The traditional Chinese medicine Aralia elata (Miq.) Seem., also known as Aralia mandshurica, has the effect of "tonifying Qi and calming the mind, strengthening the essence and tonifying the kidneys, and dispelling wind and invigorating blood circulation". It is used in the treatment of neurasthenia, Yang deficiency and Qi deficiency, kidney Qi deficiency, spleen Yang deficiency, water-dampness stagnation, thirst, and bruises. Aralia elata saponins are the main components for the pharmacological effects. From the perspective of modern pharmacological science, Aralia elata has a wide range of effects, including anti-myocardial ischaemia and alleviation of secondary myocardium ischemic reperfusion injury by regulating ionic homeostasis, anti-tumor activity by inhibiting proliferation, promoting apoptosis and enhancing immunity, hypoglycemia and lipid lowering effects by regulating glucose and lipid metabolism, and hepato-protective, neuroprotective, anti-inflammatory/analgesic effects. The studies on pharmacological mechanisms of Aralia elata will be conducive to its development and application in the future. This article reviews the research progress of Aralia elata domestically and internationally in the last two decades and proposes new directions for further research.
Aralia ; Yang Deficiency ; Apoptosis ; Saponins/pharmacology* ; Myocardial Ischemia

Molecular glues can specifically induce aggregation between two or more proteins to modulate biological functions. In recent years, molecular glues have been widely used as protein degraders. In addition, however, molecular glues play a variety of vital roles, such as complex stabilization, interactome modulation and transporter inhibition, enabling challenging therapeutic targets to be druggable and offering an exciting novel approach for drug discovery. Since most molecular glues are identified serendipitously, exploration of their systematic discovery and rational design are important. In this review, representative examples of molecular glues with various physiological functions are divided into those mediating homo-dimerization, homo-polymerization and hetero-dimerization according to their aggregation modes, and we attempt to elucidate their mechanisms of action. In particular, we aim to highlight some biochemical techniques typically exploited within these representative studies and classify them in terms of three stages of molecular glue development: starting point, optimization and identification.

Objective:To explore the detection rate of prostate cancer and clinically significant prostate cancer (CsPCa) in three puncture methods: targeted biopsy fusion with MRI and ultrasound imaging, system puncture, and combined puncture.Methods:The clinical data of 164 patients who underwent both targeted biopsy and systematic biopsy in Zhejiang Provincial People's Hospital from April 2019 to April 2020 were retrospectively analyzed. The median age was 67(33-90)years. Preoperative serum tPSA was 8.97(0.64-95.63)ng/ml and fPSA was 1.31(0.29-9.25)ng/ml. There were 96 patients result in tPSA<10 ng/ml, 65 and 3 patients result in 10≤tPSA<50 ng/ml and tPSA≥50 ng/ml. The prostate volume was 34.9(11.6-152.0) cm 3. According to result of PI-RADS score, there were 42 patients got 3 points and 66, 56 patients got 4 and 5 points respectively in PI-RADS score of suspicious nodules. First, a targeted puncture (targeted biopsy) was performed on the suspected lesions by fusion imaging of magnetic resonance and ultrasound. Then 12-needle systematic prostate biopsy was performed under the guidance of ultrasound. Those two methods performed together was called combined biopsy. This study compared the detection rates of prostate cancer and CsPCa among the three popular methods in all