Association between leucocyte telomere length and erectile dysfunction in US adults: a secondary study based on 2001-2002 NHANES data.

OBJECTIVE: We aimed to explore the association between the leucocyte telomere length (LTL) and erectile dysfunction (ED) among a nationally representative sample of US adults. DESIGN: Secondary population-based study. SETTING: The National Health and Nutrition Examination Survey (NHANES) (2001-2002). PARTICIPANTS: A total of 1694 male participants were extracted from the NHANES database for 2001-2002. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary focus of the study was to determine the association between the LTL and ED, using multivariate logistic regression and restricted cubic spline models for examination. The secondary outcome measures involved conducting stratified subgroup analyses to exclude interactions of different variables with the LTL. RESULTS: Participants with ED had shorter LTLs than those without ED (p<0.05). After adjusting for confounding factors, compared with the reference lowest LTL quartile, the ORs and 95% CIs for the second, third and fourth LTL quartiles were (OR 1.51; 95% CI 1.01 to 2.26), (OR 1.79; 95% CI 1.24 to 2.58) and (OR 1.25; 95% CI 0.74 to 2.11), respectively. In addition, restricted cubic splines showed an inverted J-curve relationship between the LTL and ED. At an LTL of 1.037, the curve showed an inflection point. The ORs (95% CI) of ED on the left and right sides of the inflection point were (OR 1.99; 95% CI 0.39 to 10.20; p=0.385) and (OR 0.17; 95% CI 0.03 to 0.90; p=0.039). CONCLUSION: Our results demonstrated an inverted J-curve relationship between the LTL and ED. When the LTL was ≥1.037, the incidence of ED decreased with increasing LTL.

Risk factors for erectile dysfunction in diabetes mellitus: a systematic review and meta-analysis.

Background: Previous studies have established that diabetes mellitus (DM) markedly raises the risk of developing erectile dysfunction (ED). Despite extensive investigations, the risk factors associated with ED in diabetic men have yet to be unequivocally determined, owing to incongruent and inconclusive results reported in various studies. Objective: The objective of this systematic review and meta-analysis was to assess the risk factors for ED in men with DM. Methods: A comprehensive systematic review was conducted, encompassing studies published in the PubMed, Scopus and Embase databases up to August 24th, 2023. All studies examining the risk factors of ED in patients with DM were included in the analysis. To identify significant variations among the risk factors, odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were employed. The risk of bias was evaluated using the Newcastle-Ottawa Scale(NOS) for longitudinal studies and the Agency for Healthcare Research and Quality Scale(AHRQ) for cross-sectional studies. Results: A total of 58 studies, including a substantial participant pool of 66,925 individuals diagnosed with DM, both with or without ED, were included in the meta-analysis. Mean age (OR: 1.31, 95% CI=1.24-1.37), smoking status (OR: 1.32, 95% CI=1.18-1.47), HbA1C (OR: 1.44, 95% CI=1.28-1.62), duration of DM (OR: 1.39, 95% CI=1.29-1.50), diabetic neuropathy (OR: 3.47, 95% CI=2.16-5.56), diabetic retinopathy (OR: 3.01, 95% CI=2.02-4.48), diabetic foot (OR: 3.96, 95% CI=2.87-5.47), cardiovascular disease (OR: 1.92, 95% CI=1.71-2.16), hypertension (OR: 1.74, 95% CI=1.52-2.00), microvascular disease (OR: 2.14, 95% CI=1.61-2.85), vascular disease (OR: 2.75, 95% CI=2.35-3.21), nephropathy (OR: 2.67, 95% CI=2.06-3.46), depression (OR: 1.82, 95% CI=1.04-3.20), metabolic syndrome (OR: 2.22, 95% CI=1.98-2.49), and diuretic treatment (OR: 2.42, 95% CI=1.38-4.22) were associated with increased risk factors of ED in men with DM. Conclusion: Our study indicates that in men with DM, several risk factors for ED have been identified, including mean age, HbA1C, duration of DM, diabetic neuropathy, diabetic retinopathy, diabetic foot, cardiovascular disease, hypertension, microvascular disease, vascular disease, nephropathy, depression, metabolic syndrome, and diuretic treatment. By clarifying the connection between these risk factors and ED, clinicians and scientific experts can intervene and address these risk factors, ultimately reducing the occurrence of ED and improving patient management.

Causal associations between prostate diseases, renal diseases, renal function, and erectile dysfunction risk: a 2-sample Mendelian randomization study.

