Objective To analyze perioperative process, oncologic state and prognosis of patients with rectal carcinoma treated by lapascopic abdominoperineal resection. Methods 9 cases of rectal carcinoma treated by lapascopic abdominoperineal resection were reviewed retrospectively from December 1993 to February 1996. Results The median age was 50y(30y～67y), median follow-up time 80 months(40m～90m) and median operative time 6h (4 5h～7 5h). 9 cases were operated on by standard radical operation, including abdominal procedures under laparoscope in 8 cases and under the help of mini-incision in 1 case.Complications occurred in 4 cases, including subcutaneous emphysema and urine detention, iliac vein injury, deep vein thrombosis and part mucous necrosis, and perineal wound infection in 1 case respectively. The median number of lymph nodes in the specimen was 13(4～25). 6 patients survived and 3 ones died with the survival rate at 5-year being 77.8%. Conclusions Lapascopic abdominoperineal resection in the treatment of rectal carcinoma is feasible, and it can meet the tumor resection requirements of open radical operation.

Objective To explore the effect of preserving intercostobrachial nerve (ICBN) in axillary lymph node dissection on sensory disturbance for breast cancer.Methods Clinical data of 146 cases of stage Ⅰ,Ⅱ and Ⅲa breast cancer patients treated by modified radical mastectomy was analyzed.The patients were randomly divided into two groups.Retention group included 67 patients who were performed axillary lymph node dissection preserving ICBN,and 79 cases undergoing axillary lymph node dissection were taken as control group.Data of the two groups were assessed to compare the operation time,nunber of lymph nodes dissection and sensory abnormalities of upper arms.Results In the follow-up of 1,3 and 6 months,the incidence rate of the lateral upper ann sensory disturbance were 17.9％ and 74.9％,11.9％ and 60.7％,7.4％ and 59.5％ respectively in the retention and control group,and the difference was statistically significant (x2=46.78,P＜0.001;x2=36.54,P＜0.001;x2=42.80,P＜0.001).Meanwhile,there was no obvious difference between the retention and control group in operation time and number of lymph nodes(P＞0.05).No local recurrence after operation occurred in the follow-up of 8 months to 5 years.Conclusions For stage Ⅰ,Ⅱ and Ⅲ a breast cancer patients undergoing axillary lymph node dissection,retaining ICBN can significantly reduce the chance of the postoperative medial upper arm sensory disturbance,improve the quality of life with no increase of local recurrence rate.

Objective To investigate the relationship among the expression of miR-340 protein, occurrence, development and metastasis in triple-negative breast cancer (TNBC). Method 60 patients with breast cancer, from January 2006 to December 2012, according to the immunohistochemistry expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (HER-2), were divided into TNBC (33 patients) and non-TNBC (27 patients), and the breast cancer tissues (15 patients) were also selected at the same period, and the expression of miR-340 protein were detected by the immunohistochemistry. Results The positive expression of miR-340 protein was 73.33%in adjacent tissues of breast cancer, 51.52%in TNBC, 29.63%non-TNBC, the expression differences of each group were statistically significant(χ2=7.671,P<0.05). The expression of miR-340 protein in TNBC and non-TNBC patients were no significant difference in age, menopausal status and tumor size;while there were obvious correlation among clinical stage, lymph node metastasis and protein expression of miR-340 in TNBC(P<0.05). Conclusion The gene of miR-340 involves in the occurrence, development and metastasis of TNBC, they would be one of the purposes gene therapy in TNBC.

