Objective:To explore the predictors of upper tract urothelial carcinoma (UTUC) invading muscle.Methods:The preoperative clinical data of 169 patients with UTUC who underwent radical nephroureterectomy (RNU) in the Department of Urology, Second Hospital of Tianjin Medical University from August 2019 to September 2021 were retrospectively collected. The average age of the patients was (67.7±8.3)years. There were 95 male cases (56.2%).15 cases (15.8%) were with diabetes, 46 cases (48.4%) with hypertension, 68 cases (71.6%) with hematuria, 44 cases (46.3%) with renal pelvis tumor, 74 cases (77.9%) with hydronephrosis and 8 cases (8.4%) with multifocality. There were 15 (20.3%), with diabetes, 40(54.1%) with hypertension, 58(78.4%)with hematuria, 32(43.2%) with renal pelvis tumor, 60(81.1%) with hydronephrosis and 2(2.7%) with multifocality among 74 female patients(43.8%), respectively. Patients’ body mass index (BMI) was (24.2±3.2) kg/m 2.The tumor diameter was (3.4±1.8) cm. The average count of neutrophil (NEU) was (4.2±1.7) ×10 9/L, with monocyte (MON) (0.4±0.2) ×10 9/L, platelet (PLT) (237.8±75.3) ×10 9/L and lymphocyte (LYM) (1.7±0.5) ×10 9/L. Neutrophil-to-lymphocyte ratio (NLR) was 2.7±1.4. Mmonocyte-to-lymphocyte ratio (MLR) was 0.3±0.1 and platelet-to-lymphocyte ratio (PLR) was 151.1±59.6. The concentrations of hemoglobin (Hb) and fibrinogen (FIB) were (127.1±18.3) g/L and(3.5±1.0) g/L. Univariate logistic regression analysis was performed on all preoperative data, and a nomogram was established to predict UTUC invading muscle by stepwise regression combined with multivariate logistic analysis. Concordance index (C-index) was used to evaluate the accuracy of the model, and Hosmer-Lemeshow test was used to check the fit. Using 1000 bootstrap resampling to validate the model and draw calibration plot. Receiver operating characteristics (ROC) curves were used to determine the most appropriate cut-off point of the model to predict tumor invasion and evaluate its sensitivity and specificity. Results:In this study, there were 169 cases. Postoperative pathological results showed that 18 cases (10.6%) were of low grade and 151 cases (89.4%) were of high grade. There were 2 patients (1.2%) with pT a stage, 44 patients (26.0%) with pT 1 stage, 37 patients (21.9%) with pT 2 stage, 81 patients (47.9%) with pT 3 stage and 5 patients (3.0%) with pT 4 stage. According to tumor stage, 46 patients were included into non-muscle invasive disease (NMID, pT a/T is/T 1) group and 123 patients were included into muscle invasive disease (MID, pT 2/T 3/T 4) group. Univariate analysis showed that hydronephrosis ( OR=2.919, 95% CI 1.332-6.387, P=0.007) was significantly correlated with MID. Tumor location in ureter ( OR=1.898, 95% CI 0.960-3.800, P=0.067), higher NLR value ( OR=1.313, 95% CI 0.9901.832, P=0.082) and FIB concentration ( OR=1.436, 95% CI 1.008-2.125, P=0.056) might have potential association with MID. Stepwise regression method was used to screen out PLT, FIB and hydronefrosis as the optimal combination for MID prediction. multivariate analysis suggested that PLT decreasing ( OR=0.727, 95% CI 0.548-0.955, P=0.023), FIB increasing ( OR=1.629, 95% CI 1.084-2.552, P=0.025) and hydronephrosis ( OR=2.500, 95% CI 1.111-5.601, P=0.026) were independent predictors of MID.The C-index of the model constructed by the three factors was 0.682, and the P-value of the goodness of fit was 0.778. The ROC curve showed that the optimal cut-off point for the prediction of high-risk MID by the nomogram was 0.627, achieving 39.1% specificity, 88.6% sensitivity and 0.682 area under the curve (AUC). Conclusions:Preoperative decrease of PLT, increase of FIB and hydronephrosis were independent factors for predicting UTUC invading muscle.

