Objective To determine the effects of pub op rostatic ligament and puborectalis sling sparing on postoperative complicationgs after radical retropubic prostatectomy. Methods A total of 16 men(mean age 67,stage B 14 cases,stage C 2 cases) with clinically prostat e cancer were managed with radical retropubic prostatectomy.Puboprostatic ligame nt and puborectalis sling sparing technique were used in all patients. Results All patients recovered from the operation.During 1 to 4 y ears,follow-up,none had long term incontinence or dysuria.PSA declined to 0.00 ng/ml and stayed 0.00 ng/ml in 9 cases within follow-up period.PSA were bellow

Objective To evaluate the safety and feasibility of retroperitoneal laparoscopic excision of pheochromocytoma. Methods Retroperitoneal laparoscopic excision of pheochromocytoma was performed on 20 patients with pheochromocytoma (group A).At the same period, 20 patients with pheochromocytoma undergoing open surgery served as controls (group B).Intraoperative blood pressure, heart rate, plasma noradrenalin (NE) concentration,operative time, volume of blood loss, cases receiving blood transfusion, postoperative activity out of bed days, postoperative hospital stay,were compared between the 2 groups.The NE concentration was determined using RP-HPLC-ECD. Results The operations were successful in all the patients. Intraoperatively,3 cases (15.0%) in group A and 12 cases (60.0%) in group B experienced acute fluctuation in blood pressure,heart rate and pulse [maximum blood pressure,220/110 mm Hg(1 mm Hg=0.133 kPa) vs 210/115 mmHg; minimum blood pressure,88/57 mm Hg vs 85/60!mm Hg;maximum heart rate,122/min vs 120/min, respectively].The NE concentratioo correspondingly fluctuated from the maximum 16.82 ng/ml to the minimum 6.28 ng/ml (normal reference,0.32 ng/ml) (P

Objective To study the diagnosis and treatment of renal tuberculosis (TB). Methods A retrospective study was made on 281 cases. Results Irritation symptoms, hematuria and lumbodynia were the most common symptoms. The positive result of acid-fast stains, urinary TB-PCR, PPD-IgG were 44.5%, 44.1% and 62.5% respectively. The diagnostic accuracy of urography, CT and B-type ultrasonography were 69.1%, 84.3% and 28.3%.105 of the 128 cases have been cured on medicine ( INH + RFP + PZA for 6～8 months ). Nephro-ureterectomy was performed for 145 out of 153 cases (94.8%). Conclusions Combined use of different means of diagnostic technique would help to assess the diagnosis of renal TB especially in atypical cases.IVU is still the first choice for diagnosis and CT scan is helpful.INH,REP and PZA used combinedly yiels satisfactory outcome for early cases.When nephro-ureterectomy is indicated,the involved ureter should be excised as much as possible.

Objective: To summarize experiences in 136 cases of retroperitoneal laparoscopic surgery. Methods:From April 1997 to May 2002, retroperitoneal laparoscopic surgery were performed for 136 cases of adrenal dis-eases. There were 63 aldosterone- producing adenoma, 22 adrenalcortical adenoma, 39 nonfunctional adrenal tu-mor, 7 adrenal cyst and 5 phenochromocytoma. Results: Except for one case converts to open surgery, success hasbeen achieved in all cases without major complications. Intraoperative blood loss was 76 + 32ml without blood trans-fusion. Postoperative hospital stay was 6 + 3 days. There were statistical differences among these indices when com-paring to those of open surgery for 126 cases with adrenal diseases( P ＜ 0.05). But operative time was little longer inlaparoscopic group than in group of open surgery(P＜0.05) ,whereas it has been changed to similar in those recentcases. Conclusion:Retroperitoneal laparoscopic surgery was less traumatic to the patients, with less postoperative dis-comfort and quicker recovery and should be considered the first choice of therapy for adrenal disorders.

Primary liver cancer (PLC) includes hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (CC).In recent years, the incidence of PLC has increased significantly in the world.At present, the therapy for liver cancer tends to diversify, but surgical resection is still the first choice and the most effective treatment for HCC in general.As the biomedical, evidence-based medicine, and medical humanities are proposed, to achieve the best therapeutic effect and minimize the trauma has become the goal of modem surgery.Moreover, this could promote the transformation of surgical model from traditional experiential surgery to precision surgery.Besides, as the critical techniques of treating HCC in preoperative evaluation,operative procedures, perioperative management and the innovation of surgical instruments develop fast, precise liver resection has come into being.And now this concept is getting more and more attention from hepatobiliary surgeons.In this paper, the progress on the application of precise liver resection in the treatment of PLC is reviewed based on the preoperative evaluation and intraoperative procedures.