Background: Previous observational studies have found a potential link between prostate disease, particularly prostate cancer (PCa), and kidney disease, specifically chronic renal disease (CKD), in relation to erectile dysfunction (ED), yet the causal relationship between these factors remains uncertain. Aim: The study sought to explore the potential causal association between prostate diseases, renal diseases, renal function, and risk of ED. Methods: In this study, 5 analytical approaches were employed to explore the causal relationships between various prostate diseases (PCa and benign prostatic hyperplasia), renal diseases (CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, and kidney ureter calculi), as well as 8 renal function parameters, with regard to ED. All data pertaining to exposure and outcome factors were acquired from publicly accessible genome-wide association studies. The methods used encompassed inverse variance weighting, MR-Egger, weighted median, simple mode, and weighted mode residual sum and outlier techniques. The MR-Egger intercept test was utilized to assess pleiotropy, while Cochran's Q statistic was employed to measure heterogeneity. Outcomes: We employed inverse variance weighting MR as the primary statistical method to assess the causal relationship between exposure factors and ED. Results: Genetically predicted PCa demonstrated a causal association with an elevated risk of ED (odds ratio, 1.125; 95% confidence interval, 1.066-1.186; P < .0001). However, no compelling evidence was found to support associations between genetically determined benign prostatic hyperplasia, CKD, immunoglobulin A nephropathy, membranous nephropathy, nephrotic syndrome, kidney ureter calculi, and the renal function parameters investigated, and the risk of ED. Clinical Implications: The risk of ED is considerably amplified in patients diagnosed with PCa, thereby highlighting the importance of addressing ED as a significant concern for clinicians treating individuals with PCa. Strengths and Limitations: This study's strength lies in validating the PCa-ED association using genetic analysis, while its limitation is the heterogeneity in study results. Conclusion: The results of this study suggest a potential link between PCa and a higher risk of ED.

Association between cardiovascular disease and risk of female sexual dysfunction: a systematic review and meta-analysis.

AIMS: Female sexual dysfunction (FSD) is a considerably underestimated condition. It has been repeatedly reported that patients with cardiovascular diseases (CVD) may suffer from an increased risk of FSD. However, there is still a lack of comprehensive and systematic evaluation of various CVD and FSD. We aimed to elucidate the association between CVD and FSD through a comprehensive literature review and meta-analysis. METHODS AND RESULTS: The PubMed, Scopus, Embase, and Cochrane Library databases were systematically searched from inception to 28 February 2023. We identified all relevant studies reporting the risk of FSD in subjects with or without CVD. The associations between CVD and the risk of FSD were assessed by calculating pooled odds ratios (ORs) (cross-sectional studies) and risk ratios (RRs) (longitudinal studies) with 95% CIs. We employed random-effects models to account for potential heterogeneity, and the quality of the included studies was assessed using the Newcastle-Ottawa Scale. Fifty-four articles with 148 946 individuals were included in our meta-analysis. Compared with control subjects, subjects with CVD had a 1.51-fold increased risk of FSD (OR 1.51 95% CI, 1.34-1.69, P < 0.001, heterogeneity I2 = 91.4%, P < 0.001). Subgroup analyses indicated that the association between CVD and FSD remained significant in longitudinal studies (RR 1.50 95% CI, 1.21-1.86, P < 0.001, heterogeneity I2 = 86.7%, P < 0.001). Particularly, hypertension (OR 1.41 95% CI, 1.23-1.62, P < 0.001, heterogeneity I2 = 82.7%, P < 0.001), stroke (OR 1.81 95% CI, 1.54-2.12, P < 0.001, heterogeneity I2 = 0%, P < 0.423), and myocardial infarction (OR 2.07 95% CI, 1.60-2.67, P < 0.001 heterogeneity I2 = 82.4%, P < 0.001) were significantly associated with FSD. Meta-regression revealed that the primary sources of heterogeneity in FSD are attributable to adjustments for covariates, study design, and study population. CONCLUSION: Our meta-analysis indicated that patients with CVD suffer from a greater risk of developing FSD. Meanwhile, we validated these findings in longitudinal queues. Notably, conditions such as hypertension, stroke, and myocardial infarction demonstrated a significant association with the incidence of FSD.

Our study provides a significant advantage as the most comprehensive systematic analysis to date. It encompassed 45 cross-sectional and 11 longitudinal studies with 148 946 patients, aiming to investigate the relationship between various types of cardiovascular diseases (CVD) and female sexual dysfunction (FSD). Subgroup analyses were conducted to explore the impact of factors such as region and publication time.Accumulating evidence strongly supports a significant link between CVD and an increased risk of FSD, especially in cases of hypertension, stroke, and myocardial infarction. These findings indicate that more attention should be paid to women's sexual health, particularly in the presence of CVD.Future studies are warranted to investigate the effects of pharmacological interventions on the sexual function of women affected by CVD.

Novel heterotopic continental ileal reservoir based on the Mitrofanoff principle: a case report and review of the literature.

