PURPOSE: This study aimed to evaluate the prognostic impact of lymphovascular invasion (LVI) in patients treated with radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC). MATERIALS AND METHODS: We collected data from 180 patients who were treated with RNU from 2005 to 2013 at our institution. The Kaplan-Meier method with log-rank test and Cox proportional hazards regression models were used for univariate and multivariate analyses. RESULTS: LVI was present in 28 patients (15.6%), which was associated with higher pathological tumor stage (p < 0.001), tumor necrosis (p=0.012), lymph node metastasis (p=0.017) and multifocality (p=0.012). On multivariate analysis, LVI was an independent prognostic factor of recurrence-free survival [RFS: hazard ratio (HR)=2.954; 95% confidence interval (CI)=1.539–5.671; p=0.001] and cancer-specific survival (CSS: HR=3.530; 95% CI=1.701–7.325; p=0.001) in all patients. In patients with node-negative UTUC, LVI was also a significant predictor of RFS (HR=3.732; 95% CI 1.866–7.464; p < 0.001) and CSS (HR=3.825; 95% CI=1.777–8.234; p=0.001). CONCLUSION: LVI status was an independent predictor in patients with UTUC who underwent RNU. The estimate of LVI could help physicians identify high-risk patients and make a better medication regimen of adjuvant chemotherapy.
Carcinoma, Transitional Cell ; Chemotherapy, Adjuvant ; Humans ; Lymph Nodes ; Methods ; Multivariate Analysis ; Necrosis ; Neoplasm Invasiveness ; Neoplasm Metastasis ; Prognosis ; Urinary Tract

Objective To investigate the correlation between ultrasound findings and clinical pathological types of adrenal cortical tumors(ACT).Methods The clinical data and ultrasonographic finding of 138 ACT patients undergoing surgical treatment in Affiliated Hospital of Qingdao University from January 2006 to December 2015 were retrospectively reviewed.The correlation between ultrasonic signs and pathological types of ACT was analyzed with Spearman method.Results There were 65 males and 73 females aged 18-71 years old.Among 138 cases,90 patients were characterized by hypertension,Cushing signs,Coon signs and abnormal sexual character, with the clinical diagnosis of adrenal cortical hyperplasia or adenoma;while 48 asymptomatic patients were first detected by ultrasonography.The coincidence rate of ultrasound and clinical pathological diagnosis was 92.0%(127/138),and 11 cases were misdiagnosed.The coincidence rate of ultrasound and surgical diagnosis was 94.2%(130/138), and 8 cases were misdiagnosed.The coincidence rate for no functional adenoma was 95.8%(46/48), for cortisol cortical adenoma was 94.1%(32/34),for aldosterone cortical adenoma was 93.6%(29/31),for cortical cysts was 9/10,for no functional adenocarcinoma was 5/6,for sexual abnormal cortical adenocarcinoma was 3/4,for cortisol cortical adenocarcinoma was 2/3,for mucous cortical adenoma was 1/2.The diameter of ACT was 0.6-11.5 cm.The low echo nodules of the adrenal region with a diameter <2.0 cm were associated with aldosterone cortical adenomas(r=0.485, P=0.01); the low echo or isoechoic nodules with a diameter 2.0-5.0 cm were associated with cortical adenomas or non-functional adenomas(r=0.567,0.452,P=0.01),and the circular non-echo nodules were associated with cortical cysts(r=0.483, P=0.01); the irregular nodules with a diameter >5.0 cm were associated with cortical adenocarcinoma(r=0.595, P=0.01).Conclusion The ultrasound image of ACT is related to different clinical pathological types,which can provide important information for clinical diagnosis and selection of surgical modalities.

