Objective To discuss the clinicopathologic and imaging features of multilocular cystic renal eell carcinoma(MCRCC). Methods The data of 8 cases(5 men and 3 women)MCRCC classified according to 2004 WHO criteria were reviewed retrospectively.The tumor was incidentally found in 5 out of 8 cases.Renal ultrasound and CT scans were available in all 8 cases.CT or enhanced CT scans showed a well-defined cystid mass with irregular thickening wall or septa in 7 cases,without visible nodules found.For treatment,open or laparoscopic radical and partial nephrectomy was done in those cases. Results Postoperative pathological findings confirmed the diagnosis of MCRCC.The mean greatest diameter of the tumors was 5.6 cm.Microscopically,the wall and septa lined by one or several layers of clear cells were observed in all cases.The TNM stage of all 8 cases was T1 N0 M0.For pathologic grade,7 cases were G1 and 1 case was G2.Seven patients were followed up and remained tumor free during the average time of 8 months. Conclusions MCRCC is an uncommon subtype of RCC,it has a lower malignant potential and a better prognosis compared with other types of RCC according to the literature.Nephron-sparing surgery may be an appropriate treatment option for MCRCC.

Objective To examine ultrastructural features of the arteriole responsible for intracerebral hemorrhage or the perforating branches artery around hematoma in patients with hypertensive intracerebral hemorrhage and explore the mechanism of hypertensive intracerebral hemorrhage. Methods Twelve hypertensive patients with CT proved intracerebral hemorrhage underwent operation. The small artery specimens were obtained through cortex fistula and their ultrastructures were observed under the electron microscope. Results Twelve specimens including 4 cases of duty arteriolae and 8 cases of perforating branch arteriolae were collected, Different degrees of degeneration were observed in three layers of the arteriola in all 12 specimens. Changes in endothelial cells included endothelial cell necrosis, collapse, or fallen of from endomembrane, accompanied by degeneration of internal elastic membrane, such as uneven thickness, absence of intermittent and medial smooth muscle cell necrosis. Myofilaments in the cytoplasm were condensed to form a high electron-dense cytoplasm. No micro-aneurysm was observed. Conclusions The pathological changes of cerebral small artery walls load-bearing layer in hypertensive patients include internal elastic layer rupture, smooth muscle layer of degeneration, decreased elasticity and increased fragility. Small artery walls may rupture, resulting in bleeding under the condition of rapid dynamic changes of blood flow.

Objective To Validate the prognostic significance of the European Organization for Research and Treatment of Cancer (EORTC) risk tables in Chinese patients with non-muscle invasive bladder cancer (NMIBC). Methods According to the scoring standard of the EORTC system, 225 NMIBC patients were reviewed and divided into 3 groups: low, intermediate and high risk groups for recurrence and progression respectively. The probabilities of recurrence and progression at 1 year and 5 year for each group were calculated using life-table analysis and then compared with the EORTC risk tables. Log-Rank test and multivariable analysis were used to analyze the possible differences between risk groups and to find independent prognostic factors. Results For low (n= 32, 25), intermediate (n=109, 128) and high (n=84, 72) risk groups, the probabilities of recurrence and progression at 1 year were 15. 1%, 31.2%, 55.5% and 0. 3%, 2. 0%, 15.5% respectively. The probabilities at 5 year were 28. 2%, 55.2%, 75.0% and 1.4%, 12.9%, 54. 7%. All the results were similar to that of EORTC tables except the probability of progression at 5 year for the high progression risk group.The differences between different risk groups were significant (P＜0.01). In a multivariable analysis for recurrence and progression, the EORTC scores had independent significance (P＜0.01). Conclusions EORTC risk tables could stratify NMIBC patients effectively according to the risk of recurrence and progression. It could be a useful tool for Chinese urologists.

