Objective：To investigate the expression patterns of CKLF-like MARVEL transmembrane domain containing 5 (CMTM5), a novel tumor suppressor, and epidermal growth factor receptor (EGFR) in prostate cancer (PCa) tissues and cells and to analyze the relationship between CMTM5 and EGFR in PCa.
Methods: The expression patterns of CMTM5 and EGFR in PCa tissues and cells were detected by immunohistochemistry and Western blot, respectively. Results: CMTM5 was highly expressed in 75% (27/36) of benigh prostatic hyperplasia(BPH) tissues but 35.9% (23/64) of PCa tissues (P<0.001). There was a significant difference of CMTM5 expression between the two groups of PCa tissues with different Gleason scores (P=0.003), though its expression was not related to the age, clinical stage, and metastatic situation (P>0.05). EGFR was highly expressed in 57.8% (37/64) of PCa tissues, it had statistical significance between EGFR and CMTM5 expressions in PCa tissues. Furthermore, 23 cases (35.9%) had low CMTM5 expression and high EGFR expression. Western blot showed that CMTM5 was undetectable in PCa cells, in which the EGFR expression was upregulated. Conclusion: The loss of CMTM5 may participate in the progression of PCa resulting from deregulated EGFR.

Objective：To identify the functions and mechanisms of prostaglandin E2 (PGE2)-induced bone marrow-derived progenitor cells (BMPCs) maturation and its involved angiogenesis. Methods:BMPCs harvested by flushing through the femoral and tibial bones and cultured. This population of cells was identified by immunofluorescence staining. From which, 1 μmol/L PGE2 was taken, and quantitative-PCR (Q-PCR) and Western blot were used to detect the expressions of endothelial markers and Krüppel like factor 2 (KLF2) in BMPCs. In vitro tube formation assay was performed to demonstrate the capacity of angiogenesis. Furthermore, PGE2 and its receptors EP2 and EP4 agonists were used to elucidate the regulation of PGE2 to KLF2. Results: C-kit, von Willebrand factor (vWF) and vascular endothelial cadherin expressed in BMPCs. Treatment with PGE2 (1 μmol/L) significantly increased the differentiation of BMPCs. The mRNA levels of endothelial markers platelet endothelial cell adhesion molecule-1 (PECAM-1/CD31）and endothelial nitric oxide synthase (eNOS)， were significantly upregulated in about 2 folds by PGE2 detected with Q-PCR assay. Matrigel tube formation assay also demonstrated PGE2 enhanced the ability of angiogenesis in BMPCs. In addition, the expression of KLF2 increased in more than 2 folds with PGE2 treatment compared with the control. Such effect of PGE2 could be blocked by EP4 blocking peptide.Conclusion:Promoting the differentiation of BMPCs, PGE2 reinforced their angiogenesis by binding to the receptor of EP4 in a KLF2-dependent manner.

Objective：To investigate the concentration of basic fibroblast growth factor (bFGF) in aged rat plasma and penile tissues.  Methods: Twelve 24-month-old rats and ten 12-week-old rats were selected. We assessed the erectile responses of rats to cavernous nerve electrostimulation. Then the concentrations of bFGF in the rats’  plasma and penile tissues were detected by ELISA kit and smooth muscle contents in the rats’ cavernous corpus were evaluated by masson trichrome staining.Results:Compared with the young rats, we found that the erectile function of the aged rats were significantly attenuated (The Max ICP/MAP in the aged rats were 0.41±0.05, 0.44±0.04 and 0.51±0.06 at 2.5 volts, 5.0 volts and 7.5 volts respectively while the Max ICP/MAP in the normal controls were 0.70±0.06, 0.75±0.07 and 0.81±0.04 at 2.5 volts, 5 volts and 7.5 volts respectively, P<0.05). The concentrations of bFGF ［The bFGF levels in plasma and penile tissues in the aged rat were (6.43±0.51) μg/L and (598.6±51.7) pg/mg protein respectively while the bFGF levels in the normal control were (10.53±0.42) μg/L and (985.8±76.8) pg/mg protein］ were significantly reduced (P<0.05). Furthermore, the smooth muscle contents in the aged rats’ penile tissues (0.038±0.005) were dramatically decreased compared with the normal control (0.075±0.006, P<0.05).Conclusion: The reduced levels of bFGF may be related to the decreased smooth muscle contents in the penile tissues of the aged rats.

Objective：To compare the diagnostic accuracy of five internationally used indolent prostate cancer screen protocols in Chinese prostate cancer patients. Methods:Retrospective analysis was made of the consecutive cohort of 314 patients, from Jan. 2006 to Apr. 2014, who had both prostate biopsy and radical prostatectomy in Peking University First Hospital. The Gleason score≤6, pT2, tumor volume≤0.5 mL, margin negative and lymph nodes negative were defined as indolent prostate cancer. The predictive value of five indolent screen criteria including Epstein, Memorial SloanKettering Cancer Center (MSKCC), Prostate Cancer Research International: Active Surveillance (PRIAS), University of California, San Francisco (UCSF), and University of Miami (UM) were evaluated in Chinese prostate cancer patients. Measures of diagnostic accuracy and areas under the receiveroperating curve (AUC) were calculated for each protocol and compared.Results: A total of 16% (49 cases) of the patients met the inclusion criteria of at least one protocol, including 24 cases in Epstein, 33 cases in MSKCC, 28 cases in PRIAS, 34 cases in UCSF, and 22 cases in UM. Three percent were eligible for all the studied criteria. UCSF and MSKCC protocols had the highest sensitivity and specificity than the others. The Epstein and PRIAS protocols demonstrated acceptable positive predictive value, but the specificity and sensitivity were inefficient. The UM protocol was performed unsatisfiedly on sensitivity, positive predictive value and AUC. A strict limited protocol which contained all the five protocols could not improve the predictive accuracy. Conclusion: The UCSF protocol had better diagnostic accuracy than the others, but the results were not satisfied. A further investigation on indolent prostate cancer screening in Chinese patients is needed.

