Objective To evaluate efficacy and safety of porcine small intestine submucosa (SIS) for the repair of severe vaginal relaxation (stage Ⅳ) in women.Methods Biological repair meshes were fixed in 18 patients with stage Ⅵ vaginal relaxation,among which anterior walls were fixed in 12 cases,posterior walls in 5 cases,and both walls in 1 patient.Patients with POP underwent vaginal vault suspension first,then patient with SUI underwent transvaginal urinary incontinence surgery.Extravesicle fascia was transversely folded and sutured with 2-0 Mousse.The pelvic arch ligament together with vesicle fascia,SIS mesh and vaginal submucosa were sutured 3 stitches per side with 1-0 Mousse.Scar tissue at posterior vaginal wall was rhombically excised followed by transverse folding constriction of the rectovaginal fascia with 2-0 Mousse.A 1-0 Mousse was then used for colpoperineoplasty by suturing ruptured superficial anal sphincter,superficial transverse perineal muscle,and bulbocavernosus muscle.Patients were followed at 2,6,and 12 months post-operatively.Unsuccessful outcome was defined as diameter of outer 1/3 of vagina greater than 3.5 cm,or vagina prolapsed beyond hymen.Results The median follow-up was 13 months.Pelvic Organ Prolapse/Urinary Incontinence/Sexual Function Short Form Questionnaire (PISQ-12) was obtained in 13 patients and the score increased was noted (P＜0.01).Pelvic floor distress inventory-short form for scoring the quality of life (PFIQ) was collected from 18 patients and the score decreased was noted (P＜0.01).Pelvic floor impact questionnaire (PFIQ-7) was gathered in 18 patients and the score decreased was noted (P＜ 0.01).One unsuccessful case with stage Ⅱ anterior vaginal wall prolapse who underwent posterior vaginal wall fixed with patch ended with a diameter of outer 1/3 of vagina greater than 4.0 cm post-operation.Severe complications like infection,rosion,rejection or SUI were not noticed in any case.Conclusions The anatomical repair of pelvic floor is the most effective modality for vaginal rejuvenation.Adjunct SIS can enhance vaginal elasticity,reduce scar formation and recurrence,particularly.

Nucleos(t)ide analogues (NAs) have been widely used in clinical practice as first-line antiviral drugs.In recent years, many clinical studies have found that some patients cannot reach a satisfactory therapeutic outcome.This article introduces the antiviral indications and follow-up of chronic hepatitis B and summarizes the influence of baseline characteristics, HBV genotype, HBV mutation and drug resistance, patients'' medication compliance, presence or absence of other diseases or viral infection, and serum vitamin D level on the antiviral effect of NAs.It is pointed out that appropriate timing for antiviral therapy, patient education before treatment, regular follow-up during treatment, and timely identification of comorbidities and drug resistance help to improve the antiviral effect of NAs and delay the progression of liver diseases.

Objective To assess the diagnostic accuracy of NT-proBNP in hypertension patients by observing the effect of decreased GFR on N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration in patients with different cardiac function.Methods Eighty-nine hypertension patients were divided into two groups based on the results of UCG.Forty-three patients had normal left ventricular function and 46 patients had dysfunction.GFR,NT-proBNP and other biochemical markers of cardiac and renal function were measured.The factors affecting the NT-proBNP concentration under normal left ventricular function were analyzed,and the diagnostic value of NT-proBNP affected by normal or decreased GFR(＞ 80 ml/min or ≤80 ml/min) under different left ventricular functions were further assessed.The two-sample t test,rank sum test and multiple regression analysis were used to analyze their statistical difference and relationship.Results In patients with normal left ventricular function,GFR (β =-0.361,P ＜ 0.05) and left ventricular end-diastolic diameter (LVEDD,β =0.385,P ＜ 0.05) were significant factors to NT-proBNP level.They were both meaningful compared with LVEF (β =0.189,P ＞0.05) and septal thickness (β =0.003,P ＞ 0.05).The median concentration of NT-proBNP was 13.18 and 24.14 μg/L in patients with normal left ventricular function and dysfunction,respectively (Z =-3.19,P ＜ 0.01).While in patients with decreased GFR,6 cases with normal left ventricular function and 19 cases with dysfunction had a median concentration of NT-proBNP of 38.45 and 44.20 μg/L,respectively (Z =-0.45,P ＞ 0.05).In patients with normal GFR,37 cases with normal left ventricular function and 27 cases with dysfunction had a median concentration of NT-proBNP of 12.51 and 20.31 μg/L,which was lower than that of patients with decreased GFR (Z =-2.76,both P ＜ 0.05).The NT-proBNP concentration had no significant difference between patients of normal left ventricular function with decreased GFR and patients of dysfunction with normal GFR (38.45 and20.31 μg/L,Z=-2.18,P＞0.05).Conclusion In hypertension patients,the effect of decreased GFR on assessing the diagnostic accuracy of NT-proBNP for left ventricular dysfunction should be considered.

