Huibo Lian

Laparoscopic Radiofrequency Ablation of Renal Tumors: 32-Month Mean Follow-up Results of 106 Patients

OBJECTIVE To report our experience of laparoscopic radiofrequency ablation (RFA) on patients with renal tumors. RFA has been increasingly applied in the management of small renal tumors. However, it was performed mostly via percutaneous approach, with limited cases and a short follow-up period. METHODS From February 2006 to March 2008, laparoscopic RFA was performed on 106 renal tumors (size range: 0.9-5.5 cm) in 106 selected patients (74 men and 32 women, age range: 25-81 years). Initial contrast-enhanced computed tomography (CT) examination was performed seven days after the procedure, with subsequent CT assessment at three months, six months, and every six months thereafter. Serum creatinine measurement was conducted along with each time CT examination. RESULTS The mean follow-up period was 32 months (range: 12-48). All 106 tumors were biopsied before RFA, of which 90 were diagnosed as renal cell carcinoma (RCC) (84.90%). There was one incomplete ablation. One case with radiographic local recurrence was then proved by pathologic analysis of the nephrectomy specimen to have no cancer cells. The local tumor control rate was 98.1% (104/106). Of the 90 RCC cases, the disease-free survival rate was 97.8% (88/90); both the cancer-specific and the overall survival rate were 100%. No death or renal failure after the procedure has yet been found. CONCLUSIONS Our results showed that the laparoscopic RFA on small renal mass was safe, with outcomes of patients comparable with those by partial nephrectomy and percutaneous RFA. Further research and a longer follow-up period are needed to confirm our results.

Single-center comparison of complications in laparoscopic and percutaneous radiofrequency ablation with ultrasound guidance for renal tumors.

OBJECTIVE To report on postoperative complications associated with laparoscopic radiofrequency ablation (LRFA) and percutaneous radiofrequency ablation (PRFA) in a single-center experience. METHODS We conducted a retrospective review of medical records for patients undergoing LRFA or PRFA between February 2006 and March 2010 at our center. Demographics, radiographic variables, and complication rates were compared between the 2 groups. Risk factors for postoperative complications after operation were analyzed with multivariate logistic regression. RESULTS Of a total 191 patients included in this study, 132 underwent LRFA and 59 underwent PRFA. There were no significant differences between the 2 groups with respect to age, gender, biopsy data, American Society of Anesthesiologists classification, body mass index, single kidney, tumor size, tumor number, glomerular filtration rate, follow-up, or RENAL nephrometry score. We observed complications in 16 LRFA procedures (12.1%) and 10 PRFA procedures (16.9%) (P = .369). There was no difference in the distribution of the complications between LRFA and PRFA groups. The complication (grades 1 and 2) rate in the LRFA group (7.6%) was not significantly different from that in the PRFA group (10.2%) (P = .550). The complication (grade 3a) rate in the LRFA group (4.5%) was not significantly different from that in the PRFA group (6.8%) (P = .522). A multivariate analysis disclosed that extra ablation time was the only predictor of postoperative complications. CONCLUSION Significantly more anterior tumors were approached laparoscopically, and significantly more posterior tumors were approached percutaneously. Complication rate was not significantly different between LRFA and PRFA. Extra ablation time was a significant risk factor associated with postoperative complications.

In Situ Floating Hydrogel for Intravesical Delivery of Adriamycin Without Blocking Urinary Tract

Drug solution is commonly used in conventional intravesical instillation. However, most of them would be easily eliminated by voiding, which significantly limit their efficacy. Recent advances in intravesical drug delivery are to use hydrogels as drug reservoir to extend the drug residence time in bladder. However, because of the high viscosity of hydrogel, urinary obstruction is usually existed during the intravesical instillation. To overcome these, we developed a floating hydrogel for the delivery of Adriamycin (ADR). The floating hydrogel was made of ADR, thermosensitive polymer (Poloxamer 407) and NaHCO₃, which was liquid at low temperature, whereas formed gel at high temperature. In the presence of H⁺, NaHCO₃ decomposed and produced CO₂ that attached on the surface of hydrogel and helped the hydrogel float on the urine. Hence, the urinary tract will not be blocked. Meanwhile, the encapsulated ADR released in a controlled manner. These results suggest that the floating gel may have promising applications in intravesical therapy for bladder cancer.

Minimally invasive percutaneous cystolithotomy: an effective treatment for bladder stones in infants aged <1 year

Study Type – Therapy (case series)
Level of Evidence 4

A Floating Hydrogel System Capable of Generating CO2 Bubbles to Diminish Urinary Obstruction After Intravesical Instillation

ABSTRACTAimIntravesical instillation is commonly used to decrease the tumor recurrence after transurethral resection. However, most drug solutions would be eliminated from bladder after the first voiding of urine, so its clinical efficacy is limited. To overcome this obstacle, we developed a floating hydrogel system for controlled delivery of antitumor drugs.MethodsThe floating hydrogel was made of Adriamycin, thermo-sensitive polymer (Poloxamer 407) and NH4HCO3, which was liquid at low temperature while forming hydrogel at high temperature. Meanwhile, at high temperature, NH4HCO3 decomposed to produce CO2 bubbles, which helped hydrogel float in bladder without urinary obstruction.ResultsThe mixture containing 45% P407 and 6% NH4HCO3 was selected as the optimal formulation. At 37°C, the mixture formed hydrogel and produced many bubbles which could be observed by B ultrasound. The vitro study showed that the antitumor drug Doxorubicin was released in a controlled manner. After the mixture was instilled into rabbit bladder, it formed hydrogel and floated in the bladder. The bladder stimuli was reduced and antitumor drugs could be released continuously in the bladder.ConclusionOur results suggested that the floating hydrogel was a feasible intravesical drug delivery system and may have application prospects in intravesical therapy for bladder cancer.

