Objective To discuss the clinical value of retroperitoneal laparoscopic simple nephrectomy. Methods Retroperitoneal laparoscopic simple nephrectomy was performed in 6 patients, including 5 cases of severe hydronephrosis with non-functioning kidney resulted from ureteral calculi and 1 case of renal tuberculosis. The operation was conducted via retroperitoneal approach. After the upper ureter and the renal pedicle were exposed, the renal artery and vein were clipped and severed. The renal pedicle was occluded only with titanium clips before the removal of the kidney. Results All the operations were performed successfully without complications. The operation time was 130~220 min (mean, 150 min) and the intraoperative blood loss, 80~150 ml (mean, 120 ml). The postoperative hospital stay ranged 5~7 days. Follow-ups for 3 months in the 5 patients with ureterolithiasis revealed normal renal functions. The patient with renal tuberculosis was given anti-tuberculosis therapy and followed for 6 months. No recurrence was seen and the patient’s serum creatinine level was 120 ?mol/L, which was slightly higher than the normal. Conclusions Retroperitoneal laparoscopic simple nephrectomy has advantages of minimal invasion, short hospital stay and rapid recovery. The procedure should be regarded as the “golden standard” for simple nephrectomy.

AIM: To investigate whether efficient production of neuron-like cells from embryonic stem cells(ESCs) can be indued by astrocyte-conditioned medium(ACM) in vitro.METHODS: Based on the 4-/4+ protocol established by Bain,two groups were studied: ATRA group,ATRA with ACM group.ESCs were induced into neuron-like cells by means of three-step differentiation in vitro.The totipotency of ESCs was identified by the observation of cells' morphology and the formations of teratoma in immunocomprised mice.The cell differentiation was evaluated continuously by detection of the cellular specific markers of neural stem cell, neurons and astrocytes such as nestin,NF-200,NSE and GFAP using immuno-histochemistry assay.RESULTS:(1) The ESC-D3 cells kept the ability of differentiation into cellular derivations of all three primary germ layers after continuous passage culture.(2) The ratio of NF-200 and NSE positive cells in the cells induced by ATRA with ACM was higher than that in the cells induced by ATRA only.(3) Finally,the positive rate of the neuron-like cells was up to 73.5% in the group induced by ATRA with ACM.CONCLUSION: The ESCs are induced into neuron-like cells with high purity and efficiency by ATRA with ACM.

Objective The objective of this article is to attempt to propose the endovascular repair principles of distal-end tear of Stanford type B aortic dissection.Methods The vascular surgery of xinjiang uygur autonomous region people's hospital received and cured 101 patients of Stanford B aortic dissection from January 2013 to January 2015.The patients are divided into two groups according different treatment principles:(1)There are 57 cases in sequential treatment group,performing endovascular repair of aortic tears from near to far,(if the tear at visceral artery is not treated then the distal-end tear is also not treated);(2) There are 44 cases in non-sequential treatment group,not performing endovascular repair of aortic tears from near to far (the tears involving visceral artery are not treated and the remaining distal-end tears are performed endovascular repair).After operation,carry out statistical analysis between two groups on the growth rate of aortic diameter of the coeliac axis,occurrence rate of main discomfort complaint,false lumen thrombosis rates.Results After operation,between the two groups,the growth rate of aortic diameter of the coeliac axis is obvious difference(P ＜ 0.05),that the sequential group is with a low rate;there are obvious differences on the occurrence rates of main discomfort complaint and false lumen thrombosis rates (P ＜ 0.05),that the sequential group is superior to the non-sequential group.Conclusions After a preliminary clinical study,we get a conclusion that when treating distal-end tears of Stanford type B aortic dissection,sequential treatment is better than non-sequential treatment.

Objective To assess the treatment of splenic artery aneurysms(SAA) and curative effect evaluation.Methods Twelve SAA patients treated in our hospital from January 2012 to May 2014 were clinical analyzed.The male in Twelve patients was 4 man and others were female.The vagus splenic artery aneurysms are originated from the superior mesenteric artery,tumors are single,from 1.5cm to 2.8cm in diameter,an average of 2.1cm.Twelve cases were performed surgery,4 patients underwent elective surgery,interventional embolization of the splenic aneurysm in 3 patient,The others were performed interventional embolization + superior mesenteric artery covered stents.Results Technical success was achieved in all twelve patients,2 patients had adverse effects such as abdominal pain,fever,etc.There revealed no aneurysm recurrence was found.Twelve patients were followed for 6-24 months,the follow-up by examinations with electronic computer X-ray tomography or color Doppler ultrasonic as well as angiography every 3 months.One patient died of severe abdominal bleeding 1 year later after the operation and the other eleven patients remained in good condition with no occurrence of re-canalization of the lesions.Conclusions For the vagus splenic aneurysm with suitable for anatornic conditions,cavity therapy is safe and effective,for the vagus splenic aneurysm involving hepatic artery,need to open surgery for vascular remodeling.

