Objective To comprehensively study the oxidative stress of bone tissue in rats with chronic fluorosis treated with anti-oxidant,the oxidative damage of lipid,protein and DNA.Methods Forty Wistar rats weaned 2 weeks were randomized by weight and divided into 4 groups according to body weight,control group (treated with tap water) and 3 NaF (sodium fluoride) exposure groups (treated with NaF at 50,150 and 250 mg/L),5 female rats and 5 male rats in each group.NaF was given through drinking water.After 6 months of treatment,a 12-hour urine samples were collected,then rats were killed,serum was collected,right rear tibiofibula was separated.Bone and urinary fluoride content and incidence rate of dental fluorine were studied and the levels of bone tissue suppression function of hydroxy free radical,superoxide dismutase (SOD),catalase (CAT),glutathione peroxidase (GSH-Px),8-hydroxydeoxyguanosine (8-OHdG),protein carbonyls (PCO),and malonaldehyde (MDA) were assayed.Results ① Results of suppression function of hydroxy free radical:The difference of bone tissue suppression function of hydroxy free radical among control [(22.99 ± 4.31)U/mg prot],low-excess dose [(22.76 ± 8.11)U/mg prot],medium-excess dose [(13.47 ± 4.56)U/mg prot] and high-excess dose [(19.40 ± 5.92)U/mg prot] groups was statistically significant (F =5.01,P ＜0.05).②Results of SOD:The difference of bone tissue SOD among control [(5.06 ± 1.16)U/mg prot],low-excess dose [(5.32 ± 1.18)U/mg prot],medium-excess dose [(3.71 ± 0.72)U/mg prot] and high-excess dose [(4.80 ± 1.10)U/mg prot] groups was statistically significant (F =4.44,P ＜0.05).③ Results of CAT:The difference of bone tissue CAT among control [(25.20 ± 5.91)U/mg prot],low-excess dose [(22.53 ± 7.10) U/mg prot],medium-excess dose [(17.96 ± 4.71)U/mg prot] and high-excess dose [(19.52 ± 5.52)U/ mg prot] groups was statistically significant (F =2.85,P ＜0.05).④Results of GSH-Px:The differences of bone tissue GSH-Px among control [(52.86 ± 12.88)U/mg prot],low-excess dose [(70.05 ± 15.72)U/mg prot],medium-excess dose [(51.55 ± 6.97)U/mg prot] and high-excess dose [(57.47 ± 10.99) U/mg prot] groups was statistically significant (F =4.89,P ＜0.05).⑤Results of PCO:The differences of bone tissue PCO among control [(58.73 ± 20.86)ng/L],low-excess dose [(89.41 ± 26.20)ng/L],medium-excess dose [(97.07 ± 22.24)ng/L] and highexcess dose [(83.96 ± 29.55)ng/L] groups was statistically significant (F =4.43,P ＜0.05).⑥Results of 8-OHdG:The differences of bone tissue 8-OHdG among control [(87.66 ± 6.32)ng/L],low-excess dose [(86.31± 6.30)ng/L],medium-excess dose [(92.17 ± 4.28)ng/L] and high-excess dose [(88.02 ± 6.14)ng/L] groups was not statistically significant (F =1.88,P ＞ 0.05).⑦Results of MDA:The differences of bone tissue MDA among control [(3.70 ± 1.73) nmol/mg prot],low-excess dose [(2.10 ± 0.95)nmol/mg prot],medium-excess dose [(3.32± 2.20)nmol/mg prot] and high-excess dose [(2.71 ± 2.18)nmol/mg prot] groups was not statistically significant (F =1.37,P ＞ 0.05).Conclusions The activity of SOD and CAT of bone tissue are inhibited and suppression function of hydroxy free radical is decreasing under fluorosis influence,which results in protein damage.Oxidative stress is considered to be one of the mechanisms of skeletal fluorosis.

