Comparison between the results of UroCAD and cytology tests in training cohort.

Comparison between the results of UroCAD and urine cytology tests in the training group.

UroCAD reproduce testing results among different sampling time points

Summary of related data of UroCAD assay.

Comparison of UroCAD and urine cytology tests in the validation cohort.

Comparison of UroCAD results of urine samples stored for 2 hours and 72 hours.

目的 基于验案分析探讨柴胡桂枝干姜汤的方证特点与配伍规律.方法 检索瀚堂典藏中医药文献数据库和中国生物医学文献服务系统(SinoMed)中使用柴胡桂枝干姜汤的古今验案,用频次法计数文献中各验案的主要症状及用药情况,用因子分析和层次聚类分析其方证特点和用药配伍规律.结果 共纳入236篇文献,获得古代验案9个、现代文献验案227个.常见症状变量的因子分析显示,柴胡桂枝干姜汤验案症状可以分为少阳胆郁气滞症状、脾虚消化道症状、津液代谢失常湿盛和全身阳气不足症状4类;分层聚类分析显示,少阳郁滞、胆胃失和挟湿以及少阳郁滞、肝脾不调是其汤证的主要病机,兼见阳气不足表现.从用药情况来看,柴胡桂枝干姜汤原方药物的使用频次最高,同时多配伍健脾、和胃、养血、安神之品;药物变量分层聚类分析显示,柴胡桂枝干姜汤原方药物在用药中占绝对优势,聚为独立的一类;陈皮、党参和半夏聚为一类,发挥补虚和胃降逆化饮除湿作用;茯苓、泽泻、白术、白芍、当归和龙骨聚为一类,发挥益气养血、健脾利湿之功.结论 柴胡桂枝干姜汤主证以少阳郁滞、脾胃失调、津气不化为特征,临床又有少阳兼胃气不和与少阳兼太阴不足的细微差别,用药上应灵活加减变化.

Abstract Purpose: Urothelial carcinoma is a malignant cancer with frequent chromosomal aberrations. Here, we investigated the application of a cost-effective, low-coverage whole-genome sequencing technology in detecting all chromosomal aberrations. Experimental Design: Patients with urothelial carcinomas and nontumor controls were prospectively recruited in clinical trial NCT03998371. Urine-exfoliated cell DNA was analyzed by Illumina HiSeq XTen, followed by genotyping with a customized bioinformatics workflow named Urine Exfoliated Cells Copy Number Aberration Detector (UroCAD). Results: In the discovery phase, urine samples from 126 patients with urothelial carcinomas and 64 nontumor disease samples were analyzed. Frequent chromosome copy-number changes were found in patients with tumor as compared with nontumor controls. A novel diagnosis model, UroCAD, was built by incorporating all the autosomal chromosomal changes. The model reached performance of AUC = 0.92 (95% confidence interval, 89.4%–97.3%). At the optimal cutoff, |Z| ≥ 3.21, the sensitivity, specificity, and accuracy were 82.5%, 96.9%, and 89.0%, respectively. The prediction positivity was found correlated with tumor grade (P = 0.01). In the external validation cohort of 95 participants, the UroCAD assay identified urothelial carcinomas with an overall sensitivity of 80.4%, specificity of 94.9%, and AUC of 0.91. Meanwhile, UroCAD assay outperformed cytology tests with significantly improved sensitivity (80.4% vs. 33.9%; P < 0.001) and comparable specificity (94.9% vs. 100%; P = 0.49). Conclusions: UroCAD could be a robust urothelial carcinoma diagnostic method with improved sensitivity and similar specificity as compared with cytology tests. It may be used as a noninvasive approach for diagnosis and recurrence surveillance in urothelial carcinoma prior to the use of cystoscopy, which would largely reduce the burden on patients.

目的 探讨后腹腔镜辅助经腰小切口肾部分切除术治疗复杂性T1期肾癌的可行性及其疗效.方法 回顾分析2010年7月至2013年12月间我科收治的28例复杂性T1期肾癌患者的临床资料,肿瘤直径(3.76±1.28)cm,其中内生性肾癌13例,T1b期肾癌12例,近肾门肾癌7例,解剖性孤立肾肾癌2例,肾肿瘤解剖学特征PADUA评分为(9.07±1.25)分.所有患者均接受后腹腔镜辅助经腰小切口肾部分切除术治疗.结果 28例患者均顺利完成手术,围手术期无尿漏、大出血等严重并发症,手术时间(213.82±40.04)min,术中肾脏冷缺血时间(23.88±5.98) min,手术出血量(191.07±94.33)mL,手术切口长度(9.48±1.56)cm,患者术后疼痛评分(1.11±0.31)分,2例患者术后出现短暂性高热,经对症处理后体温恢复正常.患者术后平均住院(11.54±3.98)d,均正常出院.术后随访(21.46±12.15)个月,术后第1个月患侧肾脏肾小球滤过率(GFR)平均下降(21.71±11.48)％,随访期间均未发现肿瘤局部复发或远处转移.结论 后腹腔镜辅助经腰小切口肾部分切除术治疗体积较大、内生性生长或靠近肾门的复杂性T1期肾癌疗效满意,技术上安全、可行,便于实施和掌握,其手术切口创伤较小,值得临床推广应用,其远期疗效尚需大样本随机对照研究和长期随访观察.

