Objective To investigate the clinical efficacy of acupuncture in treating dyssomnia in children with mental retardation. Methods Sixty patients with mental retardation (4-6 years old) were randomly allocated to treatment and control groups, 30 cases each. The control group received routine rehabilitation therapy (family training guidance, and aetiological, psychological and behavioral intervention) and the treatment group, acupuncture in addition. Sleep latency, rapid eye movement (REM) sleep state and sleep efficiency were monitored by polysomnography in the two groups of patients. The clinical therapeutic effects were compared between the two groups. Results The total efficacy rate was 93.3%in the treatment group and 73.3%in the control group;there was a statistically significant difference between the two groups (P<0.05). There were statistically significant differences in pre-/post-treatment sleep latency, REM sleep state and sleep efficiency difference values between the treatment and control groups (P<0.05). Conclusion Acupuncture is an effective way to treat dyssomnia in children with mental retardation.

Objective To introduce our experience of performing posterior or anterior renal lip incision for partial nephrectomy in the treatment of renal hilum endophytic renal cell carcinoma.Methods From Jan.2010 to Jan.2014,five female patients with renal hilum tumors were treated in our institute.The median age was 54 (51-72) years.The median tumor diameter was 4.0 (2.8-4.8) cm.The median preoperative creatinine was 53.9 (52.6-75.4) μmol/L.One of them was solitary kidney with absolute indication; three cases had basic disease with relative indication; one was with selective indication.The patients were put in supine or lateral position.After general anesthesia,we preformed partial nephrectomy by cutting posterior renal lip in 3 cases and the anterior lip in 2 cases.We clamped the renal artery,opened the renal posterior or anterior lip,then dissected the tumor beside the pseudo-capsule.After removing the tumor,we used 3-0 absorption suture to control bleeding and repair the opened collecting system.Finally,we used 2-0 absorption suture to close the renal defect.Results The median operation time was 195 (155-215) min; the median renal warm ischemia time was 35 (15-70) min; the median postoperative hospital stay was 8 (7-9) d.There was no secondary bleeding and urine leakage happened.The pathological results showed that 3 cases with clear cell carcinoma,1 with papillary carcinoma and 1 with renal medullary interstitial cell tumor.All patients showed normal kidney shape.The median postoperative creatinine was 63.0 (59.4-75.4) μmol/L.After a median follow up of 24.2 mon,all patients survive without tumor recurrence.Conclusions The short-term result of posterior or anterior renal lip incision partial nephrectomy in treating endophytic renal hilum endophytic renal cell carcinoma is safe and feasible.

Background and purpose: The clinical and pathological characteristics and treatment strategy for the patients with testicular diffuse large B cell lymphoma still need to be further studied. This study was done to evaluate the diagnosis and strategy for the disease by retrospective analysis of 21 patients with testicular diffuse large B cell lymphoma. Methods: 21 patients with pathologically proved as diffuse large B cell lymphoma after surgery in the Sun Yat-sen University Cancer Center and The Guangzhou General Hospital of PLA from September 2002 to April 2009 were accrued. There were 3 in stage Ⅰ_E , 4 in stage Ⅱ_E , 5 in stage Ⅲ_E and 9 in stage Ⅳ according to Ann Arbor stage standard. All patients received adjuvant chemotherapy with CHOP regimen initially after operation. Radiotherapy or other salvage chemotherapy regimen was given after failure of the initial treatment. The follow-up information was collected for to all of the patients. Results: Follow-up time ranged from 10 to 83 months. After completion of first-line chemotherapy(CHOP), overall response rate was 72.2%(13/18)with complete remission (CR) rate of 33.3%(6/18)and partial response rate(PR) of 38.9%(7/18). 3 patients in stage Ⅰ_E survived free from disease until now. Tumor relapsed and refractory eases were observed in 10 patients, and they all showed little response to chemotherapy with a response rate of 30.0%(3/10). Among the 21 patients, 11(52.3%) cases died of the disease with a median survival time of 28 months. Of these 21 patients, 7 patients were CD10(+), 5 patients overexpressed bel-6, 12 patients were bcl-2(+), and 15 patients overexpressed MUM1.Overexpressed bcl-2 and MUM1 indicated bad prognosis. Conclusion: Most of the testieular diffuse large B cell lymphoma patients were non-GCB. And they were sensitive to CHOP chemotherapy. The results suggested that all patients should receive chemotherapy after surgery. It was curable in the early stage. However,the options of treatment method for the patients with relapsed and refractory cases are limited and need to be further explored.

