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Background: Thromboangiitis obliterans (TAO) is a chronic, non-atherosclerotic, progressive inflammatory vascular disease affecting the small- and medium-size arteries and veins of the extremities. Objective: To evaluate whether long-term anticoagulation with low-molecular-weight heparin (LMWH) and warfarin is beneficial for treating the inflammation and symptoms associated with TAO. Methods: Patients with TAO who underwent anticoagulation as the mainstay of treatment were included in this prospective study. Rest pain relief and healing of trophic lesions (as the primary and secondary endpoint) were investigated at Day 14 and after 6 months of follow-up. High sensitivity C-reactive protein (hsCRP), monocyte count, and ankle-brachial index (ABI) were recorded, and the difference was compared before and after 2-week anticoagulation. The Chi-square test was used to compare the difference between anticoagulant and aspirin groups (based on the literature). Results: From 2014 to 2019, 18 patients were included. Only 1 patient with wet gangrene received endo-therapy for a failing stent at the start of treatment. After ~14 days, 12 of 13 (92%) patients showed complete ulcer healing, and 17 of 18 (94%) patients showed complete relief from rest pain. Monocyte-counts and hsCRP levels decreased significantly (p Conclusion: Anticoagulant therapy may alleviate the inflammation and symptoms of TAO.

Abdominal aortic aneurysm (AAA) is a common disease associated with significant cardiovascular morbidity and mortality. Up to now, there is still controversy on the choice of treatment method of AAA. Even so, the mechanisms of AAA progression are poorly defined, making targeting new therapies problematic. Current evidence favors an interaction of the hemodynamic microenvironment with local and systemic immune responses. In this review, we aim to provide an update of mechanisms in AAA progression, involving hemodynamics, perivascular adipose tissue, adventitial fibroblasts, vasa vasorum remodeling, intraluminal thrombus, and distribution of macrophage subtypes.

Summary Objective Our aim was to assess whether serum vitamin D deficiency before gestational 20 weeks was associated with an increased risk of preeclampsia. Methods We investigated the serum levels of 25(OH)D before gestational 20 weeks, and analyzed associations between the 25(OH)D and the risk of preeclampsia. 7976 pregnant women were enrolled in this study between January 2017 and July 2019 at the Obstetrics & Gynecology Hospital of Fudan University. Adjusted smoothing spline plots, subgroup analysis and multivariate logistic regression analysis was conducted to estimate the relative risk between 25(OH)D and preeclampsia. Results After fully adjusting the confounding factors, serum vitamin D is a protective factor in preeclampsia (OR = 0.85, P = 0.04). Compared with adequate vitamin D, vitamin D deficiency (OR = 1.55, P = 0.031), deficiency (OR = 1.50, P = 0.049) and severe deficiency (OR = 2.6, P = 0.005) are independent of preeclampsia in pregnant women Risk factors. Conclusion Vitamin D deficiency before gestational 20 weeks is a risk factor for preeclampsia.

Review question / Objective: To assess the prevalence and associations of early postoperative stroke and death among patients undergoing inner branched thoracic endovascular aortic repair (TEVAR) of arch pathologies. Eligibility criteria: Our including criteria are as follows: 1) Patients with aortic arch pathologies, who were judged unfit for open surgery in a multidisciplinary path; 2) using inner branched TEVAR for the endovascular repair. 3) report the prevalence of 30-day postoperative stroke or death as result. Excluding criteria: 1) combined with fenestration or chimney in TEVAR; 2) full-text unavailable; 2) case reports with fewer than three cases; 3) studies with an only reconstruction of the left subclavian artery (LSA) rather than innominate artery or left common carotid artery (LCCA).

This research studied the effect of freeze–thaw cycles on the thermal conductivity, water permeability and mechanical properties of asphalt mixtures in the cold region. Three types of asphalt mixtures, namely a stone mastic asphalt (SMA) mixture, dense graded asphalt concrete (AC), asphalt-treated base (ATB) mixture, were produced in the laboratory. The thermal conductivity test and water permeability test were used to study the thermal conductivity and water permeability of asphalt mixtures, respectively. Meanwhile, the uniaxial compression test and indirect tensile test were carried out to investigate the mechanical properties of asphalt mixtures. The results showed that with the increase in the number of freeze–thaw cycles, the thermal conductivity and mechanical properties of all asphalt mixtures were weakened, while the water permeability of them was improved. In addition, the effect of freeze–thaw cycles on the thermal conductivity and mechanical properties of ATB mixture was more significant than that of SMA mixture and AC.

Global climate change has significantly changed precipitation patterns. Soil respiration (SR), as an important pathway through which CO

Background The aim of this study was to investigate the diagnostic value of (F/T)/PSAD for prostate cancer detection in the Chinese population. Material/Methods Data were collected retrospectively from patients with prostate cancer or benign prostatic hyperplasia from July 2009 to September 2014. SPSS 19.0 software was used for the receiver operating characteristic curve (ROC), and calculating sensitivity, specificity, and positive predictive values (PPV) and negative predictive values (NPV), respectively. Comparison of the area under ROC (AUC) was performed using the MedCalc v. 10.4.7.0 software. Results A total of 660 patients (including 251 patients with prostate cancer and 409 patients with prostatic hyperplasia) were included. Prostate volume (PV), prostate-specific antigen density (PSAD), free-serum PSA (FPSA)/PSAD, and free-to-total PSA (F/T)/PSAD had similar AUC (P>0.05), and had significantly higher AUC (P0.05), and significantly higher than the PV and PSAD (P50 years and has a significantly lower false negative rate than PSAD and PV with a cutoff value of ≤0.731. A new parameter, FPSA/PSAD, has similar diagnostic accuracy comparable to (F/T)/PSAD. The diagnostic value of a combination of age, FPSA, PV, PSAD, FPSA/PSAD, and (F/T)/PSAD needs further investigation.

Studying the influence of precipitation patterns on plant community diversity, soil C:N:P ecological stoichiometric characteristics, and the relationships between key soil factors and plant community diversity is of great significance for the protection of plant community diversity in desert grasslands. This paper was studied in the desert steppe of the west of Loess Plateau using a three-year precipitation manipulation experiment (40% reduction in precipitation, 20% reduction in precipitation, natural precipitation, 20% increase in precipitation, and 40% increase in precipitation), explored the influence of changes in precipitation in dry and wet years on the diversity of plant community and soil C:N:P ecological stoichiometric characteristics. And we also explored the relationship between soil C:N:P ecological stoichiometric characteristics and the key soil factors and the diversity of plant community under changes in precipitation. The results showed that in a normal year and the drier year (2013 and 2015), Patrick richness and Shannon-Wiener diversity index were significantly low under the 20% reduction treatment compared with the control and 40% increase treatments, respectively. During the wetter year, Patrick richness and Shannon-Wiener diversity index were no different between any of the precipitation treatments. In the normal year and the drier year, the soil organic carbon (SOC), total nitrogen (TN), and total phosphorus (TP) contents and the carbon-nitrogen ratio (C:N), carbon-phosphorus ratio (C:P), and nitrogen-phosphorus ratio (N:P) all decreased with an increase in precipitation (the decrease in the C:N ratio was statistically significant). During the wetter year, SOC, TN, C:P, and N:P increased with an increase in precipitation. During the normal year, precipitation treatments had no significant influence on soil water content, having a limited influence on the plant community. TN, N:P, SOC, C:N, and microbial biomass nitrogen (MBN) had a more prominent influence on plant community diversity. In the wetter year, precipitation was abundant leading to a rise in soil nutrients. Water was not the most important factor limiting to plant growth whereas soil water content, soil nutrients, and ecological stoichiometric characteristics jointly regulate plant community diversity. In the drier years, precipitation treatments had a significant impact on soil water content, whereby an increase in precipitation led to high losses of soil nutrients. Therefore, soil water content was the most important factor affecting plant community diversity during drier years. These observations indicate that under dry and wet years, plant community diversity and soil C:N:P ecological stoichiometric characteristics have variable responses to precipitation and soil C:N:P effect on plant community were also different. These results provide a theoretical basis for the protection and management of desert steppe systems under future projected changes in precipitation.

