Although surgical outcomes of totally laparoscopic total gastrectomy (TLTG) have been reported from several centers, the effectiveness of this technique has not been conclusively established. The aim ...of this study was to investigate the feasibility, safety, and efficacy of TLTG for gastric cancer.A prospectively collected and retrospectively analyzed data were used by comparing the short-term surgical outcomes of 124 patients who underwent TLTG with those of 124 patients who underwent open total gastrectomy (OTG) between March 2007 and March 2016.The 2 groups were well matched with respect to age, sex, body mass index, ASA score, and tumor stage. There was no significant difference with regard to the operation time but TLTG showed significantly less intraoperative blood loss (115.5 ± 70.2 vs 210.5 ± 146.7 mL, P < .01). Total numbers of retrieved lymph nodes were similar in the 2 groups. Postoperatively, no significant differences were found for morbidity or mortality. The time to first flatus, initiate oral intake, and postoperative hospital stay were significantly shorter in the TLTG group than in the OTG group (3.2 ± 1.0 vs 4.1 ± 1.2 days; 4.4 ± 1.2 vs 5.6 ± 2.0 days; and 8.9 ± 3.1 vs 11.3 ± 4.5 days, respectively; P < .01).TLTG for gastric cancer is technically safe, feasible, and minimally invasive compared with OTG. A prospective randomized trial is needed to establish the value of TLTG.
This study focused on the oxidative stress effect of di-n-butyl phthalate (DBP) on development of the urinary system.
We examined the mRNA expression of genital tubercle (GT) in control and DBP ...induced hypospadias group by Affymetrix Rat 230 2.0 Array. Real-time PCR and Western Blot were used to detect the protein and mRNA expression levels of inositol-1,4,5-triphate-receptor (IP3R) and epithelial-mesenchymal-transition (EMT)-related molecular markers, such as E-cadherin, β-Catenin, Snail, N-cadherin, in the GT of hypospadiac male rats and controls. The results of array were further confirmed in vitro. The changes of intracellular calcium concentration in urethral epithelial cells were detected by Fluo-3-AM before and after DBP treatment. The levels of reactive oxygen species (ROS) in urethral epithelial cells were measured by DCFH-DA with different concentrations of DBP (0, 1, 10, 100 μmol/L) treatment.
The mRNA expression profiles of GT in control and DBP induced hypospadias group showed high expression of IP3R and the abnormalities of EMT. Compared to the control group, the expression levels of IP3R, E-cadherin and β-Catenin increased at both the protein and mRNA levels. However the expression levels of Snail and N-cadherin decreased. The intracellular calcium concentration increased significantly after DBP treatment. The effect of DBP on urethral epithelial cells was linked to the generation of oxidative stress.
DBP can influence the development of GT through its oxidative stress effect, which significantly increases the concentration of calcium and inhibits EMT in urethral epithelial cells, and block the fusion process of urethral groove, causing the occurrence of hypospadias. This study provides a new understanding of DBP's molecular mechanisms on hypospadias and may lead to new treatment strategies for the disease.
•IP3R expression and EMT abnormalities may be related to the incidence of hypospadias.•DBP can influence the development of GT through its oxidative stress effect.•Calcium concentration and EMT inhibition block the fusion process of urethral groove.•A new molecular mechanism of hypospadias occurrence.
Maternal exposure to di-n-butyl phthalate (DBP) induces hypospadias via regulation of autophagy in uroepithelial cells. Here, we use gene express analysis to explore the underlying molecular ...mechanisms. Pregnant rats received DBP orally at a dose of 750 mg/kg/day during gestational days 14–18. Gene expression analysis showed an increased expression of the hedgehog interacting protein (HhIP) gene. In DBP-induced hypospadiac male offspring, immunohistochemistry (IHC) staining and Western blot analysis confirmed increased expression of the HhIP protein and inhibited hedgehog signaling. in vitro experiments suggest the involvement of the reactive oxygen species (ROS)-HhIP-Gli1-autophagy axis in DBP-treated primary rat urethral epithelial cells. Taken together, our findings show that prenatal exposure to DBP induces abnormal hedgehog signaling and autophagy in uroepithelial cells that may play important roles in the development of hypospadias.
