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ABSTRACT: Purpose: We examined the construct validity (ability to discriminate between experienced and inexperienced subjects) of the chicken crop model in the simulation of laparoscopic pyeloplasty. Materials and Methods: Dead chickens were used. The chicken crop and esophagus were used to simulate the human renal pelvis and ureter respectively. The chicken was positioned in a left lateral position within a pelvic trainer to simulate a right ureteropelvic junction. Fifteen subjects were divided into three groups according to their levels of previous laparoscopic experience. Each subject performed a laparoscopic pyeloplasty with the model using the dismembered Anderson Hynes technique. Operating time and quality scores were recorded. One-way ANOVA was used to detect differences among the groups. A Tukey multiple-comparisons test was used to detect differences between individual groups. Results: Those in the most experienced group completed the "laparoscopic pyeloplasty" in an average of 33.80 min, and got an average quality score of 9.0. Those in the less experienced group averaged 55.20 min and 7.0 respectively, and those in the group with no experience averaged 92.60 min and 4.0 respectively. There were significant differences in operating time and quality scores between the groups as shown by the One-way ANOVA (P < 0.001), and also between the individual groups as shown by the Tukey multiple-comparisons test. There was, however, no significant difference in quality scores between the most experienced group and the less experienced group. Conclusion: The chicken crop model exhibits good construct validity, and as such can be used to reproduce the technical complexity of laparoscopic pyeloplasty.
Journal of endourology / Endourological Society 04/2013; · 1.75 Impact Factor
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Tianxin Lin,
Jian Huang,
Jinli Han,
Kewei Xu,
Hai Huang, Chun Jiang,
Hao Liu,
Caixia Zhang,
Yousheng Yao,
Wenlian Xie,
Arvind Kumar Shah,
Li Huang
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ABSTRACT: Laparoscopic endoscopic single-site surgery (LESS) has recently emerged as an attempt to enhance cosmetic benefits and reduce morbidity; however, LESS for radical cystectomy is still not well established. Here we describe the technique of hybrid LESS for radical cystoprostatectomy and orthotopic ileal neobladder (RC-OIN), and evaluate its feasibility and safety.
Between November 2008 and October 2009, 12 men with bladder cancer underwent hybrid LESS for RC-OIN. A homemade multichannel port, made from two stretchable rings and a surgical glove with trocars and valves attached to its fingers, was placed into a 4- to 5-cm midline incision in the lower abdomen and was used for laparoscopic instruments. Another subumbilical port was placed for the laparoscope. Extended bilateral pelvic lymphadenectomy was performed by the lateral view; radical cystoprostatectomy was completed laparoscopically; construction of the ileal neobladder was performed extracorporeally; and the neobladder was anastomosed to the urethral stump laparoscopically, with a slipknot running suture technique. Perioperative, functional, oncologic data and complications were collected and analyzed.
All operations were performed successfully without conversion to conventional laparoscopic radical cystectomy or open surgery. There was no perioperative mortality or port-related complications. The median operative time was 383 minutes. Median blood loss was 150 mL. A median of 25 lymph nodes were removed. Surgical margins were tumor free in all cases.
Hybrid LESS for RC-OIN is technically feasible with effects similar to those of conventional laparoscopic procedures. Further instrument and technique improvement are necessary to shorten operative time and reduce intraoperative difficulties.
Journal of endourology / Endourological Society 01/2011; 25(1):57-63. · 1.75 Impact Factor
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Zheng-hui Guo,
Hai Huang,
Tao DU,
Ke-wei Xu,
Yi Cao,
Jie-qing Chen,
Wen Dong,
You-sheng Yao,
Tian-xin Lin,
Wen-lian Xie, Chun Jiang,
Jin-li Han,
Jian Huang
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ABSTRACT: To study the inhibition and significance of pigment epithelium-derived factor (PEDF) in the development and metastasis of prostate cancer.
The expression of PEDF was examined in the normal prostate tissue, benign prostatic hyperplasia, prostate cancer tissue and prostate cancer cell lines, PC-3 and Lncap by immunohistochemical SP method and Western blot. In combination with clinical data, statistical analysis was performed to evaluate the relation of the expression level of PEDF in prostate cancer and the relationship between different histological grades of prostate cancer.
