Objective To study the relationship between blood cell count and cardiac events in acute ST elevation myocardial infarction patients treated with reperfusion in the early stage. Methods In this study, we assigned 151 patients to whom reperfusion therapy had been delivered within 3 hours of STEMI symptom into two groups:primary percutaneous cor-onary intervention group and thrombolysis therapy group. Differences of cardiac events and white blood cell count in these two groups were analyzed in the first 4 days. Results In the second day and the forth day, cardiac events rate and white blood cell count were significantly lower in the primary percutaneous coronary intervention group than those in the thromboly-sis therapy group (P＜0.05). In the second day, white blood cell count has a positive correlation with cardiac events rate (r=0.226, P＜0.05). Conclusion Primary percutaneous coronary intervention decreased blood cell count and cardiac events rate. In patients with acute myocardial infarction, increasing white blood cell was related to cardiac events in the near future.

Objective:To determine the diagnostic value of multislice CT urography (MSCTU) in patients with transitional cell carcinoma ( TCG) of upper urinary tract by comparing other imageology methods used. Methods: Two hundred and thirty four cases of transitional cell carcinoma of upper urinary tract, in which 82 cases were diagnosed pathologically with pelvic carcinoma and 152 cases with ureteral carcinoma, between June 2004 and September 2006 in our institute were enrolled in a retrospective study. Most of them underwent urological ultrasound, intravenous urogram (IVU) , retrograde pyelography and MSCTU. We compared the positive rate (PR) and diagnostic rate (DR) of these methods used by chi-square test. Results: Among the 234 cases, 215 patients underwent urologic ultrasound, in which 152 cases were detected to be abnormal, with the PR of 70.1% ;Meanwhile, 58 cased were diagnosed by this examination, with the DR of 27. 0%. IVU was performed in 193 patients and 132 cases were found to be abnormal, and the PR was 68. 4% , 65 cases were diagnosed by IVU and the DR was 33.7%. And 132 patients underwent retrograde pyelography, by which 115 cases of lesion were detected, with the PR of 87. 1% ; In the meantime, 93 cases were diagnosed, with the DR of 70. 5%.MSCTU was performed in 226 cases and 220 cases were found to be abnormal, and the PR was 97.3% ;214 cases were diagnosed by MSCTU, with the DR of 94. 7%. The DR of detecting TCC of retrograde pyelography had statistically significant difference with that of ultrasound and IVU(P＜0.001). As compared with retrograde pyelography, MSCTU had statistically significant superiority (P＜0.001). Conclusion: To shorten the diagnosis time and mitigate the sufferings, patients with hematuria supposed to be TCC of upper urinary tract should be recommended to undergo MSCTU first.

OBJECTIVETo analyze the operative characteristics and indications small incision for treating simple renal cysts.

METHODS19 patients with simple renal cyst were treated by ablation with small incision from January. 1995 to September. 2001 at our institute. Surgical technique, curative effect and indications were analyzed.

RESULTSIn the 19 patients the operative procedure took 34 +/- 15 min (20-80 min) on average and the mean hospitalization was 4.4 +/- 1.5 d (3-8 d). Neither complication nor recurrence occurred from 3 to 6 months during the follow-up.

CONCLUSIONSAblation with small incision is significantly advantageous for operation, recovery, short hospital stay, and lower cost. This operation is indicated for simple renal cyst in the lower, middle pole of the kidney.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Kidney Diseases, Cystic ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Retrospective Studies ; Treatment Outcome

