Objective To evaluate the efficacy and safety of standard percutaneous nephrolithotomy(PCNL)guided by ultrasonography for calculi within horseshoe kidneys.Methods From September 2005 to January 2008,44 patients with calculi within horseshoe kidneys(51 sides)underwent ultrasonography-guided F24-tract PCNL in our hospital.Among the cases,single calculus was found in 24 kidneys,multiple calculi were detected in 18,and staghorn calculi in 9.The stones sized(24.4?5.8)mm in length.Results All the operations were completed in one session,single tract was established in 49 kidneys,while double tracts were used in the other 2;31 of the tracts were made through the upper calyx,20 via the middle calyx,and 2 through the lower calyx.The mean operation time was(48.4?11.9)min.The stone-free rate after one-session operation was 88.2%(45/51),3 cases received a second-session PCNL to remove the residual calculi.After the operation,the hemoglobin decreased by(11.3?3.7)% in the patients,none of them received blood transfusion.Postoperative rate of surgery-related infection was 5.9%(3/51).No pleural or abdominal injury occurred.44 patients were followed up for 11.4 months,during the period one of the 3 patients who received the second-session surgery achieved stone-free.The rate of recurrence at 6 months was 2.0%(1/51),and 6.5% at 1 year(3/46).Conclusions Ultrasonography-guided standard PCNL is effective and safe for calculi within horseshoe kidneys.

Objective To study the characteristics and diagnosis of renal sinus lipomatosis (RSL) complicated with renal staghorn calculi, and report our preliminary experience on percutaneous nephrolithotripsy for the disease. Methods A total of 547 patients with complex renal calculi were admitted to our hospital from January 2005 to June 2007. In 2 of them, RSL complicated with renal staghorn calculi was diagnosed by B-ultrasonography, CT, and MRI. Both the patients were female, aged 42 and 82 years respectively. B-ultrasonography-guided percutaneous nephrolithotripsy was performed on the two patients without removing the kidneys.Results Totally, 7 ml and 5 ml of stones were removed respectively from the two patients by percutaneous nephrolithotripsy. No retained calculi were found by KUB performed one week postoperation. Biopsy of the submucosal fat obtained from the renal pelvis during the operation showed hyperplasia and fibrosis of fatty tissues and inflammatory effusion. The patients were followed up for half a year, during which no recurrence of renal calculi occurred, and no abnormal fatty tissues were found at the renal sinus or surrounding the kidney. Conclusions Imaging examination is valuable for the diagnosis of RSL. B-ultrasonography-guided percutaneous nephrolithotripsy is safe and effective for RSL complicated with renal calculi.

Objective To explore an effective treatment for benign prostatic hyperplasia complicated with bladder stones.Methods Swiss LithoClast Master and transurethral resection of the prostate(TURP)were performed on 33 patients with benign prostatic hyperplasia complicated with bladder stones.Results The operations were completed successfully in all the cases with a mean lithoclasty time of 35 min(15-65 min),and mean TURP time of 85 min(50-110 min).No blood transfusion,TUR syndrome,bladder perforation,or residual stone occurred during and after the operations.Urethral catheter was withdrawn 5 days postoperation,none of the patients had urinary incontinence or dysuria.The diagnosis of benign prostatic hyperplasia was confirmed by pathology examination.Three months after the operations,IPSS decreased from 23.4?5.2 to 7.4?1.2(t=3.732,P=0.000);maximum urinary flow rate increased from(5.4?1.5)ml/s to(18.6?3.2)ml/s(t=2.491,P=0.015);and QOL decreased from 3.9?1.2 to 2.0?0.7(t=2.454,P=0.014).Conclusions EMS LithoClast Master combined with TURP is an effective treatment for benign prostatic hyperplasia complicated with bladder stones.

Objective To summarize the experience of the diagnosis and treatment of pulmonary hamartoma.Methods Bronchoscopic enucleation of tumor was conducted in 1 case of endobrochial hamartoma, while video-assisted thoracoscopic surgery was performed in 42 cases(consisting of 40 cases of pulmonary wedge resection,1 case of lobectomy,and 1 case of bilateral lesion biopsy).Results Pathological examinations revealed hamartoma in all the 43 cases,including 1 case of multiple lesions and 1 case of hamartoma complicated with lung cancer.The diagnostic accordance rate was 11.6%(5/43).Follow-up in 37 cases for 4 months~ 11 years(mean,41.2 months) showed no recurrence or malignant change.Conclusions Pulmonary hamartoma is difficult to be confirmatively diagnosed preoperatively.Endoscopic operations can give an accurate diagnosis and a thorough removal of the lesion,with minimal invasion and rapid recovery.

