Objective： To investigate the methylation status of the RASSF1A gene promoter in upper tract urothelial carcinoma (UTUC) tissues and its correlation with clinicopathologic characteristics and postoperative recurrence of primary UTUC.Methods: In a retrospective design, a total of 687 patients who underwent surgeries for primary UTUC in the urology department of Peking University First Hospital were enrolled. The methylation status of the RASSF1A gene promoter was analyzed using methylation-sensitive polymerase chain reaction on tumor specimens. Results: Aberrant methylation for the RASSF1A gene promoter was detected in 183 (26.6%) DNA samples in total. Aberrant methylation of the RASSF1A gene was strongly associated with tobacco consumption (P=0.044), ipsilateral hydronephrosis (P<0.001 ), tumor location (P<0.001 ), tumor stage (P=0.001), tumor grade (P=0.007), lymph node metastasis (P=0.001) and growth pattern (P=0.013). The methylated RASSF1A gene promoter was an independent risk factor for bladder recurrence (P< 0.001, HR=0.471) and contrala-teral recurrence (P=0.030, HR=0.269) of UTUC after surgery. Hypermethylated RASSF1A was predictive for improved bladder recurrence-free survival (BRFS) (P<0.001) and contralateral recurrence-free survival (CRFS) (P=0.021) in the UTUC patients. Compared with the patients with unmethylated RASSF1A, the patients containing tumors with hypermethylated RASSF1A had tendency toward longer recurrence-free survival time ［(114.4±3.9) months vs. (84.0±3.2) months for BRFS, (138.1±1.8) months vs. (132.9±1.9) months for CRFS］ and higher estimated cumulative recurrence-free survive rates ( five-year survival rate for example, 79.8%±3.4% vs. 57.4%±2.6% for BRFS, 98.9%±0.8% vs. 93.0%±1.4% for CRFS). Additionally, tumor multifocality (P=0.002, HR=1.538), and ureteroscopy before surgery (P=0.001, HR=1.725) were independent risk factors for bladder recurrence in postoperative UTUC patients.Conclusion: The methylation status of the RASSF1A gene promoter appears to be a promising epigenomic biomarker for assessing the aggressiveness of UTUC and a predictor predicting the urinary tract recurrence after surgery.

Objective：To investigate whether chemokine like factor (CKLF)-like myelin and lymphocyte and related proteins for vesicle trafficking and membrane link (MARVEL) transmembrane domain-containing protein 2 (CMTM2) is involved in spermatogenesis in varicocele induced sub-fertility rats and  to  discuss the possible mechanisms. Methods: Forty male SD rats (body weight: 220-330 g, age: 6-7 weeks) were randomly divided into 4 groups: varicocele for 4 weeks, varicocele for 12 weeks, sham operation for 4 weeks and sham operation for 12 weeks, with 10 rats in each group. These rats were introduced by partially ligating left kidney veins for the experimental groups, and the sham surgery groups as controls were executed with exactly the same surgery as in the experimental groups except for the ligation. The rats in control and experimental groups for 4 and 12 weeks were killed after laparotomy at the end of 4 and 12 weeks, respectively, the left testes and epididymis were taken out for counting the sperm, observing the seminiferous tubule change and immunochemistry for CMTM2. The changes included sperm density and motility, the outer diameter and inner diameter change and the changes of epithelium and the CMTM2 expression in immunochemistry. Results: Compared with the control groups, the sperm density［（63.9±7.1）×106/mL vs.（74.3±5.0）×106/mL］ and motility［（58.7%±7.9%） vs.（66.1%±4.3%）］ were reduced slightly in group of varicoele for 4 weeks, respectively (t=1.432, 1.563; P=0.076, 0.059, respectively). Varicocele significantly caused a decrease in sperm concentration ［（40.5±7.2）×106/mL vs.（71.1±4.5）×106/mL］ and motility ［（35.2%±8.5%）vs. (63.4%±4.1%)］ at 12 weeks, compared with the related sham groups (t=3.754, 3.933; P=0.004, 0.002, respectively). Additionally, testis CMTM2 exhibited the same disparity, that is, the CMTM2 protein expression in varicocele group was significantly reduced, with the ratio of sham group to varicocele group at the end of 12 weeks 2.3±0.4 (t=1.978; P=0.039). In the evaluation of seminiferous tubules diameter, the external ［(198.2±10.2) μm vs. (255.8±12.7) μm, t=2.125, P=0.003］ and epithelium diameter ［(54.1±1.5) μm vs. (75.5±4.1) μm, t=2.246, P=0.021］ were decreased compared with the sham-related groups and previous varicocele groups. In all the varicocele groups, all types of sperm motility decreased compared with the related sham-operated group (P<0.05). Conclusion: This study suggests varicocele has a detrimental effect on CMTM2 levels and decreases spermatogonia cell number, seminiferous tubules diameter, and sperm indices. CMTM2 is associated with sperm changes in rats with varicocele, and further studies are needed to study the mechanism.

Objective： To determine the mechanism of sunitinib-induced autophagy in renal cell carcinoma cells. Methods: MTS assay was applied to detect the cell viability alteration under the treatment of sunitinib (2, 8 μmol/L). The sunitinib-induced autophagy as well as cell apoptosis was measured and compared after knocking down autophagy-related protein Beclin1 and microtubule associated protein 1 light chain 3 fusion protein (LC3) by RNA interference. The transmission electron microscope was used to observe the formation of autophagosomes in ACHN cells. The fluorescence microscope was used to monitor distribution and aggregation of endogenous LC3-Ⅱ. The expressions of protein such as LC3-Ⅱ, the autophagic regulation molecules protein kinase B/ mammalian target of rapamycin (Akt/mTOR) and the symbol of apoptosis poly ADP-ribose polymerase (PARP) were capable to be detected by immunoblotting assay. Results: Sunitinib was able to significantly trigger cell viability loss in the renal carcinoma cell ACHN, which was both in a concentration-dependent and time-dependent manner (P<0.05). After reducing the autophagy by knocking down Beclin1 and LC3, the number of cleavage of PARP was increased remarkably, whereas there was nearly not any cleavage in the mock group. By the transmission electron microscope, there were more autophagic vacuoles in ACHN cells after being administrated with sunitininb compared with the control. And the nuclear-to-cytosol translocation as well as aggregation of LC3-Ⅱ was presented after sunitinib treatment by the fluorescence microscope, which was the proof of the enhanced autophagy. According to the immunoblotting, sunitinib was able to increase the accumulation of LC3-Ⅱ. At the same time, the result of sunitinib combined with chloroquine, a drug which blocked the fusion of autophagosomes and lysosomes, demonstrated that the increasing amount of LC3-Ⅱ was due to the enhanced autophagy flux by sunitinib treatment in ACHN cells. However, phosphorylation of Akt as well as mTOR was decreased at the same time. The rapamycin (mTOR inhibitor) or knocking down Akt subunits could change the sunitinib-induced LC3-Ⅱ accumulation, whereas overexpression of Akt subunits decreased the autophagic flux, indicating that Akt/mTOR was the target of sunitinib in autophagy. Conclusion: Sunitinib induced autophagy via suppressing Akt/mTOR pathway, and the auto-phagy was involved in apopotosis.

Objective： To investigate the expression of MEK/ERK signaling pathways in renal cell carcinoma with bone metastasis, and to analyze the differences of expressions of VEGFR-2, MEK, ERK on the primary and metastasis tissue and its mechanism. Methods: The tissue samples were obtained from 7 renal cell carcinoma patients kindly provided by Department of Urology, Peking University People’s Hospital from January 1, 2009 to January 1, 2010. The expression of MEK/ERK signaling pathways was detected in the 7 renal cell carcinoma patients` primary and matched metastatic tissues with ICH, The antibody concentrations were 1 ∶200, 1 ∶25, and 1 ∶250, respectively. The mutation of the twentieth exon of the PDGFRA gene, the second exon of the K-ras gene, the fifteenth exon of the Braf gene and the se-cond exon of the MEK1 gene were detected with PCR.  Results: The expression intensities of VEGFR-2, MEK, and ERK were measured by H-score ［intensity (1, 2, 3, or 4) multiplied by the distribution (%)］. VEGFR-2, MEK, and ERK expressions were divided into 3 groups according to the positive distribution of the tumor cells: 1, 0－5%; 2, 6%－50%; and 3, >50%, To assess intratumor heterogeneity, three distinct microscopic fields (×200) from each specimen were used to evaluate the expressions, Subsequently, the scores were averaged to obtain a single concatenated score for each tissue. VEGFR-2, MEK, and ERK expressions were assessed by 2 independent pathologists who were blinded to the clinicopathological data. The data were expressed as the mean value of the triplicate experiments. The expressions of MEK, and ERK were higher in the metastatic tissues than in the matched RCC tissues (6.10±4.10 vs.  1.33±0.51, P=0.015; 9.10±2.24 vs. 4.43±2.84, P=0.021) while the expression of VEGFR2 was not different between the primary and metastatic tissues (P=0.901). No mutation was detected on the twentieth exon of the PDGFRA gene, the second exon of the K-ras gene, the fifteenth exon of the Braf gene and the second exon of the MEK1 gene. Conclusion: MEK/ERK signaling pathways may play an important role in the metastasis and the resistance of sunitinib in RCC patients with bone metastasis.

