Objective:To study the influence of 3 single nucleotide polymorphisms (SNP) of IL-10 promoter (-1 082, -819 and -594) on acute rejection after renal transplantation in a donor-recipient paired mode. Methods: Three IL-10 promoter SNPs of 52 donor-recipient pairs were genotyped and phenotyped by PCR using sequence-specific primers (SSP). Recipients were followed up for 1 year after transplantation, and acute rejection episodes were observed. Incidences of rejection were compared against pair patterns and differences were analyzed using Fisher's exact test. Results: No genotype of high producer was found in any donor and recipient in this study. Forty-nine recipients were followed up for over 12 months. Of them, 18 recipients (36.7%) had acute rejection and 7 recipients (14.3%) had multiple rejection(MR). The relationship between donors with intermediate producer and acute rejection and MR tended to be statistically significant (P=0.076, P=0.051).The MR rate increased significantly in the pair of donor intermediate producer/recipient low producer (P=0.036). Conclusion: It is preferable to take donor’s IL-10 SNP into consideration in study of IL-10 SNP and renal transplantation. Donor intermediate producer can increase the risk of acute rejection. The combination of donor intermediate/recipient low producer can increase the risk of MR.

Objective To explore the value of? red blood cell distribution width (RDW) changes in acute myocardial infarction (AMI) prognosis by analysing relationship between red blood cell distribution width, cardiac troponin I (cTnI) and high-sensitivity C-reactive protein. Methods 140 hospitalized patients with AMI were selected from May 2014 to October 2014 and devided into 2 groups. 70 patients without heart failure were AMI1 group and the other 70 patients with heart failure were AMI2 group. 70 cases of healthy persons were selected as control group. RDW was compared between three groups and the relationship between the level of RDW, cTnI and hs-CRP was analyzed. Evaluating value of RDW in predicting heart failure in AMI patients by using univariate logistic regression analysis and ROC curve analysis. Results In the comparison of AMI1 group, AMI2 group and control group, either of RDW, cTnI and hs-CRP showed a trend of increasing (P < 0.01). In the AMI patients , RDW level and cTnI level were positive correlation , and there was no linear correlation between RDW level and hs-CRP level. RDW≥14.55% was the independent risk factors in predicting heart failure in patients with AMI. Conclusion RDW≥14.55% can be an available independent predictor of the prognosis of AMI.

Objective To investigate the correlation of positive margins after radical prostatectomy with Gleason score of biopsy specimens and percentage of positive biopsy cores in prostate cancer.Methods One hundred and thirty patients with localized prostate cancer were confirmed by biopsy underwent radical prostatectomy,the relationship between positive margins rate and Gleason scores,percentage of positive biopsy cores were analyzed.Results One hundred and thirty cases of biopsy specimens,Gleason score 6 group 50 cases,positive margins rate was 10.00％ (5/50),Gleason score 7 group 65 cases,positive margins rate was 21.54％(14/65),Gleason score 8 group 13 cases,positive margins rate was 0,Gleason score 9 group 2 cases,positive margins rate was 0,the positive margins rate among the different Gleason score group had no significant difference (x2 =5.917 5,P ＞ 0.05).All the statistics of percentage of positive biopsy cores were 89 cases,1％-25％ group 30 cases,positive margins rate was 3.33％ (1/30),26％-50％ group 27 cases,positive margins rate was 11.11％ (3/27),51％-75％ group 18 cases,positive margins rate was 6/18,76％-100％ group 14 cases,positive margins rate was 4/14,the positive margins rate among different percentage of positive biopsy cores group had significant difference (x2 =9.861 8,P ＜ 0.05).Conclusion There is no correlation between Gleason score and positive margins in prostate cancer,but there is correlation between percentage of positive biopsy cores and positive margins.

Objective To study the ultrastructure of the renal papillary Randall's plaque in calclum oxalate stone formers. Methods The 14 biopsy samples of the Randall's plaque in 12 patients with calcium oxalate stone undergoing PCNL for stone removal were obtained using endoscopic biopsy technique,followed by staining with hematoxylin-eosin or fixing with osmium tetroxide,and then the ultrastructure of the Randall's plaque was observed under light microscope and transmission electron microscope. Results In all 12 patients,72 renal papillae were examined.All kidReys were found to have papillary plaque and 7 of the patients had attached stones.Sixty-three papillae(87.5%)contained plaque.Calcium deposition was seen in the 12 renal papilla tissue by light microscopy.Transmission electron microscopy images of the 2 Randall's plaque samples showed several cluster of sharp and large crystals lied closer to the surface of Randall's plaque.The typical crystals were acicular with light profile. Conclusions Randall's plaque is an interstitial medullary and papillary deposit of calcium oxalate.The appearance of the deposition of calcium oxalate crystals lies upon Randall's plaque,which might be an explanation for the mechanism of calcium oxalate stone formation.

