To evaluate the clinical value of NMP22 for the diagnosis of urothelial cancer. Urinary NMP22 was determined with enzyme linked immunoaorbent assay (ELISA) in 50 patients in whom 24 patients were suffering from cancer of urothelium, and 20 cases of cancer of other origins, and 6 cases of artificial bladder after total cystectomy for cancer. The median NMP22 value of urothelial cancer was 37 49U/ml, which was significantly higher than those of other patients (4 33U/ml, P

Objective To evaluate the clinical experience in the treatment of the bladder cancer with holmium laser. Methods From June 2001 to June 2002, a total of 34 cases of transitional cell bladder carcinoma, including 30 male and 4 female, with clinical stage T 1 to T 2a and grade I to Ⅱ, were treated with holmium laser. A 550um end firing fiber was delivered through 21 Fr cystoscopy and power(1 to 1.5 J) was delivered at 15 to 40 pulses per second. Results Bladder tumors were resected easily in 26 cases with holmium laser. In 7 cases it was supplemented with TURBT. Only in one case, holmium laser treatment was given up because of continuous bleeding. The patient was then treated with partial cystectomy. Laser operating time ranged form 5min to 60min, mean 20min. Side effects such as uncontrollable bleeding, perforation of bladder, and obturator nerve reflection were not found. 30 cases were followed up for 3 to 12 months, and tumor recurrence were found in 3 cases. Conclusion Holmium laser resection of bladder tumors is a safe, effective, simple method with less side effects. But the field of vision will be obscure unless continuous irrigation is given during operation.

Objective To discuss three managements of bladder tumors under cystoscopy.Methods Of all the patients,1174 were injected compound aluminum sulphate in tumor pedicle,and 700 cases were treated with transurethral resection of bladder tumor (TURBT) and 34 cases were treated with holmium laser.Results The first management,without obturator nerve reflex and tumor recurrence in situ,was easy and economical but not fit for big tumors without pedicles.With the requirements for related techniques and equipments,TURBT might be accompanied by bleeding,obturator nerve reflex and tumor recurrence in situ.Of the 34 cases treated with holmium laser,there were 3 ones with ectopic recurrence and no one with recurrence in situ.With the requirement for holmium laser equipment,the third management was the most expensive one.Conclusion All of the three managements have their advantages and disadvantages.The doctor should select the right management or perform cross application according to the condition of the patient.

Objective To present the preliminary experience with laparoscopic ureteral reimp1ant for distal ureteral stricture without everted ureteral nipple or submucosal tunneling. Methods Six patients with distal ureteral stricture underwent transperitoneal laparoscopic ureteral reimplantation.The ureteral was reimplanted into the bladder without everting the ureter or without a tunnel.The seromuscular wall of the ureter was anastomosed eircumferentially to the bladder muscle layer by continuous suture. Results All procedures were successfully performed without any intraoperative complications or need for open conversion.Intravenous urography showed normal drainage without obstruction or reflux during follow-up. Conclusion Laparoscopic ureteral reimplantation might be technically simple and feasible.

Objective To investigate the efficacy and safety of the hemostatic techniques applied during the laparoscopic nephron-spring surgery in the treatment of renal tumor. Methods Twentytwo male and 8 female patients with renal tumors underwent laparoscopic nephron-sparing surgery by using the hemostatic techniques of harmonic scalpel, bipolar cautery and renal parenchyma defect suturing over surgical bolsters. Among them, 4 cases have been done transperitoneally and others have been done retroperitoneally. The mean patient age was 50 years. Of the 30 cases, 20 had renal cell cancers with a mean diameter of 2.5 cm, and 10 had renal angiomyolioma with a mean diameter of 2.4 cm. The operating time, estimated blood loss, length of postoperative hospital stay, complications and surgical results were recorded. Results All procedures were successfully completed. No case had converted to open surgery. The mean operating time was 169min and mean estimated blood loss was 100 ml. Major complications happened in 2 patients. One of them had accepted transfusion during surgery. Another case had retroperitoneal hemorrhage three days after surgery and had been treated with 800 ml blood transfusion. The mean post-operative hospital stay was 9 days. During the mean 9 month follow-up, no patient had local or trocar port site recurrence.Conclusion The hemostatic techniques of harmonic scalpel, bipolar cautery, renal parenchyma defect suturing over surgical bolsters could be effectively and safely applied in the laparoscopic nephron-sparing surgery.