Objective：To investigate the change of biological characteristics after stable knockdown of CKLF-like MARVEL transmembrane domain containing 3 (CMTM3) expression in PC3 by lentivirus shRNA and to reveal new therapeutic targets. Methods: The research includes two groups: sh393 is the experimental group in which CMTM3 is knocked down in PC3 cell line; shN is the control group in which CMTM3 is negatively knocked down. The expression of CMTM3 was detected by Western blot. The migration ability of PC3 after stable knockdown was detected by Transwell and Wound healing assay. The invasion ability of PC3 was detected by Matrigel assay. Results were obtained from at least three indivi-dual experiments.  Results: The expression of CMTM3 in sh393 group is significant lower than shN group (0.004 0±0.000 4 vs. 0.490 0±0.055 7, P<0.001) detected by Western blot. It also had statistical significance in Matrigel assays (248.6±4.5 vs. 113.0± 3.3), Transwell (203.6±1.9 vs. 103.0±1.2) and Wound healing assays (95.0±2.9 vs. 33.0±1.5) that knockdown of CMTM3 promoted migration, and invasion of PC3 cells in vitro (P<0.001). Conclusion: Negative correlation exists between the stable knockdown of CMTM3 and change of biological characteristics in PC3 cells, and knocking down CMTM3 affects migration, and invasion ability in PC3 cells.

Objective： To study the clinicopathological features and differential diagnosis of metanephric adenoma (MA). Methods: The clinicopathological data of 16 cases with MA diagnosed and treated in Peking University First Hospital from 2004 to 2016 were retrospectively analyzed, and the clinical characteristics, pathologic parameters, differential diagnosis, treatment options and prognosis of MA were analyzed with literature review． Results: The patients included 10 females and 6 males. The age of patients ranged from 14 to 83 years (mean=33.7 years). The partial nephrectomy was carried out for most patients. All cases were located in renal codex with 3 growing into the renal sinus. Histologically, the tumor was composed of tubules, papillary or glomeruloid structures and psammoma bodies were focally seen. Immunohistochemical study showed that all the cases expressed vimentin, and 94% cases expressed CD57, 63% WT1, 75% AE1/AE3, 19% cytokeratin 7 (CK7) and 13%α-methylacyl-CoA racemase (AMACR), and negative expressions for MA included CD10, neuronspecific enolase (NSE) and CD56. Follow-up information from 1 to 125 months was available in all the patients; and none of the patients showed any evidence of recurrence and metastasis. Conclusion: The benign tumor characteristics of MA are not obvious for preoperative imaging diagnosis, and the diagnosis of MA should be based on the unique pathological features. Positive immunostain of CD57 is a useful indicator for MA diagnosis and differential diagnosis. The partial nephrectomy surgical treatment can achieve good clinical cure with good prognosis.

Objective： To assess the discrepancy between preoperative needle biopsy (NB) Gleason score and pathological specimen Gleason score (GS) after radical prostatectomy, and to explore the risk factors of postoperative upgrading of GS. Methods: We retrospectively evaluated 160 patients who suffered from biopsy proved prostatic carcinoma and performed radical prostatectomy. Age of the patients was 57-82 years, with the average age of 71.6; prebiopsy prostate specific antigen (PSA) was 0.31-40.32 μg/L，with the average PSA of 11.29 μg/L; body mass index (BMI) was 16.41-32.04 kg/m2, with the average BMI of 23.63 kg/m2; prostate volume (PV) was 9.52-148.46 mL, with the average PV of 40.19 mL. All the patients included in the study had complete information for clinical variables, including age, BMI, prebiopsy PSA level, PV, number of biopsy cores obtained, percentage, clinical stage, and biopsy GS. Grading of NB Gleason score was compared with their corresponding radical prostatectomy specimens, and the discrepancy between the NB and prostatectomy specimens GS assessed. Upgrading was defined as any increase in the pathological GS over that of the biopsy GS as a total sum of primary and secondary grades or a change in the order of primary and secondary grades towards higher ones. Univariable and multivariable Logistic regression analyses were used to identify predictors of pathological grading changes.  Results: Of the 160 patients, the specimen GS was upgraded in 49 (30.6%) patients and remained with no change in 82 (51.3%) patients. Univariate and multivariate regression analysis showed that prostate volume and biopsy GS were independent predictors with postoperative upgrading of GS. Age, BMI, PSA before needle biopsy, clinical stage and needle number showed no statistical significance (P＞0.05). Conclusion: Lower biopsy GS and smaller prostate volume are increased risks for clinically upgrading of GS after radical prostatectomy. This fact should be kept in mind when deciding on therapy decisions for patients with prostate cancer.

Objective：To discuss the treatment options for patients with azoospermia factor (AZF) c microdeletion on Y chromosome. Methods: One hundred and eighty three patients, who were diagnosed as AZFc microdeletion on Y chromosome in Peking University Third Hospital, were recruited in our stu-dy. In order to get better treatment option for this kind of patients, we retrospectively analyzed their clinic data including the treatment process and pregnancy outcome and found out the characteristics of their semen.  Results: Among the 183 patients, sperms can be found in ejaculated semen in 105 patients (57.4%, 105/183). One hundred and three patients (98.1%, 103/105) were diagnosed as severe or extremely severe oligospermia. Regular medication was given to 98 patients, 6 patients (6.1%, 6/98) of which got natural pregnancy. The other 99 patients who have sperms in their semen received intracytoplasmic sperm injection (ICSI), 68 patients (68.7%, 68/99) of which got pregnancy. Seventy eight patients were diagnosed as azoospermia among all the 183 patients. Forty nine patients received testicular sperm aspiration (TESA), and 21 patients choose to receive micro-TESE directly. Among the 49 patients with TESA, sperms were retrieved in 17 patients (34.7%, 17/49), and sperms were not retrieved in 32 patients (65.3%, 32/49), of which 12 patients (37.5%, 12/32) gave up treatment and 20 patients (62.5%, 20/32) choose micro-TESE. Among the 41 patients who choose to receive micro-TESE, ope-ration has been done on 19 patients, of which 11 patients (57.9%, 11/19) got sperms. Among the 11 patients, TESA has been done on 6 patients before microTESE, of which 4 patients (66.6%, 4/6) got sperms. ICSI has already been done on 7 azoospermia AZFc microdeletion patients who underwent micro-TESE, of which 4 patients (57.1%, 4/7) get pregnancy. Conclusion: AZFc microdeletion patients who had sperms were always diagnosed as severe or extremely severe oligospermia. ICSI was their first choice instead of drug therapy. For AZFc microdeletion patients who were diagnosed as azoospermia, TESA was one of their choices, however, the success rate is not high. Micro-TESE is still possible to get sperms even after the failure of TESA. Therefore, we may choose micro-TESE instead of TESA in some azoospermia patients in order to reduce surgical trauma on patients.

Objective：To investigate the association between metabolic factors, such as obesity, blood pressure, blood glucose, serum lipid profile, and the histopathological characteristics of renal cell carcinoma. Methods: The medical records of 382 consecutive renal cell carcinoma patients who underwent radical or partial nephrectomy at Peking University People’s Hospital from January 2009 to January 2015 were retrospectively reviewed. Metabolic factors were collected from the records, including weight, body mass index, waist circumstance, blood pressure, fasting blood glucose, serum total triglyceride, serum total cholesterol, serum low-density lipoprotein-cholesterol and serum high-density lipoprotein-cholesterol. The patients were divided into different groups according to tumor grade, stage and diameter. Statistics analysis, such as t test, Mann-Whitney U test and Logistic analysis, were performed to investigate the association between metabolic factors and grade, stage and tumor diameter of renal cell carcinoma.  Results: A total of 80 (20.94%) of the tumors were classified as high grade disease, 63 (16.49%) were classified as advanced disease and 153 (40.05%) tumor diameter more than 4 cm. The patients in high grade group were found to have lower high-density lipoprotein-cholesterol level than in low grade group (P=0.015), body mass index, total cholesterol and high-density lipoprotein-cholesterol were found to be lower in advanced disease than in localized disease (P=0.022, P=0.005 and P=0.006, respectively), and low-density lipoprotein-cholesterol was found to be lower in larger tumors (P=0.030). Other factors were comparable between the different groups. The results of Logistic analyses showed that, body mass index (OR=0.906, 95%CI： 0.852-0.986, P=0.023) and total cholesterol (OR=0.660, 95%CI： 0.492-0.884, P=0.005) were associated with the tumor stage, high-density lipoprotein-cholesterol level was significantly associated with tumor grade (OR=0.293, 95%CI： 0.108-0.797, P=0.016) and stage (OR=0.204, 95%CI： 0.065-0.635, P=0.006), and low-density lipoprotein-cholesterol level was significantly associated with tumor diameter (OR=0.756, 95%CI： 0.586-0.975, P=0.031). Conclusion: The results of our study indicate that metabolic factors, especially obesity and serum lipid profile, are closely related with the histopathological characteristics of renal cell carcinoma.

