Objective To investigate the changes of tumor necrosis factor-?(TNF-?) and platelet-derived growth factor(PDGF) in gallbladder carcinoma (GA) patients with cell wall-deficient bacleria(L-form) infection .Methods The levels of TNF-? in gallbladder mucosa were detected by radioimmunoassay and the activity of PDGF was detected by bioactivity assay in patients with GA or cholecystitis and normal gallbladder(control group).Results The positive detection rates of L-forms in gallbladder mucosa of gallbladder carcinoma , chronic cholecystitis, and control group were 80.0%(16/20),82.5%(33/40) and 0(0/20), respectively.The TNF-? and PDGF levels in patients with L-form infection-positive gallbladder carcinoma were significantly higher than those in patients without L-form infection and in control group.The levels of TNF-a and PDGF in patients with L-form infection positive chronic cholecystitis were significantly higher than those in patients without L-form infection and in control group.Conclusions L-form may be one of the direct factors leading to the increase in PDGF during gallbladder oncogenesis,and there is positive correlation between PDGF and gallbladder oncogenesis when L-form induces inflammatory reaction and predisposes gallbladder mucosa to develope neoplasms.

Objective To explore the correlation between anxiety,depression and the symptoms of interstitial cystitis/bladder pain syndrome (IC/PBS) patients,improving the psychological knowledge of IC/PBS patients,providing theoretical basis for psychological intervention.Methods During November 2009 to October 2011,54 IC/PBS patients including 42 women and 12 men patients were treated,with mean age of (41.0±12.4) years and mean course of the disease of (63.0±59.2) months.O'Leary-Sant questionnaire was used for IC/PBS symptoms assessment,and Visual Analogue Scale (VAS) was used to evaluate pain associated with bladder,Self-rating Anxiety Scale (SAS) was used for anxiety assessment,and Beck Depression Inventory Ⅱ (BDI-Ⅱ) was used for depression assessment.The relationship between depression,anxiety and the symptoms of IC/PBS patients was evaluated.Results Of the 54 IC/PBS patients,mean ICSI score was (15.0±1.84) points,mean ICPI score was (8.0±2.6) points,mean O'Leary-Sant questionnaire score was (24.0±3.9) points,mean VAS score was (7.0± 1.0) points,mean anxiety score was (52.0± 7.2) points,with 35 cases (64.8％) suffering from anxiety symptoms.Mean depression symptoms score was (16.0±4.5) points,with 41 cases (75.9％) suffering from depressive symptoms.The degree of anxiety and depression were associated with education level,the sleep quality and monthly income of IC/PBS patients.Anxiety and depression had no definite correlation with marital status and working conditions.Anxiety and depression were closely related (proportion) with the symptoms (frequency,urgency,pain or discomfortrelated to bladder) of IC/PBS patients.Conclusions Anxiety and depression are common in patients with IC/PBS,and they are related to symptom severity.In order to improve the quality of life,much attention must be paid to psychological condition assessment and treatment of IC/PBS patients.

Objective To classify patients with pelvic pain and to improve the understanding of etiology and to guide treatment by using a clinical phenotype system (UPOINT) and to examine the relationship between UPOINT and symptoms in patients with interstitial cystitis/painful bladder syndrome. Methods From November 2009 to October 2011,54 IC/PBS patients including 42 female and 12 male patients were treated.The mean age was 41.0 ± 12.4 yrs (range from 21 to 76 yrs).Median symptom duration was 63.0 ± 59.2 months ( range from 6 to 240 months).54 patients with interstitial cystitis/painful bladder syndrome were classified in each domain of UPOINT,that was urinary,psychosocial,organ specific,infection,neurological/systemic and tenderness.Symptoms were assessed using the Interstitial Cystitis Symptom Index,Pain/Urgency/Frequency score and visual analogue scale for pain/urgency/frequency.Clinically relevant associations were calculated. Results In the 54 IC/PBS patients,median ICSI score was 15.0 ± 1.84 points ( range from 9 to 19 points) ; Median PUF was 20.0 ± 2.3 points ( range from 14 to 25 points) ; Median pain associated with bladder score of VAS was 7.0 ± 1.0 points (range from 5 to 10 points).The percent positive for each domain was urinary 100％,psychosocial 44％,organ specific 96％,infection 33％,neurological/systemic 24％ and tenderness 28％,respectively.All patients were included in at least 2 domains,with 2 domains of 11％,3 domains of 38％,4 domains of 36％,5 domains of 13％ and 6 domains of 2％.The number of domains was associated with greater symptom duration ( Spearman r =0.76,P ＜0.01 ) but not age.The number of domains was also associated with poorer general interstitial cystitis and pain symptoms ( Spearman r =0.89,P ＜ 0.01 ) but not with frequency or urgency.The psychosocial domain was associated with increased pain,urgency and frequency,while tenderness was associated with increased ICSI score,PUF score and urgency.The neurological/systemic domain was associated with increased ICSI score while the infection domain was not associated with any increased symptoms. Conclusions The UPOINT phenotyping system can classify patients with interstitial cystitis according to clinically relevant domains.The UPO1NT system can act as the guiding theoretical basis for directing multimodal therapy,it deserves clinical promotion.

