BACKGROUND:Cyclosporine A has shown its immunosuppressive effects and has been widely used in clinical organ transplantation.OBJECTIVE:To review the recent studies on the immunosuppressive mechanisms and the active pathway of cyclosporine A.RETRIEVAL STRATEGY:A compute-based online search of ScienceDirect Onsite,ProQuest,Springer and Ovid,based on the data from Peking University Medical Library,was undertaken for the English articles concerning with the immunosuppressive mechanism of cyclosporine A from January 1990 to December 2006,with the keywords of "cyclosporine A,mechanism/action,immunosuppression".Totally 68 articles were collected after the first trial,and the preliminary screening was conducted for the titles and abstracts.Inclusion criteria:articles related with the immunosuppressive mechanisms of cyclosporine A.Repetitive studies were excluded.Fifty accorded with the inclusive criteria,and 46 of them regarding tracheal transplantation were selected for the full-texts as the references.LITERATURE EVALUATION:Forty-six included articles included 6 ones about the clinical use and effects of cyclosporine A,and 40 involving the related studies on the molecular mechanisms of cyclosporine A.DATA SYNTHESIS:The review of literatures indicates that,the immunosuppressive mechanisms of cyclosporine A consist of:① the calcineurin/nuclear factor of activated T-cells pathway,②the activation of JNK and P38 signaling pathways,③other effects.CONCLUSION:Cyclosporine A selectively regulates the function of peripheral blood lymphocytes subgroup,blocks the activation of cytotoxic T-cells,and possibly inhibits the formation or reaction of memory T-cells.But it doesn't affect activation and proliferation of suppressive T-cells,or expression of interleukin-2 receptors,which may induce selective immunosuppression.

To investigate the relationship between the prognosis and the HER-2 expression and its significance as a prognosis predictor in patients with breast cancer. In 185 samples of breast cancer the expression of HER-2 was immunchistochemically deternined and the survival time of the patients was respectivaly affirmed. 120 patients (64.9%) with complete followed-up data were indudal, of whom 28 patients died (15%). The records of other 65 patients (35.1%) were not available for this study. It was showed that the positive rate for HER2 was 37.3%. There was significant difference between the survival curves in patients exhibiting different grades of HER2 expression (P

Objective To evaluate the clinical efficacy of retroperitoneoscopic nephrectomy for tuberculous nonfunctioning kidneys.Methods From October 2003 to November 2006,retroperitoneoscopic nephrectomy was performed in nine cases of tuberculous nonfunctioning kidneys in our hospital.Dissecting kidney and ureter with ultrasound scalpel,blocking kidney pedicle with Endo-GIA(n=4) or Hem-o-lok(n=5),kidney was put into kidney bags and taken out.Results All nine cases were performed nephrectomy successfully without conversions to open surgery.The mean of operative time was 110 min(range,90-180 min);the mean of blood loss was 94.4 ml(range,20-200 ml);the mean of postoperative hospital stay was 5.5 days(range,3-8 days).One case had a little cheese-like pura extravasation induced by laceration of kidney capsule.Peritoneum damage occurred in one case.The nine patients showed a primary healing of the wound.Follow-up of 1-38 months in nine cases showed normal function of contralateral kidney.Conclusions Retroperitoneoscopic nephrectomy for renal tuberculosis has advantages of minimal invasion,less blood loss and quicker recovery,therefore it is a fairly safe and reliable procedure for tuberculous nonfunctioning kidneys.

