Objective To explore the value of hydronephrosis volume measured by 64 slice CT scan, evaluating renal function in patients with obstructive hydronephrosis.Methods The patients performed with both single photon emission computed tomography(SPECT) renal dynamic imaging and 64 slice CT scan in three days were chosen, 176 cases included finally.The images of renal dynamic imaging were divided into normal renal function group, mild renal impairment group, moderate renal impairment group and severe renal impairment group according to glomerular filtration rate (GFR) measured by SPECT.At the same time, CT three-dimensional reconstruction technique has been used to measure the volume of hydronephrosis, compare the differences of hydronephrosis volume among these groups, and future analyze the correlation of hydronephrosis volume with renal GFR value.Results The hydronephrosis volume of the four groups were respectively (31.47±3.81) cm3,(83.43±7.81) cm3,(208.53±15.47) cm3 and (577.31±61.32) cm3.There was statistical significance among these groups (P<0.01),except between normal renal function group and mild renal impairment group.The volume of hydronephrosis showed positive correlations with renal GFR (r=-0.614).Conclusion The volume of hydronephrosis measured by 64 slice CT has positive correlation with GFR measured by SPECT, which could reflect renal function to some extent.

Objective:To explore the effects of exosomes derived from bone-marrow endothelial progenitor cells(EPCs-Exos)on the angiogenesis and collagen deposition in vitro,and to illustrate the possible mechanism for EPCs-Exos to accelerate the cutaneous deficiency repair.Methods:The endothelial progenitor cells (EPCs) were isolated, cultivated and identified;at the same time, the EPCs-Exos were also isolated and identified.The EPCs-Exos uptake in EPCs was observed and analyzed.16 rats were randomly divided into 4 groups, and then the models of skin defect were established, respectively.The equal volume of PBS and 50, 100, 150 mg·L-1 EPCs-Exos were injected into the area around skin defect of the rats in 4 groups.The wound closed sizes on the 0, 3rd, 7th and 14th days were measured, and Masson''s trichrome staining and CD31 immunofluorescence staining were performed on the 14th day for evaluating the tissue healing efficacy after EPCs-Exos treatment.In vitro,the mediums containing PBS and 50, 100, 150 mg·L-1 EPCs-Exos were used to culture the human umbilical vein endothelial cells (HUVECs), respectively.Scratch test and tubule formation assay were used to detect the migration and capillary network formation of HUVECs.At the same time, Western blotting was used for analyzing the expression level of angiogenesis related gene vascular endothelial growth factor A (VEGFA) in HUVECs.Results: The primary EPCs were isolated and identified successfully, and EPCs-Exos were purified and characterized.The CD31 immunofluorescence staining and double staining of DiL-ac-LDL and FITC-UEA-I of EPCs were positive.The electron microscope results showed that EPCs-Exos were nearly spheroidal, with the diameter about 40-100 nm.For the models of rat skin injury treated by EPCs-Exos, with the increasing of injection doses, the sizes of skin defect scar were gradually reduced, the degrees of scar healings were gradually increased,and the differences between various groups were statistically significant (P< 0.05).EPCs-Exos promoted the collagen maturity of healing skin in a dose-dependent manner;on the 14th day, the effect in 150 mg·L-1 EPCs-Exos group was the most significant.In vitro, EPCs-Exos promoted the migration and capillary network formation of HUVECs and increased the expression level of VEGFA;the migration rate,the net number of branches and the expression level of VEGFA in 150 mg·L-1 EPCs-Exos group were significantly higher than those in 50 mg·L-1 EPCs-Exos group and PBS group (P< 0.05).Conclusion: EPCs-Exos can promote the repair of traumatic skin defect of the rats by positively regulating the vascular endothelial cell function.

