Purpose To investigate the value of 99Tcm-(methoxyisobutvlisonitrile,MIBI)bone uptake on hungry bone syndrome(HBS)in renal secondary hyperparathyroidism(SHPT)after parathyroidectomy.Materials and Methods From June 2014 to December 2021,106 renal SHPT patients who underwent successful parathyroidectomy in Jiangyin Hospital Affiliated Nantong University were retrospectively enrolled.Visual analysis was used to evaluate the abnormal bone uptake of 99Tcm-MIBI.The patients were divided into HBS group and non-HBS group based on whether occurred HBS.The clinical features,laboratory indicators and 99Tcm-MIBI bone uptake were compared between the two groups.Results Of 106 renal SHPT patients,42(39.62%)patients with bone uptake on visual assessment,showed diffusely increased tracer accumulation,particularly in sternum,clavicle and ribs.The age in HBS group was younger than that in non-HBS group(t=-3.058),the alkaline phosphatase and parathyroid hormone level in HBS group were higher than that in non-HBS group(Z=-5.148,-2.218),the serum corrected calcium in HBS group was lower than that in non-HBS group(Z=-2.102),the positive rate and number of 99Tcm-MIBI bone uptake in HBS group was 50%and 2(1,3),which was higher than that of 28%and 1(1,1)in non-HBS group(χ2=5.344,Z=-2.970),respectively,all showed statistically significant difference(all P<0.05).Conclusion Renal SHPT patient with HBS after parathyroidectomy is commonly related to a high level of alkaline phosphatase and parathyroid hormone,and more likely to develop abnormal 99Tcm-MIBI bone uptake.

Objective:To investigate the long-term survival and safety in patients with muscle-invasive bladder cancer (MIBC) who experienced a noninvasive down-staging (≤pT 1)after transurethral resection of bladder tumor (TURBT) plus systemic chemotherapy and received bladder-sparing treatment. Methods:The records of patients with MIBC who underwent maximal TURBT plus systemic chemotherapy-guided bladder-sparing treatment were reviewed retrospectively from Dec 2013 to Dec 2020. Eventually, 22 patients who achieved noninvasive down-staging underwent conservative management. The total patient cohort contained 10 males and 12 females. A majority of patients had single lesion and stage T2 disease. The median age of the patients was 66 years and the median tumor size was 3.0 cm. All patients underwent maximal TURBT to resect all visible diseases and followed by 3-4 cycles platinum-based systemic chemotherapy. After achieving noninvasive down-staging, 14 patients received concurrent chemoradiotherapy, and the other 8 patients underwent surveillance. Overactive bladder symptom score (OABSS) was used to assess the bladder function after treatment.Results:Twelve patients achieved pT 0 and 10 patients were down-staged to cT a-T 1. At a median follow-up of 36.7 months, 90.9%(20/22) patients retained their bladder function successfully. Among the 14 patients who received concurrent chemoradiotherapy, 4 had grade 3 or 4 adverse events. Among the 8 patients who underwent surveillance, 3 had grade 3 or 4 adverse events after systemic chemotherapy.Nine patients experienced tumor recurrence in the bladder, and 2 patients died of bladder cancer. Seven (31.8%) patients experienced Ⅲ/Ⅳ grade complications. The 5-year recurrence-free survival (RFS) and overall survival (OS) in patients achieved pT0 were 66.7% and 100.0%, respectively. The 5-year RFS and OS in patients achieved cTa-T1 were 40% and 72%, respectively. The OABSS score of 20 patients who retained their bladder successfully was (1.00±1.03). Conclusions:MIBC patients who achieved noninvasive down-staging might be candidates for the bladder-sparing treatment with maximum TURBT followed by systemic chemotherapy.The patients who achieved pT 0 might have better prognosis with functional bladder.

Objective:To analyze and monitor the genetic stability of Omicron strain inactivated vaccine.Methods:The virus seeds of Omicron strain for inactivated vaccine through different routes, that was with plaque purification or not, were continuously passaged on cells, and then the supernatant of cell culture was harvested to extract virus nucleic acid. The next generation sequencing was used to analyze virus transcriptome, and the differences of mutation sites, mutation frequencies and insertions/deletions in the whole genome of Omicron virus under different conditions were compared.Results:After continuous passage, more than 5% mutation sites in ORF1ab and S gene sequences were significantly less in the plaque-purified seed than those of the virus without plaque purification, and no insertion/deletion mutations were detected in the whole genome of the purified virus.Conclusions:The nucleic acid sequences of virus with different routes were analyzed by next generation sequencing. The result showed that the genetic stability of virus after plaque purification was better than that of unpurified virus strains, which provides a scientific basis for virus seed selection in the development of inactivated vaccine.

