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

TObjective：o analyze the incidence and clinicopathological features of incidental prostate cancer (IPCa) in specimens from radical cystoprostatectomy (RCP) for bladder cancer. Methods: We retrospectively reviewed the histopathological features of 865 male patients who underwent an RCP between January 2005 and March 2014. No patients had preoperative clinical or biological suspicion of prostate cancer (PCa). Results: Among the 865 specimens, IPCa was diagnosed in 235 patients (27.2%). Most tumors (228/235， 97.0%) were organconfined (pT2); And 7 cases (3.0 %) of them were diagnosed at T3. Gleason score was < 6 in 84 cases (35.7 %), 6 in 77 cases (32.8%), 7 in 64 cases (27.2 %), and > 7 in 10 cases (4.3 %). Conclusion: The rate of incidentally diagnosed IPCa was 8.5%, and that in RCP and TURP specimens was 19.5% and 4.4% respectively. The majority of these IPCas were organconfined. Gleason score in most of these specimens was ≤ 7. Moreover, prostate examination in the RCP specimen should be careful and sufficient, wholeamount prostate sections improve diagnostic accuracy.

Objective：To investigate the expression of urinary brainderived neurotrophic factor (BDNF) in benign prostatic hyperplasia patients with overactive bladder (OAB) symptoms and its correlation with the severity of OAB symptoms. Methods: According to the inclusion and exclusion criteria, a total of 178 patients with benign prostatic hyperplasia who were to undergo transurethral resection of prostate (TURP) were enrolled in this study. All the patients had accepted basic preoperative evaluations, as well as an assessment of their International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS). The patients who had been scheduled for surgery had to take the urodynamic assessment. Urinary BDNF levels were measured by the enzymelinked immunosorbent assay (ELISA) and the results were further normalized to the concentration of urinary creatinine (BDNF/Cr, mg/mol). Results: The urinary BDNF/Cr levels of the patients with moderate and severe lower urinary tract symptoms were (1.189±0.753) mg/mol and (1.817±1.110) mg/mol (P<0.001). The urinary BDNF/Cr levels of the patients with grades Ⅲ-Ⅵ obstruction were (1.382±0.945) mg/mol, (1.435±0.938) mg/mol, (1.640±1.104) mg/mol, and (1.653±1.019) mg/mol, respectively (P>0.05). There was no correlation between the urinary BDNF/Cr levels and the severity of obstruction (r=0.103, P=0.173). The urinary BDNF/Cr levels in the patients with and without OAB symptoms were (1.913±0.843) mg/mol and (0.297±0.183) mg/mol (P<0.001). The urinary BDNF/Cr levels in the patients with mild, moderate and severe OAB symptoms were (1.501±0.543) mg/mol, (1.806±0.703) mg/mol and (2.560±0.979) mg/mol, respectively (P<0.05). There was a correlation between the urinary BDNF/Cr levels and the severity of OAB symptoms (r=0.743, P<0.001). The urinary BDNF/Cr levels in the patients with urodynamic detrusor overativity were significantly higher than those without detrusor overativity ［(1.917±0.866) mg/mol and (1.194±1.013) mg/mol, P<0.001］. Conclusion: There is no correlation between urinary BDNF and severity of obstruction in benign prostatic hyperplasia patients with moderate and severe lower urinary tract symptoms. The urinary BDNF levels in patients with OAB symptoms are elevated compared with patients without OAB symptoms, and are correlated with the severity of OAB symptoms.

Objective：To investigate the characteristics and related influence factors of lymph node metastases in patients undergoing radical cystectomy and lymph node dissection for bladder cancer. Methods: The data of 522 patients who underwent radical cystectomy and pelvic lymph node dissection at Department of Urology, Peking University First Hospital from 1998 to 2012, were retrospectively collected, and the lymph node mapping was performed in all the patients to determine the location of metastatic lymph nodes.Results: For the 522 patients with bladder cancer, lymph node metastasis occurred in 99 patients, and the incidence of lymph node metastasis was 19.0%. The incidence at different tumor stages was: 3.7% in T1 (6/164), 10.5% in T2 (17/160), 36.7% in T3(40/107), and 41.9% in T4 (36/86). The most common involved lymph nodes were hypogastric/obturator lymph nodes (77/99, 77.8%) and external iliac lymph nodes (35/99, 35.4%). The mean number of lymph nodes dissected was 11.6 (1-51). The lymph node density (number of lymph nodes involved/number of lymph nodes removed) was 44.1%. The incidence of lymph node metastasis was statistical related to tumor stage (P<0.01,OR 2.71,95% CI 2.13-3.44) and tumor grade (P<0.01,OR 3.81,95% CI 1.66-8.74), while age, gender, smoke history, and weight had no statistical significance. Conclusion:Lymph node metastasis is the most common metastasis route of bladder cancer. The incidence of lymph node tumor involvement is correlated with increasing tumor stage and tumor grade. The most common involved lymph nodes are hypogastric/obturator lymph nodes and external iliac lymph nodes. Radical cystectomy and bilateral pelvic lymph nodes dissection are of great significance in the treatment of bladder cancer.

