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Objective: The aim of this study was to explore a new treatment strategy for left renal vein tumor thrombus directed at the thrombus level and the therapeutic effect of robotic surgery. Ma...

To evaluate the application of laparoscopic extended partial cystectomy (PC) and bilateral extended pelvic lymph node dissection (PLND) for the treatment of urachal carcinomas (UrCs).Combined laparoscopic extended PC and bilateral extended PLND was performed in 16 cases with UrCs in our hospital between April 2009 and December 2012. The surgical procedure included the dilation of the extraperitoneal space, circumscription of the umbilicus, dissection from the umbilicus caudad to the dome of the bladder, excision of the tumor, and the suture of the bladder. The average age of the patients was 52.8 years (35-73 years). The average tumor size was 3.2 cm (1.5-5.6 cm). A median follow-up period of 36 months was obtained to evaluate patient survival and recrudescence.All 16 procedures were completed laparoscopically without open conversion. The median operation time was 85 minutes (65-125 minutes), with a median estimated blood loss of 50 mL (30-110 mL). The median hospital stay was 5 days (4-7 days). The bladder margins were negative in all cases. However, five cases were confirmed postoperatively with positive lymph nodes. No intraoperative or postoperative complications occurred. Histopathology confirmed mucous urachal adenocarcinoma in 11 cases, mixed carcinoma in 1 case, and papillary adenocarcinoma in 4 cases. After a median follow-up period of 36 months, the 2- and 3-year survival rates were 62.5% (10/16) and 50% (8/16), respectively.Combined laparoscopic extended PC and bilateral extended PLND is a safe and feasible method for treating patients with urachal malignancy.

Renal cell carcinoma (RCC) is the most common malignancy involving the kidneys and a major cause of cancer mortality. The involvement of microRNA (miRNA) expression in the tumorigenesis and progression of RCC has been previously highlighted. Therefore, we conducted this study to investigate whether microRNA-363 (miR-363) affects the development of RCC via the Janus tyrosine kinases (JAK2)-signal transducers and activators of transcription (STAT) axis by targeting the growth hormone receptor (GHR), by observing the changes that occurred in the RCC and the normal adjacent tissues of patients with RCC. RCC cells were transfected with a series of miR-363 mimic, miR-363 inhibitor, or small interfering RNA against GHR to determine the influence of miR-363 on the expression of GHR and JAK2-STAT3 axis-related genes with the use of reverse transcription quantitative polymerase chain reaction and Western blot analysis. The angiogenesis, viability, invasion, and migration of cells were evaluated by means of in vitro angiogenesis, 3-(4,5)-dimethylthiahiazo (-z-y1)-3,5-di-phenytetrazoliumromide (MTT), wound-healing, and Transwell assays. The results revealed reduced miR-363 expression and elevated GHR expression in RCC. It was also found that miR-363 altered the activation of the JAK2-STAT3 axis through the inhibition of GHR. Cells treated with the miR-363 inhibitor presented with increased capillary vessels, cell viability, invasion, and migration, whereas it was on the contrary in the RCC cells with overexpressed miR-363. These results implicated that the overexpression of miR-363 could specifically bind to GHR to downregulate the expression of GHR, which, in turn, inactivates the JAK2-STAT3 axis, thereby influencing the angiogenesis, cell invasion, and migration abilities in RCC.

BACKGROUND Current studies indicated that PCDH17 functions as a tumor suppressor, which is frequently inactivated by aberrant promoter methylation in urologic tumors. The main purpose of this study was to investigate the methylation status of PCDH17 in serum and its clinical significance in renal cell carcinoma (RCC). MATERIAL AND METHODS The methylation status of PCDH17 in serum samples of 142 RCC patients and 34 controls was evaluated by methylation-specific PCR (MSP). Then we correlated PCDH17 methylation status with the clinicopathologic features of RCC patients and patient outcomes. RESULTS We found that PCDH17 was more frequently methylated in RCC patients than in controls. Moreover, PCDH17 methylation in serum was significantly correlated with advanced stage (p=0.044), higher grade (p=0.019), lymph node metastasis (p=0.008) and tumor progression (p