目的探讨超选择性肾动脉分支阻断术在腹腔镜下肾部分切除术中的可行性、安全性及其对患者术后肾功能的短期影响。方法回顾性分析长海医院泌尿外科2013年6月至2014年5月因肾恶性肿瘤入院,并接受同一术者经腹腹腔镜肾部分切除术治疗患者的临床资料,比较超选择性肾动脉分支阻断术（10例）和肾动脉主干阻断术（13例）对手术时间、术中出血量及术后肾功能等临床参数的影响。结果与肾动脉主干阻断术相比,采用超选择分支阻断术者手术时间延长[（257.60±22.03）min vs（199.08±36.70）min,P＜0.05]、术中出血量增多[（220.00±57.01）mL vs（71.54±30.51）mL,P＜0.05]、术后切口平均引流量增加[（113.33±24.82）mL vs（68.08±28.88）mL,P＜0.05],两组患者术后均无大出血、尿漏等严重并发症发生。但在血管阻断时间相当的条件下[（28.60±8.17）min vs（27.85±6.16）min],超选择分支阻断术对肾功能的损害小于肾动脉主干阻断术,接受分支阻断处理的患者术后早期肾小球滤过率（eGFR）的下降程度明显低于后者[（3.14±7.22）%vs（15.26±9.53）%,P＜0.05]。结论超选择性分支动脉阻断术对肾功能损害低于传统的肾动脉主干阻断术,有利于腹腔镜下肾部分切除术后肾功能的早期恢复,值得进一步研究。

目的:探讨应用即时通讯工具微信在临床实习中的作用,评估通过微信发布案例教学法在泌尿外科实习生带教中的应用及其效果.方法:随机选择第二军医大学医学院本科泌尿外科班临床实习50名学生为研究对象,分两组,实验组结合微信的典型案例教学及微信师生沟通.对照组按传统讲授式教学.结果:实验组学生的平均成绩明显高于对照组,P＜0.05,差异有统计学意义.结论:微信案例教学法及师生微信方式互动有助于提高学生的实习兴趣和知识的吸收率,锻炼了学生的逻辑思维能力及解决问题能力,为泌尿外科学临床实习教学改革提供了新的思路和模式.

随着社会的发展和自我意识的觉醒,人们对自己权利的保护意识也越来越高。在外科临床教学中出现的患者依从性降低,不愿意配合临床教学等问题越来越突出。如何从伦理学角度出发,促进和增强患者配合的意愿,为此本文分析总结了在外科临床教学中应遵从的伦理学原则。

Animal Surgery is an important bridge course between basic and clinical medicine.Its teaching requirements and teaching methods are different from other general medical courses in that the goal of it is skill acquisition and the main content of it is repeated practice.We try to teach animal surgery with the introduction of micro-message,forming three-dimensional space-time teaching mode among teachers and students by actively releasing smartphone-based micro-message with content of educational administration,professional knowledge,medical images and videos,strengthening real-time and high efficient information dissemination and interactive communication among educational administration division,teachers and students,achieving a thorough information obtaining and medical learning anywhere and anytime,breaking through the time and space constraints of traditional teaching mode,fully realizing a positive feedback of medical education and teacher-student interaction,as well as strengthening teacher-student emotion,even in the student sentiment and comprehensive moral education.This new teaching strategy significantly improved the quality and obtained the good effect in animal surgery teaching.

目的 评价经后腹腔镜联合经腰小切口及超声辅助下行中心型肾癌保留肾单位手术的临床疗效,总结手术经验.方法 回顾性分析2010年8月至2012年3月12例经后腹腔镜联合经腰小切口及超声辅助下行保留肾单位手术治疗中心型肾癌患者的临床资料.男9例、女3例,平均年龄(56.2±2.8)岁；肿瘤平均直径(2.2±1.4) cm.术前均经超声、CT、MRI或CT动脉造影检查.患者全身麻醉后取健侧卧位,后腹腔镜常规方法游离出肾动脉、肾静脉及肾脏,切开腋后线与腋前线的两个Trocar之间的皮肤及肌肉,建立小切口,将超声探头从小切口置于肾表面,对肿瘤进行定位并标记手术切缘,放置冰屑于肾周,行肾动脉阻断或动、静脉阻断下保留肾单位手术.结果 12例手术均获成功,手术平均时间(124.5±5.8) min,术中平均热缺血时间(26.3±8.6) min,术中平均出血量(65.8±21.6) mL.切缘阴性率100％,平均手术切口(8.8±2.4) cm,术后平均住院时间(12.4±2.6)d；术后无并发症发生.随访平均(13.6±7.4)个月,未见肿瘤复发及转移.结论 后腹腔镜联合经腰小切口及超声辅助下对中心型肾癌行保留肾单位手术具有创伤小、出血少、热缺血时间短、恢复快的优点,是一种安全、有效的治疗方法,具有良好的临床应用前景.

