OBJECTIVE:To explore the clinical application value of using needle electrode in transurethral plasmakinetic resection of bladder tumor around ureteral orifice.METHODS:Retrospective analysis was performed on the clinical data of 16 cases who had bladder tumors around ureteral orifice and underwent transurethral resection using plasmakinetic needle electrode in Department of Urology, Peking University International Hospital from June 2015 to December 2019. There were nine cases with the tumor of one to two centimeters from the ureteral orifice. The rest of the seven cases had tumor that was within one centimeter from the ureteral orifice, including two cases whose ureteral orifice was invaded by the tumor. All the patients studied were diagnosed before surgery and contraindications were excluded. The plasmakinetic needle electrode was used to treat the tumor with en bloc resection, and all the excised tissue was sent for pathological examination. Intravesical chemotherapy and postoperative follow-ups were performed. Statistical analysis was performed on the operation time, the incidence of obturator nerve reflex, the peri-operative bleeding, the parameters of indwelling ureteral catheter or double-J stent, the incidence of postoperative hydronephrosis, the clinical stage of tumor, and the recurrence rate.RESULTS:The operation was successfully completed for all the sixteen cases. The operation time was 16 to 57 minutes, with an average of (32.6±11.8) minutes. No obvious obturator nerve reflex and perioperative bleeding occurred in all the patients. Ureteral catheters were indwelled prior to the operation of tumor resection in seven cases. Four of the seven cases had the ureteral catheters remained while the rest three were replaced by double-J stent after surgery. Postoperative pathological analysis showed that all the tumors were urothelial carcinoma, including 9 cases of low grade and 7 cases of high grade. Pathological staging: 10 cases were in Ta stage, 5 cases in T1 stage, and 1 case in T2a stage. All tumor bases and lateral margins were negative. All the patients received 3-56 months, with an average of (26.0±18.1) months of follow-up. There was no case of upper urinary tract hydronephrosis or tumor recurrence.CONCLUSION:The transurethral plasmakinetic resection of bladder tumor using needle electrode can realize en bloc tumor resection without obturator nerve reflex and reduce the risk of ureteral orifice injury. It is a safe and effective surgical method for treating bladder tumors around the ureteral orifice.

目的 探讨输尿管双J管膀胱端附壁结石致拔管困难的处理方法.方法 回顾性分析我院2017年6月～2020年5月26例因双J管膀胱端附壁结石导致拔管困难的临床资料.双J管放置时间1～18.5月,中位数8.75月.奥布卡因凝胶尿道局麻,先尝试经膀胱镜(或纤维膀胱镜)用异物钳将肾端猪尾环拉出尿道口,反复向尿道注入奥布卡因凝胶并保持一定张力持续缓慢牵拉双J管;如此方法失败,以肾镜代膀胱镜用大口径异物钳反复钳夹双J管表面附壁结石,将结石夹碎后取出双J管;如仍失败,经尿道膀胱镜(或纤维膀胱镜)下钬激光碎石,将双J管表面结石粉末化击碎后取出双J管.结果 26例均局麻下一期拔除双J管,其中6例奥布卡因凝胶充分尿道局麻后取出,11例大口径异物钳夹碎双J管表面结石后取出,9例行钬激光碎石后取出.手术时间6～51 min,(20.6±8.1)min.无严重并发症.拔管后2周均复查泌尿系超声,未见肾积水或残留结石.结论 双J管膀胱端附壁结石致拔管困难可以局麻下一期治疗,必要时使用大口径异物钳或钬激光碎石.

目的 探讨输尿管镜气压弹道碎石取石术后不留置双J管的安全性.方法 设计前瞻性随机对照研究,选择2017年6月～2019年2月有手术指征的输尿管结石,排除结石合并感染、妊娠,术中发现结石嵌顿,发生输尿管严重损伤以及>0.5 cm结石残留者,共60例纳入研究.随机分为2组,术后不留置双J管30例(无管组),留置双J管2周30例(置管组).比较2组手术时间、术后住院时间、术后发热、血红蛋白下降值、腰胁部疼痛视觉模拟评分(Visual Analogue Scale,VAS)以及肉眼血尿、膀胱刺激症状、输尿管狭窄发生率等指标的差异.结果 与置管组比较,无管组术后7、14天腰胁部疼痛评分显著降低[术后第7天中位数0(0～1)vs.2(0～3)分,Z=-5.655,P=0.000;术后第14天0(0～1)vs.2(0～3)分,Z=-5.875,P=0.000],术后7、14天肉眼血尿发生率明显降低(术后第7天3.3％vs.60.0％,χ2=22.259,P=0.000;术后第14天0％vs.60.0％,P=0.000),术后7、14天膀胱刺激症状发生率明显降低(术后第7天3.3％vs.53.3％,χ2=18.468,P=0.000;术后第14天0％vs.50.0％,P=0.000).2组术后第1天腰胁部疼痛评分、肉眼血尿发生率、膀胱刺激症状发生率以及2组手术时间、血红蛋白下降值、术后发热、术后住院时间差异无显著性(P>0.05).2组术后6个月均无输尿管狭窄发生.结论 输尿管结石如果不合并感染、结石嵌顿、输尿管损伤等复杂因素,行输尿管镜气压弹道碎石取石术后不留置双J管不影响手术安全性,而且可以减少术后置管并发症发生.