ObjectiveThe clinical features of T1G3 bladder cancer and the risk factors of the recurrence,progression and death were studied. Methods One hundred and eighty-seven cases with T1G3 bladder cancer were diagnosed from 1998 to 2006 in the Institute of Urology of Tianjin.There were 162 males and 25 females in the study group.The average age was 66 years (35 -92 years).A clinical epidemiology study was carried out and prognosis information was collected.The risk factors were preliminary screened with Kaplan-Meier univariate analysis and then finally determined with multivariate Cox proportional hazards regression model. ResultsBased on a mean follow-up of 46 months (range,12 to 111 months),100 (53.5％) of the cases had a recurrence,61 (32.6％) cases progressed and 37( 19.8％ ) cases died.The 1-,2-,3-,5-year probability of tumor recurrence was 35.0％,60.0％,63.0％,65.0％.The 1-,2-,3-,5-year probability of disease progression was 12.0％,27.0％,34.0％,38.0％ and the 1-,2-,3-,5-year probability of death was 0,11.0％,17.0％,26.0％,respectively.The tumor size,number of tumors,immediately intravesical instillation and the first recurrence time ≤6 months were the risk factors associated with tumor recurrence of T1G3 bladder cancer.The tumor modality,cancer in situ,the first recurrence time ≤ 6 months and frequency of recurrence were the risk factors of disease progression.Only progression was a risk factor of death. ConclusionsTumor of T1G3 bladder cancer patients with features such as the tumor size ≥3 cm,tumor multiplicity,and first recurrence time ≤6 months were more likely to relapse.Immediately intravesical instillation could reduce the risk of recurrence.Cystectomy must be carried out early if the patient with T1G3 bladder cancer has the risk factors of progression such as the nodous tumor,tumor in suit,the first recurrence time ≤6 months and frequency of recurrence ＞ 1.

Objective To determine the main CT features and the key points of differential diagnosis of multilocular cystic renal cell carcinoma (MCRCC) classified according to 2004 WHO pathological diagnostic criteria. Methods According to the criteria, 40 patients were divided into two groups: MCRCC group and other subtypes of cystic renal cell carcinoma (CRCC). The CT findings were evaluated and compared between two groups for cystic content, wall, septum, nodularity, calcification and enhancement. ROC curve was used to determine the cut-off value of the possible CT feature which could distinguish MCRCC from other subtypes of CRCC. Results Seventeen cases of MCRCC group and 23 cases of CRCC group were included in this study according to the diagnostic criteria. MCRCC appeared as a well defined multilocular cystic mass with thin wall and sepia and no expansile solid nodules. Thickness of cystic wall and/or septum is was main CT findings to distinguish MCRCC from other subtypes of CRCC (P ＜ 0.01 ). The cut-off value of the thickness was 6 mm and its sensibility, specificity was 89% ,75% respectively. Conclusion Cystic wall and/or septum with a thickness of less than 6 mm are the main CT findings to dis tinguish MCRCC from other subtypes of CRCC.

Objective To investigate the relationship between tumor location and the risk of developing bladder cancer in pafients treated by nephroureterectomy(NU)for upper urinary tract transitional cell carcinoma(UUT-TCC).Methods The clinical data of 168 UUT-TCC patients who underwent NU were reviewed.Univariate and multivariate analysis were carried out to determine the risk factors for intravesical recurrence after NU.Results The recurrence-free survival rate at 1,3 and 5 years after NU were 88%, 76%and 63%.All patients were followed up for a median period of 45(12-107)months During this period, a total of 49 patients developed bladder tamors after surgery,of which 28 cases were renal pelvic carcinoma, 2 cases were rniddle ureter carcinoma and 19 cases were distal ureter carcinoma.The recurrence-free survival of renal pelvic carcinoma and ureter carcinoma had no significant difference by Log-Rank test(P>0.05).On multivariate analysis,only locating in distal ureter carcinoma was the independent risk predictor for intravesical recurrence after NU (P<0.01).Conclusion Pafients with UUT-TCC at distal ureter carry a higher risk for intraeesieal recunerrce after NU than those with TCC at other location of upper urinary tract.

Objective To compare health status of senior high school graduates living as urban vs suburban areas in Beijing.Methods Wilcoxon rank sun test,Ridit analysis and fuzzy mathematics synthesis were used to evaluate body shape index,physical function index and health defects indicator of 39 982 senior high school graduates in Beijing.Results A total of 9 117 urban boys,9 299 suburban boys,10 380 urban girls and 11 186 suburban girls were studied.For the boys,the urban was superior to the suburban areas in body shape index (Rurt=0.518,Rsub=0.482,P＜0.05) and physical function index (Rurt=0.520,Rsub=0.480,P＜0.05),and the urban was inferior to suburban areas in health defects indicator (Rurb=0.501,Rsub=0.554,P＜0.05) and the composite index (Ruurb=0.484,Rsub=0.516,P＜0.05).For the girls,the urban was superior to the suburban areas in physical function index (Rurb=0.562,Rsob=0.442,P＜0.05),and the urban was inferior to the suburban areas in health defects indicator (Rurb=0.473,Rsub=0.523,P＜0.05).The differences between urban and suburban areas tended to be of no statistical significance in body shape (U=5.79,P＞0.05) and composite index (U=5.73,P＞0.05).In fuzzy mathematics synthesis,the scores of urban boys,suburban boys,urban girls and suburban girls were 68.37,69.13,69.83 and 69.79,respectively.Conclusion Our investigation identified some differences in body shape index,physical function index and health defects indicator among senior high school graduates living at urban vs.suburban areas,although the differences of synthetical health were not statistically significant.

