BackgroundThis study aims to describe a novel laparoscopic aspirator bracket (LAB) and its use in laparoscopic nephron-sparing surgery (NSS) by a simple enucleation (SE) technique.MethodsA total of 123 renal tumor cases who underwent laparoscopic NSS via LAB or laparoscopic aspirator between July 2017 and April 2021 were retrospectively analyzed. General characteristics, perioperative data and postoperative follow-up data of patients were compared.ResultsThe application of LAB in laparoscopic renal tumor SE surgery shortened the operation time (88.58 ± 38.25 vs. 102.25 ± 35.84 min, p < 0.05) and improved the zero ischemia rate (18.75% vs. 3.39%, p < 0.05), shortened warm ischemia time (16.17 ± 5.16 vs. 19.39 ± 5.62 min, p < 0.05) and decreased intraoperative blood loss (166.19 ± 111.60 vs. 209.15 ± 127.10 ml, p < 0.05). In addition, the serum creatinine and eGFR values in the LAB group also showed faster and better renal function recovery.ConclusionThe new LAB could aspirate and expose the operative field with a single instrument. In operations that need to expose and aspirate simultaneously, such as in renal tumor simple enucleation, it could shorten operation time, reduce intraoperative blood loss and improve the postoperative renal function recovery.

BackgroundSome articles suggest that using HbA1c alone for diabetes diagnosis is inappropriate. It requires considerable researches to explore the efficacy of HbA1c for diagnosing hyperglycemia in patients with pancreatic disease. MethodsThis study analyzed 732 patients, comprising of 331 without pancreatic disease and 401 patients diagnosed with pancreatic diseases. All participants underwent the HbA1c assay and oral glucose tolerance test. Kappa coefficients were calculated to assess agreement between the HbA1c and glucose criteria. The receiver operating characteristic curve (ROC) was used to calculate the optimal HbA1c value. DeLong test was analyzed to compared the aera under curves (AUCs). ResultsThere were 203 (61.3%) patients with NGT, 78 (23.6%) with prediabetes, and 50 (15.1%) with diabetes in patients without pancreatic diseases. In patients with pancreatic disease, 106 participants were diagnosed with NGT (36.4%), 125 with prediabetes (31.2%), and 130 with diabetes (32.4%). Patients with pancreatic disease exhibited elevated levels of bilirubin, transaminase enzymes, aspartate transaminase, high density lipoprotein cholesterol and total bile acid. The sensitivity and specificity of the HbA1c (6.5%) for diagnosing pancreatic diabetes were 60.8% (95% CI 52.3, 69.3) and 92.6% (95% CI 89.5, 95.7). In prediabetes, the sensitivity and specificity of HbA1c (5.7%) is 53.2% (44.3, 62.0) and 59.6 (51.5, 67.6). The optimal HbA1c value for diagnosing diabetes was 6.0% (AUC = 0.876, 95% CI 0.839, 0.906), with the sensitivity of 83.8% and the specificity of 76.8%. The optimal HbA1c value for the diagnosis of prediabetes was 5.8% (AUC = 0.617, 95% CI: 0.556, 0.675), with the corresponding sensitivity and specificity of 48.0% and 72.6% respectively. The combined tests (HbA1c, 6.0% or FPG, 7.0mmol/L) presented the sensitivity of 85.7% (95% CI 79.1, 91.3)and the specificity of 92.6% (95% CI 87.6, 97.3) in pancreatic diabetes. ConclusionFrom our results, the recommended HbA1c by ADA criterion may not be sufficiently sensitive to diagnose hyperglycemia in pancreatic disease. The optimal value of 5.8% and 6.0% improved the accuracy for diagnosing prediabetes and diabetes and should be considered to be applied. Besides, we advocate the combination of HbA1c and FPG test for the diagnosis of diabetes in patients with pancreatic diseases.