Objective To estimate the association of beta-blocker use with postoperative adverse events of CEA based on real-world data. Methods Electronic bibliographic sources (MEDLINE, EMBASE, and CENTRAL) were searched up to Apr. 2021 using a combination of thesaurus and free-text terms to identify the studies about the effect of beta-blockers on outcomes of CEA. The systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. All observational studies and randomized controlled trials investigating the effect of preoperative beta-blockers on the outcomes of CEA were included. Independent extraction of articles by two authors using predefined data fields, including study quality indicators. All pooled analyses were based on a random-effects model. Results A total of seven observational studies (six case-control studies and one cohort study) were included. Of the three case-control studies that examine the association of beta-blockers with composite postoperative adverse events, two studies including three datasets totaled 24161 participants were included in the quantitative synthesis and the overall results showed a statistically significant association between beta-blocker use and composite postoperative adverse events of CEA (OR 1.35, 95%CI 1.15- 1.59, p = .0003; I2 = 13%). Publication bias was not present in the meta-analysis (Egger’s test showed non-significant results: p = .453). Two of the included studies utilized indirect measures of cerebral ischemia: intraoperative EEG, intraoperative hemodynamic indicators; and found a significant association between beta-blockers and intraoperative cerebral ischemia. Another two studies were included for meta-analysis on the association between beta-blockers and 30-day strokes or death of CEA (OR 1.61, 95%CI 0.98-2.65, p = .06; I2=0%). Of all included studies, there is only one cohort study that reported the association of beta-blockers with postoperative MI by chi-squared analysis (OR 1.96, 95%CI 1.86-2.07). Conclusion This systematic review suggested that there was an increased risk of postoperative adverse outcomes of CEA among beta-blocker users compared to non-users in the real world.

To make early predictions of preeclampsia before diagnosis, we developed and validated a new nomogram for the early prediction of preeclampsia in pregnant Chinese women. A stepwise regression model was used for feature selection. Multivariable logistic regression analysis was used to develop the prediction model. We incorporated BMI, blood pressure, uterine artery ultrasound parameters, and serological indicator risk factors, and this was presented with a nomogram. The performance of the nomogram was assessed with respect to its calibration, discrimination, and clinical usefulness. Internal validation was assessed. The signature, which consisted of 11 selected features, was associated with preeclampsia status (P < 0.1) for the development dataset. Predictors contained in the individualized prediction nomogram included BMI, blood pressure, uterine artery ultrasound parameters, and serological indicator levels. The model showed good discrimination, with an area under the ROC curve of 0.8563 (95% CI: 0.8364-0.8761) and good calibration. The nomogram still had good discrimination and good calibration when applied to the validation dataset (area under ROC curve of 0.8324, 95% CI: 0.7873-0.8775). Decision curve analysis demonstrated that the nomogram was clinically useful. The nomogram presented in this study incorporates BMI, blood pressure, uterine artery ultrasound parameters, and serological indicators and can be conveniently used to facilitate the individualized prediction of preeclampsia.

To investigate the effects of down-regulation of PTTG1 expression on the proliferation, invasiveness and apoptosis of androgen-independent human prostate cancer LNCaP-AI cells and their sensitivity to androgen antagonists.Human prostate cancer LNCaP-AI cells were transfected with siRNA targeting the PTTG1 gene using the Lipofectamine 2000 transfection reagent. The proliferation, invasiveness and apoptosis of the cells were detected by MTT, Transwell assay and flow cytometry, respectively. The protein expressions of PTTG1, p-Akt, and p-ERK were determined by Western blot and the mRNA expression of PTTG1 measured by agarose gel electrophoresis.The siRNA expression vector markedly down-regulated the expression of PTTG1, which effectively suppressed the proliferation of the LNCaP-AI cells, with the inhibition rates of (19.47 ± 2.12), (24.01 ± 2.13) and (48.02 ± 2.22)% at 24, 48 and 72 hours, respectively, after transfection, with statistically significant differences among the three groups (P0.05). The number of the cells passing through the polycarbonate film was remarkably decreased at 24, 48 and 72 hours (74.67 ± 9.85, 56.44 ± 8.66 and 37.33 ± 6.14) as compared with the baseline (111.11 ± 13.47) (P0.01), while the apoptosis rate of the cells was significantly increased at 24, 48 and 72 hours (18.32 ± 0.94), (19.94 ± 1.30) and (21.73 ± 1.88)% in comparison with the baseline (［2.17 ± 0.49］%)， (P0.05). PTTG1 siRNA combined with androgen antagonist flumatide exhibited even more significant effects in inhibiting the proliferation and promoting the apoptosis of the LNCaP-AI cells than either used alone, and in a flumatide dose-dependent manner. The inhibition and apoptosis rates of the LNCaP-AI cells treated with 50 nmol/L flumatide were (27.13 ± 3.52) and (3.94 ± 0.48)%, and those treated with siRNA + 50 nmol/L flumatide were (67.51 ± 5.13) and (19.93 ± 1.72)%, respectively, both with statistically significant differences between the two groups (P0.05). The inhibition and apoptosis rates of the cells treated with 100 nmol/L flumatide were (43.72 ± 3.90) and (5.33 ± 0.66)%, and those treated with siRNA + 100 nmol/L flumatide were (73.19 ± 4.78) and (23.43 ± 1.76)%, respectively, both with statistically significant differences between the two groups (P0.05).The siRNA expression vector can down-regulate the expression of PTTG1, which can inhibit the proliferation and invasiveness of LNCaP-AI cells, promote their apoptosis, and increase their sensibility to androgen antagonists. Suppressing the expression of PTTG1 may enhance the effect of androgen-deprivation therapy on advanced prostate cancer.目的： 探讨下调垂体肿瘤转化基因1（PTTG1）表达对雄激素非依赖性前列腺癌LNCaP-AI细胞增殖、侵袭、凋亡，以及对雄激素拮抗剂敏感性的影响。方法： LNCaP-AI细胞转染靶向PTTG1基因的siRNA，MTT法检测细胞增殖，Transwell法检测细胞侵袭，流式细胞术检测细胞凋亡，Western印迹检测PTTG1、p-Akt、p-ERK等蛋白表达水平，琼脂糖凝胶电泳法检测PTTG1 mRNA表达水平。结果： siRNA有效抑制了PTTG1的表达；下调PTTG1表达有效抑制了LNCaP-AI细胞在去雄激素培养液中的增殖，24、48、72 h抑制率分别为（19.47±2.12）%、 （24.01±2.13）% 、(48.02±2.22) %，组间比较有显著性差异（P0.05）；降低其侵袭力，Transwell试验显示，对照组、转染24、48、72 h后穿过聚碳酸酯膜细胞个数分别为111.11±13.47、74.67±9.85、56.44±8.66、37.33±6.14，组间比较有显著性差异（P0.01）；siRNA-PTTG1转染LNCaP-AI细胞后，空白对照组、转染24、48、72 h后凋亡率分别为(2.17±0.49)%、(18.32±0.94)%、(19.94±1.30)%、(21.73±1.88)%，各组间比较有显著性差异（P0.05）。siRNA联合氟他胺组对LNCaP-AI增殖的抑制作用和促凋亡作用显著强于siRNA或者氟他胺组，并呈氟他胺浓度相关性；50 nmol/L氟他胺、siRNA联合50 nmol/L氟他胺对LNCaP-AI的抑制率分别为（27.13±3.52）%、（67.51±5.13）%，两组间比较有显著性差异（P0.05）；凋亡率分别为（3.94±0.48）%、（19.93±1.72）%，两组间比较有显著性差异（P0.05）；100 nmol/L氟他胺、siRNA联合100 nmol/L氟他胺的抑制率分别为（43.72±3.90）%、（73.19±4.78）%，两组间比较有显著性差异（P0.05）；凋亡率分别为（5.33±0.66）%、（23.43±1.76）%，两组间比较有显著性差异（P0.05）。结论： siRNA下调PTTG1表达能够抑制LNCaP-AI的增殖和侵袭，促进凋亡，提高了LNCaP-AI细胞对雄激素拮抗剂氟他胺的敏感性，抑制PTTG1表达可能会强化雄激素剥夺治疗晚期前列腺癌的作用。.

