H.W. Jiang

Ureteroscopy and Holmium: YAG Laser Lithotripsy as Emergency Treatment for Acute Renal Failure Caused by Impacted Ureteral Calculi

OBJECTIVES To present our clinical outcomes in managing acute renal failure caused by impacted ureteral calculi with ureteroscopy and holmium: yttrium-aluminum-garnet laser lithotripsy as emergency treatment. METHODS A series of 27 patients with acute postrenal failure were treated from November 2002 to December 2005. Impacted calculi were located in bilateral ureters in 22 patients and unilateral ureters in 5 patients with a solitary or single functioning kidney. Acute renal failure was demonstrated with oliguria or anuria and a significant increase in serum creatinine and blood urea nitrogen. Patients were treated emergently with ureteroscopy and holmium:yttrium-aluminum-garnet laser lithotripsy in the hospital within 24 hours. Ureteral stenting was performed in all cases. Postoperative renal function, electrolytes, and urine volume were monitored daily for 7 days. Radiography and/or ultrasonography were performed at a follow-up visit in 4 weeks. RESULTS Ureteroscopy and laser lithotripsy were successfully performed in all patients. The mean operative time was 29.2 minutes (range 15-60). The successful fragmentation rate in the ureteroscopic procedure was 93.9% (46 of 49), and the overall stone-free rate was 88.9% (24 of 27). Shock wave lithotripsy was used in 3 patients after recovery of renal function. Of the 27 patients, 26 (96.3%) returned to normal renal function within 7 days. One patient (3.7%) had significant improvement of renal function, but it had not returned to normal at 12 weeks of follow-up. No intraoperative complications or postoperative ureteral stricture occurred. CONCLUSIONS Emergency ureteroscopy and holmium: yttrium-aluminum-garnet laser lithotripsy can be safely and successfully performed by skilled endourologists for acute renal failure caused by impacted ureteral calculi.

Estudio sobre susceptibilidad de cáncer de vejiga y polimorfismos genéticos de XPC, XPG y CYP en fumadores y no fumadores

AIM To investigate the gene susceptibility of bladder cancer and potential relation with smoking. METHODS An analysis of SNPs were conducted among DNA repair genes of XPC, XPG, XRCC1, and six members of metabolic enzyme gene CYP 450 via TaqMan Probe-based polymerase chain reaction. A total of 130 patients with bladder cancer and 304 healthy controls were involved. RESULTS Polymorphisms of XPC gene was related to bladder cancer. It was also related to smoking status in bladder cancer patients, as well as to tumour stage, male gender and older age. The XPG gene polymorphism was also related to bladder cancer yet it was prevalent in female non-smokers. No association was acquired for XRCC1 gene. The combination of more than 2 polymorphisms in DNA repair genes was associated with bladder cancer. No association was obtained in any of the metabolic enzyme gene of CYP450 with either bladder cancer or smoking status. CONCLUSION DNA repair genes XPC and XPG could be related to carcinogenesis and tumour progression of bladder cancer. Confirmation within larger population was warranted.

REG1A predicts recurrence in stage Ta/T1 bladder cancer

AIMS Stage Ta/T1 urothelial carcinoma of the bladder (Ta/T1 BC) has a marked tendency to recur. Regenerating protein 1 A (REG1A) has been reported to be expressed in human cancers, and it may be positively correlated with patients prognosis. The aim of the present study was to evaluate the prognostic value of REG1A in Ta/T1 BC. METHODS Immunohistochemistry was done on 110 paraffin-embedded specimens of human Ta/T1 BC to detect the proteins REG1A, PCNA and MMP2. The relationships between REG1A expression and the clinical-pathological characteristics of Ta/T1 BC patients were evaluated. RESULTS Sixty-five out of 110 specimens were REG1A-positive. Grade and expression levels of MMP2 and REG1A were significantly correlated with the recurrence rate. REG1A expression (Hazard ratio: 3.1; 95% CI: 1.1-8.5; P=0.030) was an independent predictor of recurrence rate in multivariate Cox regression analysis. A significant association between REG1A expression and MMP2 expression (P=0.023) was also observed. CONCLUSION Expression of REG1A is an independent predictor of recurrence in Ta/T1 BC.