Objective To verify whether the concomitant performance of modified radical inguinal lymphadenectomy and penectomy may increase complications and compromise oncological effectiveness.Methods From June 2002 to June 2010,a total of 110 simultaneous inguinal lymphadenectomies were performed on 55 patients (mean age 49 years),including 107 modified radical lymphadenectomies,2 radical lymphadenectomies and 1 lymphadenectomy before which the sapheous vein was resected.The records of all patients were reviewed.Results Of 107 simultaneously modified radical inguinal lymphadenectomy,only 1 (0.9％) had wound infection.There were 18 ( 16.8％ ) leg lymphedema and 6 (5.6％) skin flap necrosis,postoperatively.The average number of inguinal lymph nodes dissected was 11 (3 -23 ).Overall 3-year survival was 84％.Conclusions Penile surgery combined with simultaneously modified radical inguinal lymphadenectomy could be feasible,which may have oncological control without increasing the risk of surgical complications.

Objective To report a modified radical inguinal lymphadenectomy the aim of which is to reduce the incidence of the complication of skin necrosis.Methods One hundred and twenty-six modified radical inguinal dissections were performed in 63 patients with penile carcinoma from June 2002 to June 2010.A modified radical inguinal dissection characterized by an S-shaped incision and precisely separating layers using an anatomical mark was performed.The boundaries of dissection were the same as classic radical inguinal lymphadenectomy.The incidences of complications of skin flap necrosis were retrospectively analyzed.Results The follow-up time ranged from 12 to 93 months.A total of 37 complications occurred,including 7 minimal skin necroses (5.6％),3 wound infections (2.4％),19 lymphedemas (15.1％),2 seroma formations (1.6％),5 lymphocele (4.0％),and 1 deep venous thrombosis (0.8％).There were no complications in 106 dissections (84.1％ ),and 20 dissections had one or two minor complications ( 15.9％ ).Conclusions The complication of skin necrosis related to groin dissection in patients with penile carcinoma could be reduced by using this modified inguinal dissection technique,which characterized by an S-shaped incision and precisely separating layers with using an anatomical landmark.

Objective To estimate the feasibility of QOL score in functional assessment of or-thotopic neobladder after radical cystectomy. Methods Questionnaire survey,QOL score sheet and urodynamic examination were done in 22 patients with orthotopic neobladder.Investigations were fo-CUS on the micturition interval during daytime and nighttime.Micturition time,degree of incontinence and their relationship with QOI.scores and urodynamic parameters wete also analyzed. ResuIts There were 3,6,7,1,2,3 and 0 cases which QOI.score were 0 to 6 accordingly.In the dav time,2 patients complained a light incontinence while 1 patient of moderate incontinence.In the nighttime.3 patients had the complaint of moderate incontinence while 4 patients of light incontinence.The average daytime mlcturltlon interval was 136 min(45-210 rain).The average maximum urinary flow rate,maximal urethral closure pressure and postvoid residual were 12.9 ml/s(2.7-22.1 ml/s),69.3 cm H2O(33-114 em H20)and 91.8 ml(5-300 m1)respectively.QOL scores had D.sitive correlation with the degree of incontinence during daytime and nighttime(daytime:r-0.510,P=0.015,night time:r=0.911,P<0.001).The QOL scores had negative correlation with daytime micturition inter-val(r=-0.749,P<0.001).The factors which influenced the QOL scores included the maximaI ure-thral closure pressure,postvoid residual and the maximum urinary flow rate. Conclusions QOL score reflects the patients"continent ability,subjective feelings on quality of life.It is correlated with the common urodynamic parameters.QOI.score might be used as a new index to estimate the function of orthotopic neobladder.

