Adult ; Female ; Humans ; Intestinal Obstruction ; etiology ; therapy ; Postoperative Complications ; etiology ; therapy ; Rectal Neoplasms ; radiotherapy ; surgery

New method of prostate cancer has grown more precise with the development of medical imaging.Multi-parametric MRI targeted biopsy and fusion biopsy reduce the cores,at the same time they have similar positive rates compared to systematic biopsy.The most used biopsy methods are still transrectal guided transrectal biopsy and transperineal biopsy in China.If we can predict biopsy result before the operation by physical and laboratory examination,it will help improve the detection rate and avoid repeating biopsies.And it has been indicated that age,tPSA,PSAD,fPSA/tPSA,PV,DRE,PHI and PCA3 are the predicting factors.Chinese Prostate Cancer Consortium Risk Calculator is fit for Chinses people.

BACKGROUND: One major reason for transplanted kidney failure is BK virus (BKV) associated nephropathy, which leads to renal inadequacy and ureteral obstruction. OBJECTIVE: To identify the incidence of BKV viremia in kidney transplant recipients, as well as to analyze the risk factors of BKV infection. DESIGN, TIME AND SETTING: A retrospective case analysis was performed at the Department of Urology, Affiliated Beijing Friendship Hospital of Capital Medical University from September 2001 to December 2007. PARTICIPANTS: One hundred and twenty-one renal transplant patients, and 20 renal failure patients, who underwent hemodialysis were served as control group. METHODS: The viral load in plasma was quantified with a real-time PCR method. The recipients were divided into the PV+ group (BKV DNA positive blood samples) and PV- group (BKV DNA negative in blood samples) according to the detection outcomes. The gender, age, cold ischemia time, immunosuppressive agent, donor type and other clinical parameters were compared between 2 groups. MAIN OUTCOME MEASURES: Logistic regression was performed to determine risk factors for BKV infection. RESULTS: The incidence rate of BKV viremia accounted for 24.7% (30/121) of kidney recipients, which was higher than the control group (1/20), the difference between them was significant (P = 0.03). Logistic regression found that cold ischemia time (RR 3.34, 95% CI 2.76-5.60) and cadaver donation (RR 2.19, 95% CI 1.32-3.97) were significantly related to BKV viremia. However, ages of recipients, time of collecting samples, and intravenous glucocorticoid therapy was independence to BKV viremia. CONCLUSION: Kidney recipients are the high risk population who are susceptive to BKV infection. Cold ischemia time and cadaver donation may be the risk factors of BKV viremia.

