Objective To evaluate the risk factors of urethral recurrences following radical cystectomy for transitional cell carcinoma of the bladder and to discuss the treatment options. Methods Clinical data of 278 patients who underwent radical cystectomy for bladder cancer were analyzed retrospectively. Urethral recurrences were observed in 24 patients. Risk factors of recurrence were evaluated by Cox's multifactor regression model. Results None of the 6 patients undergoing selective prophylactic urethrectomy died;10 of the 24 patients with urethral recurrence died of tumor metastasis.Multiple factor analysis suggested that prostate involvement,bladder neck involvement,trigone tumor,multiple tumor and carcinoma in situ were the high risk factors,and their relative risk coefficients were 1.573,1.532,1.360, 1.337 and 1.213,respectively. Conclusions Simultaneous urethrectomy following radical cystectomy should be performed for patients with high risk factors (prostate involvement, bladder neck involvement, trigone tumor,multiple tumor and carcinoma in situ) of urethral recurrence,while patients without risk factors are eligible candidates for reconstruction of the urinary tract after cystectomy by an orthotopic neobladder.

Modern immunology has established that tumor immune escape is associated with hidden or missing tumor-specific antigens and tumor-associated antigens,as well as immune suppressors that are released from tumor cells to inhibit the immune cytotoxicity and antigen-presenting cells (APCs).The changes in tumor microenvironment have an impact on tumor immunity and treatment outcomes.The immune effects finally depend on activation and inhibition of T cell receptors and other co-regulated receptors (CD28,CD80/CD86,and CTLA-4) in spite of the existence of APCs and cytotoxic T lymphocytes in tumor microenvironment.Recent studies have revealed that radiotherapy induced not only DNA damage but also immunogenesis in tumor cells.Both conventionally fractionated radiotherapy and hypofractionated radiotherapy can induce immunogenesis in tumor cells.Immunogenic regulation makes many tumor antigens expressed in cells exposed to irradiation,which induces immune recognition and cytotoxicity;cell content (DNA,HMGB1,etc.) released from dead immunogenic cells can trigger immune effects and in situ tumor vaccination,which further induce an abscopal effect of radiotherapy.A lot of anti-tumor immunotherapy fails to achieve satisfactory treatment outcomes.Therefore,how to combine radiotherapy,especially stereotactic body radiotherapy,with anti-tumor immunotherapy has recently become a new challenge for researchers.

ObjectiveTo investigate the expression of TGF ?1 and type Ⅰ receptor and their relations with intimal hyperplasia in autogenous vein grafts in rats. Methods Autogenous vein graft model was established in 48 Wistar rats. The vein grafts were harvested on day 3, 7, 14, and 28.Histomorphological methods were used to measure the thickness of intima and wall at different time points. Immunohistochemistry and Western blot were used to detect the protein expression of TGF ?1 and TGF ?RⅠ . RT PCR was used to detect their mRNA level. ResultsThe intimal thickness increased on day 7 compared with controls( P

Objective To investigate the expression of survivin (an apoptosis inhibitor) in thyroid carcinoma and its relationship with vascular endothelial growth factor (VEGF) expression. Methods Sixty-eight cases of thyroid carcinoma, 12 cases of thyroid adenoma and 10 cases of normal thyroid tissue were involved. Immunohistochemistry (SABC method) was used to detect the expression of survivin, caspase-3 and VEGF, and then their relationship with the major clinicalpathologicalparametersofthyroidcarcinoma was analysed. Results No survivin was expressedinnormalthyroidtissue,butsurvivinwasweakly expressed in thyroid adenoma (16.7%) and strongly expressed in thyroid carcinoma (57.4%); caspase-3 was obviously expressed in three kinds of tissue (70.0%, 75.0%, 69.1%), and VEGF was expressed in 75.0% of thyroid carcinoma and 41.7% of thyroid adenoma. In thyroid carcinoma, survivin expression had no correlation with caspase-3 expression, but significant positive correlation existed between surviving and VEGF (r=0.302,P

Objective To evaluate the efficacy of combination solifenacin and tamsulosin for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy. Methods 120 patients (male:100 female:20 age:18-67 yrs) randomly assigned to 4 groups (each group 30) with the calculi diameter range from 0.5 to 1.1 cm.All patients performed extracorporeal shock wave lithotripsy (X ray oriented).The control group did not accept any medical treatment.The solifenacin group were administered solifenacin 5 mg,once per day.The tamsulosin group were administered tamsulosin 0.2 mg,once per day.The combination group were administered solifenacin 5mg,plus tamsulosin 0.2 mg,each per day.The observation duration was set at 2 weeks. Results The stone-free rate (according to KUB) within 2 weeks were 80.0％,83.3％,93.3％ and 96.7％ in the control group,solifenacin group,tamsulosin group and combination group respectively.Statistical differences were significant among the tamsulosin group,the combination group and the control group.The stone expulsion times were (7.6 + 3.7) d,(6.3 ± 2.5) d,(4.4 + 2.3) d and (3.5 ± 2.2) d in the 4 groups respectively.Statistical differences were significant among the tamsulosin group,the combination group and the control group.The uses of analgesics were 13,5,9 and 3 in the 4 groups respectively.The bladder irrtative symptoms were 12,6,4 and 4 in the 4 groups respectively.Statistical differences were also significant for the use of analgesics and relief of bladder irritation between the solifenacin group,the combination group and the control group. Conclusions Tamsulosin and solifenacin could be safe and effective for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy.It could significantly improve the stone expulsion rate,relief the pain and improve bladder irrtative symptoms.