Vías relacionadas con IGF-1 (Insulin-like growth factor-1) y promoción de dieta alta en grasas en la progresión del cáncer de próstata en ratones TRAMP (Transgenic Adenocarcinoma of the Mouse Prostate)

INTRODUCTION We aimed to investigate the role of IGF-1 related pathway in high-fat diet (HFD) promotion of TRAMP mouse PCa progression. METHODS TRAMP mice were randomly divided into two groups: HFD group and normal diet group. TRAMP mice of both groups were sacrificed and sampled on the 20th, 24th and 28th week respectively. Serum levels of insulin, IGF-1 and IGF-2 were tested by ELISA. Prostate tissue of TRAMP mice was used for both HE staining and immunohistochemical staining of IGF-1 related pathway proteins, including IGF-1Rα, IGF -1Rβ, IGFBPs and AKT. RESULTS The mortality of TRAMP mice from HFD group was significantly higher than that of normal diet group (23.81% and 7.14%, p=.035). The tumor incidence of HFD TRAMP mice at 20(th) week was significantly higher than normal diet group (78.57% and 35.71%, p=.022). Serum IGF-1 level of HFD TRAMP mice was significantly higher than that of normal diet TRAMP mice. Serum IGF-1 level tended to increase with HFD TRAMP mices age. HFD TRAMP mice had higher positive staining rate of IGF-1Rα, IGF-1Rβ, IGFBP3 and Akt than normal diet TRAMP mice. CONCLUSIONS IGF-1 related pathway played an important role in high-fat diet promotion of TRAMP mouse PCa development and progression.

El nivel de BLCA-4 urinario es útil para la detección del carcinoma de células uroteliales de vía urinaria superior

OBJECTIVE Upper urinary tract urothelial cell carcinomas (UUT-UCCs) are rare but usually invasive at diagnosis. Early diagnosis of UUT-UCCs is thus warranted. UUT has the same embryological origin with bladder and BLCA-4 is a highly sensitive and specific marker for bladder cancer. We intend to investigate the viability of BLCA-4 in detecting UUT-UCCs. MATERIAL AND METHODS Urines from 30 UUT-UCC patients, 10 ureteral polyp patients, 20 infected patients with incarcerated ureteral stones, and 30 normal controls were included. BLCA-4 antibody was produced and applied in an indirect ELISA assay. RESULTS Urinary BLCA-4 is significantly higher in UUT-UCC group than «Polyp» group (P=0.0017), «Infection» group (P<0.0001), or « Normal» group (P<0.0001). The «Polyp» group is also higher than «Infection» group (P=0.015), or «Normal» group (P=0.0009). ROC curve revealed at cut-off of 5.5×10(-4)A, sensitivity was 93.3% and specificity was 100%. When grouped as ureteral mass vs normal, same cut-off value yielded 93.3% sensitivity and 83.3% specificity. At 2.4×10(-4)A, sensitivity was 56.7% and specificity was 97.2%. CONCLUSIONS Urinary BLCA-4 is also highly specific in UUT-UCCs detection. For incidentally identified ureteral mass, BLCA-4 can be considered an auxiliary indicator besides biopsy.

Primary Bilateral Adrenal Non-Hodgkin's Lymphoma Associated With Normal Adrenal Function

Primary bilateral adrenal non-Hodgkins lymphoma is rare. Adrenal insufficiency or adrenal failure as a result of tumor destruction is the main pathophysiological change of most cases. Normal adrenal function despite bulky bilateral adrenal masses is extremely rare. We present a case of primary bilateral adrenal non-Hodgkins lymphoma associated with normal adrenal function. Positron emission tomography-computed tomography is helpful to the diagnosis.

An improved dosage regimen of sertraline hydrochloride in the treatment for premature ejaculation: an 8‐week, single‐blind, randomized controlled study followed by a 4‐week, open‐label extension study

This study aimed at evaluating the safety and efficacy of an improved dosage regimen of sertraline in patients with premature ejaculation (PE) and to examine whether the premature ejaculation diagnostic tool (PEDT) can be used as a measure of treatment response in these patients.