Advances in Medical Treatment of Primary Aldosteronism

Primary aldosteronism(PA)is the most common form of secondary hypertension,with its main manifestations including hypertension and hypokalemia.Early identification of PA is extremely important as PA patients can easily develop cardiovascular complications such as atrial fibrillation,stroke,and myocardial infarction.The past decade has witnessed the rapid advances in the genetics of PA,which has shed new light on PA treatment.While surgery is the first choice for unilateral diseases,bilateral lesions can be treated with mineralocorticoid receptor antagonists(MRAs).The next-generation non-steroidal MRAs are under investigations.New medications including calcium channel blockers,macrophage antibiotics,and aldosterone synthase inhibitors have provided a new perspective for the medical treatment of PA.

Ultrasound-guided Transversus Abdominis Plane Block Improves Postoperative Analgesia and Early Recovery in Patients Undergoing Retroperitoneoscopic Urologic Surgeries:A Randomized Controlled Double-blinded Trial

Objective To evaluate the effects of ultrasound-guided transversus abdominis plane(TAP) block on postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.Methods This was a randomized,controlled,double-blinded trial.Eligible patients scheduled for retroperitoneoscopic urologic surgeries were randomly assigned to two groups.Group TAP received ultrasound-guided TAP block with 0.5% ropivacaine 20 ml at 30 minutes before surgery,and Group C received TAP sham block with normal saline.All patients received retroperitoneoscopic urologic surgeries under general anesthesia.The primary outcome was the severity of pain after surgery.Secondary outcomes included opioids consumption,analgesics,postoperative nausea and vomiting,time to Foley catheter removal and to passage of flatus,length of post-anesthesia care unit stay and hospital stay.Results Eighty patients completed the study,forty cases in each group.Compared to the Group C,the Group TAP had lower visual analogue scale pain scores within two postoperative days(all P<0.05).They also had less consumption of intraoperative fentanyl(2.0±0.5 vs. 3.8±0.7 μg/kg,P<0.05),reduced incidence of postoperative rescue analgesic usage(12.5% vs. 45.0%,P<0.05),and lower incidence of postoperative nausea and vomiting within postoperative 48 hours(12.5% vs. 25.0%,P<0.05) when compared to the Group C.In addition,Group TAP had a shortened post-anesthesia care unit stay(25±8 vs. 49±12 minutes,P<0.05),and a greater proportion of patients discharged within postoperative three days(57.5% vs. 35.0%,P<0.05).Conclusion Preoperative ultrasound-guided TAP block is an effective technique to improve postoperative analgesia and early recovery in patients undergoing retroperitoneoscopic urologic surgeries.

1.9 μm Thulium Laser Treats Ureteral Carcinoma via Rigid-ureteroscopy

RADICAL nephroureterectomy is the gold standardtreatment for patients with upper urinary tracturothelial cell carcinomas.1 However, ureteroscopehas enabled urologists to easily approach theupper urinary tract and resect tumor.2 Patients for whomendoscopic tumor resection is recommended includedthose with a solitary kidney, renal insufficiency, bilateraltransitional cell carcinoma （TCC） of the upper urinary tract。

Clinical Characteristics and Outcome of Gleason Score 10 Prostate Cancer on Core Biopsy Treated by External Radiotherapy and Hormone Therapy

