Objective To evaluate the efficacy of self-retaining suture (QuillTM SRS) in retroperitoneal laparoscopic partial nephrectomy for complicated renal tumor by assessing perioperative parameters.Methods Between 2010 and 2012,78 cases of complicated renal tumor (R.E.N.A.L score ≥ 7) treated by retroperitoneal laparoscopic partial nephrectomy (LPN) with two layers continuous knotless barbed suture (QuillTM SRS group) (n=30) or traditional absorbable vicyl suture (non-SRS group) (n=48) were retrospectively analyzed.In QuillTM SRS group,2-0 Quill SRS was used to suture the deep wound bed,and the second outcr layer renorrhaphy was performed with a 1-0 Quill SRS by the same way.In non-SRS group,the inner layer was sutured using a 15cm in length 2-0 monicryl suture by the same method mentioned above.A second outer layer was sutured with 1-0 vicryl suture across the wound.Cases were matched for R.E.N.A.L score.Comparison was made in term of operation time,preoperative parameter and perioperative complications between SRS group and non-SRS group.Results Renorrhaphy was successfully performed in all cases except 1 case converting to open surgery in non-SRS group.Mean warm ischemia time in SRS group was shorter than non-SRS group (18 vs 25 min,P =0.021).The proportion of bleeding requiring intervention in the non-SRS group (7/48,14.5％) was 4.3-fold higher than that of the SRS group (1/30,3.3％),but the differernce is not significant (P＞0.05).There were no significant differences between two groups in postoperative creatinine changes.Limitations of this study include the absence of randomization and the relative small sample size.Conclusions SRS can be safely used for complicated renal tumor during LPN,and SRS can significantly reduce the WIT and may also reduce bleeding during the operation.

Objective To investigate the diagnosis and treatment of active adrenal tuberculosis.Method The clinical data of 1 patients with adrenal tuberculosis was retrospectively analyzed and the related literatures were reviewed.The male patient,54 years old,complained abuot the dry cough and intermittent fever for 9 months.He was found the left adrenal gland tumor for 1 weeks and admitted to our hospital on November 1st,2016.The physical examination showed the obvious left kidney percussion tellderness.The local hospital,considered the left adrenal tumor.The pathological diagnosis of left adrenal tumor by biopsy was chronic inflammation.The patient accepted anti-inflammatory therapy,but his symptom was not relieved.In our hospital,blood bacterial culture and urine bacterial culture and PPD was negative.Blood tuberculosis antibody was positive.Triple acid-fast bacilli were negative in urine.Chest CT did not exclude the interstitial pulmonary tuberculosis.Adrenal contrast-enhanced CT showed mild enhancement,strip calcification shadow.Primary diagnosis was left adrenal tumor,which the abscess and tuberculosis could not to be excluded.Then,the patient accepted regularly anti-tuberculosis therapy (Isoniazid,0.3 g/d,rifampicin,0.45 g/d,ethambutol,0.6 g/d).Mter 3 days,his temperature returned to normal.Since the left adrenal mass was too large,which was about 6.8 cm × 5.5 cm,to distinguish with the tumor,the patient accepted successfully retroperitoneal adrenal tumor resection two weeks later.The left adrenal tumor surface was greyish and yellow,which was adherent with spleen and pancreas.After carefully separating,the tumor was successfully removed.Result The operation was successful,which last 85 min.Intraoperative blood loss was about 50 ml.Pathological report showed adrenal tuberculosis.The patients accepted regularly antituberculosis therapy(Isoniazid,0.3 g/d,rifampicin,0.45 g/d,ethambutol,0.6 g/d) for half a year,and followed up for 1 year after operation.No further hormone replacement therapy was used.No fever was noticed and his rhythm cortisol level was normal.Conclusions Adrenal mass associated with recurrent fever,should be suspected as adrenal tuberculosis if antibiotic therapy is not effective.If the adrenal CT showed adrenal calcification associated with the ectepic tuberculosis,patient should be diagnosised active adrenal tuberculosis.They should accept anti-tuberculosis treatment.However,if the volume of tuberculosis is large,or not to exclude tumor possibility,we recommend to proceed adrenal tumor resection for diagnosis.

