Objective To determine whether argon-beam-coagulation (ABC) suture-free technique results in more favorable renal function than conventional suture technique after laparoscopic partial nephrectomy. Methods This study was a single-center, open-label randomized controlled study. A total of 32 patients with T1a renal tumor and R.E.N.A.L score ≤7 were recruited. The primary endpoint of the study was the absolute variation of the ipsilateral split renal function (SRF) at 12 months. The following secondary endpoints were addressed: the 1, 3, 6, and 12-months variation of eGFR; the 1, 3, 6-months variation of SRF; perioperative outcomes (including operative time, warm ischemia time, time to hemostasis, blood loss). Results The suture-free group had a significantly shorter operative time (90.4 ± 22.0 minutes vs. 117.8 ± 23.5 minutes, p = 0.003) and warm ischemia time (9.6 ± 4.7 minutes vs. 21.3 ± 8.3 minutes, p < 0.001) than the suture group. At the last follow-up, the change of ipsilateral SRF was 7.5 ± 5.1 ml/min for the suture-free group and 13.1 ± 6.7 ml/min for the suture group (p = 0.014). The change of eGFR demonstrated a similar trend (5.5 ± 4.4 ml/min vs. 12.6 ± 6.0 ml/min, p=0.001). Multivariate linear analysis confirmed that suture-free technique was associated with a less decrease of renal function. Conclusions Suture-free partial nephrectomy is a feasible technique for T1a renal masses and benefits long-term SRF and eGFR compared to conventional procedure.

BackgroundIn this study, effective antigens of mRNA vaccine were excavated from the perspective of ICD, and ICD subtypes of PRAD were further distinguished to establish an ICD landscape, thereby determining suitable vaccine recipients.Research design and methodsTCGA and MSKCC databases were applied to acquire RNA-seq data and corresponding clinical data of 554 and 131 patients, respectively. GEPIA was employed to measure prognostic indices. Then, a comparison of genetic alterations was performed utilizing cBioPortal, and correlation of identified ICD antigens with immune infiltrating cells was analyzed employing TIMER. Moreover, ICD subtypes were identified by means of consensus cluster, and ICD landscape of PRAD was depicted utilizing graph learning-based dimensional reduction.ResultsIn total, 4 PRAD antigens were identified in PRAD, including FUS, LMNB2, RNPC3, and ZNF700, which had association with adverse prognosis and infiltration of APCs. PRAD patients were classified as two ICD subtypes based on their differences in molecular, cellular, and clinical features. Furthermore, ICD modulators and immune checkpoints were also differentially expressed between two ICD subtype tumors. Finally, the ICD landscape of PRAD showed substantial heterogeneity among individual patients.ConclusionsIn summary, the research may provide a theoretical foundation for developing mRNA vaccine against PRAD as well as determining appropriate vaccine recipients.

Abstract Background To summarize our clinical experience of cryoablation in renal cell carcinoma (RCC) of Chinese population and to evaluate the long-term outcomes of laparoendoscopic single-site (LESS) cryoablation (LCA) as well as percutaneous CT-guided cryoablation (PCA) for biopsy-proven T1a and T1b RCC. Methods This was a multi-center, retrospective study investigating T1 stage RCC patients from 2011 to 2021. The patients were treated by LCA or PCA according to individual situation. Overall survival (OS), cancer-related survival (CSS), and progression-free survival (PFS) were evaluated for oncological outcomes, and kidney function, complications, and hospital stay were used to estimate technical outcomes. Results A total of 163 consecutive patients were included. Among them, 59 cases were treated by LCA and PCA was performed in 104 cases. All operations were processed successfully. Mean diameter of the mass was (2.9±1.4) cm; median blood volume was 45ml (10~200 ml). The mean operation time was 84.0 ± 24.5 min. The median postoperative hospital stay was 3 days (1~6 days). Compared with LCA, procedure time of PCA was shortened, the volume of bleeding was reduced, and the hospital stay was decreased. The overall adverse events rate was 9.8% (16/163). The mean preoperative and postoperative eGFR of LCA were 77.6±15.3 ml/min and 75.6±17.4 ml/min, respectively. Analogously, the values of PCA were 78.7±12.9 ml/min and 76.7±14.3 ml/min. Mean follow-up time was 64.2 ± 30.2 months (range, 7–127 months). Local recurrence was observed in 13 patients (8.0%), 4 (6.8%) cases of LCA and 9 (8.7%) cases of PCA. PFS at 5 and 10 years were 95.5% and 69.2% for LCA and 96.7% and 62.8% for PCA. In total, 26 patients (16.0%) (11 patients from LCA and 15 from PCA) died throughout the follow-up period. OS at 5 and 10 years were 93.8% and 31.4% for LCA, and 97.4% and 52.7% for PCA. Six patients (3.7%) (3 cases from LCA and 3 from PCA) died of metastatic RCC. CCS for LCA were 98.0% and 82.8% at 5 and 10 years, while the data were 100% and 86.4% for PCA. Conclusion LCA and PCA for T1 stage RCC provides satisfactory long-term oncological and renal function preservation outcomes, with acceptable complication rates.

