Objective To investigate and compare the effects of minimally invasive percutaneous nephrolithotomy for renal upper calyceal stones with approaches through upper edge of the 1 lth rib and lower edge of the 11th fib.Methods Two hundred and sixteen cases of kidney stones in our hospital from July 2008 to July 2010 were reviewed.Of which 66 patients were renal calyceal stones.Thirty-two patients underwent the approach through upper edge of the 11th rib (group A),with 15 males and 17 females,with a mean age of 42 years.Ten cases with stone were located on the left side,right 21 cases,and bilateral 1 case,with calculi average maximum diameter of 1.9 cm.Thirty-four cases underwent the approach through lower edge of the 11th path (B group),with 14 males and 20 females,with a mean age of 44 years.Thirteen cases with stone were located on the left side,right 21 cases,with calculi average maximum diameter of 1.7 cm.The two groups underwent minimally invasive percutaneous nephrolithotomy holmium laser lithotripsy lithotomy.The average puncture time,one-time success rate of puncture and disposable stone-free rate were compared.Results Puncture time of group A was 3.0-14.0 min,with an average of 5.8 min,and group B was 3.0-17.0 min with an average of 6.4 min.The disposable puncture success rate of the two groups was 100％.Disposable stone-free rate was 100％ in group A (32/32),and 88％ in group B (30/34) (P ＜ 0.05).There were no pneumothorax,hemothorax,abdominal viscera injury in two groups.Conclusions The minimally invasive percutaneous nephrolithotomy through the approach of upper edge of the llth fib was better than through the approach of conventional lower edge of 11 subcostal margin,with shorter percutaneous renal access distance,and higher stone-free rate.

150 ml in 22 patients (31%).Ten patients (14%) had detru-sor instability.Six patients were incapable to void during the test. The volume of first bladder sensation was(203.25?107.53)ml (range,125 -630 ml) in the diabetes patients.The bladder capacity was (428.09?227.89)ml (range,220 -1350 ml).The maximum flow rate was (10.70?3.27) ml/min.The residualurine volume was (100.57?108.08) ml.In early stage group the volume of first bladder sensation was(151.67?24.07) ml;while in progressive stage group it was (268.16?13.90)ml,and bladder capacitywas (592.97?252.51)ml.The maximum flow rate was (8.61?2.04) ml/min. PQmax was (33.16?19.81)cm H2O (1 cm H2O=0.098 kPa).The residual urine volume was (169.03?137.25) ml. Theseparameters were all abnormal. In the detrusor strips test,the threshold of the tension which made the detrusorstrips contract was significantly higher in T2DM rats [(0.72?0.33) g] than in control rats [(0.32?0.18)g] (F=59.63,P

The changes in excitability and autorhthmicity of bladder detrusor in experimental non-insulin dependent diabetes mellitus (NIDDM) rats were observed. Sixty-nine NIDDM rats as NIDDM group and 69 normal rats as control group were enrolled into this experimental study. At 6th, 10th, 14th, 18th, 22nd and 26th week after the rats were injected last time, the changes in the excitability and autorhthmicity of detrusor strips in vitro were observed. The results showed that the threshold of the tension which made the detrusor strips contract was significantly higher in NIDDM group (0.716 +/- 0.325 g) than in control group (0.323 +/- 0.177 g) (F = 59.63, P < 0.001). At different stages, the threshold of the tension resulting the contract of the detrusor strips in NIDDM group was also higher than in control group. At 18th week after STZ injection, the frequency of spontaneous contract of the detrusor strips in NIDDM was significantly higher than in control group (P < 0.05), whereas at 22nd week, that in NIDDM group was significantly lower than in control group (P < 0.05). It was concluded that the decreased excitability of the bladder detrusor was the earliest and most obvious changes in bladder function in diabetes rats and the autorhthmicity had also changed at the early stage of diabetic bladder.
Diabetes Mellitus, Experimental/*physiopathology ; Diabetes Mellitus, Type 2/physiopathology ; Muscle Contraction/physiology ; Muscle Relaxation/physiology ; Rats, Wistar ; Urinary Bladder/*physiopathology ; Urinary Bladder Diseases/etiology ; Urinary Bladder Diseases/*physiopathology

