Objective To evaluate the correlation betwe en operative procedures for pelviureteral carcinoma and the occurrence of postop ertive occurrence of bladder carcinoma. Methods 94 cases of pelviureteral carcinoma with postopertive occurrence of bladder carcinoma we re retrospectively studied. Results With nephrouretectom y without cuff resection of the bladder,the postoperative occurrence of bladder carcinoma was 54.5%(6/11),being obviously higher than nephroureterectomy with pa rtial bladder resection (23.5%,12/51) or nephroureterectomy with bladder mucosal cuff resection (33.3%,3/9,P0.05).The lap between the primary ope ration and the occurrence of bladder carcinoma was usually short and the occurre nce was mostly on the same affected side.In pelviureteral carcinoma with multior gan involvement,the postopertive occurrence of bladder carcinoma was as high as 72.2%(13/15) in spite of nephroureterectomy with partial resection of the bladde r . Conclusions Cuff resection of the bladder on the same side is the key point to prevent postoperative occurrence of bladder carcinoma.T he improved bladder mucosa cuff technique is a sound procedure to prevent tumor cell implantation.

Objective To evaluate the affect of Smad 4 in bladder cancer. Methods Immunohistochemical methods were used to study the Smad 4 expression in BBN induced bladder cancer in big rats. Results The positive expression rate of Smad 4 in the hyperplastic bladder mucosa was 24%(5/21),and in the bladder cancer 53%(17/32), P

Background: The conventional therapy for chronic hepatitis C is the combination of interferon-alpha and ribavirin. However, it has some adverse effects and does not response to some patients, and it is also very expensive. Objective: To assess the efficacy and safety of Chinese medicinal herbs for chronic hepatitis C virus infection. Search strategy: Electronic and manual searches were conducted and the search ended in July 2009. Inclusion criteria: We included randomized clinical trials testing Chinese herbal medicine vs placebo, non-specific treatment, antiviral treatment, or Chinese herbal medicine combined with antiviral treatment vs antiviral treatment alone. Data extraction and analysis: Selection of trials for inclusion, assessment of methodological quality, data extraction and data syntheses were conducted according to the protocol of a Cochrane systematic review by the authors. Results: Fifty-one randomized trials (involving 3 678 patients) with various methodological quality were included. The studies published in English had good quality, while studies published in Chinese were of poor quality. The pooled results showed that Chinese herbal medicine alone or in combination with antiviral treatment was generally better than non-specific treatment or antiviral treatment alone, and herbal medicine appeared equal to antiviral treatment regarding comprehensive clinical effect in terms of symptoms, liver function and virological response. Regarding virological response including loss of serum hepatitis C virus (HCV) RNA and anti-HCV antibodies, herbal medicine was better than non-specific treatment, equal to antiviral treatment, and the combination of herbs and antiviral treatment was better than antiviral treatment alone. Similar positive findings were found for liver function improvement. Adverse effects were observed among herbal injections and interferon treatment, and few cases had severe adverse effects. Conclusion: Herbal medicines included in this review have effects in improving symptoms, liver function, and loss of HCV markers in patients with chronic hepatitis C. However, for majority of the included trials were published in Chinese and had low quality, the promising effects from some herbs need to be confirmed in rigorous clinical trials, and the design and reporting of trials should follow international standards. Systematic review registration: http://www.cochrane.org, 380700081611301089.

Objectives To assess the efficacy and safety of Xiaoyao Powder (Carefree Powder) in the treatment of depression using the method of systematic review of evidence-based medicine.Method Data published before December 2009 were searched from MEDLINE,Cochrane library,CNKI,VIP,CBM.We included randomize-controlled trials (RCT) testing Xiaoyao Powder against placebo or antidepressants,and Xiaoyao Powder combined with antidepressants against antidepressants alone.Two researchers collected data independently.The assessment of methodological quality was based on Cochrane handbook and the materials were analyzed with software RevMan 5.017.The outcome measure index was relative risk or difference of mean value (95% confidence interval).Results Thirty-two RCTs involving 2 253 patients were included.Involved trials published in Chinese were of low quality.In the trials of comparison between Xiaoyao Powder and placebo,only decrease of self-rating depression scale (SDS) score was not significantly different.For general clinical improvement and decrease of Hamilton rating scale for depression (HAMD) and SDS scores,Xiaoyao Powder combined with antidepressants was more effective than antidepressants alone,but the effect of Xiaoyao Powder was equal to antidepressants.No adverse effect was reported in the trials regarding Xiaoyao Powder.Conclusions Xiaoyao Powder appears to be effective for depression.However,the exact effect needs to be confirmed in well-designed large-sampled clinical trials.

