Introduction Krüppel-like factors (KLFs), which comprise 17 family members, exert important functions during the development of cancer. The role of KLF16 seems controversial in carcinogenesis because both tumor suppressive and promoting effects have been reported. Methods The expression level of KLF16 was analyzed based on public data sets from The Cancer Genome Atlas (TCGA) and evaluated by immunohistochemical (IHC) staining. CCK8 assay, colony formation analysis, transwell assays and the PI/Annexin V-APC assay kit were performed to detect cell growth, colony formation, cell migration and apoptosis of BC cells. Xenograft tumorigenesis assay was performed to detect the KLF16 expression on BC growth in vivo. Dual-luciferase reporter assay and chromatin immunoprecipitation (ChIP)-qPCR assay were performed to analyze the interaction between KLF16 and its target. Results In this study, we explored the role of KLF16 in bladder cancer (BC). We demonstrated that KLF16 was overexpressed in human BC tissues. The high expression of KLF16 was a potential predictor of a poor prognosis in patients with BC. Interference with KLF16 expression in 563 cells, having relatively higher levels of KLF16, repressed cell proliferation and migration. In contrast, upregulation of KLF16 in T24 cells enhanced cellular function, including cell growth and migration. KLF16 also suppressed the apoptosis of BC cells. Additionally, KLF16 inhibited the expression of the TGF-type III receptor (TGFBR3) by binding to its promoter sequence and reducing transcriptional activity. There was a negative correlation between KLF16 and TGFBR3 in human BC tissues. Furthermore, TGFBR3 was revealed to be a negative regulator of BC cell proliferation and migration. KLF16 also supported BC tumorigenesis by downregulating TGFBR3 expression in vivo. Discussion These results suggested that KLF16 acts as an oncogene in BC through transcriptional inactivation of TGFBR3. This study provides evidence that targeting the KLF16/TGFBR3 axis may be beneficial for BC patients.

加速康复外科(enhanced recovery after surger-y ,ERAS)是指采用一系列经过循证医学证明的围手术期优化处理措施,以缓解手术给患者身心带来的创伤应激反应,减少术后并发症和促进患者快速康复的一种多模式的治疗方案[1 ].

膀胱癌在我国是泌尿系统最常见的肿瘤,大多数为低级别非肌层浸润性膀胱癌,标准的手术方式为经尿道膀胱肿瘤电切术,但术后如果不采取其它治疗,两年内肿瘤复发率将超过 50％[1].膀胱灌注化疗是目前预防非肌层浸润性膀胱癌术后复发最常用的一种治疗手段[2].膀胱灌注可选用的药物很多,常用的包括吡柔比星、表柔比星等.吡柔比星是新一代半合成蒽环类抗肿瘤药物,既往实验研究表明,吡柔比星在膀胱肿瘤组织内弥散速度快、抗癌活性强,可有效、迅速杀伤肿瘤细胞.多项临床研究亦证实吡柔比星对预防膀胱癌电切术后复发有较好的疗效[3,4].但应用吡柔比星灌注后即刻拔除导尿管,除了膀胱刺激相关症状外,患者往往主诉不同程度的尿道疼痛,导致患者恐惧,成为降低治疗依从性的原因之一.目前对于缓解灌注后尿道疼痛的方法报道有限,本研究拟通过比较吡柔比星膀胱灌注化疗后延迟拔除导尿管或即刻拔管对拔管后尿道疼痛的影响,以期探究改善灌注后尿道疼痛的方法.

膀胱癌是泌尿系统常见的恶性肿瘤之一[1] .低级别非肌层浸润性膀胱癌患者经尿道膀胱肿瘤电切术( transurethral resection of bladder tumors , TURBT)术后进行膀胱灌注化疗,可减少膀胱癌的复发,提高患者生活质量、延长生存时间[2] .我院泌尿外科在2017年1月至2018年12月对228例行TURBT 术后膀胱灌注化疗的患者实施个性化护理,使患者能够按时进行灌注治疗,提高了患者灌注治疗的依从性,保证了膀胱灌注化疗的效果.现报告如下.

