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Extracellular vesicles (EVs) contain thousands of proteins and nucleic acids, playing an important role in cell-cell communications. Sertoli cells have been essential in the testis as a "nurse cell". However, EVs derived from human Sertoli cells (HSerCs) have not been well investigated.EVs were isolated from HSerCs via ultracentrifugation and characterized by transmission electron microscopy, tunable resistive pulse sensing, and Western blotting. The cargo carried by HSerCs-EVs was measured via liquid chromatography-mass spectrometry and GeneChip miRNA Arrays. Bioinformatic analysis was performed to reveal potential functions of HSerCs-EVs.A total of 860 proteins with no less than 2 unique peptides and 88 microRNAs with high signal values were identified in HSerCs-EVs. Biological processes related to molecular binding, enzyme activity, and regulation of cell cycle were significantly enriched. Specifically, many proteins in HSerCs-EVs were associated with spermatogenesis and regulation of immune system, including Septins, Large proline-rich protein BAG6, Clusterin, and Galectin-1. Moreover, abundant microRNAs within HSerCs-EVs (miR-638, miR-149-3p, miR-1246, etc.) had a possible impact on male reproductive disorders such as asthenozoospermia and oligozoospermia.Our study has shown that HSerCs-EVs contain diverse components such as proteins and microRNAs. Further research is required to evaluate HSerCs-EVs in spermatogenesis, which are underutilized but highly potent resources with particular promise for male infertility.

This study aimed to investigate the value and feasibility of combining fractional anisotropy (FA) values from diffusion tensor imaging (DTI) and total kidney volume (TKV) for the assessment of kidney function in chronic kidney disease (CKD). Fifty-one patients were included in this study. All MRI examinations were performed with a 3.0 T scanner. DTI was used to measure FA values, and TKV was obtained from DTI and T2-weighted imaging (T2WI). Patients were divided into three groups (mild, moderate, severe) according to eGFR, which was calculated with serum creatinine. Differences in the FA values of the cortex and medulla were analysed among the three groups, and the relationships of FA values, TKV, and the product of the FA values and TKV with eGFR were analysed. Receiver operating characteristic (ROC) curve analysis was used to compare the diagnostic efficiency of the FA values, TKV, and the product of the FA values and TKV for kidney function in different CKD stages. Medullary FA values (m-FA), TKV, and the product of the m-FA values and TKV (m-FA-TKV) were significantly correlated with eGFR (r = 0.653, 0.685, and 0.797, respectively; all P

PurposeTo assess the diverse cell populations of human corpus cavernosum in patients with severe erectile dysfunction (ED) at the single-cell level.MethodsPenile tissues collected from three patients were subjected to single-cell RNA sequencing using the BD Rhapsody™ platform. Common bioinformatics tools were used to analyze cellular heterogeneity and gene expression profiles from generated raw data, including the packages Seurat, Monocle, and CellPhoneDB.ResultsDisease-related heterogeneity of cell types was determined in the cavernous tissue such as endothelial cells (ECs), smooth muscle cells, fibroblasts, and immune cells. Reclustering analysis of ECs identified an arteriole ECs subcluster and another one with gene signatures of fibroblasts. The proportion of fibroblasts was higher than the other cell populations and had the most significant cellular heterogeneity, in which a distinct subcluster co-expressed endothelial markers. The transition trajectory of differentiation from smooth muscle cells into fibroblasts was depicted using the pseudotime analysis, suggesting that the expansion of corpus cavernosum is possibly compromised as a result of fibrosis. Cell-cell communications among ECs, smooth muscle cells, fibroblasts, and macrophages were robust, which indicated that inflammation may also have a crucial role in the development of ED.ConclusionsOur study has demonstrated a comprehensive single-cell atlas of cellular components in human corpus cavernosum of ED, providing in-depth insights into the pathogenesis. Future research is warranted to explore disease-specific alterations for individualized treatment of ED.

Exosomes have been suggested as promising targets for the diagnosis and treatment of neurological diseases, including schizophrenia (SCZ), but the potential role of exosome-derived metabolites in these diseases was rarely studied. Using ultra-performance liquid chromatography-tandem mass spectrometry, we performed the first metabolomic study of serum-derived exosomes from patients with SCZ. Our sample comprised 385 patients and 332 healthy controls recruited from 3 clinical centers and 4 independent cohorts. We identified 25 perturbed metabolites in patients that can be used to classify samples from patients and control participants with 95.7% accuracy (95% CI: 92.6%–98.9%) in the training samples (78 patients and 66 controls). These metabolites also showed good to excellent performance in differentiating between patients and controls in the 3 test sets of participants, with accuracies 91.0% (95% CI: 85.7%–96.3%; 107 patients and 62 controls), 82.7% (95% CI: 77.6%–87.9%; 104 patients and 142 controls), and 99.0% (95% CI: 97.7%–100%; 96 patients and 62 controls), respectively. Bioinformatic analysis suggested that these metabolites were enriched in pathways implicated in SCZ, such as glycerophospholipid metabolism. Taken together, our findings support a role for exosomal metabolite dysregulation in the pathophysiology of SCZ and indicate a strong potential for exosome-derived metabolites to inform the diagnosis of SCZ.

It has been suggested that dysregulation of hormones is associated with schizophrenia (SCZ). This study aimed to measure the serum levels of progesterone and testosterone in 125 SCZ patients at different stages of treatment and 96 healthy control (HC) subjects. Our results showed that first-episode drug-free SCZ patients had significantly increased testosterone levels when compared with HC subjects, and chronic medication, but not short-term medication, further increased the serum testosterone levels in the patients. Further analysis suggested that the sex of the patients did not affect testosterone levels. In contrast, serum progesterone levels did not show significant differences between first-episode, drug-free SCZ patients and controls, and the antipsychotics increased progesterone levels in the male SCZ patients, but not female patients. Interestingly, our analyses demonstrated that the serum progesterone levels were negatively correlated with PANSS total score and PNASS positive score, suggesting a correlation between blood hormone levels and disease severity in SCZ patients. Taken together, our data showed differential changes in serum testosterone and progesterone levels in SCZ patients with or without antipsychotics, and our results suggest that increased sex hormone levels may be a defensive response to protect the human body under stress.

Genetic variants conferring risk for schizophrenia (SCZ) have been extensively studied, but the role of posttranscriptional mechanisms in SCZ is not well studied. Here we performed the first genome-wide microRNA (miRNA) expression profiling in serum-derived exosome from 49 first-episode, drug-free SCZ patients and 46 controls and identified miRNAs and co-regulated modules that were perturbed in SCZ. Putative targets of these SCZ-affected miRNAs were enriched strongly for genes that have been implicated in protein glycosylation and were also related to neurotransmitter receptor and dendrite (spine) development. We validated several differentially expressed blood exosomal miRNAs in 100 SCZ patients as compared with 100 controls by quantitative reverse transcription-polymerase chain reaction. The potential regulatory relationships between several SCZ-affected miRNAs and their putative target genes were also validated. These include hsa-miR-206, which is the most upregulated miRNA in the blood exosomes of SCZ patients and that previously reported to regulate brain-derived neurotrophic factor expression, which we showed reduced mRNA and protein levels in the blood of SCZ patients. In addition, we found 11 miRNAs in blood exosomes from the miRNA sequence data that can be used to classify samples from SCZ patients and control subjects with close to 90% accuracy in the training samples, and approximately 75% accuracy in the testing samples. Our findings support a role for exosomal miRNA dysregulation in SCZ pathophysiology and provide a rich data set and framework for future analyses of miRNAs in the disease, and our data also suggest that blood exosomal miRNAs are promising biomarkers for SCZ.