Objective To explore the surgery methods for multiple fibroadenoma of breast,provide a ref erence for the surgical treatment of breast multiple fibroadenoma.Methods The clinical data of 152 cases of breast multiple fibmadenoma admitted from January 2008 to October 2012 in Department of Breast Surgery,Obstetrics and Gynecology Hospital of Fudan University were analyzed retrospectively.All the cases were applied intraoperative B-ultrasound guided,taken the areola incision through breast subcutaneous layer approach for resection of multiple breast fibroadenoma.The surgical incision design,surgical procedures and results of operations were analyzed.Results All 152 cases fibroadenoma were resected which were guided by B-ultrasound with areola incision.One month and three months after operation,the assessment of physician-patient for the scars were different.There was no significance in the Pearson Correlations which were 0.894 (P =0.106) and 0.905 (P =0.065),respectively.But twelve months later,it satisfied with the appearance of scar,either the patients or the doctors (P ＜ 0.05).The Pearson Correlation was 0.946 (P ＜0.001).Conclusions B-ultrasound guided areola incision through the breast subcutaneous layer approach could removal multiple breast fibroadenoma at one time,patients were satisfacted with the good cosmetic results,we believe this operation method has short operation time and good clinical value.

Objective To explore the clinical efficacy and safety of modified Ponticelli regimen in treating patients with idiopathic membranous nephropathy (IMN).Methods A retrospective analysis was performed in 90 patients with IMN (type Ⅰ / Ⅱ,79/11 respectively) diagnosed by clinical data and renal biopsy.The patients were divided into modified Ponticelli group (n =23),steroid plus cyclophosphamide (CTX) (CTX group,n =39) and steroid plus cyclosporine A(CsA) (CsA group,n =28) according to the treatment.Liver function,renal function,serum lipid,proteinuria were recorded before and after treatment.Efficacy and adverse reactions were evaluated in three groups.Results (1) In all three groups,the quantity of proteinuria after treatment for 3 months [(3.33 ± 1.53) g/d,(4.70 ± 2.97) g/d,(3.92 ± 2.57) g/d],6 months [(1.60 ± 1.10) g/d,(2.34 ± 1.61) g/d,(2.25 ± 1.78) g/d] was significantly decreased compared with baseline level[(7.26 ± 2.06) g/d,(7.50 ± 2.55) g/d,(7.54 ± 2.70) g/d;P ＜ 0.05].Serum albumin levels at 3 months [(31.42 ± 3.86) g/d,(30.59 ± 5.79) g/d,(30.90 ± 7.87) g/d],6 months [(36.25 ± 4.20) g/d,(34.70 ± 6.70) g/d,(35.36 ± 8.29) g/d] were significantly increased compared with baseline levels [(24.13 ± 2.61) g/d,(23.98 ± 3.79) g/d,(22.94 ± 4.57) g/d;P ＜ 0.05],whereas serum creatinine at 3 and 6 months had no significant changes (P ＞ 0.05).(2) After treatment for 3 months,partial remission rates in modified Ponticelli group,CTX group and CsA group were 39.1％,35.9％,35.7％ respectively and complete remission rates were 8.7％,5.1％,10.7％,which were not statistically significant in all three groups (P ＞ 0.05).At 6 months,partial remission rates in three groups were 56.5％,41.0％,42.9％ respectively and complete remission rates were 21.7％,20.5％,28.6％,which did not suggested significant difference in all three groups either (P ＞ 0.05).(3) In modified Ponticelli group,steroid diabetes,impaired liver dysfunction,infections and gastrointestinal adverse events occurred in 1,1,2 and 2 patients,respectively.In CTX group,steroid diabetes,infections and gastrointestinal adverse events occurred in 5,8 and 2 patients,respectively.In CsA group,steroid diabetes and infections occurred in 1 and 3 patients,respectively.Conclusion Modified Ponticelli regimen to treat patients with IMN has a trend of better outcome than classic CTX regimen.The efficacy is not inferior to CsA regimen with fewer side effects.

