Objective To summarize the clinical experience of retroperitoneal and transperitoneal laparoscopic adrenalectomy for adrenal tumors.Methods Laparoscopic adrenalectomy was carried out in 56 cases of adrenal tumors via transperitoneal(10 cases) or retroperitoneal(46 cases) approaches.For transperitoneal laparoscopic adrenalectomy,the operation was performed through 3 abdominal trocars.After the peritoneum and the Gerota's fascia were opened,the adrenal gland or tumor were disconnected near the upper polar of the kidney.Then the tumor was removed by using the LigaSure system and a harmonic scalpel.For retroperitoneal laparoscopic adrenalectomy,a self-made balloon was used to dilate the retroperitoneal space.Then the Gerota's fascia was opened and the tumor was removed by using the LigaSure system and a harmonic scalpel. Results Of the 10 cases of transperitoneal adrenalectomy,conversions to open surgery were required in 3 cases because of extensive abdominal adhesion;of the 46 cases of retroperitoneal adrenalectomy,a conversion to open surgery was needed in 1 case because of massive hemorrhage of the inferior vena cava.Of the remaining 52 cases,the intraoperative blood loss was 20~200 ml(mean,70 ml) and no blood transfusion was needed.The operation time was 40~200 min(mean,110 min).The postoperative hospital stay was 3~8 d (mean,5.4 d).Follow-up for(6~36) months(mean,8 months) in 52 cases showed no tumor recurrence and metastasis.Conclusions Laparoscopic adrenalectomy has advantages of reliable effects,minimal invasion,rapid recovery,and short hospital stay.This procedure can be used as the first choice for the treatment of adrenal tumors.

Objective To explore the factors imfluencing the prognosis of patients with renal cell carcinoma after laparoscopic partial nephrectomy.Methods Clinical data from 593 renal cell carcinoma patients underwent laparoscopic partial nephrectomy in our institution from December 2010 to December 2015 were retrospectively collected..Tbere were 396 males and 197 females,aged 35 to 72 years old(mean 55.4 years).There were 181 cases of smoking history,206 cases of hypertension and 105 cases of diabetes.Before operation,98 cases of liver function were damaged and 122 cases were anemia.There were 521 cases with PLT ＜ 450 × 109/L,72 cases PLT≥ 450 × 109/L.Thc tumor of 292 cases on the left and 301 cases on the right.The Kaplan-Meier method log-rank test was used for survival analysis.Univariate analysis and factors which were significantly associated with survival in the univariate analysis were conducted into the multivariate analysis with Cox proportional hazards model.Results The operative time was 88.0-120.6 min,mean 104.3 min,the blood loss during operation was 47.2-157.8 ml,mean 102.5 ml. Pathological tumor stage revealed that 398 cases were T1 and 195 cases were T2 . Fuhrman classification revealed that 29 cases were grade Ⅰ,411 cases were grade Ⅱ,150 cases grade Ⅲ,3 cases grade Ⅳ . The median follow-up time was 36 months(ranged 6 to 99 months) . Five cases (1.3％) in the T1 patients relapsed,recurrencefree survival (RFS) rate was 98.7％;In the T2 patients,7 cases (3.6％) relapsed,1 of them had local recurrence and died of lung metastasis,and the RFS rate was 96.4％.Univariate analysis revealed that T stage,Fuhrman grade,tunor necrosis,tumor pseudocapsule,lymphovascular invasion,collection system violation,anemia,and high platelet were significantly associated with RFS of patients.Multivariate analysis found that T stage (HR =1.524,95 ％ CI 1.326-1.926,P =0.001),Fuhrman grade (HR =1.600,95 ％ CI 1.035-2.364,P =0.022),tumor necrosis (HR =2.315,95％ CI 1.523-3.624,P =0.001) were independent risk factors for the RFS of patients with renal cell carcinoma after retroperitoneal laparoscopic partial nephrectomy.Conclusion High T stage,high Fuhrman grade and tumor necrosis were independent risk factors for the RFS of patients with renal cell carcinoma after retroperitoneal laparoscopic partial nephrectomy.

