OBJECTIVE: To compare the efficacy and safety of complete transperitoneal laparoscopic nephroureterectomy (CTNU) and traditional retroperitoneoscopic nehroureterectomy (TRNU) for the management of upper urinary tract urothelial carcinoma(UTUC). METHODS: We retrospectively collected the clinical data of UTUC patients who underwent CTNU or TRNU surgery from January 2011 to December 2018 in Peking University First Hospital and Fujian Provincial Hospital, and compared the clinical characteristics, perioperative parameters, and follow-up results between the CTNU and TRNU surgeries. RESULTS: Finally, a total of 266 cases were included, with 94 cases in the CTNU group and 172 cases in the TRNU group. The proportion of left side lesions was bigger in TRNU group when compared with CTNU group (P<0.05). No significant differences were observed in clinical characteristics, such as age, gender, body mass index (BMI), American society of anesthesiologists score (ASA score) and tumor laterality. All surgery procedures were completed. The vascular resparing was performed by reason that left arteria renalis was injured accidently during surgical operation in one case of TRNU group. No serious complications were observed in both CTNU and TRNU groups. In CTNU group, operating time was (202.9±76.7) min, estimated blood loss was (68.4±73.3) mL, drainage duration was (3.9±1.5) d, drainage volume was (181.7±251.5) mL, and postoperative hospital stay was (7.8±4.1) d. In TRNU group, operating time was (203.5±68.7) min, estimated blood loss was (130.2±252.1) mL, drainage duration was (4.3 ±1.6) d, drainage volume was (179.1±167.5) mL, and postoperative hospital stay was (8.2±3.7) d. The estimated blood loss in CTNU group was significantly less than that in TRNU group (P=0.005).The median follow-up time was 39 months (range: 1-88 months). The 5-year overall survival rate (OS), cancer specific survival rate (CSS), intra-vesical recurrence free survival rate (IvRFS), disease free survival rate (DFS) of CTNU group was 75.6%, 86.9%, 73.8%, 57.5%, respectively. The OS, CSS, IvRFS and DFS of TRNU group was 66.3%, 83.5%, 75.9%, 58.6%, respectively.No significant differences were observed in the OS, CSS, IvRFS and DFS between the CTNU and TRNU groups. CONCLUSION CTNU technique is a safe and effective surgical option, and further prospective randomized controlled trial is needed for further evaluation.
Carcinoma, Transitional Cell ; Humans ; Nephrectomy ; Nephroureterectomy ; Retrospective Studies ; Treatment Outcome ; Urologic Neoplasms

In order to investigate the effect of Shouwu Shudi Yin on dopaminegic neurons in MPTP induced Parkinson's disease mouse model and the possible mechamism, the experimental mice were randomly divided into 4 groups: control, Shouwu Shudi Yin, MPTP and the treatment (MPTP+Shouwu Shudi Yin) groups. The number of tyrosine hydroxylase (TH) positive cells in the substantia nigra was measured by immunohistochemistry, and mRNA expression of TH and glutathione peroxidase (GPX) were detected by PCR. The results showed that the number of TH positive cells and mRNA expression of TH were significantly reduced in MPTP group compared with the control (P<0.05), and pretreated with Shouwu Shudi Yin didn't show protective effect. Compared to MPTP group, the mRNA expression of four subtypes of GPX were increased in various degrees in the treatment group pretreated with Shouwu Shudi Yin, although the difference was not statistically significant. These indicated that the preventive medication of Shouwu Shudi Yin don't have protective effect on the mice with Parkinson' s disease induced by MPTP, but it may enhance the antioxidant capacity through increasing the expression of GPX.

