Objective To evaluate the long term efficacy of radical cystectomy and ileal conduit in the treatment of bladder cancer. Methods 196 cases of bladder tumor treated from Jan. 1985 to Jan. 2000 with radical cystectomy and ileal conduit for urinary diversion were studied retrospectively. Results Bladder neck or trigone was involved by the neogrowth in 126(64.3%).The growth has been invasive in 145(74.0%). 93.4%(183/196) of the tumor were transitional cell carcinoma. Early operative complication occurred in 19(9.7%) and late complication in 10(7.4%).On following up for 1 to 15 years with a mean of 6.6 years,the 5 year survival rate has been 66.2%. Conclusions Radical cystectomy is the optimal in treating invasive bladder tumor and ileal conduit is a good means of urinary diversion which is simple with minimal complications.

Objective To evaluate transureteroscopic pneumatic lithotripsy in the treatment of ureteral calculi. Methods 116 cases of ureteral calculi treated with ureteroscopic pneumatic lithotripsy from Dec.1999 to Feb.2002 were studied retrospectively.There were 49 male patietns and 67 female with an average age of 43,3 being upper ureteral stone,24 middle and 68 lower ureteral stone.21 ureteral stone-street. Results The stone fragmentation rate was 90%(104/116),85%(99/116) of which being fragmented on the first treatment session.The main complications were failure to insert the ureteroscope in 3 cases and ureteral perforation in 4.94 cases were follow-up for one to eighteen months and 91 cases were stone free within one month.No ureteral stricture has been observed on intravenous urogram. Conclusions Treatment of ureteral calculi by transureteroscopic pneumatic lithotripsy has been safe, effective and less invasive.

Objective To explore clinical progress about the deep vein thrombosis after hip replacement at home and abroad,and discuss the preventive effect of nursing intervention.Methods The documents about the deep vein thrombosis after hip replacement were retrieved from PUBMED,China National Network Knowledge Infrastructure (CNKI),Chinese Scientific Journal Database (VIP),Chinese Bio Medical Literature Database (CBM) and Wan fang Database.And the retrieving duration was from 1st Jan.2001 to 1st Sept.2013.The research progress about prevention of deep vein thrombosis after hip replacement was analyzed through the analysis of the same and the difference of comparative literatures at home and abroad.Results There were totally 228 Chinese documents and 5 English documents of the deep vein thrombosis after hip replacement,and the number of document showed an increasing trend year by year.In the past five years,the clinical progress about the deep vein thrombosis after hip replacement was obvious,the research methods used was accurate,the involving intervention measures was continuously improved,literature quality was increased.Conclusions The quality of the documents published in domestic Chinese journals needs to be improved,and we should improve the quality of research design,research new methods of intervention,formulate the optimal nursing measures in order to achieve optimal care.

Objective To evaluate the relationship between lifestyle and development of Alzheimer's disease(AD).Methods Two hundred and thirty-eight AD patients(102 males and 136 females) and 476 healthy controls(204 males and 272 females) were recruited from Ningbo communities into this 1 ∶ 2 matched case-control study.Mini-Mental State Examination(MMSE) and Clinical Dementia Rating(CDR) were required to fill in.Chi-square test and conditional logistic regression were used for data analysis.We adopted Epidata 3.1 to establish the database and did statistical analysis by SPSS15.0.The count data were analysis by Chi-square test,meanwhile multiple factors analysis by conditional Logistic regression analysis.Results Through single factor analysis we found thatcigarette ≥20/day(F=8.687,P=0.003),children visiting(F=22.721,P＜0.05),friendship(F=16.784,P＜0.05),family gathering(≥1 times/week)(F=8.198,P=0.004),working after retirement(F=33.099,P＜0.05),travel(F=16.784,P＜0.05),social activities(F=24.919,P＜0.05),physical exercises(F=24.404,P＜0.05),eating pickles or pickled products(F=6.662,P=0.01),saturated fatty acid intake(F=23.069,P＜0.05),daily consumption of fruits and vegetables(F=8.401,P=0.004),chess(F=17.365,P＜0.05),reading(≥30 min/d)(F=36.390,P＜0.05),using computer(F=8.688,P=0.003) were related AD,the difference was statistically significant(P＜0.05).In multiple factors analysis,social activities,chess games or joke,travelling,working after retirement,reading,physical exercises,friendship,family gathering,saturated fatty acid intake and daily consumption of fruits and vegetables were risk factors of AD(odds ratio(OR) values were 0.571(0.342-0.753),0.623(0.343-0.889),0.686(0.461-0.942),0.534(0.326-0.714),0.276(0.175-0.438),0.538(0.336-0.738),0.585(0.385-0.765),0.466(0.316-0.745),0.527 (0.368-0.787) and 0.482(0.316-0.665),respectively; constant terms:OR=0.526).Conclusion A positive and leisure lifestyle and health reasonable diet could effectively reduce the risk of AD.