Objective To explore the application of three-dimensional intelligent qualitative and quantitative analysis system (IQQA) in the planning,simulation and implementation of precise surgery for bilateral renal tumors.Methods A retrospective analysis a total of 7 patients with bilateral kidney tumors in our center from June 2017 to August 2018 was performed.There were 5 males and 2 females,with an average age of (54.6 ± 6.0) years,ranging 47.0-63.0 years.The average BMI index was (23.4 ± 2.4) kg/m2,ranging 21.2-28.0 kg/m2.The average diameter of 14 renal tumors in 7 patients was (3.8 ± 1.1) cm,ranging 1.9-5.3 cm.The average R.E.N.A.L score was 6.6 ± 1.2,ranging 5.0-9.0.The tumor stage was T1N0M0.The mean preoperative hemoglobin,albumin,creatinine and GFR were (138.6 ± 17.0)g/L and (47.3 ± 2.5 g/L),(51.6 ± 19.1) μmol/Land (56.9 ± 6.7) ml/min,respectively.Before operation,the original data of CT were input into IQQA system.Then we reconstructed kidney,blood vessel,collecting system and tumors using system.And the structure of kidney,tumors and vessels was visualized directly.The systematic analysis of the operation is carried out at terminals vary from various angles,and the surgical resection simulation.The position,angle and curvature of the cut surface are adjusted according to the effect.The plan of partial nephrectomy is designed.The resection area,remaining area of kidney is calculated.In this way,we can construct individualized and accurate laparoscopic partial nephrectomy planning before operation.Last,we carried out the operation according to the designed plan.The laparoscopic standard partial nephrectomy was performed in 11 cases.The laparoscopic selective partial nephrectomy was performed in 2 cases.One underwent laparoscopic partial nephrectomy without obstruction.We achieved precise resection of tumors and rapid suture of wounds according to the preoperative planning of excision and suture.We collected of the surgical success rate,conversion to opening rate,operation time,warm ischemia time,intraoperative bleeding volume,complications and hospitalization after operation.The related laboratory indicators such as eGFR and creatinine were followed up for 3 months,and the prognostic indicators such as renal CT and pulmonary CT for 6 months after operation were evaluated and analyzed.Result 14 renal tumors were successfully reconstructed by IQQA in 7 patients.The operations were completed successfully without conversion to open surgery or radical nephrectomy.The average operative duration was (68.9 ± 9.2) minutes,ranging 50.0-80.0 minutes.The average renal artery occlusion duration was (20.7 ± 4.1) minutes,ranging 15.0-29.0 minutes.The average intraoperative bleeding volume was (70.7 ± 29.7) ml,ranging 30.0-120.0 ml.The average indwelling time of drainage tube was (5.5 s0.7) days,ranging 5.0-7.0 days.The average hospitalization time was (6.3 ± 0.5) days,ranging 6.0-7.0 days.There were no perioperative complications such as bleeding,urinary leakage,infection,incision dehiscence and pulmonary infection.Postoperative pathology revealed 13 clear cell renal carcinoma and 1 renal angiomyoma.No recurrence or metastasis was found in chest CT and lung CT after 6 months follow-up.The creatinine and GFR in 3 months after operation were (52.0 ± 15.2) μmol/L(36.0-72.0 μmol/L) and (56.7 ± 5.3) ml/min(46.7-66.3 ml/min).There was no significant difference of creatinine and GFR with the preoperative (P ＞ 0.05).The mean Hb and albumin levels in 3 months after operation were (120.9 ± 17.0) g/L(90.0-147.0 g/L) and (41.4 ± 2.6) g/L (38.0-46.0 g/L),which were significantly lower than those before operation (P ＜ 0.05).Conclusions The three-dimensional intelligent qualitative and quantitative analysis system (IQQA) can visualize the kidney,tumor and the vasculature of bilateral kidney tumors by preoperative three-dimensional reconstruction.The optimal surgical plan of partial nephrectomy can be designed by preoperative operation planning and computer terminal in order to enhance the safety of partial nephrectomy for bilateral kidney tumors and preserve the possibility of kidney,and protect the renal function to the greatest extent.To accurately predict the retention of renal function after operation,so that patients with bilateral renal tumors can get the greatest benefit in partial nephrectomy.

