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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.

To identify the risk factors that would aid in the identification of patients at the greatest risk of developing postoperative paralytic ileus.In the retrospective study, 749 patients who received radical cystectomy from January 2005 to August 2014 were reviewed, of whom, 9 who received orthotopic ileal neobladder were excluded. Of the 740 patients, 82 (11.1%) developed postoperative paralytic ileus. The correlation between the clinical characters and the occurrence of post-operative paralytic ileus was identified.The postoperative paralytic ileus was significantly correlated with the patient's age (68 vs. 67, P=0.025), body mass index (23.0 kg/m2 vs.24.1 kg/m2, P=0.008), different urinary diversion reconstruction methods [13.2% (66/500) for ileal conduit and 7.3%(16/240) for cutaneous ureterostomy, P=0.008] and pelvic lymph node dissection [12.2% (77/632) vs.4.6% (5/108), P=0.021].The postoperative paralytic ileus caused a prolonged hospital stay and delayed recovery (24 d vs. 17 d, P=0.000). There was no significant correlation between the postoperative paralytic ileus and the patients' gender, previous abdominal operations, preoperative hemoglobin and creatinine, American Society of Anesthesiologists score, operative time, estimated blood loss, transfusion requirement, laparoscopic and open surgery, ICU admission or tumor staging. On multivariate analysis, age (hazard ratio 1.185, 95% confidence interval 1.036-1.355, P=0.013), body mass index (hazard ratio 0.605, 95% confidence interval 0.427-0.857, P=0.005), different urinary diversion reconstruction methods (hazard ratio 2.422, 95% confidence interval 1.323-4.435, P=0.004) and pelvic lymph node dissection (hazard ratio 2.798, 95% confidence interval 1.069-7.322, P=0.036) were significantly correlated with the presence of the postoperative paralytic ileus.Increasing age, decreasing BMI, ileal conduiturinary diversion and pelvic lymph node dissection were significantly correlated with the presence of postoperative paralytic ileus in patients undergoing radical cystectomy.

INTRODUCTION AND OBJECTIVES: MicroRNAs (miRNAs) are noncoding RNAs that regulate gene expression and influence tumor development and progression. We previously identified miRNAs upregulated in clear cell renal cell carcinoma (ccRCC) compared to matched-pair normal kidney using microarray analysis. However, such cancer-specific miRNAs are not always associated with patient survival and/or recurrence. This study aims to identify miRNAs that are upregulated in ccRCC and that are also associated with survival and/or recurrence. METHODS: We obtained 183 ccRCC clinical specimens from patients who underwent nephrectomy at our hospital between 2000 and 2012. We selected 24 frozen samples, of which 11 patients had evidence of disease or died from cancer (Group 1) and 13 patients had no evidence of disease (Group 2) within two years after surgery. Quantitative real time PCR (qRT-PCR) was performed on the samples to expression of 22 miRNAs that our microarray results indicated as upregulated in ccRCC, and hits were further validated using another 159 frozen samples. Functional analysis of the miRNA was performed using siRNA-mediated knockdown in RCC cell lines. RESULTS: Five miRNAs (Table.1) were upregulated in Group 1 compared to Group 2, and we validated these results using 159 samples of ccRCC. High miR-21-3p (p

This paper focuses on the fluid-solid interaction between a vibrating rotor and the unsteady flowfield around it in labyrinth gas seals. The object under consideration is a zero damping Jeffcott rotor subjected to an unsteady fluid field in labyrinth gas seals. An unsteady time-accurate three-dimensional Navier-Stokes solver is used to simulate the flowfield in the labyrinth gas seals, and the unsteady aerodynamic force vector acting on the vibrating rotor is obtained. A fourth-order explicit Adams scheme is used to simulate the dynamic response of the rotor. The coupled fluid-solid vibration of the rotor is studied under various inlet tangential velocities. The research shows that the current method is more accurate in predicting the stability of such shafts than the conventional method.

