Objective To investigate the clinlic therapeutic result of detenial sigmoid neobladder after radical cystectomy. Methods 50 patients with bladder cancer (41 males and 9 females;age range from 35 to 82 years) were admitted and underwent radical cystectomy and detenial sigmoid neobladder. Results All the 50 patients were followed up for a mean of 18.6 months(range from 6 to 29 months).The blood Cr and BUN levels were both in the normal range without acidosis in all the cases.Only 2 had unilateral ureteral urine reflux during cystography.Of the 50 patients 45 cases(90%) achieved continence during daytime;10 cases(20%) were incontinent at night,but 8 of the 10 cases could control urination by being woken up at night.The capacity of the neobladder was 220 to 550 ml with a mean of 350 ml and the maximal pressure of the neobladder during filling was 15 to 55 cmH 2O(1 cmH 2O=0.098 kPa) with a mean of 35 cmH 2O. Conclusions As a simple operation the detenial sigmoid neobladder can be performed easily with less complications and more reliable results.This operation may be generally applied in clinical practice.

BACKGROUND: At present, there is little related report about producing a whole-kidney acellular matrix (ACM) scaffold in rats using perfusion. The cellular biocompatibility of the ACM is poorly understood. OBJECTIVE: To produce a whole-kidney ACM scaffold in rats by perfusion, to evaluate the cytocompatibility of ACM with the L929 cells in vitro, and to assess the possibility of ACM as the cytoskeleton and tissue-engineered urinary organ construction. DESIGN, TIME AND SETTING: An in vitro observation was performed at the Central Laboratory of Zhujiang Hospital, Southern Medical University from February to May 2009. MATERIALS: Kidneys were obtained from 12-week-old Whista rats, while ureter, renal veins and renal artery were reserved. Intravenous catheters were inserted through renal arteries to establish channels for perfusion. Whole-kidney retrograde perfusion was performed with successively heparinized PBS, 1% SDS, deionized water, 1% TritonX-100 and antibiotic-containing PBS under a pressure of 9.81 kPa to prepare whole-kindney acellular matrix scaffolds. METHODS: ① Samples were randomly divided into blank group (without any cells), negative control group (culture media), experimental group (rat kidney ACM leaching liquor), and positive control group (culture media containing 0.64% phenol). L929 cells in the logarithmic phase were seeded in 96-well plates at the density of 4×10~3/well, with 5 wells in each group. At 24, 72, and 120 hours after incubation, cells were stained with MTT method to detect absorbance at 490 nm and calculate relative growth rate. ② Control group (culture medium), experimental group (rat kidney ACM leaching liquor), and positive control group (culture media containing 0.64% phenol) were set up to detect cell apoptosis at 48 hours after culture using flow cytometry. MAIN OUTCOME MEASURES: Microstructure of the scaffold, cytotoxicity and cell apoptotic rate. RESULTS: After SDS and TritonX-100 union processing, reticulate structures made of basilar membrane and collagen were shown under scanning electron microscope rather than normal structures of cells. At every time intervals (24, 72, and 120 hours), there was no significant difference in the absorbance between experimental group and negative control group (P > 0.05). The grade of the cytotoxicity of the ACM was .0-1. There was no significant difference in cell apoptotic rate between experimental group and negative control group (P > 0.05). CONCLUSION: The whole-kidney acellular matrix scaffolds in rat by perfusion have good biocompatibility.

Objective To present our initial experience of pure laparoendoscopic single-site surgery (LESS) for radical cystectomy and bilateral pelvic lymph node dissections. Methods 10 patients with pathology confined bladder urothelial carcinoma underwent laparoendoscopic single-site radical cystectomy, including 9 males and 1 female. After a 3-4 cm lower median abdominal incision was made, quadport or homemade single multichannel port was inserted, and conventional and prebent laparoscopic instruments were utilized. The surgical procedure included bilateral pelvic lymphadenectomies, radical cystectomy and building with a sigmoid orthotopic neobladder by open surgery.Results No extra port needed, neither conversion to open or conventional laparoscopic surgery. The time of LESS procedure ranged from 130 to 330 min (mean 243 nin). Estimated blood loss ranged from 50 to 600 ml (mean 270 ml). 5 patients needed blood transfusion of 2 to 4 units. The pathologic evaluation revealed bladder urothelial carcinoma, negative margins and negative pelvic lymph node involvement. No mortality or severe complications were observed perioperatively. After followup of more than 6 months, all revealed controllable urination at daytime, while 4 revealed nocturnal incontinence and needed one or two pads during nighttime. No evidence of recurrent or metastatic disease was detected. Conclusions LESS radical cystectomy and bilateral lymphadenectomies was safe and feasible, and short-term follow-up showed good tumor control outcomes. Homemade single multichannel port made of two elastic ring and glove was simple and effective.

