Diamond-like carbon(DLC)films age characterized by hish wear resistance,low friction coefficients and chemical inertness,and thus hish-corrosion resistance.The properties of DLC can further be modified by incorporating other elements in the films,such as N,F,AS,and so on,to adjust them for specific applications.These properties make the films good candidates as biocompatible coatings for biomedical devices and implants.The review gives an overview of the biomedical chagacteristics of diamond-like carbon films and their potential apphcafions.

Objective To report the modified surgical technique currently used for the construction of an orthotopic ileal neobladder.So as to improve the vesical function of urinary storage and urination after total cystectomy. Methods Radical cystectomy and ileal neobladder with double “U” shape were performed in 20 patients with transitional cell carcinoma. After the detubularized ileal segment approximately 40 cm in length was arranged in a U configuration,the two medial borders of the U-shaped open segment were oversewn with a single layer seromuscular continuous 2-0 polyglycolic acid suture.The bottom of the U was folded over between the two ends of the U.Thus a spherical pouch, the neobladder, was fashioned. During that period, the neobladder anastomosed to the urethra.The ureters were implanted according to the improved stitching method. Results The operative time to form a neobladder was (90?15)min.Follow-up turned out that no perioperative or early postoperative mortality was observed, and no severe early complications occurred. The mean postoperative follow-up time was 25 (range,6 to 48) months.All the 20 cases achieved excellent continence except for 6 cases with temporary incontinence at night.Dysuria occurred in 1 case,and hydronephrosis on the left was found in 1 case.Six months later, the mean bladder capacity was 340 ml (range,250 to 450 ml). Conclusions The construction of an ileal neobladder using a smaller part of ileum that has been completely detubularized and fashioned by double U shape is easy and agreeable to perform.This mode of operation has low complication rates, achieves adequate capacity at low pressure, and provides satisfactory continence rates.

Objective To investigate the etiology,clinical presentation,diagnosis and treatment of inverted papilloma of the ureter. Methods The clinical data of 3 cases (all males,age range from 61 to 67 years) of inverted papilloma of the ureter were analysed retrospectively.All of 3 cases were diagnosed intraoperatively with the frozen section.Of them 1 case underwent segmental excision of the papilloma at ureter;1,nephrectomy plus subtotal ureterectomy;and 1,orthotopic excision of the papilloma. Results Postoperative pathology of the 3 cases confirmed the diagnosis of inverted papilloma of the ureter.No recurrence and metastasis were found postoperatively during a follow-up of 4.5,17 and 46 months in the 3 cases respectively. Conclusions Inverted papilloma of the ureter is a rare benign tumor with a good prognosis.Endoscopy and biopsy are the most important diagnostic procedures.Excising the local lesion and retaining the renal function is the preferred therapeutic choice.

