Acute pulmonary embolism and severe post thrombolysis renal bleeding, two deadly complications following mini-percutaneous nephrolithotomy: a rare case report.

BACKGROUND: Acute pulmonary embolism and severe renal bleeding are two lethal postoperative complications, but there has been no report that involves both of them after mini-percutaneous nephrolithotomy. CASE PRESENTATION: A 62-year-old woman was admitted to our hospital with extremely severe hydronephrosis and multiple right renal calculi. After thorough examination, she received prone-position mini-percutaneous nephrolithotomy under spinal anaesthesia. Three days postoperatively, the patient complained of chest pain and dyspnea. Computed tomography pulmonary angiogram (CTPA) showed multiple embolisms in the left pulmonary artery and its branches. Symptoms were relieved after anticoagulant and thrombolysis therapy. On the 6th postoperative day, the patient developed shortness of breath, computed tomography angiography (CTA) showed massive hemorrhage in the right kidney, diffused contrast medium in the middle and lower part of the right kidney was seen during digital substraction angiography (DSA). Superselective right renal artery embolization (SRAE) was then applied using coil to occlude the responsible artery. The patient generally recovered under conscientious care and was approved to be discharged 26 days postoperatively. CONCLUSIONS: This is the first case that involved both acute pulmonary embolism and severe post thrombolysis renal bleeding. The importance of D-dimer in the prediction and early detection of pulmonary embolism should be noted. For post thrombolysis renal bleeding, SRAE is considered as a reliable treatment.

Comparison of levofloxacin-based prophylaxis regimens for transrectal prostate biopsy: a prospective randomized single-center study.

To develop an optimal prophylactic regimen among Chinese patients who accept transrectal prostate biopsy. We enrolled 420 patients who accepted transrectal prostate biopsy. They were randomly classified into three groups (n = 140 for each): Group A received a single 500-mg tablet of levofloxacin without enema; group B received a single 500-mg tablet of levofloxacin plus enema; group C received 3-day levofloxacin orally plus enema. Patients were assessed if they had a febrile urinary tract infection (FUTI). The incidence of FUTI was compared among groups. Subgroup analysis was performed between patients at high and low risk of infection in each group. There were 15 cases developed FUTI: 7 (5%), 6 (4.3%), and 2 (1.4%), respectively, in groups A, B, and C. Of the 15 patients who developed FUTI, Escherichia coli was detected in blood culture in two cases. Urine culture results were all negative. FUTI patients (73.3% (11/15)) had at least one high risk factor. Subgroup analysis showed that the incidence of FUTI in group A was significantly higher than that in group C among high-risk patients. There was no statistical difference between group A and group B among both high- and low-risk patients. A single 500-mg dose of levofloxacin without enema represents excellent prophylaxis for transrectal prostate biopsy in Chinese patients at low risk of infection. For those at high risk, 3-day levofloxacin prophylaxis is the optimal regimen. Prebiopsy enema provides no clinically significant outcome advantage and is unnecessary.

Chinese Shang Ring Male Circumcision: A Review.

Chinese Shang Ring adult male circumcision (SC) is a safe and effective procedure which is easy to learn and to perform. By a specially designed small device, male circumcision (MC) can be performed in 5 min. Compared with conventional adult MC (CC), SC has shorter operation time, less blood loss, less pain score, higher appearance satisfaction rate, and lower complication rate. SC was first developed in China. As recent studies have demonstrated that MC reduced the risk of acquiring human immunodeficiency virus (HIV) infection via vaginal intercourse in African countries, SC was introduced into Africa to fight HIV. Other sexually transmitted diseases such as human papillomavirus infection may also be prevented by SC. In conclusion, Chinese Shang Ring, a small device, provides an easy, quick, safe, and effective method to perform adult MC.

[Gene therapy study on bladder cancer with recombinant adenoviral vector carrying LRIG1 gene driven by Survivin promoter].