OBJECTIVE To describe the technique of laparoscopic-assisted partial nephrectomy melded with open procedure in resection of postero-medial renal tumors. METHODS Six patients with postero-medial renal tumors were admitted between July 2008 and March 2009. They included 4 diagnosed renal cell carcinomas and 2 renal angiomyolipomas on preoperative imaging, and their tumors ranged from 2.5-4.3 cm in diameter. They underwent laparoscopic-assisted nephron-sparing surgery combined with a small-incision procedure. RESULTS All 6 patients underwent successful resection. The mean operating time was 124 minutes and the average duration of pneumoperitoneum was 25 minutes. The duration of renal arterial blockage ranged from 19-36 minutes, with an average of 23 minutes. The intraoperative hemorrhage volume averaged 160 mL. Postoperative pathology revealed negative margins in all resected specimens. No urinary fistula or secondary hemorrhage occurred postoperatively, and renal function showed no impairment. The patients were followed for 1-8 months. Ultrasonographic or computed tomography examination revealed no recurrence. CONCLUSIONS The laparoscopic-assisted partial nephrectomy combined with an open procedure is a novel technique for the resection of posterior medial renal tumors. The technique is safe and effective.

To assess the clinical efficacy and safety of photoselective laser vaporization of the prostate (PVP) in the treatment of patients with acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH).Forty-two patients (mean age 72 +/- 5 years, range 65-89) with AUR because of BPH were treated with a prospective trial of PVP with the potassium-titanyl-phosphate (KTP) laser. The treatment outcome was evaluated with subjective and objective tests at 1, 3, 6, and 12 months after PVP using the International Prostate Symptom Score (IPSS), disease-specific quality of life (QoL) score, postvoid residual (PVR) urine volume, and maximum urinary flow rate (Qmax). The International Index of Erectile Function questionnaire and a self-designed ejaculatory questionnaire were completed at different follow-up times to determine patient satisfaction and changes in sexual function.After preliminary urine drainage and adequate preoperative preparation, PVP was performed and bladder outlet obstruction was effectively relieved. The mean prostate volume was 62.5 +/- 11.7 cc, and the mean residual volume with retention was 650 mL (range 240-1200 mL). Mean operative time was 28.6 +/- 5.7 minutes. Mean catheterization duration was 5.6 days (range 3-14 d). There was significant subjective improvement of symptoms and objective improvement in urinary flow rates at 12 months. The mean IPSS and QoL score decreased significantly (P0.05). Mean PVR volume also decreased. The mean Qmax was 16.2 +/- 4.6 mL/sec after treatment. Only two patients had recurrent urinary retention during follow-up. There were no intraoperative or postoperative adverse events.The early clinical results suggest that the PVP is a promising safe, effective, and less-invasive treatment with minimal morbidity for patients with urine retention secondary to BPH.

To prevent terrorism during anti-terror war, we developed a reproducible animal model for the induction of a urethral stricture in a war wound rabbit, and to evaluate the feasibility and effect of using a biodegradable urethral stent in the prophylaxis and treatment of urethral strictures in a war wound (or traumatic) rabbit urethral model. The urethral stricture rabbit model was successfully performed by a self-control explosion destructor. New biodegradable urethral stents were placed in the urethras of 20 war wound (traumatic) rabbits, but no stent was used in the 8 rabbits which formed the control group. Follow-up investigation included assessment of procedure success, stent changes, urethrascopy and retrograde urethrography, and histological findings were obtained after sacrifice at 4, 6, 8 and 12 weeks after stent placement. The urethral stricture model owing to a war wound (trauma) was tested by tissue reactions and urethroscopy. The length of the urethral strictures was 5-10 mm; the coarctation of the urethral lumen was more than 50%. Biodegradable stent placement was technically successful in 20 rabbits. Urethral specimens obtained from the 4 week stent placement group showed diminished inflammatory cell infiltration and decreased thickness of the papillary projections of the epithelium. There was a strong tendency towards regression of the papillary projections and regeneration of urethral mucosa epithelium in the 8 week group. In particular, the injured urethra has recovered completely in the biodegradable stent groups compared with the control group at 12 weeks. The biodegradable urethral stent seems feasible for treating and preventing urethral strictures owing to a war wound (or traumatic) urethra. There are distinct advantages in terms of safe, effective and less-invasive treatment for the reconstruction of post-traumatic urethral strictures.

