Objective To assess the laparoscopic technique combined with open surgical technique in pyeloplasty.Methods Overall,45 patients with ureteropelvic junction obstruction underwent laparo- scopic dissection of the renal pelvis and upper ureter transperitoneally,and pyeloplasty was performed through a expanded trocar-incision(extension of 1-2 cm)as open surgery was performed.Results The opera- tion was successful in all 45 patients.The mean operative time was 58 min(range,40-85 min),and the mean blood loss was 22 ml(range,15-30 ml).No complication was observed during and after operation. Follow-up for 3-36 months was available in 34 patients.Intravenous urography(IVU)showed no obstruc- tion of the anastomotic stoma,and B-ultrasound indicated relief of hydronephrosis.Conclusions Laparo- scopic approach combined with open surgery in pyeloplasty is an effective way to treat ureteropelvic junction obstruction.This technique can simplify the operative manipulation and shorten the operative time without more trauma to the patients.It is worth general application in clinical practice.

OBJECTIVETo investigate the proliferation of tissue-engineered cartilage cells stimulated by different intensities of compressive stress.

METHODSHuman embryonic cartilage cells were seeded into type II collagen sponge scaffold. The cells of the pressure groups were stimulated by different compression rate (0-5%, 0-10%, and 0-20%) at a cyclical frequency of 0.1 Hz. The cells of the control group were cultured without pressure. Gross observation, histological section, MTT assay and flow cytometry were used to observe the morphology, cell number and distribution and detect the cell proliferation and cell cycle.

RESULTSTissue-engineered cartilage cells in 0-10% group showed the largest size and greatest thickness with normal morphology. Tissue biopsies showed the largest number of cartilage cells with more uniform distribution, close alignment, more matrix secretion. The cartilage cell activity was significantly enhanced and the percentage of S phase cells significantly increased in the pressure group compared with those in the control group, and such changes were especially obvious in 0-10% group in which the S phase cells increased by 59.0% compared with that in the control group.

CONCLUSIONThe proliferation of tissue-engineered cartilage cells is regulated by the cyclic stress intensity, and a pressure frequency of 0.1 Hz with compression rate of 0-10% can better promote the cell proliferation.

Cell Proliferation ; Cells, Cultured ; Chondrocytes ; cytology ; Humans ; Stress, Mechanical ; Tissue Engineering ; Tissue Scaffolds

Objective To investigate the effect of emodin on the gemci-tabine-resistant pancreatic cancer cell line SW1990/Gemcitabine (GEM),and explore the potential mechanism of its action .Methods The pancreatic cancer cell line SW1990 was treated by intermittently in-creasing the concentration of gemcitabine in the culture medium for 10 months, and SW1990/GEM cells were obtained.This experiment was di-vided into control group ,emodin group,gemcitabine group and combina-tion group ( emodin +gemcitabine ) .SW1990/GEM and SW1990 cells were treated with emodin ( 10 μmol · L-1) and gemcitabine ( 20 μmol· L-1) alone or those two together in three groups for 48 h, in con-trol group cells were treated with 0.1%DMSO for 48 h.Cell proliferation was analyzed by MTT.Reverse transcription -polymerase chain reaction was performed to analyze the protein and gene expression of multidrug re-sistance gene-1 ( MDR-1) .Flow cytometric was applied to analyze the function of the P-glycoprotein(P-gp).The Rhodamine l23 efflux experiment was applied to assay P -gp function in SW1990/Gemcitabine cells.Results Compared with gemcitabine group , the combination group could significantly inhibit the proliferation of SW1990/GEM cells.Treatment of SW1990/GEM and SW1990 cells with gemcitabine alone could inhibit 13.34%and 36.52%of cell viability,there was significant difference between the two group (P＜0.05). The results showed that the SW1990 /GEM cell line had an obvious resistance to gemcitabine compared with the cell line SW 1990.While SW 1990/GEM and SW 1990 cells were treated with gemcitabine combined with emodin , cell via-bility was inhibited to 40.45%and 43.87%, there was no significant difference between the two group .The emodin could enhance the anti -proliferative effect of gemcitabine on drug -resistance cell SW1990/GEM.Compared with gemcitabine group, the combination group could significantly inhibit the expression of MDR-1 gene,and the difference was statistically significant (P＜0.05).Conclusion Effect of emodin can down -regulate the expression of MDR -1 and then improve the drug resistance of gemcitabine in pancreatic cancer .