OBJECTIVE: To investigate the treatment efficiency and mechanism of recombinant adenoviral vector carrying LRIG1 gene driven by Survivin promoter for bladder cancer. METHODS: Human bladder cancer cell line BIU87 and immortalized human bladder epithelial cells SV-HUC-1 were infected with Ad-Surp-LRIG1 and Ad-LRIG, respectively. The selective infection efficiency of Ad-Surp-LRIG1 and Ad-LRIG were evaluated by checking the expression of epidermal growth factor receptor (EGFR). The MTT method was used to test cell growth inhibition ratio of Ad-Surp-LRIG1 and Ad-LRIG. Heterotransplanted models of human bladder cancer cell line BIU87 cells in nude mice were established. The mice were randomly divided into 3 groups during the experiment: Ad-Surp-LRIG1 group received viral supernatant solution of Ad-Surp-LRIG1 by tail vein injection; Ad-LRIG group received viral supernatant solution of Ad-LRIG by tail vein injection; and PBS group received phosphate buffer solution (PBS). The growth of tumors were observed and the growth curve was mapped. The expression of LRIG1 and EGFR were examined by reverse transcription PCR (RT-PCR). RESULTS: When Multiplicity of infection was 25, the transfection efficiency of Ad-Surp-LRIG1 was 74.56% in BIU87 cells and 0 in SV-HUC-1 cells (χ² = 58.640, P = 0.000), while the transfection efficiency of Ad-LRIG was 68.27% in BIU87 cells and 72.52% in SV-HUC-1 cells (χ² = 0.075, P = 0.784). The transfection efficiency difference of Ad-Surp-LRIG1 and Ad-LRIG in BIU87 cells was not statistically significant (χ² = 0.016, P = 0.898). Compared with PBS, Ad-Surp-LRIG1 and Ad-LRIG1 could inhibit BIU87 cell growth, the difference was significant in 4 days after transfection (F = 15.960, P = 0.000). There was not significant difference in cell growth rate of Ad-Surp-LRIG1 group and Ad-LRIG1 group. The tumor growth rate in Ad-Surp-LRIG1 group was slower than that in the other 2 groups. The tumor quality in Ad-Surp-LRIG1 was lighter than that in the other two groups, the differences were statistically significant (F = 97.860, P = 0.000), the quality difference in Ad-LRIG1 group and PBS group was not statistically significant difference (t = 1.73, P = 0.06). Compared with Ad-LRIG1 group and PBS group, the mRNA expression of LRIG1 was obviously up-regulated and that of EGFR was down-regulated in Ad-Surp-LRIG1 group (P < 0.01). CONCLUSIONS: The recombinant adenoviral vector of Ad-Surp-LRIG1 could selectively transfected BIU87 cells, which could inhibit significantly the growth of bladder cancer in vivo and in vitro, the mechanism may be partly LRIG1 can downgrade the expression of EGFR.

Bilateral hematoma after tubeless percutaneous nephrolithotomy for unilateral horseshoe kidney stones: A case report.

BACKGROUND: Bilateral perirenal hematoma is rarely reported in endoscopic management of horseshoe kidney stones, and there are few studies reporting the formation of bilateral hematoma following tubeless percutaneous nephrolithotomy (PCNL) for unilateral horseshoe kidney calculi. CASE SUMMARY: A 32-year-old man was admitted to our hospital because of repeated intermittent hematuria for 10 years. Plain abdominal computed tomography (CT) scan revealed calculi in the horseshoe kidney; the largest being 2 cm in diameter. Tubeless PCNL was performed to remove the stones. Three days after the operation, the patient was discharged in a stable situation. Three days after discharge, the patient presented to our emergency department because of right low back pain and vomiting. Emergent CT scan revealed subcapsular and perirenal hematocele and exudates in both kidneys. Ultrasound-guided puncture and drainage of perirenal effusion were performed. After the temperature stabilized, the patient received low-pressure injection of urokinase 100000 U for 3 d. His routine blood indexes and the renal function returned to normal in 3 wk. CT re-examination 3 mo after lithotripsy showed that the subcapsular and perirenal hematoma and exudates in both kidneys were significantly absorbed as compared with those before. The patient was followed up for 1 year, during which no flank pain or hematuria recurred. CONCLUSION: This is the first case report on the formation of bilateral hematoma following tubeless PCNL for unilateral horseshoe kidney calculi.

