Objective To investigate the effect of L-carnitine on the apoptosis in Schwann cells induced by high glucose.Methods The cell line RSC96 cultured in vitro were seeded in 96-well plates at a density of 1.5 × 104/ml (200 μl/well) or in 6-well plates at a density of 2 × 105/ml (2 ml/well) and cultured for 24 h.The cells were randomly divided into 4 groups (n =24 each) using a random number table:normal control group (group C),high glucose group (group H),high glucose + L-carnitine group (group H + L),and mannitol osmotic control group (group M).The cells in group C were incubated in the plain culture medium containing normal glucose (5.6 mmol/L).The cells were incubated in the medium containing glucose 50 mmol/L in group H or in the medium containing glucose 50 mmol/L and L-carnitine 50 μmol/L (final concentration) in group H + L.The cells were incubated in the medium containing normal glucose (5.6 mtmol/L) and mannitol 44.4 mmol/L in group M.At 48 h of incubation,cell growth conditions were observed under inverted microscope,superoxide dismutase (SOD) activity was measured by xanthine oxidase method,malondialdehyde (MDA) content was measured by thiobarbituric acid test,cell viability was measured by MTT assay and cell apoptosis was measured by flow cytometry.The expression of activated caspase-3 and poly (ADP-ribose) polymerase-1 (PARP-1) protein was detected by Western blot.Results Compared with group C,the cell viability and SOD activity were significantly decreased,MDA content and apoptotic rate were increased,and the expression of activated caspase-3 and PARP-1 protein was up-regulated in H and H + L groups,and no significant changes were found in group M.Compared with group H,the cell viability and SOD activity were significantly increased,MDA content and apoptotic rate were decreased,and the expression of activated caspase-3 and PARP-1 protein was down-regulated in group H + L.Conclusion L-camitine can attenuate high glucose-induced apoptosis in Schwann cells by inhibiting oxidative stress responses and down-regulating the expression of activated caspase-3 and PARP-1.

Objective To discuss the feasibility and accuracy of dual-source CT ( DSCT) in the evaluation of aortic stenosis ( AS) with transthoracic echocardiography ( TTE) as reference.Methods A total of 53 patients who underwent both DSCT and TTE were prospectively evaluated.All of them were assessed by TTE for aortic stenosis.Maximum aortic valve area ( AVA) in systolic phase was measured with DSCT , and was compared to that index obtained from the continuity equation on TTE.The severity of AS was graded as mild , moderate , or severe according to the AVA.Linear regression analysis and Bland-Altman plots were used to compare the AVA measured by using CT and TTE.Agreement on semi-quantitative grades of AS severity between the two methods was tested by using Kappa statistics.Results The mean AVA using DSCT was (1.45 ±0.35 ) cm2 compared to the mean AVA of ( 1.33 ±0.36 ) cm2 using TTE, with a significant correlation between them (r=0.92,P<0.01).Bland-Altman analysis demonstrated good inter-modality consistency between DSCT and TTE.However , DSCT demonstrated a slight overestimation of the AVA compared to TTE.As identified by TTE, there were 53 patients with AS, 13 with mild AS, 21 with moderate AS , and 19 with severe AS.In 3 patients DSCT showed no AS , TTE detected mild AS.In 6 cases, TTE had graded the stenosis as moderate , but the stenosis degree was graded as mild using DSCT.Kappa analysis showed a good agreement between the two methods on semi -quantitative grades of aortic stenosis severity (Kappa=0.75,P<0.01).Conclusion AVA measurements using DSCT is feasible and reasonably accurate for those patients with moderate to severe aortic stenosis.

