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【Objective】 To compare the clinical application value of controllable negative pressure suction outer sheath and ordinary flexible endoscope outer sheath in flexible ureteroscopic lithotripsy with holmium laser in the treatment of renal calculi less than or equal to 2 cm in diameter. 【Methods】 A total of 85 patients with renal calculi were selected and randomly divided into negative pressure group (n=45) and ordinary group (n=40). The operation time, complications, infection indexes 2 h after operation, adverse reactions, treatment efficacy and stone-clearance rate were compared between the two groups. 【Results】 The sheath was successfully implanted and holmium laser lithotripsy was performed in both groups. The negative pressure group had significantly shorter operation time than the ordinary group [(43.3±4.9) min vs. (66.2±5.8) min, P0.05). The increase of infection indexes (procalcitonin and leukocyte) 2 h after operation were significantly lower in the negative pressure group than in the ordinary group (P<0.05). The efficacy in the negative pressure group was 91.11% (41/45) and the stone-clearance rate was 95.56% (43/45), which were significantly better than those in the ordinary group (72.50% (29/40) and 80% (32/40), respectively. The total incidence of adverse reactions such as renal colic, gross hematuria and ureteral stone street was higher in the ordinary group than in the negative pressure group (P<0.05). 【Conclusions】 Controllable negative pressure suction sheath in flexible ureteroscopic lithotripsy is more effective, as the circulation perfusion keeps the operation field clear, reduces the operation time and improves the stone-clearance rate, while the negative pressure suction lowers the pelvis pressure to prevent infectious urine from entering the blood.
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Objective:To evaluate the prognostic value of the ratio of androgen receptor splice variant 7 (AR-V7) and androgen receptor (AR) in prostate cancer.Methods:One hundred and five prostate cancer patients treated by castration therapy were selected in this study in People′s Hospital of Gaozhou City, Guangdong Province from March 2013 to March 2018. The expression of AR and AR-V7 in biopsy specimens was detected by immunohistochemistry. The relationship between AR, AR-V7, AR-V7/AR and prognosis of patients was analyzed. Cox regression was used to analyze the related factors affecting prognosis of prostate cancer.Results:The positive rate of AR expression was 59.0% (62/105), and the positive rate of AR-V7 expression was 19.0% (20/105). The patients were followed up for 15 to 61 (44.8 ± 10.1) months. The progression free survival (PFS) and overall survival (OS) in AR-V7 positive patients were significantly shorter than those in AR-V7 negative patients: (10.8 ± 2.2) months vs. (25.0 ± 3.4) months and (20.3 ± 5.1) months vs. (42.8 ± 7.4) months, and there were statistical differences ( P<0.01). The PFS and OS in high AR-V7/AR expression patients were significantly shorter than those in low AR-V7/AR expression patients: (12.5 ± 3.2) months vs. (24.9 ± 5.5) months and (22.5 ± 4.6) months vs. (42.1 ± 8.3) months, and there were statistical differences ( P<0.01). In multivariate Cox regression analyses, T4 stage (HR = 2.618, 95% CI 1.362 to 4.986, P<0.01) and high AR-V7/AR ( HR = 5.799, 95% CI 2.541 to 13.253, P<0.01) could effectively and independently predict the prognosis of hormonal therapy. Conclusions:AR-V7 positive and high AR-V7/AR prostate cancer patients treated by castration therapy may have shorter PFS and OS, compared with AR-V7 negative and low AR-V7/AR patients. High AR-V7/AR is the independent predictor of the prognosis of prostate cancer.
