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Objective]To explore the diagnostic value of magnetic resonance imaging(MRI)combined transrectal ultrasound (TRUS)to guide prostate cancer detection at different serum prostate-specific antigen(PSA)levels.[Methods]Totally 278 patients who underwent a systematic biopsy were collected in our hospital from November 2014 to June 2016. Preoperative tests of PSA , MRI,TRUS were performed in all the included patients. According to the PSA level of 4~10 ng/mL,10~20 ng/mL,over 20 ng/mL, 278 cases were divided into three group of A ,B ,C. Retrospective analysis was performed within the three groups of diagnostic accuracy.[Results]In Group A,the areas under ROC for MRI+TRUS and TRUS were 0.73 and 0.59,respectively(P = 0.02). In Group B ,the areas under ROC for MRI+TRUS and TRUS were 0.68 and 0.56 ,respectively (P < 0.001). In Group C ,the area under ROC for MRI+TRUS and TRUS were 0.74 and 0.63,respectively(P < 0.001). There is more significant statistical difference in Group B and C.[Conclusion]MRI combined TRUS has higher diagnostic value in cancer detection than TRUS before biopsy between different PSA levels ,which Indicates that MRI combined TRUS is an effective method for the improvement of prostate cancer detection.
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Objective To investigate the safety and efficacy of nephron-sparing surgery (NSS)for selective T2 stage renal tumor.Methods The surgical database of 26 patients treated with NSS for clinical T2 stage renal cell carcinomas between March 2010 and May 2013 were collected and analyzed retrospectively.There were 17 males and 9 females,with a mean age of 52 years (39-74 years),mean tumor size of 10.3 cm(7.2-16.5 cm),and mean R.E.N.A.L score of 7.5 (6-10).Patients'demographics,clinical characteristics,oncologic outcomes,renal function were reviewed.Results The renal masses were removed successfully and the surgical margins were negative.There were 21 (80.8％) cases of clear cell carcinoma,4 (15.4％) papillary carcinoma and 1 (3.8％) chromophobe carcinoma.The mean ischemia time was (28.3 ± 12.5) minutes (7 patients were clamp-free).Three patients needed transfusion,one experienced urine fistula and cured by conservative treatment,and one patient's renal function got progressive worsening and required long-term hemodialysis.The average serum creatinine was 121 μ mol/L before and 136 μmol/L after surgery (P =0.06).After a period of 22-47 months' follow-up,no patient had local recurrence or metastasis.Conclusions NSS can be safely performed and provide effective oncologic outcomes for selective patients with clinical T2 stage renal cell carcinomas.R.E.N.A.L nephrometry is an important factor and should be used to evaluate the feasibility of NSS.
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Objective To investigate the efficacy and safety of radical nephrectomy associated with venous thrombectomy and the role of preoperative angioembolization.Methods From Sep 2006 to Dec 2014,the data from 15 cases with renal cell carcinoma and venous tumor thrombus were collected and analyzed retrospectively.The 15 patients included 8 men and 7 women,whose age ranged from 16 to 75 years.Before operation,all patients underwent imaging examinations which demonstrated the renal tumor and venous thrombus.The tumors size ranged from 5.4 to 14.5 cm.The levels of venous thrombus included 0 grade in 4 cases,Ⅰ grade in 2 cases,Ⅱ grade in 6 cases and Ⅲ grade in 3 cases.The 15 patients were divided into angioembolization group (n =5) and non-angioembolization group (n =10) according to the conduction of preoperative angioembolization.Results All cases successful accepted the nephrectomy.The venous thrombectomy were undergone in 14 cases except for one case due to the severe adhesion between renal vein and aorta.The average operative time was 243.3 ± 77.0 min.The mean blood loss was 1 373.3 ± 1 440.9 ml and the volume of blood transfusion was 533.3 ± 521.9 ml.The average time of postoperative hospital stay was 12.7 ± 5.2 days.Symptomatic tumor thrombus embolism didn't occur in all cases,perioperatively.There were no significant difference between these two groups in operative time,blood loss,blood transfusion volume and postoperative hospital stay (P ＞ 0.05).Eight cases were followed up with a period of 6 to 69 months.Four cases had disease-free survival during follow up.Two cases died at 30 and 55 months after surgery,respectively.One had tumor recurrence at 6 months after surgery.One patient accepted a 6-months target therapy (sunitinib) before surgery.However,his thrombus could not be removed during the operation.After the operation,he continued to choose the target drug therapy for 18 months.No progression for thrombosis or metastasis has been found.Conclusions Nephrectomy and venous thrombectomy could be safe and effective for renal cell carcinoma associated with venous thrombosis.Preoperative angioembolization could not reduce the perioperative risk such as blood loss.
