Objective To investigate the safety and efficacy of Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system. Methods 29 patients with paroxysmal atrial fibrillation in this study. A nonfluoroscopic mapping system was used to generate a 3D electroanatomic LA mapping, and all pulmonary vein ostia were marked under the help of pulmonary veins angiography on the 3D map. Radiofrequency (RF) energy was delivered to create continuous linear lesions encircling the pulmonary veins. It was delivered with a target temperature of 43℃, a maximal power limit of 30W and applied for ≥20 seconds until the maximal local electrogram amplitude decreased by ≥50%. The ablation was completed by finishing the circular line. Results The mean procedure duration was 180?18 minutes, with mean fluoroscopy time of 80?20 minutes. The average number of RF pulses was 120?15. After a follow-up of 6.0 months, 24 patients maintained sinus rhythm. 3 patients suffered from less frequent paroxysmal atrial fibrillation during the first 3.0 months after the ablation and remained Af free after 6 months. 1 patient had atrial fibrillation episodes and 1 patient had atrial fibrillation attacks unchanged. No pulmonary vein narrowing was observed. Conclusion Left atrial linear ablation of paroxysmal atrial fibrillation guided by three-dimensional electroanatomical system was safe and effective.

Objective　To study the induction of apoptosis and the regulation of apoptosis related genes bcl-2, bax and ICE expression by wild-type p53 gene. Methods　A p53 gene recombinant adenovirus vector, ad CMV p53, was transfected into human bladder cancer cell HTB9. The level of bax mRNA was quantified by reverse transcription-polymerase chain reaction (RT-PCR). The content of Bcl-2, Bax and ICE protein were detected by immunochemical staining. Agarose gel electrophoresis of DNA、 terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) method and flow cytometric technique were used for analysis of apoptosis. Results　Introduction of wild-type p53 could increase the mRNA and protein level of bax, and could induce apoptosis in HTB9 cells with the apoptotic percentage of 50.4%. At the same time, the introduction also increased the protein level of ICE, but that of Bcl-2 decreased.Conclusion　It's very possible that wild-type p53 gene induced apoptosis by regulating the expression of apoptosis-related genes including bax, bcl-2 and ICE.

Objective To evaluate the lower urinary tract symptoms(LUTS)after Drostate cancer brachytherapy. Methods 122 patients with prostate carcinoma underwent125 I seed implanta-tion.All patients were at clinical stage Tl.N0 Mo-T3.N.Mo with Gleason score 5 to 9,serum PSA 0.9-65.Ong/ml,prostate volume 12 to 57m1.30-86 seeds were implanted bv 16-28 needles with seed activity 1.11-1 9.6 MBq mci,total seed activity 444-1 5 9 1 MBq. International prostate symp-tom score(IPSS)ranged from 3 to 19,with mean of 12.All the patients received d-blocker and 106 cases(86.9%)received androgen deprivation therapy(ADT). Results Patients were foilowed up for 3-34 months(mean 21 months).Acute urinary retention was found in 8 cases(6.6%)and mild urina-ry incontinence was found in 10 cases(8.2%).During the follow-up,107(87.7%)of them had LUTS or LUTS symptoms aggravated.Percentage of patients with LUTS after brachytherapy at different time point were as follow:15 d,16.4%;1 month,80.3%;2 months,81.2%;3 months,74.6%;6 months,42.0%;9 months,25.2%;12 months,18.5%;15 months,11.5%;18 months,7.4%;21 months,2.5%;24 months,3.3%and 30 months,O%.Larger prostate volume and higher IPSS before brachytherapy were correlated with LUTS lasting time.Simple linear regression analyses re-vealed prostate volume(r=0.281,P=0.003)and IPSS(r=0.254,P=0.012)before brachytheraDy to be significant predictors of LUTS period respectively. Conclusion IUTS after prostate cancer brachytherapy is common and long lasting,but not serious,which could be relieved by mblockers and ADT.