Objective To evaluate the effect of hydrogen-rich saline on Toll-like receptor 4 (TLR4) /nuclear factor kappa B (NF-κB) signaling pathway in the sciatic nerve of rats with diabetic neuropathic pain (DNP).Methods Pathogen-free male Sprague-Dawley rats, aged 8 weeks, weighing 180-210 g, were used in the study.DPN model was established by intraperitoneal injection of 1％ streptozocin (STZ) 65 mg/kg.Twenty-four diabetic rats were randomly divided into 2 groups (n =12 each) using a random number table: DPN group and hydrogen-rich saline group (HRS group).Another 12 normal rats were randomly selected and served as control group (group C).At 14 days after STZ injection, hydrogenrich saline 5 ml/kg was injected intraperitoneally once a day for 14 consecutive days in group HRS, while the equal volume of normal saline was given in C and DNP groups.Mechanical paw withdrawal threshold to yon Frey stimuli (MWT) and thermal paw withdrawal latency (TWL) were measured at 2 days before STZ injection (T0) , and 7, 14, 21 and 28 days after STZ injection (T1-4).The motor nerve conduction velocity (MNCV) of the right hindlimb was measured after pain threshold was measured at T4.After measurement of neurological function was completed, the expression of TLR4 and NF-κB was detected in the sciatic nerve (by Western blot) , the tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) contents in sciatic nerves were measured by enzyme-linked immunosorbent assay, and the neuronal apoptosis was detected by TUNEL.The apoptosis index was calculated.Results Compared with group C, the MWT was significantly decreased at T1-4, TWL was shortened at T2-4, and MNCV was decreased at T4, the expression of TLR4 and NF-κB, contents of TNF-α and IL-6, and apoptosis index were increased in HRS and DNP groups (P＜0.05).Compared with group DNP, the MWT was significantly increased, and TWL was prolonged at T3,4 MNCV was increased T4, and the expression of TLR4 and NF-κB, contents of TNF-α and IL-6, and apoptosis index were decreased in group HRS (P＜ 0.05).Conclusion Hydrogen-rich saline can mitigate DNP through blocking TLR4/NF-κB signaling pathway in the sciatic nerve of rats.

Objective To study the changes of renal cortex angiotensin Ⅱ (AngⅡ) expression and podocyte autophagy in aging rats with normotension versus hypertension,to further investigate the possible mechanism of renal injury in hypertension during aging.Methods Normotensive Wistar-Kyoto-rats (WKYs) were allocated to three groups by age of 3-month-old group,13-month-old group,22-month-old group.Gender,age and number-matched spontaneously hypertensive rats (SHRs) served as controls.Blood pressure was monitored.Levels of urinary albumin,urinary creatinine,serum creatinine (SCR),blood urea nitrogen (BUN),Ang Ⅱ in serum and in renal cortex were detected.The kidney ultrastructural changes and podocyte autophagosomes were observed under light and transmission electron microscopy.Expressions of nephrin,LC3B Ⅱ,Atg5 and p62 in glomeruli were analyzed by Western blotting.Results Blood pressure was significantly higher in SHRs than in WKYs (P＜0.05).During aging from 3-month-old to 13-month-old and to 22 monthold group,the urinary albumin/creatinine ratio was increased significantly in SHRs with hypertension and in WKYs with normotension [WKY:(0.12±0.01) g/mmol,(0.14±0.04) g/mmol vs.(0.34± 0.05) g/mmol;in SHR:(0.29±0.04) g/mmol,(0.31±0.05) g/mmol vs.(0.72±0.16) g/mmol,P＜0.05],but SCR and BUN levels had no significant difference in SHRs and WKYs during aging (both P＞0.05).And Ang Ⅱ levels in both serum and renal cortex had no significant change in normotension group during aging three time points (both P＞0.05).An age-dependent decrease of Ang Ⅱ level in renal cortex appeared during aging three time points in hypertensive rats [SHR:(0.02 ±0.00) μg/L,(0.02±0.00) μg/L vs.(0.01±0.00) μg/L,P＜0.05],but serum level of Ang Ⅱ had no significant difference during aging three time points (P＞ 0.05) in hypertension group.The structural changes,including glomerulosclerosis,tubular atrophy and interstitial fibrosis were observed during aging three time points both in normotensive and hypertensive rats,but these pathological changes were more serious in hypertensive rats.Autophagosomes relatively accumulated in aging normotensive rats.The protein expressions of LC3B Ⅱ,Atg5 and p62 were increased in normotensive rats during aging (all P＜0.05).While the protein expressions of nephrin,LC3B Ⅱ,Atg5 and p62 were decreased in aging hypertensive rats (all P ＜ 0.05).Conclusions Ang Ⅱ expression level in renal cortex is decreased during aging in hypertensive rats.Podocyte autophagic activity is relatively decreased during aging in normotensive rats,but is relatively increased during aging in hypertensive rats.Ang Ⅱ-induced podocyte autophagy may be involved in the pathogenesis of renal injury in hypertension during aging.

