Adult ; Burnout, Professional ; Female ; Humans ; Jurisprudence ; Male ; Mental Health ; Middle Aged

Here we reviewed the applications of laser scanning confocal microscope in biomedical field. The reformation and improvement based on this technique were also summarized. After analyzing the defects, we highlighted its potential applications in the future.

Objective To identify the crucial gene implicated in rheumatoid arthritis (RA) pathogenesis by comparing microarray-based gene expression profiles of synovial fibroblast in arthritis patients and that in control.Methods The public datasets were obtained from NCBI GEO and EBI ArrayExpress.The qualified microarray-based gene expression profiles were integrated and normalized using the method implemented in GeneSpring software.Furthermore,the differentially expressed genes (DEGs) were identified using significance analysis of microarrays (SAM) method.The online tool DAVID and STRING were applied to conduct the enrichment analysis and gene product interaction analysis respectively.Results There were two datasets that were qualified and analyzed in the present study.A total of 336 significant DEGs were identified by comparing the whole-genome gene expression profiles from synovial fibroblast of RA patients and control group.Among these DEGs,261 were significantly downregulated and 75 upregulated.About 13.6％ of the downregulated genes were associated with extracellular matrix degradation.The COL9A3 and COL4A5,indispensable component of hyaline cartilage and basement membrane respectively,were significantly downregulated,as well as genes in WNT family,including WNT2,WNT11,and WNT16.In contrast,matrix metalloproteinase 13 (MMP13) was found to be significantly upregulated in RA patients.MMP13 is a matrix metallopeptidase that degrade extracellular matrix and hyaline cartilage,and it could possibly interact with other proteins to regulate morphogenesis.Conclusion Molecular mechanisms underlying RA pathogenesis were investigated by analyzing the public datasets.A few genes that associated with extracellular matrix degradation,construction and regulation,including MMP13,WNT2,WNT11,WNT16,COL9A3 and COL4A5,could be regarded as therapeutic targets in RA treatment.

Objective To evaluate the outcomes of laparoscopic live donor nephrectomy via retroperitoneal approach. Methods From December 2003 to June 2004,6 patients underwent laparoscopic live donor nephrectomy (younger brother to elder sister in 1 case,elder brother to younger brother in 1, younger sister to elder brother in 1,elder sister to younger brother in 1,father to son in 1,mother to son in 1).For tissue matching,1 case was mismatched of 0 locus,2,of 2 loci and 3,of 3 loci.The results of PRA and lymphocytotoxicity test were negative.The patient was placed in the lateral decubitus.With 3 trocars, the left kidney was dissected via retroperitoneal approach.The arteries and veins were cut off by endoscopic articulating linear cutter. The donor's left kidney was taken out through a 6-7 cm long incision between 2 trocars.Staplers on renal arteries and veins were cut off,and the donor kidney was perfused with liquid,and then was implanted at the right iliac fossa of the recipients.Triple immunosuppressant therapy was used to prevent rejection. Results Laparoscopic donor nephrectomy was successfully performed on all the 6 cases by retroperitoneal approach.The kidney transplantations using the donor live kidneys were also successful.Postoperatively,the mean urine volume was 5036 ml(range,3500-6500 ml) on the first day;the mean serum creatinine level was 598 ?mol/L on the first day and 129 ?mol/L at 1 month.Follow-up of 3-9 months showed that the renal function was normal and no rejection occurred. Conclusions Laparoscopic donor nephrectomy via retroperitoneal approach is safe,feasible,and less invasive to the donor; however,this technique needs skilled surgeons of laparoscopy and renal transplantation.