Purpose: To explore the mechanisms underlying clear-cell renal cell carcinoma (ccRCC) metastasis using transcriptional profiling and bioinformatics analysis of ccRCC samples, and to elucidate the role of FOXO3a in ccRCC metastasis. Experimental Design: Gene expression profiling was performed using four primary metastatic and five primary nonmetastatic ccRCC samples. The mRNA and protein levels of FOXO3a in ccRCC samples were investigated by real-time reverse transcription PCR and immunohistochemistry, respectively. The association between metastasis-free survival of patients with ccRCC and FOXO3a mRNA levels was analyzed. Biologic functions of FOXO3a in renal cancer cell lines were investigated. The influence of FOXO3a on tumor metastasis was also studied in vivo orthotopic xenograft tumor model. Finally, the mechanism by which FOXO3a attenuation could increase invasion and migration of tumor cells was explored. Results: Bioinformatics analysis of the profiling data identified FOXO3a as a key factor in ccRCC metastasis. FOXO3a expression was decreased in primary metastatic ccRCC samples. Patients with low FOXO3a mRNA levels had poor metastasis-free survival (P = 0.003). Knocking down FOXO3a induced tumor cell invasion and migration in the nonmetastatic ccRCC cells. Induced FOXO3a overexpression in SN12-PM6 cells could inhibit tumor metastasis in vivo. Downregulation of FOXO3a increased SNAIL1 expression, thereby activating the epithelial–mesenchymal transition (EMT) of RCC cell lines. Conclusions: The loss of FOXO3a induced EMT of tumor cells by upregulating SNAIL1, which promoted tumor cells metastasis in vitro and in vivo. Thus, FOXO3a could be considered as an independent prognostic factor in ccRCC metastasis and could be a marker of occult metastases. Clin Cancer Res; 20(7); 1779–90. ©2014 AACR.

// Qing Bo Huang 1,* , Xin Ma 1,* , Hong Zhao Li 1 , Qing Ai 1 , Shang Wen Liu 2 , Yu Zhang 1 , Yu Gao 1 , Yang Fan 1 , Dong Ni 3 , Bao Jun Wang 1 and Xu Zhang 1 1 Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China 2 Department of Urology, Chinese PLA 303 Hospital, Nanning, China. 3 Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, China. Correspondence: Xu Zhang, email: // Keywords : Kidney neoplasms, Neoplasm metastasis, Cell communication, Signal transduction, Angiogenesis Received : January 2, 2014 Accepted : March 14, 2014 Published : March 14, 2014 Abstract The Notch ligand Delta-like 4 (DLL4) plays an important role in tumor angiogenesis, which is required for tumor invasion and metastasis. Here we showed that DLL4 was elevated in endothelium and Notch signaling was activated in renal cell carcinoma (RCC). Exogenous DLL4 induced RCC cell migration and invasion by activating intercellular Notch signaling. Importantly, the DLL4/Notch/Hey1/MMP9 cascades connecting the endothelium to the cancer cells in metastasis were identified. Knockdown of Hey1 decreased expression of MMP9 and attenuated tumor invasion. The clinical investigation on 120 cases of RCC specimens indicated that expressions of Hey1 and MMP9 correlated with DLL4 density. Moreover, univariate and multivariate analyses showed that tumor hematogenous metastasis not only was depended on microvessel density but was also associated with tumor size and DLL4 density. During 4-year surveillance, high-level of DLL4 density was associated with a higher probability of developing metastasis and being sensitive to target therapies. Our data suggest that RCC progression is caused in part by activated DLL4/Notch signaling, interaction of endothelium and cells, which can be therapeutically targeted.

Purpose: The purpose of this study was to introduce a new method for locating the renal artery during retroperitoneal laparoscopic renal surgery. Patients and Methods: The medial arcuate ligament (MAL) is a tendinous arch in the fascia under the diaphragm that arches across the psoas major muscle and is attached medially to the side of the first or the second lumbar vertebra. The renal artery arises at the level of the intervertebral disc between the L1 and L2 vertebrae. We evaluate the role of the MAL that serves as an anatomic landmark for locating the renal artery during retroperitoneal laparoscopic renal surgery. Results: There is a reproducible consistent anatomic relationship between MAL and the renal artery in 210 cases of retroperitoneal laparoscopic renal surgery. Two main types of the MAL, the “narrow arch” and the “fascial band” types, can be observed. Conclusion: MAL can serve as an accurate and reproducible anatomic landmark for the identification of the renal artery during retroperi...

To our knowledge we present the initial experience with and the short-term outcome of laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy using conventional instruments.Between June 2009 and April 2010, 25 patients underwent laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy. A TriPort™ Access System was inserted through a 2.5 to 3.0 cm transverse skin incision below the tip of the 12th rib. Adrenalectomy was done using a 5 mm 30-degree laparoscopic camera and 2 conventional laparoscopic instruments. After Gerota's fascia was incised we explored the first dissection plane between the perirenal fat and the anterior renal fascia at the superomedial side of the kidney. The adrenal gland was identified at the initial stage of the operation.Laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy was successfully accomplished in 23 patients. An additional 5 mm port was required in 1 of the 2 unsuccessful cases and in the other it was necessary to convert to standard anatomical retroperitoneoscopic adrenalectomy. Median incision length was 3.0 cm, median operative time was 55 minutes and median estimated blood loss was 15 ml. No major intraoperative complications occurred. In the initial 10 cases median operative time was significantly longer (62 vs 50 minutes) and median blood loss was significantly higher (75 vs 10, each p0.001) than in the subsequent 15. In 3 cases pheochromocytoma was successfully excised without undesirable hemodynamic oscillation. Postoperative complications developed in 2 patients, including angina and contralateral atelectasis in 1 each.In properly selected patients laparo-endoscopic single site anatomical retroperitoneoscopic adrenalectomy with conventional instruments is feasible, safe and effective, causes minimal morbidity and results in excellent cosmesis.