The Use of High-Intensity Focused Ultrasound (HIFU) Plus 150mg Bicalutamide as First Line Salvage Therapy for Local Recurrent Prostate Cancer.

Patients with localized prostate cancer (PCa) are often treated with radical prostatectomy (RP). However, more than 30% of such patients have high risk of recurrence. Salvage radiotherapy (SRT), androgen deprivation therapy (ADT) and combination of radiotherapy and ADT are the standard care for recurrent PCa. Recently, high intensity focused ultrasound (HIFU) has gradually applied in the treatment of recurrent PCa. Here, we proposed a hypothesis that combined HIFU and bicalutamide 150mg as first line salvage therapy to treat patients with local recurrent PCa with visible lesions due to the following advantages: (1) HIFU is effective in reducing local tumor load, and bicalutamide 150mg is a feasible and safety option to combine with HIFU. (2) Compared with radiotherapy, HIFU plus 150mg bicalutamide is minimal invasiveness with fewer adverse effects and better quality of life(QOL); (3) Radiotherapy can be preserved as the second-line salvage method in the cases who are failure to HIFU and 150mg bicalutamide combination. More clinical trials are warranted to confirm this hypothesis in treatment with recurrent PCa.

Atypical granular cell tumor of the urinary bladder: A case report.

BACKGROUND: Granular cell tumor (GCT) is a neurogenic tumor mainly occurring in the head and neck. GCT in the genitourinary system is extremely rare and only sporadic cases of urinary bladder GCT have been reported. Most urinary bladder GCT cases are benign and only two malignant cases have been reported. Due to its rarity, no consensus criteria for the treatment of urinary bladder GCT are available at present. CASE SUMMARY: A 62-year-old Chinese woman was found to have a urinary bladder tumor without any clinical manifestations on physical examination. Cystoscopy revealed a semispherical shaped lesion measuring approximately 4.0 cm in diameter at the junction of the left wall and roof of the bladder, which was covered with normal bladder mucosa. Computed tomography scan demonstrated a high-density lesion on the left wall of the bladder, measuring approximately 2.9 cm × 2.4 cm with clear boundaries. Contrast-enhanced pelvic magnetic resonance imaging revealed a space-occupying lesion on the left wall of the bladder (non-mucosal origin/ external pressure), which was preliminarily suspected to be a desmoplastic fibroma or leiomyoma. In the context of the above findings, a pre-operative diagnosis of bladder leiomyoma was made. The patient consequently underwent a laparoscopic partial cystectomy. The resected bladder mass looked yellowish and well-demarcated, measuring 4.0 cm × 3.5 cm and infiltrated the muscular layer. The diagnosis of urinary bladder GCT was finally made by postoperative pathology, with positive immunohistochemical S-100 staining and negative pancytokeratin. The patient has been followed for 6 mo so far, with no tumor recurrence detected. CONCLUSION: This case highlights the biological feature and differential diagnosis of urinary bladder GCT at the pathological and molecular levels. Transurethral resection of the bladder tumor and partial cystectomy are recommended in most urinary bladder GCT cases, while radical cystectomy is recommended in malignant cases.

[Sexual function and mental state in patients with redundant prepuce or phimosis].