Background 5-Methylcytidine (m5C) methylation is an emerging epigenetic modification in recent years, which is associated with the development and progression of various cancers. However, the prognostic value of m5C regulatory genes and the correlation between m5C methylation and the tumor microenvironment (TME) in prostate cancer remain unknown. Methods In the current study, the genetic and transcriptional alterations and prognostic value of m5C regulatory genes were investigated in The Cancer Genome Atlas and Gene Expression Omnibus datasets. Then, an m5C prognostic model was established by LASSO Cox regression analysis. Gene set variation analyses (GSVA), gene set enrichment analysis (GSEA), clinical relevance, and TME analyses were conducted to explain the biological functions and quantify the TME scores between high-risk and low-risk subgroups. m5C regulatory gene clusters and m5C immune subtypes were identified using consensus unsupervised clustering analysis. The Cell-type Identification By Estimating Relative Subsets of RNA Transcripts algorithm was used to calculate the contents of immune cells. Results TET3 was upregulated at transcriptional levels in PCa compared with normal tissues, and a high TET3 expression was associated with poor prognosis. An m5C prognostic model consisting of 3 genes ( NSUN2 , TET3 , and YBX1 ) was developed and a nomogram was constructed for improving the clinical applicability of the model. Functional analysis revealed the enrichment of pathways and the biological processes associated with RNA regulation and immune function. Significant differences were also found in the expression levels of m5C regulatory genes, TME scores, and immune cell infiltration levels between different risk subgroups. We identified two distinct m5C gene clusters and found their correlation with patient prognosis and immune cell infiltration characteristics. Naive B cells, CD8+ T cells, M1 macrophages and M2 macrophages were obtained and 2 m5C immune subtypes were identified. CTLA4 , NSUN6 , TET1 , and TET3 were differentially expressed between immune subtypes. The expression of CTLA4 was found to be correlated with the degree of immune cell infiltration. Conclusions Our comprehensive analysis of m5C regulatory genes in PCa demonstrated their potential roles in the prognosis, clinical features, and TME. These findings may improve our understanding of m5C regulatory genes in the tumor biology of PCa.

Prostate cancer is still the main male health problem in the world. The role of metabolism in the occurrence and development of prostate cancer is becoming more and more obvious, but it is not clear. Here we firstly identified a metabolism-related gene-based subgroup in prostate cancer. We used metabolism-related genes to divide prostate cancer patients from The Cancer Genome Atlas into different clinical benefit populations, which was verified in the International Cancer Genome Consortium. After that, we analyzed the metabolic and immunological mechanisms of clinical beneficiaries from the aspects of functional analysis of differentially expressed genes, gene set variation analysis, tumor purity, tumor microenvironment, copy number variations, single-nucleotide polymorphism, and tumor-specific neoantigens. We identified 56 significant genes for non-negative matrix factorization after survival-related univariate regression analysis and identified three subgroups. Patients in subgroup 2 had better overall survival, disease-free interval, progression-free interval, and disease-specific survival. Functional analysis indicated that differentially expressed genes in subgroup 2 were enriched in the xenobiotic metabolic process and regulation of cell development. Moreover, the metabolism and tumor purity of subgroup 2 were higher than those of subgroup 1 and subgroup 3, whereas the composition of immune cells of subgroup 2 was lower than that of subgroup 1 and subgroup 3. The expression of major immune genes, such as CCL2, CD274, CD276, CD4, CTLA4, CXCR4, IL1A, IL6, LAG3, TGFB1, TNFRSF4, TNFRSF9, and PDCD1LG2, in subgroup 2 was almost significantly lower than that in subgroup 1 and subgroup 3, which is consistent with the results of tumor purity analysis. Finally, we identified that subgroup 2 had lower copy number variations, single-nucleotide polymorphism, and neoantigen mutation. Our systematic study established a metabolism-related gene-based subgroup to predict outcomes of prostate cancer patients, which may contribute to individual prevention and treatment.