Objective：To characterize the long-term outcome of surgical extirpation for local recurrence after radical nephrectomy of renal cell carcinoma (RCC) and identify prognostic factors for locally recurrent RCC. Methods: Peking University First Hospital urologic database was queried for all patients with isolated local recurrence following radical nephrectomy for localized RCC. According to previous literature, local recurrence included relapse in the renal fossa, ipsilateral adrenal gland and ipsilateral retroperitoneal lymph nodes. The median follow up was 62 months. The cancer specific survival and relapse patterns were estimated using the Kaplan-Meier method. Results: In our institutional database,1 045 patients were treated with nephrectomy for localized RCC from January 1994 to December 2011.With a postoperative follow-up of (62.7±36.2) months, 15 patients (1.44%) experienced local recurrence, 9 of which were managed by surgical resection, and the rest 6 did not receive operation. The patients who received surgical resection had a 1-year cancer specific survival rate of 87%, compared with 60% of the patients without receiving surgical treatment. The 4-year cancer specific survival rate was 72% vs. 30%.The survival time was(51.8±7.4) months vs. (28.4±9.2) months. The recurrence interval was (39.4±29.5)months vs. (29.3±23.9) months. Conclusion: Surgical resection for local recurrence of RCC in selected patients is a feasible management and may prolong the survival time.

Objective：
To investigate the length of interval time between biopsy and laparascopic radical prostatectomy in difficulty and effects of surgery. Methods: We retrospectively analyzed 89 cases of laparascopic radical prostatectomy from June 2011 to September 2013. The patients were divided into two groups according to the interval time of 6 weeks. The mean interval time was 3.1 weeks (ranging from 1.5 to 4.4 weeks) in group IT<6 weeks and 4.4 weeks (ranging from 6.0 to 16.2 weeks) in group IT≥6 weeks. The mean age was 67 years (ranging from 57 to 78 years). The PSA level was 15.4 μg/L (ranging from 5.2 to 72.0). The prostate volume was 55 mL (ranging from 42 to 89 mL). The parameters, such as operation duration, blood loss, positive surgical margin rate, incharge time postoperation, were evaluated. Results: All the surgeries went successfully. The average operation duration was 150 min (ranging from 110 to 242 min), and the blood loss was 230 mL (ranging from 100 to 750 mL). The positive surgical margin rate was 18% and the urinary continence rate was 100% at 3 months after operation. The clinical recurrence was not found during the followup. No significant difference was found between the groups in the patients’ age, preoperative PSA, Gleason score and prostate volume (P>0.05). No statistical significance existed in the operation time, blood loss, positive margin rate, postoperative hospital stay, urinary continence rate at 3 months after operation, postoperative differences of clinical recurrence rates. Conclusion: The length of interval time between prostate biopsy and laparascopic radical prostatectomy does not influence the difficulty and effect in the early stage, and the long time survival and recurrent rate need further observation.

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

Objective：To compare and analyze semen quality improvement between the patients with microscopic varicocelectomy and laparoscopic varicocelectomy. Methods: A total of 291 patients with varicocele were included in this study, of whom 176 underwent microscopic varicocelectomy and 115 laparoscopic varicocelectomy. The improvement rates of semen quality and pregnancy rates between the two groups were compared.Results: The improvement rate of sperm density in microscopic group was significantly higher than that of laparoscopic group (87.6% vs. 73.7%, P=0.006). Spouse pregnancy rate of microscopic group was significantly higher than that of laparoscopic group (45.4% vs. 30.3%, P=0.017). Conclusion: The effect of microscopic varicocelectomy was superior to that of laparoscopic varicocelectomy.

Objective：To evaluate the related factors of upper urinary tract deterioration in spinal cord injured patients. Methods: Medical records of spinal cord injured patients from Jan.2002 to Sep.2009 were retrospectively reviewed. All the patients were divided into the upper urinary tract deterioration group and non-deterioration group according to the diagnostic criteria. Indexes such as demographic characteristic (gender, age), spinal cord injury information (cause, level, completeness), statuses of urinary tract system (bladder management, urine routine, urine culture, ultrasound, serum creatinine, fever caused by urinary tract infection) and urodynamics information(bladder compliance, bladder stability, bladder sensation, detrusor sphincter dyssynergia, detrusor leak point pressure, maximum cystometric capacity, relative safe bladder capacity, maximum flow rate, maximum urethra closure pressure) were compared between the two groups.Then Logistic regression analysis were performed.Results: There was significantly difference between the two groups in spinal cord injury level（χ²=8.840, P=0.031）,bladder management（χ²=11.362, P=0.045）,urinary rutine（χ²=17.983, P=0.000）, fever caused by urinary tract infection（χ²=64.472, P=0.000）, bladder compliance（χ²=6.531, P=0.011）, bladder sensation（χ²=11.505, P=0.009）, maximum cystometric capacity（t=2.209,P=0.043）, and detrusor-sphincter dyssynergia（χ2=4.247, P=0.039）. The multiplefactor non-conditional Logistic regression analysis showed that bladder management (OR=1.114，P=0.006), fever caused by urinary tract infection(OR=1.018，P=0.000)， bladder compliance(OR=1.588，P=0.040) and detrusor-sphincter dyssynergia（OR=1.023，P=0.034） were the key factors of upper urinary tract deterioration in spinal cord injured patients.Conclusion: Urinary tract infection, lower bladder compliance, detrusor-sphincter dyssynergia and unreasonable bladder management are the risk factors of upper urinary tract deterioration in spinal cord injured patients.