In normal prostate tissue and benign prostate tissue, the expression of PEDF were elevated and it was far higher than the prostate cancer and prostate cancer cell line. The expression of PEDF and the pathological grade of prostate cancer were related to the differentiated carcinoma of prostate tissue, and the expression level of PEDF in poorly differentiated carcinoma below the highly differentiated carcinoma of prostate cancer. In metastatic prostate cancer, the expression of PEDF was lower than that of prostate cancer without metastasis (12% vs 43.1%).
The expression of PEDF and the incidence of prostate cancer have a negative correlation. The lower grade of prostate cancer cells, the less the tissue expression of PEDF and the higher tendency of invasion and metastasis.
Zhonghua yi xue za zhi 11/2010; 90(42):2980-3.
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ABSTRACT: Fluorescence cystoscopy (FC) with intravesical instillation of a photosensitizing agent has emerged as an adjunctive and safe diagnostic tool with high sensitivity and reasonable specificity; however, it has not been widely accepted, because it is time-consuming and expensive. The aim of the present study was to determine whether the use of the fluorescent dye pirarubicin [(2"R)-4'-O-tetrahydropyranyl doxorubicin] (THP) in endoscopy can improve detection of nonmuscle invasive urothelial carcinoma of the bladder.
Forty-eight patients with known or suspected bladder urothelial carcinoma were enrolled in this prospective study between January 2008 and April 2009. The Storz D-light system was used to detect fluorescence 15 minutes after intravesical instillation with 30 mg THP. Endoscopic findings, histopathologic evaluation of biopsy lesions, and adverse effects of THP were recorded.
After THP uptake, the lesions appear bright orange under white light, and produce bright red fluorescence under blue light. Among 238 biopsies evaluated (84 malignant, 20 dysplasia, and 134 benign), sensitivity of overall tumors, carcinoma in situ (CIS), and dysplasia detection using FC was 96% (81/84), 100% (6/6), and 90% (18/20), respectively. The specificity of FC was 74.7% (115/154), and its false-positive rate was 32.5% (39/120). No significant systemic side effects or allergic reactions were observed other than a few cases of mild cystitis.
THP endoscopy may improve the detection of nonmuscle invasive urothelial carcinoma of the bladder, especially CIS and flat lesions. Results indicate that THP is a promising fluorescent dye for diagnosis and follow-up of nonmuscle invasive bladder carcinoma. Moreover, it is inexpensive, easily available, simple to administer, and is associated with few side effects.
Journal of endourology / Endourological Society 10/2010; 24(11):1801-6. · 1.75 Impact Factor
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ABSTRACT: Radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer (BCa). Large series with long-term oncologic data after laparoscopic RC (LRC) are rare.
To report oncologic outcomes of LRC for 171 cases with a median 3-yr follow-up.
From December 2002 to June 2009, 171 consecutive patients with BCa who underwent LRC with orthotopic ileal neobladder (OIN) at our institution were enrolled in this retrospective study.
All patients underwent LRC OIN. Adjuvant chemotherapy was administered to patients with non-organ-confined disease or positive lymph nodes.
The demographic, perioperative, complication, pathologic, and survival data were collected and analysed.
Most tumours were transitional cell carcinoma (TCC; 160, 93.6%). Tumours were organ confined in 113 patients (pT1-T2; 66.1%) and non-organ confined in 58 patients (pT3-T4a; 33.9%). There was involvement of the lymph nodes in 38 patients (22.2%). Surgical margins were all tumour free. The mean number of removed lymph nodes was 16 (5-46). Follow-up ranged from 3 to 83 mo, and 54 (31.6%) patients completed 5-yr follow-up. Two patients (1.2%) had local recurrence and distant metastasis, 9 patients (5.3%) had local recurrence alone, and 23 patients (13.5%) had distant metastasis. One patient (0.6%) had port-site seeding. One hundred twenty-four patients (72.5%) were alive with no evidence of recurrence; 28 patients (16.4%) died, 20 from metastasis and 8 from tumour-unrelated causes. The estimated 5-yr overall survival, cancer-specific survival, and recurrence-free survival rates were 73.7%, 81.3%, and 72.6%, respectively. The relatively low percentage of patients reaching 5-yr follow-up is a limitation of this retrospective study.
Surgical technique of LRC with OIN can achieve the established oncologic criteria of open surgery, and our oncologic outcome is encouraging. Long-term follow-up is needed for further confirmation.