Objective:To explore the efficacy and safety of one-stage transurethral ureteroscopic lithotripsy for the management of ureteral calculi with secondary silent obstructive pyonephrosis.Methods:Retrospective analysis was performed on the clinical data of 32 cases who had ureteral calculi with secondary silent obstructive pyonephrosis and underwent one-stage transurethral ureteroscopic lithotripsy in Peking University International Hospital from January 2018 to May 2020. Of all the 32 patients, 27 were males and 5 were females, with median age of 39.5 years, ranged from 18 years to 76 years.The distribution of stone location included left side in 23 cases and right side in 9 cases.The median stone volume was 138.84 mm 3, ranged from 33.28 mm 3 to 866.32 mm 3.All patients had no fever before surgery, and no obvious infection was indicated by preoperative blood routine, urine routine and urine bacterial culture.All patients underwent one-stage transurethral ureteroscopic lithotripsy and the dignosis of pyonephrosis was made intraoperatively.Purulent urine was collected during the operation for urine routine and bacterial culture test.We first suck out the pus at low pressure through an aspirator, and then turned down the perfusion pressure and flow to the lowest value of the pump.Intermittent low pressure and low flow perfusion combined with negative pressure suction were maintained during the subsequent lithotriptic operation.The double J stent must be indwelt routinely at the end of the operation, and anti-infective drug therapy was started postoperatively.We evaluated the stone free rate by rechecking KUB on the second day after the operation, and urinary CT scan or color ultrasound examination 4-6 weeks after the double J stent was removed.Postoperative infection was evaluated according to the incidence of systemic inflammatory response syndrome(SIRS) and the score of sequential organ failure assessment (SOFA) scale.Complications were graded by a Clavein-Dindo system to evaluate the safety of surgery. Results:All 32 patients underwent one-stage ureteroscopic lithotripsy, and 28 of them completed successfully, with a single-stage stone free rate of 87.5%. The operation time was 11 to 66 minutes, with a median of 28 minutes.During the operation, there were two patients calculi returned to the kidney, one patient had a too narrow ureter, and one patient had a unclear intraoperative visual field to continue the operation.Double J stents were indwelt in all of them at the end of the first stage surgery, and secondary ureteroscopic lithotripsy or flexible ureteroscopic lithotripsy was performed several weeks later. Calculi were cleared in all of them, with a second-stage stone free rate of 100%.Urine routine tests of pyuria collected during the operations showed that the bacterial count was 46-2 488/μl with a median of 295/μl and white blood cell count 57-7 863/μl with a median of 160.5/μl.The bacterial culture results of the pus showed that 22 cases had no bacterial growth and 10 cases had bacterial growth. One patient had fever on the first day after surgery, but the blood culture was negative. The temperature returned to normal after antibiotic treatment and symptomatic treatment for 1 day.There were 6 cases developed to SIRS but no sepsis occurred.No Clavein-Dindo Ⅲ or Ⅳ grade of operative complications occured.Conclusions:Transurethral ureteroscopic lithotripsy is clinically feasible with high stone free rate and no serious postoperative complications for one-stage treatment of ureteral calculi with secondary silent obstructive pyonephrosis for selected cases.Operation time should be shortened and the perfusion pressure and flow should be turned down as low as possible.

经皮肾镜术后出血是泌尿外科常见的手术并发症,本院收治1例患者由于合并胡桃夹综合征造成经皮肾镜术后反复肉眼血尿.现回顾其临床资料报道如下. 1 病例资料 患者男性,53岁.主因“发现左肾结石3年,左侧腰部胀痛1d”于2017年7月12日入院.泌尿系CT平扫提示:双肾多发结石,左侧为主,左侧输尿管上段结石,左肾盂积水.遂于2017年7月17日行超声引导下左侧经皮肾镜碎石取石术,留置左侧双J管及左肾造瘘管后结束手术.术后3d拔除左肾造瘘,术后10 d拔除尿管,患者出院.

在FPGA平台上,利用降低电源电压的方法使电路关键路径上的数据建立失败,从而达到注入故障的目的.基于合适的故障模型,攻击者可以有效地获取密钥信息,实现了针对密码模块的高效率、低成本的非侵入式故障攻击方法.攻击实验利用一台电压源和一台个人电脑,通过8组正确和错误密文对,成功地恢复出一个FPGA中AES密码模块的128bit完整密钥.

In this paper,the chaotic characteristics of Logistic map and problem of its property degeneration due to finite precision implementation are analyzed.Method of perturbing the chaotic map with m-sequence generated by Linear Feedback Shift Register is used to implement chaotic Pseudo Random Bit Generator (PRBG).The consumption of hardware resources is researched for various hardware quantization wordlength.The generated sequences are tested under SP800-22 standard launched by National Institute of Standards and Technology (NIST) and their random properties are analyzed.Experimental results indicate that through adjusting perturbing interval and range,the chaotic characteristics degeneration due to the finite precision effects could be overcome effectively, and the output sequences have favorable random property.

