Objective To detect the expression of Bmi-1 and p16 gene in transitional cell carcinoma of bladder(TCC) tissue and explore its clinical significance.Methods The expression of Bmi-1 and p16 gene were detected by real-time quantitative polymerase chain reaction in 61 cases of TCC tissue and 12 cases of normal bladder tissue.Results The expression of Bmi-1 gene in TCC tissue was significantly higher than that in normal bladder tissue (0.242 ± 0.129 vs.0.031 ± 0.011),and the expression of p16 gene was significantly lower than that in normal bladder tissue (0.059 ± 0.021 vs.0.165 ± 0.029),there was significant difference (P ＜ 0.05).The expression of Bmi-1 and p16 gene were highly correlated with pathological grades,clinical stages and tumor recurrence (P ＜ 0.05 or ＜ 0.01).But there were not correlated with age and gender (P ＞ 0.05).There was a negative correlation between the expression of Bmi-1 gene and p16 gene in TCC tissue(rs =-0.714,P＜ 0.05).Conclusions Bmi-1 gene high expression and p16 gene low expression may be involved in the occurrence and development process of TCC.Bmi-1 may decrease the expression of p 16 gene in some ways,and then lead to the occurrence and development of TCC.

Objective To evaluate the effect of transurethral feedback microwave thermotherapy with the ProstaLund CoreTherm Device (PLFT) in benign prostate hyperplasia ( BPH ) patients with high risk factors 24 months after treatment.MethodsSixty-two BPH cases with high risk factors of aged ≥ 80or complicating severe conditions of no less than one organ or system,were treated with PLFT under urethral local anesthesia.The average pre-treatment prostate volume,international prostate symptom score (IPSS),quality of life score (QOL) and maximal urinary flow (Qmax) were 62.03 ml,23.19,4.58 and 4.33 ml/s,respectively.The changes of prostate volume,IPSS,QOL and Qmax at 3 months,12 months and 24 months after treatment were analyzed.ResultsAll patients tolerated well of PLFT performed in common therapy room except lightly bleeding,minor infection and temporary incontinence.There was no severe surgical adverse event.After 3 months,the prostate volume reduced to 43.85 ml,IPSS decreased to 11.63,QOL decreased to 2.44,Qmax rose up to 11.44 ml/s； The average values were 45.10 ml,12.23,2.61 and 10.91ml/s at 12 months after treatment.The corresponding values were 45.80 ml,12.37,2.66 and 10.82 ml/s,respectively at 24 months after treatment.Compared with pre-treatment,all the parameters showed significant improvement ( P ＜ 0.01 ).ConclusionsPLFT is one of the effective and safe treatment options for BPH patients with high risk factors.It can be safely used on day-surgery patients.The best effect appears at 3 months after treatment.

Objective To detect the gene expression of PCA3 and PSA in peripheral blood and urine simultaneously to investigate whether PCA3 combining PSA gene could become new markers for diagnosis of Pca. Methods From June 2009 to December 2009,the initial urine after prostatic massage and the peripheral blood specimens were collected from 37 patients with PCa and 68 patients with BPH that were pathologically confirmed,g patients with urinary stone were used as normal control,the expression of PCA3 and PSA mRNA of mononuclear cells in urine sediments and peripheral blood were detected by fluorescence real-time quantitative PCR,with β-actin mRNA as internal control. Results The sensitivity and specificity of the expression of PCA3 mRNA in peripheral blood for diagnosis of prostate cancer were 48.6％ and 100％ respectively.ROC curve analysis was performed for the PCA3 score and the area under the ROC curve was 0.908.Using 64.6 as the cutoff,the sensitivity was 81.1％ and the specificity was 86.8％.In group with serum tPSA value ＜4 pg/L,the positive rate and negative rate of urinary PCA3 score for diagnosing prostate cancer were 80％ (4/5) and 89.4％ (20/22) respectively.In group with serum tPSA value 4 - 10 μg/L,the positive rate and negative rate of urinary PCA3 score were 66.7％ ( 2/3 ) and 84.2％(16/19) respectively.In group with serum tPSA value ＞ 10 μg/L,the positive rate and negative rate of urinary PCA3 score were 82.8％ (24/27) and 81.5％ (22/27) respectively.The sensitivity of simultaneous detection of PCA3 mRNA in peripheral blood and urinary PCA3 score was 86.5％. Conclusions The expression of PCA3 mRNA in peripheral blood was a specific marker for the diagnosis of PCa.The simultaneous detection of PCA3 mRNA in peripheral blood and urinary PCA3 score could increase the sensitivity for the diagnosis of PCa.