Objective To evaluate the treatment of ilioinguinal approach surgery associated acute iatrogenic deep venous thrombosis (DVT).Methods The clinical data and treatment of 11 patients with ilioinguinal approach surgery associated acute iatrogenic DVT were analyzed.Results These 11 patients initially suffered from complicated acetabulum fracture,7 cases were treated by single ilioinguinal approach surgery and the other 4 cases were combined with Kocher-Langenbeck approach.In 3 days after surgery,DVTs were found by Doppler sonography,and all the DVTs were proved having closed relationships with ilioinguinal approach through digital subtraction angiography(DSA):iliac-femoral veins appeared stenosis at ilioinguinal segment in all the 11 cases,DVTs were found distal to the stenosis in 9 cases,both sides in 2 cases (1 case combined extensive iliac vein emphraxis and the other case combined extensive femoral vein emphraxis).After retrievable inferior vena cava filters were implanted,11 patients received catheter-directed thrombolysis for 5-12 days.Complete thrombolysis was achieved in 8 cases and thrombi residual left in 3 cases.The iliac-femoral veins were recanalized completely.After (10 ± 4) month fellow-up,no DVT recurred and no PTS appeared.Conclusions Ilioinguinal approach surgery seriously effects iliac-femoral veins,and is a important precipitating factor of DVT.Early catheter-directed thrombolysis under the protection of inferior vena cava filter is an effective treatment.

Objective To observe the effects of TLR9 on the nude mouse transplanted tumor growth of human pancreanc cancer and its drug resistance.Methods The nude mouse transplated tumor of human pancreatic cancer PANC-1 was established and randomly divided into 6 groups for conducting the experiment:sterile normal saline group,TLR9 agonist,TLR9 inhibitor group,gemcitabine group,TLR9 inhibitor plus gemcitabine Bin group,TLR9 agonist plus gemcitabine.The tumor size and growth situation were recorded by the vernier caliper.The immunohistochemical method was used to detect tumor TLR9 receptor expression.The tumor growth,metastasis and paracancerous nssue invasion situation were observed by the magnetic resonance imaging (MRI).Results The volume and growth speed of resected tumor mass in the gemcitabine group,TLR9 agonist + gemcitabine group,TLR9 inhibitor plus gemcitabine group was significantly smaller than those in other groups (P＜0.05),which in the TLR9 agonist + gemcitabine group were significantly greater than those in the TLR9 inhibitor plus gemcitabine group and gemcitabine group (P＜0.05),the difference between the TLR9 inhibitor plus gemcitabine group and gemcitabine group had statistical significance (P＜0.05),while the difference among the TLR9 agonist group,TLR9 inhibitor group and normal saline group had no stastistical significance (P＞0.05).The tumor in mice at 7 weeks after planting showed oval shape with clear boundary by MRI observation,no obvious metastais and paracancerous invasion were seen in paracancerous nssues no statistically significant,5 weeks,6 weeks after planting,seven weeks mice observed in MRI,the tumor into an,state clearly that the transfer of the surrounding tissue,no significant vascular invasion,heart,liver,kidney disease.The TLR9 expression on the surface of tumor tissue was detected and identified.Conclusion Pancreatic cancer nude mouse transplated tumor has definitely positive expression of TLR9,TLR9 activation can significantly decrease the sensitivity of pancreatic cancer to chemotherapy,increases the drug resistance of tumor,on contrary promotes the tumor growth.

Objective To investigate the indication,techniques,safety and efficacy of medical suture versus traditional suturein thoracoscopic surgery incision closure.Methods From October 2014 to January 2016,121 patients undergoing thoracoscopic surgery were divided into two groups according to the method of incision closure:53 cases of traditional suture group and 68 cases of medical suture hasp group.The time of closure,healing time,wound healing scores and patient's satisfaction were recorded and statistically analyzed.Results All patients were successfully operated without perioperative death.One patient underwent postoperative bleeding in the medical suture hasp group.The medical suture hasp was found to be reliable and easy to remove in secondary operation.The postoperative incision was changed to traditional suture.Two patients in each group had delayed healing.Two patients of medical suture hasp group were caused by incision bleeding,of whom one case switched to traditional suture,and one patient was treated with pressure bandage and healed.The wound closure time of the medical suture hasp group was significantly shorter than that of the traditional suture group:(110.0 ± 12.7) s vs.(305.0 ± 31.6) s,P ＜ 0.01.The wound healing scores of medical suture hasp group were higher than those of traditional suture group 2 weeks and 1 month after surgery (P ＜ 0.01).There was no significant difference in healing rate between two groups (P ＞ 0.05).The satisfaction scores of the patients in medical suture hasp group were higher than those in traditional suture group (P ＜ 0.01).Conclusions The use of medical suture hasp in the thoracoscopic surgical incision closure process is safe and reliable.It can accelerate the early repair of incision,and improve patient's satisfaction.

