Imatinib,a small-molecule kinase inhibitor,has proven useful in the treatment of recurrent or metastatic gastrointestinal stromal tumors ,However,resistance to imatinib is a more and more serious problem.This review summarizes the existing knowledge of the imatinib resistance mechanism in gastrointestinal stromal tumors and describes the treatment directions in further.

Objective To evaluate the clinical value of laparoscopic nephrectomy. Methods Laparoscopic nephrectomy was used in 26 cases (transperitoneal approach in 19 cases and retroperitoneal approach in 6 cases), including 8 cases of radical resection of renal cancer, 7 cases of total resection of kidney and ureter (2 cases of carcinoma of renal pelvis and 5 cases of carcinoma of ureter ), 6 cases of non-functioning or atrophic kidney and 5 cases of living donor nephrectomy. Results All the operations were accomplished successfully. The operative time was 120 min ～ 250 min (mean, 190 min) and the intraoperative blood loss was 50 ml ～ 200 ml (mean, 130 ml). No blood transfusion was needed and no operative complications occurred. Follow-up for a mean of 16 months in 8 cases of renal cancer and 20 months in 7 cases of total resection of kidney and ureter revealed no recurrence or metastasis except for 1 case of local recurrence of ureteral carcinoma. Conclusions The laparoscopic nephrectomy has the advantages of minimal invasion, less blood loss and rapid recovery.

Objective:To compare the accuracy of renal calyceal fornix puncture and complication between non-vascular contrast-enhanced ultrasound (NV CEUS) and conventional ultrasound guided in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis.Methods:This randomized controlled trial was conducted in nephrolithiasis patients with slight or no hydronephrosis in our hospital from May 2018 to June 2019. The patients were randomized to receive NV CEUS or conventional ultrasound guided PCNL.Inclusion criteria: age 18-70 years old and nephrolithiasis patients with slight or no hydronephrosis. Exclusion criteria: pregnant women, functional solitary kidney, abnormal anatomy or high-risk of intestinal injury, acute urinary tract infection, coagulation dysfunction or taking drugs that affect blood coagulation, heart failure, severe arrhythmia or other high-risk diseases, abnormal renal function (SCR > 1.2-fold upper limit), or severe obesity (BMI>40 kg/m 2). Patients in both groups underwent anterorenal pyelography of renal fistula. Data of the study were recorded: the decrease in hemoglobin, the puncture time, the success rate of one needle puncture, the time of hospital stay, the stone for free, and postoperative renal fistula anterograde pyelography to confirm whether the puncture was performed through the calyces. Results:A total of 48 patients were enrolled, 24 patients in each group, the preoperative parameters were comparable between the two groups(all P>0.05). The puncture accuracy of calyces fornix in experimental group and control group was 87.50%(21/24) and 41.67%(10/24), respectively.The hemoglobin drop was 2.0(0.0, 12.0) and 14.0(7.0, 17.0) g/L, the puncture time was 40.0(28.5, 53.0) and 70.0 (55.5, 84.5) seconds, and the success rate of one needle puncture was 95.83%(23/24) and 75%(18/24). The differences between the two groups were statistically significant (all P<0.05). No blood transfusion, interventional embolization, septic shock and other serious infection complications were found in the two groups. Conclusions:For nephrolithiasis patients with slight or no hydronephrosis, NV CEUS guided can significantly improve the accuracy of calyx vault puncture, shorten the puncture time and reduce bleeding compared with conventional ultrasound guided PCNL.

Xenotransplantation can probably overcome the critical shortage of human organ donors for clinical transplantation.Recently,research progresses in the biology of xenograft rejection and zoonotic infections,and the generation of α1,3-galactosyltransferase-deficient pigs have moved this approach closer to clinical application,but immunological rejection is also the primary barrier in the study of xenotransplantation.This review sumarries the research progress of immunological rejection of xenotransplantation,providing some advices for the future of clinical xenotransplantation.

Induction of immune tolerance is characterized by high efficiency,low toxicity and economic advantages,and immune tolerance has very important significance in organ transplantation.In the establishment of immune tolerance,dendritic cells (DCs) play the key roles such as clonal deletion or clonal anerge,expressing t-cell inhibiting factors,activating helper T cells electively and inducing regulatory T cells,especially CD4 + CD25 + regulatory T cells,etc.Similarly,CD4 + CD25 + regulatory T cells whose primary target point is dendritic cell also have various functions such as affecting dendritic cells'maturing,restraining dendritic cells'antigen presentation to T cells,inhibiting the activation of T cells in non-specific ways and inducing immune tolerance.Current research shows,dendritic cells and CD4 + CD25 + regulatory T cells regard each other as target point and work synergetically.Here we mainly discuss the function and interaction of dendritic cells and CD4 + CD25 + regulatory T cells in the immune tolerance.