Objective：To investigate the factors that may predict the effectiveness of metastatic castration resistant prostate cancer (mCRPC) patients who received docetaxel plus prednisone treatment. Methods:We retrospectively collected the clinical data of mCRPC patients who has received docetaxel chemotherapy in Peking University First Hospital between February 2010 and March 2015, and the clinical factors were analyzed using univariate analysis. Results:A total of 60 cases of patients were treated, of whom 33 with complete clinical data were analyzed. PSA responsive was defined as PSA declining ≥50% of baseline and without progression according to RESCIST criteria. The median PSA at chemotherapy was 153.4 μg/L (6.6-9 952.0 μg/L), and a total of 20 cases (60.6%) were PSA responsive. Univariate analysis found that lower Gleason score (Gleason scores≤7) (25% vs.72%, P=0.034), the existence of positive Lymph node (78% vs. 40%, P=0.032), the existence of visceral metastasis (80% vs. 44%, P=0.041) and baseline blood HGB value≤120 g/L (30% vs. 74%, P=0.024) were associated with chemotherapy effectiveness.Conclusion:High Gleason score, lymph node metastasis, visceral metastasis and normal HGB level may predict PSA response after docetaxelbased chemotherapy.

Objective： To evaluate the efficacy and outcome of palliative transurethral resection of the prostate (pTURP) in patients with server bladder outlet obstruction (BOO) due to prostatic obstruction induced by advanced prostate cancer.Methods:All the 16 patients who had a pTURP between November 2007 and January 2015 due to BOO (high residual urine volume combined with hydronephrosis or urinary retention refractory to medical treatment ) at our institution were retrospectively assessed. All the patients were diagnosed with advanced prostate cancer (Ⅲ stage or Ⅳ stage). The clinical data, functional and oncological follow-up results were evaluated. The cancer specific survivals were estimated by Kaplan-Meier analysis.Results:The mean age of the patients was 73.8 years (63－81 years). Five  cases were graded in stage Ⅲ of prostate cancer and 11  in stage Ⅳ. The indications for pTURP were refractory urinary retention in 12 cases, and high residual urine volume with hydronephrosis in 4 cases. The mean prostate volume at pTURP was 43.2 mL (28－78 mL) and the mean PSA (prostate specific antigen) level before pTURP was 48.2 μg/L (2－107 μg/L). The patients had mean residual urine volume 166.4 mL (50－450 mL) and mean urinary flow rate 3.6 mL/s(0－6 mL/s, n=7) before pTURP. It took mean 62.9min (35－94 min) in pTURP with mean estimated blood loss 126.9 mL (30－263 mL) and mean resected tissue 14.1 g (10－22 g). There were no transfusion cases. Postoperative mean serum PSA 20.5 μg/L (1－41 μg/L), residual urine volume 43.4 mL (0－400 mL) and urinary flow rate 10.1 mL/s (7-16 mL/s, n=7) were shown in these cases. A patient encountered persistent hematuria needing irrigation. Compared with preoperation, the patients had significantly lower serum PSA level (P<0.001), less residual urine volume (P<0.001) and more urinary flow rate (P=0.001) after pTURP. The mean follow-up after pTURP was 36 months (1－86 months). In addition, 2 patients received repeated pTURP. At the time of the latest analysis, 3 patients died from prostate cancer progression. As estimated by KaplanMeier analysis, the 2-, 3- and 5-year cancer specific survival rates after pTURP were 91%, 78% and 58%, respectively.Conclusion:Despite less resected tissue, greater delay in urination and reoperation rates, pTURP is a fairly effective procedure in patients with server BOO . Although a potential negative impact of pTURP on survival cannot be excluded, the estimated 3 and 5year cancer specific survival rates in this series seem to justify this intervention.

Objective： To explore the safety and efficacy of “sandwich ”urethra reconstruction in laparoscopic radical prostatectomy (LRP) for the early recovery of continence. Methods: LRP was performed using a urethra surrounding tissue reconstruction in 37 consecutive patients, and without reconstruction procedure in 34 consecutive patients at the same period from March 2012 to January 2013. The baseline data, preoperative data: The patient age, body mass index (BMI， kg/m2), International prostate symptoms score (IPSS), prostate volume, preoperative PSA, Gleason score were assessed retrospectively; Operative data: The neurovascular bundle preservation, operation time, blood loss were assessed; and the primary outcome measure was urinary continence assessed at the end of 1, 2, 4, 12 and 24 weeks after the catheter was removed. Other data recorded were duration of indwelling catheter, positive margin rate and complications.Results: There were no significant differences between the two groups with respect to baseline，preoperative and operative data except of the operative time (P=0.003). Between the two groups, the continence of the reconstruction group was higher than that of the control group at the end of 4 and 12 weeks (P=0.007, P=0.020, respectively). Conclusion:Urethra surrounding tissue reconstruction in LRP is safe and feasible, and it could improve early recovery of continence.

Objective：To elucidate clinicopathological independent prognostic factors for intravesical recurrence after nephroureterectomy for native upper tract urothelial carcinoma (UTUC) in renal transplant recipients. Methods: In this study, 38 patients clinically diagnosed as localized UTUC after renal transplantation were included, and treated by retroperitoneal laparoscopic nephroureterectomy between April 2006 and March 2013, after exclusion of those with a previous and/or concurrent history of bladder cancer. The clinicopathologic features, risk factors, and intravesical recurrence free survival were analyzed using the Kaplan-Meier method. Univariate and multivariate analyses by Cox’s proportional hazards regression model were used to identify independent risk factors for intravesical tumor recurrence. Results: Of all the patients, 16/38 (42.1%) developed subsequent intravesical recurrence during a median follow-up period of 38 months (range 12 to 104 months), of whom, 12/16 (75.0%) developed recurrent bladder cancer within 2 years after nephroureterectomy, and the median interval between surgery and intravesical recurrence was 15.5 months (range 6 to 48 months). Multifocal tumors, native aristolochic acid nephropathy (AAN) and distal ureter involvement were determined as risk factors for intravesical recurrence by univariate analysis. The intravesical recurrence rate was 62.5%(5/8)  in the group of native AAN , and 46.2% (12/26) in the group of multifocality. By multivariate analyses, multifocality (HR=2.603, 95% CI=1.529-8.906, P=0.019) and native AAN (HR=2.179, 95% CI=1.085-8.093, P=0.038) were identified as independent predictors for the development of recurrent bladder cancer after surgery for UTUC in renal transplant recipients. Conclusion: The incidence of intravesical recurrence after laparoscopic nephroureterectomy for UTUC in renal transplant recipients is high, and most subsequent bladder cancers recur within 2 years after surgery. Tumor multifocality and native AAN are significant independent risk factors in developing initial intravesical recurrence after laparoscopic surgery for primary UTUC after renal transplantation.