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ObjectiveTo evaluate the clinical effect of post bladder sparing surgery intra-arterial chemotherapy combined with intravesical chemotherapy for the treatment of T1G3 bladder urothelial carcinoma.MethodsSeventy-four T1G3 bladder cancer patients were enrolled in this study.After bladder sparing surgery,22 patients received intra-arterial chemotherapy combined with intravesical chemotherapy,while the other 52 patients were treated with intravesical chemotherapy only.There was no significant difference between the 2 groups in sex,age,the size and number of bladder tumor and newly diagnosed cases (P ＞0.05).Twenty-two patients were treated with intra-arterial chemotherapy of piarubicin or epirubicin (40 -60 mg)+ cisplatin (60 -80 mg) 2 or 3 weeks after bladder sparing surgery,3 times as a cycle,repeat every 4 - 6 weeks.All the patients received the same protocol of intravesical chemotherapy.With a median follow-up of 32 months,effects of combination therapy group were compared with intravesical chemotherapy group in the aspects of tumor-specific death rates,recurrent rate,progressive rate,recurrent interval and the adverse reactions.ResultsThe tumor-specific death rates of combination therapy group and intravesical chemotherapy group were 0％ (0/22) and 13.5％ (7/52),respectively.There was no difference between the 2 groups (P =0.096).The recurrent rates were 13.6％ (3/22) and 46.2％ ( 24/52 ) ； The progressive rates were 0％ (0/22) and 21.2％ (11/52).There were significant differences between the 2 groups in recurrent rate (P =0.000) and progressive rate (P =0.048 ).The recurrent intervals of the 2 groups were 15 months and 6.5 months.During the interval of intra-arterial chemotherapy cycle,12 patients suffered 1 -2 degree nausea and vomit,2 patients suffered hypoleukemia,2 patients suffered neutropenia,4 patients'liver function was impaired and 1 patient's renal function was impaired.All the adverse reactions were minimal and reversible.ConclusionsIntra-arterial chemotherapy combined with intravesical chemotherapy is effective in preventing T1 G3 bladder cancer from recurrence and metastasis after bladder sparing surgery.The adverse reactions of this protocol were minimal and reversible.
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ObjectiveTo explore the expression of novel protein kinase C ε (PKCε) in normal prostate (NP) tissue, benign prostate hyperplasia(BPH), peficancerous (PC) tissue and prostate cancer (Pca), and study its correlation with the grade and stage of Pca.MethodsTen NP slides, ten BPH slides, ten PC slides and 43 Pca slides were collected from our hospital. These slides were routinely proceased and analyzed according to the requirement of immunohistochemical staining. Tumors were classified according to the 2002 TNM staging system. The grading system used in the study was based on the Gleason grade.ResultsWe was found that the expression of PKCεs in Pca (27/43) were significantly higher than those in NP(1/10), BPH (0/10) and PC (2/10) tissue, and the difference was statistically significant ( P ＜0.05 ). With regard to grade of prostate cancer, the expression of PKCε in Pca with Gleason score ≥8 group (12/13) was higher than the Gleason score 2 -4 group (4/10) and the Gleason score 5 -7 group (11/20). The difference was statistically significant (P ＜ 0.05 ). Moreover, the T3 and T4 stages had a more positive rate (10/12 & 9/10) than the T1 and T2 stages( 1/6 &7/15). There is statistically significant difference between early and advanced stage of prostate cancer ( P ＜ 0. 05 ). Furthermore, the positive expression of PKCε in prostatic carcinoma samples increased significantly in the metastasis group (9/10)compared to the non-metastasis group ( 18/33 ) ( P ＜ 0. 05 ), but the difference was not statistically significant between the concentration of prostate-specific antigen in blood serum ( P ＞ 0. 05 ).Conclusions PKCε is expressed in prostate cancer, and it correlates with the grade and stage of prostate cancer. PKCε may be related to the origin and the development of Pca, and it may be used as a prognostic factor for Pca.