Abstract Background Laparoscopic nephron-sparing surgery (NSS) is the standard of care for small renal masses whenever feasible. This study aims to describe a novel laparoscopic aspirator bracket (LAB) and its use in laparoscopic NSS by a simple enucleation technique. Methods Between July 2017 and July 2019, we performed 54 laparoscopic NSS due to renal tumour using an SE technique by either LAB (n = 26) or laparoscopic aspirator (LA, n = 28) in 3 independent medical centres by 6 experienced surgeons. The novel aspirator could aspirate liquid and expose the operative field simultaneously. The details of operative technique are provided in the accompanying video. General characteristics and perioperative data of all patients were collected and retrospectively. Patients were followed up for 12 months after laparoscopic renal tumor simple enucleation (SE) operation. Renal function outcomes and perioperative complications were assessed. Results All 54 patients were successfully operated without conversion to open surgery. The use of the LAB in laparoscopic renal tumor SE operation can shorten the warm ischemia time ([WIT], LAB 12.92 ± 8.38 min vs. LA 17.89 ± 6.73 min) and increase the zero ischemia (ZI) rate (LAB 23.08% vs. LA 3.57%). In the one-year follow-up, the LAB group showed quicker renal function recovery (ipsilateral renal function 3 months after the surgery, LAB 41.67 ± 10.11% vs. LA 36.75 ± 10.30%). The limitations of this study were limited number of patients and retrospective attribute. Conclusion The new LAB could aspirate and expose the operative field with a single instrument. In operations that need to expose and aspirate simultaneously, such as in renal tumor simple enucleation, it could shorten WIT and improve the postoperative renal function recovery.

This study aimed to establish nomograms to preoperatively predict the possibility of testicular salvage (TS) in patients with testicular torsion. The clinical data of 204 patients with testicular torsion diagnosed at Xijing Hospital and Tangdu Hospital (Xi'an, China) between August 2008 and November 2019 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to determine the independent predictors of TS. Based on multivariate regression coefficients, nomograms to predict possibility of TS were established. The predictive ability of the nomograms was internally validated by receiver operating characteristic (ROC) curves and calibration plots. The duration of symptoms ranged from 2 h to 1 month, with a median of 3.5 days. Thirty (14.7%) patients underwent surgical reduction and contralateral orchiopexy, while the remaining 174 (85.3%) underwent orchiectomy and contralateral orchiopexy. Finally, long symptom duration was an independent risk predictor for TS, while visible intratesticular blood flow and homogeneous testicular echotexture under color Doppler ultrasound were independent protective predictors. Internal validation showed that the nomograms, which were established by integrating these three predictive factors, had good discrimination ability in predicting the possibility of TS (areas under the ROC curves were 0.851 and 0.828, respectively). The calibration plots showed good agreement between the nomogram-predicted possibility of TS and the actual situation. In conclusion, this brief preoperative prediction tool will help clinicians to quickly determine the urgency of surgical exploration.

Objective: To investigate the long-term effect of triple organ transplantation (liver, kidney, and pancreas) in a patient with end-stage liver disease, post chronic hepatitis B, cirrhosis, chronic renal failure, and insulin-dependent diabetes mellitus caused by chronic pancreatitis and to explore the optimal surgical procedure. Case: A 43-year-old man with progressive emaciation and hypourocrinia for 2 months. Results indicated exocrine pancreatic insufficiency and insulin-dependent diabetes related to chronic pancreatitis (CP) after developing end-stage hepatic and renal failure. Simultaneous piggyback orthotopic liver and heterotopic pancreas-duodenum and renal transplantation was performed in 2005. Pancreatic exocrine secretions were drained enterically to the jejunum, and the donor kidney was placed in the left iliac fossa. Patient was prescribed with prednisone, tacrolimus, mycophenolate mofetil, Rabbit Anti-human Thymocyte Immunoglobulin, and simulect for immunosuppression. Results: Satisfactory hepatic and pancreatic functional recovery was achieved within 7 days post-surgery. The kidney was not functional, and continuous renal replacement therapy was used. However, the donor kidney was removed at day 16 post-surgery due to acute rejection reaction. A new renal transplantation at the same position was performed, and satisfactory kidney function from the new graft was achieved 3 days later. In 14 years of follow-up, patient has not had any rejection reactions or other complications such as pancreatitis, thrombosis, and localized infections. The patient is insulin independent with normal liver and renal functions. FK506+Pred was used for immunosuppression, and the tac tough level maintained 3.0-4.5 ng/ml. Lamivudine was prescribed for long-term use to inhibit HBV virus duplication. Conclusion: Simultaneous piggyback orthotopic liver and heterotopic pancreas-duodenum and renal transplantation is a good therapeutic option for patients with exocrine pancreatic insufficiency and insulin-dependent diabetes combined with hepatic and renal failure.