Background: Xiaochaihu Tang was a compound traditional Chinese herbal medicine recorded in ancient Chinese medical book Shanghanlun, and has been widely used for chronic liver diseases especially in Japan. Objective: To assess the beneficial effects and safety of Xiaochaihu Tang, for chronic hepatitis B (CHB). Search strategy: Electronic and manual searches were conducted and the search ended in November 2009. Inclusion criteria: We included randomized clinical trials testing Xiaochaihu Tang against placebo, non-specific treatment, antivirals, or combined with antivirals against antivirals alone. Data extraction and analysis: Selection of trials for inclusion, assessment of methodological quality by Jadad score, data extraction and data syntheses were conducted according to the Cochrane Hepato-Biliary Group methods. Results: Sixteen randomized trials (involving 1 601 CHB patients) with various methodological quality were included. One trial published in English had good quality, while other trials published in Chinese were of poor quality. The pooled results showed that Xiaochaihu Tang combined with antiviral drugs was more effective in serum loss of hepatitis B viral markers and in improving liver function compared with antiviral drugs alone. Xiaochaihu Tang was not different from placebo in terms of viral clearance or improving liver function. However, Xiaochaihu Tang was superior to non-specific treatment in liver function improvement. There were no adverse effects reported in the trials regarding Xiaochaihu Tang, but adverse effects were reported in patients treated by interferon, and severe adverse effects occurred in few cases. Conclusion: Xiaochaihu Tang in this review appears to be effective in improving liver function and clearance of serum hepatitis B viral markers in patients with chronic hepatitis B. However, due to poor methodological quality in the majority of included trials the potential benefits need to be confirmed in rigorous clinical trials following international standards.

Objective To investigate the influence of early oral feeding (EOF)after laparoscopic surgery in the function status and gastrointestinal living quality of the patients with colorectal cancer,and to clarify the feasibility of EOF after laparoscopic surgery.Methods Sixty-three patients underwent laparoscopic surgery of colorectal cancers participated in the trial.Of these,31 patients received EOF as EOF group,received a clear liquid diet on the first postoperative day followed by a regular diet as tolerated;the other 32 patients received traditional oral feeding (TOF ) as TOF group who were fed with feeding only after the recovery of their postoperative gastrointestinal functions. The nasogastric tube was removed from all patients in both groups immediately after surgery.Self-designed EOF questionnaire data, Karnofsky Scores and Gastrointestinal Quality of Life Index (GIQLI)Scores were used to evaluate the functional status and gastrointestinal living guality of the patients. Results The using time of total parenteral nutrition (TPN),time of postoperative hospital stay,and costs after surgery in EOF group were lower than those in TOF group (P<0.05);but there were no significnat differences in the first passage of flatus and feces time between two groups (P<0.05),also there were no significant differences in the incidence of nasogastric tube reinsertion, pulmonary infection, intestinal obstruction, balance of intestinal bacteria,fistula,incision infection between two groups (P>0.05),and the incidence of abdominal distension was higher than that in TOF group (P<0.05);on postoperative day 7,the albumin recovered faster in EOF group (P<0.05),and on postoperative day 4 and 7,the pro-albumin also recovered faster in EOF group (P<0.05);the patients in EOF group had a higher Karnofsky score (P<0.05)and GIQLI score compared with the patients in TOF group (P<0.05 ). Conclusion EOF after laparoscopic surgery in the patients with colorectal cancers is beneficial for rehabilitation,and it can reduce the risk of hospitalization and saving its costs;it plays an active role in protein recovery,and improves the functional status and gastrointestinal living quality of the patients.