To assess the clinical efficacy and safety of photoselective vaporization of the prostate (PVP) in the treatment of patients with acute urinary retention, secondary to benign prostatic hyperplasia

Objective: We evaluated 3-D computed tomography angiography (3-D CTA) in the diagnosis of the nutcracker phenomenon, and its significance in postoperative follow up. Patients and Methods: Three-dimensional CTA was used to compare the anatomical relations of the left renal vein with the aorta and the superior mesenteric artery in patients with the nutcracker phenomenon and in a control group. Four patients with the nutcracker phenomenon received a surgical procedure of the transposition of the left renal vein. The 3-D CTA was used for all patients during postoperation follow-up testing. Results: The 3-D CTA showed a compression of the left renal vein between the aorta and the superior mesenteric artery (SMA) and the abnormal acute angle between them. The angles and distances between the SMA and the aorta were 39.3 ± 4.3° and 3.1 ± 0.2 mm in the patient groups and 90 ± 10° and 12 ± 1.8 mm in the control groups, respectively. Differences in angles and distances were statistically significant between the two groups (P

Objective: To construct a mutant pEGFP- hTERT expression vector, to observe its steady expression in transfected human bladder carcinoma cell line T24 and its role in molecular regulatory mechanisms of telomerase, and to provide a new target gene for bladder cancer. Methods: PCR amplification was performed by using primers based on the known gene sequence of hTERT. PCR production was cloned into plasmid pGEMT-T easy and the sequence of mutant hTERT gene was analyzed. A recombinant mutant hTERT vector (pEGFP-hTERT) was constructed at the EcoR I and Sal I sites of the pEGFP-C1 vector. After transfecting the fusion gene into bladder carcinoma cell line T24 by calcium phosphate-DNA coprecipitation, the steady expression of GFP-hTERT fusion protein was tested by fluorescent light microscopy. The proliferation changes of bladder carcinoma cell line T24 were detected by light microscopy and senescence correlated β-galactosidase staining. Results: Identification of pEGFP-hTERT by enzyme digestion showed that mutant hTERT fragment had been cloned into EcoR I and Sal I sites of the pEGFP-C1 vector. The steady expression of GFP-hTERT fusion protein was localized in the nucleus of transfected cells. Expression of senescence-associated β-galactosidase in transfected cells gradually increased with extended cultured time and cell growth was suppressed. Conclusion: The mutant-type hTERT gene suppresses the proliferation of bladder carcinoma cell line T24 by competitive effect on telomerase activity. This suggests that hTERT gene might be a suitable gene target for bladder cancer therapy.

Objective To evaluate the clinical effect of laparoscopic ureterolysis in the treatment of retroperitoneal fibrosis,and compare the effectiveness with the therapy of open ureterolysis.Methods The clinical data of 10 patients undergone laparoscopic ureterolysis(LS group) and 13 patients undergone open ureterolysis(OS group) were retrospectively reviewed.A comparison was performed between the two groups in terms of operative preparing time,operating time,estimated blood loss,recovery of intestinal function,ambulation activities after operation,postoperative length of hospital stay,total length of hospital stay and complication.Results The estimated blood loss,recovery of intestinal function,postoperative length of hospital stay,total length of hospital stay in LS group(59.50ml,2.70±0.82d,8.70±1.42d,17.40±5.64d) were all better than those in OS group(100.00ml,3.85±1.07d,11.62±3.18d,23.38±5.45d,P < 0.05).The operative preparing time in LS group was longer than that in OS group(29.25±11.43min vs 19.85±7.36min,P < 0.05).No difference existed between the two groups in the operating time and ambulation activities after operation(P > 0.05).No transfusion was required and no complication occurred in the both groups.With a follow-up of 18 months,no recurrence in situ and no obstruction were observed in the both groups.Conclusions Laparoscopic ureterolysis has the advantages of less blood loss,rapid recovery of intestinal function,shorter hospital stay as compared to that of open ureterolysis.It is therefore a safe and effective surgical procedure in treatment of retroperitoneal fibrosis.

The tumor suppressor gene BRCA1 on chromosome 17q21 has been characterized and shown to be mutated in patients with familial breast and ovarian cancer. Several studies examined the relatives of women with breast cancer and noted an association with ovarian and prostate cancer. This study investigated 24 human prostate cancer specimens for BRCA1 gene mutations and loss of heterozygosity (LOH) on chromosome 17q21 assessed by the polymerase chain reaction. LOH was identified using 7 highly polymorphic tandem repeat markers on chromosome 17q21, in addition to an analysis of the whole coding region of the BRCA1 gene. Four of the 24 prostate cancer specimens showed LOH at one or more loci, all of which were histologically poorly differentiated (4 of 11) and stage D (4 of 15). One of the 24 cases showed a germ-line mutation of the BRCA1 gene, and a sister of this patient died of ovarian cancer. It appears that the BRCA1 gene is not frequently involved in the development of primary prostate cancer.

Purpose Alterations of the p53 tumor suppressor gene are the most common genetic change detected in human cancers. The incidence of p53 gene mutation in bladder tumor patients were studied and were compared with clinicopathological findings, smoking history and prognosis. Materials and methods Polymerase chain reaction single-strand conformation polymorphism (PCR-SSCP) was used for analysis from exon 4 to 9 of p53 gene in 105 cases of primary bladder tumors. Result p53 matations were detected in 38 or 105 patients (36.2%). Kaplan-Meier Survival curves fo groups wit or without p53 gene mutation show a statistically significant difference (p = 0.0098). The mutation of p53 gene in stages pT 1 pT 1. pT 2, pT 3, pT 4 was found in 2 of 12 (16.7%), 8 of 32 (25.0%), 10 of 25 (40.0%), 12 of 20 (60.0%), 6 of 16 (37.5%) and in grades I, II, III, was noted in 1 of 17 (5.9%), 16 of 49 (32.7%), 21 of 39 (53.8%) cases, respectively. Significant differences were found for groups with grade I and grade II-III (p = 0.0045) cancers and in cases of superficial (stage pTa-1) and muscle-invasive (pT 2-4) tumors (p = 0.0148). However, mutation of p53 was not related to either age or sex in 105 patients. Recurrence rates in stage pTa-1 superficial tumor group with or without p53 mutation showed a statistically significant difference (p = 0.0419). No statistically significant difference was noted between p53 mutation and habitual smoking as well as durations of smoking. Conclusions p53 mutations occur more commonly in higher grades and later stages of bladder tumors. Our results suggest that the prognostic factor is linked to not only histological findings but also to the presence of p53 mutation. The mutations of the p53 gene may be involved in the late events of tumorigenesis and might be used as good molecular markers for prognosis in bladder tumor.

We investigated the prognostic value of pituitary tumor transforming gene 1 (PTTG1) expression according to clinicopathological features among localized or locally advanced prostate cancer cases receiving hormone therapy. A retrospective study involved 64 patients receiving combined androgen blockade treatment was performed. PTTG1 expression was determined by immunohistochemical staining using initial needle biopsy specimens for diagnosis. Associations of PTTG1 with various clinicopathological features and disease-free survival were examined via uni- and multivariate analyses. No association between PTTG1 expression and clinical T stage, Gleason score, pretreatment PSA levels, risk groups was found (p =0.682, 0.184, 0.487, 0.571, respectively). Univariate analysis revealed that increased PTTG1 expression, T3 stage and high risk group were associated with increased risk of disease progression (p =0.000, 0.042, and 0.001), and high PSA level had a tendency to predict disease progression (p =0.056). Cox hazard ratio analysis showed that PTTG1 low expression (p =0.002), PTTG1 high expression (p =0.000) and high risk group (p =0.0147) were significantly related to decreased diseasefree survival. In conclusion, PTTG1 expression determined by immunohistochemical staining in needle biopsy specimens for diagnosis is a negative prognostic factor for progression in localized or locally advanced prostate cancer receiving hormone therapy.

