Bacterial adherence in a rat bladder augmentation model: ileocystoplasty versus colocystoplasty

PURPOSE: Various intestinal segments are used to reconstruct the urinary tract. For unclear reasons asymptomatic chronic bacteriuria is common in patients treated with reconstruction. We compared bacterial adherence in ileum, colon and bladder in rats with ileal and colonic bladder augmentation. MATERIALS AND METHODS: Bladder augmentation using ileum or colon was performed in 8-week-old rats. After 3 months urinary pH was measured and urine was cultured. Urovirulence factors of Escherichia coli aspirated from the augmented bladders were detected by polymerase chain reaction. In rats with negative urine culture after augmentation experimental cystitis was induced by the transurethral inoculation of E. coli C5, with type I pili and aerobactin or E. coli C92 with type I pili, P fimbriae and aerobactin at a concentration of 10(5) colony forming units per 0.3 ml. After 14 days we counted the colony forming units per cm.(2) of bladder and cm.(2) of intestinal augmentation tissue. RESULTS: When cultures were negative, mean urinary pH plus or minus standard deviation for ileocystoplasty (7.35 +/- 0.33) was significantly higher than that for colocystoplasty (6.80 +/- 0.45) or in controls (6.67 +/- 0.30). Bacterial colonization occurred in 60 of 96 ileocystoplasties (62.5%) and 36 of 68 colocystoplasties (52.9%). All 32 E. coli strains aspirated from ileocystoplasties had type I pili. In colocystoplasties 14 strains had type I pili, 4 had P fimbriae and type I pili, and 1 had no virulence factor. In experimental cystitis in the ileal patch and bladder there were 10(3.2) to 10(6.2) (log mean 4.9) and 10(1.1) to 10(5.1) (log mean 3.5) colony forming units of E. coli C5, respectively. In the colonic patch and bladder there were 10(2.2) to 10(6.2) (log mean 3.9) and 10(2.1) to 10(5.1) (log mean 3.7) colony forming units of E. coli C5, respectively. In the ileal patch and bladder versus the colonic patch and bladder there were 10(3.2) to 10(6.2) (log mean 5.0) and 10(3.1) to 10(6.1) (log mean 4.5) versus 10(3.2) to 10(6.2) (log mean 4.3) and 10(2.1) to 10(6.1) (log mean 3.8) colony forming units of E. coli C92, respectively. E. coli C5 adhered to more ileum than bladder, while bacterial adherence did not differ for colon and bladder. Adherence of E. coli C92 did not differ significantly in bladder and implanted ileum or colon. CONCLUSIONS: The colonic segment offers more resistance to E. coli than the ileal segment in urinary diversion.     

回肠膀胱扩大术治疗结核性挛缩膀胱的效果观察

目的探讨回肠膀胱扩大术治疗结核性挛缩膀胱的诊治经验及疗效。方法回顾性分析2016年9月至2017年8月遵义医科大学附属医院7例晚期泌尿系结核患者的临床资料。所有患者经抗结核治疗2~4周后行患肾切除术,并在抗结核治疗2~6个月后行保留原膀胱的回肠膀胱扩大术。结果所有患者术后平均住院13.6d,均能自行排尿,术后2周最大膀胱容量扩大至120~209mL,平均180mL。术后1个月膀胱最大容量扩大至310~375mL,平均354mL。健侧肾积水、肾功能损伤以及膀胱残余尿情况在术后有加重趋势,尤其在术后3个月最严重,但术后6个月上述情况均较术后3个月时明显好转(P<0.05),而与术前比较差异无统计学意义(P>0.05)。术后1个月生活质量评分(SF-36)与术前比较差异无统计学意义(P>0.05),而术后3个月及术后6个月生活质量较术前改善,差异具有统计学意义(P<0.05)。所有患者尿频、尿急、尿失禁症状均有明显改善,肾功能未出现进一步恶化。结论保留原膀胱的回肠膀胱扩大术是治疗晚期肾结核挛缩膀胱的有效方法。     

