Objeetive To investigate the changes of kidney cortex hemoperfusion before and after extracorporeal shock wave lithotripsy (ESWL) with contrast-enhanced ultrasonography (CEUS) and time-intensity curve.Methods Thirty patients of renal calculi were treated with ESWL and examined with CEUS before and after ESWL.Renal cortex blood perfusion parameters of the lithotriptic areas,including the contrast agent arrival time (AT) ,time to peak (TTP) .peak intensity (PI) and velocity parameters (β) were quantitatively measured with ACQ software.Results The value of AT,TTP and β were not significantly different before and after ESWL (P＞0.05) .PI value after ESWL was lower than that before ESWL (P＜0.05) . Conclusion CEUS can quantitatively evaluate the changes of kidney cortex hemoperfusion after ESWL,and reflect the minor renal damage resulted from ESWL.CEUS can be used as a new method of observing and evaluating the renal damage caused by ESWL.

To study the traditional Chinese medicine (TCM) syndrome distribution in patients with hepatitis B virus (HBV) infection in Qidong region of Jiangsu Province, China.

Objective To analyze the characteristics of hepatic metastasis of pure immature ovarian teratoma and explore its proper diagnosis and treatment.Methods Eighteen cases of hepatic metastasis of pure immature ovarian teratoma were included in this study. The clinical stage, operation, chemotherapy and histopathology of primary and secondary tumors as well as the data from long term follow-ups were analyzed retrospectively,Results All of the hepatic metastatic tumors were located on the surface of the liver. 61.1％ (11/18) of them were clinical stage Ⅲ and 44.4％ (8/18) were grade 1 at first operation. The hepatic metastatic rate was 16.7％ (3/18) in the standard adjuvant chemotherapy group but increased markedly to 31.2％ (15/48) in the irregular chemotherapy group. Auxiliary diagnostic methods could not indicate the correct results. The surgical resection rate of hepatic metastasis of pure immature ovarian teratoma was 94.4％ (17/18). There were less complications in the group with tumor diameter less than 15 cm. The follow-up time ranged from 3 to 205 months with a mean of 20.9 months. The 3-year-survival rate was 77.8％ (14/ 18), and mortality rate was 22.2％. The 5- and 10-year-survival rate was 55.6％ (10/18) and 38.9％ (7/18), respectively. The rate of loss in follow-up was 22.2％ (4/18) and 38.9％ (7/18), respectively, and one patient has survived for more than 17 years.Conclusions The hepatic metastatic rate of pure immature ovarian teratoma could be decreased using standard adjuvant chemotherapy. Suitable surgical treatment could reduce complications and improve the prognosis for patients.

ObjectiveTo investigate the effects of over expression of miR-34a on cellular proliferation and migration in bladder cancer cell line J82 by targeting Notchl.MethodsmiR-34a was predicted as a putative gene which can target Notchl through bioinformatics analysis,qRT-PCR and Western blot were performed to measure the expression levels of Notchl and miR-34a in invasive transitional cell carcinoma of bladder (TCCB) tissues and J82 cells transfected with miR-34a.Luciferase assay was employed to determine if miR-34a could target Notchl through binding to the 3'-untranslated region (3'UTR) of Notchl mRNA.J82 cells were transfected with pcDNA3.0-miR-34a or pcDNA3.0 control plasmid.MTS colorimetry was used to evaluate the effect of miR-34a on cell proliferation.The effect of miR-34a on cell migration was assessed by transwell migration assay.ResultsThe expression level of miR-34 in invasive TCCB tissues was lower than in adjacent bladder tissues (0.016(0.018) vs 0.042 (0.059),N =16; P =0.0006).On the contrary,the average levels of Notchl mRNA and protein were higher in tumors than in adjacent bladder tissues (2.765(2.156) vs 2.312(1.365),N =16; P =0.0025 and 0.857 ±0.197 vs 0.648 ±0.171 ;P ＜0.0001 ).After the transfection of miR-34a,the expressive level of miR-34a in J82 was highly induced ( (2.408 ±0.789) × 10-4 vs(0.153 ±0.029) × 10-4; P =0.0026).However,the expressive levels of Notchl mRNA and protein were obviously decreased (3.001 ± 0.106 vs 4.998 ± 1.053 ; P =0.0308 and 0.747 ± 0.050 vs 0.988 ± 0.102 ; P =0.0215 ).The results of luciferase assay showed that firefly activity was highly dimished (0.422 ± 0.028 vs 2.392 ± 0.148 ; P ＜ 0.0001 ).Cellular proliferation was inhibited after the transfection of miR-34a in J82 (P ＜ 0.0001 ).Moreover,number of migration cells of J82 was significantly reduced after the ectopic expression of miR-34a ( 179.3 ± 21.02 vs 269.7 ± 23.71 ; P =0.0078 ).ConclusionsmiR-34a inhibits the cellular proliferation and migration of bladder cancer cell line J82 via binding to the 3UTR of Notchl mRNA.

