Granulocytic sarcoma with long spinal cord compression:A case report

BACKGROUND As an extramedullary form of proliferating myeloblasts,granulocytic sarcoma(GS)is common in patients with acute myeloid leukemia.GS in the central nervous system is rare,and an intraspinal space-occupying lesion caused by GS is even rarer.Surgical decompression is often necessary to remove the intraspinal space-occupying lesion.To the best of our knowledge,we report,for the first time a case of GS that caused extensive compression in the spinal canal without surgical decompression treatment.CASE SUMMARY A 15-year-old male suddenly developed numbness and weakness in his lower limbs for 10 d,which affected his walking ability.Acute myeloid leukemia was later diagnosed in the Department of Hematology.Magnetic resonance imaging revealed that multiple segmental space-occupying lesions were causing severe spinal cord compression in the thoracic spinal canal.As a result,the patient received routine chemotherapy before surgery.Interestingly,the intraspinal space-occupying lesions completely diminished on magnetic resonance imaging after a course of chemotherapy,and the sensation and strength in his lower limbs markedly recovered.CONCLUSION An intraspinal space-occupying lesion could be the first symptom of acute myeloid leukemia,causing spinal nerve compression without any other symptoms.Following standard chemotherapy,spinal canal compression can be quickly relieved,and the spinal cord and nerve function restored,avoiding emergency surgery.

“Zero ischemia”laparoscopic partial nephrectomy by high-power GreenLight laser enucleation for renal carcinoma:A single-center experience

BACKGROUND Laparoscopic partial nephrectomy has been widely used in renal cell carcinoma treatment.The efficacy of GreenLight laser on Laparoscopic partial nephrectomy is still unknown.AIM To present the first series of laparoscopic partial nephrectomy(LPN)by GreenLight laser enucleation without renal artery clamping.Due to the excellent coagulation and hemostatic properties of the laser,laser-assisted LPN(LLPN)makes it possible to perform a“zero ischemia”resection.METHODS Fifteen patients with T1a exogenous renal tumors who received high-power GreenLight laser non-ischemic LPN in our hospital were retrospectively analyzed.All clinical information,surgical and post-operative data,complications,pathological and functional outcomes were analyzed.RESULTS Surgery was successfully completed in all patients,and no open or radical nephrectomy was performed.The renal artery was not clamped,leading to no ischemic time.No blood transfusions were required,the average hemoglobin level ranged from 96.0 to 132.0 g/L and no postoperative complications occurred.The mean operation time was 104.3±8.2 min.The postoperative removal of negative pressure drainage time ranged from 5.0 to 7.0 d,and the mean postoperative hospital stay was 6.5±0.7 d.No serious complications occurred.Postoperative pathological results showed clear cell carcinoma in 12 patients,papillary renal cell carcinoma in 2 patients,and hamartoma in 1 patient.The mean creatinine level was 75.0±0.8μmol/L(range 61.0-90.4μmol/L)at 1 mo after surgery,and there were no statistically significant differences compared with pre-operation(P>0.05).The glomerular filtration rate ranged from 45.1 to 60.8 mL/min,with an average of 54.0±5.0 mL/min,and these levels were not significantly different from those before surgery(P>0.05).CONCLUSION GreenLight laser has extraordinary cutting and sealing advantages when used for small renal tumors(exogenous tumors of stage T1a)during LPN.However,use of this technique can lead to the generation of excessive smoke.