Preclinical and clinical studies suggest that brain-derived neurotrophic factor and nerve growth factor are involved in the pathogenesis of schizophrenia (SCZ). However, the roles of other neurotrophic factors in SCZ remain unclear. The aim of this study was to investigate the blood levels of FGF2 and ADNP in first-episode, drug-free SCZ patients compared with healthy control subjects. 20 SCZ patients, and 20 age and sex matched controls were recruited in this study. Serum FGF2 and ADNP protein levels were measured by ELISA assay, and the results showed that FGF2 levels were significantly increased in patients with SCZ when compared with controls, whereas ADNP protein levels did not significantly associated with SCZ. However, we found that blood ADNP mRNA levels were significantly increased in the patients with SCZ when compared with controls. In addition, subgroup analyses suggested that FGF2 levels were significantly increased in female patients of SCZ, but not in male patients of SCZ. Correlation analyses suggested that age and disease severity (PANSS score) did not have moderating effects on the serum FGF2 levels. Taken together, our results for the first time demonstrated that blood FGF2 was up-regulated in first-episode, drug free-SCZ patients, therefore enhancing the knowledge of neurotrophic factor profile in patients with SCZ.

To compare the reproducibility and performance of quantitative metrics between ZOOMit and conventional intravoxel incoherent motion (IVIM) magnetic resonance imaging (MRI) in the diagnosis of early- and mid-stage Sjögren's syndrome (SS).Twenty-two patients (mean age ± standard deviation, 52.0 ± 10.8 years; male:female, 2:20) with early- or mid-stage SS and 20 healthy controls (46.9 ± 14.6 years; male:female, 7:13) were prospectively enrolled in our study. ZOOMit IVIM and conventional IVIM MRI were performed simultaneously in all individuals using a 3T scanner. Quantitative IVIM parameters - including tissue diffusivity (D), pseudodiffusion coefficient (DInter- and intra-observer reproducibility was better with ZOOMit imaging than with conventional IVIM imaging (ZOOMit vs. conventional, intraclass correlation coefficient of 0.897-0.941 vs. 0.667-0.782 for inter-observer reproducibility and 0.891-0.968 vs. 0.814-0.853 for intra-observer reproducibility). Significant differences in ZOOMit f, ZOOMit DConsidering its better reproducibility and performance, ZOOMit IVIM may be preferred over conventional IVIM MRI, and may subsequently improve the ability to diagnose early- and mid-stage SS.

AIM To investigate the impact of fecal microbiota transplantation (FMT) treatment on allergic colitis (AC) and gut microbiota (GM). METHODS We selected a total of 19 AC infants, who suffered from severe diarrhea/hematochezia, did not relieve completely after routine therapy or cannot adhere to the therapy, and were free from organ congenital malformations and other contraindications for FMT. Qualified donor-derived stools were collected and injected to the AC infants via a rectal tube. Clinical outcomes and follow-up observations were noted. Stools were collected from ten AC infants before and after FMT, and GM composition was assessed for infants and donors using 16S rDNA sequencing analysis. RESULTS After FMT treatment, AC symptoms in 17 infants were relieved within 2 d, and no relapse was observed in the next 15 mo. Clinical improvement was also detected in the other two AC infants who were lost to follow-up. During follow-up, one AC infant suffered from mild eczema and recovered shortly after hormone therapy. Based on the 16S rDNA analysis in ten AC infants, most of them (n = 6) had greater GM diversity after FMT. As a result, Proteobacteria decreased (n = 6) and Firmicutes increased (n = 10) in post-FMT AC infants. Moreover, Firmicutes accounted for the greatest proportion of GM in the patients. At the genus level, Bacteroides (n = 6), Escherichia (n = 8), and Lactobacillus (n = 4) were enriched in some AC infants after FMT treatment, but the relative abundances of Clostridium (n = 5), Veillonella (n = 7), Streptococcus (n = 6), and Klebsiella (n = 8) decreased dramatically. CONCLUSION FMT is a safe and effective method for treating pediatric patients with AC and restoring GM balance.

Prenatal administration of mitotoxin methylazoxymethanol acetate (MAM) in rats produces behavioral, pharmacological, and anatomical abnormalities once offspring reach adulthood, thus establishing a widely used neurodevelopmental model of schizophrenia. However, the molecular aspects underlying this disease model are not well understood. Therefore, this study examines epigenetic and transcriptional dysregulation in the prefrontal cortex and hippocampus of MAM rats as these are brain regions closely associated with schizophrenia pathogenesis. Upon sequencing messenger and microRNA (mRNA and miRNA, respectively), differential expression was revealed in the prefrontal cortex and hippocampus between MAM- and saline-treated rats; sequencing data were validated by qualitative real-time polymerase chain reaction. Bioinformatic analyses demonstrated that the differentially expressed (DE) genes were strongly enriched in interactive pathways related to schizophrenia, including chemical synaptic transmission, cognition, and inflammatory responses; also, the potential target genes of the DE miRNAs were enriched in pathways related to synapses and inflammation. The blood of schizophrenia patients and healthy controls was further analyzed for several top DE mRNAs: DOPA decarboxylase, ret proto-oncogene, Fc receptor-like 2, interferon lambda receptor 1, and myxovirus (influenza virus) resistance 2. The results demonstrated that the expression of these genes was dysregulated in patients with schizophrenia; combining these mRNAs sufficiently differentiated schizophrenia patients from controls. Taken together, this study suggests that the MAM model has the potential to reproduce hippocampus and prefrontal cortex abnormalities, relevant to schizophrenia, at the epigenetic and transcriptional levels. These data also provide novel targets for schizophrenia diagnoses and treatments.

Brain-derived neurotrophic factor (BDNF) has been implicated in the pathogenesis of psychiatric disorders, and studies have shown BDNF aberrations in major psychiatric diseases including schizophrenia (SCZ) and major depressive disorder (MDD). However, data from clinical studies were inconsistent. In this study, we recruited 34 patients with MDD, 77 patients with SCZ and 65 healthy control (HC) subjects to clarify the circulating BDNF levels in MDD and SCZ patients, and to assess whether serum BDNF levels were associated with the disease severity. Our results showed that serum BDNF levels were significantly decreased in the patients with SCZ (Mean difference = -4.517, 95%CI of difference = -7.854 to -1.180, p 0.01) and MDD (Mean difference = -5.699, 95%CI of difference = -9.892 to -1.506, p 0.01) when compared with HC subjects. Sub-group analyses suggested that BDNF levels were significantly reduced in the female SCZ (Mean difference = -5.700, 95%CI of difference = -10.21 to -1.189, p 0.01) and MDD (Mean difference = -5.840, 95%CI of difference = -10.66 to -1.019, p 0.05) patients, but not in male patients. Further analyses indicated that serum BDNF levels were not correlated with disease severity of MDD and SCZ. In addition, the transcriptional expression of TrkB was significantly down-regulated in the blood of MDD patients, but not in SCZ patients. However, there was no significant correlation between BDNF concentrations and TrkB mRNA levels. Taken together, our results revealed differential changes of BDNF-TrkB signaling in MDD and SCZ patients, therefore contributed to a better understanding of MDD and SCZ pathophysiology.