This paper focuses mainly on a model of the aerodynamic force of rotors subjected to an unsteady flowfield in labyrinth gas seals. An unsteady three-dimensional Navier-Stokes solver is used to simulate the flowfield in labyrinth gas seals. The basic time marching algorithm used to solve the fully three-dimensional unsteady governing equations is known as a hybrid finite analytic difference scheme. The ɛ- k model is chosen to model the turbulent components in the governing equations owing to its widely acknowledged reputation. The three-dimensional unsteady flowfield in labyrinth gas seals and the aerodynamic force acting on the rotor under various conditions are predicted, and then the rotordynamic coefficients of the rotor are estimated. It is shown that the relationship between the force excited by the flow and the displacement and velocity is not simply linear. A non-linear model of aerodynamic force for labyrinth seals is developed. The study shows that the direct stiffness increases rapidly with increase in the non-dimensionalized amplitude in the x direction, Āx the cross-coupled stiffness increases in a very moderate manner with increase in Āx, the direct damping decreases dramatically with increase in the non-dimensionalized maximum velocity in the x di1rection, V V xmax and the cross-coupled damping decreases at a small rate with increase in V V xmax. Furthermore, the direct stiffness and damping coefficients are also functions of displacement and velocity.

A numerical method based on three-dimensional unsteady compressible Navier-Stokes equations with moving boundaries is employed to predict the fluid reaction forces and the rotordynamic coefficients of labyrinth gas seals. A large number of simulations under various conditions have been conducted. Comparison of the values from an experimental, two-control-volume model and current unsteady computational fluid dynamics (CFD) under different conditions shows that the computer code works well for most of the simulations.

Investigation on the EtOH extract of the leaves of Loropetalum chinensis led to the isolation of seven compounds (1–7). Their structures were identified using spectroscopic methods. Among these compounds, compound 1 is a new lignan, and 2–7 were isolated from this plant for the first time.

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

To study the characteristics of histopathologic features of small renal carcinoma.This retrospective study collected the data of renal cell carcinoma from the patients who underwent surgery from January 2002 to June 2012. They were all preoperatively diagnosed as renal cancer by CT scan, and pathologically diagnosed as renal cell carcinoma after surgery with the diameter ≤ 4 cm. We recorded and analyzed the tumor size, histologic subtype, Fuhrman grading, TNM stage, the existence of tumor vascular invasion, sarcomatoid differentiation, and whether it was multifocal, and then grouped them for comparison.A total of 1 276 patients were included in the study and were analyzed, of whom 306 (24.0%) had small renal cell carcinoma less than 2.0 cm, 526 (41.2%) 2.0-3.0 cm, and 444 (34.8%) bigger than 3.0 cm. Of all the subjects, 1 158 (90.7%) suffered from clear cell carcinoma, 49 (3.8%) papillary carcinoma, 32 (2.5%) chromophobe cell carcinoma, whose distribution was not related with tumor size. Of the ≤ 2.0 cm and2.0 cm groups, Furmann grades of G3/4 were 15 (4.9%), 98 (10.1%), respectively (P=0.007). T3a + stage and above were 1 (0.3%), and 32 (3.3%), respectively (P=0.004). Synchronous distant metastases occurred in 6 patients, all in group2.0 cm. Tumor sarcomatoid differentiation (0.3% vs. 0.9%), vascular invasion (0.6% vs. 2.1%) and multifocal (1.3% vs. 2.7%) had no significant difference between the two groups.Small renal cell carcinoma with diameter over 2.0 cm are more aggressive, suggesting that renal cancer bigger than 2.0 cm in diameter should not select a non-surgical treatment.

Systemic inflammation may be a common mechanism for the development of osteoporosis (OP) and atherosclerosis. Elevated arterial stiffness is an index of subclinical atherosclerosis. Recent studies found that neutrophil/lymphocyte ratio (NLR), is a useful marker of cardiovascular disease and a more powerful predictor than any other leukocyte subtypes. However, little research has been conducted to investigate the relationship between NLR and arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV).In this cross-sectional study, we examined the relationship between NLR and baPWV in 512 subjects.Compared to the control subjects, NLR and baPWV increased in patients with OP. Partial correlation analysis revealed that there was a significant correlation between NLR and baPWV after adjusting for confounding factors in OP. Multivariate linear regression analysis showed that NLR was a significant factor for increased baPWV in patients with OP (β=0.249, p0.001). However, there was no association between NLR and baPWV in control subjects.NLR and baPWV are elevated in OP. Moreover, NLR is independently associated with baPWV. Further studies are warranted to investigate whether anti-inflammatory treatment could improve arterial stiffness in postmenopausal women with OP.