To identify clinical characteristics and mutation spectra in Chinese patients with renal angiomyolipoma (AML) associated with the tuberous sclerosis complex (TSC, TSC-AML), examined the efficacy and safety of short-term everolimus therapy (12 weeks). We analyzed the frequency distribution of each TSC-related clinical feature and investigated gene mutations by genetic testing. Some subjects received everolimus for 12 weeks at a dose of 10 mg/day, and the efficacy and safety of short-term everolimus therapy were examined. Finally, 82 TSC-AML patients were enrolled for analysis in this study. Of the 47 patients who underwent genetic testing, 22 patients (46.81%) had at least one detectable mutation in the TSC1 or TSC2 gene: 7 were TSC1 gene mutations, 13 were TSC2 gene mutations, and 2 were found in both TSC1 and TSC2 . Everolimus treatment had a statistically significant effect on the renal AML volume reduction during follow-up ( P < 0.05), and the mean reduction rate of volume for all cases was 56.47 ± 23.32% over 12 weeks. However, 7 patients (7/25; 28.00%) experienced an increase in renal AML tumor volume within 12 weeks after discontinuation of the everolimus treatment. Although most patients (27/30, 90.00%) experienced some adverse events during the treatment period, all such events were mild, and no patients discontinued or needed dose reduction because of adverse events. Overall, in this study, the mutation rate of TSC-AML patients is much lower than other reports. Short-term everolimus treatment for TSC-AML is effective and safe, but the stability is much lower than long-term therapy.

To evaluate the antitumor effect of sinoporphyrin sodium mediated photodynamic therapy (DVDMS-PDT) against human colorectal cancer (CRC) and to investigate the role of autophagy in its effect. Shrunken cells, condensed nuclei and increased levels of cleaved caspase-3 and Bax were observed in DVDMS-PDT treated HCT116 cells, reminiscent of apoptosis. DVDMS-PDT showed better antitumor efficiency in HCT116 cells than Photofrin mediated photodynamic therapy (PF-PDT) both in vitro and in vivo. And DVDMS-PDT caused autophagic characteristics: double membrane autophagosome structures and changes in autophagy-related protein expression (ATG7, P62, Bcl-2 and LC3-Ⅱ). In addition, inhibition of autophagy by chloroquine (CQ) promoted apoptosis, suggesting a possible protective role of autophagy in DVDMS-PDT-treated HCT116 cells, which was proved by flow cytometry and western blotting. The results of xenograft mouse model showed markedly increased apoptosis and significantly reduced tumor size in DVDMS-PDT treated group than Control, and DVDMS-PDT exhibited better antitumor efficiency than PF-PDT. Further, no visible tumor was observed in the CQ+DVDMS-PDT group at the end of the xenograft mouse experiment, which confirmed the hypothesis that autophagy was protective to DVDMS-PDT treated HCT116 cells. Our findings suggest that DVDMS is a promising photosensitizer and the combined use of autophagy inhibitor can remarkably enhance the DVDMS-PDT mediated anti-cancer efficiency in HCT116 cells both in vitro and in vivo.