Hypertension (HTN) and osteoporosis are associated with the development and progress of atherosclerosis. However, little research has been conducted to examine the relationship between arterial stiffness and bone mineral density (BMD) in men with HTN. This cross‐sectional study recruited 355 men with HTN and 353 control patients without HTN. Brachial‐ankle pulse wave velocity (baPWV) and BMD measurements were performed. BMD was decreased and baPWV was elevated in patients with HTN compared with control patients (femoral neck [FN] BMD in the HTN and control groups were 0.662±0.195 g/cm(2) and 0.713±0.204 g/cm(2), respectively [P=.001], and baPWV in the HTN and control groups were 1403.3±156.8 cm/s and 1354.8±136.0 cm/s, respectively [P

Oxidative stress has been suggested to be involved in schizophrenia, but studies have demonstrated inconsistent results on oxidative stress marker level/activity in patients with schizophrenia. In order to clarify the circulating oxidative stress marker level/activity in patients with schizophrenia, this study recruited 80 schizophrenia patients (40 first-episode, drug-free and 40 chronically medicated patients) and 80 controls to analyze serum activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and total antioxidant capacity (T-AOC), and levels of lipid peroxidation marker malondialdehyde (MDA) in schizophrenia patients, and whether they associate with the severity of the disease. We showed that only serum GSH-Px activity was significantly reduced in unmedicated patients with schizophrenia when compared with control subjects, whereas the other three analyzed oxidative stress markers did not show significant differences between cases and controls. Moreover, our results demonstrated that chronic medication increased GSH-Px activity and MDA levels in patients with schizophrenia, but reduced SOD activity in the patients. We also found that short-term antipsychotic treatments on the patients with schizophrenia reduced the SOD activity. Correlation analyses indicated that the oxidative stress marker activity/level is not significantly associated with the severity of schizophrenia, except that SOD level correlated with PANSS positive score significantly. Taken together, the data from the present study suggested that the dysfunctions of oxidative stress markers in patients with schizophrenia were mainly caused by antipsychotics, emphasizing increased oxidative stress as a potential side effect of antipsychotics on the patients.

Objective To evaluate the performance of a convolutional neural network (CNN) model that can automatically detect and classify rib fractures, and output structured reports from computed tomography (CT) images. Materials and methods This study included 1079 patients (median age, 55 years; men, 718) from three hospitals, between January 2011 and January 2019, who were divided into a monocentric training set (n = 876; median age, 55 years; men, 582), five multicenter/multiparameter validation sets (n = 173; median age, 59 years; men, 118) with different slice thicknesses and image pixels, and a normal control set (n = 30; median age, 53 years; men, 18). Three classifications (fresh, healing, and old fracture) combined with fracture location (corresponding CT layers) were detected automatically and delivered in a structured report. Precision, recall, and F1-score were selected as metrics to measure the optimum CNN model. Detection/diagnosis time, precision, and sensitivity were employed to compare the diagnostic efficiency of the structured report and that of experienced radiologists. Results A total of 25054 annotations (fresh fracture, 10089; healing fracture, 10922; old fracture, 4043) were labelled for training (18584) and validation (6470). The detection efficiency was higher for fresh fractures and healing fractures than for old fractures (F1-scores, 0.849, 0.856, 0.770, respectively, p = 0.023 for each), and the robustness of the model was good in the five multicenter/multiparameter validation sets (all mean F1-scores > 0.8 except validation set 5 [512 × 512 pixels; F1-score = 0.757]). The precision of the five radiologists improved from 80.3% to 91.1%, and the sensitivity increased from 62.4% to 86.3% with artificial intelligence-assisted diagnosis. On average, the diagnosis time of the radiologists was reduced by 73.9 seconds. Conclusion Our CNN model for automatic rib fracture detection could assist radiologists in improving diagnostic efficiency, reducing diagnosis time and radiologists' workload.

Various vascular risk factors such as smoking, obesity, and diabetes mellitus are associated with hyper- viscosity and lumbar disc herniation (LDH). However, the changes of viscosity in LDH have not been examined. AIMS: The present study was to elucidate 1) the rheological parameter levels in patients with LDH, 2) the risk factors that were related to rheological parameters. METHODS: Our study evaluated the rheological parameters in 307 cases with LDH and in 307 control subjects. Multiple linear regression analysis was conducted to assess the significant factors for whole blood viscosity (WBV) at low shear rate. RESULTS: LDH patients had markedly lower physical activity and significantly higher WBV 3 s -1 compared with non-LDH subjects (p < 0.001). Moreover, WBV (3 s -1 ) tended to increase as physical activity decreased. Multiple linear regression analysis revealed that reduced physical activity was a significant factor contributing to elevated WBV (3 s -1 ). CONCLUSIONS: WBV (3 s -1 ) is elevated in patients with LDH. In addition, reduced physical activity is a significant factor for WBV (3 s -1 ). Further studies are warranted to determine the role of WBV (3 s -1 ) in LDH.

To investigate the efficacy of ileal ureteric replacement in the treatment of iatrogenic long segment ureteric injuries.The hospital records of 9 cases with iatrogenic long segment ureteric injuries during Aug. 2010 to Sept. 2014 treated with ileal ureteric replacement were retrospectively reviewed and followed-up postoperatively. The patients included 3 males and 6 females with a median age of 40 years. The length of injury segment was 13-25 cm (median 20 cm). The etiology of the iatrogenic injury was urological surgery (n=6), gynecological surgery (n=2) and general surgery (n=1), respectively. The ureter stent was removed in 1-2 month postoperatively in all the 9 cases.All the operations were successful. The operation time was 203-394 min, with the average of (278.1±68.8) min. The bleeding volume was 10-1 000 mL, with the median of 200 mL. The mean length of hospital stay was (16.8±7.5) days. Four minor complications (Grade I-II) developed, including 3 ileus (33.3%) and 1 proximal anastomotic leakage (11.1%). The median follow-up time was 11 months, serum creatinine decreased or remained stable in 8 patients (88.9%). Three patients (33.3%) developed mild hydronephrosis and short-time urinary tract infection was seen in 1 patient (11.1%). Metabolic acidosis was not detected during the follow-up.Ileal ureteric replacement is a safe and effective method in patients with complex or difficult iatrogenic long segment ureteric injuries.

The relationship between single nucleotide polymorphism (SNP) of interleukin-17 (IL-17A), transforming growth factor β (TGF-β), as well as its receptor (TGFR-β2) and susceptibility to intracerebral hemorrhage in patients with brain arteriovenous malformation (BAVM) was investigated in the present study. A total of 53 patients with BAVM and 120 healthy controls were recruited, all of whom were Han Chinese from South China. There were no statistically significant differences in the IL-17A-197 guanine/adenine (G/A) or TGF-β1-509 cytosine/thymine (C/T) genotypes or gene frequencies between BAVM patients and controls (p>0.05), but the gene frequency of the TGFR-β2-875 A/G genotype in patients with BAVM was significantly higher (p

Hydroxysafflor yellow A (HSYA) is a main bio-active compound important of a traditional Chinese medicine named Carthamus tinctorius L. and has been shown to possess various effects, especially anti-inflammatory benefits and potential protections against acute lung injury (ALI) in previous studies. Therefore, in this present study, we aimed to evaluating effects of HSYA on lipopolysaccharide (LPS)-induced ALI in mice. ALI was induced by intratracheal instillation of LPS into lung, and dexamethasone was used as a positive control. Results demonstrated that HSYA abated LPS-induced pathological change and attenuated lung vascular permeability and edema. HSYA down-regulated both the ability of myeloperoxidase (MPO) in lung tissues and levels of inflammatory mediators including tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6 and IFN(interferon)-β in serum. Moreover, HSYA prevented toll-like receptor 4 (TLR4), myeloid differentiation factor 88 (MyD88) and TIR-domain-containing adapter-inducing interferon-β (TRIF) protein up-expressions. In addition, the activations of mitogen-activated protein kinases including p38, extracellular signal-regulated kinase (ERK), c-Jun N-terminal kinase (JNK) were blocked by HSYA. And also, the phosphorylations of interferon regulatory factor 3 (IRF3), translocation of nuclear factor kappa B (NF-κB)/p65 and inhibitory kappa B (IκB)-α were inhibited by HSYA. In conclusion, HSYA attenuated inflammatory response in ALI mice through inhibition of TLR 4-dependent signaling pathways.

