Dongliang Hu

Tongji Hospital, Wu-han-shih, Hubei, China

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Publications (5)12.5 Total impact

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    ABSTRACT: BACKGROUND: In a previous experience, anatomical retroperitoneoscopic adrenalectomy (ARA) was proven safe, effective, and technically efficient for surgical adrenal diseases. However, laparoscopic adrenalectomy for adrenal metastasis is controversial. We evaluated the safety, effectiveness, and efficiency of modified ARA technique for adrenal metastasis and predicted survival factors. METHODS: From 2000 to 2010, a consecutive series of 75 patients with adrenal metastases underwent 78 ARAs (three bilateral ARAs). Three modifications and one key procedure were specified in this study. Medical records and follow-up data were retrospectively studied. Then, the surgery data of ARA were compared with those of other approaches to evaluate its safety, effectiveness, and efficiency. Additionally, univariate and multivariate analyses were used to predict the risk factors for survival. RESULTS: The most common primary tumor was renal cell carcinoma (RCC, n = 26), followed by non-small-cell lung carcinoma (NSCLC, n = 23), and hepatocellular carcinoma (HCC, n = 12). A total of 76 successful ARAs and two conversions to open surgery were performed, with a median operation time of 53 (range, 40-250) min and median estimated blood loss of 25 (range, 10-700) mL. The local recurrence rate was 5.3 %, and the median survival was 24 months. These data were comparable with or even better than other approaches in previous studies. The independent prognostic factors of survival were body mass index (BMI, p < 0.001), tumor type (p < 0.001), tumor size (≥4 cm vs. <4 cm, p = 0.017), and margin status (negative vs. positive, p = 0.011). CONCLUSIONS: ARA is a safe and effective approach for the management of adrenal metastasis in selected patients. BMI, tumor type, tumor size, and margin status may independently predict survival.
    Surgical Endoscopy 12/2012; · 3.43 Impact Factor
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    ABSTRACT: To introduce our experience in using anatomic retroperitoneoscopic adrenalectomy (ARA) for adrenal tumors >5 cm and evaluate this procedure's safety and efficiency. Of the 1400 ARAs performed in the past 8 years, 110 were performed on patients who had adrenal tumors with a diameter >5 cm. The perioperative indexes of these patients were retrospectively collected and analyzed. The mean tumor size on postoperative pathologic examination was 7.2 ± 2.1 cm (range 5-14). Only 1 patient with right-sided adrenal pheochromocytoma (7.8 cm diameter) required conversion to open surgery owing to the tumor's severe adhesions to the liver and inferior vena cava. The mean operative time and evaluated blood loss was 70.8 ± 18.6 minutes and 81.3 ± 46.1 mL, respectively. The average postoperative interval to oral intake and drainage withdrawal was 2.1 and 2.2 days, respectively. No patient died during the operation. Major intraoperative complication (ie, injury to the vena cava) occurred in 1 patient, necessitating open surgery. Minor complications during the perioperative period occurred in 10 patients (9.1%). When performed by experienced surgeons, ARA is a safe and feasible procedure for large adrenal masses with a diameter >7 cm; however, this procedure results in a longer operation time and greater blood loss compared with ARA performed on smaller masses. Open surgery is indicated when the tumor adheres to, or has infiltrated, the surrounding tissues.
    Urology 06/2011; 78(2):348-52. · 2.42 Impact Factor
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    ABSTRACT: The expression of steroidogenic factor-1 (SF-1) was elevated in adrenal aldosterone-producing adenoma (APA). The influence of SF-1 on adrenal tumorigenesis by adrenocortical cell line H295R cells was investigated. Real-time PCR and Western blotting were used to detect SF-1 expression in 16 APA samples and 12 normal adrenal samples. Specific SF-1-shRNA plasmid was transfected into H295R cells to inhibit SF-1 expression. Western blotting and real-time PCR were used to verify the effects of RNAi on SF-1 inhibition. Subsequently, WST-1 and cell count were applied to evaluate cell proliferation at different SF-1 levels. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was used to measure cell apoptosis, and proliferation marker Ki-67 was studied by immunohistochemistry. Compared with normal adrenal samples, SF-1 mRNA and protein levels in APA samples were significantly higher. It was 10.48:1 at SF-1 mRNA and 0.87 ± 0.05 vs. 0.39 ± 0.07 at protein levels, respectively (P < 0.01). A decreased SF-1 significantly inhibited cell proliferation in the experimental and control cells. These results were supported by weaker Ki-67 staining in SF-1-inhibited cells [(36.9% ± 4.17%) vs. (58.48% ± 7.16%) (P < 0.01)]. Moreover, SF-1 inhibition induced a 2.7-fold increase in the percentage of apoptotic H295R cells (P < 0.01). Elevated SF-1 may play an important role in APA formation and primary aldosteronism. SF-1 acts as an oncogenic factor, and its inhibition provides new insight into the understanding and treatment of related adrenal diseases.