Objective To evaluate the feasibility and effectiveness of bladder-preserving local resection combined with intra-artery chemotherapy for patients with T1G3 bladder cancer.Methods Thirty five cases with T1G3 bladder cancer were analyzed retrospectively. Patients were all treated by bladder-preserving local resection combined with intra-artery chemotherapy. Results Thirty five cases were followed up. The time of follow-up ranged from 7 to 116 months,and mean time was(66.0±18.3)months.The 5 year recurrence and bladder-preserving rate were 48.6 ％(17/35)and 68.6 ％(24/35),respectively.The overall and tumor specific survival at 5 years was 77.1％ (27/35)and 82.9 ％ (29/35).The effect of bladder-preserving local resection plus intra-artery chemotherapy was satisfactory. Moreover, intra-artery chemotherapy had no obvious side effects.Conclusion Bladder-preserving local resection combined with intra-artery chemotherapy not only can retain normal bladder function, decrease in the recurrence, but also does not reduce the survival rate. It is an effective treatment for some patients with T1G3 bladder cancer instead of cystectomy over-treatment.

Objective To investigate the application of highly selective alpha 1-blockers in treatment of ureteral stone after extracorporeal shock wave lithotripsy (ESWL). Methods One hundred and twenty patients with ureteral stone who accepted ESWL were divided into three groups by random digits table,each 40 cases. Tamsulosin group received tamsulosin (0.4 mg,once daily) after ESWL,doxazosin group received doxazosin (4 mg,once daily) ,control group were given no ureteral smooth musclar relaxant served. All patients were observed for 2 weeks. Results During the 2 weeks, only 4 patients withdrew due to adverse drug reactions. In tamsulosin group and doxazosin group, the stones expulsion rate [89.7%(35/39), 83.8%(31/37) respectively] were significantly higher than control group [65.0%(26/40)] (P＜0.05), the expulsion time [(3.1-1.2), (3.7 ± 1.4) d] were significantly lower than control group [(6.5 ±1.1) d] (P ＜0.05),the incidence of renal colic [12.8%(5/39), 21.6%(8/37)] and the stone street formation rate [7.7% (3/39), 13.5% (5/37)] were significantly lower than control group [45.0% (18/40) and 40.0% (16/40)] (P ＜ 0.05). But there was no significant difference between tamsulosin group and doxazosin group (P ＞ 0.05). Orthostatic hypotension occurred in 1 patient in tamsulosin group, but 7 patients experienced orthostatic hypotension in doxazosin group,the difference was significant (P ＜ 0.05).Conclusions Highly selective alpha 1-blockers can improve the stone-free rate of ureteral stone after ESWL,reduce expulsion time,decrease renal colic rate,and it is safe and tolerated. It can be regarded as an auxiliary clearance method after ESWL for ureteral stone.

ObjectiveTo evaluate the value of intraoperative frozen section examination (IFS) in the diagnosis and surgical procedures selection for renal occupying lesions. MethodsFrom January 2006 to December 2010,IFS was used in 114 men and 81 women with renal occupying lesions.The mean age was 52 years (range 17 -78).In 104,89,and 2 patients,lesions were in the right,left and bilateral kidneys,respectively.All patients underwent physical examination,129 were asymptomatic at presentation while clinical symptoms were observed in 66.The largest dimension of the tumors were 4 cm or less in 128 patients,4- 7 cm in 49,and larger than 7 cm in 18,respectively.The outcomes between IFS and postoperative routine paraffin section examination were compared.In cases with renal tumors nephrectomy or partial nephrectomy was performed.The results of IFS were compared between the 2 groups. ResultsThe sensitivity and specificity of IFS for renal malignant lesions was 96.6％ and 100％,respectively.The total accuracy rate of IFS for renal occupying lesions was 97.4％.By subgroup analysis,the accuracy rate of clear cell carcinoma,papillary cell carcinoma,chromophobe cell carcinoma,sarcomatoid cancer,nephroblastoma,benign tumor and urothelial cancer was 94.3％,25.0％,16.7％,0,0,97.6％ and 100.0％,respectively.Partial nephrectomy and nephrectomy were performed in 57 and 123 patients with renal tumors,respectively.The surgical procedures selection was significantly associated with the lesion size (4 cm or less for 80.7％ vs 62.6％,P =0.015) and the malignant lesion diagnosed by IFS (31.6％ vs 93.5％,P＜0.001). Conclusion The accuracy of frozen section analysis for renal malignant lesions during surgery is reliable and significantly high,and the results can exert an important impact on surgical procedures selection.

