Objective： To investigate the mechanisms of nuclear export signal of androgen receptor (NESAR) in the regulation of androgen receptor (AR) protein expression and stability in prostate cancer. Methods: The green fluorescent protein fusion protein expression vectors pEGFP-AR(1-918aa), pEGFP-NESAR (743-817aa), pEGFP-NAR (1-665aa) and pEGFP-NAR-NESAR, and lysine mutants of NESAR pEGFP-NESAR K776R, pEGFP-NESAR K807R and pEGFPNESAR K776R/K807R, were transiently transfec-ted into prostate cancer cell line PC3. Fluorescence microscopy, Western blot and immunoprecipitation were used to detect NESAR regulation of androgen receptor stability. Results: Under the fluorescence microscope, NESAR-containing fusion proteins were cytoplasmic localization, and their fluorescence intensities were much weaker than those without NESAR. The expression levels of NESAR-containing fusion proteins were significantly lower than those without NESAR. The half-lives of GFP-NESAR and GFP-NAR-NESAR were less than 6 h, while the expression of GFP and GFP-NAR was relatively stable and the half-life was more than 24 h in the presence of cycloheximide. The expression levels of GFP-NESAR were significantly increased by proteasome inhibitor MG132 treatment in a dose-dependent manner; in contrast, MG132 did not show any significant effect on the protein levels of GFP. When new protein synthesis was blocked, MG132 could also prevent the degradation of GFP-NESAR in the transfected cells in the presence of cycloheximide, while it had no significant effect on GFP protein stability in the parallel experiment. GFP immunoprecipitation showed that the ubiquitination level of GFP-NESAR fusion protein was significantly higher than that of the GFP control. The mutations of lysine sites K776 and K807 in NESAR significantly reduced the level of ubiquitination, and showed increased protein stability, indicating that they were the key amino acid residues of NESAR ubiquitination. Conclusion: NESAR was unstable and decreased the stability of its fusion proteins. NESAR was the target of polyubiquitination and mediated the degradation of its fusion proteins through the ubiquitin-proteasome pathway in prostate cancer cells. Our research provides a new way to regulate the level and/or activity of AR proteins, thus helping us understand the molecular mechanisms of AR degradation and strict control of AR in the progression to castration-resistance.

Objective： To study the expression of transmembrane protein CMTM2 in the testis and sperm of adult males and to approach the potential function of the protein in the male reproductive system. Methods: The expression of CMTM2 in human testis and sperm was confirmed by Western blot. Immunohistochemical staining was used for detecting CMTM2 localization in the testis tissue, TRITC-CMTM2 and FITC-Hoechst double immunofluorescence staining was performed to examine the subcellular localization of CMTM2 in the human sperm before and after acrosome reaction, that is, immunofluorescent staining was used for detecting CMTM2 localization in both the testis and sperm before and after the acrosome reaction. Results: CMTM2 was presented in both human testis and sperm. In the testis, CMTM2 immunoreactive particles were observed mainly in the membrane of the different stages of spermatogenic cells. In the human sperm, its immunoreactivity was restrictively localized to the posterior head where sperm-egg fusion occurred, and the CMTM2 localization was not affected by sperm acrosome reaction. CMTM2 was widely expressed in seminiferous tubules of the human testis, mainly in the cell membranes of spermatogenic cells, which was consistent with the previous reports. The immunofluorescence performed on frozen human testis slides showed similar findings with immunohistochemistry, which gave weight to the localization of CMTM2 in the cell membranes of spermatogenic cells at different stages. TRITC-CMTM2 and FITC-Hoechst double immunofluorescence staining was performed to examine the subcellular localization of CMTM2 in the human sperm before and after acrosome reaction. CMTM2 was localized at the posterior head of sperm before and after acrosome reaction. The localization and expression of CMTM2 were not affected by sperm acrosome reaction. Conclusion: Expression of CMTM2 in the male reproductive system of the adult human exhibits cell- and regionspecific patterns, which suggests that they may play an important role in spermatogenesis and sperm-egg fusion. The expression of CMTM2 in the male reproductive system of the adult human exhibits cell-and region-specific patterns, which suggests that they may play an important role in spermatogenesis and sperm-egg fusion. However, it still remains to be further elucidated about the definite role of CMTM2 in male reproductive system and the process of spermatogenesis. And in vitro fertilization experiments are needed to confirm the role of CMTM2 in fertilization in future.

Objective： Tuberous sclerosis complex (TSC) is a multisystem genetic disorder caused by mutations in the TSC1 and TSC2 genes, but the molecular events contributing to TSC are not well understood. However, little is known about the role of microRNAs in TSC. To explore the microRNA differential expression profile between tuberous sclerosis complex cell line TSC2-/- MEFs and normal type cell line TSC2+/+ MEFs, and to provide new clues to study the mechanism of microRNA function in tuberous sclerosis complex. Methods: TSC2-/- MEFs and TSC2+/+ MEFs cell lines were cultured in vitro, each with three samples chosen as the experimental group and the control group respectively. Total RNA was isolated using TRizol and purified with RNeasy mini kit according to manufacturer’s instructions. RNA quality and quantity were measured by using nanodrop spectrophotometer and RNA integrity was determined by gel electrophoresis. Total RNAs were extracted by TRizol, followed by RNA quantification and quality control. MicroRNA profiles were analyzed by microarray and the threshold value used to screen up-regulated more than 2-fold change or down-regulated less than 0.5-fold change compared with controls. Real-time PCR was used to validate the reliability of microarray. Cell counting kit-8 (CCK-8) assay was performed to evaluate the proliferation. Results: Fourteen microRNAs, including miR-18a-5p, miR-376c-3p, miR-136-5p, miR-467c-5p, miR-467b-5p, miR-5104, miR-3098-3p, miR-30a-3p, miR-302b-3p, miR-18a-3p, miR-19b-1-5p, miR-19a-5p, miR-20a-5p, miR-155-5p, were up-regulated, while twenty-six microRNAs, including miR-200b-3p, miR-450a-1-3p, miR-542-5p, miR-199b-5p, miR-10a-5p, miR-466c-5p, miR-450a-5p, miR-450b-5p, miR-542-3p, miR-351-5p, miR-322-3p, miR-199a-3p, miR-335-5p, miR-10b-5p, miR-351-3p, miR-155-3p, miR-497a-5p, miR-503-5p, miR-148a-3p, miR-1843a-5p, miR-199a-5p, miR-490-5p, miR-450a-2-3p, miR-322-5p, miR-214-3p, miR-450b-3p, were downregulated in tuberous sclerosis complex cell line TSC2-/- MEFs compared with normal type cell line TSC2+/+ MEFs (P<0.05). Real-time PCR confirmed the expressions of miR-136-5p, miR-30a-3p, miR-302b-3p, miR-10b-5p, miR-148a-3p, miR-199a-5p consistent with the microarray data (P<0.05). Furthermore, the overexpression of miR-199a-5p significantly inhibited cell proliferation (P<0.05). Conclusion: There are differences in the expression of miRNA between the tube-rous sclerosis complex cell line TSC2-/- MEFs and normal cell line TSC2+/+ MEFs. MiRNA-199a-5p plays an important role in tuberous sclerosis complex, which may be developed as an important molecular target for the treatment of tuberous sclerosis complex.

Objective： To analyze the clinical pathologic characteristics of cases with fluorescence in situ hybridization (FISH) positive of exfoliated urothelial cells, so as to evaluate the clinical utility of FISH in the diagnosis of urothelial carcinoma (UC). Methods: A total of 271 cases of FISH positive in Department of Urology of Peking University First Hospital from Apr. 2012 to Sep. 2015 were recruited in this study. Retrospective analysis was made on their clinical data. For FISH analysis, labeled probes specific for chromosomes 3, 7, 17, and the p16 (9p21) gene were used to assess chromosomal abnormalities indicative of malignancy. The positive predict values (PPV) of all the techniques were analyzed. Results: Of the 271 patients, 207 cases were UC, 7 cases were non-UC, and 57 cases were benign diseases. The PPV of FISH in detecting UC was 76.4%, while the 95% confidence interval (CI) 71.3% to 81.5%. In the cohort of FISH positive, this value was similar to that of urinary cytology (PPV 86.8%, 95% CI: 78.5%-95.0%). The PPV of FISH was lower than that of cystoscopy and ureteroscopy (PPV 96.1%, 95% CI: 91.7%-100.0%). There were significant differences between this study and the PPV of FISH reported abroad (PPV 53.9%, χ2=33.048, P<0.001). Of all the UC with FISH positive, bladder cancer showed an earlier pathological stage versus renal pelvic carcinoma and ureteral carcinoma, with significance (χ2=5.894, P=0.015, and χ2=13.601, P<0.001, respectively). However, no difference was found in the size, pathological stage and pathological grade of tumors between the urinary cytology positive group and the urinary cytology negative group. The rate of high-grade UC in ureteral carcinoma of FISH positive was 92.3%, much higher than that of ureteral carcinoma reported domestically. Conclusion: The PPV of FISH in detecting UC is higher relatively, with a better clinic value for Chinese patients. The ureteral carcinoma with FISH positive obtains a higher pathological grade, which is of great guiding significance for UC.