cases, different PI-RADS cases, and different tPSA cases. Results:In this study, patients was detected as positive result in 126 of 164 patients. The detection rates of prostate cancer in targeted biopsy and systematic biopsy were 66.46%(109/164) and 64.02%(105/164), respectively, the result reveals no statistical significance ( P=0.64). In contrast, the positive rate of combined biopsy [76.83%(126/164)] was higher than targeted biopsy ( P=0.04) and systematic biopsy ( P=0.01), and the difference was statistically significant. In the detection rate of CsPCa, the positive detection rates of targeted biopsy group, systematic biopsy group and combined biopsy group were 50.61%(83/164), 45.12%(90/164) and 54.88% (126/164), respectively. Moreover, there was no significant statistical significance among the three groups ( P>0.05). Group comparison was analyzed according to PI-RADS score. In PI-RADS 4 group and PI-RADS 5 group, combined biopsy was[90.91%(60/66), 100.00%(56/56)] and systematic biopsy was [71.21%(47/66), 87.50%(49/56)] which reveals significant difference in prostate cancer detection rates ( P=0.00, P=0.01). In PI-RADS 4-5 groups, the detection rate of prostate cancer by targeted biopsy [86.89%(106/122)] was significantly higher than systematic biopsy [78.69%(96/122), P=0.01], but still lower than that by combined biopsy [95.08%(116/122), P=0.03]. The CsPCa detection rates of PI-RADS 3 group targeted biopsy, systematic biopsy and combined biopsy were 2.38%(1/42), 7.14%(3/42) and 7.14%(3/42), respectively. There were 59.09%(39/66), 46.97%(31/66) and 62.12%(41/66) in PI-RADS 4 groups, respectively; There were 78.57%(44/56), 71.43%(40/56) and 82.14%(46/66) in PI-RADS 5 groups, respectively, with no statistical significance ( P>0.05). However, in PI-RADS 4-5 groups, the CsPCa detection rate of combined biopsy [71.31%(87/122)] was higher than that of systematic biopsy [58.20%(71/122)], with statistical significance ( P=0.03). In the tPSA<10 ng/ml group, the prostate cancer detection rate of combined biopsy[72.92%(70/96)] was higher than that of systematic biopsy[59.38%(57/96)], and the difference was statistically significant ( P<0.05). There was no significant difference between the detection rate of targeted biopsy[61.43%(59/96)]and combined biopsy ( P=0.09). In the group of 10ng/ml≤tPSA<50ng/ml, the prostate cancer detection rates of targeted biopsy, systematic biopsy and combined biopsy were 72.31%(47/65), 69.23%(45/65) and 81.54%(53/65), respectively, and there was no statistical significance ( P>0.05). In tPSA≥50 ng/ml group, the prostate cancer detection rate of the three biopsy methods was 100.00% (3/3), and there was no statistical significance ( P>0.05). Conclusion:For patients with highly suspected prostate cancer on multiparameter MRI(PI-RADS 4-5) or tPSA<10 ng/ml, combined biopsy was an appropriate method to diagnose the prostate cancer.

Prostate cancer (PCa) is one of the most common invasive cancers in men. Radical prostatectomy is the gold standard for localized prostate cancer, but the postoperative biochemical recurrence rate can reach 20%-50%. In some cases, salvage lymph node dissections (SLND) seem to improve cancer control and delay systemic treatment. In this article, we review the current state of diagnostic imaging, accurate patient selection criteria, exploration of SLND surgical procedures, as well as the safety and tumor outcomes of SLND. Overall, although there is still a lack of strong prospective evidence to support the role of SLND, advances in preoperative imaging techniques and the widespread use of minimally invasive surgery have led to encouraging tumor outcomes with SLND. However, further large-scale and high quality trials are needed to confirm the effectiveness and safety of SLND.

