Laparoscopic partial nephrectomy is gaining more and more popularity in treating patients with early renal carcinoma in recent years. Compared with radical nephrectomy, laparoscopic partial nephrectomy is a mini-invasive, safe method with satisfactory postoperative survival rate. However, there were still limited laboratory and clinical data about laparoscopic partial nephrectomy, and the experimental data of traditional laparoscopic surgery and open surgery were still used. Based on the existing data and the authors' experience, this article proposes three hypotheses for the problems puzzling urologic surgeons; the authors hope to verify the hypotheses through basic or clinical research.

Objective: To explore the procedures and clinical outcomes of retroperitoneal partial nephrectomy for early malignant renal tumors. Methods: A total of 21 patients (19 men and 2 women, with a mean age of 49 years) with early malignant renal tumors were subjected to retroperitoneal partial nephrectomy using ultrasound knife and electron microscopy. The 21 patients included 17 with clear cell renal carcinoma, 3 with granule cell renal carcinoma, and 1 with oxyphil cell renal carcinoma. The mean diameter of the tumors was (2.8±0.8) cm. Results: All the 21 cases underwent successful retroperitoneal partial nephrectomy without conversion to open operation. Mean surgical time was (105 ± 15) min and mean blood loss was (120 ± 22) ml. Four patients had a mean blood transfusion of 400 ml. One patient had urine leakage, with drainage volume of 200-300 ml; the drainage was stopped 15 days after operation when the drainage was less than 20 ml. The mean postoperative hospital stay was (9±2) days (7-17 days). No patients had local recurrence during a mean follow up of (20±4) months. Conclusion: Laparoscopic partial nephrectomy is feasible and safe.

Objective: To summarize our experience on laparoscopic adrenalectomy. Methods: From August 2001 to Jun 2007, a total of 203 patients (128 male and 75 female, aged 21-74 years, with a mean of [45±2] years old) received laparoscopic adrenalectomy. Six patients had bilateral tumors. The diameters of the adrenal tumors or nodules were 0.4-18 cm. Results: The 203 patients received a total of 209 times of laparoscopic adrenalectomy: including 34 cases via transperitoneal approach, 166 via retroperitoneal approach and 3 via hand-assisted approach. The overall successful rate of laparoscopic adrenalectomy was 97.04% (197/203). Six person-times (2.96%) were converted to open operation due to bleeding or adhesion. The mean operation time was 135±35 min and the estimated blood loss was 40-250 ml (with a mean of 75±25 ml). The patients could get down the bed for activity 1-3 days after operation. The postoperative hospital stay was 7-10 days (with a mean of 7± 2 days). The complications included vena caval injury (1 case), pleural injury (1 case), lumbar hematoma (4 cases), and fat liquefaction (1 case). Conclusion: Laparoscopic adrenalectomy has advantages for treating adrenal tumors. But different approaches should be chosen according to the size and pathological types of the tumors. Transperitoneal approach should be chosen for patients with larger tumors, for obese patients or for patients with bilateral lesions.

Objective: To discuss the procedure and clinical effect of retroperitoneal laparoscopic nephropexy (RLN). Methods: From August 2001 to June 2006, RLN was performed on 28 female patients aged 26-45 years old (mean, 34±2.5) with symptomatic nephroptosis, including 15 with the right kidney, 12 with the left, and 1 with both. The preoperative complaint of patients included subjective symptoms (constant and recurring pain in 28 patients) and objective symptoms (upper urinary infections in 16, hematuria in 12, and upper tract obstruction in 12). One patient underwent nephropexy via the transperitoneal approach and the others underwent nephropexy via the retroperitoneal approach. A retroperitoneoscopic procedure was performed after positioning the patients in the flank position. Digital preparation of the retroperitoneal space was made and standardized trocar was placed. The key step of the surgery was complete exposure of the kidney within Gerota' fascia, which was aimed to separate the potential adhesions between the colon and kidney or between the inferior blood vessels of the kidney. Nephropexy was performed between the fibrous capsule at the lower pole of the kidney and the dissected psoas muscle, using three sutures placed by intracorporeal technique or the percutaneous needle both for introduction and removal of the suture; the sutures were separately tied over the sacrospinalis fascia. Results: The mean operative time was (125±9) min (ranging 115-240 min); the mean postoperative hospital stay was (9±1.2) days, largely owing to the required 5-12 days' bed rest. During a mean follow-up of (24±4.2) months(ranging 3 to 70 months), 3 patients had paresthesia, 5 had constant and recurrent ache, 20 were completely free of pain, and 4 had micro-hematuria. One patient had further episodes of pyelonephritis and upper tract obstruction after operation. Intravenous pyelogram(IVP) revealed that the ptosis incorporated into more than one vertebral body in 2 patients. Postoperative renal function test showed an improvement in renal function. Conclusion: RLN is mini-invasive and has less complication. The procedure should be considered as one of the optimal therapy for nephroptosis.