Objective To investigate the expression of insulin resistance on glomerular podocyte lesion of patients with IgA nephropathy.Methods Fifty-one patients with IgA nephropathy diagnosed by renal biopsy were selected as our subjects.The expression of WT1,a marker of podocyte of the renal tissue of patients with IgA nephropathy,was detected by immunohistochemistry.The density of podocyte per glomerulus was calculated by using specific software.The insulin sensitivity index (ISI) was severed as the degree of insulin resistance.Results There were strong negative correlations between ISI and WT1,mean arterial blood pressure,triglyceride,plasma uricemia,serum creatinine,body mass index,glomerular sclerosis integral,integral,mesangial proliferation of vascular lesions integral(r =-0.521,P ＜ 0.05 ;r =-0.544,P ＜ 0.05;r =-0.646,P ＜ 0.01 ;r =-0.559,P ＜0.05 ;r =-0.741,P ＜0.01 ;r =-0.561,P ＜0.05 ;r =-0.740,P ＜ 0.01 ;r =-0.695,P＜0.01;r =-0.535,P ＜ 0.05 respectively).There was no significant relationship between ISI and 24 h quantitative urinary protein (r =-1.425,P ＞ 0.05).Conclusion Insulin resistance was involved in glomerular podocyte lesion and may contribute to the progression of IgA nephropathy.

Objective To study the relationship between intrarenal arterial lesions(IAL)and carotid atherosclerosis(AS)in patients with renal glomerular disease.Methods 251 cases with IAL were selected and 129 age-,pressure-and eGFR-matched renal glomerular disease cases without IAL were randomly selected.The carotid intima-media thickness(IMT)was detected.Clinical and laboratory examination and renal histological characteristics were compared the two guoups.Results ①The detection rate of carotid AS was higher in patients with IAL than those without IAL(38.2%vs.20.2%),and higher in patients≥40 years than in patients＜40 years(51.3%vs.13.1%)(P<0.05 for each). ②The carotid AS group was older and had higher frequencey of fasting blood glucose,body mass index,smoking,and family history of hypertension,longer duration of established hypertension and renal glomerular disease,higher prevalence of hypertension,IAL and renal lesions,and had lower eGFR than the carotid normal group(all P＜0.05).Binary logistic regression analysis revealed that IAL and age emerged as an independent risk factor for carotid AS(OR=1.826 and 1.129,P=0.001 and 0.003).Conclusion The intrarenal arterial lesion is an independent risk factor for carotid atherosclerosis in patients with renal glomerular disease.Controlling blood glucose,blood pressure,weight,smoking quit and delaying progression of kidney disease have important significance in relieving or preventing atherosclerosis and intrarenal arterial lesions of patients with renal glomerular diseases.

BACKGROUND: The reason for the short of cornea donator is the olden donating conception or the limit knowledge of cornea transplantation remains poorly understood. OBJECTIVE: To explore the awareness level of the medical staff to corneal transplantation and corneal donation. METHODS: The study consisted of 820 medical staff from different departments of 5 hospitals, including doctor, nurse, technician, and administrator. Awareness level was evaluated with an interviewer-study. RESULTS AND CONCLUSION: Totally 805 interviewer-studies were effect. The correct answer fill rate in department of ophthalmology was higher than other departments. Different measures should be taken to teach the medical staff to improve the awareness level of the transplantation and corneal donation.

Objective To investigate the effects of TNF-?,IL-12,IL-15 and underglycosylation IgA_1 in mesangial deposition in the clinicopathological study of IgA nephropathy(IgAN).Methods Seventy-four patients with IgAN were enrolled in the study,with 10 patients randomly selected after remission,10 MCD and 10 healthy volunteers as control groups.The levels of TNF-? in serum and urine were examined by radioimmunoassay,and the levels of IL-12 and IL-15 were examined by ELISA.Immunohistochemistry was used to detect the expression of TNF-? in renal tissue,and the directed immunofluorescence was used to detect the underglycosylation of IgA_1(UGIgA_1)in mesangial deposition.Results The levels of TNF-?,IL-12 and IL-15 in serum of patients with IgAN were higher than those of MCD group,healthy control group and remission group.Compared with the negative group,33 patients with UGIgA_1 positive in renal tissues had lower levels of TNF-? in serum,longer course and less class of renal tissue injury.The positive areas of TNF-? in renal tissue and levels of TNF-? in serum were positively correlated with urinary protein(r=0.249,0.702,P=0.000).There was negative correlation between the levels of TNF-? in serum and Ccr(r=-0.231,P=0.048).The levels of IL-15 was positively correlated with the course of disease(r=0.266,P=0.022) and negatively with Scr(r=-0.320,P=0.005).Conclusions The TNF-?,IL-12 and IL-15 are all involved in the onset of proteinuria in IgAN patients,and IL-15 acts as a factor against renal injury.The patients with UGIgA_1 positive in mesangial have longer course and less pathological changes damaged than those of the UGIgA_1 negative patients.The TNF-? may serve as an important factor in the aggravation of IgAN.

