Objective To evaluate the risk factors of urethral recurrences following radical cystectomy for transitional cell carcinoma of the bladder and to discuss the treatment options. Methods Clinical data of 278 patients who underwent radical cystectomy for bladder cancer were analyzed retrospectively. Urethral recurrences were observed in 24 patients. Risk factors of recurrence were evaluated by Cox's multifactor regression model. Results None of the 6 patients undergoing selective prophylactic urethrectomy died;10 of the 24 patients with urethral recurrence died of tumor metastasis.Multiple factor analysis suggested that prostate involvement,bladder neck involvement,trigone tumor,multiple tumor and carcinoma in situ were the high risk factors,and their relative risk coefficients were 1.573,1.532,1.360, 1.337 and 1.213,respectively. Conclusions Simultaneous urethrectomy following radical cystectomy should be performed for patients with high risk factors (prostate involvement, bladder neck involvement, trigone tumor,multiple tumor and carcinoma in situ) of urethral recurrence,while patients without risk factors are eligible candidates for reconstruction of the urinary tract after cystectomy by an orthotopic neobladder.

Objective To investigate the role of NF-kB in radiation-induced apoptosis ot human non-Hodgkin lymphoma (NHL) cells and the mechanism involved.Methods Three human non-Hodgkin lymphoma cell lines,Namalwa,Ramos,and Raji cells were divided into control,IR and IR + QNZ ( 10nmol/L) groups,respectively.Annexin-V kit was used to determine cell apoptosis. Protein expression levels of Survivin,Bax,Bcl-2 and cleaved Caspase-3 were evaluated by Western blot.Survivin mRNA was quantified by real-time PCR.Results Inhibition of NF-kB by QNZ pretreatment significantly enhanced X-ray induced apoptosis in human NHL cells in a dose-dependent manner (t =2.93 - 12.52,P ＜ 0.05).At the same time,QNZ significantly reversed the expression levels of Survivin protein and mRNA that were upregulated by radiation(t =3.29 - 16.72,P ＜ 0.05).QNZ also increased the levels of Caspase-3 and proapoptotic protein Bax,but reduced anti-apoptotic protein Bcl-2 expression level and hence the ratio of Bcl-2/Bax.Conclusions Inhibition of NF-kB could enhance radiation-induced cell apoptosis in human NHL cells through down-regulating Survivin expression and decreasing Bcl-2/Bax ratio.

Objective To investigate the sequence variations of mitochondrial D-loop region in chronic glomerular nephritis patients and family members and their possible associations with chronic glomerular nephritis.Methods 20 patients with chronic glomerular nephritis and 48 unaffected pedigree members,as well as 122 cases of normal control were recruited.mtDNA extracted from peripheral blood were examined by PCR-based assay for D-loop sequence variations,followed by sequencing analysis.Results Compared with the normal control and standard sequence,a total of 61 sequence variants were detected,among these,three high variations were found,and the base variation rate of patients with chronic glomerular nephritis(CGN)and unaffected pedigree members(UAPM)(0.88%,0.72%)significantly increased compared with the control group(0.61%).The distibutional difference of base variation rate in the experimental groups were significantly higher than those in the control group(x2=21.220,7.964,all P<0.05).Especially in microsatellite variation in D310 region,the mutation frequency and base variation rate in patients with CGN were 100.00% and 30.00%,respectively,which of UAPM were 81.30% and 17.95%,respectively,while those in the normal control group were 53.30% and 6.05%,respectively.Among them,the patients with CGN compared with the control group had statistically significant differences(x2=15.610,150.047,all P<0.05).Likewise,UAPM also had statistically significant difference compared with the control group(x2=11.347,66.188,all P<0.05).Conclusion D-Loop of mitochondrial genome mutations may be related to the development of chronic glomerular nephritis.