European urology 09/2010; 58(3):442-9. · 7.67 Impact Factor
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Jian Huang,
Tian-Zin Lin,
Ke-Wei Xu,
Jin-Li Han,
Feng Ye,
Hai Huang, Chun Jiang,
Cai-Xia Zhang,
You-Sheng Yao,
Wen-Lian Xie,
Hao Liu
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ABSTRACT: To evaluated the feasibility and therapeutic effect of laparoscopic-endoscopic single-site surgery (LESS) for radical cystoprostatectomy and orthotopic ileal neobladder.
Between November 2008 and August 2009, 8 male patients with bladder cancer underwent modified single port laparoscopic cystoprostatectomy and orthotopic ileal neobladder with a home-made multichannel port made up of two stretchable rings and a surgical glove with trocars and valves attached to its fingers. A 4 - 5 cm midline incision was made in lower abdomen and the multichannel port placed into this incision. Laparoscopic instrument was extended through the multichannel port. Another port was placed at the umbilicus site for laparoscope. The investigators performed the modified single port transperitoneal technique neobladder extracorporeally and urethro-pouch anastomosis under laparoscopy with a slipknot running suture technique. The perioperative and postoperative data were collected and analyzed prospectively.
In all cases, no conversion into conventional laparoscopic or open surgery was necessary. The mean operative duration, including extended lymph node dissection, was 399 min (range: 355 - 455 min). Mean estimated blood loss was 154 ml (range: 90 -210 ml). The mean postoperative hospital stay was 15 d (range: 14 - 18 d). No peri-operative mortality was reported. One case had delirium 2 days postoperatively and there was no port-related complication. The pathological report confirmed surgical margins were tumor-free for all cases. The average number of removed lymph node was 20. The mean follow-up period was 6.1 months (range: 2.0 -10.0 months). All patients remained disease-free until the last follow-up.
With a reduction of 4 ports, modified single port laparoscopic radical cystectomy with orthotopic ileal neobladder is technically feasible with a low complication rate. Our initial outcome is encouraging, but additional work and a further follow-up are warranted to critically compare the oncological outcome with open surgery.
Zhonghua yi xue za zhi 06/2010; 90(22):1542-6.
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Zhenghui Guo,
Hai Huang,
Lexiang Zeng,
Tao Du,
Kewei Xu,
Tianxin Lin, Chun Jiang,
Wen Dong,
Yi Cao,
Jieqing Chen,
WeiDe Zhong,
Jian Huang
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ABSTRACT: Prostate-specific membrane antigen is a type II membrane protein with folate hydrolase activity produced by prostatic epithelium. It has been demonstrated that prostate-specific membrane antigen over-expression may be correlated with prostate cancer, particularly in advanced cancer. The aim of the current study was to explore the possibility of prostate-specific membrane antigen as a therapeutic target for the treatment of prostate cancer. To address this problem, lentivirus-mediated small interfering RNA was employed to reduce endogenous prostate-specific membrane antigen expression in prostate cancer cell lines—LNCaP and DU-145. Then, the tumorigenesis, migration ability and invasiveness of prostate-specific membrane antigen-reduced prostate cancer cell lines were also examined. The prostate-specific membrane antigen expression in LNCaP and DU-145 cells was persistently and markedly reduced by lentivirus-mediated RNA interference. Down-regulation of prostate-specific membrane antigen expression significantly suppressed the growth rates of LNCaP and DU-145 cells. Moreover, the specific down-regulation arrested cells in G0/G1 phase of cell cycle. Furthermore, we also observed that the silence of prostate-specific membrane antigen could decrease the migration ability and the invasiveness of LNCaP and DU-145 cells. Our investigation demonstrated that lentivirus-mediated RNA interference silencing targeting prostate-specific membrane antigen might reduce the proliferation, and induce potent antitumor activity of LNCaP and DU-145 cells. Prostate-specific membrane antigen has considerable potential as a new therapeutic target for the treatment of prostate cancer.
Medical Oncology 04/2010; 28(3):878-87. · 2.14 Impact Factor
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Jian Huang,
Hai Huang,
Tian-xin Lin,
Ke-wei Xu,
Cai-xia Zhang,
Zheng-hui Guo, Chun Jiang,
Xin-bao Yin,
Jin-li Han,
You-sheng Yao,
Wen-lian Xie
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ABSTRACT: To compare the clinical therapeutic effect and complications of laparoscopic radical cystectomy with orthotopic ileal neobladder (LRC-INB) with open radical cystectomy with orthotopic ileal neobladder (ORC-INB).
