Objective To evaluate the morphological features and distribution of Cajal-like cells in the human upper urinary tract after the laparoscopic nephrectomy.MethodsFrom January 2008 to August 2008,specimens of the kidney were obtained from 23 patients after laparoscopic nephrectomy in our hospital.Each specimen included the renal calyces,renal pelvic,and proximal ureter.HE staining and CD117 immunohistochemical staining were performed.The Cajal cells harvested from normal colon were used as positive control.The cells were observed under light microscope and the distribution of the Cajal-like cells in the upper urinary tract were analyzed.ResultsThe morphology of Cajal-like cells in the human upper urinary tract were similar to those collected from the colon,both showed fusiform shape and were positive for CD117.The Cajal-like cells within the colon were located surrounding the myenteric nerve plexus between the smooth muscles,whereas the Cajal-like cells distributed in the human upper urinary tract were diffused within the lamina propria and muscles.The density of Cajal-like cells at the renal calyces,renal pelvic,and proximal ureter was 15.4?5.4/cm2,22.6?6.6/cm2,and 19.9?5.8/cm2,respectively.The density at the renal calyces was significantly lower than those in the renal pelvic and proximal ureter(P=0.000,P=0.014),whereas,no significant difference was found in density between the renal pelvic and proximal ureter(P=0.129).ConclusionsCajal-like cells exist in the human upper urinary tract with different distribution characteristics from those in the gastrointestinal tract.In the upper urinary tract,the density of the cells is various,which may be related to the functions of the different parts of the tract.

ObjectiveTo compare the clinical characteristic and postoperative histopathological parameters in different prostate size and to assess the effect of prostate volume on histopathological outcomes in patients after laparoscopic radical prostatectomy. MethodsTwo hundred and sixteen patients from 2006 to 2011 who were proved prostatic carcinoma by biopsy and performed laparoscopic radical prostatectomy wewe retrospectively evaluated.All patients were divided into the small group ( ＜ 30 ml,103 cases),intermediate group(30 -60 ml,71 cases) and large group ( ＞60 ml,42 cases) according to prostate volume.Clinical variables included age,body mass index (BMI),preoperative PSA level,prostate volume,percentage of positive needles,clinical stage,and biopsy Gleason score (GS).Histopathological parameters included pathological GS,upgrading or not compared to biopsy GS,pathological stage and surgical margins status.Preoperative clinical variables and postoperative histopatholgogical parameters were compared among the 3 prostate groups. ResultsPatients with smaller prostates had lower PSA levels than those with intermediate and larger prostates (P =0.000).They also had worse histopathological outcomes such as pathological GS ( P =0.034 ),upgrading of GS ( P =0.037 ),and pathological stage ( P =0.025 ).35.0％ of patients in smaller prostate group had a positive surgical margin compare to 33.8％ and 19.0％ in intermediate and larger prostate groups,but there was no significant difference (P =0.152).ConclusionMen with smaller prostate may have more high-grade cancer and more advanced disease after laparoscopic radical prostatectomy.

Objective To report a retroperitoneal laparoscopic surgery for ureteropelvic junction obstruction (UPJO) by double renal veins.Methods A 28-year-old male patient with left low back pain for 6 months was diagnosed as left hydronephrosis and UPJO.A ureteral stent had been placed 3 months before and failed to improve hydronephrosis,so the ureteral stent was pulled out.CT scan showed that left UPJ went through the two renal veins,suggesting UPJO.Nephrogram showed that left GFR and right GFR were 35 ml/min and 34 ml/min,respectively.These results indicated mechanical obstruction of left upper urinary tract.The patient underwent retroperitoneal laparoscopic Anderson-Hynes dismembered pyeloplasty.Results The surgical procedure was successful.Two left renal veins were found,and the ventral one was in front of ureter,compressing the ureter.An aberrant renal artery went into left kidney with the ureter.0.5 cm stenosis of ureteropelvic junction was excised,and pyeloplasty was performed.A ureteral stent was placed into the ureter,then the pelvis and the ureter were sew up in front of the ventral renal vein.The surgical time was 240 min,and blood loss was 50 ml.Postoperative hospital stay time was 4 d.During 4 months' follow up,hydronephrosis was attenuated significantly.Conclusion Retroperitoneal laparoscopic surgery for UPJO with aberrant two renal vein might be a minimally-invasive and effective procedure.