Objective To study the clinic features and risk factors of bladder cancer occurrence after radical nephroureterectomy of urothelial carcinoma of the upper tract.Methods 61 cases of urothelial carcinoma of the upper tract from March 2013 to December 2013 in Beijing Friendship Hospital are retrospectively studied.31 patients are male,while the other 30 patients are female.Age of them ranges from 43 to 90 years old,and the average age is 69 years old.17 patients are accompanied with diabetes.32 patients are accompanied with hypertension.12 patients have the history of chronic nephrosis.7 patients have the history of renal transplation operation.47 patients have the symptom of hematuresis.16 patients have the symptom of lumbago.Body mass index ＜ 18.5 kg/m2 2 cases,18.5 ～ 22.9 kg/m2 25 cases,23.0 ～ 24.9 kg/m2 10 cases,25.0 ～ 29.9 kg/m2 20 cases,≥ 30.0 kg/m2 4 cases.25 patients' serum creatinine is abnormal,while the other 36 patients'is normal.36 patients have left tumors,while the other 25 patients have right tumors.39 patients have hydronephrosis before operation.25 patients go through ureteroscopy.11 patients have the concurrence of bladder cancer preoperatively.25 patients have renal pelvic carcinoma,while the other 36 patients have carcinoma of ureter.14 patients have multiple tumors,while the other 47 patients just have single tumors.The size of tumor ranges from 0.5cm to 8.0cm,and the average size is 2.9cm.27 patients have the cauliflower-like tumors,while the other 34 patients have other shaped tumors.28 cases have the positive results of cytology,while the other 33 cases donl have.6 patients go through cystoscopic operation of ureterovesical junction,while the other 55 patients go through open operation of ureterovesical junction.Kaplan Meier analysis is used to find univariate risk factors of the bladder cancer occurrence postoperatively,and Log-rank test is used after that.Cox regression analysis is used to identify the independent risk factor from all the univariate risk factors.Results Time of surgery ranges from 2.0 hours to 7.5 hours,and the average time is (4.9 ± 1.2) hours.39 patients' tumors are equal or greater than T2 stage,while the other 22 patients'tumors are less than T2 stage.2 patients have Ⅰ grade tumors,40 patients have Ⅱ grade tumors,and the other 19 patients have Ⅲ grade tumors.12 patients go through systematic chemotherapy,while the other 49 patients don l.23 patients go through intravesical instillation postoperatively,while the other 38 donl.Follow-up time of 61 cases ranges from 22 months to 31 months,and the average time is (27.3 ± 2.7) months.3 to 30 months after radical nephroureterectomy,21 cases(34.4％) have bladder cancer occurrence.4 of patients who have concurrence of bladder cancer preoperatively go through the occurrence of bladder cancer(57.1％,4/7),and 17 of patients who dont have concurrence of bladder cancer preoperatively go through the occurrence of bladder cancer(3 1.5％,17/54).8 of patients with multiple tumors go through the occurrence of bladder cancer(57.1％,4/7),while 13 of patients with a single tumor go through the occurrence of bladder cancer(27.7％,13/47).18 of patients who have tumors equal or greater than T2 stage have the occurrence of bladder cancer(46.2％,18/39),while 3 of patients who have tumors less than T2 stage have the occurrence of bladder cancer(13.6％,3/ 22).3 of patients with postoperative intravesical instillation have the occurrence of bladder cancer(13.0％,3/23),while 18 of patients without postoperative intravesical instillation have the occurrence of bladder cancer(47.4％,18/38).Single factor analysis shows that preoperative concurrence of bladder cancer(P =0.003),multiple tumors (P =0.044),T stage (P =0.023) and postoperative intravesical instillation (P =0.002) have significant influence on the occurrence of bladder cancer.And Cox proportional hazards regression model analysis shows that the preoperative concurrence of bladder cancer (RR =2.860,P =0.024,regression coefficient =1.051) and postoperative intravesical instillation (RR =0.201,P =0.011,regression coefficient =-1.065) are significantly related to the occurrence of bladder cancer after radical nephroureterectomy.Conclusions The preoperative concurrence of bladder cancer and postoperative intravesical instillation are the independent risk factors of the bladder cancer occurrence after radical nephroureterectomy.And the preoperative concurrence of bladder cancer is a risk factor,while the postoperative intravesical instillation is a protective factor.

Modern immunology has established that tumor immune escape is associated with hidden or missing tumor-specific antigens and tumor-associated antigens,as well as immune suppressors that are released from tumor cells to inhibit the immune cytotoxicity and antigen-presenting cells (APCs).The changes in tumor microenvironment have an impact on tumor immunity and treatment outcomes.The immune effects finally depend on activation and inhibition of T cell receptors and other co-regulated receptors (CD28,CD80/CD86,and CTLA-4) in spite of the existence of APCs and cytotoxic T lymphocytes in tumor microenvironment.Recent studies have revealed that radiotherapy induced not only DNA damage but also immunogenesis in tumor cells.Both conventionally fractionated radiotherapy and hypofractionated radiotherapy can induce immunogenesis in tumor cells.Immunogenic regulation makes many tumor antigens expressed in cells exposed to irradiation,which induces immune recognition and cytotoxicity;cell content (DNA,HMGB1,etc.) released from dead immunogenic cells can trigger immune effects and in situ tumor vaccination,which further induce an abscopal effect of radiotherapy.A lot of anti-tumor immunotherapy fails to achieve satisfactory treatment outcomes.Therefore,how to combine radiotherapy,especially stereotactic body radiotherapy,with anti-tumor immunotherapy has recently become a new challenge for researchers.

