Objective To investigate the value of prevention of cerebral ischemia with multi-modality neuroelectrophysiological monitoring in intracranial aneurysm embolization. Methods The clinical data of 44 patients with intracranial aneurysm treated with endovascular embolization from May 2013 to June 2014 were analyzed retrospectively. The patients were divided into two groups according to whether they used intraoperative neuroelectrophysiological monitoring. There were 21 patients in a monitoring group and 21 in a non-monitoring group. According to the site of the aneurysms,somatosensory evoked potential ( SEP),motion evoked potential( MEP),scalp electroencephalogram,and brainstem auditory evoked potential (BAEP)were monitored,and at one day after procedure,their newly developed neurological deficits and the follow up observation after 3 months in both groups were compared and analyzed. Results The intraoperative SEP,MEP,and scalp EEG changes in the monitoring group were observed in 9,3 and 4 patients,respectively. Timely preventive measures were taken for 9 of the patients with cerebral ischemia revealed by neuroelectro-physiological monitoring. At the first day after procedure,the incidence of patients with new neurological deficit was 17. 4%(4/23)in the monitoring group,and that was 47. 6%(10/21)in the non-monitoring group. There was significant difference between the 2 groups(χ2 =4. 623;P<0. 05). There was significant difference in the good prognosis rates(87. 0%[20/23]vs. 57. 1%[12/21])after 3-month follow-up (χ2 =4. 919;P<0. 05)between the 2 groups. There were no deaths in both groups. Conclusion Multimode in combination with neuroelectrophysiological monitoring may decrease ischemic complications in aneurysm interventional treatment and improve the safety of procedure.

Objective To explore the protocol of tissue matching and anti-rejection therapy in highly sensitized patients (HSP). Method The panel reactive antibody (PRA), human leukocyte antigen (HLA) matching and renal transplantation outcomes of 45 HSPs were retrospectively analyzed. Results Hyperacute rejection occurred in 2 patients. Acute rejection occurred in 9 patients and reversed by anti-rejection therapy. One year patient/graft survival rate was 95.6% / 91.1% respectively. Conclusions To avoid specific antibody through HLA matching is the key point for successful renal transplantation of HSP. Antithymocyte globulin (ATG) induction therapy combined with tacrolimus, mycophenolate mofetil therapy can decrease the rate of acute rejection and prolong graft survival.