Objective： To provide an important tool for the study of diagnose and treatment of prostate cancer (PCa) osseous metastasis and change of bone stress force on prostate cancer (PCa) osseous metastasis and a platform, which is more congruous to clinical process, for prevention and cure of neoplastic bone metastases, and to carry out the construction and improvement of animal models of PCa with different positional osseous metastasis in vivo. Methods: Different gradient concentrations of RM-1 cells were inoculated into the cavity of left femoral bone or lumbar vertebra of mice (C57BL/6) respectively. The change of mouse  activity, tumor formation, tumor size and survival time were observed respectively. And the femur tissue and spinal tissue were obtained from the mice after death. The gray value of iconography were measured by imageological examination of femur tissue, and the final histopathological examination were taken to determine the tumor type in both femur and spinal tissue. Results: The tumor growth could be touched at the puncture site in all the mice after inoculated for 7 days. There were no obvious differences in the time of tumorigenesis, the rate of tumor growth and tumor size among the mice in the same group (P>0.05). As the result, the construction femoral bone and lumbar vertebra metastatic models of PCa had been confirmed by iconography and pathology detection. At the same time, the survival time of the mice inoculated with low concentrations of PCa cells was obviously longer than that of high concentrations of PCa cells ( at least 2 weeks longer).   Conclusion: The animal models with different positional osseous metastasis (limbs and axial skeleton) of PCa using the same PCa cells (RM-1) had been first constructed successfully in our study. At the same time, a high success rate of construction of PCa animal model with bone metastasis was obtained by femoral bone marrow cavity injection of PCa cells. The rate of tumor growth was rapid, animal survival time was appropriate, and the PCa animal model with bone metastasis can be stably reproduced by our method. These animal models can be used to explore the pathogenesis of different positional PCa bone metastasis and provide a new platform, which were more congruous to clinical process, for prevention and cure of neoplastic bone metastases.

Objective： To evaluate the effectiveness and safety of radical nephrectomy and inferior vena cava thrombectomy in the treatment of patients with Mayo Ⅲ tumor thrombus, and to introduce our experience and surgical technique. Methods: The clinical data of 8 patients with Mayo Ⅲ tumor thrombus from October 2014 to September 2016 were analyzed retrospectively. Of the 8 patients, 3 were male and 5 were female. The average age was (50.8±18.7) years (18 to 77 years). The average body mass index (BMI) was (22.7±4.4) kg/m2 (15.2 to 30.8 kg/m2). Imaging suggested the right renal tumor in all the 8 cases. The average tumor size was (7.9±2.5) cm. Open radical nephrectomy and inferior vena cava thrombectomy was conducted in 5 cases and laparoscopic surgery in 3 cases, and 1 case was converted to open surgery. Results: All the 8 surgeries were completed successfully with no death case. The average surgery time was (370.3±101.6) min, ranging from 272-567 min. The average vena cava blocked time was (41.0±12.1) min, ranging from 17-55 min. The blood loss volume was (1 181.3±915.7) mL, ranging from 200-3 000 mL. During the operation, 5 cases were infused with suspended red blood cells, the amount of blood transfusion was 800-2 000 mL. 3 cases were infused of plasma with 400-1 000 mL. The average hospital stay was 9-23 d, with an average of (14.1±4.0) d. In the 8 patients, 4 cases underwent inferior vena cava wall resection because of invasion by tumor thrombus. Preoperative serum creatinine was 60-101 μmol/L, with an average of (76.4±15.3) μmol/L. Serum creatinine 1 week after the operation was 74-127 μmol/L, with an average of (100.8±21.1) μmol/L. Pathological diagnosis showed 6 cases of clear cell carcinoma, 1 case of papillary carcinoma type Ⅱ, and 1 case of Ewing’s sarcoma. Among the 8 patients, early postoperative complications occurred in 5 cases. Postoperative complications were graded as level Ⅱ, according to the Clavien classifications. The 8 cases were followed up for 2 to 24 months with an average of 11.3 months. There was 1 patient who suffered from lung metastasis. Conclusion: Our initial clinical results show that radical nephrectomy and inferior vena cava thrombectomy is safe and effective for patients with Mayo Ⅲ tumor thrombus. The wide extension of grade Ⅲ vein tumor thrombus leads to the difficulty of operation technique. Sufficient preoperative preparation, rich operative experience and skills can improve the safety of operation.

Objective： To evaluate the impacts of the prognostic factors of T2N0M0 upper tract urothelial carcinoma (UTUC) for Chinese patients. Methods: A retrospective study was conducted including 235 patients who were diagnosed with T2N0M0 UTUC in our hospital and received radical nephroureterectomy (RNU) or partial ureterectomy during January 2000 and December 2013. The 3 and 5-year can-cer-specific survival rates and bladder recurrence-free survival rates of all the patients were valued using Kaplan-Meier method, and the survival curves with statistical significance between the two were compared using the Log-rank test. Variables with significant differences in the univariate analysis were subjected to the multivariate analysis by Cox regression model. Results: A total of 235 patients were included in this study, including 95 (40.4%) male patients and 140 (59.6%) female patients. The mean age was 66.73±10.49 years.The median follow-up time was 53 (rang: 3－142) months, and during the follow-up, 74 (31.5%) patients died of UTUC after a median of 35 months，and 96 (40.9%) patients developed intravesical recurrence after a median of 19.5 months. The 3 and 5year cancer-specific survival rates of all the patients were 89.1% and 85.9%, respectively; the bladder recurrence-free survival rates were 85.5% and 80.2%, respectively. The independent prognostic factors of cancer-specific mortality were tumor age elder than 55 years (HR=3.138, 95%CI: 1.348－7.306, P=0.008) and diameter larger than 5 cm (HR=3.320, 95%CI: 1.882－5.857, P<0.001). The independent prognostic factors of bladder recurrence-free survival were ureter tumor (HR=1.757, 95%CI: 1.159－2.664, P=0.008) and lower tumor grade (HR=1.760, 95% CI: 1.151－2.692, P=0.009). Conclusion: T2N0M0 UTUC has a better cancer-specific survival. The intravesical recurrence was equivalent to non-muscle invasive UTUC but earlier. The tumor diameter larger than 5 cm and the patient age elder than 55 years were independently associated with cancerspecific mortality; the primary tumor located in ureter and lower tumor grade were more likely to develop intravesical recurrence.

Objective： Retro-laparoscopic partial nephrectomy is a challenge for ventro-renal tumors, especially hilar tumors. The tumors are partial or entirely out of operative field and there is blind space for operation. To solve this problem, a set of techniques including renal pedicle rotation is developed. Methods: A set of techniques including renal pedicle rotation, double-layer suture, early artery unclamping for retro-laparoscopic nephrectomy for ventro-renal tumors, especially hilar tumors were developed. Hilar tumors were located anteriorly to the angle of the renal and renal arteries and in contact with the anterior surface of the renal artery. The evaluation of the outcomes included the operation time, warm ischemia time, estimated haemorrhage, surgical margin, renal function after operation, and complications. This study reviewed the data of 28 patients with ventro-renal tumor, including 15 patients with complex hilar tumors. Results: The average tumor size was (3.8±0.5) cm. The average R.E.N.A.L score was 8 (ranging from 7 to 9). The average warm ischemia time was (23.8±4.7) min, and suture time was (26.2±6.5) min, and operation time was (124.1±12.1) min. The median hospital stay was 4 days and the average estimated haemorrhage was (139.1±54.0) mL. All the surgeries were operated under laparoscope and no surgery switched to open surgery. Seven patients developed Clavien Dindo Ⅰ-Ⅱ complications after operation. Three patients (10.7%) developed collective system damage and received repair of collective system in time and three patients (10.7%) developed slightly gross hematuria (Clavien-DindoⅠ). Two patients developed wound infection (Clavien-DindⅡ). Three patients (10.7%) got renal vein clamped because of capillary hemorrhage from basilar part of tumors. There were 14 patients received early unclamping of renal artery, and no obvious renal vessel damage was found. There were statistically significant differences between the serum creatinine levels (P<0.05) and the estimated glomerular filtration rates (P=0.02) before and after surgery. All the patients’ serum creatinine levels were in normal range and no patient needed regular dialysis. There was no positive surgical margin and the median follow-up was 7 months without local recurrence or distant metastasis. Conclusion: It is safe and effective to apply renal pedicle rotation technique in retro-laparoscopic partial nephrectomy for ventro-renal tumors. The short-term follow-up results are optimistic, but long follow-up is required.