For patients undergoing radical cystectomy with standard lymphadenectomy for bladder cancer, appropriate urinary diversion (with a pouch and conduit) improves postoperative quality of life, reduces postoperative complications, and prolongs survival. We developed a novel heterotopic ileal reservoir to achieve these goals. This report describes the methodology involved and the incidence of intraoperative and postoperative complications. Three patients who underwent novel heterotopic ileal reservoir creation following radical cystectomy and standard lymphadenectomy (for bladder cancer) were evaluated. The ileum served as a pouch in which the ureters and appendix were implanted by extramural tunnelling. The appendix served as a conduit and pelvic reperitonealization was performed. Operative times, intraoperative blood loss, time to intestinal function recovery, incidence of intestinal obstruction and ureteric reflux, and bladder volumes and continence levels were evaluated. The surgical intervention was successful with operation times ranging 410-525 min, blood loss ranging 300-700 ml, and recovery time for intestinal function ranging 3-5 days. The postoperative hospitalization time was 11-15 days. Subileus occurred in patient B, who recovered after fasting and fluid replacement. Patients B and C achieved complete continence 6 weeks after surgery, while patient A experienced umbilical urine leakage with catheterization time intervals that exceeded 4 h. At 3 months after surgery, the bladder capacities of all patients ranged 250-370 ml. Follow-up cystography suggested the presence of bilateral ureteral reflux in patient A, with mild and moderate reflux on the left right sides, respectively. All patients achieved complete continence. Patients were followed for 3-9 months postoperatively; chest and abdominal computed tomography and cystography showed absence of hydronephrosis, recurrence, or distant metastasis during this period. The novel heterotopic continent ileal reservoir described in this study may be suitable for selected patients. The surgical procedure is safe when performed by well-trained and highly experienced urologists.

The relationship between sleep disorders, quality, and duration and sexual dysfunction: a systematic review and meta-analysis.

BACKGROUND: The associations between sexual dysfunction (SD) and sleep disorders, sleep quality, and sleep duration remain unclear. AIM: To assess the relationship between sleep and SD through a literature review and meta-analysis. METHODS: The PubMed, Scopus, Embase, Ovid MEDLINE, and Cochrane Library databases were systematically searched from inception to November 10, 2022. OUTCOMES: Pooled relative risks and 95% CIs were used to examine the association of sleep disorders with SD in longitudinal studies. Pooled odds ratios (ORs) and 95% CIs were used to examine the associations between SD and sleep disorders, sleep quality, and sleep duration in cross-sectional studies. RESULTS: Forty-three articles, including 11 longitudinal studies and 32 cross-sectional studies, were included in the quantitative analysis. The pooled relative risk of SD in patients with sleep disorders was 1.97 in longitudinal studies (95% CI, 1.46-2.67, P < .001; heterogeneity: I2 = 95.0%, P < .001), while the pooled OR of SD in patients with sleep disorders was 2.05 in cross-sectional studies (95% CI, 1.76-2.39, P < .001; heterogeneity: I2 = 91.4%, P < .001). When compared with controls, subjects with poor sleep quality had a 1.49-fold increased risk of SD (OR, 1.49; 95% CI, 1.31-1.71, P < .001; heterogeneity: I2 = 73.4%, P < .001). In addition, short sleep duration was associated with the risk of SD (OR, 1.14; 95% CI, 1.06-1.22, P < .001; heterogeneity: I2 = 0.0%, P = .849). CLINICAL IMPLICATIONS: The risk of SD is significantly increased in patients with sleep disorders and poor sleep quality, indicating that clinicians should monitor sleep among patients with SD. STRENGTHS AND LIMITATIONS: This study is the most comprehensive meta-analysis of the association between sleep and SD to date. However, different sleep disorders may have varying associations with sleep duration and sleep quality; thus, we could not identify the independent effects across the studies. CONCLUSION: Our systematic review and meta-analysis results suggest that sleep disorders, especially obstructive sleep apnea, increase the risk of SD in men and women. Poor sleep quality is significantly associated with SD. Short sleep duration is associated with an increased risk of SD.

FTO-stabilized miR-139-5p targets ZNF217 to suppress prostate cancer cell malignancies by inactivating the PI3K/Akt/mTOR signal pathway.

As one of the most important demethylases for RNA N6-methyladenosine (m6A) modifications, fat mass and obesity-associated protein (FTO) plays anti-cancer role during prostate cancer (PC), but it is still unclear the detailed molecular mechanisms. Here, this study verified that FTO inactivated the tumor-accelerating PI3K/Akt/mTOR pathway to hamper PC development through regulating the downstream miR-139-5p/zinc finger protein 217 (ZNF217) axis. Through performing clinical analysis, it was revealed that FTO was apparently ablated in the cancerous tissues compared to the normal tissues collected from PC patients, and patients with high-expressed FTO predicted a favorable prognosis. Functional experiments confirmed that overexpression of FTO suppressed cell proliferation, mitosis, epithelial-mesenchymal transition (EMT), tumorigenesis and lung metastasis both in vitro and in vivo. The following mechanical experiments verified that FTO stabilized miR-139-5p to increase its expression levels in a m6A-dependent manner, and elevated miR-139-5p induced degradation of ZNF217 through binding to ZNF217 mRNA, resulting in the inactivation of the PI3K/Akt/mTOR signal pathway. Finally, our rescuing experiments confirmed that overexpressed FTO-induced tumor-suppressing effects on PC cells were abrogated by miR-139-5p ablation and ZNF217 overexpression. Collectively, this study firstly validated that FTO exerted its anti-tumor effects in PC through regulating the miR-139-5p/ZNF217 axis in a m6A-dependent manner, providing novel biomarkers for the advancement of anti-cancer agents for PC treatment.

The association between sexual dysfunction and prostate cancer: a systematic review and meta-analysis.