To develop a new porcine model with horn of the uterus to mimic an enlarged ureter for training for laparoscopic ureteral reimplantation (LUR) and to evaluate its feasibility.Ten female pigs were used in the training. The pig was placed to a dorsal position after an anesthetic was administered. The horn of the uterus near the bladder was dissected, then spatulated and trimmed to replace the enlarged ureter. LUR was performed according to standard operation steps. Four trainees completed the LUR procedure based on a mentor-trainee model to guarantee the success of the procedure and the quality of the anastomoses. The learning curve of operative time was analyzed. The anastomotic stoma was cut off postoperatively and checked extracorporeally. After the course, questionnaire surveys were sent to the trainees to investigate satisfaction of the training and assess the impact of the training on their learning of "real" LUR in future practice.This model reproduced the key technique steps of LUR. Four LUR procedures were performed on each pig. The operative time declined from 170.0 +/- 10.3 minutes to 90.3 +/- 3.7 minutes (P0.01) after the trainees had performed 10 LURs. There was proper stitching in each "ureterovesical" anastomosis. At the end of training, all trainees could accomplish a LUR procedure skillfully on the model; they were satisfied after the course and thought the training was helpful to future practice of LUR.The new model was feasible and cost-effective for training in the basic skills of laparoscopic ureteral reconstruction procedures.

Raf kinase inhibitor protein (RKIP) has been shown to be a metastasis suppressor in many kinds of malignant tumors. But its function in breast cancer was not yet clarified completely. We detected RKIP expression in clinical samples of primary breast cancer, breast cancer metastases, and in different breast cancer cells. Compared with the normal breast epithelia, benign breast epithelia, or in situ ductal carcinoma, the expression level of RKIP is decreased in invasive carcinoma and significantly reduced or lost in the metastasis lymph node matched to the invasive carcinoma. To explore the potential role of RKIP in breast cancer metastasis, we studied the effect of RKIP on the malignant phenotypes of the breast cancer cells with ectopically overexpression or knockdown of RKIP. Cell proliferation, soft-agar colony formation, in vitro adhesion assay, invasion, and migation assays were done to examine the malignant phenotypes of the transfected cells. Consequently, RKIP has no effect on in vitro proliferation rate or colony-forming ability of MDA-MB-435 cells. In vitro cell invasion and migration assays indicated that the RKIP expression was inversely associated with the invasiveness of MDA-MB-435 cells. Consistent with these results, in the orthotopic murine models, we observed that overexpression of RKIP in breast cancer cells impaired invasiveness and metastasis, whereas down-regulation of RKIP expression promoted invasiveness and metastasis. These results indicate that RKIP is a metastasis suppressor gene of human breast cancer. (Mol Cancer Res 2009;7(6):832–40)

Loss of function of metastasis suppressor genes is an important step in the progression to a malignant tumor type. Studies in cell culture and animal models have suggested a role of Raf kinase inhibitor protein (RKIP) in suppressing the metastatic spread of prostate cancer, breast cancer, and melanoma cells. However, the function of RKIP in ovarian cancer (OVCA) has not been reported. To explore the potential role of RKIP in epithelial OVCA metastasis, we detected the expression levels of RKIP protein in tissue samples from patients with epithelial OVCA. Consequently, the expression of RKIP is reduced in the poorly differentiated OVCA than in the well-differentiated and moderately differentiated OVCA. In addition, in vitro cell invasion assay indicated that the RKIP expression was inversely associated with the invasiveness of five OVCA cell lines. Consistent with this result, the cell proliferation, anchorage-independent growth, cell adhesion, and invasion were decreased in RKIP overexpressed cells but increased in RKIP down-regulated cells. Further investigation indicated that RKIP inhibited OVCA cell proliferation by altering cell cycle progression rather than promoting apoptosis. Furthermore, the overexpression of RKIP suppressed the ability of human OVCA cells to metastasize when the tumor cells were transplanted into nude mice. Our data show the effect of RKIP on the proliferation, migration, or adhesion of OVCA cells. These results indicate that RKIP is also a metastasis suppressor gene of human epithelial OVCA. (Mol Cancer Res 2008;6(6):917–28)