Objective To analyze the clinical features and summarize diagnosis and therapeutic efficacy for ureteropelvic junction obstruction(UPJO). Methods Two hundred and twenty-two patients with UPJO were treated from 2000 to 2008,including 155 males and 67 females:the age rangeed from 13 to 75 and mean age was 29 years.One hundred and seventy-three cases presented with back pain;19 cases with urine infection;12 cases with abdomen bump;7 cases with macroscopic hematuria;11 cases found by B-ultrasound examine.Etiological factors included 185 patients of ureteropelvic junction stenosis;18 cases of high location of the junction;19 cases which were diagnosed UPJO due to benign oppression,including fiber cords and peculiar vessels.A total of 222 cases of surgical procedures were conducted,of them Anderson-Hynes dismembered pyeloplasty was conducted for 191 cases,fiber cords and peculiar vessels were relieved for 19,nephrectomy for 12 cases because of nonfunction. Results One hundred and ninety-one cases who underwent Anderson-Hynes dismembered pyeloplasty were all succeeded with operation.They were followed up for 6 months to 8years with a mean of 38 months.B-ultrasound and IVU showed that hydronephrosis was obviously relieved.The clinical symptoms disappeared in all cases.The levels of serum creatinine of 7 cases who had higher ereatinine recovered. Conclusion Anderson-Hynes dismembered pyeloplasty could be a good choice and effective method for the treatment of UPJO.

Objective To evaluate the efficacy of combination solifenacin and tamsulosin for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy. Methods 120 patients (male:100 female:20 age:18-67 yrs) randomly assigned to 4 groups (each group 30) with the calculi diameter range from 0.5 to 1.1 cm.All patients performed extracorporeal shock wave lithotripsy (X ray oriented).The control group did not accept any medical treatment.The solifenacin group were administered solifenacin 5 mg,once per day.The tamsulosin group were administered tamsulosin 0.2 mg,once per day.The combination group were administered solifenacin 5mg,plus tamsulosin 0.2 mg,each per day.The observation duration was set at 2 weeks. Results The stone-free rate (according to KUB) within 2 weeks were 80.0％,83.3％,93.3％ and 96.7％ in the control group,solifenacin group,tamsulosin group and combination group respectively.Statistical differences were significant among the tamsulosin group,the combination group and the control group.The stone expulsion times were (7.6 + 3.7) d,(6.3 ± 2.5) d,(4.4 + 2.3) d and (3.5 ± 2.2) d in the 4 groups respectively.Statistical differences were significant among the tamsulosin group,the combination group and the control group.The uses of analgesics were 13,5,9 and 3 in the 4 groups respectively.The bladder irrtative symptoms were 12,6,4 and 4 in the 4 groups respectively.Statistical differences were also significant for the use of analgesics and relief of bladder irritation between the solifenacin group,the combination group and the control group. Conclusions Tamsulosin and solifenacin could be safe and effective for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy.It could significantly improve the stone expulsion rate,relief the pain and improve bladder irrtative symptoms.

Objective To discuss the diagnosis and treatment of normotensive pheochromocyto-ma. Methods The clinical data of 22 patients with normotensive pheochromocytoma were reviewed. Inclusion criteria for normotensive pheochromocytoma were no previous history of hypertension and episode of symptoms suggesting high blood pressure. The blood pressure on admission was 90-130/ 60-90 mm Hg with an average of 113/72 mm Hg. Seven patients were found adrenal mass by routine ultrasonic examination. Twelve patients presented with superior abdominal or flank pain. Four pa-tients were present with fatigue, and 2 patients had fever. Headache and palpitation were found in 1 patient. Most of patients were present with large and round mass with low density area in the center of the tumor by uhrosonography and CT. Four patients had elevated level of plasma epinephrine and nor-epinephrine. 24 hours urine CA and VMA were elevated in 5 and 4 patients respectively. Seven pa-tients were prepared with infusion preoperatively to expand intravascular volume, and 2 patients were given prazosin 1.5 mg/d for 5 to 7 days. Results During the operation, seventeen patients had ele-vated blood pressure and 5 patients had no changed. One of seven patients with preoperative prepara-tion had obvious hypertension during operation, and 11 of 15 patients without preoperative preparation had obvious hypertension. The tumors were removed successfully in 21 patients. All the patients were diagnosed pheochromocytoma pathologically. Twenty-one patients had normal blood pressure with no recurrence during the follow-up from 1 month to 7 years. Conclusions The patients with normotensive pheochromocytomas may have lower catecholamine in their plasma and urine. The application of α-blockers and the expanding intravascular volume before operation could be important for the patients safe.

