Objective To investigate the use of protective agent of gastric mucosa of helicobacter pylori quadraple therapy with pantoprazole based plus (Hp) positive duodenal ulcer intestinal microflora influence.Methods One hundred and twenty cases patients with Hp positive duodenal ulcer who were treated in Fuzhou University Hospital from September 2015 to September 2016 were selected and randomly divided into triplet group,quadruplet group,quadruplet + protective agent group.Triplet group were treated with pantoprazole 40 mg,oral amoxicillin 1 000 mg and oral clarithromycin 500 mg,2 times one day,for 14 d treatment.Quadruplet group were given triple group therapy plus bismuth potassium citrate 220 mg,2 times one day,oral treatment,for 14 d treatment.Quadruplet+protective agent group was given quadruple group therapy plus oral rebamipide 200 mg,3 times one day.The effect of Hp eradication and the distribution of intestinal microflora after treatment were compared.Results The eradication rate of Hp in triple group was 65.00％(26/40),in quadruplet was 82.50％(33/40),in quadruplet+protective agent group was 87.50％ (35/40),Hp eradication rate in quadruplet +protective agent group was higher than the triple group and quadruplet group (P ＜ 0.05).Overall symptom improvement rate in quadruplet + protective agent group(95.00％) was better than quadruple group(80.00％)and triplet Group (75.00％),the difference was significant (P＜ 0.05).After the eradication of gastric antrum,gastric body was higher than the number of Lactobacillus((1.7424±0.162) vs.(1.6796±0.223),t=4.023,P＜0.05).Ggastric acid bacillus,clostridium,and number of enterobacteriaceae were higher than the before eradication((1.742±0.162) lg cfu/mg vs.(1.505±0.250) lg cfu/mg,(2.106±0.083) lg cfu/mg vs.(2.010± ±0.131) lg cfu/mg,(2.030±0.119)lg cfu/mg vs.(1.609±0.399) lg cfu/mg),the differences were significant (t =3.225,3.174,3.571,P ＜ 0.05).The number of clostridium quasiballs lower than before eradication((1.654± 0.177) lg cfu/mg vs.(1.808 ± 0.300) lg cfu/mg),the difference was significant (t=2.896,P＜0.05).The body of the stomach Lactobacillus number was higher than before eradication((1.680± ±0.223) lg cfu/mg vs.(1.524±0.294) lg cfu/mg),the difference was significant(t =2.974,P ＜0.05).Clostridium quasiballs quantity was lower than before eradication ((1.694±0.216) lg cfu/mg vs,(1.8526± ±0.1193) lg cfu/mg),the difference was significant(t =1.332,P＜0.05).The number of fecal lactobacillus was higher than that before treatment ((40.406 ± 3.242) lg cfu/mg vs.(38.2034 + 3.036) lg cfu/mg),the difference was significant (t =3.115,P ＜ 0.05).Conclusion Pantoprazole based quadruple therapy plus the eradication rate of gastric mucosal protective agent can improve the use of Hp positive duodenal ulcer Hp,improve the overall symptoms,and it is more conducive to the balance of intestinal micro flora after Hp eradication.

Objective To evaluate argon-helium cryoablation combined with transcatheter arterial chemoembolization (TACE) in treating advanced hepatocellular carcinoma (HCC). Methods The clinical data of 66 patients with pathologically-proved HCC were retrospectively analyzed. Based on the therapeutic scheme the patients were divided into TACE group (n=31) and combination group (TACE+argon-helium cryoablation, n=35). All the patients were followed up for 5-35 months. The complete remission rate, total effective rate and survival time were evaluated. The short-term and the long-term effectiveness were compared between the two groups. Results Both the complete remission rate and total effective rate of the combination group were significantly higher than those of TACE group (P<0.05). The median survival time of the combination group was significantly longer than that of TACE group (P=0.038). The half-year, one-year and 2-year overall survival rates of the combination group were higher than those of TACE group, although the differences were not statistically significant (P>0.05). Conclusion For the treatment of advanced hepatocellular carcinoma, argon-helium cryoablation combined with TACE can improve the short-term effect and prolong the progression-free survival time, although its exact effectiveness still needs to be confirmed by large sample, multi-central and randomized controlled studies.

