Objective To discuss the diagnosis and treatment of acquired cystic kidney disease complicated by kidney cancer. Methods Clinical data of 11 patients with acquired cystic kidney disease complicated by kidney cancer were analyzed retrospectively. Eight patients were male and three were female. The mean age was 55 years old (range 37 to 68). The time of hemodialysis ranged from 2.8 to 7. 4 years, mean 4. 8 years. Results Follow-up ranged from 17- 83 months, mean 55 months. One patient died of cardiovascular disease. Lung metastasis was detected in one patient two years after surgery. Seven patients survived free of tumor recurrence and there was no follow-up on one patient. Conclusions Increased incidence of cancer was observed in patients with end-stage renal disease who have undergone long-term dialysis. In particular, renal cell carcinoma (RCC) showed an excess incidence in ACKD patients. RCC showed an increased prevalence compared with the general population. Patients with predialysis azotemia or a dialysis duration of longer than 3 years should be screened for ACKD. Sonegraphy or CT scanning are useful for early diagnosis of ACKD. We should pay close attention to complications, including ACKD malignant tendency, in patients who have been taking long-term dialysis and positive therapy.

Objective To compare the results of the anterior approach (AA) with the conventional approach in the treatment of large hepatocellular carcinoma (HCC).Methods We searched the Medline,PubMed,Cochrane Library,Wanfang database on randomized clinical controlled trials and non-randomized clinical controlled trials comparing AA with the CA in right hepatic resection for large hepatocellular carcinoma.The data were analyzed with the RevMan5 software.Results Five non-randomized clinical controlled trials (NRCTs) and three randomized clinical controlled trials involving 615 patients (304 in the AA group,311 in the CA group) were enrolled into the analysis.There was no significant difference in the operation time between the two groups.Compared with the CA,the AA had lower intraoperative blood loss (WMD=-680.2 ml; 95％CI,-1023.97～-336.43;P=0.0001),blood transfusion rate (OR=0.38;95％ CI,0.25～0.59;P＜0.0001),intraoperative tumor rupture (OR=0.33;95％CI,0.11～0.97;P=0.04),surgical complication (OR=0.59;95％CI,0.38 ～ 0.93 ; P =0.02),hospital mortality (OR =0.37 ; 95 ％ CI,0.21 ～ 0.67 ; P =0.0009),and hospital stay (WMD=-4.75 d;95％CI,-7.82～-1.67;P=0.002).Conclusion AA is superior to CA in the treatment of larger.The operation time is the same for the 2 approaches.

Objective To analyze the clinicopathological characteristics and the prognostic survival factors of young patients who have undergone hepatectomy for primary hepatic carcinoma.Methods Clinicopathological da-ta and treatment outcomes in 79 young (≤40 years old)and 67 elderly (≥65 years old)patients who underwent hep-atectomy for primary hepatic carcinoma between 2008 and 2012 were retrospectively collected and compared using various parameters.Then the survival rate and prognostic factors of the younger patients were analyzed using Kap-lan-Meier and COX multivariate proportional hazards model.Results The positive rate of HBs-antigen and alpha-fetoprotein level were significantly higher in the younger patients than in the elderly patients (P<0.05).However, the positive rate of Anti-HCV-Ab was markedly lower in the younger patients (P<0 .0 5 ).The two groups did not significantly differ in gender,clinical symptoms,intraoperative parameters or pathological features (P>0.05).The overall survival rate was similar between the two groups.COX multivariate proportional hazards model analysis showed that the independent prognostic factors of overall survival were pre-operative albumin level <3 5 g/L and maximum tumor diameter ≥5 cm.Conclusion Hepatectomy is a safe and feasible treatment for young and elderly patients with primary hepatic carcinoma.The independent prognostic factors of survival for young patients are pre-operative albumin level <3 5 g/L and the maximum tumor diameter ≥5 cm.

OBJECTIVETo investigate the effect of salidroside on hypoxia-induced apoptosis of corpus cavernosum smooth muscle cells (CCSMCs) in rats.

METHODSRat CCSMCs were cultured in vitro by the enzyme digestion method and identified by immunofluorescent staining of anti-alpha-SMA and anti-Desmin. The non-toxic dose of salidroside was determined by MTT assay. Low-oxygen mixed gas (1% O2, 5% CO2, and 94% N2) was piped into a modular incubator chamber to induce hypoxia. The CCSMCs were divided into a normal, a hypoxia, and a 32 microg/mL salidroside intervention group. The apoptosis of the CCSMCs was detected by flow cytometry and the expression of the caspase-3 protein determined by Western blot.

