Objective To anaLyse the efficacy and side‐effect of sunitinib in the treatment of advanced renaL carcinoma in a singLe center . Methods A retrospective anaLysis was made for meta‐static renaL ceLL carcinoma (mRCC) patients treated with sunitinib from Sep .2012 to Jan .2016 in Af‐fiLiated HospitaL of Qingdao University .T wenty‐eight patients received sunitinib 50 mg Qd ,4／2 weeks scheduLe primariLy ,2 patients received 50 mg Qd ,2／1 weeks scheduLe and 1 patient received 37?5 mg Qd . ResuLts T wenty‐six maLe and 5 femaLe patients were anaLyzed .Four cases were CR (12?9%) ,2 cases were PR(6?5%) ,15 cases were SD (48?4%) and 10 cases were PD (32?3%). Disease controL rate was 67?7% .T he main side‐effect incLuded hand‐foot syndrome (90?3%) ,fa‐tigue (87?1%) ,hypogeusia(77?4%) ,etc.Side‐effect of 1‐2 grade was found in 80?6% patients . ConcLusions As the first‐Line therapy for patients with mRCC ,sunitinib can gain high disease con‐troL rate and sLight‐to‐miLd side‐effect ,w hich is safe and weLL toLerated .

Objective To investigate the clinical effect of retroperitoneal laparoscopic partial nephrectomy with selective renal artery branch clamping in the treatment of renal tumor patients with a RENAL score of ≥7.Methods A total of 63 renal tumor patients with a RENAL score of ≥7 who were hospitalized in The Affiliated Hospital of Qingdao University and Jiaozhou Central Hospital from June 2013 to December 2015 were enrolled and treated with selective renal artery branch clamping or standard partial nephrectomy.The two groups were compared in terms of time of operation,warm ischemia time,rate of positive resection margin,blood transfusion rate,intraoperative blood loss,postoperative complications,and length of hospital stay,as well as renal function at different time points.Results The standard partial nephrectomy group had a significantly shorter time of operation than the selective renal artery branch clamping group (t =4.859,P＜0.05).There were no significant differences between the two groups in warm ischemia time,rate of positive resection margin,blood transfusion rate,intraoperative blood loss,incidence rates of postoperative complications,and length of hospital stay (P＞0.05).At one month after surgery,the selective renal artery branch clamping group had a significantly greater reduction in estimated glomerular filtration rate (eGFR) compared with the standard partial nephrectomy group (t =2.687,P ＜0.05);at 12 months after surgery,there was no significant difference in eGFR between the two groups (P＞0.05).Conclusion In renal tumor patients with a RENAL score of ≥7,retroperitoneal laparoscopic partial nephrectomy with selective renal artery branch clamping can protect their renal function in the early stage after surgery and does not increase intraoperative blood loss and postoperative complications.It is a safe and effective surgical method and thus holds promise for clinical application.

Objective:To compare the difference between renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusions (Xp11.2 RCC) and clear cell renal cell carcinoma (CCRCC) in terms of clinical characters,imaging features and pathological traits.Method:From January 2010 to December 2015,411 patients who were operated in Affiliated Hospital of Qingdao University were identified with renal carcinoma including 12 cases diagnosed as Xp11.2 RCC and 302 cases diagnosed as CCRCC.Clinical traits,imaging features and pathology characters were compared between the two groups.Result:Xp11.2 RCC often occurred in young patients [average age:Xp11.2 RCC (33.1±18.4);CCRCC (63.1±11.2) years old] whose clinical presentations were gross hematuria (58.3％) and examinations (16.7％) and below 45 years old (83.3％) whereas CCRCC often occurred in men patients (66.6％) whose clinical presentations were examination (55.9％) and gross hematuria (19.5％).CT of unenhanced scanning showed the lesions were slightly high density,and punctate calcifcations and heterogeneous changes can be easily seen in part of the Xp11.2 RCC.Enhanced scanning showed the CT number of the arterial,venous and balance phases were (83.4±40.1) HU,(95.8±39.1) HU and (80.4±30.1) HU.On the aspect of CCRCC,unenhanced scanning showed equal or mixed density,but calcifcation was rare.Enhanced scanning showed the CT number of the arterial,venous and balance phases were (133.4±37.1) HU,(102.8±19.1)HU and (87.4±29.1)HU.MRI scanning showed T1WI of the Xp11.2 RCC was mediate signal,and T2WI low signal.T1WI of CCRCC was mediate or high signal,and T2WI was uneven signal.Enhanced scanning showed progressive delayed enhancement in all patients.Immunohistochemical exam illustrated that all Xp11.2 RCC were positive for TFE3,and it was confirmed by FISH.However,no TFE3 was positive in CCRCC.Four patients (33.3％) were diagnosed as distant metastasis after 12 to 72 months (59.7± 10.6) of follow-up period among Xp11.2 RCC.Twenty-three patients (7.6％) were diagnosed as distant metastasis among the CCRCC.Conclusion:Young women patients with hematuria usually occur in Xp11.2 RCC,and dynamic CT scanning shows low into-slow out strengthening.Elderly men with examination usually occur in CCRCC,and dynamic CT scanning shows fast into-fast out strengthening.Differential diagnosis depends on FISH rather than MRI.

