Objective To investigate the expression of PMN Fas/FasL,Caspase-3 from peripheral blood in patients with SIRS and observe the effect of emodin on the PMN apoptosis and explore its mechanism.Methods The samples of peripheral blood were collected from 8 patients(all suffer from acute pancreatitis)with SIRS and 6 healthy volunteers.The circulating neutrophils were isolated and cultured.There were three groups of in our study:control group,SIRS group and emodin-treated group.The change of the PMN apoptosis and the expression Ieve]of Fas/FasL.Caspas-3 were observed.Results Compared with healthy volunteers.the percentage of PMN apoptosis significantly reduced in patients with S1RS(P＜0.05).After emodin was used,the percentage of PMN apoptosis in patients with SIRS increased(P＜0.05).Compared with healthy volunteers,the expression of Fas and Caspase-3 reduced in patients with SIRS(P＜0.05).Emodin could significantly induce the expression of Fas and Caspase-3(P＜0.05).After 24 hours of in vitro culture.the expression of FasL was not detected.Conclusion PMN from patients with SIRS shows profoundly delayed rates of apoptosis in vitro compared with PMN from healthy volunteers,and the decreased percentage of PMN apoptosis is associated with the reduced expression of Fas and Caspase-3.Emodin can significantly inhibit the delayed PMN apoptosis in patients with SIRS by inducing the expression of Fas and Caspase-3.

Objective To discuss the presentations, pathologic features, diagnosis and treatment of primary synovial sarcoma of the kidney. Methods One case of primary synovial sarcoma of the kidney was reported and the relevant literature was reviewed. A 55-year-old man was admitted with complaint of right abdomen and flank pain for 5 h. Computerized tomography revealed a 12.5 cm × 11.0 cm × 9. 0 cm mass located at the middle and lower pole of the right kidney. The patient was taken radical nephrectomy. Results The diagnosis of primary synovial sarcoma of the kidney in the patient was confirmed by postoperative pathology. Under microscope, tumor was typically mitotically active, monomorphic spindle cells growing in intersecting fascicles or in solid sheets with epithelial differentiation. In some areas a haemangiopericytoma-like pattern was found. Immunohistochemical staining showed that the tumor cells were positive for the markers Vimentin, CD99 and Bcl-2, but CK was negative. The patient died of local recurrence and multi-metastasis at 8 months after surgery. Conclusions Primary synovial sarcoma of the kidney is extremely rare with a high grade of malignancy,and its prognosis is poor. The diagnosis depends on pathological features, Immunohistochemical studies and RT-PCR detection. Radical resection combined with chemicaltherapy is considered to be the most reliable treatment so far.

Objective To propose SHA.LIN nephrolithometry scoring system for assessing and predicting the stone-free rate of percutaneous nephrolithotomy ( PCNL) and to investigate the clinical value of SHA.LIN scoring system for nephrolithiasis in patients undergoing PCNL .Methods A literature review from 1976 to 2014 was performed to identify clinically relevant and reproducible variables that could affect the outcomes of PCNL. Six reproducible variables available from preoperative noncontrast-enhanced computed tomography were measured , including stone size ( S) , hydronephrosis ( H) , anatomic distribution (A), length of tract(L), indicator of CT(I), number of involved calices(N) and was named as SHA.LIN nephrolithometry scoring system .A retrospective analysis was conducted of clinical data of 116 patients with nephrolithiasis undergoing PCNL from June 2011 to March 2015. The general conditions , preoperative information , stone characteristics and perioperative variables were collected . The correlation of nephrolithometry scores based on SHA.LIN scoring system with stone-free status, operation time, blood loss, length of hospital stay and postoperative complications were analyzed . Receiver operating characteristic ( ROC) curves was drawn to detect sensitivity and specificity of SHA .LIN score in predicting the stone-free rates of PCNL.Results The SHA.LIN score was 9.13 ±2.24 in this cohort.The stone free rate was 75.9%(88/116).Postoperative complications occurred in 32 (27.6%) cases.In those patients with stone
free, the SHA.LIN score was 8.27 ±1.62, significantly lower than that in those patients with residual stones 11.86 ±1.72 ( t =-10.069, P=0.000) .The SHA.LIN score showed significant correlation with the postoperative stone free status, operation time, estimated blood loss (P<0.01).But, it did not correlate with postoperative complications and length of hospital stay (P>0.05).The area under curve of ROC curves for the SHA.LIN scoring system was 0.923 ( 95%CI 0.870 -0.975 ) . Conclusions The SHA.LIN nephrolithometry scoring system can predict postoperative stone-free status of PCNL and can be used for disease related assessment.Further research is required to evaluate its performance in predicting peri-operative variables and postoperative complications .