Objective：To evaluate the prevalence and the risk factors of the ureteral stricture following renal transplantation and outcomes of surgical managements. Methods: By a retrospective analysis, we assessed 1 293 patients who underwent renal transplantation between January 2001 and December 2013 at our center. The patients with ureteral stricture had undergone surgical management which included neoureterocystostomy, ureteral anastomosis with the native ureter and endoscopic therapy. Results: Ureteral stricture following renal transplantation was diagnosed in 17 cases (1.3%) including 6 males and 11 females. The mean age of the patients at the time of surgery was 44 (29 to 64) years. The median interval between ureteral stricture obstruction and kidney transplantation was 4 (1 to 120) months. The ureteral stricture was significantly correlated with multiple renal arteries, donor age and delayed graft function. The effective rate of surgical management was 65.75%. Conclusion: The incidence of ureteral stricture as a urologic complication after renal transplantation is low. The advanced techniques that preserve the ureteric blood supply should be applied. The surgical managements have respective advantages and disadvantages. The neoureterocystostomy shows best outcome, while ureteral anastomosis with the native ureter has poor outcome.

Objective：To investigate the pathogenesis and therapy of hydronephrosis after hematopoietic stem cell transplantation (HSCT). Methods: From March 2004 to March 2014, 23 patients with hydronephrosis after HSCT were identified. With these data, the pathogenesis of hydronephrosis after HSCT were analyzed. According to the surgical intervention of hydronephrosis and ureteral dialation of ureteral stricture, the patients were divided into two groups, ranksum test and exact probability test were used to evaluate whether there were significant differences in the time of hemorrhagic cystitis (HC) occurred, ureteritis and viremia. Results: HC, ureteritis, ureteral stenosis were all the causes of hydronephrosis after HSCT. In this study, 69.6% (16/23) of the patients suffered from HSCT were cured by conservative treatment, 30.4% (7/23) by surgical intervention, and 13.0% (3/23) by insertion DJ stent or nephrostomy.Of the patients ［17.4% (4/23)］ who suffered ureteral stenosis, 2 were cured after the balloon dialation of ureter, 1 needed DJ tube longterm insertion, and 1 was still followed-up. Rank-sum test and exact probability test results showed that the patients who needed surgical intervention might suffer from HC later than other patients, and their incidences of viremia and ureteritis were higher, but the differences between the two groups were not statistically significant (P=0.524, P=0.169, and P=0.124, respectively). The results also showed that the ureteritis incidences of the patients who suffered from ureteral stricture and needed ureteral dialation were higher than that of the other patients, and the difference between the two groups was statistically significant (P=0.024). The patients who needed ureteral dialation suffered from HC later and their incidences of viremia was higher, but the differences between the two groups were not statistically significant (P=0.73 and P=0.27). Conclusion: HC, ureteritis and ureteral stenosis may cause hydronephrosis after HSCT. Patients may treated by conservative treatment first. Patients who suffered from HC later, viremia and especially ureteritis should be paid more attention to, and be treated with surgical intervention when necessary. The patients with ureteral stenosis could be treated by ureteral balloon dialation.

Objective：To investigate the diagnosis and treatment of renal pelvic tumor combined with renal urinary calculi and hydronephrosis. Methods: Five patients with renal pelvic tumor who underwent relief of the upper urinary obstruction were reviewed. Results: One of the cases lost the opportunity of surgical therapy when pelvic tumor was detected at the advanced stage, and the other 4 cases had received surgery and were followed up. Conclusion:As pelvic tumor progresses rapidly after the renal blood flow is improved, and renal urinary calculi with hydronephrosis relieved; the patients with renal pelvic tumor need early diagnosis, aggressive treatment and close follow-up.

Objective：To evaluate the feasibility and efficacy of percutaneous renal puncture in percutaneous nephrolithotomy guided by novel needle-tracking ultrasound system. Methods: From may to october 2013, 16 cases of percutaneous nephrolithotomy were performed under the guidance of ultrasound system. The clinical data including the time of completing percutaneous renal puncture, the color of urine sucked out from the kidney calices, and the complications were analyzed retrospectively. Results: Of the 16 patients, 18 percutaneous renal access were established guided by ultrasound system. All of them were successtul for the first time, and the average time of completing percutaneous renal punctures was (26.90±11.37) s (15 to 54 s). After the operation, the hemoglobin decreased by (9.56±5.27)%(1.41% to 24.06%), and no complications occurred except for postoperative fever in 2 case. Conclusion: The novel ultrasound system is a safe and effective technique that can reduce the technical difficulty of percutaneous renal puncture in percutaneous nephrolithotomy.