Objective： To investigate the safety and efficacy of low dose rate brachytherapy in local low and intermediate risk prostate cancer patients. Methods: All 133 local prostate cancer patients were included and divided into low and intermediate risk groups respectively according to Memorial Sloan Kettering Group (MSKG) definition followed by brachytherapy. All the data including prostatic specific antigen (PSA), international prostatic symptomatic score (IPSS), postoperation complications and image evaluation were collected and recorded. Results: The average radiation dose delivered to 90% of the prostate （D90）of (152.0±17.3) Gy was performed in the patients with a mean pre-operation PSA level of (13.45±7.1) μg/L and prostate volume of (44.37±21.43) mL. Neoadjuvant therapy was performed in 24 patients with prostate volume larger than 60 mL for 3-6 months. There was no difference in the mean age, prostate volume and D90 between low risk group and intermediate risk group. The mean IPSS reached its peak at the end of the 2nd month post-brachytherapy and compared with the baseline at the end of the 4th month. PSA failure occurred at the end of the mean 31.7 months in 4 patients during the follow-up (1 in low risk group and 3 in intermediate risk group) and no metastasis occurred.Conclusion:Lower urinary tract symptom (LUTS) is the most common complication post-operation. Brachytherapy associates with an encouraging tumor progress-free survival in local low and intermediate risk prostate cancer patients.

Objective：To evaluate the feasibility and efficacy of novel modular flexible ureteroscope in the treatment of upper urinary calculi. Methods: From Nov. 2013 to Jul. 2014, 36 cases of upper urinary calculi were treated with holmium laser lithotripsy through novel modular flexible ureteroscope. The clinical data including the location and diameter of the calculi, time of operation, stonefree rate, complications and hospital stay after operation were analyzed retrospectively.Results: The operation was performed successfully in 34 cases, the average time of operation was 108.5 min (70-145 min), the postoperation hospital stay was 2-5 d (average 2.3 d), and the stonefree rate was 83.33%. No serious complications occurred except postoperative fever in 2 cases and haemorrhage in 1 case. Conclusion: The novel modular flexible ureteroscope is a safe and effective medical instrumentation for treatment of upper urinary calculi.

Objective：To evaluate the efficacy and safety of flexible ureteroscopic holmium laser lithotripsy in treating calyceal diverticular calculi with stenotic infundibulum and to present our initial experience.Methods: From Nov. 2012 to Nov. 2014, 10 patients with stonebearing calyceal diverticulum and stenotic infundibulum underwent flexible ureteroscopic holmium laser lithotripsy in our hospital, including 3 female patients and 7 male patients with an average age of 36.9 years (range: 20 to 62 years). There were 6 patients with right side while 4 patients with left side calyceal diverticular calculi. The average cumulative stone size was (1.33±0.43) cm. Five patients underwent extracorporeal shock wave lithotripsy (ESWL) before hospital admission but no stone was discharged. All the patients received intravenous urography (IVU) and CT-urography (CTU) preoperatively and underwent double-J stents placement 2 weeks before operations. A digital-fiber flexible ureteroscopy and 200 μm holmium laser fiber were used for treatment. Surgeries began with routine flexible ureteroscopy and methylene blue injection was used to identify the small ostium of infundibulum. Then infundibulectomy followed by lithotripsy was performed. All the patients receive double-J stents placement and traditional Chinese medicine for 1 to 3 months after operations. The stone clearance was estimated by kidney ureter bladder (KUB) within 3 months’ follow up.Results:The locations of calyceal diverticulum were upper pole in 7 patients, and interpolar regions in 4 patients. The average operation time was (123.7±59.6) min, and the average estimated blood loss was (29.3±32.1) mL. Successful flexible ureteroscopic holmium laser infundibulectomies were performed in all the 10 patients. Success rate was 100%. The stone clearance rates for 1 and 3 months after surgery were 50.0% and 80.0%, respectively, which were observed by KUB follow-up. Two patients had serious postoperative fever (>38.0 ℃) in coexistence with chills. The mobidity of urosepsis was 20.0%. No major complications were identified.Conclusion:In selected patients, calyceal diverticular calculi with stenotic infundibulum can be treated safely and efficiently with flexible ureteroscopic homium laser lithotripsy. CTU and IVU should be completed preoperatively for calyceal diverticulum location and technique difficulty prediction. Retrograde methylene blue injection can be used to identify the ostium during surgery. And prolonged post-operation stone clearance was observed.

Objective：To explore the clinical characteristics, treatment and prognosis of IgG4-related retroperitoneal fibrosis (RPF). Methods: All the patients diagnosed as RPF in Peking University People’s Hospital between February 2008 and October 2014 were included. Among them, 5 patients were identified as IgG4 related RPF. We analyzed their medical records and summarized the clinical, laboratory, and imaging features of IgG4 related RPF, which had taken the recent literature into account. Results: All the 5 patients were male, with the average age 62.2 years (55-67 years). They mainly complained of abdominal pain, flank pain and weight loss, two of whom had concurrent antoimmune pancreatitis. Renal insufficiency was present in 3 patients (3/5). Four patients (4/4) showed increased erythrocyte sedimentation rate (ESR), while 3 patients (3/4) had higher serum C-reactive protein (CRP) and IgG. In addition, 4 patients (4/4) had significantly elevated serum IgG4 level. On computed tomography (CT) imaging, 5 patients showed retroperitoneal mass which surrounded the abdominal aorta and the iliac arteries, and even enveloped the ureters and the inferior vena cava. Only one patient received tissue pathological examination, which indicated the numbers of IgG4-positive plasma cells per high power field >10 and a ratio of IgG4-positive cells to all IgGbearing cells >40%. One patient received simple surgical intervention, and 1 patient received medical treatment alone, while the remaining 3 patients received combined treatment of surgery and medications. Follow-up was available for the 4 patients, all of whom had good prognosis. Conclusion: Part of RPF was actually IgG4-related, which was also nominated as IgG4 related RPF. It was a rare disease with unknown etiology, characterized by the elevated serum IgG4 concentration (≥1.35 g/L), with marked tissue infiltration by lymphocytes and IgG4-positive plasma cells with fibrosis, in addition to the presence of retroperitoneal mass. Glucocorticoids were the first-line therapy and IgG4 related RPF had a favourable prognosis.