Objective： To evaluate the clinical effect of retroperitoneoscopic renal pedicle lymphatic disconnection via extra-adipose capsule in the management of chyluria and to discuss the management of its complications. Methods: From August 2013 to June 2008, five patients with chyluria were admitted. All the patients were female,  aged from 26 to 73 years， and disease course from 1 to 10 years．All the five patients had complained of intermittently voiding milky urine with varying degrees of weight loss, and fatigue, of whom two presented with flank pain and one with anemia. Their urine chyle tests were confirmed to be positive. Preoperative cystoscopy found that chyluria was from the left side in 3 cases，and from the right side in 2 cases．Their proteinuria ranged from+to++++. All the cases had been treated with the modified procedure by which lymphatic ligation was performed to hilar vessels and proximalureter via extraadiposecapsule without disconnection of perirenal fat tissues. The operation time, intraoperative blood loss, postoperative intestinal function recovery, catheter time, drainage tube removal time and complications during operation were collected.  Results: All the five cases were performed successfully. The operation time ranged from 75 to 170 minutes, mean (126.0±39.6) minutes, with the intraoperative blood loss 20 to 60 mL, mean (38.0±16.4) mL, and the postoperative intestinal function recovery time 1 to 3 days, mean (1.9±0.4) days. The catheter time was 1 to 4 days, mean (2.1±0.3) days and the drainage tube removal time ranged from 3 to 15 days, mean (9.3±1.8) days. Postoperatively lymphorrhagia was found in two cases. No renal vessels injury occurred during operation. Chyluria of all the patients disappeared on the operation day with negative chyluria test after surgery. Furthermore, urine test revealed that proteinuria was totally negative. No recurrence was detected in our patients in the 9 to 31 months’ follow-up. Conclusion: This modified procedure does not have to disconnect perirenal fat tissues and nephropexy during operation. It was characterized with shorter operation time, definitive effect and fewer complications.

Objective：To evaluate the safety and efficacy of retroperitoneal laparoscopic nephrectomy with autotransplantation in cases of severe iatrogenic proximal ureteral damage. Methods: From July 2011 to March 2015, two patients, aged 44 (female) and 54 years (male), underwent retroperitoneal laparoscopic nephrectomy and autotransplantation for treatment of severe iatrogenic proximal ureteral injuries. Both injuries were proximal ureteral avulsion during ureterolithotomy with the holmium laser for ureteral calculi. computed tomography angiography (CTA) and computed tomography urography (CTU) was performed in both patients before operation. A 3-port retroperitoneal technique was used for the patients placed in a lateral decubitus position. A retroperitoneal laparoscopic nephrectomy with autotransplantation approach was used in both the patients, and the kidneys were removed to the right iliac fossa. Case 1’s kidney was removed through the right Gibson incision, while Case 2’s kidney was removed through the left lumbar incision. The renal artery and renal vein were ligated using the Hem-o-lok. The kidneys were taken out quickly from the patients and infused with 4 ℃ kidney preserving fluid immediately.  Results: The retroperitoneal laparoscopic nephrectomy with autotransplantations was performed 4 hours in Case 1 and 2 years in Case 2 after atrogenic proximal ureteral injuries. Case 2 was associated with dense perinephric and perihilar fibrosis. The procedures were successful, with immediate return of renal function in both the patients. After ex vivo graft preparation, ureteral and vessel length and quality were adequate for transplantation in both the cases. A direct ureterovesical anastomosis was performed in both patients. In the 2 patients, the warm ischemia time was 3 and 5 minutes, the total operation time 185 and 246 minutes, and the estimated blood loss 70 and 200 mL, respectively. No perioperative complications occurred. At the end of the follow-up, the transplanted kidneys were functional, and the patients had returned to their normal activity. Conclusion: Retroperitoneal laparoscopic nephrectomy with autotransplantation is an excellent alternative to nephrectomyor bowel interposition in patients with proximal urete-ral loss. This procedure is associated with acceptable morbidity and preserves the renal function. This report supports the safety and efficacy of retroperotoneal laparoscopic nephrectomy with autotransplantation in experienced hands.

Objective：Carcinoma of bladder is the most common malignancy in the urinary system in China. Most patients with this disease had non-muscle invasive bladder cancer (NMIBC) at the time of diagnosis. Radical cystectomy was indicated for patients with high risk or refractory NMIBC. We aimed to investigate the overall survival and disease-specific survival and related influence factors in patients undergoing radical cystectomy for pathological non-muscle invasive bladder cancer.  Methods: From Jan. 2006 to Dec. 2012, a total of 164 patients with pathological non-muscle invasive bladder cancer underwent radical cystectomy in Peking University First Hospital. Clinical data were retrospectively collected.Incidence of lymph node metastasis and disease recurrence were calculated. The risk factors of disease recurrence were analyzed. Kaplan-Meier plots were used to estimate the overall survival and cancer-specific survival. Multivariate Cox regression analysis was used to evaluate the prognostic factors for survival.Results: Of all the patients included, 159 had T1 disease, and 5 had CIS only. The median follow-up duration was 46.5 months (range: 7－99 months). Fourteen patients were lost during the follow-up. Lymph node metastasis was noted in 6 patients (3.7%), 4 patients had N1 disease, one patient had N2 di-sease, and one patient had N3 disease. Disease recurrence occurred in 16 patients (9.8%).The most common recurrence sites were the liver, bones, and lungs. The 5-year overall survival and disease-specific survival for all the patients were 85% and 91%, respectively. The patients who underwent pelvic lymph node dissection showed a better prognosis in terms of disease-specific survival than those without (P=0.012). Patients with recurrence harbored a significant poorer survival (P<0.001). According to univariate Cox regression analysis, whether lymph node dissection was performed was an independent risk factor of disease recurrence (P=0.050, OR=2.695, 95%CI 0.999－7.271). In COX regression mo-del, age (P=0.008, OR=1.071, 95%CI 1.018－1.126) and whether lymph node dissection was performed (P=0.011, OR=3.385, 95%CI 1.329－8.621) were related to disease-specific survival. Conclusion: Patients with pathological non-muscle invasive bladder cancer underwent early radical cystectomy have a favorable prognosis, and bilateral pelvic lymph node dissection is essential for this procedure as it gains a survival benefit for the patients.

Objective：To analyze the impact of different surgical methods on perioperative complication rate after radical cystectomy in patients over 75 years of age. Methods: A retrospective study reviewed 1 432 patients who received radical cystectomy from January 2003 to January 2015. A total of 239 patients were ≥75 years (median age: 78 years), of whom, 74 patients (31.0%) suffered one or more perioperative complications. According to the different operation methods, patients could be divided into ileal conduit group and cutaneous ureterostomy group. The ileal conduit group included laparoscopic and open radical cystectomy with ileal conduit. The cutaneous ureterostomy group included transperitoneal laparoscopic, transperitoneal and extraperitoneal open radical cystectomy with cutaneous ureterostomy.  Results: Perioperative complications were significantly associated with the patient’s age (P=0.012), American Society of Anesthesiologists (ASA) score (P=0.001), node staging (P=0.043), and different surgical methods. Perioperative complications caused a prolonged hospital stay and delayed recovery (34 d vs. 21 d, P=0.002). For different surgical methods, the perioperative complication rate of ileal conduit was higher than cutaneous ureterostomy (P=0.013). However, there were no significant differences between transperitoneal laparoscopic and open radical cystectomy with ileal conduit in perioperative complication rate (P=0.836). The perioperative complication rate was statistically significant among transperitoneal laparoscopic, transperitoneal and extraperitoneal open radical cystectomy with cutaneous ureterostomy (P=0.022). On multivariate analysis, age (hazard ratio=4.856, 95% CI: 1.465-16.103, P=0.010), ASA score (P=0.008), and different surgical methods (P=0.016) were significantly associated with the perioperative complication rate. Conclusion: The perioperative complication rate after radical cystectomy in elderly patients was associated with the patients’ age, ASA score, and different surgical methods. Patients who received extraperitoneal open radical cystectomy with cutaneous ureterostomy suffered fewer perioperative complications, which was an appropriate choice for elderly patients.