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Objective To discuss the feasibility and safety of retroperitoneal laparoscopic nephrectomy for treatment of kidney tuberculosis. Methods From March 2005 to February 2009, 28 patients with kidney tuberculosis underwent retroperitoneal laparoscopic nephrectomy. The patients′ data were reviewed and analyzed. Results There were 18 men and tencwomen with an average age of 36 (26-51) in the cohort. Sixteen patients had lesions on the left kidney and 12 on right kidney. All patients had a normal renal function on the contra lateral side. The severely impaired renal function of the lesion side was confirmed before operation. Anti-tuberculosis chemotherapy was administered to patients for two weeks to six months in advance of the surgery. No active lesion of tuberculosis was found and ESR level was normal before operation. All the operations were successfully performed without switching to open surgery. The average operative time was 170 (121-258) minutes, blood loss was 110 (70-250) ml and average postoperative hospital stay was 5.7 (5-14) days. Peritoneum injury was seen in three patients and incision infection in two patients. No severe complications were observed. Anti-tuberculosis chemotherapy was continued for three months. Twenty-four patients were followed-up, and the average follow-up time was 12.5 (6-20) months. All patients recovered without any lesion remaining. Conclusions Retroperitoneal laparoscopic nephrectomy could be a safe and reliable method for the treatment of non-functioning kidney due to tuberculosis.
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Objective To evaluate the feasibility of European Organization for Research and Treatment of Cancer (EORTC) risk tables in non-muscle invasive bladder cancer in Chinese patients.Methods A retrospective analysis was performed on the data from 185 patients with non-muscle invaaive urothelial bladder cancer from January 2003 to February 2009. Among the 185 patients, 128 patients were stage Ta compared with 57 patients who were stage T1. There were 87, 53 and 45 patients with grade G1, G2 and G3 respectively. Transurethral resection of the bladder tumor was performed on all the patients and all the patients received routine post-operative intravesical instillation. A telephone interview follow-up was conducted on all the patients, and the average follow-up period was 36 months. EORTC risk tables were used to calculate risk scores for recurrence and progression for each patient. The recurrence and progression rates of different risk groups were recorded and compared with the estimated rates by EORTC risk table. Statistical analysis was used for comparison. ResultsTotal 1-year recurrence rate and progression rate for these patients were 25.9% and 3.8% respectively. According to calculated values of the patients, the 1-year recurrence rates of Group 0, Group 1-4, Group 5-9, Group 10-17 were 10.4%(5/48), 21. 5%(14/65), 35. 2% (19/54), 55.6%(10/18), respectively. The 1-year progression rates of Group 0, Group 2-6, Group 7-13, Group 14-23 were 0% (0/43), 1.5% (1/67), 6. 7% (4/60), 13. 3% (2/15). There was no significant difference between the real rates and estimated rates of the EORTC risk tables (P＞0. 05). However,the 1-year recurrence and progression rates between the low risk group, the medium risk group and the high risk group showed significant differences respectively (P ＜ 0. 05 ). Conclusions The EORTC risk tables are feasible to evaluate the recurrence and progression risk of non-muscle invasive bladder cancer in the present cohort. Nevertheless, the long term value and feasibility need more research to confirm.
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[Objective]This study was designed to determine growth inhibition of diallyl trisulfide(DATS)in human prostate cancer cells by inducing apoptosis and further to investigate the mechanism underlying such effect.[Methods]Growth inhibition by DATS was estimated by the tetrazolium(MTr)assay.Apoptosis induction in DATS-treated cells was assessed by fluorescence microscopy analysis of cells with condensed and segmented nuclei following staining with DAPI and flow cytometric analysis of cells with sub-G1 DNA content following staining with propidium iodide.Protein levels of apoptosis regulating proteins were determined using western blot.The activity of caspase-3 was measured using a colorimetric assay.[Result]DATS showed tumor growth inhibition in a time-and dose-dependent manner,IC_(50) of DATS was 14 μmol/L at 72 h.DATS evoked apoptosis as confirmed by cell morphology and by the analysis of flow cytometry.The expression of Bcl-2 and Bcl-xL,the apoptosis-suppressing proteins,was more down-regulated.The activity of caspase-3 was enhanced by DATS.[Conclusion]DATS inhibits growth of prostate cancer cells by inducing apoptosis in association with down-regulation of Bcl-2 and Bcl-xL and activation of caspase-3.