Objective To investigate the correlations of plasma brain natriuretic peptide (BNP) levels and the subtypes and the severity of acute ischemic stroke.Methods Consecutive patients with acute ischemic stroke were enrolled in the study.They were divided into large-artery atherosclerosis (LAA),smallartery occlusion (SAO) and cardioembolism (CE) according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification.Electrochemiluminescence immunoassay was used to measure plasma BNP.OsiriX software was used to calculate the cerebral infarction volume of MRI.Results A total of 159 patients with acute ischemic stroke were enrolled.Compared to the CE group,there were significant differences in the proportions of hyperlipidemia,atrial fibrillation,BNP ＞ 100 ng/L,and in the levels of lowdensity lipoprotein cholesterol (LDL-C) and BNP,as well as in the National Institutes of Health Stroke Scale (NIHSS) score and the infarct volume in the groups of LAA and SAO (all P ＜0.05).Multivariate logistic regression analysis showed that atrial fibrillation (odds ratio [OR] 148.638,95％ confidence interval [CI]17.532-1 260.182; P ＜ 0.001) and BNP ＞ 100 ng/L (OR 3.490,95％ CI 1.033-11.789; P =0.044)were the independent risk factors for CE ischemic stroke.Receiver operating characteristic curve analysis showed that the optimal cutoff value for predicting plasma BNP level of the CE ischemic stroke was 101.4 ng/L,and its sensitivity,specificity,positive predictive value,and negative predictive values were 80.56％,76.42％,50.00％,and 93.07％,respectively.The optimal cutoff value was used as a boundary,the patients were divided into a BNP ≤ 101.4 ng/L group and a ＞ 101.4 ng/L group.The proportions of males (P=0.031),hyperlipidemia (P=0.002) and smoking (P =0.026),as well as the levels of total cholesterol (P=0.020),triglyceride (P=0.024) and LDL-C (P=0.013) were significantly lower than those in the BNP ≤ 101.4 ng/L group,while the proportions of patients with ischemic heart disease (P ＜0.001) and atrial fibrillation (P＜0.001),as well as the NIHSS score and the infarct volume were significantly higher and larger than those in the BNP ≤ 101.4 ng/L group.Spearman rank correlation analysis showed that the plasma BNP levels were significantly negatively correlated with the triglycerides (r=-0.224,P=0.004) and LDL-C (r=-0.170,P=0.032) levels,and were significantly positive correlated with the NIHSS scores (P=0.167,P=0.044) and the infarct volume (P=0.281,P＜0.001).Conclusions Plasma BNP level can be used as a biological marker for early differentiating CE from non-CE ischemic stroke,as well as identifying the severity of stroke.

Aim The aim is to purify fibrinolytic enzyme from Scolopendra subspinipes mutilans L.Koch and to study the thrombolytic and anticoagulant effect.Methods Scolopendra subspinipes mutilans L.Koch fibrinolytic enzyme(SSFE) was purified by ammonium sulphate precipitation,DEAE-cellulose and SephadexG-75 column chromatography from Scolopendra subspinipes mutilans L.Kochby.And fibrinolytic activity was determined by fibrin plate.The anticoagulant effect was measured on mice with haemolytic test and hemorrhagic test.The thrombolytic effect was measured with rats In vitro and in vivo,and the activated partial thromboplastin time(APTT),plasma prothrombin time(PT),thrombin time(TT) were measured.Results SSFE was single component with fibrinolytic activity and without any hemolyzation and hemorrhagic activity.All doses of SSFE(2,5,10 mg?kg-1) could obviously prolong activated partial thromboplastin time(APTT) and thrombin time(TT) ;Middle dose of SSFE(5 mg?kg-1) could prolong plasma prothrombin time(PT) while high dose of SSFE(10 mg?kg-1) didn't prolong obviously.Conclusion SSFE has obvious thrombolytic effect and anticoagulant effect.