To determine whether the extruded irrigation solution bag during passage of rigid cystoscope will reduce the patient's discomfort.In the study, 378 male patients undergoing rigid cystoscopies were randomized into "Institute of Urology Peking University (IUPU)" technique group (n = 193) and routine manipulation group (n = 185). All the patients had received 10 mL oxybuprocaine gel before manipulation. In the IUPU technique group, irrigation solution bag was connected with cystoscope sheath and obturator. As the scope passed through the bulbar urethra, a nurse was instructed to extrude the irrigating fluid bag. A 10-point visual analog pain scale assessment was completed by the patient after the procedure.The visual analog pain score was 2 (1-2) in the IUPU technique group and 4 (3-6) in the routine manipulation group (P0.001, Mann-Whitney U test). All the procedure indications had no effect on the findings.This study has shown that a simple IUPU technique can significantly reduce the patient's discomfort during outpatient rigid cystoscopy. We strongly recommend this technique for all male patients undergoing rigid cystoscopy.

Alzheimer's disease (AD) is a progressive neurological disorder that primarily affects memory, and its prevalence is rising. Increasing evidence suggests that dysfunction of the blood-brain barrier (BBB) may be involved in AD and other neurodegenerative diseases. Herein, we report that the permeability of the BBB is increased and that AD-like alterations are present in Slit-2 overexpressing transgenic mice. We found that behavioral change and the corresponding molecular diagnostic markers of AD, such as hippocampal neuron apoptosis, amyloid-β (Aβ) protein deposition, and acetylcholinesterase expression, were increased in the Slit-2 transgenic mice. Moreover, the endothelial cells were dysfunctional, the size of the lateral ventricle cavity increased, and the permeability of the BBB increased. Additionally, there was an increased serum level of glutamate indicating that the BBB is related to AD. Finally, histopathological analysis of other organs in the Slit-2 overexpressing mice did not show any marked abnormalities. These findings demonstrate that Slit2 overexpression may be responsible for AD-like alterations and the increased BBB permeability in these mice. Our study provides a potential novel mechanism for the development of AD.

To summarize more than thirty years of experience with urachal carcinoma and to discuss the clinical features of urachal carcinoma.The clinical data of 22 patients with urachal carcinoma, 18 males and 4 females, their median age at diagnosis was 52 years (range: 31-77 years), were analyzed retrospectively.Twenty-one cases were urachal adenocarcinoma, and 1 was small cell carcinoma. The first common symptom was gross hematuria in the urachal carcinoma patients (20/22, 90.9%), and CT showed calcification in 18.75% of them (3/16). The cystoscopic finding was a mass seen at the dome of the bladder or anterior wall in all. Twenty cases were followed up (90.9%), with the median follow-up 28 months (range: 3-184 months). The overall 5-year cancer-specific survival rate was 49.5%. It was significantly different in survival between T2 and T3 or more in the urachal carcinoma patients by survival analysis (P=0.026).The results indicate that the most important predictor of prognosis is tumor stage, and it is critical for diagnosis of urachal carcinoma by CT scan and cystoscopy. Extended partial cystectomy is the main surgery of patients with urachal carcinoma. Active multimodal treatments may improve the survival of patients with recurrent and metastatic disease.

Sunitinib has been proved an effective new option for treatment of metastatic renal cell carcinoma (mRCC). Analysis of clinical data of 22 patients, who were exposed to sunitinib for at least 1 year, was conducted to evaluate the long-term efficacy and safety of sunitinib for the treatment of mRCC.A total of 54 patients with mRCC were treated with sunitinib malate, 50 mg/d orally, on a 4-weeks-on and 2-weeks-off dosing schedule in Peking University First Hospital. Treatment continued until disease progression, unacceptable adverse events (AEs), or death. Among them, 22 patients continued treatment for at least 1 year. The clinical data of these 22 patients were prospectively collected for analysis. AEs were assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 3.0. Tumor response was evaluated in accordance with the Response Evaluation Criteria in Solid Tumors.Median progression-free survival was 19.5 months until last follow-up. The best efficacy results achieved were complete response, partial response, and stable disease for 2, 9, and 11 patients, respectively. Objective response rate was 50%. The most common AEs were hand-foot syndrome (95%) and hypertension (91%). Other common AEs were thyroid-stimulating hormone elevation (82%), platelet decrease (77%), and loss of appetite (77%). Only one patient withdrew from treatment for cardiac infarction. Another nine patients experienced dose modifications or short-term suspensions.Long-term exposure to sunitinib malate showed encouraging efficacy in the treatment of mRCC. At the same time, the tolerability was good.

To analyse the predictive factors for worse pathological outcome (muscle invasive pT2+, non-organ-confined pT3+ or N+ and histological Grade 3) of upper tract urothelial carcinoma (UTUC) in a Chinese population from a nationwide high-volume centre in China.Predictors were studied by retrospectively reviewing the clinicopathological data of 729 consecutive patients with UTUC treated in our centre from January 2002 to December 2010. Univariate and multivariate logistic regression analyses were used.There were more female patients (56.4%) than males and more tumours were located in the ureter (52.7%) than in the pelvis. In multivariate analysis, male gender (hazard ratio [HR] 1.898, P = 0.001), sessile architecture (HR 3.249, P0.001), high grade (HR 5.007, P0.001), ipsilateral hydronephrosis (HR 4.768, P0.001), renal pelvis location (HR 2.620, P0.001) and tumour without multifocality (HR 1.639, P = 0.028) were predictive factors for muscle-invasive UTUC. Male gender (HR 2.132, P0.001), renal pelvis location (HR 3.466, P0.001), tumour without multifocality (HR 2.532, P = 0.001), sessile tumour architecture (HR 3.274, P0.001), and high grade (HR 3.019, P0.001) were predictive factors for non-organ-confined disease. Chronological old age (HR 1.047, P0.001), sessile tumour architecture (HR 25.192, P0.001), ipsilateral hydronephrosis (HR 1.689, P = 0.024), and positive urinary cytology (HR 1.997, P = 0.006) were predictive factors for histological Grade 3 UTUC.There was a predominance of female patients and ureteric tumours in UTUCs of this Chinese population. Male gender, sessile architecture, tumour location, tumour without multifocality, high histological grade and preoperative ipsilateral hydronephrosis were independent predictive factors for worse pathological outcome of UTUCs.

To investigate the clinical significance of preoperative aspects and dimensions used for anatomic (PADUA) and radius exophytic/endophytic nearness anterior/posterior location (RENAL) scoring systems for renal neoplasms in patients undergoing laparoscopic partial nephrectomy.A retrospective analysis was carried out on clinical data of 245 Chinese patients with renal neoplasms undergoing laparoscopic partial nephrectomy from June 2008 to June 2012. The perioperative complications and variables, as well as PADUA and RENAL score, were compared.The PADUA and RENAL scoring systems were significantly associated with percent change in estimated glomerular filtration rate (P = 0.032 and P = 0.026 respectively), whereas the RENAL scoring system was also significantly associated with warm ischemia time (P = 0.032). On multivariate analysis, both scores were able to predict percent change in estimated glomerular filtration rate (PADUA, P = 0.011; RENAL, P = 0.028). There were no significant associations between the two scoring systems assessed and the occurrence of complications or tumor stage. The correlation between PADUA classification and RENAL nephrometry score was significant (P 0.0001). Fleiss' generalized kappa was 0.69-0.89 for the various components of the PADUA score and 0.67-0.89 for the RENAL nephrometry components.The PADUA classification and RENAL nephrometry score are comprehensive assessment tools for delineating renal tumor anatomy. The reproducibility of the PADUA and RENAL scores is substantial, but further research is required to evaluate its performance in more accurately predicting operative and patient-related outcomes.