Objective　To evaluate the safety and primary outcomes of transumbilical laparoendoscopic single-site radical nephrectomy (LESS-RN) by using home-made single-port device.　Methods From July 2010 to November 2011,we had performed transumbilical LESS-RN on eleven renal cell carcinoma patients by using the home-made single-port device.There were 5 males and 6 females in this group.The mean age was 49 (37 -68) years and mean body mass index was 24.2 (18.4 -30.4) kg/m2.Ultrasound and CT scan revealed 11 renal tumors (7 on left and 4 on right),with 3 on the upper pole,4 in the middle and 4 in the lower pole.There were 2 cases with suspicious lymph node metastasis and one case with renal cyst.There was no distant metastasis.The intracorporal procedure was similar to conventional laparoscopic radical nephrectomy.　Results　Except two cases converted to conventional laparoscopic RN and one case converted to hand-assisted laparoscopic RN,the other procedures were completed successfully without open conversion.The mean operative time was 225 min (155 -297 min) and mean estimated blood loss was 271 ml (50 -900 ml).Postoperative results showed that all cases were renal cell carcinoma and there were 3 cases in T1a,5 cases in T1b and 3 cases in T2a.The mean visual analog pain scale (VAPS) was 4 (3 -6),and mean hospital stay was 10 d (5 -15 d).With the mean follow-up of 17 months (8 -24 months),all patients were alive with no evidence of local recurrence or metastasis.Patients were satisfied with the cosmetic results of the wound recovery.　Conclusions　Transumbilical LESS-RN using home-made single-port device is a safe approach in selected patients and has excellent cosmetic results. Primary oncologic outcomes are good.However,we will still need large clinic trials to further evaluate the efficacy and safety of LESSRN.

Objective To investigate the expression of estrogen receptor (ER) α and β in human prostate cancer (PC), peri-cancer tissue and benign prostatic hyperplasia (BPH) tissue, and to discuss the role of estrogen receptor in prostate cancer. Methods The expression of ERα and ERβ in PC (n=28), peri-cancer tissue (n=28) and BPH (n=29) were detected by immunohistochemistry with En vision method. The ERα and ERβ expression were compared among different tissues by chisquare. The relationship between ER expression and related clinicopathologic features was statistically analyzed by spearman rank collection. Results ERα was localized dominantly in the stromal cell of PC. There were significant differences of the expression of ERα in PC, peri-cancer tissue and BPH tissue (epithelial cell 0%, 14%, 24%, P＜0. 05; stromal cell 57%, 68%, 31%,P＜0. 05). ERβ was localized in both epithelial and stromal cell of PC. There were significant differences of the expression of ERβ in PC, peri-cancer tissue and BPH tissue (epithelial cell 39%, 64%, 29%, P＜0.01; stromal cell 50%, 75%, 79%, P＜0.05). There was a significant difference of the expression of ERβ in different Gleason scores of PC tissue. Conclusions ERα is localized in the stromal cell of PC tissue.ERβ is localized in both epithelial and stromal cell of PC tissue. The ERβ might be related to the tumor differentiation of PC.

Objective To describe our experience in laparoscopic radical prostatectomy (LRP)for incidental prostate cancer after TURP. Methods From April 2007 to July 2010, 5 patients with incidental prostate cancer after TURP were treated with a mean age of 73 years. The patients underwent LRP (2.8± 1.1) months after TURP. Results The five cases of LRP were performed successfully, with 1 case of transperitoneal approach and 4 cases of extraperitoneal approach. Mean operation time was (227.6±38.4) min, mean blood loss was (130±152.5) ml, and the mean follow-up was (16.1 ± 15.9) months. All five patients survived, and their urinary function was good without any incontinence. Conclusions Previous TURP represents a technical challenge when performing LRP, but highly skilled surgeons trained to perform LRPs can handle it.

SUMMARY Anaphylaxis is an acute and fatal systemic allergic reaction to an allergen , and it could be an unpre-dictable and life-threatening cause during anesthesia .The main purpose of this paper is to report a case of anaphy-lactic shock during the anesthesia induction and to review the prophylaxis and treatment of anaphylactic reactions and anaphylactoid reactions during the anesthesia period .A 63-year-old man, with a mass on his adrenal , was scheduled to a laparoscopic adrenal tumor excision .During the anesthesia induction period , after administrated sul-fentanil, propofol and rocuronium , the blood pressure was decreased and the heart rate was increased .Then, the patient had rash on his whole body and developed an anaphylactic shock .After being treated with the anti-allergic agents and norepinephrine , the rash disappeared and the vital sign become stable .The patient felt nothing uncom-fortable during the two weeks ’ follow-up.Anaphylactic reactions and anaphylactoid reactions are not rare during the anesthesia period .The most common inducements are muscle relaxant , latex and antibiotics .Anaphylactic reac-tions in the perioperative period are often serious and potentially life-threatening conditions , involving multiple or-gan systems in which the clinical manifestations are the consequence of the release of preformed mediators from mast cells and basophils .Before anesthesia , we should acquire the allergic history .During the anesthesia period , the vi-tal sign and the skin should be observed carefully .