Objective To discuss the feasibility of percutaneous nephrolithotomy (PCNL) for treating upper urinary calculi under local anesthesia.Methods One thousand three hundred and sixty-three patients who suffered with upper urinary calculi were treated with PCNL, the puncture and tracts were created using local anesthesia and guided through ultrasound.Of the 1363 patients, 475 patients had complicated renal caluli, 520 patients had kidney pelvic calculi and 368 had upper uretere calculi.Results All of the patients successfully received PCNL under the local anesthesia.Of the 1363 patients five tracts were used in two patients, four tracts were used in four patients, three tracts were used in nine patients, double tracts were used in 25 patents and one tract was used in the remaining patients.The stone-free rate was 96.0% in the kidney pelvic calculi patients, 100.0% in the upper uretere calculi patients, and 90.1% in the complicated renal caluli patients.90.0% patients were find well throught the operation, 10.0% patients find a little pain and solved by another more 5 - 10 ml lidocaine local injection or 50 - 75 mg pethidine hydrochloride intramuscular injection.No case stop operation because of pain or position changed.All without any severe complications such as damaged of liver, spleen, thorax and intestine.Conclusion The PCNL handled under local anesthesia was simple safe and effective, deserved clinical popularizing use.

Objective To explore the inhibitory effect of tetramethylpyrazine (TMP) on ultraviolet A-induced senescence as well as matrix metalloproteinase-1 (MMP-1) and-3 (MMP-3) mRNA expressions in human dermal fibroblasts (HDFs).Methods HDFs were isolated from the prepuce by enzymatic digestion, and subjected to primary culture.Cultured HDFs were randomly divided into several groups: control group cultured in high-glucose DMEM medium and receiving no treatment, three TMP groups treated with 20, 50 and 100 mg/L TMP respectively, UVA group receiving UVA radiation alone, UVA + TMP groups pretreated with 20, 50 and 100 mg/L TMP respectively for different durations followed by UVA radiation.UVA radiation was given once daily for 5 consecutive days.The 55th passage HDFs served as the P55 group (senescence control group).Subsequently, CCK-8 assay was performed to evaluate the proliferative activity of HDFs in vitro, optical microscopy to observe the morphologic changes of HDFs after UVA radiation, β-galactosidase staining to estimate the senescence in HDFs, and real-time fluorescence-based quantitative PCR to quantify the mRNA expressions of MMP-1 and MMP-3 in HDFs.Statistical analysis was carried out by one-way analysis of variance (ANOVA) followed by least significant difference (LSD)-t test or Dunnett's T3 test.Results Compared with the control group, the proliferation of HDFs was significantly but transiently inhibited in vitro after the treatment with 100 mg/L TMP for 48 hours (P ＜ 0.05), but showed no significant changes after the treatment with 20 or 50 mg/L TMP for 24, 48 or 72 hours or after the treatment with 100 mg/L TMP for 24 or 72 hours (all P ＜ 0.05).The pretreatments with TMP of 20, 50 and 100 mg/L for 24, 48 and 72 hours all promoted the proliferation of HDFs to a certain degree in the UVA + TMP groups compared with the UVA group, with significant differences in cellular proliferative activity among the UVA group, UVA + TMP groups and control group at 24, 48 and 72 hours (F =17.451,15.231, 23.535, all P ＜ 0.01).Compared with the UVA group, the proliferative activity of HDFs was significantly increased in UVA + 100-mg/L TMP group at 24, 48, 72 hours, UVA + 50-mg/L TMP group at 24 and 72 hours and UVA + 20-mg/L TMP group at 72 hours.After repetitive UVA radiation, HDFs in the UVA group experienced an increase in cell volume, granule acount, and β-galactosidase expression, which was similar to the changes in the P55 group, while the pretreatments with 20, 50 and 100 mg/L TMP for 24 hours suppressed these UVA-induced changes in HDFs.The percentage of β-galactosidase-positive HDFs was 68.417％ ± 1.181％ in the UVA group, 58.167％ ± 5.620％ in the UVA + 20-mg/L TMP group, 45.167％ ± 5.502％ in the UVA + 50-mg/L TMP group, 43.000％ ± 2.000％ in the UVA + 100-mg/L TMP group, 33.667％ ± 5.865％ in the control group, and 76.000％ ± 6.557％ in the P55 group, with significant differences among these groups (F =45.918, P ＜ 0.01).Furthermore, the UVA group significantly differed from the UVA + TMP groups and control group in the percentage of β-galactosidase-positive HDFs and mRNA expressions of MMP-1 and MMP-3 (all P ＜ 0.05).Conclusion TMP can protect HDFs against senescence induced by repetitive UVA radiation, and down-regulate the mRNA expressions of MMP-1 and MMP-3 during senescence.