To analyze the clinicopathologic features of 10 Chinese prostate adenocarcinoma patients under 50 years.Between January 2007 and April 2012, 10 cases of prostate adenocarcinoma patients under 50 years (age: 36-49) were diagnosed at our institution through prostate biopsy. The indications of biopsy were abnormal digital rectal examination (7 cases) and/or a total prostate specific antigen (PSA) over 4.0 μg/L (4 cases). The clinicopathological data of these patients were reviewed. The results of biopsy were 1 case with Gleason score (GS) 6, 4 cases with GS 7 and 5 cases with GS 9. In the study, 7 patients were diagnosed with cT4. Lymph node metastasis and bone metastasis were found in 5 and 4 cases, respectively. The treatments were hormonal therapy in 5 cases, radical prostatectomy in 2 cases and combination therapy in 3 cases.During the follow-up, 6 patients were in progression within 3 to 7 months, 1 patient died after 3 years, and 4 patients were lost of the follow-up.These findings suggest that the Chinese prostate adenocarcinoma patients with age under 50 years are likely to have more aggressive tumor and combination therapy might be appropriate.

To investigate and analyze the treatment and Long-term follow-up results of adult Wilms' tumor.Medical records for diagnosed Wilms' tumor in patients aged more than 15 years from Jan. 1970 to Dec. 2011 were reviewed retrospectively. The clinical presentations, stages, operative details, pathologic findings, adjuvant therapies and outcomes were analyzed. All the patients received regular follow-up, and particular attention was paid to the median follow-up period and tumor specific survival time.The records revealed the 10 patients with a median age of 33.5 year. Male and female were each 5. Left was 4 and right was 6. In the study, 80% of the patients had clinical presentations, and 30% of the patients presented with abdominal mass, and 30% of the patients had distant metastasis at the time of diagnosis. The number of the patients with tumor stages I,II, III, and IV were 2, 1, 4, and 3. One patient just underwent fine needle biopsy due to advanced tumor stage, and the others underwent surgical operations. The range of the follow-up time was 12 to 187 months, and the median follow-up period was 20 months. One patient lost the follow up , 5 patients died, 2 patients survived with tumor recurrence, and 2 patients survived without tumor recurrence. The median survival period was 42 months, and one patient lost the follow-up.The Long-term follow-up data demonstrated the poor prognosis of adult Wilms' tumor. Early tumor stage and the combination of operation, radiotherapy and chemotherapy are key factors to improve the outcomes.

To investigate the clinical significance of R.E.N.A.L. nephrometry score for renal neoplasms in patients undergoing nephron sparing surgery.A retrospective analysis was conducted of clinical data of 110 patients with renal neoplasms undergoing nephron sparing surgery, who were admitted to Peking University First Hospital from January 2010 to January 2012. The operation approaches, perioperative variables and perioperative complications as well as R.E.N.A.L. scores were compared.The R.E.N.A.L. nephrometry score was significantly associated with the operation approach (P0.001), while there was no significant association between the scoring system and the occurrence of complications (P0.611). Meanwhile, it was associated with ischemia time (P0.023) and percentage change in the creatinine level (P0.025). Low complexity tumors had significantly shorter ischemia time and low percentage change in the creatinine level than high complexity tumors (P0.008, P0.010). Fleiss' generalized kappa was 0.52 to 0.89 for the R.E.N.A.L. nephrometry components.The R.E.N.A.L. nephrometry score is a comprehensive assessment tool for delineating renal tumor anatomy. The reproducibility of R.E.N.A.L. nephrometry scores is substantial, but further research is required to evaluate its performance in predicting operative outcomes more accurately.

To evaluate the changes in perioperative outcomes that might refect progress along the learning curving by a single-surgeon's experience in our institution with laparoscopic radical cystectomy (LRC).This report was conducted between May 2004 and January 2012 in 60 patients (9 women and 51 men) who underwent LRC for bladder cancer. The mean patient age was (60.8±11.4) years, and mean BMI was (23.9±2.7) kg/m(2). We divided the patients into 3 groups (group A, group B, and group C; each group had twenty patients) by the time, and compared the operative time, intraoperative blood loss, hospital stay among the three groups.The mean intraoperative blood loss was (799.2±717.8) mL, the mean operative time was (420.2±119.8) minutes, and the mean hospital stay was (15.7±11.0) d; There was no statistically significant difference in age, American Society of Anesthesiologists (ASA) scores and BMI among the three groups (P0.05). Their operative time was (497.5±131.2), (413.6±75.6) and (349.4±100.2) minutes, respectively, for each group, P0.001. The intraoperative blood loss was (1 080.0±1 028.8), (862.5±510.6) and (455.5±262.3) mL, for each group, P=0.018. The hospital stay was (20.8±13.5), (16.4±10.6) and (9.8±4.4) d, for each group, P=0.005. However, there was no statistically significant difference in postoperative complications among the three groups.Our experience of LRC appears to be favorable with reduction in blood loss, operative time and hospital stay with increasing experience. The curving shows a significant decline at 2 different breakpoints: after the first 20 cases, and after 40 cases.

To investigate the predictive value of prostate-specific antigen (PSA) and Gleason sum for results of radionuclide bone scintigraphy in prostate cancer patients, in order to determine when to perform a radionuclide bone scintigraphy in Chinese patients with newly diagnosed prostate cancer.We retrospectively reviewed the charts of 624 consecutive patients with a pathology diagnosis of prostate cancer hospitalized in Department of Urology, Peking University First Hospital between Jan. 1994 and Dec. 2005, and evaluated the relationships between results of bone scintigraphy and serum tPSA, and between bone scintigraphy and Gleason sum. The receiver operating characteristics (ROC) curves were analyzed to determine the cut-off values of tPSA and Gleason sum for predicting positive results of bone scintigraphy.In the study, 443 patients underwent both a radionuclide bone scan and a serum PSA test prior to treatment, of whom, 216 (48.8%) got positive results, and 338 also possessed the Gleason sum for pathological evaluation. The serum tPSA levels were significantly higher in patients with positive results of the bone scan ( median: 71.00 μg/L; range: 1.30-2 400.00 μg/L) than those with negative results ( median: 60.00 μg/L; range: 0.60-201.00 μg/L; rank P0.001), and the Gleason sums were also significantly higher in positive-bone-scan patients than in negative-bone-scan patients (7.7±1.5 vs. 6.7±1.8, P0.001). Linear regression analysis suggested significant positive correlation between the results of the bone scan and the two afore-mentioned parameters, respectively (lg[PSA]: r=0.933, B=0.352, P=0.001; Gleason sum: r=0.971, B=0.096, P0.001). The incidence of a positive bone scan result was 9.0% in patients with tPSA10 μg/L and 3.8% in patients with Gleason sum5. When the indication for bone scan was established as tPSA15 μg/L or Gleason sum≥7,its sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy for positive results were 97.5%, 24.7%, 54.4%, 91.5% and 60.0%, respectively.In patients with prostate cancer, their positive results of the bone scan are significantly positively correlated to their higher PSA levels and higher Gleason sums, respectively. Our analyses suggest that a patient with newly diagnosed prostate cancer would not need to undergo radionuclide bone scintigraphy when the PSA level is lower than 10 μg/L and Gleason sum is less than 5, and that a prostate cancer patient with tPSA15 μ g/L or Gleason sum≥7 should take a bone scintigraphy.