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Objective To compare WHO 2004 and WHO 1973 pathological grading methods of non-muscle invasive urothelial neoplasms. Methods The clinical pathological features of 160 non-muscle invasive urothelial neoplasms patients, treated in our hospital from February, 1998 to Decem-ber, 2008, were re-graded according to WHO 2004 and WHO 1973 classification system. To evaluate recurrence and progression of all the patients during the follow up period, we used statistical method to analyses the differences between two classification system. Results There were 160 patients, ac-cording to WHO 1973 classification methods: 5 cases of papilloma, 52 cases of grade 1 tumors, 83 ca-ses of grade 2 and 20 cases of grade 3;By WHO 2004 classification method: 7 cases of papilloma, 31 cases of low-grade malignant potential of urothelial papilloma, 99 cases of low-grade papillary urotheli-al carcinoma and 23 cases of high-grade papillary urothelial carcinoma. There was no difference in re-currence among the grades of WHO 2004 and WHO 1973 pathological grading system (both P>0.05). Regarding the progress of non-muscle invasive papillary urothelial neoplasms, no significant difference was found among grades of WHO 1973 classification system(P>0.05)while difference exis-ted among grades of WHO 2004 pathological grading system (P<0.05), especially between papillary neoplasm of low malignant potential (PNLMP) and high grade papillary urothelial carcinomas(HG-PUC) (P<0.01). Moreover, HGPUC grade had more progression rate (30.4%) than G_3 grade (15.0%). Conclusions Compare to G_3 grade, HGPUC grade was more easily to make progress in pa-tients,due to this grade include more high malignant papillary urothelial carcinomas. Therefore, it is necessary for urologists to use a more rigorously follow up and therapy method in connection with HG-PUC grade of new classification system.
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Objective To discuss the clinical application and significance of non-enhanced computed tomography axis rotating movie imaging technique in PCNL for complex renal calculi. Methods Thirty-one cases unilateral and 2 cases bilateral multiple and staghorn renal calculi with mild or mediurn hydronephrosis patients were performed bilateral kidneys non-enhanced CT scanning,three dimensional reconstruction and the axis rotating movie composition were carried on by computer software,PCNL accesses were designed and the residual stone were predicted referred to the access-calyces angle measured in axis rotating movie image,PCNL were performed after while.Comparing between preoperation accesses design and residual stone prediction with in-operation practice were carried out.Results The first PCNL access was constructed via posterior middle upper minor calyces in 22 renal units and via posterior middle lower minor calyces in 13 renal units,which was consistent with pre-operation design according to CT axis rotating movie image.The second PCNL accesses were constructed via lower calyx posterior upper minor calyces in 9 renal units and via lower calyx posterior lower minor calyces in 5 renal units,nephrolithotomy were performed in the same operation,clinical stone clearance rate was 80%(28/35),other 7 cases with residual stone were consistent with pre-operation prediction,No blood transfusion was necessary and no severe complication happened in all 33 cases.Conclusions Non-enhanced CT axis rotating movie imaging provided the detail three dimensional shape and spatial structure of complex renal calculi intuitively) that was benefit for designing appropriate PCNL accesses for complex renal calculi patients, guiding for searching stone fragments in operation, predicting residual stone, and ensuring operation safety.
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Objective To discuss hemodynamic and electrolyte changes associated with irrigation fluid absorption during percutaneous nephrolithotripsy(PCNL). Methods Eithty nine upper urinary tract lithiasis patients underwent PCNL assisted with pressure irrigation. Sixty five cases were with renal calculi and 24 cases were with ureteral calculi. There were 62 males and 27 females. Nor mal saline was used as irrigation fluid. Heart rate(HR),central venous pressure(CVP),cardiac out put(CO),stroke volume(SV),systemic vascular resistance(SVR),thoracic fluid content(TFC) wererecorded before operation and every 30 min during irrigation. Serum Na+,K+,CI ,Ph,BE weredetected before and after irrigation. One way ANOVA,linear correlation and paired t test were usedas statistic analysis. Results The mean irrigation time was 105 min. Mean irrigation fluid volumewas 18 391 ml and mean irrigation velocity was 174.46 ml/min. HR,CO,SV,SVR and blood Na+ ,K+,C1 did not change significantly during and after irrigation. CVP and TFC significantly increasedduring irrigation. The increasing of CVP and TFC were correlated with irrigation time, volume andvelocity. CVP and TFC increased rapidly in 5 patients with calyx laceration and recovered after diuret ic injection. No serious complication was detected. Conclusions Irrigation fluid absorption is observed during PCNL with pressure irrigation. Generally, no significant changes in hemodynamic andelectrolyte balance are found in patients with normal cardiac and renal function.