Objective:To analyze the molecular characteristics of Echovirus 11 (Echo11) strains isolated in Xiangyang, Hubei Province from 2016 to 2017 based on the sequences of VP1 gene.Methods:Rectal and throat swab specimens were collected from children with hand, foot and mouth disease (HFMD) in Xiangyang from 2016 to 2017. Echo11 strains were detected by real-time reverse transcriptase PCR (RT-PCR) and isolated after cultured in human rhabdosarcoma (RD) cells. The VP1 regions of Echo11 strains isolated from RD cells and the whole genomes of three representative Echo11 strains were amplified by conventional RT-PCR and the sequences were analyzed. DNAStar7.0 (MegAlign) and MEGA6.0 (Data) were used to analyze the homology and mutation sites in nucleotide and amino acid sequences. Neighbor-joining method was used to construct phylogenetic trees. Recombination analysis was performed with SimPlot software (BootScanning).Results:A total of 11 Echo11 strains were isolated from 3 494 HFMD cases, accounting for 0.31%. They were highly homologous in the VP1 gene. These strains shared 98.4%-100.0% homology in nucleotide sequences and 98.3%-100.0% homology in amino acid sequences. The homology between the 11 Echo11 strains and the prototype strain (Echo11/Gregory, X80059) was 73.9%-74.8% in nucleotide sequences and 87.7%-88.7% in amino acid sequences. All of the Echo11 strains circulating in Xiangyang were classified into lineage D, having a similarity to the strains circulating in some regions of mainland China since 2013. In multiple regions of the genome, the Echo11 strains isolated in Xiangyang were highly similar to the Henan Echo1 strains in 2010 and the Hubei Echo6 strains in 2015, suggesting there was recombination within the genome of Echo11 strains in Xiangyang.Conclusions:The Echo11 strains circulating in Xiangyang from 2016 to 2017 belonged to lineage D and were recombinant strains.

Renal clear cell carcinoma metastasis to the gallbladder is rare. This paper reported a case of gallbladder metastasis of renal clear cell carcinoma detected after two years of left radical nephrectomy. The patient underwent laparoscopic cholecystectomy and followed by postoperative targeted therapy of sunitinib. No new metastasis was found after 5 months of follow-up.

Purpose: Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy. Materials and Methods: Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate. Results: Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory. Conclusion After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.

Objective:To explore the application effect of multidisciplinary teamwork mode in patients with laparoscopic partial nephrectomy of renal carcinoma.Methods:A total of 86 patients with renal cancer who received laparoscopic partial nephrectomy in Ningbo First Hospital of Zhejiang Province from February to December 2019 were selected by the convenient sampling method. According to admission time, the patients were divided into the control group and the observation group, with 43 cases in each group. The control group implemented urological nursing routines and various measures recommended in the accelerated rehabilitation surgery guidelines, while the observation group adopted a multidisciplinary team collaboration model based on evidence-based nursing on the basis of the control group. The Kolcaba General Comfort Questionnaire (GCQ) and Numerical Pain Rating Scale (NPRS) were used to evaluate the comfort and low back pain of the two groups at 1, 3, and 5 days after surgery. Hamilton Anxiety Scale was used to evaluate anxiety of patients in both groups 5 days after surgery, and postoperative rehabilitation indicators (postoperative supine position time, absolute bed time, anal exhaust time, drainage tube indwelling time, postoperative hospital stay) were collected in both groups.Results:The total score of GCQ of observation group was higher than that of control group on 1, 3, and 5 days after operation, and lower back pain score was lower than that of control group. The postoperative anxiety score, postoperative supine position time, absolute bed time, anal exhaust time, drainage tube indwelling time and postoperative hospitalization days in the observation group were lower than those in the control group. There were statistically significant differences between the two groups ( P< 0.05) . There was no postoperative bleeding or deep venous thrombosis (DVT) in the lower limbs of patients of the two groups. Conclusions:The multidisciplinary teamwork model can alleviate the postoperative anxiety of patients with partial nephrectomy, improve their overall comfort, shorten the postoperative hospital stay and promote postoperative recovery.