目的:总结单孔腹腔镜肾癌保肾手术临床应用经验,分析其适应证、安全性、手术方式的选择及治疗效果.方法:回顾性分析2010年12月-2021年6月笔者分别在上海长海医院(22例)、上海第九人民医院(46例)主刀完成的单孔腹腔镜肾部分切除术(13例)、单孔腹腔镜肾癌冷冻消融术(33例)和单孔腹腔镜免缝合肾部分切除术(22例),评估单孔腹腔镜的手术效果、手术并发症及近、远期治疗效果.结果:所有手术均顺利完成,未增加额外切口.肿瘤平均最大径2.6(1.5～6.2) cm,术后平均住院3.3(3～5)d.术后1例因并发出血行DSA栓塞术止血,其余病例均未出现明显术中及术后并发症.结论:经典单孔腹腔镜下肾部分切除术对外生性肿瘤可行并有一定优势.免阻断的单孔腹腔镜肾肿瘤冷冻消融术风险小、恢复快、肾功能影响小,为一般情况差、合并症多、孤立肾肿瘤、双肾肿瘤及畏惧切除性手术等部分肾肿瘤人群提供了理想选择.外生型T1a期肾癌行肾部分切除术的患者,可尝试单孔腹腔镜下免缝合技术,该术式能够更精准地保留肾单位,并缩短术者单孔腹腔镜的学习曲线.

Over the last decade, more than 10 independent SNPs have been discovered to be associated with the risk of renal cell carcinoma among different populations. However, the biological functions of them remain poorly understood. In this study, we performed eQTL analysis, ChIP-PCR, luciferase reporter assay, and Cox regression analysis to identify the functional role and underlying mechanism of rs67311347 in RCC. The ENCORI database, which contains the lncRNA–miRNA–mRNA interactions, was used to explore the possible target miRNA of ENTPD3-AS1. The results showed that the G > A mutation of rs67311347 created a binding motif of ZNF8 and subsequently upregulated ENTPD3-AS1 expression by acting as an enhancer. The TCGA-KIRC and our cohorts both confirmed the downregulation of ENTPD3-AS1 in RCC tissues and demonstrated that increased ENTPD3-AS1 expression was associated with good OS and PFS. Furthermore, ENTPD3-AS1 interacted with miR-155-5p and activated the expression of HIF-1α, which was an important tumor suppressor gene in the development of RCC. The functional experiments revealed that overexpression of ENTPD3-AS1 inhibited cell proliferation in RCC cell lines and the effect could be rescued by knocking down HIF-1α. Our findings reveal that SNP-mediated lncRNA-ENTPD3-AS1 upregulation suppresses renal cell carcinoma via miR-155/HIF-1α signaling.

Ureteral artery fistula (UAF) is a rare complication after long-term indwelling of ureteral stent. In this study, two cases were presented. Both of them underwent pelvic tumor surgery and radiotherapy, and had a history of cutaneous terminal ureterostomy and long-term indwelling of ureteral stents. The first case, a 52-year-old female, was admitted to hospital because of intermittent bleeding from ureteral dermostomy for 1 week on April 2, 2020. CT examination revealed hematocele in the left upper urinary tract, and left nephrectomy was performed.However, bleeding still presented and the distal ureteral resection was performed at the same time, and partial ureteral was ligated. Postoperative diagnostic was ureteral artery fistula. After 8 months of follow-up, no recurrent bleeding presented. Another case, a 82-year-old male, was admitted to hospital because of bleeding at the ureteral dermostomy for an hour on June 15, 2020. Contrast enhanced CT examination revealed intersecting of the left ureter and common iliac artery, and interventional surgery was performed, by which UAF was diagnosed. Embolization of left internal iliac artery and stent implantation of common iliac artery and external iliac artery were performed intraoperatively. The bleeding stopped immediately after the operation, and there was no further bleeding during follow-up of 6 months.

