Objective To investigate changes of synaptic interface structural in the hippocampus Cal in high and low conditioned place preference(CPP) rats after chronic morphine treatment.Methods The male SD rats were randomly distributed to experiment group 130 cases(intraperitoneal injected morphine twice a day for ten days in an ascending dosage schedule) and control group 30 cases(injected saline of the same volume at same time).The rats in experiment group were re-classified into high preference group(HP),middle group and low preference group(LP) according to the numerical value of the CPP.The middle group was rejected.The rats in HP and LP were scarified at the time of 3h,3d and 14d after the last injection.The hippocampus Cal were removed and prepared for electron microscope specimen.The synaptie interface structure parameter were analyzed by image processing technique.Results ①No significant difference of pretest scores staying at the non-preference chambet existed among the three groups(F=0.78,P=0.47).However,the test scores of the CPP minus the time stayed at pretest natural preference in the high group was significantly higher than that of the low group(P=0.00).②At the 3h and 3d,the PSD of the high group((15.20±-3.65)nm) was significantly lower than low group((17.63±6.61)nm,P<0.01);the synaptic cleft of high group((5.77±2.08)nm) was significantly higher than low group ((4.92±1.65)nm,P<0.05).At the 14d,the PSD of the high group((16.22±4.93)nm) was significantly lower than low group((18.42±3.78)nm,P<0.01).Conclusion In hippocampal Cal area the synaptic cleft in the HP group was higher than that of LP group,the post-synaptic density in the HP group was lower than that of LP group.These changes may be the synaptic basic of the different susceptibility.

Objective To establish the rats model of different susceptibility of heroin addiction,and to explore the possible dopamine D2 receptor (D2R) and dopamine transptor (DAT) mechanism leading to the different susceptibility. Methods 130 male SD rats were carried out CPP training,and the rats were randomly assigned into heroin exposure group (n = 100) and saline control group (SC, n = 30). Heroin exposure group were re-classified into two groups according to the numerical value of the CPP-Pre (the testing score minus that of the pretest):high preference group(HP group) and low preference group(LP group) ,each accounting for 30% of the total rats.The D2R and DAT protein expression of high and low preference group and saline control group rats were detectedwith immunohistochemical method in PFC at 30 minutes and on the 1st,3rd,7th, 14th days after the last injection(149.33 ±2.51 vs 135.83 ±1.78 vs99.33 ±2.84,141.83 ±2.50 vs 131.67 ± 1.87 vs99.17 ±3.61,132.83 ±2.40 vs 122.00 ±2.67 vs 100.33 ±4.26,125.67 ±2.22 vs 113.17 ±2.81 vs 98.33 ±3.25,116.86 ± 1.94 vs 108.63 ± 2.31 vs 98.17 ± 3.82 , respectively, P＜0.05). The D2R protein expressions of HP rats were significantly lower than those of the LP and control group rats (P ＜ 0. 05), and those of LP rat were than lower than those ferent among three groups on addiction phase and 1st,3rd days after the last injection of heroin respectively, respectively (P ＜ 0. 05). The DAT protein expressions of HP and LP rats were significantly lower than those of controlgroup rats (P＜ 0. 05). At all testing time-points, the DAT protein expressions had no significant difference betweenHP and LP group(P＞0. 05). Conclusion D2R and DAT of the rats show appears down-regulation in the PFC after chronic heroin exposure. Different individuals have different D2R sensitivity or receptor levels ,and lower D2R related to the high susceptibility to heroin. Susceptibility to heroin addiction may not be directly related to the expression of DAT.