AIMTo elucidate possible mechanisms underlying the differences between 1S-[1a,2b,3b,4a(S*)]-4-[7-[[1-(3-chloro-2-thienyl)methylpropyl]propyl-amino]-3H-imidazo[4,5-b]pyridyl-3-yl]-N-ethyl-2,3-dihydroxycyclopentane carboxamide (AMP- 579) and adenosine in pharmacological and clinical effects. METHODSNa+/Ca2+ exchange current was recorded by patch-clamp technique in whole-cell configuration. RESULTSAMP579 significantly enhanced both outward and inward Na+/Ca2+ exchange currents in a concentration dependent manner. Neither infusion of an adenosine A1 receptor antagonist PD116948 30 μmol*L-1 or an adenosine A2 receptor antagonist DMPX 10 μmol*L-1 nor a protein kinase A special blocker KT 5720 0.2 μmol*L-1 or a protein kinase C special blocker GF 109203X 0.4 μmol*L-1 had effect on Na+/Ca2+exchange current increased by AMP579, suggesting that AMP579 possess a direct activating effect on Na+/Ca2+ exchange current. CONCLUSIONAMP579 possibly possesses a direct activating effect on Na+/Ca2+ exchange current.

Objective To evaluate of the clinical efficacy of two kinds of methods extracorporeal shock wave lithotripsy in treatment of ureteral calculi. Methods A retrospective analysis was conducted on the data of 108 patients with acute renal colic and ureteral stones (calculi diameter<2 cm) from March 2011 to April 2013. The patients were divided into two groups. 69 cases in A group underwent emergency positioning urography ureteral catheterization combined extracorporeal shock wave lithotripsy, 39 cases in B group underwent emergency extracorporeal shock wave lithotripsy. Results A group:lithotripsy was successful in 63 cases among 69 cases at the first time,the first success rate was 91.33% (63/69), the second success rate was 94.2%(65/69),2 cases of retrograde ureteroscopy failed, 2 cases of self-discharge after intubation stones, the recurrent renal colic rate was 14.3%(9/63),the use of analgesic drugs rate was 11.1%(7/63) . B group:the first success rate of stone clearance rate was 74.4%(25/39),the second success rate of stone clearance rate was 87.2%(34/39),5 cases underwent ureteroscopy lithotripsy, the renal colic recurrence rate was 20.5% (8/39), the use rate of analgesic drugs was 15.4% (6/39) . Conclusion Extracorporeal shock wave lithotripsy assisted by urography through retrograde ureteral catheterization has satisfying therapeutic effect in treatment of patients with ureteral calculi.

Objective To study the variation characteristics of plasma von Willebrand factor antigen (vWF Ag) after the off-pump coronary artery bypass graft (OPCAB) and its predictive value on the assessment of cardiovascular ischemia events in the postoperative patients.Methods A total of 338 patients with non-ST-segment elevation myocardial infarction were selected from 2010 to 2012 in this retrospective cohort study,with 249 males and 89 females and a mean age of (69.2 ± 4.5) years.The level of vWF Ag was assayed by the IL ACL-TOP 700 blood coagulation instrument.Receiver-operator curve (ROC) analysis of vWF Ag levels in the prediction of risk of ischemic events was performed.x2 test and Logistic regression were conducted to analyze the relevance between vWF Ag and clinical pathological factors.Cox regression analysis model were used to evaluate the effect on prognosis.Results There was significant difference in vWF Ag level at different time point between the poor recovery group and the stable disease group (x2 =129.53 and 101.48 respectively,both P＜0.01).And the vWF Ag level was higher in the poor recovery group on the 14th,30th,60th,90th day after OPCAB than in the stable disease group at the same time points respectively (all P＜0.05).The optimum cut-off point of vWF Ag (the 30th day after OPCAB) for prediction of ischemic events was 251 ％ within the 31-90th day after OPCAB,the area under ROC curve was 0.839 (95％ confidence interval:0.776-0.902).The Logistic regression analysis showed that the vWF Ag level on 30th day after OPCAB was affected by age,left ventricular ejection fraction,left main artery disease,serum creatinine level,vascular number of bypass grafts,history of myocardial infarction and hypertension (all P＜0.01).The Cox analysis showed that the cut-off value of vWF Ag (on the 30th day after OPCAB) was the independent prognostic assessment parameter for ischemic events in patients with cardiovascular diseases within one year.Conclusions The variation of serum vWF Ag level can reflect the integrated influence of multiple pathological factors on vascular endothelial function after the OPCAB,it can become the effective predictor for disease progression within 90 days and the long-term prognosis after OPCAB.

