OBJECTIVE: To investigate the safety and prognostic factors influencing the treatment of upper urinary tract urothelial carcinoma (UTUC) combined with bladder cancer (BCa) by laparoscopic simultaneous radical cystectomy and nephroureterectomy (RCNU). METHODS: The clinical data of patients admitted to Peking University Third Hospital for laparoscopic RCNU surgery from January 2009 to September 2023 were analyzed retrospectively. Based on the same gender, age (±5 years), history of uroepithelial tumors, underlying diseases, T-stage, N-stage, M-stage, American Society of Anesthesiologists (ASA) score, Charlson comorbidity index, and body mass index (BMI) (±5), 34 patients with RCNU were matched 1 ∶1 with patients with bladder cancer who underwent laparoscopic radical cystectomy (RC) alone. Kaplan-Meier survival analysis was used to calculate patient survival, and Cox proportional regression risk model was used to analyze clinical factors affecting prognosis. RESULTS: Of the 68 patients enrolled, the follow-up rate was 100% with a median follow-up time of 27.0 (11.7, 60.2) months. Comparison of intraoperative conditions (including operation time, estimated intraoperative bleeding, intra-operative blood transfusion, etc.) between the two groups of patients showed no significant difference (P>0.05). Comparison of preoperative creatinine and postoperative creatinine between the two groups of patients showed significant differences (P < 0.05). The perioperative Clavien grade Ⅲ-Ⅳ complication rates were 2.9% (1/34) in the RC group and 5.9% (2/34) in the RCNU group. There was no significant difference in terms of perioperative complications between the two groups. Overall survival was significantly lower in the patients receiving RCNU compared with the matched group receiving RC alone (P < 0.05). Cox regression analysis suggested that two factors, high N stage and high postoperative creatinine, were independent risk factors affecting the prognosis of patients in the 2 groups (P < 0.05). CONCLUSION The overall survival prognosis of patients undergoing RCNU surgery was worse compared with laparoscopic RC surgery alone during the same period. There was no clinically significant difference between the two groups in terms of operation time, intraoperative bleeding, and perioperative complications, and there were clinically significant differences in preoperative renal function and post-operative renal function.
Humans ; Laparoscopy/methods* ; Nephroureterectomy/methods* ; Cystectomy/methods* ; Prognosis ; Male ; Retrospective Studies ; Female ; Urinary Bladder Neoplasms/mortality* ; Middle Aged ; Aged

Objective: To investigate the value of preoperative dynamic contrast-enhanced MRI in reducing the rate of tumor-positive resection margins after breast conserving surgery in patients with early non-mass breast carcinoma. Methods: Seventy-two patients with early non-mass breast carcinoma received ultrasonographic and mammographic examination and subsequently underwent dynamic contrast-enhanced MRI examination before breast conserving surgery. The control group consisted of 74 patients who had early non-mass breast carcinoma. They only received ultrasonographic and mammographic examination and didn′t undergo contrast-enhanced MRI examination. The comparison of the rate of tumor-positive resection margins between two groups was performed. The MRI findings that had the significant influence on the rate of tumor-positive resection margins were analyzed using Logistic regression model. Results: In 28 patients (28/72, 38.9%), dynamic contrast-enhanced MRI could correct or supplement the ultrasonographic and mammographic findings and resulted in the reasonable change of surgical program. The preoperative MRI examination group (n=30) had lower rate of tumor-positive resection margins than control group for invasive ductal carcinoma (23.3% vs 40.0%, P=0.02), but there was no significant difference (21.4% vs 26.9%, P=0.10) between two groups for ductal carcinoma in situ (n=28). The preoperative MRI examination group (n=14) had lower rate of tumor-positive resection margins than control group for the other pathologic types of breast carcinoma (14.3% vs 38.9%, P=0.02). The statistical analysis on the basis of Logistic regression model showed that some main MRI findings, including change surrounding the tumor, distance between tumor and nipple and tumor size, had the significant influence on the rate of tumor-positive resection margins. Conclusion Preoperative dynamic contrast-enhanced MRI significantly increased the accuracy of resection margins evaluation, and greatly reduced the rate of tumor-positive resection margins after breast conserving surgery in patients with early non-mass breast carcinoma.