OBJECTIVE: To investigate the correlation of sexual dysfunction with psychological abnormalities by analyzing the sexual function and mental state of the patients with redundant prepuce or phimosis. METHODS: This study included 216 randomly selected patients with redundant prepuce or phimosis and 85 normal male controls. We conducted investigations among the subjects using a questionnaire on the general data of the patients, Chinese Index of Sexual Function for Premature Ejaculation (CIPE), International Index of Erectile Function (IIEF), and Symptom Checklist 90 (SCL-90). Then we assessed the status of premature ejaculation (PE) and erectile dysfunction (ED), calculated the incidence of psychological abnormalities, such as depression and anxiety, and analyzed the correlation of PE and ED with the mental state of the patients. RESULTS: The PE and ED patients scored significantly higher than normal controls on SCL-90, somatization, compulsion, depression, anxiety and other factors (P < 0.05). CIPE scores were correlated with the scores on SCL-90, somatization, compulsion, interpersonal sensitivity, depression, anxiety and other factors, while ED-related scores showed no correlation with the scores on SCL-90 and other factors. CONCLUSION: Patients with redundant prepuce or phimosis have poor mental health, and there is an interaction between PE and the mental state of the patient.

[A recommendable standard protocol of adult male circumcision with the Chinese Shang Ring: outcomes of 328 cases in China].

OBJECTIVE: Standardization of and training in adult male circumcision can significantly reduce its complication rate. Currently no such program exists for its standardization and training, making it difficult to guarantee the quality of male circumcision services. We therefore established a standardized surgical protocol for adult male circumcision in China using the Shang Ring, and applied it to a clinical study examining the performance of the Shang Ring in adult male circumcision. METHODS: A total of 328 adult men aged 18-58 (mean 27.8) years, 25 with phimosis and 303 with redundant prepuce, underwent circumcision with the Shang Ring, and evaluation of the operation time, pain scores (using the visual analog scale), postoperative complications, time for wound healing, and their satisfaction with the postoperative appearance. RESULTS: The operation time was 4.7 +/- 1.3 minutes. The pain scores were 0. 2 +/- 0.6 during the surgery, 1.6 +/- 1.0 twenty hours postoperatively, 1.7 +/- 1.1 twenty hours prior to the ring removal, and 2.7 +/- 1.4 during the ring removal. Complications included infection in 2 (0.6%), bleeding in 2 (0.6%), and wound dehiscence in 2 (0.6%) of the patients. None of the patients with wound dehiscence required postoperative suturing and all were managed conservatively instead. Sixteen of the patients (4.9%) experienced penile edema. The time for complete wound healing after circumcision was 20.3 +/- 6.7 days. The rate of the patients'satisfaction was 99.7% (327/328). CONCLUSION: The standard protocol of adult male circumcision with the Shang Ring has the advantages of short operation time, slight pain, low rate of complications, and high satisfaction and acceptance of the patients. Strict standardization of the surgical protocol can maximize its clinical advantages for adult male circumcision.

Sinularin exerts anti-tumor effects against human renal cancer cells relies on the generation of ROS.

Sinularin, a soft corals-derived natural product, exerts anti-tumorigenic activity in various types of human cancer cells. However, the action of Sinularin and its mechanism in renal carcinoma is not well understood. In the current study, we demonstrated that Sinularin inhibited the viability of human renal cancer cells 786-O and ACHN in a dose- and time-dependent manner, but did not show significant toxicity against non-malignant HRCEpic cells. Cell cycle analysis revealed that Sinularin induced G2/M arrest significantly. In addition, Sinularin could induce apoptosis in cells along with caspase-3/-9 activation, release of mitochondrial proteins, up-regulation of pro-apoptotic Bcl-2 family proteins and inhibition of anti-apoptotic Bcl-2 family proteins. Sinularin could also repress the activation of PI3K/Akt/mTOR signaling pathway. Moreover, Sinularin triggered the activation of MAPKs and p38 activation was essential for the anti-tumor effect of Sinularin. The generation of ROS (reactive oxygen species) was critical for Sinularin-induced apoptosis since ROS scavenger NAC (N-acetyl cysteine) could block the Sinularin-triggered apoptosis. In conclusion, all the results indicated that Sinularin may be applied as a therapeutic natural agent for human renal cancer.