Objective To analyze the causes of under-staging in first transurethral resection of bladder tumor (TURBt) and find out solutions. Methods We retrospectively analyzed 118 cases (93 males and 25 females) of non-muscle invasive bladder cancer and compared the grade and stage between the first TURBt with the second transurethral resection (TUR) or partial cystectomy (PC) or radical cystectomy (RC) from January 2006 to March 2011.The mean patient age was 63.0 ±8.6 yrs.The tumors located in lateral,dome and posterior wall were 71,23,24 respectively; 75 of them were with single and 43 were with multifocal lesions; the sizes of tumor ranged from 0.5 -4.0 cm and 39 of them were ≥3.0 cm; The procedures performed by senior and junior urologist were 53 and 65 cases,respectively.In the study,we used the 2004 WHO/ISUP and 2002 TNM classification system for grading and staging.The data were analyzed with x2 and the logistic regression test to find out the causes of under-staging in first TURBt. Results There were 13 and 105 cases with high-grade Ta and T1 (low-grade T1 44 cases,high-grade T1 61 cases) in first TURBt,respectively.The finial stages were low-grade Ta(2),high-grade Ta(6),low-grade T1 (36),highgrade T1 ( 38 ),T2 (36) and 39 cases (33.1 ％ ) were under staged ( P ＜ 0.01 ).There were 17 and 22 under-staged cases compared with the second-TUR group (60 cases) and PC/RC groups (58 cases),respectively.The reasons of under-staging were related to tissue morphology changes (63 cases) and the absence of the detrusor muscle (56 cases) in specimens collected during the first TURBt.Multivariate analyses revealed that large tumors ( ≥3 cm),and lateral/dome/anterior wall tumors were independent risk factors to the absence of the detrusor muscle in the resected specimens with OR (95％ CI):3.766 ( 1.263 -11.225 ),and OR (95 ％ CI):5.951 (2.186 - 16.203 ),respectively.While surgery performed by senior surgeons was the protective factor to the presence of detrusor muscle,OR (95％ CI):0.274 (0.127 -0.593). Conclusions It is difficult for the first TURBt to completely avoid under-staging.The causes were related to tissues morphology changes and the absence of underlying detrusor muscle in specimens collected during the first TURBT procedure.Tissues morphology changes and the absence of detrusor muscle are related to the tumors location and size.A senior urologist and second-TUR can improve the under-staging.

Objective To evaluate permissive hypocaloric intake in postoperative patients by a prospective, randomized, controlled trial. MethodsForty-two postoperative patients were randomly assigned to receive 117kJ?kg~ -1?d~ -1in control group, and 75kJ?kg~ -1?d~ -1in experimental group intravenously. Blood routine, liver and renal functions were measured one day before and day 1, 3, 5 post operation. Blood glucose level, insulin intervention, infectious complications, hospital stay, and relevant cost were also evaluated. ResultsHypocaloric intake in the experimental group post-operatively did not influence the hemoglobin level, liver function, and other indicators in the serum. The fasting blood glucose and glucose levels after infusion, as well as the volume of insulin intervention were significantly higher in the control group during 4 days of parenteral nutrition. Experimental group had lower relevant hospital cost, while two groups had similar duration of hospital stay. ConclusionPermissive hypocaloric intake shortly after surgery does not influence the patient nutritional status, besides it avoids to some extent the hyperglycemia, reduces the need for insulin intervention .

Objective To investigate the effect of Ulinastatin, a urinary trypsin inhibitor on the outcome of patients undergoing liver resection. Methods In this prospective, randomized, and controlled clinical study, 42 patients undergoing hepatectomy were randomly divided into treatment group and control group. In treatment group Ulinastatin was given on the day of surgery and the three consecutive days. Blood was tested for biochemistry. ResultsSerum ALT and AST levels in treatment group were significantly lower than those in control group 12 hours post-operation, especially in patients undergoing multisegmentectomy. Difference became insignificant at the time point of 60 hours post-operation. Administration of Ulinastatin resulted in faster decrease of serum bilirubin level in patients undergoing small volume hepatectomy, and no effect on coagulative function was observed. Conclusions The protective effects of urinary trypsin inhibitor exist mainly in early stage of major liver resection.