We present our experience with retroperitoneoscopic renal pedicle lymphatic disconnection. We compared the clinical efficacy of this treatment for chyluria with that of open surgery.From January 1998 to June 2004, 53 patients (55 renal units) with chyluria underwent renal pedicle lymphatic disconnection via the retroperitoneoscopic and conventional open approaches. The diagnosis of chyluria was confirmed by the ether test and the side of chylous reflux was determined by cystoscopy. Operative time, intraoperative blood loss, postoperative intestinal recovery and hospital stay were evaluated. Increases in hemoglobin and serum albumin were compared before and after surgery during followup.Retroperitoneoscopic renal pedicle lymphatic disconnection or open surgery was performed successfully in all patients. In terms of operative time, intraoperative blood loss, postoperative intestinal recovery and hospital stay retroperitoneoscopy was superior to conventional open surgery. During retroperitoneoscopy the inferior vena cava was injured in 1 case but repaired successfully by laparoscopy without conversion to open surgery. Postoperative gross hematuria in 1 case disappeared 4 days later. In the open surgery group the renal segmental artery was inadvertently injured in 1 case and anastomosis was performed successfully. Wound healing was delayed in 1 case due to hypoalbuminemia. Recurrence developed in 2 patients during the 6 to 84-month followup.Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria has the advantages of minimal invasion and rapid recovery compared with open surgery.

Previous investigations have demonstrated that the neuronal activity in the lateral hypothalamic area (LHA) is respectively modulated by afferent inputs from the gastric vagal nerves innervating the upper gastrointestinal tract, as well as the cerebellar interpositus nucleus (IN). The aim of this study was to examine whether the gastric vagal and cerebellar IN inputs converge onto single LHA neurons in rats, especially those sensitive to glycemia. Of the 114 LHA neurons recorded, 60 (52.6%) and 51 (44.7%) responded to gastric vagal and cerebellar IN stimulation, respectively. Of the 60 LHA neurons responsive to gastric vagal stimulation, 30 also responded to the cerebellar IN stimulus, indicating a convergence of gastric vagal and cerebellar inputs onto single hypothalamic cells. When the gastric vagal nerves and cerebellar IN were stimulated simultaneously, a summation of the responses was observed in all 6 neurons tested. Moreover, of 24 neurons that responded to both the gastric vagal and cerebellar IN stimuli, 15 (62.5%) were identified as glycemia-sensitive. These results demonstrate that the visceral information transmitted by the gastric vagal nerves and the somatic information forwarded by the cerebellar IN converge onto single LHA neurons, especially those sensitive to glycemia. The findings also suggest that integration of somatic-visceral responses related to short-term feeding regulation may take place in the LHA.

To evaluate renorrhaphy techniques and to analyze surgical outcomes in retroperitoneal laparoscopic partial nephrectomy.A retrospective study from January 2008 to December 2011 analyzed 526 patients with renal tumors in whom renorrhaphy was changed from one layer, interrupted, figure-of-eight (n = 228) suture to two layers, continuous, unknotted (n = 298) suture. All procedures were carried out by the same laparoscopic surgeon (XZ). Patient demographics, tumor characteristics, operative outcomes and perioperative renal function were compared.Median follow up for one layer, interrupted, figure-of-eight suture and two layers, continuous, unknotted suture was 31 and 28 months, respectively. The two layers, continuous, unknotted suture group had shorter warm ischemia time (P = 0.021), faster removal of Jackson-Pratt drains (P = 0.029) and shorter hospital stay (P = 0.037) than the one layer, interrupted, figure-of-eight suture group. There was a trend towards a better preservation of glomerular filtration rates in the two layers, continuous, unknotted suture group (P = 0.045). In a multivariable model, the two layers, continuous, unknotted suture technique was a statistically significant independent predictor of warm ischemia time (P = 0.01), hospital stay (P = 0.001) and estimated glomerular filtration rates (P = 0.043).Two layers, continuous, unknotted suture renorrhaphy allows better outcomes than one layer, interrupted, figure-of-eight suture renorrhaphy in retroperitoneal laparoscopic partial nephrectomy. A longer clinical follow-up evaluation is warranted.

Partial nephrectomy is currently the standard treatment for clinical T1 renal neoplasms, as it can provide oncologic outcomes equivalent to radical nephrectomy. The aim was to evaluate the efficacy of self-retaining suture (SRS) in renorrhaphy technique in retroperitoneal laparoscopic partial nephrectomy (LPN) for a single renal mass of moderate or high complexity by assessing peri-operative outcomes.A retrospective analysis was done of 64 patients between 2010 and 2012 for complex renal mass (RENAL score ≥ 7) in whom retroperitoneal LPN was performed with two layers using continuous knotless barbed suture (Quill PDO SRS group; n = 34) and absorbable vicryl (non-SRS group; n = 30), respectively. Cases were matched for RENAL score. All the surgical procedures were performed by the same surgeon with experience of more than 500 cases of LPN. Comparisons were made in patients and preoperative outcomes and peri-operative complications between SRS group and non-SRS group.Mean warm ischemia time (WIT) in SRS group was less than non-SRS group (18.0 vs. 24.8 minutes, P = 0.021). Renorrhaphy suture cost in SRS group was lower than non-SRS group ($269.6 vs. $335.8, P = 0.001). There were no significant differences between the two groups for postoperative changes in creatinine and estimated glomerular filtration rate and the rate of peri-operative complications.SRS was safe for complex renal tumor with two layers, continuous and unknot suture, during LPN and would reduce the WIT and renorrhaphy suture cost significantly.

