Objective To evaluate the clinical value of laparoscopic renalcyst unroofing as compared with open surgery.Methods The clinical data of 30 cases(group A) receiving glaparoscopic renalcyst unroofing from February 2002 to March 2005 and 15 cases(group B) receiving open renalcyst unroofing from February 2002 to February 2004 were retrospectively analyzed.The rating of depression and anxiety before operation,operating time,amount of bleeding during operation,recovery of intestinal function after operation,ambulation and normal activities after operation,the time of using intravenous after operation,the times of using analgesic after operation,the operation cost,total cost of hospitalization,the hospital stay and complications were compared between group A and group B.Results In group A,the amount of bleeding during renalcyst unroofing operation,the recovery of intestinal function after operation,ambulation after operation,the hospital stay,the resume of normal activities after operation and the occurrence of complications the time of using intravenous after operation,the times of using analgesic after operation were all better than those in group B(P

Objective To assess the cause of iatrogentic urethral stricture,prevention methods.Methods A total of 21 cases of iatrogentic urethral stricture patients were retrospectively analyzed. Results 2 cases of corpus glandulare prostatae extraction on ospectinis,2 cases of urethrolithotomy, 12 cases of transurethral resection of the prostate foe the treatment of symptomatic BPH, 5 cases of exelcymosic UCL all gained urethral sounding and urethra sliver and electrotomy. Conclusion Iatrogentic urethral stricutre can be prevented by iatrogentic urethral catheterization operation technical,reconstruction the time size quality of urethral catheterization, using intravenous. By urethral sounding and intracavitary operation,iatrogentic urethral stricture all gained satisfaction.

Henoch-Schonlein purpura(HSP)is the most common vasculitic disease affecting children,which is a multisystem immunoglobulin A mediated vasculitis with a self-limited course affecting the skin,joints,gastrointestinal tract and kidneys.Antiphospholipid syndrome(APS)is a systemic autoimmune disorder characterized by a combination of arterial or venous thrombosis and recurrent fetal loss,accompanied by elevated titers of antiphospholipid antibodies.Both HSP and APS are multisytem diseases and are thought to result from immunologically mediated processes.It was known that APS can associated with HSP,but the relationship between the 2 diseases is unclear.The literature on HSP associated with APS was reviewed and the possible mechanism was analyzed.

Objective To evaluate the effectiveness of spiral stone dislodger combined with pneumatic lithotriptor under ureteroscopy for managing upper ureteral stones. Methods 106 patients with upper ureteral stones with spiral stone dislodger combined with pneumatic lithotriptor under ureteroscopy were treated. The transverse diameter of the stones was 4～12mm and the vertical length 6～15mm. Results 87.7% (93/106) stones were fragmented for one session of treatment. 8 cases were pushed upward then undergoing extracorporeal shock wave lithotripsy(ESWL) after surgical operations. Operations in 5 cases had to be changed to open surgery,and ureteral perforations happened in 1 case. Conclusion Successful entrance of the uretersocop is a prerequisite for crushing the stone,appropriate fixation of the stone is the key to their crushing,spiral stone dislodger is an effective means of fixing ureteral stones.

Administration, Inhalation ; Adrenergic beta-Agonists ; adverse effects ; Child ; Extremities ; Humans ; Male ; Paralysis ; chemically induced ; Terbutaline ; administration & dosage ; adverse effects

Objective To observe the characteristic features of musculoskeletal ultrasound (MSUS) in gouty arthritis (GA) and to assess its value in GA diagnosis.Methods Patients with GA and non-GA who underwent MSUS examination in Chinese PLA General Hospital were enrolled in this study. The synovitis,tenosynovitis,soft tissue swelling,bone erosion,bursitis and ossification were measured by greyscale ultrasound,and the synovial vascularity was measured by power Doppler ultrasound to evaluate the degree of inflammation.Results The ultrasound images of GA were intended to have specific features like tophus,hyperechoic deposition on the surface of the articular hyaline cartilage ( double contour sign ),hyperechoic deposition in the synovium appearing as bright stippled foci,and bright strap in tendons with a significant difference when compared with non-GA group (P ＜ 0.05).The percentage of tenosynovitis and bone erosion in non-GA group was higher than that in the GA group with a significant difference (P ＜0.05 ). Tophus,double contour sign,bright stippled foci or bright stippled foci in tendons together suggested gout with a specificity of 92.4％ and a sensitivity of 60.3％,the AUC of ROC was 0.764 ( P ＜0.05).Conclusion Tophus,double contour sign,bright foci and bright strap detected by MSUS are of diagnostic value on GA and MSUS may be a promising tool in diagnosing GA.