Objective To investigate the efficacy of plasmapheresis therapy for treating the antibody-mediated acute rejection (AMR) after kidney transplantation.Methods The study group consists of 2 male patients and 3 female patients,who suffered with AMR after receiving first-time allograft renal transplantation from January 2011 to September 2013 in our hospital.The age ranged from 41 to 52 years old,average 46 years old.The preoperative diagnosis in all patients was chronic renal insufficiency (uremia stage) and the regular hemodialysis was given to them.The 5 patients received basic immunosuppressive therapy,including cyclosporine A [5 mg/(kg · d)] or FKS06 [0.1 mg/(kg · d)],mycophenolate mofetil (MMF) (1.5 g/d) and steroids.All the antibody-mediated acute rejections were diagnosed by renal allograft biopsy and serum DSA determination within 2 weeks after transplantation.Seven cycles of plasmapheresis rescue therapy were given to those patients respectively after the failure therapy of high dose of corticosteroids (1 000 mg/d) and ALG (250 mg/d).4 cases with primary glomerulonephritis,whose preoperative serum creatinine level was (784± 154) μ mol/L,were given plasmapheresis therapy within 2 weeks after transplantation.One case with primary anti-glomerular basement membrane disease,whose preoperative serum creatinine level was 935 μmol/L,received plasmapheresis 35 d after transplantation.The serum DSA in all patients was positive before plasmapheresis.Results After 7 cycles of plasmapheresis rescue therapy,the AMR was reversed in four 4 cases,whose plasmapheresis was given within 2 weeks after transplantation.Within three months follow-up,their renal function recovered well,which the mean serum creatinine level was (113± 12) μmol/L.In the case,whose plasmapheresis was given 35 days after transplantation,rejection was not reversed.His serum creatinine was 524 μmol/L and the intermittent hemodialysis was given,subsequently.With a follow-up of 12 months,the ultrasound examination showed that the atrophy of transplanted kidney and a high level of serum creatinine (758 μmol/L).Low dose of FK506 (0.5 mg/d) was given based on those results.Conclusions Active application of plasmapheresis can effectively reverse antibodymediated acute rejection within two weeks after transplantation.

Objective A kidney transplantation patient who was diagnosed with autoimmune hemolytic anemia (AIHA) caused by passenger lymphocyte syndrome (PLS) was reviewed.Method A male kidney transplantation patient aged 31 was admitted due to severe anemia.Direct antiglobulin test (DAT) was positive and reticulocyte was elevated significantly,and PLS was diagnosed.He was treated with blood transfusion,glucocorticoid and intravenous immunoglobulin,and recovered at last.Result PLS is a rare but important cause of AIHA after kidney transplantation,often occurs in blood type A patient who received a kidney from a blood type O donor.Final diagnosis depends on the detection of anti-erythrocyte antibody in recipient serum.Conclusion PLS should be considered when anemia with unknown reasons occurred in kidney transplantation patients.

Objective:To describe a feasible surgical technique for patients with renal cell carcinoma associated with a supradiaphragmatic tumor thrombus that avoids cardiopulmonary bypass procedure. Methods:We retrospectively analyzed 2 cases with right kidney tumor and tumor thrombus above the dia-phragm treated in April and August,2015.The two patients were both female,aged 73 and 67 years. The tumor sizes of right kidneys were 7.0 cm ×6.3 cm ×5.7 cm and 8.7 cm ×7.0 cm ×5.2 cm,and the tumor thrombuses were 1.3 cm and 1.8 cm above the diaphragm.The second patient had synchro-nous metastasis in right adrenal gland ,and the tumor thrombus arose from the adrenal vein but not the renal vein.Intraoperative transesophageal echocardiography (TEE)was used to assess real-time mobility of the thrombus.A modified chevron incision was used,the right kidney was mobilized laterally and pos-teriorly,and the renal artery was identified,ligated,and divided.The infradiaphragmatic inferior vena cava (IVC)was exposed and isolated by mobilizing the liver off the diaphragm or to the left (piggyback liver mobilization,case 2).The central diaphragm tendon was dissected or incised in the midline until the supradiaphragmatic intrapericardial IVC was identified and gently pulled beneath the diaphragm and into the abdomen.The tumor thrombus was then “milked”downward out of the intrapericardial IVC un-der the guidance of TEE.The distal and proximal IVC to the tumor thrombus,porta hepatis,and left re-nal vein were clamped.Tumor thrombus was removed from the IVC.The IVC was sutured and vascular clamps were placed below the major hepatic veins.Pringle’s maneuver was then released and hepatic blood drainage was permitted during closure of the remaining IVC.Related literature was reviewed.Re-sults:Complete resection was successful through the transabdominal approach without CBP in both pa-tients.Estimated blood loss was 1 500 mL and 2 000 mL,and 1 200 mL and 800 mL of blood were trans-fused.The postoperative courses were uneventful.Both patients subsequently underwent tyrosine-kinase inhibitor therapy.Both patients were alive without tumor recurrence or new metastasis during the follow-up of 6 months and 9 months.Conclusion:In selected cases,renal cell carcinoma extending into the IVC above the diaphragm can be resected without sternotomy,CBP or DHCA.