Objective:To clarify the anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava during laparoscopic surgery.Methods:In December 2018, two frozen and two fresh adult cadavers were dissected. The chest of the frozen cadavers was opened along the bilateral midline of the clavicle, the anterior pericardial wall was opened, and the superior vena cava and the inferior vena cava was dissected. The abdominal cavity was opened along the midline of the abdomen, the left and right hepatic lobes were turned over, the inferior vena cava and the second hilum of the posterior segment of the liver were exposed, and the hiatus of the inferior vena cava was opened and entered the pericardium.The anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava were observed, and the length of the superior segment of the inferior vena cava was measured. The fresh frozen cadaver patients underwent laparoscopic surgery.Five 12 mm trocars were placed at the side of umbilicus, right rectus abdominis about 4 cm from umbilicus, midline of abdomen about 6 cm above umbilicus, right axillary front about 2 cm below inferior edge of liver, left midline of clavicle about 2 cm below inferior edge of liver. Laparoscopic-assisted turning of the left and right hepatic lobes, exposing the posterior inferior vena cava and the second hilum of the liver, opening of the vena cava hiatus into the pericardium.The anatomical characteristics and adjacent relationship of the upper diaphragmatic segment of the inferior vena cava were observed.Results:In two autopsies, the inferior vena cava entered the chest through the cava sulcus of the liver and the phrenic foramen cava, and then through the fibrous pericardium into the right atrium. The length from the diaphragm of inferior vena cava to the right atrium was 1.67 cm, 2.57 cm. In laparoscopic operation, the diaphragm entrance of the posterior segment of the liver inferior vena cava, the second hepatic portal and the inferior vena cava could be well exposed.The diaphragm could be opened along the hole of the vena cava with a relatively non vascular anatomical layer of adipose tissue.There was a large anatomical gap between the pericardium and the right atrium, and the inferior vena cava, the superior vena cava and the right atrium could be well exposed, and the whole diaphragm could be completely and continuously exposed from the bottom to the inferior vena cava at the entrance segment of the right atrium.Conclusions:There was a relatively avascular anatomical layer beside the inferior vena cava. During laparoscopic operation, opening the diaphragm through the abdominal cavity could safely enter the pericardium and expose the inferior vena cava, the superior vena cava and the right atrium, which provides a possibility for the removal of Mayo Ⅳ grade inferior vena cava tumor thrombus through this approach.