Objective： To identify the risk factors that would aid in the identification of patients at the greatest risk of developing postoperative paralytic ileus. Methods: In the retrospective study, 749 patients who received radical cystectomy from January 2005 to August 2014 were reviewed, of whom, 9 who received orthotopic ileal neobladder were excluded. Of the 740 patients, 82 (11.1%) developed postoperative paralytic ileus. The correlation between the clinical characters and the occurrence of post-operative paralytic ileus was identified. Results: The postoperative paralytic ileus was significantly correlated with the patient’s age (68 vs. 67, P=0.025), body mass index (23.0 kg/m² vs.24.1 kg/m², P=0.008), different urinary diversion reconstruction methods ［13.2%(66/500) for ileal conduit and 7.3%(16/240) for cutaneous ureterostomy, P=0.008］ and pelvic lymph node dissection ［12.2%(77/632) vs.4.6% (5/108), P=0.021］.The postoperative paralytic ileus caused a prolonged hospital stay and delayed recovery (24 d vs. 17 d, P=0.000). There was no significant correlation between the postoperative paralytic ileus and the patients’ gender, previous abdominal operations, preoperative hemoglobin and creatinine, American Society of Anesthesiologists score, operative time, estimated blood loss, transfusion requirement, laparoscopic and open surgery, ICU admission or tumor staging. On multivariate analysis, age (hazard ratio 1.185, 95% confidence interval 1.036-1.355, P=0.013), body mass index(hazard ratio 0.605, 95% confidence interval 0.427-0.857, P=0.005), different urinary diversion reconstruction methods (hazard ratio 2.422, 95% confidence interval 1.323-4.435, P=0.004) and pelvic lymph node dissection (hazard ratio 2.798, 95% confidence interval 1.069-7.322, P=0.036) were significantly correlated with the presence of the postoperative paralytic ileus. Conclusion: Increasing age, decreasing BMI, ileal conduiturinary diversion and pelvic lymph node dissection were significantly correlated with the presence of postoperative paralytic ileus in patients undergoing radical cystectomy.

Objective：To report a new endourological technique-percutaneous “sandwich” endopyeloplasty for ureteropelvic junction obstruction (UPJO). Methods:In the study, 71 patients with UPJO had endopyeloplasty by percutaneous balloon dilation before and after endopyelotomy, so called “sandwich” endopyeloplasty. The ureter stent was removed after 2 months and all the patients were followed up at least 12 months by ultrasound, intravenous urogram (IVU) or renal scintigraphy. Results: There were 12 patients with primary UPJO, and 59 patients with iatrogenic UPJO after pyelolithotomy, pyeloplasty, ureteroscopic lithotripsy or percutaneous nephrolithotomy. The mean length of stricture was (1.4±0.8) mm while 5 cases had complete stenosis ureteropelvic junction (UPJ). The mean glomerular filtration rate (GFR) of the affected kidney was (19.8±10.8) mL/min.69 patientshad one-stage operation successfully and 2 patients with complete UPJ stenosis were recanalized in the secondary procedures. The mean time of the operation was (39.3±24.2) min. The complications included 1 case of hemotoma, and 2 cases with residual stones. In the follow-up period, 7 patients were re-obstructed. Conclusion:Percutaneous “sandwich” endopyeloplasty shows good results for UPJO of selected patients with simple operation, minimal invasiveness, quick recovery and few severe complications.

Objective：To analyze the efficiency of diuretic renography in the management of unilateral ureteropelvic junction obstruction (UPJO) patients, by observing the affected kidney relative renal function (RRF) and drainage in the period of follow-up. Methods:In the study, 76 patients diagnosed as unilateral UPJO were retrospectively collected. Diuretic renography was performed on all the patients initially, and during the period of follow-up. No morphological or functional abnormalities were detected on the contralateral kidney. Changes of affected renal RRF and drainage were observed during the follow-up period. The correlations of initial RRF (RRFinitial) and drainage type with RRF improvement were analyzed.Results:In the operative group (57 cases), the RRFinitial of affected kidney was 40.81%±12.96%, and the RRF in the last follow-up (RRFrecent) was 44.63%±13.21% (P<0.05). Drainage improvements was found in 54.00% of the obstructive patients (27/50), and unchanged in 71.43% of the non-obstructive patients (5/7). In the conservative group (19 cases), the RRFinitial was 46.47%±12.84%, and the RRFrecent was 46.95%±11.86% (P>0.05). One obstructive patient (1/10) was found with improved drainage, and the other 9 obstructive patients (9/10) and all of the non-obstructive patients (9/9) were observed with unchanged drainage. Four patients with deteriorated RRF in the conservative group received surgery. There were no significant differences in the changes of affected renal RRF in different RRFinitial and drainage types in both operative and conservative groups.Conclusion:Diuretic renography could be effectively applied in the follow-up of unilateral UPJO patients. Operation could improve affected kidney’s RRF, and better some patients’ drainage conditions. However, for those patients with no or minor clinical symptoms, conservative management could be accepted if RRF remains stable during the period of follow up.