Objective To analyze the impac factors of serum N?terminal pro?brain natriuretic peptide (NT?proBNP) in patients with renal failure in non?dialysis phase, and to determine the cut?off point of as a diagnostic values in these patients with heart failure (HF). Methods Cross?sectional study was applied. Clinical data of 145 patients (37 cases of CKD4, 89 cases of CKD5, and 19 cases of acute renal injury (AKI) with renal failure in non?dialysis phase were collected. Comparison between groups and lineal regression analysis were utilized to investigate the impact factors of NT?proBNP, and the receiver operating characteristic curve (ROC curve) to select a better cut?off point of diagnosis in these patients with HF. Results (1) Compared with patients without HF, patients with HF had significantly higher edema, cardiac troponin I, serum phosphorus concentration, and left atrial diameter (LA), while ALB and left ventricular ejection fraction (LVEF) were decreased (P<0.05). (2) The NT?proBNP was divided into 4 groups with four points: First groups of 36 cases, NT?proBNP 1 ?862 ng/L, second groups 37 cases, 866?2670 ng/L, third groups 37 cases, 2790?20 000 ng/L, fourth groups 35 cases, 20 900?35 000 ng/L. With the increase of NT?proBNP levels, the occurrence of AKI and CKD4 decreased gradually while the occurrence of CKD and edema were significantly increased (P<0.01). Systolic blood pressure, troponin I, uric acid, serum phosphorus, parathyroid hormone, 24 hours urine protein, LA, interventricular septum thickness (IVS), left ventricular posterior wall thickness (LVPW) level gradually increased. Hb, ALB, calcium, CO2, eGFR, LVEF significantly decreased (P<0.01). The serum NT?proBNP of patients with HF was significantly higher than that of patients without HF (19 150 ng/L vs 1530 ng/L, P<0.01). The serum NT?proBNP of patients with edema was significantly higher than that in patients without edema (5460 ng/L vs 1630 ng/L, P<0.01). (3) Single factor linear regression analysis indicated that higher NT?proBNP was positive correlated with HF, edema, cardiac troponin I, uric acid, serum phosphorus, LA, IVS and LVPW (P<0.05), while negative correlated with Hb, eGFR, ALB, serum calcium, CO2, LVEF (P<0.05), and not correlated with eGFR, uric acid, serum calcium (P>0.05). (4) The best cut?off point of NT?proBNP predicting HF in patients with renal failure in non?dialysis phase was 3805 ng/L, AUC=0.848, 95%CI 0.786?0.910. Sensitivity was 82.4%, specificity 74.5%, positive predictive value 62.1%, negative predictive value 87.3%, positive likelihood ratio 3.2, negative likelihood ratio 0.24. Conclusions The level of NT?proBNP>20 000 ng/L is mainly found in end?stage renal disease patients with HF. HF is a main factor for the increase of NT?proBNP in patients with renal failure in non?dialysis phase. High phosphorus viremia, anemia, and hypoalbuminemia are closely related to NT?proBNP. Therefore NT?proBNP predicting HF should take into account the effects of these confounding factors in these patients.