A total of 171 patients were evaluated, including 63 cases with ORC-INB and 108 cases with LRC-INB from June 1994 to May 2007 at our institution. The parameters analyzed included perioperative data, postoperative complications, new bladder function and effect of tumor control.
There was no significant difference in demographic characteristics of patients between these 2 groups. The mean operating time was 330 min in the LRC group and 310 min in the ORC group (P > 0.05). The mean blood loss was 320 ml in the LRC group and 1100 ml in ORC group (P < 0.001). The mean oral intake after operation was 2.4 days for LRC group and 4.5 days for ORC group (P < 0.001). No perioperative death was occurred in both groups. The complication rate was 18.5% in LRC group, while 30.0% in ORC group (P < 0.05). Twelve months after operation, the day-time and night-time continence rate were 90.7% and 82.6% for the LRC group, 88.3% and 81.6% for the ORC group respectively (P > 0.05). There was no significant difference of VOL, pressure and residual urine volume (RUV) of neobladder between these 2 groups. Surgical margin were tumor free for 107 cases except one T4 case in laparoscopic group had positive margin (P > 0.05). The mean number of removed lymph node were 12 and 8 in LRC and ORC group respectively (P < 0.05). The 2 years tumor free survival rate of the same stage or grade was no significant different (P > 0.05).
LCR had advantages of less blood loss, shorter oral intake time, less postoperative complications, comparable continent rate and short-term tumor control with ORC. Long-term follow up is needed to confirm the oncological outcome.
Zhonghua wai ke za zhi [Chinese journal of surgery] 01/2009; 46(24):1870-4.
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Tian-Xin Lin,
Jian Huang,
Ke-Wei Xu, Chun Jiang,
Hai Huang,
Jin-Li Han,
Cai-Xia Zhang,
You-Sheng Yao,
Wen-Lian Xie,
Zheng-Hui Guo,
Xin-Bao Yin,
Wen Dong
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ABSTRACT: To analyze the effects, complication, and outcome of laparoscopic radical cystectomy.
108 patients with bladder cancer, 96 males and 12 females, aged 61 (36 - 81) underwent laparoscopic radical cystectomy with orthotopic ileal neobladder. Five-port transperitoneal approach was applied. The surgical procedure included standard laparoscopic pelvic lymphadenectomy, radical resection of bladder, extracorporeal formation of ileal pouch; extracorporeal implantation of ureters; and laparoscopic urethra-neobladder anastomosis. Erectile nerve sparing procedure was performed for 26 cases. The patients were followed up for 1 - 53 months.
The median operation time was 330 min, and the median blood loss was 320 ml. Conversion to open surgery was not necessary in any of the patients. There was no peri-operative mortality. The complication rate was 18.5% (20/108). Surgical margins were tumor free for all cases. The day-time and night-time continence rates were 90.7% and 82.6% respectively in 6 months postoperatively. 10 of the 26 patients undergoing erectile nerve-sparing procedure had potency for intercourse. Follow-up showed 5 cases with local recurrence, 1 case with trocar site seeding and 6 cases with distant metastasis, 8 of the patients died of tumor-related disease and 3 died of diseases not related to tumor.
Laparoscopic radical cystectomy with extracorporeal formation of orthotopic ileal neobladder is a feasible technique with low morbidity and acceptable neobladder function.
Zhonghua yi xue za zhi 10/2008; 88(34):2437-40.
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ABSTRACT: To create and evaluate the effectiveness of an in vitro training model for laparoscopic urethrovesical anastomosis.
Chicken posterior trunks and porcine colons were used to construct the training model, which was later compared with the chicken skin model. The posterior trunk of a chicken was used to simulate a human pelvis, and a 3-mm cloacal stump was used to simulate a human urethral stump. A 15-cm segment of porcine colon with a 1-cm orifice was used to simulate a human bladder or neobladder. An imitation urethrovesical anastomosis was performed with laparoscopic instruments in a laparoscopic training box. The simulated urethral stump and bladder neck were anastomosed with six interrupted stitches. Forty urologic residents were randomized into two groups. The residents in group A (n = 20) practiced using this model for 8 hours, while those in group B (n = 20) practiced using the chicken skin model for 8 hours. The residents' skills were assessed using the porcine model before and after training.
