Identification and control of the central adrenal vein (CAV) are key steps in laparoscopic adrenalectomy. However, the retroperitoneal laparoscopic left adrenalectomy (RLLA) lacks identifiable ...anatomical landmarks and does not have advantage of quickly exposing CAV. Here, we developed surgical maneuver and tactics of using the inferior phrenic vein (IPV) as a landmark in RLLA. During operations, we searched for the IPV between superior margin of renal artery and anterior aspect of psoas major muscle, and then the left IPV was followed and applied as an anatomical landmark to identify the CAV. Moreover, our study showed that variations in the left adrenal venous anatomy occurred in cases with pheochromocytomas. The application of left IPV as a landmark to search for CAV has important clinical significance in RLLA.
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EMUNI, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is a common disease of urology, of which the pathogenesis and therapy remain to be further elucidated. Quercetin has been ...reported to improve the symptoms of CP/CPPS patients. We aimed to verify the therapeutic effect of quercetin on CP/CPPS and identify the mechanism responsible for it.
Methods
A novel CP/CPPS model induced with Complete Freund Adjuvant in Sprague Dawley rats was established and the prostates and blood specimens were harvested for further measurement after oral administration of quercetin for 4 weeks.
Results
Increased prostate index and infiltration of lymphocytes, up‐regulated expression of IL‐1β, IL‐2, IL‐6, IL‐17A, MCP1, and TNFα, decreased T‐SOD, CAT, GSH‐PX, and increased MDA, enhanced phosphorylation of NF‐κB, P38, ERK1/2, and SAPK/JNK were detected in CP/CPPS rat model. Quercetin was identified to ameliorate the histo‐pathologic changes, decrease the expression of pro‐inflammatory cytokines IL‐1β, IL‐2, IL‐6, IL‐17A, MCP1, and TNFα, improve anti‐oxidant capacity, and suppress the phosphorylation of NF‐κB and MAPKs.
Conclusions
Quercetin has specific protective effect on CP/CPPS, which is mediated by anti‐inflammation, anti‐oxidation, and at least partly through NF‐κB and MAPK signaling pathways.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Objective. It has been well elucidated that multiple types of cancers are at high risk of thrombosis. Several studies have indicated the prognostic value of fibrinogen (Fib) and D-dimer (DD) in ...prostate cancer (PCa). However, it remains unclear regarding the association of the comprehensive coagulation markers with the clinicopathological features of PCa. Methods. A total of 423 pathologically diagnosed patients with PCa were consecutively collected and stratified as low-intermediate-risk or high-risk groups. The association of coagulation parameters including Fib, DD, prothrombin (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and antithrombin III (AT-III) with clinicopathological features was determined by univariate and multivariate logistic regression analyses. Results. The levels of Fib, DD, and PT were significantly higher in the high-risk group (p<0.001, p<0.001, and p=0.043, resp.), while APTT, TT, and AT-III were similar between two groups (p>0.05, all). Univariate logistic regression analysis demonstrated that Fib, DD, and PT were all positively correlated with high-risk PCa (OR=2.041, p<0.001; OR=1.003, p<0.001; OR=1.247, p=0.044). Nonetheless, after adjusting for PSA, grade, and stage, Fib (T3 vs. T1, OR=15.202, 95% CI: 1.725-133.959, p=0.014) but not DD or PT was the unique independent factor associated with high-risk PCa in the multivariate regression analysis. Conclusions. Our study firstly revealed that Fib but other coagulation markers was independently associated with the severity of PCa, suggesting Fib might be useful in PCa risk stratification beyond PSA, stage, and grade.
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DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
It is well known that the role of gut microbiota in drug metabolism, especially in oral difficult absorbable drugs. Understanding the gut microbiota could enable us to understand drugs in new ways. ...The purpose of the study was to investigate explore the metabolites of the anti-prostate cancer drug Abiraterone by examining gut microbiota metabolism and hepatic metabolism
in vitro
. In this study, five metabolites (M1, M2, M3, M4 and M5) of Abiraterone were discovered using LC/MS
n
-IT-TOF. Four isomeric metabolites M1-M4 were found in liver microsome. M5 was found in the intestinal contents of Sprague-Dawley rats with a molecular weight of 388.31. Among them, M4 was found to be Abiraterone N-Oxide by comparison with the standard sample. After further comparing the metabolic behavior of Abiraterone in rat gut microbiota and liver microsomes, we delineated the possible metabolic pathways of Abiraterone. In conclusion, Abiraterone is metabolized specifically in liver microsomes and gut microbiota. This study can provide a theoretical basis for elucidating the metabolic mechanism of Abiraterone and guide its rational application in clinic.