Objective To examine the effects of benazepril and losartan on glomerular podocyte autophagy in aged spontaneously hypertensive rats (SHRs) and investigate the underlying mechanisms of renal-protective effects of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB).Methods Wistar-Kyoto rats (WKYs) were used as the normal control (NORM) group (2 ml physiological saline per day).SHRs were randomly divided into 4 groups:the CTRL group (2 ml physiological saline per day),the ACEI group (10 mg · kg-1 · d-1),the ARB group (30 mg· kg-1 ·d-1) and the combined group (10 mg· kg-1 · d-1 benazepril and 30 mg· kg-1 · d-1),with six 18-month-old make rats in each group.The experiments were conducted during a 4-month period.Blood pressure was monitored regularly.At the end of the experiments,we measured the levels of urine protein,urine creatinine,serum creatinine (SCR),blood urea nitrogen (BUN),and serum and renal cortex angiotensin Ⅱ (AngⅡ).Ultrastructural changes in the kidney were examined under light and transmission electron microscopy.The expressions of nephrin,LC3BⅡ,Atg5 and p62 in the glomerulus were analyzed by Western blot analysis.Results After treatment,the blood pressure and the urine albumin/creatinine ratio of the four SHR groups were still significantly higher than those of the NORM group,but the blood pressure and the urine albumin/creatinine ratio of the ARB group and the combined group were significantly lower than those of the CTRL group (all P＜ 0.05);There were no significant differences in SCR and BUN levels among these five groups (P＞ 0.05);The level of serum AngⅡ of the combined group was significantly higher than that of the CTRL group [CTRL (0.08±0.00) μg/L,Combined (0.12±0.01) μg/L,P＜0.05];The levels of cortex AngⅡ of the four SHR groups were significantly lower than those of the NORM group,while the level of cortex AngⅡ of the ARB group was significantly higher than that of the CTRL group (all P＜0.05);Renal ultrastructural examination revealed shrunken glomeruli,fused or effaced epithelial cell foot processes,and focal atrophy of renal tubules in the four SHR groups.These pathological changes were more serious in the CTRL group but less so in the combined group.There were significantly more autophagosomes in the NORM group and the combined group than in the CTRL group (P＜0.05).Compared with the NORM group,the expressions of nephrin,LC3BⅡ,Atg5 and p62 in the CTRL group were suppressed significantly (P ＜ 0.05).The expressions of nephrin,LC3BⅡ and Atg5 in the ACEI group and the expressions of nephrin,LC3BⅡ,Atg5 and p62 in the ARB group and the combined group were higher than in the CTRL group (P＜0.05).Conclusions ACEI/ARB can decrease the autophagic activity of glomerular podocytes.The renal-protective effects of ACEI/ARB may be mediated by glomerular podocyte autophagy,which is induced by AngⅡ.

OBJECTIVETo investigate the result of hip arthroplasty for failed internal fixation of femoral neck fractures.

METHODSFrom June 2007 to January 2014, 29 cases who underwent hip arthroplasty for failed of internal fixation of femoral neck fractures were reviewed. There were 12 males and 17 females. The mean age was 60.3 years (ranged 43 to 83 years) at the time of the fracture. Left hip was in 16 cases, right hip was in 13 cases. The average interval from fracture to arthroplasty was 23.3 months (ranged, 3 to 48 months).

RESULTSAll of 29 cases were performed total hip arthroplasty. There were 20 cases of cementless cup,7 cases of cementless cup with bone graft, 2 cases of cemented cup with bone graft; 13 cases of cementless stem, 16 cases of cemented stem. There were no complications occurred such as intraoperative fracture of the greater trochanter. The average operative time was (115 ± 38) minutes,the mean intraoperative blood loss was (420 ± 175) ml, the average postoperative drainage volume (240 ± 119) ml, intraoperative blood transfusion was (200 ± 220) ml, intraoperative fluid volume was (2,200 ± 400) ml, the average postoperative blood transfusion was (300 ± 200) ml. There was 1 case get postoperative dislocation. All patients were followed up for 14.7 months in average (ranged, 5 to 24 months). There was no revision for mechanical failure. Harris Hip Score significantly was improved from 51.1 ± 7.5 before the conversion to 88.5 ± 6.4 points at the final follow-up.

