Objective To evaluate the effects and complications of percutaneous nephrolithotomy (PCNL) in the treatment of renal stone after repeated extracorporeal shockwave lithotripsy (ESWL).Methods Forty-four patients who had a history of repeated ESWL (treatment group) and 50 patients with-out surgical intervention (control group) were submited to PCNL,and clinical data was documented in details and analyzed.Results The time to establish access in treatment group and control group was (11.8 ± 4.1) min and (10.9 ± 2.5) min,respectively,and there was no significant difference (t =1.308,P =0.194).The time to extract stone in both groups was (92.0 ± 13.5) min and (66.6 ± 17.6) min,respectively,and there was significant difference (t =7.776,P =0.000).The operative time in treatment group was (113.9 ± 12.0) min,which was longer than that in control group with (87.6 ± 13.6) min (t =8.354,P =0.000).The clearance in both groups was 81.8％ and 94.0％,and there was no significant difference (x2 =3.361,P =0.067).The was no death or other severe complication in both groups.Conclusions The operation time in treatment group was longer than that in control group,and there was no significant difference in clearance and complication rate.Thus it was safe and effctive to perform PCNL in these patients with a history of failed repeated ESWL.

Objective To dynamically observe photodamage of subcellular sites by use of laser scanning confocal microscopy (LSCM). Methods The samples were divided into four groups. Murine lung endothelial cells were subcultured and incubated with HMME for 24 hours. Then the cells were stained with rhodamine-123 for demonstration of mitochondria. LSCM was applied and organelle-cell fluorescence intensity ratio analysis was adopted to study the intracellular distribution of HMME. Then dynamic fluorescence images sequence of rhodamine-123 was collected. Results Rhodamine-123′s fluorescence images of cell sample with HMME was changed gradually during irradiation: the typical characteristic of mitochondria disappeared gradually with decreasing fluorescence intensity. The fluorescence of rhodamine-123 was diffused and distributed in nuclear, while rhodamine-123′s fluorescence images of cell sample without HMME was not changed. Conclusion Mitochondria and nucleus are photodamage sites by HMME-PDT; LSCM can be applied in dynamic observation of photodamage of subcelluar sites.

Objective To investigate the influence of tethered cord syndrome (TCS) on the up-per urinary tract and its etiology. Methods Forty patients with TCS diagnosed by spinal MRI were enrolled in this study. There were 21 males and 19 females with mean age of 23 years old. The course of disease ranged from 1 to 40 years. Urinalysis, mid-stream urine culture, serum creatinine(SCr), urinary system ultrasound, IVU, eystography and urodynamic study were carried out on all patients. Results Urinary tract infection was found in 17 patients and increased level of SCr was found in 6 pa-tients (251.64±98.5μmol/L). Of the 29 patients who underwent urinary system ultrasound examina-tion, 12 cases had hydronephroais and dilated upper ureter. Of the 30 patients who underwent IVU, 10(33.3%) had ureterectasia and hydronephrosis, 22 cases had bladder turriform or Christmas tree like deformity with diverticulum and trabeculum. Of the 22 patients accepted cystography, 17 cases had vesieoureteral reflux on 27 sides. Post-void residual (PVR) was evaluated in 35 patients and found increased in 31 cases. Cystometry had been done in 33 patients. The mean value of maximal detrusor pressure (Pdetmax) during filling phase was 41.2±20.9 cm H2O. The detrusor compliance was 22.35±18.8 ml/cm H2O. During voiding phase, detrusor-sphincter dyssynergia(DSD)was observed in 16 patients, detrusor areflexia was observed in 16 patients and detrusor underactivity was observed in 13 patients. Resting urethral pressure profilemetry was measured in 16 patients. Maximal urethral closure pressure (MUCP) was 76.1±33.1 cm H2O. The upper urinary tract deterioration was de-fined as increased SCr, hydronephrosis or vesicoureteral reflux. There were 20 patients diagnosed as upper urinary tract deterioration. The compliance of the upper urinary tract deteriorating group and the no-deteriorating group was 9.4±7.8 vs 19.3±15.8 ml/cm H2O, Pdetmax was 43.1±21.2 vs 24.0±11.9 cm H2O, PVR 189.0±138.0 vs 47.8±36.8 ml, MUCP 86.2±32.4 vs 46.8 5±20.8 cm H2O, incidence of damaged detrusor 100.0% vs 69.2% and DSD 65.0% vs 23.1%, respectively. There were significant differences between the 2 groups(P<0.05). And when comparing the VUR group with no VUR group, the incidence of urinary tract infection was 94.1%(16/17) vs 20.0%(1/ 5) (P=0.003). And when comparing urinary tract infection group with no infection group, the inci-dence of upper urinary tract deterioration was 88.2% (15/17) vs 21.7%(5/23)(P=0.000). Condn-sion Low compliance bladder, high Pdetmax during filling phase, increased PVR, high MUCP, damage of detrusor contractive function and DSD are the risk factors for upper urinary tract deteriora-tion in the TCS patients.