Objective:To investigate the effect and mechanisms of Phloroglucinol ( PG) on renal ische-mia and reperfusion injury (IRI).Methods:Forty-eight male Wistar rats were divided into 3 groups (16 rats per group):sham operated, saline-treated I/R (I/R), and PG-treated I/R (PG).I/R model:Af-ter removing the right kidney , renal I/R injury was induced by clamping the left renal artery for 45 min followed by reperfusion.The rats were administered with PG (30 mg/kg, intraperitoneally) or saline 15 min before renal ischemia .The blood and kidneys were harvested 6 and 24 h after reperfusion .Renal function and histologic changes of serum creatinine (SCr) and blood urea nitrogen(BUN)were assessed. Malondialdehyde (MDA),catalase (CAT),superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) were measured.Nuclear factor-kapa B ( NF-κB) and caspase-3 in the kidneys were also measured.Results:SCr and BUN were (103.9 ±10.4) μmol/L and (15.2 ±1.0) mmol/L in I/R group, and (81.8 ±13.4) μmol/L and (11.5 ±1.2) mmol/L in PG group 6 h after reperfusion .SCr and BUN were (154.9 ±12.1) μmol/L and (28.1 ±1.4) mmol/L in I/R group, and (103.8 ±5.9)μmol/L和(16.0 ±1.0) mmol/L in PG group 24 h after reperfusion.PG treatment significantly attenua-ted renal dysfunction and histologic damage caused by I /R injury(P<0.05).The I/R-induced elevation in kidney MDA level decreased , where as reduced kidney SOD ,CAT and GSH-Px were increased .What is more , the apoptotic tubular cells , the levels of active caspase-3 ,and active nuclear factor kappa B dra-matically decreased after PG treatment .Conclusion:PG protects murine kidney I/R injury by suppres-sing oxidative stress , inflammation , and cell apoptosis .

Objectives To explore the brain white matter integrity among the patients with buprenorphine tables,scopolamine and promethazine solution(BSP) dependence after abstinence.Methods BSP-dependent patients( n=16)and age/eduction-matched healthy control subjects ( n=18) were assessed by diffusion tensor imaging (DTI) after 3 days,1 month and 2 months of abstinence.White matter (WM) integrity was measured with DTI as fractional anisotropy ( FA),an index of intravoxel orientational coherence of white matter fibers.Results Compared with health controls,FA values were significantly lower in frontal,parietal,temporal and corpus callosum in the BSP addicts after 3-day withdrawal (P＜0.001,uncorrected).Increased FA values in left superior frontal cortex,right medial frontal gyms and fight inferior parietal gyrus were found in BSP users after 2 months of abstinence (P ＜0.001,uncorrected).However,no significant difference was found between these BSP addicts after 1-month abstince.Compared with health controls,BSP dependent subjects still exhibited significantly lower FA in the corpus callosum,frontal,parietal and temporal WM after 2-month withdrawal (P ＜ 0.001,uncorrected ).Conclusion The abnormalities showed less recovery in BSP dependent individuals with abstinence in white matter that suggests that rehabilitation time should be further prolonged for BSP addicts and emphasis cognitive-behavioral therapy to assist BSP abusers rebuild social functions.