Objective:To explore the safety and efficacy of laparoscopic non-blocking partial nephrectomy assisted by high power lateral green laser in the treatment of T 1a renal tumor. Methods:The clinical data of 10 patients with T1a stage renal tumor from February 2021 to April 2021 in department of urology, Gongli hospital affiliated to Naval Military Medical University were retrospectively analyzed. There were 7 males and 3 females, aged 47.0-74.0 years, with average of(58.8±9.7)years old. The diameter of the tumor ranged from 2.0 cm to 3.8 cm, with an average of (3.1±0.6)cm. There were 6 cases on the left side and 4 cases on the right side, locate on lumbar side in 9 cases and ventral sied in 1 case. The R. E.N.A.L score was 4.0-6.0, with an average of (5.0±0.8). The preoperative creatinine was 66.9-90.1μmol/L, with an average of (75.1±9.0)μmol/L, preoperative GFR of 44. 6- 67. 3 ml /min, with an average of(56.7±7.7)ml/min, preoperative hemoglobin level of 119.0-156.0g/L, with an average of (135.8±11.4)g/L. All patients underwent laparoscopic non-blocking partial nephrectomy assisted by 180w lateral green laser, free the surrounding area of the tumor fully and completely expose the renal tumor. The laser fiber was placed through the green laser hand piece, and the fiber was connected with normal saline to wash the strip. The initial green laser vaporization power was set at 80W, and the hemostasis power at 35W.About 3mm away from the edge of the tumor, and one optical fiber away from the renal parenchyma, the renal parenchyma was cut with 80W power. In order to reduce the interference by smoke, high-pressure flushing was used through the optical fiber while vaporizing, and an attractor was used to push and peel the tumor. In case of bleeding during operation, hemostatic power can be used to close the bleeding point and gradually advance until the tumor was completely removed. The wounds of renal inner medulla and renal outer cortex were continuously sutured in 1-3 layers with barbed suture. It involved 9 cases via retroperitoneal approach and 1 case via abdominal approach. The operation time, postoperative hemoglobin decrease, extraction time of negative pressure drainage, postoperative hospital stay, postoperative pathology and postoperative complications were recorded, and the serum creatinine level and GFR level of the affected side were followed up 1 month after operation.Results:All the operations were successfully completed, and there was no conversion to open surgery or radical nephrectomy. One case changed to scissors fast resection and sutured hemostasis due to severe intraoperative bleeding. The operation time was 90.0-120.0 min, with the average of (104.5±9.0)min. The postoperative hemoglobin level was 96.0-132.0g/L, with an average of (115.2±11.8)g/L, and the difference was statistically significant ( P<0.05). The postoperative hemoglobin decreased from 12.0g/L to 25.0g/L, with an average of (20.6±4.6)g/L. The time of vacuum drainage was 5.0-7.0 days, with an average of (5.7±0.7)d. Postoperative hospital stay was 6.0-8.0 days, with an average of (6.7±0.7)d. No bleeding, urinary leakage and other complications occurred in all patients. There were 7 cases of clear cell carcinoma, 2 cases of papillary renal cell carcinoma and 1 case of angiomyolipoma. All margins were negative. One month after operation, creatinine ranged from 66.0 to 90.4μmol/L, with an average of (76.8±8.3)μmol/L, which was not significantly different compared with that before operation ( P>0.05). One month after operation, GFR was 45.1-60.8 ml/min, and with an average of (55.5±4.7)ml/min, and there was no significant difference compared with preoperative data( P>0.05). Conclusions:For T 1aN 0M 0 stage and exophytic renal tumors, laparoscopic non-blocking partial nephrectomy assisted by lateral green laser is safe and effective.