The brain, heart, liver, kidney, and other organs are susceptible to the harmful effects of ischemia-reperfusion injury (IRI), where the excessive production of reactive oxygen species (ROS) following IRI contributes to tissue damage and ensuing inflammation. In recent years, researchers have designed various nanoparticles that are responsive to ROS for the treatment of IRI. Empagliflozin (EMPA), an inhibitor of the sodium-glucose cotransporter-2 commonly used in type 2 diabetes mellitus, shows promise in mitigating IRI. However, its water-insolubility and low bioavailability present challenges in fully realizing its therapeutic efficacy. To tackle this issue, we formulated EMPA-loaded nanomicelles designed to respond to ROS, aiming to prevent renal damage caused by ischemia-reperfusion. Extensive characterization confirmed the effectiveness of the formulated nanomicelles. Through simulations and release studies, we observed structural modifications in the micelles leading to the release of EMPA upon encountering ROS (H2O2). In animal studies, rats treated with EMPA-loaded micelles showed normal renal tissue architecture, with only some remaining tubular swelling. Molecular assessments revealed that IRI triggered cell apoptosis through mechanisms involving hypoxia, metabolic stress, ROS, and TNF-α elevation. EMPA treatment reversed this process by upregulating B-cell lymphoma protein 2 and reducing levels of associated X (BAX) protein, Caspase 3, and Caspase 8. These results indicate that ROS-responsive micelles could act as a spatially targeted delivery system, effectively transporting EMPA directly to the ischemic kidney. This offers a promising therapeutic strategy for alleviating the impact of renal IRI.

随着肾移植水平的提高,患者对肾移植术后生活质量的要求越来越高,而性能力的恢复是衡量生活质量的一个重要指标.早在50年前,就有学者认为肾移植成功的标志之一,恢复肾移植受者生育能力[1].既要获得满意的性生活质量,又要维持良好的移植肾功能状态成为肾移植患者的对生活质量的更高要求.

老年女性发生膀胱损伤后容易出现膀胱瘘,其中膀胱腹壁瘘较为常见,但合并大腿膀胱瘘并继发脓肿则相对比较罕见,本院近期收治了1例88岁的女性患者,继发于膀胱大腿尿瘘继而形成大腿脓肿,患者既往有骨盆骨折以及膀胱腹壁瘘病史,给予对症治疗后好转,本文总结了该患者的病例特点,并进行了文献复习.

阴茎折断也称为阴茎白膜及海绵体破裂或阴茎骨折,是阴茎闭合性损伤中的一种,更是泌尿外科急症的泌尿系损伤患者中的一种病种之一,临床少见. 部分患者在阴茎损伤轻微时羞于就诊或者在不正规医院就诊,造成阴茎纤维瘢痕形成、硬结、勃起疼痛、性功能不全等不良后果. 现将2013年7月至2017年5月收治的17例患者病例资料进行分析,总结阴茎诊断的临床诊治体会,以期提高对阴茎折断疾病诊断及治疗水平.

目的:探讨小剂量西地那非、心理-行为疗法联合治疗早泄伴发勃起功能障碍临床效果.方法:对照组给予小剂量西地那非治疗,研究组给予小剂量西地那非联合心理-行为疗法治疗.结果:研究组临床总有效率(88.89％)优于对照组(33.33％),P<0.05.结论:利用小剂量西地那非、心理-行为疗法联合治疗早泄伴发勃起功能障碍患者可显著提高其临床疗效.

肾盂输尿管连接部梗阻(UPJ O)是小儿及青少年肾积水常见原因之一,且大部分为先天性疾病.如果不采取治疗或干预措施,随着肾积水的加重肾功能会进行性下降.UPJO有多种手术治疗方法,开放肾盂成形术一直以来都是治疗UPJO的“金标准”.随着科技的发展,微创手术以其优点有逐步取代开放手术的趋势.