Objective: To investigate the molecular mechanism of colistin resistance in Klebsiella pneumoniae (K.pneumoniae). Methods: Three clinical isolates of colistin-resistant K. pneumoniae (FK1149, FK1920 and FK1934) and three colistin-resistant mutants (FK660R, FK713R and FK729R) were investigated. Resistance genes of pmrAB, phoPQ, mgrB, crrAB, mcr-1 and mcr-2 were detected by PCR and then analyzed by sequencing. PROVEAN platform was used to predict changes in the biological functions of proteins related to drug resistance. Expression of pmrH, pmrC, mgrB and phoP genes was measured using quantitative real-time PCR. LPS silver staining and conjugation assay were performed to analyze the three clinical colistin-resistant isolates. Results: Amino acid substitutions in PmrA (G53V), PmrB (T157P, R256G), MgrB (F44C) and CrrB (E189K) were detected. ISkpn14 and IS5-like insertion sequences were detected in FK713R and FK729R, respectively. FK1149, FK1920 and FK1934 were negative for mcr genes. Compared with the wild-type strain, expression of pmrH and pmrC genes at the transcriptional level was increased in all investigated isolates. Changes in the expression of phoP and mgrB genes were also observed. A partial deletion of LPS was identified in FK1149. Conclusion LPS modification induced by inactivation of PmrAB or MgrB is the main molecular mechanism of colistin resistance in K. pneumoniae isolates in this study. Mutations in PmrA (G53V), MgrB (F44C) and CrrB (E189K) that might be related to colistin resistance are detected for the first time in clinical isolates of K. pneumoniae.

Betatrophin is a newly found factor that affects the metabolisms of sugar and fat , which is mainly ex-pressed in the liver and adipose tissue .This factor not only has an influence on the glucolipid metabolism , but also has regulating effect on replicating pancreatic βcell.Glucose and lipid metabolic disorder and the decrease in the number of pancreatic βcell are main risk factors of diabetes , diabetic great vascular complications and other com-plications.Therefore, betatrophin level has close relationship with diabetes .

Objective To explore clinical value of the color Doppler ultrasonic(CDU)and TNM staging of renal cell carcinoma.Methods 265 cases of renal cell carcinoma(RCC)confirmed by surgical pathology were retro-spectively analyzed.According to the WHO 2004 pathological types of classification standards and the American Joint Committee on Cancer(AJCC)cancer staging manual/6th TNMstaging criteria.The analyzed application of a CDFI to TNMstaging of renal cell carcinoma,and surgical pathology results werecompared.Results 265 cases of RCC and right kidney in 136 cases,129 cases of left kidney;Diameter of 1.5 -12.8cm;Pathological diagnosis of renal clear cell carcinoma in 226 cases(85.28%),28 cases of papillary renal cell carcinoma(10.57%),renal too color cell car-cinoma in 5 cases(1.89%),4 cases of multilocular cystic renal cell carcinoma(1.51%),Bellini duct carcinoma in 2 cases(0.75%).Diagnosis results of CDU and pathological in 250 cases(94.34%),CDU misdiagnosis leakage 15 cases(5.66%).Within the kidney showed low echo or high echo,and mixed echo lumps,and invasive growth to the surrounding tissues or organs sign for it.CDU showed the various blood flow signals were given priority to with renal clear cell carcinoma;CDU and surgical pathology TNMstaging coincidence rate was 90.40%(226 /250),inclu-ding T1 N0 -1 M0 ,T2 N0 -1 M0 ,T3 N0 -2 M0 -1 and T4 N0 -2 M0 -1 of coincidence rate were 92.12%(152 /165),85.71%(36 /42),82.14%(23 /28)and 100.00%(15 /15).Conclusion CDU can be used as the preferred method of diag-nosis and evaluation of renal cell carcinoma,which can can provide valuable information for TNMstaging.

Huazhong University of Science and Technology is one of the five schools that trial implementing eight-year program medical education of first batch.Eight-year program medical students in Tongji college came into obstetrics and gynecology clinical contact in 2010.According to the characteristics of students and discipline,obstetrics and gynecology department used multiple teaching methods and means as PBL teaching,integrated case management,typical clinical case conference,clinical diagnosis and treatment,academic lecture,research report,experimental design,scientific research and experi-ment,etc.Available practice mode was reformed.Those students accomplished clinical practice,and achieved expected effect.

Objective To understand the application and effect of problem based,case based and evidence based (PCE) combined teaching method in urology surgery clinical teaching.Methods A total of 50 clinical medicine students were selected.PCE combined teaching method was applied in urology surgery clinical teaching and the teaching effect was evaluated.Results The ratios of student who thought PCE combined teaching method could stimulate learning enthusiasm,improve learning efficiency and improve the abilities of logical thinking,inductive analysis,practical application,self-study,literature retrieval,innovation and team cooperation were 96％,94％,95％,94％,100％,88％,100％,96％ and 95％ respectively.All students thought this new teaching method could be extended in other subjects.Conclusions Application of PCE combined teaching method in urology surgery clinical teaching can achieve good teaching effect and it is worth recommending in clinical teaching.