目的 探讨术泰舒在泌尿外科腔镜手术操作中的止血疗效及临床应用价值.方法 选取2017年2月～ 2019年1月间在本院泌尿外科接受腔镜手术治疗的150例患者,依据随机数表法分为观察组和对照组,每组纳入75例.观察组在手术中持续给予术泰舒生物多糖胶液冲洗处理,对照组采用生理盐水进行冲洗.观察并对比两组患者术中出血量、术后液体渗出量、肛门排气时间以及住院时间,记录两处理组术后相关并发症情况.结果 观察组患者术中出血量明显低于对照组,差异有统计学意义(P=0.000).观察组和对照组患者术区渗出量分别随时间延长呈逐渐下降趋势(P＜0 05).观察组患者术后肛门排气时间和住院时间均明显低于对照组,差异均具有统计学意义(P＜0.05).观察组患者围手术期腹痛例数(13例)明显低于对照组(27例),差异具有统计学意义(P＜0.05).结论 术泰舒在腔镜手术中可有效控制出血,缓解患者创伤应激反应,减少术后腹腔液体渗出并促进患者早期恢复,其临床疗效优于生理盐水,值得临床推广.

Bladder cancer (BC) is the ninth most frequent malignancy and the thirteenth leading cause of cancer-related death worldwide. CDKN1A-interacting zinc finger protein 1 (CIZ1) is involved in the development of various cancers, while its role in BC remains unclear. In this study, we found that CIZ1 was up-regulated in BC tissues and cells. Knockdown of CIZ1 suppressed the proliferation and growth of T24 and 5637 cells. Apoptosis and caspase 3/7 activity were enhanced after CIZ1 silencing in both cells. At the molecular level, PCNA, Ki67, HIF-1α, survivin, CCND1 and CCNB1 were down-regulated, and caspase-3, p53, p21, caspase-9 were up-regulated by CIZ1 knockdown. This suggested that silencing of CIZ1 suppressed BC cell proliferation through inducing apoptosis and reducing cell cycle progression. Our study suggests that targeting CIZ1 maybe a potential therapeutic strategy for BC.

Objective To assess the clinical value of MRI-TRUS fusion guided transperineal prostate targeting combined with saturation biopsy in patients with suspected prostate cancer. Methods From March 2018 to July 2018, 15 patients with suspected prostate cancer were treated at the Department of Urology, Xuanwu Hospital of Capital Medical University. All patients underwent prostate MRI and transrectal ultrasound (TRUS). MRI-TRUS fusion guided transperineal prostate targeting combined with saturated prostate biopsy was performed. According to the patient's PI-RAIDS score and MRI-TRUS fusion image, the highly suspected prostate cancer nodule area and suspicious nodule area were marked in different colors, which were used as puncture target and suspicious target areas. A total of 30 or 36 puncture needles were punctured in the target area, suspicious target area, and non-target area in each patient. The positive rate of puncture, pathological results, and complications were analyzed. Results A total of 20 targets and 5 suspicious targets were labeled in 15 patients. The puncture results from 17 targets and 3 suspicious targets in 12 patients were positive. The total positive rate of targeted puncture was 80% (20/25). The pathological results of puncture in all positive cases were prostate acinar carcinoma. The puncture results from 3 target areas and 2 suspicious target areas in the other 3 patients were negative, and the pathological results were reported as benign prostatic hyperplasia (BPH) with inflammatory changes. Prostate cancer cells were found in 5 cases at the same time in non-target area. The positive rate of prostate cancer diagnosed in non-target area was 33.3% (5/15). Of the 15 patients, only 1 developed hematuria after operation, which resolved on the 2nd day after operation, and 2 had perineal pain discomfort, which resolved on the 3rd day after operation. No patients had complications such as bloody stool, fever, sepsis, and acute urinary retention. Conclusion MRI-TRUS fusion guided transperineal prostate targeting combined with saturated biopsy has the advantages of high positive rate, few postoperative complications, and high safety and feasibility, representing an ideal method for prostate biopsy. Key words: Magnetic resonance imaging; Transrectal ultrasonography; Prostatic neoplasms; Prostate biopsy