Visualized intravesical floating hydrogel encapsulating vaporized perfluoropentane for controlled drug release

Abstract Intravesical drug delivery is the main strategy for the treatment of bladder disorders. To reduce the relief arising from frequent intravesical instillation, mucoadhesive hydrogel was used for the controlled release of the drug. However, the viscosity of mucoadhesive gel might cause severe urinary obstruction and bladder irritation. To solve all these problems, a floating hydrogel delivery system was developed using perfluoropentane (PFP) as the floating agent. After intravesical instillation of the floating hydrogel, the increased temperature in bladder vaporized PFP, resulting in the generation of microbubbles in the hydrogel. Then, it can float in urine to avoid the urinary obstruction and bladder irritation. In this study, systematic experiments were conducted to investigate the influences of PFP vaporization on the morphology and floating ability of hydrogels. The floating process is much milder and safer than other floating methods published before. In addition, PFP had been used as contrast agent, which affiliated the monitoring of gels during the operation. Therefore, this new drug delivery system addresses the problems of conventional intravesical instillation and is promising for clinic use.

Retroperitoneoscopic-Guided Cool-Tip Radiofrequency Ablation of Adrenocortical Aldosteronoma

PURPOSE To analyze the feasibility, safety, and therapeutic effects of retroperitoneoscopic-guided cool-tip radiofrequency ablation (RCRFA) used for the treatment of adrenocortical aldosteronoma. PATIENTS AND METHODS We performed a retrospective comparison of RCRFA (n=12) and laparoscopic partial adrenalectomy (LPA) (n=26) in the patients with solitary aldosterone-producing adenoma in our center from 2006 to 2009. Intraoperative and follow-up data were reviewed for clinical parameters and hormone levels. Univariate analysis was performed to measure the consistency of these clinical parameters preoperatively and postoperatively. RESULTS All patients presented hypertension, hypokalemia, and high aldosterone/renin ratio (ARR>30) preoperatively and were finally histologically confirmed as aldosteronoma. Technical success rate of these two procedures was 100%. Every patient was followed up for more than 3 years (mean 49.2±15.6 months). There was no evidence of residual or recurrent lesion postoperatively. ARR declined significantly postoperatively compared with preoperatively (54.33±24.90 vs 5.50±3.30 in the RCRFA group and 51.45±29.12 vs 6.67±3.75 in the LPA group, p<0.05). Hypokalemia was resolved in all patients after the surgery. A majority of patients (91.7% in the RCRFA group and 96.2% in the LPA group) were cured without any further need of antihypertensive medication or experienced an improvement in hypertension. Antihypertensive medications reduced significantly after surgical procedures. RCRFA and LPA demonstrated similar therapeutic effects. Compared with LPA, RCRFA provided a shorter operative time (65.6±13.5 minutes vs 86.0±16.5 minutes in LPA, p<0.05), less blood loss (20.0±11.3 mL vs 60.8±52.0 mL in LPA, p<0.05), and lower complication rate (16.7% vs 26.9% in LPA). CONCLUSIONS RCRFA might be an alternative for LPA in selected patients with adrenocortical aldosteronoma. Due to limited sample size, more experience is necessary to validate this procedure.

miR-138-5p contributes to cell proliferation and invasion by targeting Survivin in bladder cancer cells

BackgroundSurvivin (encoded by the gene BIRC5) plays an important role in the carcinogenesis of bladder cancer. Identifying miRNAs that target Survivin in the setting of bladder cancer will help to develop Survivin-based therapies for bladder cancer.MethodsThe expression levels of miR-138-5p and Survivin protein were measured in 12 resected bladder cancer specimens. The correlation between miR-138-5p and Survivin was further examined by evaluating Survivin expression in human bladder cancer cell lines that either overexpressed or knocked down miR-138-5p. A luciferase reporter assay was performed to test the direct binding of miR-138-5p to the target gene BIRC5. We also investigated the biological role of miR-138-5p targeting to Survivin in bladder cancer cell lines both in vivo and in vitro.ResultsIn this study, we found that the Survivin protein was either absent or weakly expressed in normal adjacent tissues and consistently up-regulated in bladder cancer tissues; however, the mRNA levels did not vary as much, suggesting that a post-transcriptional mechanism was involved. Because microRNAs are powerful post-transcriptional regulators of gene expression, we used bioinformatic analyses to search for microRNAs that could potentially target BIRC5 in the setting of bladder cancer. We identified 2 specific targeting sites for miR-138-5p in the 3′ untranslated region (3′-UTR) of BIRC5. We further identified an inverse correlation between miR-138-5p and Survivin protein levels in bladder cancer tissue samples. By overexpressing or knocking down miR-138-5p in bladder cancer cells, we experimentally confirmed that miR-138-5p directly recognizes the 3′-UTR of the BIRC5 transcript and regulates Survivin expression. Furthermore, the biological consequences of the targeting of BIRC5 by miR-138-5p were examined in vitro via cell proliferation and invasion assays and in vivo using a mouse xenograft tumor model. We demonstrated that BIRC5 repression by miR-138-5p suppressed the proliferative and invasive characteristics of bladder cancer cells and that miR-138-5p exerted an anti-tumor effect by negatively regulating BIRC5 in a xenograft mouse model.ConclusionsTaken together, our findings provide the first clues regarding the role of miR-138-5p as a tumor suppressor in bladder cancer by inhibiting BIRC5 translation.