Objective：To investigate the risk factors of systemic inflammatory response syndrome (SIRS) after one-phase treatment for apyrexic calculous pyonephrosis by percutaneous nephrolithotomy (PCNL). Methods: Clinical data of consecutive apyrexic calculous pyonephrosis patients who underwent one-stage PCNL from January 2008 to December 2013 were analyzed retrospectively. The data collected included white blood cells in urine analysis before surgery, midstream urine culture, preoperative renal function, using antibiotics time before surgery, operative time, the number of tracts, intraoperative irrigation peak flow, blood transfusion, and stone composition. Chi-square, t test and Logistic regression methods were used for analysis of each factor and SIRS. Results: A total of 182 patients were enrolled in this study and 38 patients developed SIRS (20.88%). There were no statistically significant differences among white blood cells in urine analysis (P=0.483), urine culture positive (P=0.136), and struvite (P=0.324) in terms of the incidence of postoperative SIRS. Multivariate Logistic regression model indicated that risk factors of SIRS for apyrexic calculous pyonephrosis after one-phase PCNL were renal insufficiency (OR=5.41, 95% CI 1.84 to 22.64, P=0.014), operative time (OR=1.01, 95% CI 1.00 to 1.02, P=0.024), operative tracts (OR=3.37, 95% CI-1.92 to 32.55, P=0.077), intraoperative irrigation peak flow ≥500 mL/min (OR=45.87，95% CI 4.39 to 231.68, P=0.007), and blood transfusion (OR=5.98, 95% CI 1.12 to 46.66, P=0.043). The protective factor was antibiotics use for more than 3 days (OR=0.34, 95% CI -3.92 to 12.55, P=0.047). Conclusion: The incidence of SIRS after one-phase PCNL treatment for apyrexic calculous pyonephrosis was similar to that of other patients. It is relatively safe and reliable to do this. Preoperative antibiotics should be used for more than 3 days before surgery. Careful manipulation is needed to avoid blood transfusion. It is better to shorten the operative time and to reduce multiple tracts operation. Particularly, irrigation peak flow ≥500 mL/min should be avoided in the circumstance of bleeding or turbid urine.

Objective：To investigate the change of the female patients’ sexual function after tension free vaginal tape (TVT) or transobturator suburethral tape (TVT-O) surgery for stress urinary incontinence (SUI). Methods: Female sexual function index (FSFI) was sent to 66 female patients who underwent a TVT/TVT-O surgery at least 3 months after the operation, to a maximum of 5 years. All The patients were divided into two groups according to different surgical methods, different follow-up intervals (more than or less than 1 year) and whether there was concomitant coital incontinence (CCI) before the operation. The changes of FSFI scores before and after the operation were compared between the two groups by multiple covariances analysis. The total score was higher, and the sexual function was better. Results: In the study, 60 patients answered the questionnaire, and 51 questionnaires were available. Before surgery, there were no significant difference between TVT and TVT-O groups in FSFI, age, body mass index (BMI). As to patients who had TVT/TVT-O surgery, when the influence of the postoperative period and symptoms accompanying intercourse were corrected, the two groups had no significant difference in difference of FSFI (dFSFI) scores after operation (F=2.52, P=0.119), and they had similar sexual function improvement ratio (40.0% vs. 44.4%, P>0.05). But to the patients who had concomitant coital incontinence before the operations, the dFSFI scores was higher than patients who did not have concomitant coital incontinence (1.86±1.95 vs. -0.09±2.24, P<0.05). Conclusion: TVT and TVT-O surgery have no significant difference in influence on sexual function in women between each other, but the patients who suffer from CCI before the surgery will have a better sexual function improvement.

Objective：To describe a new technique using the rotary excision appliance for the treatment of female urethral obliteration and to evaluate the effect of the management.Methods: Between October 2000 and July 2013, 5 cases of female urethral obstruction (age from 23 to 65 years, time to treatment from 3 to 60 months, obliteraion length from 0.5 to 1.8 cm) were managed using the rotary excision appliance and the patients had been followed up.Results: After a mean of 32.4 months (range: 5 to 75 months) of followup, normal micturation had been achieved in all the patients. The maximal urinary flow rate (MFR) ranged from 15 to 28 mL/s (mean 20.6 mL/s). Three patients were continent and 2 patients had slight incontinence.Conclusion: The rotary excision appliance is a useful instrument for the management of female urethral obliteration. Our long-term follow-up provides further support for use of this technique by demonstrating that urethral continuity can be established without increased incidence of stricture formation or incontinence.

Objective：To investigate the application of the Chinese Urological Association (CUA) guidelines on prostatitis and the effects on the clinical practice patterns of diagnosing and treating chronic pelvic pain syndrome (CPPS) among Chinese urologists. Methods: We conducted a questionnaire investigation of the CUA guidelines on prostatitis among the urologists from 399 hospitals in 63 cities of China, and performed statistical analyses on all the eligible questionnaires collected. Results: Of the 2 251 questionnaires distributed, 2 046 (90.9%) were eligible, of which 92.5% were from the urologists in tertiary or secondary hospitals, of whom 72.3% had senior or intermediate professional titles, and 90.2% had studied the CUA guidelines. Most respondents agreed that Type Ⅲ prostatitis was a clinical syndrome, of which the diagnosis should be made after other conditions with similar symptoms had been ruled out and the aim was to relieve pain, alleviate urination symptoms and improve quality of life. Those who had and those who had not studied the CUA guidelines differed in their viewpoints on CPPS as illustrated in the guidelines. In clinical practice, the most common treatment options for CPPS were pharmaceutical therapy (95.0%), life style adjustment (88.9%), and psychotherapy (79.9%), and the most frequently prescribed drugs were phytotherapy (84.5%), α-blockers (79.0%) and antibiotics (64.0%). Conclusion: CUA guidelines on prostatitis has gained a nationwide application and promoted the standardization of the management of CPPS in China.