研究可用于Montgomery算法的基于二次编码的不同阶的Booth大数乘法器的性能和面积.通过SMIC0.13 μm工艺实现的阶64,128和256的128 bit和256 bit的Booth大数乘法器,分别在160 MHz和125 MHz的频率下实现模乘运算.实验结果表明,阶64,128和256的Booth乘法器在速度上性能一致,但随着阶的增加,由于预计算和产生部分积的复杂度上升,乘法器的面积将增加.

针对射频识别(RFID)芯片面积和能量资源极其有限的特点,设计实现了一种基于广义二进制Hessian 曲线(GBHC)的椭圆曲线密码(ECC)处理器.在算法上采用Montgomery Ladder点乘算法和w坐标法,以优化加速运算时序,在结构上精细设计循环移位寄存器组和门控时钟,以降低面积和能量消耗.实验表明,在保证安全精度不变的情况下,所实现的密码处理器具有较快的运算速度、极小的芯片面积和超低的能量消耗,并能抵抗简单功耗分析(SPA)等侧信道攻击(SCA).

OBJECTIVE:To investigate the inhibitory effect of silencing androgen receptor (AR) gene by AR short-hairpin RNA (shRNA) on the growth of human prostate cancer xenograft in nude mice.METHODS:Human 22RV1 prostate cancer cells were inoculated subcutaneously into nude mice to establish xenograft models of human prostate cancer. Meanwhile, a short-hairpin RNA that was capable of suppressing the expression of AR was constructed and then recombinant plasmids producing AR shRNA were prepared in a large number. The tumor-bearing mice were randomly divided into 2 groups: the control group and the experimental group. When the tumor volume grew to about 300 mm(3), the plasmids prepared previously were injected into the tail veins of the mice once at the dose of 2 μg/g in the experimental group, whereas the mice in the control group was injected with the same amount of saline as control. The tumor volumes were monitored every other day until 14 days after the treatment.At the endpoint,the mice were sacrificed and the tumors were excised, weighed, fixed in buffered-formalin, and embedded in paraffin for the immunohistochemical analysis of AR,Ki-67 (a marker of proliferative cell) levels and apoptotic cell labeling by TUNEL (terminal deoxynucleotidyl transterase-mediated dUTP nick end labeling) assay. A semiquantitative immunohistochemical scoring system, HSCORE system, was used to evaluate the expression of AR and proliferative index/Ki-67 labeling index (PI/Ki-67 LI) and apoptotic index (AI) were used to assess the cell proliferation and cell apoptosis, respectively.RESULTS:Compared with the control group, the treatment induced an evident inhibitory effect on the tumor growth in the nude mice with prostate cancer. At the endpoint, the tumor volume of (1 199.56±86.48) mm(3) in the experimental group was significantly smaller than that of (1 742.02±98.16) mm3 in the control group (P=0.002). The tumor weight of (1 006.2±79.1) mg in the experimental group significantly decreased compared with that of (1 383.4±74.8) mg in the control group (P=0.005). The AR HSCORE,PI and AI in the experimental group were 25.8±6.7, (26.0±3.1)%, (55.6±7.9)%, respectively, and those in the control group were 268.8± 18.7, (87.6±7.9)%, (27.2±3.9)%, respectively. There were significant differences between the two groups (all P<0.01).CONCLUSION:AR shRNA could be injected intravenously to suppress the expression of AR in vivo and hence inhibit the growth of human prostate cancer xenograft in nude mice.

OBJECTIVE:To investigate the efficacy and safety of percutaneous nephrolithotomy (PCNL) for upper urinary tract calculi patients complicated with metabolic syndrome (MS).METHODS:The clinical data of 66 PCNL cases with upper urinary tract calculi from March 2010 to February 2011 were retrospectively reviewed. Patients were divided into two groups according to 2004 Diagnostic Criteria of Metabolic Syndrome by the Chinese Diabetes Society (CDS). Twenty six upper urinary tract calculi patients complicated with metabolic syndrome were defined as case group (average aged 52.4 years, 16 males and 10 females). The other 40 cases without MS served as control group (average aged 45.9 years, 21 males and 19 females). The stone burden was (7.2 ± 1.8) cm(3) in case group and (6.4 ± 1.3) cm(3) in control group (P=0.712). The stone free rate, operative time, drop in hemoglobin level and fever were compared between the two groups.RESULTS:The operation time was (87.1 ± 9.0) min in case group and (87.6 ± 6.0) min in control group (P=0.963). The stone free rate was 76.9% (20/26) vs. 75.0% (30/40), P=0.859. The drop in hemoglobin level was (8.4 ± 1.6) g/L vs. (9.1 ± 1.4) g/L, P=0.739. The incidence of post-operative fever was 38.5% (10/26) vs. 45.0% (18/40), P=0.599.CONCLUSION:MS will neither increase the difficulty of surgery, nor reduce the stone free rate of PCNL for upper urinary tract calculi. And it will not raise the incidence of postoperative complications.