Objective To evaluate the clinical characteristics and outcomes of patients with Gleason score 10 prostate cancer treated by external radiotherapy and hormone therapy. Methods From January 2003 to March 2014, 1832 patients with prostate cancer were treated, among which 9 patients(represented 0.49%) were identified as Gleason score 10 disease on prostate core biopsy without distant metastases when first diagnosed. All 9 patients were treated by whole pelvic external radiotherapy(The whole pelvic dose was 50.0 Gy and the boost dose ranged from 76.2 to 78.0 Gy) and long-term hormone therapy. We assessed the clinical characteristics, treatment outcomes and treatment toxicities. Survival curves were calculated using the Kaplan-Meier method. Results The median follow-up was 4.8 years. Six patients' pre-treatment prostate-specific antigen(PSA) levels were lower than 20.0 μg/L and three patients' pre-treatment PSA levels were higher than 70.0 μg/L. The median percentage of positive biopsy cores was 91%. Three, four and two cases were classified as T2 c, T3 a and T3 b stage, respectively. Three cases were assessed as N1 stage. The 5-year biochemical failure-free survival, distant metastasis-free survival, cancer specific survival and overall survival rates were 28.6%, 57.1%, 66.7% and 57.1%, respectively. Five patients experienced grade 1-2 acute gastrointestinal toxicities and six patients complained of grade 1-2 acute genitourinary toxicities. No bone fracture or cardiovascular disease was detected. Conclusions Gleason score 10 prostate cancer on core biopsy is usually combined with other high risk factors. The pre-treatment PSA levels lie in two extremes. Timely and active treatments are urgent needed because unfavourable oncological outcomes are often presented.

Ureteral Stent Fragmentation:a Case Report and Review of Literature

SINCE the introduction of double J stents in 1978, ureteral stents have become an integral tool in treating ureteral obstruction from calculi and other causes.1 Owing to the widespread usageof indwelling ureteral catheters,a number of possible complications such as migration,

Effects of Sunitinib Malate on Growth of Human Bladder Transitional Cell Line T24 In Vitro

Objective To investigate the growth-inhibitory effect of sunitinib malate on human bladder transitional cell carcinoma(TCC) in vitro. Methods Human bladder TCC cell line T24 was cultured and exposed to graded concentrations of sunitinib malate for 72 hours in vitro to determine the sensitivities to drug. Cell viability was measured by MTT assay. Cell apoptotic morphology was observed by fluorescence microscope following DAPI staining. Band expressions of Fas, Fas ligand, poly(ADP-ribose) polymerase(PARP) and β-actin were analyzed by Western blot. Wound healing process of T24 cells exposed to sunitinib malate was assayed. Results Sunitinib malate exerted a concentration-dependent and time-dependent inhibitory effect on the T24 cell lines. Fluorescence microscopy showed that small vacuoles appeared in the nuclei of T24 cells and the vacuoles were bigger with higher drug concentrations. The expressions of Fas ligand and PARP in T24 cells treated with sunitinib malate exhibited a concentration-dependent increase. Moreover sunitinib malate suppressed the wound healing process in a concentration-dependent manner. Conclusion Sunitinib malate exerted marked inhibitory activity against bladder cancer cell line T24.

Medical Foreign Bodies in Urinary Bladder: a Case Report

RETAINED foreign bodies in the urinary tract after surgical or diagnostic procedure,named iatrogenic foreign bodies,are rarely reported,though the estimated incidence was as high as1/1500 cases.1Prompt and proper retrieval is required due to potential complications.We report a case of iatrogenic foreign body into the bladder.CASE DESCRIPTION A 60-year-old man had recurrent hematuria for 9months and vesicular mass for 1 month.He received a suprapubic transvesical prostatectomy 9 months ago,but gross hematuria had appeared since then.

Bilateral Ureteral Fibroepithelial Polyps:a Case Report

PRIMARY benign ureteral tumors are rare and they arise from the mesodermal tissue of the ureteral wall.Less than 200 cases have been documented in published reports.1 Bilateral ureteral fibroepithelial polyps are extremely rare and commonly occur in the proximal ureter,causing complete ureteral obstruction.Pyeloplasty is an effective treatment for improving renal function.Here we report a case with sequential bilateral ureteral fibroepithelial polyps causing obstructive hydronephrosis.