Objective:To investigate the efficacy and safety of green laser vaporization enucleation of the prostate with end-fire fiber in the treatment of benign prostatic hyperplasia.Methods:The clinical data of 218 patients with benign prostatic hyperplasia admitted to Zhejiang Provincial People's Hospital from August 2018 to July 2019 were retrospectively analyzed. All 218 patients presented symptoms of varying degrees of frequent voiding, urgency, nocturia, and progressive dysuria, with age of(76.2±8.4) years, prostate volume of(77.3±21.6) ml, and preoperative PSA of (3.5±0.9)ng/ml, preoperative maximum urine flow rate (Qmax)of(7.9±1.8)ml/s, residual urine volume of(82.3±26.3)ml, quality of life score(QOL) of(4.9±1.1)points, and International Prostate Symptom Score (IPSS) of (25.4±7.6) points. Lithotomy position was used intraoperatively, and intravenous combined general anesthesia or intraspinal anesthesia was performed before the green laser vaporization enucleation of the prostate. Intraoperatively, green laser equipment used a vaporization power of 80W, an optical fiber with a end-fire fiber of 800μm in diameter, and hemostasis power of 20W. The surgical procedure was firstly to vaporize and cut 3 grooves from the bladder neck to the ejaculatory hole plane of the prostate at 5, 7 and 12 o'clock, reaching deep enough to expose the surgical capsule, in order to set up" three lines and one side" anatomical landmarks. A combination of sheath peeling and vaporization cutting along the envelope layer was used to enucleate the hyperplastic glands according to the " three-leaf " method. After enucleation, the tissue was pushed into the bladder, and the enucleated tissue was crushed and aspirated with a tissue morcellation. Perioperative and postoperative parameters including vaporized enucleation time, tissue morcellation time, hemoglobin changes, bladder irrigating time, indwelling catheterization time, postoperative hospital stay, postoperative Qmax, residual urine volume, postoperative complications, IPSS and QOL were recorded. Urgency with involuntary urine leakage was diagnosed as urge incontinence, involuntary urine leakage after coughing was diagnosed as stress urinary incontinence, and the incontinence degree was defined according to the amount of pad used, with mild of 1-2 pads/day, moderate of 3-4 pads/day, and severe of 5 or more pads/day.Result:All 218 operations were successfully completed. Capsule perforation occurred in 8 cases(3.7%), and there was no bladder perforation. The time of vaporization and enucleation was (42.5±8.3)min, and the time of tissue morcellation was(12.1±3.4)min. The intraoperative and postoperative hemoglobin loss was(4.7±1.3)g/L, and there were no blood transfusion or re-operation for stopping bleeding. The average bladder irrigation time after operation was(6.3±1.6)h, the average indwelling catheterization time was(1.2±0.2)days, and the average postoperative hospital stay was (2.2±0.7)days. The Qmax 1 month after operation was(18.5±4.8) ml/s, and the residual urine volume of the bladder was(6.4±1.9)ml, which showed a statistical difference compared with the preoperative parameters( P<0.01). In addition, the QOL(2.1±0.4) and IPSS(7.1±2.1)showed a statistical difference at 3 months follow-up, compared with the parameters before or 1 month after the operation( P<0.01). The volume of the prostate at 3 months after the operation was(34.6±6.3) ml, and the PSA was(2.4± 0.5) ng/ml, which was statistically different from the preoperative corresponding parameters( P<0.01). During the follow-up within one year, 11 cases were detected incontinence during the 1-month follow up, including 6 cases of urge incontinence. After drug treatment, good continence achieved 3 months after the operation. The other 5 cases had stress urinary incontinence, 3 of whom got good continence after the drugs treatment and pelvic floor muscle exercise, and two patients recovered to one pad per day. A total of 24 cases of urethral stricture were found during the 12-month follow-up, including 16 cases of anterior urethral stricture, which was treated with 3 months of regular urethral dilation. Another 8 cases had bladder neck contracture, and were treated by bladder neck resection and regular urethral dilatation. All of them did not recur 6 months after the procedure. Conclusions:The end-fire green laser vaporization enucleation of the prostate has the advantages of short operation time, less intraoperative bleeding, and obvious improvement in postoperative symptom scores. The short-term effect is obvious, and the long-term effect still needs further study to confirm.