To compare the costs and benefits of different thrombolytic strategies with urokinase (UK) and recombinant tissue plasminogen activator (rt-PA) in treating acute pulmonary thromboembolism (PTE), with aim of providing optimal thrombolytic medication.Data from 156 patients with PTE from January 2006 to December 2011 in Tangshan Gongren Hospital was analyzed retrospectively. All patients were treated by thrombolysis, among them 104 patients were treated with 1×10(4) U/kg of UK and 52 patients were treated with 50 mg of rt-PA. The therapeutic effects of two methods were compared and the complication incidence rate and medical cost were also compared.There were no significant differences in the symptom remission rate, the recanalization rate, and the incidence of complications between UK group and rt-PA group (68.2% vs. 71.2%, 63.5% vs. 73.1%, 14.4% vs. 17.3%, all P0.05), but the treatment cost (yuan) of UK group was remarkably lower than that of rt-PA group (408 ± 120 vs. 6500 ± 634, P0.01).Different thrombolytic strategies with UK and rt-PA yield similar efficacy, however, the medical cost was significant decreased in UK group.

To evaluate the feasibility of laparoscopic adrenalectomy in the treatment of adrenal ganglioneuromas.The clinical data of 12 cases of adrenal ganglioneuromas undergoing laparoscopic adrenalectomy between February 2002 and August 2010 were reviewed retrospectively.None of them had endocrine function. The average long diameter of ganglioneuromas was 6.5 cm (range: 1.5 - 16.8 cm). Ten tumors were resected through retroperitoneal approach with an average long diameter of 6.0 cm and another two through transperitoneal approach with 7.5 and 10.7 cm in size respectively. Three tumors surrounded renal pedicle and one adhered to kidney. The average operative duration was 144 minutes, average blood loss 194 ml and average postoperative hospitalization stay 5.4 days. None had local recurrence and distant metastasis during a mean follow-up period of 45 months.Laparoscopic adrenalectomy is both safe and feasible for adrenal ganglioneuromas if an appropriate approach is chosen and renal pedicle well-protected.

To summarize the clinical outcome and adverse events of estrogen therapy for hormone refractory prostate cancer.A total of 32 patients with hormone refractory prostate cancer received diethylstilbestrol (DES) 2 mg daily at our institute. The data of PSA (prostate-specific antigen) change, time to progression, overall survival rate, disease-specific survival rate and adverse events were collected and analyzed.The data of 29 patients were complete. The mean duration of DES dosing was 8.6 ± 0.9 months. Among them, 8 (27.5%) patients achieved a PSA response with a 50% decrement of PSA or more. Seven (24.1%) patients had a stable level of PSA (50%PSA125%) while 14 of 29 (48.3%) maintained a PSA progression with a 25% increment of PSA or more. The overall median time to progression was 4 (1 - 12) months. And the median time to progression was 6 (5-12) months in the PSA response group. The overall survival rate was 48.3% and disease-specific survival rate 55.2%. The main adverse events were gynecomastia (10/29, 34.5%) and deep vein thrombosis (3/29, 10.3%).When used for the treatment of hormone refractory prostate cancer, diethylstilbestrol at a daily dose of 2 mg can achieve a PSA response in 27.5% patients and a PSA stability in 24.1% patients. And the median time to progression is 4 months. Estrogen is efficacious for the patients with hormone refractory prostate cancer.

The tyrosine kinase inhibitors (TKIs) sunitinib, the first targeted agent for the first line treatment of metastatic renal cell carcinoma (RCC), targets the vascular endothelial growth factor (VEGF) pathway. The objective of this study was to investigate the efficacy and safety of sunitinib in treating metastatic clear-cell RCC and to confirm if hypertension is an effective predictive factor.A total of 36 patients with metastatic RCC were enrolled between June 2008 and December 2010. Among them 29 cases were first line therapy and 7 cases were in progression on first-line cytokine or sorafinib therapy. The pathology of all patients was confirmed predominant in clear cell type. Sunitinib mono-therapy was administered in repeated 6-week cycles of daily oral therapy for 4 weeks, followed by 2 weeks off in 34 patients; and 3 patients were administered with 37.5 mg/d continuously until disease progression or unacceptable toxicities occurred. Overall response rate and safety were evaluated. We divided patients into Group A and Group B according to the blood pressure level.The median follow-up was 15 months (10 cycles, range 1.5 - 30.0 months (1 - 20 cycles)). Ten patients (29.4%) achieved partial responses (PR); 23 patients (67.6%) demonstrated stable disease (SD) lasting ≥ 2 cycles. Seventeen patients (50%) developed progressive disease (PD) during follow-up. The median progression-free survival (PFS) was 15 months (range 3.0 - 28.5) months. A total of 9 patients died; the overall survival has not been reached; the median survival time of the deceased patients was 13 months (range 7 - 24) months. The most common adverse events were hand-foot syndrome (77.8%), thrombocytopenia (75.0%), hypertension (61.1%) and diarrhea (46.0%). Most adverse events were reversible by treatment interruption. Twenty-two patients (61.1%) developed hypertension; and hypertension was associated with a long time to disease progression and long overall survival (P = 0.004, 0.000, respectively).The results of this study demonstrate the efficacy and manageable adverse event profile of sunitinib as a single agent in first- or second-line therapy for patients with metastatic clear cell RCC. Further, sunitinib-associated hypertension may be a strong predictive marker for treatment efficacy in metastatic RCC.

To discuss the surgical skills and clinical value of complete transperitoneal laparoscopic nephroureterectomy.We collected and analyzed the clinical data of 25 patients (14 renal pelvic carcinoma and 11 carcinoma of ulreter, right side 15 and left side 10) who underwent complete transperitoneal laparoscopic nephroureterectomy for the upper urinary tract urothelial carcinoma (UUT-UC) in Peking University First Hospital from May 2010 to April 2011.All the operations were successfully done by one surgeon with standard 4 or 5 trocars technique. The mean operative time was 150 min (120-180 min), the blood loss about 20-100 mL (mean 40 mL) and no severe complications observed. The postoperative hospital stay was 4-6 days with an average length of 5.5 days. The mean follow-up was 5.5 (1-11) months. One of 19 patients underwent trans urethral resection of bladder tumour (TURBT) for recurrent non-muscle invasive bladder tumor.Complete transperitoneal laparoscopic nephroureterectomy is a minimally invasive, safe and effective way to treat UUT-UC. The patients recover soon and have a shorter length of stay.

To discuss the feasibility and safety of laparoscopic transperitoneal and transmesenteric pyeloplasty for recurrent ureteropelvic junction obstruction (UPJO).From May 2006 to June 2008, we admitted 5 cases of recurrent UPJO who had received open retroperitoneal pyeloplasty with 3 males and 2 females. They were 19 to 32 years old with the average of 24.5 years and suffered from recurrent UPJO 3 to 16 years with the average of 7.8 years after operation. They felt discomfort in the lumbar region to different extent and their intravenous pyelography (IVP) or computerized tomography for urinary system (CTU) showed typical UPJO. The nucleotide renal scan (NRS) revealed that the renal excretion was slow, even after intravenous injection of diuretics. The laparoscopic transperitoneal and transmesenteric pathway was done in such a way that the incision was longitudinal at the mesentery of small intestine near the affected ureteropelvic junction (UPJ). The UPJ was isolated to avoid injuring the intestine and the mesenteric blood vessels. The UPJO was removed with the routine Anderson-Hynes technique and the anastomosis between pelvis and ureter was carried out by 2 separate and running sutures.The operating time was 105-230 min with the average of 165 min and the estimated blood loss was 50 to 120 mL with the average of 75 mL. Patients left bed on the first day and the drainage tube was taken out on the 4th to 5th day after the operation. There were no other injuries and complications. By October of 2008, they had been followed up for 33 to 49 months with the average of 37.5 months and IVP or CTU and the diuretic NRS showed smooth excretion of the operated UPJ.As for experienced hands, the laparoscopic transperitoneal and transmesenteric pyeloplasty is feasible and safe for recurrent UPJO, but it's not recommended to the beginners of laparoscopic procedures.

