Mounting evidence indicates that circular RNAs modulate the initiation of clear cell renal cell carcinoma (ccRCC). However, their specific roles in the malignancy of ccRCC is understudied. Here, we present a novel circular RNA, circDHX33, that is up-regulated in ccRCC cell lines and tissues. Upregulated circDHX33 in ccRCC patients significantly correlates with advanced TNM stage and metastasis. Suppressing circDHX33 expression inhibits the proliferation and invasion of cultured cells, and suppresses tumor growth in vivo. Mechanistically, we show that circDHX33 promotes ccRCC progression by sponging miR-489-3p and modulating MEK1 expression. In conclusion, our findings suggest that circDHX33 plays a role in promoting ccRCC via the miR-489-3p/MEK1 axis and may serve as a novel therapeutic target for the treatment of ccRCC patients

医疗联合体是实现分级诊疗与优化医疗资源配置的重要手段.同济大学附属第十人民医院将优质资源下沉至宁海县第一医院,探索大型三甲综合性医院跨区域协管县级医院可行路径.通过重组宁海县第一医院组织架构、输出优秀医院管理团队与管理理念、加强人才培养及引进等措施,有效提升了宁海县第一医院综合实力.同时,宁海县第一医院病种结构得以不断优化,学科建设实现新的突破,医院管理逐步规范化、精细化.

目的 探讨不同的保存方法和保存时间对尿液中所含的尿蛋白浓度的影响.方法 收集本院肾内科和内分泌科109例患者的24 h尿液,分别对标本用麝香草酚化学防腐法、2～8℃冷藏法、CO2物理保鲜法和常温保存法保存,分别在放置24 h、48 h、72 h、96 h、192 h、384 h时检测尿蛋白浓度,对同一患者的尿蛋白浓度检测结果进行比较.结果 单独效应分析,CO2保存组不同时间点尿蛋白浓度差异具有统计学意义(FCO2=2.630,P=0.029),其他保存方法不同时间点尿蛋白浓度差异均无统计学意义;尿蛋白浓度CO2保存方法各时间点与24 h测量比较,192 h和384 h与24 h差异均具有统计学意义(P<0.05).结论 检测24 h尿蛋白浓度时,尿液标本可不用防腐剂、冷藏和CO2保存方法,用常温保存法即可,保存时间不宜超过384 h.

目的 探讨盆底肌训练(PFMT)对前列腺术后膀胱过度活动症(OAB)控制的临床效果.方法 选取2016年5月～2018年3月收治的男性前列腺手术患者196例作为研究对象,进行盆底肌训练,在专科护士指导下进行常规的围手术期护理加盆底肌训练,对患者手术前后均进行生活质量评分(QOL评分)、国际前列腺症状评分(IPSS评分)、最大尿流率Qmax测定、残余尿量PVR测定及膀胱过度活动症调查表(OABSS评分)等评分.结果 根据这196名前列腺手术患者的盆底肌训练后的生活质量评分(QOL评分)、国际前列腺症状评分(IPSS评分)、最大尿流率Qmax测定、残余尿量PVR测定及膀胱过度活动症调查表(OABSS评分等详细数据与以前未曾做盆底肌训练的196名前列腺手术患者进行回顾性比较.治疗组膀胱过度活动症(白天排尿次数、夜间排尿次数、尿急、急迫性尿失禁)发生率明显低于对照组,差异有统计学意义(P<0.05).结论 盆底肌训练能有效减少前列腺手术患者膀胱过度活动症发生率,改善患者生活质量,取得经济效益与社会效益双丰收,值得临床推广.

Favorable osteogenic activity and antibacterial ability are highly desired for hard tissue repair and replacement materials. However, as a typical implant material, nearly equiatomic nickel-titanium (NiTi) alloy exhibits poor osteogenic and antibacterial capacities despite its good biocompatibility and unique mechanical properties. In this work, nickel-titanium-oxygen (Ni-Ti-O) nanopores (NPs) coatings incorporated with magnesium (NP-Mg) are fabricated on the NiTi alloy by anodization and hydrothermal treatment (HT). The results show the amount of loaded Mg can be regulated by the NPs length (1.8 and 10.4 mu m) and the hydrothermal duration (1 and 5 h). In addition, the surface morphology of the coatings transform to nanosheets after HT for 1 h and to NPs with small diameter after HT for 5 h. Bone marrow mesenchymal stem cells (BMSCs) cultured on NP-Mg-coated NiTi alloy show better proliferation and osteogenic differentiation than that of pristine and as-anodized specimens. Antibacterial experiments show although HT reduces Ni ion release and increase corrosion resistance, the NP-Mg coatings yet maintain potent antibacterial activity especially against adherent bacteria. The NPs coating with thickness of 10.4 mu m and HT for 5 h shows favorable osteogenic activity, antibacterial ability, little Ni ion release, and good corrosion resistance thus is a promising candidate to functionalize the surface of the NiTi alloy for orthopedic applications.

