10±3.89)%, P=0.221], sperm survival rate [(27.90±2.59)% vs (26.93±3.20)%, P=0.122]was not statistically significant between experimental group and control group. 3 months after operation, sperm concentration [(23.45±4.39) million/ml vs (20.07±2.91) million/ml, P=0.001], forward motor sperm rate [(34.80±3.56)% vs (31.62±3.75)%, P=0.001], sperm survival rate [(44.55±4.29)% vs (39.52±4.49)%, P=0.001] was statistically significant between experimental group and control group. Preoperative follicle stimulating hormone [(8.97±0.64) IU/L vs (9.17±0.96) IU/L, P=0.238] and luteinizing hormone [(6.75±0.49) IU/L vs (6.64±0.37) IU/L, P=0.744], testosterone [(10.87±1.66) nmol/L vs (9.98±1.17) nmol/L, P=0.064] was not statistical significance between experimental group and control group. 3 months after operation, Follicle stimulation. [(6.96±0.66) IU/L vs (7.34±0.77) IU/L, P=0.043], luteinizing hormone [(6.04±0.39) IU/L vs (6.15±0.38) IU/L, P=0.038], testosterone [(14.46±1.30) nmol/L vs (12.23±2.23) nmol/L, P=0.001] was statistically significant between experimental group and control group. Pregnancy rate of the spouse 1 year of the experimental group was higher than the control group [65.0% (13/20) vs 48.3% (14/29)], but it was not statistically significant between two groups (χ2=1.34, P=0.247).@*Conclusions@#Laparoscopic high ligation of spermatic vein combined with compound Xuanju capsule in the treatment of infertility caused by varicocele can significantly improve semen quality and sex hormone levels. From visual data, the natural pregnancy rate is also improved compared with the simple operation group. It is worthy of clinical recommendation.
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Objective To investigate the application efficacy of oral acetaminophen stapler with compound lidocaine cream combined with lidocaine injection in local anesthesia cystoscopy.Methods From January 2016 to June 2017,180 male patients aged from 60 to 86 years old,whose average age was 71 years old and treated by local anesthesia cystoscopy were collected in this study in the department of Urology of Xuzhou Medical University Affiliated hospital.They were divided into two groups according to the time sequence of visiting doctor.The patients in the research group were treated with oral acetaminophen stapler with compound lidocaine cream and lidocaine injection urethral infusion anesthesia before the examination.The control group was using lidocaine injection urethral infusion anesthesia.To compare the successful rate of operation,operating time and the visual analogue score (VAS) before and after the operation,the patients'limb twist and the tension were observed and recorded.The software of SPSS 16.0 was used for statistical analysis.Results The successful rate of operation in research group and control group was 97.78％ and 91.11％.The VAS score before the operation was (3.2 ± 1.8) and (6.8 ± 2.2).The incidence of complications after treatment was 5.55％ (5/90) and 27.78％ (25/90).The PSS score of 1 h after treatment was (1.1 ± 1.7) and (3.1 ± 1.2).The satisfaction rate was 90.0％ (81/90) and 57.8％(52/90).The differences between the two groups were statistically significant(P ＜ 0.05).However,the opertion time between the two groups was (6.2 ± 1.7) and (6.9 ± 2.1) min.One hour after the opertion,the VAS score was (1.2±0.7) and (1.5±1.1).The score of PSS before the opertionwas (3.4±1.5) and (3.8±1.1).There were no significant differences between the two groups (P ＞ 0.05).Conclusions Taking oral acetaminophen stapler with compound lidocaine cream combined with lidocaine injection in local anesthesia cystoscopy could obviously reduce urethral pain and the anxiety in the opertion of local anesthesia cystoscopy,which obviously superior to use lidocaine injection urethral infusion anesthesia only.The efficacy and safety were definitely and had got better clinical outcomes.