肌层浸润性膀胱癌(muscle-invasive bladder cancer,MIBC)约占膀胱癌的 25％[1],病灶的血供主要来自髂内动脉.髂内动脉灌注化疗尤其适用于高龄或体质差的 MIBC 患者[2],但若手术前后护理不当,可能导致严重并发症.2007 年 2 月至 2015年 6 月我院对 71 例 MIBC 患者行经髂内动脉灌注化疗,对手术前后全面护理积累了一些经验.现报告如下.

目的 观察癃闭舒胶囊联合西医治疗良性前列腺增生的疗效及对中医证候积分、生活质量(QOL)积分的影响.方法 将116例良性前列腺增生患者随机分为2组,对照组58例给予盐酸坦索罗辛缓释胶囊治疗,观察组在对照组治疗基础上加用癃闭舒胶囊治疗,2组均治疗3个月.观察2组治疗效果,治疗前后中医证候积分、QOL积分变化情况及不良反应发生情况.结果 治疗后,观察组总有效率明显高于对照组(P<0.05);2组治疗后最大尿流率均高于治疗前(P均<0.05),膀胱残余尿量、前列腺体积、中医证候积分、QOL积分均显著降低(P均<0.05),且观察组上述指标改善情况均优于对照组(P均<0.05);2组不良反应发生率比较差异无统计学意义(P>0.05).结论 盐酸坦索罗辛缓释胶囊联合癃闭舒胶囊治疗良性前列腺增生疗效确切,可显著改善中医证候及生活质量,且安全可靠.

Huanxing Sun, Elizabeth Calle, Xiaosong Chen, Aditi Mathur, Yangyang Zhu, Julio Mendez, Liping Zhao, Laura Niklason, Xueyan Peng, Hong Peng, and Erica L. Herzog Departments of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine and Anesthesiology, Yale School of Medicine, New Haven; Beijing University of Chinese Medicine, Second School of Clinical Chinese Medicine, Beijing; School of Engineering, University of Connecticut, Farmington, Connecticut; and The Second Xiangya Hospital of Central-South University, Department of Respiratory Medicine, Changsha, Hunan, China

目的 探讨2μm铥激光尿道内切开治疗男性尿道狭窄及尿道闭锁的手术方法. 方法 使用德国LISA公司RevoLix 2μm连续波医用铥激光手术治疗系统,最大功率40 W,行手术治疗男性尿道狭窄17例,男性尿道闭锁6例.手术均在尿道镜直视下配以寻光法引导进行.后续治疗采用传统的尿道扩张方法,每周1次尿道扩张,连续10次以上,之后每月1次尿道扩张持续1年以上. 结果 平均手术时间52(35～70) min,术后4～8周拔除导尿管,患者均排尿通畅,术后配合尿道扩张巩固疗效.1例患者术后4个月时尿道扩张困难,再次行经尿道狭窄激光内切开术,术后排尿通畅. 结论 2μm铥激光尿道内切开术治疗尿道狭窄及尿道闭锁操作简便,创伤小,并发症少,疗效可靠且安全性高.

The aim of this study was to explore and evaluate biotubes consisting of autologous tissues. The biotubes were prepared by intra-abdominally embedding silicon rods as moulds. The specimens were analyzed by mechanical tests, histological observation and superficial study. The intra-abdominal implantation of the silicone tubes readily stimulated the development of the biotubes. The biotubes consisted of collagen-rich extracellular matrices. Myofibroblasts appeared as elongated cells with circumferential or longitudinal orientations. Subsequent to one month of embedding, the thickness of the tube wall was 70–250 μm. The burst strength was 1100±187 mmHg and the suturability was excellent. Biotubes that have the ability to be widely variable in their shapes are composed of autologous cells and glomerular extracellular matrices. Biotubes are ideal grafts for tissue engineering as they are able to avoid immunological rejection and are of sufficient mechanical strength.

