前列腺癌作为仅次于肺癌的全球男性第二高发肿瘤,其治疗是医疗界面临的一大挑战.但可喜的是前列腺癌的病死率在许多国家持续降低,这不仅得益于早期筛查诊断方法的改善,也得益于治疗方法的进展,使得某些已出现转移的患者推迟了因前列腺癌死亡的时间.转移性前列腺癌(mPC)大体可分为两种:未接受雄激素剥夺治疗(ADT)且对雄激素治疗敏感的mPC,即转移性激素敏感性前列腺癌(mHSPC)和对ADT不再敏感的mPC,即转移性去势抵抗性前列腺癌(mCRPC).本文重点关注的是对mHSPC诊疗中所取得的进展与面临的挑战.

Objective:To investigate the 2 years’ efficacy of intravesical instillation of domestic BCG versus epirubicin in the prevention of recurrence of intermediate-risk or high-risk non-muscular invasive bladder cancer and predictive factors of BCG instillation.Methods:From July 2015 to June 2020, 18-75 years old patients with moderate to high-risk non muscle invasive bladder cancer (NMIBC) confirmed by pathological examination were involved. The ECOG score was 0-2. Exclusion criteria included ①immune deficiency or impairment (such as AIDS), using immunosuppressive drugs or radiotherapy, suspected allergic to BCG or epirubicin or excipients of the two drugs, fever or acute infectious diseases including active tuberculosis or receiving anti tuberculosis treatment, with severe chronic cardiovascular and cerebrovascular diseases or chronic kidney disease; ②combined with other urogenital system tumors or other organ tumors; ③combined with muscle invasive bladder urothelial carcinoma (≥T 2); ④undergoing chemotherapy, radiotherapy or immunotherapy within 4 weeks (immediate instillation after surgery not included); ⑤ pregnant or lactating women; ⑥ comfirmed or suspected bladder perforation; ⑦gross hematuria; ⑧cystitis with severe bladder irritation that may affect the evaluation; ⑨participat in other clinical trials within 3 months; ⑩alcohol or drug addiction; ?any risk factors that may increasing the risk of patients. Epirubicin 50 mg was irrigated immediately after the operation(TURBT or laser resection). The patients were randomly divided into BCG15 group, BCG19 group and epirubicin group by the ratio of 2∶2∶1, and the patients were maintained intravescical instillation for 1 year. The recurrence and adverse events of the three groups were compared. Univariate and multivariate analysis was performed to predict the risk factors of BCG irrigated therapy failure. Result:By June 15, 2020, the median follow-up duration was 22.1 months(12.1, 32.3), and there was no statistical difference between the groups ( P=0.9024). There were 274 patients enrolled in BCG19 group, 277 patients enrolled in BCG15 group and 130 patients enrolled in the epirubicin group. The drop-off rate was 16.6%(113 cases)and made no difference between groups( P=0.6222). There were no significant difference in age, gender, BMI, or ECOG score( P>0.05). During the follow-up, 116 cases was detected recurrence or progression. The recurrence rate of the three groups was 14.2% and 14.8% in BCG19 group and BCG15 group, and 27.7% in the epirubicin group. There was no difference in recurrence rate between BCG19 and BCG15 group( P=0.9464). The recurrence rate of BCG19 group was lower than that of the epirubicin group ( P=0.0017). The recurrence rate of BCG15 group was lower than that of the epirubicin group ( P=0.0020). There was no difference in the cumulative recurrence free survival rate between BCG19 and BCG15 group (95% CI0.57-1.46, P=0.7173). The cumulative recurrence free survival rate of BCG 19 group was better than that of the epirubicin group( HR=0.439, 95% CI0.26-0.74, P=0.0006), and the cumulative recurrence free survival rate of BCG15 group was better than that of the epirubicin group ( HR=0.448, 95% CI0.29-0.80, P=0.0021). The total incidence of adverse events in 19 BCG19, BCG15 and epirubicin group were 74.5%, 72.6% and 69.8% respectively. There was no difference in the incidence of adverse events between BCG19 and BCG15 group( P=0.6153). The incidence of adverse events in epirubicin group was lower than that of BCG19( P=0.0051) and BCG15( P=0.0167) groups.There was no significant difference in the incidence of serious adverse events (SAE) among the three groups ( P=0.5064). Log rank test univariate analysis and Cox risk regression model multivariate analysis showed that the history of bladder cancer recurrence( HR=6.397, 95% CI1.95-20.94, P=0.0001)was independent risk factor for BCG irrigation failure. Conclusions:The 2 years’ efficacy of intravesical instillation of domestic BCG is better than than of epirubicin with good tolerance and safety. There is no difference between BCG19 and BCG15 group. BCG doesn’t increase SAE compared with epirubicin. Recurrence status was an independent prognostic factor regarding recurrence-free survival.

