BACKGROUND: Intravascular low-level laser irradiation (ILLLI) therapy with He-Ne laser can effectively inhibit the occurrence of heroin withdrawal syndrome, but the therapeutic effect should be evaluated by quantitative standards.OBJECTIVE: To evaluate the effect of intravascular low-level He-Ne laser irradiation against withdrawal syndrome with intravenous according to the criteria proposed by the authors.DESIGN: Randomized controlled trial in heroin-addicted patients.SETTING: Analysis and Testing Laboratory of Xinxiang Medical College and Center of Laser Medical Research of Zhenzhou University Medical CollegePARTICIPANTS: The study was completed in Center of Laser Medical Research in Zhengzhou University in January 2003. Thirty heroin addicts from the Detoxification Center of Zhengzhou including 25 male and 5 female patients aged 19- 45 years were divided randomly into experimental group and control group with 15 cases in each. The patients' history of drug abuse ranged from 0. 5 to 5 years and the daily doses they took was 1.0-4.0 g.INTERVENTIONS: Patients in the experimental group were treated by ILLLI therapy after hospitalization. The therapy was administered once daily for 60 minutes in each session, for a total of 10 days for a treatment course. The irradiating power of the laser was 2.0-3.0 mW with a power density of 7.07-10.6 mW/mm2. Patients in the control group were treated with conventional therapy with algidon combined with buprenorphine hydrochloride. The 12 main symptoms(vomiting, goose pimples, sweating, agitation, shaking, lacrimation, nasal congestion, insomnia, abdominal pain,body temperature changes, muscular pain, and heart rate changes) were scored for 0, 1, 2, and 3 corresponding to absent, mild, moderate, and severe symptoms, with the total score of 36.MAIN OUTCOME MEASURES: Comparison of the scores for the withdrawal symptoms between the two groups.RESULTS: The 30 cases were all available for result analysis. The scores of vomiting, insomnia, agitation, shaking, goose pimples and abdominal pain in the experimental group were 2.0±0.5, 2.5±0.4,4.6±0.3,3.6±0.7,3.1±0.3 and 5.7±0.6 respectively, which were obviously lower than those in control group(5.1±0.7,6.0±0.7,7.4±0.6, 7.1±0.6,5.7±0.6 and 6.4 ±0.7 respectively, t =9.90-16. 81, P＜0.01).CONCLUSION: Intravascular low-level He-Ne laser irradiation can effectively relieve heroin withdrawal syndrome.

Objective To observe the feasibility of laryngeal mask ventilation general anesthesia com- bined epidural block in laparoseopie eholecystectomy. Methods One hundred and forty eases of selective laparoscopie eholecystectomy were performed to T8～T9 gap catheterization, with 1.5 percent lidoeaine epi- dural block, block levels in the following T4. After conventional anesthesia into 4# or 5# LMA, balloon gas was injected in 20 mL～30 mL, manual ventilation, respiratory resistance and the situation thorax ups and downs were observed. Results The patients epidural catheterization smoothly, in the anesthesia plane fol- lowing T4, insert the LMA blood pressure, heart rate without significant change. Pneumoperitoneum after the rebound in blood pressure[(20.6 5.0) mm Hg], heart rate did not change significantly, and then airway pressure increased[(5.7 1.6)cm H2O] , surgery performed smoothly, and quickly regained consciousness after the surgery, when all patients admitted gallbladder, they have resumed breathing independently. Con- dusion Laryngeal Mask Airway general anesthesia combined epidural block cause mechanical damage vocal cords and airway, make the stress response light and the sense of rapid recovery, which is a safe and feasible method of anesthesia.