OBJECTIVETo summarize our initial experience with laparoendoscopic single-site (LESS) retroperitoneal lymph node dissection (RPLND) for treatment of nonseminomatous testicular cancer.

METHODSFrom September 2010 to June 2011, 3 patients (aged 19-27 years) with right testicle enlargement and elevated alpha-fetoprotein level underwent right radical orchidectomy. Histopathological analysis revealed nonseminomatous germ cell tumor. LESS-RPLND was performed 3 weeks after orchiectomy. The homemade port was inserted through a 3-cm right pararectal incision in the right lower quadrant for unilateral RPLND using nerve-sparing technique and modified right-sided template removal similar to those in open RPLND.

RESULTSThe operation was successfully performed with a mean operative time of 240 min and a mean estimated blood loss of 50 ml. No conversion to open or conventional laparoscopic surgery was required. No major perioperative complications were observed. For the first case, the number of lymph nodes obtained for final histopathological examination was 11, and two positive nodes were detected. For the other 2 cases, no positive nodes were detected. Chemotherapy was administered in the first case. Alpha-fetoprotein level decreased close to the baseline one week postoperatively and no relapse occurred in these cases 3 month after RPLND. Follow-up at 1 year after the surgery showed good tumor control and preservation of the sexual function.

CONCLUSIONLESS-RPLND is safe and feasible for treatment of nonseminomatous testicular cancer, and the pararectal incision provides an ideal surgical approach with good cosmetic result, but the long-term effect needs to be tested by further large population-based study.

Adult ; Follow-Up Studies ; Humans ; Laparoscopy ; methods ; Lymph Node Excision ; methods ; Male ; Neoplasms, Germ Cell and Embryonal ; surgery ; Orchiectomy ; Retroperitoneal Space ; surgery ; Testicular Neoplasms ; surgery ; Young Adult

Objective To explore the effects of transitional nursing on the quality of life in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 118 patients in the stable phase of COPD, who were discharged from the Affiliated Hospital of Xuzhou Medical University during March 2015 to June 2016 were selected by convenience sampling method and divided into observation group (n=60) and control group (n=58) according to the random number table. The patients in the control group were treated with routine nursing mode, while the patients in the observation group were given transitional care after discharged on the basis of routine nursing. The effects of the transitional care and patients' quality of life were evaluated with Care Transitions Measure (CTM) and Chronic Obstructive Pulmonary Disease Assessment Test (CAT) at three time points, before intervention, three and six months after the intervention. Results There was no statistical difference in the score of CTM between the two groups before intervention (P>0.05). After intervention for 3 and 6 months, the CTM score of the observation group patients were significantly higher than that of the control group, and the differences were statistically significant (P<0.05). Before intervention and 3 months after intervention, patients' CAT score had no statistical difference between the two groups (P> 0.05). The CAT score of the patients in the observation group was lower than that in the control group after intervention for 6 months, and the difference was statistically significant (P<0.05). Conclusions Transitional nursing mode can improve the cognition of patients in COPD stable phase, promote healthy lifestyle and behavior, and improve patients' quality of life.