Objective To assess the value of percutaneous balloon catheter occlusion technique for tumor thrombectomy in renal or adrenal neoplasm extending into the inferior vena cava(IVC). Methods Twelve patients with renal or adrenal neoplasm extending into retrohepatic or subhepatic IVC were diagnosed by the investigations of CT, MR1, and Doppler ultrasound. There were 7 men and 5 women with a mean age of 51 years (range, 20 to 76 years). Of these patients, 11 had renal ne-oplasm and 1 had adrenal tumor; 11 in the right and 1 in the left; 11 with retrohepatic caval thrombus (level 2a) extension and 1 with extension into the subhepatic vena cava (level 1). On the operation day, all patients had a pereutaneous preset of the balloon catheter into the IVC, at the position be-tween hepatic vein and the tip of tumor thrombus. During surgical resection, the balloon was filled via the catheter to occlude the IVC prior to vena cavotomy. Results Radical nephrectomy and resection of vena cava thrombus was successfully performed with this technique on 12 patients. There were no operative or perioperative pulmonary embolisms or deaths, no any complication. The mean postopera-tive hospital stay was 12 d (range, 9 to 15 d). Pathological investigation revealed clear cell carcinoma in 6 patients, papillary renal cell carcinoma (RCC) in 3, metastatic hepatocellular carcinoma in 1, an-gioleiomyolipoma in 1 and adrenal leiomyosarcoma in 1. The pTNM stage in 9 patients with RCC was T3b N0 M0 in 8 patients, T3b Nx M1 in I patient. The mean followup was 21±10 months (median follow-up 24 months). Four patients died of lung or liver metastasis, and the recurrence of liver cancer at 6, 9, 15, and 22 months postoperatively. Eight patients have survived for 6 to 35 months (mean 26 months). The postoperative 1-, and 3-year cancer-specific survival rates in 9 patients with RCC were 78% and 67%. Conclusions Percutaneous balloon catheter occlusion technique is a feasible, safe, and effective method for tumor thrombectomy of low retrohepatic (level 2a) or subhepatic (level 1) type in patients with renal or adrenal neoplasm extending into the IVC. Additional experience and con-tinued investigation are warranted.

OBJECTIVETo summarize our experience with extraperitoneal robot-assisted laparoscopic radical prostatectomy (RLRP).

METHODSTwenty patients with confirmed prostate cancer by transrectal needle biopsy but no metastasis detected by radiographic examination underwent extraperitoneal RLRP, including 7 with Gleason score of less than 6, 10 with a score of 7, 2 with a score of 8, and 1 with a score of 9.

RESULTSThe procedures were performed successfully in all the patients. In 4 cases, a postoperative PSA value of more than 0.2 ng/ml at 4 weeks suggested residual tumor, for which maximal androgen block therapy was administered before elective radiotherapy. Sixteen patients were followed up for 10 to 37 months (mean 15.5 months). In the 20 cases, the operation was completed in a mean of 180 min (range 150-230 min), with the mean installation time of 48.5 min (range 40-60 min) and average blood loss of 298 ml (range 80-800 ml). The mean postoperative eating time was 1.7 days (1 to 3 days), the mean bladder catheter time was 10.7 days (7 to 14 days), and the mean hospital stay was 10.7 days (range 7-14 days). No postoperative complications occurred in these cases. Postoperative pathology showed a Gleason score no higher than 6 in 6 cases, 7 in 5 cases, and no less than 8 in 9 cases.

