Chaussy等 [1]在1980年首次运用体外冲击波碎石机治疗尿路结石,自此体外冲击波碎石术(extracorporeal shock wave lithotripsy,ESWL)成为治疗尿路结石的主要手段, ESWL具有损伤小、费用低、治疗便捷等优点,但随着经皮肾镜碎石取石术的微型化以及输尿管镜碎石取石术广泛应用于临床,ESWL治疗尿路结石的数量下降了.尽管ESWL经历了30多年的尿路结石治疗历史,但迄今为止,ESWL依然是唯一的非侵入性且安全有效的治疗尿路结石的方法,本文就ESWL治疗尿路结石的机制、方法、并发症及应用前景做一综述.

目的 探讨非增强CT值预测结石成分及其在输尿管下段结石体外冲击波碎石治疗中的应用价值.方法 308例输尿管下段结石患者治疗前行非增强CT扫描,根据结石CT值分为低密度组160例(CT值≤800 Hu)、高密度组148例(CT值>800 Hu),体外冲击波碎石后应用红外光谱对结石成分进行分析,统计结石对应的CT值,记录两组间CT值及体外冲击波碎石次数.结果 结石CT值在354～1562 Hu,各种成分结石CT值不同,含钙结石CT值较非含钙结石显著高(P<0.05).单一成分结石109例,混合成分结石159例;结石彻底清除268例,结石残留40例;低密度组平均CT值(685±135)Hu,平均冲击波次数为(2198±269)次,高密度组平均CT值(1057±261)Hu,平均冲击波次数为(2449±492)次,组间差异显著(P<0.05);低密度组结石清除率〔95％(152/160)〕显著高于高密度组〔78％(116/148),P<0.05〕.结论 结石CT值不能准确预测输尿管下段结石的化学成分,但含钙结石CT值较高,较高CT值的结石行ESWL时需要更多冲击次数治疗.

As a endogenous opioid peptide, opioid growth factor not only can regulate cell renewal, wound healing, angiogenesis and development activity, but its anti-tumor effect is becoming more and more attention because of binding the specific receptor. it is constitutively expressed, autocrine produced, inhibit tumor proliferation. The action of opioid growth factor are stereospecific, noncytotoxic, nonapoptotic, anchorage-independent, reliant on RNA and protein synthesis,it occurring at physiologically relevant concentrations. A variety of its anti-tumor mechanism, for example, it can inhibit DNA synthesis of tumor cell, through multiple pathways to produce antitumor effects, it made breakthrough progression in animal experiments and clinical, it can not only as a main therapy but can be combined with other drugs in the treatment of tumor. Opioid growth factor and its receptor has broad application on clinical.

<正>熊果酸(ursolic acid,UA)又名乌苏酸、乌索酸(其化学分子式如图1所示),是广泛存在于自然界中的α-香树脂醇型五环三萜类化合物,通常以游离或与糖结合成苷的形式分布于自然界中约7个科46个属62种植物中,UA是脂溶性物质,可穿透细胞膜起效,实验证明UA具有广泛的生物学活性,包括抗肿瘤、抗炎、抗病毒、保肝等作用[1],目前,UA抗肿瘤机制已成为当今研究的热点。一、诱导肿瘤细胞凋亡1.活化Caspase:通常情况下,Caspase家族间可以相互激活,导致级联反应,促使细胞凋亡,广泛表达于多种肿瘤组织及正常人体组织,可通过线粒体通路和死亡受体通路被激活,UA活化Caspase-3、8和9后能剂量依赖性地诱导结肠癌HT-29细胞凋亡[2]。UA可通过活化Caspase-3诱导非小细胞肺癌A549细胞凋亡[3]。

[Objective] To summarize the clinic experience of flexible ureteroscope in diagnosis and treatment of upper urinary tract disease.[Method] From Nov 2007 to Dec 2008,58 humaturia cases underwent flexible ureteroscope for diagnosis and treatment of upper urinary tract.Clinical data was analyzed retrospectively.[Results] All the cases were diagnosed and cured successfully in one stage.17 cases were diagnosed epithelium cancer,6 cases were diagnosed non-specificity pyeloureteritis,19 cases were calculus of ureter,7 cases were renal pelvis venous hemorrhage,9 cases were no abnormality seen.No serious complication of ureter perforation,avulsion and hemorrhage.And the average time for whole surgery was 10～70 min and the average time was 40 min.Hospitalization time was 3～9 days,average time was 4 days.[Conclusion] Flexible ureteroscope can be used to diagnosis and cure tumor,calculus,inflammation and other disease of upper urinary tract,especially,to upper urinary minimal lesion.Flexible ureteroscope obviously dominates more than other examination.