Objective:To construct a eukaryotic expression vector of leptin gene,and to transfect it into human placental mesenchy-mal stem cells(HPMSCs)and appraise its expression.Methods:Primers were designed and the leptin gene was obtained by RT-PCR from human adipose tissue.The aimed segments were inserted into the eukaryotic expression vector pIRES2-EGFP,plasmid pIRES2-EGFP-LEP was constructed and identified by restricted enzymatic resection,and then transfected it into HPMSCs by liposome.The ex-pression of leptin in the transfected cells was detected by RT-PCR and Western blotting,the multi-differentiation potential of the cells was indentified.Results:The length of specific fragment was 500 bp,the recombinant plasmid pIRES2-EGFP-LEP presented 5.3 kb and 500 bp bands by restriction enzyme digestion.Leptin gene was expressed in transfected HPMSCs and the transfected HPMSCs maintained multi-directional differentiation potential.Conclusion:The eukaryotic expression vector of leptin can be transfected and ex-pressed in HPMSCs.

Objective To explore the surgical technique and the efficacy of free descending genicular artery perforator flap without saphenous vein for tissue defect. Methods 18 cases of extremity tissue defect were involved in this study from Au?gust 2010 to April 2014, including 16 males and 2 females with an average age of 32.4 years (8 plantar or heel soft tissue defect, 10 back of hand or palm soft tissue defect). 2 old injury cases that had soft tissue defect after scar release were treated by free flaps and the other 16 were open injury with infection, among which 5 cases were combined with fractures or bone defect. Sizes of the skin and soft tissue defect were 2.0 cm × 8.0 cm to 9.0 cm × 12.0 cm. All wounds were treated by free descending genicular artery perforator flap from the contralateral limb. Medial femoral cutaneous nerve was kept in flaps as far as possible. The projection points of descending genicular artery perforator and saphenous vein were detected by Doppler, then the flaps were cut with reverse approach, and saphenous vein and saphenous nerve were preserved. Results All 18 flaps were survived and all cases were fol?lowed up for 3 to 30 months (average, 10.3 months). The flap sizes varied from 2.5 cm×9.0 cm-9.5 cm×13.0 cm. 2 cases with bone defect were healed 3 months later without infection, and the other 3 cases with fractures were healed 2-3 months after operation. The two point’s discrimination distance was 7.0-12.0 mm on the flap. The disabilities of the arm, shoulder, and hand question?naire score averaged 51, and the mean Japanese Orthopaedic Association's foot rating scale was 70.5. Most patients were satisfied with appearance of the recipient and donor sites, among which 5 cases had skin?graft on the donor sites, and the other 12 cases had small scars on the donor sites. Poor healing was detected in 1 case on the thigh which was healed 3 weeks later. There was no par?esthesia and rash on the donor sites. The mean distance between projection points of descending genicular artery perforator and sa?phenous vein was 3.7 cm. Conclusion Free descending genicular artery perforator flap without saphenous vein is an optimal therapy for the extremity tissue defect, which has the advantage of covert donor site, less invasion, less variation of perforator, and could recover the skin sense of recipient site.