目的 探讨全反式维甲酸(all-trans-retinoic acid,atRA)在脂多糖(lipopolysaccharide,LPS)诱导的附睾上皮细胞炎性反应中的作用及分子机制.方法 以LPS诱导附睾上皮细胞建立炎症模型,给予不同浓度的atRA、atRA受体抑制剂处理,以及转染转化生长因子β1(Transforming growth factorβ1,TGF-β1)的小干扰RNA,敲低细胞中内源性TGF-β1的表达,采用实时荧光定量PCR检测细胞中炎性因子白细胞介素1β(interleukin-1β,IL-1β)、白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)和TGF-β1的mRNA表达水平,酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测细胞上清中IL-1β、IL-6、TNF-α的分泌量,Western blot方法 检测附睾上皮细胞中TGF-β1的蛋白表达水平.结果 LPS组附睾上皮细胞中IL-1β、IL-6和TNF-αmRNA的表达水平明显高于对照组,给予不同浓度的atRA处理后小鼠附睾上皮细胞的炎性因子IL-1β、IL-6和TNF-αmRNA的表达水平明显降低,呈浓度梯度依赖性(P<0.01).LPS组附睾上皮细胞培养基上清中IL-1β、IL-6和TNF-α含量明显高于对照组,给予不同浓度的atRA处理后小鼠附睾上皮细胞培养基上清中IL-1β、IL-6和TNF-α含量明显降低,呈浓度梯度依赖性(P<0.01).LPS组小鼠附睾上皮细胞中TGF-β1 mRNA的表达水平明显低于对照组,给予不同浓度atRA处理后小鼠附睾上皮细胞中TGF-β1 mRNA的表达水平明显升高,呈浓度梯度依赖性(P<0.01).Si-TGF-β1组TGF-β1 mRNA表达水平明显低于Si-Ctl组(P<0.01).atRA+Si-Ctl+LPS组小鼠附睾上皮细胞IL-1β、IL-6和TNF-αmRNA相对表达量低于Control+LPS组,atRA+Si-TGF-β1+LPS组小鼠附睾上皮细胞IL-1β、IL-6和TNF-αmRNA相对表达量明显高于atRA组(P<0.01).atRA+Si-Ctl+LPS组小鼠附睾上皮细胞培养液上清中IL-1β、IL-6和TNF-α含量低于Control+LPS组,atRA+Si-TGF-β1+LPS组小鼠附睾上皮细胞培养液上清中IL-1β、IL-6和TNF-α含量明显高于atRA组(P<0.01).atRA组小鼠附睾上皮细胞中维甲酸α受体(retinoic acid receptor alpha,RARα)和维甲酸β受体(retinoic acid receptor beta,RARβ)mRNA相对表达量明显高于Normal组(P<0.01).atRA组TGF-β1 mRNA相对表达量明显高于Control组,atRA+BMS 195614组TGF-β1 mRNA相对表达量明显低于atRA组(P<0.01).结论 atRA可以抑制LPS诱导小鼠附睾上皮细胞炎性反应,其分子机制可能是通过与RARα受体结合上调TGF-β1的表达而抑制其抗炎反应.

目的 观察复方丹参片联合硫酸镁治疗附睾炎的临床效果及对血清炎性因子水平的影响.方法 附睾炎病人120例,根据随机数字表将病人分成实验组和对照组,每组60例.对照组使用盐酸左氧氟沙星注射液治疗21天.实验组在对照组用药方式的基础上,加用复方丹参片联合硫酸镁湿敷治疗21天,观察两组的疗效和临床症状评分,比较两组病人白细胞介素(IL)-1β、IL-6和肿瘤坏死因子(TNF)-α的水平.结果 实验组治疗总有效率为91.67％,高于对照组的80％(P<0.05).对照组治疗前后疼痛评分分别为(10.57±0.05)和(5.30±0.11),实验组分别为(10.54±0.09)和(3.30±0.02);对照组治疗前后生活质量(QOL)评分分别为(8.33±0.82)和(4.37±0.04),实验组分别为(8.57±0.03)和(3.26±0.03),治疗前后组内比较和治疗后组间比较差异均有统计学意义(P<0.05).实验组治疗后病人血清IL-1β、IL-6和TNF-α 含量分别为(49.92±0.45)pg/ml,(8.94±0.16)pg/ml和(7.10±0.14)pg/ml,对照组分别为(88.31±0.31)pg/ml,(18.25±0.26)pg/ml和(16.06±0.22)pg/ml,治疗后实验组炎性因子水平均较对照组降低(P<0.05).结论 复方丹参片联合硫酸镁湿敷可有效治疗附睾炎,降低血清炎性因子水平.