All residents accomplished the training course and both assessments. There was no significant difference between the groups in anastomosis time (122.65 +/- 19.98 minutes v 120.70 +/- 17.30 minutes, P > 0.05) and quality (3.80 +/- 1.24 v 3.75 +/- 1.16, P > 0.05) before training. After the training sessions, both groups improved in anastomosis time and quality. Compared with residents in group B, residents in group A required less time (63.55 +/- 11.08 minutes v 76.55 +/- 12.46 minutes, P < 0.05) and achieved a higher quality score (8.80 +/- 1.00 v 7.65 +/- 0.88, P < 0.05).
This training model more accurately resembles the structure and characteristic of the human pelvis, urethral stump, and bladder (neobladder). In addition, all the materials needed for this model are inexpensive and easily obtained. Therefore, it is an effective, convenient training model for laparoscopic urethrovesical anastomosis.
Journal of endourology / Endourological Society 07/2008; 22(7):1541-5. · 1.75 Impact Factor
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Jian Huang,
Tianxin Lin,
Kewei Xu,
Hai Huang, Chun Jiang,
Jinli Han,
Yousheng Yao,
Zhenghui Guo,
Wenlian Xie,
Xinbao Yin,
Caixia Zhang
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ABSTRACT: The preliminary results of laparoscopic radical cystectomy in 85 patients are presented in this study. The functional and oncologic outcomes of this procedure in these patients are discussed.
Between December 2002 and May 2006, we performed 85 laparoscopic radical cystectomies with orthotopic ileal neobladder for bladder cancer in 77 men and 8 women. A 5-port transperitoneal approach was applied. The standard bilateral pelvic lymphadenectomy was performed first, then radical cystectomy was completed laparoscopically. The construction of the ileal neobladder and the anastomosis of ureter-neobladder were performed extracorporeally. The neobladder was anastomosed to the urethral stump under laparoscopy. A nerve-sparing procedure was performed for eight patients.
The median operative time was 320 min, and the median blood loss was 280 mL. Conversion to open surgery was not necessary in any of the patients. The average time to oral intake after operation was 3.9 days. There were no perioperative mortalities. The complication rate was 14.1% (12/85), including such complications as three uretero-pouch anastomotic strictures, one vesicourethral anastomotic stricture, one pouch-vaginal fistula, one colonic pouch fistula, one ileo-pouch fistula, three ileus, one pneumonia, and one pyelonephritis. The daytime continence rate was 91.2%, and the nighttime continence rate was 82.4% at 6 months postoperatively. The neobladder capacity was about 343 mL. Surgical margins were tumor free for all patients. Of the eight patients who underwent a nerve-sparing procedure, four patients had potency for intercourse. During a follow-up period of 1 to 41 months (average 21.3 months), three patients had local recurrence, one patient had trocar site seeding, and five patients had distant metastasis, of whom four died.
Laparoscopic radical cystectomy with extracorporeal formation of a neobladder is a feasible procedure with low morbidity and acceptable neobladder function. Long-term follow-up is needed to confirm the oncologic outcomes.
Journal of Endourology 06/2008; 22(5):939-46. · 1.85 Impact Factor
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Tian-xin Lin,
Cai-xia Zhang,
Ke-wei Xu,
Hai Huang, Chun Jiang,
Jin-li Han,
You-sheng Yao,
Zheng-hui Guo,
Wen-lian Xie,
Xin-bao Yin,
Jian Huang
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ABSTRACT: Bladder carcinoma is the most common malignant urological tumor in China. We present our preliminary experience and results of laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder in female patients with bladder carcinoma.
From February 2003 to February 2008, 14 female patients with bladder carcinoma underwent LRC with orthotopic ileal neobladder. Nine of these patients underwent hysterectomy and ovariectomy, and the other 5 had preservation of the uterus and ovarian appendage. Standard bilateral pelvic lymphadenectomy was followed by radical cystectomy that was completed laparoscopically with hysterectomy and ovariectomy when needed. The tumor was removed by a 4 - 5 cm lower midline abdominal incision, followed by the construction of ileal neobladder and the extracorporeal anastomosis of ureter-neobladder. The neobladder was anastomosed to the urethral stump under a laparoscope.