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.

In thrust bearings, cavitation may occur at high rotational speeds or low lubricant supply pressures, and it will influence the bearing performances. In this paper, a hydrodynamic tapered land thrust bearing has been studied both experimentally and numerically, with concentration on the cavitation phenomenon and its effects on the bearing performances. Evident cavitation regions have been observed in the experiments at higher rotational speeds. Traditional Reynolds equation and 3D Navier–Stokes equation (3D NSE) with a cavitation model have been used for numerical simulation, and the predicted results are examined against the experimental results. Compared with Reynolds equation, 3D NSE with Rayleigh–Plesset model provides better predictions of both oil–film pressure profile and cavitation area. Furthermore, the effects of the cavitation phenomenon on the thrust bearing performances are studied by parametric studies involving various rotational speeds and oil feeding pressures, using 3D NSE. It is found that the load capacity decreases at higher speeds because of enlargement of the cavitation area. And the negative effects of cavitation can be reduced at smaller film thickness and higher oil supply pressure. Conclusively, the above results show that the cavitation phenomenon has significant influences on the bearing performances at higher speeds, and 3D NSE provides an effective tool for analyzing the cavitation effects in thrust bearings.

To investigate the characteristics and related influence factors of lymph node metastases in patients undergoing radical cystectomy and lymph node dissection for bladder cancer.The data of 522 patients who underwent radical cystectomy and pelvic lymph node dissection at Department of Urology, Peking University First Hospital from 1998 to 2012, were retrospectively collected, and the lymph node mapping was performed in all the patients to determine the location of metastatic lymph nodes.For the 522 patients with bladder cancer, lymph node metastasis occurred in 99 patients, and the incidence of lymph node metastasis was 19.0%. The incidence at different tumor stages was: 3.7% in T1 (6/164), 10.5% in T2 (17/160), 36.7% in T3(40/107), and 41.9% in T4 (36/86). The most common involved lymph nodes were hypogastric/obturator lymph nodes (77/99, 77.8%) and external iliac lymph nodes (35/99, 35.4%). The mean number of lymph nodes dissected was 11.6 (1-51). The lymph node density (number of lymph nodes involved/number of lymph nodes removed) was 44.1%. The incidence of lymph node metastasis was statistical related to tumor stage (P0.01, OR 2.71,95% CI 2.13-3.44) and tumor grade (P0.01, OR 3.81,95% CI 1.66-8.74), while age, gender, smoke history, and weight had no statistical significance.Lymph node metastasis is the most common metastasis route of bladder cancer. The incidence of lymph node tumor involvement is correlated with increasing tumor stage and tumor grade. The most common involved lymph nodes are hypogastric/obturator lymph nodes and external iliac lymph nodes. Radical cystectomy and bilateral pelvic lymph nodes dissection are of great significance in the treatment of bladder cancer.

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.

To explore the technique of vascular control in transperitoneal laparoscopic nephrectomy.From May 2010 to September 2013, 191 consecutive transperitoneal laparoscopic nephrectomies were performed by a single surgeon. The operations included 116 radical nephrectomies, 57 nephroureterectomies, and 18 simple nephrectomies. Improved 4-trocar method was applied. Through lifting up inferior pole of the kidney by an assistant, and observing renal vascular from the bottom or back of the kidney, the exposure of renal vessels were improved. The renal vessels were managed with Hem-o-lock or Endo GIA. For tumors of stage ≥ T2, ipsilateral lymph node dissection of renal hilus was performed.Of the entire 191 cases,190 were performed successfully, only 1 converted to open surgery because of the difficulty in separating the tumor from the invaded colon. The average time of operation was 171.5 min (74-352). The blood loss was 5-1 000 mL with an average of 94.8 mL. The complications included vascular injuries (5 cases), cerebral infarction accompanied by acute renal injury (1 case), and pulmonary infection (2 cases). The mean postoperative hospital stay was 5.6 days (2-19 days). No perioperative death occurred.The reformative technique of vascular control could improve the exposure of renal vessels, increase surgery safety, and shorten the time of transperitoneal laparoscopic nephrectomy.