Objective To design simulated pulmonary air embolism demonstration model,so as to solve the problem of pathological anatomy of pulmonary air embolism in experiment teaching. Methods According to the principle of the disturbance of local blood circulation and air embolism, we designed a pulmonary air embolism model. We took 223 school nursing students as the object of this study,and randomly divided them into 2 groups:animal experiment teaching group and model control group,then we compared the teaching effect between the two groups. Result The test scores of students in the animal experiment teaching group were higher than control group (P<0.05) . Conclusion The use of simulated pulmonary air embolism demonstration model teaching can improve the students’experimental test scores,and can be repeatedly used,stimulate students' study interest,reduce the cost of teaching,and improve the teaching quality.

Objective To evaluate the diagnostic value of multi-slice spiral CT urography (MSCTU)in kidney tuberculosis. Methods Thirty cases(16 men and 14 women)of kidnev tuberculosis diagnosed by clinic and pathology were retrospectively analyzed.The patients' mean age was 44 years(range,19-73 years).Of them,17 cases were on the left and 13 on the right.Eighteen cases had irritation symptoms,18 cases had low back pain,6 cases had hematuria,2 cases had a fever; renal tuberculosis was incidentally detected in 2,1 case had left scrotal swelling.The enhancement scanning and three-dimensional reconstruction of multi-slice spiral CT were conducted in all patients. Resuits Among the 30 cases,29 cases of renal tuberculosis were diagnosed with CTU(97%).The low density area in renal parenchyma was seen in 25 cases without expansion and fluidify of pelvis,tubercle calcification was seen in 18 cases,the thickening of renal pelvis and ureter wall was seen in 17 cases,the thinning of cortex of kidney was seen in 12 cases,and the contracture of bladder and poor filling was seen in 2 cases.IVU diagnosed 9 cases of renal tuberculosis(30%).Twenty cases of renal pelvis,calyceal failed to show contrast filling. Conclusion MSCTU has advantages in the diagnosis of renal tuberculosis compared with IVU.

Objective To improve the diagnosis and treatment of asymptomatic adrenal pheochromocytoma. Method The clinical data of 33 patients with asymptomatic adrenal pheochromocytoma were reviewed. Results All the patients were not preut with typical signs and symptoms of pheochromocytoma, 16 patients were found adrenal mass by routine physical examination, 15 patients presented with superior abdominal or flank pain, 1 patient was fever and 1 patient was diarrhea. Most of patients were prent with round mass with low density in the center of the tumor,5 patients had elevated level of plasma epinephrine and norepinephrine (16% ,5/31),24 hours urine CA and VMA were elevated in 6 patients (24%, 6/25) and 5 patients (20%, 5/25) respectively, 26 patients who were suspected pheochromocytoma preoperatively were treated with α-adrenergic blockade (prazosin) to control the blood pressure or with intravenous colloid fluids and blood transfusion to expand intravascular volume before operation. The tumors were removed successfully in 32 patients, and biopsy was done in 1 patient because of the serious invasion to the vena cava by the tumor. All the patients were diagnosed pheochromocytoma histopathologically,and followed up for 1 month to 7 years, no tumor recurrence. Conclusions The patients with asymptomatic adrenal pheochromocytoma have lower catecholamine excretion in their plasma and urine. Combination of modem imaging examinations are useful methods to diagnose asymptomatic adrenal pheochromocytoma. To lower the risk of operation, the control of blood pressure and the expanding of intravascular volume are important for the patients with huge adrenal mass or typical suspected appearance of pheochromocytoma.

Objective To investigate the regulation of T cells in the process of liver regeneration using a model of mice after 70% liver resection.Methods We performed 70% hepatectomy in T-cell-deficient mice and control mice.The liver mass and body mass ratio, BrdU infiltration level, proliferating cell nuclear antigen (PCNA),expression of M phase marker protein p-HDAC3, and serum transaminase levels were measured.Results The recovery of liver mass and body mass ratio of thymus-deficient mice occurred significantly later than that of control mice.The peak time of BrdU infiltration levels and the expression of PCNA and p-HDAC3 in T-cell-deficient mice were later than in control mice, but the degree of liver injury was lower.Conclusion T cells are involved in the regulation of liver regeneration, and the absence of T cells delays the process of liver regeneration.

Objective To construct a highly efficient expression plasmid of eukaryotic nuclear membrane protein Omega 3 fatty acid desaturase gene Fat‐1 in E .coli .Methods Using molecular cloning technology to construct the recombinant prokaryotic expression plasmid pET32a Fat‐1 and pET32a‐Mistic‐Fat‐1 fused with Membrane proteins expression chaperon mistic ;the two re‐combinant plasmids were transformed into E .coli strain BL21 (DE3) ,the expression of Fat‐1 protein and M110 Fat‐1 protein in‐duced by IPTG were identified by SDS‐PAGE and gray degree analysed the amount of expression ,further identified by Western blot .Results The results of enzyme digestion and sequencing demonstrated that we successfully constructed the prokaryotic ex‐pression vectors pET32a Fat‐1 and pET32a‐Mistic‐Fat‐1;SDS‐PAGE and Western blot showed that Fat‐1 fatty acid desaturase wasn′t significantly induced ,but the overexpression of M110 Fat‐1 fusion protein was obtained in E .coli ,accounting for 15% of the total amount of whole cell proteins .Conclusion The fusion with Mistic proteins to express the Fat‐1 gene has realized the overex‐pression of eukaryotic nuclear membrane integrated protein Omega 3 fatty acid desaturase in prokaryotic host .