BACKGROUND: Whether there is a connection between sexual dysfunction (SD) and prostate cancer (PCa) is controversial. AIM: We sought to review the interrelationship between SD and PCa and to determine whether there is a definitive risk of men developing PCa after suffering from SD. METHODS: A complete search of the PubMed, Web of Science, Ovid MEDLINE, Embase, and Cochrane Library databases was performed to search for eligible studies published up to October 2022. The protocol for this meta-analysis is available from PROSPERO (ID: CRD42022342381). OUTCOMES: The associations between SD and the risk of PCa were assessed by calculating pooled ORs with 95% CIs, and the standard mean difference (SMD) and its 95% CI were used to assess the relationship between SD and prostate-specific antigen (PSA) levels or prostate volume (PV). Random-effects models were used to account for potential heterogeneity, and the Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included studies. RESULTS: Twenty studies involving 215,626 individuals were included in our meta-analysis. Compared with controls, subjects with SD had a 1.62-fold increased risk of PCa (OR = 1.62, 95% CI, 1.77-2.23, P = .003; heterogeneity: I2 = 97.8%, P < .001). Patients with SD had higher PSA levels than controls (SMD =0.07, 95% CI, 0.00 to 0.13, P = .041; heterogeneity: I2 = 55.6%, P = .027). However, there was no association between SD and PV (SMD = 0.03, 95% CI, -0.05 to 0.11, P = .122; heterogeneity: I2 = 48.5%, P = .100). CLINICAL IMPLICATIONS: Current evidence confirms a potential link between SD and the risk of PCa and that SD in PCa patients should be of concern to clinicians. STRENGTHS AND LIMITATIONS: The strength of this study is that it is to our knowledge the first meta-analysis of studies on the risk of PCa in men with SD. A limitation is that most of the studies included in this meta-analysis focused on ED. CONCLUSION: Our systematic review and meta-analysis results suggest that men with SD have a higher risk of PCa and higher PSA levels than men without SD. However, this is merely inferential, and causality cannot be determined based on the current data. Further longitudinal studies should be performed to validate our preliminary findings.

Mortality relevant factors of COVID-19 infection in kidney transplantation recipients: a systematic review and Meta-analysis / 中华器官移植杂志

Objective:To assess the evidence for relevant factors associated with mortality in COVID-19 kidney transplantation recipients(KTR) through Meta-analysis.Methods:A complete search of PubMed, Web of Science, Medline, Scopus, Cochrane Library, CNKI and Wanfang Database were performed to search for eligible studies on 18 August 2022.Results:twenty-nine studies involving 7 978 Cases were included in our Meta-analysis.Patients with mean age ≥60 years( OR=1.09, 95% CI: 1.06-1.13), Comorbidities including diabetes mellitus( OR=1.49, 95% CI: 1.26-1.76), cardiovascular disease( OR=1.88, 95% CI: 1.33-2.65), and acute kidney injury( OR=3.46, 95% CI: 1.35-8.89) significantly increased mortality risk.KTR with dyspnea ( OR=2.17, 95% CI: 1.38-3.42), higher Hemoglobin ( OR=1.09, 95% CI: 1.00-1.19), Use of mycophenolic ( OR=1.18, 95% CI: 1.02-1.37) and Antibiotics( OR=7.26, 95% CI: 2.11-25.07) at presentation were at higher mortality risk, while diarrhea( OR=0.57, 95% CI: 0.34-0.96) and higher eGFR( OR=0.95, 95% CI: 0.92-0.98) decreased the risk.Overall in-hospital mortality in COVID-19 KTR was 19%, 95% CI: 15%-23%. Conclusions:Our systematic review and -analysis results suggest that overall in-hospital mortality in COVID-19 KTR declined progressively over time.KTR with these risk factors should receive more intensive monitoring and early therapeutic interventions to optimize health outcomes.

Risk factors of incidental prostate cancer in patients undergoing radical cystoprostatectomy / 现代泌尿外科杂志

【Objective】 To investigate the risk factors and clinical significance of incidental prostate cancer (IPCa) in patients undergoing radical cystoprostatectomy (PCR). 【Methods】 The clinicopathological data of 260 patients undergoing RCP in our hospital during Jan. 2010 and Jan. 2022 were retrospectively analyzed, including 39 cases of IPCa detected with postoperative pathology, and 221 non-IPCa cases. 【Results】 The detection rate of IPCa was 15%. Univariate logistic regression analysis showed age (P<0.001), smoking (P<0.05), T stage (P<0.05), number of tumors (P<0.05), involvement of trigone (P<0.05), prostate volume (P<0.05), and preoperative total prostate-specific antigen (tPSA) (P<0.05) were influencing factors of prostate cancer. Multivariate logistic regression analysis showed that age (OR=1.061, 95%CI: 1.021-1.107, P=0.004), smoking (OR=2.852, 95%CI: 1.296-6.677, P=0.012), involvement of trigone(OR=2.967, 95%CI: 2.365-3.657, P=0.019) and preoperative tPSA (OR=1.109, 95%CI: 1.011-1.223, P=0.030) were independent risk factors of IPCa. 【Conclusion】 Advanced age, smoking, bladder tumor in trigone and preoperative PSA abnormality are risk factors for incidental prostate cancer in bladder cancer patients.