BACKGROUND:There is a very close relationship between osteoporosis and periodontal disease in postmenopausal women, but the mechanism remains unclear. OBJECTIVE:To investigate the expression of nuclear factor-κB in the alveolar bone andinterleukin-17 in the serum and gingiva in the mouse model of osteoporosis caused by ovariectomy. METHODS:Female mice aged 3 months were randomly divided into ovariectomy and sham operation groups. At 6 months after surgery, the mouse models were evaluated histologically on the submandibular bone and thigh bone stained with hematoxylin and eosin. In the submandibular bone, the expression levels of OCN and Runx2 were detected by RT-PCR, and the expression level of nuclear factor-κB was detected by immunohistochemical staining and western blot assay. Besides, the expression level of interleukin-17 in the serum and gingival homogenate was evaluated using Cytometric Beads Array. RESULTS AND CONCLUSION:The thigh bone in the ovariectomy group revealed the thin cortical bone, enlarged marrow cavity, and increased resorption lacunae, as well as fewer, thinner trabeculae with lower density and irregular structure. Compared with the sham operation group, the expression levels of OCN and Runx2 in the alveolar bone were decreased in the ovariectomy group. The activation of nuclear factor-κB (P65)appeared with P65 positive expression in the submandibular bone in the ovariectomy group, and the relative expression level was higher than that in the sham operation group. The serum level of interleukin-17 in the ovariectomy group was higher than that in the sham operation group, but the level in the gingival tissue showed no significant difference between the two groups. These results indicate that estrogen deficiency after ovariectomy can activate nuclear factor-κB signal pathway to play a role in periodontal osteolysis. However interleukin-17 in the local periodontal tissue may not be a key cytokine to damage the periodontal tissue.

Objective To analyze the causes of misdiagnosis of esophageal leiomyoma.Methods The clinical data of 20 patients who were preoperatively misdiagnosed as esophageal leiomyoma at our hospital in 16 years were retrospectively analyzed.There were 11 males(55%) and 9 females(45%) with a mean age of(45.9 ± 16.4) years(range, 13-71 years).The initial presentations were obstructive symptoms in 12 patients(60%).CT imaging were performed in 9 patients(45%), of which 4 cases were enhanced CT(20%).Results The misdiagnosed patients included 5 cases of extraesophageal lesions(4 cases of paraesophageal lymph node tuberculosis and 1 case of lymph node hyperplasia), 8 cases of begin interstitial diseases(3 cases of neurinoma, 3 cases of inclusion cyst, 2 cases of angioma), 5 cases of malignant interstitial diseases(4 cases of GIST, 1 case of PNET), and 2 cases of esophageal cancer.The 4 cases of esophageal tuberculosis were misdiagnosed due to the absence of CT examination.The patients with esophageal cancer were treated with esophageal resection and reconstruction without clear staging of the tumor.This might be associated with the neglection of the rapid symptom development and the characteristic lumen stenosis under the gastroscope.The characteristic mucosal ulcer in patients with highly malignant GIST was overlooked.The disease relapsed postoperatively because only tumor enucleation was performed.Conclusion Preoperative diagnosis of esophageal leiomyoma is not uncommon.This disease is most often misdiagnosed as paraesophageal lymph node tuberculosis or esophageal GIST.CT examination is useful in distinguishing esophageal leiomyoma and paraesophageal lymph node tuberculosis.The roles of reoperation and adjuvant therapy in the surgical treatment of esophageal leiomyoma need further investigation.

Objective To study the endogenous glucocorticoid on rat femoral head microenvironment of 11 hydroxysteroid dehydrogenase expression ,and to discuss the influence of combined with femoral head pathological changes of the corresponding mechanism .Methods Sixty SD rats were divided into control group ,1‐month group ,3‐months group ,each 20 rats in group .1‐month group and 3‐months group inject cortisone acetate in the abdominal cavity intraperitoneal for 1‐month or 3‐months each .Im‐munohistochemical ,immunofluorescence ,Real‐time qPCR ,HE staining were employed in this study .Results From immunohisto‐chemical ,immunofluorescence ,Real‐time qPCR ,the 11 hydroxysteroid dehydrogenase content of 1‐month group and 3‐months group were higher than that of the control group(P<0 .05) .From HE staining we detected 1‐month group in the bone marrow cavity in‐creased in fat cells ,3‐months group subchondral trabecular bone density decreased ,compared with the control group(P< 0 .05) . Conclusion Supplement of corticosterone could promote rat femoral head microenvironment 11 hydroxysteroid dehydrogenase ex‐pression and subchondral trabecular bone density decrease .