Objective To investigate the influence of murine cytomegalovirus ( MCMV) infection on the expression of downstream differentiation related target genes of Wnt signaling pathway in neural stem cells (NSCs) in vitro and explore the molecular mechanism of fetal encephalodysplasia caused by CMV infection. Methods NSCs were separated from fetal BALB/c mouse and cultured in vitro. The NSCs infected by MCMV at a MOI (multiplicity of infection) of 5, 1 and 0.1, respectively, were cultured in differentiation medium. The dynamic expression of the downstream differentiation related target genes ( c-myc, cyclinD1, ngn-1 and ngn-2) of Wnt signal pathway in NSCs were measured by Western blot. Real-time RT-PCR was employed to measure the expression levels of the key differentiation genes ngn-1 in Wnt signal pathway of NSCs post infection. Results The protein levels of c-myc in the infected groups were significantly lower than that in the normal control at 0.5-5 d (P＜0.05) ; At 0. 5 d and 1 d post-infection (p. i. ) , the protein levels of cyclinDl in the infected groups were lower than that in the normal control (P＜0.05). At 2 d and 3 d p. i. , the cyclinD1 expression in the infected groups was higher than that in the control group (P ＜ 0. 05). However, at 4 d and 5 d p. i. , the cyclinD1 levels in the group of the MOI of 5 were lower than in other three groups (F＜0.05). The expression of ngn-1 protein in the infected groups was reduced importantly compared with normal control at 1 -5 d p. i. ( P ＜ 0.05 ). The expression of ngn-1 mRNA in the infected groups was lower than that in the control group at all time points (P ＜ 0. 05 ). The expression of ngn-2 protein decreased at first and then increased, which was opposite to the normal control. The peak of ngn-2 expression in groups of the MOT of 0.1 and 1 occurred later and were significantly lower than that in the normal control (P ＜0. 05). No distinct peak was seen in the group of the MOI of 5. At 1 d p. i. , the expression of ngn-2 of all infected groups was significantly lower than that in the normal control ( P ＜ 0. 05 ). At 2 d p. i. , the expression of in the group of the MOI of 5 was still lower (P ＜ 0.05). While at 3 d, 4 d and 5 d p. i. , the protein levels in all infected groups were higher than that in the normal control (P ＜ 0. 05). The protein expression of these genes increased following the increase of MOI. Conclusion MCMV inhibited the protein expression of c-myc and ngn-1 in differentiated NSCs, repressed the mRNA expression of ngn-1 and caused the perturbed expression of cyclinDl and ngn-2 in a MOI-dependent manner. These data suggest that inhibition of or interference with the protein expression of downstream differentiation related target genes of Wnt signaling pathway in NSCs by MCMV may be one of the important mechanisms, by which proliferation and differentiation of NSCs are inhibited and thus fetal brain is impaired after MCMV infection.

Objective To study the efficacy and safety of implantation of a modified temporary self-expanding metallic stent for cardia achalasia.Methods A total of 30 patients diagnosed as having cardia achalasia were randomly divided into 2 groups,group A (traditional stents) and group B (modified stents)(n =15 in each group).Two days after stent implantation at the cardia by endoscopy,stents were withdrawn with endoscope guided by X-ray.LES Pressure,X-ray images ( including the diameter of the most dilated part of esophageal and the most narrow part of cardia) and the symptoms of dysphagia were compared before and half year after the treatment.The width changes of the most narrow stenting part on the point of stenting and 2 days after removal were compared.The side effects and complications during the treatment were recorded.Results All thirty stents were successfully implanted and removed.Stent dislocation occured in 2 cases in group A,but none in group B.Dysphagia had significant improvement after the treatment in both groups ( P ＜ 0.05 ),but the recurrence rate of group A ( 26.7％ ) was significantly higher than group B (6.67％ ) in 6 months ( P ＜ 0.05 ).LES pressure and X-ray images of both groups significantly improved after treatment ( P ＜ 0.001 ),and those of group B were superior to group A ( P ＜ 0.05 ).There was no difference in adverse reaction between the two groups.No perforation occured in any group.Conclusion Self-expanding metallic stents is safe for patients with cardia achalasia,with implantation convenience,symptomatic improvement,low recurrence,and few complications or dislocation.