OBJECTIVE:To provide reference for the rational application of antimicrobial drugs. METHODS:Medical records of all acute exacerbation of chronic obstructive pulmonary disease(AECOPD)hospitalized patients were collected from respiration department of our hospital during Sept. 2013 to Apr. 2014 and May 2014 to Dec. 2014,73 and 88 cases respectively. The applica-tion of antimicrobial drug was analyzed comparatively,and the rationality of drug use in AECOPD patients was evaluated. RE-SULTS:After the special rectification activities,the antimicrobial use intensity dropped from 217.74 to 91.58;drug combination rate dropped from 67.12% to 6.82%;no reason to change the antimicrobials conditions dropped from 15.07% to 0;hospital stay shortened from(10.21±3.44)d to(7.13±3.14)d;the total cost of medical treatment dropped from(6 117.73±1 164.52)yuan to (4 574.82±997.28)yuan;percentage of medicine expenses and antimicrobial drug expenses dropped from(61.83±11.49)% and (28.84±9.55)% to(43.52±9.97)% and(20.07±6.43)%,respectively;there was statistical significance(P<0.05),and the clinical treatment effect were uninfluenced. CONCLUSIONS:The special rectification activities of antimicrobial drugs could effec-tively improve the rational application of antimicrobial drugs and enhance the efficacy of antimicrobial drugs and decrease the cost of drug use.

Objective To study the expression situation of matrix metalloproteinase-9(MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in the endometrium of women with unexplained infertility and normal endometrium, and to explore the relationship between MMP-9/TIMP-1 expres-sion and unexplained infertility. Methods Immunohistochemieal assay(SP method) was employed to deteet the expression of MMP-9/TIMP-1 in 20 cases of impaired endometrium(unexplained infertility group,endometrial plantation window phase)and 20 cases of normal endometrium(heahhy control group). Results There were different levels of MMP-9/TIMP-1 expression in kytoplasms of glandular epicytes and stromal cells of all endometrial samples. The expression of MMP-9/TIMP-1 was signifi-cantly weaker in unexplained infertility group than that in healthy control group(P＜0.05). Conclusion Low expression of MMP-9/TIMP-1 in the endometrial plantation window phase may be one of impor-tant factors for unexplained infertility.

Objective To evaluate the effieaey of test bolus technique with multi-slice spiral CT (MSCT) for determining the optimal scan delay time in CT Hepatic artery (HA)-portal vein (PV) angiography and multi-phase scanning.Methods MSCT liver angiography and multi-phase scanning were performed in 187 patients divided randomly into two groups.In group A (n =59),the scan delay time was set according to the subjective experiences of operators; in group B (n=128),the scan delay time was determined by test bolus technique.Abdominal aorta and superior mesenteric,vein were selected as target blood vessels,and 50 HU was set as enhancement threshold value.20 ml contrast agent was injected intravenously and time-density curve of target blood vessels were obtained,then HA-PV scanning delay time were calculated respectively.The quality of CTA images obtained by using these 2 methods were compared and statistically analysed using Chi-square criterion.Resuits For hepatic artery phase,the images of group A are:excellent in 34(58%),good in 17(29%),and poor in 8 (13%),while those of group B are excellent in 128( 100%),good in 0(0%),and poor in 0(0%).For portal vein phase,the images of group Aare:excellent in 23(39%),good in 27(46%),and poor in 9(15%),while those of group B are excellent in 96 (75%),good in 28 (22%),and poor in 4 (3%) respectively.There was statistically significant difference between the ratios of image quality in group A and group B (X2=14.97,9.18,P < 0.05).Conclusion Accurate scan delay time was best determined by using test bolus technique,which can improve the image quality of liver angingraphy and multi-phase scanning.