Conditional Knockout of Src Homology 2 Domain-containing Protein Tyrosine Phosphatase-2 in Myeloid Cells Attenuates Renal Fibrosis after Unilateral Ureter Obstruction

Background：Src homology 2 domain-containing protein tyrosine phosphatase-2 （SHP-2） is a kind of intracellular protein tyrosine phosphatase.Studies have revealed its roles in various disease,however,whether SHP-2 involves in renal fibrosis remains unclear.The aim of this study was to explore the roles of myeloid cells SHP-2 in renal interstitial fibrosis.Methods：Myeloid cells SHP-2 gene was conditionally knocked-out （CKO） in mice using loxP-Cre system,and renal interstitial fibrosis was induced by unilateral ureter obstruction （UUO）.The total collagen deposition in the renal interstitium was assessed using picrosirius red stain.F4/80 immunostaing was used to evaluate macrophage infiltration in renal tubular interstitium.Quantitative real-time polymerase chain reaction and enzyme linked immunosorbent assay were used to analyze the production of cytokines in the kidney.Transferase-mediated dUTP nick-end labeling stain was used to assess the apoptotic renal tubular epithelial cells.Results：Src homology 2 domain-containing protein tyrosine phosphatase-2 gene CKO in myeloid cells significantly reduced collagen deposition in the renal interstitium after UUO.Macrophage infiltration was evidently decreased in renal tubular interstitium of SHP-2 CKO mice.Meanwhile,the production of pro-inflammatory cytokines was significantly suppressed in SHP-2 CKO mice.However,no significant difference was observed in the number of apoptotic renal tubular epithelial cells between wild-type and SHP-2 CKO mice.Conclusions：Our observations suggested that SHP-2 in myeloid cells plays a pivotal role in the pathogenesis of renal fibrosis,and that silencing of SHP-2 gene in myeloid cells may protect renal from inflammatory damage and prevent renal fibrosis after renal injury.

The prognostic value of lymphovascular invasion in radical prostatectomy, a systematic review and meta-analysis

To systematically evaluate the prognostic value of lymphovascular invasion （LVI） in radical prostatectomy （RP） by a meta-analysis based on the published literature. To identify relevant studies, PubMed, Cochrane Library, and Web of Science database were searched from 1966 to May 2014. Finally, 25 studies （9503 patients） were included. LVI was found in 12.2% （1156/9503） of the RP specimens. LVI was found to be correlated with higher pathological tumor stages （greater than pT3 stage） （risk ratio [RR] 1.90, 95% confidence interval [CI] 1.73-2.08, P〈 0.00001）, higher Gleason scores （greater than GS = 7） （RR 1.30, 95% CI 1.23-1.38, P 〈 0.00001）, positive pathological node （pN） status （RR 5.67, 95% CI 3.14-10.24, P 〈 0.00001）, extracapsular extension （RR 1.72, 95% CI 1.46-2.02, P 〈 0.00001）, and seminal vesicle involvement （RR 3.36, 95% CI 2.41-4.70, P 〈 0.00001）. The pooled hazard ratio （HR） was statistically significant for Biochemical Recurrence-Free （BCR-free） probability （HR 2.05, 95% ／ CI 1.64-2.56; Z = 6.30, P〈 0.00001）. Sensitivity analysis showed that the pooled HR and 95% CI were not significantly altered by the omission of any single study. Begg＇s Funnel plots showed no significant publication bias （P = 0.112）. In conclusion, LVI exhibited a detrimental effect on the BCR-Free probability and clinicopathological features in RP specimens, and may prove to be an independent prognostic factor of BCR.

Improved closure techniques for laparoscopic partial nephrectomy in moderately complex renal cell carcinoma

Laparoscopic partial nephrectomy(LPN)as a minimally invasive nephron-sparing surgery is gradually becoming the preferred surgical treatment for T1a renal carcinoma since it yields faster post-operative recovery and equivalent oncological outcomes to radical nephrectomy.[1]However,it is difficult to perform LPN for complex renal tumors,resulting in a longer warm ischemic time(WIT),which consequently affects the recovery of post-operative renal function.[2]With the development of laparoscopic instruments and techniques and the accumulating experience of surgeons,the WIT during LPN may be shortened using anatomy-based early unclamping(EUC)[1]after the placement of one or two running sutures on the tumor bed.In this study,we improved the closure techniques for LPN using EUC in patients with complex renal tumors and assessed their effectiveness.