BACKGROUND: Numerous evidence has demonstrated that the magnesium aloy with excelent mechanical properties can degradein vivo, and can be used as vascular stent materials, bone fixation materials, porous materials for bone repair. But it is not reported in the biliary stent. OBJECTIVE:To observe the degradation procedures and evaluate the changes of mechanical characteristics of biliary stents made of magnesium aloy (AZ 31B) in human bilein vitro. METHODS:The baloon-expandable biliary stents were made of magnesium aloy with laser sculpture. Then, 15 stents treated with micro-arc oxidation on the surface served as experimental group and another 15 stents without micro-arc oxidation as control group. A dynamic numerical simulation system was establishedin vitro to simulate the internal environment of human biliary tract. Al of the biliary stents were placed into this system. Their shapes were observed, and their qualities and radical forces were measured every 20 days. At the same time, their surfaces were scanned by scanning electron microscope. RESULTS AND CONCLUSION:(1) The degradation speeds of the stents in the experimental group were obviously slower than those in the control group. The fracture of the connecting rods in control group and experimental group appeared 20 days and 40 days later, respectively. The peak time of degradation in the control group and experimental group were 30 days and 50 days, respectively. The stents were fuly biodegraded within 70 days in the control group while within 90 days in the experimental group. With time, the stent surface became more rough, and the density, area and depth of etch pits were al increased in the two groups. At the same stage, the degradation speed of the control group was more rapid than that in the experimental group. (2) The qualities and radical forces of the stents were gradualy reduced with time in both groups. However, the degradation speed of stents in the experimental group was much slower than that in the control group. In summary, the degradation speed of the biliary stents made of magnesium aloy treated with micro-arc oxidation is appropriate and can meet the clinical requirement for the degradation time of biliary stents. This novel material could potentialy be used for the preparation of biliary stents.

Objective:To determine whether chewing gum during the postoperative period facilitates the recovery of bowel function in patients after radical cystectomy with ileum urinary diversion.Methods:In the study,60 patients who underwent radical cystectomy followed by ileum urinary diversions during Nov.2014 and Nov.2015 in Department of Urology of Peking University First Hospital were randomized into three groups:gum chewing group,placebo group treated with the abdomen physical therapy machine and control group treated with ordinary method.Time to flatus,time to bowel movement,incidence of postoperative distension of the abdomen and abdominal pain,and gut related complications (such as ileus,intestinal fistula,and volrulus)of all the patients were recorded and analysed.Results:In gum chewing group,the median time to flatus was 57 hours (49 -72 hours),and the median time to bowel movement was 95 hours (88 -109 hours),which were significantly shortened compared with the other two groups of patients (82 hours,109 hours in placebo group and 81 hours,108 hours in control group, respectively).No significant difference of the median time to flatus and to bowel movement was observed between placebo group and control group.There were no significant differences in the incidence of post-operative distension of the abdomen and abdominal pain,and gut related complications among the three groups.Conclusion:Chewing gum had stimulatory effect on bowel function recovery after cystectomy fol-lowed by ileum urinary diversion.Chewing gum was safe and simple,and could be routinely used for postoperative treatment after cystectomy and ileum urinary diversion.

Objective To summarize the experience in open surgery for huge adrenal tumors in order to improve its safety and efficiency of this complicated surgical procedure. Methods Fortyfour consecutive patients with huge adrenal tumors underwent open surgery with mean long tumor diameter of 13 cm (9-34 cm), and autologous blood transfusion was prepared in routine. It was analyzed retrospectively for clinical data, perioperative complications and the effective and safety results of this procedure. Results The incision was oblique in lumbar region in 5 cases, subcostal unilaterally in 32 cases and abdomino-thoracic joint in 7 cases. There were 27 malignant tumors (61.4%) in 44 cases, 3 with hepatic invasion, 6 with thrombi extending into inferior vena cava, among which 2 needed translocation of artificial blood vessels and 3 needed cardio-pulmonary bypass. The mean blood loss was 1309 ml (100-3000 ml) in 41 cases(93.2%)and the autologous blood transfusion was used in 20 case (45.5%). There were 1 diaphragmatic injury, 1 pleura injury, 3 hemorrhage in large amount more than 15 000 ml and 2 peritoneal cavity infection.There were no perioperative deaths and 42 tumors (95.5%) were curatively resected. Conclusions Open surgery for huge adrenal tumors is a complicated surgical technique with high risk and large amount of blood loss. The key points to success are proper selection of incision, routine autologous blood transfusion, perfect surgical skills and good cooperation between different specialties.