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Objective To investigate the clinical efficacy and complications of minimally invasive transforaminal lumbar-interbody fusion (TLIF) in the treatment of lumbar spondylolisthesis. Methods Total 142 patients with single level spondylolis-thesis who treated by TLIF from 2010.01 to 2015.06 were included in this study, with 68 cases in minimally invasive TLIF (MIS-TLIF) group and 74 cases in traditional open TLIF group. The general information (age, gender, isthmic or degenerative type, per-centage of slip degree, levels), operative time, blood loss, length of postoperative hospital stay, Visual Analogue Scale (VAS) of low-back pain and leg pain, and Oswestry Disability Index (ODI) were recorded and collected. The posterior height of the interverte-bralpace and segmental lordosis, reduction of spondylolisthesis and cross-sectional area of spinal canal were measured. Results There was no statistically significant difference between the two groups in age, gender ratio, percentage of slip degree, and sur-gicallevels distribution. Total of 66 cases in MIS-TLIF group and 71 cases in Open TLIF group finished 2 years follow up, and 25 cases in MIS-TLIF group and 31 cases in Open TLIF group finished 5 years follow up. The blood loss of the MIS-TLIF group was 164.7±51.7 ml, significantly lower than the open TLIF group of 239±69.3 ml(P<0.001). The length of postoperative hospital stay was 5.9 ± 1.5 days in MIS-TLIF group, significantly shorter than the open TLIF group of 7.3 ± 3.1 days(P<0.001). The operative time of MIS-TLIF and Open TLIF was 146.3±21.9 mins, 152.0±20.4 mins, respectively, and no significant differ-ence was found between them. The VAS ofback pain, leg pain, ODI in MIS-TLIF group was 1.76±1.16, 1.91±1.36 and 23.5± 7.3 at 2 years follow up, and in Open TLIF was 1.73±1.10, 1.83±1.36 and 23.8±6.7, respectively, all of them were significant-ly different to pre-operation, however, no significant difference was found between two groups. The VAS of back pain, leg pain, ODI in MIS-TLIF group was 1.73±1.21, 1.93±1.48, and 25.4±6.8 at 5years follow up, and in Open TLIF was 1.85±1.02, 1.85± 1.33 and 26.1 ± 6.5, respectively, no significant difference between twogroups. The posterior height of the intervertebral space and segmental lordosis of MIS-TLIF was 9.52±1.67 mm and 12.11°±3.44° at 2 years follow up, while the open TLIF was 9.88± 1.54 mm and 12.98 ± 3.83° , all of them were significantly different to pre-operation,however, no significant difference between two groups. The posterior height of the intervertebral space and segmental lordosis of MIS-TLIF was 9.37 ± 1.46 mm and 11.55° ± 2.77° , while the open TLIF was 9.66 ± 1.68 mm and 12.59° ± 4.23° , no significant difference between two groups. The percentage of slip degree was reduced to 5.2％±4.6％ in MIS-TLIF and 5.6％±4.3％ in open TLIF, the cross-sectional area of spinal canal was enlarged to 139.7±19.5 mm2 and 141.7±20.7 mm2, no significant difference between two groups either. Con-clusion MIS-TLIF has less blood loss, shorter postoperative hospital stay than open TLIF, and similar clinical pain and function-al outcomes. MIS-TLIF is suggested to be a safe and effective choice in the treatment of lower grade lumbar spondylolisthesis (Grade II or less).
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Objective To investigate the role of signal transducer and activator of transcription (STAT1) signaling pathway in osteoblast apoptosis,and to study the effect of STAT1 inhibitor (fludarabine) on osteoblast.Methods The viability of the osteoblasts in different concentration of fludarabine was detected by cell counting kit-8 (CCK-8) assay.Osteoblasts were divided into 4 groups:control group,dexamethasone (Dex) group,fludarabine (Flu) group,and Dex + Flu group.Enzyme linked immunosorbent (ELISA) was used for determining the protein expression of Bcl-2 Associated X Protein (BAX),STAT1 and phosphorylation-sigual transducers and activators of transcription 1 (p-STAT1),and cleaved caspase-3 to reflect the apoptosis in all groups.Results Treatment with Dex increased the protein expression of apoptosis-related proteins and p-STAT1 in time-dependent and dose-dependent manner.Exposure of the cells to Flu,which was a selective STAT1 inhibitor,resulted in a decreased the protein levels of apoptosis-related proteins.Conclusions Our results suggest that fludarabine could suppress Dex-induced apoptosis through the inhibition of STATl-mediated up-regulation cleaved caspase-3 expression in osteoblasts.