目的 比较机器人辅助腹腔镜肾盂成形术(Robot-assisted and laparoscopic pyeloplasty,RALP)与腹腔镜肾盂成形术(Laparoscopic pyeloplasty LP)两种手术方式治疗肾盂输尿管连接部梗阻的疗效及安全性.方法 检索2002年1月-2014年12月国内外公开发表的有关于RALP与LP比较的相关研究性文献.由2名评价者对所纳入的相关文献的研究质量进行共同评价.使用Rev-Man 5.3软件进行数据处理.结果本篇Meta分析共纳入了10篇文献,共纳入497例患者,其中RALP组259例,LP组238例.Meta分析结果提示,在缝合时间(WMD=-13.06,95％CI-22.54～-3.58,P=0.007)、住院时间(WMD=-1.40,95％CI-2.04～-.0.76,P＜0.0001)和术后并发症率(OR=0.53,95％CI 0.29～0.98,P=0.04)方面,RALP优于LP,差异有统计学意义(P＜0.05).在手术时间、术中失血量、和手术成功率方面,RALP与LP之间差异无统计学意义(P＞0.05).结论 与LP相比,RALP在缝合时间、住院时间、术后并发症率方面更具优势.

骨肉瘤（osteosarcoma）是青少年中最常见的恶性骨肿瘤之一，该肿瘤好发于儿童胫骨的上段和股骨的下段且恶性程度极高，预后不良。进些年来，多种药物的联合化疗以及手术治疗使骨肉瘤患者的5年生存率由原来的20％提高到70％左右［1］。然而进30年来，5年生存率波动幅度较大，部分患者手术后复发率高，对于出现远处转移的患者5年生存率不到30％［2］。多年来骨肉瘤肿瘤形成的分子水平机制仍然不清楚，因而从分子水平寻求新的治疗靶点和方法抑制骨肉瘤的形成和发展就显得尤为重要。P53基因是最常见的抑癌基因之一，根据文献［3］报道，在许多肿瘤的发生发展过程中，抑癌基因中P53基因发生突变的频率最高，有60％的肿瘤都含有突变的P53基因。本研究旨在通过构建过表达P53质粒，初步探讨P53基因与骨肉瘤细胞系凋亡的关系。

Objective To study the expression of matrix metalloproteinases 9 (MMP-9) in bladder cancer and its clinical significance. Methods Meta analysis of relative literatures published In domestic Chinese journals from 1998 to 2014 ,bladder cancer tissues as cases, normal bladder mucous membrane tissues as control group;Odds ratio (OR) as the effect index. Then apply RevMan 5.2 software to statistical data , calculate merger OR values and 95%confidence interval, and draw the forest map of Meta analysis. Results 12 studies involving 792 patients that met the inclusion criteria, were included in the Meta analysis. OR values in bladder cancer tissue and normal bladder tissue group, superficial bladder cancer group and invasive bladder cancer group, low grade bladder cancer group and senior grade bladder cancer group were 58.99,0.17,0.29. The positive rate of MMP-9 in bladder cancer group were significantly higher than that in normal bladder tissue group, in invasive bladder cancer group were significantly higher than that of superficial bladder cancer group, in senior grade bladder cancer group were significantly higher than the low grade bladder cancer group. Conclusion The high expression of MMP-9 have a role in in bladder cancer occurrence and development; to detect the expression of MMP-9 contributes to the understanding of the biology of bladder cancer, and provide information for clinical treatment and prognosis.

精索静脉曲张（varicocele，VC）是男性不育症的主要致病原因之一，在普通男性人群的发病率约为15％～20％，在不育症患者中发病率达35％～40％［1］，精索静脉曲张患者合并生精功能异常的概率达54.8％［2］。生精细胞可能会受到精索静脉曲张的影响而出现异常的细胞凋亡，从而导致精液异常，引起男性不育症的发生。细胞凋亡一般情况又可称为细胞的程序性死亡，是生物体新陈代谢的一组基本的分子生物学机制，这种机制在精子发生过程中可以起到清除多余或异常细胞的作用，可以调控产生精子的数量，是一种正常的生理现象，但如果生精细胞出现病态的凋亡异常增多，则会使精子的生成数量减少，从而出现男性的生育功能障碍。