Objective To compare the effect of intra-articular injection of recombinant human tumor necrosis factor-Fc (rhTNFR:Fc) in the treatment of knee arthritis in spondyloarthritis (SPA) with that in rheumatoid arthritis (RA).Methods The subjects included in this study were SpA and RA patients with knee arthritis without deformity,moderate or severe bone erosion and obvious joint space narrowing in radiography,who had taken at least 6-week therapy with routine dosage of disease modifying anti-rheumatic drugs (DMARDs) before the study.All subjects received one dose of 25 mg rhTNFR:Fc injected to the target knee joints after synovial fluid being drawn away before injection.They were followed up for four weeks after injection.The primary end-point was the 4-week change in the moditied hospital for special surgery (HSS) knee score for the target knee.The secondary end-point were the 4-week change in patients assessment of the knee,and investigators assessment of knee,pain VAS of the knee joint when walking or standing,the range of knee inflexion,circumference of the knee cross section,synovium thickness detected by ultrasound in the part of the thickest synovium in the suprapatellar bursa.Paired t test,independed t test and Wilcoxon test were used for statistical analysis.Results Twenty-seven SpA patients and fifteen RA patients were included in the trial.The modified HSS knee score for the SpA group was 66±14 at baseline,86±11 (P＜0.05) at follow-up,and for the RA group,the score was 64±13 at baseline,80±9 (P＜0.05) at follow-up.24.2％ (16.5％-41.9％) improve-ment on the modified HSS knee score was achieved in the SpA group,while 22.2％ (15.3％-37.7％) improvement on the modified HSS knee score was achieved in the RA group (P＞0.05).31.8％ (9.3％-57.3％) improvement on the synovium thickness was achieved in the SpA group,while 1.5％ (-19.3％-25.5％) improvement on the synovium thickness was achieved in the RA group (P＜0.05).Adverse events were observed in six patients in SpA group and two patients in RA group.No serious adverse events had been observed.Conclusion Single intra-articular rhTNFR:Fc injection is an effective and safe therapeutic option for knee arthritis in both SpA and RA patients.This treatment may relieve knee synovitis in SpA patients more effectively than in RA patients.

Objective To study inflammatory cytokines changes in brain tissue of neonatal rats with periventricular leukomalacia (PVL).Method A total of 80 neonatal SD rats (P3) were randomly assigned into 2 equal groups,sham-operated group and PVL group.Rats in each group were further assigned into four subgroups (12,24,48,72 h),with 10 rats in each subgroup.The hypoxic-ischemic PVL modal were established following the procedure:first,isolation and ligation of left common carotid artery,and then exposed to 8％ O2 and 92％ N2 for 2.5 h.The sham-operated rats were processed with isolation of left common carotid artery only.Rats of the four subgroups were sacrificed at 12,24,48 h and 72 h respectively,then the brains were rapidly removed in corresponding time.Pathological changes of brain tissues were observed using HE stain.The mRNA expression levels of tumor necrosis factor α(TNF-α)and inter leukin-1β (IL-1β) were assessed using real-time quantitative PCR assays,the protein levels of TNF-α and IL-1β were detected using enzyme linked immunosorbent assay method.Result The brains tissues of rats in PVL group showed remarkably hyperemia and edema,with left ventricle enlargement.Periventricular white matter structure was disintegrated comparing with sham-operated group.The expression of TNF-α and IL-1 β mRNA in PVL group increased significantly,reaching peak by 24 h and then gradually decreased 72 h after the procedure.The mRNA levels of TNF-c and IL-1 β were significantly different between each two time points of 12,24 h and 48 h in PVL group (P ＜0.05).However,there was no differences between 72 h and 48 h within PVL and sham-operated group group(P ＞0.05).In PVL group,the protein expression trends of TNF-α and IL-1 β were similar to mRNA expression trends.Moreover,the protein levels were significantly different between each two time points of TNF-α and IL-1 β,respectively (P ＜ 0.01).The protein expression levels of TNF-α were different at each time point between PVL group and sham-operated group[(189.2 ± 20.4) pg/ml vs.(131.4 ±5.2) pg/ml at 12 h,(213.8 ± 16.7) pg/ml vs.(127.7 ±7.4) pg/ml at 24 h,(181.7 ± 15.0) pg/ml vs.(126.3 ± 6.0) pg/ml at 48 h,(159.6 ± 25.3) pg/ml vs.(131.4 ± 6.0) pg/ml at 72 h;P ＜0.01].The protein levels of IL-1β were different between the two groups only at 24 h and 48 h.[(121.8 ±30.0) pg/ml vs.(67.4 ± 13.7) pg/ml,(83.3 ± 15.7) pg/ml vs.(65.3 ± 14.9) pg/ml;P ＜0.05].In sham-operated group,no differences of TNF-α and IL-1 β protein levels were found between any different time points (P ＞ 0.05).Conclusion Inflammatory cytokines such as TNF-α and IL-1β are involved in ischemic-hypoxia induced PVL.Dynamic detection of inflammatory factors is expected to be an important method of early diagnosis,assessment of treatment efficacy and prognosis of PVL.

Objective To compare the effects of every-other-day dose simvastatin administration with that of daily therapy of same dose.Methods This was a randomized,prospective,nonblinded clinical trial.The 186 patients with high low-density lipoproteim cholesterol(LDL-C) and/or high total cholesterol (TC),triglycerides (TG),low high-density lipoprotein cholesterol(HDL-C)was studied.All patients were randomized into two groups.The every-other-day do- sing group recerived 20mg of simvastatin in alternate-day and daily dosing group received 20mg of simvastatin every day.Before and after 6 weeks,12 weeks of treatment,serum lipoprotein,Live function tests and ereatine kinase con centra- tion and so on were drawn and bad-side effect were studies.Results The two groups significantly reduce LDL-C,TC, TG and a little increased HDL-C compared with baseline.No stalistically significant differences existed between the two groups in percentage in decrease in lipoprotain at 6 weeks,12 weeks compared with baseline.The bad-side effect in the two groups also had not a singnificant different.Conclusion The every-other-day dose of simvastatin have similar effi- cacious and safe to daily dosing in patients with hyperlipidemia and some cost savings.It can take a primary prevention to coronary heart disease in patients with relatively low-risk hyperlipidemia.

Objective To find the relationship between mutation of gamma 2 subunit of the gamma-aminobatyric acid type A receptor(GABRG2) and generalized epilepsy with febrile seizure plus(GEFS+).Methods Probands of 10 families with GEFS+ were selected,the GABRG2 gene were sequenced.Results We found a single nucleotide polymorphism site,and did not find the reported mutations.Conclusion GABRG2 mutation is not common in Hans of northern China.