Objective To compare the role on determining the functional location of primary hyperaldosteronism (PHA)by multi-slice spiral CT (MSCT)and by adrenal vein sampling (AVS),and to discuss the reasonable method to use MSCT and AVS in localization diagnosis of PHA.Methods Clinical data of 78 patients with PHA were analyzed retrospectively.These patients were diagnosed in our department from June 2014 to June 2018.There were 27 male and 51 female patients.With mean age of (47.5 ± 11.2) years old.The mean systolic blood pressure was (190 ± 24)mmHg and mean diastolic blood pressure was (111 ± 16) mmHg.The mean history of hypertension was (6.0 ± 6.0) years.The mean serum potassium was (2.4 ± 0.6) mmol/L.The mean plasma aldosterone concentration (PAC) was (415.7 ± 235.4) pg/ml.The mean plasma renin activity (PRA) was (3.2 ± 5.7) ng/(ml · h).The mean aldosterone/renin ratio (ARR) was 409.0 ± 434.9.All PHA patients underwent MSCT and AVS,the accuracy on determining the functional location of PHA by MSCT and by AVS were evaluated based on the pathological results and clinical outcomes.The influence of adrenal size and character on the accuracy of determining the functional location of PHA by MSCT were analyzed.Results The rate of accuracy of determining the location of PHA by AVS was higher than that by MSCT[100.0％ (78/78) vs.71.8％ (56/78),P ＜ 0.05].When MSCT indicated:adrenal hyperplasia,adrenal tumor volume less than 1 cm,1 cm ＜ adrenal tumor volume ≤ 2 cm,adrenal tumor volume ＞ 2 cm,the rate of accuracy in localization diagnosis with MSCT was 50.0％ (4/8),81.0％ (17/21),92.9％ (26/28),100.0％ (9/9) respectively.Its trend has statistical significance (P ＜ 0.05).The diagnostic accuracy rate of MSCT for aldosterone adenoma was 79.6％ (43/54),while that of adrenal hyperplasia was 58.3 ％ (7/12).There was no statistical significance between two diagnostic accuracy rate of MSCT(P ＞ 0.05).Conclusions AVS is the gold standard for localization diagnosis.When MSCT indicates that there is no obvious abnormality in the adrenal gland,adrenal hyperplasia,small tumor (≤ 2 cm),and bilateral adrenal lesions,AVS should be examined at the same time,which can be considered as the gold standard for localization diagnosis.For isolated adrenal tumor (＞ 2 cm) in PHA,the accuracy of localization diagnosis in MSCT is very high and the AVS is unnecessary.

Objective To analyze the main causes for unplanned re-operation of pheochromocytoma (PCC) and explore the countermeasures on reducing the re-operation rate.Methods The clinical data of 6 patients with pheochromocytoma who underwent an unplanned re-operation were analyzed retrospectively between September 2011 and December 2016 in our hospital.There were 4 males and 2 females with a mean age of 46 years,ranged from 24 to 60 years.Only 1 patient had paroxysmal hypertension and headache,and the other 5 patients had no symptoms or atypical symptoms.Tumors of 3 cases were located in adrenal,and 3 were extra-adrenal PCCs.The average size of tumors was 5.25cm,ranged from 3 to 10 cm.Among the 6 cases,2 cases were diagnosed as PCC preoperatively and underwent adequate preparationwith stable hemodynamics during the first operation,who encountered post-operative bleeding soon after the surgery.Four cases were misdiagnosed,with poor preoperative preparation and operation was aborted.One case was misdiagnosed as bladder carcinoma and underwent transurethral resection.Results All 6 re-operations were performed by urologists.The main causes for unplanned re-operation were as follows:perioperative hemodynamic unstability (50％,3/6),post-operative bleeding (33.3％,2/6),uncertainty of surgical outcome (16.7％,1/6).Conclusions A precise diagnosis and an adequate preoperative preparation are the key to prevent a second-look surgery.An appropriate surgical approach and a complete surgical hemostasis could help lowering the re-operation rate.

Objective To analyze the typical clinical manifestations and imaging characteristics of renal pelvic carcinoma.Methods The clinical data in 69 cases of renal pelvic carcinoma verified by postoperative pathology in this department of the hospital from July 2013 to November 2016 were retrospectively summarized to analyze its typical clinical manifestations,imaging features and treatment regimens.Results All the cases were hospitalized due to hematuria and presented gross hematuria.The detectable rate of B-ultrasonic examination was 71.43 ％,which of computed tomography urography(CTU) was 84.21％ and which of intravenous urography(IVU) + kidney ureter bladder(KUB) was 70.27 ％,which of retrograde pyelography(RP) was 90.32 ％,which of flexible ureteroscope(FU) was 91.67 ％,the pathological detection rate of biopsy tissue by this method was 58.33 ％ and detection rate of fluorescence in situ hybridization was 79.07 ％.Sixty-nine cases all were performed the retroperitoneal laparoscopy combined with hypogastric incision renal pelvic carcinoma radical operation,postoperative pathological examination verified renal pelvis carcinoma.Conclusion Flexible ureteroscope examination has the highest definite diagnosis rate of renal pelvic carcinoma,but the pathological positive rate of biopsy tissue by this method is not ideal;the definite diagnosis rate of RP and CTU were secondary,urinary system B-ultrasonic examination,FISH and KUB+IVP can serve as the preliminary screening and postoperative re-examination means of renal pelvic carcinoma.