Background Endothelial DLL4 plays an important role in controlling of tumor angiogenesis, which is required for tumor invasive growth and metastasis. However, the regulation of DLL4 in clear cell renal cell carcinoma (ccRCC) has not yet been systematically elucidated. Methodology We performed bioinformatical analysis to explore miRNAs targeting DLL4. miR-30a was selected as a representative to validate its functional association in endothelial cell. Then, the expressions of DLL4 and mature miR-30a from 90 cases of ccRCC and 28 cases of nonmatched adjacent non-tumor tissues were measured by quantitative real-time PCR. Finally, the expression of miR-30a was correlated with DLL4 expression, tumor features (metastatic condition and microvessel density), and patient metastasis-free survival. The univariate and multivariate analyses were performed to select the risk factors associated with hematogenous metastasis, respectively. Principal Findings miR-30a negatively regulated DLL4 and inhibited the proliferation and migration of endothelial cells. DLL4 was up-regulated in ccRCC and further increased in hematogenous metastatic cases, while miR-30a was down-regulated in tumor tissues and further decreased in hematogenous metastatic ccRCC (student t test, all p

To increase awareness of the anatomical variation of the posterior lumbar tributaries of the left renal vein in retroperitoneoscopic left living donor nephrectomy.A total of 61 cases of retroperitoneoscopic left living donor nephrectomy were carried out from March 2008 to June 2010. The anatomical variations of the posterior lumbar tributaries of the left renal vein in these patients were noted.According to the variation of posterior lumbar tributaries, there were seven types in total, including five main types (accounts for 95.1%, 58/61 cases) and the type of reno-hemi-azygo-lumbar trunk (AZV; accounts for 16.4%, 10/61 cases). According to the number of posterior lumbar tributaries, no lumbar vein covers accounted for 16.4% (10/61 cases), one lumbar vein accounted for 47.5% (29/61 cases), two lumbar veins accounted for 32.8% (20/61 cases) and three lumbar veins accounted 3.3% (2/61 cases). According to the operation time during the process of managing posterior lumbar veins, it was type 4 (AZV) on which the surgeon spent the most time (P0.05), and type 5 (no lumbar vein) on which the surgeon spent the least time (P0.05).This is the first report of the anatomical variation of the posterior lumbar tributaries of the left renal vein in retroperitoneal laparoscopic left living donor nephrectomy. Detailed knowledge of these anatomical variations will undoubtedly help surgeons to avoid the potential risk of vein damage during nephrectomy and to obtain a longer renal artery for the following renal transplantation.

To review a single-institution experience with retroperitoneal laparoscopic living donor nephrectomy (RLDN).Fifty-eight donors underwent RLDN at our institution (including 32 male and 26 female donors aged 20-61 years, mean 42 years). Left nephrectomy was performed in 56 cases. The first 35 patients underwent total RLDN, and the latter 23 received modified RLDN.RLDN was performed successfully in all the patients without conversion to open surgery. The mean surgical time was 93 min (range 70-130 min), and the mean blood loss was 20 ml (range 10-50 ml), with a mean warm ischemia time of 2.8 min (1.3-6 min). Retroperitoneal hematoma occurred postoperatively in one case. The mean hospital stay of the donors was 6.4 days (5-10 days). Two recipients showed delayed graft function, and one graft was lost because of acute rejection. The other recipients had normal renal function in two weeks except for 3 having normal renal function in 4 weeks.RLDN is a safe procedure with minimal invasiveness, and the modified RLDN lowers the learning curve of the surgery.

