Impact of tumor architecture on prognosis of patients with upper tract urothelial carcinoma / 中华泌尿外科杂志

Objective:To investigate the prognostic significance of tumor architecture in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy.Methods:A retrospective study was performed on 958 patients who underwent nephroureterectomy in Second Affiliated Hospital of Zhejiang university (156) and Renji Hospital (802) between January 1998 and June 2019. There were 630 males and 328 females with median age 67 years old, ranging 30-89 years old. Among them, 499 patients suffered with preoperative hydronephrosis, 370 patients suffered with hypertension, 120 patients suffered with diabetes, 252 patients had history of smoking and 119 patients had history of non-muscle invasive bladder cancer (NMIBC) or with NMIBC. 489 patients had tumor in renal pelvic, 394 patients had tumor in ureter and 75 patients had tumor in both sites. Laparoscopic surgery was performed in 543 patients while open surgery was performed in 415 patients. The χ 2 test was used to detect the association between tumor architecture and several clinicopathological features. Kaplan-Meier method with the log-rank test was used to assess survival analysis. Multivariate analyses were conducted using Cox proportional-hazards regression model. Results:516 cases (53.9%) showed papillary architecture(Group A) and 442 cases (46.1%) showed sessile architecture(Group B). 543 patients had a tumor ≤3 cm and 415 had a tumor >3 cm. Low pathological grade and high grade was diagnosed in 275 and 683 patients, respectively. The distribution of pathological stage was pT a-1 in 441 cases, pT 2 in 180 cases, pT 3 in 308 cases and pT 4 in 29 cases. Lymphadenectomy was performed in 227 patients and 62 patients were pathologically confirmed lymph node metastasis. 48 patients were found squamous or glandular differentiation. Lymphovascular invasion (LVI) was observed in 150 patients. 134 patients were multifocality. Positive surgical margin was found in 43 patients. Median follow-up was 39 (ranging, 2-206) months. During follow-up, a total of 304 patients died and 236 died of UTUC. 5-year OS and CSS were 76.6% and 81.8%, respectively, in patients with papillary architecture (group A), which were significantly higher than 54.4% and 60.5% in patients with sessile architecture (group B, all P<0.001). Patients in group B had more female patients (38.9% vs.30.3%, P=0.005), ureteral location (47.1% vs. 36.1, P=0.002), hydronephrosis (55.9% vs.48.8%, P=0.030) and postoperative adjuvant chemotherapy (27.1% vs. 14.7%, P<0.001), higher pathological grade (89.6% vs.55.6%, P<0.001) and stage (79.4% vs.32.4%, P<0.001), lymph node metastasis rate (12.0% vs.1.7%, P<0.001), squamous or glandular differentiation (9.5% vs.1.2%, P<0.001) and LVI (24.4% vs.8.1%, P<0.001) than patients in group A. Cox multivariate regression analysis showed that sessile architecture ( P=0.022, 0.028), age ≥65 years ( P<0.001, <0.001), history of diabetes ( P=0.008, 0.043), history of NMIBC or with NMIBC ( P<0.001, <0.001), higher grade ( P=0.002, <0.001), advanced tumor stage ( P=0.003, 0.005), lymph node metastasis ( P=0.003, 0.044), squamous or glandular differentiation ( P=0.008, 0.027) and positive surgical margin ( P=0.003, 0.010) were independent risk factors for OS and CSS. However, tumor >3 cm ( P=0.013, 0.131) and positive LVI ( P=0.045, 0.174) were independent risk factors for CSS rather than OS. Conclusions:UTUC is high malignancy. Tumor architecture was one of an independent risk factor for OS and CSS in UTUC patients and sessile tumors were more malignant, more aggressive and have worse prognosis.

Correlation between multimodality MRI findings and molecular typing of breast cancer / 实用医学杂志

Objective To investigate the characteristics of multimodal MRI of breast cancer with different molecular subtypes and the correlation between each molecular type and MRI findings. Methods Multimodality MRI date of 87 patients with breast cancer confirmed by pathology were retrospectively analyzed. According to the expression of estrogen receptors(ER),progesterone receptors(PR)and human epidermal growth factor receptor-2 (HER-2),the tumors were classified into triple-negative breast cancer,HER-2 overexpression,Luminal A and Lu-minal B subtypes. The MRI features of breast cancers of different molecular subtypes were compared. Results Among the 87 cases of breast cancer,luminal type A accounted for 29.9%(26/87),luminal type B accounted for 36.8%(32/87),HER-2 type accounted for 19.5%(17/87),and triple-negative type accounted for 13.8%(12/87). The average ADC value is 0.97 × 10-3 mm2/s;those whose irregular or edge burr like mass were more often Lu-minal type MRI,triple-negative breast cancer showed the edge smooth,clear boundary,annular enhancement, more easily showed enhanced mode of TIC type Ⅲ. The mean ADC values of type Luminal and HER-2 over-expres-sion were lower than the mean ADC values of the triple-negative type. Conclusion The different molecular sub-types of breast cancer MRI morphologic and hemodynamic characteristics and the value of ADC has certain charac-teristics. The MRI features of breast cancer can be predicted to analyze the molecular typing,providing a reference for clinical treatment.