Objective To discuss the optimal operation mode and operation path in minimally invasive technique for living donor nephrectomy.Methods From September 2013 to August 2015, 68 living donor nephrectomy was retrospectively reviewed. Thirty-one patients were performed with robotic-assisted laparoscopic living donor nephrectomy(robotic group), twenty-nine patients underwent totally retroperitoneal laparoscopic living donor nephrectomy(non hand assisted group),and eight patients were performed with hand assisted retroperitoneal laparoscopic living donor nephrectomy(hand assisted group). Operation time, warm ischemia time, intraoperative hemorrhage volume, hospitalization time, complications and preoperative and postoperative serum creatinine value of the recipients between the two groups were compared.Results The operations of three groups were all performed successfully. Intraoperative hemorrhage volume in the three groups were(39±15)ml,(62±37)ml and(53±19)ml, and there were significant differences between these groups(P<0.05). But hospitalization time ,operation time, warm ischemia time and complications occurred rate in the three groups had no significant difference(P>0.05). In robotic group,2 donors occurred with splenic injury during operation and 1 donor was detected with hemorrhage after operation. In non-hand assisted group, 1 donor occurred with urinary tract infection, 1 donor occurred with external iliac vein thrombosis. In hand assisted group 1 donor was detected with wound fat liquefaction after operation. All the donors were followed up for more than 9 months, no hypertension, proteinuria and renal dysfunction complications were detected. The blood creatinine in three groups of recipients after operation of 5th day and 28th day were(118±26)μmol/L, (130±33)μmol/L,(128±41)μmol/L and(114±17)μmol/L,(116±34)μmol/L,(115±29)μmol/L, respectively, and there was no statistical difference(P>0.05).Conclusions Minimally invasive technique for living donor nephrectomy is beneficial to patients' recovery. Surgery doctors should combine personal experience and the hospital's hardware conditions and other factors. The principle is to ensure the donor's safety and to balance the interests of the donor and the recipient, to choose their own most skilled way of surgery.

Introduction: Several recent neuroimaging studies have identified functional and structural abnormalities in the cerebral cortex of lifelong premature ejaculation (LPE) patients, including task-related and resting-state brain function, and cortical thickness, although changes in white matter microstructure have not been reported. Aim: To assess the differences in white matter microstructure between LPE patients and healthy controls. Methods: Diffusion tensor imaging (DTI) and tract-based spatial statistical analysis were used to detect differences in white matter microstructure between 32 LPE patients and 32 matched healthy controls. We also analyzed correlations of clinical indices with significant DTI-based features. Main Outcome Measures: DTI-based features (including fractional anisotropy [FA], mean diffusivity, axial diffusivity, and radial diffusivity) were assessed in LPE patients and controls, as well as the correlation of white matter changes in LPE patients with clinical data (including the premature ejaculation diagnostic tool score and the International Index of Erectile Function). Results: LPE patients showed widespread increases in FA and axial diffusivity values compared with controls, including in the right posterior thalamic radiation, posterior corona radiata, bilateral posterior limb of the internal capsule, superior corona radiata, and external capsule. Further, FA in the right posterior thalamic radiation was positively correlated with the premature ejaculation diagnostic tool score in LPE patients. Clinical Implications: Changes of white matter microstructure may be an underlying marker for evaluating sensory conduction efficiency in LPE patients. Strengths & Limitations: There are no previous studies examining white matter microstructure in LPE patients. The present study furthers our understanding of the etiology of LPE. Limitations include a cross-sectional study design without causal information, and no measurement of conduction efficiencies such as cortical somatosensory-evoked potential from the penis, or psychosocial factors. Conclusion: Our findings show potential microstructural white matter abnormalities related to LPE, suggesting that changes in fiber pathways connecting the cerebral cortex and the thalamus may play roles in the etiology of LPE. Copyright (C) 2018, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Purpose Premature ejaculation (PE) is one of the most common sexual dysfunctions in men. However, there has been little research evaluating alterations in brain structure related to PE. We aimed to investigate the characteristics of nonmedicated PE patients in terms of brain morphometry. Materials and Methods The sample consisted with 32 medication‐naïve adult men with clinical diagnosed PE and matched 31 healthy controls. All participants received diagnostic interviews and 3.0 Tesla MRI scans. Automatic segmentation processing of MRI structure images was performed using FreeSurfer software and cerebral cortical thickness between groups was compared. Results The PE group had thicker cortex in widespread regions, including the frontal, parietal and occipital lobe, and limbic system, compared with the healthy control group ( P < 0.05). Moreover, the duration is negatively correlated with the mean cortical thickness of the right medial orbitofrontal cortex, right precentral gyrus and left superior frontal cortex (R 2 = 0.29, P < 0.003; R 2 = 0.163, P < 0.04; R 2 = 0.2, P < 0.02), while the Premature Ejaculation Diagnostic Tool score is negatively correlated with the mean cortical thickness of the left caudal middle frontal cortex (R 2 = 0.33, P < 0.005). Conclusion The result highlights the structural features of PE and suggests the relationship with the severity of impairment is related to the severity of anatomic abnormality with the relevant brain region. These results support the value of imaging measures as markers for understanding the physiopathology of PE. Level of Evidence : 1 Technical Efficacy : Stage 3 J. Magn. Reson. Imaging 2018;47:656–662.