Objective To investigate the effect of targeted inhibition of microRNA-106b (miR-106b) on the proliferation,invasion,and apoptosis of in vitro bladder cancer cells.Methods Cell transfection was used to construct the colonies of bladder cancer cells with targeted inhibition of miR-106b,and quantitative real time PCR was used to detect the silence of miR-106b.The bladder cancer cells were divided into blank control group (group A),negative control group (group B),and miR-106b small-molecule inhibitor transfection group (group C).Cell proliferation assay and colony-forming assay were used to measure the effect of targeted inhibition of miR-106b on the growth of bladder cancer T24 cell,Annexin V/PI was used to measure the effect on the apoptosis of T24 cells,and cell migration assay and invasion assay were used to measure the effect on the invasion of in vitro T24 cells.Results There were significant differences in miR-106b expression,survival rate of cells,number of cell colonies formed,cell apoptosis rate,and number of cells across membrane between group C and groups A/B (F=37.24-87.89,q=9.5716.53,P＜0.05).Conclusion Targeted inhibition of miR-106b can inhibit the proliferation,invasion,and apoptosis of bladder cancer cells in vitro,and miR 106b is the target gene for the treatment of bladder cancer.

目的:研究新型光敏剂叶绿酸e6对人膀胱癌5637细胞的杀伤作用,并对其作用机制进行探讨.方法:将5637细胞培养至对数生长期,加入光敏剂叶绿酸e6共同孵育,以650 nm激发光照射,MTT法检测叶绿酸e6对5637细胞的杀伤作用,流式细胞术检测细胞凋亡情况.结果:在能量密度为1 J/ema2条件下,在2.5、5、10μg/ml浓度时叶绿酸e6对5637细胞的生长抑制率分别为15.92％、43.18％和67.00％,在能量密度为4 J/cm2条件下,叶绿酸e6在2.5、5、10 μg/ml浓度时对5637细胞的生长抑制率分别为36.78％、72.23％和75.32％;流式细胞仪结果显示5637细胞经光动力作用后,凋亡率为(42.67±1.2)％,与对照组有显著差异.结论:新型光敏剂叶绿酸e6对人膀胱癌5637细胞有明确的杀伤作用,诱导细胞凋亡是可能机制之一.

