OBJECTIVE:To study the relationship between activation of TLR4-signaling pathway and B7-H1 expression in T24 bladder cancer cells,and research the role they play in bladder cancer immune evasion.METHODS:T24 bladder cancer cell lines were cultured and treated with LPS(1μg/mL) for 0,2,4,6,8,12 h.TLR4 expression was examined by flowcytometrty and B7-H1 mRNA and protein expression were examined by RT-PCR and Western-Blot respectively.One-way ANOVA and Spearman rank correlation analysis were applied in the data analysis.RESULTS:Flowcytometrty analysis showed the TLR4 expression of T24 bladder cancer cells was significantly up-regulated depending on the duration of LPS stimulation.The positive rate of TLR4 on T24 cells were 0 h(3.34±0.86)%,2 h(6.71±1.38)%,4 h(9.71±1.24)%,6 h(11.57±0.91)%,8 h(25.24±5.32)%,12 h(21.67±1.81)%,at the same time B7-H1 mRNA and protein expression showed a very similar tendency after LPS stimulation.The B7-H1 mRNA relative expression quantity were 0 h(0.86±0.06),2 h(1.30±0.11),4 h(1.67±0.20),6 h(1.99±0.10),8 h(2.57±0.23),12 h(1.51±0.04),and B7-H1 protein 0 h(0.66±0.08),2 h(0.65±0.10),4 h(0.87±0.11),6 h(1.07±0.23),8 h(1.45±0.19),12 h(1.13±0.06).One-Way ANOVA analysis showed that the differences between groups were statistically significant(F values were 83.049,84.719,195.258,P<0.05).B7-H1 mRNA and protein expression was significantly related to TLR4 expression respectively(r1=0.753,r2=0.836,P<0.05).CONCLUSION:TLR4-signaling pathway may be involved in bladder cancer immune evasion process by up-regulating B7-H1 expression.

患者,男,53岁,因"大便习惯改变8个月、便血2 d"于2010年8月25日来我院就诊.查体未见异常.实验室检查:血常规、肝肾功能及电解质均未见明显异常.盆腔CT检查发现直肠壁增厚,盆腔淋巴结增大.直肠镜检查发现直肠壁多发性溃疡,行溃疡部活检,病理检查结果为弥漫大B细胞淋巴瘤,免疫组织化学检查:CD20、Bcl-2、Ki-67均阳性,CD3、CD30、MVM-1、Cyclin D1均阴性.腹部CT检查发现左肾上极1类圆形软组织肿块,7.5 cm×7.0 cm×6.5 cm,边界欠清,增强后呈轻度不均匀强化.

爱活尿通(Eviprostat)是德国汉堡爱活大药厂出品的一种治疗良性前列腺增生(BPH)、前列腺炎的植物药,在国外已广泛用于良性前列腺增生的治疗,但对治疗慢性前列腺炎的报道还属空白.为了进一步评价爱活尿通治疗中国人慢性前列腺炎的安全性和有效性,2006年9月-2007年2月,由复旦大学附属华山医院、上海交通大学附属仁济医院、中国医科大学第一附属医院、山西大学第一医院、安徽医科大学附属医院和青岛大学医学院附属医院6所医院合作,对该药进行了为期12周的开放性、多中心的临床研究,现报道如下.

Objective To evaluate the efficacy and safety of endogenous field thermal chemotherapy for the prevention of recurrence of urothelial carcinoma of bladder after surgery.Methods Twenty cases of urothelial carcinoma of bladder who underwent surgical management received bladder perfusion with mitomycin in 24 hours bostoperatively,and one month postoperatively received bladder perfusion with mitomycim 20 mg,supined aud proned every 10 minutes,and then received endogenous field thermal chemotherapy for one hour,monthly,and received the bladder endoscopy every three months.If no recurrence occured after one year,then changed to bimonthly,and received bladder endoscopy every half a year.Total treatment was for two years,total dose was 360 mg.Results All 20 cases except one were followed up for 3 months to 32 months.One case got recurrence within 9 months.The recurrence rate was 5.26％.No obvious side effect was found in all cases.Conclusions Endogenous field thermal chemotherapy is effective for preventing the recurrence of urothelial carcinoma of the bladder after surgical management.