Objective：To investigate the clinical characteristics, treatment and prognosis of primary penoscrotal extra-mammary Paget’s disease (PSPD). Methods: The clinical and pathological data of 22 cases of primary PSPD were retrospectively reviewed. Survival rate of the overall patients, the invasive patients, and the patients with positive surgical margin or negative surgical margin were analyzed with Kaplan-Meier survival curve method. Results: Among all the patients with primary PSPD, the median age of onset was 64.5 (39-84) years, the median time of disease duration was 40 (2-300) months, and the median long diameter of lesion was 4.75 (1-10) cm. In the study, 12 patients (54.5%) were in pathological stage A1, 6 patients (27.3%) were in pathological stage A2, and 4 patients (18.2%) were in pathological stage B. Scrotum and penile of most patients (n=12, 54.5%) were involved, 5 patients (22.7%) were scrotum only, and 5 patients (22.7%) were penile only. Erythema (n=18, 81.8%), itchiness (n=16, 72.7%), ulcerate (n=12, 54.5%), exudation (n=11, 50.0%), and pain (n=4, 18.2%) were the major manifestations. All the patients with primary PSPD were treated with wide surgical excision. The rate of invasive patients was 77.3% (n=17). Of them, 6 patients had positive surgical margin. The surgical margins of non-invasive patients were all negative. Twelve patients exhibited local recurrence or/and metastases, and the status of surgical margins (P=0.015) and the depth of invasion (P=0.010) were important risk factors. Inguinal lymph nodes were generally involved. The difference of the delay of diagnosis between metastasis and non-metastasis was significant (P=0.040). The 5-year survival rates of the overall and invasive patients were 33.7% and 27.9%, respectively. The patients with positive surgical margin had poor prognosis. Conclusion: Primary PSPD, with the characteristics of long duration, high invasive tendency and high incidence of local recurrence or metastases, generally occurs in the elderly. Surgery should be performed at first. The delay of diagnosis, positive surgical margins and the involvement of inguinal lymph node are important risk factors. Biopsy, frozen section and inguinal lymph node biopsy (ILNB) can standardize diagnosis and treatment.

Objective：To evaluate the risk factors of systemic inflammatory response syndrome (SIRS) in the patients with type 2 diabetes diagnosed with kidney stone after percutaneous nephrolithotomy (PCNL). Methods: In this study, 461 patients with type 2 diabetes who received PCNL in Peking University People’s Hospital from June 2006 to December 2015 were reviewed. There were 281 males and 180 females with an average age of 57 years were included, of whom, 137 were diagnosed with SIRS after PCNL. The demographic data, clinical features, and test results were compared between the patients with SIRS and without SIRS, trying to identify the correlation between their clinical characters and the occurrence of SIRS.  Results: The SIRS was significantly correlated with the patients’ preoperative white blood cell counting (×109/L) ［7.76 (4.00-17.96) vs. 6.31 (2.00-17.40), P<0.001］, preopera-tional blood glucose level (mmol/L) ［7.30 (3.08-19.90) vs. 6.40 (3.42-16.78), P<0.001］, operative time (min) ［75 (20-270) vs. 60 (20-200), P<0.001］, length of stay (d) ［12 (2-46) vs. 11 (3-29), P=0.019］, staghorn stones ［38.8% (33/85) vs. 27.7% (104/376), P=0.042］, and preoperational urinary tract infection ［36.8% (50/136) vs. 26.6% (81/304), P=0.032］. There was no significant correlation between the SIRS and the patients’ age, body mass index, preoperative hemoglobin level, preoperative serum creatinine, and transfusion. In multivariate analysis, abnormal preoperative white blood cell counting (OR=3.194, 95% CI: 1.531-6.666, P=0.002), operative time longer than 60 min (OR=1.635, 95% CI: 1.088-2.456, P=0.018), and preoperational blood glucose level higher than normal 7.1 mmol/L were significantly correlated with the presence of SIRS. Conclusion: The high level of preoperational blood glucose, abnormal preoperative white blood cell counting, and long operative time were significantly correlated with the presence of SIRS in patients with type 2 diabetes after PCNL.

Objective：To discuss the therapy for ureteral endometriosis. Methods: The clinical data of 25 cases of histopathologically confirmed ureteral endometriosis during 2001－2015 were retrospectively analyxed.  Results: In the 25 cases, all the patients took urinary ultrasound for examination before surgery, of whom 21 (84%)  were examined by CT and 5 (20%) by MRI. Three (12%) cases underwent preoperative KUB and intravenous pyelogram (IVP) examination. Four (16%) cases were examined by retrograde pyelography before surgery. Eight (32%) of them took cystoscope for examination and 11 (44%)  took preoperative radionuclide renal dynamic imaging examination. All of these cases were affec-ted with unilateral ureter, 13 (52%) in the right and 12 (48%) in the left. The ureter lesions were at the upper part in 21 (84%) cases and at the middle part in 4 (16%) cases. In these cases, 11 (44%) received partial ureteral resection and end-to-end ureteral anastomosis, 10 (40%) received partial ureteral resection and ureterocystoneostomy, 3 (12%) received retroperitoneal laparoscopic nephroureterectomy, and 1 (4%) received endoscopic resection of ureteral endometriosis lesion. All of these cases were confirmed with ureteral endometriosis by post-surgery pathology results, with the expression of CA125 and ER in the glandular tissue and expression of PR in the mesenchymal tissue inside the ureteral muscle detected by immunohistochemistry. Four (16%) cases took postoperative adjuvant hormonal therapy. And no recurrence was found among 16 (64%) cases with the successful follow-up which ranged from 3 to 76 months and the median follow up was 28 months. Fifteen cases were submitted to the follow-up by urinary ultrasound (93.8%) and 5 (31.3%) underwent CT for examination. All the cases relieved from hydronephrosis, and symptoms of 10 (63.5) cases disappeared. The cases with double-J stent all had the stent removed within 3 to 6 weeks. Conclusion: Surgical procedures should be considered as the main therapy for ureteral endometriosis. We recommend ureterolysis for patients with mild ureteral obstruction and hydronephrosis. As for those with moderate and severe ureteral obstruction and hydronephrosis, we recommend partial ureteral resection. When the situation comes to patients with little renal function of the affected side, the recommended management is nephroureterectomy.

Objective： To investigate the impact of preoperative urodynamic study on the diagnosis and treatment for female patients with clinical diagnosis of stress urinary incontinence by studying their diagnosis and treatment database, and to assess its clinical significance of urodynamic study. Methods: From April 2011 to December 2015, 196 female patients diagnosed clinically with stress urinary incontinence underwent preoperative urodynamics study, after excluding pelvic organ prolapse. The preoperative urodynamic data of these 196 cases were analyzed and the clinical significance of urodynamics on differential diagnosis and treatment for the female patients with stress urinary incontinence was evaluated. Results: In this study, 23 cases (11.73%) changed or amended their diagnoses by the urodynamic study, which were inconsistent with the previous clinical diagnoses concluded by the symptoms, physical examinations, and lab tests. A total of 10 cases underwent a different surgery or conservative treatment instead of the original treatment according to urodynamic study. Of them, 3 were diagnosed as detrusor overactive and undertook conservative treatment; 3 were diagnosed as bladder outlet obstruction plus stress urinary incontinence and were undertaken the transurethral resection of the bladder neck (TURBN) plus tension free vaginal tape (TVT); 2 were diagnosed as bladder outlet obstruction plus stress urinary incontinence and were undertaken TURBN alone; 1 was diagnosed as bladder outlet obstruction plus stress urinary incontinence and was undertaken TURBN plus tension free vaginal tape obturator (TOT); 1 was found no abnormal bladder function turned out to be interstitial cystitis and went for a bladder instillation of drug. The changed treatments avoided the risk of dysuria or residual urine increased after operation due to inappropriate surgical methods. Conclusion: In order to make a correct diagnosis and suitable treatment for female patients with stress urinary incontinences, the preoperative urodynamic study is necessary besides detailed medical history, physical examination, and laboratory tests. With the help of the urodynamic study, the concomitant diseases of patients with stress urinary incontinence may be detected, the individualized treatment regimen can be developed, and more importantly, the inappropriate surgical decision can be avoided.

Objective：To compare the effects of rotational night shifts on the micturition patterns of female nurses. Methods: A total of 58 nurses without lower urinary tract symptoms were recruited, who worked in the Peking University People’s Hospital during January and June in 2014. The nurses aged 20-43 years were divided into two groups, the night-shift group (n=28) and the non-shift group (n=30). The alcohol or coffee intaking were forbidden. In the night-shift group, nurses had worked on rotational shifts for at least 6 months. Their average age was (26.75±4.11) years. In the non-shift group, nurses took regular daytime work, whose average age was (27.80±5.60) years. A voiding diary was kept for 7 consecutive days at the end of 6 months, starting 2 days before their night duties until 4 days after completion of their night duties. For comparison, the non-shift group with regular shifts completed a 7-day voiding diary. In the 7-day recording voiding diary, the nurses were required to have the normal intake of liquid about 1 500-2 000 mL/d. The frequency volume charts of nocturia, the 8hour interval urine production and frequency were compared between the two groups.  Results: Nocturia frequency was increased in the night-shift group ［0.5 (0-2.4)］ compared with the non-shift group ［0 (0-2), P=0.02］. The volume of nocturia was increased in the night-shift group ［125 mL (0-660 mL)］ compared with the non-shift group ［0 mL (0-340 mL), P<0.01］. The 8-hour interval indices showed that urine production changed with shift (P<0.01). In the consecutive 7 days, the nocturnal volume of the night-shift group increased on the day after night shift. When the night-shift nurses returned to daytime duty, the volume of urine decreased but nocturnal urine production remained high, and the frequency of nocturia also increased significantly (P<0.05). Compared with the 8-hour interval indices, the night-shift group’s voiding volume ［(542.35±204.66) mL］ and voiding frequency (2.24±0.69) were more than those of the non-shift group at the afternoon time (from 2 pm to 10 pm). During the 8 h interval night time (from 10 pm to 6 am), the volume of nocturia in the nightshift group ［(309.74±162.74) mL］ was more than that in the non-shift group ［(199.38±153.98) mL, P=0.01］; the frequency of nocturia in the night-shift group (1.31±0.52) was increased than that in the non-shift group (0.82±0.55, P<0.01).Conclusion: The rotational shifts affect the micturition patterns of nurses who go through the night shift work, which increases the volume and frequency of the nocturia.