Objective To summarize the surgical experience about the robot-assisted laparoscopic nephrectomy for living-donor kidney transplantation,as well as its efficacy and safety.Methods From September 2013 to January 2014,the clinical data of 2 male and 10 female patients who were underwent robot-assisted nephrectomy for living-donor kidney transplantation in our hospital were analyzed.The mean age in those patients were 47 years old (range 38 to 60 years old).11 underwent a left nephrectomy and the 12th patient underwent a right nephrectomy.As to the receptor,all of them,including 8 male and 4 female patients,were suffered from the uremia due to the chronic glomerulonephritis.The mean age in those receptors were 26 years old (range 20 to 36 years old).The duration of hemodialysis in those patients ranged from 8 to 25 months (mean 14 months).Their transplanted kidneys were all donated from their parents.Operative time,bleeding volume,warm ischemia time,length of vein and artery preservation,surgical related complication and changing of renal function in donor were analyzed.Results All patients underwent totally robotic nephrectomy without open procedure conversion.The median console time was 140 minutes (range 110-195 min).Median intraoperative bleeding was 50 ml (range 30-120 ml).The median warm ischemia time was 170 s (range 100-280 s).The median length of vein preservation was 2.4 cm (range 1.9-3.0 cm) and 1.8 cm (range 1.4-2.3 cm) for artery.Spleen injuries occurred in two cases whcn the kidney was takcn out and splenorrhaphy was performed.The hospital stay of all donors was 5 days.None of the transplant recipients developed delayed graft functional recovery.Conclusions Robot-assisted laparoscopic nephrectomy is a safe,reliable,minimal invasive and effective procedure for living-donor kidney transplantation.More attention,however,should be paid to the spleen when the left kidney is taken out.

Nanobiotechnology is an important research area of nanotechnology,and it has broad prospects for applications in medicine.As a product of combination of nanotechnology and modern medicine as well as other disciplines,nanobiotechnology has seen rapid advances and become an important tool of personalized medicine.This article aims at reviewing applications future prospects of nanobiotechnology in personalized medicine.