Guided method was used in the Clinical Laboratory Instrument courses to guide students with inquiry-based learning problems,breaking the traditional"cramming"teaching,learning and giving full play the initiative and enthusiasm,stimulateing students'interest in learning to optimize the teaching process and improve the quality of teaching.

Objective Abstract:Objective To inquire into the reason that chronic diabetic foot ulcer(CDF) was difficult to be cured by clarifying their interaction between interin-1?(IL-1?) and fibroblast proliferation,the activity and protein expression of matrix metalloproteinase-2(MMP-2),matrix metalloproteinase-9(MMP-9)in fibroblasts from CDF.Method Fibroblast collected from the edge area of the diabetic foot ulcer was cultured for 4-6 generations,and added in with different concentration of IL-1? at the 24 hr,48 hr and 72 hr,then the effect of IL-1? on the activity and expression of MMP-2 and MMP-9 in fibroblasts were observed by methods of zymography and Western blott.Results There was a significant difference of IL-1? between CDF and acute diabetic lesions(ADL);IL-1? in 0.5 ng/ml-5 ng/ml could promote fibroblast proliferation obviously,but weakened gradually with increasing of the IL-1?,but no affection on fibroblast proliferation when IL-1? was in 50 ng/ml,and inhabited fibroblast proliferation over 50 ng/ml of IL-1?;IL-1? in 50 ng/ml increased the activity and protein expression of MMP-2 and MMP-9 in fibroblasts from CDF. Conclusion The reason that CDF was difficult to be cured were related to significant increase of IL-1?.The increase of IL-1? not only inhibits the fibroblast proliferation,but also promotes the activity and protein expression of MMP-2 & MMP-9,and it results in the increase of extracellular matrix degradation.

Acute Disease ; Adenoviridae Infections ; epidemiology ; Adolescent ; Child ; Child, Preschool ; China ; epidemiology ; Humans ; Infant ; Infant, Newborn ; Respiratory Tract Infections ; epidemiology ; virology

Objective To analyze the levels and speciation of arsenic metabolites in urine of rats treated with sodium arsenite and sodium arsenate in order to investigate the different aspects of metabolism between sodium arsenite and sodium arsenate,thus to understand further the basic data about relationship between it's metabolism and mechanism of toxicity. Methods Seventy Wistar rats,weighting 80-120 g,were divided into 7 groups of 10 each,such as normal control group,high,middle and low sodium arsenite group and high,middle and low sodium arsenate group. After the animals were fed for one month,the urine was collected by metabolic cage in 12 hours. Applying the high efficiency liquid chromatography and hydride genesis atomic fluorescence spectroscopy (HPLC-HGAFS),the levels and speciation of arsenic metabolites were determined in urine of rats. Meanwhile,the recovery rate of dimethyl arsinic acid(DMA) would be determined to estimate the degree of accuracy of results. Results The levels of iAs~(3+),iAs~(5+) and DMA in middle sodium arsenite group[(121.66±1.26),(10.26±2.68),(200.91±0.56) μg/L]were higher than the high sodium arsenite group[(113.20±0.75),(5.16±1.32),(147.70±μ0.77)μg/L,all P < 0.05]and low sodium arsenite group[(79.35±2.12),(5.13±2.25),(56.35±1.23)μg/L,all P < 0.05]. The levels of iAs~(3+) and DMA in middle sodium arsenate group[(315.81±1.69),(245.12±1.18)μg/L]were higher than the high sodium arsenate group[(85.03±0.56),(110.34±1.04)μg/L,all P< 0.05]and low sodium arsenate group[(22.97±2.67),(15.75±2.15)μg/L,all P < 0.05]. Compared with sodium arsenate group,the levels of iAs~(3+) and DMA in high and low sodium arsenite group were higher(all P < 0.05) ; and the levels of iAs~(3+) and DMA in middle sodium arsenite group were lower(all P < 0.05). Meanwhile,the average urinary recovery rate of DMA of rats in different sodium arsenite group were 94.80%-102.70%,and the average urinary recovery rate of DMA of rats in different sodium arsenate group were 95.33%-108.40%. Conclusion The speciation and levels of arsenic are influenced by the external exposure dose,and some distinction appeared in the metabolism and metabolic path between sodium arsenite and sodium arsenate in urine in vivo.