<正>女性原发性尿道黑色素瘤(primary malignant melanomaof the female urethra,PMMFU)极为少见,约占黑色素瘤的0.2%～1.0%。现就我们收治的1例患者报道如下,并结合文献资料进行讨论。

Objective:To study a streamlining design of laparoscopic radical nephrectomy(LRN) and its effect on learning cure.Methods:Young laparoscopic doctor had a training of LRN.which was streamlined in mode and procedure.Then initial 30 cases by streamlining LRN between Jan.2009 and Jan.2011 were collected and the learning curve of LRN was analyzed.And 30 cases which underwent conventional LRN previously were recruited and served as controls.Results:The turning point of learning curve was appeared ahead of time in experimental group than in control group.The average operation time and blood loss were lower in experimental group than in control group with a significant difference.The transfusion rate and postoperative complications were also decreased in experimental group than in control group,but show no significant difference.Conclusions:The learning curve of LRN can be shortened by LRN training with a streamlining design.

Objective To investigate the effect of high-energy shock wave(HESW) on damage of mucosa of renal pelvis in rabbits and the protection of mannitol. Methods A total of 36 rabbits were randomized to three groups: traumatic group(group 1),mannitol group(group 2) and control group.After HESW,the animals in group 2 were given intravenous mannitol immediately;to those in group 1,normal saline was given;to control group,given only normal saline,with no HESW.The mucosa of renal pelvis of the three groups were observed,light-microscopically and electron-microscopically,on the 1st day and 1st,2nd,4th and 8th week after the procedures. Results HESW damaged the mucosa of renal pelvis of the rabbit,but no obvious impact on renal function(P0.05).The injury could be seen in groups 1 and 2,but not in the control,under electron microscope and light microscope. Conclusion HESW may injure the mucosa of renal pelvis of rabbit,and mannitol shows its protection.

Objective To establish the TRAIL-resistant renal cancer cell line and investigate the relationship between resistance and cFLIP protein.Methods A resistant cell line 786-0TR was established by stepwise increasing dose of TRAIL and intermittent administration.The resistant cell line IC50 and resistant index were measured.The cFLIP mRNA and protein of the resistant cell line and sensitive cell line were measured by RT-PCR and western blot.Then we compared the result.Results IC50 of resistant cell line was 739.347 2 μg/L,and its resistant index was 9.642 7.The expression of cFLIP mRNA and protein in resistant cell line higher than sensitive cell line (P<0.05).Conclusions We established the TRAIL resistant renal cancer cell line successively.cFLIP protein play an important role in renal cell carcinoma resisiting TRAIL.

Objective To detect the specific protein expression in the urine of bladder transitional cell carcinoma(TCC),find out new tumor markers,and then explore the roles of those proteins in the pathogenesis of TCC and the value of proteomics in studying TCC.Methods Urine samples from 24 TCC patients and the control group(including 12 postoperative patients with TCC and 12 healthy volunteers)were analyzed using surface enhanced laser desorption/ionization-time of flight-mass spectrometry(SELDI-TOF-MS)ProteinChip technology,then the proteins which had been picked out would be identified in Swiss-Prot protein database.Results Some protein differences of protein were detected in the urine samples between TCC group and Control group by IMAC-Cu-3 chip,including six potential TCC biomarkers and two protein clusters.Combination of the 3438Da and 8002Da biomarkers significantly increased the sensitivity(83.3%)and the specificity(75.0%)for detecting TCC.The 3438Da biomarker had been identified as α-defensin and the 4310Da~5150Da protein cluster was identified as gp40 protein in the SWISS-PRO protein database.Conclusion SELDI-TOF-MS ProteinChip technology can directly,quickly and expediently pick out specific TCC biomarkers from the urine of patients.It will contribute to study the pathogenesis of TCC and provide a valuable approach in detecting tumor marker.