RNA结合模体蛋白(RBM)家族几乎在所有细胞中均有表达,而且在进化上高度保守.以前的研究表明,RBM5在膀胱尿路上皮癌(bladder urothelial carcinoma,BUC)组织中表达下调,由此引起的细胞凋亡减少,进而促进肿瘤的进展.然而,RBM5氨基酸序列与其同源的RBM6在膀胱尿路上皮癌中的作用及相关机制尚不清楚.本研究检测RBM6在膀胱尿路上皮癌中的表达,探索其在膀胱癌细胞系中过表达对细胞增殖和凋亡的影响.利用qRT-PCR和Western印迹等技术,研究发现,RBM6在人膀胱尿路上皮癌组织和所检测的2个膀胱癌细胞系中表达均显著下调,并且其下调程度与患者的预后不良呈正相关.MTS检测细胞增殖的结果显示,RBM6过表达导致细胞增殖活性下降.细胞克隆形成实验结果也表明,RBM6过表达抑制细胞克隆形成能力(P＜0.01).原位末端转移酶标记技术(terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay,TUNEL染色)检测细胞凋亡表明,在RBM6过表达的细胞中,TUNEL阳性细胞数由对照组的17.17±3.27增加到44.00±8.04(P＜0.05).RBM6抗增殖及促凋亡的作用机制研究发现,在T24细胞中过表达RBM6后,β-联蛋白(β-catenin)和G1/S-特异性细胞周期蛋白-D1(G1/S-specific cyclin-D1,cyclin D1) mRNA表达水平分别降低65％和79％,对应的蛋白质水平分别降低60％和73％;反之,细胞周期蛋白依赖性激酶抑制因子1A (cyclin dependent kinase inhibitor 1A,CDKN1A/p21) mRNA表达水平升高约1.9倍,对应蛋白质水平升高约1.8倍.重要的是,糖原合酶激酶3beta(glycogen synthase kinase-3 beta,GSK-3β)磷酸化水平升高约2.4倍.细胞过表达β-联蛋白促进细胞增殖(P＜0.05),而利用小分子化合物LY294002促进GSK-3β磷酸化后,抑制细胞增殖(P＜0.05).综上所述,RBM6通过GSK-3β/β-catenin调节途径对膀胱尿路上皮癌细胞发挥抗增殖和促进凋亡作用.干预该调节途径可能是治疗膀胱尿路上皮癌的潜在靶点.

目的 探讨细胞因子诱导的凋亡抑制因子1(CIAPIN1)基因和Fibulin-3在膀胱尿路上皮癌中的表达及其与临床病理特征之间的关系.方法 收集膀胱癌及同一患者的癌旁标本98例,以癌旁组织作为对照,分别用实时定量PCR (qRT-PCR)检测组织样本中CIAPIN1和Fibulin 3基因的mRNA变化,利用Western blot检测组织样本中CIAPIN1和Fibulin-3蛋白表达情况;分析两者在膀胱癌临床病理表达特征之间的关系及两个基因的相关性.结果 CIAPIN1和Fibulin-3的mRNA水平在膀胱癌组织中的表达显著高于癌旁组织(P＜0.01),CIAPIN1在膀胱癌组织和癌旁组中的表达分别为4.223±0.986和2.054±0.866 (P＜0.05);而Fibulin 3在膀胱癌组织和癌旁组中的表达率分别为5.284±1.586和1.981±0.937 (P＜0.05);Western blot结果显示,与癌旁组织相比,CIAPIN1和Fibulin-3的蛋白水平在膀胱癌组织中的表达显著上调(P＜0.05).CIAPIN1和Fibulin-3基因在膀胱癌中的表达与病理分级、临床分期和淋巴转移相关(P＜0.05),两者均与患者年龄和性别无关(P＞0.05).膀胱癌组织中CIAPIN1和Fibulin-3的mRNA表达呈正相关(r=0.2577,P＜0.05).结论 CIAPIN1和Fibulin-3在膀胱癌中的表达均显著上调,联合检测可能增加膀胱癌诊断的准确率.