Objective To study a modified method of laparoscopic partial nephrectomy with hypothermic renal artery perfusion in situ.Methods Laparoscopic partial nephrectomy with hypothermic renal artery perfusion in situ was performed in 5 patients from March 2009 to May 2009.There were 3 males and 2 females,with an average age of 49 years (39 to 63 years).There were 3 tumors in the left kidney and 2 in the right kidney,with an average diameter of 5.6 cm (range,3.8 to 7.0 cm).There were 2 cases of chronic renal insufficiency,1 case of solitary kidney,1 case of contralateral renal atrophy and 1 case of larger benign tumor.The procedure of laparoscopic partial nephrectomy with hypothermic renal artery perfusion in situ was as follows:A catheter with balloon was placed in the renal artery with percutaneous approach through the femoral artery preoperatively.During the operation the balloon of the catheter was inflated with water in order to block the renal artery,and renal artery perfusion of about 200ml saline of 4 ℃ was conducted through the catheter under high pressure in order to achieve low temperature in situ kidney.The water of the balloon was extracted after the accomplishment of the laparoscopic partial nephrectomy.Results Laparoscopic partial nephrectomies with hypothermic renal artery perfusion in situ were carried out successfully in 5 cases.The average operative time was 102 min (80 to 120 min),the average renal artery occlusion time was 35 min (range,29 to 39 min),and the average amount of bleeding was 190 ml(50 to 300 ml).The temperature of skin,kidneys,and tumor after hypothermic perfusion dropped by an average of 0.6℃,10.0 ℃,and 9.8℃,respectively.The endogenous creatinine clearance rate was(84.7±16.9),(48.9±14.5),(52.1±12.4),(54.5±13.8),and(54.6±11.7)ml/min before and 1 day,3 days,5 days and 10 days after operation.There was significant difference among the 5 groups in endogenous creatinine clearance rate(P=0.001).There was significant difference between each 2 groups except that between the group at 5 days and 10 days after operaton,The endogenous creatinine clearance rate kept steady in 5 days after operation.Conclusions Laparoscopic partial nephrectomy with hypothermic renal artery perfusion in situ is feasible and safe in favor of the extension of renal ischemic time and the protection of renal function.And it has resolved 2 problems in laparoscopic partial nephrectomy,that is,the laparoscopic artery occlusion and the hypothermic perfusion.

Objective To study the application of the combined detection of Golgi glycoprotein 73(GP-73),phosphatidylinositol proteoglycan 3(GPC3 )and percentage of AFP heteroplasmon(AFP-L3%)in the diagnosis of primary hepatocellular carcinoma (PHC).Methods The concentrations of GP-73,GPC3 and AFP-L3 were detected by enzyme-linked immunosorbent assay(ELISA) in 154 patients with PHC(PHC group),78 patients with cirrhosis(cirrhosis group)and 56 healthy subjects(control group).Then the detection results were statistically analyzed.Results The levels of GP-73,GPC3 and AFP-L3% in the PHC group were signifi-cantly higher than those in the liver cirrhosis group and the control group(P <0.05).The positive rates of GP-73,GPC3 and AFP-L3% in the PHC group were 66.2%,72.1% and 53.2% respectively.The positive rate in the combined detection of these three in-dices could reach 97.9%,which was higher than the sensitivity and accuracy in any single index detection and the combination de-tection.In the PHC group,the comparison between different levels of GP-73 and AFP-L3% with the AFP levels showed the statis-tically significant difference(P <0.05 ).Conclusion The combination detection of GP-73,GPC3 and AFP-L3% can improve the sensitivity and accuracy for diagnosing PHC and has reference significance in the differential diagnosis of early PHC.

Objective To investigate the efficacy and safety of 3D-laparoscopic surgery in adrenalpheochromocytomas /paragangliomas.Methods From December 2012 to July 2014,23 cases of adrenal pheochromocytomas/paragangliomas were treated by 3D-laparoscopic surgery.Among them,7 cases were male and 16 cases were female,whose mean age are 47 (32-68) years old.Their clinical symptoms including sustained hypertension in 11 cases,intermittent hypertension in 8 cases,sustained hypertension with intermittent progression in 2 cases and asymptom in 2 cases.All tumors were diagnosed by endocrine examination,image test and nuclear medicine.Mean diameter of tumors are 8 cm,ranged from 3-14cm.In order to adjust the blood pressure,patients took α-receptor blocker for 2-4 weeks preoperatively.Under the general anesthesia,19 patients received the 3D-laparoscopic surgery via retroperitoneal approach and 4 cases received the procedure via peritoneal approach.Results All operations were completed successfully.There were no major intraoperative complications.Mean operating time was (78 ± 21) min and mean estimated blood loss was (54.8 ± 36.3) ml.Mean hospital stay after operation was (3.8 ± 1.4) days.The pathological diagnosis included pheochromocytomas in 15 cases and paragangliomas in 8 cases.During the 3 to 18 months following up,no recurrence or metastasis was found in this study.Conclusions 3D-laparoscopic surgery has obvious advantage in spatial location and the sense of depth for adrenal pheochromocytomas /paragangliomas,which shortens the operation time and increase the safety obviously.