Objective:To increase the understanding of neuroleptic malignant syndrome, rhabdomyolysis and acute renal injury in advanced-aged patients with Parkinson's disease after abdominal surgery.Methods:We report a case of malignant syndrome, rhabdomyolysis and acute renal injury in an 85-year-old patient with Parkinson's disease after abdominal surgery in our department.The diagnosis and successful treatment experience were summarized, and a literature review was conducted.Results:The body temperature was as high as 40.5℃ in this patient, accompanied by stiffness, sustained involuntary shaking, increased muscle tone, serum creatine kinase at 104 615 U/L, tachycardia, low blood pressure, accelerated breathing rate, disturbance of consciousness, excessive sweating and other clinical manifestations, which met the diagnostic criteria for neuroleptic malignant syndrome.The patient had complications including concurrent rhabdomyolysis, acute renal injury and shock.The emergency was resolved after an early diagnosis and proactive treatment.Conclusions:If patients with Parkinson's disease have a high fever with rigidity or sudden aggravation within a short period of time after medication, the possibility of neuroleptic malignant syndrome should be considered and the causes should be screened.

Objective To investigate clinical features and prognosis of patients with cancerrelated isolated distal deep vein thrombosis(IDDVT).Methods Data of 64 patients with malignant tumor complicated with IDDVT at our hospital from January 2003 to January 2013 were retrospectively analyzed for the clinical features and prognosis.Results Among the 64 patients,32 male and 32 female cases were involved,aged 37 to 87 years,average(66.0 ± 12.6) years.There were 42 cases aged 65 years and older and 22 cases aged under 65 years.The IDDVT involved veins of lower extremity in 64 patients,unilaterally (47/64)or bilaterally (17/64).The intermuscular veins were involved by IDDVT in 46 cases(71.9％).Posterior tibial veins were involved in 17 cases(26.6％),peroneal veins were involved in 14 cases(21.9％),anterior tibial veins were involved in 2 cases (3.1 ％).Common symptoms were swollen lower extremity and pain (53.1％).Bleeding occurred in 2 (3.6 ％) of the 55 patients(55/64,85.9 ％) who underwent anticoagulant therapy,and no major bleeding occurred.The cumulative incidence of IDDVT at 3,6,and 12 months after tumor diagnosis was 64.0％ (41/64 cases),75.0 ％ (48/64 cases) and 85.9 ％ (55/64 cases),respectively.The cumulative incidences of IDDVT at 3 and 6 months were higher after diagnosis of lung cancer than after diagnosis of digestive tract tumors(P =0.005 and 0.035).By the end of follow-up(a median follow-up of 13.0 months),30 patients(46.9 ％)died.The mortality rate was lower in the non-elderly group than in the elderly group (22.7％ vs.59.5％,x2 =7.850,P=0.005).The mortality rate was lower in patients with stage Ⅰ-Ⅲa than in patients with stage Ⅲb-Ⅳ(24.0％ vs.68.8％,x2=11.246,P=0.001).The mortality rate was lower in patients with gynecologic tumors(10.0％) than in patients with lung cancer(55.6％),digestive tract tumors (40.0％) and hematologic tumors (71.4％) (P =0.041,0.037 and 0.035,respectively).TNM Ⅲ b-Ⅳ (OR =8.42,95 ％ CI:1.93-30.00,P =0.004) and age ≥ 65 years (OR =6.28,95％CI:1.50-27.76,P=0.012)were independent risk factors for death.Conclusions Cancerassociated IDDVT most commonly involves the intermuscular veins.The incidence of hemorrhage after anticoagulant therapy is low.For patients without anticoagulation contraindications,active anticoagulant therapy should be recommended.The advanced cancer and old age are independent risk factors for cancer-related IDDVT death.

Objective To explore the clinicopathological significance of the presence of lymphovascular invasion (LVI) in the high-grade stage pT1 bladder cancer (BC) after first transurethral resection of bladder tumor (TURBT).Methods The retrospective study was performed with 27 patients of high-grade stage pT1 BC after first TURBT from January 2006 to December 2011,and another 54 patients were matched as negative control in terms of gender,age,pathological pattern,grading and staging.All the data were calculated by using SPSS17.0 software.Qualitative variables were compared by using chi-square test.The Kaplan-Meier method was used to calculate total survival and cancer-specific survival and differences were assessed with the Log-rank statistic.Results Twenty-four patients (89％) experienced cancer recurrence in LVI group,while 19 cases (35％) experienced recurrence in control group.Progress developed in 56％ (15/27) and 24％ (13/54) in the 2 groups respectively.LVI was detected to be a prognostic factor for overall recurrence (x2 =20.845,P＜0.001) and progress (x2 =7.887,P =0.005) in patients with high-grade T1 stage BC.Furthermore,overall survival and recurrence-free survival according to the presence or absence of LVI was 54±6 months and 84±3 months,17±5 months and 67±5 months,respectively.LVI was proved to be associated with worse overall survival (x2=13.443,P＜0.001) and recurrence free survival (x2=33.094,P＜0.001).Conclusion In patients with high-grade T1 stage BC,LVI in first TURBT specimens predicts disease recurrence,progression and overall recurrence and recurrence free survival.