Objective To explore the feasibility and advantages of totally laparoscopic radical cystectomy plus ρshape orthotopic ileal neobladder,and to summarize the experiences.Methods The clinical data of 11 patients with bladder cancer admitted to the second hospital of Hebei medical university from October 2018 to May 2019 were retrospectively analyzed.All patients were male,aged 33 to 77 years,with an average of 64.4 years.Body mass index ranged from 18.0 to 31.8 kg/m2,with an average of 23.2 kg/m2.One case underwent partial cystectomy and 10 cases underwent transurethral resection of bladder tumor,with 10 cases of invasive urothelial carcinoma and 1 case of adenocarcinoma.No case underwent neoadjuvant therapy,and all cases were clinically staged as cT2a-3b N0-2 M0.Totally laparoscopic radical cystectomy and ρ shape orthotopic ileal neobladder intraperitonealy were performed.The specific procedures were described as follows.After bladder resection,the ileal segment of 55 cm in length was intercepted at 25 cm from ileocecal valve,with the proximal part retaining 15 cm lumen as the input loop,and the distal part of 40 cm ileum being folded in 1∶1 ratio.The folded intestinal segment was made into a allantoic sac by using a linear incision closure device,forming a “ρ” shape with the input loop,bilateral ureters and the input loop.Anastomosis of wall,distal end of allantoic and urethra was performed.Record the perioperative data such as operation time,estimated bleeding,postoperative recovery,complications,and follow-up results.Result All of the 11 cases underwent successfully operation,and no cases were transferred to open surgery.The operation time ranged from 320 to 440 minutes,with an average of 357.1 minutes.The estimated amount of bleeding ranged from 100 to 300 ml,with an average of 207.1 ml.The total time of intestinal tract procedure was 80-100 minutes,with an average of 89.3 minutes,and the time of allantoic preparation was 14-19 minutes,with an average of 16.1 minutes.The pain score was 2-5 points at 4 hours after operation,with an average of 3.8 points,and 1-4 points at 24 hours after operation,with an average of 2.3 points.Postoperative exhaust time ranged from 2.5 to 3.5 days,with an average of 3.0 days.Catheter removed 21 days after operation,with 9 cases of urinary incontinence,including mild in 6 cases,moderate in 2 cases and severe in 1 case,with daytime pad of 0-3 and nighttime pad of 1-3.which improved gradually following pelvic exercise for 4-18 weeks.Postoperative hospital stay ranged from 7 to 13 days,with an average of 10.4 days.The drainage removal time was 4-11 days,with an average of 6.7 days.Postoperative pathology revealed 7 cases of high-grade invasive urothelial carcinoma,3 case of low-grade invasive urothelial carcinoma and 1 case of adenocarcinoma.The tumors invade the prostate in adenocarcinoma patient,with left (3/13) and right (1/9) positive lymph nodes.One case of high-grade invasive urothelial carcinoma had both left (2/11) and right (1/9) positive lymph nodes,and the other cases were negative.The margin were negative in all patients.Pathological staging was pT2a-4a N0-2 M0.Postoperative adjuvant chemotherapy with gemcitabine + cisplatin regimen were performed in 9 patients.The follow-up period ranged from 3 to 29 weeks,with an average of 17.4 weeks,the patients with adenocarcinoma died of multiple organ failure at the 13th week after operation,and the other cases have no recurrence or metastasis.Dual J-tube was removed in 9 cases in the last follow-up,and the new bladder volume was estimated 300-350 ml,with residual urine of 0-43 ml and 19 ml of average.There is no stone formation in the new bladder.No hydronephrosis or ureteral dilatation aggravated.Conclusions Totally laparoscopic radical cystectomy plus ρ shape orthotopic ileal neobladder simplify the procedure of making allantoic storage and shorten the procedure time.The patients suffered less pain and recovered quickly after operation.It is a safe and feasible surgical procedure based on this study.

Objective To observe the effects of bisphenol A (BPA) on the content of testosterone in testis of male rats and on the expressions of P450scc and 3βhydroxysteroid dehydrogenase(3β-HSD),and to explore its action mechanism. Methods Forty-eight adult male SD rats were randomly divided into 4 groups:control group,low dose group(2mg·kg-1·d-1), middle dose group (20mg·kg-1·d-1) and high dose group (200mg·kg-1·d-1),with continuous intragastric administration for 8 weeks. The serum levels of testosterone were measured in different dose groups,moreover the expression levels of P450scc and 3β-HSD protein in testicular interstitial cell were detected by immunohistochemistry. Results The testosterone levels in middle dose group and high dose group were significantly lower than those in control group(P<0.05), meanwhile,the testosterone levels were gradually decreased with the increasing of the BPA dose. The immunohistochemical image analysis showed that the average absorbance values of P450scc and 3β-HSD in the three different dose groups were obviously lower than those in control group,moreover,which in middle dose group and high dose group were significantly lower than those in control group (P <0.05). Conclusion The bisphenol A can inhibit the synthesis of testosterone and the expressions of the P450scc and 3β-HSD in testicular interstitial cells of SD rats.