Objective To assess the safety,feasibility and efficacy of retroperitoneal laparoscopic-assisted mini-incision partial nephrectomy in treatment of R.E.N.A.L.tumors with R.E.N.A.L.score ≥7,and to evaluate its clinical significance. Methods Between January 2011 and November 2012,retroperitoneal laparoscopic-assisted mini-incision partial nephrectomy was performed in 19 R.E.N.A.L.tumor patients with R.E.N.A.L.score ≥7 at our institution.The information of patients was: male/female,10/9;age(48.5±14.0) years old;body mass index(24.0±2.6) kg/m2;ASA score(1.9±0.4);Charlson co-morbidity index(age-weighted) 0.6±0.2;tumor laterality(L/R) 11/8;maximal diameter(3.3±1.2) cm;R.E.N.A.L.nephrometry score 8.6±0.9;and preoperative estimated glomerular filtration rate(eGFR)([104.8±24.0] mL/[min·1.73 m2]).The R.E.N.A.L.pedicle,involved kidney and tumors were exposed by retroperitoneal laparoscopic techniques.A mini-incision was made along the line between the two original subcostal trocar sites.The R.E.N.A.L.pedicle was clamped and ice-slush surface cooling of the kidney was given,by then the tumor resection and R.E.N.A.L.defect reconstruction was finished.Results All the 19 cases were smoothly finished without any intraoperative complications or blood transfusion.The operative time was(220.2±57.5) min,estimated blood loss was(252.6±182.9) mL,R.E.N.A.L.ischemia time was (25.2±6.6) min,and all surgical margin was negative.The recovery was smooth,with a mean postoperative hospital stay of (11.4±3.4) days.Pathological examination revealed 15 cases of R.E.N.A.L.carcinoma,2 angiomyolipoma,and 2 others.All the patients were alive after a mean follow-up of(13.1±6.7) months,without local recurrence or distant metastasis.Nevertheless,the eGFR was significantly decreased from(104.8±24.0) to(90.4±17.0) mL/(min·1.73 m2) after operation(Z=-3.099,P=0.002).Conclusion Retroperitoneal laparoscopic-assisted mini-incision partial nephrectomy is a safe,feasible and effective alternative for surgical management of complex localized R.E.N.A.L.tumors.It has the combined advantages of open operation and conventional laparoscopic partial nephrectomy,with less surgical demanding and lower cost,and is therefore deserve further popularization.

Objective To compare profiles of microRNA between the LNCaP and LNCaP-AI cell lines,so as to futher elucidate the post-transcritional mechanism regulating the progression to androgen-independence.Methods The microRNA profiles of LNCaP and LNCaP-AI cell lines were examined by Agilent's microassay.The expression of six microRNAs was verified by RT-PCR.The functions of differentially expressed microRNAs were eludicated by a search with miRBase software(http://www.mirbase.org/).Results The Aglint's microRNA microassay showed that 11 microRNAs were up-regulated and 27 were down-regulated during the LNCaP progression to androgen-independence.RT-PCR results were consistent with those of the Agilent's microassay chips.By searching the targets of microRNAs in the miRBase software,we found that the differentically expressed microRNAs were mainly involved in regulation of matrix metalloproteinase 9(MMP-9),Bcl-2,and epithelial growth factor receptor(EGFR) and genes mediating androgen metabolism.Conclusion There is alteration of microRNA during the progression of LNCaP to androgen-independence,which may involve androgen receptor related pathway,metalloenzyme,anti-apoptotic gene and genes related to androgen metabolism.