Objective：To clarify the relationship between epidermal growth factor receptor (EGFR) mutations and the clinicopathologic features of primary lung adenocarcinomas in Xinjiang. Methods: The mutations of EGFR gene at exons 18-21 in 59 cases (including 15 cases of Uighur and 44 cases of Han) of lung adenocarcinoma tissues, which were obtained from surgical resection, were detected by amplification refractory mutation system (ARMS) method. And the relationships among mutations, race and clinicopathologic features were analyzed.Results: The frequencies of EGFR mutations in lung adenocarcinoma were 20% for Uighur, which was lower than that in Han (54.5%), P<0.05. The deletion mutations at exon 19 were seen in 2 of 15 Uighur cases and 9 of 44 Han cases. EGFR mutations were present, including exon 21 L858R in one Uighur case and 12 Han cases, exon 18 G719X in two of 44 cases of Han, exon 21 L861Q in one of them. On histological type, the frequencies of EGFR mutation in alveolar predominant adenocarcinoma was 71% (22/31), which was higher than both that in solid predominant and mucinous carcinoma ( 6.7%, 20% respectively). According to statistic analysis, EGFR mutations were without correlation with the patient’s gender, age, location, gross type, smoking status and lymph node metastasis（P>0.05）. EGFR mutation was more frequent in well-differentiated cancer, mainly in acinar carcinoma, while poorly differentiated adenocarcinoma and mucous adenocarcinoma were lower. Conclusion: There was a difference of EGFR mutation in primary lung adenocarcinoma between Uighur and Han in Xinjiang, perhaps reflecting ethnic genetic variation, which is worth further analyzing. EGFR mutation was commonly detected in well or middle differentiated adenocarcinoma, mainly in acinar carcinoma.

Objective：To investigate the serum level of C-C chemokine ligand 19 (CCL19) and its clinical significance in rheumatoid arthritis. Methods: The serum CCL19 levels in both rheumatoid arthritis (RA) patients and health controls were detected by ELISA. The proportion of peripheral blood B cells and memory B cell subsets were also detected in some patients. Then the clinical and laboratory data of the patients were collected. The CCL19 levels in patients with different clinical features were analyzed. And the correlation between the clinical data, laboratory parameters, B cell subsets proportion and serum CCL19 levels were also analyzed. Independent samples t test, paired t test, Pearson and Spearman correlation were used for statistical analysis. Results: The levels of CCL19 was higher in the RA patients than the health controls (P<0.05). The serum CCL19 levels were decreased in the RA patients who accep-ted disease-modifying anti-rheumatic drugs (DMARDs) treatment for 6 months (P<0.001). Serum CCL19 levels were correlated with the titers of both rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibody (r=0.42, P=0.002; r=0.33, P=0.013), but not with erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and disease activity score in 28 joints (DAS28) (P>0.05). The levels of CCL19 were higher in the serum positive (RF and anti-CCP antibody) patients, but there were no differences between low and high disease activity RA, as well as early and non-early RA. There was no correlation between the serum CCL19 levels and the proportion of B cells as well as memory B subsets. All the proportion of peripheral blood CD27+ memory B cell subsets in RA was lower than the healthy controls, including CD27+IgD+, CD27+IgD- and CD27+ B cells. Conclusion: The increased serum CCL19 levels in RA patients are associated with the activity of B cells, so CCL19 might predict whether the RA type is a B cell mediated RA, and specify the treatment directions for the rheumatologist.

Objective：To explore the effect of ulinastatin on prevention of acute respiratory distress syndrome (ARDS). Methods: A prospective multicentral cohort study was conducted. The patients from three intensive care units (ICUs) of grade A tertiary hospitals in Beijing and a ICU of grade A tertiary hospitals in Cangzhou from January 2012 to December 2014, included 77 ARDS atrisk patients with ulinastatin treatment and 108 ARDS atrisk patients without ulinastatin treatment (control) were eligible. Both groups received normal treatment; additionally, the intervention group received 600 000 units of ulinastatin via intravenous infusion for 5 days. The control group received the same amount of saline via intravenous infusion for 5 days. Venous blood human neutrophil elastase (HNE) and peptidase inhibitor 3 (PI3) levels were measured on days 1, 3, and 7, respectively. Other outcomes included acute physiology and chronic health evaluation scoring Ⅱ (APACHE Ⅱ), body temperature, respiratory rate, heart rate, mean arterial pressure, white blood cell counts, PaO2/FiO2, ARDS incident, mechanical ventilation time, ICU treatment and hospitalization duration, 28 days mortality.  Results: The PI3 levels showed no statistical difference on day 1, but significant differences on day 3 and day 7 between the two groups (P<0.01). HNE/PI3 ratio showed no statistical difference on day 1, but significant differences on day 3 and day 7 (P<0.05). PaO2/FiO2 was significantly higher in ulinastatin group on day 3 and day 7 (P<0.05). The incident rate for ulinastatin group was 15.58%, lower than that for the control group (33.33%), and the difference was statistically significant (P<0.05). The mechanical ventilation time and ICU treatment time in ulinastatin group was shorter than that in the control group, and the difference was statistically significant (P<0.05). There were no significant effects in other factors. Conclusion: Increased dose of ulinastatin can recover the balance of HNE and its antagonist, lower the HNE’s damage to lungs, and further reduce the ARDS incident rate.

Objective：To investigate the prevalence of fever after intravenous injection of  for the first time in osteoporotic patients who have or haven’t taken  bisphosphonates orally.Methods:Bone mineral density measurement was conducted of the osteoporotic patients using dual-energy X-ray absorptiometry method, and according to the WHO diagnostic criteria for osteoporosis, the patient whose T score was less than -2.5 was defined as osteoporosis. The data of 113 osteoporotic patients who received intravenous injection of  zoledronic acid in our hospital for the first time were used for analysis. Among them, 35 who had the history of oral bisphosphonates were defined as group A, and 78 who didn’t have the history of oral bisphosphonates were defined as group B (control group). Moreover, we also compared the prevalences of fever between the patients. Pearson chi-square test was used to investigate the association between oral bisphosphonates therapy and prevalence of fever, and binary logistic regression was used to analyze the impact factors of fever after intravenous injection of zoledronic acid. Results:Among the 35 patients who had the history of oral bisphosphonates, nobody had high fever, and 2 patients had low or mo-derate degree of fever (5.71%). Among the 78 patients who didn’t have the history of oral bisphosphonates, 33 patients had fever (42.3%), 15 with low fever, and 14 with moderate degree of fever, and 4 with high fever. Pearson chi-square test showed that the prevalence of fever between group A and group B had significant difference, and that differences of prevalence of fever between the outpatients and the inpatients was not statistically significant. Binary Logistic regression analysis showed that oral bisphosphonates medication history was a protective factor of fever, and with the increasing of previous oral bisphosphonates for one month, there was a reduction of fever for 23.1%. Conclusion:Patients who have the history of oral nitrogenous bisphosphonates alendronate have a significant reduction in prevalence of fever after intravenous injection of zoledronic acid for the first time. That is, oral nitrogenous bisphosphonates alendronate history is a protective factor of fever for patients with intravenous injection of zoledronic acid for the first time.