应用基因芯片技术比较两种不同表型的胆管癌组织中基因表达的差异

目的 研究与胆管癌侵袭、转移表型及预后相关的基因表达情况。方法 应用基因芯片（cDNA array）技术,从两个胆管癌标本分离得到的 mRNA逆转录合成探针,分别与尼龙膜上的14802个基因进行杂交,杂交后的膜经扫描仪成象和软件进行光密度分析后得出表达发生改变的基因。结果 所分析的14802个基因或序列中,表达差异的基因或序列共有754条,其中有455条是已知功能的基因,经进一步分析得出有30余条是比较有意义的,如:MUC18、KGF、TCF-4、PSP94、Smad5、TACC1、α-Catenin、Syndecan-1、Angiogenin、myosin等。结论 胆管癌组织中与肿瘤转移及预后相关的基因是很多的,应用基因芯片技术,为同时分析多个基因的表达状况提供了一个可用的方法,这一方法为了解不同生命过程中基因表达概况提供了一种途径。     

利用高通量基因芯片建立与分析单侧隐睾症睾丸基因表达谱

目的:利用高通量基因芯片技术分析单侧隐睾症睾丸组织中差异表达的基因。方法:抽提6例单侧隐睾症患者和3例正常生育男性患者睾丸组织中mRNA,反转录后,探针标记cDNA。使用高通量cDNA微阵列人类全基因表达谱基因芯片(45 034个基因)检测睾丸组织基因表达谱。差异表达基因在MAS系统中进行Path-way和GO分析。结果:Ratio>3.0或<0.33的数据项为差异表达的基因,单侧隐睾症患者睾丸生精组织中共检测到346个差异表达基因。其中上调基因60个,主要分布在1、15、5和19号染色体,集中在细胞周期、纤毛或鞭毛运动、DNA复制等聚类。下调基因286个,主要分布在1、19、16和11号染色体等,集中在精子发生和抗凋亡相关的基因聚类中。结论:单侧隐睾症涉及多功能基因表达的变化;单侧隐睾症睾丸基因表达谱的建立可为分析单侧隐睾症的遗传因素和探讨其生精功能异常的病因提供新的理论基础。     

回肠膀胱腹壁造瘘术与Bricker术的疗效对比

目的分别对全膀胱切除术后行回肠膀胱腹壁造瘘术、Bricker术的膀胱尿路上皮癌患者进行长期随访,评价两种尿流改道术式的临床疗效。方法 2010年1月至2019年4月,我科共行98例全膀胱切除术,其中57例行回肠膀胱腹壁造瘘术(造瘘术组),41例行Bricker术(Bricker术组),比较两种不同术式患者的一般资料、围手术期情况、术后并发症等。结果两组一般临床资料比较,差异无显著统计学意义(P>0.05);造瘘术组平均手术时间(4.4±0.3)h,显著低于Bricker术组(5.8±0.3)h(P<0.05),但两组在术中出血、术后住院时间、术后拔除盆腔引流管时间、术后拔除输尿管支架时间等方面无统计学差异(P>0.05);造瘘术组术后总肾功异常发生率(2.0%vs.11.2%)、造瘘口周围皮炎及疤痕发生率(0.0%vs.10.2%)均显著低于Bricker术组(P<0.05)。此外,两组患者在随访时间、术后TNM分期、漏尿、肠梗阻、肾积水、膀胱结石、回肠造瘘口坏死或狭窄等方面均无统计学差异(P>0.05)。结论与Bricker术相比,回肠膀胱腹壁造瘘术临床疗效可靠,手术疗效无明显差别,但手术时间更短,术后总肾功异常发生率更低、造瘘口并发症更少,可弥补Bricker术的不足,有望成为更加理想的尿流改道术式。     

Analysis of vitamin D-regulated gene expression in LNCaP human prostate cancer cells using cDNA microarrays

BACKGROUND: 1,25-dihydroxyvitamin D(3) [1,25(OH)2D3] exerts growth inhibitory, pro-differentiating, and pro-apoptotic effects on prostate cells. To better understand the molecular mechanisms underlying these actions, we employed cDNA microarrays to study 1,25(OH)2D3-regulated gene expression in the LNCaP human prostate cancer cells. METHODS: mRNA isolated from LNCaP cells treated with vehicle or 50 nM 1,25(OH)2D3 for various lengths of time were hybridized to microarrays carrying approximately 23,000 genes. Some of the putative target genes revealed by the microarray analysis were verified by real-time PCR assays. RESULTS: 1,25(OH)2D3 most substantially increased the expression of the insulin-like growth factor binding protein-3 (IGFBP-3) gene. Our analysis also revealed several novel 1,25(OH)2D3-responsive genes. Interestingly, some of the key genes regulated by 1,25(OH)2D3 are also androgen-responsive genes. 1,25(OH)2D3 also down-regulated genes that mediate androgen catabolism. CONCLUSIONS: The putative 1,25(OH)2D3 target genes appear to be involved in a variety of cellular functions including growth regulation, differentiation, membrane transport, cell-cell and cell-matrix interactions, DNA repair, and inhibition of metastasis. The up-regulation of IGFBP-3 gene has been shown to be crucial in 1,25(OH)2D3-mediated inhibition of LNCaP cell growth. 1,25(OH)2D3 regulation of androgen-responsive genes as well as genes involved in androgen catabolism suggests that there are interactions between 1,25(OH)2D3 and androgen signaling pathways in LNCaP cells. Further studies on the role of these genes and others in mediating the anti-cancer effects of 1,25(OH)2D3 may lead to better approaches to the prevention and treatment of prostate cancer.     