Objective To discuss the relationship between bone mineral salt metabolism index change and bone density in different stage of chronic kidney disease (CKD).Methods Three hundred and forty-five non-dialysis patients with CKD were enrolled in this study.According to the serum creatinine (SCr),glomerular filtration rate (GFR),they were divided into stage 1-5.CKD 1 had 75 cases,CKD 2 had 65 cases,CKD 3 had 65 cases,CKD 4 had 65 casès,CKD 5 had 75 cases.The level of blood calcium (Ca),phosphorus (P) and SCr were detected by ion selective electrode method.The level of urea nitrogen (BUN) was detected by picric acid method.The level of intact parathyroid hormone (iPTH) and 1,25 (OH)2VitD3 were detected by chemiluminescence.Results With the decline of renal function,the level of iPTH and blood P increased gradually,especially in stage CKD 4 and CKD 5,and compared with stage CKD 1,there were significantly differences [(289.6578 + 187.7945),(482.0667 + 232.2065) μ g/L vs.(77.8431 + 52.9760) μ g/L and (1.6938 + 0.1960),(2.6034 ± 0.5986) mmol/L vs.(1.3833 ± 0.4068) mmol/L,P ＜ 0.05].The level of blood Ca and 1,25 (OH)2VitD3 decreased gradually,especially in stage CKD 4 and CKD 5,and compared with stage CKD 1,there were significantly differences [(1.9185 +0.4633),(1.8293 ± 0.3075) mmol/L vs.(2.0893 + 0.2245) mmoi/L and (10.0892 + 0.2638),(7.6058 +0.4356) ng/L vs.(18.0036 + 0.3218) ng/L,P ＜ 0.05].With the decline of renal function,the proportion of osteoporosis also gradually increased,especially in stage CKDS,and compared with stage CKD 1 and CKD 2,there was significantly difference [60.00％ (45/75) vs.20.00％ (15/75),23.08％ (15/65),P ＜ 0.05].Conclusion With the decline of renal function,the level of blood P and iPTH increase,and blood Ca,1,25(OH)2VitD3,bone density decrease,especially in stage CKD 4 and CKD 5 patients.

Objective To study the expressions of mucin (MUC) 1 and 2 in extramammary Paget's disease(EMPD) lesions. Methods Tissue specimens were obtained from the lesions of 19 patients with EMPD and normal skin of 19 human controls during cosmetic surgery. Streptavidin-perosidase (SP) technique was used to detect the expressions of MUC1 and MUC2 in these specimens. Results As haematoxylin-eosin (HE) staining showed, 3 cases were accompanied by poorly differentiated adenocarcinoma, 6 were invasive Paget's disease and 10 were intraepithelial EMPD. MUC1 was expressed in 2 cases accompanied by poorly differentiated adenocarcinoma, and in all the cases of invasive and intraepithelial EMPD; MUC2 was observed in all the cases of adenocarcinoma-complicated EMPD and invasive EMPD, but only in 2 of 10 cases of intraepithelial EMPD.Neither MUC1 nor MUC2 was observed in normal control specimens. A significant increase was observed in the expression of MUC1 in lesions of intraepithelial EMPD compared with invasive EMPD and adenocarcinoma-complicated EMPD (both P ＜ 0.05), and in the expression of MUC2 in lesions of invasive EMPD and adenocarcinoma-complicated EMPD compared with intraepithelial EMPD (both P ＜ 0.05). The expression of MUC1 was uncorrelated to that of MUC2 (r= -0.5, P＞ 0.05). Conclusions MUC1 is generally expressed in the lesions of EMPD, while MUC2 is expressed in those of adenocarcinoma-complicated EMPD and invasive EMPD.