Objective To compare the different pathological type of renal tumor,clinical epidemiology,imaging and pathological features,summarize its value in the diagnosis of renal tumor.Methods The clinical data of 2198 patients who underwent surgical treatment in our hospital due to renal tumors from January 2010 to January 2019 were retrospectively analyzed.There were 1 404 males and 794 females with an average age of (56.5 ± 11.7) years old.The clinical epidemiology,image features and pathological features were compared.Results Among them,the pathological results concluded 1 891 cases of renal clear cell carcinoma (86.0％),112 cases of papillary renal cell carcinoma (5.1％),76 cases of chromophobe cell carcinoma (3.5％),23 cases of multilocular cystic renal tumors with low malignant potential (1.0％),13 cases of Xp11.2 translocation carcinoma (0.6％),4 cases of collecting duct carcinoma (0.2％),58 cases of anadipotic angiomyolipoma (2.6％),18 cases of acidophiloma (0.8％),and 3 cases of metanephric adenoma (0.1％).The overall differences in age and gender among patients with renal tumors of different pathological types were statistically significant (F =13.8,P ＜ 0.05;x2 =20.5,P ＜ 0.05),Xpl 1.2-translocated carcinoma had the lowest mean age of onset,which was (44.9 ± 17.1 years old).The percentage of women with anadipotic angiomyolipoma was higher (41,70.7％),and the percentage of men with clear cell carcinoma and papillary renal cell carcinoma was higher (1 253,66.3％) and(77,68.8％).There was no statistically significant difference in side sex and clinical manifestations among patients with different pathological types of renal tumors (x2 =16.27,P ＞ 0.05).No significant difference in the distribution of left and right side,the clinical manifestations were mainly sporadic (x2 =19.63,P ＞ 0.05).The results of renal tumors ultrasound ith different pathological types showed statistically significant difference (x2 =67.l,P ＜ 0.05).Hyperechoic (20,34.5％) and mixed echogenicity (16,27.6％) were the main manifestations of lipoma.Multilocular cystic renal tumors with low malignant potential were mostly cystic and solid mixed echogenicity (14,60.9％).CT values of renal tumors of different pathological types at all stages showed statistically significant differences (P ＜ 0.05).The CT values of clear cell carcinoma at the arterial phase of CT enhanced scan were significantly higher than those of other types of tumors (F =11.6,P ＜ 0.05),but decreased significantly in the parenchymal phase,showing the enhancement characteristics of "fast in and fast out".The CT values of papillary cell carcinoma in the third phase of enhanced scan were all lower than those of clear cell carcinoma and chromophobe cell carcinoma (P ＜ 0.05),showing a "progressive enhancement".The enhancement effect of chromophobe cell carcinoma is somewhere in between.The CT value on plain scan of anadipotic angiomyolipoma was higher than that of clear cell carcinoma,and the enhancement was followed by continuous enhancement,showing the characteristics of "fast in and slow out".The majority of clear cell carcinoma and papillary cell carcinoma were tan section (1 235,72.55％;51,52.13％).The grey-white section was the most common type of adipogenic angiomyolipoma (21,40.4％).Conclusions The epidemiological characteristics,imaging and pathological features of renal tumors of different pathological types have certain characteristics,especially the enhanced CT features of renal clear cell carcinoma,papillary renal cell carcinoma,chromophobe cell carcinoma and anadipotic angiomyolipoma,which are of certain value for the differential diagnosis of renal tumors of different pathological types.