Objective：To investigate the efficacy of ileal ureteric replacement in the treatment of iatrogenic long segment ureteric injuries. Methods: The hospital records of 9 cases with iatrogenic long segment ureteric injuries during Aug. 2010 to Sept. 2014 treated with ileal ureteric replacement were retrospectively reviewed and followed-up postoperatively. The patients included 3 males and 6 females with a median age of 40 years. The length of injury segment was 13-25 cm (median 20 cm). The etiology of the iatrogenic injury was urological surgery (n=6), gynecological surgery (n=2) and general surgery (n=1), respectively. The ureter stent was removed in 1-2 month postoperatively in all the 9 cases. Results: All the operations were successful. The operation time was 203-394 min, with the average of (278.1±68.8) min. The bleeding volume was 10-1 000 mL, with the median of 200 mL. The mean length of hospital stay was (16.8±7.5) days. Four minor complications (Grade Ⅰ-Ⅱ) developed, including 3 ileus (33.3%) and 1 proximal anastomotic leakage (11.1%). The median followup time was 11 months, serum creatinine decreased or remained stable in 8 patients (88.9%). Three patients (33.3%) developed mild hydronephrosis and shorttime urinary tract infection was seen in 1 patient (11.1%). Metabolic acidosis was not detected during the followup. Conclusion: Ileal ureteric replacement is a safe and effective method in patients with complex or difficult iatrogenic long segment ureteric injuries.

Objective：To evaluate the safety and efficacy of scrotoscope in diagnosis and treatment of testicular and epididymal diseases. Methods:From September 2010 to March 2012, a total of 75 patients, aged 15-64 years (mean age is 42.4 years) were included in this study. Based on ultraso-nagraphy before surgery, 12 cases were diagnosed as testicular torsion and 63 cases were diagnosed as epididymal mass. All the patients underwent scrotoscope examination or scrotoscope epididymectomy. A small scrotal incision of 1.0 cm was performed. Bluntly dissection was then performed through the scrotal layer until the tunica sac was disclosed. We used cystoscope or resectoscope as scrotoscope. Keeping the drip fusion of isotonic solution inflowing, the scrotum was maintained appropriate distended. The tunica sac wall including parietal and visceral tunica was checked. The testis, epididymis was then examined from the anterior, posterior and both lateral aspects to find out any potential pathology. The operation time of scrotoscope, postoperative complications, surgery record, ultrasound and pathology results were collected from medical record. Visual analog pain scale (range from 0 points to 10 points, 0 represent no pain, 10 represent the most severe pain) was used to assess scrotal pain. The postoperative complications, recurrence and pain relief were evaluated, the accuracy rates of the diagnosis was compared between scrotoscope and ultrasound based on pathology results.Results:  All the patients were successfully performed scrotoscope except one because of inflammatory adhesion. The average time of the operation was 34.3±5.8 minutes, and no serious complications, such as severe edema, hematoma, testicular hydrocele and wound infection occurred. The accuracy rate of scrotoscope and ultrasound for the diagnosis of testicular torsion was 100% vs. 66.7%, and the accuracy rate of scrotoscope and ultrasound for the diagnosis of epididymal mass was 76.2% vs. 58.7%. In the study, 63 patients received scrotoscope epididymectomy, the visual analogue pain score before surgery was 7.1±0.8, 6 months after operation, and the pain score was 2.4±0.6. Conclusion: Scrotoscope is safe. There are no serious complications such as severe edema, hematoma, testicular hydrocele and wound infection occurred. Scrotoscope is superior to ultrasound for diagnosis of testicular torsion and epididymal mass. Scrotoscope epididymectomy is effective for pain relief, especially for patients with epididymal cyst.

Objective：To investigate the relationship between single nucleotide polymorphisms (SNPs) of cytochrome P450 (CYP450) 3A4 rs2242480 and interindividual differences of sufentanil consumption in accouchement sans douleur. Methods: A total of 131 parturient women were collected. According to the distribution of genotypes and allele frequencies of rs2242480, the doses of sufentanil were individually designed. CC homozygotes were given the standard analgesia dose, CT heterozygotes and TT homozygotes were given 87.6% of standard sufentanil dose. Results:Visual analogue score (VAS) between CC group and CT/TT group were 3.67±1.2 and 3.44±1.5, consistent with the expected analgesic standards. The difference was not statistically significant. Conclusion:The parturient women carrying CT heterozygotes and TT homozygotes of CYP3A4 rs2242480 required less sufentanil in accouchement sans douleur.

Objective：To investigate the clinical characteristics, laboratory features, outcome and prognosis of microscopic polyangiitis (MPA) patients with autoimmune hemolytic anemia (AIHA). Methods:In this study, 63 cases diagnosed as MPA from October 2006 to November 2013 in Peking University People’s Hospital were reviewed. The clinical characteristics, outcome and prognosis of MPA patients with AIHA were retrospectively analyzed.Results: There were 12.7% (8/63) MPA patients with AIHA. The patients with AIHA had higher prevalence of fever, fatigue, hematuresis, albuminuria and new-onset hypertension, compared with non-AIHA group(87.5% vs.29.1%;100% vs. 49.1%; 100% vs. 60%; 75% vs. 20%, all P<0.05). In patients with AIHA, there were significantly lower levels of red blood cell（RBC）, hemoglobin（Hb）, alanine albumin（Alb） and complement C3［（2.3±0.5 ）×10¹²/L vs.（3.0±0.7）×10¹²/L;（66.2±13.1）g/L vs.(90.0±20.3) g/L; (26.1±4.4) g/L vs.(33.5±6.4) g/L; (0.7±0.2) g/L vs.(0.9±0.3）g/L,all P<0.05］. However, the levels of erythrocyte sedimentation rate (ESR), IgG and Birmingham Vasculitis Activity Score (BVAS) were higher, compared with those in the patients without AIHA ［（102.1±25.7) mm/1h vs.(76.5±31.1) mm/1h; (20.9±6.1) g/L vs.（14.5±6.0） g/L; ( 23.7 ±5.7)vs.(17.3 ± 4.1)， all P<0.05］. The study suggested that there were more severe multi-system damage in the patients with AIHA than in those without AIHA. In the MPA patients with AIHA, six cases received treatment of methylprednisolone combined with immunosuppressant, and two received treatment of methylprednisolone only. Among the eight cases, three were recovered from anemia and four improved. One died of severe lung infection. After 4 years follow-up,in the seven MPA patients with AIHA, three received remission, two died，and two suffered from anemia and abnormal renal function. Conclusion: MPA with AIHA is more complicated by multi-system damage and not rare in clinical settings. Glucocorticoid combined with immunosuppressant is beneficial to induce remission for MPA patients with AIHA.