Objective To study the effect of urinary trypsin inhibitor (UTI) on the release of inflammatory media and oxidation reaction and the mechanism by which UTI protects postoperative liver function following hepatectomy. Methods This was a prospective, randomized, controlled clinical trail, in which cases undergoing hepatectomy were divided into control group (n = 15) and treatment group (n = 15). UTI was administered beginning the day of operation and three days post-op consecutively in the treatment group. Serum CD4, CD8, C-reactive protein(CRP), and gene expressions of IL-1, Il-6, TNF-alpha, iNOS were measured. Results TNF-alpha and iNOS levels significantly decreased in treatment group compared with control 12 hours after surgery (0. 053?0. 02 & 0. 12?0. 04 vs. 0. 084?0. 01 & 0. 21?0. 02, all P

Objective　To report the experience in diagnosis and treatment of inferior vena cava stenosis (IVCS) after orthotopic liver transplantation (OLT). Methods　The clnical data of 3 patients with IVCS out of 51 OLT patients were analysed retrospectively. Results　The incidence of IVCS after OLT was 5.8% (3/51) in our hospital. In the 3 cases, IVCS of the posteriorhepatic IVC segment occurred within the first postoperative month. IVCS was identified by color duplex ultrasonography and confirmed by angiography. Percutaenous transluminal angioplasty (PTA) or metallic stent replacement were used in the 3 cases resulting in restoration of normal venous flow and elimination of legs edema. The first patient died of cerebral hemorrhage 14 days after transplantation during anti-coagulative therapy. The other two recovered smoothly with good liver function, abdominal ultrasonography demonstrated patency of the IVC. The 2 cases were alive for 18 and 4 months respectively. Conclusions　The venacavographic balloon angioplasty and metallic stent replacement are safe and useful for post-OLT IVCS. The short-term result is excellent.

Objective To investigate the effect of mitogen-activated protein kinases (MAPKs) activation on the heat stressinduced apoptosis of pulmonary microvascular endothelial cells (PMVECs).Methods A mouse model of severe heat stroke was made and TUNEL and immunohistochemistry were employed to detect lung tissue damage.MACS separation was used for isolation of neonatal PMVECs,and TUNEL was utilized to detect the apoptosis of PMVECs.Western blotting was used for determining the MAPKs activation during heat stress recovery (0,2,6h).The monolayer permeability of endothelial cells was detected in terms of transmembrane resistance (TEER) and horseradish peroxidase (HRP).Cells were pretreated with MAPKs activation inhibitors to examine the effect of heat stress on the monolayer cell permeability and apoptosis.Results In mice with severe heat stroke,extensive apoptosis of PMVECs was found in their pulmonary tissues.TUNEL revealed that the number of apoptotic cells increased over time during heat stress recovery period and heat stress could activate MAPKs in PMVECs.Compared with heat stress group,in the cells pretreated with p38 or ERK activation inhibitor PD98059 and SB203580,the monolayer permeability and apoptosis increased while in cells pretreated withJNK inhibitor SP600125,the cellular permeability and apoptosis decreased.Conclusion In mice with severe heat stoke,PMVECs might experience apoptosis and p38 and ERK could inhibit apoptosis while JNK could promote apoptosis.

Objective To summarize the clinical diagnosis and treatment of nodular regenerative hyperplasia of the liver. Methods Retrospective analysis was made on the clinical manifestations,imagings, laboratory tests, diagnosis, treatment and prognosis of 18 consecutive cases finally established as NRH during the past 26 years. Results 15 of the 18 cases showed portal hypertension, 4 cases showed mono or multiple occupations of the liver, 8 cases suffered from concurrent autoimmune diseases, 3 cases were suspected of blood diseases. Preoperatively, 13 cases were diagnosed as cirrhosis, 2 cases were diagnosed as liver cancer or focal nodular hyperplasia ( FNH). All cases were diagnosed by operative wedging biopsy. 3 cases received splenectomy, 4 cases received disconnection /Phemister surgery, 3 cases received liver occupation/liver lobe resection, 1 case received partial small bowel resection, and 1 case received spleen artery restrictive surgery. Postoperatively, symptoms of portal hypertension relieved obviously. Follow-up study showed most of the patients were stable and prognosis of the NRH was good.Conclusions NRH may relate to the disturbance of liver blood supply, and most common clinical manifestation is portal hypertension, and can combine with immune diseases, hematopathy also can present single or multiple liver occupations. Differential diagnoses include liver cirrhosis, FNH, idiopathic portal hypertension. Diagnosis of NRH relies on liver wedging biopsy. Surgery can relive concurrent portal hypertension.