Objective： To evaluate the clinical effect and safety of retroperitoneal laparoscopic surgery combined with miniflank incision “hybrid surgery” for partial nephrectomy of complex renal tumors. Methods: Between April 2015 and December 2016, the clinical data from 16 patients with complex renal tumors who underwent the “hybrid surgery”, including 10 males and 6 females, were retrospectively reviewed. The average age was (50.2±10.7) years, 9 cases were located in the left side and 7 cases in the right side, the mean tumor size was （6.1±1.0） cm, and the mean R.E.N.A.L. nephrometry score was 9.3±1.3. All the patients received the “hybrid surgery”, the first step was to adequately mobilize the kidney and tumor, prepared the renal artery by retroperitoneal laparoscopy, and then the incision about 10-12 cm was  done under the twelve rib to convert to open surgery. After the renal artery was clamped, the tumor was removed and the wound was closed under direct vision. The operative time, ischemia time, estimated blood loss, intraoperative and postoperative complications and short-term renal function were recorded. Results: All the 16 patients’ “hybrid surgeries” were successfully performed. The mean operative time was (164.9±23.6) min, mean ischemia time was (32.4±6.2) min, and mean estimated blood loss was (204.0±125.1) mL. The mean drainage tube removal time was (4.1±1.0) d, and the mean postoperatively hospital stay was (6.9±1.5) d. There were 2 patients with Clavien Ⅲ grade complications. One patient was injured with collecting system, and 1 patient received a second emergency surgery for acute postoperative bleeding. The mean 1 day postoperative serum creatinine level was (126.3±26.4) μmol/L, which was statistically significant (P<0.05) compared with the preoperative serum creatinine level（74.3±16.9）μmol/L. There were no significant differences (P>0.05) in comparing the 1 month postoperative serum creatinine level（92.6±18.2） μmol/L, 3 months postoperative serum creatinine level （80.8±18.4） μmol/L with the preoperative serum creatinine level. During 3 to 20 months follow-up periods, no local recurrence or distant metastasis occurred. Conclusion: This “hybrid surgery” combined retroperitoneal laparoscopic surgery with mini-flank incision for partial nephrectomy is safe and effective. It could decrease the operative difficulty and be worthy of further application for some selected complex renal tumor patients.

Objective： To assess the diagnostic rate, safety and clinical application of percutaneous renal masses biopsy for advanced renal cell carcinoma patients. Methods: In this retrospective study, we collected the data of renal masses from the patients who underwent renal masses biopsy under ultrasound from April 2001 to December 2014 in  Peking University First Hospital. A total of 75 patients who were undiagnosed or diagnosed with advanced renal cell carcinoma by the imageological method were enrolled in this study. The patient and lesion characteristics such as tumor size, pathology of tumor, histologic subtype, pathological grade, biopsied location and biopsied cores were recorded and analyzed. Results: Among all the 75 patients, biopsy was diagnostic in 64 cases (85.3%) and nondiagnostic in 11 cases (14.7%). Of the 64 diagnostic biopsies, 60 were malignant, including 37 (61.7%) renal cell carcinoma (RCC), 13 (21.7%) urothelial carcinoma and 10 (16.7%) other malignant masses. Of all the RCC subjects, 24 suffered from clear cell RCC, 5 papillary RCC, 3 collecting duct carcinomas, 1 unclassified RCC and 4 unknown subtypes. The 11 non-diagnostic biopsied samplings included inflammatory, blood and extrarenal tissue and normal renal tissue. The proportion of collecting duct carcinoma in RCC was 10.8% and the proportion of squamous carcinoma in urothelial carcinoma was 23.1%, which  were both higher than the previous research findings. For the male and female groups, non-diagnostic yields were 6.5% and 30.4%, respectively (P=0.022). Of all the 75 patients, 13 renal cell carcinoma patients underwent the surgical treatment and got the results of postoperative pathology. Comparing preoperative biopsy pathological diagnosis with postoperative pathological diagnosis, we found the diagnostic correct rates for benign and malignant lesions, pathological subtype and pathological grade were 100%, 81.8% and 60%, respectively. Mild macroscopic hematuria occurred in 1 case after RMB and there were no serious complications in all the cases. Conclusion: Percutaneous renal masses biopsy under ultrasound with a high diagnostic rate which can define the histologic subtype of renal cell carcinoma. With  targeted therapy, more and more patients whose evaluation suggests local advanced disease or metastatic tumors adopt renal tumor biopsy to define the histologic subtype, which could avoid unnecessary surgical treatment.

Objective： To investigate the position and the size of ureteral stone in patients before treated with ureteroscopic lithotripsy or percutaneous nephrolithotomy (PCNL), as well as the dilatation of ureter caused by stone, which may be helpful for better understanding of pathogenesis of ureteral stone and improvement of the diagnosis and treatment in clinic. Methods: A total of 129 cases with ureteral stone for endourologic lithotripsy in Peking University People’s Hospital from Aug. 2016 to Mar. 2017 were included for the retrospective review. The CT data of the ureteral stones and the ureteral dilatation were collected, including the position of stone, the transverse and longitudinal diameter of stone, and the transverse diameter of dilated upper ureter and ureteropelvic junction (UPJ). The distribution of ureteral stones and dilatation in different parts of ureter were compared and analyzed. Results: All of the 129 cases of ureteral stone, stones were located at UPJ in 9 cases (7.0%), proximal ureter in 75 (58.0%), ureter crossing external iliac vessel (UEIV) in 6 (4.7%), distal ureter in 26 (20.2%), and ureterovesical junction (UVJ) in 13 (10.1%). The mean transverse diameter of proximal ureteral stones was greater than that of distal ureteral stones ［(8.47±2.36) mm vs. (6.74±1.99) mm, P<0.001］, as the same as the mean longitudinal diameter ［(11.00±4.41) mm vs. (7.50±4.28) mm, P<0.001］. In 114 cases of dilated ureter for stone, the UPJ had a greater transverse diameter compared with the upper ureter ［(14.39±6.09) mm vs. (11.45±3.85) mm, P<0.001］. Conclusion: The most common location of stone is the proximal ureter in patients for endourologic lithotripsy, as the location in UEIV is rare. Both transverse and longitudinal diameters of stone in proximal ureter are greater than those in distal ureter. For dilated ureter, it is more severe in UPJ than in upper ureter. Traditionally, it is accepted that the stones lodge at 3 sites of natural narrowing in ureter, which may be questioned.

Objective： To evaluate the development, safety and efficacy of percutaneous nephrolithotomy(PNL) for management of upper urinary tract calculi in pediatric patients. Methods: In the study, 77 pediatric patients undergoing 87 PNLs through mini or standard tract for upper urinary tract calculi between January 2005 and December 2016 in Peking University People’s hospital were reviewed, including 69 renal calculi, 6 upper ureteral calculi, 12 renal and upper ureteral calculi, 35 single calculi, 43 multiple calculi and 9 staghorn calculi. The development and efficacy of PNL in pediatric patients were studied by analyzing the characteristics and clinical indexes, and by reviewing the associated literature. The Clavien classification system was used to evaluate the complications after PNL. Results: A total of 87 PNLs were performed in 77 pediatric patients. Eighty-one upper urinary tract calculi were managed through a single tract(93.1%), 5 pediatric patients were managed through 2 tracts(5.7%), and 1 pe-diatric patient was managed through 3 tracts(1.2%). The mean operating time was (77.0±29.8) min. The stone-free rate after one session was 100% for single calculi and 71.2% for multiple or staghorn calculi, 5(5.8%) children underwent auxiliary procedure to remove the residual calculi and the final stone-free rate of PNL was 88.5%. One of the main complications of pediatric PNL was fever. Sixteen(18.4%) had moderate fever(38-39 ℃), 5(5.7%) had high fever(39-40 ℃) and there were no severe complications of infection, such as sepsis or septic shock. The mean hemoglobin loss was （10.3±16.1） g/L and the serum creatinine rise was (7.0±13.3) μmol/L. One(1.2%) pediatric patient suffered ureteroscopic lithotripsy because of the obstruction by the residual stone in ureter. No injury of organs or retroperitoneal urinary extravasation occurred. General assessment of the complications showed Clavien grade Ⅰ complications in 14 (16.1%) pediatric patients, grade Ⅱ in 7(8.0%) children and grade Ⅲ in 1(1.2%) children. There was no grade Ⅳ or Ⅴ complications. The overall complication rate was 25.3%. Conclusion: PNL for management of upper urinary tract calculi in pediatric patients is effective. Complications after PNL, as assessed with Clavien classification system, are mild and PNL in pediatric patients is safe.