Objective To assess and compare the effects of standard percutaneous nephrostomy (S-PCN) and minimally invasive percutaneous nephrostomy (MI-PCN) on renocortical damage of solitary kidney in pig. MethodsA solitary-kidney animal model was established by removing the left kidney in 12 female pigs, which were randomized to S-PCN and MI-PCN groups, an ultrasound guided PCN was done two weeks later. The tracts in S-PCN group were dilated to 24F with Amplatz fascial dilator, and that in MI-PCN to 16F. Urea nitrogen, serum creatinine, urine kalium, natrium, chlorine, and total amount of carbon dioxide in serum (ECO2) were detected, before and after surgery. Four weeks later, the pigs were sacrificed and the kidneys removed for macroscopic and histologic examination. The scar tissues surrounding the tracts were dissected and Massion staining done, the area of scar was measured with digital image analysis, the volumes of scar and renal cortex were calculated. The volumes of scar and that accounting for the volume of renal cortex in percentage between the two groups were compared.ResultsA PCN model in pigs with solitary kidney was successfully set up. The above items detected, before and after surgery, showed no statistical differences between the two groups (P0.05), and no significant difference was found in terms of gross and microscopic observation of the kidney. There was no statistical difference of scar volume (P0.05) and that ratio to total renal cortex volume (P0.05) between the two groups. ConclusionBoth S-PCN and MI-PCN have a very little impact on renal function and renal cortex. MI-PCN has no obvious superiority over S-PCN in reducing parenchymal damage of solitary kidney.

Objective To study the effect of mannitol at different doses on renal damage induced by the high-energy shock wave in rabbits.Methods A total of 24 rabbits were assigned to 3 groups randomly(Control group,Low-dose mannitol group and High-dose mannitol group).After ESWL,the animals were given different dose of mannitol.All the animals were free to drink water.Then the changes in kidney function were observed.Plasma ET-1 and SOD were measured.Results After ESWL,the peak value of plasma ET-1 in Low-dose mannitol group was significantly lower than in other groups(P0.05).The activity of plasma SOD in Low-dose mannitol group was significantly higher than in other groups(P0.05).Conclusion Lowe-dose mannitol have protective effects on shockwave-induced renal injury in rabbits,but high-dose mannitol increase kidney damage.

Objective To explore the prognostic factors of renal cell carcinomas with different symptoms. Methods A total of 401 cases were included in this study. 20 clinical-pathological factors were analysed with the Kaplan-Meier univariate method and Cox multivariate analysis. All data were assessed with SPSS11.5. Results On univariate analysis age,gender,sarcomatoid component,histologic subtypes,grade,symptoms,venous thrombus,tumor size,lymphatic metastasis,distant metastasis,TNM stage,and ECOG performance status were significant prognostic factors (P<0.01). On multivariate analysis age,sarcomatoid component,systemic symptoms,venous thrombus,lymphatic metastasis,distant metastasis,and TNM stage remained independent prognostic factors (P<0.05). Conclusion Worse prognosis is prone to patiens with old age,sarcomatoid component,systemic symptoms,venous thrombus,lymphatic metastasis,distant metastasis and high TNM stage.