Objective To explore the clinical effects of flexible ureteroscopy combined with percutaneous nephrolithotomy (PCNL) on complex nephrolithiasis. Methods Fifty-one patients with complex nephrolithiasis who were treated in our hospital from January 2015 to July 2017 were randomly divided into control group (n=20) and observation group (n=31),which was subdivided into the first observation group (n=16) and the second observation group (n=15). The patients in control group who had kidney stones with a mean diameter of [3.73 ± 0.73 (range,2.8 ~5.4)] cm were treated by PCNL. By contrast,the patients in the first observation group who had stones with a mean diameter of[3.74 ± 3.93 (range,2.8~5.2)] cm were treated by PCNL combined with flexible ureteroscopy at stage one, and the patients in the second observation group who had stones with a mean diameter of 3.93 ± 0.73(range,2.9~5.2)cm were treated by PCNL before being treated by flexible ureteroscopy. Then, the operation time, stone clearance rate and complication rate were observed and compared among groups. Results All the surgeries were successfully completed in 51 patients. The operation time in control group was (89.50 ± 18.27)min,which in the first observation group was (81.56 ± 14.57)min,both were significantly shorter than that [(121.00 ± 18.15)min] in the second observation group (P<0.05).However there was no significant difference in operation time between control group and the first observation group (P>0.05).The stone clearance rates in the first observation group (93.7%) and the second observation group (93.3%) were significantly higher than that (65%) in control group(P<0.05),but there was no significant difference between the two observation groups(P>0.05). The clavien-Dindo grade I and Clavien-Dindo grade II of poestoperative complicatins were observed among the three groups, but there were no significant differences among the three groups.Conclusion The retrograde flexible ureteroscopy combined with percutaneous nephrolithotomy in treatment of complex nephrolithiasis can shorten operation time and decrease incidence of postoperative complications,which is a safe and feasibleand operation method in treatment of complex nephrolithiasis.

Objective To analyze the feasibility and safety in application of resectoscope combined with laparoscopy in the operation treatment of paraganglioma of urinary bladder.Methods 7 cases patients with paraganglioma of urinary bladder treated in our hospital from November 2014 to August 2018 were analyzed retrospectively.There were 5 males and 2 females,average age of 31.1 years (22-37 years),average body mass index was 22.3 kg/m2 (18.3-22.5 kg/m2).All the 7 cases patients complained of dizziness and palpitation after urination,average basal systolic blood pressure was 111.8 mmHg (97-124 mmHg),the average fluctuation of systolic blood pressure before and after urination was 64.9 mmHg(28-91 mmHg),the CT and cystoscopy prompt bladder tumor,the average diameter was 2.7 cm(2.1-3.5 cm).The average of plasma norepinephrine was 706.3 pg/ml(330-997 pg/ml);the average of plasma dopamine was 101.1 pg/ml(44-145 pg/ml);the average of 24h urinary vanilmandelic acid was 13.4 mg/24h (10.3-16.1 mg/24h).All the patients has controlled the blood pressure and dilate the blood vessels with phenoxybenzamine hydrochloride,accepted the operation of resectoscope combined with laparoscopy partial cystectomy and bladder sutura per abdomen after ample dilatancy.The patients had lithotomy position with trendelenburg,preparation of gas peritoneal cavity by transabdominal,inside the resectoscope by transurethral at the same time,mutilated bladder mucosa beside 1cm at the edge of the tumor,and cut full thickness bladder wall,take the extraperitional fat as the standard procedure;we could see the cutting edge clear at this time by laparoscopy,cut off the pelvic peritoneum,extraperitional fat and the tumor.The sample placed in bladder,close the bladder with absorbable or barbed wires,take out the sample by resectoscope.Results All the 7 cases patients operation was successfully completed,no cases has been transfered to open.The average time of operation is 85.3 min(65-100 min),the average amount of bleeding is 27.9 ml(10-50 ml).The average fluctuation of systolic blood pressure is 8.7 mmHg(6-15 mmHg).Bladder washout was stopped 24h after operation,catheter was removed 1 weeks after operation.There is no obvious complications occurred.The average hospital stay is 3.7 days (3-5 days).The average pain score of 4 cases 4h after operation is 3.8 (2-5),reevaluation 24h after operation is 2.3 (1-4).The average follow-up time is 7.9 months(2-15 months).All the 7 cases patients clinical symptoms disappeared,there is no fluctuation of systolic blood pressure before and after urination,there is no recurrence of the tumor.Conclusions To the paraganglioma of urinary bladder in fundus of bladder or anterior wall of bladder,we can accurate resection tumor by resectoscope combined with laparoscopy,reduce blood pressure fluctuations,reduce the surgical trauma and the distress of patients.It is a safety and effective minimally invasive surgery.