Objective To investigate the techniques of laparoscopic retroperitoneal lymph node dissection(LRPLND)through extraperitoneal approach. Methods Seven non-seminomatous germ cell testicular tumor(NSGCT)patients of clinical stage Ⅰ underwent LRPLND through extraperitoneal approach.The average age was 31(27-39 years old),the average weight was 62 kg(weight 58-72 kg).Pathological examination revealed 2 testis mixed carcinoma(major of embryonal carclnoma and seminoma),2 yolk sac tumor,1 ehoriocarcinoma,2 teratoma with seminoma.Two of them were in right side,and 5 in left.All the chest X-ray,abdominal CT and bone scanning of them were normal before operation.All patients were general anesthetized.Three or 4 trocars were placed,from 2 of them two gasbags were used to expand the retroperitoneal space at volume of 800-900 ml.The retroperitoneal fat was cleared off from the surface of Gerota's fascia to iliac fossa and the plane spance betwwwn anterior rena fascia and posterior peritoneum was separated In the same way the Plane between dorsal renal and the surface of psoas major and quadratus lumborum unto iliae lossa was exposed.Abdominal aorta or vena cava was exposed,then divided and dissected free from surfaee of psoas maior.The conflux of renal vein and testicular vein at the deep face of renal artere(left)was exposed,then testicular vein was ligated and divided it at its end.Fat and lymph tissue between ureter and vessels was dissected to the crotch of abdominal aorta or inferior vena cava.The primary inguinal incision of testectomy was then excided.Normal antegrade ejaculation recovered in 1 month postoperatively. Results The initial 2 operations were converted to open way as the peritoneum were penetrated largely.The other 5 operations were successful.The average operating time was 285 min(245-350 min),intraoperative blood loss was 100-250 ml.Four patients'pathologic results accorded with clinical staging,and 2 positive lymph nodes were found in the other one.The average number of lymph node resected was 25.6 counts(22-31).Follow-up for 3-20 months,chest X-ray and abdominal CT revealed no evidence of recurrence or distant metastasis,and serum tumor markers were in normal range.Normal antegrade ejaculation recovered in 1 month postoperatively. Conclusions The technique through extraperitoneal approach could be applied for LRPLND.It might be an approach for diagnosis and treatment of stage Ⅰ NSGCT.

Objective To explore if it is essential to excise ipsilateral adrenal gland in radical nephrectomy.Methods Two hundred and sixty-three patients underwent radical nephrectomy were analyzed retrospectively.The duration of operation,bleeding volumn,complications and survival rates were compared between the adrenalectomy and adrenal preserved groups.The clinical data of the patients with adrenal gland involvement were analyzed as well.Results There were 214 clinical localized(T_(1-2)N_0M_0 )renal cell carcinoma (RCC) patients,26 local advanced RCC(T_(3-4)N_(0-2)M_0 ) patients and 23 metastatic RCC(T_(1-4)N_(0-2)M_1) patients in this study.In the 263 patients,146 cases received ipsilateral adrenal gland excisions,while 117 cases had the ipsilateral adrenal glands preserved.The duration of operation,estimated blood loss and the complications did not differ significantly between these two groups.Only 8 patients had adrenal gland involvement.The mean size of the 8 tumors was 9.7 cm and 5 of them had a diameter ≥8 cm.In the 8 patients,6 had the tumor in the upper pole and 2 had the whole kidney involved.One hundred and twenty-nine clinical stage Ⅰ and Ⅱ patients had ipsilateral adrenal excised,while only 4 (3.1%) had adrenal gland involvement.Seventeen clinical stage Ⅲ and Ⅳ patients had ipsilateral adrenal excised,and 4 (23.5%) had adrenal gland involvements.The clinical stages of these 8 patients were stage Ⅲand Ⅳ.The patients were followed up for 28 months (3-102 months).There was no significant difference of 5-year survival rates between the ipsilateral adrenal gland excised and preserved patients categorized according to pathological stage.Conclusion For patients with renal cancer larger than or equal to 8 cm,localized in upper pole of kidney or with the whole kidney involve and with a clinical stage higher or equal to Ⅲ,it is essential to excise ipsilateral adrenal gland in radical nephrectomy,otherwise the ipsilateral adrenal can be preserved.