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Objective To compare the clinical effect of two-person operations of disposable circumcision stitching instrument and one-man operations of disposable circumcision stitching instrument.Methods Clinical data of 340 patients with redundant prepuce or phimosis from March 2015 to August 2017 were randomly divided into control group which patients with two-person operation of disposable circumcision stitching instrument and study group which patients with one-man operation of disposable circumcision stitching instrument were reviewed prospectively.There were 188 patients in the study group,including 22 patients with phimosis and 166 patients with redundant prepuce;Among the 152 patients in the control group,there were 17 cases with phimosis and 135 cases with redundant prepuce.Two groups with operation time,intraoperative blood loss,postoperative skin staple missing,2 hours postoperative pain,postoperative edema,the swelling subsided time,postoperative complications,postoperative patient satisfaction,and so on.Measurement data were represented as (x) ± s,and comparison between groups was analyzed using t test;count data were represented as percentage and comparison between groups was analyzed chi-square.Results All operations were finished successfully for the patients by two-person or one-man of operations of disposable circumcision stitching instrument.In terms of operation,the operation time of the observation group and the control group was (7.76 ±0.45) minutes and (7.86 ±0.91) minutes respectively,and the difference was not statistically significant(P ＞ 0.05).Intraoperative hemorrhage of observation group and control group were (1.77 ± 0.22) ml and (1.72 ± 0.26) ml,and the difference was not statistically significant (P ＞ 0.05).There was no statistically significant difference between the observation group and the control group (P ＞ 0.05) in the postoperative 2 hours pain score and skin staple missing.In the postoperative complications,the deviation rate of the prepuce was 1.11％,significantly lower than the control group 5.92％,and the difference was statistically significant (P ＜ 0.05).There was no statistically significant difference between the observation group and the control group in terms of edema on the third postoperative day,short postoperative anastomosis,patient satisfaction,and postoperative infection.Conclusion The way of one-man operation of disposable circumcision stitching instrumente not only saves labor costs,but also has a good postoperative clinical effect,meanwhile,it has high efficiency and strong operability,and is worthy of promotion for clinical first-line urologists.
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Objective@#To investigate the expression of LIM and SH3 protein 1 (LASP1) in renal cell carcinoma and its significance in the invasion and migration of renal clear cell carcinoma 786-O cell line.@*Methods@#The expression level of LASP1 in 41 cases of renal cell carcinoma tissues and normal renal tissues was analyzed by immunohistochemistry. The relationship between the expression level of LASP1 and clinical characteristics was further analyzed. Expression of LASP1 in 10 cases of tumor tissues with or without lymph node metastasis was analyzed by Western blot. Furthermore, small interfering RNA (siRNA) targeting LASP1 was constructed and transfected into 786-O cells to downregulate LASP1 expression. The interference effect of LASP1 siRNA on LASP1 protein and the expression of related proteins in epithelial mesenchymal transition (EMT) pathway were detected by Western blot. The effects of LASP1 knockdown on cell proliferation, migration and invasion and gene expression were then assessed using CCK8 assay, transwell cell migration system and western blot analysis, respectively.@*Results@#The positive rate of LASP1 expression in renal clear cell carcinoma tissues was 90.2% (37/41), which was significantly higher than that in the adjacent tissues (29.3%, P=0.002). The expression of LASP1 in renal cell carcinoma was positively correlated with lymph node metastasis and TNM stage of renal cell carcinoma (P<0.05). The results of Western blot showed that LASP1 (0.696±0.053) was highly expressed in renal cell carcinoma (1.459±0.628), especially in cases with lymph node metastasis (2.692±0.186, P<0.05). The LASP1 siRNA remarkably down-regulated the expression of LASP1 protein in 786-O cells. The abilities of proliferation, invasion and migration of 786-O cells were decreased significantly in the LASP1 siRNA groups.The relative expression of E-cadherin protein in the siRNA group (0.848±0.020) was significantly higher than those in the siRNA-NC group (0.671±0.018) and control group (0.691±0.037, P<0.05). The relative expression of N-cadherin protein in the siRNA group (0.449±0.047) was significantly lower than those in the siRNA-NC group (0.613±0.018) and control group (0.633±0.045, P<0.05). The relative expression of vimentin protein in the siRNA group (0.477±0.029) was significantly lower than those in the siRNA-NC group (0.598±0.069) and control group (0.633±0.045, P<0.05 for both).@*Conclusions@#LASP1 is highly expressed in renal clear cell carcinoma, which is closely related to the development of the cancer. The effects of LASP1 on the invasion and migration of 786-O cells and lymph node metastasis may be related to the EMT.
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Objeetive To investigate the effect of TURP on the quality of life of elderly PCa patients with LUTS symptoms.Methods A retrospective analysis of the clinical data from January 2012 to January 2014 of 75 patients admitted to our hospital after prostate puncture biopsy and pathological diagnosis of PCa in elderly patients,mean age (79 ± 7) years old,which 44 cases were associated with different degrees of LUTS symptoms,of which,20 underwent TURP.After the rule of endocrine therapy,we observe and record of patients before and after treatment and 3,12,6 months after the IPSS and QOL score,compared with the changes in the quality of life of patients.Results Forty-four cases of patients with IPSS score in treatment group after 3,6 and December were (6.25 ± 2.53),(5.15 ± 2.25),(5.00 ± 2.36).Compared with the preoperative IPSS basal value (30.55 ± 3.62),the difference was statistically significant (P ＜0.01).However,there was no significant difference in the postoperative patients (P =0.209,0.863,0.154).The QOL score of treatment group after 3,6 and 12 months were (1.35 ± 1.14),(0.85 ± 0.75) and (0.70 ± 0.87).Compared with the preoperative QOL basal value (4.70 ± 0.73),the difference was statistically significant (P ＜ 0.01).However,there was also no significant difference in the postoperative patients (P =0.078,0.023,0.593).Compared with the control group of IPSS and QOL score,there was no significant difference before treatment in the treatment group (F =0.105,P =0.747),however,there was significant difference after treatment(P ＜ 0.01).Conclusions TURP is a safe and effective method to improve the quality of life and improve the quality of life of patients with prostate cancer.