Objective To investigate the expressions of metallothionein-2A (MT-2A), E-cadherin, interleukin-6 (IL-6), cyclin E, proliferating cell nuclear antigen (PCNA) and bcl-2 in prostate cancer tissues and their correlation with biochemical recurrence of prostate cancer. Methods Tissue specimens from 128 cases of prostate cancer who underwent radical prostatectomy in Shanxi Dayi Hospital from October 2012 to October 2017 were processed and transferred into tissue microarrays, the clinicopathological parameters of patients were also recorded. The expression levels of MT-2A, E-cadherin, IL-6, cyclin E, PCNA and bcl-2 were detected by immunohistochemical avidin-biotin complex (ABC) staining. The correlation between different molecular markers and biochemical recurrence of prostate cancer was analyzed. Results The biochemical recurrence rate of 128 patients with prostate cancer was 30.5％ (39/128). The biochemical recurrence rates of low-risk, intermediate-risk and high-risk prostate cancer patients were 14.8％(8/54), 38.7％(24/62) and 58.3％ (7/12), respectively. The risk classification and pathological T stage of patients with prostate cancer were associated with the expressions of MT-2A, cyclin E, IL-6 and E-cadherin (all P< 0.05). Multivariate Cox risk model showed that the high risk classification (HR= 1.81, 95％CI 1.56-2.19, P=0.042), MT-2A positive expression (HR= 2.01, 95％CI 1.08-3.15, P= 0.005), cyclin E positive expression (HR= 1.79, 95％CI 1.08-2.21, P= 0.042) and E-cadherin negative expression (HR= 1.92, 95％ CI 1.22-2.45, P= 0.020) were the independent risk factors for biochemical recurrence of prostate cancer. Conclusion The expression of MT-2A, cyclin E and E-cadherin may serve as independent predictors for biochemical recurrence of prostate cancer.

Objective To analysis the clinical features,diagnosis,treatment and prognosis of adrenal eosinophilic tumor with low testosterone levels.Methods The clinical data of a 22 years old male patient with adrenal eosinophilic tumor and low testosterone levels was analyzed.Blood pressure was 151/88 mmHg.The patient got bilateral gynecomastia.His bilateral testicular was soft and became smaller,with short penisr.Endocrine examination results showed:Estradiol 666 pg/ml,Prolactin 19.08 ng/ml,Testosterone 0.18 ng/ml,follicle stimulating hormone ＜ 0.2 U/L.The CT showed the mass density of soft tissue in the left adrenal region with diameter 7 cm,which was inhomogeneous and enhanced.There were many small vessels enhanced in the CT arterial phase,and the blood flow in the tumor was abundant.Clinical diagnosis of left adrenal tumor was pheochromocytoma.The patient underwent laparoscopic left adrenal tumor resection.The left adrenal gland was located in the superior pole of the left kidney,and there was an independent supply of the artery.Results Pathological result showed the tumor weigh was 60 g,7 cm in diameter and brown in section.The tumor cells were arranged in solid nests or acini,with more eosinophilic granules in cytoplasm.The nuclei was round and the nucleoli was located in the center,had clusters of pleomorphic and clustered cells.The tumor was wrapped in a thick fibrous envelope,mainly consisted of eosinophils,granulation tissue.There was no necrosis,mitosis,and vascular invasion.Immunohistochemical staining showed that the expression of CD56 and syn protein was positive.Pathological diagnosis was left adrenal eosinophilic tumor.After 4 months,the blood testosterone levels rose to 3.90 ng/ml,the blood pressure returned to normal (118/75 mmhg).The estradiol (21 pg/ml) was significantly inhibited.The patient began to appear beards and breasts became smaller.There were no signs of clinical or imaging recurrence.After 16 months follow-up,serum testosterone was 4.68 ng/ml and serum estrogen levels dropped to 33 pg/ml.Semen routine showed no sperm.Conclusions The clinical morbidity of functional adrenocortical oncocytoma with low testosterone levels and high estradiol levels is low.The pathological components are mainly eosinophilic granulation tissue.The adrenocortical oncocytoma are rare and preoperative diagnosis is difficult.Clinical manifestation,imaging examination and adrenal biochemistry examination should be considered to determine the localization and qualitative of tumor.Minimally invasive surgery is an effective treatment.The close follow-up after operation is essential.