Di-n-butyl phthalate (DBP) is a pollutant that is widely present in the environment. We have previously demonstrated that maternal exposure to DBP resulted in renal fibrosis in offspring, but the ...underlying mechanism was not well elucidated. Therefore, the current study aims to understand the underlying molecular mechanisms in these sex-specific developmental alterations. Here, we used RNA-seq analysis to explore the underlying molecular mechanisms of DBP-associated renal fibrosis. Pregnant rats received DBP orally at a dose of 850 mg/kg BW/day during gestational days 14–18. Upregulated autophagy in renal tubules in offspring was confirmed in the DBP-treated group via accessing LC3Ⅱ/Ⅰ protein expression. Increased expression of the HhIP gene was found in the DBP-treated group via RNA-seq analysis. Immunohistochemistry (IHC) staining and Western blot analysis confirmed increased expression of HhIP protein and inhibited hedgehog signaling. Increased HhIP expression further leaded to impaired activation of hedgehog signaling, which is critical for normal embryonic development. Additional in vitro experiments on renal tubular cells suggest that inactivation of hedgehog signaling induced autophagy in renal tubular cells. Taken together, our findings show that maternal exposure to DBP induced autophagy through regulation of hedgehog signaling via overexpression of HhIP in foetal renal tubular cells, which may be essential for renal fibrosis development.
•Maternal exposure to DBP resulted in renal fibrosis in offspring, involving increased expression of the HhIP gene.•DBP -related HhIP expression leaded to impaired activation of hedgehog signaling in offspring kidneys.•Autophagy and hedgehog signaling may play a role in DBP induced renal fibrosis in offspring.
Objectives: Previous prognostic factor models for metastatic renal cell carcinoma (mRCC) have not included erythrocyte sedimentation rate (ESR). We designed the present study to evaluate the ...prognostic value of ESR for mRCC patients treated with sorafenib.
Methods: Sorafenib was given to 83 patients with clear cell mRCC. Serum ESR was tested before treatment and every 4 weeks after first administration of sorafenib. Oncological evaluation was carried out every 8 weeks. Analyzed factors included age, sex, performance status, method of nephrectomy, number of metastatic organs, anemia, lactate dehydrogenase, corrected calcium, albumin, baseline ESR level and ESR kinetics status. Kaplan–Meier and Cox regression analyses on progression‐free survival (PFS) were carried out.
Results: Baseline ESR levels ranged from 3 to 154 mm/h, and 43 (41.0%) patients had an ESR level higher than 40 mm/h. Median PFS was 10.0 months (95% CI 7.6–12.4 months). Dividing the cohort into three groups according to ESR kinetics status, median PFS was 27 months in the decreased ESR group, 12 months in the stable ESR group and 6 months in the increased ESR group. Performance status, time from diagnoses to sorafenib treatment, number of metastatic organs and ESR kinetics were independent predictors for PFS in multivariable Cox regression model analysis, with an area under the curve of 0.865 in a binary logistic regression model of 12‐month PFS probability.
Conclusions: ESR kinetics can be useful to monitor the treatment response and to predict PFS for mRCC patients treated with sorafenib as second‐line therapy.
Objective To evaluate the role of electrical stimulation (ES) in the recovery of postprostatectomy urinary incontinence (UI). Methods We performed a meta-analysis of all available randomized ...controlled trials comparing ES enhanced pelvic floor muscle training (PFMT) with PFMT alone for postprostatectomy UI. We separated in the analysis the continence rate within 3 months or longer than 6 months after operation, which stand for the early and late recovery of UI after operation, respectively. Relative risk (RR) reductions and their 95% confidence intervals (CIs) were calculated for categorical outcomes. Results Four studies randomizing 210 cases were included in the meta-analysis. Three studies enrolling 186 cases reported the continence rate within 3 months after radical prostatectomy. The pooled analysis did not show that ES improved early recovery of UI better than did PFMT (RR 1.21; 95% CI = 0.95-1.54, P = .12). All 4 studies provided data for 6-12 months after RP; the pooled analysis did not show a relative benefit (RR = 1.03; 95% CI = 0.88-1.20, P = .73). Conclusion Based on available evidence, ES enhanced PFMT did not improve the return to continence more than PFMT in men with postprostatectomy UI.