Objective：To examine the prevalence of anaplastic lymphoma kinase (ALK) fusion gene in Chinese patients with non-small cell lung cancer (NSCLC). Methods: In this study, 95 patients with NSCLC and corresponding clinical information and formalin-fixed paraffin-embedded (FFPE) tissue blocks were included. Hematoxylin & eosin (HE) staining, conventional ALK immunochemistry (IHC) staining and intercalated antibody-enhanced polymer (iAEP) IHC staining, and dual-color split fluorescence in situ hybridization (FISH) for ALK fusion gene were performed. Results: Eight ALK-positive cases were detected using anti-ALK immunohistochemistry with the iAEP method, and FISH analyses revealed 4 patients of them who harbored the ALK fusion gene (4.2%, 4/95), including 2 cases of female patients with solid signet-ring cell adenocarcinoma and 2 cases of male patients with adenosquamous carcinoma. The positive cases were all non-smokers without EGFR/KRAS mutations. Furthermore, the positive cases all survived, and the overall postsurgery survival time of 2 cases was more than 5 years. Conclusion: ALK IHC with the iAEP method is better than conventional ALK IHC, and the percentage of the positive cells is more important than that of the intensity. ALK translocations were infrequent in the entire NSCLC patient population (<5%) with better prognosis.

Objective：To examine the relationship of interleukin (IL)6 and IL10 genetic variants and cardiovascular factors ［oxygenized low density lipoprotein (oxLDL), lower physical activity, overweight, etc.］ with IL6 and IL10 secreted by monocytes. Methods: In the study, 40 health persons, aged from 51 to 80 years, without stroke and myocardial infarction, were randomly sampled from a communitybased population in Beijing in 2010. Their data on smoking, drinking, blood pressure, fasting glucose, and lipid were collected. The single nucleotide polymorphisms (SNPs) of IL6 (rs1800796, rs1524107, rs2066992) and IL10 (rs1800872, rs1554286, rs3021094) were genotyped. The human monocytes were cultivated in RPMI 1640 medium for 24 h; then divided into two equal parts, in which oxLDL (50 mg/L) and phosphate buffer solution (PBS) were added for another 48 h. Finally, the secretions of IL6 and IL10 in the culture supernatants were measured with ELISA. Results: Paired Wilcoxon tests showed that the IL6, IL10, and IL6/IL10 were significantly higher in oxLDL medium than in PBS one (all P<0.01). The concentrations in PBS/oxLDL taken as repeated measurements, and adjusted for age and gender, the repeated general linear models showed: IL10 was significantly lower for those overweight (BMI≥26 kg/m2) than for those normal weight (P=0.007), and IL6/IL10 was significantly higher in those overweight (P=0.003). The IL6/IL10 was significantly higher in those with lower physical activity ［metabolic equivalent of energy, METS<166 kJ/(kg·d)］ than those with higher physical activities (P=0.046). IL6 and IL10 were significantly higher in alcohol drinkers (P=0.049 and P=0.006). IL6 was significantly higher in those with higher highdensity lipoproteincholesterol (HDLc, ≥56.4 mg/dL, P=0.027). There were significant interactions between IL10 SNPs and oxLDL on IL10 (all P<0.05), but no significant interactions between IL6 gene SNPs and oxLDL on IL6. Conclusion: The oxLDL together with lower physical activity and overweight shifts the balance of proinflammatory and antiinflammatory in the direction of proinflammatory. The interaction between IL10 gene and oxLDL is intensively correlated with the secretion of the antiinflammatory cytokine IL10.

Objective：To assess left atrial (LA) phasic function in hypertension (HT) and to evaluate its relationship with left ventricular diastolic function. Methods: Cross-sectional data of 738 population (149 non-HT as control, and 589 HT were further grouped into normal left ventricular diastolic function, mild diastolic dysfunction and moderate/severe diastolic dysfunction sub-groups) in an urban community of Beijing were used. LA global longitudinal strain in late diastole (Sa), early diastole (Se), and total strain (Stot=Sa+ Se), strain rate in late diastole (SRa), systole (SRs), and early diastole (SRe) were measured using off-line speckle-tracking echocardiography analyzing software, and were compared between nonHT and HT groups, and among HT sub-groups. Results: LA reservoir ［Stot: 22.7%±5.9% vs. 21.0%±5.8%, P=0.002; SRs: (1.1±0.3)/s vs. (1.0±0.3)/s, P=0.033］ and conduit ［Se: 11.1%±4.8% vs. 9.6%±4.2%, P=0.001; SRe: (1.0±0.4)/s vs. (0.9±0.3)/s, P<0.001］ indexes were reduced significantly in HT, while contraction (Sa & SRa) indexes were similar to those of non-HT. Conclusion:LA reservoir and conduit functions are impaired in HT and deteriorate with left ventricular diastolic dysfunction. LA contraction is preserved in HT with normal and mild diastolic dysfunction while impaired in moderate/severe diastolic dysfunction.