目的 探讨三萜类化合物熊果酸(UA)对人膀胱癌T-24细胞增殖、迁移及裸鼠皮下移植瘤生长的抑制作用及其机制.方法 应用熊果酸处理体外培养的人膀胱癌T-24细胞,四甲基偶氮唑蓝(MTT)比色法、细胞迁移法检测UA对T-24细胞的增殖抑制效应;建立膀胱癌皮下移植瘤模型,观察UA对移植瘤的生长抑制作用.结果 体内﹑外实验结果显示:各治疗组UA能较明显抑制T-24细胞增殖、迁移,并在48 h抑制作用明显.在体内使裸鼠皮下移植瘤体积明显缩小,并表现具有一定的剂量-时间依赖关系.结论 UA能明显抑制肿瘤细胞生成,其作用靶点可能为肿瘤新生血管内皮细胞.

Objective To evaluate the efficacy and safety of solifenacin in patients with overactive bladder (OAB). Methods A multicenter clinical trial was conduced. 216 patients with OAB were enrolled. All the patients received solifenacin(5 mg once daily). With 5 weeks'treatment, all the patients recorded the diary and the adverse events as well. The symptoms of urgency, frequency, nocturia, urine volume, incontinence were evaluated. The results of the efficacy and safety were analyzed by using SPSS 13. 0. Results After 5 week treatments, all the index obviously improved(P<0.05). 187 cases (86.7%)were cured and 43 cases recovered normal voiding, 29 cases improved obviously. 11cases(5.0 %)reported adverse effect as dry mouth, dry eye. Conclusion Solifenacin could be the safe and effective drug in the treatment of OAB patients.

[Objective]To evaluate the clinical effective results of transurethral suspend plasma resection of superficial bladder tumor (SPRSBT). [Methods]Fifty six cases of superficial bladder tumor were treated with SPRSBT, respectively. Retrospective study of the treatment effect was carried out. Intravesical chemotherapy of mitomycin C (MMC) and cystoscopy was used after transurethral resection. [Results]A total of 56 patients were treated with SPRBT, the mean tumor size was 2.0 cm (0.6～3.5 cm) in diameter. The mean operative time was 30 min (15～60 min), and the mean postoperative hospitalization period was 4 days (3～5 days) without TURS blood transfusion and bladder perforation. There were 8 (14.2%) complications, including 5 (8.9%) obturator reflexs and 3 (5.3%) urethral strictures. A mean follow-up was 2.1 years (range 1.5～3.5 years), Upon follow-up, 17(30.3%)of 56 patients had recurrence and 14 cases was treated with SPRBT, 3 (5.3%) underwent radical cystoprostatectomy because of progressive disease. The 3-year recurrence-free rate was 43.2%. [Conclusion]SPRSBT is a safe and efficient procedure, the treatment is worth being widely used in clinic.

Objective To evaluate the clinical efficacy of transurethral suspendplasma resection of prostate(SPRP).Methods Ninety-six cases of BPH were underwent with SPRP.Retrospective study of the treatment efficacy and complication of the cases was made.Adverse events were recorded during the hospital stay and follow up.Results All the cases were successful by SPRP.Operating time was 56.8±13.4 min,and the average blood loss was 131±31.4 ml,the resected tissue was 32.4±8.5 g,the bladder irrigating time was 2.5±1.5 days,the catheterization time was 4.2±0.8 days,the average hospitalization time was 5.0±1.2 days,no hemorrhea peplos,perforation and TURS cases.There were 7 transient urinary incontinence,3 urethral stricture and 4 epididymitis cases afte operation,but all were recovery through treatment.the IPSS,QOL,Qmax and RUV of all the cases were significantly improved.Conclusion SPRP has advantages of totally hemostasis,high safety,less complication.

为了评价经尿道前列腺汽化电切(TUVP)和经尿道前列腺悬浮离子电切(SPRP)治疗良性前列腺增生症(BPH)的疗效,本院自2006年1月至2008年12月采用上述两种术式治疗BPH共112例,结果报道如下.