Objective：To investigate the anti-tumor efficacy of dendritic cells (DC) vaccination transfected with total RNA of cancer stem like cells and to discuss the mechanism of immune response, so as to provide experimental basis for clinical application.Methods: Dendritic cells were isolated from F344 bone marrow cells, then these dendritic cells were transfected with total RNA of 9L cancer stem cells or 9L monolayer cells. F344 rats bearing with 9L brain tumors were treated by subcutaneous injection of either PBS, unpulsed DC, DC transfected with 9L monolayer cells RNA (DC-9LTS) or DC transfected with 9L tumor spheres RNA (DC-9L)3, 10, 17. And 21 days after tumor implantation, the brains and sera were obtained from the different groups, the lymphocytes infiltration was detected by immunohistochemistry, and the concentration of interferon-γ(IFN-γ) was tested by ELISA. The survival time was observed and determined using the method of Kaplan Meier analysis.Results: The rats vaccinated with DC transfected with 9L tumor spheres RNA (DC9LTS) and the monolayer cell RNA (DC-9L) expired with median survival time of 36 and 31 days, respectively. The animals bearing intracranial 9L gliosarcoma were vaccinated with unpulsed DC vaccine, all expired with a median survival time of 21 days. The Kaplan-Meier survival curve showed that the rats treated with DC-9LTS had longer survival than the other groups (P＜0.01). There was significant difference among DC-9L group, DC group, and PBS group (P＜0.01). There was no significant difference between DC group and PBS group (χ2＝0.071, P=0.789).The concentration of IFNgamma of DC-9LTS group［（157.08±7.25) ng/L］was much higher than those of the other groups (P＜0.05). DC-9LTS could effectively enhance T-cell infiltration, a large number of CD8+ cells were detected in and around the tumor in DC-9LTS group, compared with DC-9L group, DC and PBS group (P＜0.001). The expression of CD8+ cell was not detected in DC group and PBS group. However no expression of CD4+ cells was observed in all the groups. Conclusion: Immunotherapy using DC transfected with 9L CSLCs total RNA was more effective for the treatment of 9L brain gliomas, and the strategy prolonged the survival of 9L glioma-bearing rats significantly, which provides a scientific foundation for further investigation of this approach to eradicate gliomas.

Objective： To compare the diffusion properties of fluorescent probes dextran-tetramethylrhodamine (DT) and lucifer yellow CH (LY) and magnetic probe gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) in porous media and to screen out a suitable fluorescent probe for optical imaging of brain interstitial space (ISS). Methods:Agarose gels sample were divided into DT group, LY group and Gd-DTPA group, and the corresponding molecular probes were imported in each group. The dynamic diffusions of DT and LY in agarose gels at different time points (15, 30, 45, 60, 90, and 120 min) were scanned with laser scanning confocal microscope, the dynamic diffusion of Gd-DTPA was imaged with magnetic resonance imaging. The average diffusion speed of LY were demonstrated to be consistent with those of Gd-DTPA. The LY was introduced into caudate putamen of 18 rats, respectively, the diffusion of LY in the sequential slices of rat brain at different time points (0.5, 1, 2, 3, 7, 11 h) were scanned, and the results were compared with those of rats’ brain with Gd-DTPA imported and imaged in vivo with magnetic resonance imaging.Results:The diffusions of the three probes were isotropic in the agarose gels, and the average diffusion speeds of DT, LY and Gd-DTPA were: (0.07±0.02)×10^－2 mm²/s, (1.54±0.47)×10^－2  mm²/s, (1.45±0.50)×10^－2 mm²/s, respectively. The speed of DT was more slower than both LY and Gd-DTPA (ANOVA, F=367.15, P＜0.001; Post-Hoc LSD, P＜0.001), and there was no significant difference between the speeds of LY and Gd-DTPA (Post-Hoc LSD, P=0.091). The variation tendency of diffusion area of DT was different with both that of LY and that of Gd-DTPA (Bonferroni correction, α=0.0125, P＜0.001), and there was no significant difference between LY and Gd-DTPA (Bonferroni correction, α=0.0125, P=0.203),  in analysis by repeated measures data of ANOVA. The diffusions of LY and Gd-DTPA were anisotropy in rat caudate putamen,and the average diffusion speeds of LY and Gd-DTPA were: (1.03±0.29)×10^-3 mm²/s, (0.81±0.27)×10^－3 mm²/s, respectively, no significant difference was demonstrated (t=0.759, P=0.490); half-time of single intensity of LY and Gd-DTPA was (2.58±0.04) h, (2.46±0.10) h, respectively, no significant difference was found (t=2.025, P=0.113). The diffusion area ratios between LY and Gd-DTPA in rat caudate putamen was not statistically different at hours 0.5, 1, 2, 3 and 7 (t=2.249, P=0.088; t=2.582, P=0.061; t=1.966, P=0.121; t=0.132, P=0.674; t=0.032, P=0.976), while, a slightly difference was found at 11 h (t=2.917, P=0.043,in analysis by t test) .Conclusion:LY present the same diffusion property with GdDTPA in porous media witch including agarose gels and live rat brain tissue, indicates that LY is a suitable fluorescent probe for optical imaging of brain ISS, and it can be used for microscopic, macro and in vitro measure of brain ISS.

Objective： To investigate the changes of neuroapoptosis in brain and learning ability after neonatal mice are exposed to inhaled sevoflurane.Methods: Twenty-one postnatal day (P) 7 Wistar rats were randomly divided into 7 groups for the preliminary experiment. Arterial blood samples were obtained immediately at the end of anesthesia, then blood analysis was performed. According to the results of the blood analysis, the groups that had no carbon dioxide accumulation were chosen for the following experiment. Ninety postnatal day (P) 7 Wistar rats were randomly divided into 5 groups: group A ［sham anesthesia］, group B ［1% (volume fraction) sevoflurane for 2 h］, group C (1% sevoflurane for 4 h), group D ［2% (volume fraction) sevoflurane for 2 h］ and group E (2% sevoflurane for 4 h). The animals from each group were perfused transcardially with 0.1 mol/L phosphate buffer containing 4% (volume fraction) paraformaldehyde 6 h after the end of anesthesia, and then the brains were exposed for immunohisochemistry, and caspase-3 positive cells were detected. Behavioral studies which included Morris water maze and passive voidance test were performed separately when the rats were 5-week-old, 8-week-old and 14-week-old. Results: The blood gas data in the mice during the anesthesia showed that the pH, arterial carbon dioxide tension, arterial oxygen tension, and arterial oxygen saturation did not differ significantly from those of the sham controls. The amount of the caspase-3 positive cells in the rat brains of group B, group D and group E was greater than that in group A. When facing the spatial reference memory task or space exploration task, the rats from the different groups made it uniformly. The rats exposed to sham anesthesia had longer latency and less mistake times than those to sevoflurane in passive voidance test when they were 5-week-old, while all the rats had no significant difference in 8 weeks. Conclusion: Exposure to the concentration of 2% sevoflurane causes brain cell apoptosis of newborn rats. The memory ability to pessimal stimulation is decreased as the anesthesia mice were 5-week-old, such changes recede along with the growth of the rats. Exposure to the concentration of 2% sevoflurane does not affect the spatial reference memory of newborn rats during their growth.