This paper focuses on a novel modified technique about the treatment of adult obstructed megaureter by the transperitoneal laparoscopic procedure. With the improvement of the laparoscopic surgery, many urological surgeries can be safely and effectually performed by laparoscopic approach. The previously reported laparoscopic methods for treatment of adult obstructed megaureter were complex and time-consuming. To simplify the method, we modified the laparoscopic approach based on the previous methods. The innovative points of our novel technique are the extracorporeal tailoring of ureter and nipple ureteroneocystostomy. By this modified procedure, the time of operation can be obviously reduced while the procedure is effective. We hope this modified procedure will be accepted by more urologists.

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.

We consider a new system of multivalued mixed variational inequality problem, which includes some known systems of variational inequalities as special cases. Under suitable conditions, the existence of solutions for the system of multivalued mixed variational inequality problem and the convergence of iterative sequences generated by the generalizedf-projection algorithm are proved. A perturbational algorithm for solving a special case of multivalued mixed variational inequality problem is formally constructed. The results concerned with the existence of solutions and the convergence of iterative sequences generated by the perturbational algorithm are also given. Some known results are improved and generalized.

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.

To investigate the pathological feature, therapy and prognosis of bilateral sporadic renal cell carcinoma.The data of 59 bilateral sporadic renal cell carcinoma patients diagnosed from Apr. 1986 to Dec. 2009 were collected. We retrospectively analyzed the treatment, pathological features, long term survival and prognosis factors of the disease.We found 59 patients with bilateral sporadic renal cell carcinoma (RCC) in the database diagnosed from Apr. 1986 to Dec. 2009. The median age was 56 years. Of all the cases, 37 were bilateral synchronous sporadic renal cell carcinoma and 22 bilateral metachronous sporadic renal cell carcinoma. Forty-three patients underwent bilateral surgeries, 11 unilateral surgery, and 5 no treatment. There were 122 masses in the 59 patients and 109 masses had pathological reports. All the 59 cases were RCC, and clear cell carcinomas was the main subtype (96.6%). The median follow-up time was 62.1 months (range 4-277 months). Thirty-nine patients (66.1%) survived without tumor recurrence, 4 survived with tumors recurrence, and 16 (27.1%) died. Kaplan-Meier curve revealed that the 3-year and 5-year overall survival rates were 83.5% and 81.1%, respectively; the 3-year and 5-year cancer special survival rates were 73.1% and 64.8%, respectively. The disease-free survival rates of bilateral synchronous and bilateral metachronous RCC were similar. Multivariate regression suggested that post-operative application of interferon-α and bilateral surgeries were related with a better prognosis.The main subtype of bilateral sporadic renal cell carcinoma was clear cell carcinoma (96.6%). Bilateral synchronous and bilateral metachronous RCC both had a long time disease-free survival. Interferon-α application after surgery and bilateral surgeries were related with a better prognosis.

To evaluate the surgical management and long-term outcomes of patients with renal cell carcinoma and venous tumor thrombus.From Aug. 2000 to Dec. 2011, 140 patients underwent radical nephrectomy and thrombectomy in our hospital, of whom, 80 were with renal vein tumor thrombus, 41 with inferior vena caval (IVC), level I tumor thrombus (below hepatic vein), 13 with IVC level II tumor thrombus (above hepatic vein but below diaphragm) and 6 with IVC level III tumor thrombus (above diaphragm). The overall and cancer-specific survival rates were analyzed with Kaplan-Meier survival curve method.The follow-up information of the 114 patients was gained. The median follow-up period for all the patients was 20.5 months (1-96). In the last follow-up, 47 patients died. The median survival time for all the patients was 51 months. The median survival time for the patients with renal vein tumor thrombus and IVC level Ito III tumor thrombus were 57, 43, 40 and 27 months. The 5 year overall survival (OS) and cancer-specific survival (CSS) rates for all the patients were 40.1% and 47.2%, respectively. The survival time of the patients with early tumor thrombus (below hepatic vein) was significantly longer than that of the patients with advanced tumor thrombus (above hepatic vein) (54.1±4.8 months vs. 26.9±5.7 months, P=0.049).Radical nephrectomy and thrombectomy are effective therapies for RCC patients with venous extension. The patients can obtain a relatively promising long-term outcome, which is comparable to previous western studies. Long-term outcome of the early tumor thrombus patients is significantly better than that of the advanced tumor thrombus patients.