Our previously study shown that Lysophosphatidylcholine Acyltransferase1 (LPCAT1) is overexpressed in castration resistant prostate cancer (CRPC) relative to primary prostate cancer (PCa), and androgen controls its expression via the Wnt signaling pathway. While highly expressed in CRPC, the role of LPCAT1 remains unclear. In vitro cell experiments referred to cell transfection, mutagenesis, proliferation, migration, invasion, cell cycle progression and apoptosis, Western blotting, Pulse-chase RNA labeling. BALB/c nude mice were used for in vivo experiments. We found that LPCAT1 overexpression enhanced the proliferation, migration, and invasion of CRPC cells both in vitro and in vivo. Silencing of LPCAT1 reduced the proliferation and the invasive capabilities of CRPC cells. Providing exogenous PAF to LPCAT1 knockdown cells increased their invasive capabilities; however platelet activating factor acetylhydrolase (PAF-AH) and the PAFR antagonist ABT-491 both reversed this phenotype; proliferation of CRPC cells was not affected in either model. LPCAT1 was found to mediate CRPC growth via nuclear re-localization and Histone H4 palmitoylation in an androgen-dependent fashion, increasing mRNA synthesis rates. We also found that LPCAT1 overexpression led to CRPC cell resistance to treatment with paclitaxel. LPCAT1 overexpression in CRPC cells drives tumor progression via increased mRNA synthesis and PAF production. Our results highlight LPCAT1 as a viable therapeutic target in the context of CRPC.

Exosome-derived miRNAs are regarded as biomarkers for the diagnosis and prognosis of many human cancers. However, its function in clear cell renal cell carcinoma (ccRCC) remains unclear. In this study, differentially expressed miRNAs from urinal exosomes were identified using next-generation sequencing (NGS) and verified using urine samples of ccRCC patients and healthy donors. Then, the exosomes were analysed in early-stage ccRCC patients, healthy individuals and patients suffering from other urinary system cancers. Thereafter, the target gene of the miRNA was detected. Its biological function was investigated in vitro and in vivo. The results showed that miR-30c-5p could be amplified in a stable manner. Its expression pattern was significantly different only between ccRCC patients and healthy control individuals, but not compared with that of other urinary system cancers, which indicated its specificity for ccRCC. Additionally, the overexpression of miR-30c-5p inhibited ccRCC progression in vitro and in vivo. Heat-shock protein 5 (HSPA5) was found to be a direct target gene of miR-30c-5p. The depletion of HSPA5 caused by miR-30c-5p inhibition reversed the promoting effect of ccRCC growth. In conclusion, urinary exosomal miR-30c-5p acts as a potential diagnostic biomarker of early-stage ccRCC and may be able to modulate the expression of HSPA5, which is correlated with the progression of ccRCC.

IL-22, a member of the IL-10 cytokine family, accelerates tubule regeneration upon acute kidney injury, hence we speculated on a protective role also in chronic kidney disease. We quantified intrarenal IL-22 expression after unilateral ureteral (UUO) in wild-type mice and performed UUO in IL-22 knock-out animals. Obstruction phenotypic differences between IL22(+/+) and IL22(-/-) mice were assessed by histology, immunohistochemistry, immunofluorescence as well as western blotting and reverse-transcriptase quantitative PCR ex vivo. Additionally, we performed in vitro experiments using both murine and human tubular cells to characterize IL-22 effects in epithelial healing. We found increasing IL22 positivity in infiltrating immune cells over time upon UUO in wild-type mice. UUO in IL22(-/-) mice caused more tubular cell injury as defined by TUNEL positive cells and loss of tetragonolobus lectin staining. Instead, tubular dilation, loss of CD31+ perivascular capillaries, and interstitial fibrosis were independent of the Il22 genotype as assessed by standard histology, immunostaining, and mRNA expression profiling. In vitro experiments showed that recombinant human IL-22 significantly enhanced human tubular epithelial cell proliferation and wound closure upon mechanical injury, and electric cell-substrate impedance sensing studies revealed that recombinant IL-22 sustained tubular epithelial barrier function upon injury. In contrast, IL-22 had no such direct effects on human fibroblasts. Together, in progressive kidney remodeling upon UUO, infiltrating immune cells secrete IL-22, which augments tubular epithelial integrity and epithelial barrier function, but does not affect vascular rarefaction or fibrogenesis. We conclude that IL-22 could represent a molecular target to specifically modulate tubular atrophy.