Objective.To evaluate the role of hysterectomy for patients with gestational trophoblastic tumor.Methods.We retrospectively analyzed 68 cases of gestational trophoblastic neoplasia treated by hysterectomy from 1985～1997 at PUMC hospital. Thirty-eight cases were diagnosed of choriocarcinoma and 30 were invasive mole.Results.Twenty-three elder patients who didn't desire to preserve fertility were selected for hysterectomy after shorter courses of chemotherapy, 22 of them had a complete remission(95.6%), the total aver-age courses of chemotherapy was 4.2. Of twenty-seven chemorefractory cases who were suspected of a refractory isolated lesion in the uterus, delayed hysterectomy as an adjunct to chemotherapy was performed, 20 of them got a complete remission(74.1%), the total average courses of chemotherapy were 9.4. Emergency hysterectomy is indicated in 18 patients with uterine perforation or life-threatening hemorrhage, 17 cases had a complete remission(94.4%), the total average courses of chemotherapy were 7.6.Conclusion.Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor, hysterectomy remains an important adjuncts in the treatment of a selected subset of patients; in order to operate more completely and prevent recurrence, it's better to perform extended hysterectomy for the indicated patients.

Retroperitoneal laparoscopic live donor nephrectomy offers an intrinsic advantage over conventional transperitoneal laparoscopic nephrectomy because of the potentially lower risk for early and late donor intraperitoneal complications. Herein we presented our experience performing retroperitoneal laparoscopic live donor nephrectomy in 105 donors. All donor nephrectomy was successful. There were no donor deaths and no conversion to open surgery. Mean operation time was 112 min (range, 70-200 min). Intraoperative blood loss was 10-150 mL with an average of 30 mL. Warm ischemia time was 1.3 to 6 min with an average of 3.1 min. Postoperative retroperitoneal hematoma occurred in only one case and there were no other surgical complications. Donors were discharged from the hospital 5 to 10 days postoperation. Average postoperative hospital stay was 6.4 days. One graft was removed due to acute rejection. Delayed graft function occurred in two recipients but renal function returned to normal within four weeks. The other recipients had normal renal function in two weeks except three recipients in four weeks. We believe that retroperitoneal laparoscopic live donor nephrectomy is safe, reliable, and less invasive.

Objective To investigate the relationship between raf kinase inhibitor protein (SKIP), a novel metastasis suppressor gene, and metastasis of ovarian carcinoma. Methods Immunohistochemistry, RT-PCR, and western blot analysis were performed to examine the expression of SKIP in clinical samples of ovarian tumors and five human ovarian carcinoma cell lines. Stable cell lines over-expressed or deleted of SKIP were cloned to investigate the function of SKIP in ovarian cancer cells. The recombinant plasmids expressing sense (ss) or antisense (as) SKIP cDNA or empty vector was transfected into ovarian cancer cell line SKOV3 by lipofectamine. The expression level of mitogen-activated protein kinase/extracellular signal-regulated kinase kinase (MEK) and extracellular signal-regulated kinase (ERK) in ovarian cancer cells were detected by western blot analysis. Assays of cell proliferation, soft-agar colony formation, cell adhesion, and cell invasion in vitro were used to examine the malignant phenotypes of the transfected cells. Flow cytometric analysis was performed to observe the effect of SKIP on cell cycle distribution before and after transfection. Results (1 ) The expression levels of SKIP protein in ovarian carcinoma tissues from patients were found to be reduced than those in ovarian benign tumor and borderline tumor. SKOV3 clones stably expressing full-length recombinant ssRKIP, asRKIP, and their respective empty vector were obtained. (2)RKIP was able to block basal levels of MEK and ERK in ovarian cancer cells. The expression level of phosphorylation MEK in ssRKIP#1 and ssRKIP#4 cells were 0. 35, 0. 34; while the expression level of phosphorylation ERK in ssRKIP#1 and ssRKIP#4 cells were 0.48 and 0.46. (3) Abilities of cell proliferation in the ssRKIP vector-transfected cells were decreased compared with that in the non-transfected cells (P ＜0. 01 ). (4)Anchorage-independent growth in the ssRKIP#1 and ssRKIP#4 cells (83.7 ± 5.7, 106. 0±9. 2) were decreased compared with that in the empty vector-transfected cells (158.3 ± 14. 6, P＜ 0. 01). (5)Cell adhesion in the ssRKIP#1 and ssRKIP#4 cells [(68.3±0. 8)%, (64. 1±0. 9)%] were decreased compared with that in the non-transfected cells [(100. 0 ± 1.1 )%, P ＜ 0. 01]. (6) Cell invasion in the ssRKIP#1 and ssRKIP#4 cells (24 ± 5, 25±4) were decreased compared with that in the non-transfected cells (68 ± 5, P ＜ 0. 01 ). (7) ssRKIP cells had a significant increase in the G1 phase and decrease in the G2 + S phase. Conclusion RKIP could inhibits the metastasis, but also the growth of ovarian cancer cells.

