【Objective】 To investigate the clinicopathological features and prognosis of clear cell papillary renal cell carcinoma (CCPRCC). 【Methods】 The clinicopathological and follow-up data of 40 CCPRCC patients treated during Jun. 2011 and Oct.2021 were retrospectively analyzed. The prognosis was compared with that of 40 cases of clear cell renal cell carcinoma (ccRCC) and 19 cases of papillary renal cell carcinoma (PRCC) treated in the same period. Survival analysis was performed by Log-rank test and Kaplan-Meier survival curves were plotted. 【Results】 Among the 40 patients, 28 were male and 12 were female, aged 31-84 years; 38 cases had unilateral and 2 cases had bilateral tumors; 3 cases had multifocal lesions. All patients received surgery. The maximum diameter of the masses ranged from 3.0 to 95.0 mm, with an average of (27.6±18.1) mm. Pathological grade was Fuhrman 1-2 in all cases. Immunohistochemical tests were positive for CK7 and CA-IX. During the follow-up of 5-129 (average 56) months, 1 case died after bone metastasis, 2 had ipsilateral recurrence, and 1 developed primary esophageal cancer. CCPRCC patients had a significantly better prognosis than CCRCC (P<0.001) and PRCC (P=0.005) patients, while there was no significant difference in the prognosis between CCRCC and PRCC patients (P=0.93). 【Conclusions】 CCPRCC has low malignancy. The diagnosis relies on characteristic pathological and immunohistochemical features. Surgery is an effective treatment. CCPRCC has a better overall prognosis than CCRCC and PRCC.

Objective:To explore the surgical technique and efficacy of pure retroperitoneoscopic extravesical standardized seeable (P.R.E.S.S.) technique for bladder cuff excision (BCE).Methods:Ninety five patients with UTUC from five domestic centers (30 cases from Changzheng Hospital, 21 cases from Peking University First Hospital, 20 cases from Yuhuangding Hospital, 21 cases from Dalian Medical University affiliated No.2 Hospital and 3 cases from General Hospital of Eastern Theater Command)between August 2017 and December 2020 were retrospectively analyzed. There were 57 males and 38 females with a mean age of (67.7±10.0) years and median tumor size of 3.0 cm. All patients underwent pure retroperitoneoscopic radical nephroureterectomy with a single surgical position and four (36 cases) or five (59 cases) trocar layout according to the surgeon’s prefer habit and experience. The demographics of the two groups were the age of [(66.3±11.2)years vs. (68.6±9.1)years], male/female ratio of (25/11 cases vs. 32/27 cases), body mass index of [(25.0± 3.0)kg/m 2 vs. (24.8±3.4)kg/m 2], tumor maximum diameter of [2.8(1.6, 3.5)cm vs. 3.0(2.0, 4.0)cm], left/right side tumor of(19/17 cases vs. 34/25 cases), T 1-2/T 3-4/Tis stage of(25/10/4 cases vs. 49/10/0 cases), and multifocal tumors of(3 cases vs. 2 cases), and the difference was not statistically significant( P>0.05). On the other hand, the differences of hydronephrosis of the operated kidney(13 cases vs. 39 cases, P=0.004), and tumor location (in renal pelvis or calyx or upper/middle/lower ureter being 23/9/4 cases vs. 35/4/20 cases, P=0.005), were statistically significant. The umbilical artery cord was used as anatomical landmark in the process of P. R.E.S.S. bladder cuff excision. The pelvic floor and extraperitoneal space around the ureter were expanded, the bladder wall was opened to form pneumovesicum, and a sufficient bladder cuff resection and exact bladder cuff closure was performed. Perioperative outcomes and follow-up data were analyzed, and the clinical outcomes between the four and five trocars were compared to evaluate the impact of trocar layout on the surgical outcomes. Results:There were 91(95.8%) cases successfully undergoing P. R.E.S.S. BCE technique, with one case converted to open BCE due to bleeding and three cases converted to distal ureter Hem-o-lok clipping because of poor exposure. Median operative time was 180(125, 230)min, and estimated blood loss was 100(50, 100)ml. The overall complication rate was 10.5%(10/95), including 2 cases(2.1%) of intraoperative bleeding, with 1 case treated by transfusion (400 ml), the other case converted to open surgery without transfusion. There were 8 cases of postoperative complications(8.4%), including 7 cases of Clavien-Dindo grade Ⅱ(3 cases of secondary hemorrhage, one case for each of drug allergy, acute renal insufficiency, blood creatinine increased to 490 μmol/L, or lung infection with lymphatic leakage), 1 case of grade Ⅲa(intestinal obstruction treated with insertion of the intestinal obstruction catheter under local anesthesia), and all these patients were discharged smoothly. The difference between the four and five trocars was not statistically significant in the following variables, including the rate of surgical conversion(8.3% vs. 1.7%), estimated intraoperative blood loss(100 ml vs. 60 ml), ratio of intraoperative lymph node dissection (25.0% vs.20.3%), P. R.E.S.S. bladder cuff excision success rate(91.7% vs.98.3%), the incidence of intraoperative and postoperative complications (13.8% vs.8.5%), pT 1-2/pT 3-4/pTis stage(22/11/3 cases vs.37/19/3 cases) and the proportion of recurrence or metastasis(8.3% vs.3.4%)(all P>0.05). However, the differences in the operation time(190 min vs.170 min, P=0.011)and postoperative hospital stay(5 d vs.6 d, P=0.005) were statistically significant. Conclusions:P. R.E.S.S. bladder cuff resection technique is safe and feasible during the procedure of pure retroperitoneoscopic radical nephroureterectomy by a single surgical position and facilitates seeable adequate bladder cuff excision by establishing an enlarged pelvic lateral extraperitoneal space and pneumovesicum. Five-trocar technique is more suitable for patients with lower ureteral tumors but may be associated with a longer postoperative hospital stay compared with the four-trocar technique.