Effect of ileocystoplasty on contractile response of the bladder,ileum, and cystoplastic ileal segment

Bladder augmentation or substitution with ileal segments is being used to a greater extent in recent years. The goal of the present study is to characterize the physiologic and pharmacologic changes in the ileal segment that occur following ileal cystoplasty. Four weeks following ileocystoplasty in rabbits, the contractile response of sections of normal terminal ileum, bladder body, and the cystoplastic segment of ileum (ileocystoplasty) was studied in isolated muscle baths. Results were as follows: 1) The ileum responded to a maximal dose of bethanechol with an increase in the amplitude and frequency of phasic contractions whereas the bladder displayed a rapid and sustained increase in basal tension. The cystoplastic ileal segment showed a marked increase in basal tension with superimposed phasic contractions. 2) Maximally effective doses of ATP and methoxamine reduced tension in the normal ileal segments but contracted both the bladder and cystoplastic ileal segments. 3) Isoproterenol reduced tension in all three segments. The pharmacological response of the cystoplastic segment of ileum significantly shifted from that of the ileum toward the response of the bladder. This effect is important as a manifestation of the functional plasticity of smooth muscle.     

Urodynamic comparison of ileum vs. sigmoid in augmentation cystoplasty for neurogenic bladder dysfunction

We performed multichannel urodynamics before and after augmentation Cystoplasty in 26 patients (11 females, 15 males) to determine which bowel segment is best to achieve a large volume and low pressure reservoir. All 26 patients had a neurogenic cause for their bladder dysfunction, lleum was used in 14 patients and sigmoid was used in 12 patients. Detubularization was performed in all patients. Capacity improved significantly in both the ileum and the sigmoid group after surgery. When detubularized ileum was used, the maximum amplitude of uninhibited reservoir contractions was significantly improved or eliminated postoperatively. When sigmoid was used, uninhibited reservoir contractions did not significantly improve postoperatively and were, in fact, more common than preoperatively. Despite the detubularization, pressure waves were identified in 15 of the 26 patients postoperatively. There was significant improvement in end filling pressures at capacity (compliance) with both ileum and sigmoid postoperatively. However, end filling pressures were significantly higher in the sigmoid group. In conclusion, good capacity was achieved with both ileum and sigmoid postoperatively. However, ileum provided lower reservoir pressures and better compliance. We feel that urodynamically detubularized ileum is better suited than sigmoid for augmentation Cystoplasty in patients with neurogenic bladder dysfunction. © 1995 Wiley-Liss, Inc.     

应用微阵列方法探讨室管膜瘤的基因表达谱

目的　了解室管膜瘤的差异基因表达状况。方法　术中收集 4例新鲜室管膜瘤及 1例正常脑组织标本 ,提取总RNA逆转录合成32 P标记探针。按Atlas微阵列试剂盒说明书操作获得微阵列杂交图 ,应用专用软件分析 ,并以RT PCR验证。结果　与正常脑组织相比 ,有 3 1个基因在室管膜瘤的病理组织中表达上调 ,1个下调。大部分基因是首次发现在该肿瘤中有异常表达。结论微阵列技术高通量、高效率地揭示了室管膜瘤与正常脑组织间的差异表达基因 ,为研究该肿瘤的分子病理学提供了新信息     