Objective To explore the clinical efficacy of laparoscopic tumor resection combined with aspiration for central renal angiomyolipoma(RAML).Methods Retrospective analysis of clinical data of 11 patients with central RAML between November 2015 and August 2018,including 8 females and 3 males,aged 35-58 years,mean (45.3 ± 4.8) years;4 cases on the left side,7 cases on the right side,including 4 endophytic tumors,7 exophytic tumors;body mass index (BMI) 22-27 kg/m2,mean (24.9 ±1.8) kg/m2.The maximum diameter of these tumors were 4.2-8.9 cm,with an average of (6.7 ± 2.4)cm.The preoperative serum creatinine was 53-85 μmol/L,with an average of (64.6 ± 16.4) μmol/L,and the glomerular filtration rate (GFR) of the affected side was 42-55 ml/min,with an average of (45.5 ±3.6) ml/min.Lateral kidney function is normal.8 patients underwent retroperitoneal laparoscopic surgery and 3 cases underwent laparoscopic surgery.Based on the preoperative imaging,tumor tissue was aspirated as much as possible by suction device if the tumor got maximal fat component and had not abundant blood supply.Clamp the renal artery in case of bleeding affected the surgery vision.On the contrary,if the tumor had abundant blood supply,the renal artery was clamped first,then removed the section of tumor with scissor and the remaining basal tumor was aspirated totally by suction device.The operation time,warm ischemia time,intraoperative blood loss,postoperative hospital stay,postoperative complications and surgical results were analyzed.Results All the 11 cases were successfully completed without conversion to open surgery,only one case got injury of renal collection system.The operation time was 95-126 min,mean (110.5 ± 12.8) min,and the blood loss was 120-200 ml,mean (155.6 ± 38.4) ml.The warm ischemia time was 22-31 min,mean (27.6 ± 3.3) min,and the postoperative hospital stay was 5-7 days.RAMLs were diagnosed by the postoperative pathological examination.The renal function was normal and no recurrence occurred in these patients at a mean follow-up of 13.9 months.All the 11 cases were successfully completed.Postoperative pathological diagnosis was RAML.There was no complication in the 11 cases.Preoperative serum creatinine and serum creatinine in the first month after surgery [(64.6 ± 16.4)μmol/L vs.(66.7 ± 15.5)tμmol/L,P =0.38] and preoperative renal GFR and GFR in the first month after surgery [(45.5 ± 3.6)ml/min vs.(43.2 ± 3.3) ml/min,P =0.067],the difference was not statistically significant.No recurrence was observed in the 11 cases with an average follow-up of 13.9 months.Conclusions Our initial experience suggests that laparoscopic tumor resection combined with aspiration is a safe,effective and minimally invasive method for the treatment of central RAML.

Objective To investigate the combined effect and mechanism of metformin (Met) and 2-deoxy-D-glucose (2DG) on cell proliferation and apoptosis in liver cancer cells HepG2 and Hep3B.Methods Wst-1 reagent was used to determine the anti-proliferation effects after treatments with Met and 2DG alone or combined in HepG2 and Hep3B cells.Microscopy was used to observe cell morphological changes after treatments with Met and 2DG alone or combined in HepG2 and Hep3B cells.Cell apoptosis was observed by flow cytometry after treatment of different kinds of drugs.Western blotting was used to analyze the protein expressions of Caspase-3,PARP,Mcl-1 of HepG2.Results The survival rate of HepG2 cells in the combination group was (22.48 ± 0.51)％,and compared with the control group (100.00 ± 5.05)％,Met group (80.68 ±5.10)％ and 2DG group (72.56 ±4.34)％,the differences were statistically significant (P ＜ 0.001;P ＜ 0.001;P =0.001).The survival rate of Hep3B cells in the combination group was (29.16 ± 1.34) ％,and compared with the control group (100.00 ± 1.23) ％,Met group (59.58 ± 1.92) ％ and 2DG group (33.87 ± 1.95) ％,the differences were statistically significant (P ＜ 0.001;P ＜ 0.001;P =0.001).Microscopy observation showed that combined treatment of Met and 2DG caused less viable adherent cells of HepG2,but more floating dead cells.While the combination group also caused a decrease in the density of Hep3B cells,but did not significantly increase the shedding of cells.The apoptosis of HepG2 cells in the combination group was (39.63 ± 0.21) ％,and compared with the control group (7.12 ± 0.14) ％,Met group (12.56 ± 0.35) ％ and 2DG group (15.16 ± 1.93) ％,the differences were statistically significant (P ＜0.001;P ＜ 0.001;P =0.001).The apoptosis of Hep3B cells in the combination group was (12.58 ± 1.03) ％,and compared with the control group (2.82 ± 0.51) ％ and Met group (8.98 ± 0.86) ％,the differences were statistically significant (P ＜ 0.001;P =0.007),but compared with the 2DG group (12.40 ± 1.78) ％,the difference was not statistically significant (P =1.000).Furthermore,Western blotting demonstrated that the combined treatment induced evident Caspase-3 activation and poly ADP-ribose polymerase (PARP) cleavages,and decreased expression of Mcl-1.Conclusion The combination of Met and 2DG can effectively inhibit cell proliferation of HepG2 and Hep3B,and induce apoptosis of HepG2 cells.The mechanism may be involved with Caspase-3 activation,cutting PARP substrate and decreasing Mcl-1 protein.