Objective:To investigate the effects of mycophenolate mofetil(MMF)on the expression of endothelial CD40L and lymphocyte-endothelium adhesion.Methods:HUVEC was used for adhesion assay and CD40L detection.The effect of mycophenolic acid(MPA),an active metabolite of MMF,was observed in the study.HUVEC were treated with TNF-? or/and MPA for 24 hours.The lymphocyte-endothelium adhesion was detected by Rose Bengal staining.After treated with TNF-?,rIFN-?,and LPS,HUVEC CD40L expression was detected.HUVEC was treated with any of the modulators or each combined with MPA,respectively for 24 hours and different doses of MPA combined with LPS were also designed to stimulate HUVEC for 24 hours.The expression of CD40L on HUVEC was detected by cell-ELISA method.Results:MPA inhibited adhesion to lymphocytes of the HUVECs of either resting or stimulated with TNF-?.The cytokines used in the study induced expression of CD40L on HUVECs.MPA did not inhibit CD40L expression on resitng HUVECs,whereas it inhitbited CD40L expression induced by TNF-?,rIFN-?,or LPS,and the inhibition of CD40L expression on the cells induced by LPS was shown in dose of MMF-dependnet pattern.Conclusion:Endothelial cells express a low level of constitutive CD40L that is increased by treated with simple cytokines.MMF inhibits interactions between endothelial cells and lymphocytes by suppressing the expression of CD4OL on endothelial cells.

Objective To evaluate the clinical safety and efficiency of applying 125I permanent-implant prostate brachytherapy (BRT) in elderly prostate cancer patient treatment.Methods From Jan.2007 to Dec.2011,23 elderly patients (age ≥75 years) with a diagnosis of localized prostate cancer were treated at our institution and then were evaluated retrospectively.The average age was 79.7 (ranged from 75-87) years.The average prostate volume was 52 (ranged from 35-78) ml.PSA level was 6.2±1.5 (ranged from 3.3 to 9.8) μg/L.Seven cases were in T1cN0M0,sixteen cases were in T2aN0M0.Five cases were with Gleason score of 4,two cases were with Gleason score of 5,sixteen cases were with Gleason score of 6.All patients received a single 125I permanent-implant brachytherapy with a total dosage of 145 Gy.Patients were stratified according to biochemical recurrence-free survival (bDFS),overall survival rate (OS) and complications.All the patients had not accepted anti-androgen therapy or external radiotherapy.Results The average followed up were 50 (ranged from 4 to 77) mon.After 3 months,the average serum PSA was 2.4±0.4(ranged from 0.9-3.8) μg/L,there was significant difference compared with that before treatment (P=0.003).After 1 years,the average serum PSA was 0.2-2.7 μg/L and 87％ (20/23) patient's PSA was less than 1 μg/L.2 cases had biochemical recurrence (bNED rate,91％).4 patients died,among them 1 patients died of prostate cancer.The overall survival rate was 83％,and the cancer-specific survival rate was 96％.Of the patients with urethral adverse effects,0-V adverse effect rates were 34.8％,43.5％,17.4％,4.3％,0 and 0.No serious complication such as rectal fistula occurred.Conclusions BRT is an effective and safe monotherapy in elderly prostate cancer patients.

Objective:To study the correlation between deposition of C4d along peritubular capillaries (PTC) and interstitial eosinophilic infiltration in renal allografts.Methods:Deposition of C4d in kidneys was assayed by indirect immunoflourescence of the renal allograft biopsies.Twenty-six patients were demonstrated strongly diffuse staining of PTC,who were defined as C4d+ group,while the biopsies of thirty patients with acute rejection exhibited negative for PTC C4d staining served as the controls,who were defined as C4d-group.Eosinophils were counted under microscope.Results:The C4d+group was demonstrated significantly greater interstitial eosinophilic infiltration than did the C4d-group(P

With the hereotopic heart transplantation, immune tolerance induced by portal venous inoculation of donor spleen cells was studied.Methods:The recipient rats received donor spleen cells through portal vein combined with of cyclosporine A(CsA).The NK cell activity and IL-2, IFN-y expression of recipient spleen cells were detected. Results: Hie inoculation of donor spleen cells through the portal vein could significandy prolong survival time of heart allografts.IL- 2, IFN-y expression of recipient spleen lymphocytes and the recipient NK cell activity was also inhibitied.Conclusion:The inoculation of donor spleen cells through the portal vein could induce immune tolerance.The suppression of IL-2-NK-IFN-y immunologic net may be an important mechanism of portal vein tolerance.