OBJECTIVETo observe the effect differences among the comprehensive therapy, acupuncture and oral mecobalamine for senile sensorineural hearing loss.

METHODSA total of 126 senile sensorineural hearing loss patients were randomized into a comprehensive group, an acupuncture group and a western medication group, 42 cases in each group. After removing and discontinuing cases, 40 cases in each group were included in the analysis. Acupuncture, acupoint injection and auricular point pressing were used in the comprehensive group. Acupuncture for 2 courses was at the affected Tinggong (SI 19), Tinghui (GB 2), Yifeng (TE 17), etc, once every other day, 10 times as a course with one week rest between 2 courses, 3 times a week. Acupuncture as the comprehensive group was applied in the acupuncture group. Mecobalamin tablet was prescribed orally for 2 courses in the western medication group, 3 times a day, 0.5 mg a time, 3 weeks as a course, one week at the interval. Pure tone hearing threshold value and tinnitus grading were observed before and after intervention in the three groups. The clinical effects were compared.

RESULTSAfter treatment, pure tone hearing threshold value and tinnitus grading were better than those before treatment in the three groups (all <0.05), with better results in the comprehensive group than those in the other two groups (all <0.05). The total effective rate of pure tone hearing threshold value was 82.5% (33/40) in the comprehensive group, which was superior to 67.0% (27/40) in the acupuncture group and 62.5% (25/40) in the western medication group (both <0.05). The total effective rate of tinnitus was 83.3% (30/36) in the comprehensive group, which was superior to 69.7% (23/33) in the acupuncture group and 57.1% (20/35) in the western medication group (both <0.05).

CONCLUSIONThe clinical effects of comprehensive therapy on senile sensorineural hearing loss are superior to those of simple acupuncture and oral administration of mecobalamin in terms of pure tone hearing threshold value and tinnitus grading.

OBJECTIVETo analyze relationships between the tumor deposits (TD) and clinicopathologic features of gastric cancer and investigate the value of TD in staging and prognosis in gastric cancer patients.

METHODSRetrospective cohort study was conducted to evaluate the clinicopathologic data of 388 gastric cancer patients who underwent surgical procedures in Chinese PLA General Hospital between November 2011 and December 2012. Relationships between TD and clinicopathologic features were analyzed by χor Fisher exact tests. Survival curves were also generated by Kaplan-Meier method. The univariate and multivariate analysis were performed with Log-rank and COX proportional hazard model to examine the association between prognosis and TD.