A multifaceted coating for hard tissue implants, with favorable osteogenesis, angiogenesis, and osteoimmunomodulation abilities, would be of great value since it could improve osseointegration and alleviate prosthesis loosening. However, to date there are few coatings that fully satisfy these criteria. Herein we describe a microporous TiO2 coating decorated with hydroxyapatite (HA) nanoparticles that is generated by micro-arc oxidation of pure titanium (Ti) and followed annealing. By altering the annealing temperature, it is possible to simultaneously tune the coating's physical (morphology and wettability) and chemical (composites and crystallinity) properties. A coating produced with micro-arc oxidization (MAO) with an annealing temperature of 650 °C (MAO-650) exhibits numerous favorable physicochemical properties, such as hybrid micro-nano morphology, superhydrophilicity, and highly crystalline HA nanoparticles. In vitro experiments reveal that the MAO-650 coating not only supports proliferation and differentiation of both osteoblasts and endothelial cells, but also inhibits the inflammatory response of macrophages and enables a favorable osteoimmunomodulation to facilitate osteo/angio-genesis. In vivo evaluation mirrors these results, and shows that the MAO-650 coating results in ameliorative osseointegration when compared with the pristine MAO coating. These data highlight the profound effect of surface physicochemical properties on the regulation of osteo/angio-genesis and osteoimmunomodulation in the enhancement of osseointegration.

Recently, increasing studies showed that long noncoding RNAs (lncRNAs) play critical roles in tumor progression. However, the function and underlying mechanism of HOMEOBOX A11 antisense RNA (HOXA11-AS) on renal cancer remain unclear. In the current study, our data showed that the expression of HOXA11-AS was significantly upregulated in clear cell renal cell carcinoma (ccRCC) tissues and cell lines. High HOXA11-AS expression was associated with the advanced clinical stage, tumor stage, and lymph node metastasis. Function assays showed that HOXA11-AS inhibition significantly suppressed renal cancer cells growth, invasion, and ETM phenotype. In addition, underlying mechanism revealed that HOXA11-AS could act as a competing endogenous RNA (ceRNA) that repressed miR-146b-5p expression, which regulated its downstream target MMP16 in renal cancer. Taken together, our findings suggested that HOXA11-AS could promote renal cancer cells growth and invasion by modulating miR-146b-5p-MMP16 axis. Thus, our findings suggested that HOXA11-AS could serve as potential therapeutic target for the treatment of renal cancer.

Coating materials applied for intraosseous implants must be optimized to stimulate osseointegration. Osseointegration is a temporal and spatial physiological process that not only requires interactions between osteogenesis and angiogenesis but also necessitates a favorable immune microenvironment. It is now well-documented that hierarchical nano-micro surface structures promote the long-term stability of implants, the interactions between nano-micro structure and the immune response are largely unknown. Here, we report the effects of microporous titanium (Ti) surfaces coated with nano-hydroxyapatite (HA) produced by micro-arc oxidation and steam-hydrothermal treatment (SHT) on multiple cell behavior and osseointegration. By altering the processing time of SHT it was possible to shift HA structures from nano-particles to nano-rods on the microporous Ti surfaces. Ti surfaces coated with HA nano-particles were found to modulate the inflammatory response resulting in an osteoimmune microenvironment more favorable for osteo-/angio-genesis, most likely via the activation of certain key signaling pathways (TGF-beta, OPG/RANKL, and VEGF). By contrast, Ti surfaces coated with nano-rod shaped HA particles had a negative impact on osteo-/angio-genesis and osteoimmunomodulation. In vivo results further demonstrated that Ti implant surfaces decorated with HA nano-particles can stimulate new bone formation and osseointegration with enhanced interaction between osteocytes and implant surfaces. This study demonstrated that Ti implants with micro-surfaces coated with nano-particle shaped HA have a positive impact on osseointegration. Statement of Significance Osteo-/angio-genesis are of importance during osteointegration of the implants. Recent advances unravel that immune response of macrophages and its manipulated osteoimmunomodulation also exerts a pivotal role to determine the fate of the implant. Surface nano-micro modification has evidenced to be efficient to influence osteogenesis, however, little is known links nano-microstructured surface to immune response, as well the osteoimmunomodulation. This study demonstrates that the nano-particles decorated micro-surface, compared with the nano-rods decorated micro-surface enables osteogenesis and angiogenesis concurrently that has not been investigated previously. This study also unravels that the immune response of macrophages can be manipulated by the nano-micro surface, especially the nano dimension matters, leading to a differential effect on osteointegration. The additional knowledge obtained from this study may provide foundation and reference for future design of the coating materials for implantable materials. (C) 2018 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