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Objective: To summarize experiences in 136 cases of retroperitoneal laparoscopic surgery. Methods:From April 1997 to May 2002, retroperitoneal laparoscopic surgery were performed for 136 cases of adrenal dis-eases. There were 63 aldosterone- producing adenoma, 22 adrenalcortical adenoma, 39 nonfunctional adrenal tu-mor, 7 adrenal cyst and 5 phenochromocytoma. Results: Except for one case converts to open surgery, success hasbeen achieved in all cases without major complications. Intraoperative blood loss was 76 + 32ml without blood trans-fusion. Postoperative hospital stay was 6 + 3 days. There were statistical differences among these indices when com-paring to those of open surgery for 126 cases with adrenal diseases( P ＜ 0.05). But operative time was little longer inlaparoscopic group than in group of open surgery(P＜0.05) ,whereas it has been changed to similar in those recentcases. Conclusion:Retroperitoneal laparoscopic surgery was less traumatic to the patients, with less postoperative dis-comfort and quicker recovery and should be considered the first choice of therapy for adrenal disorders.
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Objective To evaluate the safety and feasibility of retroperitoneal laparoscopic excision of pheochromocytoma. Methods Retroperitoneal laparoscopic excision of pheochromocytoma was performed on 20 patients with pheochromocytoma (group A).At the same period, 20 patients with pheochromocytoma undergoing open surgery served as controls (group B).Intraoperative blood pressure, heart rate, plasma noradrenalin (NE) concentration,operative time, volume of blood loss, cases receiving blood transfusion, postoperative activity out of bed days, postoperative hospital stay,were compared between the 2 groups.The NE concentration was determined using RP-HPLC-ECD. Results The operations were successful in all the patients. Intraoperatively,3 cases (15.0%) in group A and 12 cases (60.0%) in group B experienced acute fluctuation in blood pressure,heart rate and pulse [maximum blood pressure,220/110 mm Hg(1 mm Hg=0.133 kPa) vs 210/115 mmHg; minimum blood pressure,88/57 mm Hg vs 85/60!mm Hg;maximum heart rate,122/min vs 120/min, respectively].The NE concentratioo correspondingly fluctuated from the maximum 16.82 ng/ml to the minimum 6.28 ng/ml (normal reference,0.32 ng/ml) (P
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Objective To study the diagnosis and treatment of renal tuberculosis (TB). Methods A retrospective study was made on 281 cases. Results Irritation symptoms, hematuria and lumbodynia were the most common symptoms. The positive result of acid-fast stains, urinary TB-PCR, PPD-IgG were 44.5%, 44.1% and 62.5% respectively. The diagnostic accuracy of urography, CT and B-type ultrasonography were 69.1%, 84.3% and 28.3%.105 of the 128 cases have been cured on medicine ( INH + RFP + PZA for 6～8 months ). Nephro-ureterectomy was performed for 145 out of 153 cases (94.8%). Conclusions Combined use of different means of diagnostic technique would help to assess the diagnosis of renal TB especially in atypical cases.IVU is still the first choice for diagnosis and CT scan is helpful.INH,REP and PZA used combinedly yiels satisfactory outcome for early cases.When nephro-ureterectomy is indicated,the involved ureter should be excised as much as possible.