Objective To summarize our clinical experience of cryoablation for renal cancer and to analyze the therapeutic indication,security,selection of cryoablation and outcomes.Methods Sixty-four patients suffered with T1a renal cell carcinoma were enrolled in this study from March 2012 to March 2018.Among them,5 cases were senile patients (≥ 80 years),5 cases complicated with other cancers,3 cases complicated with renal insufficiency,4 cases complicated with decompensated cirrhosis,3 cases with bilateral renal cancer,4 cases with solitary kidney cancer and 39 cases with some other complications.The preoperative serum creatinine level was(80.5 ± 38.2)μmol/L.The patients underwent laparoscopic singlesite (LESS) renal cryoablation,conventional laparoscopic renal cryoablation,or percutaneous image-guided cryoablation according to individual situation.Contrast-enhanced CT scan or MRI were used during the procedures and follow-up was performed.Results All operations were completed successfully and technical success was achieved as well in all cases.Blood transfusion was necessary for 2 cases because of hemorrhage.The mean diameter of the mass was (2.6 ± 0.90) cm,the median volume of blood loss was 50ml(10-110 ml),and the mean operation time was(96.0 ± 24.5) min.The median inpatient hospital stay was 3 d (1-6 d).In one case,digital subtraction angiography (DSA) embolization was performed due to hemorrhage after surgery.None of the other cases had intraoperative or postoperative complications.The serum creatinine level after surgery was not significantly decreased [postoperative (83.8 ±42.1) μmol/L,P =0.64].The contrast-enhanced CT or MRI of the kidneys one week postoperatively showed uniform low density in all lesion areas,which represented complete ablation and regression of the tumor.All cases were followed up regularly.One case showed relapse at the 6 th month follow-up and underwent cryoablation again.Another case,who was not regularly followed up,relapsed at 69th month after surgery.No relapse was observed in the other cases during the follow-up.Conclusions Renal cancer cryoablation is a safe,feasible and efficacious therapy for the patients who suffered from unresectable T1a renal cell carcinoma because of high surgical risk or multifocal lesions.

Notch and interleukin-22 (IL-22) signaling are known to regulate tissue homeostasis and respond to injury in humans and mice, and the induction of endogenous aryl hydrocarbon receptor (Ahr) ligands through Notch links the two pathways in a hierarchical fashion. However in adults, the species-, organ- and injury-specific gene expression of the Notch-AhR-IL22 axis components is unknown. We therefore performed gene expression profiling of DLL1, DLL3, DLL4, DLK1, DLK2, JAG1, JAG2, Notch1, Notch2, Notch3, Notch4, ADAM17/TNF-α ADAM metalloprotease converting enzyme (TACE), PSEN1, basigin (BSG)/CD147, RBP-J, HES1, HES5, HEY1, HEYL, AHR, ARNT, ARNT2, CYP1A1, CYP24A1, IL-22, IL22RA1, IL22RA2, IL10RB, and STAT3 under homeostatic conditions in ten mature murine and human organs. Additionally, the expression of these genes was assessed in murine models of acute sterile inflammation and progressive fibrosis. We show that there are organ-specific gene expression profiles of the Notch-AhR-IL22 axis in humans and mice. Although there is an overall interspecies congruency, specific differences between human and murine expression signatures do exist. In murine tissues with AHR/ARNT expression CYP1A1 and IL-22 were correlated with HES5 and HEYL expression, while in human tissues no such correlation was found. Notch and AhR signaling are involved in renal inflammation and fibrosis with specific gene expression changes in each model. Despite the presence of all Notch pathway molecules in the kidney and a model-specific induction of Notch ligands, IL-22 was only up-regulated in acute inflammation, but rapidly down-regulated during regeneration. This implies that for targeting injury responses, e.g. via IL-22, species-specific differences, injury type and time points have to be considered.