Objective To evaluate effectiveness of the applying pelvic double-slice retractor in the division of bladder and prostate pedicles in male patients with previous surgery history during radical cystectomy (RC) and anterograde radical prostatectomy (ARP). Methods The pelvic double-slice retractor was used to expose the bladder and prostate pedicles in 43 RC (30 cases with BMI ＞ 28 kg/m2,16 cases had previous partial cystectomy) and 37 ARP ( all cases with BMI ＞ 28 kg/m2 ). Results The pelvic double-slice retractor provided excellent exposure for the division of bladder and prostate pedicles.The handling of bladder and prostate pedicles became easy and safe without unnecessary bleeding and injury to the rectum.The median operating time to control the pedicles during RC and ARP were 12 min and 7 min,and the average blood loss were 30 ml and 20 ml,respectively. Conclusion The use of pelvic double-slice retractor for the exposure of the bladder and prostate pedicles is simple and effective in male patients with complicated pelvic anatomy during RC and ARP.

Objective:To investigate the effect of the new nanomaterials,polyamidoamine dendrimers PAMAM-D,mediated foreign gene human decay accelerating factor(hDAF) for xenotransplantation transfected pig sperm cells.Methods:PAMAM-D/hDAF cDNA compounds were made.The compounds were divided into 0.2 μg,0.4μg,0.6μg,0.8 μg and 1.0μg groups (each group adding corresponding dose of PAMAM-D in accordance with the N/P ratio 10:1,20:1,40:1),then were digested by restriction enzymes.The compounds were incubated with washed pig sperm cells.Then the transfection efficiency was detected by in situ hybridization in the different groups.Results:The PAMAM-D molecule can prevent electrophoretic migration of DNA in the compound.After digested the compounds by restriction enzymes,DNA can not be degraded.The transfection efficiency was different in different groups.Among the total,the efficiency was higher in both groups of 0.4 μg and 0.6μg than that of others.The top was the group of 0.4 μg linear plasmid plus PAMAM-D when the N/P ratio was 20:1(47.5%±O.2%,167% vs control group).Conclusion:PAMAM-D can improve the efficiency of exogenous gene transfeeted pig sperm cells,which can reinforce the stable binding of exogenous DNA to sperm cells.

Objective To evaluate the feasibility and clinical effect of Argon plasma coagulator in simple enucleation for small renal cell carcinoma. Methods On the basis of successful performing the animal experience of coagulating therapy on the wound tissue during partial nephrectomy with Argon plasma coagulator in rabbit models, 10 cases of simple enucleation for small renal cell carcinoma with Argon plasma coagulator were accomplished. Results Both with the standard of stopping bleeding of wound tissue by Argon plasma coagulator and with the standard of re-spraying the wound tissue for 2 s after stopping bleeding using Argon plasma coagulator, the depth of wound tissue necrosis without blocking the renal pedicle is deeper than that with blocking the renal pedicle(P=0. 012 and P=0. 002, respectively).If the wound tissue was re-sprayed for 2 s after stopping bleeding by Argon plasma coagulator, the depth of the wound tissue necrosis without blocking the renal pedicle was deeper than that just with blocking the renal pedicle(P=0. 007 and P=0. 002,respectively). In the part of application in clinical, all procedures were successfully completed. The mean operative time was 163 min (range, 100-210 min) and mean blood loss was 230 ml (range, 100-400 ml). Drainage tube was pulled out 1 month after operation in 1 case for being allergic to absorbable hemostatic gauze, and the mean pulling drainage tube out time in others was 4. 2 d (range, 3-5 d). During a mean follow-up of 22 months (range, 10-38 months), no local tumor recurrence and distant metastasis was found. Conclusion Argon plasma coagulator can be used in simple enucleation for small renal cell carcinoma, and the clinical effectiveness is ideal.

