The modified three-level technique for retroperitoneal laparoscopic adrenalectomy (RLA) has proven beneficial in the treatment of adrenal lesions in patients with BMI≥25 Kg/m
. This paper aims to ...summarize our institution's seven-year experience using this technique for all patients with Adrenal Lesions ≤ 6cm.
Between January 2016 and December 2022. The patients underwent laparoscopic adrenal surgery were categorized into Zhang's technique (ZT) (Three-level Technique) group and modified technique (MT) group. The fundamental characteristics and perioperative data were analyzed, with statistical significance set at p<0.05.
In total, 731 patients were stratified into two groups: ZT (n=448) and MT (n=283). Statistically significant distinctions were not detected between the two groups regarding sex, BMI, tumor location, tumor size, tumor type, or American Society of Anesthesiologists (ASA) score (p>0.05). The MT group demonstrated superior outcomes compared to the ZT group in terms of operative time, estimated blood loss, drainage volume, diet recovery time, complication rates, and postoperative hospitalization duration (p<0.05). 17 (4.34%) in the ZT group required unplanned adrenalectomy, while there was none in MT group (P<0.05).
MT retroperitoneal laparoscopic adrenalectomy has demonstrated its benefits in the treatment of adrenal lesions across all patients with adrenal lesions ≤ 6cm, serving as a valuable point of reference for the surgical management of adrenal diseases.
We have made modifications to the classic retroperitoneal laparoscopic adrenalectomy and achieved superior surgical outcomes, resulting in a procedure known as modified retroperitoneal laparoscopic adrenalectomy. This technique is suitable for both obese individuals and the general population with adrenal lesions ≤ 6cm.
Abstract
The most common site of metastasis of prostate cancer (PCa) is bone. Skeletal-related events can increase the risk of death in patients with PCa by 28%. Due to the low detection rate of ...lesions in patients with low prostate-specific antigen (PSA) levels, the value of
99m
Tc methylene diphosphonate (
99m
Tc-MDP) bone scintigraphy is limited. Prostate-specific membrane antigen (PSMA) is a small molecular probe that can efficiently and specifically detect PCa lesions. This prospective study aimed to evaluate the difference between
99m
Tc-PSMA single-photon emission computed tomography (SPECT)/CT and
99m
Tc-MDP SPECT/CT in the detection of bone metastasis in PCa. A total of 74 men with pathologically confirmed PCa from October 2019 to November 2021 were prospectively enrolled in this study. The median age was 70 (range, 55–87) years. All patients underwent both
99m
Tc-PSMA SPECT/CT and
99m
Tc-MDP SPECT/CT at an average interval of 12.1 (range, 1–14) days. The detected imaging-positive bone lesions were scored as “typical metastasis” or “equivocal metastasis” by a standard reporting schema. Subsequent therapy modality details were observed through follow-up. Twenty-five of the 74 patients were diagnosed with bone metastases.
99m
Tc-PSMA SPECT/CT and
99m
Tc-MDP SPECT/CT detected 20 and 18 bone metastases, with sensitivities of 80.0% (20/25) and 72.0% (18/25), specificities of 100.0% (49/49) and 81.3% (40/49), and AUCs of 88.0% and 84.9%, respectively. There was a significant difference in the AUC between the two imaging methods (
P
< 0.001). In an analysis of the number of bone metastasis lesions, the proportion of “typical metastasis” versus “equivocal metastasis” detected by the two imaging methods was 26.3:1 (PSMA) and 2.9:1 (MDP), and the difference was statistically significant (
P
= 0.005). There was a significant difference in the detection of bone metastatic lesions by
99m
Tc-PSMA and
99m
Tc-MDP when the maximum diameter of the lesions was ≤ 0.6 cm (
P
< 0.05). The optimal cut-off value for PSA was 2.635 ng/mL (PSMA) and 15.275 ng/mL (MDP).
99m
Tc-PSMA SPECT/CT led to a change in management to a more individualized therapy modality for 11 of 74 men (14.9%).
99m
Tc-PSMA SPECT/CT was superior to
99m
Tc-MDP SPECT/CT in the detection of bone metastases in PCa, especially for small lesions and in patients with low PSA levels, and demonstrated an additional benefit of providing information on extraskeletal metastases. With regard to therapy,
99m
Tc-PSMA scans might have utility in improving the subsequent therapy modality.
Bladder transitional cell carcinoma (BTCC) is highly fatal and generally has a poor prognosis. To improve the prognosis of patients with BTCC, it is particularly important to identify biomarkers ...related to the prognosis. In this study, differentially expressed messenger RNAs were obtained by analyzing relevant data of BTCC from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. Next, hub genes that were suitable for correlation analysis with prognosis were determined through constructing a protein–protein interaction (PPI) network of differentially expressed genes and screening of major modules in the network. Finally, survival analysis of these hub genes found that three of them (
CCNB1
,
ASPM
, and
ACTC1
) were conspicuously related to the prognosis of patients with BTCC (
p
< 0.05). By combining the clinical features of BTCC and the expression levels of the three genes, univariate Cox and multivariate Cox regression analyses were performed and denoted that
CCNB1
could be used as an independent prognostic factor for BTCC. This study provided potential biomarkers for the prognosis of BTCC as well as a theoretical basis for subsequent prognosis-related research.