Objective To assess the safety,efficacy and reliability of IUPU(Abbreviation of Institute of Urology,Peking University)technique in setting up the retroperitoneal cavity for retroperitoneoscopy. Methods From February 1996 to March 2006,more than 1100 retroperitoneoscopic procedures were performed with the IUPU technique in setting up the retroperitoneal cavity,First,at the cross point of the line 2 cm above the iliac crest and the longitudirml line close to the anterior auxiliary line,a 1 cm skin incision was made and the Veress needle was penetrated into the retroperitoneal space(RPS)with a 0°-30° angle to the perpendicular line.The CO2 gas was pumped into the RPS till the pressure increases to 14mmHg and the first port was inserted into the RPS.The laparoscope was then inserted into the RPS through the first port and kept swinging right and left with its tip and trunk tO set up the retroperitoneal cavity.Other 2 ports were put into the RPS at cross points of the sub-costal line and anterior and posterior auxiliary lines under monitor observation.Then other appliances are introduced into the RPS to expand the cavity.More than 1100 procedures had been done with the IUPU technique,including 54 cases of simple nephrectomy (loss of function due to tuberculosis,hydronephrosis and atrophy), 188 radical nephrectomy, 154 ureteronephrectomy, 344 adrenalectomy, 302 renal cyst decortications, 35 partial nephrectomy, 37 pyeloplasty. Results The average time for the IUPU technique was (5.4±2.8)min (range 4. 5 to 14. 5 min) to set up the RPS. Complications included converting to open surgery due to bleeding in 8 cases(8/1114,0. 72%) when the first port was inserted into the RPS and entered into the peritoneal cavity for the first port penetration in 32 cases (32/1114,2. 87%),although the retroperitoneal cavity could be set up successfully by adjusting the laparoscope into the RPS.There was no injury to other viscera. Conclusions The IUPU technique is safe, efficient and reliable in setting up the RPS and no other special instrument is needed. It can be finished within 5 min on skilled hands and is valuable as a routine method to set up the retroperitoneal cavity.

Objective To evaluate the safety and efficacy of the anatomical retroperitoneoscopic nephrectomy(RSN)and standardize the procedure of RSN. Methods The retrospective analysis was performed on 405 consecutive patients underwent anatomical RSN in Our institute from January 2002 to June 2008.There were 232 male and 173 female patients with the average age of(57.2±14.2)years,among whom there were 228 renal cell carcinoma patients accepted RSU,96 and 49 renal pelvic carcinoma and ureteral carcinoma cases accepted retroperitoneoscopic ureteronephrectomy (RSUN) and 32 cases accepted simple RSN due to loss of renal function caused by benign renal discsses.The tadical RSN was performed by dissecting outside Gerota's fascia and in the latent cavities between this fascia and lateral conal fascia in the dorsal side and between this fascia and prerenal fusion fascia in the ventral side,whereas the simple RSN was done inside Gerota's fascia by making direct incision on it and dissecting between this fascia and perirenal adipose tissue.Kidneys and perirenal adipose tissue were completely removed by dissection along several avascular planes around the kidney under the amplified view of laparoscopy. The software SPSS 12.0 was used for the statistical analysis of all data. Results The mean operative time was (132±48)min for radical and simple RSN and (245 ± 62)min for radical RSUN, which included the time for position change and second skin preparation. The medium estimated blood loss was 100 ml(10-2500 ml) and the average drainage volume was 150 ml (0-1152 ml) postoperatively. 15 cases (3. 70%) required blood transfusion with the median volume of 400ml (400-1650 ml). Four cases (0. 99%) were converted to open surgery due to severe adhesion (2 cases), difficult exposure of renal helium (1 case) and severe bleeding (1 case).The mean drainage time was (3. 9±1.8)d, the mean time to first oral intake was (2.7±1.2)d and the mean postoperative hospital stay was (8.6±3. 8)d. Conclusion The anatomical RSN is safe and effective and should be the standard surgical procedure for laparoscopic nephrectomy.