Objective： To analyze the efficiency of ureteroscope and biopsy in the diagnosis of tumor grade, muscle-invasiveness and multifocality in suspected upper tract urinary carcinoma (UTUC) patients in order to find out whether it can be used in the risk stratification of UTUC patients. Methods: A retrospective study of 76 UTUC patients who underwent preoperative ureteroscope and/or biopsy and received radical nephroureterectomy in Peking University Third Hospital during January 2014 to December 2016 was undertaken. Results: In this study, 76 patients were included. There were 31 males (40.8%), and 45 females (59.2%). The median age was 64.5 years (31-88), and 51 patients had the symptom of hematuresis. The tumor was located in renal pelvis in 39 patients, and in ureter in 37 patients. Post-operative pathology confirmed that all the 76 patients included in this study suffered from UTUC, of whom 21 (21.6%) were of low-grade, 51 (67.1%) were of high-grade, 4 (5.3%) were undetermined, and 47 (61.9%) patients were muscle-invasive, and 27 (35.5%) were not, and 2 (2.6%) were undetermined. Among the 50 patients, in whom the grade of the tumor could be diagnosed by biopsy, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value for low-grade tumor was 88.2%, 69.7%, 76.0%, 60.0% and 92.0%, respectively. Among the 27 patients, in whom the muscle-invasiveness could be diagnosed by biopsy, 5 patients were diagnosed with muscle-invasiveness, all confirmed by pathology after surgery and 22 patients were diagnosed with none muscle-invasiveness, turned out to be 50% muscle-invasive and 50% none-muscle invasive after surgery. The accuracy was 59.3%. The accuracy of ureteroscopic biopsy to diagnosis multifocality was 61.0%. On univariate ana-lysis, biopsy grade was associated with postoperative pathology (P=0.001), while gender, age, side, body mass index (BMI), hematuresis, preoperative estimated glomerular filtration rate (eGFR), hydronephrosis, tumor size, location, multifocality and sessile were not associated with postoperative pathology grade. Biopsy grade (P=0.02), preoperative eGFR＜90 mL/(min·1.73 m2)(P=0.025) and tumor located in pelvis (P=0.049) were associated with muscle invasiveness. Gender, age, side, BMI, hematuresis, hydronephrosis, tumor size, multifocality and sessile were not significantly associated with muscle invasiveness. Conclusion: Ureteroscope and biopsy can assist risk stratification in upper tract urothelial carcinoma patients.

Objective： To evaluate the medium and long term outcomes of tension-free mid-urethral sling in the treatment of female patients with mixed urinary incontinence (MUI). Methods: Twenty-six patients who underwent the tension-free mid-urethral sling procedure for MUI from April, 2010 to September, 2016, were followed up. Four of the 26 patients underwent retropubic tension free mid-urethral sling (TVT), and 22 of them underwent transurethral middle obturator sling (TOT). Scales were used in the follow-up, such as urinary incontinence severity score (UISS), detrusor instability score (DIS), incontinence quality of life scale evaluation (I-QOL), Urogenital Distress Inventory short form (UDI-6), and the outcomes before and after the procedure were compared. Results: The mean age was 62 years, with a range of 42-80 years. The mean body mass index (BMI) was 26.82 kg/m2, with a range of 21.48-31.14 kg/m2. The mean follow-up time was 26 months, with a range of 8-69 months. Twelve patients never took M-blockers and the rest 14 patients took M-blockers within two weeks. None of the pa-tients had complications, including dysuria, injury of bladder, urethra, obturator vessel or nerve during the surgery. After pulling out the catheter, no one suffered moderate or severe pain or difficulty of urination. The overall cure rate for stress urinary incontinence (SUI) was 96.15% with 25 patients cured, and for urge urinary incontinence (UUI) was 76.92% with 20 patients cured. The patients’ life quality also improved significantly (P<0.05). Conclusion: Ten of the 26 patients showed an overactive bladder according to urodynamic study, from whom all of the six failed patient were. And 16 patients didn’t show an overactive bladder, which may due to two reasons. One is that their sense of urge is not so serious, the other one is that their sense of urge is from urethra. Proximal urethra is full of nerve, which plays a role in sense and urine control. The sense of urge may come from urethra instead of bladder. Tension-free mid-urethral sling procedure is an effective treatment for women with mixed urinary incontinence. Even without taking the M-blockers, the cure rate for urge incontinence reached 76.92%. The efficacy of surgery remained stable in medium and long term, and the patients’ quality of life improved significantly.

Objective： To examine the effects of perioperative intravenous administration of flurbiprofen axetil (FA) on pain associated with transrectal ultrasound-guided prostate biopsy. Methods： This was a randomized，controlled study. Eighty-one patients who underwent 12 core prostate biopsy were included in  the study. The patients were randomly assigned to one of three groups (n=27 in each) by type of procedure during prostate biopsy. Group intrarectal local anesthesia (IRLA) received intrarectal 5% (0.05 g/L) lidocaine gel 60 mg, 5 minutes before the procedure alone； Group FA received intravenous flurbiprofen axetil (1 mg/kg) 1 hour before the procedure；Group IRLA+FA received intrarectal 5% lidocaine gel 60 mg,  5 minutes before the procedure and intravenous flurbiprofen axetil (1 mg/kg) 1 hour before the procedure. The patients were asked to score the pain by using visual analogue scale (VAS) in 4 situations，including when the probe was inserted (VASⅠ)，during anesthesia (VASⅡ)，during biopsy (VASⅢ) and 20 minutes after biopsy (VASⅣ). The findings were evaluated with analysis of variance，and the Tukey post hoc test was followed with an overall 2-tailed significance level at α =0.05. P1, P value between Group IRLA and Group FA；P2, P value between Group FA and Group IRLA +FA，P3, P value between Group IRLA and Group IRLA +FA. The bonferroni method was used to adjust the test level, α=0.017，a P value of less than 0.017 was accepted as the threshold for statistical significance. Results： No major complications，including sepsis and severe rectal bleeding，were noted in any patient. There were no differences in general condition of the patients before procedure among the 3 groups. There were statistically significant differences in VAS scores among the 3 groups in VASⅡ (5.7±2.2， 3.0±1.5，3.3±1.9，respectively，P=0.012) and VASⅢ (6.7±2.3，3.0±2.1，2.9±1.6，respectively，P=0.001). There were no differences in the pain scores among the 3 groups during probe insertion (VASⅠ, 3.2±1.0，4.1±2.1，4.2±1.7， respectively，P=5.752) and 20 minutes after biopsy (VASⅣ, 1.4±2.1，1.0±0.9，1.1±0.7，respectively，P=3.772). Betweencolumn differences among the 3 groups were VASⅡ (P1=0.007，P2=5.655，P3=0.001，respectively) and VASⅢ(P1=0.008，P2=7.517，P3=0.001，respectively)，the differences between Group IRLA and Group FA，Group IRLA and Group IRLA +FA in VASⅡ and VASⅢ were statistically significant. Conclusion：The intravenous flurbiprofen axetil was found to be more effective than intrarectal lidocaine gel alone.

Objective： Testicular mixed germ cell tumor is mixed with embryonal carcinoma, choriocarcinoma, yolk sac tumor, teratoma, seminoma and other two or more components of the testicular tumor, the clinical is relatively rare and high degree of malignancy, this article will summarize its clinical features and optimize its treatment. Methods: A retrospective analysis of the clinical data of 22 patients with testicular tumor mixed germ cell in Peking University Third Hospital from May 1994 to November 2016 was conducted using a combination of statistical analysis and discussion of the relevant literature. Results: The mean age of the 22 patients was （30.8±10.4） years  and the rate of cryptorchidism was 13.6%. The maximum diameter of the tumor was （5.1±2.7 ） cm. The pathological results suggested that 12 cases (54.5%) contained two different germ cell tumor components, 7 cases (31.8%) contained 3 different tumor components, 2 cases (9.2%) contained 4 different tumor components, and 1 case (4.5%) contained 5 different tumor components. Tumor constituent analysis included yolk sac tumors(16 cases, 72.7%), mature teratoma (7 cases, 31.8%), immature teratoma (5 cases, 22.7%), embryonal carcinoma (17 cases, 77.3%) , choriocarcinoma (4 cases, 18.1%) and seminoma (6 cases, 27.3%). American Joint Committee of Cancer tumor staging indicated 19 cases of stage Ⅰ a tumor, 2 cases of stage Ⅱa tumor and 1 case of stage Ⅲa tumor. The mean values of human chorionic gonadotropin, alpha-fetoprotein and lactate dehydrogenase were 414.50 MIU/mL, 242.95 μg/L, 196.95 U/L (preoperative) and 17.20 MIU /mL, 90.20 μg/L, 183.70 U/L (postoperative within a year), and the comparison of the P values between the preoperative and the postoperative within a year were 0.079, 0.043 and 0.624.  Fourteen patients underwent retroperitoneal lymph nodes dissection. Most patients lived with long-term survival (94.4%) after operation. Conclusion: Comprehensive treatment of radical orchiectomy with retroperitoneal lymphadenectomy combined with necessary radiotherapy or chemotherapy might help to control the tumor and achieve long-term survival for most patients with testicular mixed germ cell tumor.