Objective：To explore the protective effect and possible mechanism of intensive lipid modulation on the perioperative period of patients with stable coronary artery disease undergoing noncardiac surgery. Methods: In the study, 60 patients with stable coronary artery disease undergoing elective noncardiac surgery were randomly divided into intensive lipid modulation group (n=30) and conventional group (n=30). In intensive lipid modulation group, the patients were given atorvastatin 40 mg every night before surgery, 80 mg 12 h before surgery, and 40 mg 2 h before surgery, and 40 mg every night after noncardiac surgery. In conventional group, the patients were given atorvastatin 20 mg every night before surgery and also after the surgery. The occurrence of perioperative major adverse cardiac events (including sudden cardiac death, acute myocardial infarction, unplanned revascularization) were compared in the two groups. Preoperative and 48 h postoperative changes of lipid levels and inflammatory markers were also compared in the two groups. Results: In conventional group, one patient suffered myocardial infarction with acute anterior ST-segment elevation and was given emergency left anterior descending artery interventional reperfusion therapy, and 7 patients suffered asymptomatic myocardial infarction. In intensive lipid modulation group, one patient suffered asymptomatic myocardial infarction, and the incidence rate of perioperative acute myocardial infarction reduced significantly compared with conventional group (P<0.05). There was no significant difference in preoperative and postoperative changes of lipid levels in the two groups (P>0.05), and compared with conventional group, there was significantly lower levels of inflammatory markers in intensive lipid modulation group (P<0.05). Conclusion:The intensive lipid modulation group significantly reduced the incidence of perioperative major adverse cardiac events especially asymptomatic myocardial infarction, and the inhibition of the inflammatory response may be one of the protective mechanisms, which still needs to be further confirmed by large multicenter randomized controlled clinical trials.

Objective：To assess the safety and effectiveness of middle cerebral artery angioplasty in treatment of subcortical watershed infarcts (S-CWI) with moderate or severe disabilities. Methods：From June 2011 to May 2012, 5 S-CWI patients (six lesions) with moderate or severe disabilities combining severe stenosis in Ipsilateral middle cerebral artery received middle cerebral artery angioplasty in Interventional Radiology and Vascular Surgery Department, Peking University Third Hospital. We observed the neurological score before and after angioplasty and assessed the improvement of neurological functions. Results：The National Institute of Health stroke scale（NIHSS） scores were decreased by 4-6 points and modified Rankin scale（mRs） scores were decreased 1 point in 7 days. In the 3 months’ follow-up, 4 patients’ mRs scores were 1 point, and 1 patient’s was 2 points. In the 1-year follow-up, there were no new strokes and in-stent restenosis events. Conclusion： Middle cerebral artery angioplasty in treatment of SCWI with moderate or severe disabilities is beneficial.

Objective：To build the radio-frequency thermocoagulation (RFT) interface under navigation including foramen ovale and trigeminal ganglion based on CT/MRI image fusion technology, to visualize the relationship between the trigeminal ganglion and the puncture needle, and to observe clinical effects of this method. Methods: CT and MRI data of 20 trigeminal neuralgia patients which were input into BrainLAB-iPlan navigation planning system, were aligned and merged, so that the 3-dimentional image fusion interface of CT and MRI for puncture was built. According to the image fusion interface, the pathways targeting the trigeminal ganglion were planned to assist trigeminal ganglion puncture and RFT. The treatment consequences were observed and compared with 20 patients under the RFT only with the direction of pre- and intra-operative CT. Results: In the group of CT/MRI image fusion cases, 3 cases had been predicted to be difficult because of unreachable ganglion through the foramen ovale pathway. The postoperative clinical examination proved that the ganglions of these 3 cases were only insufficiently damaged or undamaged. The other 17 cases proved better results, except 2 cases whose treatment was changed in operation. The valid rates for both image fusion navigation group and CT group were all above 95%. Conclusion:Navigation interface including both foramen ovale and trigeminal ganglion based on CT/MRI image fusion made visualization of the pathway targeting ganglion come true, which made the treatment more accurate and individual. Whether the pathway could reach the ganglion might distinguish the trouble cases from others.