RESULTSThe majority of the CCSMCs were positive for alpha-SMA and Desmin at immunofluorescent staining. Salidroside at < 32 microg/ml produced no obvious toxicity to CCSMCs. Compared with the normal control group, the rates of early and late apoptosis of CCSMCs were both increased significantly in the hypoxia group ([12.77 +/-1.41]% vs [18.69 +/- 1.29]%, P < 0.01 and [14.63 +/- 2.00]% vs [21.03 +/- 1.530]% , P < 0.05). Western blot showed a markedly increased expression of cleaved caspase-3 (P < 0.01). Intervention with 32 microg/ml salidroside significantly reduced hypoxia-induced early apoptosis of CCSMCs ([13.46% +/- 1.87]%, P < 0.01) and decreased the expression of cleaved caspase-3 (P < 0.01).

CONCLUSIONSalidroside can reduce the expression of cleaved caspase-3 and inhibit hypoxia-induced apoptosis of CCSMCs in rats.

Animals ; Apoptosis ; drug effects ; physiology ; Caspase 3 ; metabolism ; Cell Hypoxia ; physiology ; Cells, Cultured ; Glucosides ; pharmacology ; Humans ; Male ; Myocytes, Smooth Muscle ; cytology ; drug effects ; enzymology ; Penis ; cytology ; drug effects ; Phenols ; pharmacology ; Rats

Eighty six patients with renal masses≤4.0 cm underwent ultrasound or CT-guided core needle biopsies.The clinical data including the initial biopsy technique,pathologic findings,and the clinical outcome were retrospectively reviewed. Biopsies were failed for diagnosis in 6 cases ( 7％ ) because of necrosis or hemorrhage of the tissue specimens.Of 80 successful biopsies,52 cases (65％) were diagnosed as malignant tumor and 28 cases (35％) as benign. Five patients had biopsy complications (6％),including postoperative hypotension,hemouria and perirenal hematoma. Forty-seven patients underwent surgical extirpation ; the consistency rate of histopathological diagnosis between biopsy and surgical specimens was 100％ in these patients.The results indicate that ultrasound or CT-guided core needle biopsy is an effective and safe procedure for diagnosis of renal small masses.

OBJECTIVETo compare therapeutic effects between suspine rotation and flexion manipulation for treating lumbar disc herniation.

METHODSFrom December 2008 to January 2011, 134 patients with lumbar disc herniation were treated, including 74 males and 60 females,ranging in age from 17 to 67 years,33 patients with age over 50 years old. According to diagnosis the ladder of the 9 cases bulging type, 74 hernia type, 51 cases free type. The patients were randomly divided into treatment group ( 69 cases) and control group (65 cases). All the patients were treated with the three-dimensional computer-controlled traction therapeutic apparatus,with continued traction for 20 minutes. After traction, flexion manipulation and rotat-ing manipulation were respectively adopted in treatment group and control group (on alternate days one time, 3 times as a course of treatment). The symptoms and signs (including back pain and discomfort, lower limb pain and numbness, powerless urination and defecation,numbness in perineum, straight-leg raising degree,ability of lower extremity walking,work and live) of patients were observed after treatment.

RESULTSAll patients were followed up for 0.5 to 6 months with an average of 1.1 months. After treatment, the symptoms and signs of patients have significantly improved (P < 0.01), but the symptomes of powerless urination and defecation,numbness in perineum was not improved obviously (P>0.05). Forty-two of 69 patients in treatment group got excellent result, moderate in 20, poor in 7; Twenty of 65 patients in control group got excellent result, moderate in 25,poor in 20.

CONCLUSIONThe whole effect of lumbar backwards rotation manipulation is more satisfactory than flexsion manipulation for treating lumbar intervertebral disc herniation. But spinning force and times should be noticed.

Adolescent ; Adult ; Aged ; Case-Control Studies ; Female ; Humans ; Intervertebral Disc Displacement ; physiopathology ; therapy ; Lumbar Vertebrae ; physiopathology ; Male ; Manipulation, Orthopedic ; methods ; Middle Aged ; Recovery of Function ; Rotation ; Young Adult

OBJECTIVETo compare the effect of different antegrade pulmonary blood flow on the further development of pulmonary artery after Glenn procedure in cyanotic congenital heart defects (CHD) patients.