Objective To discuss hemodynamic and electrolyte changes associated with irrigation fluid absorption during percutaneous nephrolithotripsy(PCNL). Methods Eithty nine upper urinary tract lithiasis patients underwent PCNL assisted with pressure irrigation. Sixty five cases were with renal calculi and 24 cases were with ureteral calculi. There were 62 males and 27 females. Nor mal saline was used as irrigation fluid. Heart rate(HR),central venous pressure(CVP),cardiac out put(CO),stroke volume(SV),systemic vascular resistance(SVR),thoracic fluid content(TFC) wererecorded before operation and every 30 min during irrigation. Serum Na+,K+,CI ,Ph,BE weredetected before and after irrigation. One way ANOVA,linear correlation and paired t test were usedas statistic analysis. Results The mean irrigation time was 105 min. Mean irrigation fluid volumewas 18 391 ml and mean irrigation velocity was 174.46 ml/min. HR,CO,SV,SVR and blood Na+ ,K+,C1 did not change significantly during and after irrigation. CVP and TFC significantly increasedduring irrigation. The increasing of CVP and TFC were correlated with irrigation time, volume andvelocity. CVP and TFC increased rapidly in 5 patients with calyx laceration and recovered after diuret ic injection. No serious complication was detected. Conclusions Irrigation fluid absorption is observed during PCNL with pressure irrigation. Generally, no significant changes in hemodynamic andelectrolyte balance are found in patients with normal cardiac and renal function.

Objective To compare the antalgic effects of ropivacaine in various doses on brachial plexus nerves. Methods 87 patients undergoing upper arm surgery were enrolled in this study. The patients were unpremed-itated. The patients were randomized to receive ropivacaine of 0.30,0.25 or 0.20% (group Ⅰ,Ⅱ and Ⅲ) with mor-phine of 0.1mg/ml and Lidocaine of 10mg/ml. In order to analygesia of brachial plexus nerves,the rejecting of load dose is firstly 10ml,the total dose is 10ml/24h interval every time,the antalgic time is about 50 hours. To compare the antalgic effects of ropivacaine in various doses based on standard of VAS. Based on standard of Bromage to assess the situation of motor neuron blocking. Results According to standard of VAS in 6,12,24 and 48 hours after underwent surgery, the group Ⅲ is more effective than group Ⅰ and group Ⅱ ; according to standard of Bromage, the group Ⅰ is more effective than group Ⅱ and group Ⅲ. it has no adverse reactions to patients. Condusion 0. 25% of ropiva-eaine with morphine of 0.1mg/ml and lidocaine of 10mg/ml have obtained good antalgic effects for patients after un-dergoing upper arm surgery,it is fit for applying in clinic.

Objective To investigate the modulation role of autophagy in radiation-induced cell death by detecting the response of src kinase activity and autophagy in HEK293 cells irradiated with different dose of α-particle.Methods HEK293 cells were irradiated by contral group (0 cGy) a low dose group (10 cGy) and high dose group (300 cGy) α-particles.Molecular probe 2',7'-dichlorofluorescin (DCFHDA) was used to detect the cell ROS.The src kinase activity and endogenous protein level of LC3Ⅰ/Ⅱ were monitored by Western Blot.Cell death rate of irradiated cells pretreated with autophagy inducer of rapamycin was tested by flow cytometry.Results Compared with control group,the ratio of LC3Ⅰ/Ⅱ decreased (t =4.07,P ＜ 0.05) and the percentage of cells with GFP-LC3 punctuate dots increased (t =12.29,P ＜0.05) under 10 cGy irradiation,indicating the induction of autophagy.On the contrary,the ratio of LC3Ⅰ/Ⅱ increased (t =2.93,P ＜ 0.05) and the GFP-LC3 morphology had no obvious change under 300 cGy irradiation.The cellular ROS level reached to the maximum value at 4 h postirradiation.Both 10 cGy and 300 cGy irradiation could elevate the ROS level (t =17.93,22.88,P ＜0.05),whereas the amplitude of elevation of 300 cGy irradiation was higher than that of 10 cGy irradiation (t =15.76,22.66,14.22,P ＜ 0.05).Compared with control group,the 419th site of tyrosine residue in src kinase manifested hyper-phosphorylation (t =5.66,P ＜0.05) under 10 cGy irradiation whereas it had hypo-phosphorylation under 300 cGy irradiation (t =4.67,P ＜ 0.05).Treatment of cells with DMSO could partly restore the impact on src kinase activity under high or low dose irradiation.Pre-treating the cells with autophagy inducer rapamycin could reduce cell death under 300 cGy irradiations (t =12.14,P ＜ 0.05).Conclusions High or low dose of α-particles irradiation could inhibit or activate src kinase and autophagy system,respectively.ROS mediated the response of src kinase activity and autophagy system induced by irradiation.Modulation of autophagy could desensitize cell responses to irradiation.