Objective To evaluate the clinical efficacy of retroperitoneoscopic surgery for adrenal cyst.Methods From May 2002 to December 2006,retroperitoneoscopic surgery was performed in 12 cases of adrenal cyst.The diameter of cyst was ranged from 3.6 cm?2.2 cm-10.0 cm?8.0 cm.After the retroperitoneal space was dilated,the perinephric fascia was opened.The adipose tissues around the upper polar of the kidney and the adrenal gland were dissected.Then the upper polar of the kidney and the cyst of adrenal gland were separated along the renal surface with a ultrasound scalpel.The cysts and normal adrenal tissue 1 cm away from the cysts were resected.Results The operation was successful in all of 12 patients without conversion to open surgery.The mean operative time was 65 min(range,50-120 min);the mean blood loss was 45 ml(range,10-150 ml);the mean hospital stay was 4.5 days(range,3-7 days).Intraoperative cyst rupture occurred in 2 cases of larger cysts,then the cystic fluid was drawn out and the cyst wall was fully excised.No incision infections occurred.A follow-up period of 2-55 months(mean,32 months) in 12 patients showed no cysts recurrence.Conclusions Retroperitoneoscopic surgery for adrenal cyst has the advantages of minimal invasion,less blood loss,quicker recovery,and shorter hospital stay,therefore it provides the first choice for adrenal cyst.

Objective　To evaluate the safety and primary outcomes of transumbilical laparoendoscopic single-site radical nephrectomy (LESS-RN) by using home-made single-port device.　Methods From July 2010 to November 2011,we had performed transumbilical LESS-RN on eleven renal cell carcinoma patients by using the home-made single-port device.There were 5 males and 6 females in this group.The mean age was 49 (37 -68) years and mean body mass index was 24.2 (18.4 -30.4) kg/m2.Ultrasound and CT scan revealed 11 renal tumors (7 on left and 4 on right),with 3 on the upper pole,4 in the middle and 4 in the lower pole.There were 2 cases with suspicious lymph node metastasis and one case with renal cyst.There was no distant metastasis.The intracorporal procedure was similar to conventional laparoscopic radical nephrectomy.　Results　Except two cases converted to conventional laparoscopic RN and one case converted to hand-assisted laparoscopic RN,the other procedures were completed successfully without open conversion.The mean operative time was 225 min (155 -297 min) and mean estimated blood loss was 271 ml (50 -900 ml).Postoperative results showed that all cases were renal cell carcinoma and there were 3 cases in T1a,5 cases in T1b and 3 cases in T2a.The mean visual analog pain scale (VAPS) was 4 (3 -6),and mean hospital stay was 10 d (5 -15 d).With the mean follow-up of 17 months (8 -24 months),all patients were alive with no evidence of local recurrence or metastasis.Patients were satisfied with the cosmetic results of the wound recovery.　Conclusions　Transumbilical LESS-RN using home-made single-port device is a safe approach in selected patients and has excellent cosmetic results. Primary oncologic outcomes are good.However,we will still need large clinic trials to further evaluate the efficacy and safety of LESSRN.

Objective To study the microstructural and ultrastructural changes of the epididymis of experimental varicocele in adolescent rats and it's role in infertility resulting from varicocele. Methods A varicocele model was performed in adolescent Sprague Dawley rats by partially ligating the left renal vein,the different segments of the epididymides of the rats were prepared for light and electron microscopy,the microstructure and ultrastructure of the epididymis were studied. Results There were lesions of different degree and segment specific changes in the epididymis with varicocele.Light microscopically,the main changes were interstitial vascular hyperemia,lymphocytes infiltration,sperm granuloma developed in the interstitial;The structure of the columnar epithelia was anomalies,epithelial cells degeneration,even the vacuoles appeared in the epithelial cells.The number of halo and clear cells increased.Inside the cavity of the duct,there were shedding cells,macrophage,deformed sperms and residual bodies.Electron microscopically,numerous large lysosomes,the residual bodies,the defected main cellular organelles(e.g. the endoplasmic reticulum,the mitochondrion and the Golgi complex etc.)and even large clear vacuoles were presented in the cytoplasm of principal cells.Clear cells were filled with lysosomes that made them frequently bulging into the lumen.The microvilli of the columnar epithelia were sparse and showed local defects.The thickness of the basal membrane increased.Conclusion\ The experimental varicocele in adolescent rats lead to microstructure and ultrastructure lesions in the epididymis,which may be another important reason of infertility resulting from varicocele.\;[

