Objective To study the diagnosis and surgical outcomes of renal cell carcinoma with inferior vena cava tumor thrombus.Methods The clinical data from 31 cases of renal cell carcinoma with inferior vena cava tumor thrombus were retrospectively reviewed from January 2000 to December 2014.Among them,21 cases were male and 10 cases were female.The mean age ranged from 38 to 79 years,mean 57 years.The location of tumor included right renal in 29 cases and left renal in 2 cases.The distribution of the tumor thrombus was recorded as follow:level Ⅰ in 20 cases,level Ⅱ in 8 cases and level Ⅲ in 3 cases.All patients received radical nephrectomy and tumor thrombectomy.Ipsilateral subcostal oblique incision was chosen in 20 cases.Transrectus incision was chosen in 10 cases.And abdominal transperitoneal L shaped incision was chosen in 1 case.Three patients were given neoadjuvant molecular targeted therapies before operation.Results All patients accepted the operation successfully.There was no death during perioperative period.The pathological diagnosis showed clear cell carcinoma in 30 cases and chromophobe cell tumor in 1 case.The Fuhrman grading showed that 17 cases were grade Ⅱ,8 cases were grade Ⅲ and 5 cases were grade Ⅳ.Among them,the lymphatic metastasis in the renal hilum was found in 5 cases.After operation,16 patients received molecular targeted therapies,including sorafenib in 10 cases and sunitinib in 6 cases.Six patients were given autologous tumor lysate-pulsed dendritic cells co-cultured with cytokine induced killer cells treatment.The median overall survival was 44 months (range 4-60 months).The 1-,3-,and 5-year overall survival rates for all patients were 100％,52％,and 39％,respectively.There were significant differences of the overall survival rates between level Ⅰ / Ⅱ and level Ⅲ tumor thrombi(81.5％ vs 0) (P =0.012).Similar difference was noticed between Fuhrman grade Ⅱ and grade Ⅲ/Ⅳ (94.1％ vs 46.2％)(P =0.003).There was also significant difference between those with or without lymph node metastases (40.0％ vs 80.8 ％) (P =0.0 1 6).Conclusions Radical nephrectomy and tumor thrombectomy could improve the survival of patients of renal cell carcinoma with inferior vena cava tumor thrombus.The overall survival rate might be related to the tumor thrombus level,tumor grade,and local lymph node metastasis.

Objective To observe and analyze the change state of serum inflammatory mediators of patients with secondary septic shock after chemotherapy for acute leukemia .Methods 56 patients with secondary septic shock after chemotherapy for acute leukemiawere were selected as the group A,56 patients without secondary septic shock after chemotherapy for acute leukemia were selected as the group B ,56 healthy persons of the same age were selected as the group C,then the serum inflammatory mediators levels of three groups were detected and compared,and the serum indexes of group A with different severity degree of shock were compared, then the detection results of group A and group B with different types ( lymphocytic leukemia and nonlymphocytic leukemia)were compared.Results The serum inflammatory mediators levels, including TNF-α, IL-4, IL-6, IL-10 and other inflammatory factors, including PGE2 , sICAM-1, sVCAM-1 and sCD44, there were group A >group B >group C, severe shock >moderate shock>mild shock ( all P<0.05 ) .The above serum inflammatory mediators and other inflammatory factors levels of different types in group A were higher than those in group B, and the above mediators in lymphocytic leukemia of group A and group B were higher than those in nonlymphocytic leukemia (all P<0.05).Conclusion The serum inflammatory mediators of patients with secondary septic shock after chemotherapy for acute leukemia show higher expression state,and the influence of shock degree and leukemia types for the expression are great.