Objective To analyze and summarize the short-term clinical efficacy and surgical points of transurethral columnar balloon dilation of prostate for middle-aged and high-risk prostatic hyperplasia patients.Methods A total of 30 patients with benign prostatic hyperplasia(BPH) admitted to our department from March 2016 to December 2016 was retrospectively analyzed,including 9 middle-aged patients(less than 60 years old) and 21 high-risk patients with various underlying diseases(more than 80 years old).Transurethral columnar balloon dilation of prostate was adopted and performed in accordance with standard operation process.Results All 30 patients were operated successfully by extending their prostate at the direction of 12 o'clock to the fat layer with short operation time and less amount of bleeding.The complication rate was 6.7％ (2/30),and the catheter was removed smoothly after the operation.After 1 month and 6 months follow-up,the international prostate symptom score(IPSS),quality of life score(QOL),maximum urinary flow rate(Qmax),residual urine(RUV) and other indicators were analyzed and were statistically significant(P＜0.05).Conclusion Transurethral columnar balloon dilation of prostate is an effective and supplemental method for the treatment of BPH in middle-aged and high-risk patients.

Objective To investigate the clinicalmanifestations,imaging features,diagnosis and differential diagnosis,treatment and prognosis of renal malignant solitary fibrous tumor(SFT).Methods The clinical data in 1 case of rare renal malignant SFT were retrospectively analyzed.Referring to related literatures,the histological origin,pathological features,differential diagnosis,treatment and follow-up of renal malignant SFT were analyzed.Results The patient was preoperatively diagnosed as right renal clear cell carcinoma.Postoperative pathological examination diagnosed as low grade malignant SFT of right kidney.And immunohistochemistry indicated CD34+,BCL-2 +,CD68+,CD99+,vimentin,Ki-67 5％ +,SMA focal weakly positive.No recurrence or metastasis occurred after 4-month follow-up period.Conclusion Malignant SFT of the kidney is very rare,its diagnosis and differential diagnosis depend on postoperative pathological and immunohistochemical examination.Radical nephrectomy is the main option for malignant SFT of the kidney with good prognosis.

Objective To explore the influence of up-regulated Foxp3 on Treg function and kidney transplantation chronic rejection reaction in rat model.Method The kidney transplantation chronic rejection reaction rat model was established.The F344 kidney was transplanted to Lewis rats,and retroviruses highly expressing Foxp3 were constructed.The Banff 97 hierarchical diagnostic criteria were used to diagnose chronic renal allograft nephropathy (CAN).The rat models were divided into three groups by random number table.In experimental group,the pSCV-BsdRFP-FoxP3 retroviruses were injected into the rats via the tail vein after operation.In negative control group,the pSCV-BsdRFP retroviruses were injected into the rats via the tail vein after operation.In blank group,the normal saline was injected into the rats via the tail vein after operation.Enzyme-linked immunosorbent assay (ELISA) was used to detect the changes of interleukin-10 (IL-10) and tumor necrosis factor-β (TGF-β) immediate,1,2,3,and 4 weeks after operation.The rats were killed at 4th week after operation,and kidney tissues were taken out for pathological examination.Result The pathological changes of CAN were observed at 4th week.The typical chronic rejection change was seen at 12th week.The levels of IL-10 and TGF-β were increased,and reached the peak at 3rd week.The levels of IL-10 and TGF-β in experimental group were higher than in negative control group and blank group at 1st,2nd,3rd,and 4th week.At 4th week,obviously different degrees of intimal thickening,and mild hyperplasia of interstitial fibers,glomerular sclerosis and infiltration with lymphocytes and plasma cells were observed in the three groups.In the experimental group,the lesions were mildest,and apparent neointimal hyperplasia was found.Conclusion pSCV-BsdRFP FoxP3 retroviruses can reduce the kidney transplantation chronic rejection reaction in rat model,and have the potential treatment effect.