Reprt of the short-term efficacy of a new type of ileal orthotopic cystectomy / 中华泌尿外科杂志

In this study, a new ileal orthotopic bladder (Urumqi Bladder) modified by our center based on the ileal "W" type orthotopic bladder and Studer bladder was used on 8 patients with invasive bladder cancer. All of patients were male and aged between 54 and 66 years. The history of disease ranged from 1 month to 3 years, including 5 patients with initial onset, 3 patients with ≥2 TURBT history. 6 patients had multiple tumors, tumor size from 0.5 cm to 2.5cm. There were 2 patients with single tumor. Preoperative PET-CT examination showed no distant metastasis and pelvic lymph node enlargement, no urinary tract hydronephrosis, and cystoscopy showed no suspected tumor in the urethra. Preoperative pathological results: high-grade invasive urothelial carcinoma was found in 6 cases and muscular invasive urothelial carcinoma in 2 cases. In 8 patients, 50cm ileum was taken from 15cm away from ileocecum after radical cystectomy, which was crimped clockwise inward from the right end into a nearly circular shape, with 10cm left at the left end. The remaining 40cm ileum was formed into 3 sections of about 13cm each, which were decanted to form a storage capsule. The last 10cm intestinal tube was crossed from the front of sigmoid colon. The end of intestine was anastomosed with the left ureter. The right ureter was anastomosed with the top of the right intestine pouch, and the urethra was anastomosed with the pouch to complete the diversion of urine flow. During 3-12 months of postoperative follow-up, 4 patients had short-term mild urinary incontinence. All had complete urinary control at 12 months. 1 patient still had mild left ureter reflux 12 months after surgery, and the other 7 patients had no ureter reflux. In this group of 8 patients, postoperative excretory cystography showed satisfactory effect of bladder voiding, residual, and bladder capacity. Follow-up review of chest CT, urinary CT and abdominal ultrasound showed no hydronephrosis, and no tumor recurrence or distant metastasis.

Circular RNA UBAP2 promotes the proliferation of prostate cancer cells via the miR-1244/MAP3K2 axis.

Prostate cancer (PCa) is a common male malignant disease with a high incidence, which can seriously affect the quality of life of patients. The survival rate of patients with PCa has improved to 98.6%; however, new insights for the molecular mechanism are still urgently required. Circular RNA (circ)UBAP2 is a tumor-associated circRNA that has been demonstrated to promote the progression of various types of cancer. CircUBAP2 has been demonstrated to be significantly upregulated in PCa, but its role in the progression of PCa remains unclear. The present study aimed to provide an improved understanding of the regulatory mechanism of circUBAP2 in PCa. circUBAP2 expression was identified to be upregulated in four PCa cell lines and clinical tissues by using reverse transcription-quantitative PCR analysis. Binding sites analysis and luciferase reporter gene assay indicated that the microRNA(miR)-1244/MAP3K2 axis was the target of circUBAP2. Gain-of-function assays revealed that circUBAP2 promoted the proliferation of PCa cells by sponging miR-1244 and promoting the MAP3K2 axis. The present findings may be essential for providing new strategies in the diagnosis and targeted therapy of PCa.

Clinical features and prognosis of renal malignant mesenchymal tumors / 中华泌尿外科杂志

Objective:To discuss the clinical features, treatment and prognosis of renal mesenchymal malignancy.Methods:Retrospective analysis was performed on the clinical data of 48 patients with renal mesenchymal malignancies admitted from January 2005 to June 2019.The patients' age ranged from 16-79 years, including 29 males and 19 females. There were 21 cases of Han nationality and 27 cases of ethnic minorities. The main complained of lumbago were 31 cases, bloating 8 cases, blood urine 2 cases, and 6 cases by physical examination. And one case was seen in orthopedics due to upper arm pain. The patient's completion of the examination indicated a tumor of kidney origin. CT examination mostly showed renal space-occupying lesions. After enhancement, the tumor was irregularly enhanced, with unclear edges, which was difficult to distinguish from renal carcinoma. The tumors were on the left in 30 cases and on the right in 18 cases. All patients perfected preoperative blood routine, biochemical, coagulation and other examinations. Prothrombin time was normal in 39 cases. Clinical staging was conducted according to the imaging results at the time of initial diagnosis. 7 were in clinical Stage T 1, 16 were in Stage T 2, 20 were in stage T 3, and 5 were in stage T 4.Distant metastases were found in 8 cases, including 4 lung metastases, 2 retroperitoneal metastases, and 2 bone metastases. 13 patients underwent needle biopsy to confirm the diagnosis. Among the 48 cases in this group, 29 cases were diagnosed as renal tumor, 12 cases were diagnosed as renal space occupying lesions, and 7 cases were diagnosed as retroperitoneal space occupying. 17 underwent radical nephrectomy, 22 underwent partial nephrectomy, and 9 did not receive surgical treatment after needle biopsy. Results:Among the 48 patients, Conventional pathology confirmed 17 cases as leiomyosarcoma, 17 cases as liposarcoma, and 14 cases as other types of mesenchymal malignancies. Follow-up ranged from 7 to 180 months, with an average follow-up of 38.8 months. Thirty patients died, and the average survival time was 39 months. The 5-year survival rates of leiomyosarcoma, liposarcoma and other types of tumors were 18.2%, 30.8% and 50.1%, and the difference was statistically significant ( P=0.047). The 5-year survival rates of patients with normal and abnormal prothrombin time were 36.8% and 11.0%, the difference was statistically significant ( P=0.018). The 5-year survival rates of radical surgery and partial nephrectomy were 44.6% and 29.8%, and the difference was statistically significant ( P<0.05). The 5-year survival rates of T 1, T 2, T 3 and T 4 patients were 40.0%, 31.6%, 35.4% and 0, and the differences were statistically significant ( P=0.020). Multivariate analysis showed that preoperative prothrombin time ( P=0.013), clinical T stage ( P=0.030) and surgical method ( P=0.006) were independent factors affecting the prognosis of patients with RMM. Conclusions:Renal mesenchymal malignant tumor is rare, and highly malignant. Preoperative needle biopsy did not affect the prognosis of RMM. Patients with normal prothrombin time, early clinical staging and radical surgery had better prognosis. Renal liposarcoma has a better prognosis than renal leiomyosarcoma.