Objective To study the expression and clinical significance of matrix metalloproteinase 2 (MMP-2) in chinese patients with bladder cancer. Methods The relevant original articles published in journals from 1998 to 2014 were selected. The ratio of the case group and the control group (OR value) regarded as an effect index. Then the original data were analyzed using Meta analysis software RevMan 5.0, the combined OR values and 95%confidence interval were calculated, and the forest map was draw. Results 13 studies involving 692 patients that met the inclusion criteria were included in the Meta analysis. The OR values of bladder cancer tissue group and normal bladder tissue group, superficial bladder cancer group and invasive bladder cancer group, and low grade bladder cancer group and senior bladder cancer group were 45.83, 0.22 and 0.31, respectively. The positive rates of MMP-2 in bladder cancer tissue group, invasive bladder cancer group and advanced bladder cancer group were significantly higher than those in normal bladder tissue group, superficial bladder cancer group and low grade bladder cancer group (all P< 0.05). Conclusions The high expression of MMP-2 has a certain effect in bladder cancer. The detection of MMP-2 contributes to the understanding of the biology of bladder cancer, and provides information for clinical treatment and prognosis.

目的:探讨前列腺平滑肌肉瘤的临床诊治和预后特点.方法:汇报1例39岁前列腺平滑肌肉瘤患者,以“进行性排尿困难2个月余,不能自主排尿15天”入院.超声检查提示:考虑为脓肿可能;前列腺MRI检查提示:前列腺异常信号,考虑为占位病变;膀胱镜检查示:前列腺不规则增生.于2013年3月18日在腰硬联合麻醉下行“经尿道前列腺诊断性电切术”,手术顺利.查阅相关文献复习讨论.结果:病理报告示:组织呈灰白、灰红色,HE染色可见短梭形细胞、核大小差异较大,细胞丰富、密集、呈浸润性生长、核异型性明显、可见核分裂象;免疫组化示:Vimentin(+++)、Desmin(+)、SMA(+)、Caldesmon(+++),病理诊断:低分化平滑肌肉瘤.结论:前列腺平滑肌肉瘤是一种罕见的前列腺肿瘤,其发病机制目前还不清楚,临床诊断常较为困难,确诊需依靠病理学组织学及免疫组化染色检查.治疗以手术切除联合放化疗为主,但其病情进展迅速,预后不佳.

Objective To explore the protective role of tea polyphenol on the oxidative stress and cellular apoptosis of testicular tissues in experimentally-induced varicocele rat models .Methods A total of 32 male prepubertal Wistar rats were randomly divided into 4 groups ,with 8 rats in each group .Group I was the sham operation group .Group Ⅱ was the varicocele model group .Group Ⅲ and Ⅳ were the tea polyphenol groups ,in which the varicocele models were treated with tea polyphe-nol of different concentrations .Four weeks after the models were established ,group I and Ⅱ were fed with 1 mL/100 g nor-mal saline ,group Ⅲ and Ⅳ were fed with 10 mg/kg and 40 mg/kg tea polyphenol respectively .After being fed once every day for 4 weeks ,all rats were executed and the left testes were collected to detect the vitality of superoxide dismutase (SOD) ,con-tent of malondialdehyde (MDA) ,and the apoptosis index (AI) .Results Group I showed the highest vitality of SOD ,fol-lowed by group Ⅱ ,Ⅲ and Ⅳ (P<0 .05) .Group II had the highest measurement of MDA and AI ,followed by group Ⅲ ,Ⅳ andⅠ (P<0 .05) .Conclusion Tea polyphenol can significantly reduce the oxidative stress and cellular apoptosis of testicular tis-sues ,indirectly improving the spermatogenesis in rats .

Objective To systematically evaluate the efficacy and safety of solifenacin versus tolterodine, for treatment of overactive bladder (OAB). Methods Chinese and English literatures of randomized controlled trials us-ing solifenacin versus tolterodine for treatment of OAB were collected, and the references included in the literatures were searched. Statistical software, RevMan 5.0 was used for the meta-analysis. Results Eight studies, involving a to-tal sample size of 832 cases, were included for the meta-analysis, with the same examined baseline. By comparing five common parameters and adverse reactions after medication, meta-analysis found that there were no statistical differ-ences in improving OAB daily frequency of urgent urination, urinary incontinence, and nocturia between using solife-nacin and tolterodine. However, the effect of using solifenacin in improving daily frequency of urination and micturi-tion volume per voiding were better than those of using tolterodine, with statistically significant differences ( P<0.05). For adverse reactions, the dry mouth incidence of using solifenacin was 50%lower than that of using tolterodine, with statistically significant difference (P<0.05). There were no statistical differences in constipation, blurred vision, and dyspepsia between using solifenacin and tolterodine. Conclusion Both of solifenacin and tolterodine can improve symptoms of OAB, whereas the effects of using solifenacin in improving daily frequency of urination, micturition vol-ume per voiding, and dry mouth are better than those of using tolterodine. As the included literatures and sample size were limited, large sample size and long-term follow-up of high-quality clinical trial can provide better evidence-based findings.