Objective To evaluate the clinical effects of endobronchial ultrasound - transbronchial needle aspiration (EBUS-TBNA) in the evaluation of staging of lung cancer.Methods Between July 2008 to March 2010,the first 128 patients selected by CT or PET/CT scanning with lung cancer in whom metastatic carcinoma in the hilar and/or mediastinal lymph nodes underwent EBUS-TBNA and were clinically followed up.There were 102 males and 26 femals with the age of 37 - 85 years,average 60.1 years.Review the performance in check and the result of biopsy.Results From 128 patients of mean age 60.1 years ( range 37 - 85 ),189 lymph nodes were punctured.The mean diameter of the nodes was 12.3 mm and the range was 6-16 mm.There were no procedural complications.Accuracy,sensitivity,and specificity for EBUS-TBNA were 98.53％,98.50％,and 100％,respectively.Conclusion EBUS-TBNA allows real-time visualization of mediastinal and hilar lymph nodes,allowing sampling safely and efficiently.It has great potential for diagnosis of staging of lung cancer.

Objective To study the effects of high concentration oxygen exposure on the Sox17 expression of vascular endothelial cells of neonatal mice lungs,and to explore the pathogenesis of blocked lung vascular development.Methods Thirty two C57B1/6J newborn mice within six hours after birth were randomly divided to hyperoxia group (n=16) and room air group (n=16).Mice of hyperoxia group were exposed to 85％ oxygen.Eight mice of either group were sacrificed at 7 and 14 days after birth respectively to observe the lung morphology and calculate radial alveolar counts (RAC),which is the number of alveoli on the straight line from the center of respiratory bronchioles to the nearest fibrous septa or the pleura.Sox 17 expression in the pulmonary vessels was detected by immunohistochemical staining.Sox17 mRNA was measured by reverse transcription polymerase chain reaction.Sox17 protein level was measured by Western blot.Two independent samples t-test was used for statistical analysis.Results Compared with day 7,the lung structures matured with more uniformed alveoli and the septas became thinner on day t4 in room air group.However,the lungs developed slowly with simplified and non-uniformed alveoli on day 14 in hyperoxia group.The Sox17 protein was positive on endothelial cells of pulmonary arteries,veins and alveolar capillarys,as well as the alveolar epithelial cells.The RAC on day 7 and day 14 in hyperoxia group were both lower than that in room air group (3.7±0.7 vs 5.0±0.8,5.3±0.6 vs 8.3±0.9,respectively,t=3.057 and 8.148,both P ＜ 0.01).Sox17 mRNA on day 7 and day 14 in hyperoxia group were both lower than that in room air group (0.62±0.10 vs 0.88±0.11,0.44±0.06vs 0.90±0.15,t=3.607 and 6.926,both P ＜ 0.01).Sox17 protein level on day 7 and day 14 in hyperoxia group were both lowered than that in room air group (0.32±0.04 vs 0.76±0.04,0.36±0.07 vs 0.96±0.06,t=3.102 and 8.421,both P ＜ 0.01).Conclusions Exposure of high concentration of oxygen may cause impairment of lung vascular development by inhibiting Sox17 expression in lungs of neonatal mice.

Objective To investigate the effect of dexmedetomidine (DEX) on proliferation and differentiation of rat embryonic neural stem cells in vitro. Methods Embryonic neuraI stem cells of fetal SD rats were separated from rats with gestational age of 14-16 days , and underwent primary culture for nestin expression. Cells were divided into control group, low-dose DEX group, and high-dose DEX group, which were cultured with 0,1 and 10 ng/mL DEX respectively. Cell viability was detected by MTT assay;the proliferation rate was estimated by BrdU incorporation; the phosphorylation of ERK1/2 in the proliferation phases was detected by western blot; the differentiation of neuronal cells,astrocytes,oligodendrocyte and neural stem cells were assessed by immunocytochemistry of cell specific markers. Results More than 95% of the embryonic neural stem cells in primary culture were Nestin-positive. Cell viability , BrdU-positive cells and phosphorylation of ERK1/2 in low-dose DEX group increased significantly (P<0.05), and decreased significantly in high-dose DEX group compared with control group and low-dose DEX group (P < 0.05). NeuN-, GFAP- and MBP-positive cells increased (P < 0.05), while Nestin-positive cell decreased (P<0.05) in both low and high dose DEX group compared with control group. However, no significant difference was found in low and high dose DEX group (P > 0.05). Conclusions The proliferation of neuraI stem cells can be promoted by low-dose DEX and depressed by high-dose DEX , as well as regulated by DEX of the phosphorylation of ERK1/2. DEX induces neural stem cells non-selective differentiation.