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 risk factors of bloodstream infection-related death after liver transplantation.Methods The retrospective case-control study was adopted.The clinical data of the 107 patients with bloodstream infection from 365 liver transplantation patients who were admitted to the Third Xiangya Hospital of Central South University (220 patients) and South Central Hospital Affiliated to Wuhan University (145 patients) from January 1,2002 to December 31,2015 were collected.The patients received modified piggyback liver transplantation.The second or third generation celphalosporin or carbapenems antibiotics were preventively used against infection according to the bacterial culture results before surgery,and the immune inhibitor basic program after surgery was FK506 + prednisone.The observation indicators included:(1) the bloodstream infection status after liver transplantation:incidence of bloodstream infection,frequency of bloodstream infection,inadequate antiinfection treatment,primary infection position,microorganism infection type,bacterial culture results and bloodstream infection-related mortality.(2) The risk factors of blood stream infection-related death after liver transplantation in univariate and multivariate analyses in cluded:the gender,age,resource of donor,usage of immune inhibitor,time between infection and liver transplantation,infection temperature,primary infection position(intraperitoneal or biliary infection),pathogenic microorganism type,nosocomial infection,inadequate antibiotic usage,serum creatinine level,serum albumin (Alb) level,white blood cell (WBC) in peripheral blood,lymphocyte in peripheral blood,platelet (PLT) in peripheral blood and septic shock indexes.The patients were followed up by outpatient examination and telephone interview up to January 31,2016,the follow-up contents included the survival status of the patients,vital signs,using status of immune inhibitor,immune inhibitor concentration,blood routine,biochemical indexes,surgery,other infection-related complications and acute rejection.Continuous variables with normal distribution were represented as ~ ± s.The univariate analysis was done by the Chi-square test.The multivariate analysis was done by the Logistic regression model.Results (1) The bloodstream infection status after liver transplantation:186 bloodstream infections were happened in 107 patients undergoing liver transplantation,with a total incidence of bloodstream infection of 29.32％ (107/365).The incidence of bloodstream infection was 28.18％ (62/220) in the Third Xiangya Hospital of Central South University and 31.03％ (45/145) in the South Central Hospital Affiliated to Wuhan University,with no statistical difference (x2=0.186,P ＞0.05).Of 107 patients,56 patients had once bloodstream infection,31 had twice bloodstream infection and 20 had three times or more bloodstream infection (frequency of the most bloodstream infection was 6).The inadequate anti-infection treatment was applied to the 41.12％ (44/107)of patients with liver transplantation and bloodstream infection.The number of patients with primary infection positions in abdomen,lung,urethra,intravascular catheter and unknown sites were 40,39,3,1 and 24,respectively.The Gram positive bacteria,Gram negative bacteria,fungus and mixed infection of microorganism infection type were detected in 28,24,4 and 51 patients,respectively.There were 102 patients with nosocomial infection.Bacteria culture results in 186 strains of blood sample illustrated:84 strains were Gram positive bacteria as major pathogenic bacteria,among which enterococcus (31 strains) and staphylococcus aureus (23 strains) were dominant strains.The bloodstream infection-related mortality was 37.38％ (40/107),including 35 patients dying of septic shock.(2) The univariate analysis showed that the gender,resource of the donor,infection temperature,type of microorganism,serum creatinine level,serum Alb level,WBC in peripheral blood,PLT in peripheral blood and septic shock were the risk factors affecting bloodstream infection-related death after liver transplantation (x2=5.801,5.920,13.047,12.776,11.366,7.976,25.173,9.289,51.905,P ＜0.05).The multivariate analysis showed that serum Alb level ＜ 30 mg/L and septic shock were the independent risk factors affecting bloodstream infection-related death after liver transplantation (OR =5.839,44.983,95 ％ confidence interval:1.145-29.767,12.606-160.514,P ＜ 0.05).Conclusion It is prone to happen bloodstream infection after liver transplantation,and serum Alb level ＜ 30mg/L and septic shock are the independent risk factors affecting bloodstream infection-related death after liver transplantation.