Objective To observe vancomycin and vancomycin in elderly patients with renal toxicity.Methods 105 cases because of infection from March 2013 to October 2014 were collected and randomly divided into two groups, one had 52 patients and were given vancomycin for anti-infection treatment, another group had 53 patients and were given norvancomycin for anti-infective treatment.Changes of serum urea nitrogen and creatinine levels and adverse reactions were observed and compared between two groups.Results Creatinine levels of patients with vancomycin group after 10 days and 7 days after withdrawal were (97.86 ±8.27)μmoI/L, (82.03 ±5.72)μmoI/L, and the norvancomycin group were (98.67 ±8.34)μmoI/L, (83.47 ± 5.91)μmoI/L, the difference were not significant.Urea nitrogen levels of patients with vancomycin group after 10 days and 7 days after withdrawal were (6.71 ±1.15)mmoI/L,(6.09 ±1.09)mmoI/L, respectively, and the norvancomycin group were(6.75 ±1.17)mmoI/L,(6.15 ±1.12)mmoI/L, the difference were not statistically significant.The total effective rate of vancomycin group was 78.85%, and norvancomycin group was 75.47%, the difference was not statistically significant.Adverse reactions of vancomycin group during treatment was 13.46%, and norvancomycin group was 13.21%, the difference was not statistically significant.Conclusion Vancomycin and norvancomycinboth have anti-infective effect on renal function in patients with certain adverse effects, urea nitrogen, creatinine levels in two groups were elevated during treatment, but decreased after withdrawing medicine.

Objective To establish a method used for quantitative determination of bufadienolides in human liver tissues by HPLC. Methods using solid phase extraction of human liver with Oasis (HLB car-tridge coupled with reserved phase HPLC and diode array detection. Results Recoveries obtained from spiked liver for the bufadienolides were better than 70% . The linearity was studied up to 1200ng/g and the detection limits of the method was 0.4ng for cinobufotalin and bufalin, 0.5ng for cinobufagin and resibufo-genin. Conclusion This method is fast and accurate. It is useful for forensic medicine detection.

Objective To evaluate the efficacy of PTCRA+ PTCA in patients with complicated coronary disease Methods PTCRA+PTCA were performed on 16 lesions in 14 patients in our hospital Results In 14 lesions, PTCA was performed after direct PTCRA in order to achieve opital angigraphic result; PTCRA was performed in 5 coronary artery lesions after failed PTCA 14 patients (100%) had successful result Conclusion The combined use of PTCRA+PTCA can improve the success rate during revasculrization for patients with complicated coronary artery disease

Objective To explore the techniques and efficacy of retroperitoneal laparoscopic operations in the treatment of renal cyst. Methods A total of 35 patients were operated on under general anesthesia. A water-filled balloon was used to dilate the retroperitoneal cavity. The renal cyst was exposed by identifying the psoas major muscle, peritoneal reflection, pillar of diaphragm and so on. All cyst walls were unroofed with ultrasonic scalpel 3～5 mm from the edge of renal parenchyma. Results With renal cysts removed, the operations were successfully accomplished in all the 35 patients. The operation time was 15～60 min (mean, 32 min). The intraoperative blood loss was 5～60 ml (mean, 35 ml). The postoperative hospital stay was 3～6 days. Pathological examinations reported benign lesions in 34 patients and suspected cystadenocarcinoma in 1 patient. All the 35 patients were followed for 1～22 months. No recurrence was found with exception of 1 case of remaining renal cyst 1.5 cm in diameter under B-ultrasonography at the first postoperative month. The patient with suspected adenocarcinoma had been followed for 1 year and no evidences of neoplasm or metastasis were detected on the chest roentgenogram and B-ultrasonography of the liver and the kidneys. Conclusions Retroperitoneal laparoscopic unroofing is a safe and effective procedure for renal cyst.

Objective To evaluate the feasibility and curative effects of retroperitoneal laparoscopic surgery for adrenal pheochromocytoma. Methods Clinical records of 9 cases of retroperitoneal laparoscopic adrenalectomy of pheochromocytoma from October 2002 to November 2004 were reviewed. Results The operations were successfully completed in all 9 cases without severe complications. A sudden rise of blood pressure with an amplitude over 30 mmHg appeared in 3 cases during the operation, which took a favorable turn after adjusting the surgical performance and blocking the central vein. The operation time was 90~210 min (mean, 150 min). The intraoperative blood loss was 30~150 ml (mean, 50 ml). Blood transfusion was required in no cases. The postoperative length of hospitalization was 4~9 days (mean, 5 days). Pathological examination revealed benign adrenal pheochromocytoma in all cases. Follow-up for 3~24 months (mean,11 months)in the 9 cases found symptom free and no recurrence by B-ultrasonography or CT scans. Conclusions Retroperitoneal laparoscopic surgery for adrenal pheochromocytoma is a feasible procedure which offers advantages of minimal invasion, short operation time, less blood loss, quick postoperative recovery, fewer complications and good curative effects, having a promising future.