Objective：To examine the dynamic maturational alterations of random amplified polymorphic DNA (RAPD) molecular marker polymorphism resulted from differential expressions of multiple fungi in the caterpillar body, stroma and ascocarp portion of Cordyceps sinensis (Cs). Methods: Used the fuzzy, integral RAPD molecular marker polymorphism method with 20 random primers; used density-weighted cluster algorithms and ZUNIX similarity equations; compared RAPD polymorphisms of the caterpillar body, stroma and ascocarp of Cs during maturation; and compared RAPD polymorphisms of Cs and Hirsutella sinensis (Hs). Results: Density-unweighted algorithms neglected the differences in density of the DNA amplicons. Use of the density-weighted ZUNIX similarity equations and the clustering method integrated components of the amplicon density differences in similarity computations and clustering construction and prevented from the loss of the information of fungal genomes. An overall similarity 0.42 (< the overall dissimilarity 0.58) was observed for all compartments of Cs at different maturation stages. The similarities for the stromata or caterpillar bodies of Cs at 3 maturational stages were 0.57 or 0.50, respectively. During Cs maturation, there were dynamic Low→High→Low alterations of the RAPD polymorphisms between stromata and caterpillar bodies dissected from the same pieces of Cs. The polymorphic similarity was the highest (0.87) between the ascocarp and mature stroma, forming a clustering clade, while the premature stroma and caterpillar body formed another clade. These 2 clades merged into one cluster. Another clade containing the maturing stroma and caterpillar body merged with mature caterpillar body, forming another cluster. The RAPD polymorphic similarities between Hs and Cs samples were 0.55-0.69. Hs were separated from Cs clusters by the outgroup control Paecilomyces militaris. Conclusion: The wealthy RAPD polymorphisms change dynamically in the Cs compartments with maturation. The different RAPD polymorphism for Hs from those for Cs supports the hypothesis of integrated micro-ecosystem Cs with multiple fungi, but does not support the “single fungal species” hypothesis for Cs and the anamorph-teleomorph connection between Hs and Cs.

Objective：
To prepare doxorubicin-loaded polyvinylalcohol-acrylic acid (PVA-AA) microspheres and evaluate properties of this chemoembolic agent. Methods: PVA-AA microspheres were synthesized by inverse suspension polymerization method and then verified by infrared spectroscopy. drug loading (DL) and entrapment efficiency (EE%) were measured after doxorubicinwas loaded on PVA-AA microspheres. Their morphology and elasticity were investigated by optical microscope，environmental scanning electron microscope and texture analyzer，respectively. T-cell apparatus was used to evaluate the in vitro release behavior of doxorubicin-loaded microspheres.The external carotid of the rabbit was chosen as an embolization site to evaluate the in vivo embolic property of the microspheres. Results：PVA-AA microspheres, which were transparent spheres，turned into red spheres after doxorubicin loading. DL of the microspheres was （20.56±0.69）g/L and （23.25±0.27）g/L，and EE% was 82.22%±2.76% and 93.00%±1.06% within 20 min and 6 h，respectively. The in vitro release results showed a significantly delayed release of the drug for 10.32%±0.47% after 24 h. The Young’s modulus was （178.30±12.33） kPa and （213.29±15.61） kPa for blank microspheres and doxorubicinloaded microspheres，respectively. Both blank microspheres and doxorubicinloaded microspheres exhibited good elasticity. In vivo embolization showed that 0.3 mL of microspheres could produce distal embolic efficiency. Conclusion：The doxorubicin-loaded microspheres are expected to be a promising new chemoembolic agent.

Objective：To determine whether the extruded irrigation solution bag during passage of rigid cystoscope will reduce the patient’s discomfort.Methods: In the study, 378 male patients undergoing rigid cystoscopies were randomized into “Institute of Urology Peking University (IUPU)” technique group (n=193) and routine manipulation group (n=185). All the patients had received 10 mL oxybuprocaine gel before manipulation. In the IUPU technique group, irrigation solution bag was connected with cystoscope sheath and obturator. As the scope passed through the bulbar urethra, a nurse was instructed to extrude the irrigating fluid bag. A 10-point visual analog pain scale assessment was completed by the patient after the procedure. Results: The visual analog pain score was 2 (1-2) in the IUPU technique group and 4 (3-6) in the routine manipulation group (P<0.001, Mann-Whitney U test). All the procedure indications had no effect on the findings.Conclusion: This study has shown that a simple IUPU technique can significantly reduce the patient’s discomfort during outpatient rigid cystoscopy. We strongly recommend this technique for all male patients undergoing rigid cystoscopy.

Objective：To evaluate the efficacy and safety of transperitoneal laparoscopic radical nephrectomy with the modified Pfannenstiel incision. Methods: Between Aug. 2012 and Jul. 2013, the same surgeon performed transperitoneal laparoscopic radical nephrectomy for 12 patients with renal masses. The approach was usually performed through 3 ports or 4 ports placed in a traditional manner. After laparoscopic radical nephrectomy was completed, and the specimen was entrapped in a specimen retrieval bag, a 7 cm modified Pfannenstiel skin incision was made over the symphysis pubis, lateralized slightly toward the side of surgery. Results: All the procedures were completed without conversion to open radical nephrectomy. The operative time was 106 to 234 minutes and the blood loss was minimal. There was no intra- or post-operative complications. The pathological result was renal cell carcinoma. One patient died of multiple organ metastasis after 5 months. No recurrence was seen after 9 to 20 months’ follow-up. Conclusion:Laparoscopic radical nephrectomy with the modified Pfannenstiel incision where the kidney is removed offers the benefits of improved cosmesis over the traditional musclecutting extension of an upper abdominal, lateral port site. The modified Pfannenstiel incision combines the advantages of a low abdominal incision and improved cosmesis, and can be considered a potential alternative for traditional laparoscopic nephrectomy.