Objective:To explore the influencing factors of postoperative chronic kidney disease (CKI) in patients with primary aldosteronism (PA).Methods:The clinical data of 103 patients who underwent adrenalectomy for PA in our center from August 2018 to August 2019 were analyzed retrospectively. There were 53 males and 50 females, aged (47.02±10.06) years old, including 27 diabetes patients (26.2%). The body mass index (BMI) were (24.47±3.24) kg/m 2, tumor maximum diameter were (15.61±5.66) mm, preoperative systolic blood pressure were (166.93±12.22) mmHg(1 mmHg=0.133 kPa), preoperative blood potassium were (3.35 ± 0.48) mmol/L, plasma aldosterone concentration (PAC) were (55.75±8.56)ng/dl, aldosterone-renin ratio(ARR) were (165.13±38.21) and preoperative glomerular filtration rate (GFR) were (77.96±14.77) ml/(min·1.73m 2). All patients underwent laparoscopic adrenalectomy. The operation time and bleeding volume were recorded. The GFR, blood potassium, PAC and ARR were recorded at the third month after surgery. The paired sample t test was used to compare GFR before and after surgery. Pearson correlation analysis was used to evaluate the correlation between the parameters and GFR after surgery. The independent predictors of GFR≤60ml/(min·1.73 m 2) were analyzed by univariate and multivariate logistic regression. Results:The surgery time were (85.37±21.66) min, and the bleeding volume were (10.54±4.84) ml. GFR (62.66±8.53) ml/(min·1.73 m 2) at 3 months after surgery was significantly different from that before surgery ( P<0.01). Univariate analysis showed that age ( OR=1.36, P<0.01), preoperative GFR ( OR=0.81, P<0.01), preoperative blood potassium ( OR=2.95, P=0.02), preoperative PAC ( OR=1.28, P<0.01) and preoperative ARR ( OR=1.08, P<0.01) were significantly correlated with postoperative CKI. In Pearson analysis, older age ( r=-0.51, P<0.01), lower preoperative GFR ( r=0.62, P<0.01), lower preoperative blood potassium( r=0.41, P=0.02), higher preoperative PAC ( r=-0.49, P<0.01) and higher preoperative ARR ( r=-0.56, P<0.01) increased the risk of CKI. Multivariate logistic regression analysis showed that age ( OR=1.26, P=0.05), preoperative GFR ( OR=0.79, P=0.02) and preoperative PAC( OR=1.29, P=0.01) were independent risk factors for postoperative CKI. Conclusions:CKI may occur in PA patients after adrenalectomy. PA patients with older age, higher preoperative PAC, higher preoperative ARR, lower preoperative blood potassium and lower preoperative GFR are more likely to have CKI. Age, preoperative GFR and preoperative PAC were independent predictors of CKI.

Objective:To examine the safety and complications of two methods of establishing retroperitoneal cavity in urology.Methods:Totally 83 patients undergoing retroperitoneal laparoscopic surgery in Department of Urology, Shanxi Bethune Hospital from January 2020 to June 2021 were analyzed retrospectively. There were 47 males and 36 females, aged (48.3±11.3) years (range: 35 to 71 years). Forty-three cases in Hasson group(the first Trocar channel was selected at the junction of the 12 th rib and the posterior axillary line or lumbar triangle), 40 cases in modified Hasson group(the first Trocar channel is selected at 1.5 cm above the iliac crest on the mid-axillary line). The t test, χ2 test, and Fisher exact test were used to compare the surgical safety indicators and complications of the two groups of patients. Results:There was no statistical difference between the two groups in gender, age, body mass index, waist length, and height ( P>0.05). The comparison of safety indicators, included the time from skin incision to establishment of the retroperitoneal cavity and the amount of bleeding from the cavity were statistical difference between the two groups ( P<0.05). Compared to that in Hasson group, the time from skin incision to establishment of the abdominal cavity in modified Hasson group was shorter ((8.56±2.64) minutes vs. (5.32±1.36) minutes, t=6.949, P<0.01), the blood loss of establishment was less ((15.32±6.09) ml vs. (9.85±3.55) ml, t=4.951, P<0.01). In terms of complication indicators, the incidence of Trocar hernia and the number of subcutaneous emphysema in modified Hasson group were lower than that in Hasson group (20.9% (9/43) vs. 2.5% (1/40), P=0.015, 18.6% (8/43) vs. 2.5% (1/40), P=0.030). Conclusions:The modified Hasson group is a safe method of establishing retroperitoneal cavity. The technique is simple and fast. It provides urologists with a more effective and easy-to-implement option with fewer complications.