Objective To investigate the effects of different dosages of bone marrow mesenchymal stromal cells (BMSC) on lung fibrosis. Methods BMSCs with red fluorescence protein (RFP) from male FVB mice were cultured in vitro. Twenty-four female wild type FVB mice were randomly divided into four groups: normal group, model group, BMSC 1 group and BMSC 2 group (n = 6). Mouse pulmonary fibrosis models were induced by bleomycin via single intratracheal perfusion. Twenty-four h after model establishment, mice in BMSC 1 group and BMSC 2 group were injected with 1 × 10~6 BMSCs and 2 × 10~6 BMSCs, respectively through vena caudalis for each mouse. All the animals were sacrificed 21 d after model estalishment, and mouse lung tissue samples were obtained. The pathological changes were observed by light microscopy, the hydroxyproline ( Hyp) contents were measured by alkaline hydrolysis assay, the distribution of RFP( + ) BMSCs and quantitation of RFP were analysed by laser scanning confocal microscopy and immunohistochemistry, the expression of surfactant protein A (SP-A) was detected by immunohistochemistry, and the expression of transforming growth factor-β (TGF-β) and platelet-derived growth factor (PDGF) mRNA was detected by Real-time PCR. Results Compared with model group, the pulmonary fibrosis in BMSC 1 group was significantly alleviated, and that of BMSC 2 group became much more severe.A large number of RFP( +) BMSCs were found in fibrosis area of BMSC 2 group,which exhibited morphology similar to fibroblasts. As far as the expression of SP-A was concerned, normal group was higher than BMSC 1 group, BMSC 1 group was higher than BMSC 2 group and model group (P < 0. 05), while there was no significant difference between BMSC 2 group and model group (P >0. 05). Normal group, BMSC I group, model group and BMSC 2 group fell in the increase order by Hyp contents (P <0.01, P <0.05), and BMSC 2 group, BMSC 1 group, model group and normal group fell in the decrease order by expression of TCF-|$ and PDGF mRNA (P < 0.05). Conclusion Proper dose of BMSC has a favourable effect on bleomycin-induced lung fibrosis, while excessive dose of BMSC can aggravate the fibrosis.

Upper urinary tract calculi with infection is a quite difficult acute urologic emergency.And what is more, upper urinary tract obstruction after radical cystectomy following urinary diversion may be fatal in the vulnerable patients with this kind of situation.Postoperative anatomy and other factors affect the upper urinary tract calculi, and urinary tract infection greatly increased the risk.But it is particularly difficult to handle with patients with poor general condition and septic shock treatment, so how to optimize the selection program is worth further studying.A 65-year-old man was admitted to hospital for combining with renal and ureteral calculi after radical cystectomy (Bricker) in March 2017.The patient underwent transurethral resection of bladder tumor in the outer court because of the discovery of bladder tumor one year before, The postoperative pathology was high-grade papillary urothelial carcinoma and he underwent regular irrigation of the bladder.Because of tumor recurrence, he came to Peking University Third Hospital for further treatment in August 2016, and the examination of urinary tract CT indicated bladder can-cer;for bilateral multiple renal pelvis and renal calices calculi, he was given laparoscopic radical cystecto-my.After four months, due to sudden chill fever, he was hospitalized.After definite diagnosis, anti-inflammatory treatment combined with left nephrostomy was given.The two-stage lithotripsy was performed.After expansion of the original left renal fistula to 24 F(1 F=0.33 mm), 24 F sheath was inducted into the kidney.We introduced a flexible ureteroscopy into the channel down to the ureteral obstruction, where we found a 1 cm oval black brown stone obstructed.A guide wire was inducted through the stones down to ileal conduit in the right lower quadrant.Through the ureteroscopy, we made ureteral calculi broken into powder, and replaced the residual stones into the renal pelvis.Then we used the nephroscopy for lithotropsy in the pelvis, and finally we introduced a flexible cystoscopy for the residual stone.The operation was successful, the operation time was 181 min, and intraoperative bleeding was 10 mL.After operation, no residual stones were found in kidney, ureter, bladder (KUB) plain films.No operation complications were related to the urinary tract.Therefore, multiple endoscopy with combination therapy of upper urinary tract calculi following urinary diversion is safe and effective, and the reasonable choice with the advantages of each instrument can improve the stone clearance rate and shorten the operation time.This can be used as a useful complement to traditional treatment.

Objective: Testicular mixed germ cell tumor is mixed with embryonal carcinoma, choriocarcinoma, yolk sac tumor, teratoma, seminoma and other two or more components of the testicular tumor, the clinical is relatively rare and high degree of malignancy, this article will summarize its clinical features and optimize its treatment.Methods: A retrospective analysis of the clinical data of 22 patients with testicular tumor mixed germ cell in Peking University Third Hospital from May 1994 to November 2016 was conducted using a combination of statistical analysis and discussion of the relevant literature.Results: The mean age of the 22 patients was (30.8±10.4) years and the rate of cryptorchidism was 13.6%.The maximum diameter of the tumor was (5.1±2.7) cm.The pathological results suggested that 12 cases (54.5%) contained two different germ cell tumor components, 7 cases (31.8%) contained 3 different tumor components, 2 cases (9.2%) contained 4 different tumor components, and 1 case (4.5%) contained 5 different tumor components.Tumor constituent analysis included yolk sac tumors(16 cases, 72.7%), mature teratoma (7 cases, 31.8%), immature teratoma (5 cases, 22.7%), embryonal carcinoma (17 cases, 77.3%) , choriocarcinoma (4 cases, 18.1%) and seminoma (6 cases, 27.3%).American Joint Committee of Cancer tumor staging indicated 19 cases of stage Ⅰ a tumor, 2 cases of stage Ⅱa tumor and 1 case of stage Ⅲa tumor.The mean values of human chorionic gonadotropin, alpha-fetoprotein and lactate dehydrogenase were 414.50 MIU/mL, 242.95 μg/L, 196.95 U/L (preoperative) and 17.20 MIU /mL, 90.20 μg/L, 183.70 U/L (postoperative within a year), and the comparison of the P values between the preoperative and the postoperative within a year were 0.079, 0.043 and 0.624.Fourteen patients underwent retroperitoneal lymph nodes dissection.Most patients lived with long-term survival (94.4%) after operation.Conclusion: Comprehensive treatment of radical orchiectomy with retroperitoneal lymphadenectomy combined with necessary radiotherapy or chemotherapy might help to control the tumor and achieve long-term survival for most patients with testicular mixed germ cell tumor.