Objective：To analyze the reasons of early failure of the PHILOS in proximal humerus fractures. Methods:From Nov. 2010 to Nov. 2014, there were 117 patients with humerus fractures treated with PHILOS locking plate in Department of Orthopaedics, Xuanwu Hospital. All of the patients were treated with the plate by open reduction internal fixation, and we analyzed these cases retrospectively. After the operation, we removed the drainage tube within 48 h, and the patients were allowed to do the passive motion 3 days after the surgery if the X-Ray showed the plate and screws were reliable. Eight cases failed within 4 weeks after the operation. We analyzed the reasons of the failure. Results: The rate of the failed cases was 6.83%(8/117). The average age was 72.4(66-82) years. In the 8 failed cases, 3 were on the right side, and the other 5 on the left side. As for the reason of the fractures, 2 cases were because of car accidents, and the other 6 because of daily life injury. According to the Neer classification, 3 cases were 2-part fractures, and the other 5 3-part fractures. Three cases were total failure, and the other 5 partial failure. All the 8 failed cases failed within 4 weeks after the operation, of which 1 was on the sixth day after surgery, the other 7 2 to 4 weeks after the surgery.The 3 totally failed cases were treated by removing the screws and plates, the other 5 by conservative methods. All of the cases were malunion at the end.Conclusion: The early failure of the PHILOS locking plate in proximal humerus fractures is related to the bad reduction during the operation, the loss of medial cortex support, the limitation of screw length, the osteoporosis and the improper rehabilitation after operation.It is very important to do good preoperative plan for a surgeon. During the operation, we should try our best in the fracture reduction, use the appropriate plate and screws, and then pay attention to the rehabilitation after the operation. After all of this, the rate of failure may be decreased.

Objective：To screen the ectodysplasin A (EDA) gene mutation in the patients with non-syndromic tooth agenesis and ectodermal dysplasia, and to analyze the phenotype of missing teeth pattern in these two groups of patients. Methods: In the study, 174 patients with tooth agenesis (143: non-syndromic, 31: ectodermal dysplasia) and 451 health control volunteers were enrolled from the clinic, and the genome DNA was extracted from either peripheral blood or oral mucosal swab. The coding region of EDA gene was then amplified by PCR, sequenced and blasted to online NCBI database. The missing teeth were recorded for all patients, and the missing teeth from patients with EDA mutation were compared among the different dentition sites.  Results: 33 patients were identified with EDA mutation. In the non-syndromic patients, 13/143(9.09%) were identified with EDA mutation, while in patients with ectodermal dysplasia, 20/31(64.52%) were found with EDA mutation. Ten novel EDA mutations were identified (c.769G>C［p.G257R］，c.936C>G［p.I312M］，c.223G>A［p.E75K］， c.1166C>T［p.P389L］，c.133G>C［p.G45R］，c.1109G>A［p.E370K］，c.914G>T［p.S305I］，c.916C>T［p.Q306X］，c.602G>T［p.G201V］，c.88-89insG［p.A30GfsX69］). For each dentition site there was no statistic difference in the number of missing teeth between the left and right sides, so the number from both sides were combined later in the analysis. In the patients with EDA mutation, the non-syndromic patients had fewer missing teeth (15.9±6.4 missing teeth for each, 207/364 in total) than the patients with ectodermal dysplasia (23.9±4.3, 478/560). In the non-syndromic patients with EDA mutation, the maxillay central incisors and first molars were less affected, with the same missing rate as 19.2% (5/26). While the mandibular central incisors (with a missing rate of 76.9%, 20/26), the maxillary late-ral incisors (the missing rate: 88.5%, 23/26), the mandibular lateral incisors (the missing rate: 80.8%, 21/26), and the maxillary first premolars (the missing rate: 80.8%, 21/26) were more likely to be missing. In the ectodermal dysplasia patients with EDA mutation, only maxillary central incisors (the missing rate: 60%, 24/40), maxillary canines (the missing rate: 70%, 28/40), mandibular canines (the missing rate: 67.5%, 27/40), maxillary first molars (the missing rate: 65%, 26/40) and mandibular first molars (the missing rate: 72.5%, 29/40) had  higher possibility of persistence. Teeth at other dentition sites were more likely to be affected (the minimum missing rate: 87.5%, 35/40). Conclusion: The findings would help to reveal the EDA gene and its function in ectodermal organogenesis.

Objective： To explore the relationship betweensleep/psychological distress and temporomandibular disorders (TMD) and to discuss the possibility of disturbed sleep and psychological distress as risk indicators in relation to TMD in a Chinese population. Methods: The standardized and validated selfreported Chinese version questionnaires including Pittsburgh sleep quality index (PSQI) and depression, anxietyandstress scales-21 (DASS-21) were used to measure sleep quality and psychological distress. A total of 755 TMD patients (172 males and 583 females)with a mean age (29.99 ± 13.60) years were included in the study. The patients were divided into 7 diagnostic groups based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), including Group Ⅰ(exclusively myofascial pain), Group Ⅱ(exclusively disc displacement), Group Ⅲ (exclusively arthralgia or degenerative joint disease), Group Ⅳ (myofascial pain plus disc displacement), Group Ⅴ (myofascial pain plus arthralgia or degenerative joint disease), Group Ⅵ (disc displacement plus arthralgia or dege-nerative joint disease) and Group Ⅶ (myofascial pain plus disc displacement plus arthralgia or degenerative joint disease). For statistical analysis, the patients were subsequently grouped into those with (181 patients) and without (574 patients) myofascial pain. Chisquare tests, independent-samples t test, partial correlation as well as stepwise Logistic regression analysis were used to analyze the data, using software SPSS 20.0 and P<0.05 was of significance. Results: The prevalence of moderate to (extremely) severe disturbed sleep and psychological distress was significantly higher in the myofascial pain group (27.1%, 28.7%, 60.8% and 32.0%) than in the non-myofascial pain group (disc displacement and arthralgia or degenerative joint disease, 11.1%, 10.1%, 27.4% and 11.0%, P<0.05).The comorbidity of self-reported disturbed sleep and psychological distress was significantly higher in the myofascial pain patients than those without myofascial pain (P<0.05). Stepwise logistic regression analysis demonstrated that disturbed sleep (OR=1.74), more specifically, subjective sleep quality (OR=1.69) and sleep disturbance (OR=1.63) respectively, anxiety (OR=3.14) and stress (OR=2.15) were possible risk indicators for myofascial pain, and the results were still significant even after controlling for age, sex, educational level, disease duration, sleep quality, depression, anxiety and stress respectively (P<0.05). Conclusion: Disturbed sleep and psychological distress symptoms are common in TMD patients. Disturbed sleep, anxiety and stress are possible risk indicators for myofascial pain, compared with disc displacement and arthralgia or degenerative joint diseases.

Objective： To explore and compare the perfusion pattern of oral mucosa on Han Chinese and Caucasian by laser-doppler flowmetry.Methods: A crosssectional study was carried out, in 20 healthy Han Chinese adult subjects (average age: 28.4 years) and 20 healthy Caucasian (average age: 25.3 years) adult subjects, either gender with 10 subjects. Gingival perfusion was evaluated at 8 points (including upper incisor labial gingival, lower incisor labial gingival, palatal mucosa, cheek mucosa) using a laser-doppler flowmetry(O2C, Medizintechnik GmbH, Germany). Each measurement was carried out 25 seconds consisting 5 seconds of foreperiod and 20 seconds of work period, without pressure. The measurements were taken by two well-trained doctors, each measurement was exammed 3 times by an examiner, and the average value was recorded as final data. Each measurement has 4 parame ters: SpO2(oxygen saturation), rHB (relative amount of hemoglobin), flow (the blood flow of unit interval), and velocity (blood flow velocity). We compared the data by different sites, different genders, and different races.Results: For palatal gingival, the average SpO2 was 77.1%±10.9%, the average rHB 67.8±11.1, and the average flow 194.1±63.7, which presented significant lower values than other oral mucosa. There was no significant difference among other sites. There was some significant difference between the Caucasian and the Han Chinese: the maxillary central incisor oxygen saturation (SpO2) which were averages of 75.6%±8.2% and 70.4%±7.6%; buccal mucosa hemoglobin (rHB) averages of 79.9±5.8 and 83.5±6.6, which had statistical differences. For most measurement points, the oxygen saturation on men was lower than that on women, which had significant difference.Conclusion: To investigate microcirculation pattern, oral mucosa can be the good observation site. Laser-doppler flowmetry is a well-documented instrument to survey on microcirculation.There may be differences between the genders in hemoglobin oxygen-binding capacity, which may have some impact on the ability of soft tissue healing. Oral mucosa display more blood perfusion than attached gingival. As the recipient site of gingival graft, maxilla and mandible have slight difference in blood supply.