目的 了解来氟米特对体外培养的大鼠树突状细胞(DC)成熟过程的影响,探讨来氟米特处理后的DC延长移植存活及其诱导对供者特异性免疫耐受的机制.方法 将体外培养的大鼠DC分为对照组、来氟米特处理组、脂多糖(LPS)刺激组、LPS+来氟米特联合处理组(联合组),用流式细胞仪对各组细胞进行免疫表型分析,采用ELISA方法检测白细胞介素-12(IL-12)的分泌,并作混合淋巴细胞培养以观察其对同种T细胞的刺激能力.结果 培养15d,对照组和来氟米特处理组DC细胞簇少且小、细胞体积小;LPS刺激组DC细胞簇多且大,细胞体饱满;联合组DC细胞簇较对照组和来氟米特处理组多,细胞体积更大.LPS刺激组DC表面CD80、CD86表达阳性率高于对照组、来氟米特处理组和联合组,联合组DC表面CD80、CD86表达阳性率高于对照组、来氟米特处理组,差异有显著意义(F=197.5、160.1,q=4.391～31.360,P＜0.05).来氟米特处理组IL-12表达低于对照组,LPS刺激组、联合组IL-12表达高于对照组及来氟米特处理组,联合组IL-12表达低于LPS刺激组,差异有统计学意义(F=412.2,q=3.411～41.250,P＜0.01).LPS刺激组刺激指数值高于来氟米特处理组、对照组和联合组,联合组高于来氟米特处理组,对照组高于来氟米特处理组,差异有显著意义(F=36.2,q=4.793～9.675,P＜0.05).结论 来氟米特通过抑制DC的成熟过程,延长同种移植物存活时间,调控对供者抗原特异性免疫耐受.

目的:探讨体质指数(body mass index,BMI)对后腹腔镜下肾部分切除术的手术操作及术后恢复情况的影响.方法:回顾性分析2012年1月～2014年7月于我院行后腹腔镜下肾部分切除术患者的临床资料,按BMI分为两组:非肥胖组(BMl＜25 kg/m2)43例,超重组(BMI≥25 kg/m2)57例,分别比较两组手术时间、术中出血量、术中肾脏缺血时间、手术前后血红蛋白差值、术后住院天数、留置引流管时间、引流量,并发症发生等情况.结果:100例行后腹腔镜下肾部分切除术患者中,超重组肿瘤直径1.0～6 cm,非肥胖组肿瘤直径0.5～4 cm,两组患者术后引流量、引流管留置天数、术后住院天数及术后并发症发生率差异无统计学意义(P＞0.05);两组手术时间分别为(151.7±48.8)min和(131.3±32.2)min,肾脏热缺血时间分别为(23.5±4.8)min和(21.3±4.7)min,术中出血量分别为(87.9±134.1)ml和(51.6±55.3)ml,手术前后血红蛋白差值分别为(17.8±16.5)g/L和(12.8±9.6)g/L,超重组指标均高于非肥胖组,差异均有统计学意义(P＜0.05).结论:对于行后腹腔镜下肾部分切除术的患者,BM1的增加将增加手术时间、术中出血量及术中肾脏热缺血时间,而对于术后的恢复及并发症的发生情况并无明显影响.

Objective To explore the implementation of the ability oriented clinical skill training model for post-graduates majoring in urological surgery.Methods Thirty post-graduates majoring in urological surgery of Grade 2009 and 2010 were randomly divided into two groups,with 15 post-graduates in each group.One group of post-graduates was given traditional training model,while the other group was given the ability oriented clinical skill training model.Objective structured clinical examination(OSCE) was used to evaluate their clinical skills before they graduated.Results Compared with traditional training model,the scores of post-graduates who received the ability oriented clinical skill training model were significantly higher in evaluation of medical record,preoperative preparation,operative procedure and postoperative dealing,and clinical thinking.Conclusions The ability oriented clinical skill training model is a good method for post-graduates majoring in urological surgery to improve their clinical skills.