Efficacy and safety of ultrasound-guided upper-pole access percutaneous nephrolithotomy for the treatment of renal staghorn calculi / 局解手术学杂志

s: Objective To investigate the efficacy and safety of ultrasound-guided upper-pole access percutaneous nephrolithotomy (PCNL) for the treatment of renal staghorn calculi. Methods From October 2008 to July 2012,193 cases of renal staghorn calculi treated with ultrasound-guided upper-pole access PCNL were reviewed. Among the 193 cases,74 cases were complete staghorn calculi while the other 119 cases were partial staghorn calculi, and the calculi diameter was 2. 5 to 9. 0 cm. All the 193 cases were treated through upper-pole ac-cess successfully,70 accesses were accomplished below the 12th rib,while the other 123 accesses were accomplished between the 11th adn 12th rib. Disintegration of the stone was accomplished using Holmium laser. Results The mean operative time was 70 min (45~150 min), single tract was used in 186 cases, and double tracts were used in the other 7 cases. The stone clearance rate for one session was 72. 0%(139/193),and the total stone clearance rate was 88. 1%(170/193). Transfusion was required in 6 patients, while 2 patients with signifi-cant bleeding were treated with selective renal arterial embolization. Hydrothorax occured in 4 patients, and closed thoracic drainage was re-quired in 2 of them. 20 patients had fever, and they recovered after effective antibiotic treatment. No patients had injury to the lung or other viscera. Conclusion Upper-pole access offers optimal visibility and convenience for rigid ureteroscope to achieve a high rate of stone-free status and operating time reduce. Ultrasound guided upper-pole access PCNL should be attempted in selected cases of renal staghorn stone.

Comparative analysis of transurethral Holmium laser, electric resection and open surgery for the distal ureter and bladder cuff in the procedure of nephroureterectomy / 中华泌尿外科杂志

ObjectiveTo present the innovative transurethral resection of the distal ureter and bladder cuff by Holmium laser and to compare the perioperative and oncological outcomes following nephroureterectomy using three different methods of managing the distal ureter and bladder cuff.Methods From January 2000 to December 2010,162 patients underwent excision of the distal ureter and bladder cuff by transurethral Holmium laser (32 cases,Group A),transurethral electric resection (51 cases,Group B) or open procedure (79 cases,Group C) combined with open or retroperitoneal laparoscopic nephroureterectomy.5 French ureteral balloon catheter was inserted into the targeted ureter to prevent possible microscopic tumor seeding.The therapeutic effectiveness,perioperative complications,postoperative recovery and oncologic outcomes were compared among groups.The follow-up time was 3 -96 months.ResultsGroup A and B showed statistically significant better results on the operative time (203.6 ± 31.5 min and 207.2 ±24.3 min),blood loss ( 127.4 ± 63.2 ml and 135.0 ± 82.7 ml) and postoperative hospital stay (5.8 ± 1.3d and 5.6 ±1.2 d) than those of Group C (248.0 ±42.9 min,484.5 ±217.7 ml,8.7 ±3.5 d),respectively ( P ＜ 0.01 ).Six cases of obturator nervous reflex occurred in Group B,with 3 cases of bladder peroration and 2 conversions to open procedure.There were no difference in bladder tumor occurrence,retroperitoneal recurrence,tumor cell seeding and cancer-specific survival among the 3 groups.ConclusionsOur data have validated the superiority of transurethral approach over conventional open procedure including perioperative index,recovery and comparable oncologic outcomes with open group.Holmium laser demonstrated better results including fewer complication,cleaner surgical vision and operating accuracy than that of electric resection.Transurethral Holmium laser resection of the distal ureter and bladder cuff has been proved to be a technically innovative minimally invasive and oncological safe method.

In vitro susceptibility testing of Penicillium marneffei against several antifungal agents / 中华皮肤科杂志