Objective To evaluate the susceptibility of Chlamydia trachomatis clinical isolates to rifampin, and assess the relationship between rpoB mutations and antibiotic resistance in them.Methods A microculture method was used to determine the minimal inhibitory concentration (MIC) of rifampin in 52 Chlamydia trachomatis clinical isolates.The rpoB gene was amplified from all the clinical isolates and a standard strain of Chlamydia trachomatis followed by single-strand conformation polymorphism (SSCP)analysis.Sequencing of PCR products was carried out for two clinical isolates.Results No rifampin-resistant strain was found among these clinical isolates.The MIC of rifampin varied from 0.004 to 0.030 mg/L Neither SSCP analysis nor sequencing showed rpoB mutations.Conclusions No rpoB mutations were found in Chlamydia trachomatis isolates from patients unresponsive to rifampin.The unresponsiveness to rifampin may be attributed to multiple factors.

Objective To study the effect of Shaoyaozhitong Mixture on stageⅢ-Ⅳendometriosis, and explore its mechanism. Methods Ninty-five cases of stageⅢ-Ⅳ endometriosis were randomly divided into three groups. The traditional Chinese medicine (TCM) group (31 cases) was treated with Shaoyaozhitong Mixture, the GnRHa group (31 cases) was treated with Triptorelin Acetate for Injection, while the expectant group (33 cases) received no medications. The changes of CA125, TNF-α and VEGF levels, visual pain score and SF-36 score, total effective rate, pregnancy and recurrence were compared. Results There were significant increases in CA125, TNF-α and VEGF levels, visual analogue pain score and SF-36 score in all the three groups after treatment (P<0.05). The decline of CA125, TNF-αand VEGF levels and visual analogue pain score in TCM group and GnRHa group was significantly faster and greater than that of the expectant group (P<0.05). The total effective rates of TCM group was 83.9%(26/31), GnRHa group was 87.1%(27/31), and expectant group was 60.6%(20/33), TCM group and GnRHa group were superior to the expectant group, respectively (P<0.05). The pregnancy rate was higher and recurrence rate was lower in TCM group and GnRHa group than that of expectant group, but there was no statistical difference (P>0.05). Conclusion Shaoyaozhitong Mixture is effective in treating endometriosis by inhibiting the growth of ectopic endometrium.

Objective Toinvestigate the molecular characteristics including antibiotic resistance,strain type,serotype,virulence,biofilm formation of Streptococcus pneumoniae isolated from Shanghai adult patients.Methods A total of 37 non-repetitive S.pneumoniae isolates causing community acquired and hospital acquired infections of adults were collected from Shanghai Huashan Hospital from January 2011 to December 2013.The inhibitory zone diameter or minimum inhibitory concentrations (MICs) of 9 antimicrobial agents (penicillin,vancomycin,erythromycin,clindamycin,levofloxacin,cefprozi,ceftriaxone,cefotaxime and linezolid) were determined by Kirby-bauer (K-B) method or Etest method;Serotypes were tested by polymerase chain reaction (PCR) and S.pneumoniae antisera agglutination;Genomic characteristics of different serotype strains were determined by pulsed field gel electrophoresis (PFGE)method;Multilocus sequence types (MLST) was used for strain type;Semi quantitative biofilm formation test was used for the biological membrane formation.Ten main pneumococcal virulence genes (cbpA,pspA,cps2A,lytA,nana,pavA,piaA,ply,psaA and spxB) were detected by PCR and gel electrophoresis.Statistical analysis was performed using Stata software and association statistics were tested using Fisher's exact test.Results The most frequent serotypes were 19F (13.5％),23 F (13.5％),14 (10.8％),19A (10.8％).The penicillin resistance rate was 64.9％.Serotypes 19 F,19A and 23 F were significantly associated with penicillin resistance (x2 =5.89,P =0.015) and the isolates belonged to these serotypes were all multi-drug resistant (MDR).ST81 and ST271 showed high resistance rates to several antibiotics including penicillin (x2 =4.57,P =0.033).Biofilm formation was significantly associated with serotypes 19A (x2 =5.55,P =0.018) and strain type ST320 (x2 =4.33,P =0.037),but not associated with penicillin resistance (x2 =0.16,P =0.686).Virulence gene lytA,pavA,ply,psaA,spxB were found in all isolates.Conclusions Penicillin resistance rate of S.pneumoniae in adult is rising.Specific serotype,epidemic clone and antibiotic resistance are closely related,and can provide the basis for the infection control.The virulence factors such as PspA will be the new targets for vaccine development to reduce S.pneumoniae infection in the future.