0.05].The mean follow-up of 45 pat ients is 36(1～76) months.No local tumor recurrence has been noted. C onclusionsNSS can be performed with satisfactory result in RAML,and it is the first choice of surgical treatment.

Objective To compare the clinical outcomes of urethral resectoscopy and retroperitoneal laparoscopic nephroureterectomy with open surgical nephroureterectomy. Methods A total of 44 patients with renal pelvic and ureteral neoplasms were included.Urethral resectoscopy and retroperitoneal laparoscopic nephroureterectomy were performed in 15 cases (Group A) and open surgical nephroureterectomy in 29 cases (Group B).The therapeutic effectiveness,postoperative recovery,relevant cost and complications were compared between Group A and Group B. Results The analysis showed that the intra-operative bleeding volum [(75.1?29.5)ml],the postoperative intesinal function recovery [(24.1?12.6)h],time to ambulation [(24.3?10.5)h],use of antalgesic [(3.0?0.8)d],intravenous antibiotic [(7.2?3.1)d],hospital stay [(6.3?1.2)d],convalescene of normal activities [(28.0?7.8)d] and incidence of complications with Group A were significantly superior to those with Group B(P

A bacterial cell surface display technique based on an ice nucleation protein has been employed for the development of live vaccine against viral infection.Due to its ubiquitous ability to invade host cells,Salmonella typhimurium might be a good candidate for displaying viral antigens.We demonstrated the surface display of domain III of Japanese encephalitis virus E protein and the enhanced green fluorescent protein on S.typhimurium BRD509 using the ice nucleation protein.The effects of the motif in the ice nucleation protein on the effective display of integral protein were also investigated.The results showed that display motifs in the protein can target integral foreign protein on the surface of S.typhimurium BRD509.Moreover,recombinant strains with surface displayed viral proteins retained their invasiveness,suggesting that the recombinant S.typhimurium can be used as live vaccine vector for eliciting complete immunogenicity.The data may yield better understanding of the mechanism by which ice nucleation protein displays foreign proteins in the Salmonella strain.

Objective To investigate the appropriate incision for intact specimen extraction during retroperitoneoscopic radical nephrectomy. Methods One hundred and nineteen patients in need of retroperitoneoscopic radical nephrectomy were randomized into two groups. One group of 60 patients received intact specimen extraction through a muscle-splitting abdominal incision. The second group of 59 patients received intact specimen extraction through a muscle-cutting lumbar incision. All procedures were performed by the same team of surgeons, and the intact specimens were extracted by the same surgeon. Standard operative features were measured and recorded (operative time, the time of specimen extraction, incision length, specimen weight, the time to get out of bed, the recovery time of gastrointestinal function, postoperative hospital stay, analgesia requirement, and complication rate). Results The two groups were matched in regard to patient age, body mass index, the maximum diameter of the kidney, and the stage of TNM (each P>0.05). There were significant differences between the abdominal incision group and lumbar incision group in terms of operative time (99±14 min vs 115±12 min; P=0.000), incision length (4.9±0.3 cm vs 5.3±0.4 cm; P=0.000), the time of specimen extraction (14±2 min vs 24±6 min; P=0.000), analgesia requirement (35±27 mg vs 52±29 mg; P=0.002), the time to get out of bed (20±2 h vs 21±4 h; P=0.016). The differences were not significant between the 2 groups in terms of the recovery time of gastrointestinal function (21±3 h vs 20±4 h; P=0.457), hospital stay (6±1 d vs 6±1 d; P=0.476), and specimen weight (469±181 g vs 459±169 g; P=0.776). There was no complication of incision in the 2 groups at 12 months′ follow-up (rang, 6 to 18 months). Conclusion A muscle-splitting abdominal incision for intact specimen extraction is more appropriate than a lumbar incision during retroperitoneoscopic radical nephrectomy, with small incision, little injury, short operative time, quick recovery, and less pain.

To investigate whether saikosaponin-d (SSd) had estrogen-like effects in mice.