目的 比较2 μm激光与冷刀在肾脏部分切除术中的应用价值.方法 随机选取60例肾脏肿瘤患者,TNM分期均为T1aN0M0期的单发肿瘤患者,分成试验组27例,对照组33例,试验组肾脏部分切除中应用2 μm激光,对照组肾脏部分切除术中应用冷刀.结果 2组平均手术时间、术后近期复发率、术后平均住院时间差异无统计学意义(P>0.05),试验组术中出血量[(16.8±9.5)ml]比对照组[(92.1±30.5)ml]明显减少,差异有统计学意义(P<0.05),试验组中肿瘤切除时间[(8.7±5.5)min]比对照组[(13.8±8.2)min]明显减少,差异有统计学意义(P<0.05).结论 2 μm激光在肾脏部分切除术中安全有效,不仅提高了手术效率,而且不会增加复发率.

目的 探讨组合式输尿管软镜治疗上尿路结石的临床效果和安全性.方法 输尿管上段及肾结石患者358例应用组合式输尿管软镜联合钬激光碎石术.输尿管结石125例,结石大小13～23 mm,平均(17.3±1.3)mm.肾结石233例,其中肾盂结石105例,上、中盏结石63例,下盏结石65例;结石大小14～39 mm,其中结石＜20 mm 146例,结石大小14～19 mm,平均(16.5±1.4)mm,≥20 mm 87例,结石大小20～39 mm,平均(24.3±6.5) mm.观察结石清石率、手术时间及并发症.结果 输尿管上段结石组及肾结石组的一次进镜成功率差异无统计学意义,输尿管结石组碎石、清石率高于肾结石组,而手术时间短于肾结石组.按结石大小分组,其中＜20mm肾结石组清石率高于≥20 mm肾结石组,而手术时间短于≥20 mm肾结石组.按结石部位分组,不同部位的肾结石亚组一次进镜率、碎石和清石成功率、手术时间差异均无统计学意义.2组术后并发症为Clavien Ⅰ或Ⅱ级,10例术后出现发热、寒战,3例出现血压低等休克表现,经治疗后好转,2组并发症发生率差异无统计学意义.结论 输尿管软镜结合钬激光治疗输尿管上段结石及肾结石安全、有效,可作为上尿路结石的首选治疗方式.

目的 探讨膜联蛋白A2(ANXA2)和组织型纤溶酶原激活剂(t-PA)在肾透明细胞癌(clear cell renal cell carcinoma,ccRCC)中的表达及临床意义.方法 选取45例ccRCC癌组织标本及30例癌旁正常肾组织标本,采用免疫组织化学染色(免疫组化)及反转录聚合酶链反应(RT-PCR)技术分别检测ANXA2和t-PA在ccRCC癌组织及癌旁正常肾组织中的表达情况并进行比较.结果 免疫组化结果显示:ANXA2和t-PA阳性表达区域主要分布于胞膜和胞浆;ANXA2和t-PA在ccRCC癌组织中的表达显著高于癌旁正常肾组织(P均＜0.05),二者表达呈正相关(r=0.524,P=0.002),且其表达与组织学分级及临床分期有关(P＜0.05).RT-PCR结果显示:ANXA2及t-PA在ccRCC癌组织中的mRNA相对表达量明显高于癌旁正常肾组织(P均＜0.05).结论 ANXA2和t-PA的表达与组织学分级和临床分期相关,可能在ccRCC的浸润和转移中起着一定的协同作用.

目的 探讨Rab25蛋白(Ras-associated blinging protein)和磷酸肌醇3-激酶(Phosphatidylinositol 3-Kinase,PI3K)在肾透明细胞癌(clear cell renal cell carcinoma,ccRCC)中的表达及临床意义.方法 选取43例ccRCC癌组织标本及23例癌旁正常肾组织标本,分别应用免疫组织化学染色及反转录聚合酶链反应(RT-PCR)法检测Rab25、PI3K表达及mRNA相对表达情况,分析二者表达的相关性及其与临床病理特征的关系.结果 Rab25及PI3K阳性表达主要定位于胞膜或胞浆,癌旁正常肾组织多不着色.ccRCC癌组织中Rab25、PI3K阳性表达率及mRNA相对表达量均明显高于癌旁正常肾组织(P＜0.05);Rab25、PI3K在ccRCC中的表达呈正相关(r=0.487,P＜0.01),且二者的表达与肿瘤临床分期、淋巴结转移、病理分级密切相关(P＜0.05).结论 Rab25和PI3K可能与ccRCC的发展、侵袭、转移有紧密联系,且二者存在协同作用.