METHODSBetween October 2000 and December 2006, 132 CHD patients with decreased pulmonary artery blood flow underwent bidirectional Glenn shunt, among them 18 patients received intraoperative lung biopsy. Patients were divided into two groups according to their different sources of antegrade pulmonary blood flow: antegrade arterial blood flow group (n = 33) and antegrade venous blood flow group (n = 99). The percutaneous oxygen saturation (SpO2), hemoglobin (Hb) concentration, and hemotocrit (Hct) value were examined and recorded before and after operation. The diameters of left pulmonary artery (LPA) and right pulmonary artery (RPA) were measured with two-dimensional echocardiography and the results were used to calculate the pulmonary artery index (PAI). The method of half-quantitative morphometric technique and an image analyzer were used to measure the following indicators of pulmonary microvessels: the percentage of media thickness (MT%), the percentage of media section area (MS%), vascular numbers of per square centimeter (VPSC), and mean alveolar number (MAN).

RESULTSBefore the operation, obvious cyanosis was found in both groups, while SpO2, Hct, and Hb were not significantly different (P > 0.05). LPA, RPA, and PAI were not significantly different between two groups (P > 0.05). The MT% and MS% in antegrade venous blood flow group were significantly less than those in antegrade arterial blood flow group (P < 0.05), but VPSC and MAN were not significantly different (P > 0.05). After Glenn procedure, hypoxia and cyanosis were remarkably improved in both two groups. There was a significantly negative correlation between SpO2 and Hct (r = -0.49, P < 0.01) or Hb (r = -0.196, P < 0.01 ). The PAI increased by 22% in antegrade arterial blood flow group and 44% in antegrade venous blood flow group (P < 0.05). The diameters of LPA and RPA in antegrade venous blood flow group were significantly larger than those in antegrade arterial blood flow group (P < 0.05) and the growth of RPA in antegrade arterial blood flow group was not significant.

CONCLUSIONA better pulmonary artery growth occurs in the patients of pulmonary stenosis after Glenn shunt than in those of pulmonary atresia, and it contributes to an earlier completion of Fontan procedure.

Blood Flow Velocity ; Cardiac Surgical Procedures ; Child ; Child, Preschool ; Female ; Heart Defects, Congenital ; physiopathology ; surgery ; Humans ; Infant ; Male ; Pulmonary Artery ; growth & development ; physiopathology ; surgery ; Pulmonary Veins ; physiopathology ; Treatment Outcome

OBJECTIVETo investigate the relationship between pulmonary pathological features and clinical physiology of congenital heart defects (CHD) with decreased pulmonary artery blood flow.

METHODSBetween July 2001 and May 2006, 18 patients with CHD with decreased pulmonary artery blood flow undergoing palliative or definitive repair and having lung biopsy intraoperatively were enrolled in this study. The patients' age was 0.4 - 8.0 years, and body weight was 6.0 - 20.0 kg. The method of semi-quantitative morphometric technique and an image analyzer were applied to measure the following indices of pulmonary microvessels: the percentage of media thickness (MT%), the percentage of media section area (MS%) and numbers of microvessels per square centimeter (VPSC). The diameters of left pulmonary artery (LPA) and right pulmonary artery (RPA) were measured with two-dimensional echocardiography. The percutaneous oxygen saturation (SpO(2)), hemoglobin concentration (HB) and hematocrit value (HCT) were examined and recorded preoperatively.

RESULTSThere was a significant negative correlation between SpO(2) and HCT or Hb (R(2) = 0.4914, P = 0.001 and R(2) = 0.5505, P < 0.001), the variation trend of these three variables was linked. There was a negative correlation between SpO(2) and the body weight (R(2) = 0.2208, P = 0.049), which is in accordance with clinical features of aggravated process of cyanosis and hypoxia. The morphological observation of lung biopsy specimens indicated that most of peripheral pulmonary arteries were distended, irregular and their walls were uneven, and "lake" type of pulmonary AV malformations were observed. There was a positive correlation between VPSC and the body weight or BSA (R(2) = 0.5472, P < 0.001 and R(2) = 0.5233, P = 0.001). There was a significant correlation between VPSC and LPA or RPA (R(2) = 0.4312, P = 0.003 and R(2) = 0.2463, P = 0.036). It was shown that the diameter of central pulmonary arteries could be a reflection of peripheral pulmonary artery growth. The diameter of LPA also correlated with the diameter of RPA (R(2) = 0.286, P = 0.022).