CONCLUSIONThe effect of the hip replacement for patients with failed internal fixation of femoral neck fractures was confirmed. This method can shorten the time on the bed and reduce the complications. It benefits the patients earlier functional recovery, but it must control operation indication. The long term efficacy is necessary to further observation.

Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; methods ; Female ; Femoral Neck Fractures ; surgery ; Fracture Fixation, Internal ; Humans ; Male ; Middle Aged ; Treatment Failure

Objective:To discuss the type, treatment and results of different therapies of biliary fistula after orthotopic liver tansplantation(OLT).Methods:Data of 24 patients who developed biliary fistula after OLT in the First Affiliated Hospital of Xi′an Jiaotong University from January 2000 to March 2019 were retrospectively analyzed. Patients with biliary fistula were classified into 4 types according to presence or absence of stricture. All patients were treated by endoscopic retrograde cholangiopancreatography (ERCP) or interventional therapy, including endoscopic nasobiliary drainage (ENBD), endoscopic retrograde biliary drainage (ERBD) or percuteneous transhepatic cholangial drainage (PTCD). Main outcome measurements were the onset time of biliary fistula, the site of biliary fistula, the complications of ERCP or PTCD, the time of removing abdominal or biliary drainage tube, and the onset of new biliary stricture.Results:Biliary fistula was found in (46.5±36.6) days (6-122 days) after OLT. The numbers of patients in four types of biliary fistula were 6, 14, 2 and 2, respectively. Biliary fistula was cured in 22 patients, with clinical cure rate of 91.7%. All patients underwent ERCP first, and the technical success rate and clinical cure rate were 87.5% (21/24) and 85.7% (18/21), respectively. The clinical cure rates of ERCP forⅠ-Ⅳ biliary fistula were 6/6, 84.6%(11/13), 1/2, and 0, respectively. The clinical cure rates of ENBD and ERBD were 8/10 and 6/8, respectively. Five cases in whom ERCP failed, underwent PTCD, with technical success and clinical cure rates of 4/5 and 3/4 respectively. Eight patients(33.3%)developed cholangitis after treatment, and the incidence rate seemed higher in type Ⅱ biliary fistula than that in type Ⅰ [35.7% (5/14) VS 16.7% (1/6)]. Incidence of cholangitis was higher in patients with non-anastomotic stricture than those with anastomotic stricture [83.3%(5/6) VS 16.7%(3/18)].Conclusion:The first line treatment for biliary fistula after OLT is ERCP, followed by PTCD. The best procedures of biliary fistula typeⅠ-Ⅳ were ENBD, ENBD combined with ERBD, ENBD and PTCD, respectively.

Objective To evaluate the feasibility and effectiveness of the application of IQQA (Intelligent/interactive Qualitative and Quantitative Analysis) three-dimensional reconstruction technique in precise laparoscopic or robot-assisted laparoscopic partial nephrectomy (LPN or RAPN) for renal hilar tumors.Methods The study retrospectively reviewed 11patients with hilar tunors from February 2016 to February 2017.Of the 11 patients,4 were women and 7 were men,with an average age of 51 years (range 38 to 70 years).The average tumor size was 3.1 cm (range 1.7 to 4.3 cm).For tumor stage,9 patients were in T1a stage and 2 patients were in T1b stage.Tbe average R.E.N.A.L score was 8.7 (range 7 to 10).The mean preoperative GFR was 40.6 ml/min (range 32 to 45 ml/min).IQQA three-dimensional reconstruction technique was applied for the purpose of precise navigation and resection of the tumors.Multivariate analysis was used to identify predictors of warm ischemia time,estimated blood loss,major perioperative complications,and postoperative renal function.Results All 11 laparoscopic or robot-assisted laparoscopic hilar partial nephrectomies were successfully completed without conversion to a hand-assisted or an open approach.Under the navigation of IQQA,all tumors were found precisely at the first time during surgeries.The final pathologic examination revealed that all the 11 patients were clear cell renal cell carcinomas.The mean operative time was 142 minutes (range 90 to 230 minutes),with a mean warm ischemia time of 24 minutes (range 17 to 33 minutes).The estinated blood loss was 146 ml (range 50 to 400 ml).No intraoperative complications occurred.Two patients suffered from postoperative complications.One patient with gross hematuria was recovered by consistent bladder irrigation.The other patient with postoperative hemorrhage needed transfusion.All patients had negative margins on the final pathologic examination.At a mean follow-up period of 3 months,the mean GRR is 22.5 ml/min (range 13 to 34 ml/min) without any disease recurrence.Conclusions With peculiar features,such as accurate location,complete resection and fewer perioperative complications,the application of IQQA three-dimensional reconstruction technique in precise partial nephrectomy represents a safe and effective procedure for hilar tumors.