Objective This retrospective study is to analysis the special medical conditions that most Chinese secondary hospitals are facing with,and to review the safeguards and pitfalls for arterial switch operations,in order to probe intothe feasibility of this procedure for Chinese secondary hospitals and provide our experiences to help other surgeons to avoid pitfalls on complex procedures.Methods Between January 2006 and December 2011,totally 21 newborns and infants with TGA/VSD and TGA/IVS underwent arterial switch operation.There were 15 males and 6 females.In the TGA/VSD group,there were 16 cases,ranging from 30 days to 1 year at surgeries,and weight from 3.4-8.5 kg with average of (5.33 ± 1.42) kg.In the TGA/IVS group,there were 5 cases,ranging from 13 days to 1 month at surgeries,and weight from 3.1-5.5 kg with average of (3.75 ± 1.17)kg.All patients underwent one stage of arterial switch operation.Routine follow-up checking points are set at discharging,3 months,half year and every year after operation.Results The early death rate is 9.5％ (2/21),and the reexploration rate is 9.5％ (2/21).In the TGA/VSD group,average cardiopulmonary bypass time is (151 ± 33) minuntes with the aortic crossclamp time is (1 19 ± 26) minutes.Ventilator support time is 24-159 hours,and the length of ICU stay is 3-17 days.1 case has residual VSD with the diameter less than 2 mm.The pulmonary flow velocity in 2 cases increase mildly to 2.0 m/s and 2.2 m/s,and another 2 cases increase severely to 3.1 m/s and 3.7 m/s.The aortic flow velocity in 3 cases increase to 2.0m/s.ECG instructs no case has myoinfarction signs.In the TGA/IVS group,average cardiopulmonary bypass time is (170 ± 52) minuntes with the aortic crossclamp time is (137 ± 48) minutes.Ventilator support time is 51-144 hours,and the length of ICU stay is 4-14 days;The pulmonary flow velocity in 2 cases increase mildly to 2.0 m/s.The aortic flow velocity in 1 cases increase to 2.0 m/s.ECG instructs no case has myoinfarction signs.Conclusion Unbalanced medical resources distribution causes significant differences between heart centers and the secondary hospitals in China,especially on the complex congenital heart diseases procedures.However,with relatively solid background on correction of the simple congenital heart diseases,the Chinese secondary hospitals can still perform arterial switch operation with satisfactory mortality and morbidity,and provide more prompt medical services for more population.

Objective To study the variation of D-dimer after the off-pump coronary artery bypass grafting(OPCAB),and to evaluate its value for the assessment of postoperative cardiovascular ischemia events.Methods This is a retrospective cohort study.203 patients with non-ST-segment elevation myocardial infarction(NSTEMI) were random selected from the Tianjin medical university general hospital from 2010 to 2012,including 151 males and 52 females with a mean age of (66.9 ±8.4) years.The level of D-dimer was analysed by using the Biomerieux VIDAS fluor-euzymelinked immunoassay Analyzer assay.Receiver operating characteristic curve (ROC) was used to evaluate the sensitivity and specificity,the relevance between D-dimer and clinical pathological factors was analysed by x2 test,the effect on prognosis was evaluated by using cox regression analysis model.Results Compared the group with stable disease,the level of D-dimer was increased remarkable in the group with poor recovery on the 14th day after surgery,(U =75.09,P ＜0.01).The optimum cut-off point with D-dimer(the 14th day after surgery) for the diagnosis of ischemic events within the 31th-90th day after surgery was 2 590μg/L,the area under ROC curve was 0.867(95％ confidence interval:0.791-0.943).The logistic analysis showed that the D-dimer was influenced by the sex,age,left ventricular ejection fraction,left main coronary artery disease,the number of vascular with bypass grafts,using internal mammary artery,hypertension and other factors,OR value was 0.495(95％ CI:0.327-0.694),0.527(95％ CI:0.370-0.812),0.564(95％ CI:0.419-0.638),0.331(95％ CI:0.278-0.426),0.592(95％ CI:0.440-0.785),2.093(95％ CI:1.533-2.856),0.580 (95 ％ CI:O.451-0.709) respectively (P ＜ 0.01).The Cox analysis showed that the level of Ddimer on the 14th day after surgery was not the independent assessment parameter for long-term prognosis.Conclusion The serum D-dimer was influenced by multiple pathological factors after the OPCAB,the level of serum D-dimer(on the 14th day after surgery) could be used as effective estimate parameter for the adverse events within the 31 th-90th after OPCAB.