4569 Background: Immunotherapy holds promise in RCC therapy. However, tumor-induced immune mechanisms add to resistance in RCC and little is known about how immunotherapy affects this. Interleukin-22 (IL-22) directly stimulates tumor cells, hence we examined the effect of IL-22 and its receptor (IL22R) on both RCC overall survival (OS) and progression free survival (PFS) and characterized the biological effect of IL-22 on RCC cells. Methods: RNA-seq data on 413 RCC cases from TCGA were analyzed by cbioportal. Intratumoral IL-22 and IL22R expression-stratified OS and PFS were calculated with Kaplan-Meier. Results were validated in an independent cohort of 40 RCC patients. FFPE-tissues were stained for IL-22 and IL22R. An array of eleven RCC cell lines was screened for IL22R expression and their biological behavior was characterized. Results: IL22R expression in RCC patients inversely correlates with median OS (46.12 vs. 85.45 mo; p < 0,01) and PFS (72.9 vs.91.33 mo; p < 0.05), and higher IL-22 expression is also associated with reduced median OS (47.04 vs. 85.45 mo; p = 0.0107mo). In the validation cohort, the association was confirmed for IL22R and IL-22 on the protein level. RCC cell lines have heterogeneous IL22R expression and IL22R+ cells increase their invasiveness, proliferation, hypoxic survival and resistance to RCC therapy in the presence of IL-22 in a dose-dependent manner. Conclusions: We show an effect of IL-22 on RCC outcomes in two independent patient cohorts. Both intratumoral IL-22 and IL22R are associated with worse prognosis and these findings are linked to RCC biology in vitro. We suggest IL22R as a prognostic marker and for the first time provide evidence for potential negative effects of immunotherapy by inducing T cell-derived IL-22 in RCC.

目的 探讨肾癌组织趋化因子受体CXCR4核定位表达与肾癌转移及预后的相关性.方法 采用免疫荧光染色法检测413例肾癌组织CXCR4的亚细胞定位表达,根据染色结果分为核定位阳性表达组及核定位阴性表达组,对比分析两组患者的临床资料及预后.结果 413例肾癌组织中170例CXCR4核定位阳性表达,243例CXCR4核定位阴性表达,两组基线资料差异无统计学意义.统计分析结果表明:与核定位阴性表达组相比,核定位阳性表达组Robson分期高、癌栓发生率高、淋巴结转移率高、远处转移率高,差异均有统计学意义(P＜0.01).核定位阳性表达组生存率为86.5％(147/170),低于核定位阴性表达组97.1％(236/243),差异有统计学意义(P＜0.001).结论 肾癌组织中CXCR4核定位表达与Robson分期高、癌栓形成、淋巴结转移、远处转移及患者预后差相关.

OBJECTIVE:To investigate the expression pattern of a novel long noncoding ribonucleic acid (RNA), RCCRT1, in renal cell carcinoma (RCC) tissues among the patients with various clinicopathologic features and to detect the role of RCCRT1 in migration and invasion of RCC in vitro. MATERIALS AND METHODS:We found out a novel long noncoding RNA, RCCRT1, that expressed differently between high-grade (Fuhrman grade III-IV) and low-grade RCC tissues (Fuhrman grade I-II) by gene chip analysis, then verified it with quantitative polymerase chain reaction. The expression of RCCRT1 was diminished by transfecting with small interfering RNA. RCCRT1 effects were assessed by cell proliferation, cell apoptosis, transwell assay, and wound-healing assay. RESULTS:Compared with adjacent noncancerous tissues, RCCRT1 is upregulated remarkably in RCC, particularly in high-grade RCC tissues. After analyzing the relative expression of RCCRT1 in various tissues by quantitative reverse transcription polymerase chain reaction and clinicopathologic characteristics of patients, we drew the conclusion that RCCRT1 is associated with clinicopathologic findings such as tumor size, pathologic T stage, tumor grade, lymph node metastasis, and distant metastasis. Furthermore, small interfering RNA-induced depletion of RCCRT1 expression suppressed migration and invasion in RCC cell lines. CONCLUSION:The results of the present study suggest that RCCRT1 promoted migration and invasion of RCC and that RCCRT1 may offer a biomarker to verdict prognosis as well as an attractive new target for prognostic and therapeutic intervention for RCC patients in the future.