Objective To evaluate the efficacy of laparoscopic adrenalectomy and open adrenalectomy in treating recurrent Cushing′s disease. Methods Forty-three patients (29 females and 14 males) with recurrent Cushing′s disease treated with laparoscopic adrenalectomy (LA, n=32) or open (OA, n=11) adrenalectomy from 2000 to 2008 were retrospectively analyzed. Patients completed the follow-up survey including a 36 item short-form (SF-36) health survey. Results All 43 patients achieved successful adrenalectomies without intraoperative complication. The duration of the LA was significantly shorter than that for the OA. Intraoperative blood loss was low in both groups. Median length of hospital stay was shorter in the laparoscopic adrenalectomy group, P<0.05. The median follow-up was 48.5 mon. Of the 34 (79.1%) patients available for follow-up, 22 (64.7%) had an adrenocorticotropic hormone levels >200 ng/ml and six (27.3%) had clinical Nelson syndrome. Thirty-four patients who completed the SF-36 survey reported that they felt their health status had changed from good to excellent after adrenalectomy. However, except for social activity, they showed significantly lower SF-36 scores compared with the general population, P<0.05. No statistical difference was found in SF-36 scores between the laparoscopic and open groups. Conclusions Adrenalectomy is safe and an effective option in the treatment of recurrent Cushing′s disease. It can help patients to improve both survival rate and quality of life.

Objective To assess the safety and efficiency of systematic transperineal ultrasound guided template positioning biopsy for the high-risk population of prostate cancer.Methods From January 2010 to January 2012 a total of 42 high-risk men of prostate cancer underwent systematic ultrasound guided biopsy using the transperineal template positioning technique.All patients got at least one previous biopsy,and all the patients showed negative results,including prostatic intraepithelial neoplasia,and/or atypical small cell acinar proliferation.During the follow-up,all the patients still had high prostate specific antigen (PSA) velocity (＞ 0.75 μg/L) or high PSA level (＞ 10 μg/L).Results A mean of 18.7 biopsy cores had been obtained.Cancer was identified in 19 of the 42 men (44％).The mean Gleason score was 6 (from 4 to 9).Mean prostate volume in the positive and negative biopsy groups was 44 and 71 ml.The only significant independent influence factor for positive biopsy was prostate volume (P ＜ 0.05).The positive rate showed no statistic difference in term of presence of PIN,AHH,the number of biopsy sites,or PSA value (P ＞0.05).Adenocarcinoma was found in transition zone in 14 of 19 cases (74％),and 5 (36％) was positive only in the transition zone.Complications were rare and self-limiting,including hematuria (29％)and urinary retention (0.9％).Conclusions Systematic transperineal template positioning biopsy of the prostate is a safe and precise biopsy technique in patients who remain at high-risk for prostate adenocarcinoma.

BACKGROUND: Immune function of chemotaxis signal has been a key focus in medical research. However, the immune activation and related action mechanism of chemotatic factor RANTES are unclear.OBJECTIVE: To investigate the immune activation and related action mechanism of chemotatic factor RANTES stimulation on peripheral mononuclear cells.DESIGN: Control Experiment.SETTING: Department of Urologic Surgery, Clinical Medical College, Yangzhou University.MATERIALS: The experiment was performed at the Laboratory of Department of Immunology, University of Louisville from December 2004 to August 2005. Main reagent and equipments included RPMI 1640 complete medium, recombinant human RANTES, anti-CD3 monoclonal antibody, pyrrolidine dithiocarbamate(PDTC),CTLA4Ig, LS500 liquid scintillation counter and FACS Epics XL flow cytometry.METHODS: Peripheral mononuclear cells were collected and stimulated by different concentrations of recombinant human RANTES and/or anti-CD3 monoclonal antibody. Cells with significantly proliferative response were intervened by pyrrolidine dithiocarbamate (PDTC) or CTLA4lg. 3H-thymidine incorporation was used to detect the proliferation of mononuclear cells. Flow cytometry was applied to measure the phenotypes of lymphocytes.MAIN OUTCOME MEASURES: Incorporation efficiency of 3H-thymidine, the ratio of CD4 to CD8, expression of CD25,CCR5 and CD28.RESULTS: Proliferative reaction of mononuclear cells reached two peaks with recombinant human RANTES concentrations of 100 μg/L and 5000 μg/L respectively. The proliferation of peripheral mononuclear cells stimulated by 100 μg/L recombinant human RNATES was significantly higher than that in the presence of 50 μg/L anti-CD3 monoclonal antibody (P<0.05).There were no rivalry or synergistic effect between them.The immune active effects of recombinant human RANTES could be inhibited by PDTC or CTLA,Ig in a dose dependent manner.After RANTES treatment,the level of cell surface CD25 increased (P<0.05) and the CCR5 expression decreased (P<0.05), but there were no significant differences in CD28 expression and the ratio of CD4/CD8 of lymphocytes(P>0.05).CONCLUSION: RANTES has a specific function of inducing the immune activation of mononuclear cells. This special signal works depending on the activation of interleukin-2 signal pathway, CD28 co-stimulatory pathway and nuclear factor-κB,but independent of CD3 activation.