Objective To discuss the therapeutic methods of idiopathic retroperitoneal fibrosis (IRF). Methods Nineteen cases of IRF were reviewed.The main clinical menifestation included lamber pain and nephrohydrosis,nausea,loss of appetite,body weight descend,hypourocrinia,percussion tenderness over kidney region.The imaging showed soft tissue mass behind the peritoneum,which surrounded the abdominal aorta,and wrapped the ureter and inferior vena cava.There were 9 cases treated by open surgery,in 7 of which ureterolysis and placement into abdominal cavity were performed,and in the other 2 cases kidney fistulation was undertaken because of failure of ureterolysis.In 10 cases endoscopic stent of double J stent was taken.Glueocortieoid was given in 17 patients.Results Seventeen cases were followed up from 5 to 81 months.Six cases with ureterolysis were followed up,whose symptom disappeared and renal function recovered or kept slowly increasing state.In 2 cases undertaken kidney fistulation,urinary tract infection took place repeatedly after 3 months and 7 months respectively from operation.And 1 case needed hematodialysis therapy.There were 9 cases undertaken ureterai stent combined with prednisone were followed up,in whom hydronephrosis relieved obviously and serum Cr averaged 103±48μmol/L when keeping the double J stent.In 3 cases hydronephrosis recurred after removing the stent. Conclusions Ureterolysis and placement into abdominal cavity is the valid treatment of IRF.The way of endoscopic stent combined prednisone treated IRF is simple,which effect is satisfied in short term.

[ ABSTRACT] AIM: To investigate the regulatory mechanism of histone acetylation on cardiac hypertrophy in -duced by phenylephrine , and to provide a new idea for preventing and curing hypertrophic cardiomyopathy .METHODS:Phenylephrine was given by continuous subcutaneous injection for modeling cardiac hypertrophy in C 57BL/6 mice.The le-vel of histone H3 lysine 27 acetylation (H3K27ac) in the promoter of cardiac nuclear transcription factor GATA4 and the mRNA expression of GATA4 were identified by chromatin immunoprecipitation (ChIP) and real-time PCR, respectively. Meanwhile, the protein expression of histone H3K27ac, atrial natriuretic peptide (ANP) and α-myosin heavy chain (α-MHC) was determined by Western blot .Cardiac hypertrophy in the mice was observed by HE staining and echocardio-graphy.RESULTS:The results of Western blot showed that the level of histone H 3K27ac in phenylephrine group was sig-nificantly increased compared with normal saline group (P<0.05), and ChIP-qPCR data showed that the level of histone H3K27ac in the promoter of GATA4 was increased significantly in the same samples (P<0.05).The expression levels of GATA4 mRNA and ANP protein in phenylephrine group were apparently increased compared with normal saline group ( P<0.05).However, histone acetylase inhibitor anacardic acid attenuated histone H 3K27 hyperacetylation induced by pheny-lephrine, and downregulated the over-expression of GATA4 and ANP in the heart of the mice (P<0.05).HE staining and echocardiography data showed that phenylephrine apparently increased left ventricular posterior wall thickness and de -creased left ventricular end-systolic diameter and left ventricular end-diastolic diameter , while anacardic acid also reversed these indexes that mentioned above and attenuated cardiac hypertrophy induced by phenylephrine in the mice .CONCLU-SION:Histone acetylation modification imbalance is involved in cardiac hypertrophy induced by phenylephrine , and the histone acetylase inhibitor anacardic acid decreases histone hyperacetylation induced by phenylephrine and attenuates car -diac hypertrophy in the mice .

Objective To evaluate the test -retest reliability of sentence materials, and to standardize Man_darin Speech Test Materials (MSTMs). Methods Forty normal-hearing subjects aged from 18 to 30 years old were recruited in this study. The sentence materials were tested at 9 dB HL to these subjects according to the prepare ex_periment. The retest was carried out in the same condition after an interval of 14~28 days. The difference between test and retest score was examined by t-test, and the critical difference (CD) was analyzed with 95% confidence in_terval (CI). ResuIts There was no significant difference between the test and retest scores about speech perception performance. The critical difference was 18. 93% at 95% confidence interval, and the number of the corresponding key words was 10. ConcIusion The results showed that sentence materials of MSTMs have good test-retest relia_bility except list 6. The interventions could be considered effective just when the difference of the same subject's score exceed 18. 93%, that means 10 key words are necessary to improve that the intervention is effective.