OBJECTIVE To define whether previous control of the adrenal vein is a crucial procedure in laparoscopic adrenalectomy for pheochromocytoma. METHODS From January 2000 to December 2010, 114 patients with pheochromocytoma who underwent laparoscopic adrenalectomy through transperitoneal or retroperitoneal approach were included. The patients were divided into 2 groups randomly (group 1: dissection after ligation; group 2: dissection before ligation). Blood samples for the measurement of catecholamines levels using high performance liquid chromatography were taken at the following time points: t1, before anesthesia; t2, during manipulation-extraction of pheochromocytoma; t3, after removal of pheochromocytoma. The blood pressure fluctuation was recorded. RESULTS Laparoscopic adrenalectomy was successfully performed on 113 patients with 1 elective open conversion because of dense peritumor adhesions. The operating time ranged from 80 to 150 minutes (mean 108, 102 in group 1, 110 in group 2). Mean blood loss ranged from 20 to 500 mL (mean 120 mL, 110 in group 1, 125 in group 2). The concentrations of plasma catecholamines between the 2 groups had no statistical differences. The blood pressure fluctuation incidence between the 2 groups had no marked difference. But the incidence increased with high functionary grade, and the difference was significant (P = .043). CONCLUSION This study demonstrated that previous control of the adrenal vein was not a determinate factor in dealing with dangerous hypertension during laparoscopic adrenalectomies. UROLOGY82: 606-611, 2013. (C) 2013 Elsevier Inc.

Object To evaluate the safety and efficacy of ex vivo operation as means of treatment in special urological disease.Methods Case 1:Ex vivo tumor resection was performed on a 69-old-year man for renal cell carcinoma in a solitary kidney.The renal auto-transplantation was performed after the tumor resection.Case 2:A donor with small non-obstructing unilateral nephrolithiasis detected on preoperative CT angiography underwent donor nephrectomy.Immediately after cold perfusion,ex vivo ureteroscopy(ExURS) was performed with ice-cold saline irrigation.Basket extraction and holmium laser lithotripsy was performed.Calculi were fragmented with pneumatic intracorporeal lithotripsy and fragments were removed with forceps.Results Case 1:The renal cell carcinoma histological subtypes were clear cell and the patient survived with local recurrence-free and metastasis-free during the 7-month follow-up.Case 2:Pyeloscopy was successfully performed.A total of 2 calculi with diameters of 8 mm and 12 mm,respectively,were visualized in the donor kidney.Access to the renal collecting system and stone fragmentation was technically successful in this case.Indwelling ureteral stents were kept during transplantation.No intraoperative complications were noted.At a follow-up of 10 months no recurrent calculi formation was founded in the recipient.Conclusion Such ex vivo operations may offer the chance of curative therapy for patients with special urological diseases.

Over the recent years,rapid advances in synthetic biology,particularly in next generation sequencing technology,have made genome-wide sequencing possible for the diagnosis and treatment of various diseases.Progress in sequencing technologies has placed personalized genomic medicine on our agenda.Synthetic biology is an emerging technology which aims to design and build new biological systems,in order to meet the urgent medical care and other social needs.Synthetic biology is unique in that it derives design principles from nature and applies it to the creation of novel,functional molecular systems with structures and functions not found in nature,making possible the provision of personalized medical care for various diseases,including cancer.