Two cases of hypogonadotropic hypogonadism caused by pituitary stalk interruption syndrome treated by pulse infusion of gonadorelin via micropump were reported, and their clinical features and the treatment process of pulse infusion of gonadorelin via micropump summarized. Both of the 2 patients were presented primarily with hypogonadotropic hypogonadism. After the treatment with pulse infusion of gonadorelin via micropump, their syndrome of androgen deficiency improved and the gonadotropin levels promoted at the end of 12 weeks’ follow-up. Pulse infusion of gonadorelin via micropump is an alternative to treat hypogonadotropic hypogonadism caused by pituitary stalk interruption syndrome.

Objective：To report a case of leucine-rich glioma inactivated-1 protein antibody (LGI1-Ab) associated limbic encephalitis. Methods: A 76-year-old woman was admitted to the hospital because of cognitive impairment and faciobrachial dystonic seizures for six months. Hyponatremia was also noted in this patient. Antibodies to the LGI1 were positive.18F-FDG uptake was measured on the PET-CT scans of this patient. Results: PET-CT showed bilateral putamen hypermetabolism with hypometabolism in other regions. Her symptoms were improved after intravenous immunoglobulin therapy. Conclusion: LGI1-Ab associated encephalitis can manifest as basal ganglia hypermetabolism and faciobrachial dystonic seizures.

The clinical features and pathologic findings of one case of cystic nephroma was reported，and the safety of treatment by retroperitoneal laparoscopic partial nephrectomy evaluated. The patient was a 20-year-old woman, and found left renal cyst for 1 year with pain in her left flank one month ago. The patient was diagnosed as complex renal cyst, then underwent retroperitoneal laparoscopic partial nephrectomy. In the operation, the tumor was located in the middle and lower part of her left kidney, with a number of small sample masses, and a solid mass near the renal parenchymal part. The operation time was 224 min, and the artery occlusion time was about 17 min. The blood loss was 20 mL, with no blood transfusion. The pathology was cystic nephroma. No operation complication was seen, nor was recurrence after a short-term follow-up. Cystic nephroma is a relatively rare benign lesion of the kidney. Retroperitoneal laparoscopic partial nephrectomy is a safe and effective way to treat cystic nephroma.

Objective：To evaluate the safety and efficiency of using abiraterone and prednisone in the treatment of patient with metastatic castration resistant prostate cancer (mCRPC) no prior chemotherapy. Methods: Three mCRPC no prior chemotherapy patients accepted abiraterone and prednisone treatment. The clinical data were analyzed retrospectively and the safety and efficiency of this treatment option were discussed. The Gleason scores of the three mCRPC patients were 5, 9, and 9. The clinical stages were T3aNxM0, T3aNxM1b, and T3aNxM1b. The patients received abiraterone 1 000 mg daily and prednisone 5 mg twice daily and androgen deprivation therapy in the treatment. Their blood pressure, complete blood count, prostate specific antigen (PSA), biochemical parameters, whole body CT scan and bone scan were done regularly to monitor the progression of the diseases. Results: In this study, the general condition improved in two patients. Two of the three patients experienced decrease of PSA and no progression. One patient experienced disease progression. Generally, abiraterone and prednisone resulted in prolonged radiographic progression-free survival and delayed in PSA progression in mCRPC no prior chemotherapy. There were no severe side effects, such as hypokalemia, hypertension, and water-sodium retention. The patient’s tolerance was good. Conclusion:Abiraterone and prednisone are safe and can improve mCRPC no prior chemotherapy patient’s life quality and may prolong the overall survival.

Urethral stricture is a common urologic disease and there are many therapeutic methods for it. Here we investigated the application of balloon dilation under B-mold ultrasound monitoring in the treatment of urethral stricture.Five male patients suffering from urethral stricture were treated with balloon dilation under B-mold ultrasound monitoring.Their urination was assessed after operation.All the patients underwent the operation successfully，without serious complications.The urinary catheter was removed 3-4 weeks after operation.The patients were followed up for 8 to 15 months.Four patients were voiding well and one improved.Balloon dilation under B-mold ultrasound monitoring in the treatment of urethral stricture was intuitive, safe and effective.

Paroxysmal kinesigenic dyskinesia (PKD) is a rare neurological condition in which brief and frequent dyskinetic attacks are provoked by sudden movement. PKD is more common in men and can be idiopathic (commonly familial) or due to a variety of causes. The pathophysiology of PKD is uncertain but it could be an ion-channel disorder. Genetic linkage studies have isolated several loci on chromosome 16, and proline-rich transmembrane protein 2 (PRRT2) has been identified as a causative gene of PKD by using a combination of exome sequencing and linkage analysis. Antiepileptic drugs, particularly, carbamazepine are very helpful in a large proportion of cases. Sometimes it can be difficult to distinguish this syndrome from epilepsy. We reported 2 patients who presented abnormal involuntary attack. Evaluations included general physical examinations, endocrinologic and metabolic studies, video electroencephalograms and brain MRI imaging. All of these studies were normal. All of symptoms showed excellent response to carbamazepine.