To quantitatively characterize the dosimetric effects of long on-couch time in prostate cancer patients treated with adaptive ultra-hypofractionated radiotherapy (UHF-RT) on 1.5-Tesla magnetic ...resonance (MR)-linac.
Seventeen patients consecutively treated with UHF-RT on a 1.5-T MR-linac were recruited. A 36.25 Gy dose in five fractions was delivered every other day with a boost of 40 Gy to the whole prostate. We collected data for the following stages: pre-MR, position verification-MR (PV-MR) in the Adapt-To-Shape (ATS) workflow, and 3D-MR during the beam-on phase (Bn-MR) and at the end of RT (post-MR). The target and organ-at-risk contours in the PV-MR, Bn-MR, and post-MR stages were projected from the pre-MR data by deformable image registration and manually adapted by the physician, followed by dose recalculation for the ATS plan.
Overall, 290 MR scans were collected (85 pre-MR, 85 PV-MR, 49 Bn-MR and 71 post-MR scans). With a median on-couch time of 49 minutes, the mean planning target volume (PTV)-V
of all scans was 97.83 ± 0.13%. The corresponding mean clinical target volume (CTV)-V
was 99.93 ± 0.30%, 99.32 ± 1.20%, 98.59 ± 1.84%, and 98.69 ± 1.85%. With excellent prostate-V
dose coverage, the main reason for lower CTV-V
was slight underdosing of seminal vesicles (SVs). The median V
change in the rectal wall was -1% (-20%-17%). The V
of the rectal wall increased by >15% was observed in one scan. A slight increase in the high dose of bladder wall was noted due to gradual bladder growth during the workflow.
This 3D-MR-based dosimetry analysis demonstrated clinically acceptable estimated dose coverage of target volumes during the beam-on period with adaptive ATS workflow on 1.5-T MR-linac, albeit with a relatively long on-couch time. The 3-mm CTV-PTV margin was adequate for prostate irradiation but occasionally insufficient for SVs. More attention should be paid to restricting high-dose RT to the rectal wall when optimizing the ATS plan.
Endourological treatment modalities for kidney stones include extracorporeal shock wave lithotripsy （ESWL）, flexible ureteroscopy （fURS）, percutaneous nephrolithotomy （PCNL）, and laparoscopy.PCNL is ...currently the recommended treatment for patients with complex renal stones. However, for complex renal stones, the residual stone after PCNL is very common, and the treatment is a sticky business.
Background： Percutaneous nephrolithotomy （PCNL） is the most widely recommended treatment lbr calyceal diverticular calculi, providing excellent stone-free results. However, its invasiveness is not ...negligible considering its major complication rates. Flexible ureteroscopy （FURS） is currently used to treat calyceal diverticula. However, the greatest drawback of FURS is locating the diverticulum since its neck is narrow and concealed. In such a case, the FURS procedure must be converted to PCNL. The aim of this study was to evaluate ultrasound-guided flexible ureteroscopy （UFURS） identifying diverticulum and the managenlent of calyceal diverticular calculi. Methods： A retrospective analysis was conducted on 24 patients who had calyceal diverticnlar calculi. In all 12 patients in tile UFURS group, direct FURS failed to find evidence of calyceal diverticula but were confirmed with imaging. The other 12 patients in the PCNL group received PCNL plus fulguration of the divenicular walls. Results： Puncture ofcalyceal diverticulum was successful in all 12 UFURS patients. Two patients in this group had postoperative residual calculi and two patients developed lever. In the PCNL group, percutaneous renal access and lithotomy were successful in all 12 patients. One patient in this group had residual calculi, one had perirenal hematoma, and two patients developed fever. No significant difference was found in the operating time （UFURS vs. PCNL, 91.8 ± 24.2 vs. 86.3 ± 18.7 min）, stone-free rate （UFURS vs. PCNL, 9/12 vs. 10/12）, and rate of successful lithotripsy （UFURS vs. PCNL, 10/12 vs. 11/12） between the two groups （all P 〉 0.05）. Postoperative pain scores in the FURS group were significantly lower than that in the PCNL group （2.7 ±1.2 vs. 6.2 ±1.5. P 〈 0.05）. Hospital stay in the UFURS group was significantly shorter than that in the PCNL group （3.4 ± 0.8 vs. 5.4 ± 1.0 days, P 〈 0.05）. All patients were symptom-free following surgery （UFURS vs. PCNL, 10/10 vs. 12/12）. Conclusion： Ultrasound-guided puncture facilitates identification of calyceal diverticula during FURS and improves the success rate of FURS surgery.
Background: Robot-assisted/laparoscopic intracorporeal ileal conduit (ICIC) has been reported in many experienced centers. Whether laparoscopic ICIC is superior to extracorporeal ileal conduit (ECIC) ...and whether laparoscopic ICIC should be promoted is still controversial. The aim of the study was to compare surgical and early oncological outcomes between patients undergoing laparoscopic radical cystectomy (LRC) with ICIC and ECIC.