Objectives To compare the outcomes of 2 techniques of varicocelectomy in patients with varicocele.Methods The study included 80 patients with varicocele,and patients were randomly divided into two groups,low-approach microscopic group (L-MV group,40 cases) and laperoscopic varicocectomy group (LV group,40 cases).two groups of patients are compared with preoperative and postoperative 1,3 and 6 months of semen quality changes with operation time;Operation cost;Intraoperative blood loss and postoperative complications (hydrocele and recurrent varicocele) and pregnant rate and so on,all patients were followed for an average of 11 months(range 6 to 18 months).Results L-MV and LV group postoperative sperm density,sperm counts and sperm motility than preoperative have improved significantly(P ＜0.05),but the postoperative 1,3,6 months of semen quality parameters is no statistical difference(P ＞ 0.05),L-MV group operating time whether unilateral or bilateral group were longer than the LV unilateral or bilateral needed operation time (P ＜ 0.05);L-MV operation costs less than LV group(P ＜ 0.05);Intraoperative blood loss between the two groups have no significant difference (P ＞ 0.05);Postoperative complications,follow-up for half a year,incidence of hydrocele L-MV set to 0,15％ incidence of LV gnup,differences between the two groups was statistically significant(P ＜0.05);Postoperative recurrence of VC,L-MV set to 0,10％ incidence of LV group,between the difference was statistically significant (P ＜ 0.05);Postoperative the pregnancy rate at 1 year L-MV group was 34.28％,the LV group was 21.9％,Postoperative pain symptoms were improved in both groups,and occasional scrotal mild postoperative pain were recorded in about 10 days.Conclusions The above two kinds of operation in the treatment of varicocele,low-approach microscopic is better efficacy than laparoscopic varicocelectomy,which is a kind of more economic,effective treatment,where the equipment and ability,should give the promotion,as the preferred treatment.

>患者,男,58岁。2009年3月12日因尿频、尿急1年余入院。夜尿8～10次,无腰痛、肉眼血尿,无午后低热、盗汗;否认结核病史。查体无阳性体征。尿找抗酸杆菌连续3次阳性。红细胞沉降率64 mm/1 h。尿常规示白细胞(+++),红细胞(+),蛋白(+)。B超检查:右肾上极高回声结节1.9 cm×1.5cm,考虑血管平滑肌脂肪瘤;右肾下极等回声结节2.5 cm×2.7 cm,考虑肾癌;左侧上尿路轻度积水,左输尿管全程扩张,左输尿管末端狭窄,原因不明。CT检查:左肾上极肾窦区、左肾盂及左输尿管慢性炎症改变并左肾、输尿

目的 探讨肾脏原发类癌的临床和病理特点.方法 回顾分析1例肾脏原发类癌的临床和病理资料.结果 该例肾脏原发类癌为体检时发现,无自觉症状.肿瘤大小为2.5 cm×2.5 cm,切面黄褐色,部分呈囊性,侵达局部被膜.免疫组化:突触素(Syn)(+),神经元特异性烯醇化酶(NSE)(+),嗜铬颗粒蛋白A(CgA)(-),细胞角蛋白(CK)(+/-),Ki-67＜67%.结论 肾脏原发类癌罕见,影像学多无特征表现,外科手术为目前唯一可行的治疗方法.

目的:通过比较血清中早期前列腺癌抗原-2(EPCA-2)与前列腺特异性抗原(PSA)在前列腺癌(PCa)诊断中的特异性与敏感性,研究血清中EPCA-2对诊断PCa的临床意义.方法:收集非前列腺疾病患者20例(作为A组),BPH患者56例(作为B组),PCa患者44例(作为C组),采用酶联免疫吸附实验(ELISA)分别检测三组患者血清中EPCA-2和PSA水平,进行统计学分析.结果:①C组患者血清中EPCA-2和PSA水平分别与A组和B组患者的进行比较,均显著增高,差异有统计学意义(P＜0.01).②A组血清中EPCA-2水平均≤分界点(30 μg/L).③以30 μg/L为分界点,EPCA-2对PCa诊断的特异性为92.1％,敏感性为93.2％;以4μg/L为分界点,PSA对PCa诊断的特异性为55.3％,敏感性为79.5％;PSA结合fPSA/tPSA(以0.15为分界点),对PCa诊断的特异性为78.9％,敏感性为68.2％.结论:EPCA-2作为新的诊断PCa的肿瘤标志物,较PSA具有更高的特异性和敏感性,对临床PCa的诊断具有重要意义.