OBJECTIVE:To provide reference for improving the level of rational drug use in public hospitals at county level. METHODS:The relevant indicator data of rational drug use in our hospital was analyzed,and the relevant indicator data of the hos-pitals at county level around it was investigated and analyzed,a total of 36 parts of rational drug use management indicator system was established,including administrative management indicators,outpatient management indicators,hospital management indica-tors,and drug procurement management indicators,and it was constantly improved and optimized. Meanwhile,relevant indicator data of rational drug use from 2010 to 2014 was statistically analyzed to evaluate the effect of the effectiveness of the system. RE-SULTS:In the 5 years,the drug revenues accounted for revenue ratio(the ratio of drug)decreased by 10.3%;the use indicators of antibiotics in clinic showed gradual optimization,the proportion of outpatient antibiotic prescriptions decreased from 57.1% to 19.3%,the use rate of inpatient antibiotic decreased from 90.2% to 56.3%,the proportion of type I incision operation preventive use of antibiotics decreased from 94.6% to 28.6%,and the submission rate of microbiological sample of inpatients before they re-ceived the treatment of antibiotics increased from 8.4% to 32.7%;the proportion of essential medicines increased 25.5%,and pro-portion of use amount increased to 24.1%;the application of the system promoted the improvement of rational drug use and phar-macy management level in our hospital,and also helped the hospital successfully passed the national three class comprehensive hos-pital evaluation. CONCLUSIONS:The established rational drug use management indicator system is comprehensive and feasible, and can provide reference for strengthening rational drug use management and medical and health system decision in China.

Objective:To assess the discrepancy between preoperative needle biopsy (NB)Gleason score and pathological specimen Gleason score (GS)after radical prostatectomy,and to explore the risk factors of postoperative upgrading of GS.Methods:We retrospectively evaluated 160 patients who suf-fered from biopsy proved prostatic carcinoma and performed radical prostatectomy.Age of the patients was 57 -82 years,with the average age of 71.6;prebiopsy prostate specific antigen (PSA)was 0.31 -40.32 μg/L,with the average PSA of 11.29 μg/L;body mass index (BMI)was 16.41 -32.04 kg/m2 , with the average BMI of 23.63 kg/m2;prostate volume (PV)was 9.52 -148.46 mL,with the average PV of 40.19 mL.All the patients included in the study had complete information for clinical variables, including age,BMI,prebiopsy PSA level,PV,number of biopsy cores obtained,percentage,clinical stage,and biopsy GS.Grading of NB Gleason score was compared with their corresponding radical pros-tatectomy specimens,and the discrepancy between the NB and prostatectomy specimens GS assessed. Upgrading was defined as any increase in the pathological GS over that of the biopsy GS as a total sum of primary and secondary grades or a change in the order of primary and secondary grades towards higher ones.Univariable and multivariable Logistic regression analyses were used to identify predictors of patho-logical grading changes.Results:Of the 160 patients,the specimen GS was upgraded in 49 (30.6%) patients and remained with no change in 82 (51.3%)patients.Univariate and multivariate regression analysis showed that prostate volume and biopsy GS were independent predictors with postoperative upgra-ding of GS.Age,BMI,PSA before needle biopsy,clinical stage and needle number showed no statistical significance (P >0.05).Conclusion:Lower biopsy GS and smaller prostate volume are increased risks for clinically upgrading of GS after radical prostatectomy.This fact should be kept in mind when deciding on therapy decisions for patients with prostate cancer.

SUMMARY To explore the clinical pathological characteristics and improve the recognition in the diag-nosis and treatment of basal cell carcinoma (BCC)of prostate.Three cases of BCC of prostate were re-ported and the relevant literature was reviewed to investigate the diagnosis and treatment of this disease. We analyzed three cases of prostatic BCC.Their ages were within a range of 57 to 83 years.One of them complained of hematuria and two complained of dysuria.All of them presented with prostatic hyperplasia. Two of them presented with high prostate specific antigen (PSA)and one with normal PSA.Case 1 had prostate cancer invasion of bladder,rectal fascia,with lymph node metastasis,bone metastasis and lung metastases.The patient received bladder resection +bilateral ureteral cutaneous ureterostomy +lymph node dissection on November 2,2014 .Postoperative pathological diagnosis showed BCC.Reexamination of pelvic enhanced MRI in January 8,2015 suggested pelvic recurrence.Abdominal enhanced CT showed multiple liver metastases and pancreatic metastasis on July 11,2015.Prostate cancer specific death occurred in October 2015.Case 2 was diagnosed as BCC in prostate biopsy on March 27,2015. Positron emission tomography and computed tomography (PET-CT)showed pulmonary metastasis and bone metastasis.Then the patient received chemotherapy,endocrine therapy and local radiation therapy. Reexamination of PET-CT on January 11,2016 showed that the lung metastase tumors and bone metas-tase tumors were larger than before.Up to January 10,2016,the patient was still alive.Postoperative pathological changes of transurethral resection of prostate (TURP)in case 3 showed BCC might be con-sidered.The PET-CT suggested residual prostate cancer,which might be associated with bilateral pelvic lymph node metastasis.In April 20,2016,the review of PET-CT showed pelvic huge irregular hybrid density shadow,about 14.5 cm ×10.0 cm ×12.9 cm in size,and tumor recurrence was considered. Then the patient received local radiation therapy.The patient survived in the followed upon January 10, 2016.BCC of prostate is a rare subtype.Due to the local infiltrative and distant metastatic potentiality, active management is preferred and a life-long follow-up is necessary.