To investigate the relationship between raf kinase inhibitor protein (RKIP), a novel metastasis suppressor gene, and metastasis of ovarian carcinoma.Immunohistochemistry, RT-PCR, and western blot analysis were performed to examine the expression of RKIP in clinical samples of ovarian tumors and five human ovarian carcinoma cell lines. Stable cell lines over-expressed or deleted of RKIP were cloned to investigate the function of RKIP in ovarian cancer cells. The recombinant plasmids expressing sense (ss) or antisense (as) RKIP cDNA or empty vector was transfected into ovarian cancer cell line SKOV3 by lipofectamine. The expression level of mitogen-activated protein kinase/extracellular signal-regulated kinase kinase (MEK) and extracellular signal-regulated kinase (ERK) in ovarian cancer cells were detected by western blot analysis. Assays of cell proliferation, soft-agar colony formation, cell adhesion, and cell invasion in vitro were used to examine the malignant phenotypes of the transfected cells. Flow cytometric analysis was performed to observe the effect of RKIP on cell cycle distribution before and after transfection.(1) The expression levels of RKIP protein in ovarian carcinoma tissues from patients were found to be reduced than those in ovarian benign tumor and borderline tumor. SKOV3 clones stably expressing full-length recombinant ssRKIP, asRKIP, and their respective empty vector were obtained. (2) RKIP was able to block basal levels of MEK and ERK in ovarian cancer cells. The expression level of phosphorylation MEK in ssRKIP#1 and ssRKIP#4 cells were 0.35, 0.34; while the expression level of phosphorylation ERK in ssRKIP #1 and ssRKIP #4 cells were 0. 48 and 0.46. (3) Abilities of cell proliferation in the ssRKIP vector-transfected cells were decreased compared with that in the non-transfected cells (P0.01). (4)Anchorage-independent growth in the ssRKIP#1 and ssRKIP#4 cells (83.7 +/- 5.7, 106.0 +/- 9.2) were decreased compared with that in the empty vector-transfected cells (158.3 +/- 14.6, P0.01). (5)Cell adhesion in the ssRKIP#1 and ssRKIP#4 cells [(68.3 +/- 0.8)%, (64.1 +/- 0.9)%] were decreased compared with that in the non-transfected cells [(100.0 +/- 1.1)%, P0.01]. (6) Cell invasion in the ssRKIP#1 and ssRKIP#4 cells (24 +/- 5, 25 +/- 4) were decreased compared with that in the non-transfected cells (68 +/- 5, P0.01). (7) ssRKIP cells had a significant increase in the G1 phase and decrease in the G2 + S phase.RKIP could inhibits the metastasis, but also the growth of ovarian cancer cells. patients were found to be reduced than those in ovarian benign tumor and borderline tumor. SKOV3 clones stably expressing full-length recombinant ssRKIP, asRKIP, and their respective empty vector were obtained. (2) RKIP was able to block basal levels of MEK and ERK in ovarian cancer cells. The expression level of phosphorylation MEK in ssRKIP#1 and ssRKIP#4 cells were 0.35, 0.34; while the expression level of phosphorylation ERK in ssRKIP #1 and ssRKIP #4 cells were 0.48 and 0.46. (3) Abilities of cell proliferation in the ssRKIP vector-transfected cells were decreased compared with that in the non-transfected cells (P0.01). (4) Anchorage-independent growth in the ssRKIP#1 and ssRKIP#4 cells (83.7 +/- 5.7, 106.0 +/- 9.2) were decreased compared with that in the empty vector-transfected cells (158.3 +/- 14.6, P0.01). (5) Cell adhesion in the ssRKIP#1 and ssRKIP#4 cells [(68.3 +/- 0.8)%, (64.1 +/- 0.9)%] were decreased compared with that in the non-transfected cells [(100.0 +/- 1.1)%, P0.01]. (6) Cell invasion in the ssRKIP#1 and ssRKIP#4 cells (24 +/- 5, 25 +/- 4) were decreased compared with that in the nontransfected cells (68 +/- 5, P0.01). (7) ssRKIP cells had a significant increase in the G1 phase and decrease in the G2 + S phase.RKIP could inhibits the metastasis, but also the growth of ovarian cancer cells.

To present a new technique of retroperitoneoscopic Anderson-Hynes dismembered pyeloplasty (AHDP) in infants and children with ureteropelvic junction obstruction (UPJO) based on our clinical experience.From March 2003 to February 2007, retroperitoneoscopic AHDP was performed in 60 (44 boys and 16 girls) UPJO infants and children with a three-port lateral retroperitoneal approach. The retroperitoneal space was entered via a 1-cm longitudinal incision beneath the 12th rib and further developed by a glove balloon. Video-retroperitoneoscopy was undertaken with a 5-mm laparoscope between the mid axillary line and 1 cm away from the superior border of iliac crest. Dismembered pyeloplasty was carried out with the Anderson-Hynes anastomosis where 5-0 or 6-0 vicryl sutures were over a double-J ureteric stent. Anastomosis was completed with freehand intracorporeal suture techniques. Follow-up studies were conducted by intravenous urography and renal ultrasonography.Among the 60 patients (62 sides) with retroperitoneoscopic AHDP, only the first two cases were converted to open surgery due to difficulties in developing the retroperitoneal space, and the remaining cases succeeded. The average operative time was 70 +/- 12.6 min (ranging from 55 to 130 min), the average estimated blood loss was 10 +/- 2.2 ml (ranging from 5 to 20 ml), and the average postoperative hospital stay was 7 +/- 1.3 days (ranging from 3 to 15 days). Aberrant artery vessel was intraoperatively observed in seven patients. Postoperative urinary leakage occurred in two patients, but spontaneously disappeared on the 6th and 11th days after the surgery, respectively; and one of them underwent open surgery for recurrent UPJO 8 months later. During an average follow-up period of 24 months, we performed radiographic assessment by intravenous urography and found that all the cases showed good results except the patient who underwent open surgery later.Our experience with retroperitoneoscopic AHDP demonstrates that this technique is safe, effective and time saving for treating UPJO in infants and children.