To investigate the effect of intermittent hormonal therapy (IHT) for patients with different stage/grade prostate cancer (PCa).The number of cycles and the duration of ON/OFF therapy for 45 PCa patients receiving IHT were observed. Maximal androgen blockade (MAB) therapies were used for six to nine months, and then stopped until the serum prostate specific antigen (PSA) was decreased below 0.2 microg/L, which lasted for three months. It was decided whether MAB went on according to the level of PSA.The average follow-up time was 40.7+/-13.4 months. Forty-one patients started the second cycle of treatment, of whom, 8 became androgen-independent and 7 were at T3-4M0 or M1 stages and the Gleason scores were above 8. Sixteen patients entered the third cycle, of whom, 14 were at lower than stage III and 13 had the Gleason scores below 7. From the first to the fourth courses of treatment, the average intervals were 8.7+/-5.4 (47.1%), 8.4+/-4.9 (49.3%), 7.0+/-3.4 (43.7%), and 3.7+/-0.6(42.5%) months respectively. Five patients developed bone metastasis. No one died up to now. According to the evaluation criteria, patients were divided into tolerance (n=16) and intolerance groups (n=29). Compared with the intolerance group, the patients who tolerated the treatment well had lower Gleason scores (P=0.002), lower PSA levels (P=0.053) and lower tumor stages (P=0.001). There was no evidence that age, lymph node metastasis, bone metastasis and the state of recurrence were associated with an increased risk of the outcome. Non-conditional Logistic regression analysis showed that the proportion of patients at stage IV was the only independent risk factor for the tolerance of the treatment (OR=12.113, 95%CI 1.330-110.312, P=0.027).Intermittent hormonal therapy is more effective and proper for the patient with highly differentiated tumor and at lower stages (or = III). The patients who progressed to hormone-independence are mostly at stage IV with poorly differentiated tumor. Intermittent hormone therapy could be more adaptive for the patients at lower than stage III.

To compare the safety and efficacy of laparoscopic and open partial nephrectomy for small renal cell carcinoma.To collect and analyze the data such as operation time, warm ischemia time, complications, recovery and surgical margins of 110 patients of small renal carcinoma (T1aN0M0) from January 2004 to March 2009, 52 of which underwent laparoscopic partial nephrectomy (LPN) and the other 58 patients underwent open partial nephrectomy (OPN).The mean operation time of LPN group and OPN group were 177.8 min and 126.7 min (t = 3.973, P0.01), respectively. The warm ischemia time of the two groups were 28.3 min and 21.9 min (t = 4.627, P0.05), respectively. Two cases in LPN group and 1 case in OPN group (3.8% vs 1.7%, chi(2) = 0.010, P0.05) needed blood transfusion. The increment of creatine after operation were 4 micromol/L in LPN group and 6 micromol/L in OPN group (t = -2.018, P0.05). Six cases (11.5%) in LPN group and 8 cases (13.8%) in OPN group needed collection system repairing (chi(2) = 0.130, P0.05)and the same data of hematuria after operation was observed. There was no urinary fistula or other severe complications in all patients. The hospital stay after operation was 10.6 d and 12.9 d (t = -3.244, P0.01) in the two groups, respectively. All surgical margins were negative.LPN and OPN have the same safety and efficacy, LPN primary treatment can be used for selected patients of T1aN0M0 renal cell carcinoma because of its fast recovery.

To evaluate the efficacy and safety of Sunitinib in the treatment of metastatic renal clear cell carcinoma in our institution.A total of 23 patients with metastatic clear cell RCC were enrolled from June 2008 to June 2009, male 16, female 7, median age 52 years. Twenty cases were treated by using Sunitinib as first-line therapy and 3 cases as second-line therapy. All pathological diagnosis was clear cell carcinoma. Sunitinib monotherapy was administered in repeated 6-week cycles of daily oral for 4 weeks, followed by 2 weeks off, until disease progression or intolerable toxicities occurred. Overall response rate and safety were evaluated.The median follow-up were 7.5 months (5 cycles). Four of 23 patients (17.4%) were treated with Sunitinib achieved partial responses (PR); 18 patients (78.3%) demonstrated stable disease (SD); 1 patient (4.3%)developed progressive disease (PD) during the study. Seventeen patients received treatment over 6 months (5 cycles). The 6 months' overall survival rate was 100%, 6 months' progression-free survival rate was 88.2%. The most commonly reported grade 3 adverse events included hand-foot syndrome (13.0%), thrombocytopenia(8.7%), diarrhea (4.3%)and fatigue (4.3%). Most grade 3 adverse events were ameliorated by dose-adjustment or treatment interruption.The results of this study demonstrate the efficacy and manageable adverse-event profile of Sunitinib as a single therapy in first-line or second-line therapy for patients with metastatic clear cell RCC.

To observe the clinical and pathological characteristics of brain arteriovenous malformations (BAVM) embolized with the non-adhesive aqueous embolic agent Onyx and evaluate its application in comprehensive treatment of BAVM.Thirty-four patients underwent BAVM embolization using Onyx, and their clinical manifestations, architecture of the malformed vessels, emblization procedure, and complications associated with the procedures were recorded. The resected tissues after embolization with Onyx were observed with electron microscope, and the prognosis of the patients was estimated with modified Rankin Score (mRS).These patients included 21 male and 13 female patients with a mean age of 30.45-/+11.81 years and an estimated mean size of the nidus of 3.98-/+1.43 cm. The patients received a total of 52 endovascular treatment procedures with Onyx to embolize 86 feeding pedicals, which resulted in an average estimated size reduction of the nidus of (72.35-/+21.26)%. Complications associated with the procedure occurred in 7 patients, and 23 patients received surgical resection or radiosurgery after embolization. Follow-up of the patients for 6 months to 4 years showed that the mRS was below 3 in 32 cases andor =3 in 2 cases. Vasodilatation, brain tissue edema surrounding the nidus, and inflammatory cell infiltration were observed in the resected tissues after embolization. In some major feeding pedicals, thrombus recanalization was observed after embolization with Onyx (diameteror =3 mm).Endovascular treatment of BAVM with Onyx can achieve high occlusion rate, enhance the safety of operation and radiosurgery, and improve the clinical prognosis of the patients.

Although circulating ghrelin levels correlate inversely with adiposity at baseline, little is known about the effect of percent visceral adipose tissue value (PVATV) on ghrelin expression and secretion in response to fasting. Our study demonstrated that ghrelin increased with 24-h fasting in rats with the lowest PVATV (less than 6%), after 3 days in rats with intermediate PVATV (6–9%) and 5 days in rats with the highest PVATV (greater than 9%). Ghrelin mRNA in the stomach was increased after 3 days in low-PVATV (5.8±0.9%) rats but not in high-PVATV (14±1.6%) rats. Therefore, both ghrelin secretion and mRNA were delayed in response to fasting in rats with increased visceral fat. In rats matched for PVATV, but with different body weights, the fasting induced similar levels of increased ghrelin while in rats with different PVATV ghrelin secretion was different in response to fasting, even when body weights were matched in two groups. These data suggested that the initial PVATV, not lean mass, was related to the pattern of plasma ghrelin in response to fasting in rats.