CONCLUSIONSFor patients with congenital heart defects with decreased pulmonary blood flow, the pulmonary pathological changes are the bases of their clinical physiologic features. It is suggested that they should be treated in their earlier stage of life.

Child ; Child, Preschool ; Female ; Heart Defects, Congenital ; pathology ; physiopathology ; Humans ; Infant ; Lung ; blood supply ; Male ; Pulmonary Artery ; abnormalities ; pathology ; physiopathology

BACKGROUNDThe molecular mechanism of human tetralogy of Fallot (TOF) is incompletely defined. Animal models have suggested that neurotrophic tyrosine receptor kinase 3 (NTRK3) might be associated with the outflow tract defect, similar to that seen in human TOF, however, the expression pattern of NTRK3 in human TOF heart tissues has never been investigated.

METHODSQuantitative real-time PCR (qRT-PCR) and immunohistochemistry were applied to detect NTRK3 mRNA and protein levels in right ventricular outflow tract tissue samples of TOF patients, ventricular septal defect (VSD) patients and normal control infants (n = 10 in each group).

RESULTSqRT-PCR analysis indicated that NTRK3 mRNA levels were significantly decreased in the TOF group compared to the VSD group (0.024 +/- 0.003 vs 0.085 +/- 0.004, P = 0.022) and the normal control group (0.024 +/- 0.003 vs 0.091 +/- 0.002, P = 0.006). Quantitative immunohistochemical analysis showed that NTRK3 protein was mainly localized in the myocardium cytoplasm in all 3 groups. The immunoreactivity of NTRK3 protein was again significantly lower in the TOF group compared to the VSD group (1.42 +/- 0.62 vs 14.12 +/- 1.83, P = 0.023) and the control group (1.42 +/- 0.62 vs 16.25 +/- 2.31, P = 0.008). The expression of NTRK3 in the VSD group and in the control group showed no significant differences at both mRNA and protein levels.

CONCLUSIONSInsufficient expression of NTRK3 is associated with the outflow tract defect of human tetralogy of Fallot and may contribute to the progression of this defect.

Female ; Humans ; Immunohistochemistry ; In Vitro Techniques ; Infant ; Male ; Receptor, trkC ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Temperature ; Tetralogy of Fallot ; genetics ; metabolism

OBJECTIVETo investigate the value of spiral CT examination for diagnosis occult fracture of the patients with negative result of X-ray examination and with high suspicion of fractures,so as to reduce misdiagnosis.

METHODSFrom January 2007 to June 2010, 31 patients with ankle trauma performed spiral CT examination, including 18 males and 13 females, ranging in age from 21 to 67 years, with a mean of 35 years. The main symptoms of the patients included ankle pain, local swelling, obvious tenderness and activity limitation. All the patients had negative results of X-ray examination.

RESULTSThe spiral CT examination revealed 11 patients with fractures, involving a total of 17 points. Single fracture were found in 6 cases,and multiple fractures were found in 5 cases. Among single fractures, the lateral malleolus fracture was found in 1 case, talus fracture was found in 1 case, scaphoid fracture was found in 1 case, the fracture of the base of 5th metatarsal base was found in 1 case and calcaneal fractures were found in 2 cases. Within multiple fractures,internal and lateral malleolus fracture were found in 1 case; medial malleolus, calcaneus and talus fractures were found in 1 case; talus and scaphoid fractures were found in 1 case; the fractures of 1st and 2nd cuneiform bone were found in 1 case; the 2nd and 3rd metatarsal base fracture was found in 1 case.

CONCLUSIONFor the patients with negative X-ray examination and high suspicion of fractures,the spiral CT examination is needed, which could significantly improve the detection rate of occult fractures, and provide imaging basis for clinical treatment and judicial identify.

Adult ; Aged ; Ankle Injuries ; diagnostic imaging ; Female ; Foot Injuries ; diagnostic imaging ; Fractures, Closed ; diagnostic imaging ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, Spiral Computed ; methods