Objective To introduce the experience of surgical access to left renal pedicle at the level of Treitz ligament in complicated nephrectomy.Methods A total of 51 left transperitoneal nephrectomies,in complicated cases such as big renal carcinoma(with or without renal vein cancer embolus),transition cell carcinoma of renal pelvis and pyonephrosis,were performed from September 1997 to December 2008,by direct access to left renal pedical at the level of Treitz ligament.The anatomy and relationship of Treitz ligament,renal vein,aorta,adrenal vein and inferior mesenteric vein were reviewed and the key point of procedures was described.Results All operations were performed successfully,no operative death,and no severe intraoperative and postoperative complications occurred.The time required to explore the renal vein and to deal with renal pedicle were 3 to 5 minutes,10 to 20 minutes,respectively,after entering the abdominal cavity.Conclusions This access to renal pedicle is technically feasible and operation through it has following advantages:①Easy to approach the renal pedicle in the aspects of anatomy and it is safe,quick to deal with renal pedicle with less blood loss.②It follows the classic principles of radical nephrectomy allowing to perform the procedure without any manipulation of the tumor.This surgical access is especially suitable for complicated left nephrectomy such as radical nephrectomy(with renal vein cancer embolus) and pyonephrosis.

Objective To characterize the proteome expression overall profile of superficial bladder tumor.On the basis of expression profile,the discovery of urine biomarker was discussed.Methods ① Purified highly superficial transitional cell carcinoma cells were obtained by laser capture microdissection(LCM);② Peptide mixture were separated by two-dimensional liquid chromatography(2D-LC),followed by electrospray ionization-tandem mass spectrometry(ESI-MS/MS) identification and bioinformatics analysis of the identified proteins.Results A total of 440 proteins appeared co-expression in 4 specimens.There were 76(17.3%) of proteins with molecular weight(MW)<10 kDa or >100 kDa,84(19.1%) proteins with pI>9,312/304 proteins with biological process/cellular component annotation as to the Gene Ontology(GO).There were 41/22 GO terms exhibited as enriched/depleted within the biological process annotation and 25/11 GO terms exhibited as enriched/depleted within the cellular component annotation.The GO biological process enrichment/depletion analysis was strongly consistent with that of urine proteome.Proteins that belong to the term of cell adhesion,cell proliferation,cell differentiation are good candidate biomarkers for cancer detection from urine.Conclusions The present experiment identified an extensive expression profile in superficial bladder tumor,providing valuable information for the understanding of cell biology and discovery of urine biomarkers.

Objective To study T2 urothelial bladder carcinoma patients underwent radical cystectomy and partial cystectomy,then find the influence of two operation manners on survival rate.Methods The clinical data,histopathological reports and follow-up results of T2 urothelial bladder carcinoma patients underwent radical cystectomy and partial cystectomy were studied retrospectively.Results From 1991 to 2006,168 patients(70.6%)were underwent partial cystectomy.Of this group 103 patients had T2a(superficial) and 65 had T2b(deep) muscle invasive tumors.After partial cystectomy,all patients were underwent intravesical chemotherapy.70 patients(29.4%) were underwent radical cystectomy.Of this group 34 patients had T2a(superficial) and 36 had T2b(deep) muscle invasive tumors.After radical cystectomy,patients with pelvic node positive were underwent adjuvant chemotherapy.At follow-up of 2-18 years,135 patients occurred recurrence,102 patients had distant metastatic disease,and 108 patients died after partial cystectomy.19 patients had distant metastatic disease,and 28 patients died after radical cystectomy.No significant difference was observed in 3-year survival rate between patients underwent radial cystectomy and patients underwent partial cystectomy(82.6% vs 77.6%,P>0.05),but difference was observed in 5-year survival rate and 10-year survival rate between the two groups(73.7% vs 51.8%,P<0.05;57.0% vs 32.4%,P<0.05).Conclusions the first operation manner has influence on the survival rate of T2 urothelial bladder carcinoma patients,patients underwent radical cystectomy have better long survival rate than patients underwent partial cystectomy.

Objective To evaluate the prognostic factors affecting recurrence,progression and cancer-specific survival in patients with primary superficial transitional cell carcinoma of bladder.Methods Using Kaplan-Meier method,Log-rank test and Cox proportional hazards model,the retrospective survival analysis was performed in 153 patients with superficial transitional cell carcinoma of bladder.Results The main variables affecting recurrence were tumor size,histological grades and intravesical chemotherapeutic instillations.The main variables affecting progression were tumor shape,histological grades,the duration of symptoms and intravesical chemotherapeutic instillations.The variables that could predict cancer specific survival were tumor shape,histological grades and the duration of symptoms.Conclusions By cancer-specific survival analysis of the follow-up data,we can identify the main prognostic factors was histological grades,intravesical chemotherapeutic instillations was the protective facter.