Objective To evaluate the effect of alprostadil on the microcirculation and mortality after the fluid resuscitation in patients with septic shock.Methods The patients who met the criteria of septic shock admitted to our hospital from March 2015 to September 2016 were selected as the subjects.After the shock resuscitation reached the standard,they were randomly divided into control group and alprostadil group.Control group was given a standard treatment.On the basis of standard treatment,alprostadil group was given alprostadil 10μg/d plus tube.The heart rate,mean arterial pressure (MAP),central venous pressure (CVP),lactic acid (Lac) and urine volume were recorded at 0,1,3 and 7 days.The microcirculation index under the tongue including small vessel density (TvDs),perfused small microvessel density (PvDs),small vessel perfusion ratio (PPVs),microvascular flow index (MFI) and heterogeneity index (HI) were recorded at 0,6,24 and 72h.The patients' hospitalization time in ICU,total hospitalization time and mortality rate of follow-up 28 days were recorded.Results Forty-eight patients were enrolled in this study,of which 23 were in control group and 25 in alprostadil group.The heart rate and MAP had no significant changes in alprostadil group,but the CVP decreased significantly compared with control group (P＜0.05) at 1,3,7 days after the treatment,and urine volume increased at 3 and 7 days in the alprostadil group (P＜0.05);but TvDs did not increase at 6 and 24h in the two groups,while PvDs,PPVs,MFI,HI increased at 6,24 and 72h in the two groups,with a higher value at 24 and 72h than the 6h.The 72-h indexes were significantly higher in alprostadil group than in control group (P＜0.05).The mechanical ventilation (MV) was significantly lower in alprostadil group than in control group (P＜0.05);ICU hospitalization time and total hospitalization time was significantly shorter in alprostadil group than in control group (P＜0.05).The hospital mortality and 28-day mortality were lower in alprostadil group than in control group (P＜0.05).Conclusions Alprostadil could significantly improve the microcirculation and urine volume in the patients after resuscitation for septic shock,with little effect on systemic circulation,effectively improve the prognosis of patients,and shortening the mechanical ventilation time,ICU stay time and total hospitalization time,thus reducing the mortality rate.

BACKGROUNDEndogenous nitric oxide and adenosine increase simultaneously to keep the balance of energy demand and supply when the oxygen supply is insufficient, which suggests that nitric oxide and adenosine might exert a synergistic myoprotection during tissue hypoxia. In this study, we tested this hypothesis utilizing a canine model of prolonged global myocardial ischaemic reperfusion injury.

METHODSIn this double blind, controlled study, the hearts of 24 anaesthetized mongrel dogs were arrested for 2 hours with aortic cross clamping and blood cardioplegia. The treatment groups were those supplemented with 2 mmol/L L-arginine (ARG), supplemented with 1 mmol/L adenosine (ADO), ARG + ADO supplemented with both, and no supplementation (control) (n = 6 in each group). Haemodynamics, biochemical indices, adenosine triphosphate (ATP) content and myeloperoxidase activities of myocardium were determined to evaluate myocardial injury. Statistical comparison was performed by two way ANOVA.

RESULTSAlthough the requirements for inotropic supports were higher, the cardiac outputs were lower in control group than in ARG, ADO and the combination groups. Plasma cardiac troponin I levels were higher and the areas of hydropic changes were larger in control group than in ARG and ADO groups. Combination of arginine and adenosine provided further myoprotection with respect to better cardiac performance, lower release of cardiac troponin I, and smaller areas of hydropic changes compared with ARG and ADO groups. ATP content was higher, but myeloperoxidase activities of myocardium were significantly lower in the combination group than in control, ARG and ADO groups (P < 0.05).

CONCLUSIONSCombination of L-arginine and adenosine provides synergistic myoprotection in a canine model of global myocardial ischaemia. Thus, the combination is recommended when the heart is exposed to a prolonged ischaemia during cardiac surgery.

Adenosine ; therapeutic use ; Adenosine Triphosphate ; analysis ; Animals ; Arginine ; therapeutic use ; Cardiotonic Agents ; therapeutic use ; Disease Models, Animal ; Dogs ; Drug Synergism ; Energy Metabolism ; Female ; Heart Arrest, Induced ; Male ; Myocardial Reperfusion Injury ; prevention & control ; Myocardium ; metabolism ; pathology ; Peroxidase ; metabolism

Adult ; Female ; Humans ; Kidney Transplantation ; Laparoscopy ; methods ; Living Donors ; Male ; Middle Aged ; Nephrectomy ; methods

BACKGROUNDLaparoscopic dismembered pyeloplasty with less trauma than open surgery is commonly performed for ureteropelvic junction obstruction despite a longer operating time and a long learning curve. We describe in this paper a new technique, which combines laparoscopic and open procedure in dismembered pyeloplasty, that we have developed in 51 patients and achieved excellent results.