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Objective To determine the radiographic feasibility of oblique lumbar interbody fusion (OLIF) corridor to treat lumbar disease at each lumbar disc level,including the corridor's numerical value and the influence of diaphragmatic crura and aorta abdominalis.Methods A retrospective CT study was conducted on 110 patients (including 69 males and 41 females,average age 47.95 years,range 16-83 years) that continuously collected and analyzed in the PACS system.The oblique corridor was defined as the area between the left lateral border of the aorta abdominalis(or iliac artery) and the right lateral border of the left psoas.The distances and angles of L1-2,L2-3,L3-4 and L4-5 levels were measured.Whether the change of diaphragmatic crura and aorta abdominalis affected the building of the corridor was also observed.Results The mean distances of oblique corridor to the levels of L1-L5 discs were:L1-2 15.90 mm,L2-3 14.82 mm,L3-4 17.57 mm,L4-5 11.16 mm.At the levels of L1-2 and L3-4,all of the images could build the corridor.But there were only 97.27％ images allowing operation at both L2-3 and L4-5,and the other 3 cases couldn't build the corridor since the aorta abdominalis was very close to psoas,and the distance was almost 0 mm.The max mean distance was 36.79 mm at L3-4 level.The mean angles were:L1-2 36.98°;L2-3 37.76°;L3-4 40.96°;L4-5 37.85°.The significant difference was at L3-4,ranged from 13.09 to 61.93°.The level of the aortic bifurcation was from the lower third of the L3 vertebral body to the middle third of the L5 vertebral body.The levels of left diaphragmatic crura's ending point in the lumbar was divided into four groups:1) Group L1 vertebral body level:the level at L1 vertebral body and above,5 cases (4.55％);Group L1-2 disc to L2 vertebral body level:at L1-2 disc and L2 vertebral body,67 cases (60.91％);Group L2-3 disc to L3 vertebral body level:at L2-3 disc and L3 vertebral body,36 cases (32.72％);Group L3-4 disc to L4 vertebral body level:at L3-4 disc and L4 vertebral body,2 case (1.81％).Conclusion The OLIF corridor can be built successfully at L1-2 and L3-4.However,it may be difficult at L2-3 and L4-5 for some patients due to the aorta abdominalis which is too close to psoas.The angles of L1-L5 levels were similar.While the left diaphragmatic crura was mainly impact the corridor insertion at L1-2 and L2-3.And the level of the aortic bifurcation was mainly located at the upper endplate of L4 to the L4-5 disc (87％).