目的 探讨输尿管软镜下钬激光碎石取石治疗肾下盏结石的疗效.方法 52例肾下盏结石患者采用输尿管软镜下钬激光碎石取石治疗,观察其疗效.结果 所有患者均一期置管成功,二期成功完成手术.本组患者手术时间15～100min,平均35min;住院时间4～45d,平均7.7 d;2例在术后排石过程中行体外碎石1次,1例术后出现肾包膜下血肿,卧床6周后吸收.本组患者术后6个月复查CT,示直径＞3mm结石残留3例,结石清除率9423％(49/52).结论 输尿管软镜下钬激光碎石取石治疗肾下盏结石具有安全有效、创伤小、术后恢复快及并发症少的特点,值得推广.

目的 探讨腹腔镜下经腹膜外前列腺癌根治术的手术方法和疗效.方法 收集我科自2012年5月至2014年10月行腹腔镜下经腹膜外途径前列腺癌根治术治疗的14例前列腺癌患者的临床资料.手术经过腹膜外路径顺行切除前列腺及精囊,切开膀胱颈部之前以2-0可吸收线缝扎阴茎背深复合体.结果 14例均手术成功,无中转开放及直肠损伤.手术时间100～240min,平均140 min,术中出血量50～1 000 mL左右,平均约250 mL,11例患者于术后2周拔除导尿管.14例术后均出现不同程度尿失禁,经提肛训练等辅助治疗后好转,3例出现尿漏.术后复查PSA o～o.08 ng/L,所有患者均在访,未见肿瘤复发.结论 腹腔镜下经腹膜外途径前列腺癌根治术安全有效,创伤较小,恢复较快,腹腔并发症少.

目的 探讨负压吸引式经皮肾镜钬激光碎石用于清除肾脏及输尿管上段结石疗效及安全性.方法 回顾性分析34例采取负压吸引式经皮肾镜钬激光碎石术清除肾脏及输尿管上段结石患者的临床资料.结果 所有患者手术均获成功,结石大小为1.0cm×1.0cm～6.0cm×4.5cm.其中术后结石完全清除28例,4例残留细小结石未特殊处理,2例行二次手术碎石;1例术后出血,予输血等保守治疗后治愈;2例出现术后发热,经过积极抗感染治疗后治愈,未发生感染性休克.结论 负压吸引式经皮肾镜钬激光碎石能有效降低肾盂内压力,控制感染,提高清石率,缩短手术时间.

目的 探讨改良后腹腔镜下肾上腺切除术的效果.方法 自解剖学角度对侧位后腹腔镜下肾上腺切除术进行改进,术中根据肾上腺肿瘤的位置调整套管穿刺点,对27例患者临床资料进行回顾性分析.结果 27例手术均顺利完成,手术时间48～142 min,术中出血量30～260ml.术中1例腹膜破裂,予以闭合后继续完成手术.本组术后住院时间6～10d,25例获随访3～34个月,未见其他并发症发生.结论 改良后腹腔镜肾上腺手术可有效避开肾脏的阻挡,有利于肾上腺的暴露,提高手术的安全性.

目的 探讨后腹腔镜输尿管切开取石术和经尿道输尿管镜碎石术在治疗复杂性输尿管上段结石的疗效情况.方法 分析120例复杂性输尿管上段结石患者临床资料,依据手术方式分为治疗Ⅰ组(后腹腔镜输尿管切开取石术组)60例和治疗Ⅱ组(经尿道输尿管镜碎石术组)60例.结果 治疗Ⅰ组手术时间长于治疗Ⅱ组,术中出血量明显低于治疗Ⅱ组,临床治疗总有效率和术后并发症均低于治疗Ⅱ组,差异均有统计学意义(均P＜0.05).结论 后腹腔镜输尿管切开取石术治疗复杂性输尿管上段结石创伤小、疗效好,术后并发症少,值得临床推广应用.