Objective To evaluate the value of renal parenchymal volume and thickness by non-contrast spiral CT in evaluating the differential glomerular filtration rate (GFR) for chronic obstructed kidneys, and to compare the correlations between the two morphologic indices of renal parenchyma and the GFR for chronic obstructed kidneys. Methods Seventy-one patients who had a diagnosis of unilateral chronic upper urinary tract obstruction were included in this analysis. (1) The renal parenchymal volume was mea-sured by non-contrast spiral CT. Both kidneys were scanned by non-contrast spiral CT. The renal parenchymal area of each section was marked manually. Renal parenchymal volume was calculated as the sum of renal parenchymal area multiplied by the width of each section. The volume percentage of obstructed kidney (%CTvol) was also calculated. (2) Renal parenchymal thickness was measured on the first and last non-contrast CT image levels from the anterior, posterior and lateral locations of the kidney that clearly contained the collecting system. The mean of these measurements was defined as the renal parenchymal thickness. The differential renal parenchymal thickness of the obstructed kidney (%CTt) was defined as the percentage of the obstructed renal parenchymal thickness to the total renal parenchymal thickness for both kidneys. GFR was determined with 99Tcm-DTPA dynamic imaging system by Gates method. The differential GFR for obstructed kidney (%GFR) was the GFR percentage of obstructed kidney to the total GFR for both kidneys. The Pearson relation test was carried out between the %CTvol, %CTt and the %GFR respectively. Results %CTvol and %CTt correlated well with %GFR in chronic obstructed kidneys among the 71 test group patients. Pearson correlation coefficient r was 0.80 (t=11.20, P＜0.05) and 0.66 (t=7.24, P＜0.05), respectively. The linear correlation equation respectively was %GFR=0.05+0.80×%CTvol (F=125.48, P＜0.05) and %GFR=0.12+0.66×%CTt (F=52.36, P＜0.05). Conclusions Renal parenchymal volume and thickness by non-contrast spiral CT might be used as clinical practical parameters to evaluate the differential GFR for chronic obstructed kidneys. Renal parenchymal volume is more accurate than renal parenchymal thickness.

BACKGROUND: Studies have demonstrated that incidence rate of acute rejection in renal transplant recipients with pre-production of major histocompatibility complex class I chain-related gene A (MICA), including parts of autoantibody, before transplantation in body, is obviously greater than that of recipients with negative antibody. OBJECTIVE: To investigate effects of exogenous antigen on MICA expression in endothelial cells. METHODS: The endothelial cells were cultured with exogenous recombinant MICA protein (group M5, M10 and M25) and heat shock protein-70 (group H5, H10 and H25) with dosages of 5, 10 and 25 μg/L, respectively, for 48 hours. Same volume of phosphate buffer saline was added into the control groups. RESULTS AND CONCLUSION: At 48 hours after induction, the expressions of MICA mRNA and protein were increased significantly in each experimental group (M5, M10 and M25) than that of the control group with significant (P < 0.05). The expression of MICA mRNA and MICA protein of group M5 and group M10 were remarkably higher than group M25 (P < 0.05); however, there was no significant difference between group M5 and M10 (P > 0.05). The expression of MICA membrane protein in the group M10 was obviously greater than that of the group M5 and M25 (P < 0.05). The level of soluble MICA (sMICA) in experimental groups (M5, M10 and M25) was decreased obviously comparing with that of the control group. These differences had statistical significances (P < 0.05). But there was no significant difference among the experimental groups (P > 0.05). However, the expression of MICA gene and sMICA level did not change after heat shock protein-70 stimulation. The exogenous MICA antigen up-regulates the expression of MICA mRNA and protein, especially increases the expression of membrane protein on the cell surface significantly, but sMICA in supernatant was dramatically decreased.