目的:探讨新近开发的单切口尿道中段吊带术(TVT SECUR)治疗女性压力性尿失禁(SUI)的有效性及手术关键.方法:回顾分析2009～2011年共16例SUI患者资料,ALPP均大于60cmH2O,施行“H”术式,术中以示指引导保持穿刺方向及穿刺层面.术后24、48及72h采用直观模拟量表(VAS)对患者术后早期切口疼痛进行评价,3个月时门诊随访评判疗效及并发症.结果:本研究中16例手术平均24min,无尿道膀胱损伤,无阴道穿孔,无吊带暴露、无明显肢体运动障碍及局部血肿形成,无明确伤口感染及排斥反应发生.术后24小时VAS为(2.6±1.5),术后3个月随访时总有效率为93.7％(15/16),一过性并发症包括排尿困难(2/16),急迫性尿失禁(5/16),泌尿系感染(4/16).结论:TVT-SECUR“H”术式治疗SUI,操作简单,安全有效,并发症少.术中手指触摸引导有利于确定穿刺方向及深度,对保证术后疗效和减少并发症具有重要意义.

Objective: Older men with obstructive urinary tract disorders in the event of a cerebral vascular accident,whether through the early symptoms or type of urinary symptoms(obstructive or irritating) to predict the cause of voiding dysfunction.Methods: 57 cases of stroke emperor complained of voiding dysfunction in elderly male patients,all patients were bladder outlet obstruction(BOO) symptoms secondary to benign prostatic hyperplasia(BPH).After a comprehensive history and physical examination,all patients underwent urodynamic studies.Findings were classified by the Abrams-Griffiths nomogram as obstruction,no obstruction or equivocal.Results: The average age of the patients was 70 years old(54-87).Patients were grouped according to the presenting voiding complaints(purely irrita-tive in 42 percent,purely obstructive in 34 percent or mixed in 24 percent).In 51 patients(89 percent) the onset of symptoms paralleled the occurrence of the cerebrovascular accident.Detrusor hyperreflexia was noted in 82 percent of the patients.There was no statistically significant difference in the occurrence of detrusor hyperreflexia among the 3 symptom groups.Pressure-flow analysis clearly showed ob-struction in 24 patients(63 percent),no obstruction in 9(24 percent) and equivocal results in 5(13 percent) according to the A-G nomo-gram.There was no statistically significant difference in the incidence of obstruction among the 3 symptom groups.Conclusions: Elderly male patients presented symptoms can not predict bladder outlet obstruction or detrusor hyperreflexia,After stroke,the incidence of void-ing dysfunction symptoms significantly increase,which suggests that the cerebrovascular accident induced voiding dysfunction in the face of preexisting bladder outlet obstruction may exacerbate the symptoms of the latter condition or vice versa.

尿失禁是一个让人尴尬的疾病,在影响患者的生活质量,影响社交活动的同时,还会严重影响个人卫生,导致皮肤感染、泌尿系感染、膀胱结石,严重时会影响肾脏功能.因此,患有尿失禁应及时就医. 轻度尿失禁患者可运用行为治疗缓解症状.锻炼方法为提肛运动,每次收缩10秒,休息10秒,每次练习30次,每天练习3次.在药物治疗方面,可服用肾上腺素能药物和雌激素,但目前可使用的药物均有严重副作用,故临床较少使用.

Objective To investigate the cause,diagnosis and management of Wunderlich's syndrome associated with renal tumor. Methods Clinical data of 8 cases of Wunderlich's syndrome associated with renal tumor was reviewed. Ultrasonography and Computed tomography(CT)were used as preoperative diagnostic methods.Results Five patients underwent radical nephrectomy and two cases diagnosed of renal angiomyolipomas by CT were treated by superselective embolization.Conservative treatment was adopted in one case.Disease specific survival of the entire cohort was 100％.All these patients had a follow-up for 6 months to 5 years.Nobody suffered from tumour recurrence and metastasis. No retroperitoneal hemorrhage and urinemia were noted. Conclusions Wunderlich's syndrome is associated with renal tumor.CT should be performed in all patients.If the bleeding is caused by a malignant tumour,radical nephrectomy is still the treatment of choice.For those with benign tumours,selective renal artery embolization and other renal sparing treatment can be used.