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<p><b>OBJECTIVE</b>To assess the effects of warm ischaemia time (WIT) on renalfunction after laparoscopic partial nephrectomy (LPN) for renal masses in patients.</p><p><b>METHODS</b>From January 2010 to December 2012, 39 patients treated with LPN for a single T1 renal tumor were enrolled in this prospective study. There were 24 male and 15 female patients. Their age was (58 ± 10) years old, and their body mass index was (27 ± 3) kg/m(2). The mean operation time was (132 ± 12) minutes, and the mean WIT was (29 ± 8) minutes. Clinical parameters, the single glomerular filtration rates (sGFR) were compared before the operation and after 3 and 12 months in order to observer the effects on renal function and find the factors predicting the renal function impairment.</p><p><b>RESULTS</b>There were significant differences between 3, 12 months after the operation ((26.8 ± 5.6) ml/min and (28.6 ± 5.6) ml/min, respectively) and preoperation ((31.9 ± 6.3) ml/min) in sGFR (F = 4.882 and 5.511, both P < 0.05). And there were significant negative correlations between the sGFR in 3 and 12 months after the operation and WIT (r = -0.569, P = 0.000 and r = -0.448, P = 0.004) . The preoperative sGFR (β = 0.260, 95%CI:0.089-0.431) and WIT (β = 0.369, 95%CI:0.189-0.555) were independent predictors for function decline of the operated kidney (both P < 0.05). The analysis showed that the effects of WIT within 30 minutes on renal function is relatively small. Longer WIT was associated with lower postoperative sGFR values (F = 22.128 and 20.552, both P = 0.000) .</p><p><b>CONCLUSIONS</b>For the LPN operation, the longer of the WIT, the more serious of renal function damage. sGFR is an accurate measurement to assess the renal damage. Every effort should be made to minimise WIT during LPN, and the limit of 30 minutes should be not exceeded.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Kidney , Kidney Function Tests , Kidney Neoplasms , General Surgery , Laparoscopy , Nephrectomy , Operative Time , Prospective Studies , Warm IschemiaABSTRACT
Aim To explore the protective effect of Sertoli cells on the co-transplanted allogeneic renal cells in male and female recipient rats. Methods Testicular Sertoli cells were prepared by digestion with trypsin， collagenase and DNase， while renal cells were prepared by digestion with trypsin alone. FasL and Fas expressions were detected respectively by FCM before transplantation. About 106 cells were injected into the allogeneic renal subcapsule. In order to demonstrate the survival of renal cells， the expression of g-PG in graft was examined by SABC method. Apoptosis of the lymphocytes surrounding the graft was observed by TUNEL(terminal deoxynucleotidyl transferase-mediated X-dUTP nick end labeling). Results The grafts were analyzed histologically 20 days after transplantation. The renal cells transplanted alone were all rejected, while the survival rates of the mixed cell transplantation were 87.5％ and 77.8％ in male and female recipients respectively. When the renal cells co-transplanted with Sertoli cells treated by anti-FasL mAb， only 30.0％ grafts were survived. Apoptosis of lymphocytes surrounding the graft were quite evident. Conclusion Sertoli cells expressing FasL can protect renal cells from allograft rejection by inducing apoptosis of Fas expressing T cells surrounding the grafts.
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Purpose:To compare the sensitivity and specificity of urinary cytokeratin test with voided urine cytology in detection of bladder cancer and to evaluate their clinical values. Methods:For 136 patients suspected to have bladder cancer urinary concentrations cytokeratin 8 and 18 and cytology were conducted in the same voided urine samples. Of them 87 patients with bladder transitional cell carcinoma were confirmed histologically The sensitivity and specificity of urinary cytokeratin and urine cytology were analyzed. 49 patients without bladder cancer were selected as control.Results:The overall sensitivity and specificity of urinary cytokeratin test were 70.1% and 73.3%,respctively ,those of urine cytology were (42.5%) and 83.7%, respectively, there was no significant difference between the specificity of urine cytology and that of urinary cytokeratin test ;however, urinary cytokeratin was significantly more sensitive than urine cytology in detection of any stages and grades of bladder cancer (P