To systematically evaluate the diagnostic efficacy of confocal laser endomicroscopy (CLE) in detection of bladder cancer.
A systematic literature search on CLE in diagnosing bladder cancer in PubMed, ...Embase, and the Cochrane Library databases was performed. A bivariate meta-regression model was used for meta-analysis to evaluate the pooled diagnostic value of CLE.
A total of 5 eligible studies involving 302 lesions were available for this meta-analysis. In a per-lesion analysis, pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and summary receiver-operating curve (SROC) area under the curve (AUC) of CLE for malignant lesions were 0.90 (95% confidence interval CI: 0.85-0.94), 0.72 (95% CI: 0.59-0.82), 3.20 (95% CI: 2.14-4.79), 0.14 (95% CI: 0.09-0.21), 23.27 (95% CI: 11.71-46.25), and 0.91 (95% CI: 0.89-0.94), respectively. For low-grade urothelial carcinomas, pooled sensitivity, specificity, PLR, NLR, DOR, and AUC for CLE were 0.72 (95% CI: 0.57-0.84), 0.87 (95% CI: 0.77-0.93), 5.48 (95% CI: 3.12-9.62), 0.32 (95% CI: 0.20-0.50), 17.19 (95% CI: 8.01-36.89), and 0.85 (95% CI: 0.82-0.88), respectively. For high-grade urothelial carcinomas, pooled sensitivity, specificity, PLR, NLR, DOR, and AUC for CLE were 0.82 (95% CI: 0.62-0.92), 0.84 (95% CI: 0.73-0.91), 4.96 (95% CI: 2.58-9.54), 0.22 (95% CI: 0.09-0.52), 22.49 (95% CI: 5.33-94.85), and 0.89 (95% CI: 0.86-0.91), respectively.
CLE is a promising endoscopy technique for real-time tumor grading of bladder cancer.
We previously demonstrated that maternal exposure to di-n-butyl phthalate (DBP) resulted in renal fibrosis in male offspring; however, the underlying mechanism governing this effect has not been ...thoroughly elucidated to date. We hypothesized that DBP exposure induces TGF-β expression and abnormal activation of epithelial-mesenchymal transition (EMT) in fibrotic kidneys. Pregnant rats received DBP orally at a dose of 850 mg/kg BW/day during gestational days 14–18. In the DBP-exposed group, immunohistochemistry (IHC) staining showed increased expression of TGF-β1 and EMT markers. In rat kidney tubular epithelial cells (NRK52E), ROS production increased expression levels of TGF-β1 and subsequently contributed to the induction of Snail1-mediated EMT. Notably, DBP exposure also promoted autophagy that downregulated TGF-β1. Taken together, our findings suggest that maternal exposure to DBP promotes EMT in tubular epithelial cells via upregulation of TGF-β1.
•Maternal exposure to DBP promoted TGF-β1 expression in kidney.•Autophagy regulated expression of TGF-β1 induced by DBP in renal tubular cells.•TGF-β signaling regulation contributed to DBP-induced EMT.
Objective
Confocal laser endomicroscopy (CLE) is an emerging endoscopic technique that can provide in vivo histopathologic information. It may improve the diagnostic criteria for benign and ...neoplastic lesions of the bladder. In this study, we reported our experience with utilizing CLE imaging when treating bladder neoplasms, and investigated its diagnostic value with respect to histologic diagnosis.
Materials and methods
Twenty-one patients scheduled for diagnostic cystoscopy or transurethral resection of the bladder tumor were enrolled prospectively. CLE was performed after intravesical fluorescein administration and confocal video sequences were reviewed and analyzed retrospectively. Histopathology served as reference standard for comparison.
Results
Confocal laser endomicroscopy-based classification combined with white light cystoscopy (WLC) images was consistent with histopathology in 17 cases (81.0%). Consensus with histopathological results was found in six cases (85.7%) for low-grade urothelial carcinoma and eight cases (80.0%) for high-grade urothelial carcinoma.
Conclusion
Confocal laser endomicroscopy was proved to be a useful technique that could complement white light cystoscopy by providing real-time histopathological information of bladder lesions.
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