Objective:To examine the safety and complications of two methods of establishing retroperitoneal cavity in urology.Methods:Totally 83 patients undergoing retroperitoneal laparoscopic surgery in Department of Urology, Shanxi Bethune Hospital from January 2020 to June 2021 were analyzed retrospectively. There were 47 males and 36 females, aged (48.3±11.3) years (range: 35 to 71 years). Forty-three cases in Hasson group(the first Trocar channel was selected at the junction of the 12 th rib and the posterior axillary line or lumbar triangle), 40 cases in modified Hasson group(the first Trocar channel is selected at 1.5 cm above the iliac crest on the mid-axillary line). The t test, χ2 test, and Fisher exact test were used to compare the surgical safety indicators and complications of the two groups of patients. Results:There was no statistical difference between the two groups in gender, age, body mass index, waist length, and height ( P>0.05). The comparison of safety indicators, included the time from skin incision to establishment of the retroperitoneal cavity and the amount of bleeding from the cavity were statistical difference between the two groups ( P<0.05). Compared to that in Hasson group, the time from skin incision to establishment of the abdominal cavity in modified Hasson group was shorter ((8.56±2.64) minutes vs. (5.32±1.36) minutes, t=6.949, P<0.01), the blood loss of establishment was less ((15.32±6.09) ml vs. (9.85±3.55) ml, t=4.951, P<0.01). In terms of complication indicators, the incidence of Trocar hernia and the number of subcutaneous emphysema in modified Hasson group were lower than that in Hasson group (20.9% (9/43) vs. 2.5% (1/40), P=0.015, 18.6% (8/43) vs. 2.5% (1/40), P=0.030). Conclusions:The modified Hasson group is a safe method of establishing retroperitoneal cavity. The technique is simple and fast. It provides urologists with a more effective and easy-to-implement option with fewer complications.

Adrenocortical carcinoma (ACC) is a rare and highly aggressive endocrine malignancy. This paper provides a review of the pathways involved in the development of ACC and the progress of targeted drug therapy. The pathways reviewed include Wnt/β-catenin, P53, epithelial-mesenchymal transition(EMT), insulin growth factor(IGF) and fibroblast growth factor(FGF) signalling pathways.

Objective:To explore the safety and feasibility of adrenal tumor resection under day surgery mode for the treatment of unilateral primary aldosteronism (UPA).Methods:The clinical data of 83 patients who underwent adrenalectomy for the treatment of UPA from January 2020 to January 2023 were retrospectively analyzed. There were 42 males (50.6%)and 41 females (49.4%), age (49.0±12.3)years old. Body mass index (25.4±3.6)kg/m 2. There were 17 patients with diabetes, 58 patients with preoperative hypertension, and the duration of hypertension was 8.2(1, 15)years. Systolic blood pressure was 151.8(137.0, 160.0)mmHg (1 mmHg=0.133 kPa), and diastolic blood pressure was 97.4(87.0, 107.0)mmHg. 20 cases had severe preoperative hypokalemia, with preoperative blood potassium levels of (2.9±0.6)mmol/L. The ratio of preoperative plasma aldosterone to renin activity was 54.1(13.0, 77.2). Tumors were located on the left side in 47 cases (56.6%)and on the right side in 36 cases (43.4%). The maximum diameter of the tumor is 1.5(1.0, 1.7)cm. Patients diagnosed with unilateral primary aldosteronism were included, and patients diagnosed with adrenal pheochromocytoma, adrenal malignancy, or severe cardiovascular disease that cannot tolerate surgery were excluded. The patient was admitted to the hospital on the same day, underwent surgery on the same day, and was evaluated after extubation within one day after surgery. The patient had no fever or lower back pain after surgery, was able to freely get out of bed, and had no obvious abnormalities in blood routine, electrolyte and other test indicators. The patient was discharged from the hospital and received continuous care outside the hospital. The patient was guided to undergo regular outpatient follow-up. Evaluate the efficacy using the Primary Aldosterone Hyperaldosteronism Surgical Outcome (PASO)criteria. Results:The patients had a mean length of hospital stay of 43.0(40.3, 44.6)hours, an operation time of 89.6(70.0, 103.0)minutes, and an operation cost of 23 820.2 (21 150.8, 24 948. 3)yuan. The postoperative free position time was 29.5(20.8, 39.7)hours, the postoperative time for fluid placement of the diet was 25.2(20.1, 27.8) hours, and 42.2(37.9, 41.9)hours of postoperative drain removal. The overall postoperative clinical remission rate was 85.5%. There were four postoperative complications, accounting for 4.8% of cases. These included two cases of interosseous vein thrombosis, one case of delayed healing, and one case of peritoneal rupture. No case of readmission was reported within 30 days.Conclusions:UPA adrenal tumour resection in ambulatory mode is safe and effective when strict inclusion and exclusion criteria are followed, adequate preoperative preparation is carried out, and expert physician assessment is provided.