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AIM:To study the blocking effect of shRNA on the expression of PSMA gene in LNCaP cell line by using shRNA eukaryotic expression vector.METHODS:Three pairs of DNA templates coding shRNA,synthesized against PSMA and cloned into the vector pSilencer 2.1-U6-neo,which was named pSilencer 2.1-U6-neo-shRNA,were identified by restriction endonuclease digestion analysis and DNA sequencing.LNCaP cells were then transfected with these three pSilencer 2.1-U6-neo-shRNAs and the negative control pSilencer 2.1-U6-neo-NC.After G418 selection,the cells were selected and the interfering effect was detected by RT-PCR and Western blotting.The biological behaviours of the transfected LNCaP cells were also tested.RESULTS:Restriction endonuclease digestion analysis and DNA sequencing results all showed that the 3 target segments were cloned into pSilencer 2.1-U6-neo vector respectively.After transfected into LNCaP cells,the inhibitory ratio of PSMA mRNA was 33.15%,9.26% and 41.97% respectively,and that of PSMA protein was 26.26%,6.47%,40.69% respectively.The p-shRNA3 was chosen to test the cell growth and its invasive power in vitro.The results showed that after interfering,the invasiveness of LNCaP cells were enhanced.CONCLUSION:The vector-based shRNA on PSMA gene effectively knocks down the PSMA gene expression.The successful construction of PSMA shRNA makes it possible for further study of the interaction between PSMA and prostate cancer.
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AIM: To find out the gene structure and diversity of protate specific membrane antigen(PSMA) alternative spliced variants, and probe into the pathogenesis of prostate cancer.METHODS: 5'-RACE and 3'-RACE methods were used to amplify the 5' and 3'end of alternative spliced variant and then those viariants were sequenced for analyzing the gene stucture and diversity of PSMA alternative spliced variants of prostate cancer tissues.RESULTS: Four new alternative spliced variants of PSMA were discovered from prostate cancer tissues.Compared with reported PSMA alternative spliced variants,different insertions and deletions existed in different sites of those new variants.CONCLUSION: The discovery of the new variants confirms the diversity of PSMA spliced variants and provides the clues for seeking the target of diagnosis and therapy of prostate cancer.
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AIM: To discuss the relationship between prostate specific membrane antigen(PSMA) and prostate cancer and to seek a target for diagnosis and therapy of prostate cancer.METHODS: A pair of primers was designed according to the published PSMA mRNA sequence.Total RNA was extracted from prostate cancer tissues and was reversely transcribed into cDNA,which was used as a template for PCR to amplify the PSMA gene.The recombinant was sequenced and the result was analyzed by BLAST.The PSMA5 gene specific primers were designed to identify its expression in different cells and prostate tissues.RESULTS: A new alternatively spliced variant of PSMA named PSMA5 was discovered when sequencing the recombinant.PSMA5 showed well pathological tissue-specificity,and its expression rate in prostate cancer,benign prostatic hyperplasia of prostate,and normal prostate tissue were 92.6%,78.8% and 10.0%,respectively.It expressed specifically in Pca cell line LNCaP,not in cell lines of PC3,bladder carcinoma,renal carcinoma,or hepatoma.CONCLUSION: A new alternative spliced variant of PSMA named PSMA5 was discovered,which was well correlated with prostate cancer and benign prostatic hyperplasia.This finding may give a new clue to the evolution of prostate cancer and may provide a target for the diagnosis and therapy of prostate cancer.
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Objective To determine the effects of pub op rostatic ligament and puborectalis sling sparing on postoperative complicationgs after radical retropubic prostatectomy. Methods A total of 16 men(mean age 67,stage B 14 cases,stage C 2 cases) with clinically prostat e cancer were managed with radical retropubic prostatectomy.Puboprostatic ligame nt and puborectalis sling sparing technique were used in all patients. Results All patients recovered from the operation.During 1 to 4 y ears,follow-up,none had long term incontinence or dysuria.PSA declined to 0.00 ng/ml and stayed 0.00 ng/ml in 9 cases within follow-up period.PSA were bellow
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AIM: To obtain eukaryotic expression vector of Chinese prostate-specific membrane antigen. METHODS: Chinese prostate-specific membrane antigen (PSMA) cDNA was amplified by RT-PCR from prostate cancer tissues, then cloned into eukaryotic expression vector pcDNA3 0 and sequenced. RESULTS: Seven bases in Chinese PSMA cDNA sequence were found different from those reported by Israeli, which lead to two different amino acids. CONCLUSION: We have obtained the PSMA cDNA, and the recombinant eukaryotic expression vector was successfully constructed. The study lays foundation for DCs vaccine modified by PSMA gene for the treatment of prostate neoplasms.