RESULTSTD were observed in 67 (17.3%) of 388 gastric cancer patients, including 48 male patients (48/289, 16.6%) and 19 female patients (19/99, 19.2%). There were 40 patients (40/198, 20.2%) whose age was above 64 years old. TNM staging of positive TD patients was as follows: for pathology, there were 5 patients (5/64, 7.8%) in stage II(b, 6 patients (6/58, 10.3%) in stage III(a, 14 patients (14/75, 18.7%) in stage III(b, 30 patients (30/135, 22.2%) in stage III(c, 12 patients (12/39, 30.8%) in stage IIII( and no one in stage I(b or II(a; for T-staging, there were 2 patients (2/18, 11.1%) in stage T2, 2 patients (2/27, 7.4%) in stage T3, 36 patients (36/259, 13.9%) in stage T4a and 27 patients (27/84, 32.1%) in stage T4b; for N-stage, there were 5 patients (5/72, 6.9%) in stage N0, 6 patients (6/72, 8.3%) in stage N1, 19 patients (19/82, 23.2%) in stage N2, 27 patients (27/100, 27.0%) in stage N3a and 10 patients(10/62, 16.1%) in stage N3b; for M-stage, there were 12 patients (12/40, 30.0%) in distal metastases; for vascular invasion, there were 29 patients (29/129, 22.5%). Among positive TD patients, the number of TD >3 was found in 38 of 67 cases(56.7%). TD was associated with pTNM-stage (χ=16.898, P=0.010), T-stage (χ=17.382, P=0.001), N-stage (χ=18.080, P=0.001), M-stage (χ=5.060, P=0.036) and vascular invasion(χ=3.675, P=0.039). The median survival time of positive TD patients was significantly shorter as compared to negative TD patients (22 months vs. 32 months, χ=23.391, P=0.012). Among positive TD patients, the median survival time of patients with TD number >3 was significantly shorter as compared to those with TD number <3 (17 months vs. 25 months, χ=5.157, P=0.023). Multivariate survival analysis showed that TD number >3 was the independent risk factor of prognosis (RR=2.350, 95%CI:1.345 to 4.106, P=0.003).

CONCLUSIONSTD state is closely associated with the staging of gastric cancer and TD number >3 indicates a poor prognosis.

Aged ; China ; Cohort Studies ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Invasiveness ; pathology ; Neoplasm Metastasis ; Neoplasm Staging ; methods ; statistics & numerical data ; Prognosis ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; classification ; diagnosis ; mortality ; pathology ; Survival Rate

Objective The purpose of this study was to examine the inhibitory effect of ONO-AE3-208, an EP4 antagonist, on prostate cancer with bone metastasis in an animal model . Methods A PC3/LUC cell line was constructed by stably transfecting luciferin to prostate cancer PC 3 cells and inoculated into the left ventricle of nude mice to establish an animal model of prostate cancer with bone metastasis .After modeling , the animals in the experimental group and control groups were intraperitoneally given ONO -AE3-208 and double-distilled water, respectively, followed by examination of the metastasis loci and tumor burden by bioluminescence ima -ging and statistical analysis with survival curves . Results At 60 days after modeling , the animals in the control group exhibited sig-nificantly increased metastases and fluorescence burdens as compared with the experimental group (P<0.01), and the increase was in a time-dependent manner (P<0.01).At 60 days, the controls began to die while the experimental animals remained well alive , and at 180 days, the mice of the control group all died .The survival rate of the animals was significantly higher in the experimental group than in the control ( 13.3% vs 0%, P <0.01 ) and the median survival time remarkably longer in the former than in the latter group (162 d vs 116 d, P <0.01). Conclusion The EP4 antagonist ONO-AE3-208 inhibited the bone metastasis of prostate cancer and prolonged the survival time in the model mice .