Objective:To evaluate the clinical efficacy and safety of ultrasound negative pressure suction with percutaneous nephroscope in the treatment of perirenal abscess.Methods:The clinical data of 11 patients with perirenal abscess admitted to Zhejiang Provincial People's Hospital from January 2013 to February 2021 were retrospectively analyzed. There were 4 males and 7 females. The average age was 59(51-76) years. The abscess was located on the left side in 4 cases and on the right side in 7 cases. The average diameter of abscess was 11.2(8.1-19.2) cm. All patients had fever, low back pain and abdominal mass, accompanied by bladder irritation in 6 cases, gross hematuria in 5 cases, abdominal distension, nausea and anorexia in 3 cases. There were 7 cases with type 2 diabetes, 2 cases with rheumatoid arthritis and 6 cases with ipsilateral kidney and ureter stone. Among the 11 patients, 6 had a history of urinary tract infection, 1 had a history of upper respiratory tract infection, 1 had secondary infection of perirenal hematoma after traumatic renal rupture, and 3 had secondary infection of perirenal hematoma after percutaneous nephroscopy. All patients were treated with ultrasound negative pressure suction with percutaneous nephroscope under local anesthesia by single operator. The operation time, intraoperative blood loss, drainage volume, drainage tube indwelling time, postoperative body temperature returned to normal time, postoperative hospital stay, therapeutic effect and complications were analyzed.Results:All operation procedures of 11 patients were successfully completed, including 8 cases of single channel, 2 cases of double channels and 1 case of three channels. The average operation time was 44(20-74)min, the average amount of blood loss was 15(10-20)ml, the average amount of pus was 325(200-500)ml, the average indwelling time of drainage tube was 8(6-12)d, the average time of body temperature returned to normal was 0.9(0.5-2.0)d, and the average hospitalization time was 9.6(7.0-14.0)d. Before discharge, CT reexamination showed that the perirenal abscess disappeared. There were no serious complications during and after operation. The average follow-up time was 4.4(3-8) months. There was no recurrence in all patients.Conclusions:Ultrasound negative pressure suction with percutaneous nephroscope is one of the safe and effective surgical methods for the treatment of perirenal abscess. It has the advantages of small trauma, quick recovery, complete drainage, exact effect and fewer complications.

Objective To discuss outcome and safety after implementation of enhanced recovery after surgery(ERAS) protocols to patients who underwent robotic assisted radical cystectomy (RARC) with intracorporeal orthotopic "U" shaped ileal neobladder creation using STAPLER technique.Methods Between October 2014 and April 2019,71 patients(59 males and 12 females)with MIBC (Muscle Invasive Bladder Cancer) who underwent RARC with intracorporeal urinary diversion using orthotopic "U" shaped ileal neobladder in Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College) were studied retrospectively.They had an average age of (65.2 ± 5.6)y and BMI of (22.18 ± 3.75) kg/m2.The median age-adjusted charlson comorbidity index (aCCI) was 4,median ASA score was 2.All patients underwent these inspections pre-RARC:chest Xray,vascular ultrasound (jugular vein included),abdominal ultrasound,CT urography,cystoscopy with biopsy or TURBT(trans-urethral resection of a bladder tumour).All patients were pathological diagnosed with MIBC,with no evidence of systemic metastasis and no history of radiotherapy,systemic chemotherapy and open abdominal surgery before RARC.All 71 patients received RARC with intracorporeal orthotopic "U" shaped ileal neobladder creation using STAPLER technique.Between October 2014 and September 2016,37 cases (29 males and 8 females) were managed without ERAS protocols perioperatively.They had an average age of (65.3 ±5.7)y and BMI of (23.66 ± 3.47)kg/m2.The median aCCI was 4,median ASA score was 2.Between October 2016 and April 2019,another group of 34 cases (30 males and 4 females) were managed with ERAS