2-Amino-3-hydroxylpyridinE-H2O2-horseradish peroxidase (HRP) voltammetric enzymE-linked immunoassay based on N-heterocyclic substrate has been successfully applied for the detection of carcionembryonic antigen(CEA) in human serum. 2-Amino-3-hydroxylpyridine is oxidized with H2O2 catalyzed by HRP, and the resulting electroactive product produces a sensitive voltammetric peak at the potential of 0.36 V(vs. SCE) in Britton-Robinson (B-R) buffer solution. By this voltammetric peak, free HRP can be measured and immunoassay of HRP label can be developed. The enzymE-catalyzed reaction conditions and voltammetric detection conditions have been optimized, and the electrode procedure of the enzymatic product was investigated. The selected optimum reaction conditions were that the reaction medium was pH 6.0 B-R buffer solution for 10 mL reaction solution containing 1.0 mL of 0.2 mol/L B-R buffer solution, 3.0 mL of 8.0 mmol/L 2-amino-3-hydroxylpyridine solution and 1.5 mL of 0.5 mmol/L H2O2 solution, and the reaction time was 30 min at 37 ℃. The optimum detection conditions were that the supporting electrolyte was pH 7.0 B-R buffer solution for 10 mL of the overall detection solution containing 5 mL of reaction solution and 1.0 mL of 0.2 mol/L B-R buffer solution. The optimum instrumental conditions for the detection were chosen as follows: the initial potential, 0.00 V; the final potential, -0.80 V; the potential scanning rate, 400 mV/s; the mercury drop standing time, 7 s. Under the optimum conditions, the linear range for detection of free HRP was 4.0×10-4-1.0 μg/L with a detection limit of 0.12 μg/L. Based on the new immunoassay system, the linear range of the detection to CEA was 0.50-80 μg/L and the detection limit was 0.50 μg/L, which is 10 times lower than that of traditional spectrophotometric enzymE-linked immunosorbent assay method. The 2-Amino-3-hydroxylpyridinE-H2O2-HRP voltammetric enzymE-linked immunoassay new system exhibits excellent performance having wider linear range and lower detection limit. The new method is inexpensive and simple. It has a great potential in clinical diagnosis.

Objective To explore the influence of time and dose of mannitol on neural and renal functions in the treatment of hepertensive cerebral hemorrhage.Methods 300 patients with hepertensive cerebral hemorrhage were divided into full-dose group and half-dose group.Full-dose group was divided into group A and group B,and half-dose group was divided into group C and group D.Full-dose group given 20％ mannitol 250ml,and half-dose group was given 20％ mannitol 125ml.Groups A and C were given drug 12h after incerebral hemorrhage occurs,and groups B and D were given drug in the occurrence of cerebral hemorrhage within 12h.The neural and renal functions of every group were compared before the treatment and one week after that.Results The treatment of full-dose group and hulf-dose group was all better,the total effective rate was 71.3％,72.7％,respectively,and there was no significant difference between the two groups ( P ＞ 0.05 ).The total effective rate of groups A,C ( 92.0％,90.7 ％ ) was significantly higher than that of groups B,D (53.3％,50.7％ ) ( all P ＜ 0.05 ).The number of cases [ ( BUN increased more than 7remol/L,61 cases) and(Cr increased more than 133remol/L,64 cases)] in full-dose group was significantly higher than that of half-dose group( 17 cases,17 cases) ( all P ＜ 0.05 ).Conclusion The effect of full-dose and half-dose mannitol in the treatment of hypertensive intracerebral hemorrhage is all better,but renal injury in halfdose mannitol was lower.Giving drug 12h after incerebral hemorrhage occurs is more conducive to hypertensive intracerebral hemorrhage controlled,and could better improve the prognosis.

Objective To study normal imaging features of choroid fissure and to improve the ability of diagnosis of choroid fissureneuroepithelial cyst.Methods The MR manifestations of choroid fissure were studied by comparing general brain specimen with MR images of normal brains.The analysis of CT and MRI findings of choroid fissure neuroepithelial cysts in 14 cases were also conducted.Results The whole choroid fissure was clearly displayed as fissures full of cerebrospinal fluid on MRI.Cysts were shown round or ellapse foci with sharpmargins and homogeneous low density on CT or cerebrospinal fluid-like signal intensity on MRI.There was no enhanced contrast or nodramatic changes in follow-up studies.Conclusion The recognization of MR anatomy of choroid fissure and imaging manifestations ofchoroid fissure neuroepithelial cysts can improve the ability of diagnosis and differential diagnosis of cysts.