Objective.To evaluate the diagnosis and treatment for malignant gestational trophoblastic tumor(MGTT) with pulmonary metastasis complicated with pulmonary tuberculosis.Methods.To analyze ten cases of MGTT with pulmonary metastasis complicated with pulmonary tuberculosis in our hospital from 1980 to 1997 retrospectively.Results.From the x-ray film,there are great resemblances between MGTT with pulmonary metastasis and pulmonary tuberculosis.Of 10 patients,7 of them were examined out pulmonary tuberculosis during the chemotherapy of MGTT.Pulmonary tuberculosis appeared six months before chemotherapy in three cases.All of the patients were treated with multiagent chemotherapy.Seven patients achiceved a complete remission,2 patients developed drug resistance and died of cerebral haemorrhage and cerebral herniation,1 woman who had achieved a complete remission from MGTT for 14 months died of miliary tuberculosis.Conclusion.It is very important to make differential diagnosis of the MGTT with pulmonary metastasis complicated with pulmonary tuberculosis.Trying to avoid excessive anti-tumor treatment owing to mistake pulmonary tuberculosis for pulmonary metastasis,and avoiding missing an opportunity of anti-tuberculosis treatment because of missed diagnosis should be emphasized.

Retroperitoneal laparoscopic live donor nephrectomy offers an intrinsic advantage over conventional transperitoneal laparoscopic nephrectomy because of the potentially lower risk for early and late donor intraperitoneal complications.Herein we presented our experience performing retroperitoneal laparoscopic live donor nephrectomy in 105 donors.All donor nephrectomy was successful.There were no donor deaths and no conversion to open surgery.Mean operation time was 112 min (range,70—200 min).Intraoperative blood loss was 10—150 mL with an average of 30 mL.Warm ischemia time was 1.3 to 6 min with an average of 3.1 min.Postoperative retroperitoneal hematoma occurred in only one case and there were no other surgical complications.Donors were discharged from the hospital 5 to 10 days postoperation.Average postoperative hospital stay was 6.4 days.One graft was removed due to acute rejection.Delayed graft function occurred in two recipients but renal function returned to normal within four weeks.The other recipients had normal renal function in two weeks except three recipients in four weeks.We believe that retroperitoneal laparoscopic live donor nephrectomy is safe,reliable,and less invasive.

In early stage after liver transplantation(LT), coagulation function of recipients stays in a fragile balance. Affected by a variety of complex mechanisms, blood is usually hypercoagulable. An imbalance between coagulation factors and physiological anticoagulants, elevated level of vWF, an occurrence of fibrinolysis inhibition and dosing of immunosuppressive agents cause a hypercoagulable state in an early stage after LT. Blood hypercoagulability may lead to such thrombotic complications as hepatic artery, portal vein and deep vein thromboses. Some studies have demonstrated that postoperative prophylactic anticoagulation has some effect in reducing the risks of early postoperative thrombosis. However, there is still a great lack of high-quality evidence. This review summarized the latest researches on early coagulation dysfunction, thrombosis and preventive anticoagulation after LT.