Objective： To investigation the diagnosis and treatment of ectopic adrenocorticotrophic hormone (ACTH) syndrome. Methods: The clinical characters of 57 cases of ecotopic ACTH syndrome from Jan. 1996 to Dec. 2016 were collected and analyzed. The 57 cases included 32 males and 25 females. The age ranged from 11 to 68 years ( average 32 years). ACTH levels significantly increased from 16.5 to 365.6 pmol/L, with average 77.6 pmol/L (normal range ＜10.1 pmol/L). The pituitary MRI did not found lesions. The CT showed that their bilateral adrenal glands diffused small nodular changes or nodular hyperplasia. The 57 cases were divided into 3 groups according to different treatment options. In the study, 25 ectopic ACTH syndrome cases (44%) were group A, without identified source of ectopic hormone, were treated with bilateral or unilateral adrenalectomy due to the severity of the disease and difficulty of operation. Group B was composed of 16 cases (28%) diagnosed as ectopic ACTH syndrome by finding ectopic ACTH tumors and surgical resection. Group C included 16 cases (28%) with nonsurgical therapy. Different treatment results and prognosis were analyzed. Results: In the study, 40 cases of the 57 had been followed up for 6 months to 10 years. In group A, of the 25 cases with bilateral or unilateral adrenalectomy, 4 died of diabetes and severe pulmonary infection, 18 survived, and 3 were lost to the follow-up, and the survival rate was 81% (18/22). In group B, of the 16 cases with radical tumor resection, 5 died of tumor recurrence 0.5-6.0 years after operation, 3 survived, and 8 were lost to the follow-up, and the survival rate was 37.5% (3/8). In group C, of the 16 non-operation patients, 4 with radiotherapy and chemotherapy died of metastases, diabetes or pulmonary infection, 6 with chemotherapy died of pulmonary infection within 1 year and the others were lost to the follow-up, and the survival rate was 0. Conclusion: Ectopic ACTH syndrome is difficult to treat. Adrenalectomy is effective for the management of ectopic ACTH syndrome, especially for those patients with severe Cushing’s syndrome, but the primary tumor can not be located.

Objective： To explore risk factors including prostate-specific antigen (PSA) kinetics for the prediction of castration-resistant prostate cancer (CRPC), and to build a practical model for predicting the progression to CRPC after androgen deprivation therapy(ADT) so as to facilitate clinicians in decision-making for prostate cancer patients receiving ADT. Methods: A total of 185 patients with prostate cancer who had received ADT as the primary therapy in Department of Urology of Peking University First Hospital from 2003 to 2014 were enrolled retrospectively. All the patients were diagnosed with prostate cancer via prostate biopsy and followed up every four weeks from the initiation of ADT. All the patients received ADT with luteinizing hormone-releasing hormone agonists (LHRH-A) or surgical castration accompanied with an antiandrogen (bicalutamide or flutamide, combined androgen blockade). The clinical information of the patients were collected including age, clinical TNM stage, Gleason score (GS), risk groups of prostate cancer, PSA at the initiation of ADT, PSA nadir after ADT, PSA decline velocity, and the time to PSA nadir. The end point of this study was the diagnosis of CRPC, which was based on the European Association of Urology (EAU) Guideline 2016. Cox proportional hazards regression models were established to analyze and estimate their effects on the time of progression to CRPC. Results: In this study, 185 patients with prostate cancer who had received ADT as the primary therapy were included. The mean age was (71.02±8.67) years. The median time to progression to CRPC in this cohort was 38 months (ranging from 4 to 158 months). On univariate analysis, we found clinical T stage, N stage, the metastasis state before ADT, risk groups of prostate cancer, PSA decline velocity, and PSA nadir were all related to the time to CRPC progression, P<0.01 for all the above variables. And on multivariate analysis, the presence of distant metastasis before ADT (HR=6.030, 95% CI: 3.229-11.263, P=0.001), higher PSA nadir (HR=1.185, 95% CI: 1.080-1.301, P=0.001), higher PSA decline velocity>11 μg/(L·month) (HR=2.124, 95% CI: 1.195-3.750, P=0.001), and time to PSA nadir ≤ 9 months (HR=3.623, 95% CI: 1.640-4.817, P=0.004) were found to be significantly associated with an increased risk of progression to CRPC. Conclusion: Patients with rapid decreasing of PSA in the initial ADT were more likely to progress to CRPC.

Objective：It has been found that serum CXCL16 concentration in rheumatoid arthritis (RA) patients are significantly higher than those in osteoarthritis (OA) and normal subjects, and are positively correlated with disease activity and bone erosion. However, how is CXCL16 involved in the pathogenesis of RA is unclear. To evaluate the expression of CXCL16 and its receptor CXCR6 in fibroblast-like synoviocytes (FLS) of rheumatoid arthritis (RA) patients, and to explore the role of CXCL16 in the proliferation of RA-FLS. Methods: FLS were isolated from knee synovial tissues obtained from 8 patients of RA, 7 osteoarthritis (OA) and 3 normal controls. The diagnosis of RA was in line with the 1987 American Rheumatology Association (ACR) RA classification criteria, osteoarthritis met the 1996 ACR revised knee osteoarthritis classification criteria. Control synovium were obtained from trauma caused knee joint injury in healthy individuals who required surgery. Human knee FLS were cultured by tissue explants adherent method.FLS between passages 3 and 5 were used in the experiment. Expression of CXCL16 and its receptor CXCR6 were performed in Western blot analysis. FLS proliferation follo-wing stimulation with TNF-α and different concentrations of CXCL16 was examined by cell counting kit-8 (CCK-8). Expression of phosphorylated AKT (pAKT) in RA-FLS stimulated by CXCL16 was quantified by Western blot. Different concentrations of recombinant human CXCL16 were added to the culture medium of RA-FLS. After 48 h culture, supernantants were collected, and TNF-α, IL-6, RANKL and MMP3 in culture supernatants of RA-FLS were determined by enzyme-linked immunosorbent assays (ELISA) operated following the kit instructions. Results: Expression of CXCL16 and CXCR6 in RA-FLS was significantly higher than that of OA and controls (P<0.05), but no significant difference was found between OA-FLS and control FLS. Proliferation of RA-FLS was markedly up-regulated after stimulation of CXCL16 (P <0.05). In the case of the CXCL16 stimulated OA-FLS and control FLS, the FLS proliferation remained basically unchanged. Expression of phosphorylated AKT in RA-FLS increased remarkably in condition of CXCL16 (50,100, 200 μg/L) stimulation. The levels of IL-6 and RANKL in culture supernatants of RA-FLS were obviously increased under CXCL16 (200 μg/L) stimulation, while TNF-α and MMP-3 levels in the culture supernatants remained unchanged after CXCL16 (200 μg/L) stimulation. Conclusion: This study shows that the expression of CXCL16 and its receptor was highly elevated in RA-FLS. Recombinant CXCL16 promoted RA-FLS proliferation and activation in vitro. All these indicate that CXCL16 play an important role in the pathogenesis of RA, anti-CXCL16 treatment may help to relieve inflammation and bone damage of RA patients. However, due to the limitations of this study, the role of CXCL16 and its receptors in RA-FLS remains to be elucidated by further research.

Objective： To evaluate the prognostic value of chemotherapy-induced neutropenia (CIN) in metastatic colon cancer undergoing first-line chemotherapy with FOLFOX. Methods: Data were collected from a retrospective survey of 158 consecutive metastatic colon cancer patients who had undergone FOLFOX chemotherapy. The clinicopathological characteristics and chemotherapy features of the patients were analyzed as potential prognostic factors. The patients were stratified by the decreased level of CIN to three groups: large decreased level (the number of neutrophil decreased more than 1.0×109 compared with that before chemotherapy),small decreased level (the number of neutrophil decreased less than 1.0×109 compared with that before chemotherapy) and the absence of neutropenia. Results: According to a multivariate COX model, decreased level of CIN was a independent prognostic factor of colon cancer patients. Hazard ratios of death were 0.687 (95% CI: 0.381-0.812, P=0.016) for patients with large decreased level of CIN and 0.817 (95% CI: 0.527-0.939,P=0.027) for those with small decreased level of CIN compared with those of absent neutropenia patients. Median overall survival was 12.9 months (95% CI: 10.4-15.4) for patients without neutropenia (A) compared with 20.8 months (95% CI: 18.3-23.1) for patients with large-decreased level of CIN (L) and with 17.3 months (95% CI: 16.2-18.8) for those with small-decreased level of CIN (S vs. L, P=0.018; L vs. A, P=0.009; S vs. A, P=0.011). Conclusion: Our results demonstrate that the decreased level of CIN is a predictor of prognosis in patients with metastatic colon cancer undergoing FOLFOX chemotherapy. Patients who have experienced large decreased level of CIN haave longer survival time than small decreased level of CIN or absent patients. To monitor CIN decreased level timely and adjust chemotherapy drug dose may help improve the prognosis.