Objective To establish a rat model of chronic nonbacterial prostatitis (CNP) and investigate the histopathological characteristics of CNP in rat. Methods The prostate tissues of 4 male SD rats were taken out under aseptic condition,and prostate tissue homogenate supernate (PTHS) was made.Another 20 male SD rats were randomly divided into control group and CNP group with 10 rats each.Each rat of group CNP was immunized with 1.0 ml PTHS (20 mg/ml) emulsified by isopyknic Freund's complete adjuvant (FCA) intradermally in the multiple points,and simultaneously immunized with 0.5 ml pertussisdiphtheria-tetanus (PDT) vaccine intraperitoneally on 0 and 30th day.Each rat of control group was injected with equivalent normal saline in the same way.Rats from each group were sacrificed 45 days after immunization,and the prostates were harvested under aseptic condition.Prostatic tissues were examined macropathologically and histologically for degree of inflammation.Another 80 CNP rats were established after confirming success of the modeling.They were divided into high-dose androgen group (H),medial-dose androgen group (M),low-dose androgen group (L) and control group (C) with 20 in each.Rats of group H,M and L were injected with different concentrations of testosterone propionate ( 1,2,4 mg/ml).Rats of group C were injected with sterilized peanut oil.O.5 ml was applied through subcutaneous injection every other day.Each group was equally divided into 4 subgroups,in which the durations of medication were 1,2,4 and 6 weeks,respectively.After the expiration of the injection,animals from each subgroup were sacrificed and the macropathological and histological features of the prostatic tissues were examined as above. Results Macroscopic features of prostate tissues of group CNP at the 45th day were serious congestion and edema,adhesion with surrounding tissues,aneretic prostate capsule and so on.Histologically,the prostatic tissues were characterized by lymphoid tissue proliferation and chronic inflammatory cell infiltration in the stromal connective tissue around the acini or ducts.The rats of control group showed no inflammatory manifestations as above.After injection of testosterone propionate,the inflammatory degree of the CNP rats was lessen in varying degrees.For example,the destructive glands and stroma appeared repair and regeneration,the lymphoid tissue proliferation was alleviated,and the locations,ranges and amount of chronic inflammatory cell infiltration were also decreased.Furthermore,the relief of inflammatory degree had a positive correlation with the concentration and duration of testosterone propionate.The degree of inflammation in group C scarcely changed. Finally,the histopathological characteristics of CNP in rat model were summarized according to the results of histopathology,including inflammation locations,ranges and grades.Inflammation locations:①inflammation in the glands referred to the inflammatory cell infiltration in the ductal epithelium,alveolar epithelial and (or)glandular cavity; ②inflammation in the periglandular tissues referred to the inflammatory cell infiltration in the stroma and around the glandulartube; ③inflammation in the stroma referred to the inflammatory cell infiltration in the stroma without the glandulartube.Inflammation-rangeg:①focal inflammation indicates that the area of inflammatory cell infiltration was less than 10％ ; ②multifocal inflammation indicates that the area of inflammatory cell infiltration ranged from 10％ to 50％ ; ③diffuse inflammation indicates that the area of inflammatory cell infiltration was more than 50％.Inflammation grades:①grade Ⅰ meant that scattered inflammatory cells were in the specific area,cell count 1 - 10/HP; ②grade Ⅱ meant that inflammatory cell assembled without glandular epithelial tissue destruction or lymphoid nodule/follicle formation,cell count l1 -20/HP; ③grade Ⅲ meant that inflammatory cell assembled with part of glandular epithelial tissue destruction or lymphoid nodule/follicle formation,cell count ＞ 20/HP; ④grade Ⅳ meant that inflammatory cell assembled with a mass of glandular epithelial tissue destruction or lymphoid nodule/follicle formation,cell count full field of vision/HP. Conclusions The CNP rat model can be established by immunized with syngeneic PTHS plus FCA and PDT.The histopathological characteristics of CNP in rat can be evaluated according to the locations,ranges and grades of inflammation,which serve for further research of pathogenesis and treatment of this disease.