目的:系统评价微创经皮肾镜取石术(MPCNL)与标准通道经皮肾镜取石术(SPCNL)治疗普通型肾结石的有效性与安全性.方法:计算机检索PubMed、Cochrane Liabrary、CNKI、维普、万方数据库,检索时限从1992年1月1日至2015年4月1日.筛选两种方法治疗肾结石的随机对照试验(RCT)并评价文献质量,采用RevMan5.2软件进行统计学处理.结果:共纳入9个RCT,1017例患者,其中MPCNL组为508例,SPCNL组为509例.结果显示两种通道处理普通肾结石的清除率MPCNL组低于SPCNL组[OR=0.62,95％CI (0.43,0.91),P=0.01];在手术时间方面,MPCNL组手术时间长于SPCNL组[MD=14.23,95％CI (6.30,22.16),P=0.0004];在住院时间、术中出血量、总的并发症方面两者无明显差异,结果分别为[MD=0.88,95％CI (-0.69,2.44),P=0.27]、[MD=-19.87,95％CI (-64.36,24.61),P=0.38]、[OR=1.28,95％CI (0.90,1.84),P=0.17].结论:清石率方面MPCNL组低于SPCNL组,并且MPCNL的手术时间较长,可能会影响患者的术后恢复,在并发症、住院时间、术中出血量方面两组无明显差异.故在治疗普通型肾结石方面还是倾向于标准通道经皮肾镜取石术.

患者男，29岁，因车祸致胸腹部联合损伤，腹壁破裂，部分肠管外露，无意识，后就诊于当地医院，考虑腹部开放性损伤、左侧胸腔积液，急诊行剖腹探查术，术中发现膈肌撕裂、部分小肠坏死、部分降结肠坏死，行膈疝修补术＋肠部分切除术＋结肠造瘘术＋左侧胸腔闭式引流术，术中输浓缩红细胞及血浆，因病情危重，术后3d 转入我院进一步治疗。平素体健，无食物、药物过敏史，无肝炎、结核等传染病病史。入院查体：结肠造瘘口排便通畅，全身多处瘀斑、瘀点，多处皮肤软组织擦伤，左腰背部皮下血肿，可及肿块，伴有波动感。入院查泌尿系CT （图1）：考虑有左肾挫伤。入院后给予监测生命体征、抗感染、保肝、补液、纠正电解质紊乱及酸碱失衡等对症支持治疗；因左腰背部皮下血肿积液行切开引流，持续有脓液渗出，并坏死组织脱出（图2），给予定期换药期间腹部伤口不愈合，遂行清创缝合术。入院2个月后病情平稳复查 CT （图3）示左肾缺如，肾窝局部有渗出。建议行肾动态显像检查，患者及家属不同意行该检查。同时，本例患者左腰背部瘘口间断仍有脓液渗出，不愈合，行造影检查（图4）考虑与后腹腔行通，建议行探查或清创术，患者及家属暂不同意。目前患者病情平稳，肾功能正常，已办理出院。