Objective To investigate the long-term effect of triple organ transplantation (liver,kidney,and pancreas) in a patient with end-stage liver disease secondary to chronic hepatitis B and cirrhosis combined with chronic renal failure and insulin-dependent diabetes,and explore the optimal surgical procedure.Methods A 43-year-old male patient presented with progressive ematiation and hypourocrinia for 2 months.Blood test showed ALT 117 U/L,AST 113 U/L,ALB 26.9 g/L,TBIL 102 μmol/L,BUN 23.6mmol/L,CRE 664 μmol/L.The fasting and postprandial plasma glucose were 10.8 mmol/L and 18.4mmol/L,respectively.Ultrasound and CT scan showed hepatic cirrhosis,hydroperitoneum,splenomegaly,enlarged caput pancreatic duct,expanded main pancreatic duct and renal atrophy.Nephorgram showed both kidneys were impaired severely.The eaminations indicated exocrine pancreatic insufficiency and insulin-dependent diabetes related to chronic pancreatitis (CP) after developing end-stage hepatic and renal failure.Simultaneous piggyback orthotopic liver and heterotopic pancreas-duodenum and renal transplantation was performed on 17-01-2005.Pancreatic exocrine secretions were drained enterically to the jejunum and the donor kidney was placed in left iliac fossa.Patient was prescribed prednisone,tacrolimus,mycophenolate mofetil,ATG (Rabbit Anti-human Thymocyte Immunoglobulin) and simulect for immunosuppression.Results Satisfied hepatic and pancreatic function was achieved within 7 days after surgery.The kidney did not function and CRRT (Continuous Renal Replacement Therapy) was used.Subsequently,the donor kidney was removcd at day 16 after surgery due to acute rejection.The second renal transplantation at the same position was perfromed and the new graft kidney functioned 3 days later.The patient had no rejection reaction or other complications such as pancreatitis,thrombosis,or local infections during the following 8 years.The patient has become insulin independent with normal liver and renal functions.The immunosuppressive drugs FKS06+Pred was used and the tacrolimus level maintained 3.0-4.5 μmol/L,Lamivudine was long-term used to inhibition HBV virus duplication.Conclusions Simultaneous piggyback orthotopic liver combined with heterotopic pancreas-duodenum and renal transplantations is a good therapeutic option for patients with exocrine pancreatic insufficiency and insulin-dependent diabetes combined with hepatic and renal failure.

N-myc downstream regulated gene 2 (NDRG2) is involved in invasion and metastasis of cancer, furthermore it is frequently down-regulated in prostate cancer. Herein we evaluated the effect of NDRG2 overexpression on invasiveness and bone destruction in prostate cancer. The human prostate cancer cell line PC-3 and DU145 were infected with Ad-NDRG2 or Ad-LacZ. Overexpression of NDRG2 not only inhibited the growth of the cells, but also suppressed invasiveness of the cells in an in vitro assay. PC-3 cells infected with Ad-NDRG2 or Ad-LacZ were injected into the tibias of nude mice. Four weeks later, we found the mice injected with PC-3 cells overexpressing NDRG2 had smaller tumors and less bone destruction. These results demonstrate that NDRG2 overexpression can inhibit tumor growth and invasion, furthermore, it can decrease bone destruction caused by prostate cancer bone metastasis.

Objective To define clinical parameters associated with gastrointestinal hemorrhage in the early stage after renal transplantation,and to develop a series of effective methods to treat gastrointestinal hemorrhage.Methods Risk factors for gastrointestinal hemorrhage in 266 patients with renal transplantation were studied by a multivariable logistic regression analysis.The binary and multinomial logistic regression analysis was performed respectively to define the correlation factors and high risk factors of gastrointestinal hemorrhage after operation.The effective treatment for the gastrointestinal hemorrhage was also summarized.Results In this cohort the incidence of gastrointestinal hemorrhage was 10.5%.Most gastrointestinal hemorrhage occurred during delayed graft function(DGF) period.It was found that total dosage of methylprednisolone,pulmonary infection,heparin hemodialysis and blood vessel puncturation before hemodialysis were significantly associated with gastrointestinal hemorrhage,and the allograft survival was significantly affected by the occurrence of gastrointestinal hemorrhage renal transplantation.Conclusion The results suggest that gastrointestinal hemorrhage is prong to occur during the DGF period.Prompt management of hemorrhage,adequate adjustment of immunosuppressant and prophylaxis of pulmonary infection are needed to manage bleeding crises in recipients.The risk of gastrointestinal hemorrhage can be predicted with the help of logistic regression analysis.Therefore,relevant clinical intervention and optimal allocation decision can be conducted.