ObjectiveTo test the susceptibility of Penicilliosis marneffei (PM) isolates from Guangxi bamboo rats and patients to voriconazole and several commonly used antifungal agents.MethodsAccording to the Clinical and Laboratory Standards Institute(CLSI) M27-A2 and M38-A document,a microdilution method was used to determine the minimum inhibitory concentration(MIC) of voriconazole,itraconazole,terbinafine,amphotericin B,and fluconazole against mycelial phase (25 ℃) and yeast phase (37 ℃) of 14 PM isolates from Guangxi Bamboo rats and 25 PM isolates from patients.The difference in MIC of the antifungals was assessed by two-sample t test between Bamboo rat PM isolates and clinical PM isolates,and by paired t test between the mycelial and yeast phase of PM isolates.Results The MIC ranges of voriconazole,itraconazole,terbinafine,amphoteriein B and fluconazole were 0.0313-0.1250,0.1250-1.0000,0.0313-0.5000,0.2500-4.0000,2.0000-8.0000 mg/L,respectively for mycelial phase of Bamboo rat PM isolates,0.0078-0.2500,0.0313-0.5000,0.0313-1.0000,0.2500-2.0000,1.0000-8.0000 mg/L,respectively for yeast phase of Bamboo rat PM isolates,0.0313-0.2500,0.0625-1.0000,0.0313-1.0000,0.2500-4.0000,2.0000-32.0000 mg/L,respectively for mycelial phase of clinical PM isolates,0.0039-0.2500,0.0313-0.5000,0.0313-2.0000,0.1250-2.0000,2.0000-16.0000 mg/L,respectively for yeast phase of clinical PM isolates.None of the PM isolates was resistant to any of the antifungals.The MIC of voriconazole was found to be the lowest for PM isolates from both Bamboo rats and patients at the same temperature (37 ℃ or 25 ℃),followed by itraconazole,terbinafine,amphotericin B and fluconazole.Statistical difference was found in the MIC values of itraconazole,terbinafine,amphotericin B between the yeast and mycelial phase of the same PM isolate,but not found in antifungal MIC values between Bamboo rat isolates and clinical isolates at the same phase.ConclusionsOf the tested drugs,voriconazole shows the strongest antifungal potency. The PM isolates from Guangxi Bamboo rats are similar to clinical PM isolates in the sensitivity to voriconazole,itraconazole,terbinafine,amphotericin B and fluconazole.The phase of PM isolates may affect their susceptibility to itraconazole,amphotericin B and terbinafine.

Search of serum protein biomarkers for systematic lupus eryt.hematosus using protein chip tech- nology / 中华皮肤科杂志

Objective To study the changes of serum protein spectrum in patients with systematic lupus erythematosus (SLE) in order to screen specific protein markers. Methods Serum samples from 72 patients with SLE and 85 age- and sex-matched controls were assessed using surface-enhanced laser desorp-tion/ionization time-of-flight mass spectrometry (SELDI-TOF-MS) with weak cation exchange (CM10) pro-rein chip. Forty samples from the patients and 50 control samples were randomly selected to serve as a pre-liminary training set; significantly different protein peaks were automatically chosen for the system training and development of a decision classification tree model. The validity of the model was then challenged with a blind test set (including another 32 samples from patients and 35 from human controls). Results A total of 73 effective protein peaks were detected within the mass/charge ratio (m/z) interval 2000 - 50000, among which, 15 protein peaks significantly differed between patients with SLE and controls (P < 0.01). Three pro-tein peaks with an m/z value of 4001, 6305 and 7356 were automatically chosen as a biomarker pattern in the training set that discriminated patients with SLE from controls with a sensitivity of 90.0% (36/40), speci-ficity of 92.0% (46/50) and accuracy rate of 91.1% (82/90). When the SELDI marker pattern was tested with the blinded test set, it yielded a sensitivity of 87.5% (28/32), specificity of 91.4% (32/35) and accuracy rate of 89.6% (60/67). Conclusions SELDI-TOF-MS protein chip could be used to screen serum protein for SLE, and the decision classification tree model with these biomarkers may favor the diagnosis of SLE.

A comparative study of the efficacy and safety of holmium laser enucleation of the prostate vs transurethral resection of the prostate / 中华泌尿外科杂志

Objective To compare the safety and efficacy of holmium laser enucleation of the prostate (HoLEP), one of the minimally invasive treatments available for men with benign prostatic hyperplasia (BPH),with transurethral resection of the prostate (TURP). Methods A total of 337 cases of BPH were divided into 2 groups;of them 185 cases underwent HoLEP and 152,TURP.The volume of irrigating fluid absorption and blood loss,and other therapeutic results were measured and compared between the 2 groups. Results Comparison between HoLEP group and TURP group included the following:irrigating fluid absorption was (604.8?97.6)ml vs (1095.0?209.8)ml;blood loss,(124.3?24.1)ml vs (330.3?36.9)ml;resected prostate weight,(17.4?2.2)g vs (25.2?3.4)g;operating time,(54.9?20.0) min vs (45.1?18.0) min;catheterization time,(2.2?0.2) d vs (3.4?0.3)d;and length of hospital stay after operation, (5.2?1.1) d vs (8.8?1.3) d. Significant differences were found between the 2 groups (P

Preparation of Diclofenac Lysine Sustained-release Tablets and Investigation of the Stability / 中国药房

AIM： On the basis of in vitro study， a preliminary survey of the stability of diclofenac lysine sustained-release tables(DLST) was carried out to identify the period of validity.METHODS： To observe the changes of DLST under high temperature， blaze， high humidity and room temperature(for long period) and to perform accelerating test for 3 months.RESULTS： The drug release was accelerated under high temperature， and the tablet was apt to absorb moisture because of its hydrophilic matrix and the drug release became faster at day 10 under blaze， and therefore DLST should be stored away from high temperature， high humidity and blaze.CONCLUSION： DLST is stable and the period of validity is tentatively fixed at 2 years.