Objective To assess the value of CT perfusion imaging in differentiation of mild from moderate liver fibrosis .Methods 18 patients with mild liver fibrosis (F1 phase) and 21 ones with moderate fibrosis (F2 and F3 phase) confirmed by liver biopsy were analyzed ,and all patients underwent the liver 256‐slice CT perfusion imaging .The differences in the CT parameters including hepatic arterial perfusion (HAP) ,portal venous perfusion (PVP) ,total liver perfusion (TLP) and time to peak (TTP) between dif‐ferent fibrosis were analyzed .ROC curve was used to evaluate the ability of perfusion indexes to distinguish mild from moderate liver fibrosis ,then the maximum Youden index was selected as a cutoff point to calculate the sensitivity and specificity .Results Compared with the mild fibrosis ,the TTP [(43 .86 ± 13 .41)s vs (37 .84 ± 9 .97)s ,P=0 .034)] in liver with moderate fibrosis was significantly increased .However ,no differences in the HAP ,PVP and TLP were found .The ROC curve analysis showed that a TTP threshold of 41 .7 s allowed discrimination of mild from moderate fibrosis with a sensitivity of 72 .7% and a specificity of 75% .Conclusion 256‐slice CT perfusion imaging can reflect the hemodynamic changes of liver fibrosis ,and the TTP may help to discriminate mild from moderate fibrosis .

OBJECTIVETo evaluate the clinical efficacy of transrectal 125 I seeds implantation brachytherapy (BT) combined with intermittent hormonal therapy (IHT) in the treatment of locally advanced prostate cancer.

METHODSWe treated 27 patients with locally advanced prostate cancer by transrectal 125I seeds implantation BT combined with IHT, and dynamically observed the changes in the PSA level, prostate volume, maximum urinary flow rate (Qmax) and International Prostate Symptoms Score (IPSS).

RESULTSAll the implantation procedures were completed smoothly, lasting 20 to 35 minutes, with 40 to 58 seeds implanted. At 6 months after implantation, the PSA level was < 0.2 microg/L in all the patients (< 0.1 microg/L in 19 cases), the prostate volume was significantly reduced (P < 0.05), and Qmax and IPSS remarkably improved (P < 0.05). At 3 years after implantation, 19 cases were in the first cycle and the other 8 in the third cycle of IHT, of which 2 progressed to androgen-independent prostate cancer, and another 2 developed early bone metastasis. The rates of 3-year biochemically and clinically progression-free survival were 70.3% and 85.2%, respectively, and the rate of therapeutic effectiveness was 92.6%. No severe complications occurred in any of the cases.

CONCLUSIONTransrectal 125I seeds implantation BT combined with IHT is a safe and minimally invasive procedure for locally advanced prostate cancer, which can effectively retard its clinical progression with no such complications as severe urethral, rectal or erectile dysfunction.

Aged ; Brachytherapy ; Combined Modality Therapy ; Hormones ; therapeutic use ; Humans ; Iodine Radioisotopes ; administration & dosage ; therapeutic use ; Male ; Prostatic Neoplasms ; radiotherapy ; therapy ; Treatment Outcome

Objective To compare the operative effectivity and incidence of postoperative complication between conventional uvulopalatopharyngoplasty (UPPP) and modified coblation assisted UPPP (M-CAUP) in treating patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).And to explore the more effective,safer and minimally invasive operative method in surgical therapy of OSAHS.Methods It was a controlled trial.A retrospective analysis was made on surgical complications of conventional UPPP and of M-CAUP performed on OSAHS patients from 1995 to 2010.There were 451 patients in UPPP group and 323 patients in M-CAUP group.x2 test and Fisher's Exact test were used in statistical analysis.Results The incidence of serious surgical complications was higher in conventional UPPP group (3.77％,17/451) than that in M-CAUP group (0.62％,2/323),x2 =7.800,P ＜ 0.01,while the incidence of short-term complications was higher in M-CAUP group (90.40％,292/323 ) than that in conventional UPPP group (60.98％,275/451),x2 =83.186,P ＜ 0.01.The difference of long-term complications was not statistically significant between M-CAUP group and conventional UPPP group (P =0.1331,Fisher Exact test).There was no significant difference in incidence of asphyxia between M-CAUP group and conventional UPPP group (P ＜ 0.01,Fisher Exact test).However,the incidence of post-operative primary hemorrhage was obviously lower in M-CAUP group than that in conventional UPPP group ( 3.99％,18/451 ),x2 =12.133,P ＜ 0.01.While the incidence of delayed hemorrhage,temporal velopharyngeal insufficiency,and foreign body sensation at pharynx were higher in M-CAUP group (8.05％, 12.69％, 68.42％,respectively) than that in conventional UPPP group (3.77％,3.33％,51.00％,respectively) P ＜0.01,respectively.There was no significant difference in incidence of permanent velopharyngeal insufficiency,stenosis of nasopharynx and nasopharyngeal atresia,alteration of taste,throat itch and coughing.Conclusion Compared to the conventional UPPP,M-CAUP was more effective and safer in treating OSAHS with less severe complications during and after the operation.