CONCLUSIONThe technique of extraperitoneal RLRP can be easily mastered by the surgeons and is especially advantageous for complicated pelvic operations.

Aged ; Humans ; Laparoscopy ; methods ; Male ; Middle Aged ; Prostatectomy ; methods ; Prostatic Neoplasms ; surgery ; Robotics

With the development of tumor precise immunotherapy,it is a hot topic to find biomarkers to predict the response ability of programmed death receptor-1 (PD-1)/programmed death ligand-1 (PD-L1).So far,many predictors,such as the PD-L1 expression in tumor tissue,tumor-infiltrating lymphocyte,tumor mutational burden,serum markers and radiographic markers,have shown predictive value in the process of anti-PD-1/PD-L1 immunotherapy.But each predictor has its limitations.

Traumatic brain injury (TBI) is a major reason for temporary or permanent dyskinesia and cognitive impairment of the organism. Generally, TBI induces subsequent neuroinflammation to assist cell debris removal and tissue repair and regeneration after injury. However, overactivation or long-term activation of immune cells will exacerbate nerve damage or death, cause cognitive dysfunction, and ultimately lead to neurodegenerative diseases. Therefore, secondary damage caused by persistent inflammation is a key component of TBI pathological process. As the main metabolite of anaerobic glycolysis, lactate is increased after TBI and participates in brain inflammation as an important immune regulatory molecule rather than a metabolic waste. Importantly, histone lysine lactylation as a novel type of histone post-translational modifications (HPTM) derived from lactate allows lactate to participate in the regulation of complex immunopathophysiological processes of the central nervous system after TBI. Further study on the process of histone lactylation and its immune regulation mechanism during TBI may provide new insights for early intervention and improvement of TBI prognosis. Thus, the authors reviewed the role of histone lactylation in the immune regulation of TBI, so as to further elucidate the mechanism of TBI and the explore new warning and prevention measures from the perspective of HPTM.

Objective: To investigate the function of anti-PD-1 (scFv)/IL-15/IL-15Rα-sushi fusion protein (PD-S15) to specifically bind to PD-1 in vitro and to explore its effect on NK/T cell proliferation. Methods: The human anti-PD-1 (scFv) gene sequence and human IL-15/IL-15Rα-sushi fusion gene sequence were synthesized chemically. The recombinant expression plasmid pUC57-PD-S15 was constructed by enzyme digestion and ligation of the two target genes, and then transiently transfected into HEK293T cells by lipofectamineTM 2000. The supernatants of cell culture medium were acquired, and the expression of PD-S15 fusion protein in cell culture supernatants was detected by Wb assay. PBMCs and TILs were cultured in mediums with different proportion of PD-S15/X-VIVOTM15, respectively. Then, the capacity of PD-S15 fusion protein to bind to PD-1 in vitro and its effect on the proliferation of PBMCs and the proportion of CD3+CD8+, CD3+CD4+ and CD3-CD56+ subsets were detected by flow cytometry. The effect of PD-S15 fusion protein on the proliferation of TILs was detected by cytometry. Results: The successful construction of pUC57-PD-S15 eukaryotic expression plasmid was confirmed by double enzyme digestion and sequencing, and then successfully transfected into HEK293T cells. The relative molecular weight of the target protein was approximately 55 000, and was in line with expectations. PD-S15 fusion protein could specifically combine with PD-1 in vitro (P<0.05) and stimulate NK/T cell proliferation (P<0.05). Compared with classical TILs culture method, the efficiency of activation and amplification of T cells in vitro by PD-S15 culturemethodwasbetter (P<0.01). Conclusion: PD-S15 fusion protein can specifically target PD-1 and rapidly expand NK/T cells in vitro, which lays a foundation for the selective expansion of CD8+PD-1+ antigen-specific T lymphocytes from tumor tissues and even peripheral blood.