Objective Renal cell carcinoma ( RCC) is a common renal malignancy, which is resistant to nearly all chemo-therapeutics and radiotherapy.Wnt signaling plays an important role in the tumorigenesis and cell proliferation and apoptosis of RCC. This study was to explore the inhibiting effect of 15-oxospiramilactone NC043, a new Wnt molecule inhibiter, on the xenograft growth of human renal carcinoma (ACHN) cells in nude mice. Methods ACHN cells (1 ×107) were suspended in 100μL PBS and injec-ted subcutaneously into the right side of the posterior flank of female BALB/c athymic nude mice to establish a xenograft model.The nude mice bearing ACHN cells were randomly divided into three groups, negative control, low-dose medication, and high-dose medica-tion, treated by daily intraperitoneal injection of 3%DMSO, NC043 at 45μg/kg, and NC043 at 90μg/kg, respectively, for 15 days. At 16 days, all the mice were killed, the body weight and tumor volume obtained, and the expressions of ki67, TCF4 and β-catenin determined by immunohistochemistry. Results NC043 significantly inhibited the growth of the xenograft tumor, with an inhibition rate of 36.4%in the 45 ug/kg group and 56.4% in 90 μg/kg group.The expressions of ki67, TCF4, andβ-catenin were markedly down-regu-lated in a dose-dependent manner ( P <0.01 ) . Conclusion NC043 can effectively suppress the growth of ACHN cells in the xeno-graft tumor and reduce the expression of Wnt-related proteins, andtherefore is a potential compound for the treatment of renal cell carcinoma.

Objective The occurrence and progression of renal cell carcinoma ( RCC) is complicated process associated with DNA abnormal methylation , histone modification , and Wnt signaling pathway .This study aimed to investigate the expression of histone methylase SET8 in RCC, its relationship with the Wnt signaling pathway , its action mechanism in RCC , and its clinical significance . Methods We selected 50 cases of RCC treated by radical nephrectomy , detected the expression of SET 8 in the RCC and adjacent noncancerous kidney tissues by immunohistochemical EliVision two-step staining with β-catenin.We compared the expression levels of SET8 and β-catenin in the two types of tissue and analyzed their relationship with the patients′clinical information and the pathologic stage and grade of tumor as well as the correlation between the SET 8 andβ-catenin expressions . Results SET8 was mainly express in the cytoplasm of the RCC and noncancerous kidney tissues , partially in the cell membrane and nucleus , while theβ-catenin protein chiefly in the cell membrane of renal tubular epithelial cells in the normal kidney tissue .The expression levels of SET 8 and β-catenin in the RCC tissue were closely related to the TNM stage and tumor grade (P<0.05).The positive expression of SET8 in the RCC tissue (76%[38/50]) showed no significant difference from that in the ad-jacent noncancerous kidney tissue (66% [33/50]) (P>0.05), but that of β-catenin was remarkably higher in the former (68%[34/50]) than in the latter (4%[2/50]) (P<0.01).There was a positive correlation between the positive expression of SET 8 and the abnormal expression of β-catenin (r=0.219, P<0.05). Conclusion SET8-activated H4K20me-1 controls the activation and abnormal activities of the Wnt signaling pathway , affects the gene transcription and cell activity , and participates in the occurrence , progression, and distant metastasis of RCC .

BACKGROUND:There are many animal models used for studying discogenic pain, but percutaneous puncture annulus is rarely reported. Minimal y invasive approach to establish a discogenic pain model in Spraque-Dawley rats could reduce the interference factors of surgical trauma.
OBJECTIVE:To establish a Spraque-Dawley rat model of discogenic pain by percutaneous puncture annulus, with easy operations, high stability and obtaining large-scale productions, and to confirm the model by the results of behavior, MRI and molecular biology.
METHODS:Eighty-eight male Sprague-Dawley rats, of specific pathogen free level, were randomly divided into three groups, model group (n=44), control group (n=10) and sham group (n=34). In the model group, the annulus was percutaneously punctured under X-ray guidance;while rats in the sham group were punctured at the paravertebral tissue, rather than the annulus.
RESULTS AND CONCLUSION:The 50%mechanical withdrawal threshold of both hind paws in model group were reduced compared with control group and sham group. In the model group, the L 5/6 intervertebral disc degeneration was apparently visible, and the degree of degeneration was aggravated along the time. In the model group, the expression of calcitonin gene-related peptide in dorsal root ganglion of rats began to increase at 3 days post-operation and reached the peak at 21 days post-operation, then remained at high levels until the 35th day post-operation. The expression of tumor necrosis factor-αin dorsal root ganglion of rats increased at 3 days post-operation and reached the peak at 14 days post-operation, then remained at a higher level until the 35th day post-operation. The experiment result verifies that the discogenic pain model of Spraque-Dawley rats induced by percutaneous puncture annulus has the advantages of good stability and less trauma. The model can be used to study discogenic pain.