protocols including nutritional assessment,thrombosis prevention,pain assessment and management,perioperative diet management etc.They had an average age of (64.5 ± 4.3) y and BMI of (21.87 ± 4.85) kg/m2.The median aCCI was 4,median ASA score was 2.There were no statistical significance between the two groups with regard to general information.Surgical and follow-up data were collected for all patients.Results Surgeries were successful in all 71 cases with postoperative follow up for 3-51 months.In ERAS group,there were 22 cases in pT2 and 12 cases pT3 according to classification of malignant tumours:with 2 cases of incidental prostate cancer (IPCa).In non-ERAS group,pT2 in 25 cases and pT3 in 12 cases:with 1 case of IPCa.Statistical significance were observed between groups with regard to the first anal exhaust time [(20.5 ± 18.7) h vs.(29.9 ± 17.4)h,P =0.032],the first defecation time [(72.6 ±27.1)h vs.(88.7 ±35.8)h,P =0.004],length of hospital stay after surgey [(14.1 ± 3.3) d vs.(16.2 ± 4.8) d,P =0.037],numeric rating scales (NRS) Pain Score 8.0,24.0,48.0 h after surgery [(3.2 ±0.5)vs.(3.6 ±0.8),P =0.015;(1.9 ±0.3) vs.(2.2 ± 0.6),P =0.011;(1.3 ± 0.4) vs.(1.6 ± 0.7),P =0.032],respectively.There were no significance between groups with regard to operating time [(290 ± 65) min vs.(282 ± 46) min,P =O.549],intraoperative blood loss [(190.5 ± 235.6) ml vs.(221.1 ± 250.3) ml,P =0.438],transfusion rate [5.9％ (2/34) vs.8.1％ (3/37),P =0.922],readmission within 30 days after surgery [2.9％ (1/34) vs.5.4％ (2/37),P =0.940],early severe complications(within 30 days) [2.9％ (1/34) vs.2.7％ (1/37),P =0.940],late severe complications (after 30 days) [5.9％ (2/34) vs.8.1％ (3/37),P =0.922].Conclusions The implementation of ERAS protocols to patients who underwent RARC with intracorporeal orthotopic "U" shaped ileal neobladder using STAPLER technique is safe and effective.It can reduce postoperative pain and hospital stay,shorten bowel recovery time,improve early functional recovery without increasing major complications.This adoption should be encouraged.

Objective To evaluate the clinical efficacy and safety of robotic-assisted laparoscopic Boari flap ureteroplasty for ureteral strictures after kidney transplantation.Methods The clinical data of 2 patients with ureteral stricture after kidney transplantation in our department from May 2017 to September 2017 were retrospectively analyzed.All 2 cases were male.Case 1 was 73 years old and the transplanted kidney was located in the left iliac fossa.The patient was hospitalized due to still recurrent fever with longterm retention of nephrostomy tube because of hydronephrosis with repeated urinary tract infection after calculi surgery.Case 2 was 62 years old and the transplanted kidney was located in the right iliac fossa.The patient was hospitalized due to hydronephrosis and ureteral calculi after calculi surgery.All 2 cases were treated by robotic-assisted laparoscopic Boari flap ureteroplasty.The operative and postoperative complications were recorded and the postoperative examination data were collected.Results The operation time of the 2 cases were 165min and 189min,and the bleeding amount were 50ml and 100ml respectively.No urinary leakage,renal colic,high fever and other complications occurred.In case 1,nephrostomy tube was removed 8d after operation.The urinary catheters were removed 14d after operation in the 2 cases.The postoperative hospital day was 9d and 6d respectively.CT examination was performed 3 months after surgery.Compared with preoperative,case 1 had no significant change in hydronephrosis and the hydronephrosis of case 2 obviously relieved.In case 1,double J tube was removed in 3 months after operation.In case 2,double J tube was replaced in 3 months after operation and was removed after 3 months.2 patients were followed up to 18 months and 14 months after operation,respectively.Nohydronephrosis aggravated.Conclusions Robotic-assisted laparoscopic Boari flap ureteroplasty is a safe and effective treatment for ureteral strictures after kidney transplantation.It has the advantages of small trauma,quick recovery,exact effect and few complications.