Objective To explore the effect of early goal-directed therapy (EGDT) according to pulse indicated continuous cardiac output (PiCCO) on septic shock patients.Methods Eighty-two septic shock patients in Subei People's Hospital of Jiangsu Province from January 2009 to December 2012 were enrolled and randomly divided into two groups using a random number table,standard surviving sepsis bundle group (n=40) and modified surviving sepsis bundles group (n =42).The patients received the standard EGDT bundles in standard surviving sepsis bundle group.PiCCO catheter was placed in modified surviving sepsis bundles group.Fluid resuscitation was guided by intrathoracic blood volume index (ITBVI) with the aim of 850-1 000 mL/m2.Dobutamine was used to improve the heart function according to left ventricular contractile index (dPmax) and stroke volume index (SVI).The mean arterial blood pressure (MAP) was maintained 65 mmHg (1 mmHg=0.133 kPa) or above with norepinephrine.Extra-vascular lung water was monitored for the titration of liquid and diuretics.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sequential organ failure assessment (SOFA) score,the number of patients needed vasopressor,serum procalcitonin (PCT),lactic acid and lactate extraction ratio,the amount of fluid resuscitation,duration of mechanical ventilation,duration of intensive care unit (ICU) stay,hospital mortality were recorded in both groups.Results After treatment,the APACHE Ⅱ score,SOFA score and the number of patients needed vasopressor were gradually reduced in both groups,and those in modified surviving sepsis bundle group were significantly lower than those of standard sepsis bundle group at 72 hours (APACHE Ⅱ score:13.1 ± 6.5 vs.20.9 ± 7.5,SOFA score:8.8 ± 4.3 vs.14.6 ± 4.9,the number of patients needed vasopressor:8 vs.17,all P＜0.05).Arterial blood lactate clearance rate was gradually increased after treatment in both groups.Lactate clearance rate in modified surviving sepsis bundle group was significantly higher than that of standard surviving sepsis bundle group [6 hours:(18.2 ± 8.3)％ vs.(10.8 ± 7.5)％,t=-6.036,P=0.001 ; 12 hours:(22.6 ± 7.3)％ vs.(12.4 ± 8.1)％,t=-4.536,P=0.001 ; 24 hours:(27.8 ± 5.6)％ vs.(16.4 ± 9.5)％,t=-5.882,P=0.000].The amount of fluid resuscitation within 6 hours in modified surviving sepsis bundle group increased significantly compared with standard surviving sepsis bundle group (mL:3 608 ± 715 vs.2 809 ± 795,t=-3.865,P=0.033).The amount of fluid resuscitation within 24,48 and 72 hours in modified surviving sepsis bundle group was significantly less than that of standard modified surviving sepsis bundle group with the nadir at 72 hours (mL:918 ± 351 vs.1 805 ± 420,t=5.907,P=0.037).Duration of mechanical ventilation (hours:98.4 ± 20.3 vs.143.3 ± 29.6,t=9.766,P=0.001) and ICU stay (days:7.1 ± 3.1 vs.9.5 ± 2.5,t=2.993,P=0.004) were significantly reduced in modified surviving sepsis bundle group compared with standard surviving sepsis bundle group.The hospital mortality in modified surviving sepsis bundle group was slightly lower than that in standard surviving sepsis bundle group [16.7％(7/42)比 17.5％(7/40),x2=0.010,P=0.920].Conclusions Modified surviving sepsis bundle treatment according PiCCO can reduce the severity of disease in patients with septic shock,can make more accurately guide fluid resuscitation,and can reduce lung water and duration of mechanical ventilation and ICU stay.It has great clinical significance.

Objective To investigate the clinical effects of the pulse indicator continuous cardiac output (PiCCO) in goal-optimized fluid management on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with respiratory failure.Methods A total of 71 AECOPD patients with respiratory failure who were hospitalized in department of Critical Care Medicine in our hospital were selected from October 2010 to September 2013.The PiCCOtechnology was applied to monitor intrathoracic blood volume index (ITBI) and extravascular lung water index (ELWI).We compared the relationship of ELWI with ITBI and oxygenation index,and a simple correlation analysis was used for statistical analysis.Results A significantly negative correlation was found between ELWl and oxygenation index (r=-0.743,P＜0.01).ELWI =14 ml/kg was defined as the cutoff value for the subgroup analysis.A negative correlation still was found between ELWI and oxygenation index in the subgroup with ELWI ＜ 14 ml/kg,but it had no significant difference (r=-0.533,P=0.080),while a significantly negative correlation was found in the subgroup with ELWI≥14 ml/kg (r=-0.961,P＜0.01).There was no significant correlation between ELWI and ITBI (r=0.477,P=0.072).ITBI=1 000 ml/m2 was defined as the cutoff value for the subgroup analysis.There is no significant correlation between ELWI and ITBI in the subgroup with ITBI＜1 000 ml/m2(r=0.338,P=0.116),but in the subgroup with ITBI≥1 000 ml/m2,a significantly positive correlation between ELWI and ITBI was found (r=0.677,P＜ 0.01).Conclusions The results suggest that when ELWI is higher than 14 ml/kg,ELWI becomes an important influencing factor for oxygenation,which can be decreased to improve oxygenation in patients with AECOPD,and when ITBI≥ 1 000 ml/m2,ITBI can be reduced by decreasing ELWI.PiCCO has an important clinical significance on a goal-optimized fluid management in AECOPD patients with respiratory failure.