Using a fretsaw in treating chronic penial incarceration:A case report

BACKGROUND Penial incarceration(PI)is a rare situation.It is usually caused by a foreign object which strangulates at the base of the penis.PI may derive from pranks,sexual demand,mental disease,or intention to prohibit urinary disease.Generally,these situations are emergent and immediate treatments are needed.Cases of chronic PI are less reported,and their treating methods are yet to be discussed.CASE SUMMARY We reported a case on treating a 73-year-old male who had PI with a metallic hoop for three months.After multidisciplinary consultation,the operation was performed successfully with the help of a fretsaw.Despite the chronic strangulation,the prognosis of the patient was satisfying.To the best of our knowledge,this case was rare and precious as it featured the longest strangulating time,which might enlighten the treating process of future PI cases.Also,we have reviewed and summarized major published cases to encapsulate appropriate approaches when facing diverse strangulation situations.CONCLUSION The selection of surgical tools depends on the material of the strangulating objects,the availability of equipment,and the severity of the penial damage.The urination function may not be affected after three months of incarceration as in our case,whilst prudent preoperative measures and multidisciplinary evaluations are always essential.Although using a fretsaw is comparatively slow,it is safe and feasible to treat metallic penial incarceration.

Status and Change Pattern of Kidney Transplantation:One Center Research

Objective To retrospectively investigate the distribution in kidney transplantation for fifteen years in Peking Union Medical College Hospital.Methods We conducted a descriptive research counting up the number of patients who received kidney transplantation each year in our hospital during 1995 and 2010.Results The first kidney transplantation in our hospital occurred in the 1960s.The number of kidney transplantation increased until reaching a maximum of 47 grafts in 2001;since then the number fell.Conclusions With the decreased number of kidney transplantation,we have realized the shortage of transplantable organs is very serious.The continuing transplant shortage requires major efforts to expand the donor pool.Donation after cardiac death offers the potential to enlarge the donor pool,but we need to strictly control the criteria for potential donors.

Pneumothorax during retroperitoneal laparoscopic partial nephrectomy in a lupus nephritis patient:A case report

BACKGROUND Downgrading target treatment and laparoscopic partial nephrectomy have become increasingly popular in patients with renal cell carcinomas.Rare as it is,pneumothorax is one of the most severe intraoperative complications which needs immediate recognition.On the other hand,as a rheumatological disease,lupus nephritis requires a long period of hormone therapy.Cases of pneumothorax in hormone-consuming renal cancer patients are even fewer.CASE SUMMARY A 39-year-old woman was admitted to our department to take a laparoscopic partial nephrectomy.The patient had a medical history of lupus nephritis and renal clear cell carcinoma with hormone and target treatment.Her blood oxygen saturation dropped to 92%during the operation,and pneumothorax was detected by ultrasound.O2 inhalation and lung dilation were performed.Her vital signs were monitored closely throughout the operation.The operation was accomplished,and she regained consciousness smoothly.A postoperative bedside chest X-ray was conducted after she was transferred to the urosurgery ward,while no evidence of further pneumothorax or lib injury was observed.CONCLUSION Pneumothorax is a severe complication in laparoscopic or robotic-assisted laparoscopic operations,especially in retroperitoneal ones.It is easily neglected unless the injury of the diaphragm is found.Low insufflation pressure and shorter operation time are necessary for patients with a history of long-term hormone consumption or chronic immune system disease.

Combined thoracoscopic and laparoscopic approach to remove a large retroperitoneal compound paraganglioma:A case report

BACKGROUND Paragangliomas(PGLs)are rare catecholamine-secreting neuroendocrine tumors,which often present with secondary hypertension.The most common location is the retroperitoneal space.For the first time,we report a rare case of large retroperitoneal compound PGL,and we have innovatively applied a new surgical plan to completely remove the tumor.CASE SUMMARY A 55-year-old middle-aged man was admitted to the hospital for fluctuating blood pressure for more than 1 year with intermittent headache.He suffered dozens of attacks every day.Blood and urine catecholamines were elevated,somatostatin receptor imaging was positive,and the diagnosis of PGL was clear.The imaging examination revealed a large tumor on the right front of the mediastinal spine at the level of T10-L1(the posterior space of the right phrenic foot).For the first time in our department,a combined thoracoscopic and laparoscopic operation was used to detect and remove large tumors.CONCLUSION This is the first reported case of using a thoracoscopic and laparoscopic approach simultaneously to remove a large retroperitoneal compound PGL,which may provide a new surgical approach for similar cases.