目的 探讨经尿道前列腺电切术(TURP)常见并发症防治方法.方法 回顾性分析1 025例采用TURP治疗前列腺增生患者的临床资料.结果 1 025例无一例中转开放,手术时间40～125 min,术中输血2例.术中术后并发症情况:发生TUR综合征57例,术后大出血二次手术11例,术后仍排尿不能4例,膀胱穿孔1例,术后短期出现精神症状21例,术后慢性膀胱尿道炎、附睾炎致再次入院9例,术后尿道狭窄13例,暂时性尿失禁52例,永久性尿失禁1例.结论 TURP是一种微创治疗前列腺增生的方法,实际工作中应严格掌握手术适应证,知晓手术要点并熟练手术操作,积极预防和处理相关并发症.

目的探讨经尿道前列腺电切术(TURP)常见并发症防治方法。方法回顾性分析1025例采用TURP治疗前列腺增生患者的临床资料。结果 1025例无一例中转开放,手术时间40～125min,术中输血2例。术中术后并发症情况:发生TUR综合征57例,术后大出血二次手术11例,术后仍排尿不能4例,膀胱穿孔1例,术后短期出现精神症状21例,术后慢性膀胱尿道炎、附睾炎致再次入院9例,术后尿道狭窄13例,暂时性尿失禁52例,永久性尿失禁1例。结论 TURP是一种微创治疗前列腺增生的方法,实际工作中应严格掌握手术适应证,知晓手术要点并熟练手术操作,积极预防和处理相关并发症。

目的探讨后腹腔镜输尿管切开取石术治疗输尿管中上段结石的疗效。方法对33例输尿管中上段结石患者行后腹腔镜输尿管切开取石术,对滑入肾盂的结石结合胆道镜取石。结果 33例均取净结石,无中转开放手术。手术时间为90～180min,术中出血量为10～30ml,术后4～5d拔除后腹腔引流,术后5～8d排除导尿管,术后住院5～8d。术后均获得随访,随访时间1～24个月,平均6个月,结石无复发,输尿管无狭窄,肾功能改善。结论后腹腔镜输尿管切开取石术具有安全、效果确切、损伤小、康复快及并发症少的特点,值得推广。

目的观察中药辅助治疗在同期手术治疗前列腺增生合并膀胱结石中的效果。方法 78例前列腺增生合并膀胱结石患者随机分为观察组和对照组,各39例。对照组采用常规分期手术方法治疗,观察组采用中药联合同期手术治疗。比较两组治疗效果。结果观察组手术时间、尿管留置时间和术后住院时间均短于对照组。观察组患者术后6个月膀胱结石复发率低于对照组。结论中药辅助联合同期手术治疗可有效降低术中出血量,缩短术后住院时间,降低治疗费用和结石复发率。

目的探讨负压式微创经尿道钬激光碎石治疗膀胱结石的临床疗效。方法回顾性分析19例采用负压吸引式微创经尿道钬激光碎石治疗膀胱结石患者的临床资料。结果 19例均一次性碎石清石,碎石时间为2～25 min,平均10.2min;术中及术后无膀胱穿孔、大出血及水中毒等严重并发症发生。结论该项技术治疗膀胱结石具有微创、高效率及操作简便等特点,对患者及器械带来的损伤更小,值得临床推广。

Objective:To investigate the efficacy and safety of ultrsonography-guided minimally invasive percutaneous nephrolithotomy(mPCNL) in management of renal staghorn calculi. Methods:52 patients with renal staghorn calculi had undergone mPCNL with holmium YAGlaser lithotripsy accessed by one steps dilation to F16 tract with ultrasound guidance.Stone-free rate and complication were assessed. Results:The stone-free rate was 71.2% after the first session,84.7% at the end of session.2 cases had high fever after surgery,no other adverse event was noted. Conclusions:Invasive percutaneous nephrolithotomy in management of renal staghorn calculi can crash calculi quickly and reduce the time of operation,efficient technique and less trauma.It is an effective and safe technique for renal staghorn calculi.

目的探讨后腹腔镜联合胆道镜治疗输尿管上段结石合并肾盏小结石的临床应用。方法 4年来对12例经后腹腔途径在腹腔镜下使用胆道镜取出肾盏结石的手术进行回顾总结。结果 12例手术均获成功,手术时间90～180分钟,术中出血40～100ml,术后住院5～8天,未发生因器械、设备故障或改变手术方式,术中、术后无并发症发生。结论后腹腔镜联合胆道镜取石术是输尿管上段结石合并肾盏小结石治疗的一个可选择方法。