Up-regulation of DRAM2 promotes tolerance of bladder transitional cell carcinoma to gemcitabine.

INTRODUCTION: Bladder transitional cell carcinoma (BTCC) is one of the most prevalent human malignant diseases. Gemcitabine is commonly applied in the treatment of BTCC while acquired gemcitabine resistance has caused a severe impediment to recovery. This study aimed to investigate the function of DRAM2 in regulating gemcitabine resistance of BTCC. MATERIAL AND METHODS: GSE77883 was introduced to screen out the differentially expressed autophagy-related genes in T24 cells and gemcitabine-resistant T24-GEM cells. After establishing T24-GEM cells ourselves, aberrant expression of DRAM2 was detected by qRT-PCR and Western blot. After stably manipulating the expression of DRAM2 in T24 and T24-GEM cells, the changes of cell biological functions under gemcitabine treatment were compared, including cell viability, apoptosis and autophagy, using colony formation, flow cytometry and electron microscopy respectively. RESULTS: DRAM2 was up-regulated in gemcitabine-resistant T24-GEM cells. Silencing of DRAM2 in T24-GEM cells inhibited the cell autophagy induced by treatment with gemcitabine and contributed to attenuated gemcitabine resistance. Also, overexpression of DRAM2 in T24 cells enhanced the autophagy, strengthened the chemoresistance and decreased the cell apoptosis rate under the treatment with gemcitabine. CONCLUSIONS: Our data suggested that downregulation of DRAM2 rescued the sensitivity of T24-GEM cells to gemcitabine, providing an appropriate therapeutic target for BTCC treatment.

Comparison of efficacy between extended pelvic lymph node dissection and standard pelvic lymph node dissection in open radical cystectomy / 中华泌尿外科杂志

Objective To compare the efficacy of extended pelvic lymph node dissection (ePLND) and standard pelvic lymph node dissection (sPLND) in open radical cystectomy.Methods We retrospectively analyzed the clinical data of 139 patients with bladder cancer cases in our hospital from January 2007 to January 2017,who underwent open radical cystectomy and pelvic lymph node dissection performed by the same group of surgeons.There were 117 males and 22 females,aged from 20 to 84 years old,with an average of (64.6 ± 11.7) years,91 patients were underwent ePLND group and 48 patients were underwent sPLND group.The preoperative anemia-free patients was compared between the ePLND group and the sPLND group [24 (50.0％)] vs.58 (54.9％),respectively],the patients with anemia were [24 (50.0％) vs.41 (45.1％)].The range of ePLND is:sway to the common iliac artery and the lower aortic (unreaching the inferior mesenteric artery);the lateral boundary to the reproductive femoral nerve;the distal end of the iliac artery at the groin level,the posterior border to the iliac vessels and closure,which contains the anterior tibial lymph nodes between the two sides.The range of sPLND is below the level of the common iliac artery bifurcation,and the rest of the range is the same as ePLND.The average operative time,average intraoperative blood loss,intraoperative blood transfusion,intraoperative and postoperative complications,postoperative eating time,postoperative activity time,postoperative exhaust time,postoperative hospital stay,mean gastric tube indwelling time,average pelvic drainage tube indwelling time,lymph nodes positive rate,lymph node density,and cancer-free survival were evaluated.Results All 139 patients underwent surgery successfully.The average operative time in the ePLND group and the sPLND group were [(351.2 ±79.5)min vs.(342.5 ± 69.3) min],average intraoperative blood loss [(314.6 ± 120.6) ml vs.(298.3 ± 126.3)ml],intraoperative blood transfusion [(702.9 ± 645.7) ml vs.(936.9 ± 818.1) ml],no intraoperative complications,postoperative complications [29 cases (31.9 ％) vs.18 cases (37.5 ％)],postoperative eating time [(5.4 ± 1.9) d vs.(4.8 ± 2.1) d],postoperative activity time [(2.1 ± 0.9) d vs.(1.9 ± 0.8) d],postoperative exhaust time [(3.8 ± 0.9) d vs.(3.6 ± 1.0) d],postoperative hospital stay [(14.9 ± 7.8) d vs.(15.5 ± 6.9) d],average gastric tube indwelling time [(4.8 ± 2.6) d vs.(4.53 ± 1.9) d],average pelvic drainage tube indwelling time [(11.1 ± 4.9) d vs.(10.9 ± 4.9) d],the difference was not statistically significant (P ＞ 0.05).A total of 2 359 lymph nodes were dissected from the two groups.The number of lymph nodes dissected in each of the ePLND group and the sPLND group was [(20.3 ± 3.8) vs.(10.6 ± 3.1),P ＜ 0.01],and the average number of positive lymph nodes was [(0.6 ± 1.3) vs.(0.3 ±1.0),P =0.034],the ratio of lymph node positive patients was [33 (36.3％) vs.9 (18.8％),P =0.026],and the lymph node density was [7.9％ (146/1848) vs.4.1％ (21/511)],the difference was statistically significant (P ＜ 0.05).In regard to prognosis,the disease-free survival rate (DFS) of ePLND group was 94.5％,91.0％,84.4％,81.1％,75.3％ at 1,2,3,4 and 5 years follow-up respectively.The other group was 70.5％,63.5％,57.8％,51.4％,41.1％ respectively.DFS of ePLND group tended to be higher than that of sPLND group in lymph node positive subgroups.The difference between the two groups was statistically significant (P ＜ 0.001).Conclusions In open radical cystectomy,ePLND and sPLND have similar surgical safety,but expanded lymph node dissection can improve disease-free survival in patients and improve the prognosis by increasing the detection range of positive lymph nodes.