Objective To improve the diagnosis and treatment ot adrenocorticotropin-independent macornodular adrenal hyperplasia (AIMAH).Methods The clinical data of 17 cases with AIMAH from 2000 to 2011 were analyzed retrospectively,including 3 subclinical AIMAH,10 clinical AIMAH and 4 highrisk AIMAH patient,with common radiological characteristic of bilaterally enlarged adrenal glands with multiple nodules like ginger.The 3 cases of subclinical AIMAH patients presented with decreased serum ACTH,normal or slightly elevated plasma cortisol and urinary free cortisol level,no suppression following 1 mg overnight dexamethasone suppression test and absence of clinical signs of Cushing syndrome (CS).While clinical AIMAH and high-risk AIMAH presented with clinical signs of CS,elevated plasma cortisol and urinary free cortisol level,suppressed serum ACTH,loss of normal circadian rhythm in cortisol secretion and no suppression following the low-dose and high-dose overnight dexamethasone suppression test.Among the 4 cases of high-risk AIMAH,2 cases presented with osteoporosis,2 cases with hepatic dysfunction,3 cases with cardiopulmonary dysfunction,and 4 cases with severe hypertension.Three cases of subclinical AIMAH were treated with symptomatic treatment,10 cases of clinical AIMAH patients with surgical operation,4 cases of high-risk AIMAH patients with ketoconazole and surgical operation.Results Three subclinical AIMAH patients received symptomatic treatment and discharged from hospital with normal blood pressure and blood glucose.During the period of follow-up from 3 months to 3 years,endocrine results were normal.Seven clinical AIM AH patients underwent unilateral adrenal tumor resection plus ipsilateral partial adrenalectomy or total adrenalectomy.CS disappeared completely after 6 to 9 months.Two clinical AIMAH patients underwent simultaneous bilateral adrenalectomy.One case died of adrenal crisis after operation,and the other case presented with adrenal insufficiency but returned to normal after glucocorticoid replacement therapy,no Nelson's syndrome happened during the follow-up for 5 years.One clinical AIMAH patient undertook unilateral adrenalectomy twice by interval,followed by routine corticosteroid replacement therapy.Followed up for 10 years,no Nelson's syndrome happened.Four high-risk AIMAH patients received ketoconazole and then underwent right total adrenalectomy.Cortisol levels returned to normal after 1 to 2 months and during the follow-up for 1 to 3 years,the laboratory examinations maintained normal.Conclusions Different treatment methods should be adapted to different subtypes of AIMAH.For subclinical AIMAH,the principal treatment is symptomatic,and close follow-up with regular adrenal imaging and endocrine examination is required.Surgical operation should be performed when clinical symptoms of AIMAH appear.Medical management is essential for high-risk AIMAH to inhibit the production of cortisol at first.Once these patients could stand the stimulation caused by operation,the adrenal glands should be resected as soon as possible.The unilateral adrenalectomy is an effective treatment for clinical AIMAH.

ObjectiveTo investigate the diagnosis and treatment of adrenocorticotropin-independent macronodular adrenal hyperplasia (AIMAH). MethodsThe clinical data of 14 cases of AIMAH from August 1972 to July 2010 were retrospectively analyzed.The cases included 5 males and 9 females with a mean age of 45 (range 26 to 58 ) years.Ten patients demonstrated typical Cushing's syndrome (CS) and 4 patients presented with weight gain,hypertension or diabetes mellitus without any signs of CS.The circadian rhythm of serum cortisol was abnormal.Low and high dose dexamethasone suppression tests failed to suppress cortisol secretion.CT scan showed bilateral enlargement of the adrenal glands with multiple macronodules.All patients underwent open surgery,including 5 cases of unilateral adrenalectomy,6 cases of adrenalectomy combined with contralateral subtotal adrenalectomy and 3 cases of bilateral adrenalectomy.ResultsIt was established by pathological examination that all patients had bilateral adrenal macronodular or adenomatoid hyperplasia.During the mean follow-up of 69 months (range 12 to 120 months),the clinical symptoms of CS disappeared after surgery in all cases.The 5 patients who received unilateral adrenalectomy had urinary free cortisol and serum cortisol within normal ranges and no further enlargement of the contralateral gland was noticed.Among the 3 patients who received bilateral adrenalectomy,1 case died of adrenal crisis on day seven post-operation.The remaining 2 cases presented with adrenal insufficiency but returned to normal after glucocorticoid replacement therapy.Nelson's syndrome was not observed in the other patients.ConclusionsAIMAH has unique endocrinological and pathological features,presenting as an independent etiology of CS.Unilateral adrenalectomy appears to be an effective and safe alternative treatment for AIMAH and long-term remission can be achieved.Bilateral adrenalectomy or unilateral adrenalectomy combined with contralateral subtotal adrenalectomy may be performed if the symptoms have not improved or recurred after unilateral adrenalectomy.