Objective To investigate the expression of Bcl-2 associated athanogene 3 (BAG3) in cervical cancer tissues and cells and its role in epithelial mesenchymal transition (EMT) of cervical cancer.Methods (1) Cervical cancer samples were collected from September 2015 to March 2017 in the Qilu Hospital of Shandong University and Shangdong Provincial Hospital.While,50 normal tissues were collected from August 2015 to March 2017 in the Dezhou Municiple Hospital,which were obtained from patients with uterine mnyoma underwent hysterectomy and patients with cervical biopsy.Reverse transcription (RT)-PCR and western blot were used to detect the expression of BAG3 mRNA and protein,and their clinical significances were analyzed.(2) The expression of BAG3 mRNA and protein was detected using RT-PCR and western blot method in HeLa and SiHa cell lines and normal cervical epithelial cells.The experiment was divided into two groups,BAG3 small interfering RNA transfected group (st-BAG3) and the control group transfected with small interfering RNA (siRNA).Cell counting kit 8 (CCK-8) analysis was used to detect cell proliferation of two groups.Wound-healing and transwell assay were used to detect the migration and invasion ability of HeLa and SiHa cells.The xenograft model of cervical cancer in nude mice was used to observe the effect of BAG3 on tumor xenografts and the tumor-related biomarkers were tested by western blot.Results (1) The expression levels of BAG3 mRNA and protein in cervical carcinoma tissues were 1.20±0.15 and 1.10±0.16,which were significantly higher than that in normal cervical tissue,0.23± 0.04 and 0.29 ± 0.03 (both P＜0.01).The results showed that the expression levels of BAG3 mRNA and protein were significantly correlated with cervical carcinoma staging and lymph node metastasis (P＜0.05).However,its expression was not conrelated with the patient's age,pathological grade,and diameter of tumor (all P＞0.05).(2) Compared with normal cervical epithelial cells,the expression of BAG3 mRNA and protein levels in HeLa and SiHa cells were significantly increased (P＜0.01),the expression levels of BAG3 mRNA and protein in HeLa and SiHa cells transfected with si-BAG3 were significantly lower than that in control group (all P＜0.01).After post-transfected 72 hours,A value of HeLa and SiHa with transfection were significantly lower than those in control group [(0.88±0.08) vs (1.22±0.13),(0.92±0.09) vs (1.35±0.12);both P＜0.01].After post-transfected 24 hours,the migration level of HeLa and SiHa cells with transfection were significantly lower than those in the control group [(20.1±2.1)％ vs (58.6±5.6)％,and (21.1±2.1)％ vs (61.7± 5.4)％;both P＜0.01].The transmembrane cell number in HeLa and SiHa cells with transfection were 76± 11 and 71±8,which were significantly less than those in control group (131± 12 and 129± 14;both P＜0.01).After the inoculation into nude mice,tumor formation time of HeLa and SiHa cells with transfection were (9.5±0.5) and (10.5 ± 1.3) days,respectively,which were significantly longer than those in control group [(4.5±0.5) and (5.2± 1.1) days;both P＜0.05].Compared with those in the control group,the expression level of Slug,N-cadherin and matrix metalloproteinase-2 (MMP-2) protein in HeLa and SiHa cells with transfected in tumor tissues were significantly decreased (all P＜0.01),while the expression level of E-cadberin protein was significantly increased (P＜0.01).Conclusion BAG3 could be involved in the proliferation,migration and invasion of cervical cancer cells by affecting cervical cancer EMT,and BAG3 may be an effective target for the treatment of cervical cancer.

ObjectiveTo evaluate creatinine proficiency testing data by robust Z-score analysis.MethodsThe data were collected from three proficiency surveys of routine biochemical test in 2009,to which 1 179,1 169 and 1 168 laboratories participated respectively.Creatinine data were divided into Jaffe group and enzymatic group based on the analytical method used.The results tested by both methods were compared using Mann-Whitney test.The outliers were deleted using the TUKEY fence established by quartile values.The normality of raw data and trimmed data was tested using one-sample Kolmogorov-Smirnov test.The performance of the laboratories was assessed using robust Z-score,whose values were considered satisfactory when ｜ Z-score｜ ≤2,questionable when 2 ＜ ｜ Z-score ｜ ＜ 3 and unsatisfactory when ｜ Z-score ｜ ≥3.Results86.7％ results tested using Jaffe and enzymatic methods were not comparable.The raw data in all research groups were not normally distributed.After deletion of outliers,73.3％ trimmed data in most research groups were normally distributed.For the three proficiency tests in 2009,in Jaffe group,the satisfactory rates were 89.8％( 495/551 ),87.2％( 468/537 ) and 89.5％( 476/532 ) respectively,unsatisfactory rates were 3.3％ ( 18/551 ),6.5％ (35/537) and 4.5％ (24/532) respectively; while in enzymatic group,the satisfactory rates were 88.8％ (558/628),89.3％ (564/632) and 88.1％ (560/636) respectively,unsatisfactory rates were 5.6％( 35/628 ),5.2％ (33/632) and 6.6％(42/636) respectively.Conclusion It is reasonable to choose robust Z-score as a proficiency testing assessment index,because it avoids the influence of the outliers on evaluation results.