Objective To investigate the value of the application of the fresh first morning midstream urine in cytological study of bladder cancer patients. Methods The results of the fresh first and second morning midstream urine cytological studies for 52 bladder cancer patients were analyzed.Continual three urine samples and single urine sample were treated as study objects respectively. The positive rates in different tumor stages and grades were evaluated. Results The positive rate of overall 52 patients was 78. 8 % (41/52) in fresh first morning midstream urine and 80. 8% ( 42 / 52) in the fresh second morning midstream urine. While in 156 single urine samples, the positive percentages were 56.4%(88/156) and 60. 9% (95/156). The positive rates of the fresh first and second morning midstream urine were 69.7% (23/33) and 72.7% (24/33) respectively in grade 1- 2 patients, and 44.4 % (44/99) and 48. 5 % (48/99) in 99 single urine samples. The positive rates of 42 non-muscle invasive bladder cancer patients were 73. 8% (31/42) and 76.2% (32/42) in the fresh first and second morning midstream urine, while in 126 single urine samples, the positive rates were 54.8% (69/126)and 57.1% (72/126). There were no significant differences between positive rate of the fresh first and second morning midstream urine in diagnosis of bladder cancer, low grade bladder cancer and nonmuscle invasive bladder cancer. Conclusion The fresh first morning midstream urine can be used for urine cytological study in the diagnosis of bladder cancer, even in the diagnosis of low stage and low grade bladder cancer.

Objective To investigate the effects of preserving continence important structures during Studer pouch surgery. Methods Radical cystectomy and Studer orthotopic neobladder surgeries were performed on 68 male patients with muscle invasive bladder cancer.The anatomic configuration of the rhabdosphincter complex,pudendal nerve supply,and musculofascial support system to the proximal urethra were carefully preserved.The neobladder functions were then evaluated. Results The pathological classification of the 68 patients was as follows:T3a N0M0 in 20 cases and T2N0M0 in 48 cases.The patients were followed up for 6 to 36mon(mean 12 mon).Complete urinary continence was achieved in 67 patients 24 hours a day and the remained one had nocturnal incontinence.Of these patients,59 patients could urinate well without residual urine and the other 9 patients had residual urine of 20 to 30 ml. Conclusions A well-performed Studer pouch should pay specific attention to the anatomic configuration of the rhabdosphincter complex,pudendal nerve supply,and musculofascial support system to the proximal urethra to achieve the goal of maximizing continence preservation.

Objective To study the gene mutation of fibroblast growth factor receptor 3 (FGFR3) and p53 in bladder cancer tissue and to explore their relationship with tumor recurrence. Methods DHPLC and PCR direct sequence were used to detect the mutation of FGFR3 and p53 in BTCC (n=98) and normal bladder mucosa (n=10). Genomic DNA of 98 BTCC was extracted. The exon 5-8 of P53 and the exon 7, 10, 15 were amplification by PCR. The products of PCR was screened by DHPLC to detect the mutation of the production. The results of the FGFR3 and p53 mutation were analyzed by Kaplan-Meier method and no recurrence survival rate was tested by log rank test. All the analysis were aim to explore the clinical biological value of the mutation of FGFR3 and p53. Results Mutation of FGFR3 in BTCC (44. 9%) was higher than normal bladder mucosa(0, P<0.01). Mutation in T_a-T_1 was 75. 6%(33/45) ,T_2 -T_4 was 26. 6%C10/53). Mutation in G_1 was84. 6%(11/13),inG_2 was 61. 4% (27/44), in G_3 was 14. 6% (6/41), (P<0. 05). The mutation rate was lower with the higher of stage and grade. Mutation of p53 in BTCC (34. 6%) was higher than normal bladder mucosa (0%) (P<0. 01). Mutation in T_a - T_1 was 20. 0% (9/45), T_2 - T_4 was 47. 2%(25/53). Mutation in G_1 was G_1 7. 7%(1/13), in G_2 18. 2%(8/44),in G_3 58. 1%(25/41) , (P<0. 05). The mutation rate was higher in the higher stage and grade. Kaplan-Meier method results revealed that mutation of FGFR3 indicating a favorable prognosis while mutation of p53 indicating a poor prognosis. As to the analysis of genotype, the type of FGFR3mut/p53wt had a relative longer recurrent interval (P<0. 01). Conclusions Mutation of FGFR3 indicated a relative longer recurrent interval, which revealed a favorable prognosis of BTCC. Mutation of p53 indicated a relative shorter recurrent interval, which revealed a poor prognosis.