Tumors originating from ectopic adrenal tissue are relatively rare. In this article, we describe a case with Cushing's syndrome caused by an ectopic adrenal adenoma. A 38 year-old male patient presenting with cushingoid appearance for 2 years was diagnosed to have ACTH-independent Cushing's syndrome based on endocrinological evaluation. Mutiple radiological examinations detected bilateral adrenal atrophy. When the images were investigated in a more expanded scope, a 3.0×3.5×5.3 cm mass was detected in the anterior of left renal hilum and left renal vein. The mass was successfully resected with intraoperative endoscopy and pathological evaluation revealed an ectopic adrenal tumor. It is suggested that when the endocrinlogically confirmed adrenal neoplasm could not be well and definitely localized, the possibility of ectopic adrenal should be presumed and further radiography examinations should extend to the field where ectopic adrenal usually presents.

To analyze the influence of benign prostatic hyperplasia (BPH) drugs on incidence and pathology grading of prostate cancer in China.Retrospectively investigated the history of drug treatment in 1029 cases of BPH in patients from February 1998 to December 2004. According to the history of drug use, the patients were divided into 4 groups: finasteride group, alpha-receptor inhibitor group, finasteride and alpha-receptor inhibitor combination group and control group (untreated group). We gathered pathology sections of patients in all groups, and gave Gleason Score to each. The difference of incidence and pathology grading of prostate cancer were analyzed by Stata 7.0.The incidence of prostate cancer in the population of our study was 13.5%; The incidence in finasteride group, alpha-receptor inhibitor group, combination group and control group was 9.8%, 16.0%, 10.3% and 18.6%, respectively. There was significant difference between the two groups with the use of finasteride and the two groups without it (P0.05). In our study, the ratio of middle or high level pathology grading (Gleason ≥ 7) in prostate cancer patients was 58.3%, the ratio of middle or high level pathology grading prostate cancer patients in the four groups was 71.4%, 59.6%, 67.7% and 40.0%, respectively. In the comparison of composition ratio of middle or high level prostate cancer, there was significant difference between the two groups with the use of finasteride and the two groups without it (P0.05).Finasteride can lower the risk of prostate cancer, but increase the pathology grade of the prostate cancer which has occurred in the same time. The alpha-receptor inhibitor does not have the same effect.

To present the technique and experience of robotic-assisted laparoscopic radical cystectomy (RARC) by da Vinci surgical system.From December 2007 to September 2008, 4 patients underwent RARC and urinary diversion. The age of patients was 44 to 63 years old. The body mass index was 22.8 to 27.7. All their clinical stages were lower than T2N0M0. The technique for RARC involving ureters dissection, posterior dissection, lateral pedicle control, anterior dissection, dorsal vein complex control, neurovascular bundles sparing, lymphadenectomy, ureter-ileal anastomosis, urethra-neobladder anastomosis to either ileal conduit urinary diversion or neobladder reconstruction performed extracorporeally.All the operations were accomplished successfully. The urinary diversion of 2 case was ileal conduit and others was ileal orthophoria neobladder. The operation time was 300 to 450 min. The time of radical cystectomy was 150 to 180 min. The estimated blood loss was 100 to 500 ml. The postoperative hospital stay was 9 to 35 d. The bed rest time was 4 to 9 d. There was 1 patients who had incomplete intestinal obstruction at 8th postoperative day cured by conservative therapy. The patients were followed up for 3 to 12 months, all patients survived without tumor recurrence. The patients have satisfied urinary continence and normal renal functions without hydronephrosis after the operation.RARC is small incision and safe, the results are definite. It is one of the direction of minimally invasive urologic surgery.

OBJECTIVE To evaluate the adhesion and growth of rabbit urethral epithelial cells (UECs) on a biodegradable unbraided mesh urethral stent, and to assess the feasibility and effect of the cell-seeded urethral stent for treating post-traumatic urethral stricture (PTUS) in a rabbit model. MATERIALS AND METHODS Rabbit UECs were collected by biopsy from adult rabbit urethra and seeded onto the outer layer of a mesh biodegradable urethral stent. The growth of UECs in cell-scaffolds was assessed by scanning electron microscopy, immunohistochemical and fluorescence staining. In all, 32 male New Zealand rabbits were used, with either PTUS or uninjured, as a control group. Cell-seeded stents were implanted into the rabbits strictured urethra. The histological and immunohistochemical findings were assessed after death at 1, 2, 8, 12 and 24 weeks, respectively. The reconstruction and function were evaluated by urethroscopy and retrograde urethrography. RESULTS The cultured UECs adhered to the stent and grew well. Immunohistochemistry showed that the cells were stained positively for cytokeratin. At 4 weeks, vs 2 weeks, the thickness of the papillary projections of the epithelium decreased and inflammatory cell infiltration diminished. At 24 weeks the injured urethra was completely covered by integrated regeneration of three to five layers of urothelium. There was no evidence of voiding difficulty, stricture recurrence or other complications. CONCLUSIONS The unbraided mesh biodegradable urethral stent with autologous UECs seemed to be feasible for treating PTUS in the rabbit urethra, and provides a hopeful avenue for clinical application allowing reconstruction of PTUS.

To investigate the role of the tumor suppressor gene BRCA1 in response to DNA damage and to confirm that the function of the BRCA1 protein is regulated by a variety of mechanisms including transcriptional control, phosphorylation and protein-protein interaction.With the human breast cell line MCF7 as the positive control, we determined the subcellular distribution of BRCA1 in the prostate cancer cell lines LNCaP, DU145 and PC3 by immunohistochemical staining and Western blotting analyses.BRCA1 was present in the prostate cancer cell lines LNCaP, DU145 and PC3. Ionizing radiation induced BRCA1 nuclear export, increasing from 14% to 40% in the cytoplasma (P0.01) and decreasing from 46% to 21% in the nuclei (P0.01). This DNA damage-induced BRCA1 nuclear export occurred only in the p53 wild-type but not in the p53 mutant cell line. The apoptosis rate of LNCaP cells was as high as 40% after nuclear export, with an obvious increase of cleaved caspase-3, which was correlated with BRCA1 nuclear-cytoplasmic shuttling.Cytoplasmic relocalization of the BRCA1 protein may be a mechanism whereby the BRCA1 function is regulated in response to DNA damage. Its induction of a higher rate of cell apoptosis indicates BRCA1 to be another good biomarker for the treatment of prostate cancer.