Objective To study the mechanism of novel antiapoptosis factor clusterin in EJ cell. Methods MMC was used to induce apoptosis of EJ cells and the ratio of apoptosis was studied by flowcytometry after the use of clusterin. Results Clusterin in low dose can inhibit the apoptosis induced by MMC. Conclusions Clusterin can influence the development of bladder cancer by antiapoptosis.The expression of clusterin may have some relationship with the drug resistance or recurrence of bladder cancer.The study of clusterin is helpful to elucidate the biological mechanism of the bladder cancer and direct the therapy of bladder cancer using the antibody of clusterin.

Objective To investigate the role of GYLZ-RCC18 in the generation and development of renal cell carcinoma (RCC). Methods By using SMART RACE and RT-PCR the full length of GYLZ-RCC18 was cloned and its expression was detected in RCC of different grade and stage by amplification of a special fragment sequence in the first reading frame about 504 bp. Results The full length of GYLZ-RCC18 about 3.5 kb expressed in RCC in higher level than in normal kidney tissue.GYLZ-RCC18 overexpressed in high grade and high stage RCC being 1-9 folds higher than that in low grade and low stage ones. Conclusions GYLZ-RCC18 is a new gene especially related to RCC and is closely related to the generation and development of RCC.Study of the gene will be helpful in the understanding of the molecular mechanism of the generation and development of RCC and may direct the diagnosis and treatment of RCC.

Objective To study clusterin expression in bladder cancer cell line EJ and its antiapoptosis mechanism. Methods The expression of clusterin in EJ cells was detected by means of immunocytochemical staining and its effect on apoptosis studied by 3′TUNEL method. Results Clusterin expressed clearly in EJ cells.Likewise,when a small dose of clusterin was added,clusterin was stained strongly in the cytoplasm of the EJ cells and MMC induced apoptosis of the EJ cells was markedly inhibited. Conclusions Clusterin can penetrate the cell membrane getting into the cell cytoplasm and there in the cytoplasm the antiapoptosis effect is evoked.By detecting the clusterin expression,recurrence and multidrug resistance of a bladder cancer may be evaluated.It is hopeful that the use of clusterin antibody in the treatment of bladder cancer might be feasible.

Objective To study the expression and significance of antiapoptosis facter-clusterin in prostate neoplasm. Methods Reverse transcriptive polymerase chain reaction(RT PCR) was used to examine the expression level of clusterin in prostate cancer tissues(3 cases),prostate cancer cell line PC3M and normal prostate tissues(3 cases). Results Compared with the internal marker gene ? actin , the expression level of clusterin in prostate cancer is much higher than that of normal prostate. Conclusions The high expression level of clusterin in prostate cancer indicates that clusterin may play an important role in the biological characteristics of prostate cancer through the antiapoptosis pathway.

Objective To study the application of ESWL for ureteral stones in acute colic and with impairment of renal function. Methods From Mar.1987 to Sep.2000,emergent ESWL was performed for 168 cases of ureteral stone in acute colic and with impaired renal function on IVU (nonvisualization on IVU). Results All the patients got well after ESWL.104 patients less than 60 with a history of renal colic within 1 month have been followed up for 1 year.The renal function has reco vered and the urinary tract became visualized on IVU. Conclusions Ureteral stone may induce acute injury to the kidney but the harm is temporary and reversible when the ureteral stone is cured by ESWL on time.