To investigate the incidence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in men agedor = 50 years and to achieve the correlation between LUTS (obstructive symptoms and stimulant symptoms) and ED.We investigated 245 men agedor = 50 years and with regular sex mates using International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5), designed diagnostic interrogation and medical examination, and statistically analyzed the results of IPSS, IIEF-5, LUTS and their correlation with erectile function.The incidence of ED was 81.9% (140/171) among the men with LUTS, 73.1% (38/52), 82.1% (46/56) and 88.9% (56/63) respectively in the 50-59, 60-69 andor = 70 age groups, with significant differences in IPSS, IIEF-5 (P0.01) and the severity of ED (P0.01) among different age groups. ED incidence was found significantly correlated with the severity of LUTS (r = 0.52, P0.01), 71.3% (57/80), 89.6% (60/67) and 95.8% (23/24) respectively in the groups of mild, moderate and severe LUTS. The mean scores on obstructive and stimulant symptoms were (3.1 +/- 3.6) and (6.8 +/- 4.9), and their correlation coefficients with IIEF-5 were r = -0.41 (P0.01) and r = -0.59 (P0.01), respectively.The incidence of ED is high in men with LUTS and positively correlated with the severity of LUTS. Stimulant symptoms have greater influence than obstructive symptoms on the sexual life of old and middle-aged males.

The present study was to investigate the therapeutic efficacy of the magnetic arsenic trioxide (ATO) nanoparticles against osteosarcoma in vivo tumor models. ATO was incorporated in the magnetic nanoparticles and encapsulated by poly lactic acid. Human MG-63 osteosarcoma cells were injected subcutaneously into the nude mice. After 15 days, the mice were randomly assigned to the four groups (n=6 mice): group 1: control, saline only (10 mL kg(-1) day(-1), intravenously (i.v.)); group 2: ATO alone (5 mg kg(-1) day(-1), i.v.); group 3: magnetic ATO nanoparticles at a dose equivalent to 50% of the ATO alone, with an external magnetic field on the tumor; group 4: CDDP, cisplatin (5 mg kg(-1) day(-1), i.v.). The mice were sacrificed after 21 days. In vitro release profiles showed that ATO was released rapidly from the nanoparticles. The magnetic ATO evaluation indicated that the magnetic nanoparticles might localize under the magnet in vivo. The tumor volume examination showed that the treatment with magnetic ATO nanoparticles achieved the similar inhibition effect on osteosarcoma as that of CDDP or ATO alone. Electron microscopic features typical of apoptosis were identified in the tumor tissue with the three-drug treatment. This "magnetic ATO targeting" offers an opportunity to treat osteosarcoma with a lower dose.

To investigate the effect of Protein kinase B on the expression and location of p21 in mouse early development. Immunopreciptation technology was used to detect the localization of p21 and Western blotting was used to analyze the expression of p21 after microinjecting mRNA of WT-PKB, myt-PKB and PKB-KD to mouse eggs. There was no obvious difference between the three kinds of mRNA in the expression of p21. But the cell localization altered. The p21 retain in cytoplasm after microjecting myt-PKB. In mouse fertilized egg PKB/Akt controls the cell cycle by changing the cell localization of p21.

To elevate the diagnosis and differential diagnosis levels of epididymal mass by sonography.This was a retrospective study of 179 cases of epididymal mass treated by surgery in our hospital between 1990 and 2005. The analysis was focused on pathological and sonographic features.179 patients with mean age of 51.4 +/- 14.7 were enrolled. The epididymal mass was classified into four groups: epididymal cyst (n = 98), nonspecific epididymitis (n = 27), tuberculous epididymitis (n = 33) , and epididymal tumor (n = 21). Epididymal cyst could be easily diagnosed by ultrasound, the diagnostic rate was 93.8%, but nonspecific epididymitis and tuberculous epididymitis were hard to differentiate, complicating with multiple organs lesions may distinguish tuberculous from nonspecific epididymitis. Tuberculous epididymitis could be easily diagnosed when cold abscess, calcification and sinus tract emerged. The majority epididymal tumors were benign, and malignant cases were rarely seen. Patient's history, physical examination and sonographic features were all essential to make a right diagnosis.Ultrasound features may be helpful to the differential diagnosis of epididymal mass and ultrasound should be the first choice of image detection in epididymal lesions.

To summarize the experience of ultrasound guided percutaneous aspiration and sclerotherapy for peripelvic cysts and investigate the clinical effect.A total of 169 cases of peripelvic cyst patients were evaluated, of whom 36 cases (21.3%) had hydronephrosis secondary to peripelvic cysts, 8 cases (4.7%) had renal calculus. All patients underwent ultrasound and intravenous phelography (IVP) examination, 59 patients also had CT scan. Hydatid fluid was analyzed by amine test. Percutaneous aspiration was guided by ultrasound, 95% alcohol was used to sclerosis the peripelvic cysts when amine test was negative or positive but did not have communication with pelvis through opacification. Ultrasound were done at 1, 3, 6 months and every 1 year thereafter, follow-up period were 6 months to 5 years.One hundred and sixty-five peripelvic cysts (97.6%) were cured by once sclerotherapy, the diameter of another 4 cases (2.4%) diminished to less than 1.5 cm by once sclerotherapy. Thirty-six cases of hydronephrosis were all resolved after sclerotherapy. Eight cases had renal calculus, of whom 4 cases underwent extracorporeal shockwave lithotripsy, 2 cases underwent percutaneous nephrolithotomy, and 2 cases did not treat the stone. Five patients had gross hematuria after aspiration, but all diminished in 3-5 d.Ultrasound guided percutaneous aspiration and sclerotherapy for peripelvic cysts had the superiority of safety, effectiveness micro-invasion and low complication.

To investigate the effect of Zilongjin (ZLJ) on human androgen-dependent type of prostate cancer cell line LNCaP.MTT assay, flow cytometry and fluorescence microscopy were used to observe the effect of ZLJ in anti-proliferation, cell cycle arresting and apoptosis induction. RT-PCR was used to examine the effect of ZLJ on expressions of prostate marker gene (PSA), androgen receptor (AR), apoptosis related genes (bcl-2 and bax), and Western blot assay was used to detect the effect on protein expression of bcl-2 and bax.ZLJ could cause apparent inhibition on proliferation, induce G0/G1 phase arresting and apoptosis in time- and dose-dependent manner on LNCaP cells. The concentration for inhibiting cell growth by 50% (IC50) in 72 hrs was 0.79 mg/ml. ZLJ could down-regulate the expression of PSA, AR, bcl-2 genes and lower bcl-2 protein expression, but showed ineffective on bax protein expression.ZLJ displays its anti-tumor effects by way of inhibiting the cell proliferation, arresting the G0/G1 phase, inducing apoptosis, down-regulating PSA, AR, bcl-2 gene expression and lowering bcl-2 protein expressions.

Background To compare the efficacy of sorafenib and sunitinib with regard to overall survival (OS) and progression free survival (PFS) in Chinese patients with metastatic renal cell carcinoma (mRCC). Methods A multicenter, retrospective study was performed to elucidate the relationship between clinical variables and prognosis comparing sorafenib and sunitinib as first-line treatment agents in Chinese patients with mRCC. Between September 2006 and December 2014, 845 patients received either sorafenib (400 mg bid; n = 483) or sunitinib (50 mg q.d; n = 362). The primary end point was OS and PFS. Results The percentage of patients with low and moderate risk according to Memorial Sloan-Kettering Cancer Centre (MSKCC) score was significantly higher in sunitinib group, and that with high risk was significantly higher in sorafenib group (15.1 vs. 5.2%; p