Objective To assess the clinical factors impacting on the effective time of endocrine therapy for patients with prostate cancer.Methods The chnical data of 432 patients with prostate cancer who accepted endocrine therapy were analyzed retrospectively.The endpoint of the study was failure of endocrine therapy which was defined as continuous elevation of prostate specific antigen (PSA) from nadir for 2 times and more than 0.2 μg/L.The clinical data such as age,clinical stage,lymph node metastasis,bone metastasis,Gleason score,initial PSA,and PSA nadir were collected and their rehtionship with the effective time of endocrine therapy were further assessed via COX regression model.Results Age of onset was 57-88(73.70 ± 7.28) years.Initial PSA was 10.30-588.10(27.15 ± 75.90) μ g/L.The effective time of endocrine therapy was 3-62 (27.01 ± 13.10) months.Univariate regression analysis showed that initial PSA,clinical stage,Gleason score,PSA nadir,lymph node metastasis,bone metastasis were correlated with the effective time of endocrine therapy (P ＜ 0.01).Multivariate regression analysis showed that only Gleason score was correlated with the effective time of endocrine therapy(P=0.001).Compared with patients with Gleason score equal to or less than 3+4,patients with Gleason score equal to or more than 4+3 showed 2.49 fold increased risk of therapy failure (OR =2.49,95％ CI 1.44-4.30).Conclusion Gleason score has close relationship with the effective time of endocrine therapy for patients with prostate cancer,Gleason score equal to or more than 4+3 is an indicator for poor response to endocrine therapy.

Intrahepatic biliary cystadenoma (IBC) is a rare benign cystic neoplasm of liver,with malignant potential to transform into intrahepatic biliary cystadenocarcinoma.IBC predominantly occurs in women up to 85％,showing no special clinical symptoms and a polycystic lesion inside the liver on image examination.It is difficult to differentially diagnose from other cystic lesions of the liver such as simple liver cyst,intraductal papillary neoplasm of the bile duct,etc.The missed diagnosis and misdiagnosis rate were rather high in IBC,which is accurately diagnosed by pathological examination.Complete surgical removal of the tumor is the best way to cure it,and also can bring a satisfactory outcome to patients.

Objective:To investigate the safety of minimally invasive liver resection for resectable hepatocellular carcinoma (HCC) complicated with portal hypertension.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 807 patients with resectable HCC who underwent minimally invasive liver resection in 8 medical centers, including Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine et al, from June 2011 to November 2022 were collected. There were 670 males and 137 females, aged 58(50,66)years. Of the 807 patients, 173 cases with portal hypertension were divided into the portal hypertension group, and 634 cases without portal hypertension were divided into the non-portal hypertension group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and post-operative situations; (3) subgroup analysis. Propensity score matching was done by the 1:1 nearest neighbor matching method, with the caliper setting as 0.001. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was constructed using the non-parameter rank sun test. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 807 patients, 268 cases were successfully matched, including 134 cases in the portal hypertension group and 134 cases in the non-portal hypertension group. The elimination of the tumor diameter and robot-assisted surgery confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative and postoperative situations. The occlusion time of porta hepatis, cases with intraoperative blood transfusion, cases with postoperative complication, cases with complication >Ⅱ grade of Clavien-Dindo classification, cases of Clavien-Dindo classification as Ⅰ grade, Ⅱ grade, Ⅲ grade, Ⅳ grade, cases with liver related complication were 27.0(15.0,43.0)minutes, 33, 55, 15, 13, 29, 14, 1, 37 in the portal hypertension group, versus 35.0(22.0,60.0)minutes, 17, 25, 5, 14, 9, 4, 1, 13 in the non-portal hypertension group, showing significant differences in the above indicators between the two groups ( Z=-2.15, χ2=6.30, 16.39, 4.38, 20.72, 14.16, P<0.05). (3) Subgroup analysis. Results of subgroups analysis showed that in cases with major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 243.5(174.6,296.3)minutes, 200.0(150.0,600.0)mL, 7.5(6.0,13.0)days in the portal hypertension group, versus 270.0(180.0,314.5)minutes, 200.0 (75.0,450.0)mL, 7.0(5.5,10.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.54, -1.73, -0.92, P>0.05). In cases with non-major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 8.0(5.0,10.0)days in the portal hypertension group, versus 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.5,9.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-1.39, -0.10, 1.05, P>0.05). In cases with anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 210.0(150.0,285.0)minutes, 150.0(50.0,200.0)mL, 8.0(6.0,9.3)days in the portal hypertension group, versus 225.5(146.3,306.8)minutes, 100.0(50.0,250.0)mL, 7.0(6.0,9.0)days in the non-portal hypertension group, showing no significant difference in the above indica-tors between the two groups ( Z=-0.75, -0.26, -0.91, P>0.05). In cases with non-anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 173.5(120.0,231.5)minutes, 175.0(50.0,300.0)mL, 7.0(5.0,11.0)days in the portal hyper-tension group, versus 186.0(123.0,262.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.0,9.5)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.97, -1.12, -0.98, P>0.05). Conclusion:Minimally invasive liver resection or even major liver resection is safe and feasible for screened HCC patients complicated with portal hyper-tension, but attention should be paid to the prevention and treatment of postoperative complications.