Objective:To compare the effectiveness and safety of laparoscopic hepatectomy (LH) versus radiofrequency ablation (RFA) in treatment of hepatocellular carcinoma (HCC).Methods:The medical literatures on LH and RFA for HCC were searched in PubMed, Web of Science, Embase, VIP, Wanfang, CNKI and other electronic databases. The retrieval date was from database construction to June 7, 2021. According to the inclusion and exclusion criteria, studies were extracted by two authors, and Revman 5.3 software was used to conduct a meta-analysis to compare differences in operation time, blood loss, length of hospital stay, total complications, overall survival and disease-free survival outcomes between the LH group and the RFA group.Results:Of 3 690 patients who were included in 32 studies, there were 1 708 patients in the LH group and 1982 patients in the RFA group. Meta-analysis showed that compared with the LH group, the RFA group had significantly shorter surgical duration ( MD=-86.41, 95% CI: -116.21--56.60), less blood loss ( MD=-213.22, 95% CI: -273.43--153.00), shorter hospital stay ( MD=-3.23, 95% CI: -4.13--2.32), and lower incidence of complications ( OR=0.33, 95% CI: 0.26-0.43). However, local recurrence rate was significantly higher ( OR=1.83, 95% CI: 1.38-2.41). (All P<0.05). The 5-year survival rate of the LH group was significantly better than the RFA group ( OR=0.68, 95% CI: 0.51-0.90, P=0.008). Conclusion:LH provided better overall survival outcomes and lower local recurrence rates than RFA in HCC patients.

Acid-Base Equilibrium ; Adolescent ; Child ; Drinking Water ; Humans ; Kidney ; Mineral Waters ; Minerals ; Schools ; Surveys and Questionnaires ; Water Supply

Objective To explore the feasibility of robot-assisted laparoscopic inferior vena cava (IVC) thrombectomy in treating renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava thrombus.Methods From November 2014 to January 2017,5 cases of renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava tumor thrombus were treated with robot-assisted surgery.There were 4 males and 1 female with the median age of 59 years (range 54-71 years).Four cases had the renal tumor on the right side and one on the left side.The mean tumor size was 6.8 cm (range 5-9 cm) with 3 cases of T3b and 2 cases of T3c.There were 4 cases of level Ⅲ and 1 case of level Ⅳ inferior vena cava thrombus with the median length of 9 cm (range 7-11 cm).The surgical procedure for Mayo level Ⅲ inferior vena cava thrombus included mobilization of both left and right robes of liver,subsequently controlling the suprahepatic infradiaphramatic IVC and first porta hepatis simultaneously.The surgical procedure for Mayo level Ⅳ inferior vena cava thrombus included cardiopulmonary bypass by multi-disciplinary cooperation among urologists,hepatobiliary and cardiovascular surgeons.The procedures included live mobilization,control of the superior vena cava and first porta hepatis and remove thrombus in the atrium and IVC respectively.Results All operations were completed successfully.The median operative time was 440 min (320-630 min).The blood recovery device was used and the intraoperative estimated blood loss was 2 500 ml (500-6 000 ml) and all cases required intraoperative blood transfusion.The median time of intraoperative occlusion of IVC was 35 min (25-50 min).All patients were transferred to the intensive care unit for median of 4 days (2-8 days) after surgery.The median time to remove the postoperative drainage tube was 9 days (7-12 days).Postoperative pathological diagnosis revealed 5 cases of clear cell carcinoma.Postoperative renal dysfunction occurred in 3 patients and liver dysfunction occurred in 2 patients who improved after medical therapy.During median 19.6 months (12-48 months) of follow-up,1 patient died and 1 patient progressed.Conclusions Despite the high risk of surgery,robot-assisted laparoscopic IVC thrombectomy for renal tumor with Mayo level Ⅲ-Ⅳ thrombus is feasible for experienced surgeons in selected patients.However,the oncological outcomes need further investigation.