Methods: From January 2011 to June 2016, a total of 45 patients with bladder cancer underwent LRC with ileal conduit at our department, of whom 20 patients underwent LRC with ECIC and 25 patients underwent LRC with ICIC. Data of each patient's characteristics, surgical outcomes, and short-term oncological outcomes were collected and analyzed.
Results: LRC with ileal conduit was performed successfully on all 45 patients. There were no significant differences in patients' characteristics, mean total operative time, and mean estimated blood loss between the ICIC and ECIC groups. Median time of flatus and oral intake was shorter in the ICIC group compared with the ECIC group (3 vs. 5 days, P = 0.035; 4 vs. 5 days, P = 0.002). The complications rates did not show significant difference between the two groups within the first 90 days postoperatively (P = 0.538). Cancer staging showed 45% of patients in the ECIC group and 36% in the ICIC group had a pathologic stage of T3 or T4, and 50% of patients in the ECIC group and 44% in the ICIC group had a pathologic stage of N1 or N1+. Kaplan-Meier analysis showed no significant difference in overall survival at 24 months (60% vs. 62%, P = 0.857) between the ECIC and ICIC groups.
Conclusions: ICIC after LRC may be successful with the benefits of faster recovery time. No significant difference was found in complications and oncological outcomes between ICIC and ECIC. However, larger series with longer follow-up are needed to validate this procedure.
In a large clinical trial, finasteride reduced the rate of low-grade prostate cancer （PCa） while increasing the incidence of high-grade cancer. Whether finasteride promotes the development of ...high-grade tumors remains controversial. We demonstrated the role of fibroblasts and c-Jun in chemopreventive and therapeutic effect of finasteride on xenograft models of PCa. LNCaP （PC3） cells or recombinants of cancer cells and fibroblasts were implanted in male athymic nude mice treated with finasteride. Tumor growth, cell proliferation, apoptosis, p-Akt, and p-ERKI/2 were evaluated. In LNCaP （PC3） mono-grafted models, finasteride did not change the tumor growth. In recombinant-grafted models, fibroblasts and c-Jun promoted tumor growth; finasteride induced proliferation of LNCaP cells and repressed PC3 cell apoptosis. When c-Jun was knocked out, flbroblasts and/or finasteride did not promote the tumor growth. Finasteride inhibited p-Akt and p-ERKI/2 in mono-culture cancer cells while stimulating the same signaling molecules in the presence of fibroblasts. Reduced p-Akt and p-ERKI/2 were noted in the presence of c-Jun-I- fibroblasts. Fibroblasts and c-Jun promote PCa growth; finasteride further stimulates tumor growth with promoted proliferation, repressed apoptosis, and up-regulated pro-proliferative molecular pathway in the presence of fibroblasts and c-Jun. Stromal-epithelial interactions play critical roles in finasteride＇s therapeutic effects on PCa. Our findings have preliminary implications in using finasteride as a chemopreventive or therapeutic agent for PCa patients.
Objective: To present a single center experience in managing transitional cell carcinoma (TCC) in Chinese renal transplant (RTx) recipients.
Methods: In a cohort of 1429 patients who received RTx ...operation, 27 patients (six males and 21 females) were pathologically diagnosed with TCC in their native urologic system. The data were analyzed retrospectively.
Results: The incidence of TCC was 1.89% and accounted for 41.5% of the patients with post‐transplant de novo malignancies among 1429 recipients. Among the 27 recipients with TCC, 77.8% were female, 59.3% had taken a Chinese herb that contains aristolochic acid for at least 2 months before RTx, 51.9% had painless gross hematuria, while 40.7% had microscopic hematuria and/or repeated urologic infection. Two patients were found to have asymptomatic hydronephrosis during a routine check‐up. The patients with upper tract carcinoma underwent simultaneous bilateral nephroureterectomy or unilateral nephroureterectomy and bladder cuff resection. Transurethral resection of the bladder tumor was carried out in patients with concomitant or solitary superficial bladder lesions. Intravesical chemotherapy was started and immunosuppressants were adjusted in all patients immediately after the surgery. Tumor recurrence in the bladder was noted in five patients. In one patient, residual and/or recurrent carcinoma in the contralateral pelvis was detected.
Conclusions: Transitional cell carcinoma is the predominant malignancy in Chinese RTx recipients. Female sex, the Chinese herb containing aristolochic acid and immunosuppression are markedly associated with the development of TCC. Risk‐adapted screening, strict follow up, standard surgical intervention and dose reduction of immunosuppressants are very important for early diagnosis and treatment of TCC.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
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