To investigate the relationship between the expression of RASSF1A protein and promoter hypermethylation of RASSF1A gene, RASSF1A protein expression was measured by Western blotting in 10 specimens of normal bladder tissues and 23 specimens of bladder transitional cell carcinoma (BTCC). The promoter methylation in BTCC and normal bladder tissues was detected by methylation-specific PCR (MSP). The results showed that the expression level of RASSF1A protein was significantly lower in BTCC tissues than that in normal bladder tissues. However, it was not correlated with its clinical stages and pathological grades. The frequency of promoter methylation of RASSF1A gene was higher in BTCC tissues than that in normal bladder tissues. In 14 patients with the aberrant promoter methylation, 13 showed loss or low expression of RASSF1A protein. It is concluded that RASSF1A gene promoter methylation may contribute to the low level or loss of RASSF1A protein expression, the inactivation of RASSF1A gene and the genesis of BTCC. But, it may bear no correlation with its clinical stages and pathological grades.

Several studies have implicated the dorsomedial hypothalamic nucleus (DMN) in regulation of feeding behavior and body weight, but clear mechanisms by which it controls food intake are not well understood. We report the results of the present study, which showed that the DMN receives important peripheral short- and long-term feeding-related afferent signals, including gastric vagal, glycemia, and cholecystokinin (CCK) inputs, as well as from leptin, an adipostatic signal that forcefully inhibits food intake and increases metabolic rate. Among the 279 DMN neurons recorded, 173 (62.0%) responded to stimulation of gastric vagal nerves. Also, of the 123 DMN neurons responsive to gastric vagal stimulation that were tested with the administration of intravenous glucose, 75 (61.0%) were identified as being glycemia sensitive. Moreover, it is noteworthy that of the 23 DMN neurons that responded to both gastric vagal and intravenous glucose stimulation, most (19 of 23, 82.6%) were sensitive to circulating leptin, and some neurons (n = 7) were also responsive to systemic CCK, suggesting that gastric vagal, glycemic, CCK, and leptin inputs converge on single DMN neurons. Furthermore, synergistic interactions between leptin and glucose on single DMN neurons were observed (n = 6). These results demonstrate that those important peripheral feeding-related gastric vagal, glycemic, CCK and leptin signals not only reach the DMN but also interact on single DMN neurons, suggesting that the DMN may not just function as a relay station, but independently integrate the short-term and long-term feeding-associated information and actively participate in the direct regulation of feeding behavior.

To evaluate the operative methods and clinical role of retroperitoneoscopic operation for adrenal cysts.Clinical data from five male and nine female patients with a mean age of 43.5 years (range 25-68 years) who underwent retroperitoneoscopic operation for adrenal cysts from February 2000 to May 2005 were analyzed retrospectively. There were six lesions on the left side and eight on the right. The median diameter of the lesions was 8.1 cm (range 4.6-12.5 cm).Retroperitoneoscopy was successful in all the 14 cases and included 9 cyst decortications and 5 partial adrenalectomies. The median operative time, median blood loss, and mean postoperative hospital stay were 45.5 minutes (range 19-83 minutes), 34.5 mL (range 10-60 mL), and 4.0 +/- 0.8 days, respectively. No major postoperative complications occurred except for one case of subcutaneous emphysema and one of wound infection. The mean analgesic requirement for opioids and diclofenac sodium was 0 and 4.8 +/- 1.1 doses, respectively. With a median follow-up of 12 months (range 6-36 months), no recurrence was found.As a safe and reliable method, retroperitoneoscopic surgery can be a good treatment option for adrenal cysts.

To our knowledge we introduce the technique of anatomical retroperitoneoscopic adrenalectomy.From February 2000 to October 2005 anatomical retroperitoneoscopic adrenalectomy was performed in 800 consecutive patients with adrenal lesions using a 3 port lateral retroperitoneal approach. After incising Gerota's fascia 3 relatively bloodless planes were entered consecutively to expose and separate the adrenal gland. When entering the first dissection plane between the perirenal fat and anterior renal fascia located at the superomedial side of the kidney, the adrenal could be identified at the initial stage of the operation. The following dissections proceeded in the plane between the posterior renal fascia and the lateral aspect of perirenal fat, and then in the avascular plane located on the parenchymal surface of the upper renal pole. The adrenal vein was dealt with at the final stage. Operative time was defined as the time from skin incision to skin closure.Mean +/- SE operative time was 45 +/- 19.1 minutes (range 25 to 230) and mean estimated blood loss was 25 +/- 10.6 ml (range 5 to 200). Average time to oral intake and ambulation were 1.2 and 1.0 day, respectively. Minor postoperative complications occurred in 12 patients (1.5%). Major complications and perioperative mortality were not observed. The procedures resulted in marked clinical improvements in patients with a hormone secreting tumor, except in 6 with idiopathic adrenal hyperplasia.Anatomical retroperitoneoscopic adrenalectomy is a safe, effective, technically efficient procedure for surgical adrenal diseases.