    Urologic Oncology 09/2010; 30(4):457-62. · 3.65 Impact Factor
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    ABSTRACT: To identify the characteristics of circulating CD4(+)CD25(high) regulatory T cells in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). We sought to discover the possible mechanism underlying induction of CP/CPPS by autoimmune factors. A total of 69 men with CP/CPPS and 25 age-matched, asymptomatic controls underwent quantification of peripheral blood CD4(+)CD25(high) regulatory T cells, using flow cytometry, followed by measurement of interleukin (IL)-6, IL-10, tumor necrosis factor-alpha (TNF-alpha), and transforming growth factor-beta1 (TGFbeta1) in serum, and forkhead box P3 (FOXP3) mRNA level in peripheral blood mononuclear cells, using enzyme-linked immunosorbent assay and real-time quantitative reverse transcriptase-polymerase chain reaction, respectively. The FOXP3 gene mRNA level in CP/CPPS patients was significantly lower than that in controls. Serum TNF-alpha level increased but the TGFbeta1 level decreased in CP/CPPS patients. No change was observed in the levels of IL-6 and IL-10. However, there was normal frequency of CD4(+)CD25(high) T cells in CP/CPPS patients. No differences were observed in expression of FOXP3 and serum cytokines and population of CD4(+)CD25(high) T cells between CP/CPPS IIIA and IIIB patients. In addition, statistically significant correlation was only found between serum IL-6 production and national institutes of health-chronic prostatitis symptom index total score of CP/CPPS patients. The frequency of CD4(+)CD25(high) T cells and FOXP3 expression level did not correlate with age, duration, and total national institutes of health-chronic prostatitis symptom index score of CP/CPPS patients. FOXP3 and serum cytokines, such as TNF-alpha and TGFbeta1, might be important for the pathogenesis of CP/CPPS and possibly affect the suppressive function of CD4(+)CD25(high) regulatory T cells. This influence may result in the onset of CP/CPPS, but its assessment requires further study.
    Urology 10/2009; 75(4):938-42. · 2.42 Impact Factor
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    ABSTRACT: The expression of calcium epithelium TRPV5, alcium binding protein Calbindin-D28k and Na(+)/Ca(2+) exchanger NCX1 was detected in renal distal convoluted tubule, and their effects on urine calcium reabsorption and the possible pathogenic mechanism in idiopathic hypercalciuria (IH) were investigated. Genetic hypercalciuric stone-forming (GHS) rats were chosen as animal models to study urine calcium reabsorption and IH. The cognate female and male rats that had maximal urine calcium were matched to breed next generation. Twelve GHS rats and 12 normal control (NC) SD rats were selected. Western blot and real time quantitative PCR were used to detect the protein and gene expression of TRPV5, Calbindin-D28k and NCX1 respectively. The expression levels of TRPV5 protein and mRNA in GHS rats were significantly lower than in NC rats (P<0.05). Western blot revealed that the expression levels of Calbindin-D28k in GHS rats and NC rats were 0.49+/-0.02 and 0.20+/-0.01 respectively, with the difference being significant between them (P<0.05). By using real time quantitative PCR, it was found that there was no significant difference in Calbindin-28k mRNA expression levels between GHS rats and NC rats (P>0.05). There was no significant difference in the NCX1 expression between GHS rats and NC rats (P>0.05). It was suggested that TRPV5 and Calbindin-D28k might play an important role in urine calcium reabsorption and IH, but they differently contributed to the pathogenesis: The down-regulation of TRPV5 decreases urine calcium reabsorption, directly leading to loss of the urine calcium and resulting in hypercalciuria, and the increased Calbindin-D28k expression could relieve, neutralize and decrease intracellular Ca(2+) concentration to maintain calcium balance. NCX1 is not the key protein in urine calcium reabsorption.
    Journal of Huazhong University of Science and Technology 10/2008; 28(5):580-3. · 0.58 Impact Factor