Objective To investigate the efficacy and safety of salvage radical prostatectomy for men with recurrent prostate cancer (PCa) after radiotherapy.Method Ten pathologically confirmed PCa patients who relapsed after radiotherapy from Jan.2008 to Dec.2013 were retrospectively reviewed.The mean age was (64.7 ±3.7) years,with range from 56 to 72 year.Local recurrence was confirmed by retransrectal biopsy.All patients had increased PSA and/or lower urinary tract symptoms.Pelvis MRI and bone scan were performed to detect lymph node involvement and bone metastasis.All patients received radical prostatectomy with standard pelvic lymphadenectomy.Seven received open surgery (open group),three patients underwent laparoscopic surgery (laparoscopic group).Postoperative complication and PSA level were compared.Results Salvage radical prostatectomies with lymph node dissection were performed in all patients without major complications.The mean operation time of open group versus laparoscopic group were (225 ± 57)min vs.(210 ± 80)min and the mean blood loss was (275 ± 49)ml vs.(260 ± 93) ml,both of which were with no significant difference (P ＞ 0.05).The average length of stay was (14 ± 4) vs.(8 ± 2) day with significant difference (P ＜ 0.05).No rectal injury was observed.Two (20％) patients were with positive margin,and three (30％) patients had postoperative complications,including one case of deep vein thrombosis,one case of incision infection and and one case of anastomotic leakage.After a mean of 20.6 months'follow-up,two patients (25％) reached biochemical recurrence.Conclusion Both open and laparoscopic salvage radical prostatectomies after radiotherapy failure were feasible.Largescaled prospective studies were needed to verify the long-term effectiveness.

Objective To explore the safty and feasibility of transrectal ultrasound guided transperineal seminal vesicle biopsy in the evaluation of clinical staging of prostate cancer.Methods Retrospectively study 57 suspected prostate cancer patients with seminal abnormality during 2010.7-2015.1,age ranged from 50 to 78 years,average 65 ±7 years,serum total prostate specific antigen (tPSA) 3.2-131.1 μg/L, average (23.7 ± 11.3) μg/L.Twenty-two cases had palpable prostate nodules through rectal examination.All the 57 patients underwent ultrasound and template guided transperineal prostate and seminal vesicle puncture biopsies.Results Forty-four cases out of 57 found prostate cancer cells in biopsies, and 32 cases had seminal vesicle invasion (positive group) while the other 12 were negative.Twenty cases had been performed prostatectomy in the positive group and their post-operative pathological examination all showed prostate cancer with seminal vesicle invasion.Eleven cases in the negative group had been performed prostatectomy ,and 2 cases showed seminal vesicle invasion.The clinical stages of all cases in the positive group were considered as T3b both pre-operatively and post-operatively.In the negative group however, 11 cases were considered as T2 stage pre-operatively,while 2 cases were increased to T3b stage post-operatively.The sensitivity of puncturing seminal vesicle was 91％ (20/22) ,specificity was 100.0％ (9/9).Positive predictive value was 100.0％ (20/20),while negative predictive value was 82％ (9/11).All the 57 cases did not present fever after puncture biopsies, while 23 cases presented hematuria (40％) ,20 cases presented hemospermia (35％) and 1 case presented urinary retention (2％).Conclusions Transrectal ultrasound-guided transperinealseminal vesicle puncture is safe and reliable, it helps to improve the accuracy of pre-operative staging.

Objective To evaluate the anestheisa efficacy of periprostatic nerve block in transrectal ultrasound (TRUS) guided biopsy of the prostate.Methods A total of 223 patients received prostate biopsy in our hospital from July 2010 to December 2013 were retrospectively studied,and were divided randomly into two groups.One hundred and sixteen cases in nerve block group accepted local anesthesia of prostate capsule and periprostatic nerve block after local perineal skin anesthetia,and 107 cases in local anesthesia group only accepted local perineal skin anesthetia and local anesthesia of prostate capsule.Patients in the 2 groups underwent prostate biopsy successfully.The visual analogue scale (VAS) and complications were recorded.Results The age,serum PSA level before biopsy,prostate volume and the number of puncture needles had no significant differences between the 2 groups (P＞0.05).The average VAS score was 2.3± 1.1,and 4.9±2.3 in the 2 groups.The VAS had significant difference between the 2 groups (P＜0.05).The incidences of hematuria,hemospermia and urinary retention were 37.1％ (43/116),3.4％ (4/116) and 1.7％ (2/116) in nerve block group,and 39.3％ (42/107),4.7％ (5/107) and 1.9％ (2/107) in local anesthesia group.The difference was not significant (P＞0.05).Conclusion Periprostatic nerve block for TRUS guided biopsy of the prostate could be safe with good analgesic effect.