Objective To determine the risk of pregnancy for patients who conceive within one year after successful chemotherapy for gestational trophoblastic tumor (GTT).Methods We followed up and analysed retrospectively 22 patients who conceived within one year after receiving chemotherapy for GTT from 1966 through 1996.Results Of 22 patients, 9 had term delivery, 1 had premature birth, 6 requested induced abortion, and 6 experienced therapeutic abortion because of repeated hydatidiform mole (1 patient), intrauterine death (1), inevitable abortion (1), or threatened abortion (3). The fetal wastage rate was 27.3% (6/22). The incidence of gestational trophoblastic disease (GTD), including hydatidiform mole, was 9.1% (2/22). The incidence of GTT was 4.5%. The average interval between completion of chemotherapy and pregnancy was 9.78 months in the group of term pregnancy and 6.50 months in the group of fetal wastage (P<0.05).Conclusions Patients conceiving within one year after successful chemotherapy for GTT are at higher risk for recurrence of GTD and fetal wastage. Therefore, patients with preserved fertility should practice contraception for at least one year after chemotherapy to get better pregnancy outcome.

Objective To investigate the safety and feasibility of robotic nephrectomy,work bench surgery with robotic kidney autotransplantation in the treatment of complex renal tumors.Methods The clinical data of 5 patients with renal tumors admitted from January 2018 to July 2018 were analyzed retrospectively.There were 4 males and 1 females.The median age was 49 years old,ranging 32-66 years.The median body mass index was 25.6 kg/m2,ranging 21.1-27.8 kg/m2.Serum creatinine level was 87.2 μmol/L,ranging 78.0-88.9μmol/L before bench surgery.5 patients had multiple bilateral renal tumors and had undergone laparoscopic or robotic partial nephrectomy on the contralateral kidney.For bench surgery kidney,4 cases were on the left side and 1 case was on the right side.Each kidney has more than 2 separate tumors,combined with complete endophytic tumors,tumors larger than 7 cm in diameter or hilar tumors.5 patients were all performed robotic nephrectomy,work bench partial nephrectomy with robotic kidney autotransplantation under general anesthesia.The patient was first in a lateral decubitus position for robotic nephrectomy,and the kidney was removed through a median 6 cm periumbilical incision.After kidney removal,kidney tumors were resected and kidney was reconstructed on a hypothermic working table.Then the kidney was packed in a plastic bag,filling with ice slush.The corresponding parts of the plastic bag were cut to expose the renal artery and vein.Finally,the patient was moved to lithotomy position with Trendelenburg tilt of 20°,and the autologous kidney wrapped in the plastic bag was placed through the previous periumbilical incision into the abdominal cavity for robotic kidney autotransplantation.The renal artery and vein were anastomosed end-to-side with the right external iliac artery and vein.The ureter and bladder were anastomosed.Autologous kidneys were placed in abdominal cavity in 4 cases,and placed in right iliac fossa with retroperitonealization in 1 case.Ice slush on the surface of the autologous kidney did not completely melt before the blood supply was restored during the operation,and the autologous kidney immediately urinated after the blood supply was restored.Results All surgeries were performed successfully without conversion to open surgeries.The total operation time was 460 min,ranging (415-645 min),the time of robotic nephrectomy was 120 min,ranging (74-300 min),the time of robotic kidney autotransphntation was 135 min,ranging(103-163 min),the warm ischemia time was 3 min,ranging (1.5-6.0 min),the cold ischemia time was 182 min,ranging(135-210 min),the rewarming time was 50 min,ranging(45-55 min),the estimated blood loss during operation was 100 ml,ranging(50-300 ml),and the hospital stay was 6 d,ranging(5-9 d).The number of resected tumors was 4,ranging(2-6).The pathology reveals clear cell carcinoma in 3 cases and chromophobe cell carcinoma in 2 cases.The surgical margins were all negative.The serum creatinine levels were 111.1 μmol/L (87-217.6 μ mol/L) and 106.1 μmol/L (87.1-172 μmol/L) on the 7th and 30th day after operation,respectively.One month after operation,CT showed that the function and morphology of the autologous kidneys were fine.No recurrence or metastasis was found in 5 patients during a median follow-up of 7 months,ranging (5.4-11.7 mon).Conclusions For patients with complex renal tumors who cannot undergo in situ partial nephrectomy,robotic nephrectomy,work bench surgery with robotic kidney autotransplantation can completely remove the tumors,maximize the preservation of renal function and minimize the trauma of patients,making the ultimate means of nephron-sparing surgery for patients with complex renal tumors more minimally invasive and safe.