Objective To observe the effects of adrenomedullin (ADM) on the growth and angiogenesis of transplanted 786-0 renal cell carcinoma in nude mice.Methods The mouse model of renal cancer was made by transplanting human 786-0 renal tumor cells into the nude mice subcutaneously.The subjects were divided into three groups:control group,ADM group,ADM22-52 group.Tumor formation rate was recorded and the size of tumors was measured.The pathological changes were assessed by hematoxylin and eosin (HE) staining,the expression of vascular endothelial growth factor (VEGF-A) was detected by immunohistochemistry assay in tissues,and the expression of ADM receptor and VEGF-A by Western blotting.Results HE staining showed that transplanted tumors were characterized by clear renal cell carcinoma infiltrating adenocarcinoma,and there were more necrotic areas in the tumor issues in ADM22-52 group.The size of tumors in ADM group was (2 123.50 ± 349.61)mm3 after 16 days,larger than control group and ADM22-52 group (P ＜ 0.05).Immunohistochemistry showed that the expression levels of VEGF-A in control group,ADM group and ADM22-52 group were 4.0,7.5,0.0,respectively (P ＜ 0.05).Western blotting showed that ADM receptor (ADMR) expression levels in control group,ADM group and ADM22-52 group were 0.22 ± O.03,0.28 ± 0.03,and 0.06 ± 0.01 respectively,and VEGF-A expression levels in control group,ADM group and ADM22-52 group were 0.35 ± 0.11,0.51 ± 0.04 and 0.09 ± 0.01 respectively.The expression of ADMR and VEGF-A in ADM22-52 group was significantly down-regulated (P ＜ 0.05).Conclusion ADM may promote the growth of transplanted 786-0 renal cell carcinoma in nude mice by activating the autoreceptors and also may participate the angiogenesis of renal cell carcinoma.

Objective To compare the clinical effect of transumbilical single-port laparoscopy combined with improved double hernia needles with that of traditional open surgery in the treatment of hydrocele in children. METHODS We retrospectively analyzed 35 cases (54 sides) of pediatric hydrocele treated by transumbilical single-port laparoscopy combined with improved double hernia needles (laparoscopy group). We recorded the operation time, intraoperative blood loss, hospital stay, scrotal edema, and postoperative complications and compared them with those of another 46 cases (58 sides) treated by traditional open surgery (open surgery group) during the same period. RESULTS The laparoscopy group showed a significantly shorter operation time, less intraoperative blood loss, milder scrotal edema, and fewer hospital days than the open surgery group (all P<0.05). However, no statistically significant difference was found in the incidence of postoperative complications between the two groups (P>0.05). Subcutaneous emphysema developed in 2 patients in the laparoscopy group, which disappeared after 1－3 days of oxygen inhalation and other symptomatic treatment, while scrotal hematoma occurred in 1 and incision fat liquefaction in 2 patients in the open surgery group 3 days postoperatively, which healed after debridement suture and daily dressing, respectively. The patients were followed up for 3－6 months, which revealed no late complications in the laparoscopy group but 1 case of unilateral recurrence and 2 cases of offside recurrence in the open surgery group, all cured by laparoscopic internal ring ligation. CONCLUSIONS Transumbilical single-port laparoscopy combined with improved double hernia needles is superior to traditional open surgery for the treatment of pediatric hydrocele and therefore deserves clinical generalization.

Objective To explore the diagnostic value and application on hypo-vasculary small renal tumors using contrast-enhanced ultrasound. Methods All the 96 cases diagnosed with the renal masses not excluding renal tumors ( the mass<4 cm) nderwent renal-contrast enhanced ultrasound and the nature of the tumors was distinguished by perfusion and fade and high echo ring. The results of the contrast-enhanced ultrasound were compared with that of pathological diagnosis and regular follow-up. Results Among the 39 benign cases diagnosed by contrast-enhanced ultrasound, 23 cases underwent sur-gical treatment, 21 cases were proven to be benign renal tumors by pathological diagnosis, 2 cases were proved to be renal ma-lignant tumors, 16 cases without surgery were proved to be benign renal tumors by regular follow-up. In addition, among the 57 malignant cases diagnosed by contrast-enhanced ultrasound, 51 cases underwent surgical treatment, 49 cases were proved to be renal malignant tumors by pathological diagnosis, 2 cases were proved to be renal malignant tumors;6 cases without sur-gery, 2 cases were proved to be renal malignant tumors by lesion volume increase and regular follow-up, 2 cases were proved to be renal malignant tumors by the lesions with no significant alteration and regular follow-up, 2 cases were lost in follow-up when they were transferred to other hospitals. The statistical data were assessed by Chi-square tests, the sensitivity, specifici-ty, false negative rate, false positive rate, diagnostic index, Youden index, crude accuracy were 90. 24%, 96. 23%, 9. 76%, 3. 77%, 186. 47%, 86. 47%, 93. 61%, respectively. Conclusion Contrast-enhanced ultrasound in treatment of hypo-vasculary small renal tumors has high diagnostic and application value, and unnecessary surgery be avoided.