The incidence of renal tumours is increasing annually, and imaging alone cannot meet the diagnostic needs.IntroductionThe incidence of renal tumours is increasing annually, and imaging alone cannot ...meet the diagnostic needs.This single-centre study aimed to evaluate the predictors of diagnostic imaging-guided percutaneous renal mass biopsy (PRMB), its accuracy and safety, and subsequent changes to the treatment plan.AimThis single-centre study aimed to evaluate the predictors of diagnostic imaging-guided percutaneous renal mass biopsy (PRMB), its accuracy and safety, and subsequent changes to the treatment plan.We retrospectively collected the clinical data of patients who had undergone PRMB. The diagnosis rate, pathological data, and complications were analysed. Potential predictors of a diagnostic PRMB were evaluated using logistic regression analysis. Changes to the treatment plan due to PRMB results were also analysed.Material and methodsWe retrospectively collected the clinical data of patients who had undergone PRMB. The diagnosis rate, pathological data, and complications were analysed. Potential predictors of a diagnostic PRMB were evaluated using logistic regression analysis. Changes to the treatment plan due to PRMB results were also analysed.A total of 158 patients were included in this study. The univariate analysis showed that higher tumour diameter (OR = 1.223, 95% CI: 1.018-1.468, p = 0.031) and number of biopsy cores ≥ 2 (OR = 6.125, 95% CI: 2.006-18.703, p = 0.001) were significantly associated with diagnostic biopsy, and multivariate analysis results showed that higher tumour diameter (OR = 1.215, 95% CI: 1.008-1.463, p = 0.041) was an independent predictor of diagnostic biopsy. A nomogram including tumour diameter and number of biopsy cores was constructed to predict diagnostic biopsy. Compared with postoperative pathology, the concordance between biopsy and postoperative pathology at identifying malignancies, histologic type, and histologic grade were 100% (47/47), 85.1% (40/47), and 54.1% (20/37), respectively. The treatment plans of 15 patients (9.5%) changed based on the PRMB results. Fourteen patients (8.9%) had minor complications (Clavien-Dindo classification < 2).ResultsA total of 158 patients were included in this study. The univariate analysis showed that higher tumour diameter (OR = 1.223, 95% CI: 1.018-1.468, p = 0.031) and number of biopsy cores ≥ 2 (OR = 6.125, 95% CI: 2.006-18.703, p = 0.001) were significantly associated with diagnostic biopsy, and multivariate analysis results showed that higher tumour diameter (OR = 1.215, 95% CI: 1.008-1.463, p = 0.041) was an independent predictor of diagnostic biopsy. A nomogram including tumour diameter and number of biopsy cores was constructed to predict diagnostic biopsy. Compared with postoperative pathology, the concordance between biopsy and postoperative pathology at identifying malignancies, histologic type, and histologic grade were 100% (47/47), 85.1% (40/47), and 54.1% (20/37), respectively. The treatment plans of 15 patients (9.5%) changed based on the PRMB results. Fourteen patients (8.9%) had minor complications (Clavien-Dindo classification < 2).Our results suggest that tumour diameter was an independent predictor of diagnostic biopsy. Furthermore, PRMB can be accurately and safely performed and may guide clinical decision-making for patients with renal tumours.ConclusionsOur results suggest that tumour diameter was an independent predictor of diagnostic biopsy. Furthermore, PRMB can be accurately and safely performed and may guide clinical decision-making for patients with renal tumours.
Objective
To investigate the value of 3.0T MRI multi‐directional diffusion‐weighted imaging (DWI) combined with T2WI morphological features and lesion distribution in preoperative prediction of ...muscle layer invasion of bladder cancer (BC) and the correlation with postoperative Ki‐67.
Materials and Methods
This retrospective study enrolled patients with BC between 2019 and 2021. Patients with muscular invasive bladder cancer (MIBC) or non‐muscular invasive BC (NMIBC) were also analyzed by preoperative 3.0T MRI aFostic efficacy.
Results
A total of 186 patients were enrolled. About 27 patients with MIBC (35 lesions in total) and 62 with NMIBC (99 lesions in total). We found the tumor with a larger size, a wide base, and a smaller apparent dispersion coefficient (ADC) value and normalized ADC(nADC) value, without a stalk, presenting a greater risk of muscle invasion. ADC value, nADC value, maximum diameter, and stalk were independently associated with muscle invasion. Lesions located at the bladder fundus or involvement of multiple sites were independently associated with muscle invasion compared to the bladder body. In combination with morphological features, the AUCs of ADC and nADC showed accuracies of 0.925 and 0.947–0.951, respectively. TADC and nTADC showed the best diagnostic efficacy in multiple respects. KI‐67 LI was negatively correlated with ADC and nADC values.