Objective To study the effect of S-adenomethionine on early stage recovery of transplanted liver.Methods From January 2010 to October 2012,57 liver transplantation patients were divided into 2 groups beginning the first day:group A,23 patients were treated with routine liver-protecting therapy,including glycyrrhizin,glutathione,albumin; group B,34 patients treated with additional S-adenomethionine (Transmetil).AST,ALT,T-BIL,D-BIL,γ-GT,ALB and ALP were compared between the two groups at pre-operation and post-operation day 1,day 4,day 7 and day 14.Results All patients suffered from preoperative hyperbilirubinemia,decreased ALB and elevated concentration of AST,ALT,γ-GT and ALP.On the first day after transplant,AST,ALT,T-BIL,D-BIL and γ-GT elevated and ALB decreased significantly in all cases compared with that before operation (respectively t =10.493,7.089,6.584,15.134,5.164,10.344,5.289,13.034,3.389,4.366,all P ＜ 0.01).On the contrary,the value of ALB was lower (respectively t =8.239,11.662,all P ＜ 0.05).On the fourth day posttransplant,ALB level was higher and that of other parameters were lower in group B when compared with group A (respectively t =2.536,2.736,2.218,3.318,4.804,2.892,all P ＜ O.05).This tendency of liver function improvement continued till postoperative day 7 in all cases while the differences between the two groups remained significant (respectively t =6.107,3.256,2.929,11.688,8.964,2.857,all P ＜ 0.05)except for γ-GT.On day 14,while T-BIL and D-BIL in group B were lower than that in group A (respectively t =4.413,8.493,all P ＜0.001),differences of liver functions were not significant between the two groups (respectively t =1.916,1.414,1.168,1.035,1.604,all P ＞ 0.05).Conclusions Transmetil promotes the recovery of transplanted liver's function,elevates the concentrantion of ALB and reduces the concentration of AST,ALT,T-BIL,D-BIL,γ-GT and ALP at early stage after liver transplant.

AIM:To study whether or not Huangshao Yinxue Granula(HYG) has the therapeutic effect on experimental psoriasis. METHODS: The mice were treated with HYG 3.125,6.25,12.5,and 25 g/kg(i.g.) for 1 or 2 weeks.We studied the effects of HYG on mitosis in mice vagina epithelium,the formation of granular layer in scale epidermis of mice tails,the changes in CD3, CD4 and CD8 factors of the serum in psoriasis-like mice and guinea-pigs. RESULTS: HYG could inhibit the mitosis in mice vagina epithelium,promote the formation of granular layer in scale epidermis of mice tails.It could also diminish the value of serum CD4/CD8 of mice to regulate abnormal immune reaction.HYG had evident therapeutic effect on the ear skin damaged with 5% propanolol in psoriasis-like guinea-pigs. CONCLUSION: HYG has therapeutic effect on psoriasis-like animal models.

Objective To detect the expression of Id1 and HBx in HBV-related hepatocellular carcinoma (HCC) tissue samples and analyzed the correlation between Id1 expression levels and clinicopathological features of patients.Methods Tumor tissue samples obtained from a total of 113 HCC patients.The expression of Id1 proteins of these samples were detected by immunohistochemical (IHC) staining and evaluated by two independent pathologists.The corrections between the clinical pathological parameters and the IHC scores for Id1and the prognostic significance were statistical analyzed by SPSS 19.0 software.Results Ninty-six of 113 patients is HBV-related HCC.Over-expression of Id1 were found positively correlated with the HBsAg ＞ 200 s/n,histological grade,portal vein invasion.Patients with Id1 overexpression had both shorter disease-free and overall survival times.Conclusions High expression of Id1 was correlated with serum HBsAg,histological grade,portal vein invasion and poor clinical outcomes in HBV-related HCC.

Immunological rejection is the major barrier to successful transplantation.The immune response to an allograft is an ongoing dialogue between the innate and adaptive immune system that will lead to the rejection of allograft.Activation of elements of the innate immune system,triggered as a consequence of tissue injury sustained during cell isolation or organ retrieval and ischemia reperfusion,will initiate and amplify the adaptive response.Identifying the molecular pathways that trigger tissue injury,signal transduction and rejection facilitates the identification of targets for the development of immunosuppressants.

Objective To summarize the management experiences of pancreatic injuries during laparoscopic urologic surgery.Methods From June 2003 to August 2008,395 laparoscopic operations for upper urinary or adrenal diseases were performed.4 cases of pancreatic injuries which all occurred in left side introperiotoneal procedures were identified with the incidence of 1%.2 men and 2women were involved with the mean age of 45.3(range 32~76y).2 injuries occurred during left radical nephrectomy and 2 during left adrenalectomy.All the injuries located at tail of pancreas with transaction injuries in 2 cases,and mild laceration in 2 cases.Only 1 case had received open surgery for pancreatic debridement,another 3 cases had received clamp and endo-GIA occlusion laparoscopically with local styptic powder aspersing and drainage.Absolute diet,gastrointestinal decompression,,transvenous-use of Somatostatin and hyperalimentation were given routinely.Results The mean blood,urine and drainage fluid diastase that were(648?136)U、(1278.6?368.4)U and(1368.5?428.2)U respectively elevated in all 4 cases postoperatively.Only 1 case had high fever and blood WBC after operation.The mean drainage and hospital stay was 14.2 and 24.6 days.No sequelae was found.Conclusion The tail of pancreas is the most predilecting location of pancreatic injury in laparoscopic urological surgery.The key of ensuring a good prognosis is early detection and suitable management.A severe laceration of the main excretory pancreatic duct need a open surgical management,conservative managements are suitable for a small tear and mild contusion of pancreas.