Objective： To determine whether 3-dimentional CT scans is able to effectively improve the detection rate of AO B3 distal radius fractures in clinics. Methods: From Jan 2013 to Jan 2014, 30 patients with distal radius fractures were retrospectively enrolled in this study, all the patients directly visited the skeletal trauma emergency department in Beijing Jishuitan Hospital post injury and all of them accepted open reduction and internal fixation of distal radius fractures at last. All the radiographic data including X ray films and 3-dimentional CT scans of these patients were collected. Two independent observers were required to make primary AO classifications for each fracture by X rays at first, then to make final AO classifications by 3-dimentional CT scans. Finally, the detection rates of CT scans and plain films for AO B3 distal radius fractures and B3.3 distal radius fractures were compared, the agreements of the two methods for diagnosing AO B3 and B3.3 fractures were calculated by Cohen’s Kappa calculations. Results: All the 30 fractures were confirmed to be AO B3 distal radius fractures intraoperatively, and 10 of them were B3.3 fractures. The results were completely consistent with the results of 3-dimensional CT scans. However, only 80%(24/30) AO B3 distal radius fractures and 60%(6/10) B3.3 distal radius fractures could be diagnosed only by X rays. The detection rate of CT scans was proved to be significantly higher than X rays for diagnosing B3 distal radius fractures(100% vs. 80%，P<0.05), the detection rate of CT scans was also proved to be significantly higher than that of plain films for detecting B3.3 distal radius fractures(100% vs. 60%，P<0.05). The agreement of 3-dimentional CT scans and X ray was poor for detecting both the AO B3 distal radius fracture and B3.3 distal radius fracture (kappa=0). Most importantly, in the study process, two special kinds of B3 distal radius fracture were initially found and described by us. One was named as radial B3 fracture, and the other was named as ulna B3 fracture. Conclusion: 3-dimentional CT scans can effectively improve the detection rate of B3 and B 3.3 distal radius fractures, and also help find two special kinds of B3 fractures.

Objective： To explore suitable concentration of recombinant human transforming growth factor β1 (rhTGF-β1) usage and study the effect of rhTGF-β1 on differentiation of dental pulp stem cells (DPSCs). Methods: DPSCs were isolated from the undiseased third molars of people aged 18-25 years and cultured according to instructions in vitro. Different concentrations (1 , 6 , 10 μg/L) of rhTGF-β1 were added to the culture medium to examine DPSCs proliferation by CCK-8 (cell counting kit-8) assay.The suitable concentration was then selected. For differentiation, the DPSCs were incubated for 7 or 14 days with rhTGF-β1 supplemented with osteo/odontoblastic induction medium containing 10 nmol/L dexamethasone, 10 mmol/L b-glycerophosphate, 50 g/L ascorbate phosphate, 10 nmol/L 1,25-dihydroxyvitamin D3 and 10% fetal bovine serum. The cells were then washed 3 times with phosphate-buffered saline and sonicated with 1%Triton X-100 for 30 minutes on ice. Cellular alkaline phosphatase (ALP) activity was assayed with p-nitrophenyl phosphate as the substrate. The enzyme activity was expressed as p-nitrophenyl produced per milligram of protein ［bicinchoninic acid (BCA) protein assay kit］. To examine mineral nodule formation, the cultured cells were fixed in 4% paraformaldehyde and washed in water, and the mineralization of the extracellular matrix was assayed by 1% alizarin red S staining and elution of staining was examined as optical density (D) under microplate reader. The mean difference was considered significant at 0.05 and 95% confidence interval. Results: The DPSCs had ty-pical fibroblast morphology and could form mineral nodules after being cultured with osteo/odontoblstic induction medium for 14 days. 6 μg/L rhTGF-β1 significantly promoted the DPSCs proliferation on the 3rd and 5th days. After the incubation of osteo/odontoblastic induction medium, the DPSCs with the 6 μg/L rhTGF-β1 increased ALP activities compared with the control; D values in the 6 μg/L rhTGF-β1 group was 0.31±0.03, while the control group was 0.02±0.01(P<0.05). The total protein content in the 6 μg/L  rhTGF-β1 group was (2 775.46±83.54) mg/L, and the control group was (1 432.20±110.83) mg/L (P<0.05). To eliminate the cells proliferation influence, relative ALP activities, which was  defined as the total ALP divided by the total protein content, the 6μg/L rhTGF-β1 group was 6 times higher than the control group. Alizarin red S staining showed increased mineral nodule formation in the rhTGF-β1 group. The elution of staining under microplate reader also showed more optical density in the 6 μg/L rhTGF-β1-treated cells （0.83±0.02） than that in the control groups (0.55±0.05, P<0.05). Conclusion: 6 μg/L rhTGF-β1 could significantly promote DPSCs proliferation and odontoblastic differentiation in vitro.

Objective：To evaluate the changes of different parts of upper airway after alternating rapid palatal expansion and constriction via three dimensional measurement, compared with the protocol of ra-pid palatal expansion alone. Methods: In the study, 36 patients with retrognathic maxilla were selected and randomized to either group A or group B. The patients in group A were treated with rapid palatal expansion alone. The patients in group B were treated with alternating rapid palatal expansion and constriction. Three dimensional analyses were performed on all pre-and post-treatment cone-beam computed tomography (CBCT) images with the software Dolphin. Results: Two subjects in group B were lost to follow up during the treatment. The gender distributions, ages and all measuring items before treatment had no significant difference between group A and group B (P＞0.05). Nasal floor width, nasal lateral width, nasal volume, and nasopharynx volume increased significantly in each group after rapid palatal expansion alone or rapid palatal expansion and constriction (P＜0.05). The variations of oropharyngeal volume and hypopharyngeal volume had no significant difference (P＞0.05). No significant difference was observed in the nasal floor width and nasal lateral width increment among the anterior, median and posterior parts in each group either (P＞0.05). No significant difference in all the measuring items was observed between the two groups (P＞0.05). Conclusion:Alternating rapid palatal expansion and constriction could increase the volume of nasal and naopharynx cavities by the similar way of rapid palatal expansion alone, and had no obvious effect on oropharynx and hypopharynx cavities.

Objective： To evaluate the polysomnology results along with mandibular titrated advancement using oral appliance to treat obstructive sleep apnea and hyponea syndrome(OSAHS). Methods: Several electronic databases (PubMed, Embase, Cochrane Library, CNKI, VIP, and Wanfang) were systematically searched up to September 2015.There was no restriction of language or source of information. All randomized clinical trials (RCT) and before-after trials (BAT) comparing at least two different mandibular advancements were included. Two independent reviewers selected the studies, extracted data and evaluated risk of bias by quality assessment. Data were pooled using a fixed-effects model, and the summary effect measure was calculated by risk ratio (RR) and 95%CI. Meta-analysis was performed using RevMan 5.3 software. Results: Two RCTs and five BATs were included in the review. Among the five BATs, two of them were randomized, while the other three were not. Outcomes including apnea hypopnea index (AHI), oxygen desaturation index (ODI), success rate (reduction of AHI or ODI >50%), normalization rate (AHI or ODI<10/h) were assessed in this review. Based on the trial design and quality assessment, four studies were included for meta-analysis. No significant difference in the success rate was found between the group with 50% of the maximal mandibular advancement (MMA) and the group with 75% of MMA ［I2=0%, RR=0.93, with 95%CI (0.80, 1.09)］. No significant dif-ference in the normalization rate was found between the 50% of MMA and 75% of MMA groups ［I2=45%, RR=0.85, with 95%CI (0.68, 1.06)］. Subgroup analysis displayed that the severity of OSAHS before treatment was a potential factor affecting the normalization rate. Conclusion: Based on current available evidence, the success rate and normalization rate for treating OSAHS in the patients with 75% MMA were not found to be significantly higher than those with 50% MMA. Due to small simple size in this meta-analysis, the results of the present study should be interpreted with caution. Further prospective studies are needed to strengthen the evidence.

Objective：To classify the interforaminal arch form of edentulous mandibles by measuring the anterior-posterior distance (A-P distance) of implants planned to be inserted in “All-on-4” protocol using conebeam computed tomography (CBCT) data, and to investigate the influence of the arch form on the “All-on-4” distally tilted implants. Methods: Seventy-four CBCT images of edentulous mandibles were collected, including 35 males and 39 females respectively. “All-on4”implant supported fixed prostheses were designed for these patients based on the CBCT data. The A-P distance was measured in the plane which crossed bilateral mental foramens and was parallel to the occlusal plane. The interforaminal arch form of edentulous mandibles were classified according to the A-P distance. The radian of the jaw arch 7.5 mm mesially to the mental foramen was measured bilaterally, and its correlation with the A-P distance was studied. Results: The average A-P distance of implant supported fixed prostheses planned in the interforaminal region was (8.5±1.5) mm (minimum 4.5 mm, maximum 11.8 mm). In the study, 12.2% of the subjects’ mandibles were classified as square arch form with A-P distances ≤7 mm, 54.0% were classified as ovoid with A-P distances >7 mm and ≤9 mm,  33.8% were classified as tapered with A-P distances >9 mm. Bilaterally, 148 results of the radian of the jaw arch 7.5 mm mesially to the mental foramen were obtained, and the average radian was 15.9°±5.5° (minimum 5.6°, maximum 35.2°). The radian and the AP distance showed a negative correlation with statistical significance. Conclusion: In this research, the ovoid arch form was the most common type in edentulous mandibles, followed by tapered arch form. The square arch form showed the lowest percentage. As the arch form went squarer, the A-P distance became shorter, the radian of the jaw arch mesially to the mental foramen went greater, and the bone width that distally tilted implants need became bigger. The interforaminal arch form of the edentulous mandible should be analyzed before an implant supported fixed restoration is designed in the interforaminal region. The angle of inclination of distal implants should be reasonable. The bone width of the distal implant site must be adequate. The square arch form contributes negatively to the structure of implant supported fixed prostheses with distal cantilever design.