Clinicopathological features and prognosis of chromophobe renal cell carcinoma and papillary renal cell carcinoma / 中华泌尿外科杂志

Objective To analyze the clinicopathological features and prognostic factors of common subtypes of non-transparent renal cell carcinoma.Methods Retrospective analysis of 115 patients with pathologically confirmed non-transparent renal cell carcinoma from January 2003 to December 2017,including 67 males and 48 females,with a male to female ratio of 1.4∶ 1.The average age is (51.2 ± 13.4)years old.71 cases were asymptomatic renal cancer,44 cases had clinical symptoms,including 10 cases of gross hematuria,28 cases of low back pain,4 cases of hematuria with low back pain,and 2 cases of abdominal mass.There were 49 open surgery and 66 laparoscopic surgery.58 patients underwent radical nephrectomy and 57 underwent partial nephrectomy.Of the 115 patients,17 (14.9％) had abnormal hemoglobin (Hb),22 (19.1％) had abnormal platelet (PLT) count,18 (15.7％) had abnormal alkaline phosphatase,and abnormal lactate dehydrogenase 16 cases (13.9％).The Kaplan-Meier survival analysis method was used to calculate the survival rate of patients,and the Cox proportional regression risk model was used to analyze the prognostic factors.Results The postoperative pathological stage was 57 cases in T1a stage,38 cases in T1b stage,12 cases in T2a stage,8 cases in T2b stage,2 cases of regional lymph node positive,and 113 cases negative;no distant metastasis.Pathological types:42 cases of renal chromophobe cell carcinoma,37 cases of papillary renal cell carcinoma type Ⅰ,36 cases of type Ⅱ.The average follow-up time was 38.6 months,and the rate of loss of follow-up was 3.5％ (4/115).The 1,3,and 5 year overall survival rates of 115 patients with common subtypes of non-transparent renal cell carcinoma were 99.1％,95.8％,and 81.1％,respectively.Multivariate Cox regression analysis found that the pathological type (OR =4.625,P =0.014),four indicators ≥ 3 abnormalities (OR =30.853,P =0.024),lymph node metastasis (OR =35.663,P =0.006) were the group.An independent factor in the survival time of patients with common subtypes of non-transparent renal cell carcinoma.Conclusions Compared with papillary renal cell carcinoma type Ⅰ and renal chromophobe cell carcinoma,papillary renal cell carcinoma type Ⅱ has a higher degree of malignancy and a poor prognosis.The pathological types of the common subtypes of nontransparent renal cell carcinoma,four indicators (Hb,PLT count,alkaline phosphatase,and lactate dehydrogenase) ≥3 abnormalities and lymph node metastasis are independent prognostic factors for overall survival.

Growth and proliferation of human urine derived stem cells in three kinds of culture media / 中国组织工程研究

BACKGROUND: Little is reported on human urine derived stem cells, and there is still no stable and efficient culture method until now. OBJECTIVE: To compare the effects of three kinds of culture media on the growth and proliferation of human urine derived stem cells, and to optimize the culture methods. METHODS: Human urine derived stem cells were isolated and purified using centrifugation method, and then cultured using adherent method in keratinocyte serum-free medium, progenitor cell culture medium, and urinary cell culture medium (equal-proportion mixture of keratinocyte serum-free medium and progenitor cell culture medium). Cell morphology was observed, and cell proliferation was detected by MTT method to draw a cell growth curve.RESULTS AND CONCLUSION: Human urine derived stem cells could be successfully cultured in these three kinds of culture media, which grew slowly in the keratinocyte serum-free medium, grew rapidly in the progenitor cell culture medium, and grew best in the urinary cell culture medium. To conclude, the urinary cell culture medium which can rapidly and efficiently culture target cells is the best choice for the growth of human urine derived stem cells.