DNA甲基化(DNA methylation)是在DNA序列不变的情况下,控制基因表达,维护染色体的完整性和调节DNA重组及某些特定基因组区域的转录活性,是恶性肿瘤普遍存在的分子生物学改变.肿瘤相关基因启动子CpG岛甲基化状态异常广泛见于肿瘤,有望作为临床肿瘤诊断的分子标记[1].膀胱癌是泌尿系最常见的恶性肿瘤,而膀胱癌与DNA甲基化关系近年来已成为膀胱癌研究热点之一.

Objective To investigate the inhibition effect of the RNA interfere targeting VEGF on the growth of bladder cancer cell in vitro and in vivo.Methods The siRNA eukaryotic expression vector targeting VEGF gene,named PsilencerTM-VEGF-siRNA was constructed and transfected into T24 cell.The inhibition effects on VEGF gene were determined by reverse transcription PCR analysis.The invitro cellular growth activities were assayed by MTT colorimetry.The cell apoptosis was studied boflow cytometry.TO observed the therapeutic effects of siRNA VEGF through xenograft tumor nude mice model.VEGF expression was analyze with RT-PCR and Western blot.Results After the siVEGF transfected into the T24 cells,the expressio of VEGF gene was inhibited significantly(by 79%).The cellular growth activities in the T24 cells transfected with siVEGF decreased obviously,significantly lower than those in the regative control group and in the nontransfected group(P0.01).Significantly apoptosis in the T24 cells transfected with siVEGF was induced.The growth speed and formation rate of xenograft tumor in siRNA VEGF transfected mice slowed down significantly,and VEGF expression were down regulated too.However,there was no similar inhibitive effect in the control groups.Conclusion siRNA targeting VEGF gene inhibit VEGF expression and inhibits the growth of bladder cancer.

目的探讨siRNA（small interfering RNA）对T24人膀胱癌细胞株VEGF基因表达的抑制及癌细胞增殖抑制和诱导凋亡作用。方法体外构建两个针对VEGF基因的siVEGF的重组质粒,转染T24细胞;应用逆转录聚合酶链反应（RT-PCR）测定VEGF基因的表达,并用MTT法和流式细胞仪检测siVEGF对细胞的增殖抑制率和凋亡的影响。结果构建的两个siVEGF重组质粒分别使VEGF基因表达下调到空白组的21.02%和30.13%;control siRNA组的VEGF基因表达与空白组无明显差异。转染siVEGF后T24细胞生长受到抑制,并发生细胞凋亡,凋亡率分别为45.5%和35.9%。结论siVEGF可以有效抑制T24细胞株中VEGF的表达,从而抑制细胞增殖,并诱导细胞凋亡。

目的沉默人膀胱移行细胞癌细胞T24的STAT3基因,并探讨其对T24细胞生长抑制及诱导凋亡的作用机制。方法利用含有STAT3 mRNA的siRNA的pSilencer3.1-siRNA-STAT3重组质粒转染T24细胞;采用Western印迹、RT-PCR等技术观察重组质粒对STAT3基因表达的影响;用MTT法观察重组质粒对T24细胞的体外生长抑制作用;用流式细胞术(FCM)及吖啶橙染色检测重组质粒的诱导凋亡作用。结果重组质粒成功转染T24细胞;Western印迹、RT-PCR证实重组质粒在蛋白及mRNA水平都显著抑制STAT3基因的表达水平,抑制率为59%~72%;MTT及FCM证实重组质粒可显著抑制T24细胞的体外生长并诱导细胞凋亡,抑制率及凋亡率分别为53%和17.3%。结论pSilencer3.1-siRNA-STAT3重组质粒可抑制STAT3在人膀胱肿瘤细胞的表达,抑制肿瘤细胞的生长,促进其凋亡。

上尿路结石对肾功能损害重,以往开放手术取石损伤大,术中术后容易出现出血、继发性血尿、感染、发热等并发症,且术后恢复慢.体外冲击波碎石术(ESWL)治疗上尿路结石常需反复多次,不但会导致肾间质出血加重肾实质损害,而且易造成输尿管石街.我们采用在B超引导下经皮肾镜气压弹道碎石联合超声碎石术处理上尿路结石78例共85侧,均取得成功,临床效果良好,现报道如下.