Objective To study the correlation between prognosis and the sequence of vessel interruption during thoracoscopic lobectomy for early stage non-small cell lung cancer.Methods Retrospective analysis of the 1 134 cases underwent lobectomy between September 2006 and October 2012 was conducted.There were 277 cases underwent completely thoracoscopic lobectomy and confirmed as stage Ⅰ-Ⅱ non-small cell lung cancer by pathology.The cases were divided into three groups according to the vessel interruption sequence:pulmonary vein ligated first(Group V) 152 cases,pulmonary artery ligated first (Group A) 76 cases,and artery-vein-artery group(Group M) 49 cases.The preoperative condition,operative factors and the prognosis of the three groups were reviewed.All of the data for statistical analysis,count data by chi-square test.Measurement data using t test,Kaplan-Meier method applied survival analysis,Log-rank test and Cox regression model analysis for single factor and multiple factors.Results The groups were similar in age,sex,smoking history,pulmonary infection history,main comorbidity,malignant history,diameter,tumor maker and preoperative lung function.The blood loss during the operation is 109.9 ml in Group A,which is significantly less than Group V (157.5 ml),and Group M had the median blood loss 123.7 ml (P =0.027).The length of operation and postoperative complications were similar among the three groups.The recurrent conditions were also similar among the three groups,which were mostly distant metastasis.There was no significant difference statistically in disease free survival(DFS) and overall survival(OS) among the three groups.Conclusion Ligating the pulmonary artery first could decrease the blood loss during completely thoracoscopic lobectomy for stage Ⅰ-Ⅱ non-small cell lung cancer.But it did not have any influence on the surgical difficulty and postoperative complications.The sequence of vessel interruption during lobectomy by thoracoscopic surgery did not have difference effect on the prognosis of lung cancer.

Objective To investigate the efficacy of 3D conformal radiotherapy for late-stage pancreatic cancer and determine relavent prognostic factors.Methods Fifty patients with advanced pancreatic cancer were divided into 3 groups according to treatment planning: palliative radiotherapy (group A) at 10.8-56 Gy, radiotherapy alone (group B) at 8-60.5 Gy and concurrent chemoradiother-apy (group C) at 10-64 Gy.All patients received 3D-conformal radiotherapy, and smaller multiple ports were used for palliative treatment whereas large fields including pancreatic tumors and adjacent lymph node drainage system were adopted in the beginning of radiotherapy.Concurrent chemotherapy with gemcitabine (200-600 mg/m~2) alone was used with weekly protocol.Results The duration of follow-up was 3-35 months.Forty three patients died during the follow-up for multiple metastasis, de-teriation, secondary infection and hemorrhage.Among the seven surviving patients, 3 received concur-rent radiotherapy, 3 radiotherapy alone and 1 palliative radiotherapy.Only 1 patient was alive in group A.However, the symtoms were relieved in 46% of the patients.The median survival time was 5.07 months whereas it was 4.33 months for patients received less than 45 Gy and 7.33 months for patients received 45 Gy or more.Three patients were alive in group B and the symptoms were relieved in 81% of the patients.The median survival time was 6.65 months whereas it was 4.36 months for patients received less than 45 Gy and 8.33 months for patients received 45 Gy or more.Three patients were a-live in group C and the symptoms were relieved in 89% of the patients.The median survival time was 9.89 months.One patient survived for 3 months after 8 Gy irradiation.The median survival time was 10.73 months for patients received 45 Gy or more.Conclusion 3D-conformal radiotherapy is safe and effective in treatment of advanced pancreatic cancer.The symptom relieving rate and median survival time seem to be related to patient's status, extent of disease, choice of treatment and irradiation dos-age.3D-confromal concurrent chemoradiotherapy leads to the longest survival time in some patients.