Objective: The aim of the study is to validate whether the Recognition Of Stroke In the Emergency Room (ROSIER) scale can be used by general practitioners (GPs) in an emergency medical service (EMS) protocol to transfer stroke patients from primary care center to advanced hospital with acute stroke center. Methods: GPs prospectively performed the ROSIER scale and the Cincinnati Prehospital Stroke Scale (CPSS) on suspected stroke patients as a transfer protocol. All patients were immediately transferred to the Level-II hospital for further treatment. Results: 468 of the 512 suspected stroke patients met the inclusion criteria in this study. The ROSIER scale showed a diagnostic sensitivity of 83.13% (95% confidence intervals [CI] 79.74-86.52%) and specificity of 80.88% (95% CI 77.32- 84.44%). The CPSS showed a diagnostic sensitivity of 78.01% (95% CI 74.26-81.76%) and specificity of 70.59% (95% CI 66.46-74.72%). The Kappa statistic value of the ROSIER scale and the CPSS were 0.601 and 0.454, respectively. The area under the curve (AUC) of ROSIER scale was large than the CPSS (AUC 0.855 vs. 0.791). However, the difference was not significantly different. Conclusions: This study suggest that ROSIER and CPSS could be used in an EMS protocol to transfer stroke patients from a primary care center to an advanced hospital offering thrombolysis service
Stroke

Objective:To compare the accuracy of different stone scoring systems for predicting the stone-free rate (SFR) after retrograde intrarenal surgery (RIRS).Methods:The clinical data of 227 patients with lithiasis undergoing RIRS from June 2017 to December 2020 in Affiliated Benq Hospital of Nanjing Medical University and Qingdao Fuwai Hospital were retrospectively analyzed. There were 152 males and 75 females. The average age was (53.0±10.4) years old. The average body mass index was (26.9±2.1)kg/m 2. The maximum diameter of the stone was (22.7±12.8)mm. The stone is located in left side in 133 cases and in right side in 94 cases. The stones of 44 cases were located in upper ureter, upper calyceal or renal pelvis, that of 23 cases were in medium calyceal, 157 cases in lower calyceal, and 3 cases in calyceal diverticulum.The average CT value of stone was (778.3±350.4)HU. American Society of Anesthesiology (ASA)scores: 86 cases of grade Ⅰ, 129 cases of grade Ⅱ, 12 cases of grade Ⅲ. Preoperative non-contrast CT was conducted and three-dimensional data were constructed. A single observer reviewed and entered the modified S.T.O.N.E., RUSS, modified S-ReSC, R. I.R.S., SHA.LIN, Ito nomogram, S. O.L.V.E., stone free index (SFI) scores. Logistic analysis were performed between every score and SFR. Receiver operating characteristic (ROC) curve was drawn to detect sensitivity and specificity of every score in predicting the SFR. The predictive accuracies of all scores were compared. Results:The SFR was 83.0%(189/227). There were statistically significant differences in modified S. T.O.N.E.(10.5±1.9 vs. 12.7±1.8), RUSS[1(0, 4) vs. 3(0, 6)], modified S-ReSC (8.2±5.6 vs. 11.8±6.0), R.I.R.S.(6.2±1.4 vs. 8.1±1.2), SHA.LIN (9.9±2.4 vs. 13.0±2.1), Ito nomogram (12.1±5.8 vs. 4.3±3.3), S. O.L.V.E. (6.8±1.6 vs. 8.7±1.2), SFI score (7.9±1.1 vs. 6.3±0.9) between the stone-free group and the stone remaining group ( P <0.05). Logistic regression revealed that modified S.T.O.N.E., RUSS, modified S-ReSC, R. I.R.S., SHA.LIN, Ito nomogram, S. O.L.V.E. and SFI score were significantly associated with SFR( P<0.05). There were no significant differences in the area under the curve (AUC) between the modified S. T.O.N.E., RUSS, R. I.R.S., SHA.LIN, Ito nomogram, S. O.L.V.E. and SFI score( P>0.05), but there were significant differences in the AUC between modified S-ReSC score and other score ( P<0.05). When the cutoff of SHA.LIN, SFI and R. I.R.S. score was determined as 10, 6 and 6 scores, the specificity of SHA.LIN, SFI and R. I.R.S. score was 94.7%, 92.6% and 89.5%, respectively. Conclusions:All score could predict the postoperative SFR of RIRS, while the SHA.LIN, SFI and R.I.R.S. score were more accurate than the other scores. The accuracy of the modified S-ReSC in predicting SFR after RIRS was slightly worse than other scores.