BACKGROUND: The water molecules and biological macromolecules in human tissue may combine to form hydrate composite. Different types of macromolecules show different approaches to combine with water molecules. OBJECTIVE: To discuss the basic form of water molecules combined with biological macromolecules. METHODS: The theoretical hypothesis of texture composite hydration system was proposed. The relevant literatures were retrieved through the computer to discuss these issues. RESULTS AND CONCLUSION: According to the role of water in the hydrate composite, the composite ways can be divided into the following 4 groups. ①Surfaca composite: Hydrated membrane layers can form on the surface of globular protein or DNA molecules. The hydrated membrane layer shows that the speed of water molecular and hydrate density were reduced gradually from surface to inside. The hydrated layer makes the shape and physical state of the macromolecules stabilized, and it plays important role in forming of TCHS.②Swelling composite: As a result of the strong hydration of glycosaminoglycans, the hydrated proteoglycan often swells and shows high viscosity and hydrogel character. The hydrated proteoglycan play some mechanicalroles in connective tissue. For example, it can make the cartilage have a strong deformation-resistibility.③Hydrophobic composite: Hydr0phobic effect drives structural rearrangement, including the formation of bilayers (Bio-membrane). This hydrophilic-hydrophobic-hydrophilic "sandwich" structure is conducive to the self-stability in mechanics, combination with membrane protein and transmembrane transport. ④Slit composite: A lot of slit spaces with nano scale were existing inside and outside of the cells. Aqueous solution in the slit spaces shows some abnormal characters such as higher viscosity and lower ice point, because of the rearrangement of water molecules. Slit composite and surface composite have some universality, and it can be regarded the former as a special case of the latter. The classification way mentioned above has not any absolute connotations. However, the rational utilization of these hydration composite ways will be conducive to research the theory on textural composite hydrate system.

Objective To study efficacy and safety of large dose of pamidronate disodium in treatment for patients with painful bone metastasis of prostate cancer. Methods A total of 100 patients with painful bone metastasis of prostate cancer were randomized into large dose group and conventional dose group, with 50 cases each. Pamidronate disodium was administered by intravenous infusion, 90 mg on the first day and 60 mg on the second day for large dose group, and 60 mg on the first day and 30 mg on the second day for conventional dose group, respectively, every 4 weeks for two courses. Changes of pain,mobility, quality of life and adverse effect in patients before and after treatment were observed. Results After treatment, pain was relieved in 43 of 50 patients ( 86% ) in large dose group, significantly more than that in conventional dose group (21/50, 42% ) (χ2 = 22.79, P ＜ 0. 01 ). Both mobility and quality of life were improved in 39 and 33 patients ( 87% and 66% ), respectively in large dose group and 21 and 18 (46% and 36% ), respectively in conventional dose group (χ2 = 17.04 and 9. 00, P ＜0. 01 ). No severe adverse effect in both groups was observed. Conclusions Pain in patients with bone metastasis of prostate cancer can be significantly relieved with large dose of pamidronate disodium, as well as their quality of life improved.

Objective To analyze the hemodynamic characteristics in patients with iron deficiency anemia(IDA) using transcranial Doppler ultrasonography(TCD),and to discuss the diagnostic value of it.Methods There were 46 patients with IDA,among them 28 patients had moderate or severe anemia,and 18 patients had mild anemia.Hemodynamic changes in patients were observed with TCD,and compared with 40 case healthy controls. Results In addition to 3 case results of TCD were normal,the increase of velocity were found in the others patients.The cerenbral blood flow velocity of the moderate or severe anemia group were significantly higher than that of the mild anemia group(P<0.05),and these were significantly higher than that of the control group(P<0.01).The pulsatility index of the moderate or severe anemia group were significantly lower than that of the control group(P<0.01).2 case artery stenosis in 46 patients were found by TCD,there were 5 case with syncope in 46 patients.Conclusion The severness of anemia can be observed by the increased cerenbral blood flow velocities.TCD may be evaluat Effestiveness of blood flow,and TCD may be possible to raise the discover rate of artery stenosis in anemia.