Objective To investigate the influence of murine cytomegalovirus(MCMV) infection on differentiation and differentiation gene expression of neural stem cells (NSCs) in vitro for studying the mechanisms of brain abnormalities calmed by congenital cytomegalovirns infection. Methods NSCs were separated from fetal BALB/c mouse and cultured and identified in vitro. The differentiation potency of NSCs was observed by immunnfluorescence. The NSCs infected by MCMV at dosage of multiplicity of infection (MOI) equaled to 5, I and 0. 1, respectively, were cultured in differentiation medium. The morphological changes of the cells were observed by inverted microscope. The ratios of NSCs and its differentiated cells were detected by flow cytometry. The expression changes of nestin, GFAP and NSE, markers of NSCs and its differentiated cells, were studied by immunofluorescence ( MOI = 1 ). The expression of early antigen (EA) of MCMV was detected to observe the infection process. Real-time RT-PCR method was employed to measure the expression levels of the key differentiation genes Wnt-3 and Wnt-7a in Wnt signal pathway of NSCs at early phage of differentiation culture. Results NSCs isolated from embryonic mouse brains could proliferate to form neurnspheres and strongly express Nestin and differentiate into NF-200 positive neurons or GFAP positive astrocytes. The NSCs of the infected groups couldn't adhere to the wall and appear differentia-tion growth, but showed swollen gradually after differentiation culture. The nostin expression of the infected groups downregulated slowly and was higher than that of the control groups ( P < 0.05 ). The GFAP and NSE expression of the infected groups were lower than that of the control groups (P <0.05). The EA of MCMV could be always detected in the cells of the infected groups. The ratios of nestin positive cells of the infected groups were higher than that of the control groups, but the ratios of GFAP and NSE positive cells of the for-mer were lower than that of the latter from 3rd to 9th day after differentiation culture ( P < 0.05 ). The levels of Wnt-3 mRNA and Wnt-7a mRNA of the infected groups were markedly lower than that of the control groups from 1st to 2nd clay and from 12th hour to 2nd day after differentiation culture respectively ( P < 0.05 ) . These changes of the infected groups became more obvious as MCMV MOI increased . Conclusion MCMV could inhibit significantly NSCs differentiate to neurons and astrocytes and lead to the decrease of dif-ferentiated cells. MCMV could inhibit or interfere with the gene expression of Wnt-3 and Wnt-7a in Wnt sig-nal pathway of NSCs. The effect that MCMV inhibited the differentiation and the differentiation gene expres-sion of NSCs showed dose-dependent with MCMV MOI. The inhibitory effect of MCMV on the differentiation of NSCs might be induced by interfering the differentiation gene expression of NSCs, which is possibly the one of primary causes of brain development disorders caused by congenital CMV infection.

Objective To explore the role of clinical pharmacists in rational drug use through the pharmacy care of an elderly pneumonia patient with Chlamydia psittaci infection and drug-induced liver injury. Methods The clinical pharmacists participated in the treatment of one patient with Chlamydia psittaci pneumonia and drug-induced liver injury. Based on the results of second-generation gene sequencing, the characteristics of the pathogen were learned by literature search. The clinical pharmacists monitored the patient’s liver and kidney function, provided a new medication treatment plan to Doctors, and performed patient education during the treatment. Results The initial empirical anti-infective treatment with teicoplanin and imipenem-cilastatin was not effective. After the diagnosis of Chlamydia psittaci and Candida albicans infection, the combination of doxycycline with azithromycin and fluconazole was administered. Drug-induced liver injury was found with this treatment. The clinical pharmacist proposed to switch to doxycycline and clarithromycin with co-administration of magnesium isoglycyrrhizinate and polyene phosphatidylcholine to protect the liver. With this new regime, patient's liver function was improved and the infection was under control. Conclusion Individualized pharmaceutical cares provided by clinical pharmacists helped the safe, rational and effective use of medications.

Objective To construct the antisense eukaryotic vector of human TRP-1 (tyrosinase related protein 1) encoding gene, and transfect it into TRP-1 highly expressed melanocytes and malignant melanoma cell line, in order to further study the effects of antisense TRP-1 on the proliferation and functions of those cells. Methods TRP-1 cDNA was amplified by polymerase chain reaction (PCR) and the PCR products were subcloned into eukaryotic expression vector pcDNA3.1 on the opposite direction. Antisense recombinant vector was transfected into melanocytes and melanoma cell line. TRP-1 mRNA level was detected by reverse transcriptase polymerase chain reaction (RT-PCR). TRP-1 protein level was detected by Western blot. Cell cycle was determined by flow cytometry. The activity of tyrosinase was valued by L-dopa reaction. Results The recombinant antisense vector pcDNA3.1/TRP-1(-) was constructed. Positive transfected cells could steadily express TRP-1 antisense RNA. It was showed that there was a low level of TRP-1 mRNA as indicated by RT-PCR, and a low level of TRP-1 protein as indicated by Western blot. Cell cycles were blocked in G1 stage. The suppress rates of tyrosinase was 46% in transfected melanocytes and 54% in malignant melanoma cells, respectively. Conclusions TRP-1 plays an important role in the proliferation and functions of melanocytes and melanoma cells. Antisense TRP-1 could block the cell cycles and decrease the activity of tyrosinese in those cells.