Objective To review the safety and efficacy of upper-pole access percutaneous nephrolithotomy (PCNL). Methods From May 2008 to May 2010,237 cases ( 135 males and 102 females with mean age of 42 yrs) of renal or proximal ureteral calculi treated with upper-pole access PCNL were reviewed.The indications included calculus larger than 1.5 cm or impacted proximal ureteral calculi in 94 cases,calculus≥2 cm or impacted renal pelvic calculi in 26 cases,staghorn or multiple calculi in 68 cases,complex lower calyx calculi in 13 cases,upper calyx calculi not amenable to ESWL or URS in 12 cases,calculi within upper calyx diverticulum in 3 cases,combined UPJ obstruction or upper ureteral stenosis in 8 cases,morbidly obese patients in 3 cases,calculi within horseshoe kidneys in 6 cases,calculi within transplanted kidneys or ureters in 4 cases.Of the 237 cases,175 tracts (73.8％) were above the 12th rib,46were above the 11th rib,12 were below the 12th rib,4 were in the lower abdomen for renal transplant patients. Results The overall stone clearance rate with upper-pole access PCNL monotherapy was 74.3％.Additional punctures were required in 55 cases and combined ESWL in 6 cases.Total stone clearance rate at 3 months after operation was 88.2％.16 patients (6.8％) had a pleural injury.Thoracentesis was required in 8 patients,closed thoracic drainage in 5 patients,conservative treatment in 3 patients.After nephrostomy tube removed,pleural irritation symptom appeared in 12 cases (5.1％) who required symptomatic treatment.No patient had injury to the lung or other viscera.Significant bleeding requiring blood transfusion was olserved in 5 patients,while selective renal arterial embolization was required in 2 cases. Conclusions Upper-pole access offers optimal visibility,convenience for the movement of rigid nephroscope and high stone-free rate.It should be attempted in selected cages of upper ureteral calculi and complex renal calculi.

Objective To evaluate the efficacy and safety of bladder hydrodistention for the treatment of ketamine-associated bladder dysfunction.Methods Six patients were required to withdraw the ketamine and treated with bladder hydrodistention therapy and sodium hyaluronate irrigation,and medicine to pretect liver and kidney was also used.Results The biopsies of 6 cases demonstrated the cystitis through biopsy.Lower urinary tract symptoms such as urgency,thamuria and odynuria were significantly relieved after bladder installation within 30 days.The O'Leary-Sant ICSI scores and the ICPI scores reduced to 3.5 ± 1.6,2.8 ± 1.5 respectively.The functional bladder capacities increased to an anverage of (180 ± 28)ml,.2-3 times of nocturia,Qmax (14.4 ± 4.3) ml/s.All cases were followed up for 4 to 18 months.Symptoms disappeared or were significantly relieved in all patients.Conclusion Contracture of bladder might be the main presentation of ketamine-associated bladder dysfunction.Intravesical hydrodistention therapy and sodium hyaluronate irrigation could be the safe and effective therapy in the treatment of katamine-associated dysfunction.