METHODSThe surgical procedure can be divided into two steps: laparoscopic dissection of the renal pelvis and proximal ureter transperitoneally; then accomplishing the pyeloplasty through the extended port incision above the ureteropelvic junction as in open surgery.

RESULTSAll 51 operations were successful without conversion to open surgery. No intraoperative complications were observed. The operating time was 40 minutes to 90 minutes with an average of 57.5 minutes. The estimated blood loss was 15 ml to 30 ml with an average of 21.2 ml. Aberrant artery vessel and primary stricture as the cause of ureteropelvic junction obstruction was noted in 2 and 49 patients, respectively. Thirty-nine patients had fever to differing extents in the 4 days postoperation and no severe infection was observed. Four patients had urinary leakage with their drains being retained for 6 days, 6 days, 5 days or 8 days after the operation. The mean followup was 10.8 months (range 3 months to 36 months). The followup showed good results with symptom resolution in all the patients. Renal ultrasonography demonstrated that the average separation of the collecting systems decreased from preoperative 2.7 cm (range 2.0 cm to 4.7 cm) to postoperative 1.5 cm (range 1.0 cm to 2.3 cm). Excretory urography at 3 months postoperatively showed improved drainage. Of the 51 patients, 35 underwent two or more excretory urograms, demonstrating stable renal function, improved drainage and no evidence of recurrent obstruction. At the last followup visit, each patient was doing well.

CONCLUSIONSCombination of laparoscopic and open procedure in dismembered pyeloplasty offers a simpler, timesaving method in a minimally invasive fashion with low morbidity for patients with ureteropelvic junction obstruction. Ensuring quality of repair, the method provides a minimally invasive alternative with good results. It is worth future clinical application.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Humans ; Kidney Pelvis ; surgery ; Laparoscopy ; methods ; Male ; Middle Aged ; Ureteral Obstruction ; surgery ; Urologic Surgical Procedures ; methods

OBJECTIVETo study the clinicopathologic features of diffuse large B-cell lymphoma (DLBCL) with expression of anaplastic lymphoma kinase (ALK) protein.

METHODSNine hundred and forty-five (945) cases of DLBCL (including 177 consultation cases) diagnosed according to the 2001 World Health Organization classification of tumors of hematopoietic and lymphoid tissues were enrolled into the study. Immunohistochemical study for anti-ALK-11 was performed using LSAB technique. The ALK-positive cases were further confirmed by immunohistochemical study using EnVision technique. Only ALK-positive cases by EnVision technique were further analyzed by immunostaining for antigens including CD20, CD3, CD30, EMA, granzyme-B, TIA-1 and PC. Immunoglobulin heavy chain gene rearrangement study was also performed and follow-up data collected.

RESULTSThere were altogether 5 (4 males and 1 female) cases of DLBCL showing expression of ALK protein. The age of the patients ranged from 34 to 72 years. All were primary nodal DLBCL. One case belonged to clinical stage I, 2 in stage II and 2 in stage III. The duration of follow up ranged from 4 to 32 months. Three patients subsequently died and the longest survival was 32 months. Morphologic subtypes included centroblastic 2, anaplastic 1, immunoblastic with plasmacytoid differentiation 1 and plasmablastic 1. Immunohistochemically, 4 cases were CD20 positive (including 2 centroblastic, 1 anaplastic and 1 immunoblastic cases). The plasmablastic case expressed kappa light chain and was negative for CD20. Rearrangement of immunoglobulin heavy chain gene was demonstrated in all 5 cases studied. As for ALK protein staining, a mixed membranous and cytoplasmic (1 immunoblastic case), granular cytoplasmic (2 centroblastic and 1 anaplastic cases) and mixed nuclear and cytoplasmic (1 plasmablastic case) patterns were observed.

CONCLUSIONSExpression of ALK protein is a rare phenomenon in DLBCL and can be seen in centroblastic, anaplastic, immunoblastic and plasmablastic subtypes. It is often associated with aggressive clinical behavior and worse prognosis. A new pattern of ALK protein expression, mixed membranous and cytoplasmic, is reported.