Objective To perform calibration verification for the blood glucose test in Hitachi and Olympus automatic biochemistry analyzers and present a method of calibration verification and evaluate the results.Methods The glucose test results were divided into two groups:Hitachi and Olympus groups according to the different analytical instruments.The calibration verification was performed following the current College of American Pathologists strategies.The slope and intercept of the calibration line were tested by one-sample t test and the percentage differences were calculated.The percentage differences were compared with allowable errors.If the slope and intercept had no statistically significant difference from 1 and 0 respectively and the percentage differences were within the limits of allowable errors,the calibration line was evaluated as verified 1 ; if the slope and intercept had no statistically significant difference from 1 and 0 respectively and at least one of the percentage differences exceeded the limits of allowable errors,the calibration line was evaluated as different 1 ; if the slope or intercept had statistically significant difference from 1 and 0 respectively and the percentage differences were within the limits of allowable errors,the calibration line was evaluated as verified 2; if the slope or intercept had statistically significant difference from 1 and 0 respectively and at least one of the percentage differences exceeded the limits of allowable errors,the calibration line was evaluated as different 2.Results In Hitachi group,verified 1,different 1,verified 2 and different 2 were 5.4％ ( 4/74 ),0.0％ ( 0/74 ),68.9％ ( 51/74 ) and 25.7％ ( 19/74 ),respectively.In Olympus group,verified 1,different 1,verified 2 and different 2 were 16.4％ (12/73),0.0％ (0/73),58.9％ (43/73) and 24.7％ ( 18/73 ),respectively.Conclusions The current College of American Pathologist strategies could be performed as a reasonable and feasible method for calibration verification.Most of participating laboratories ( 74.8％,110/147 passed the assessment of calibration verification.

Objective To explore the feasibility and efficacy of desensitization protocol for highly sensitized renal transplant patients (HSP). Methods Thirty-five HSPs ( HLA class-Ⅰ panel reactive antibody ＞50 %), including 27 patients with a positive T and/or B cell cytotoxicity crossmatch (XM) and 8 patients with a negative T and B cell XM, received plasmapheresis plus intravenous immunoglobulin (PP-IVIG)treatment. Results The positive XM was rendered negative by PP-IVIG treatment in 25 of 27 (92.6 %)HSPs, and subsequent transplantation was performed. Two patients did not receive renal transplants due to persistent positive XM. In 25 patients receiving renal transplants, no hyperacute rejection occurred. There were 8 cases of acute rejection, including 5 cases of acute humoral rejection (AHR). All rejection episodes were reversed. During a follow-up period of 52 ± 26 months, the serum creatinine levels at 12th and 24th month were 112± 18 and 130 ± 38 mol/L respectively. The 1- and 3-year graft survival rate was 96. 0 %and 80. 0 % respectively. Conclusion The desensitization therapy by PP-IVIG is effective for HSP. High rate of AHR is the major defect of this protocol. The short-term graft survival rate after this protocol is acceptable but the long-term survival rate needs to be defined.

Objective To investigate the linearity on testing creatinine in various assay instntments,in order to evaluate creatinine testing ability of clinical laboratories. Methods Statistically standard linearity and nonlinearity were judged via polynomial regression analysis recommended by EP6-A guideline. The imprecision of analytical data were analyzed and the average deviation of best fitting curve from linearity were determined by Dr. Kroll's EP6-A extended methods. In accordance with the instruments used, the testing data were divided into four groups: Beckman LX (28 Labs), Beckman CX ( 14 Labs), Hitachi (62 Labs)and Olympus (72 Labs) groups. Results This research found that in samples analyzed by Beckman LX,Beckman CX, Hitachi and Olympus instruments, the imprecision ranged from 0. 30%-3.01%, 0.09%-3.46%, 0. 14%-4. 91% and 0. 17% -16. 44%, respectively. The imprecision in one laboratory in Olympus group exceeded the acceptable limit, while the imprecision in the remaining laboratories were precision for linear survey. The average deviations of best fitting curve from linearity ranged from 0%-2. 38%, 0%-2. 51%, 0% -5.46% and 0% -4. 66%, respectively. The linearity with statistical significance were 21.4% (6/28), 35.7% (5/14), 11.3% (7/62) and 18. 1% (13/72), respectively. The linearity with clinical significance were 78.6% (22/28), 64. 3% (9/14), 88. 7% (55/62) and 80. 6% (58/72), respectively.The percentages of laboratories whose creatinine testing met the linearity criteria were 100% (28/28),100% ( 14/14 ), 100% ( 62/62 ) and 98. 6% ( 71/72 ), respectively. Conclusion Majority of the laboratories involved in the linearity survey present good capability for creatinine testing.