Objective:To analyze the epidemic characteristics and periodicity of hemorrhagic fever with renal syndrome (HFRS) in Jingzhou City, Hubei Province, and provide a basis for scientific prevention and control of HFRS in Jingzhou City.Methods:Retrospective analysis was used to collect HFRS case data and population data of Jingzhou City and 8 counties (cities, districts) within its jurisdiction, including Shashi District, Jingzhou District, Gongan County, Jianli City, Jiangling County, Shishou City, Honghu City, and Songzi City from 1962 to 2020, from the Archives of the Jingzhou Center for Disease Control and Prevention and the Infectious Disease Report Information Management System of the China Disease Control and Prevention Information System; and the epidemic characteristics of HFRS was analyzed in Jingzhou City and 8 counties (cities, districts) within its jurisdiction. The periodicity of HFRS onset was determined using wavelet analysis.Results:From 1962 to 2020, 18 936 HFRS cases were reported in Jingzhou City, with an average incidence rate of 5.95/100 000. There were a total of three epidemic peaks, namely from 1972 to 1973 (24.82/100 000, 24.84/100 000), 1983 (60.08/100 000), and 1995 (14.57/100 000). According to different regions, the high incidence areas of HFRS showed a phased transfer trend: from the 1960s to the 1970s, the Jiangbei area (Honghu City, Jianli City) was the highest incidence area; in the 1980s and 1990s, the high incidence areas were transferred to Jiangnan area (Songzi City, Shishou City, and Gongan County); after 2005, high incidence areas were relocated to Jiangbei area (Honghu City, Jianli City, Jiangling County). The wavelet analysis results showed that there were 12.30 and 21.77 years of HFRS epidemic cycles in Jingzhou City before 2000 ( P < 0.05); among them, the periodicity of Shashi District, Gongan County, Jiangling County, Shishou City, and Honghu City was relatively consistent with that of Jingzhou City, with epidemic cycles of about 12 or 22 years ( P < 0.05). Conclusions:Jingzhou City is currently at the peak of a 22-year epidemic cycle of HFRS, with Jiangbei area as the high incidence areas. The 12-year epidemic cycle in Jingzhou City has ended after 2000.

Objective:To analyze the epidemic characteristics of brucellosis in China from 2004 to 2018, in order to understand the development trend of brucellosis.Methods:The surveillance data of brucellosis in China from 2004 to 2018 were collected from National Public Health Science Data Center. Joinpoint regression was used to analyze the trend of brucellosis incidence in China and various provinces. Overall trends were estimated by the average annual percentage change (AAPC). Seasonal and trend decomposition using loess (STL) was used to analyze the seasonal characteristics of brucellosis in China and various provinces. The age-related thermodynamic diagram of incidence rate was used to analyze the characteristics of age-onset changes.Results:From 2004 to 2018, a total of 524 980 brucellosis cases and 16 deaths were reported nationwide, with a incidence rate of 2.61/100 000 and a case fatality rate of (3.05 × 10 -3)%. The incidence of brucellosis in China was on the rise (AAPC = 11.58%, 95% CI: 7.91% - 15.25%, P < 0.001). There was no significant trend of change in Inner Mongolia Autonomous Region, Shanxi and Shaanxi provinces ( P > 0.05). Tibet Autonomous Region showed a downward trend (AAPC = - 55.19%, P < 0.001). All other provinces were showing an upward trend (AAPC > 0, P < 0.05). The peak incidence in China occurred from April to June. In terms of provinces, the peak incidence in Hainan, Sichuan, Guizhou, Fujian and Anhui provinces occurred from April to August, the peak incidence in Chongqing and Shanghai cities occurred from June to August, and the peak incidence in other provinces was generally from April to June. There were reports of brucellosis cases in all age groups nationwide, and the age distribution showed an inverted "V" shape. The peak incidence occurred in the 50 - 54 years old (5.43/100 000), followed by the 60 - 64 years old (4.94/100 000). From 2004 to 2018, the top 3 age groups of incidence rate changed from 40 - 44, 50 - 54 and 35 - 39 years old in 2004 to 50 - 54, 60 - 64 and 55 - 59 years old in 2018. Conclusions:The incidence of brucellosis is on the rise nationwide and in most provinces from 2004 to 2018. The high incidence age is gradually changing to the elderly population.