Objective To test the in vitro acitivity of azithromycin, minocyline, moxifloxacin, doxycycline and rifampicin alone or in combination against three standard strains of urogenital Chlamydia trachomatis,i.e. D-UW-5/Cx, E-UW-5/Cx and G-UW-5/Cx. Methods Three standard strains of C. trachomatis were inoculated into McCoy cells, and used to susceptibility testing after more than 90% McCoy cells were infected.Microdilution method was applied to determine the activity of the 5 antimicrobial agents alone, and checkerboard array to determine that in combination. Results The in vitro minimal inhibitory concentrations (MICs)were 0.25 mg/L for azithromycin, 0.06 mg/L for moxifloxacin, 0.063 - 0.25 mg/L for doxycycline, 0.032 -0.064 mg/L for minocyline, 0.008 mg/L for rifampicin. And, the fractional inhibitory concentration index was constantly 0.75 for the combination of azithromycin with moxifloxacin, doxycycline and rifampicin, 2.5, 2.83and 4 for the combination of minocyline with azithromycin, moxilloxacin and rifampicin, respectively. Conclusions As far as the activity against C. trachomatis is concerned, there is a synergism for the combination of azithromycin with moxifloxacin, doxycycline and rifampicin, but antagonism for the combination of minocyline with azithromycin, moxifloxacin and rifampicin.

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 test the in vitro susceptibility to macrolides of urogenital Chlamydia trachomatis (Ct) isolates, screen resistant Ct strains, and to explore resistance mechanism at the molecular level. Methods A total of 42 Ct strains were isolated from cervical or urethral swab samples and propagated in McCoy cells until the infection rate reached more than 90%. Then, susceptibility test was performed to evaluate the activity of three macrolides. Reverse transcription PCR and PCR were used to amplify two macrolide-resistance related genes, i.e., 23S rRNA gene and L4 gene, respectively in 2 erythromycin-resistant Ct strains and 4 erythromycin-sensitive strains followed by direct sequencing. Results The minimal inhibitory concentration (MIC) varied from 0.5 to 2 mg/L for erythromycin, 0.008 to 0.032 mg/L for clarithromycin, 0.125 to 0.5 mg/Lfor azithromycin. Erythromycin resistance was found in 2 isolates with the MIC value being 2 mg/L. Two mutations, C2452A and T2611A/C (Escherichia coli numbering) in the 23S rRNA gene, were detected in the resistant strains only, while the other 2 mutations, Pro113Leu and Pro156 Ala in L4 gene, were observed in all the tested strains. Conclusions Erythromycin-resistant Ct strains have emerged in clinical settings. The low-level erythromycin resistance may be associated with C2452A and T261 1C mutations in the 23S rRNA gene, whereas the point mutations in L4 gene is unlikely related to erythromycin resistance.

Objective To test the in vitro activity of azithromycin against recent clinical isolates of urogenital Chlamydia trachomatis, and combined activity of azithromycin with moxifloxacin, rifampicin, doxycycline and minocyline. Methods When more than 90% McCoy cells were infected, the 41 strains tested were collected to investigate minimal inhibitory concentrations (MICs) of 5 antimicrobials alone. Checkerboard array was used to calculate the fractional inhibitory concentrations(FICs) and then detected the interactions among the various combinations. Results In vitro, synergism or additivity effect of 51.22%,53.66% and 58.54% strains was found in azithromycin-moxifloxacin, azithromycin-doxycycline and asithromycin-rifampicin combinations, respectively. No difference was observed in all of the combinations ( P ＞0.05). However, antagonism effect of 90.24% strains was observed in azithromycin-minocyline combination. Conclusion This study indicates that the combination of azithromycin with moxifloxacin, doxycycline or rifampicin is more effective against Chlamydia trachomatis than individual antimicrobials. Therefore, these antimicrobials combinations might be recommended against Chlamydia trachomatis recurrent or persisitent infection. However, the combination of azithromycin with minocyline exhibited a markedly antagonism activity against Chlamydia trachomatis. Combined sensitivity test to a certain extent can compensate for some shortcomings of individual susceptibility test.