Survivin, an important inhibitor of apoptosis, has been found to play an important role in the initiation, progression, and chemoradioresistance of human malignancies. Previously, we have reported that upregulation of survivin in oral squamous cell carcinoma correlates with poor prognosis and chemoresistance. The aim of this study was to assess prognostic significance of survivin protein expression in RCC and analyze its correlation with radiosensitivity of RCC cells. RT-PCR and Western blot assays were performed to detect survivin mRNA and protein expression in normal human kidney epithelial cell line (HKEC) or RCC cell lines. The expression of survivin mRNA in RCC and corresponding nontumor kidney tissues was also detected by RT-PCR. Immunohistochemistry was performed to determine survivin protein expression in 75 cases of RCC tissue samples. Moreover, the association of survivin protein expression with clinicopathogical factors and prognosis of RCC patients was statistically analyzed. Small interfering RNA was used to knockdown the endogenous survivin expression in RCC cell line (ACHN) and evaluate the effects of survivin knockdown on proliferation, apoptosis, and radiosensitivity of RCC cell line. RCC cells showed sufficient expression of survivin mRNA and protein, but the expression of survivin gene was not detected in normal HKEC. Moreover, the expression level of survivin mRNA in RCC tissues was significantly higher than that in corresponding nontumor kidney tissues. The immunostaining of survivin protein was mainly located in cytoplasm of RCC tumor cells. Tumor pathological stage (P = 0.028), grade (P = 0.004), and lymph node metastasis (P = 0.017) of RCC patients were significantly correlated with survivin protein expression. In addition, patients with high survivin levels had a significantly shorter overall survival than those with low levels (P < 0.001), and the expression of survivin protein was an independent prognostic factor for RCC patients (P = 0.008). The expression of survivin gene could be reduced in RCC cell line and survivin knockdown could inhibit growth and enhance in vivo radiosensitivity of RCC cell line by inducing apoptosis enhancement. Taken together, the status of survivin protein expression may be an independent factor for predicting the prognosis of RCC patients and tumor-specific survivin knockdown combined with radiotherapy will be a potential strategy for RCC therapy.

Survivin, a key member of the inhibitor of apoptosis protein family, has been reported to be capable of regulating both cellular proliferation and apoptotic cell death. This protein is found to be overexpressed in many human cancers. The aim of this study was to evaluate the prognostic significance of survivin mRNA expression in oral squamous cell carcinoma (OSCC) and to analyze its correlation with chemoresistance. Reverse-transcription polymerase chain reaction assay was performed to detect the expression of survivin mRNA in OSCC cell lines or tissue samples. Immunohistochemistry was performed to detect the expression of survivin protein in OSCC tissues or corresponding nontumor tissues. Then the correlation between survivin mRNA expression and clinicopathologic features or prognosis of OSCC patients was analyzed. Small interfering RNA technology was used to down-regulate the expression of the survivin gene in the OSCC cell line. Methylthiazol tetrazolium and flow cytometric assays were performed to detect proliferation and apoptosis of the OSCC cell line (HSC-3). Furthermore, the effect of small interfering RNA (siRNA) targeting survivin on the sensitivity of OSCC cells to chemotherapeutic agents (cisplatin and 5-fluorouracil [5-FU]) was determined. Results showed that the levels of survivin mRNA expression were significantly higher in OSCC cells or tissues than those in normal human oral keratinocyte or corresponding noncancerous tissues. The immunostaining of survivin protein was significantly stronger in OSCC tissues than in corresponding nontumor tissues. Moreover, high survivin mRNA expression was correlated with poorer tumor differentiation, higher clinical stage, and the presence of lymph node metastasis (P < .05). Multivariate analysis showed that the status of survivin mRNA could be an independent prognostic factor for OSCC patients (hazard ratio 2.71, 95% confidence interval 1.46-5.10; P = .012). In addition, siRNA-mediated survivin down-regulation could significantly inhibit proliferation and induce apoptosis of OSCC cells. Suvivin down-regulation could also significantly enhance chemosensitivity of OSCC cells, which was associated with apoptosis enhancement. Thus, the status of survivin mRNA expression was a potential prognostic factor for OSCC patients, and siRNA-mediated survivin down-regulation could become a novel strategy for chemosensitization of human OSCCs.