OBJECTIVE To explore the safety and clinical efficacy of continuous-wave laser vaporesection for the treatment of obstructive benign prostatic hyperplasia (BPH). PATIENTS AND METHODS We treated 72 consecutive patients with obstructive BPH using a 70 W 2-µm continuous-wave laser. The mean (range) age of the patients was 68.6 (52–86) years. Before laser treatment, the patients were examined. The mean (sd, range) prostatic volume was 65.8 (21.7, 36–108) mL. The operative outcomes assessed were: resection time, transfusion rate, catheter time, and haemoglobin and serum sodium levels. The following variables were assessed before and after vaporesection: maximum urinary flow rate (Qmax), postvoiding residual urine volume (PVR), International Prostate Symptom Score (IPSS), Quality of Life Index (QoL) and sexual function. RESULTS All cases were successful using general (two cases), epidural (28) or sacral block regional anaesthesia (42). The mean (sd) vaporesection time was 56 (12.8) min. None of the patients required a transfusion. The mean (sd) catheter time was 1.7 (0.6) days. The mean Qmax increased from 5.7 (1.2) mL/s before to 20.8 (2.1) mL/s after vaporesection and the PVR decreased from 150 to 36 mL. The IPSS and QoL scores improved after vaporesection from 24.6 (4.5) to 6.8 (1.2) and 4.8 (0.2) to 1.4 (0.3), respectively (P

To study the expression of Livin, an apoptosis inhibitor gene, in prostate cancer, and to investigate its clinical and pathological implications.The expressions of Livin were detected in 62 cases of neoplastic prostate tissues and 10 cases of normal prostate tissues by RT-PCR and immunohistochemistry (SP method).The Livin gene was highly expressed in neoplastic prostate tissues, but not in normal ones. Positive expression of Livin proteins was observed in 37 of the 62 (59.7%) tumor samples and accounted for 28.6%, 60.0% and 83.3% in the high, middle and low differentiation prostatic carcinoma groups respectively, with significant difference between the high and low groups. Livin positivity was also significantly correlated with tumor stages, increasing with tumor progression.Livin may play an essential role in prostate carcinogenesis and serve as a marker for the prognosis of prostate cancer.

To improve the treatment of renal neoplasm with tumor thrombus in the inferior vena cava.From May 2005 to May 2006, 9 cases of renal neoplasm with tumor thrombus were treated with balloon catheters to block inferior vena cava under the level of liver vena during the operations. Among the patients, 6 were male and 3 were female. The patients were from 20 to 76 years old (average 53).All cases were succeed by transabdominal incisions. The average length of tumor thrombus was 5.0 cm (3.0 - 6.7 cm). The blood pressure and heart rate were stable during operations. No intraoperative or postoperative complications occurred. The follow up ranged from 6 to 18 months. One patient died at 6 months after surgery. The others lived well.The use of balloon catheter during surgical treatment of renal neoplasm with inferior vena cava thrombus is suitable for type II and III tumor thrombus.

To study the expression of Livin, an apoptosis inhibitor gene, in bladder transitional cell carcinoma (TCC), and to investigate its clinical and pathological implications.Reverse Transcription-Polymerase Chain Reaction (RT-PCR) was used to detect the expression of Livin in the tissues of TCC, 21 among them being recurrent carcinoma, obtained during operation from 60 cases, 48 males and 12 females, aged 58.6 (34 approximately 85), and 10 samples of tissues far from the TCC from the 60 cases.The overall positive rate of Livin in the 60 cases of TCC was 28.3% (17/60), and was 0 in the 10 cases of tissues far from the TCC. The Livin positivity was not correlated with tumor stage and grade (both P0.05). The positive rate of the recurrent bladder carcinoma was 38.1% (8/21), higher than that of the primary bladder carcinoma (23.1%, 9/39), however, not significantly (P0.05).Livin may play an essential role in bladder carcinogenesis and serve as a marker for prognosis of bladder carcinoma.

We evaluated 3-D computed tomography angiography (3-D CTA) in the diagnosis of the nutcracker phenomenon, and its significance in postoperative follow up.Three-dimensional CTA was used to compare the anatomical relations of the left renal vein with the aorta and the superior mesenteric artery in patients with the nutcracker phenomenon and in a control group. Four patients with the nutcracker phenomenon received a surgical procedure of the transposition of the left renal vein. The 3-D CTA was used for all patients during postoperation follow-up testing.The 3-D CTA showed a compression of the left renal vein between the aorta and the superior mesenteric artery (SMA) and the abnormal acute angle between them. The angles and distances between the SMA and the aorta were 39.3 +/- 4.3 degrees and 3.1 +/- 0.2 mm in the patient groups and 90 +/- 10 degrees and 12 +/- 1.8 mm in the control groups, respectively. Differences in angles and distances were statistically significant between the two groups (P0.05). Surgical transposition of the left renal vein was performed successfully. Postoperative 3-D CTA revealed the distance between the SMA and the aorta was nearly normal.The reconstruction imaging of the renal vein by means of 3-D CTA revealed that unusual hematuria was due to compression of the left renal vein; therefore it may be a useful alternative imaging technique instead of conventional examinations. The non-invasive 3-D CTA may be a useful tool in the diagnosis of the nutcracker phenomenon and follow-up testing.

To evaluate the detection of prostate cancer in different prostate specific antigen (PSA) level and the predict value of PSA, digital rectal examination (DRE), transrectal ultrasound scan (TRUS) and PSA density (PSAD).The clinical data of 634 cases who had underwent transrectal ultrasound guided systematic sextant prostate biopsies between April 1996 to December 2002 due to being suspicious of prostate cancer were retrospectively analyzed. The detection of prostate cancer in different PSA groups, namely PSAor = 4.0, 4.1-, 10.1-,20.0 microg/L, and the predict values of PSA, DRE, TRUS and PSAD were statistically analyzed using t test, chi2 test and logistic regression analysis.The rates of prostate cancer detection in different PSA groups were 11.6%, 26.8%, 39.8% and 68.6%, respectively. The higher the PSA, the higher the rate of prostate cancer detection, the same was the positive predictive value of DRE and TRUS. The sensitivity and specificity of PSA4.0 microg/L were 93.0% and 33.0%, and the efficiency of DRE and TRUS were very low. Logistic regression analysis indicated that PSAD was the most risk factor of prostate cancer in the group of PSA 4.1-20.0 microg/L (OR = 687.09 +/- 646.96, P = 0.000).The rates of prostate cancer detection in different PSA groups are different compared with other countries. The screening roles of DRE and TRUS are dependent on PSA level. Utilization of the screening protocol which to stratify cases into three PSA groups, namely PSAor = 4.0, 4.1 - 20.0,20.0 microg/L, can elevate the positive rate of prostate biopsies without sacrificing cancers detected.