Objective To observe the expression change of HRG-1 gene between urinary bladder carcinoma and normal tissues,and to investigate the effect of HRG-1-siRNA on the proliferation and apoptosis of human bladder carcinoma cells.Methods Immunohistochemisty was used to detect the expression of HRG-1 in 85 cases of bladder carcinomas and 20 normal bladder tissues.The siRNA of HRG-1 was designed,synthesized,and transfected into bladder cancer cell line T24.Results The HRG-1 gene expression had significant differences between bladder carcinoma and normal bladder tissues (P ＜ 0.05).The positive expression of HRG-1 gene had significant differences between the pathological grades and clinical stages of bladder carcinomas (P ＜0.05).After treated with siRNA,the expression levels of HRG-1 protein and mRNA in T24 cells decreased obviously (P ＜ 0.05).The apoptosis rate of T24 cells transfected with HRG-1-siRNA was significantly different from control-siRNA group and blank group (P ＜ 0.01).Conclusions The high expression of HRG-1 gene may play an important role in bladder carcinoma,and siRNA targeting HRG-1 can suppress HRG-1 protein expression markedly and enhance apoptosis of T24 cells.

Objective To explore the expression of a new candidate tumor suppressor N-myc downstream regulated gene 2 (NDRG2) in bladder cancer tissues and to investigate its clinical and pathological significance.Methods Formalin-fixed,paraffin-embedded tissue sections from 62 cases of bladder carcinomas and 10 cases of normal bladder tissues were analyzed retrospectively with immunohistochemistry (S-P method).Results The NDRG2 gene was highly expressed in normal bladder tissues,but low expressed in bladder carcinoma tissues.Positive expression of NDRG2 was detected in 8 of the 10 (80.0％) normal tissues and 40.3％ in bladder carcinoma ones (x2 =3.98,P ＜0.05).Furthermore,with the degree of malignancy increased,the positive expression of NDRG2 in bladder carcinoma samples was decreased.The expression of NDRG2 in bladder carcinoma was negatively correlated(r =-0.288,P ＜0.05) with C-myc(r =-0.436,P ＜0.01) and positively correlated with p53 in bladder carcinoma tissues(r =0.717,P ＜0.01).Conclusions The level of NDRG2 expression was lower in bladder carcinomas than in normal tissues.NDRG2 may play an important role in bladder carcinogenesis and in the progress of bladder cancers.

Objective:To compare the safety of adrenal central vein treated at different times in laparoscopic adrenal pheochromocytoma resection through abdominal approach.Methods:A study was conducted on 43 patients with adrenal pheochromocytoma admitted to Xijing Hospital, Air Force Military Medical University from June 2012 to June 2019. The included patients were divided into two groups according to the surgical method: observation group ( n=22) and control group ( n=21). The patients of observation group were ligated the central advenal vein before the tumor was completely isolated, and the patients of control group were ligated the central advenal vein after the tumor was isolated. The changes of blood catecholamine levels before anesthesia, before central adrenal vein ligation, and after tumor resection were compared between the two groups, as well as the differences in operative time, intraoperative blood loss, hospital stay, number of cases with intraoperative blood pressure fluctuations and frequency. Measurement data were expressed as mean±standard deviation ( Mean± SD), comparison between groups was by t-test; comparison of count data between groups was by Chi-square. Results:There was no significant difference in the mean operation time, the mean hospital stay, intraoperative blood loss, number of cases with dramatic blood pressure fluctuations between two groups ( P>0.05). The frequency of severe fluctuation of intraoperative blood pressure in observation group and control group was 19 times and 47 times, respectively, the difference was statistically significant ( P<0.05). There was no significant difference in the blood epinephrine and norepinephrine levels between the two groups before anesthesia and after tumor resection ( P>0.05). However, before ligation of the central vein, the epinephrine concentrations in the observation group and the control group were (572.1±282.1) pg/mL and (935.6±417.5) pg/mL, respectively, the noradrenaline concentrations were (8 347.9±4 103.6) pg/mL and (13 695.7 ±3 205.3) pg/mL, respectively, the difference was statistically significant ( P<0.05). Conclusion:Early ligation of the adrenal central vein can improve the safety of the laparoscopic approach to adrenal pheochromocytoma.