Objective To compare and evaluate Organelle-cell fluorescence intensity ratio analysis established in this study with other techniques to determine the subcellular localization of photosensitizers. Methods CCD fluorescence microscopy imaging system was applied and a kind of special organelle probe BODIPY was selected to label Golgi body. Directly observing, pseudo-color fusing, wave-shape comparing, correlation coefficient calcula-ting and Organelle-cell fluorescence intensity ratio analysis were adopted, respectively, to study the intracellular distribution of domestic photosensitizer Hematoporphyrin monomethyl ether (HMME). Results Fluorescence distributing modes of HMME and BODIPY were similar with each other. There ware yellow space-overlap areas in the fusion image. Wave body of changing curve of gray scale value of all pixels in the straight line in two images corresponding to space coordinate was similar with each other. Correlation coefficient in each pixel between fluorescence intensity of HMME and that of BODIPY was 0.602 4. With increasing of parameter m, namely degree of organelles congregated reducing, the average fluorescence intensity ratio (J_1/J_2) of Golgi complex was decreasing, the two parameters po-ssessed obvious relativity. P

OBJECTIVETo determine the efficacy and incidence of complications of extracorporeal shock-wave lithotripsy (ESWL) compared with pneumatic ureteroscopic lithotripsy (URSL) in the treatment of lower uretheral calculi.

METHODSFrom August 1997 to June 1999, 210 patients with lower ureteric calculi were treated with ESWL and the other 180 with URSL. The stones were fragmented with pneumatic lithotripter. The outcome was assessed by evacuation, retreatment and complication rates.

RESULTSESWL for lower ureteric calculi resulted in a stone evacuation rate of 78.1%, compared with 93.3% for URSL (P < 0.05). ESWL had a retreatment rate of 11.9% and a perforation rate of 0, while URSL caused perforation of ureters in 3.3% of patients and a refreatment of 2.2%.

CONCLUSIONFor the management of lower ureteric calculi, ESWL provides a non-invasive, simple and safe option, and URSL has a higher stone evacuation rate but causes ureter perforation more frequently than ESWL does. Both ESWL and URSL have their respective advantages. It is recommended, however, that URSL be extensively developed for better treatment efficacy, given that the operator has an adequate technical background.

Adolescent ; Adult ; Aged ; Female ; Humans ; Lithotripsy ; adverse effects ; methods ; Male ; Middle Aged ; Ureteroscopy ; Urethral Diseases ; therapy ; Urinary Calculi ; therapy

Objective : To study the relationship between different doses of subchronic sodium fluoride exposure and lung histopathological changes in rats，and to explore the effect and related mechanism of sodium fluoride induced lung tissue injury in rats． Methods: Thirty-two Wistar male rats were randomly divided into control，low，medium and high dose groups，each group included 8 rats，intragastric administration of sodium fluoride toxin solution 0， 12，24，and 48 mg / (kg · d) ．The experiment lasted for 16 weeks．The incidence of dental fluorosis and weight in each group of rats was recorded，the lung coefficient was calculated，the pathological changes of lung tissue was observed by HE staining，enzyme-linked immunosorbent assay(ELISA) was used to detect the content of superoxide dismutase (SOD) and malondialdehyde (MDA) levels in rats serum，apoptosis level of lung cells was assessed by TUNEL staining，and the Caspase-3 protein expression levels in lung tissues were determined by immunohistochemistry. Results: At the end of exposure，the upper and lower incisors of rats in different dose groups showed different degrees of dental fluorosis．The increase in body weight of the rats in the high-dose group was lower than that in the other three groups (P＜0. 05) ．The coefficient of lung organs and the content of MDA in serum of the rats in the high-dose group were higher than those in the control group (P＜0. 05) ．The rats in the low，medium and high dose groups had different degrees of pulmonary interstitial inflammatory infiltration and alveolar morphological changes．Compared with the control group，the lung cell apoptosis rate and Caspase-3 protein expression of the rats in the low ，middle and high groups significantly increased ，and the differences were statistically significant ( P < 0. 05) ． Conclusion Subchronic exposure to sodium fluoride can cause the lung tissue damage in rats ，and the mechanism may be related to the apoptosis induced by oxidative stress.