Objective: To investigate the clinicopathologic and differential diagnostic features of glomus tumor of the kidney. Methods: Four cases of glomus tumor of the kidney were collected from the archives of Peking University Third Hospital, the Second Hospital of Tianjin Medical University, Ningbo Yinzhou Second Hospital and Zhejiang Provincial People′s Hospital between January 2012 to June 2017; the clinical and radiologic features, histomorphology, immunohistochemistry, ultrastucture and prognosis were analyzed and the relevant literature was reviewed. Results: Patients consisted of 2 men and 2 women with ages ranging from 37 years to 66 years (mean 55 years). Three patients had history of hypertensive disease (grade Ⅱ, 3 to 10 years). The tumors measured in maximum diameter from 3.0 cm to 4.0 cm (mean 3.6 cm) and showed gray-white to yellow and tan on cut surface. Macroscopical examinations showed all tumors were circumscribed but non-encapsulated. Histologically, 1 tumor presented as glomus tumor with extensive myxoid change, 1 as cellular and solid pattern glomus tumor, 1 as glomangioma with focal myopericytoma-like pattern and 1 as symplastic glomus tumor with areas resembling myopericytoma. The tumor cells in two cases showed scant cytoplasm and uniform, bland-appearing nuclei without mitoses. In one case, the tumor cells were epithelioid with abundant eosinophilic cytoplasm and relatively well-defined cell borders. There was an increased mitosis of 4/50 HPF; however, no evidence of atypical mitosis or nuclear atypia was noted. In the symplastic glomus tumor the tumor cells showed frequently nuclear pleomorphism without mitoses. By immunohistochemistry, all tumors showed strong and diffuse reactivities to at least 3 of the 4 muscle-associated markers (SMA, h-Caldesmon, MSA and Calponin), 3 tumors strongly and diffusely expressed collagen Ⅳ, 2 expressed CD34 and 1 focally expressed desmin; whereas markers including epithelial, neuroendocrine, nephrogenic, melanoma-associated, STAT6, S-100 protein, CD117 and β-catenin all were negative in all the 4 tumors. Ultrastuctural analysis was done in 2 cases and showed prominent cytoplasmic actin bundles and pericellular basement membrane, and lacking of rhomboid renin crystals in both tumors. The hypertension persisted after surgical resection for all the 3 patients with this medical history. Follow-up information (range: 6-64 months, mean: 44 months)showed that no evidence of local recurrence or distant metastasis was identified in all 4 patients. Conclusions Glomus tumor rarely occurs in the kidney and usually has a good prognosis. Careful attention to its morphology with the judicious use of immunohistochemistry and ultrastuctural analysis can be helpful for its diagnosis and differential diagnosis.

Objective: To investigate the clinicopathologic features, diagnostic and differential diagnostic aspects of pigmented microcystic chromophobe renal cell carcinoma (ChRCC). Methods: Five cases of pigmented microcystic ChRCC were collected at Zhejiang Provincial People′s Hospital from January 2013 to January 2018. The clinical features, gross and histological appearances, immunohistochemistry and prognosis were analyzed and the relevant literature was reviewed. Results: There were 3 men and 2 women with age range of 45 years to 72 years (mean 57 years). All tumors were incidentally identified by imaging examinations. Grossly, the tumors were well-demarcated and showed diameters ranging from 1.8 cm to 4.0 cm(mean 2.9 cm). On cross section, the tumors were brown to gray tan with solid cut-surface mixed with multiple cysts of variable sizes. Hemorrhage was common, central scar was not seen. Microscopically, the tumors were composed predominantly of irregular and variable-sized microcystic or tubulocystic patterns, with extensive cribriform structures formation and focal adenomatous rearrangements seen in one case each, and focal pseudo-papillary structures (lacking true fibro-vascular cores) seen in two cases. Microscopic calcifications and psammoma bodies were present in all tumors. Four tumors composed mostly of eosinophilic cells whereas 1 predominated in plant-like cells. Brown pigmentations, either intracytoplasmic or extracytoplasmic, were noted in all five cases. The tumor cells had irregular, low-grade nuclei (Paner grade: 1) frequently with binucleation and perinuclar halos. Tumor necrosis or sarcomatous transformation was not seen. By immunohistochemistry, the tumor cells expressed CK, EMA, and E-cadherin diffusely and strongly in five cases; and CK7 and CD117 diffusely in four cases. They were negative for vimentin, CD10, CA9, AMACR/P504s, TFE3, HMB45, Melan A, S-100 protein, synaptophysin and chromogranin. Partial nephrectomies were performed for all five patients; there was no tumor recurrences or metastases at a follow-up of 2 to 55 months (mean, 17 months). Conclusions Pigmented microcystic ChRCC is a rare histological variant of ChRCC with relatively indolent behavior, and shows morphologic heterogeneity which can elicit a wide range of differential diagnoses. Careful attentions to search for typical features of classic ChRCC with the use of immunohistochemistry can help to distinguish this tumor from its many mimickers.