Objective To investigate the clinical features , diagnosis and key technique points of laparoscopic partial adrenalectomy for small adrenal pheochromocytoma . Methods From Oct.2006 to Jun. 2011, clinical data of 32 cases with small adrenal pheochromocytoma (≤3.0 cm) were collected and retro-spectively analyzed .Hypertension was observed in 12 patients, whereas 20 patients presented with adrenal incidentaloma .Thirteen patients had a left adrenal neoplasm , eighteen patients had a right adrenal tumor , while one patients had bilateral tumors .The positive rate of plasma-free metanephrines ( MNs) and 24-hours urinary catecholamine (CA) in diagnosing small renal pheochromocytomas was 92.6%(25/27) and 81.3%(26/32) respectively.The main localization diagnosis included ultrasonography , 131I-MIBG, and CT or MRI, with positive rates of 71.9%(23/32), 93.8%(15/16) and 96.9%(31/32) respectively.All the laparoscopic adrenalectomies were performed retroperitoneally .During the surgery , the internal part of the adrenal gland closing to the retroperitoneum was dissected first , and the whole adrenal gland was resected completely. Results Partial adrenalectomy was performed for 30 cases and radical adrenalectomy for 2 ca-ses.All operations were successful without perioperative or postoperative complications .The maximum diame-ter of tumor was 1.7±0.2 (1.0-3.0) cm.Histopathological results showed that all the cases were benign pheochromocytoma.The operative time was 82 (40-210) min.The estimated blood loss was 57 (20-180) ml.No patient required blood transfusion . Conclusions Plasma-free MNs, 24-hours urinary CA and VMA are important qualitative examinations in detection of adrenal pheochromocytoma .Ultrasonography , CT,MRI, and 131 I-MIBG are important in the localization of adrenal tumors .Retroperitoneal laparascopic partial adrenalectomy is the preferred choice in the management of small adrenal pheochromocytoma .Dissecting the internal part of the adrenal gland closing to the retroperitoneum first and exploring the whole adrenal tissue are the key technique points during the operations .

Objective To evaluate the feasibility and advantages of robot-assisted laparoscopic radical prostatectomy (RALRP) in treating high-risk prostate cancer.Methods From Mar.2010 to Dec.2014,69 men with high-risk prostate cancer (clinical stage ≥ T3a,serum PSA ≥ 20 μg/L or biopsy Gleason score ≥8) underwent surgical treatment at our center.RALRP was performed in 44 cases,with a mean age of (66.7 ± 8.6) yrs (range:50 ～ 82) and a mean baseline PSA of (23.1 ± 11.2) μg/L (range:3.6-48.8).Transperitoneal approach was adopted in all cases.Twenty-five patients were treated with ORP.The mean age was (64.3 ± 5.9) yrs (range:52-75) and baseline PSA was (21.7 ± 10.2) μg/L (range:5.7-41.3).Baseline clinical features,including age,initial PSA,biopsy Gleason score and clinical staging,were comparable between two cohorts.Surgical outcomes after RALRP were analyzed and compared between groups.Results All RALRP procedures were successfully performed with da Vinci robotic system and there was no open conversion.Mean operation duration were similarly (158 ± 47)min for RALRP group and (152± 42)min for ORP group,respectively.The mean estimated blood loss and postoperative length of hospital stay in RALRP group were (328 ± 254) ml and (8.4 ± 3.1) days,both of which were significant lower than those in ORP group,(674 ± 302) ml and (14.4 ± 3.7) days.Two cases of urine leak and two of lymphatic leak occurred after RALRP,and a statistically insignificantly higher complication rate was observed for the ORP group,in which four of urine leak and three of lymphatic leak happened.The positive surgical margin rates of two groups were 20.5％ and 24％,respectively.After the mean follow-up of 25 (RALRP) and 27 months (ORP),continence rate was significantly higher in the RARLP group (93.2％ vs.72.0％).PSA failure was observed in seven RALRP cases (15.9％) and four ORP cases (16.0％).Conclusion Compared with traditional ORP,RALRP shows significant advantages,including less blood loss,fewer complications,shorter length of stay,better postoperative continence and equivalent oncologic outcome when dealing with high-risk prostate cancer cases.Robot-assisted surgery is a safe and efficacious surgical modality in this setting.