Objective To evaluate the efficacy and safety of sunitinib in patients with metastatic renal cell carcinoma. Methods Twenty-three male patients and 8 female patients were included in this study.All patients were metastatic renal cell carcinoma with prior radical nephrectomy or biopsy.Patients received treatment with sunitinib in repeated 6-week cycles,consisting of 4 weeks of 50 mg daily sunitinib administration followed by 2 weeks off treatment(schedule 4/2).CT scan was used to evaluate the efficacy every 2 cycles. Results Twenty-four of the patients could be evaluated the efficacy.None of them achieved complete responses,5 achieved partial responses,15 were in stable and 4 were with disease progression including 1 death.Four patients were forced to stop treatments because of poor general condition,lack of financial support or hepatic injury.Three cases could not be evaluated because of no long enough follow-up.The objective response rate was 21%(5/24)and disease control rate was 83%(20/24).The common adverse effects included hand-foot syndrome,diarrhea,anorexia,stomatitis,hemorrhagic tendency and hematotoxicity.But almost all of them were curable by using adjuvant drugs. Conclusions Sunitinib is efficient in the treatment of metastatic renal cell carcisoma.Most of the side effects are tolerable or curable.

Objective To reassess the treatment of Bosniak category Ⅱ-Ⅲ renal cyst.Methods Sixty-eight cases of Bosniak category Ⅱ-Ⅲ renal cyst were operated from 2005 to 2008 in our institute.The average patient age was 40 years with the average renal cyst diameter of 5.1 cm.There were 37 left lesions and 31 right lesions with 31 cases of category Ⅱ (including 13 cases of category Ⅱ F) and 37 cases of category Ⅲ.Renal unroofing were performed in 49 cases with 9 cases found malignant and followed by radical nephrectomy,19 cases were diagnosed as malignancy preoperatively and nephron sparing surgery or radical nephrectomy were performed in these cases.Results Malignant lesions were found in 21 cases and benign lesions were found in 47 cases.The malignant rate was 9.7％ in category Ⅱ (15.4％ in category Ⅱ F),48.6％ in category Ⅲ.Nine cases were diagnosed benign preoperatively but confirmed malignancy after operation; 7 cases were diagnosed malignancy preoperatively but confirmed benign after operation.Forty-two cases were followed up for 8-65 months with 15 cases of malignancy and 27 cases of benign lesions.The recurrence of renal cyst occurred in 6 cases of benign lesions and recurrence and metastasis occurred in 3 cases of malignancy in 1-5 years.Conclusions It is difficult to draw a therapeutic principle for Bosniak category Ⅱ-Ⅲ renal cyst because of the uncertainty of the lesion.Partial nephrectomy or renal cystectomy is a good choice in the treatment of Bosniak category Ⅱ-Ⅲ renal cysts.

Objective To investigate the factors of lifestyle associated with the mild cognitive impairment (MCI). Methods A 1∶ 2 matched case-control study investigated 120 patients of MCI and 240 healthy controls with lifestyle factors associated with MCI. Results Multiple factors analysis confirmed that, participate in social activities (OR=0.562, 95%CI: 0.359~0.723), playing chess or joke (OR=0.603,95%CI: 0.323~0.884), travelling (OR=0.683, 95%CI: 0.467~0.912), continue to work after retirement (OR=0.531, 95%CI: 0. .326~0.724),reading (OR=0.272, 95%CI: 0.174~0.428), using computer (OR=0.536, 95%CI: 0.427~0.869), regular physical exercise (OR=0.437, 95% CI: 0.316~0.732), friendship (OR=0.583, 95%CI: 0.385~0.765), meeting children (OR=0.464, 95%CI: 0.316~0.745), intaking unsaturated fatty acids (OR=0.524, 95%CI: 0.368~0.787), often eating fish and seafood (OR=0.224, 95%CI: 0.171~0.383), daily consumption of fruits and vegetables (OR=0.485, 95%CI: 0.316~0.665) were protective factors for MCI. Conclusion A positive, leisure lifestyle, health reasonable diet and avoiding risk factors could effectively reduce the risk of MCI.