ObjectivesTo compare the peri‐operative and early renal functional outcomes of robot‐assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) for kidney tumours.Materials and MethodsA total of 237 patients fulfilling the selection criteria were included, of whom 146 and 91 patients were treated with LPN and RAPN, respectively. To adjust for potential baseline confounders, propensity‐score matching was performed. A favourable outcome was defined as a warm ischaemia time (WIT) of ≤20 min, negative surgical margins, no surgical conversion, no Clavien ≥3 complications and no postoperative chronic kidney disease (CKD) upstaging. Descriptive statistics and multivariable logistic regression analyses were performed before and after propensity‐score matching.ResultsWithin the propensity‐score‐matched cohort, the RAPN group was associated with significantly lower estimated blood loss (EBL; 156 vs 198 mL, mean difference [MD] = −42; P = 0.025), a shorter WIT (22.8 vs 31 min, MD = −8.2; P < 0.001) and a higher proportion of malignant lesions (88.4 vs 67.5%; odds ratio [OR]: 2.6; 95% confidence interval [CI]: 1.2–5.67; P = 0.023). With regard to early renal functional outcomes, the mean last estimated glomerular filtration rate was 95.8 and 89.4 mL/min per 1.73 m2 (MD = 6.4; P = 0.01), with a mean ± sd percentage change of −4.8 ± 17.9 and −12.2 ± 16.6 (MD = 7.4; P = 0.018) in the RAPN and LPN groups, respectively. The intra‐operative complication rate was significantly lower in the RAPN group (1.3 vs 11.7%; OR 0.1, 95% CI 0.01–0.81; P = 0.018). On multivariable analysis, surgical approach (RAPN vs LPN, OR 5.457, 95% CI 2.075–14.346; P = 0.001), Charlson Comorbidity Index (OR 0.223; 95% CI 0.062–0.811; P = 0.023), diameter‐axial‐polar score (OR 0.488, 95% CI 0.329–0.723; P < 0.001) and preoperative CKD stage (OR 3.189, 95% CI 1.204–8.446; P = 0.020) were found to be independent predictors of obtaining a favourable outcome.ConclusionsAfter adjusting for potential treatment selection biases, RAPN was found to be superior to LPN for peri‐operative outcomes (EBL, WIT and intra‐operative complications) and early renal functional preservation.

随着全基因组测序和转录测序技术的发展,长链非编码RNA(long non-coding RNA,lncRNA)逐渐成为研究的热点,越来越多的lncRNA分子被发现.lncRNA不仅作为DNA和蛋白质之间的中介发挥作用,其在细胞功能方面也具有重要作用.lncRNA通过染色体重塑、转录、转录后加工等多种途径参与调节基因表达.lncRNA调节异常与人类许多疾病尤其是恶性肿瘤相关,有望成为新型肿瘤诊断标志物和肿瘤治疗的靶点.近期研究提示,lncRNA在肿瘤诊断和治疗方面具有良好的临床应用前景.本文综述lncRNA领域最近的研究成果并探讨lncRNA调节异常与肿瘤的关联.

Objective To compare the therapeutic outcomes of standard laparoscopic and laparoendoscopic single-site(LESS)nephrectomy for benign nonfunctioning kidney.Methods From September 2009 to August 2013,a single urologist group in our center performed 72 transperitoneal laparoscopic nephrectomies for benign nonfunctioning kidney,with 50 undergoing LESS(group A)and 22 undergoing standard laparoscopic surgery(group B).The clinical data of the two groups were analyzed and the therapeutic outcomes were compared between the two groups.Results The operation was successfully performed in all cases,with no conversion to open surgery.Compared with standard laparoscopic group,the LESS group had significantly lower postoperative pain score(4.3±1.0vs 3.7±0.8,P=0.015),quicker bowel function recovery([58.1±16.1]h vs[49.2±14.0]h,P=0.032),shorter drainage duration([3.9±1.5]d vs[2.8±1.1]d,P=0.003),shorter postoperative hospital stay([7.3±3.1]d vs[6.3±3.4]d,P=0.048),and a better cosmetic satisfaction score(7.4±0.9vs8.0±0.6,P=0.001).The operative time and intraoperation blood loss were not significantly different between the two groups.Conclusion Compared to standard laparoscopic nephrectomy,transumbilical LESS nephrectomy offers a quicker recovery of bowel function,shorter drainage duration,a better postoperative pain control,and a better cosmetic satisfaction for benign nonfunctioning kidney,but its long-term therapeutic effect needs to be further verified.