To investigate the usefulness of percentage of free prostate specific antigen (FPSA/TPSA) in serum/PSA density [(F/T)/PSAD] in the diagnosis of prostate cancer.Two hundred and four patients who had been carried out transrectal ultrasound guided prostate biopsy, were involved in this study. Among them, 90 patients were proved to be suffering from prostate cancer, and other 114 patients were identified as benign prostate hypertrophy. The effect of total serum PSA level, FPSA/TPSA, PSAD and (F/T)/PSAD in the diagnosis of prostate cancer were investigated, and at the same time, selecting patients who should be carried out a prostate biopsy.The mean values of (F/T)/PSAD were significantly lower for patients with prostate cancer in different PSA levels (4.0, 4.0-, 10.1-,20.0 microg/L), when compared with benign prostate hypertrophy patients. This difference has arrived statistical significance (P0.05). (F/T)/PSAD could provide higher specificity for diagnosing prostate cancer than FPSA/TPSA or PSAD. Among all patients, at the same higher sensitivity (about 90%), the specificity of FPSA/TPSA, PSAD and (F/T)/PSAD was 31.6%, 45.6% and 64.0%, respectively. At the same time, it was suggested that clinicians use different cutoffs for (F/T)/PSAD in different PSA level. When PSA level of patients was no more than 4.0 microg/L, 2.5 as the commended cutoff for (F/T)/PSAD was preferred; if PSA level was between 4.0 microg/L and 20.0 microg/L, 0.8 was a more suitable cutoff; 0.5 also could be taken as an appropriate cutoff in case of PSA level being higher than 20.0 microg/L.Keeping high sensitivity, using of (F/T)/PSAD can improve the diagnostic specificity of prostate cancer significantly.

Aim: To explore the feasibility and safety of greenlight photoselective vaporization of the prostate (PVP) on high-risk patients presenting with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) and to evaluate their clinical and voiding outcome. Methods: A total of 85 high-risk patients with obstructive BPH underwent PVP with an 80 W potassium-titanyl-phosphate laser, which was delivered through a side-deflecting fiber with a 23 Fr continuous flow cystoscope. Operative time, blood loss, indwelling catheterzation, international prostate symptom score (IPSS), quality of life score (QoL), uroflowmetry, postvoid residual urine volume and short-term complication rates were evaluated for all patients. Results: All patients got through the perioperative period safely. The chief advantages of PVP were: short operative time (25.6 ± 7.6 min), little bleeding loss (56.8 ± 14.3 mL) and short indwelling catheterization (1.6 ± 0.8 d). The IPSS and QoL decreased from (29.6 ± 5.4) and (5.4 ± 0.6) to (9.5 ± 2.6) and (1.3 ± 0.6), respectively. The vast majority of patients were satisfied with voiding outcome. The mean maximal urinary flow rate increased to 17.8 mL/s and postvoid residual urine volume decreased to 55.6 mL. These results are significantly different from preoperative data (P < 0.05). No patient required blood transfusion or fluid absorption. There were few complications and very high patient satisfaction after operation. Conclusion: PVP has a short operative time and high tolerance, and is safe, effective and minimally invasive for high-risk patients, therefore it might be considered as a good alternative treatment for high-risk patients with obstructive urinary symptoms as a result of BPH.

The treatment of symptomatic benign prostatic hyperplasia (BPH) remains a challenge for most urologic surgeons. We studied a cumulative cohort of patients with symptomatic benign prostatic hyperplasia (BPH) who underwent photoselective vaporization of the prostate (PVP) and evaluated the efficacy and safety of this procedure.A total of 196 patients with lower urinary tract obstruction symptoms secondary to BPH were treated using laser vaporization of the prostate under sacral canal anesthesia at our institutions. The therapeutic results were assessed using following variables: the safety and efficacy of sacral anesthesia, blood loss, operative time, indwelling catheterization. Preoperative and perioperative parameters were evaluated in the international prostate symptom score (IPSS), quality of life score (QoL), maximal urinary flow rate (Qmax), post-void residual urine volume (PVR) and the change of sexual function. Patients were also assessed for 3-month follow up.PVP was performed successfully for all patients. There were 195 patients under sacral anesthesia and 1 patient under epidural anesthesia. Mean operative time was (45.2 +/- 18.5) minutes. The mean IPSS decreased from (26.6 +/- 3.2) to (5.6 +/- 1.4) and the QoL score decreased from (5.7 +/- 0.4) to (1.6 +/- 0.5), respectively (P0.05), while mean Qmax increased from (6.7 +/- 2.5) ml/s preoperatively to (19.6 +/- 2.4) ml/s, PVR decreased from 158.4 to 25.8 ml, respectively (P0.05). Average catheterization time was (1.8 +/- 0.9) days. There was no significant blood loss or fluid absorption during the period of PVP. Complications consisted of transient dysuria in 3 patients (1.5%), delayed gross hematuria in 5 patients (2.5%), respectively. Significant improvement in clinical outcomes were noted as early as 3 months after PVP treatment.PVP is considered as a high satisfaction rate by patient and a minimal postoperative complication. Hence, PVP is a novel, safe, effective and minimal invasive treatment for patients with symptomatic BPH.

OBJECTIVE To construct a mutant enhanced green fluorescence protein (pEGFP) human telomerase reverse transcriptase (hTERT) gene expression vector (pEGFP-hTERT), to observe its expression in transfected human bladder cancer cell line T24 and its role in the molecular regulatory mechanisms of telomerase, and to provide a new target gene for bladder cancer therapy. MATERIALS AND METHODS Polymerase chain reaction (PCR) amplification was performed using primers based on the gene sequence of hTERT. The PCR product was cloned into plasmid pGEMT-T Easy and the sequence of mutant hTERT gene analysed. A recombinant mutant hTERT vector (pEGFP-hTERT) was constructed at the EcoR I and Sal I sites of the pEGFP-C1 vector. After transfecting the fusion gene into T24 cells by the method of calcium phosphate-DNA co-precipitation, we detected steady expression of the GFP-hTERT fusion protein by fluorescent-light microscopy. Changes in the proliferation of T24 cells were detected by light microscopy, and β-galactosidase staining correlated with senescence. RESULTS Identification of pEGFP-hTERT by enzyme digestion showed that the mutant hTERT fragment had been cloned into EcoR I and Sal I sites of the pEGFP-C1 vector. Steady expression of GFP-hTERT fusion protein was located in the nucleus of transfected cells. Positive expression senescence-associated β-galactosidase staining in transfected cells increased gradually with extended cultured time, and their growth was suppressed. CONCLUSION The recombinant mutant vector (pEGFP-hTERT) was successfully constructed and expressed steadily in T24 cells. The mutant-type hTERT gene suppresses the proliferation of T24 cells by a competitive effect on telomerase activity. This suggests that the hTERT gene might be a suitable gene target for bladder cancer therapy.