Objective To investigate the possible mechanism for the different CPI susceptibili-ties. Methods Using a conditioned place preference (CPP) model, rats were selected into high and low preference groups. Using in situ hybridization, we examined the mRNA expression of 5-hydroxytryptamine transporter (5-HTT) and 5 -hydroxytryptamine 1 A receptor (5-HT1 AR) in 3 cruci-al regions in addiction, namely the ventral tegmental area (VTA) , the nucleus accumbens (NAc) ,and the medial prefrontal cortex (mPFC) , during the dependence and withdrawal. Results During dependence state, the expression of 5-HTT mRNA in each of the regions in the high preference group was significantly lower than that of the low preference group, while higher expression of 5-HT1AR mRNA in each of the regions in the high preference group than that of the low preference group was found (P<0.05). During withdrawal state, the expression of 5-HTT mRNA in each of the regions in high preference group was significantly higher than that of the low preference group, while lower expres-sion of 5-HTIAR mRNA in each of the regions in the high preference group than that of the low prefe-rence group was found (P<0.05). Conclusion 5-HTT and 5-HT1 AR may play a role in diffe-rences in susceptibility to morphine.

Objective:To evaluate the safety and efficacy of retroperitoneal laparoscopic nephrectomy with autotransplantation in cases of severe iatrogenic proximal ureteral damage.Methods:From July 2011 to March 2015,two patients,aged 44 (female)and 54 years (male),underwent retroperitoneal laparoscopic nephrectomy and autotransplantation for treatment of severe iatrogenic proximal ureteral inju-ries.Both injuries were proximal ureteral avulsion during ureterolithotomy with the holmium laser for ure-teral calculi.computed tomography angiography (CTA)and computed tomography urography (CTU)was performed in both patients before operation.A 3-port retroperitoneal technique was used for the patients placed in a lateral decubitus position.A retroperitoneal laparoscopic nephrectomy with autotransplantation approach was used in both the patients,and the kidneys were removed to the right iliac fossa.Case 1’s kidney was removed through the right Gibson incision,while Case 2’s kidney was removed through the left lumbar incision.The renal artery and renal vein were ligated using the Hem-o-lok.The kidneys were taken out quickly from the patients and infused with 4 ℃ kidney preserving fluid immediately.Results:The retroperitoneal laparoscopic nephrectomy with autotransplantations was performed 4 hours in Case 1 and 2 years in Case 2 after atrogenic proximal ureteral injuries.Case 2 was associated with dense peri-nephric and perihilar fibrosis.The procedures were successful,with immediate return of renal function in both the patients.After ex vivo graft preparation,ureteral and vessel length and quality were adequate for transplantation in both the cases.A direct ureterovesical anastomosis was performed in both patients.In the 2 patients,the warm ischemia time was 3 and 5 minutes,the total operation time 185 and 246 mi-nutes,and the estimated blood loss 70 and 200 mL,respectively.No perioperative complications oc-curred.At the end of the follow-up,the transplanted kidneys were functional,and the patients had re-turned to their normal activity.Conclusion:Retroperitoneal laparoscopic nephrectomy with autotrans-plantation is an excellent alternative to nephrectomyor bowel interposition in patients with proximal urete-ral loss.This procedure is associated with acceptable morbidity and preserves the renal function.This re-port supports the safety and efficacy of retroperotoneal laparoscopic nephrectomy with autotransplantation in experienced hands.

Objective The purpose of this study was to analyze the relation of blood glucose variability and 28-day mortality in patients with different degree sepsis. Methods From September 1, 2010 to September 30, 2012, all adult patients diagnosed with sepsis and treated at least 3 days in Emergency ICU (EICU) of the first affiliated hospital of Kunming Medical University were enrolled in the study. Then the blood glucose levels and the other requisite clinical data were obtained from historical electronic medical records of patients excluding the patients reached exclusive criteria. The maximum and mean of blood glucose, and the glucose variability (the standard deviation,SD of blood glucose) in each patient were calculated. The patients were assigned according to severity of sepsis, then the relationship between SD of blood glucose and 28-day mortality was statistically assessed. Results There was an important correlation between SD of blood glucose and 28-day mortality (OR=4.237, =0.021) . The glucose variability increased with the serious of sepsis ( = 0.016) . Conclusion Glucose variability is an independent predictor of 28-day mortality in septic patients. In addition, the severity of sepsis has a positive correlation with blood glucose variability.