Objective To assess the incidence,clinic feature,pathological characteristics and prognosis of incidental prostate cancer from specimens via radical cystoprostatectomy (RCP) for muscleinvasive bladder cancer.The postoperative erectile function in patients with NVB operation are also to be evaluated.Methods Between Jan 2002 and Jan 2015,150 male patients with bladder cancer who underwent radical cystoprostatectomy in our center were included in this study.133 patients underwent open surgery and 17 cases underwent laparoscopic operation (13 patients underwent NVB operation).The average age of 150 patients was 63 years (ranging 41 to 83 years).The average tPSA was 3 ng/ml(ranging 0.2 to 7.8 ng/ml).The digital rectal examination was negative,CT results didnt exhibit the evident of abnormality in prostate.Results Overall,incidental prostate cancer was diagnosed in 11 male patients (7.3％).The pathological diagnosis are all prostatic adenocarcinoma.In those patients,the mean age was 65.5 years (ranging 42 to 82 years).The mean tPSA at the time of surgery was 2.6 ng/ml (0.3-4.0 ng/ml).There was no statistical significance of tPSA values in the incidental prostate cancer group and non risk group (2.6vs.3.2ng/ml)(P ＞ 0.05).The preoperative enhanced CT imaging showed normal prostate in 7 cases,prostate hyperplasia in 2 cases,prostate calcification in 1 cases and bladder cancer invasion into the prostate in 1 cases.9 cases of incidental prostate cancer are low risk grade (Gleason score ≤ 6,the clinical stage ≤T2).Among 11 cases,bladder cancer histologic type in 10 cases was transitional cell carcinoma and small cell carcinoma in 1 case.According to the TNM classification,4 cases were less than pT2 stage and 7 cases were more than pT3 stage.11 patients were followed up between 6 to 24 months (mean 10 months).All patient survived at the end of study without the treatment of castration.Among 13 cases accepted NVB operation,8 cases achieve the preoperative level of erectile function to achieve.Conclusions The rate of incidental prostate cancer from RCP specimens is low,Most patients have low risk level,and there was no statistical significance of tPSA values between the incidental prostate cancer group and non risk group.