Comparison of the complications of traditional 12 cores transrectal prostate biopsy with image fusion guided transperineal prostate biopsy

BackgroundTo compare the complications of traditional transrectal (TR) prostate biopsy and image fusion guided transperineal (TP) prostate biopsy in our center.MethodsTwo hundred and fourty-two patients who underwent prostate biopsy from August 2014 to January 2015were reviewed. Among them, 144 patients underwent systematic 12-core transrectal ultrasonography (TRUS) guided prostate biopsy (TR approach) while 98 patients underwent free-hand transperineal targeted biopsy with TRUS and multi-parameter magnetic resonance imaging (mpMRI) fusion images (TP approach). The complications of the two groups were presented and a simple statistical analysis was performed to compare the two groups.ResultsThe cohort of our study include242 patients, including 144 patients underwent TR biopsies while 98 patients underwentTP biopsies. There was no significant difference of major complications, including sepsis, bleeding and other complication requiring admissionbetween the two groups (P > 0.05). The incidence rate of infection and rectal bleeding in TR was much higher than TP (p < 0.05), but the incidence rate of perineal swelling in TP was much higher than TR (p < 0.05). There were no significant differences of minor complications including hematuria, lower urinary tract symptoms (LUTS), dysuria, and acuteurinary retention between the two groups (p > 0.05).ConclusionThe present study supports the safety of both techniques. Free-handTP targeted prostate biopsy with real-time fusion imaging of mpMRI and TR ultrasound is a good approach for prostate biopsy.

MiR-199a-3p suppresses proliferation and invasion of prostate cancer cells by targeting Smad1

OBJECTIVES This study was intended to analyze effects of miR-199a-3p and Smad1 on proliferation, migration and invasion of prostate cancer (PCa) cells. RESULTS MiR-199a-3p was significantly decreased in PCa tissues in comparison to that in adjacent normal tissues (P < 0.05). Over-expressed miR-199a-3p markedly suppressed proliferation and invasion of PCa cells (P < 0.05). MiR-199a-3p was negatively correlated with Smad1 expression, and overexpression of Smad1 could antagonize the effects of miR-199a-3p on PCa cells. MATERIALS AND METHODS The PCa tissues and their adjacent normal tissues were collected from 54 PCa patients. Expressions of miR-199a-3p and Smad1 mRNA in tissues and cells were evaluated with real-time quantitative polymerase chain reaction (RT-qPCR), and immunohistochemistry assay was used to detect Smad1 protein expressions. The target relationship between miR-199a-3p and Smad1 was assessed by luciferase reporter assay. The PCa cell lines (i.e. PC-3 cells) were transfected with miR-199a-3p mimics and Smad1-cDNA. MTT and Transwell assays were applied to detect proliferative, migratory and invasive abilities of PCa cells. CONCLUSIONS MiR-199a-3p suppressed proliferation and invasion of PCa cells by targeting Smad1.Objectives This study was intended to analyze effects of miR-199a-3p and Smad1 on proliferation, migration and invasion of prostate cancer (PCa) cells. Results MiR-199a-3p was significantly decreased in PCa tissues in comparison to that in adjacent normal tissues (P < 0.05). Over-expressed miR-199a-3p markedly suppressed proliferation and invasion of PCa cells (P < 0.05). MiR-199a-3p was negatively correlated with Smad1 expression, and overexpression of Smad1 could antagonize the effects of miR-199a-3p on PCa cells. Materials and methods The PCa tissues and their adjacent normal tissues were collected from 54 PCa patients. Expressions of miR-199a-3p and Smad1 mRNA in tissues and cells were evaluated with real-time quantitative polymerase chain reaction (RT-qPCR), and immunohistochemistry assay was used to detect Smad1 protein expressions. The target relationship between miR-199a-3p and Smad1 was assessed by luciferase reporter assay. The PCa cell lines (i.e. PC-3 cells) were transfected with miR-199a-3p mimics and Smad1-cDNA. MTT and Transwell assays were applied to detect proliferative, migratory and invasive abilities of PCa cells. Conclusions MiR-199a-3p suppressed proliferation and invasion of PCa cells by targeting Smad1.