To investigate the necessity and safety of conversion from mycophenolate mofetil (MMF) to Azathioprine (AzA) in stable renal transplant patients.In a randomised open clinical trial, A total of 87 low-risk renal allograft recipients on triple immunosuppressive therapy (prednisone/MMF/cyclosporine) 6 months after transplantation was randomised into two groups: converted (switching MMF to AzA treatment 6 months after transplantation, n = 42) and control (continued MMF treatment, n = 45). Renal function, acute rejection episodes, side effects and related complications were analysed in each group.The outcome (such as event-free graft survival rate and incidence of acute rejection) of treatment after a 12-months follow-up of patients in two groups was similar. Liver lesion and leukocytopenia, most of which was reversible, occurred more frequently in the converted than in the control group.Under the special economic atmosphere and medical insurance system of our country, the conversion from MMF to AzA in some renal transplant patients was necessary and safe. Further study is needed to evaluate the long-term outcome of this conversion.

To evaluate CT virtual endoscopy (CTVE) based on spiral CT in the staging diagnosis of bladder neoplasms and its clinical application.Forty patients with bladder neoplasms and 10 normal patients underwent volume scanning using spiral CT. All images with thin collimation and overlapping reconstruction were transferred to computer workstation to obtain the images of CTVE. The results of all CTVE findings were compared with those of conventional CT, cystoscopy, operation and pathological data.CTVE showed the normal anatomical structure of bladder as actual cystoscopy. The size, configuration, location and extension of bladder neoplasms was detected by CTVE scans agreed with that of actual cystoscopy. CTVE revealed the structure of trigone of urinary bladder that were not available in actual cystoscopy, and they were confirmed operatively and compared with the pathological results according to the TNM classification of malignant neoplasms. The sensitivity of CTVE for bladder tumors and accuracy in preoperative neoplasms staging was 98% (39/40) and 85% (33/39), respectively. The sensitivity of mass detection of diameteror = 0.5 cm was 100%. The results were studied in a blind way.CTVE is a noninvasive, safe and reliable procedure in the staging diagnosis of bladder neoplasms. CTVE can well show bladder neck anatomy and serve as an important complementary method to conventional cystoscopy. The limitation of CTVE is that it can not observe change of mucosal appearances and perform biopsy.

Objectives. To improve our understanding of the clinical relevance of p53, mdm2, and bcl-2 protein overexpression in renal cell carcinoma, we retrospectively investigated the immunohistochemical expression of p53, murine double minute 2 (mdm2), and bcl-2 and the relationship of this expression to clinicopathologic characteristics. p53 regulates the transcription of downstream effectors such as the oncoprotein mdm2, and bcl-2 has been shown to inhibit apoptosis triggered by wild-type p53 . Methods. The expression of p53, mdm2, and bcl-2 protein was studied by immunohistochemical methods in paraffin-embedded nephrectomy specimens from 112 patients whose clinicopathologic data confirmed renal cell carcinoma. Results. The expression of the p53 and bcl-2 protein was recognized in 15 (13.4%) and 52 (42.0%) cases, respectively; the expression of the mdm2 protein, however, was seen in only 2 cases (1.8%). No correlation was noted between these three proteins and any clinicopathologic parameters, except p53 expression and Stage T1-2/T3-4 ( P = 0.0208). However, in multivariate analysis, stage (hazard ratio 3.586; P = 0.0002), expression of p53 (hazard ratio 6.090; P = 0.0126) and of mdm2 (hazard ratio 22.016; P = 0.0156), and coexpression of p53/mdm2 (hazard ratio 6.146; P = 0.0005) demonstrated a statistically significant effect on prognosis by proportional hazards regression tests. Conclusions. Our results indicate that stage, p53 expression, mdm2 expression, and coexpression of p53/mdm2 are useful to predict the clinical outcome in patients with renal cell carcinoma.

We investigated the prognostic and predictive relevance of p53, MDM2, and bcl-2 protein expression in patients with transitional cell carcinoma (TCC) of the bladder. The expression of p53, MDM2 and bcl-2 protein was studied by immunohistochemical methods in paraffin-embedded specimens from 119 patients whose clinicopathologic data confirmed TCC of the bladder. Multivariate analyses of prognostic factors were performed, and correlations with classical clinicopathologic parameters were examined. Sixty-one, 12, and 17% of cases were considered positive for expression of p53, MDM2 and bcl-2, respectively. p53 expression correlated with stage (p=0.0209), but not MDM2 and bcl-2 with any clinicopathologic parameters. In Cox's regression analysis, staging demonstrated a statistically worse prognosis (hazard ratio 1.636; p=0.0059) while bcl-2 (hazard ratio 0.179; p=0.0474) expression showed favorable prognosis in stage T2-4 invasive TCC of the bladder. Co-expression with p53/MDM2 (hazard ratio 0.367; p=0.0401) and p53/bcl-2 (hazard ratio 3.487; p=0.0111) overexpression were associated with favorable and unfavorable prognosis in stage T2-4 invasive TCC of the bladder, respectively. Our results indicate that staging is the most useful parameter to predict clinical outcome in patients with TCC of the bladder. Determinations of bcl-2 and co-expression p53/MDM2 and p53/bcl-2 may be useful for predicting tumor behavior and prognosis in stage T2-4 invasive type TCC of the bladder.

Programmed cell death is a genetically regulated pathway that is altered in many cancers. This process is, in part, regulated by the bcl-2 oncogene. Antisense oligodeoxynucleotides (ODNs) targeted to specific oncogenes have been used with some therapeutic success in animal models of leukemia and melanoma cells and human Hodgkin's lymphoma. We evaluated the effects of antisense ODNs targeted to the bcl-2 oncogene on the proliferation of human renal-cell carcinoma (RCC) cells in vitro and on the growth of human RCC xenografts in BALBc nude (nu/nu) mice.Expression bcl-2 mRNA in five RCC cell lines (ACHN, Caki-1, RCZ, RCW, and OS-RC-2) was analyzed by reverse transcriptase-polymerase chain reaction. The effects of phosphorothioated ODNs containing human bcl-2 sense and bcl-2 antisense sequences that were transfected with Lipofectin on the proliferation and viability of cultures of established human RCC cell lines were determined by MTS assay. The expression of Bcl-2 protein in ACHN tumor cells following antisense bcl-2 (AS2) ODN treatment was evaluated by Western blot analysis, and the extent of apoptosis in these cells was determined by fluorescence-activated cell sorter (FACS) analysis. The antitumor activity in ACHN xenografts in nu/nu mice was monitored by measuring differences in tumor weight in treated and control mice.Expression of bcl-2 mRNA was detected in all five RCC lines. Treatment with antisense bcl-2 ODNs inhibited the growth of all tested RCC cells and decreased Bcl-2 protein expression in ACHN cells. The AS2 antisense ODN complementary to the coding region of bcl-2 mRNA showed a superior antiproliferative effect compared with AS1 ODN complementary to the translation initiation region. Inhibition by antisense bcl-2 ODNs of ACHN cells was dose dependent. The FACS analysis revealed that growth inhibition was associated with the induction of programmed cell death. In vivo, AS2 ODN antitumor activity was noted in locally injected groups.Treatment of human RCC with antisense ODNs targeted to bcl-2 inhibits growth and is associated with the induction of programmed cell death. These results suggest therapeutic use of antisense bcl2 in the treatment of RCC.