Adult ; Aged ; Antigens, CD20 ; metabolism ; Female ; Follow-Up Studies ; Gene Rearrangement, B-Lymphocyte, Heavy Chain ; genetics ; Humans ; Immunoglobulin kappa-Chains ; metabolism ; Immunohistochemistry ; Lymphoma, Large B-Cell, Diffuse ; genetics ; metabolism ; pathology ; Male ; Middle Aged ; Neoplasm Staging ; Polymerase Chain Reaction ; Prognosis ; Protein-Tyrosine Kinases ; metabolism ; Receptor Protein-Tyrosine Kinases

Objective To determine the efficient cut-off points of fasting fingertip blood glucose test for undiagnosed diabetes mellitus(DM), impaired glucose tolerance(IGT), and impaired fasting glucose(IFG)in community-based residents aged above 45 years old. Methods A cluster-randomized study was conducted from May 2008 to January 2009. A total of 3250 subjects aged above 45 years in two communities of Baoding city received questionnaire investigation and tested for fingertip blood glucose. Those subjects whose capillary blood glucose level ≥5.1 mmol/L were subjected to 75 g oral glucose tolerance test. Undiagnosed diabetes mellitus and pre- diabetes were identified by fasting plasma glucose and OGTT. In this study, the cut-off points of fasting capillary blood glucose for detecting undiagnosed diabetes and pre-diabetes were evaluated, using receiver operator characteristic curve(ROC). Results Of 1351 subjects that having had oral glucose tolerance test, 230 cases were diagnosed as diabetes mellitus(7.3%), 166 cases(5.2%)as IFG, and 204(6.7%)as IGT under fasting capillary blood glucose as test variable and state variables according to the following criteria.(1)FPG≥7.0 mmol/L or/and 2hPG≥11.1 mmol/L(2)FPG<5.6 mmol/L (3)FPG<7.0 mmol/L and 7.8 mmol/L≤2hPG≤ 11.1 mmol/L, areas under three ROC curves were 0.905, 0.633 and 0.719, respectively. The cut-offvalues of screening for undiagnosed DM, IGT and IFG were 6.0 mmol/L, 5.7 mmol/L, and 5.7 mmol/L, respectively. When cut-off value of screening for undiagnosed DM was 6.0 mmol/L, the maximal sensitivity was 78.0% and specificity was 89.3%.But there were both lower sensitivity and specificity in screening for IFG and IGT according to the best predicting value(5.7 mmol/L)from the ROC curves(50.3% and 28.0% vs. 60.8% and 28.0%). Conclusion Fasting capillary blood glucose with the lower cut-point of 6.0 mmol/L in screening for undiagnosed diabetes mellitus alone, was relatively reliable, whereas for both IFG and IGT the fasting fingertip blood glucose tests were fallible. It was convenient and could be used in screening the DM at the community level.

OBJECTIVETo investigate the value of 11C-PD153035 as an EGFR imaging agent in C6 tumor-bearing rat.

METHODSThe tumor-bearing rats were generated by subcutaneous injection of glioma C6 cells. Positron emission tomography/computer tomography (PET/CT) scans started as soon as intravenous injection of 11C-PD153035 (15-20 MBq/0.3 ml) was completed, images were collected continuously. The region of interest (ROI) was used to study the percentage of radioactivity in major organs and implanted tumors in the rats. The accumulation and blocking study in vitro was completed.

RESULTSThere were significant differences in 11C-PD153035 uptake among major organs. The maximum uptake in the organs ranked in the following order: liver > gastrointestinal tract > kidney > lung > brain > muscle. Radioactivity could be also observed in the tumors. The radioactivity ratio (T/NT, target/non-target) peaked (4.15) at 40 - 50 min post injection. The in vitro blocking study showed that 11C-PD153035 uptaken by C6 cells could be blocked by PD153035.

CONCLUSIONThe results of this study show that 11C-PD153035 can be uptaken by EGFR-expressing tumors. 11C-PD153035 has a potential as a bioprobe to yield useful information for both diagnosis and therapy of tumors. However, the high concentration of 11C-PD153035 in the gastrointestinal tract is unfavorably affecting the tumor detection in these organs.

Animals ; Brain Neoplasms ; diagnostic imaging ; metabolism ; pathology ; Carbon Radioisotopes ; Cell Line, Tumor ; Gastrointestinal Tract ; metabolism ; Glioma ; diagnostic imaging ; metabolism ; pathology ; Liver ; metabolism ; Male ; Neoplasm Transplantation ; Positron-Emission Tomography ; Quinazolines ; pharmacokinetics ; Rats ; Rats, Wistar ; Receptor, Epidermal Growth Factor ; metabolism ; Tissue Distribution ; Tomography, X-Ray Computed