Objective To investigate the efficacy of paracentesis using jugular vein indwelling catheter (Angiocath) in the treatment of simple renal cysts. Methods We retrospectively analyzed clinical data of 61 patients with simple renal cyst treated by Angiocath paracentesis combined with sclerosing agent injection under the guidance of ultrasonography. Results Fifty-two patients were cured on one session, while a recurrence was seen in 9 patients, among which 6 patients were cured by a re-paracentesis and 3 frequently recurrent patients were cured by the unroofing operation. No complications occurred except for 3 cases of mild transient hematuria. Conclusions Paracentesis using Angiocath in the treatment of simple renal cysts is minimally invasive, safe, effective and economical.

Objective To discuss the methods of primarily repairing scalp,skull and dura defects of separated type D craniopagus Methods The huge defects in craniopagus was primarily repaired by the application of scalp expander, transferring scalp flap, repairing dura with pedicle periosteums, repairing skull defects with Titanium plates Results The survival baby has a good sharp of skull and well healing of scalp postoperatively Conclusions Defects of separated type D craniopagus can be primarily repaired

Objective To study the clinical application of ureteral grasping forceps in ureteroscopic operations. Methods A total of 74 cases treated under ureteroscope by using ureteral grasping forceps from April 2001 to July 2003 in this hospital was retrospectively analyzed. There were 25 cases of polyp resection and pneumatic lithotrity, 21 cases of rigid guidance through ureteral retortion, 19 cases of ureteral stricture dilation and ureteroscopic lithotrity, 3 cases of whole ureteral membranous obstruction, 3 cases of ascending shift of double “J” tube, 2 cases of intraoperative biopsy,4 cases of removal of double “J” tube with urethral stricture,and 2 cases of pneumatic lithotrity. Results The procedures were successfully accomplished in 69 cases.A conversion to open operation was required because of malfunction of ureteral grasping forceps in 1 case, and ureteral perforation occurred in 4 cases. Conclusions Ureteral grasping forceps is indispensable in ureteroscopic operations, which should be skillfully operated.

Objective To investigate the methods of steroid supplement following adrenalectomy in the patients with Cushing syndrome.Methods The methods and outcome of steroid supplement following adrenalectomy in 75 cases of Cushing syndrome were retrospectively reviewed.Results Supraphysiological doses of glucocorticoid was given during the perioperative period,and the dosage was reduced gradually.Prednisone with a dosage of 5 to 7.5 mg was given once a day on discharge.In the patients with adrenocortical adenoma,4 to 15 month of steroid supplement was required.The patients undergoing bilateral adrenalectomy required lifelong steroid supplementation.Steroid withdrawal syndrome occurred during steroid tapering in 8 patients with adrenocortical adenoma,2 of them had normal plasma cortisol level.Conclusion In the patients with Cushing syndrome,even those with normal plasma cortisol level might have steroid withdrawal syndrome episodes during steroid tapering.

Objective To evaluate the clinical significance of serum procalcitonin (PCT)in early diagnosis of pul-monary tuberculosis (PTB)complicated with pulmonary infection.Methods Clinical data of active PTB patients admitted to a hospital between August and December 2013 were collected,patients were divided into bacterial infec-tion group(n=104),fungal infection group(n=37)and control group (n=95)according to whether patients were associated with bacterial infection,fungal infection,and without infection,serum PCT concentrations in three groups were compared,receiver operating characteristic (ROC)curve analysis was conducted.Results The median PCT concentrations in bacterial infection and fungal infection group was 0.44ng/mL and 0.30ng/mL respectively, which was significantly higher than 0.16ng/mL of control group(Z =9.49,3.51 respectively,both P <0.001 ).The area under curve (AUC)was 0.89(0.84-0.93)and 0.69(0.61 -0.77)respectively;cut-off point was 0.31 ng/mL and 0.27 ng/mL respectively;sensitivity was 79.81%(70.57%-86.80%)and 59.46%(42.19%-74.80%)respectively;specificity was 83.16%(73.79%-89.78%)and 73.68%(63.48%-81.95%)respectively.Conclusion PCT level is a valuable predictor for early diagnosis of PTB complicated with pulmonary infection,and can provide reference for the rational use of antimicrobial agents.