OBJECTIVETo investigate whether there are different stromal compositions in the prostate tissue of patients with benign prostatic hyperplasia (BPH) and evaluate their significance in the course of the disease.

METHODSForty-three surgical or bioptic prostatic specimens of BPH and 5 autoptic normal prostatic specimens were stained by the Masson method to display the elements of the muscle fiber and collagen. The relationship of the changes in the prostatic stromal composition was analyzed with the degree of bladder outlet obstruction (BOO) , IPSS and medication results.

RESULTSThe mean ratio of muscle fiber to collagen in the normal prostate tissue was (3.2 +/- 0.2):1, significantly higher than that of the BPH patients (1: [4.7 +/- 3.1] ) (P < 0.01); that in the BPH patients with BOO was 1: (5.4 +/- 3.7) markedly lower than in those without BOO (1: [2.5 +/- 1.1] ) (P = 0.02); that in the BPH patients with severe prostatic symptoms was 1: (9.1 +/- 2.9), remarkably lower than in those with moderate (1: [5.3 +/- 3.4]) and mild prostatic symptoms (1: [2.8 +/- 1.7]) (P < 0.01); and that in the BPH patients with satisfactory medicinal therapeutic results was 1:(2.3 +/- 1.9), significantly higher than in those with poor therapeutic results (1: [7.6 +/- 4.3]) (P < 0.01).

CONCLUSIONThe stromal composition in the prostatic tissue of BPH patients undergoes different degrees of changes. More obvious BPH symptoms and poorer therapeutic results are associated with a bigger proportion of collagens and a smaller proportion of muscle fibers in the prostatic tissue. These changes may play an important role in the development and progression of BPH.

Aged ; Aged, 80 and over ; Case-Control Studies ; Fibrosis ; Humans ; Male ; Middle Aged ; Prostate ; pathology ; Prostatic Hyperplasia ; pathology ; Urinary Bladder Neck Obstruction ; pathology

OBJECTIVETo evaluate the correlation between arteriosclerotic risk factors and the severity of benign prostatic hyperplasia (BPH).

METHODSA total of 877 patients with diagnosed BPH were selected according to the inclusion criteria. The weight of the prostate was estimated by transrectal ultrasonography, the degree of bladder outlet obstruction determined by urodynamic examination, and the symptoms quantified by the International Prostate Symptom Score (IPSS). Arteriosclerotic risk factors included age, hypertension, dyslipidemia, type 2 diabetes mellitus, and smoking. Comparative studies were made on the data obtained by univariate and multivariate analyses.

RESULTSThe severity of BPH was increased with the increase in the severity of the risk factors and the incidence of the disease. The logistic regression analysis showed that type 2 diabetes mellitus was a prominent predictor of the prostate volume, IPSS and degree of bladder outlet obstruction (OR = 3.179, 3.862 and 2.847, P < 0.001), while the level of serum triglyceride was not (P > 0.05). Age, hypertension, high LDL, low HDL and smoking were all prominent predictors of the severity of BPH.

CONCLUSIONArteriosclerotic risk factors are obviously correlated with the development and severity of BPH, among which type 2 diabetes mellitus is the most important.

Aged ; Aged, 80 and over ; Arteriosclerosis ; pathology ; Diabetes Mellitus, Type 2 ; pathology ; Humans ; Male ; Middle Aged ; Prostate ; pathology ; Prostatic Hyperplasia ; pathology ; Risk Factors ; Urinary Bladder Neck Obstruction ; pathology