Correction to: Anti-tumor effects of Atractylenolide I on bladder cancer cells.

In the publication of this article [1], there is an error in Fig. 4b. The Cyto c western blot image in Fig. 4b is misrepresented. This has now been included in this correction. The authors declare that the correction does not change the results or conclusions of this paper.

Knockdown of DUXAP10 inhibits proliferation and promotes apoptosis in bladder cancer cells via PI3K/Akt/mTOR signaling pathway.

DUXAP10 is a member of long non-coding RNAs (lncRNAs) and has been reported to be upregulated in bladder cancer (BC) tissues. However, the biological functions of DUXAP10 in BC are largely unknown. The present study detected the expression of DUXAP10 in human normal bladder cell SV­HUC­1 and BC cell lines. Subsequently, cell proliferation, cell cycle, and apoptosis were analyzed by knockdown of the DUXAP10 expression. Results suggested that the expression level of DUXAP10 was significantly enhanced in cancer cells. After knockdown of DUXAP10, cell proliferation was inhibited, cell cycle was arrested at G0/G1 phase, and apoptosis was increased in T24 and 5637 cells. Western blot analysis detected that knockdown of DUXAP10 decreased the expression of Bcl-xL, cyclin D and CDK4. This increased the expression of Bad, cleaved caspase­3, cleaved caspase-9, and p27. Further studies indicated that knockdown of DUXAP10 inhibited PI3K/Akt/mTOR signaling pathway. Combining these results, our study suggests that DUXAP10 plays an important role in BC and DUXAP10 inhibition is a potential therapeutic target for BC.

[Effects of LRIG1 gene on the invasion of bladder cancer in vitro].

OBJECTIVE: To observe the change of invasion ability of the bladder cancer cell line BIU87 after transfected with LRIG1 gene. METHODS: Plasmid pLRIG1-GFP was transfected into bladder cancer cells (BIU87) by Lipofectamine 2000, and cells that could express LRIG1 stably was screened out by G418. The alteration of cellular invasion property of BIU87, BIU87-neo and BIU87-LRIG1 cells was evaluated by Boyden chamber. The expression of mRNA and protein of LRIG1 and EGFR was detected by RT-PCR and Western-blot. RESULTS: Compared with BIU87 and BIU87-neo cells, after BIU87 cell line was transfected with plasmid pLRIG1-GFP, the invasion ability decreased significantly, the expression of mRNA and protein of LRIG1 was obviously up-regulated and that of EGFR was down-regulated (P < 0.01). CONCLUSION: LRIG1 gene can significantly inhibit the invasion ability of BIU87 cell line.

[Diagnostic Values of IL-12 and IFN-γ for the Patients with Acute Leukemia].

OBJECTIVE: To explore the diagnostic values of interleukin-12 (IL-12) and interferon-γ (IFN-γ) for the patients with acute leukemia (AL). METHODS: A total of 76 cases of AL were enrolled in this study, and the 40 healthy persons were used as control group. The levels of IL-12 and IFN-γ were determined by enzyme linked immunosorbent assay (ELISA). The results were analyzed. RESULTS: The levels of IL-12 and IFN-γ in the untreated AL group, ALL and ANLL groups were lower significantly than those in the control group (P<0.05), there was no significant difference between untreated AL and ANLL groups (P>0.05). The levels of IL-12 and IFN-γ in CR patients of AL group after treatment obviously higher than that of patients before treatment (P<0.05), but there was no significant difference as campared with that in control. The levels of IL-12 and IFN-γ in NR patients of AL group after treatment were obviously lower than that in control group (P<0.05), but there was no significant difference in comparision with patients before treatment (P>0.05). The levels of IL-12 and IFN-γ of AL-CR and AL-NR patients before treatment were not significant difference before treatment (P>0.05). The levels of IL-12 and IFN-γ of AL-CR patients obviously higher than that in AL-NR patients (P<0.05). According to immure classification, the levels of IL-12 and IFN-γ of patients in untreated group were not significant difference. In regard to the clinical risk degree, the level of IL-12 of patients in untreated group was not obvious difference (P>0.05), but the level of IFN-γ of patients in untreated group was obvious different (P<0.05). The level of IL-12 of patients in untreated group positively correlated with level of IFN-γ (r=0.735, P<0.05), but the level of IL-12 did not significantly correlated with the level of IFN-γ (r=0.292, P>0.05). CONCLUSION: The serum levels of both IL-12 and IFN-γ are lower, but the changes of both serum levels may be helpful to diagnose and treatment of AL patients.