Objective：To explore the surgical treatment of paraclinoid aneurysms and evaluate the safety and efficacy of microsurgical clip and endovascular embolization of paraclinoid aneurysms. Methods:The data of 28 patients with 30 paraclinoid aneurysms receiving surgical treatment were retrospectively analyzed. According to Barami classification, 4 aneurysms were type Ⅰa, 5 aneurysms type Ⅰb, 13 aneurysms type Ⅱ, 4 aneurysms type Ⅲa, 1 aneurysm type Ⅲb, and 3 aneurysms type Ⅳ. In the study, 15 cases with 17 paraclinoid aneurysms received microsurgical treatment, of which 3 cases underwent superficial temporal artery-middle cerebral artery (STA-MCA) bypass firstly and then aneurysms were trapped. The other 13 cases received endovascular embolism, in which balloon assistant technology was performed in 3 cases and stent assistant technology in another 3 cases. Results: All the 30 paraclinoid aneurysms were treated. One patient with bilateral paraclinoid aneurysms became blind after bilateral microsurgical procedures and another patient was unexceptedly dead 10 d after operation. Vasospasm resulting with cerebral infarction occurred in one case who received endovascular embolism, while two patients suffered from hydrocephalus. Ten cases of microsurgical group and 9 cases of interventional group were followed up with digital subtraction angiography, which disclosed that 9 cases of microsurgical group were clipped completely, while 7 aneurysms of interventional group were completely embolised. One aneurysm recurred and enlarged 12 months after stent assistant embolism, and after STA-MCA bypass and bilateral anterior cerebral artery anastomy and aneurysm insulation, the patient recovered well. When the patients were discharged, their Glasgow outcome scales showed that 18 cases were with 5, 8  with 4, 1 with 3 and 1 with 0.Conclusion: According to the classification, and with appropriate treatment, the patients with paraclinoid aneurysms will get good outcomes both with microsurgical clipping and with endovascular embolization.

Objective：To evaluate the influence of dexamethasone on the incidence of postoperative nausea and vomiting (PONV) in patients undergoing modified radical mastectomy with neoadjuvant chemotherapy. Methods:In a prospective trial, 280 female (18-60 years) breast cancer patients undergoing modified radical mastectomy with neoadjuvent chemotherapy were randomized to two groups: one with dexamethasone (Group D) and one without dexamethasone (Group C, n=140). In each group, anesthesia was maintained with volatile anesthesia or total intravenous anesthesia (TIVA): TIVA (propofol) without dexamethasone (Subgroup CP); volatile anesthesia (sevoflurane) without dexamethasone (Subgroup CS); TIVA with 10 mg dexamethasone intravenously before anesthetic induction (Subgroup DP); volatile anesthesia with 10 mg dexamethasone intravenously before anesthetic induction (Subgroup DS). A standard general anesthetic technique was used. All the patients received 8 mg of ondansetron intravenously 30 minutes before the end of surgical procedures. The incidence of PONV during the 24-hour postoperative period was recorded. A Logistic regression analysis was conducted to examine relevant factors for PONV . The tested factors were: age, body mass index (BMI), duration of surgery, postoperative pain, history of motion sickness/PONV, with or without dexamethasone and anesthetic regimen.Results:There was a significant lower incidence of PONV in the patients who received dexamethasone than in those who received placebo during the 24-hour postoperative period (11.4% vs. 20.7%，P=0.034). In the early postoperative period (0-2 h) dexamethasone reduced the incidence of PONV ( 1.4%vs.6.4%， P=0.031）,but in the late postoperative period (2-24 h) the difference of the incidence was insignificantly (10.7% vs. 17.9%， P=0.088). No differences were found between TIVA and volatile anesthesia in the 24hour postoperative period. Dexamethasone was effective to prevent PONV（OR=0.447，P=0.030）, and history of PONV or motion sickness was the risk factor of PONV (OR=15.730，P＜0.001). Conclusion:Dexamethasone prevents PONV effectively in patients undergoing modified radical mastectomy with neoadjuvant chemotherapy, and TIVA cannot decrease the incidence of PONV in the 24hour postoperative period in those patients.

Objective：To study the effect of 1,4-naphthoquinone aged black carbon (BC/1,4-NQ) on reactive oxygen species and DNA strand breaks in human bronchial epithelial cells (16HBE). Methods: In the study, 16HBE cells were exposed to BC/1,4-NQ, BC and 1,4-NQ at the concentrations of BC/1,4-NQ (10.0/0.2, 20.0/0.4, 40.0/0.8, 80.0/1.6, 160.0/3.2 mg/L), BC (10.0, 20.0, 40.0, 80.0, 160.0 mg/L), 1,4-NQ (0.2, 0.4, 0.8, 1.6, 3.2 mg/L) for 24, 48, and 72 h, respectively. Cytotoxicity was detected by cell count kit 8 (CCK-8) at the end point. Then the 16HBE cells were exposed to BC/1,4-NQ (20.0/0.4, 40.0/0.8, 80.0/1.6 mg/L), BC (20.0, 40.0, 80.0 mg/L), 1,4-NQ (0.4, 0.8, 1.6 mg/L) for 24 h. The reactive oxygen species (ROS) generation was determined via flow cytometry with DCFH-DA probe. Single cell gel electrophoresis (SCGE) assay was performed to evaluate genotoxicity by Olive tail moment (OTM) value. Results: Except for the concentration of 10.0/0.2 mg/L within the exposure time 24 h, the cell viabilities of BC/1,4-NQ were significantly lower than the control (P<0.05) within the exposure time 24-72 h, showing a dose-dependent cytotoxicity. Especially, BC/1,4-NQ showed greater cytotoxicity than BC single exposure, lower than 1,4NQ at the concentration of BC/1,4-NQ≥80.0/1.6 mg/L. BC/1,4-NQ also showed greater ROS generation and OTM value than the control within the exposure time 24 h at each concentration (P<0.05). Especially, the ROS generation and OTM value of BC/1,4-NQ were greater than BC single exposure, lower than 1,4-NQ at the concentration of 80.0/1.6 mg/L (P<0.05). Conclusion:BC/1,4-NQ can induce intracellular ROS generation, cytotoxicity and genotoxicity in 16HBE cells. And at high concentration, the intracellular ROS level, cytotoxicity and genotoxicity induced by BC/1,4-NQ were greater than those by BC single exposure, but lower than those by 1,4-NQ.