MicroRNA-145 regulates the differentiation of human adipose-derived stem cells to smooth muscle cells via targeting Krüppel-like factor 4.

Understanding the molecular mechanisms underlying human adipose-derived stem cell (hASC) differentiation to smooth muscle may contribute to the development of effective therapies for relevant muscle defects, such as bladder wall and urethral defects. A previous study described the differentiation of hASCs to smooth muscle cells (SMCs) by transforming growth factor-ß1 (TGF-ß1) and bone morphogenetic protein­4 (BMP4) treatment. The present study investigated whether microRNA-145 (miR­145) may be involved in the process of hASC differentiation. The expression of miR­145 was significantly increased during differentiation of ASCs to SMCs. SMC­specific genes and proteins, including a­smooth muscle actin (α­SMA), smooth muscle protein­22α(SM22α), calponin and myosin heavy chain (SM­MHC) were upregulated by transfection of a miR­145 mimic. By contrast, these factors were downregulated following introduction of antisense oligonucleotides. In addition, Krüppel­like factor 4 (KLF4) levels, which decreased during the differentiation of hASCs, were downregulated when the cells were transfected miR­145 mimics. Futhermore, inhibition of KLF4 by treatment with short­interfering­RNA against KLF4, resulted in increased expression of SMC­specific genes and proteins. In conclusion, the results of the present study demonstrated that by regulating KLF4, miR­145 may be involved in regulating smooth muscle differentiation of ASCs induced by TGF­ß1 and BMP4.

Impact of smoking status and cumulative smoking exposure on tumor recurrence of non-muscle-invasive bladder cancer.

OBJECTIVE: To investigate the effect of smoking status, cumulative smoking exposure and smoking cessation on the outcomes of patient with non-muscle-invasive bladder cancer (NMIBC). METHODS: We collected smoking data from 484 patients with NMIBC who were treated with transurethral resection (TUR); smoking status was categorized as (never smokers vs current smokers vs former smokers). Cumulative smoking exposure was categorized as high smoking exposure (cigarette index ≥400) versus low smoking exposure (cigarette index <400). Association with outcomes was examined by multivariable analyses after adjusting for the effects of standard clinicopathologic factors, and the Kaplan-Meier method was used to estimate the effect of smoking status and cumulative smoking exposure on RFS. RESULTS: A total of 168 (34.7 %) patients were never smoker, 121 (25 %) patients were current smokers, and 195 (40.3 %) patients were former smokers. The median follow-up was 25 months. By multivariate analysis, pathological grade (p = 0.013), history of recurrence (p < 0.001), number of tumors (p < 0.001) and size of tumors (p = 0.013) were significantly associated with tumor recurrence; nevertheless, smoking status did not influence tumor recurrence (p = 0.063). Among current and former smokers, cumulative smoking exposure was significantly associated with tumor recurrence (p < 0.001), compared to current smokers, patients with smoking cessation ≥10 years had a lower risk of tumor recurrence [hazard ratio (HR) 0.456, p = 0.007]. CONCLUSIONS: Smoking affects the prognosis of patient with NMIBC, which is still controversial; however, among ever smokers, a high cumulative exposure smoking can significantly increase the risk of tumor recurrence. Quitting smoking might be associated with a lower recurrence rate for patients with NMIBC.

Functional analysis of serum microRNAs miR-21 and miR-106a in renal cell carcinoma.

OBJECTIVE: microRNAs (miRNAs) plays an important role in tumor development and progression and act as oncogenes or tumor suppressor genes in the carcinogenesis process. miRNA is stable in serum, and recent studies have demonstrated the feasibility of using circulating miRNA as biomarkers in cancer patients. However, currently, no serum biomarkers for the early diagnosis and prognosis of renal cell carcinoma (RCC) have been reported. Therefore, a new molecular marker for early diagnosis and evaluation of recurrence after surgery is required. Our purpose was to identify miRNA signatures that could distinguish the serum of RCC patients from matched healthy controls and validate identified miRNAs as potential biomarkers for RCC. METHOD: Serum samples from 30 RCC patients were collected before and 1 month after surgery. 30 cancer-free blood donor volunteers with no history of any cancer were recruited from the same institute. miR-21 and miR-106a expression levels were determined by real-time PCR. RESULT: The serum miR-21 level was significantly higher in RCC patients (median, 8.34) than in healthy control individuals (median, 0.70; p= 0.001). A month after surgery, serum miR-21 levels (median, 0.69) were significantly reduced (p= 0.032). The serum miR-106a level was higher in RCC patients (median, 8.99) compared with controls (median, 0.96; p= 0.000), while miR-106a levels (median, 1.01) were reduced a month after surgery (p= 0.028). The expression level of miR-21 and miR-106 a in RCC patients increased significantly, while miR-21 and miR-106a decreased after surgery. This outcome suggests that serum miR-21 and miR-106a expression level was closely related with kidney cancer tissue. CONCLUSION: We conclude that serum miR-21 and miR106a are expected to be molecular markers for RCC.