Purpose: We retrospectively investigated the advantages of retroperitoneoscopic nephrectomy for nonfunctioning tuberculous kidneys by comparing its clinical results, operative methods and skills with those of open nephrectomy. Materials and Methods: Clinical data on 22 patients with nonfunctioning tuberculous kidneys who underwent retroperitoneoscopic nephrectomy, including simple and subcapsular nephrectomy, were compared with those on 22 who underwent open nephrectomy for a similar indication during the same period. Results in the 2 groups were analyzed. Results: There was no statistical difference between the retroperitoneoscopy and open surgery groups with regard to patient age, sex or mean operative time ± SD (93.0 ± 12.6 vs 92.6 ± 35.5 minutes). Mean blood loss was significantly less in the retroperitoneoscopy group than in the open surgery group (78.3 ± 60.6 vs 160 ± 120.0 ml). Mean hospital stay after operation was notably shorter in the retroperitoneoscopy group compared with the open surgery group (3.3 ± 0.9 vs 9.1 ± 0.8 days). The mean analgesic requirement for opioids and diclofenac sodium was also lower in the retroperitoneoscopy group than in the open surgery group (0 vs 2.1 ± 0.9 and 5.2 ± 1.1 vs 5.8 ± 1.3 doses, respectively). Conclusions: Retroperitoneoscopic nephrectomy for renal tuberculosis has several advantages over open nephrectomy, namely a smaller wound, less blood loss and more rapid recovery. It may provide a safe and reliable method for treating refractory renal tuberculosis clinically.

To evaluate retroperitoneal laparoscopic partial or total adrenalectomy for primary aldosteronism.From February 2000 to September 2003, 130 patients (76 women and 54 men) with a confirmed diagnosis of primary aldosteronism underwent retroperitoneal laparoscopic operation. Of the 130 cases, there were 119 cases with Aldosterone-producing Adenoma and 11 cases with Idiopathic Adrenal Hyperplasia (unilateral of 2 cases). Eleven cases with Idiopathic Adrenal Hyperplasia underwent unilateral adrenalectomy. Of the 119 cases with Aldosterone-producing Adenoma, 61 cases underwent total adrenalectomy, and 58 cases underwent partial adrenalectomy. All cases were with preoperatively high plasma aldosterone, low plasma rennin and hypokalemia and arterial hypertension.Operations were successfully performed in all cases. The operative time ranged from 15 to 225 min (mean 52 +/- 40 min, Md = 43 min) and the operative bleeding ranged from 0 to 200 ml (mean 23 +/- 34 ml, Md = 20 ml, zero bleeding means that less than 5 ml) without blood transfusion. The hospital length of stay was ranged from 3 to 9 d (mean 5.1 +/- 1.3 d). No major complication occurred. Kalemia was normalized within one month and aldosterone/PRA ratio was decreased obviously in all cases. Postoperatively blood pressure was normalized within 2 month in 88 cases without using any drug.It is safe and practical to perform retroperitoneal laparoscopic partial on total adrenalectomy on the patients with primary aldosteronism.

Objectives To evaluate the feasibility and clinical efficacy of retroperitoneal laparoscopic nephron-sparing surgery for renal tumors. Methods Between June 2002 and February 2004, 11 cases of renal benign tumor and 21 cases of renal malignant tumor underwent enucleation of the tumor and wedge resection of the tumor through retroperitoneal laparoscopy, respectively. Tumor resection and hemostasis were mainly achieved by harmonic scalpel. Follow-up studies were performed with an evaluation using renal spiral computed tomography. Results All procedures were technically successful. The mean operating time was 70 minutes for enucleation and 96 minutes for wedge resection. The mean estimated blood loss was 35 mL for enucleation and 65.5 mL for wedge resection. The mean hospital stay after surgery was 6.5 days. No intraoperative complications occurred. The pathologic examination confirmed renal cell carcinoma in 21 patients and angiomyolipoma in 11. The pathologic stage was pT1a in the 21 patients with renal cell carcinoma. All resected tumor specimens had negative surgical margins for cancer. No local recurrence or trocar site metastasis was observed during a mean follow-up period of 13 months. Conclusions Our results indicate that retroperitoneal laparoscopic nephron-sparing surgery represents a feasible option for patients with localized renal tumors. This procedure could offer precise and complete tumor excision while minimizing morbidity, improving cosmesis, and shortening convalescence.