Conclusions
This is the first report in which we found Multi‐directional DWI combined with T2WI in 3.0T MRI can be used to predict the muscle layer invasion of bladder cancer. ADC values reflect the muscular invasion of bladder cancer and show a moderate negative correlation with Ki‐67. It is especially suitable for bladder cancer patients with renal insufficiency or tumor recurrence.
ROC curve representing aADC, TADC, nTADC, model 8 in discriminating NMIBC from MIBC.
Background. Prostate cancer is one of the most common malignancies in men. Protein ubiquitination is an important mechanism for regulating protein activity and level in vivo. We aimed to study the ...mechanism of SEPT6 and UBC action in prostate cancer to identify new targets. Methods. The ubiquitin-protein and the ubiquitin coding gene UBA52, UBA80, UBB, and UBC expressions were detected in clinical tissues and cells. Overexpression and knockdown of UBC were performed in prostate cancer DU145 cells. Cell Counting Kit 8 (CCK-8) assay was performed to detect cell proliferation. Cell cycle at 24 h was detected by flow cytometry. Clonal formation assay was used to measure cell clone number. Immunofluorescence (IF) was performed to detect the colocalization of SEPT6 and UBC in prostate cancer cells. Next, we overexpressed or knocked down SEPT6 expression in DU145 cells. Pearson correlation coefficient was applied to analyze the relationship between SEPT6 and UBC in prostate cancer tissue. oe-SEPT6+oe-UBC coexpressing cells were constructed to detect the upstream and downstream relationship between SEPT6 and UBC on prostate cancer cells. The tumor formation experiment was performed to explore SEPT6/UBC effect on prostate cancer. Results. UBC was upregulated in prostate cancer tissues and cells. Overexpression of UBC promoted cell survival and proliferation. IF revealed the colocalization of SEPT6 and UBC in prostate cancer cells. UBC expression decreased after oe-SEPT6, while increased after sh-SEPT6, indicating that UBC was downstream of SEPT6. Pearson correlation coefficient analysis showed that SEPT6 was negatively correlated with UBC in prostate cancer tissues. SEPT6 as an upstream gene of UBC regulated prostate cancer cell behavior through UBC. The tumor formation experiment showed that SEPT6 could inhibit tumor growth. Conclusion. In general, SEPT6 inhibited UBC expression, thereby reducing the overall ubiquitination level, affecting the expression level of downstream cell proliferation-related genes, and then affecting the progression of prostate cancer.
Dioscin possesses antioxidant effects and has anticancer ability in many solid tumors including prostate cancer (PCa). Nevertheless, its effect and mechanism of anti-PCa action remain unclear. The ...tyrosine protein phosphatase SHP1, which contains an oxidation-sensitive domain, has been confirmed as a target for multicancer treatment. Further studies are needed to determine whether dioscin inhibits PCa through SHP1. We performed
in vitro
studies using androgen-sensitive (LNCaP) and androgen-independent (LNCaP -C81) cells to investigate the anticancer effects and possible mechanisms of dioscin after administering interleukin-6 (IL-6) and dihydrotestosterone (DHT). Our results show that dioscin inhibited cell growth and invasion by increasing SHP1 phosphorylation p-SHP1 (Y536) and inhibiting the subsequent P38 mitogen-activated protein kinase signaling pathway. Further
in vivo
studies confirmed that dioscin promoted caspase-3 and Bad-related cell apoptosis in these two cell lines. Our research suggests that the anticancer effects of dioscin on PCa may occur through SHP1. Dioscin may be useful to treat androgen-sensitive and independent PCa in the future.
Whether neoadjuvant therapy confers a survival benefit in advanced prostate cancer (PCa) remains uncertain. The primary endpoints of previous retrospective and phase II clinical studies that used ...neoadjuvant therapy, including androgen deprivation therapy combined with new-generation androgen receptor signaling inhibitors or chemotherapy, were pathological downstaging, progression-free survival, prostate-specific antigen relief, and local symptom improvement. To the best of our knowledge, no studies have explored the efficacy and safety of neoadjuvant therapy in improving the surgical resection rate in cases of unresectable primary tumors of PCa. We first designed this retrospective study to evaluate the potential value of apalutamide as neoadjuvant therapy in improving the resectability rate of radical prostatectomy (RP). We initially reported 7 patients with unresectable primary lesions who underwent neoadjuvant apalutamide treatment for a median of 4 months, and all of them successfully underwent RP treatment. Our study supported apalutamide as neoadjuvant therapy, which helped improve RP’s success rate and did not significantly increase perioperative complications, and the neoadjuvant therapy was controllable. Our findings’ clinical value and benefit for survival still need further clinical research to confirm.
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