Objective：This study was based on digital orthodontic diagnosis work flow for indirect bonding transfer tray model design and three-dimensional (3D) printing, and the aim of this paper was to inspect the dimensional accuracyof 3D printed brackets, which is the foundation of the follow up work and hoped that will illuminate the clinical application of the digital orthodontics work flow. Methods: The samples which consisted of 14 cases of patients with malocclusion from Department of Orthodontics Peking University were selected, including 8 cases with tooth extraction and 6 cases without tooth extraction.All the 14 patients were taken intra-oral scan (Trios 3Shape，Denmark)and cone-beam computed tomography (CBCT, NewTom 3G volumetric scanner, Aperio Service,Italy）shooting after periodontal treatment. STL data and DICOM data were obtained from intraoral scans and CBCT images.Data segmentation, registration, fusion, automatic tooth arrangement, virtual positioning of orthodontic appliance and conversion the coordinates of malocclusion model were all done with self-programming software. The data of 3D printing model with brackets on it were output finally and printed out with EDEN260V (Objet Geometries, Israel) to make indirect bonding transfer tray. Digital vernier caliper was used to measure the length and width of upper and lower left brackets and buccal tubes on those 3D models after removal of surrounding supporting material by ultrasonic vibration and water-spray. Intra-examiner reliability was assessed by using intra-class correlation coefficients (ICC), and one-sample T test was used to compare the measurements with the standard dimensional data of the brackets. Results: There were significant differences which range in 0.04－0.17 mm between the 13 items out of the 19 measurement items. Except for the length of the lower left premolars’brackets, mean values of the other items were greater than the test value.Conclusion: Although the measurement results in the width of brackets and the width and length of the buccal tubes obtained experimentally were slightly larger than the test value,this may not reduce the accuracy of indirect bonding procedure in clinic necessarily. Whether the differences which range in 0.04－0.17 mm would actually affect the retention and positioning of brackets needs to be confirmed by further studies.

Objective： To evaluate the efficacy of the 45S5 bioactive glass on the reduction of hypersensitivity of teeth prepared for full coverage crowns. Methods: In the study, 31 prepared abutment teeth with vital pulp from 18 patients satisfied the inclusion criteria and exclusion criteria. The patients were informed consent and recruited into the study. This was a before and after self-control, single blind clinical trial. The severity of tooth hypersensitivity at baseline was evaluated, after application of the placebo, which was the powder of zinc oxide, and after application of the 45S5 bioactive glass on the same tooth. Tooth hypersensitivity was evaluated by Yeaple probe and visual analogue scale (VAS) when the tooth was stimulated by a fixed value of mechanical pressure and a blast of cold air respectively. And the dentist gave the subjective score, and the Schiff score at the same time. The three methods of measurement were repeated at baseline, after application of placebo and after application of the powder of 45S5 bioactive glass. Student’s t test and nonparametric test were used for statistical analysis. Results: The indexes measured at baseline, after the application of the placebo and after the application of the 45S5 bioactive glass were as follows, respectively: Tactile value (29.03±9.44) g, (29.68±9.48) g and (44.19±11.19) g, VAS value (50.79±22.92) mm, (46.63±22.06) mm and (30.90±20.30) mm, Schiff score 2.13±0.67, 1.97±0.66 and 1.42±0.56. After the application of bioactive glass, the values of Tactile, the VAS, and the Schiff score were statistically different from those at baseline or after application of the placebo (P＜0.05). The data measured at baseline and after application of the placebo were of no statistical difference (P＞0.05). Statistical differences between the Schiff scores of the groups were associated with gender, tooth position, primary or secondary tooth preparation. Conclusion: Results of the clinical trial showed that the powders of 45S5 bioactive glass were significantly effective on reducing the hypersensitivity of teeth with vital pulp after the full crown preparation.

Objective： To optimize and establish the best hydrolysis method of diethyl ester 4-amino-N5-formyl-N8,N10-dideazatetrahydrofolate through the optimization of simple compound of diethyl N-(4-aminobenzoyl)-L-glutamate. Methods: To increase the low yield of hydrolysis reaction of diethyl ester 4-amino-N5-formylN8,N10-dideazatetrahydrofolate due to the by-products and difficult purification, we studied the effect of NaOH and KOH, two kinds of alkalis, three concentrations between 0.175-1 mol/L and five types of reaction time involved in 20, 30, 60, 120 and 180 min on the common side chain diethyl N-(4aminobenzoyl)-L-glutamate. A high performance liquid chromatography was established for measuring the target product and the by-products in reaction liquid in different reaction conditions. Finally, on the basis of the best hydrolysis method of diethyl ester 4-amino-N5-formyl-N8,N10-dideazatetrahydrofolate, we completed the optimization of the hydrolysis reaction conditions of diethyl ester 4-amino-N5-formyl-N8,N10-dideazatetrahydrofolate. Results： We developed the best reaction condition for the hydrolysis of diethyl ester 4-amino-N5-formyl-N8,N10-dideazatetrahydrofolate, which could be carried out easily and efficiently. The results indicated that treated with the optimized condition of 0.3 mol/L KOH in 60 min at the room temperature, diethyl ester 4-amino-N5-formylN8,N10-dideazatetrahydrofolate was converted into its diacid derivative in 95.6 % yield, which turned to be a better reaction condition compared with the previous reaction condition. The structures of those compounds were identified to be correct by 1H nuclear magnetic resonance（1H NMR）, 13C nuclear magnetic resonance（13C NMR） and electrospray ionization time of flight mass spectrometry （ESI-MS）. The purity of the diacid derivative of the compound was determined to be 96% by high performance liquid chromatography（HPLC）.The new hydrolysis reaction condition could not only avoid the formation of single ester hydrolysis product and amide bond hydrolysis product, but also improve the yield of the hydrolysis reaction. Conclusion: We have developed an efficient reaction for the hydrolysis of diethyl ester 4-amino-N5-formyl-N8,N10-dideazatetrahydro. Since the final step of the synthesis of classical folic acid antagonists is always the catalyzed hydrolysis of the side chain glutamate, the reaction also has great significance for anti-folic acid anti-tumor inhibitors synthesis.

Objective：To explore a three-dimensional (3D) data fusion and integration method of optical scanning tooth crowns and cone beam CT (CBCT) reconstructing tooth roots for their natural transition in the 3D profile. Methods: One mild dental crowding case was chosen from orthodontics clinics with full denture. The CBCT data were acquired to reconstruct the dental model with tooth roots by Mimics 17.0 medical imaging software, and the optical impression was taken to obtain the dentition model with high precision physiological contour of crowns by Smart Optics dental scanner. The two models were doing 3D registration based on their common part of the crowns’ shape in Geomagic Studio 2012 reverse engineering software. The model coordinate system was established by defining the occlusal plane. crown-gingiva boundary was extracted from optical scanning model manually, then crown-root boundary was generated by offsetting and projecting crown-gingiva boundary to the root model. After trimming the crown and root models, the 3D fusion model with physiological contour crown and nature root was formed by curvature continuity filling algorithm finally. In the study, 10 patients with dentition mild crowded from the oral clinics were followed up with this method to obtain 3D crown and root fusion models, and 10 high qualification doctors were invited to do subjective evaluation of these fusion models. Results: This study based on commercial software platform, preliminarily realized the 3D data fusion and integration method of optical scanning tooth crowns and CBCT tooth roots with a curvature continuous shape transition. The 10 patients’ 3D crown and root fusion models were constructed successfully by the method, and the average score of the doctors’ subjective evaluation for these 10 models was 8.6 points (0-10 points). which meant that all the fusion models could basically meet the need of the oral clinics, and also showed the method in our study was feasible and efficient in orthodontics study and clinics. Conclusion: The method of this study for 3D crown and root data fusion could obtain an integrate tooth or dental model more close to the nature shape. CBCT model calibration may probably improve the precision of the fusion model. The adaptation of this method for severe dentition crowding and micromaxillary deformity needs further research.

Androgen insensitivity syndrome (AIS) is a very uncommon genetic disorder that results from the resistance of androgen receptor (AR) to androgen, which influences the formation of the male genitalia and in turn presents with female phenotype. Surgical resection of undesceaded testicle and different kinds of genitoplasty are crucial methods to correct the deformity of reproductive system, as well as hormone replacement therapy, which is an essential therapy for postoperational rehabilitation in AIS patients. A 43-year-old patient, who was socially female, was first admitted to gastroenterology department due to recurrent ascites and occasional abdominal pain with unknown origin. Taking physical examination, ultrasonography, karyotype analysis and sex hormone levels into consideration, the overall manifestations revealed the typical clinical features of complete androgen insensitivity syndrome. After that she was transferred to urology department for laparoscopic gonadectomy. During the surgery, doctors found that there was a vesical fistula on the upper wall near the conjunction between the bladder and ligamenta umbilicale medium, which explained the recurrent ascites for more than 4 years. After resecting the testicles and the tissues around the vesical fistula for histopathology, the result suggested Sertoli cell adenoma, hyperplastic Leydig cells and urothelium atypical hyperplasia. Hormone replacement therapy was given right after discharge. The hormone levels of follicle-stimulating hormone, luteinizing hormone, estradiol and progesterone were modulated by the dysfunction of androgen production after gonadectomy and hormone replacement therapy together with psychotherapy could stabilize her hormone levels and improve the quality of her life. The patient was suspicious of AIS family history and the pedigree was made to analyze her family which was possibly X-linked recessive pattern. We propose three possible hypotheses of the fistula, which are direct surgical injury, recurrence of bladder cancer and congenital urachal anomalies. But whether it is relevant between urachal anomalies and AIS is yet to be discovered.