目的:探讨腹腔镜膀胱部分切除术(LPC)治疗膀胱疾病的安全性和有效性.方法:回顾分析11例膀胱疾病患者(2例避孕环膀胱结石,2例膀胱憩室,7例膀胱肿瘤)行腹腔镜膀胱部分切除术(其中2例脐尿管癌行腹腔镜扩大膀胱部分切除术),并记录手术时间、出血量、围手术期并发症等指标.术后定期行膀胱镜检查并随访.结果:11例均手术成功,平均手术时间95 min(65～120 min),术中出血量52 ml(40～100 ml),术后住院时间7.5 d(6～11 d).标本采用标本袋自切口取出,标本均完整.腹腔引流管2～3 d拔除,术后8～10 d拔出尿管.术后随访8～30个月,平均18个月.术后结果,2例避孕环膀胱结石,2例膀胱憩室;术后病理:1例膀胱炎性肌纤维母细胞瘤,2例膀胱憩室,2例脐尿管癌,4例尿路上皮癌,2例为膀胱结石.1例脐尿管癌于术后16个月出现肿瘤局部复发及远处转移,保守治疗.无穿刺通道及腹腔种植转移.结论:腹腔镜膀胱部分切除术,腹腔镜膀胱部分切除术具有微创、失血少、恢复快、住院时间短、术后痛苦少、术野美观等优势,可作为治疗子宫穿人膀胱异物、膀胱憩室和膀胱良性肿瘤及经过筛选的膀胱恶性肿瘤一种安全、有效的手术方法.

Objective To investigate the clinical and pathological features,diagnosis,differential diagnosis,treatment and prognosis of secondary Hodgkin's lymphoma of ureter.Methods We retrospectively analyzed one case with retroperitoneal Hodgkin's lymphoma involving right ureter.A 63-year-old male patient was referred to our hospital on January 22th,2013 with right hydronephrosis for 15 days,detected by abdominal color Doppler ultrasound due to constipation and difficult defecation without any urinary symptoms.Urinary CT scan revealed that there were dilation and hydrops of right pelvic and ureter in the middle and upper segment.The distal portion of ureteral wall was thick with a stenosis lumen.There was multiple larged lymph nodes surrounding the abdominal aorta.So,it was clinically diagnosed as right ureteral carcinoma with lymphadenopathy and right hydronephrosis.The patient was then performed ureteroscopic inspection under general anesthesia.There was too narrow to go through smoothly the proximal ureter when the ureteroscope ascended 15 cm.Then,the exploratory surgery of right ureter was subsequently undergone.During operation,periureteral nodular mass and thickened wall were seen in the distal segment of ureter.Then the ureter lesion was partially excised with 1 cm and fast frozen pathology was undergone during operation.The result suggested chronic inflammation of ureteral.A 6Fr double J stent was left in the ureter.Then,the ureter was closed by 3-0 monocryl suture.Results The final pathological diagnosis was retroperitoneal Hodgkin's lymphoma with the lymph node involving the right ureter.After 40 days,the patient manifested high fever,night sweat,general lymphoadenomegalies.So,the clinical stage was classified as stage Ⅱ EB and poor prognosis group.Then,the patient received regular chemotherapy according to the ABVD (pirarubicin 20 mg/m2,bleomycin 10 mg/m2,vinblastine 1.4 mg/m2,dacarbazine 375 mg/m2) regimen over 8 cycles.Finally the symptomatology and diagnostic reassessment (hemato-chemical examinations and PET/CT) showed a clinical complete recovery after the follow-up period of 3 months.The follow-up plan is ongoing.Conclusions Because secondary Hodgkin's lymphoma of ureter is rare with concealed onset feature,lacking of characteristic clinical manifestations,it is relatively difficult to achieve the diagnosis and differential diagnosis.Therefore,pathology and immunohistochemistry should be assigned to confirm the diagnosis.It is stressed that physicians should be aware of the possibility of malignant lymphoma when unexplained hydronephrosis and thickness of the ureteral wall are found clinically.Generally it has a good prognosis and combination therapy for the treatment is given priority to with chemotherapy.

Over the past three decades,the progression and growing clinical application of cross-sectional imaging lead to the increasing number of incidentally discovered renal masses and an increased incidence of asymptomatic organ-confined small renal masses(SRMs).Traditionally,radical nephrectomy(RN)has been the gold standard for the treatment of clinically localised renal cell carcinoma(RCC)patients.However,with an increase in the detection of early stage RCC and development of new technologies and ideas,current treatment of RCC should be reassessed.

肉瘤样肾细胞癌(sarcomatoid renal cell carcinoma,SRCC)是肾癌的一种特殊类型,目前被广泛认为是肾细胞癌向高度恶性分期转化的一种组织病理学上的改变.组织结构酷似软组织肉瘤,易误诊为肾肉瘤或癌肉瘤,临床少见.山西医科大学第一医院于2011年10月收治1例,现报道如下.