腹腔镜下回肠膀胱扩大术治疗低顺应性膀胱的初步临床结果

目的 探讨腹腔镜回肠膀胱扩大术治疗低顺应性膀胱的有效性和安全性.方法 回顾性分析2011年6月至2013年12月浙江省人民医院泌尿外科收治的36例接受腹腔镜下回肠膀胱扩大术式治疗的高反射、低顺应性膀胱患者的资料.根据纳入排除标准共22例患者纳入本研究,其中男性13例,女性9例;年龄22 ～ 62岁,平均35.8岁.其中脊髓损伤15例,脊髓发育不良4例,泌尿系统结核3例.病程1 ～15年,平均8.5年.对术中、围手术期并发症进行观察评价,对术前、术后3、6、12、18、24、36个月患者的血肌酐水平、肾积水情况、肾小球滤过率及尿流动力学检查参数的比较采用单因变量多因素方差分析.结果 患者手术均在腹腔镜下顺利完成,手术时间90 ～ 150 min,平均(105±17) min,术中出血量60 ～ 150 ml,平均(90±26) ml,术后肠道功能恢复时间2～5d,平均(2.5±0.7)d,术后住院时间11 ～20 d,平均(15 ±4)d,术后均未发生回肠吻合口瘘、肠梗阻、严重腹腔感染或败血症等并发症.患者术后随访6 ～36个月,平均16.5个月,17例患者随访超过12个月.患者膀胱安全容量由术前的(103±38)ml增至术后末次随访的(405±46)ml (F=381.7,P=0.000),膀胱顺应性由术前的(10±3)cmH2O(1 cmH2O=0.098 kPa)增至末次随访的(38±4)cmH2O(F=678.1,P=0.000),末次随访时充盈期末膀胱内平均压力为(16±6) cmH2O,较术前的(45±16)cmH2O明显降低(F=221.5,P=0.000),血肌酐水平从术前的(184±32) μmol/L降至末次随访的(120±28)μmol/L(F=189.1,P=0.000),总肾小球滤过率从术前的(40±26)ml-1·min-1·1.73 m-2升至末次随访的(66±32)ml-1·min-1· 1.73 m-2(F=137.7,P=0.000).3例泌尿系统结核膀胱挛缩患者的最大尿流率明显增加,残余尿量有所减少,另有4例女性患者术后恢复自行排尿.结论 腹腔镜下回肠膀胱扩大术治疗低顺应性膀胱安全可行,具有创伤小、出血量少、肠道功能恢复快、术后并发症较少等优点,可明显改善术后膀胱功能,有效改善和保护患者的上尿路功能.     

腹腔镜下全膀胱切除加原位回肠代膀胱术的临床疗效(附12例报告)

目的：探讨腹腔镜下全膀胱切除加原位回肠代膀胱术的手术方法和临床效果。方法：对12例浸润性膀胱移行细胞癌Ⅱ～Ⅲ级患者行腹腔镜下全膀胱切除加原位回肠代膀胱术,观察手术时间、术中出血量、术后肠道功能恢复情况及术后并发症等于术效果。结果：手术时间7～10h,术中失血600～1500ml,术后约72h恢复肠道功能。术后2周拔除输尿管导管,术后3周拔尿管后腹压排尿正常,术后3个月IVU复查未见肾积水,未出现并发症。结论：该术式具有微创、出血少、恢复快等特点,将成为治疗浸润性膀胱癌的较好方法之一。     

Prediction of lymph node metastasis by analysis of gene expression profiles in non-small cell lung cancer

OBJECTIVE: Non-small cell lung carcinoma (NSCLC) is one of the leading causes of death in the world. Lymph node metastasis is not only an important factor in estimating the extent and the metastatic potential of an NSCLC but also in prognosticating the patient outcome. Preoperative prediction of lymph node metastasis might greatly facilitate the choice of appropriate surgical and medical options in patients with NSCLC. METHODS AND RESULTS: Using a cDNA array, we analyzed the expression profiles of 1,289 genes in 92 cancer tissues of NSCLC (37 squamous cell carcinomas and 55 adenocarcinomas). We divided the patients into two groups (classes) for each of various pathological factors, such as lymph node metastasis and pT-stage. For each pair of classes, we searched for an optimal combination of genes to classify the cases using a sequential forward selection algorithm starting from a gene set that showed significant difference in expression between the classes. We used the leave-one-out error cross-validation on a k-nearest neighbor classifier to sequentially choose the gene. Using the optimized set of genes, it was possible to stratify the patients for lymph node metastasis (pN-stage) and pT-stage at, respectively, 100% (23 genes) and 100% (55 genes) for cases with squamous cell carcinomas and 94% (43 genes) and 92% (35 genes) for those with adenocarcinomas. CONCLUSION: We conclude that expression profiling using feature selection provides a powerful means of stratification (personalization) of NSCLC patients and choice in treatment options, particularly for factors such as lymph node metastasis whose radiological diagnosis is presently incomplete.     