Objective:To investigate the perioperative efficacy of robot surgical system assisted anatomic and non-anatomic hepatectomy.Methods:The propensity score matching and retrospective cohort study was conducted. The clinical data of 103 patients who underwent robot surgical system assisted hepatectomy in Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine from March 2016 to December 2021 were collected. There were 54 males and 49 females, aged 56(range, 44?64)years. Of the 103 patients, 55 cases undergoing robot surgical system assisted anatomic hepatectomy were divided into the anatomic group, and 48 cases undergoing robot surgical system assisted non-anatomic hepatectomy were divided into the non-anatomic group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative conditions; (3) perioperative complications. Propensity score matching was done by the 1:1 nearest neighbor matching method. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were expressed as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the rank sum test. Results:(1) Propensity score matching and compari-son of general data of patients between the two groups after matching. Of the 103 patients, 94 cases were successfully matched, including 47 cases in the anatomic group and 47 cases in the non-anatomic group. The elimination of preoperative body mass index, preoperative platelet and preoperative albumin confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative conditions. After propensity score matching, the operation time and volume of intraoperative blood loss were 175(range, 120?240)minutes and 50(range, 50?100)mL in patients of the anatomic group, versus 155(range, 105?190)minutes and 100(range, 50?200)mL in patients of the non-anatomic group, showing significant differences in the above indicators between the two groups ( Z=1.97, 2.49, P<0.05). (3) Perioperative complications. After propensity score matching, cases with pleural fluid and/or ascites, case with biliary fistula, case with thrombosis, case with peritoneal infection, case with incision infection were 11, 1, 2, 4, 1 in patients of the anatomic group, versus 12, 0, 4, 1, 0 in patients of the non-anatomic group, showing no significant difference in the above indicators between the two groups ( P>0.05). Cases with complications classified as grade Ⅰ, grade Ⅱ, grade Ⅲ, grade Ⅳ of the Clavien-Dindo classification were 33, 14, 0, 0 in patients of the anatomic group, versus 28, 14, 3, 2 in patients of the non-anatomic group, showing no significant difference in the above indicators between the two groups ( Z=?1.38, P>0.05). Conclusions:Robotic surgical system assisted anatomic and non-anatomic hepatectomy are safe and feasible for clinical application. Compared with robot surgical system assisted non-anatomic hepatectomy, patients under-going robot surgical system assisted anatomic hepatectomy have long operation time and less volume of intraoperative blood loss.

In this study, the necessity of professional master's degree training in clinical pharmacy was analyzed by means of literature research and practice summary, and the existing problems in current professional curriculum, tutor team and practice teaching were discussed. In view of the existing problems, this paper puts forward that medical colleges and universities should give full play to their medical resources, draw lessons from the talents training experience of clinical pharmacists training base, adopt measures such as optimizing curriculum system, selecting tutors, attaching importance to practical teaching, so as to improve the quality of postgraduate training in clinical pharmacy, train high-level clinical pharmacists, and promote the development of clinical pharmacy in China.

OBJECTIVETo observe effects of on hepatocarcinoma (HCC) cell vasculogenic mimicry (VM) and explore the molecular mechanism by which inhibits HCC metastasis and invasion.

METHODSForty male SD rats were randomly divided into 4 groups for gastric lavage of normal saline or high, moderate or low doses of (twice daily) for 4 consecutive days. The sera were collected from the rats for treatment of cultured human HCC HepG2 cells. VM formation in the cells was detected using an image acquisition and analysis system 24 h after incubation of the cells with the sera and with the RhoA/ROCK inhibitor Y-27632(P). The expression levels of RhoA and ROCK1 in the cells were detected using Western blotting, and the contents of VE-cadherin and PI3K in the culture supernatant were determined using ELISA.

RESULTSTreatment with the sera from -treated rats significantly inhibited formation of VM in HepG2 cells, and the diameters of VM formed were significantly greater than those in the positive control group ( < 0.01). Y-27632 completely inhibited the formation of VM in HepG2 cells ( < 0.01). Treatments with and Y-27632 both inhibited the expression of RhoA and ROCK1 ( < 0.05) and significantly lowered the contents of VE-cadherin and PI3K in the culture supernatant ( < 0.05).

CONCLUSIONS can inhibit the formation of VM in HCC cells possibly by inhibiting the RhoA/ROCK pathways and the expressions of VE-cadherin and PI3K.