Lymphangioma is a rare, benign mesenchymal neoplasm, which is characterized by nume-rous intercommunicating cystic spaces containing lymphatic fluid. It is considered a congenital disease resulting from the obstruction of regional lymph drainage during the developmental period. Lymphangioma frequently occurs in the cervical neck and axilla, also in the retroperitoneum, mediastinum, mesentery, omentum, colon, and pelvis, rarely in the perirenal space. These tumors usually present in childhood, but infrequently, these also present in adults. Patients often complain of hematuria, flank pain, or abdominal pain. Complications of lymphangioma have been reported to include infection, ruputure, or he-morrhage. There are three types of lymphangioma commonly identified: capillary, cavernous, and cystic. Cystic type is the one commonly found intra-abdominally or retroperitoneally, and may be uniloculated or multiloculated. All these perirenal tumors have a very low incidence, make it difficult to diagnose. Differential diagnosis must be performed with the primary renal lymphoma, urinoma, polycystic kidney, te-ratoma, both benign and malignant tumors, etc. Endoscopic ultrasound guided fine needle aspiration is recommended in some literatures, which may help make diagnosis and further guide subsequent therapeutic strategy. Regarding treatment, surgical excision can be performed via either laparotomy or laparoscopy. And injection of sclerosants into lympahgioma has been described in the literature in nonsurgical candidates. The optimal definitive treatment is total surgical excision. Despite being rare, the tumor has an excellent prognosis. Here, we report a case of a 48-year-old woman with a left renal mass found in an abdominal ultrasonography during a health checkup. In the case presented, abdominal ultrasonography and magnetic resonance urography (MRU) revealed an approximately 11.3 cm×10.6 cm×12.8 cm multilocular cystic mass in the left perirenal space. There was no history of bowel or bladder complaint, either previous illness episodes. Full blood count and kidney function tests were within normal limits. Laparoscopic surgical removal of the cyst was accomplished without incident. A benign cystic perirenal lymphangioma was diagnosed on histology and confirmed with immunohistochemical stains. One month after the surgery the ureteral stent was removed. The patient was free of disease after a 3-month follow-up pe-riod. We report the case and discuss the management of perirenal lymphangiomatosis with a literature review.

Upper urinary tract calculi with infection is a quite difficult acute urologic emergency. And what is more, upper urinary tract obstruction after radical cystectomy following urinary diversion may be fatal in the vulnerable patients with this kind of situation. Postoperative anatomy and other factors affect the upper urinary tract calculi, and urinary tract infection greatly increased the risk. But it is particularly difficult to handle with patients with poor general condition and septic shock treatment, so how to optimize the selection program is worth further studying. A 65-year-old man was admitted to hospital for combining with renal and ureteral calculi after radical cystectomy (Bricker) in March 2017. The patient underwent transurethral resection of bladder tumor in the outer court because of the discovery of bladder tumor one year before, The postoperative pathology was high-grade papillary urothelial carcinoma and he underwent regular irrigation of the bladder. Because of tumor recurrence, he came to Peking University Third Hospital for further treatment in August 2016, and the examination of urinary tract CT indicated bladder can-cer; for bilateral multiple renal pelvis and renal calices calculi, he was given laparoscopic radical cystecto-my. After four months, due to sudden chill fever, he was hospitalized. After definite diagnosis, anti-inflammatory treatment combined with left nephrostomy was given. The two-stage lithotripsy was performed. After expansion of the original left renal fistula to 24 F（1 F=0.33 mm）, 24 F sheath was inducted into the kidney. We introduced a flexible ureteroscopy into the channel down to the ureteral obstruction, where we found a 1 cm oval black brown stone obstructed. A guide wire was inducted through the stones down to ileal conduit in the right lower quadrant. Through the ureteroscopy, we made ureteral calculi broken into powder, and replaced the residual stones into the renal pelvis. Then we used the nephroscopy for lithotropsy in the pelvis, and finally we introduced a flexible cystoscopy for the residual stone. The operation was successful, the operation time was 181 min, and intraoperative bleeding was 10 mL. After operation, no residual stones were found in kidney, ureter, bladder (KUB) plain films. No operation complications were related to the urinary tract. Therefore, multiple endoscopy with combination therapy of upper urinary tract calculi following urinary diversion is safe and effective, and the reasonable choice with the advantages of each instrument can improve the stone clearance rate and shorten the operation time. This can be used as a useful complement to traditional treatment.

Intraoperative cell salvage (IOCS) has been widely used to reduce allogeneic blood transfusion and prevent blood transfusion related complications during surgery．However, due to the risk of transfusion related reaction, contamination, and immunological reaction, its use for tumor patients has been controversial and limited．To explore the feasibility of the application of IOCS in cancer patients, we reported 2 cases of renal cell carcinoma (RCC) with tumor embolism in IVC that underwent radical nephrectomy，and inferior caval venous thrombectomy receiving IOCS combined with leukocyte depletion filter (LDF) from August 2016 to November 2016 in our hospital．The cell saver blood salvage (Haemone-tics, 5+) was used for these 2 cases. The salvaged blood was filtered through the LDF before infusion. For case 1 (male 45-year-old) the total operation time was 505 min, and the estimated blood loss was 4 500 ml. A total of 1 000 mL autologous blood, 12 u allogeneic packed red blood cells (PRBC), 1 200 mL fresh frozen plasma (FFP) were infused during the procedure. The patient was discharged from hospital after 75 days without complications. The postoperative follow-up for 3 months showed no tumor recurrence or metastasis. For case 2 (a male patient, aged 51 years), the total operation time was 490 min, and the estimated (blood loss was 7 000 mL. the patient received 2 700 mL autologous blood transfusion, 12 u allogeneic packed red blood cells (PRBC), and 2 400 mL fresh frozen plasma (FFP). The patient was discharged from hospital after 86 days without severe complications. the postoperative follow-up for 6 months showed no tumor recurrence or metastasis for this patient. Other relevant retrospective studies with this technique showed that cell salvage could be used safely in many kinds of cancer patients, for example, bladder cancer, liver cancer and kidney cancer．Furthermore，numerous researches have proved the safety and efficacy of the combination of these two techniques, the intraoperative cell salvage technique and leucocyte depletion filter in cancer patients. Here we only reported two cases using IOCS and LDF. Further work is needed to determine whether the use of intraoperative cell salvage combined with leukocyte depletion filter can be used safely for patients with HCC.

It is complicated to decide the treatment plan of hopeless anterior teeth in esthetic zone due to severe periodontitis, periodontal-endodontic combined lesion or teeth trauma. The optional treatment plan for this kind of teeth includes retention after periodontal treatment, extraction and implant treatment, extraction and prosthodontic treatment and so on. To make an appropriate treatment plan, patients’ periodontal conditions, periodontal biotype, local anatomy, esthetic demand, economic condition and social psychological status should be comprehensively considered. A combine of periodontal, endodontic and orthodontic therapy may achieve a good treatment effect in hopeless anterior teeth with severe periodontal destruction, tooth extrusion and occlusal trauma. In this case, a 20-year-old female who presented with symptoms of bleeding on brushing and upper incisors loosening for 1 month came to the Department of Periodontology, Peking University School and Hospital of Stomatology. The clinical examinations revealed that the patient’s right upper incisor had signs of mobility (Ⅲ°), intrusion of 1-2 mm, and probing depth (PD) of 9-10 mm. The periapical radiograph showed that the alveolar bone of right upper incisor absorbed horizontally to the apex. And the patients showed Angle Ⅱ° malocclusion with Ⅱ° overbite in anterior teeth and maxillary protrusion. A diagnosis of aggressive periodontitis and Angle Ⅱ° malocclusion was made. The treatment of this patient lasts for 5 years which include periodontal initial therapy, orthodontic therapy, guided tissue regeneration (GTR) of right upper incisor and supportive periodontal therapy and the clinical result is fine. A hopeless upper incisor was successfully retained and the longtime clinical condition was stable. The strategy of retention of hopeless upper anterior teeth, the relationship of periodontal treatment and orthodontic treatment, and the indications of periodontal and orthodontic combined therapy were also discussed on the basis of this case. Generally, the positive factors in retention of hopeless teeth includes young age, absence of systemic conditions, strong motivation for maintaining the tooth, single root anatomy, integrated dentition, good response to causerelated therapy, intrabony alveolar bone defect, thick periodontal biotype, and regular supportive periodontal therapy. And in the progress of orthodontic therapy, regular supportive periodontal therapy and good plaque control is extremely important.