Functional improvement in spinal cord injury-induced neurogenic bladder by bladder augmentation using bladder acellular matrix graft in the rat

Spinal cord injury (SCI) rostral to the lumbosacral level causes bladder hyperreflexia and detrusor-sphincter dyssynergia (DSD), which are accompanied by bladder hypertrophy. We hypothesize that bladder augmentation using a bladder acellular matrix graft (BAMG) can improve the function of SCI-mediated neurogenic bladder. In female rats (n = 35), SCI was induced by transection of the spinal cord at the lower thoracic level. Eight weeks following spinalization, bladder augmentation using BAMG was performed after hemicystectomy of the hypertrophic bladder. Cystometrography was performed at 8 weeks after spinalization and again at 8 weeks after augmentation. Several urodynamic parameters were measured and the grafted bladder was histologically evaluated. Thirty one rats were alive 8 weeks after spinalization. Twenty two (71%) rats developed hyperreflexic bladders and nine (29%) rats had underactive bladders before bladder augmentation. Twenty six rats survived until 8 weeks after augmentation. Urodynamic parameters showed improvement in some bladder functions in both hyperreflexic and underactive bladders after augmentation. In addition, bladder compliance was increased in hyperreflexic bladders and decreased in underactive bladders. Bladder augmentation decreased bladder capacity in high-capacity rats and increased it in low-capacity rats. Histological evaluation showed complete regeneration of BAMG in SCI-induced neurogenic bladder at 8 weeks after augmentation. This is the first report suggesting that the voiding function in SCI-induced neurogenic bladder can be improved by augmentation using BAMG. Improved voiding function was accompanied by histological regeneration of BAMG.     

机器人辅助回肠膀胱扩大术治疗神经源性膀胱的初步经验

目的:探讨机器人辅助回肠膀胱扩大术治疗神经源性膀胱的可行性、安全性和临床疗效。方法:回顾性分析2017年3月至2018年11月浙江省人民医院收治的12例神经源性膀胱患者的病例资料,男11例,女1例。平均年龄38(12~67)岁。12例术前均有尿失禁、排尿障碍以及膀胱安全容量减小、膀胱内压力增高导致输尿管反流等症状,病因...     

利用cDNA微列阵技术分析胰腺癌相关基因表达谱

目的：利用cDNA微列阵技术分析胰腺癌相关基因表达谱来寻找下一步研究的目标基因。方法：利用含有18000个cDNA克隆的微列阵，对2例正常胰腺组织和4例中分化胰腺癌标本行基因表达谱分析。结果：2份混合癌组织样品分别有1484和1353条差异表达基因，表达趋势相同的有455条，上调基因102条，下调基因353条，已知基因274条，未知功能EST181条，差异2倍以上的基因各占27．8％和52．0％，已知差异基因中包括抑癌基因、生长因子及其受体基因、信号传导相关基因、转寻调节因子等。结论：cDNA微列阵技术为分析胰腺癌相关基因表达谱提供了有力的工具,MBD1、EDG1等基因和过甲基化表达调控可能在胰腺癌发病机制中起着关键作用。     

Heparanase protein and gene expression in bladder cancer

PURPOSE: We determined the association of heparanase protein and messenger (m)RNA expression with bladder cancer invasion and metastasis. MATERIALS AND METHODS: The expression of heparanase protein and mRNA was assessed by immunohistochemical staining and in situ hybridization, respectively, in 67 bladder cancer specimens resected at various stages of disease. To our knowledge this is the first systematic study of heparanase protein and mRNA expression in human bladder cancer. RESULTS: The expression of heparanase protein in muscular invasive bladder cancer was significantly higher than in superficial cancer (68% versus 19%, p = 0.0001). It was higher in the primary tumor of patients with lymph node metastatic cancer than those with nonmetastatic cancer (80% versus 37%, p = 0.0006). In high grade disease it was significantly higher than in low grade disease (79% versus 29%, p = 0.0001). The expression of heparanase mRNA was also significantly higher in stage pT3 or greater than in stage pT2 or less bladder cancer (96% versus 33%, p = 0.0003). In metastatic N+ cases it was significantly higher than in nonmetastatic bladder cancer (93% versus 46%, p = 0.0037). The heparanase gene and protein showed similar patterns of expression in bladder cancer. CONCLUSIONS: Our study implies that the expression of heparanase protein and mRNA is associated with bladder cancer invasion and metastasis, and heparanase may have a role in disease progression.