Objective：To investigate the remodeling of alveolar bone and the changes of roots after anterior retraction with maximum anchorage by analyzing CBCT data from adult cases.Methods: The sample comprised 48 incisors and 24 canines from 12 patients (18 to 40 years of age) with problems of ma-xillary protrusion or upper arch protrusion. CBCT scans were exposed before and after treatment, and la-teral cephalometric images as well as multiple planar reconstruction images were reconstructed. Tracing superimpositions of sagittal sections and three-dimensional reconstructions were done for qualitative analysis. For all maxillary anterior teeth, changes of root length, alveolar bone height and labial-palatal thicknesses at different levels were evaluated. The average of measurements taken by the same tester in three times was processed by SPSS 17.0 statistical package.Results: In 6 of the 12 cases, alveolar thickness became thinner on labial side ［apical area: (-0.64±1.18) mm］ while thicker on palatal side ［apical area: (0.93±2.0) mm］ and the root length decreased［(-0.95±0.79) mm］. In the other 6 cases, the incisors’ alveolar bone became thicker on labial side ［apical area: (2.12±1.46) mm］ while thinner on palatal side ［apical area: (-2.88±0.58) mm］and the loss of root length was obvious［(-2.12±1.43) mm］. In all the 12 cases, the canines’ alveolar bone became thinner on labial side especially on the apical level［(-0.27±1.86) mm］ while greatly thicker on palatal side ［apical area: (6.40±6.00) mm］and the root resorption was slight ［(-1.12±1.19) mm］. For all the anterior teeth, the height of alveolar bone reduced around them after retraction.Conclusion: When the root apical moved more palatally, more root resorption would occur and the alveolar bone would get thicker on labial side but thinner on palatal side and thinner as a whole after anterior retraction with maximum anchorage.In the vertical direction, the height of the alveolar bone generally decreased on all sides and decreased the most on the palatal side.

Objective：To evaluate the efficacy of Piezosurgery in split teeth extractions. Methods:A single-center, randomized, split-mouth study was performed using a consecutive serious of unrelated healthy patients attending the departing of oral and maxillofacial surgery, Peking University School and Hospital of Stomatology. 40 patients were selected for extraction of maxillary molars without reservation value，splitting or nonvital teeth. They were divided into control (20 patients) and test groups (20 patients) randomly. Surgical treatments for both groups were under local anesthesia. Molar teeth of control group were extracted by common equipments like dental elevators, chisels, forceps, etc. While molar teeth of experimental group were extracted by Piezosurgery, aided with the use of common equipments if needed. Then we compared the duration of surgery, frequency of the usage of chisels, expansion of postoperative bony socket surgical discomfort and postoperative pain between two groups. Results: The ave-rage of operation time was (629.5±171.0) s in control group and (456.0±337.2) s in test group. The buccal alveolar bone reduced (1.07±0.64) mm in control group and (1.49±0.61) mm in test group. There was a significant difference between the two groups (P<0.05). The duration of surgery for experimental group was significantly longer than that of the control group, but the change of buccal alveolar bone was lower than the control group. For visual analogue scale (VAS) value of surgical discomfort, expansion of postoperative bony socket and the operative fear rate, there were no significant difference between the two groups (P>0.05).Conclusion:Piezosugery can be better to preserve alveolar bone, reduce trauma and patient’s fear. Application of the piezosugery reflect the characteristics of minimally invasive extraction, which has the value of promotion. The Piezosurgery technique have the advantage of reducing change of buccal alveolar bone during the surgery, but a longer surgical time was required when compared with the conventional technique. VAS value of surgical discomfort, expansion of postoperative bony socket and the operative fear rate, there were no significant difference. Minimally invasive tooth extraction technique has good clinical results and high satisfaction. Piezosurgery proved its worth as the instrument adapted to limiting the destruction of bone tissue.

Objective：To investigate the effects of erbium:yttrium aluminium garnet (Er:YAG)laser irradiation on pulp and formation of dentin bridge. The beagle dogs' coronal pulp is amputated by Er:YAG laser. Methods: In the study, 24 premolar teeth of two one-year-old Beagle dogs were used. They were divided into 3 groups: bur group, 200 mJ laser group,100 mJ laser group. The coronal pulp were removed by traditional bur or 200 mJ/20 Hz or 100 mJ/20 Hz Er:YAG laser. Then, they were dressed with mineral trioxide aggregate (MTA) and sealed with resin. Clinical, radiological and histological analyses were performed  1 day, 2 weeks, 4 weeks and 8 weeks after treatment. The mobility and gingiva si-tuation were evaluated for clinical evaluation. Periapical films were used for radiological evaluation. The extracted teeth were preserved in 10% formalin. After decalcification, tissue processing, paraffin embedding, serial sectioning at 5 μm thickness, staining (Hematoxylin and Eosin, HE), the samples were assessed by an independent observer for calcified bridge formation and radicular pulp inflammation. The mean thickness of dental bridge was measured if there was complete dental bridge.  Results: Clinical evaluation: there were no signs of fistula or mobility or any abnormal symptoms in Er:YAG laser groups and bur group during the observation period. Radiological evaluation: there were no signs of widened pe-riodontal ligament or root absorption or periapical radiolucency in Er:YAG laser groups and bur group. Histological evaluation: there was no severe inflammation reaction in 200 mJ/20 Hz, 100 mJ/20 Hz Er:YAG laser groups and bur group-1 day, 2 weeks, 4 weeks, 8 weeks post-operation in Hematoxylin and Eosin staining. A complete dentin bridge could be observed in 200 mJ/20 Hz, 100 mJ/20 Hz Er:YAG laser groups, while no complete dentin bridge  in bur group-2 weeks post-operation. Complete dental bridge could be observed in each group-4 and 8 weeks post-operation. The mean thickness of dental bridge-4 weeks post-operation in 200 mJ laser group was 77 μm, 100 mJ laser group 87 μm, and bur group  101 μm, and-8 weeks post-operation in 200 mJ laser group was 222 μm，100 mJ laser group-160 μm，and bur group 152 μm. Conclusion: The 200 mJ/20 Hz and 100 mJ/20 Hz Er:YAG laser pulpotomies show no harm to radicular pulp and can promote the formation of dentin bridge.

To explore the clinical pathological characteristics and improve the recognition in the diagnosis and treatment of basal cell carcinoma (BCC) of prostate. Three cases of BCC of prostate were reported and the relevant literature was reviewed to investigate the diagnosis and treatment of this disease. We analyzed three cases of prostatic BCC. Their ages were within a range of 57 to 83 years. One of them complained of hematuria and two complained of dysuria. All of them presented with prostatic hyperplasia. Two of them presented with high prostate specific antigen (PSA) and one with normal PSA. Case 1 had prostate cancer invasion of bladder, rectal fascia, with lymph node metastasis, bone metastasis and lung metastases. The patient received bladder resection+bilateral ureteral cutaneous ureterostomy+lymph node dissection on November 2, 2014 . Postoperative pathological diagnosis showed BCC. Reexamination of pelvic enhanced MRI in January 8, 2015 suggested pelvic recurrence. Abdominal enhanced CT showed multiple liver metastases and pancreatic metastasis on July 11, 2015. Prostate cancer specific death occurred in October 2015. Case 2 was diagnosed as BCC in prostate biopsy on March 27, 2015. Positron emission tomography and computed tomography (PET-CT) showed pulmonary metastasis and bone metastasis. Then the patient received chemotherapy, endocrine therapy and local radiation therapy. Reexamination of PET-CT on January 11, 2016 showed that the lung metastase tumors and bone metastase tumors were larger than before. Up to January 10, 2016, the patient was still alive. Postoperative pathological changes of transurethral resection of prostate (TURP) in case 3 showed BCC might be considered. The PET-CT suggested residual prostate cancer, which might be associated with bilateral pelvic lymph node metastasis. In April 20, 2016, the review of PET-CT showed pelvic huge irregular hybrid density shadow, about 14.5 cm×10.0 cm×12.9 cm in size, and tumor recurrence was considered. Then the patient received local radiation therapy. The patient survived in the followed upon January 10, 2016. BCC of prostate is a rare subtype. Due to the local infiltrative and distant metastatic potentiality, active management is preferred and a life-long follow-up is necessary.

Objective：To study the feasibility of transplantation of normal rat penile corpus cavernosum and major pelvic ganglion (MPG) into the renal subserous region of a Nu/Nu mouse based on allograft technology. Methods: Penile corpus cavernosum and MPG, harvested from Sprague-Dawley (SD) rats under sterile condition, were transplanted underneath the kidney capsule of Nu/Nu mice through the microsurgery instruments and surgery microscope. The histopathologic changes and cellular proliferation in the transplanted penile corpus cavernosum and MPG were then analyzed at the end of 1week and 4 weeks after transplantation. Histological staining and immunohistochemical staining were used to evaluate the main outcome measures. Results:After 1 week, the tissue morphology of the transplanted corpus cavernosum underneath the kidney capsule of Nu/Nu mice was consistent with normal penile corpus cavernosum, and blood could be observed in the penis cavernous sinus of the graft; after 4 weeks, the mophorlogy of the tranplanted corpus cavernosum near the kidney was consistent with normal penile corpus cavernosum, while fibrosis was noteworthy in the graft away from the kidney, but blood could still be seen in the penis cavernous sinus. After 1 week, the tissue morphology of the transplanted MPG was consistent with normal MPG, multiple islet-like cell clusters could be seen in the transplanted MPG in the renal subserous region, and angiogenesis could be observed near the kidney; after 4 weeks, a network of blood vessels was clearly visible away from the kidney, and isletlike cell clusters were still clearly observed in the transplanted MPG. In addition, ki67 positive cells were observed in the transplanted penile corpus cavernosum and MPG after 4 weeks of transplantation, which indicated that there was still cell proliferation activity in the grafts. Conclusion: The transplanted corpus cavernosum and MPG underneath the kidney capsule of Nu/Nu mice could survive at least 4 weeks. Moreover, the inner structure of the transplanted corpus ca-vernosum and MPG was close to the normal tissue. The underlining mechanism may be related to the local microenvironment underneath the kidney capsule of Nu/Nu mice and the neovascularization in the transplanted grafts.