Objective To evaluate the effectiveness, safety and feasibility of the application of trans-radial thrombus aspiration in patient with heavy burden of thrombus receiving primary coronary interventional therapy. Methods 56 patients with acute coronary syndrome receiving primary coronary interventional therapy were enrolled and randomized to two groups. 31 patients received therapy of thrombus aspiration by Thrombuster II, while 25 patients received routine coronary interventional therapy. We compared the rate of major adverse cardiac event (MACE) in hospital, left ventricular ejection fraction (LVEF) one week post procedure and left ventricular end diastolic diameter (LVEDD), TIMI frame before and after procedure between two groups. Results The rate of MACE was signiifcantly (P<0.05) lower in patients receiving thrombus aspiration (3.3%) compared with routine PCI group (12.0%). LVEF and the rate of patients with TIMI Ⅲafter procedure were signiifcantly (P < 0.05) higher in patients receiving thrombus aspiration. There’s no significant difference in LVEDD between two groups. Conclusions There lies good safety and feasibility for applying thrombus aspiration combining direct PCI in patient with heavy burden of thrombus.

The purpose of this study is to evaluate the effect of oligomeric grape seed proanthocyanidins (GSP) on isoproterenol (ISO)-induced cardiac remodeling in rats. ISO was given subcutaneously (5 mg x kg(-1), sc, 7 days) to induce cardiac remodeling in rats. Therapeutic groups were given GSP (50, 100, and 150 mg x kg(-1)) after ISO treatment. After 2 weeks intervention, heart rate (HR), left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), rate of rise of left ventricular pressure (+/- dp/dt(max)) were examined. The myocardial hypertrophy index was expressed as heart weight/body weight (HW/BW) and left ventricle weight/body weight (LVW/BW), the histological changes were investigated by HE and Van Gieson stain. SOD activity and MDA content in serum, contents of hydroxyproline (Hyp) in the left ventricular tissue were assayed by xanthinoxidase method, thiobarbituric acid (TBA) method and alkaline hydrolysis method, respectively. After the onset of ISO-treatment, GSP therapy potently improved cardiac function, inhibited myocardial hypertrophy, improved cardiac pathology change, decreased the myocardial cross-section area (CSA), collagen volume fraction (CVF) and perivascular circumferential collagen area (PVCA), reduced the content of Hyp in the left ventricular tissue, inhibited the decrease of SOD activity and increase of MDA content in serum. GSP possess protective effect against ISO induced cardiac remodeling in rats, this may be related to reducing the oxidative stress and improving antioxidant capacity.

Objective To evaluate the application of multi-slice computed tomographic coronary angiography in diagnosis of chronic total occlusion (CTO) of coronary artery.Methods Six hundred and thirty eight patients were diagnosed as CTO disease with coronary angiography (CAG) from June 2011 to December 2012 in Zhongshan Hospital;236 of them received multi-slice computed tomographic coronary angiography in 60 days before.Results In total 708 vessels of the 236 patients,244 vessels were proved totally occluded,128 (52.5％) of which were located in left anterior descending artery,31 (12.7％) were located in left circumflex coronary artery and 85 (34.8％) located in right coronary artery.Multi-slice computed tomographic coronary angiography was superior to CAG in judgment of stump anatomy (64.3％ vs.52.5％,F =7.09,P =0.010),plaque calcification (40.2％ vs.26.2％,F =10.68,P =0.001) and distal vessel interpretability (93.9％ vs.74.6％,F =34.06,P ＜ 0.001).There was no significant difference in judging side branch,tortuosity and lesion length between multi-slice computed tomographic coronary angiography and CAG (all P ＞ 0.05).Conclusion Multi-slice computed tomographic coronary angiography provides more detailed anatomy information of CTO lesions and is of value in diagnosis and treatment of CTO lesions.