对我院1997~2007年收治的27例肾上腺囊肿患者的临床资料进行回顾性分析,比较不同检查手段的术前诊断率及不同术式(开放手术、腹腔镜手术和后腹腔镜手术)的效果。结果发现B超、CT、MRI术前诊断正确率分别为58%(7/12)、39%(9/23)和100%(1/1),三者联用时为64%(7/11);三种术式手术时间无显著差异,腹腔镜手术和后腹腔镜手术患者术中出血量与术后住院时间均显著小于开放手术者(P<0·05)。术后随访2例失访,余均无复发,且生存状况良好。认为肾上腺囊肿术前应同时行B超、CT、MRI检查以提高诊断率;腹腔镜手术和后腹腔镜手术效果均优于开放手术。

32例BALB/C-nu/nu无胸腺裸鼠经脾脏接种人结肠腺癌LS-174T细胞,建立结肠癌裸鼠肝转移模型后分为四组各8只,分别于接种后10 min(早期治疗组)、10 d(中期治疗组)、20 d(晚期治疗组)经尾静脉注射三氧化二砷(As2O3)10 mg/kg 0.2 ml,对照组注射等量生理盐水。观察各组裸鼠体质量变化、肝转移结节数目、生存时间以及血清、腹水CEA水平。结果与对照组相比,早、中期治疗组体质量增加、肝转移结节数目减少、生存时间延长、血清及腹水CEA水平降低(P<0.05、<0.01),晚期治疗组差异不显著(P>0.05)。提示As2O3可抑制结肠癌肝转移,早期治疗效果优于中晚期。

Objective To evaluate the diagnosis value of F-PSA/T-PSA on early for prostate cancer(PCa) with prostate specific antigens(PSA) 4.0 μg/L.Methods The free and total PSA in 136 normal male volunteers(normal control),87 PCa patients with T-PSA≥4.0 μg/L and 12 patieats with T-PSA4.0 μg/L were measured by electrochemiluminescence immunoassay.The ratios of F-PSA/T-PSA were therefore obtained.Results The T-PSA, F-PSA and F-PSA/T-PSA consisted of 1.43±1.13 μg/L,0.44±0.34 μg/L,0.36±0.15 in cases of normal control group;31.25±20.68 μg/L,4.21±3.12 μg/L,0.17±0.08 in 87 cases with T-PSA≥4.0 μg/L PCa cases;2.56±1.11 μg/L,0.43±0.29 μg/L,0.18±0.09 in 12cases with T-PSA4.0 μg/L PCa cases.There is significant difference of T-PSA,F-PSA/T-PSA was observed between the normal control group and 12 PCa cases with 4.0 μg/L(P0.01).Significant difference of T-PSA、 F-PSA and no difference of F-PSA/T-PSA between Pca with T-PSA≥4.0 μg/L and Pca with T-PSA 4.0 μg/L.The cut off of F-PSA/T-PSA were ranked as 0.10,0.11～0.15,0.16～0.20,0.21～0.25,0.26～0.30,0.31.The 75% and 78.16% prevalence of PCa were observed in patients with T-PSA4.0 μg/L PCa,T-PSA≥4.0 μg/L PCa respectively when F-PSA/T-PSA cutoff was less than 0.20(P0.05).Conclusion The analysis of F-PSA/T-PSA is valuable for early diagnosis prostate cancer for patients with serum T-PSA≥4.0 μg/L and as low as 4.0 μg/L.

To evaluate the risk factors for invasive bladder cancer and to develop a predictive model for the improvement of individual comprehensive therapy for invasive bladder cancers.