Castleman＇s Disease： A Rare Mass in the Pararenal Retroperitoneum that Mimics Other Tumors

Castleman＇s disease （CD） is a rare lymphoproliferative syndrome typically involving a mediastinal mass. CD in the pararenal area should be distinguished from lymphoma diseases. We analyzed the clinical features often CD patients in the pararenal retroperitoneum that mimics other tumors to summarize some of our experiences and conduct a literature review.

Current Progress and Controversies in Prostate Cancer Management

Objective：The optimal management strategy for prostate cancer （PCa） remains controversial.We performed a systemic review of current progress and controversies regarding the diagnosis and treatment of PCa.Data Sources：We searched PubMed for recently published articles up to July 2017 using the following key words：＂prostate cancer,＂ ＂progress,＂ ＂controversy,＂ ＂immunotherapy,＂ and ＂prevention.＂ Study Selection：Articles were obtained and reviewed to provide a systematic review of the current progress and controversies regarding PCa management.Results：The value of serum prostate-specific antigen （PSA） screening remains controversial,but PSA screening is recommended to facilitate the early diagnosis of PCa in high-risk groups.Prostate biopsy via the transrectal or perineal approach has both advantages and disadvantages.There was a significant correlation between testosterone levels and PCa prognosis.The current research is focused on the mechanisms responsible for PCa.Active surveillance has been proposed as a management strategy for low-risk,localized PCa,but there is an urgent need for further clinical studies to establish the criteria for recommending this approach.The main complications of radical resection for PCa are urinary incontinence and erectile dysfunction,though three-dimensional laparoscopic and robot-assisted laparoscopic techniques have obvious advantages over radical surgery.Radiotherapy is also a therapeutic option for PCa,while immunotherapies may alter the prostate tumor microenvironment.Ongoing studies aim to provide guidance on effective sequential and combination strategies.Prevention remains an important strategy for reducing PCa morbidity and mortality.Conclusions：The diagnosis,treatment,and prevention of PCa are complex issues,worthy of intensive study.Further studies are needed to improve the management of PCa.

High responsivity and flexible deep-UV phototransistor based on Ta-doped β-Ga_(2)O_(3)

Deep-ultraviolet(DUV)phototransistors have shown great potential applications in UV imaging,artificial intelligence,and wearable optoelectronics.Among a large number of wide bandgap semiconductors,the quasi-two-dimensionalβ-Ga_(2)O_(3) is considered as an ideal candidate for DUV photodetector applications.Herein,we report a high responsivity(R)and fully flexible Ta-dopedβ-Ga_(2)O_(3) DUV phototransistor which exhibits outstanding optoelectrical properties with a high R of 1.32×10^(6) A/W,a large detectivity of 5.68×10^(14) Jones,a great photo-to-dark current ratio of 1.10×10^(10)%,a high external quantum efficiency of 6.60×10^(8)%,and an ultra-fast response time of~3.50 ms.Besides,the flexible Ta-dopedβ-Ga_(2)O_(3) device also displays high reliability and mechanical flexibility that can sustain well after over 1×10^(4) bending cycles.Moreover,high-contrast imaging of UV light was obtained on the flexible DUV detector arrays,which can be efficiently trained and recognized by an artificial neural network.Our findings offer a perspective to develop wearable optoelectronics and UV imaging based on high-performance flexibleβ-Ga_(2)O_(3) DUV phototransistors,providing an inspiration for the future work in artificial intelligence and bionic robot fields.