Objective To study the prognostic factors of survival in patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib.Methods From May 2008 to Dec 2012,the clinical data of 82 cases with mRCC adminstered by sunitinib were reviewed retrospectively.The study included 60 male patients and 22 female patients,whose age ranged from 29 to 82 years [mean (56.1±11.3) years].Among them,52 cases presented hematuria,flank pain and palpable mass.The size of renal tumor ranged from 2.0 to 18.0 cm [mean (8.0±3.0) cm].The location of tumor included 41 in left kidney,37 in right kidney and 4 in bilateral kidney.The pathological tissue obtained from the operation in 69 cases and from biopsy in 13 cases.The pathological results demonstrated renal cell carcinoma in 75 cases,papillary cell carcinoma in 2 cases,chromophobe cell carcinoma in 2 cases,sarcomatoid carcinoma in 2 cases,collecting duct carcinoma in one case.The site of metastasis included lung in 50 cases,liver in 11 cases,bone in 14 cases,pancrease in 3 cases,retroperitoneal lymph node in 31 cases.In 52 cases,the ECOG scores ranged from 1 to 2.The others scores were more than 3.The average level of hemoglobin,AKP,LDH and leukocyte were (132±24)g/L,(90±65) U/L,(168±114) U/L and (6.4±2.0)×109/L,respectively.Before treatment,the abnormal cases in those parameters were 59,9,6 and 2,respectively.According to the MSKCC risk model,14 cases were classified into the high risk group and 68 cases into medium risk group.74 cases were accepted the sunitinb therapy within one year after diagnosis and 8 cases were accepted same therapy until one year after diagnosis.The overall survival (OS) rates were calculated by Kaplan-Meier method and Cox regression model was used to analyze the relationship between the influencing factors and the prognosis.Results The average OS was (21.6± 14.1) months (ranged 2.8 to 64.1 months).The survival rate at 1 st,2nd and 3rd year were 71％,64％ and 58％,respectively.Single factor analysis showed that significant prognostic factors were as follows:ECOG performance status ≥ 2 (P =0.005),clinical symptom during first clinic visiting (P =0.031),without nephrectomy (P =0.012),the number of metastatic sites ≥ 2 (P =0.015),hemoglobin before treatment (P=0.005),serum AKP level before treatment (＞126 U/L) (P=0.007),MSKCC score≥ 3 (P =0.000),the presence of liver metastases (P =0.000) and bone metastases (P =0.000) and relative dose intensity in the first month (1M-RDI) of sunitinib ≥ 50％ (P=0.000).Cox regression model showed that the beneficial predictive factors were ECOG performance status＜2 (P=0.136),no symptom during the first clinic visiting (P=0.801),serum AKP ＜126 U/L (P=0.618) before treatment,the absence of bone (P =0.068) and pancreas metastases (P =0.265).Sunitinib 1M-RDI ≥ 50％ was the independent predictive factor (P=0.000).Conclusions In targeted therapy era,there is some change in the prognostic factors for mRCC and target drug play an important role in the prognosis of mRCC.Sunitinib 1M-RDI ≥50％ is the independent predictive factor for the prognosis of renal carcinoma.

Objective To assess the feasibility and efficacy of robot-assisted laparoscopic simple prostatectomy (RALSP) for the treatment of benign prostatic hyperplasia (BPH) with large prostate.Methods From January 2014 to July 2015,16 patients with large prostate (≥80 ml) were treated by RALSP.The average patient's age was 69 years.The prostate volume was (98.3 ± 12.9) ml,preoperative residual urine was (78.0 ± 24.8) ml,the average IPSS was (22.9 ± 5.9),the average QOL was (4.8 ±1.5) and the average Qmax was (8.9 ± 3.7) ml/s,respectively.All patients agreed to accept RASP.The pre-operative and three months post-operative IPSS,QOL,residual urine and Qmax were compared and analyzed.Results All 16 patients underwent the surgeries uneventfully.The average operation time was (92.5 ± 15.5) minutes,the estimated blood loss was (125.5 ±25.5) ml,drainage time was (4.6 ±0.8)days,catheterization time was (7.9 ± 1.2) days and postoperative hospital stay was (5.1 ± 1.1) days.Three months after surgery,patient's IPSS was (11.8 ± 3.1),QOL was (1.6 ± 0.9),the average residual urine was (12.3 ± 2.6) ml and Qmax was (29.4 ± 11.6) ml/s,respectively.All the parameters significantly improved compared with the preoperative data (P ＜ 0.05).Conclusions Robot-assisted laparoscopic simple prostatectomy is a safe and effective method for the treatment of BPH patients with prostate volume larger than 80 ml.