Objective To summary the experience of laparoscopic cystectomy ileal conduit (Bricker) and orthotopic ileal neo‐bladder (Hautmann) and compare the short‐term efficacy of the two types of urinary diversion for invasive bladder cancer . Methods Retorspective analysis of the patients in our hospital who accepted laparoscopic radical cystectomy from 2010 to 2014 was performed ,74 of them accepted ileal conduit ,and 30 of them accepted orthotopic ileal neobladder .The general clinical data ,postop‐erative recovery ,postoperative complications and Oncology feature were analyzed and compared between the two groups .Results There was no demonstrable difference was found in operation time ,blood loss ,intraoperative blood transfusion rate ,the number of removed lymph node ,average hospital stay ,specimens positive margin rate and postoperative pathology results between the two groups (P>0 .05) .But there were significant difference in postoperative intestinal function recovery time[(4 .2 ± 1 .4)d ,(5 .3 ± 2 .2)d] ,(P=0 .002) ,and the complication rates 31 .9% (23 cases)vs .53 .3% (16 case) ,P=0 .043 .After 6 months ,the daytime and nighttime urinary control were 76 .9% ,57 .7% ,after 12 months ,the daytime and nighttime urinary control increased to 90 .9% , 81 .8% .2 cases(7 .7% ) were diagnosed with recurrence or metastasis during follow‐up in Hautmann group ,while 9 cases(14 .1% ) were diagnosed with recurrence or metastasis in Bricker group .Conclusion Two kinds of surgical procedures both have the similar therapeutic effect ,but the postoperative quality of life is better for Hautmann orthotopic neobladder patients .

Objective To investigate the effects of cyclopamine on the proliferation ,apoptosis and the expression of PSAmRNA in prostate cancer LNCaP cells .Methods LNCaP cells were interfered with different concentrations of cyclopamine (1 ,5 ,10 ,15μmol/L) at the different timepoints(24 ,48 ,72 h) .The poliferation inhibition was measured by the MTT assay ;the apoptotic mor-phological changes were observed by the Hoechst33258 staining method ;the apoptosis rate was examined by the flow cytometry ;the effects of PSAmRNA gene expression was detected by the FQ-RT-PCR .Results 5 ,10 ,15μmol/L cyclopamine groups had obvious inhibition effect on the LNCaP cell proliferation ,which had statistically significant difference compared with the control group (P<0 .01) .10 μmol/L group reached IC50 at 48 h ;the apoptosis rates at 24 ,48 ,72 h in the 10 ,15 μmol/L groups were 37 .21% , 57 .38% ,57 .98% and 21 .16% ,71 .31% ,72 .90% respectively ,the difference had statistically significant difference compared with the control group(P<0 .01) .The cellular apoptotic morphological changes were significantly enhanced with the increase of cyclo-pamine concentration and the extension of action time .The expression level PSAmRNA gene exhibited the obvious decreasing trend with the increase of cyclopamine concentration and was significantly decreased compared with the control group (P< 0 .01) .The PSAmRNA gene expression was extremely low in 10 ,15 μmol/L cyclopamine at different time period .Conclusion Cyclopamine significantly inhibits the proliferation of LNCaP cells ,induces apoptosis and obviously down-regulates the PSAmRNA gene expres-sion in LNCaP cells .Certain concentration of cyclopamine may be effective for treating advanced prostate cancer .

OBJECTIVETo investigate the effects of exosomes derived from renal cancer cell line ACHN on the proliferation and apoptosis of ACHN cells and explore the mechanism.

METHODSExosomes derived from ACHN cells were separated and purified by ultrafiltration and sucrose gradient centrifugation. The effects of the exosomes on the proliferation and apoptosis of ACHN cells were analyzed with CCK-8 assay and flow cytometry, respectively. The changes of mRNA and protein expressions of cyclin D1, caspase-3 were examined using RT-PCR and Western blotting, and the changes in the protein expression of p-Akt and p-ERK1/2 were detected with Western blotting.

RESULTSExosomes were successfully purified by ultrafiltration and sucrose gradient centrifugation. Compared with the control cells, ACHN cells treated with the exosomes showed enhanced proliferative activity with suppressed cell apoptosis. Exosomes treatment upregulated cyclinD1 mRNA and protein expression, down-regulated caspase-3 protein expression without affecting caspase-3 mRNA expression, and upregulated the expression of p-Akt and p-ERK1/2.

CONCLUSIONExosomes can promote the growth and proliferation and inhibit the apoptosis of renal cancer cell line ACHN. Removal of the exosomes from the microenvironment of renal cancer or inhibition of its function can be new strategies for treatment of renal cancer.

Apoptosis ; Caspase 3 ; metabolism ; Cell Line, Tumor ; Cell Proliferation ; Cyclin D1 ; metabolism ; Exosomes ; metabolism ; Gene Expression Regulation, Neoplastic ; Humans ; Kidney Neoplasms ; metabolism ; pathology ; Proto-Oncogene Proteins c-akt ; metabolism

ObjectiveTo explore the clinical-pathway-based teaching effect in teaching urological postgraduate students in department of urology.Methods36 students were divided to two groups:18 students are the clinical pathway based teaching group, and the other 18 students are traditional teaching group.Examination was used to compare the effect of each teaching method after 6 month.The examination including history collection,physical examination and case file writing,clinical case analysis,clinical operational skills test and basic theory.ResultsThe record of history collection,physical examination and case file writing and basic theory test in clinical pathway based teaching group is not different between the two groups,but the record of clinical case analysis and clinical operational skills test in clinical pathway group is better than the traditional teaching group.ConclusionClinical pathway based teaching can improve the teaching effect of clinical case analysis and clinical operational skills in urological postgraduate students,and can improve the strengthen of clinical thinking and working ability.