Anti-tumor effects of Atractylenolide I on bladder cancer cells.

BACKGROUND: Atractylenolide I (ATR-1), an active component of Rhizoma Atractylodis Macrocephalae, possesses cytotoxicity against various carcinomas. However, little is known about the effects of ATR-1on bladder cancer. In the present study, the anti-tumor activity of ATR-1 was examined on bladder cancer cells both in vivo and in vitro. METHODS: MTT assay was used to assess the cytotoxic effect of ATR-1. Cell cycle distribution and apoptosis levels were evaluated using flow cytometry. Western blotting assay was applied to measure the levels of proteins associated with the apoptotic pathway, cell cycle progression and PI3K/Akt/mTOR signaling pathway. Tumor models in nude mice were induced by injection of T-24 and 253J human bladder cancer cells. RESULTS: ATR-1 inhibited bladder cancer cell proliferation, arrested cell cycle in G2/M phase through up-regulation of p21 and down-regulation of cyclin B1, CDK1 and Cdc25c. Meanwhile, ATR-1 also triggered cellular apoptosis depending on the activation of mitochondrial apoptotic pathway. Mechanism investigation indicated that ATR-1 exerts its anti-tumor effect also relies on the inhibition of PI3K/Akt/mTOR signaling pathway. Finally, mice studies showed that ATR-1 blocked the T-24 or 253J-induced xenograft tumor growth without noticeable toxicity. CONCLUSIONS: ATR-1 may be served as a potential therapeutic agent for the treatment of bladder cancer.

LRIG1, a candidate tumour-suppressor gene in human bladder cancer cell line BIU87.

OBJECTIVES: To determine the effects of LRIG1 on the growth, migration and invasion of bladder cancer cells and the mechanisms underlying such effects. MATERIALS AND METHODS: The plasmid pLRIG1-green fluorescence protein (GFP) was transfected into BIU87 bladder cancer cells by Lipofectamine2000 (Invitrogen, Groningen, the Netherlands), and the cells that expressed LRIG1 stably were screened out by G418. The changes in LRIG1 and epidermal growth factor receptor (EGFR) protein levels were measured by Western blot; growth curves were estimated by the tetrazolium (MTT) assay; then cell-cell adhesion, cell-matrix adhesion and cell invasion assays were used to measure proliferation, adhesion and invasion in LGIR1-transfected and control cells. RESULTS: The LRIG1 protein level in pLRIG1-GFP transfected cells was significantly higher than that in control cells, while the EGFR protein level was significantly lower. pLRIG1-GFP transfected cells had less proliferation than control cells. Contrasting with non-LRIG1-transfected cells, the invasion and cell-matrix adhesion ability of pLRIG1-GFP transfected cells decreased markedly, and conversely the homotypic cell-cell adhesion ability was significantly higher. CONCLUSIONS: LRIG1 might act as a tumour-suppressor gene, participating in negative feedback control of EGFR expression, which inhibits bladder cancer cells from growth, migration and invasion.