Objective:To evaluate the feasibility,safety,and efficacy of transperitoneal laparoendoscopic singlesite(LESS) adrenalectomy and seek to whether it indicates advantages compared with standard laparoscopy.Methods:Between August 2009 and May 2011,a single urologist in our center performed 13 cases of transperitoneal LESS adrenalectomy through a 2-3 cm skin incision using the TriPort access system and 26 cases of standard laparoscopic adrenalectomy.The clinical and follow-up data were statistically analyzed.Results:The 2 groups were compared with respect to patient demographics,estimated blood loss,and postoperative hospitalization(P>0.05).The LESS procedures had a longer mean operative time(148.5:112.9 mins,P =0.032),but a significantly lower postoperative visual analog pain scale score(2.3:3.7,P = 0.001).fewer patients requiring analgesics(30.8%:73.1%.P = 0.011),and an earlier resumption of oral intake(21.6:26.0 hours.P = 0.002).The mean length of the scar in the LESS group was much smaller(2.3:5.9 cm.P<0.001) with a statistically significant greater mean cosmetic satisfaction score(9.5:9.1.P = 0.042).Conclusions:The transperitoneal LESS adrenalectomy provides better postoperative pain control,faster recovery of bowel function,and better cosmetic satisfaction than standard laparoscopy. albeit with a longer operative time.It is a feasible,safe,and effective option for small adrenal tumors.

Objective To summarize the surgical experience in robotic-assisted laparoscopic partial nephrectomy,and to investigate the efficacy and safety of this surgery.Methods The clinical data of 12 patients who underwent robot-assisted laparoscopic partial nephrectomy in Changhai Hospital from March to July in 2012 were analyzed.All the patients were male and the age range was 43-66 years.In 4 cases the tumors were in the left kidney,and 8 in the right.In 7 cases the tumors were in the dorsal part of the kidney,and 2 in the ventral part.There were 3,5 and 4 cases in the upper,middle and lower pole of the kidney respectively.Preoperative GFR test was normal in all cases.Kidney CT scan showed the maximum diameters of the tumors were 2.0-5.8 cm,with an average of 3.3 cm.The pre-operative stages in all cases were T1N0M0.Results The surgery was successfully completed in all cases.The mean duration of the surgery was 160-310 min,with an average of 242 min.The blood loss was 30-300 ml,with an average of 135 ml,and the intraoperative blood transfusion was unnecessary.The warm ischemia time was 20-49 min,with an average of 31 min.There was no intraoperative morbidity,and no conversion to open surgery.The postoperative length of hospitalization was 9-31 d,with an average of 14 d.Gross hematuria arose in 1 patient at 1 week after the surgery.The post-operative pathology showed renal clear cell carcinoma with Furhman Grade Ⅱ in 11 cases,and renal angiomyolipoma in 1 case.The maximum diameters of the tumors were 2.0-5.0 cm,with an average of 3.5 cm.The tumor resection margin was negative in all cases.Conclusions Robot-assisted laparoscopic partial nephrectomy is safe and effective for local renal tumors.This surgery has significant advantage over traditional laparoscopic partial nephrectomy,in terms of the resection of the renal tumors and the reconstruction of the kidney.

Objective:To evaluate the clinical treatment efficacy of urethral stricture secondary to pelvic fracture sugery using optic internal urethrotomy guided by flexible cystoscope.Methods:12 patients undergoing suprapubic cystosctomy afer pelvic frature at the median age 33(ranger from 19 to 54)were retrospectively reviewed by certain criteria.Urethrogram and urethral sounds were used to determine the localtion and length of stricture before sugery.The internal urethrotomy was guided by flexible cystoscope which was inserted from the bladder fistula to the internal urethral orifice.The operation time,blood loss,and complication were recorded.Patients were followed every month after 1 month catheterized.The urethrogram,uroflowmetry,and IIEF was performed in 3 months postoperation.Results:All sugery successed.Operation time was(37±12)min,hemoglobin postoperation decrease was(4.5±2.3)g/L,All patients continence after remove catheter,the IIEF scores change unconspicuously between preopreation and postopreation[(12.4±6.6) vs(13.1±7.0),P>0.05].The follow-ship last from 6 to 22 months.9 of 12 satisfied with their urination.Dysuria happened in 3 cases caused by secondary urethrostenosis.2 patients urinate normally after 4 times and 1 patient for 6 times consecutively urethral dilatations(once a week),finally the F18 urethral sound can be smoothly inserted.Their Qmax were all above(16.2±5.8)ml/s three months later.Conclusions:The optic internal urethrotomy guided by flexible cystoscope is easily to be performed,minimally invasive,few complication.The recently curative effect and longterm outcome is satisfactory.It is optimum option for urethral stricture after pelvic frature.

The left radical nephrectomy with tumor thrombectomy in the presence of a duplicated inferior vena cava is of high surgical risk because the venous tumor thrombus renders the anomalous venous structures dilated and tortuous, making injury more likely. We present a case of a left kidney cancer grossly extending into the left side of a duplicated inferior vena cava. What is more important is to bring such an aberrant vascular anatomy with tumor thrombus to the attention of urologists with high-resolution pictorial illustrations.