The mean operative time and blood loss in the 14 patients were 350.2 minutes and 349.8 ml, respectively. Postoperative complications included uretero-pouch anastomotic stricture in 1 patient and pouch-vaginal fistula in 1 patient. Follow-up time of all patients ranged from 3 to 60 months, and 12 patients were followed up for more than 6 months and achieved micturition in half a year. One patient had occasional day-time urinary incontinence and 2 had night-time incontinence. Two patients who had undergone hysterectomy and ovariectomy had voiding difficulties after one year, which was treated by intermittent self-catheterization. The mean volume of the neobladder and the residual urine were 333.6 ml and 31.2 ml, respectively. Surgical margins were tumor free for all patients. One patient had bone metastasis and died 11 months after the operation.
LRC with orthotopic ileal neobladder in female patients is a technically feasible, safe and mini-invasive procedure with a low morbidity and acceptable neobladder function. Long-term follow-up is required to confirm the neobladder function and oncological outcomes.
Chinese medical journal 06/2008; 121(10):923-6. · 0.86 Impact Factor
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ABSTRACT: To screen and characterize the variable region gene about prostate specific membrane antigen (PSMA) of the Chinese Fab fragment, and to establish a new approach to researches on PSMA and prostate gene therapy.
We used purified PSMA protein as antigen, stuck it on the ELISA plate and scanned the phage Fab fragment antibody library by phage display technology. After five cycles of "absorbing-elution-amplification", we got the Fab fragment phage antibody of PSMA with high antigen binding ability and specificity, and tested it with immunodetection and sequencing.
The sequence of Fd fragment was 696 base pairs encoding 232 amino-acid residues, with 98% homological similarity to the human immunoglobulin gamma chain, while the light chain was constructed by 630 base pairs encoding 210 amino-acid residues, with 93% homological similarity to kappa chain.
Using phage display technology, we obtained the gene sequence of Fab antibody fragment specific to PSMA, and the antibody gene has the classic structural features of immunoglobulin light chain and heavy chain. The coding output of the antibody gene has the specificity and immunological competence to PSMA.
Zhonghua nan ke xue = National journal of andrology 08/2007; 13(7):601-4.
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ABSTRACT: We evaluated our method and effects of needle laparoscopic varicocelectomy for the treatment of varicocele.
72 patients (105 lateral) diagnosed varicocele were performed laparoscopic varicocelectomy under epidural combined intravenous anesthesia from Feb, 2003 to Apr, 2005. Two 2 mm incisions and one 5 mm incision were made on the midline of lower abdomen, by which two 2 mm trocars and one 5 mm trocar were introduced. Vessel-sealing device (Ligasure) was used to seal the internal spermatic veins.
All operations were completed successfully. Mean operation time was 15 minutes unilateral and 21 minutes bilateral. The patients were hospitalized for 3 to 5 days after procedure. Follow-up was scheduled for 6 to 12 months and there was no recurrence.
Needle laparoscopic varicocelectomy gives favorable effect with minimal invasion, rapid recovery, which is the best choice for the treatment of varicocele.
Zhonghua nan ke xue = National journal of andrology 12/2005; 11(11):813-4.
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ABSTRACT: To search and identify the non-steroid receptor binding cis-acting elements in the L-plastin promoter in prostate cancer, and the correlative regulation pathway and transcription factors.
On the basis of construction of the L-plastin promoter luciferase vectors which were removed the steroid hormone receptor AR and ER binding elements, the promoter on the vector was nest-deleted by Exonuclease III and the relative luciferase plasmids were constructed. Transfected these twelve plasmids into prostate cancer cell line LNCaP under dihydrotestosterone-stimulated situation or not and test the intensity of luciferase, then we got the regulation message of every 200 bp part of the promoter in prostate cancer. After the analysis of relative programme, we got the possible regu- lation pathway of non-steroid hormone transcription factors. After removing the possible transcription factors binding site sequence by site-specific mutagenesis, the changes luciferase of activities proved our reasoning.
We succeed in segmental deletion of the L-plastin promoter, and constructing the relative plasmids containing part L-plastin promoter on luciferase vector pGL3-basic. After testing the luciferase activities of constructed plasmids, we found the sequence from 206 to 1 of L-plastin promoter had significant luciferase activity. The software TRANSFECT showed that there were binding elements for transcription factors AP-4 at seq-198 to 192 and SP-1 at seq-54 to 41 on the short part promoter (206 to 1). The recombinant plasmids deleted the AP-4 and SP-1 binding elements had lower luciferase activity than the wild-type.