Objective To investigate the effect of partial nephrectomy of anatomical solitary kidney on tumor control and renal function preservation.Methods 10 patients with anatomical solitary kidney underwent partial nephrectomy from December 2007 to May 2016,including 6 males and 4 females ranged from 38 to 71 years old with an average of 57 years old.The PADUA score ranged from 6-10,with an average of 7.6.The tumor diameter ranged from 1.0 to 7.4 cm,with an average of 3.2cm.Results 7 cases underwent laparoscopic surgery.3 cases underwent open surgery.Mean operation time was 168min (ranged 103-217min).Mean blood loss was 135ml (ranged 20-400ml).The renal arteries were blocked in all patients.The ischemia time ranged from 9 to 33min,with an average of 20.6min.The mean estimated glomerular filtration rate at one week after surgery [40.7ml/(main · 1.73 m2)] decreased 44.7％ compared with pre-operation [73.6 ml/(min · 1.73 m2)].Acute kidney injury developed in 2 patients.One required temporary dialysis.The other improved after conservative treatment.There were no other complications such as urinary fistula and hemorrhage.The pathology analysis confirmed that 2 cases were angiomyolipoma,one case was benign cyst,6 cases were renal clear cell carcinoma,and one case was multilocular cystic renal cell carcinoma.4 cases were stage pT1a,one case was stage pT1b,one case was stage pT2a,and one case was stage pT4.Positive margin was found in one case.The average follow-up period was 28.2 months(ranged 3-58months).Only one patient need long-term dialysis 20 months after surgery at the latest follow up.Another patient had local recurrence and ipsilateral adrenal metastasis.Conclusions Satisfactory effect of tumor control and renal function preservation can be achieved by partial nephrectomy in solitary kidney,which prevent or delay the occurrence of hemodialysis effectively.

Objective To analyze clinical factors influencing the choice of open radical nephrectomy and inferior vena cava thrombus excision surgery.Methods 47 patients who received open radical nephrectomy and inferior vena cava thrombus excision were enrolled between January,2015 to March,2017 retrospectively.Among the 47 patients,37 were nale,10 were female.The average age was 61 years (29-84 years),with 33 patients younger than 65-year old,14 above this age.The tumor located in left in 10 patients,right in 37 patients.The average maximum diameter of tumor was 9.1 cm (3.6-23.0 cm),with ≥10 cm in 17 patients,less than 10 cm in 30 patients.The enhanced abdominal CT showed 5 patients with suspected of extra-organ invasiveness.Pre-surgery images showed 29 patients were suspected of enlarged lymph nodes.13,21,9 and 4 patients have Ⅰ,Ⅱ,Ⅲl or Ⅳ grade tumor thrombus respectively.The average major axis of tumor thrombus was 6.2 cm(1.0-20.0 cm),＞7.0 cm in 17 patients,≤7.0 cm in 30 patients.Results There were 31 patients underwent open surgery,and the other 16 underwent laparoscopic surgery.Multivariate analysis showed Ⅲ or Ⅳ grade of tumor was associated with the choice of open surgery (OR-13.476,95 ％ CI 1.044-173.882,P =0.046),but age ＞ 65 years (P =0.679),maximum diameter of tumor ≥ 10 cm (P =0.330),the side of tumor (P =0.220),suspected of enlarged lymph nodes (P =0.308) and suspected of extra-organ invasiveness (P =0.255) were not significantly associated with the choice of open surgery.Conclusions Ⅲ or Ⅳ grade of tumor was the major factor affecting the choice of open surgery,while age ＞ 65 years,maximum diameter of tumor ≥ 10 cm,the side of tumor were not the trigger for open sugcry.Suspected of enlarged lymph nodes and suspected of extra-organ invasiveness remained to be studied.