Background: Aberrant Bcl-2 transcription is closely related with nodal diffuse large B-cell lymphoma (DLBCL), however, the relationship between Bcl-2 and primary gastrointestinal DLBCL (PGI-DLBCL) was not fully studied.Aims: To investigate the relationship between Bcl-2 gene amplification and protein expression and clinicopathological characteristics, immunophenotype and prognosis of PGI-DLBCL.Methods: Clinical data was collected from 136 PGI-DLBCL patients receiving surgical treatment, and a telephone interview was conducted for survival information.Bcl-2 gene amplification and protein expression in tumor tissue were determined by fluorescence in situ hybridization and immuno-histochemistry, respectively, and relationships between Bcl-2 and clinicopathological characteristics, immunophenotype and prognosis of PGI-DLBCL were analyzed.Results: Among 136 PGI-DLBCL patients, 33 (24.3%) showing gene amplification and 90 (66.2%) showing protein expression of Bcl-2;gene amplification was correlated with primary tumor location, Ann Arbor stage, serum lactate dehydrogenase level, B symptom and International Prognostic Index (IPI) score (P<0.05), while protein expression was correlated with primary tumor location and immunophenotype (P<0.05).5-year overall survival (OS) in patients positive for Bcl-2 gene amplification and patients with non-GCB immunophenotype and positive for Bcl-2 protein expression were inferior to those negative ones (41.5%vs.71.5%, P<0.05;54.6% vs.84.6%, P<0.05).In Bcl-2 gene amplification or protein expression positive patients, 5-year OS of CHOP chemotherapy was inferior to that of rituximab combined with CHOP chemotherapy (48.6%vs.80.3%, P<0.05;66.4%vs.83.4%, P<0.05).Conclusions: Detection of Bcl-2 gene amplification is useful for prediction of prognosis in PGI-DLBCL.Both patients with Bcl-2 gene amplification and non-GCB patients with Bcl-2 protein expression have a poorer prognosis.Rituximab may improve the prognosis in patients with Bcl-2 gene amplification or protein expression.

Objective To summarize and evaluate the clinical effect of extraco-rporeal membrane oxygenation(ECMO) support for critically ill patients after heart surgery,and to explore the factors that influenced the prognosis of ECMO.Methods The clinical data of 67 patients undergoing ECMO admitted to the Second Hospital of Jilin University from August 2013 to July 2017 were retrospectively analyzed.The patient's age ranged from 22 months to 78 years,including 3 infants aged 22,24,30 months and 64 adults ranged from 32 to 78 years,the mean age was(56.52 ± 10.99) years.Results The average ECMO support time was (235.79 ± 123.87) h,the mean mechanical ventilation time was (166.11 ± 148.31) h.49 patients weaned off successfully from ECMO,38 of them were discharged and 11 died within 28 days.18 patients gaved up treatment.42 patients suffered the complications.Conclusion VA-ECMO is a significant supportive method for preoperative intensive care in patients undergoing cardiovascular surgery.The keys to optimal results are grasping the indications of ECMO,earlier stopping mechanical ventilation,cluster curing(which involves reasonable anticoagulation,protection of organ function,prevention of hemorrhage,infection and limb distal ischemia).

OBJECTIVETo construct three-dimensional (3D) models of renal stones and perform percutaneous nephrolithotomy (PCNL) virtual surgery simulation. Methods CT images were obtained from 8 patients with renal stones. Images segmentation and reconstruction were performed using MIMICS 10.0 software to construct the 3D model of the renal stones, which provided the anatomical relationships between the kidney and the adjacent organs. The optimal PCNL virtual surgery simulation for each individual case was performed using FreeForm Modeling System on the basis of the 3D model.

RESULTSEight 3D models of renal stone were constructed. The 3D model of the renal stones represented the interrelationships of the stones, intrarenal vessel, and the collecting system with the adjacent anatomical structures. Individualized PCNL virtual surgery simulations including percutaneous puncture, dilatation and pneumatic lithotripsy were performed successfully in all the 8 3D models.

CONCLUSIONDigital 3D model of renal stone provides the reliable and comprehensive imaging information for surgical design, and PCNL virtual surgery simulation has important clinical significance to improve the stone clearance rate and reduce the surgical complications.

Adult ; Female ; Humans ; Imaging, Three-Dimensional ; Kidney Calculi ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Nephrostomy, Percutaneous ; methods ; Software ; Tomography, Spiral Computed ; User-Computer Interface