Objective To study the classification and treatment of juxtaglomerular cell tumor of the kidney. Methods Five cases of juxtaglomerular cell tumors of the kidney were diagnosed and treated surgically in our hospital during the last 4 years. Seven large series of cases report of juxtaglomerular cell tumors have been published in the Pubmed. These series of cases report plus 1 case report of static juxtaglomerular cell tumor were incorporated into a review of 71 cases previously published in English literature. The clinical presentation, laboratory examination and imaging study were summarized. The clinical presentation including blood pressure, the laboratory examinations including kalium, plasma renin activity and aldosterone, and renal venous sampling for renin assay, and the imaging study including ultrasonography, CT, excretory urography, and selective renal angiography were studied retrospectively. Results The 71 cases juxtaglomerular cell tumors could be classified into 3 types, that is, typical type, atypical type and static type. The 57 typical cases had the typical characteristics of hypertension, hyperaldosteronism, and hypokalemia secondary to tumor renin secretion.The 12 atypical cases had hypertension with normal kalium, and the 2 static cases had normal blood pressure and kalium. Typical juxtaglomerular cell tumor of the kidney should be considered in hypertensive patients with secondary aldosteronism. Atypical juxtaglomerular cell tumor of the kidney should be considered in patients with hypertension and renal tumor. Static juxtaglomerular cell tumor of the kidney should be considered in patients with benign renal tumor. Conclusions The classification of typical, atypical and static juxtaglomerular cell tumors depends on blood pressure and serum kalium. As a surgically corrected disease, juxtaglomerular cell tumor of the kidney should be considered in patients with benign renal tumor, and nephron-sparing surgery is the first choice.

Objective To investigate the clinical presentations,pathologic features,treatment and prognosis of lymphoepithelioma-like carcinoma(LELC)in the upper urinary tract. Methods A case with LELC of the ureter was retrospectively analyzed.A 81-year-old female patient was hospitalized because of gross hematuria for 1 month. CTU demonstrated a 2.5cm tumor in the left ureter.Radical nephroureterectomy was performed laparoscopically. Results Pathologic findings showed invasive poorly differentiated carcinoma in a prominent lymphocytic background.The diagnosis was LELC of the ureter.Epstein-Barr virus in situ hybridization was negative.No disease progression was noted at 3-month foUow-up. Conclusions LELC of the upper urinary tract is rare.All the cases are diagnosed pathologically.The disease eould be treated with radical surgery.Although the differentiation of the tumour cells is poor,the prognosis of pure subtypes seems to be better than that of other types of urothelial carcinoma.

Objective To investigate the relationship between microchimerism and immunologic tolerance in kidney transplantation recipients. Methods In samples of peripheral blood and urinary sediment from 176 females who received male donor's kidney,DNA and mRNA expression of specific fragment in Y chromosome were determined by PCR and RT PCR. Results The test results were positive for chimerism in 137 out of 176 recipients(77.84%),and negative in 39 cases (22.16%).The mean survival period in chimerism positive group was 8.9?3.7 years,and 5.2?3.9 years in chimerism negative group.The difference was statistically significant between the 2 groups ( P

Objective To observe the development of Schistosoma japonicum after single sexual infection and double sexual infection respectively. Methods A single Oncomelania hupensis snail was infected by a single schistosome miracidium. The lar?va were induced and released from the snail after 60?day incubation at 26℃. The mice were infected by the larva(single sexual infection)and dissected 40 days after the infection. All the worms were collected and the sex of the larvae was determined by the sex of the adult worms. Then,the mice and rabbits were infected by single sex of larvae(single sexual infection)and double sex of larvae(double sexual infection)respectively. The mice and the rabbits were dissected 40 days after the infection. All the worms were collected and measured under a microscope. Results All the male or female worms were collected from the mice and rabbits after single sexual infection. There were three main forms of worms after dissection of double sexual infection of mice and rabbits:folded mature male and female,male or female. Few folded male and immature female were found. Only the double sexual larva infected mice or rabbits had schistosome eggs in the liver and the liver had typical schistosome egg nodules. The sin?gle sexual larva infected mice or rabbits had no schistosome eggs or schistosome egg nodules in the liver tissues. The single male larva could develop to worms with the testis,and with a little smaller size compared to the mature folded male,while the single sexual infection female worm could not develop to the mature stage with much thinner and smaller compared to the mature folded female. Conclusions The male or female worms from single sexual infection are smaller than those from double sexual infection (mature worms?folded male and female). So it is necessary to check single sex worms in vessels of intestinal mucosa thoroughly in the sentinel mice when no schistosome eggs were found in the liver.