Objective To evaluate the surgical treatment,effect and follow-up for renal cell carcinoma with tumor thrombus (T T) in inferior vena cava (IVC) and right atrium (RA).Methods Three cases of renal cell carcinoma with TT in IVC and RA diagnosed by Doppler ultrasonography,CT,MRI and transesophageal echocardiography were included in this retrospective analysis from January 2014 to March 2015 in our hospital.They were all male patients,aged from 50-64 years,and all patients presented painless gross hematuria.All patients underwent radical nephrectomy,inferior caval venous and atrial thrombectomy under general anesthesia,using abdomen inverted Y shaped incision and median sternal incision.Firstly,we dissected and ligated renal artery,then the vena cava was dissected;then hepatobiliary surgeons help to dissect the liver that can expose suprahepatic vena cava and inferior vena cava,and hepatic artery,hepatic portal vein;cardiothoracic surgeons help to perform sternotomy and establish cardiopulmonary bypass.Finally,TT in renal vein and IVC were extracted.Results All patients underwent radical nephrectomy,caval and atrial thrombectomy successfully.The operation time was 480-589 min,the extracorporeal circulation time was 40-110 min,the intraoperative blood loss was 1 200-4 400 ml,and the blood transfusion amount was 1 800-3 200 ml.Of the 3 patients,1 patient died on the 17th day of sepsis,respiratory failure,renal failure and coagulation disorders.One patient developed adrenal gland,lung and brain metastases in 5 months after surgery and died in 7 months after surgery.The remaining one is alive (follow-up:12 months) and without evidence of tumor recurrence or metastases.Conclusion For patients with renal cell carcinoma and TT in IVC and RA,although the overall prognosis is poor,radical nephrectomy plus caval and atrial thrombectomy is the only safe and effective therapeutic method.

Objective To assess the safety and feasibility of pure laparoscopic surgery for renal cell carcinoma with inferior vena cava tumor thrombus.Methods We retrospectively analyzed 6 cases of renal cell carcinoma with inferior vena cava tumor thrombus from December 2010 to October 2014.The patients were all male.Their age ranged from 50 to 69 years and the body mass index ranged from 21.6 to 30.9 kg/ m2.Clinical manifestations included painless hematuria in 4 cases,low back pain in 1 cases and physical examination noticing in 1 cases.Imaging suggested the right renal tumor in 4 cases and left renal tumor in 2 cases.The tumor size ranged from 4.0 to 10.6 cm.The inferior vena cava tumor thrombus was found in all patients,including type Ⅰ thrombus in 3 cases and type Ⅱ thrombus in 3 cases.The length of type Ⅱ tumor thrombus ranged from 4.0 to 4.2 cm.We completed pure laparoscopic nephrectomy and inferior vena cava tumor thrombectomy in all patients.We chose retroperitoneal laparoscopic surgery to treat right renal tumor with inferior vena cava thrombus and chose retroperitoneal combined with transperitoneal laparoscopic surgery to treat left renal tumor with inferior vena cava thrombus.Results All surgery were successful.Cancer embolus defluxion didn't occur during the opearation.The operation time was 224-873 min and the intraoperative blood loss was 200-5 000 ml.There were 4 patients get transfusion,which the transfusion volume ranged from 400 to 2 800 ml.For 1 case of left renal cell carcinoma with level Ⅱ inferior vena cava tumor,the operation time was 873 min,the blood loss was 5 000 ml,and the transfusion volume was 2 800 ml.Postoperative hospital stay was 7-14 days.And the pathological results were all renal clear cell carcinoma.In those patients,the Fuhrman grade classification was Ⅱ-Ⅲ.All patients were treated by targeted medicine to control tumor recurrence and metastasis.During the 6-48 months following up,no recurrence and metastasis were reported.Conclusions Pure laparoscopic surgery for right renal cell carcinoma with inferior vena cava tumor thrombus and left renal cell carcinoma with level Ⅰ inferior vena cava tumor thrombus is safe and feasible.However,long learning curve should be necessary for performing the left renal cell carcinoma with level Ⅱ inferior vena cava tumor thrombus.The effect of total laparoscopic surgery for renal cell carcinoma with inferior vena cava tumor thrombus is definite.