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ObjectiveTo investigate the relationship between levels of inflammatory cytokines, Ureaplasma infection in midtrimester amniotic fluid and spontaneous preterm delivery.MethodsFrom April 2009 to March 2012, a total of 1 865 pregnant women who underwent amniocentesis in midtrimester with known pregnant outcomes in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, among whom 43 cases who delivered spontaneously before 37 weeks, were classified as preterm group, and the control group consisted of 373 normal term delivery women selected from the other 1 785 cases who term delivered during the same period. Cytokines, including interleukin (IL)-10, IL-1β, IL-6, monocyte chemotactic protein-1 (MCP-1) and tumor necrosis factor-α (TNF-α) in amniotic fluid, were measured by MILLIPLEX MAP Human Cytokine/Chemokine Magnetic Bead Panel and analysis system for liquid phase chips.Ureaplasma DNA was detected by polymerase chain reaction. Sum-rank test was used to compare the difference of cytokines between the two groups and receiver-operating characteristic curve and Logistic analysis were used to analyze the value of cytokines to predict spontaneous preterm delivery.ResultsThe median maternal age in preterm group was higher than in the control group [34(24-49) vs 29(20-47) years] (Z=-3.107,P=0.002), but there was no significant difference in levels of the five cytokines among women with different age in control group(20-24, 25-29, 30-34 and≥35 years old) (allP>0.05). The levels of IL-1β and IL-6 were not significantly different between two groups (allP>0.05), but levels of IL-10, MCP-1 and TNF-α in the preterm group were much higher than in the control group [11.22(4.79-468.73) vs 7.87(0.93-26.62), 1 358.86(553.16-7 635.81) vs 1 137.98 (311.80-5 196.33), 9.78(5.72-106.51) vs 8.37(2.56-30.20) pg/ml, respectively;Z were-4.333,-2.820 and-3.390, allP<0.01]. The areas under receiver-operating characteristic curve of IL-10, MCP-1 and TNF-αwere 0.70, 0.63 and 0.66. The appropriate cut-off level of IL-10 in amniotic fluid for prediction of preterm birth was 9.06 ng/ml, with a sensitivity of 74.4% and a specificity of 57.6%, and the latter increased to 100.0% when combined with IL-10, MCP-1 and TNF-α, but the sensitivity declined to 16.3%.Ureaplasma was identified in only two preterm cases and none in the controls. However, the levels of the five cytokines in the two infected cases in preterm group were 2.12–43.00 times of the rest cases in the same group, and 2.26–60.00 times of the controls.ConclusionsAlthough IL-10, MCP-1 and TNF-α levels in midtrimester amniotic fluid are increased, it is not able to predict spontaneous preterm birth neither independently nor combined together. Ureaplasma infection rate in amnion cavity is low, but may related to parts of spontaneous preterm delivery.
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Objective The concentration of cytokines in the amniotic fluid ( AF) may reflect the immune state of maternal-fetal interface .This study aimed to investigate the level of inflammation -related cytokines in the mid-trimester AF of normal pregnant women. Methods This study included 263 pregnant women undergoing mid-trimester genetic amniocentesis , and all of them had normal pregnancy outcomes .Using MILLIPLEX MAP and Luminex, we measured the concentrations of interleukin IL-10, IL-1β, IL-6, monocyte chemotactic MCP-1, and tumor necrosis factor TNF-αin the AF collected from the women at 18-22 +6 weeks′gesta-tion.We analyzed the correlation of their concentrations with maternal age , gestational age , and fetal gender by rank sum test . Results The median concentrations of IL-10, IL-1β, IL-6, MCP-1, and TNF-αin AF at mid-trimester were 7.91, 0.97, 78.15, 1 135.57, and 8.47 pg/mL, respectively.The levels of IL-10 and IL-1βwere higher in the pregnancies with male fetuses than in those with female fetuses (8.54 and 1.18 pg/mL vs 7.72 and 0.85 pg/mL, P=0.043 and 0.008).Maternal age or gestational week at the mid-trimester exhibited no influence on the concentrations of the 5 cytokines. Conclusion The levels of IL-10, IL-1β, IL-6, MCP-1 and TNF-αremain stable in AF at mid-trimester and the former 2 are higher in pregnancies with male fetuses .
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Objective To investigate the efficacy of renal transplantation from living related renal donor.Methods A retrospective analysis of 26 cases of renal transplantation from living related renal donor and 84 cases cadaveric renal transplantation was conducted.Results All the operations in these two groups underwent smoothly.The rate of patient/renal survival was 96.15%/96.15%,96.15%/96.15%,96.15%/92.31% respectively in the group of living related renal transplantation,and 96.43%/95.23%,85.71%/80.95%,65.48%/60.71% respectively in the group of cadaveric renal transplantation 1,3,5 years after the operation.The time of cold blood-deficiency and the time of warm blood-deficiency in the living related renal transplantation group were both shorter than those of the cadaveric renal transplantation group(P