Objective To investigate the expression of placental growth factor (PlGF) protein and mRNA in lungs of neonatal rats exposed to 85%hyperoxia, and to establish the relationship between PlGF and bronchopulmonary dysplasia (BPD). Methods Forty-eight Sprague–Dawley neonatal rats were randomly exposed to air (control group)(n=24) and 85% hyperoxia (hyperoxia group)(n=24)within 12 h after birth. The rats were sacrificed at 3, 5 and 7 days after exposure (eight at each time) and their lungs were sampled. PlGF protein and mRNA expression in the lungs were determined by Western blot and real-time polymerase chain reaction (PCR) at 3, 5 and 7 days. Left lung tissue was used for morphological and histological observation with hematoxylin and eosin staining. Terminal air spaces and the secondary septa were counted manually under microscope. T-test was applied for statistics. Results Compared with the control group, morphological and histological analysis in the hyperoxia group revealed inflammatory cell infiltration, simplified alveolar structure, less alveolar, alveolar cavity expansion and thickened alveolar septum. Morphometric measurements showed that terminal air spaces and secondary septa were significantly fewer in the hyperoxia rats than those in the control group at 5 and 7 days (terminal air spaces:23.6±8.2 vs 33.1±6.2 and 28.5±9.2 vs 38.4±10.1, t=1.91, 2.53, all P<0.05;secondary septa:56.0±12.2 vs 78.3±8.2 and 75.4±12.2 vs 126.1±10.2, t=2.14, 2.72, all P<0.05). Real-time PCR showed that expression of PlGF mRNA increased significantly on day 3, 5 and 7 in the hyperoxia group compared with the control group (1.16±0.17, 1.34±0.15 and 1.65±0.19 vs 0.65±0.21, 0.47±0.11 and 0.46±0.17, respectively, t=1.93, 2.55, 2.79, all P<0.05). Western blot also showed that expression of PlGF protein on day 3, 5 and 7 in the hyperoxia group increased compared with the control group, but only being significant on day 3 (0.24±0.17 vs 0.09±0.01, t=2.44, P<0.05). Conclusions Hyperoxia (85%) exposure could increase PlGF protein and mRNA expression in the lungs of neonatal rats, likely contributing to pathogenesis of BPD, and might lead to pulmonary vascular developmental disorders in BPD.

Objective To assess the assistance role of three-dimensional reconstruction of stag-horn calculi by 16-slice spiral CT to percutaneous nephrolithotomy (PCNL). Methods A total of 87 patients with 104 staghorn stones underwent 24 F-tract PCNL. 16-slice spiral CT scan and three-di-mensional (3D) reconstruction by volume rendering technique were carried out before PCNL for tract placement planning, the necessity for multiple tracts and stone burden. Tract placement, tract num-ber, operation time, bleeding requiring transfusion and volume of stone cleared were recorded. KUB was taken to explore residual calculi after operation and thus stone free rate was noted. Results In-traoperative tract placement was according to preoperative planning with 3D reconstruction of calculi. Forty-three calculi were cleared by multiple accesses, while multiple accesses were supposed necessary for 47 caculi. The stone free rate of one-session operation was 87.5%, and the last stone free rate af-ter second-look procedure was 91.7%. The stone burden of 3D reconstruction of CT (19.35 ±19.24 cm3) was significantly correlated with the mean volume of cleared calculi (16.34±13.79 cm3) in oper-ation (r=0. 993, P=0. 000). Conclusion The 3D reconstruction of spiral CT for staghorn calculi could show the precise construction of calculi, which could help to plan tract placement, evaluate the necessity of multiple tracts and stone burden.

-Objective To evaluate the efficacy and morbidity of standard tract percu taneousnephrolithotomy (PCNL) for patients with open surgery history of kidney and upper ureter. Meth odsEleven patients with open surgery history of kidney and upper ureter underwent standard tract (24 F)PCNL. Five patients had open nephrolithotomy,3 had pyeloplasty,2 had open ureterolithotomy and 1had partial nephrectomy. Five calculi were in left kidney and 6 in right side. Two cases had single cal culus,5 had multiple,and 4 had staghorn calculi. The stone burden was 1.7 47.1 cm3. ResultsAll patients were successfully operated in one session procedure. Nine PCNLs were accomplished bysingle and 2 by double accesses. The mean operating time was 86.2±34.2 min,the mean first access ing time was 14.14±11.0 min. The stone free rate after one session operation was 91% (10/11). Nocomplication occurred. Conclusion Standard tract PCNL for patients with open surgery history ofkidney and upper ureter could be effective and safe.