Objective To analyze the outcome of intra-artery chemotherapy for T1G3 bladder cancer , and its effectiveness and safety. Methods From June 2003 to May 2014, 39 patients with T1G3 bladder cancer chose intra-artery chemotherapy (Gemcitabine plus cis-platin), and close follow-up was required after 2 cycles of chemotherapy. During the follow-up, transurethral resection of bladder tumor was performed for non-muscle invasive bladder cancer, and cystectomy was performed for muscle invasive tumor. Results Of all patients, 32 were male and 7 were female. The median age was 56 years old (range: 32-82 years), and median follow-up time was 56 months (range: 12-136 months). Nineteen patients were primary bladder cancer, and 20 were recurrent tumor. During the follow-up, 17 patients developed recurrent tumors, including 8 progressed tumors and 3 died from tumor. Two-year and 5-year progressed-free survival were 88% and 74%, and 2-year and 5-year cancer-specific survival were 97% and 89%, respectively. During 5 years′ follow-up, 81% survivor preserved intact bladder, and only 1 patient cancelled chemotherapy for adverse effect. Conclusions Intra-artery chemotherapy (GC regimen) is a choice for T1G3bladder cancer, preventing from disease progression with good tolerance.

Objective To explore the risk factors of inguinal metastasis in squamous cell carcinoma of the penis, screening lymph node metastasis high-risk patients. Methods The clinical and pathological data of 81 consecutive patients with squamous cell carcinoma of the penis were analyzed retrospectively. Age at presentation ranged from 27 to 81 years with a median of 49 years. Course of disease within one year of patients with 46 cases (56.8%), 1 year above 35 eases (43.2 %). Seventyfive patients underwent bilateral inguinal lymph node dissection, and 6 patients had unilateral inguinal lymph node dissection. Clinical stage of the primary tumor was assigned according to the 2002 TNM staging system. Variables included patients' age, redundant prepuce and/or phimosis, tumor site,size, number, macroscopic growth pattern, histological grade, inguinal physical examination and the size of inguinal lymph nodes. Results Of the 81 patients, 42 (51.9%) were staged as pN+ and 39 (48. 1%) as pN0. Metastases occurred in 32.0% (16/50) of G1, 78.3% (18/23) of G2 and 100. 0%(8/8) of G3 cases, with significant differences among them (P= 0. 015). According to the inguinal lymph node physical examination results, 63 were staged as clinically node-positive (cN+) and 18 as clinically node-negative (cN0). Metastases occurred in 63. 5% (40/63) of cases of cN+, as compared with 11.1% (2/18) of cases of cN0(P=0. 012). At a median follow up of 40 months (ranged 2-127 months), the 5-year disease free survival rates for positive and negative inguinal lymph nodes metastasis were 71.4% and 92.3%, respectively (P=0. 005) , and the 5-year cancer specific survival rates were 79.0% and 91.4%, respectively (P=0.001). Conclusions Inguinal physical examination and histological grade were the strongest predictors of inguinal metastasis. The patients with inguinal lymph nodes metastasis have lower 5-year disease free survival rates and cancer specific survival rates,and should receive positive treatment measures.