Objective To evaluate the hematological adverse events of sunitinib in treatment of advanced renal cell carcinoma.Methods Forty-four male patients and 18 female patients were included in this study.They were all with metastatic renal cell carcinoma and received sunitinib treatment at the dose of 50 mg daily in repeated 6 weeks cycle (4 weeks on and 2 weeks off).Toxicity was assessed every cycle with tumor assessments every 2 cycles via CT or PET-CT.Results Fifty patients (80.6％) had experienced treatment-related hematotoxicity,including leucocytopenia,anemia and thrombocytopenia.Severe hematological adverse events ( grade 3 -4 ) occured in 18 patients ( 29.0％ ) and slight events ( grade 1 - 2 ) in others (51.6％).Most of the hematological adverse events were manageable and reversible and treatment-changes (dose reduction,interruption) were necessary in severe cases.Almost half of the dose reduction (9/21,42.9％ ) were owing to hematotoxicity.Conclusions Sunitinib of 50 mg dose on schedule 4/2 is effective and well-tolerated in advanced renal carcinoma patients.Hematological adverse events are frequent in Chinese patients and can be controlled well.

ObjectiveTo study the risk factors of renal artery pseudoaneurysm (RAP) following partial nephrectomy.MethodsOpen partial nephrectomy was performed on a total of 464 cases of renal cell cancer from July 2003 to May 2010. Five patients ( 1.1％ ) had postoperative hemorrhage from RAP.The surgery technique of the open partial nephrectomy, the clinical presentation, imaging findings and treatment of RAP were reviewed. The anatomical characteristics of these five renal tumors on enhanced CT were quantified using the R.E.N.A.L. Nephrometry Score System.ResultsAll five cases were male, two had tumors on the left side and three on the right side. Median tumor size was 3.6 cm ( range from 2.5 to 5 cm; Radius score 1 - 2). Four tumors were exophytic of these, three had a major endophytic component (≥50％) deep in the parenchyma (Exophytic/endophytic score 2 ), one was entirely endophytic (score 3 ). The distance of all the tumors to the collecting system was ≤4 mm ( Nearness score 3 ). Four of the five tumors were across the polar line and/or renal axial midline ( Location score 3 ). The other tumor was located under the lower pole ( Location score 1 ) but close to the renal hilar. All patients presented with delayed gross haematuria and decreasing hemoglobin occurred on mean postoperative day 12 (3 -23 day). Four patients complained of flank pain, two of which had signs of hypovolemia requiring blood transfusion. The diagnosis was confirmed by the contrast medium-enhanced CT and selective angiography, and RAP was found most commonly arising from the segmental branch of renal artery. Superselective microcoil angioembolization was successfully performed in four cases, once in three cases and twice in the remaining case. The procedure failed in one patient and a nephrectomy was done. At a mean follow-up of 21 months (12 -30) , all patients had normal renal function without evidence of recurrence.ConclusionsRAP should be considered in all patients who had delayed hematuria after partial nephrectomy. A central, deep tumor and its relationship to the segmental branch of renal artery could be an important risk factor for this complication. Choosing the case properly for partial nephrectomy and suturing the transected vessels and the defect of parenchymal correctly could reduce occurrence of this serious complication. Early use of selective angioembolization could be a primary choice of treatment.

Objective To discuss the etiology and management of hemorrhage after partial nephrectomy because of renal cancer. Methods Of the 382 cases performed partial nephrectomy during a 10-year period, 5 patients(1.3%) had postoperative hemorrhage because of a renal artery pseudoaneurysm. The ages of these patients were from 42 to 63 years. All the tumors were malignant with an average diameter of 2. 8 cm. The renal pedicle was blocked in 2 cases with tumor size larger than 3 cm. The kidney was reconstructed with interrupted 0 chromic sutures in "8"or "U" style. Delayed postoperative hemorrhage occurred from 6 days to 3 months. The blood loss was from 1000 to 4500mi. Shock or lower blood pressure occurred in 3 patients. Nephrectomy was performed in 1 patient and selective angiographic embolization was performed in other 4 cases. Results Angiography revealed renal artery pseudoaneurysm in all 5 cases at the third (4 cases) or fourth branch(1 patient).Percutaneous embolization was successful in 4 patients. Four cases were followed up for 2 to 9 years without complication. Conclusions Delayed postoperative hemorrhage following partial nephrectomy is an uncommon but potentially life-threatening complication. Super-selective angiographic embolization could be the first choice of treatment.