There are some other non-steroid hormone pathway to regulate the expression of L-plastin except the steroid hormone pathway in prostate cancer. The main binding sites of the non-steroid hormone regulator lies in the sequence from 206 to 1. Transcription factors AP4 and SP-1 may up-regulated the expression of L-plastin by binding these sites.
Zhonghua nan ke xue = National journal of andrology 11/2005; 11(10):731-4.
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ABSTRACT: The laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder is now applied to treat invasive bladder cancer, however, it has not been well codified and illustrated. We describe in this paper a technique step by step that we have developed in 33 patients and achieved excellent results.
The surgical procedure can be divided into eight steps: laparoscopic pelvic lymphadenectomy and mobilization of the distal ureters; exposing Denonvillier's space and the posterior aspect of prostate; exposing retropubic space and anterior surface of the bladder; dividing the lateral pedicles of the bladder and the prostate; dividing the apex of the prostate; extracorporeal formation of the ileal pouch; extracorporeal implantation of the ureters; and laparoscopic urethra-neobladder anastomosis. This operation was performed in 33 patients, 29 males and 4 females, with muscle invasive bladder cancer between December 2002 and September 2004.
The operating time was 5.5-8.5 hours with an average of 6.5 hours; the estimated blood loss was 200-1000 ml with an average of 460 ml. The surgical margins of the bladder specimen were negative in all patients. There was no evidence of local recurrence at follow-up of 1-21 months in all the patients. However lymph node metastases were found in one case at 9 months postoperatively. Most of patients achieved urine control 1 to 3 months after surgery. The daytime continence rate was 94% (31 cases) and nighttime continence rate was 88% (29 cases). Urodynamic evaluation was performed between 3 and 6 months postoperatively for all cases. The mean value of neobladder capacity was (296 +/- 37) ml. The mean value of maximum flow rate was (18.7 +/- 7.1) ml/s. The mean residual urine volume was (32 +/- 19) ml. In all cases, excretory urography at 1 to 2 months postoperatively demonstrated slightly dilated upper urinary tracts without ureteral obstruction, which resolved at follow up. Cystography showed neobladders being similar in shapes to normal. Two small ureteral nipples with intermittently efflux of urine were observed at cystoscopy in most patients. Postoperative complications occurred in 6 of 33 patients (18%), including pouch leakage in 2 cases, pelvic infection in 1, partial small bowel obstruction in 2 and neobladder-vaginal fistula in 1.
The LRC with orthotopic ileal neobladder is a feasible option for bladder cancer when radical cystectomy is indicated. The extracorporeal formation of the ileal pouch and ureteral implantation through a small lower midline incision can simplify the complexity of the procedures, shorten the duration of surgery and reduce the medical expenses.
Chinese medical journal 02/2005; 118(1):27-33. · 0.86 Impact Factor
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ABSTRACT: To report the surgical techniques and results of an 8-year follow-up study of 42 patients with a modified orthotopic ileal neobladder restoring normal anatomical relationship.
Total cystoprostatectomy was performed extraperitoneally. A 45 - 50 cm segment of the ileal loop was isolated, detubularized, and reconfigured into an "M"-shape to form a pouch. Bilateral ureters were implanted by inserting 1 cm distal segment into the pouch. The bottom of pouch was opened and anastomosed with the urethra.
Forty-two patients were followed up for 6 to 96 months,90.5% of whom were continent in the daytime, and 85.7% at night. Two patients had a difficulty in urination. The average volume of the pouch was (361 +/- 48) ml at 12 months postoperation. Urodynamic examination showed the average peak voiding pressure was (86.8 +/- 21.4) cm H(2)O. The average maximum flow rate (Qmax) was (18.4 +/- 6.1) ml/s. No remarkable ureter reflux and obstruction were found. No patient was detected to have urethral carcinoma.
Extraperitoneal cystectomy can avoid the tumor contamination of the abdomen and intestinal interference of the operative field. The ureter-inserting implantation technique is a simple anti-reflux anastomosis method with less ureter stenosis rate. Isolating the neobladder and ureters from the peritoneal cavity can reduce the postoperative complications, such as adhesive ileus, internal hernia, and urine leakage into the peritoneal cavity. The neobladder is similar to the original bladder in position, volume, shape and anti-reflux ureter connection.
Chinese medical journal 01/2004; 116(12):1943-5. · 0.86 Impact Factor