Objective To evaluate the effect of surgical treatment on patients with retroperitoneal fibrosis. Methods The medical records of 24 retroperitoneal fibrosis patients (19 men and 5 women;mean age,52 years) who had been surgically treated from January 1985 to December 2003 were retrospectively analyzed.The initial clinical presentations included low back and abdominal pain in 11 cases,acute anuresis in 5 and incidental bilateral hydronephrosis in 8.Double-J inter-ureter drainage was performed in 11 cases, among whom the procedure failed in 4 cases, and then they underwent pricking pyelostomy.After their general condition improved,ureterocutaneostomy and ureterolysis were performed in 2 cases and 1 case, respectively.Of them 1 case died of acute myocardial infarction 3 months later.Thirteen cases who had good general condition at diagnosis underwent ureterolysis. Results One patient developed renal function failure due to repeated urinary infection 3 years after operation.One died of acute myocardial infarction 3 months after operation.The other 22 patients recovered well,and their mean creatinine level decreased from 450.9?mol/L before operation to 318.2 ?mol/L (1 month) and 265.2 ?mol/L (3 months),respectively,after operation. Conclusions Prompt and appropriate relief of urinary obstruction with surgical treatment can effectively protect the renal function in patients with retroperitoneal fibrosis.

Catheterization ; adverse effects ; Child ; Ductus Arteriosus, Patent ; therapy ; Female ; Humans ; Male ; Platelet Count ; Thrombocytopenia ; etiology ; Young Adult

Objective To explore the benefits of living donor kidney transplantation in child, and to inves-tigate the procedures of renal transplantation, post-operative immunosuppressants regimens and complication management in child. Methods Clinical data, the prognosis of renal transplantation, operative procedure and immunosuppressive agents administrated in 14 children with end-stage renal disease (ESRD) undergo-ing renal transplantation were analyzed. Results The major complications in the early stage after renal transplantation were: 2 cases had acute rejection, 3 cases had severe hypernatremia, 1 case had urological infection, 3 cases had lymphocele. The major complications in the long-term recipients included: 6 cases had hypertension, 3 cases had hyperlipidemia, 4 cases had various kinds of infections, 5 cases had drug-in-duced hepatic injury. The one year survival rates of recipient/graft were all 100%. The average creatinine was 96.43 mmol/L(43-125 mmol/L) for the 14 recipients by the end of this study. All recipients thought their life quality was improved significantly. Conclusions Living donor kidney transplantation is the most ideal method to treat children with ESRD. Adult donor kidneys are suitable to the school age of recipients. The protocol of immunosuppressive therapy (prednisone plus MMF and FKS06) should be applied.

Objective To evaluate the clinical outcomes of a reformed endoscope assisted ureteral stripping technique in post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidney.Methods Seven post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidneys(2 males and 5 females)with average age of 54 years old were recruited.Standard retroperitoneal laparoscopic nephrectomies were performed for all patients after placement of a 5 F ureteral stent as the ureteral stripper. After the closure of the ureter at the lower kidney pole level with metal clips, the distal ureter was separated and the ureteral muscle layer and serous membrane layer were split. The ureter muscle layer was then tied tightly to the ureteral stent tip. The ureter and the stent were pulled out through urethra. Transurethral resection around the everted ureteral orifice was performed and the ureter was removed afterwards. The graft function, operation time,complication and estimated blood loss were recorded.Results All the 7 patients successfully underwent the operations and no major complication such as ureteral disruption, stripping embarrassment and converting to open operation happened. The mean operation time was 126 min (ranging from 105 to 160 min) and the mean blood loss was 124 ml (ranging from 80 to 160 ml). Introvesical chemotherapy with farmorubine hydrochloride was performed 3 weeks after surgery. The mean preoperation and 6 months post-operation creatinine and urea nitrogen levels were 136.5μmol/L, 138. 6μmol/L and 7.42 mmol/L, 7.80 mmol/L respectively and there was no statistical difference. There was no tumor recurrence during 6 month follow-up except one case having simultaneous bladder cancer had bladder cancer relapse 3 months after operation and required another TURBt.Conclusion The reformed endoscope assisted ureteral stripping technique is minimally invasive and convenient in the treatment of post renal transplant patients with renal pelvic tumor of the graft homonymy primitive kidney.

According to the reality of outpatient clinic service,expanding the service items,laying off solid foundation,making the working procedures more concrete in details and establishing suitable polices,the professionalization of specialists and special diseases in outpatient clinic of multiple branches hospital,even resources of outpatient clinic of multiple branches hospital,diversified service pattern of outpatient clinic,refined outpatient clinic service procedure,informationization of treatment procedure of outpatient service,and different requirements of people of different levels are realized.