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 discuss the clinical characteristics of idiopathic renal subcapsuler fluid collection and its treatment.From 2009 to 2012, 10 patients with idiopathic renal subcapsuler fluid collection were treated at Urology Department of Peking University First Hospital and retrospective analysis was performed.These patients' ages were 19-73 years, with an average age of 39.9 years. All the patients were female. Their tumors were excluded by image studies before any treatment. Eight cases were treated by percutaneous drainage, 1 by surgery, and 1 under active surveillance. The patients were followed up for 3-15 months, with a median follow-up of 7 months. Recurrence occurred in 1 patient who took percutaneous drainage, and later she took capsulectomy. All the other patients had satisfied results.Idiopathic renal subcapsular fluid collection is a rare condition, whose cause is still unknown. The aim of therapy is to relieve symptoms and release the compression to the kidney. Percutaneous drainage or capsulectomy are both therapy options with satisfied results.

Cavitation phenomenon in lubricants significantly influences the performance of associated machinery. In this paper, the cavitation mechanism of an oil-film bearing is attributed to gaseous cavitation, and a new gaseous cavitation model based on air solubility in the lubricant is presented. The model is validated using the Reynolds equation algorithm for fixed-geometry oil-film journal bearing, and the predicted results at different eccentricity ratios show good agreement with published data. The analyses show that gaseous mechanism can explain the cavitation phenomena that occur in the bearing except for very heavy load cases. In particular, this new model is compatible with the Jakobsson–Floberg–Olsson condition. Therefore, the new model has an explicit physical meaning, can produce good results, can identify whether vaporous cavitation occurs, and more importantly, can provide a novel means of developing cavitation models for low-vapor-pressure lubricants.

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.

There are many ideas for developing shock-capturing schemes and their extension for all-speed flow. The representatives of them are Roe, HLL and AUSM families. In this paper, a uniform algorithm is proposed, which expresses three families in the same framework. The algorithm has explicit physical meaning, provides a new angel of understanding and comparing the mechanism of schemes, and may play a great role in the further research. As an example of applying the uniform algorithm, the low-Mach number behaviour of the schemes is analyzed. Then, a very clear and simple explanation is given based on the wall boundary, and a concise rule is proposed to judge whether a scheme has satisfied low-Mach number behaviour.

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.

Fourteen sesquiterpene and norsesquiterpene derivatives, comprising six different carbon skeletons, were isolated from Sanicula lamelligera. Saniculamoid A1 (1a) is an oxidation product of saniculamoid A (1), created by the transition of a formyl group to a carboxylic acid group after a period of storage in air. The known compounds 5-14 were identified in Sanicula plants for the first time. The compounds were evaluated for their anti-HIV-1, cytostatic, and nitric-oxide-production-inhibiting activities using in vitro cellular assays. The results showed that 1,5-naphthalenediol inhibited nitric oxide production in lipopolysaccharide-stimulated RAW 264.7 cells with an IC50 value of 28.1 mu M and was active toward five cancer cell lines with IC50 values in the 31.1-41.6 mu M range.

isolation and structure elucidation of a new tirucallane-type triterpenoid, alianthusaltinin A (I), and one new C29sterone, alianthaltone A (II), along with numerous known compounds

Two new dimeric lignans, zanthpodocarpins A (Ia) and B (Ib), are isolated along with a series of known lignans from the title plant bark.