Objective Studies on the application of fast track surgery ( FTS) are comparatively limited in urologic proce-dures.This randomized controlled study was to evaluate the impact of FTS on recovery after retroperitoneal laparoscopic adrenalectomy . Methods Eighty patients undergoing retroperitoneal laparoscopic adrenalectomy were randomly assigned to an FTS and a control group of equal number to receive an FTS recovery program and conventional perioperative care , respectively .Comparisons were made between the two groups in the time of the first flatus , first oral nutrition , and first mobilization , the incidence of gastrointestinal tract complica-tions, the time of drainage and transurethral catheterization , the length of postoperative hospital stay , hospitalization expenses , visual analogue scale (VAS) pain scores, and general state of the patients . Results The FTS group, in comparison with the control, showed significantly earlier time of first flatus ([20.6 ±8.3] vs [39.8 ±18.3]h, P<0.05), first oral nutrition ([21.1 ±9.9] vs [51.8 ±16.9]h, P<0.05), and first mobilization ([23.6 ±9.0] vs [55.6 ±18.5]h, P<0.05), markedly shorter time of drain-age ([20.9 ±7.9] vs [70.6 ±18.9]h, P<0.05), transurethral catheterization ([20.2 ±8.3] vs[62.5 ±27.1]h, P<0.05), and postoperative hospital stay ([2.43 ±0.94] vs [5.46 ±1.60] d, P<0.05), remarkably less expenses of hospitalization ([21.7 ± 3.2] vs [28.6 ±6.5] ￥1000, P<0.05), and lower postoperative pain scores at 12 h (0.93 ±0.89 vs 1.80 ±1.38), at 24 h while coughing (1.27 ±0.99 vs 4.65 ±1.33), and at 24 h at rest (0.70 ±0.61 vs 1.40 ±0.84) (P<0.05).The general state score was dramatically higher in the FTS patients than in the control on postoperative day (POD) 1 (6.85 ±1.00 vs 4.28 ±1.11) and POD 2 (8.30 ±0.94 vs 5.53 ±1.24) (P<0.01).No significant differ-ences were observed in the general state of the patients between POD 2 and the baseline (P>0.05), nor in the incidence of gastrointesti-nal tract complications between the FTS and control groups ( P >0.05). Conclusion By improving the general state and accelera-ting the recovery of the patients , FTS can be applied safely and effectively in retroperitoneal laparoscopic adrenalectomy .

Objective Wnt signaling plays an important role in the development and progression of renal cell carcinoma (RCC).This study aimed to evaluate the effects of the Wnt signaling inhibitor 15-oxospiramilactone on the proliferation , migration, cell apoptosis, and cycles of the human RCC cell line 786-0, and to investigate the possible mechanisms of this small molecule acting on RCC in ivtro. Methods We treated 786-0 cells with DMSO ( blank control group ) and 15-oxospiramilactone at the concentrations of1.25μmol/L (low 15 -OSL), 2.5μmol/L (medium 15-OSL), and 5μmol/L (high 15-OSL), respectively, for 72 hours.Then we observed the changes in the proliferation and migration of the 786-0 cells by MTT and scratch-wound assay and determined their apopto-sis and cycles by Annexin V-FITC/PI assay and flow cytometry . Results 15-oxospiramilactone significantly inhibited the growth of the 7860-cells, with the IC 50of 1.088 μmol/L at 72 hours, and decreased their migration distance (P<0.05).After 36 hours of treatment, the apoptosis rates of the 786-0 cells in the low, medium, and high 15-OSL groups were (12.17 ±0.56), (18.54 ± 1.07), and (50.74 ±1.28) %, respectively, significantly increased as compared with (7.85 ±0.42) %in the blank control group (P<0.05), and in an obviously concentration-dependent manner.15-oxospiramilactone remarkably reduced the number of cells in the G0/G1 phase and increased that in the G 2/M phase (P<0.05). Conclusion 15-oxospiramilactone can significantly inhibit the pro -liferation and migration and induce the apoptosis of 786-0cells in vitro.It may be a potential anti-RCC agent.