Objective To investigate the safety and effectiveness of open radical prostatectomy (ORP) for locally advanced prostate cancer (LAPC).Methods From January 2012 to April 2017,132 cases underwent ORP were included.The mean age was 65.1 years old (ranged 41 to 83 years old),median PSA was 28.9 ng/ml (ranged 1.2 to 319.7 ng/ml) and mean Glcason score was 8.0(ranged 6.0 to 10.0).The number of clinical stage T3aN0,T3bN0,T4N0 and T1 ～4N1 were 92 cases(69.7％),20 cases (15.2％),8 cases (6.1％) and 12 cases (9.0％),respectively.Results The median length of hospital day,mean operative time and median blood loss were 9 d,180 min and 350 ml respectively.The intraoperative complication rate was 3.0％ (4/132),including 2 rectum injury and 2 iliac vessel injury.Pathological tumor stage revealed that ≤ pT2 N0 7 cases (5.3％),pT3a N0 61 cases (46.2％),pT3b N0 38 cases (28.8％),pT4N0 12 cases (9.1％) and pT1～4N1 14 cases (10.6％).The mean Gleason score was 8.0 (ranged 6 tol0).The numbers of patients with perineural invasion,seminal vesicle invasion and positive surgical margin were 81 cases (61.4％),49 cases (37.1％) and 41 cases (31.1％) respectively.The median follow-up duration was 24.1 (ranged 1.8 to 62.2) months.The rate of postoperative complications was 3.0％ (4/132) including 1 urethral stricture,1 wound infection,1 intestinal fistula and 1 lymphatic fistula.The rates of patients with urinary continence 1,3,6 and 12 months after surgery were 30.4％ (38/125)、63.9％ (76/119)、72.6％ (82/112)、89.1％ (90/101).The rates of adjuvant hormonal therapy and radiotherapy were 34.1％ (45/132) and 38.6％ (51/132).One patient (0.8％) died of lung cancer.The rate of biochemical recurrence(BCR) was 25.8％ (34/132).The 5-year BCRfree survival rate was 57.2％ (95％ CI 41.9％ ～ 70.6％).Conclusion The oncological control and functional recovery outcomes of ORP for locally advanced prostate cancer were reliable.

Objective To summarize the surgical experience and primary follow-up results for robotic assisted radical cystectomy ( RARC ) , as well as to evaluate the safety and feasibility of this procedure.Methods From Jan 2013 to Oct 2015, we retrospectively analysis the perioperative data and primary follow-up data from 35 patients who underwent radical cystectomy with Da VinCi robotic laparoscopic in urological institution of Changhai Hospital.The median age was 65 (ranging from 46 to 78) years.The amount of male cases were 34, the female case were 1.There were three kinds of urinary diversion, ureterocutaneostomy, Bricker operation and orthotopic neobladder, were 2, 26 and 7 respectively.We collected the parameters including operating time, estimated blood loss, blood transfusion volume, time to flatus,length of hospital stay,perioperative complication,time of recurrence,time of death and the reason of death.Results All of the related operations had been accomplished successfully, none of which had been converted to the open procedure.The estimated operating time of ureterostomy was (315.0 ±106.1) min, Ideal conduit was ( 443.2 ±93.2 ) min, Orthotopic bladder was ( 488.3 ±80.6 ) min.The estimated intraoperative blood loss was 260.0 ±108.6(100 to 500 )ml.5 cases of all patients were transfused 400ml red cell suspension, the transfusion rate was 14.2%.The mean time to flatus was 3.1 ±1.6(1 to 7) d.The estimated time to remove the gastric tube and the drainage tube was 4.2 ±2.2d(2-10d),10.8 ±5.1d(4-25d),respectively.The length of hospital stay after surgery was 12.4 ±5.17(6 to 25) d.Overall,17,8, 10,31 and 4 of these patients had