Objective：To investigate the relationship between vitamin D receptor (VDR) gene polymorphisms and chronic periodontitis(CP). Methods: Buccal swabs from 105 patients with mild/moderate CP and 85 severe CP were collected, DNA was extracted from these buccal swabs using the TIANamp Swab DNA Kit ［TIANGEN Biotech (Beijing) CO.Ltd］. The VDR rs1544410 and rs731236 were genotyped by the Sequenom MassARRAY system (Shanghai Benegene Biotechnology Co. Ltd), which was based on MALDITOF (matrixassisted laser desorption ionization timeofflight) technology. The distribution of the genotypes and allele frequencies were analyzed. Results: The frequencies of the rs1544410 A allele and AA+AG genotype were significantly higher in severe CP than in mild/moderate CP of all the patients and the female patients respectively (all the patients: P=0.006, 0.007; the female patients: P=0.001, 0.001). The frequencies of the rs731236 C allele and CC+CT genotype were significantly higher in severe CP than in mild/moderate CP of all the patients and the female patients respectively (all the patients: P=0.003, 0.004; the female patients: P<0.001, <0.001). Conclusion: Gene polymorphisms of VDR rs731236 and rs1544410 may be associated with severe CP in Chinese Han population.

Objective： To evaluate the effect of orthognathic surgery on condylar morphology changes by comparing three-dimension surface reconstructions of condyles using cone-beam computed tomography (CBCT) data. Methods: In the study, 18 patients with mandible retrognathism deformities were included and CBCT data of 36 temporomandibular joints were collected before surgery and 12 months after surgery. Condyles were reconstructed and superimposed pre-and post-operatively to compare the changes of condylar surfaces. One-sample t test and χ² test were performed for the analysis of three-dimension metric measurement and condylar head remodeling signs. P＜0.05 was considered significant. Results: The root-mean-square (RMS) of condylar surface changes before and after the surgery was (0.37±0.11) mm, which was significant statistically (P<0.05). The distribution of condylar remodeling signs showed significant difference (P<0.05). Bone resorption occurred predominantly in the posterior area of condylar head and bone formation occurred mainly in the anterior area. Conclusion: Three-dimension superimposition method based on CBCT data showed that condylar morphology had undergone remodeling after mandibular advancement.

Objective：To investigate the internal regularities and symmetry of craniofacial structures from adults with normal occlusion in North China.Methods:The study consisted of 60 volunteers who were examined with spiral 3D computed tomography (CT). The axial images of craniofacial structure were reconstructed into 3D models and analyzed by using Proplan 1.2 software to measure the internal regularities and symmetry of craniofacial structures. Results: All the linear measurement’s value of the males were bigger than those of the females (P<0.05). There were no significant differences in the ratio measurements between the males and the females(P>0.05). Facial asymmetry was less than 10% in all the images. Conclusion: CT is an effective method for three-dimensional analyses of craniofacial structure and symmetry. There are certain and harmonious regularities in normal 3D craniofacial structures. The 3D craniofacial structure database of people with normal occlusion can provide standards and references for diagnosis and treatment planning of craniofacial deformities.

Multiple primary neoplasms are not common, those containing renal neurilemoma are even more rare. Our study involves the diagnosis and treatment of a female patient with multiple primary neoplasms with renal neurilemoma. She was previously diagnosed with left ovarian dermoid cyst, right posterior mediastinal neurilemmoma, left forearm neurilemmoma, and papillary thyroid carcinoma, underwent operation treatment. Physical examination reveals a left renal mass with a left adrenal tumor a month before, and underwent retroperitoneal laparoscopic left adrenal nodule resection and left partial nephrectomy. Operation was successful, without conversions to open. Artery occlusion time was 18 min, and blood loss was 20 mL. Post operation pathologic result shows a left renal cellular leiomyoma neurilemmoma with focal cystic change, and tumor diameter was about 3 cm. Immunohistochemistry reports S-100 (+), Ki-67 (15%+), and short-term follow-up without recurrence. In our case of study, even though the tumors were heterochronism, they were both treated with surgical resection. Renal neurilemoma is benign. Laparoscopic partial nephrectomy is not only minimally invasive, fast in recovery, but most importantly preserves renal tissue to the largest extent. It can prevent preoperative pathological uncertainty, which often undergoes radical nephrectomy.

The adrenal gland is a common site of metastases, only second to pulmonary, liver and bone. The prevalence of adrenal metastases in patients with a history of cancer is between 10%-25%.The most common sites of origin are cancers of the lung, kidney, breast, gastrointestinal tract, and skin (melanoma).The mainstays of adrenal metastases diagnosis are computerized tomogramphy (CT), magnetic resonance imaging (MRI), and positron emission tomogramphy (PET). All patients should undergo complete hormonal evaluation to rule out functional adrenal tumors. Adrenal biopsy should be reserved for cases in which the results of non-invasive techniques are equivocal. In patients with isolated adrenal metastases, adrenalectomy is recommended, because of improved overall survival. For the patient with unresectable adrenal metastases tumor, radiotherapy and ablative therapy are feasible and useful methods for controlling adrenal metastases and offer patients opportunities for improved survival.