Objective To investigate the application value of perioperative enhanced recovery after surgery (ERAS) combined with laparoscopic common bile duct exploration (LCBDE) in the treatment of choledocholithiasis.Methods The clinical data of 84 patients with choledocholithiasis who were admitted to the Yijishan Hospital from January 2011 to December 2013 were prospectively analyzed.A single-blind,randomized,controlled study was performed in the 75 patients who were allocated into the control group and the enhanced recovery after surgery group (ERAS group) based on a random number table.All the patients underwent LCBDE,the patients in the control group received conventional perioperative management and the patients in the ERAS group received perioperative management according to enhanced recovery rehabilitation program.All the patients were followed up by outpatient interview till postoperative month 6.The clinical features,liver function and residual stones in the patients were observed.The operation time,postoperative complications,postoperative intestinal function recovery,duration of hospital stay and hospital expenses in the two groups were compared.Measurement data with normal distribution were presented as x ± s.Comparison between groups were evaluated with an independant sample t test.Count data were analyzed using the chi-square test.Results All the 75 eligible patients undergoing successful operation were randomly divided into the control group (35 patients) and the ERAS group (40 patients).The operation time and volume of intraoperative blood loss in the control group and the ERAS group were (185 ±46)minutes and (124 ±28)mL,(178 ±37) minutes and (114 ±32)mL,respectively,with no significant difference (t =0.729,1.431,P ＞ 0.05).There were 12,14 and 10 patients in the control group and 5,6 and 4 patients in the ERAS group with postoperative incision pain,vomit and infection,showing a significant difference (x2=5.054,5.966,4.241,P ＜ 0.05).The level of white blood cell,alanine aminotrausferase and direct bilirubin in the control group and in the ERAS group were (11.4 ± 3.5) × 109/L,(128 ± 33)U/L,(38 ±14) μmol/L and (10.6 ± 3.0) × 109/L,(135 ± 35) U/L,(44 ± 16) μmol/L at postoperative day 1,compared with (7.8 ±2.9) × 109/L,(48 ± 14) U/L,(21 ± 8) μmol/L and (6.9 ±2.1) × 109/L,(43 ± 13) U/L,(20 ±7) μmol/L in the 2 groups at postoperative day 4,respectively,showing no significant difference between the 2 groups (t =1.018,-0.872,-1.767,1.553,1.836,1.044,P ＞ 0.05).The postoperative first flatus day,time of food intake,time of postoperative infusion and duration of hospital stay were (42 ± 13)hour,(45 ±14) hours,(6.8 ±2.3)days and (11.3 ±4.5)days in the control group,and (35± 11)hours,(19 ±7)hours,(4.2 ± 1.8) days and (9.6 ± 2.4) days in the ERAS group,with a significant difference between the 2 groups (t =2.741,10.524,5.485,2.077,P ＜ 0.05).The total hospital expenses was (18 729 ± 3 127) yuan in the control group,which was significantly greater than (16 981 ±2 756) yuan in the ERAS group (t =2.574,P ＜ 0.05).The liver function of all the patients was recovered at the postoperative month 1.Four patients with residual stones in the 2 groups were detected by T-tube cholangiography,and were cured by removal of gallstones by choledochoscopy.There were no complications of the abdominal pain,jaundice and fever in all the patients till the end of follow-up.Conclusion ERAS combined with LCBDE for the treatment of choledocholithiasis is safe and feasible,with the advantages of low morbidity,quick recovery,short duration of hospital stay and less hospital expenses.

Objective To explore the use of the right hepatic pedicle to guide classification of liver neoplasms on medical imaging and the type of liver resection.Methods From January 2009 to December 2012,32 patients with a single liver neoplasm surrounding the right hepatic pedicle,including 17 patients with primary liver cancer and 15 patients with cavernous hemangioma of liver,were recruited into this study in our hospital.Using the position of the neoplasm in relation to the right hepatic pedicle on CT or MRI,these liver neoplasms were divided into 4 types:type A neoplasms which infiltrated or surrounded the right hepatic pedicle; type B neoplasms which were in the front of the right hepatic pedicle; type C neoplasms which were at the back of the right hepatic pedicle,and type D neoplasms which were between the two branches of the right hepatic pedicle.Before surgery,a simulated plan was designed on the different hepatic vascular inflow obstruction and types of hepatectomy based on the classification in medical imaging.Results The locations of the liver neoplasm were completely in line with the preoperative imaging classification.Boththe vascular flow obstruction and the types of hepatectomy correlated with the preoperative surgery simulation planning.Five patients with type A neoplasms underwent right hemihepatectomy or extended right hepatectomy; 8 with type B tumors underwent right anterior sectionectomy or mesohepatectomy; 9 with type C neoplasms underwent segment Ⅴ,Ⅵ resection; 10 with type D tumors underwent right anterior or right posterior sectionectomy.Pringle maneuver,total hepatic blood inflow obstruction and selective right hepatic blood inflow obstruction were applied according to the operation and the regional anatomical structures.All operations were smoothly carried out with an average operation time of 145 min.The average blood loss was 320 ml and 18 patients required intraoperative blood transfusion with an average blood transfusion amount of 460 ml.Postoperative complications included bile leakage (n =3),right pleural effusion (n =2) and hemorrhage (n =1).They all responded to conservative treatment.Conclusion This classification using preoperative medical imaging of the right hepatic pedical could provide important information for liver resection,and it is helpful for formulating more refined operation scheme.