压力性尿失禁是指在咳嗽、打喷嚏或运动等腹压增高状态下,出现不自主的尿液从尿道外口漏出.据了解,中国有34.04％的女性患有这种疾病,尤以40岁以上的中老年妇女居多.尿失禁不仅妨害正常的生活及作息,也可影响人的社交活动,严重危害患者的心身疾病,有"不致命的社交性癌症"之称.

Objective To compare the clinical efficacy and safety of 2μm continuous wave laser resection and transurethral resection in the treatment of superficial bladder tumor.Methods 37 cases(experimental group) were randomly assigned to undergo 2μm continuous wave laser resection of superficial bladder tumer,and 35 cases(control group) received transurethral resection.The mean operative time,complications,postoperative recurrence rate of two groups were analyzed and compared.Results There was no significant difference in mean operative time,average hospital stay and incidence of postoperative recurrence between the two groups(P0.05).Blood loss(11.5±6.8)mL in experimental group was less than that in the contral group (20.4±8.4)mL(P0.05).There were obturator nerve reflex and bladder perforation in control group,but not in experimental group.Conclusion 2μm continuous wave laser resection of superficial bladder tumor is safe and effective with less complication.It is worth widespread.

目的观察通过膀胱镜、输尿管镜或经皮肾镜引导下使用输尿管球囊扩张导管加双重双J管置入治疗输尿管良性狭窄的疗效。方法用双腔直头球囊扩张管(头端球囊长4cm)"珠头"导丝、镍钛导丝、高压注射器等设备对18例输尿管良性狭窄的患者进行扩张,扩张后放置双重双J管。结果术后随访6～48个月,术后6～9个月经造影证实肾积水减轻、输尿管扩张部位无狭窄为有效,有效率为66.7%。按有无手术病史将患者分成两组,统计学检验两组疗效无显著性差异(P>0.05)。结论球囊扩张治疗输尿管良性狭窄(<2cm)效果满意。术中放置2根双J管支撑,既有管内引流又有管外引流,对抑制远期输尿管挛缩可能起到了一定作用。但此方法可能对移植肾输尿管膀胱吻合口狭窄治疗效果不满意,需结合腔镜下内切开治疗。

Objective To assess the symptoms of patients due to indwelling double ureteral stent and their impact on quality of life. Methods Sixty patients were assessed by the specific questionnaire. Average time of indwelling stent was 21.4 d. All patients finished the special questionnaire when the stent was removed by cystoscope, including specific urinary symptoms, IPSS (international prostate symptom score), VAS (visual analogic scale) and QOL (quality of life). To assess the pain feeling, the patients were divided into 3 groups by varied methods of anesthesia, including local anesthesia, balance anesthesia and general anesthesia. Results Insertion or removal of ureteral stents with local anesthesia provoked pain in 11 of 12 (91%) patients and 8 of 10 (80%) patients in balance anesthesia group. But 38 patients of general anesthesia group did not feel any pain when inserting stents. In 54 of 60 (90%) patients, the indwelling catheter provoked one or several urinary symptoms: nocturia (70%), frequency (65%), urgency (60%), tenesmus (58%), dysuria (52%), hematuria (35 % ) and incontinence (30 %). 75 % of the patients experienced pain, in the flank and lower abdomen. 29 (48 %) patients were found to be unsatisfied with their quality of life due to the indwelling stent. Among them, 18 (62%) patients demonstrated that the provoked overactive bladder symptoms were the main influence factor of QOL, compared with 5(17 %) patients complaining pain feeling. Conclusions Urinary symptoms and pain associated with indwelling double J ureteral stents could interfere the daily activities and 50 % of patients were found reduced quality of life. Overactive bladder symptoms were the main influence of QOL during the time of indwelling stent.