Objective： To describe a feasible surgical technique for patients with renal cell carcinoma associated with a supradiaphragmatic tumor thrombus that avoids cardiopulmonary bypass procedure. Methods: We retrospectively analyzed 2 cases with right kidney tumor and tumor thrombus above the diaphragm treated in April and August, 2015. The two patients were both female, aged 73 and 67 years. The tumor sizes of right kidneys were 7.0 cm×6.3 cm×5.7 cm and 8.7 cm×7.0 cm×5.2 cm, and the tumor thrombuses were 1.3 cm and 1.8 cm above the diaphragm. The second patient had synchronous metastasis in right adrenal gland , and the tumor thrombus arose from the adrenal vein but not the renal vein. Intraoperative transesophageal echocardiography (TEE) was used to assess real-time mobility of the thrombus. A modified chevron incision was used, the right kidney was mobilized laterally and posteriorly, and the renal artery was identified, ligated, and divided. The infradiaphragmatic inferior vena cava (IVC) was exposed and isolated by mobilizing the liver off the diaphragm or to the left (piggyback liver mobilization, case 2). The central diaphragm tendon was dissected or incised in the midline until the supradiaphragmatic intrapericardial IVC was identified and gently pulled beneath the diaphragm and into the abdomen. The tumor thrombus was then “milked” downward out of the intrapericardial IVC under the guidance of TEE. The distal and proximal IVC to the tumor thrombus, porta hepatis, and left renal vein were clamped. Tumor thrombus was removed from the IVC. The IVC was sutured and vascular clamps were placed below the major hepatic veins. Pringle’s maneuver was then released and hepatic blood drainage was permitted during closure of the remaining IVC. Related literature was reviewed.  Results: Complete resection was successful through the transabdominal approach without CBP in both patients. Estimated blood loss was 1 500 mL and 2 000 mL, and 1 200 mL and 800 mL of blood were transfused. The postoperative courses were uneventful. Both patients subsequently underwent tyrosinekinase inhibitor therapy. Both patients were alive without tumor recurrence or new metastasis during the follow-up of 6 months and 9 months. Conclusion: In selected cases, renal cell carcinoma extending into the IVC above the diaphragm can be resected without sternotomy, CBP or DHCA.

Objective：To establish a stable primary culture method of human gingival epithelial cells, with a higher successful rate and shorter culture time. Methods: Nine patients who received “crown-lengthening surgery” with relatively healthy periodontal conditions were selected (n=9). Gingival samples were collected from the 9 donors during gingivectomy. Gingival epithelial cells were isolated and cultured by both an advanced enzyme digestion method and a tissue explant method. In the advanced enzyme digestion culture process, 2.5 g/L DispaseⅡwas used to separate the epithelial tissue part from the connective tissue part, which lasted for one night. Then the epithelial tissues were digested by 0.025% trypsin without EDTA for 10 minutes, and centrifuged by keeping the digested epithelial tissues that remained. This advanced method not only decreased the concentration and digesting time of the two above-mentioned enzymes, but also simplified the centrifugel process. The tissue explant method was not changed too much compared with the original method. Growing processes of the primary cells cultured by the two methods were observed and recorded respectively, and indirect immunocytochemical staining was used to identify the type of cultured cells. At the same time, successful rates and cell culture time were also compared between the two methods. Results: Human gingival epithelial cells with typical morphology could be cultured within a shorter period by the advanced enzyme digestion method with a successful rate of 88.9%, and proliferated rapidly as sheets. After 10－14 d cells could be passaged, gradually turned to be like fibroblasts when passaged to the third generation, and eventually went to apoptosis. The primary culture time was longer by using the tissue explant method, and approximately after 17－22 d cells could be passaged, although the successful rate was the same as the enzyme digestion method. Cytokeratin staining was both positive by indirect immunocytochemical staining of cells. Conclusion: Primary human gingival epithelial cells cultured by the advanced enzyme digestion method could grow faster and be passaged to the second generation successfully, which could supply a stable origin for cellular experiments.

Objective：With the development of modern skull base minimally invasive technology mature and neural radio surgery techniques, it is necessary to re-examine the therapeutic strategy for the treatment of petroclival meningiomas. To sum up the operative experience and methods in microsurgical resection of petroclival meningiomas by the combining trans-subtemporal and suboccipital retrosigmoid keyhole approach. To explore the minimally invasive operation approach of petroclival meningiomas, to raise the removal degree and to improve the postoperative result using this approach. Methods: The clinical data of the consecutive 21 patients with the petroclival meningiomas were reviewed retrospectively. The method, degree of tumor resection，techniques of the combining keyhole approach，Karnofsky performance score (KPS) before and after operation were also analyzed. The neuronavigation guided operation was performed in 9 cases, and 12 cases were operated in the neuroelectrophysiological monitoring. Results: Total excision of the tumor resection (Simpson, Ⅰ-Ⅱlevels) was conducted in 18 cases (85.7%, 18/21), and 3 patients underwent close resection (Simpson Ⅲ level, 14.3%, 3/21). Postoperative three-dimensional CT showed good lock bone flap restoration; Postoperative pathology confirmed meningioma. Postoperative cranial nerve dysfunction or new original nerve dysfunction were aggravated in 5 cases (23.8%) , including transient trochlear nerve (3 cases), abducent nerve (1 case), and the motor branch of trigeminal nerve paralysis (1 case). Abducent nerve paralysis (1 case) appeared， with hearing impairment. After the 3-month follow-up, 11 cases had the same KPS aspreoperation, 7 cases improved, and 3 cases not improved. The KPS score was 77.14±23.12 on average, and there was no statistically significant difference compared with that before operation (P>0.05). The postoperative follow-up for half a year showed fluent speaking and writing in 19 cases (KPS 70 or higher), and general recovery in 2 cases (KPS<70). The postoperative follow-up for 3-29 months showed no tumor recurrence or progress. Conclusion: The combining trans-subtemporal and suboccipital retrosigmoid keyhole approach is simple, safe, and minimally invasive, and an ideal operation approach of petroclival menin-gioma. To master the operation skills and the intraoperative matters needing attention in the operation, is favorable to improve the resection rate and curative effect.

Takayasu’s arteritis is a rare, idiopathic, chronic inflammatory disease. Its course is unpredictable, but slow progression is usual, leading to stenosis, occlusion, or aneurismal degeneration of the aorta or its major branches. We present the anesthesia management of pregnancy in four women admitted to Peking University Third Hospital for caesarean section from year 2006 to 2015 complicated with Takayasu’s arteritis and review this disease with special reference to natural history, diagnostic criteria, classification, prognostic factors, and anesthesia considerations. Anesthesiological data were retrospectively analyzed for clinical manifestations, anesthesia process, perioperative complications, and pregnancy outcome. One patient received only epidural anesthesia, while the other three patients received combined spinal and epidural anesthesia (CSEA). Surgeries for all the four patients were successful with stable vital signs. We found comprehensive examinations including whether the disease was in the active phase and the clinical classification of the disease before conception was recommended for patients diagnosed with Takayasu’s arteritis. CSEA and continuous epidural block could be both used as anesthesiological method in patients with Takayasu’s arteritis. During the surgery, to avoid rapid hemodynamic fluctuations and protect the major organs’ function is very essential to allow for a satisfactory outcome.

A patient with previous L3-4 posterior lumbar interbody fusion, pedicle screws instrumentation and L3-4 decompression, was scheduled for left total hip arthroplasty. Two years ago, due to poor landmarks palpation, the patient experienced a failed lumbar puncture after multiple attempts before herniorrhaphy. His plain radiography showed bilateral partial laminectomy at L3-4 level, and between L3 and L4, two posterior pedicle screws connected by metal rods on both sides. This time, we used ultrasound to locate L4-5 interlaminar space in paramedian sagittal oblique view and identified the spine midline by transverse interlaminar view before puncture. According to this information, L4-5 puncture point was verified and the combined spinal-epidural anesthesia was performed in a paramedian approach. After withdrawing clear cerebral spinal fluid, 15 mg hyperbaric bupivicaine was injected into intrathecal space. An epidural catheter was then inserted into the epidural space. The sensory block level was fixed at T10 to S within 10 minutes. Intraoperatively, the patient received 10 mL 2% (mass fraction) lidocaine through the epidural catheter in total. The surgery was uneventful. No neurologic complication was observed after the surgery. This case report demonstrates that ultRASound imaging can provide useful information for neuraxial needle placement and can be a valuable tool in managing patients with anatomical change around the spine.