Objective:To investigate the protective effect of IL-22 on rat liver ischemia reperfusion injury (IRI) and the potential mechanisms.Methods:Eighteen male specific pathogen free SD rats (7-8 weeks, about 250g) were randomly divided into three groups: Sham group (Sham), hepatic ischemia reperfusion (IRI) and IL-22 preconditioning group (IL-22+ IRI), respectively. The liver IRI model of 70% rats was established. The IL-22+ IRI group was intraperitoneally injected with rcIL-22 (50 mg/kg) 1 hour before surgery, and the Sham group and IRI group were injected with the same dose of normal saline 1 hour before surgery. After 1 h ischemia and 6 h reperfusion, blood was collected from the abdominal aorta, then liver tissue, serum aspartate transaminase (AST) and alanine aminotransfease (ALT) levels were measured. The levels of superoxide dismutase (SOD) and malondialdehyde (MDA) in liver tissue were detected. The expression of signal transducer and activator of transcription 3 (STAT3), p-STAT3, nuclear factor erythorid-2 related factor 2 (Nrf2) and heme oxygenase 1 (HO-1) were detected by Western blot. Results:Compared with Sham group, serum AST [(1 923.50±92.63) U/L, (1 004.25±65.05) U/L)] and ALT [(1 172.51±180.31) U/L, (583.50±164.75) U/L] levels were increased in IRI group and IL-22+ IRI group (AST: F=293.62; ALT: F=30.33, P<0.05). The levels of MDA in IRI group and IL-22+ IRI group [(1.72±0.12) μmol/mg, (0.98±0.05) μmol/mg] in liver tissue were higher than those in Sham group (0.58±0.14) μmol/mg protein ( F=186.73, P<0.05), and the expression of p-STAT3, Nrf2 and HO-1 was increased. SOD level in IRI group (28.51±3.85) U/mg was lower than that in Sham group (70.25±5.64) U/mg protein ( F=203.41, P<0.05). Compared with IRI group, serum AST and ALT levels in IL-22+ IRI group were decreased, SOD activity in liver tissue was increased, MDA level was decreased, and p-STAT3, Nrf2 and HO-1 expression was increased (all P<0.05). Conclusion:IL-22 could alleviate liver IRI in rats, and the mechanism may be related to the activation of STAT3 and Nrf2/HO-1 signaling pathway and anti-oxidative stress.

Objective To investigate the effect of trimetazidine on ischemic bile duct injury in rats and related mechanism. Methods A total of 40 male Sprague-Dawley rats were randomly divided into sham-operation group (Sham group with 10 rats), bile duct ischemia-reperfusion injury group (BIRI group with 10 rats), 6-hour trimetazidine pretreatment group (TMZ-6h group with 10 rats), and 3-day trimetazidine pretreatment group (TMZ-3d group with 10 rats). The ischemia time was 30 minutes, and samples were collected after 24 hours of reperfusion. HE staining was used to observe bile duct injury, and the serum levels of alanine aminotransferase (ALT), alkaline phosphatase (ALP), and direct bilirubin (DBil) were measured, as well as the activity of superoxide dismutase (SOD) and the level of malondialdehyde (MDA) in bile duct tissue; Western Blot was used to measure the levels of the signal molecules related to oxidative stress and apoptosis, such as nuclear factor erythroid 2-related factor 2 (Nrf2), heme oxygenase-1 (HO-1), B-cell lymphoma-2 (Bcl-2), and caspase-3. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the Sidak t -test was used for further comparison between two groups. Results HE staining showed continuous interruption, necrosis, and exfoliation of bile duct epithelial cells in the BIRI group and no significant change in bile duct tissue in the TMZ-6h group, and in the TMZ-3d group, the bile duct epithelial cells had clear boundaries with a small amount of necrotic and exfoliated cells. Compared with the Sham group, the BIRI group had significant increases in the levels of ALT, ALP, DBil, and MDA (all P < 0.05); compared with the BIRI group, the TMZ-3d group had significant reductions in the levels of ALT, ALP, DBil, and MDA (all P < 0.05); there were no significant differences between the TMZ-6h group and the BIRI group (all P > 0.05). Compared with the Sham group, the BIRI group had a significant reduction in SOD activity ( P < 0.05), the TMZ-3d group had a significant increase compared with the BIRI group ( P < 0.05), and there was no significant difference between the TMZ-6h group and the BIRI group ( P > 0.05). Compared with the Sham group, the BIRI group had significant increases in the expression levels of Nrf2, HO-1, and caspase-3 (all P < 0.05) and a significant reduction in the expression level of Bcl-2 ( P < 0.05); compared with the BIRI group, the TMZ-3d group had significant increases in the expression levels of Nrf2, HO-1, and Bcl-2 ( P < 0.05) and a significant reduction in the expression level of caspase-3 ( P < 0.05); there were no significant differences in Nrf2, HO-1, Bcl-2, and caspase-3 between the TMZ-6h group and the BIRI group (all P > 0.05). Conclusion Trimetazidine can reduce bile duct ischemia-reperfusion injury in rats, possibly by inhibiting the level of oxidative stress in bile duct cells and reducing cell apoptosis.