ObjectiveToinvestigatetheexpressionandsignificanceofWnt3aandLgr5inbladdercancer.Methods The expression levels of Wnt3a protein and Lgr5 protein wee detected by immunohistochemistry in 11 cases of normal tissues and 39 cases of bladder cancer tissues.The expression levels of Wnt3a mRNA and Lgr5 mRNA were detected by RT-PCR in 9 cases of normal bladder tissues and 17 cases of bladder cancer tissues.Results The results by immunohistochemistry showed the positive expression rates of Wnt3a protein were 84.6%,33.3% in bladder cancer tissues and normal bladder tissues, respectively,there were significant differences between the two kinds of tissues ( P <0.05).The positive expression rates of Lgr5 protein were 84.6%,33.3% in bladder cancer tissues and normal bladder tissues,respectively,there were significant differences between the two kinds of tissues ( P <0.05).The expression of Wnt3a was positively correlated to that of Lgr5 in bladder cancer tissues ( r =0.677, P <0.01).The results by RT-PCR showed that there was a significant difference in the ratio of optical density of Wnt3a between bladder cancer tissues and normal bladder tissues ( P <0.05),there was a significant difference in the ratio of optical density of Lgr5 between bladder cancer tissues and normal bladder tissues ( P <0.05).Conclusion The expression levels of the protein and mRNA of Wnt3a and Lgr5 in bladder cancer tissues are much higher than those in normal bladder tissues,which suggest that Wnt3a and Lgr5 may be closely related with the pathogenesis and development of bladder cancer.

Objective To investigate the expression and significance of HDAC 1 and E2F1 in renal clear cell carcinoma (RCCC).Methods Immunohistochemistry was used to detect the expression levels of HDAC1 protein and E2F1 protein in 51 cases of RCCC tissues and 24 cases of peritumoral normal tissues.RT-PCR was used to detect the relative expressions of HDAC1 and E2F1 mRNA in31 cases of RCCC tissues and 14 cases of peritumoral normal tissues.Moreover the correlation between the expressions of HDAC1, E2F1 and clinicopathological characteristics of RCCC was analyzed.Results Immunohistochemical staining results showed that positive expression rate of HDAC1 protein in RCCC tissues was significantly higher than that in peritumoral normal tissues (62.7%vs 25%, P <0.05).The positive expression rate of E2F1 protein in RCCC tissues was significantly higher than that in peritumoral normal tissues (70.6% vs 37.5%, P <0.05).The expressions of HDAC1 and E2F1 protein were not correlated to patient’s sex,age and tumor sizes ( P >0.05),however, which were related with histological grade and clinical stage ( P <0.05).RT-PCR results demonstrated that the relative expression levels of HDAC1 mRNA in RCCC tissues were significantly higher than those in peritumoral normal tissues (03.51 ± 0.151vs 0.102 ±0.044, P <0.05),furthermore, the expression levels of E2 F1 mRNA in RCCC tissues were significantly higher those in peritumoral normal tissues (0.318 ±0.092 vs 0.135 ±0.032, P <0.05).The relative expression levels of HDAC1and E2F1 mRNA were not correlated to patient’ s sex,age and tumor sizes ( P >0.05),however,which were related with histological grade and clinical stage ( P <0.05).Conclusion The expression levels of HDAC1 and E21F in RCCC are obviously higher than those in peritumoral normal tissues, which are correlated to histological grade and clinical stage,moreover, which are increased with the increase of malignant degree of tumor,which may be closely related with the progress of RCCC.

目的：探讨重组人表皮生长因子（rhEGF）凝胶在尿道下裂术后尿瘘早期处理中的应用效果。方法将2011年9月至2014年7月行尿道下裂手术后出现的44例尿瘘患者随机分为2组，2组患者在给予留置尿管、常规创面换药及对症处理的基础上，试验组瘘口表面应用 rhEGF 凝胶，对照组瘘口表面涂以0．9％氯化钠溶液，观察2组尿瘘愈合情况。结果试验组共愈合14例，总愈合率63．64％，其中大瘘口愈合9例，小瘘口愈合5例；对照组共愈合5例，总愈合率22．73％，其中大瘘口仅愈合2例，小瘘口愈合3例。与对照组比较，试验组总愈合率和大瘘口的愈合率明显提高，差异有统计学意义（ P ＜0．05），而小瘘口的愈合率略高于对照组，但差异无统计学意义（ P ＞0．05）。结论尿道下裂术后尿瘘早期及时处理，小瘘口大部分能够愈合，应用 rhEGF 凝胶对瘘口愈合具有促进作用。