患者女，72岁，因“发现左肾占位6 d”入院，既往有高血压、慢性阑尾炎病史。查体：T 35.5℃，BP 170／100 mm Hg，心肺未闻及异常，右下腹轻压痛，无反跳痛，双肾区无异常隆起及叩压痛。泌尿系彩超示左肾上极见一4.1 cm ×4.2 cm ×4.0 cm不均质回声团，内未见明显血流信号，提示左肾实性占位；下腹部平扫CT示左肾外可见最大截面约为46.9 mm ×37.3 mm稍高密度影，参考CT值约54 HU，部分与肾实质相连，边缘较清（图1）；下腹部动态增强CT 示左肾后外侧见最大截面约46.9 mm ×37.3 mm的稍高密度影，病变小部分与肾实质关系密切，左肾后缘整体呈受压改变，病变边缘较清，密度欠均匀，增强后病变内强化不明显，考虑左肾后外侧占位，肾脏来源肿瘤可能性大（图2）。

>肾脏原发性恶性纤维组织细胞瘤(malignant fibrous histiocytoma,MFH)临床罕见,患者生存期短,死亡率高。2008年至2010年我院收治2例,现报告如下。例1,女,55岁。因右侧腰痛2年,血尿3 d于2008年11月入院。查体及实验室检查未见异常。B超检查:右肾上极6 cm×5 cm低回声团块,边缘不规则。增强CT检查示右肾上极较大混杂密度肿块影,不均匀强化,边界欠清,腹

目的:探讨成人节细胞神经母细胞瘤的临床和病理特点.方法:回顾分析2例成人节细胞神经母细胞瘤的临床资料和病理资料.结果:2例均为体检时发现,无自觉症状,实验室检均无异常.肿瘤大小分别为7cm×5 cm和5 cm×4 cm,包膜完整,均与周围组织有粘连,切面星鱼肉状,免疫组化NSE,Syn,CgA.S100及vimentin均为(+).1例术后随访17个月死亡,1例随访6个月无转移.结论:成人节细胞神经母细胞瘤临床少见,多为体检时发现.治疗最有效的方法是手术切除,可辅以放、化疗.

Objective:To investigate the inhibitory effects of octreotide (somatostatin analogs) on androgen independent prostate cancer PC-3 cell line and the expression of vascular endothelial growth factor( VEGF). Methods: After PC-3 cells were induced by 0. 1、0. 3、1. 0、3. 0 mg/L octreotide respectively, the cell acitvity was assayed by MTT at 24,48 and 72 hours, the morphology of apoptosis was observed by Hoechst 33258 staining under fluorescence microscope. The level of caspase-3 and VEGF were detected by reverse transcription-polymerase chain reaction (RT-PCR). Results:Octreotide could suppress the growth and promote the apoptosis of PC-3 cells in dosedependent and time-dependent manners, and the morphology of apoptosis could be examined in the study. When cells were treated with different concentrations of octreotide (0. 1,0. 3,1.0 and 3. 0 mg/L). the cell surviving rate was (0.971±0. 016 ) %、( 0. 853±0. 015 ) %、( 0. 717±0. 031 ) %、( 0. 743±0.029)% respectively at 24hours,(0.918±0. 015)%、(0. 835±0. 015)%、(0. 682±0. 018)%、(0. 727±0.014)% respectively at 48 hours and (0.922±0. 017) %、(0. 841±0. 013) %、(0. 717±0. 017) %、(0. 739±0.003)% respectively at 72 hours, the difference was obviously significant among them. The expression of Caspase-3 was upregulated while VEGF downregulated. Conclusions:Octreotide can suppress the growth and promote the apoptosis of PC-3 cells, and VEGF may involve in it.

Objective To investigate the expression of Ki-67 and vascular endothelial growth factor(VEGF) in renal cell carcinoma(RCC),and to reveal their roles in RCC occurrence and development.Methods The mRNA of Ki-67 and VEGF were detected using reverse transcription-polymerase chain reaction(RT-PCR) in 55 RCC tissues and 20 normal renal tissues.Results The expression of Ki-67 mRNA was markedly higher in RCC tissues than in normal renal tissues(χ2=28.010,P<0.05).Similarly,the expression of VEGF mRNA in RCC tissues was markedly higher,too(χ2=15.539,P<0.05).Both Ki-67 and VEGF were associated with the parameters of clinical pathology.Conclusion Ki-67 and VEGF are highly expressed in RCC with a positive correlation.They may play an important role in the development of RCC.