Objective:To investigate the efficacy of single-port intravesical laparoscopic Politano-Leadbetter in the treatment of adolescent primary obstructive megaureter.Methods:Retrospective analysis was performed on the clinical data of 11 adolescents with primary obstructive megaureter who received single-port intravesical laparoscopic Politano-Leadbetter in Fujian Provincial Hospital from January 2018 to November 2019, including 7 males and 4 females, 8 patients with left stenosis and 3 patients with right stenosis. The mean age was (13.5±2.4) years old, and the mean weight was (49.4±11.2) kg. Before surgery, the anteroposterior diameter of the affected renal pelvis was (3.25±0.69) cm, the maximum diameter of the ureter was (2.25±0.48) cm, the thickness of the affected renal cortex was (1.34±0.52) cm, and the renal function was (36.00±2.86) %. All patients underwent Politano-Leadbetter by single-port intravesical laparoscopic. Suprapubic bladder approach was used to establish a single-hole air bladder channel, and the end of the ureter was dislocated and cut, the submucosal tunnel of the bladder was established, and the end of the ureter was re-embedded. The Politano-Leadbetter ureteral replantation was completed.The dilatation and tortuousness of the affected renal pelvis and ureter and the changes of renal function of the affected kidney were analyzed before and after operation.Results:All operations were completed successfully.The operative time was (95.6±18.5) min, the intraoperative blood loss was (6.8±2.3) ml, the postoperative indwelling catheter time was (4.5±1.8) d, and the average hospital stay was (6.2±2.4) d. Postoperative follow-up time was (13.6±4.3) months.12 months after surgery, the anteroposterior diameter of the affected renal pelvis and the maximum diameter of the ureter were (2.00±0.45) cm and (1.18±0.22) cm, which were significantly lower than those before surgery ( P< 0.05). The thickness of the renal cortex was (2.17±0.49) cm, and the renal function was (44.00±1.41) %, which was significantly increased compared with that before operation ( P<0.05). Diuretic nephrogram showed no mechanical obstruction or no obstruction curve. One patient developed urinary tract infection 6 weeks after operation and recovered after removal of double J tubes.The other patient presented degree I ureteral reflux 6 months and 1 year after surgery, without urinary tract infection and low back pain.All the other children recovered well without postoperative complications.All parents were satisfied with the incision. Conclusions:Single-port intravesical laparoscopic Politano-Leadbetter for the treatment of adolescents with primary obstructed megareter can improve hydronephelectasis of the renal pelvis and renal function of the affected kidney, and overcome the difficulty of injury due to fat pad hypertrophy in the bladder area above the pubic bone and the establishment of conventional pneumo-bladder laparoscopy, the operation effect is ideal, few complications, safe and feasible.

OBJECTIVES: To explore the expression of autophagy related genes 5 (ATG5) and cyclin E in coronary heart disease (CHD) and its clinical significance. METHODS: From April 2018 to August 2018, 80 patients diagnosed with CHD in the Second Xiangya Hospital, Central South University were selected as an observation group, and another 80 healthy subjects were selected as a control group. The expression of ATG5 and cyclin E mRNA in nucleate cells and the plasma protein in the 2 groups were detected and analyzed. The model of macrophage-derived foam cells induced by oxidized low density lipoprotein (ox-LDL) was used to simulate atherosclerosis. The proliferation of macrophage- derived foam cells and the protein levels of ATG5 and cyclin E induced by ox-LDL at different concentrations were examined. RESULTS: Compared with the control group, the levels of ATG5 mRNA and protein in the blood in the observation group were decreased, and the cyclin E mRNA and protein levels were increased, there were statistically difference (both <0.05). Receiver operating characteristic (ROC) curve showed that the area under curve (AUC) of ATG5 mRNA, cyclin E mRNA, ATG5 protein and cyclin E protein were 0.739, 0.780, 0.671 and 0.807, respectively. Pearson analysis showed that the ATG5 mRNA was negatively correlated with the cyclin E mRNA (=-0.734, <0.05),while the plasma ATG5 protein was negatively correlated with the plasma cyclin E protein (=-0.746, <0.05). Macrophage-derived foam cell model induced by ox-LDL showed that the proliferation of foam cells and the expression levels of cyclin E protein were increased in a concentration and time-dependent manner, and the expression levels of ATG5 protein were decreased in a concentration-dependent manner. CONCLUSIONS The levels of ATG5 mRNA and protein are lowly expressed while the levels of cyclin E mRNA and protein are highly expressed in the patients with CHD.The ATG5 protein levels are lowly expressed in ox-LDL-treated macrophage-derived foam cells while the cyclin E protein levels are highly expressed in ox-LDL-treated macrophage-derived foam cells. Based on these observations, we conclude that ATG5 inhibits the degradation of the cyclin E and promotes the proliferation of macrophages, involving in the occurrence and development of CHD.
Autophagy ; Autophagy-Related Protein 5 ; Coronary Disease ; Cyclin E ; Foam Cells ; Humans ; Lipoproteins, LDL