Objective To investigate the approach and safety of minimally invasive surgical procedures treating symptomatic caliceal diverticular calculi. Methods Clinical data of 21 cases with symptomatic caliceal diverticular calculi were retrospectively reviewed. Twelve females and 9 males aged 22 to 57 years old. The average diameter of caliceal diverticulum was 3.7 cm (2.5-7.0 cm) and average diameter of calculi was 2.3 cm (0.8-3.5 cm). The patients underwent flexible ureteroscopic lithotripsy, PCNL or mPCNL, laparoscopic techniques and laparoscopy-assisted transperitoneal PCNL, respectively. Four cases underwent flexible ureteroscopic lithotripsy. PCNL (2 cases) or mPCNL(5 cases)were performed in 7 cases. Nine cases underwent laparoscopic techniques. Laparoscopyassisted transperitoneal PCNL was performed in 1 case. Results The operations were performed successfully in 21 cases. No case need to transfer to open surgery during the operation and no major complications like perforation or organic injury were noted. One case with iatrogenic arteriovenous fistula of the kidney after 1 week postoperative was cured by delayed hemorrhage 2 days later, while clinical symptoms of 2 cases with residue calculi relieved. 19 cases without residue calculi were followed up for 6 to 12 month without recurrence. Conclusions After handling indication of treatment efficiently and creating advisable therapeutic decision-making, minimally invasive surgical procedures treating symptomatic caliceal diverticular calculi appears to be effective and safe.

Objective To investigate the prediction of anti-human leukocyte antigen antibodies (HLA) and anti-major histocompatibility complex class I-related chain A antibodies (MICA) to the development of acute rejection (AR) and kidney allograft function. Methods Forty-one kidney transplant patients were prospectively tested for anti-HLA and anti-MICA. Thirty-seven patients were screened using Luminex/single-antigen beads to determine the HLA and MICA-specific antibody levels at 0,30,90, 180,360,720 and 1080 days post-transplantation. The patients and donors of HLA and MICA allele typing were determined by PCR-SSOP, and donor specific antibody (DSA) and non-donor specific antibody (NDSA) were identified.Simultaneously,their serum creatinine (SCr) levels and clinical data were analyzed. Results Nine patients (21.95 % ,9/41 ) had pre-existing anti-HLA and(or) anti-MICA, including 6 cases of anti-MICA,2 cases of anti-HLA, and one case of anti-MICA and anti-HLA. Nine patients had pre-existing DSA and NDSA. In the 37 patients, 6 patients (16.2% ) developed de novo anti-HLA, and 3 (8.1%) developed de novo antiMICA. In patients positive for de novo anti-HLA, the titer of antibody was gradually increased during the follow-up of three years. Four patients out of 9 patients with pre-existing antibodies were suffered from AR (44.4%); In 6 patients positive for de novo anti-HLA,three cases (50.0%) were suffered from AR; In three patients positive for de novo anti-MICA,no AR occurred (P＜0.05). In two patients positive for DSA of HLAⅡ antibody detected at the third and seventh day after transplantation, the renal grafts were renovecd due to rejection. The Scr levels in patients positive for pre-existing MICA with AR were higher than in those positive for pre-existing MICA without AR at each scheduled time point during the follow-up period (P＜0.05). The Scr levels in patients negative for antibodies pre-transplantation and having AR were higher than in those having no AR at each scheduled time point during the follow-up period (P＜0. 01 ). The Scr levels in patients positive for de novo HLA and MICA and having AR one month following transplantation were higher than in those negative for antibodies and having no AR (P＜0.01 ). Conclusion Pre-existing and de novo anti-HLA were the irnportant factors for the development of AR, but the mismatch of HLA and MICA alleles in donors and patients was primary causes for generation of de novo antibodies.