Objective To discuss the clinical characteristics and management principles of com-posite pheochromoeytoma of adrenal gland (pheochromocytoma-ganglioneuroma). Methods Four cases of composite tumor of adrenal gland diagnosed pathologically were reviewed. All the cases were male, aged 37 to 62 years;three of them had the history of hypertension, one of them accompanied with paroxysmal palpitation, while one case was asymptomatic. Computerized tomography and ultra-sonography showed single tumor in adrenal, the diameter was about 2.5、3.8、6.3、15cm respectively. Two cases showed positive results in 131Ⅰ-metaiodobenzylguanidine (MIBG) scintigraphy. One case showed positive result in 99Tcm-hydrazinonicotinamide-3trysinoctreotide (HTOC) scintigraphy. Twenty-four hours urinary catecholamine examination revealed the average of norepinephrine, epi-nephrine and dopamine were (196.1±92.2)nmol/24 h, (26.6±8.9)nmol/24 h, (1957.9±913.5) nmol/24 h respectively. Two cases were at a little elevated level and the others with normal. All cases were managed with α-adrenergic receptor blocker preoperatively for 2-4 weeks. Results Tumor re-section was performed in all 4 cases, and 3 cases by retroperitoneal laparoscopy, one by open surgery. All 4 cases were diagnosed as composite pheochromocytoma of adrenal (Pheochromocytoma-gangli-oneuroma) by pathology. All patients had no evidence of recurrence or metastasis during follow-up from 15 to 38 months. Two of three cases with hypertension reverted to normotensive. Conclusions Composite pheochromocytoma of adrenal is rare, difficult to be diagnosed preoperatively. Except mild in eatecholamine secretion, which clinical manifestations are similar to pheochromocytoma. Pheochro-mocytoma-ganglioneuroma is no apparent tendency for aggressive behaviors, the results of surgical management are favorable.

Objective To investigate the exact protocol eliciting the hippocampal CA1 long-term depression (LTD) of rats in vivo and the effect of amyloid β-protein (Aβ) on the LTD.Method By applying test stimulation to Schaffer collateral in hippocampal CA1 region in rats,recorded the in vivo field excitatory postsynaptic potentials (fEPSPs) ;further,observed the induction of LTD with different low frequency stimulation (LFS) and investigated the effect of Aβ25-35 on the LTD.Results Prolonged LFS (1,5 and 10 Hz) but not paired-pulse stimulus (PPS) effectively elicited the LTD in the hippocampal CA1 region,with significantly decreased amplitude of fEPSPs after LFS ; 1 Hz 900 pulses group induced a stronger LTD,being (63.7 ± 3.8) ％ at 120 min post-LFS,lower (P ＜ 0.05) than (75.1 ± 3.2) ％ in 600 pulses group ; different frequencies (1,5 and 10 Hz) of LFS with same pulses induced similar degree of LTD,the amplitude of fEPSPs were (63.7 ± 3.8) ％,(61.2 ± 3.6) ％ and (59.8 ± 3.9) ％ respectively,without significant differences between any two groups (P ＞ 0.05) ; after applying 12.5 nmol and 25 nmol Aβ25-35,the amplitude of fEPSPs decreased to (63.2 ± 3.8) ％ and (46.8 ± 3.9) ％,respectively,and lower and than that in control ((73.9 ± 3.0) ％,P ＜ 0.05).Conclusion Prolonged LFS effectively induced in vivo hippocampal LTD of rats,which provides an important electrophysiological protocol for the study of synaptic plasticity; Aβ25-35 injection dont affect the baseline synaptic transmission,but dose-dependently enhance the in vivo hippocampal LTD of rats,indicating that Aβ-induced LTD facilitation may be involved the early impairment of learning and memory in Alzheimer's disease.

Objective To study the expression of transient receptor potential channel (TRPC) isoforms (TRPC1,3,4,5,6,7) inrats with cardiac hypertrophy.Methods Thirty adult male SD rats,weighing 200-240 g were divided into surgical group (model group,20 rats) and sham group (control group,10 rats) by random number table according to body weight.Aortic coarctation surgery was performed to establish a rat model of myocardial hypertrophy and the control group did not ligate thoracic aorta,but the same surgical procedure with the model group was performed.After 10 weeks,echocardiography was used to check changes of cardiac function; cardiac tissues of rats were weighed and cardiac hypertrophy index was calculated.Cardiac HE staining was used for observation of myocardial tissue morphological changes.Quantitative RT-PCR method was used for measuring the mRNA expression of TPRC isoforms (TRPC1,3,4,5,6,7).Western blotting assay was applied to detect the protein expression of TRPC4 and TPRC5 in hypertrophic cardiac tissue of rats.The relationship between cardiac hypertrophy exponential and TRPC4,TRPC5 protein expression was studied.Results Echocardiography showed that the septal thickness and posterior wall thickness in model group increased significantly compared with those of the control group [mm:(2.64 ± 0.31) vs.(1.89 ± 0.15),(2.30 ± 0.14) vs.(1.60 ± 0.09),t =9.19,8.57,all P ＜ 0.05].Compared with the control group,cardiac hypertrophy index was significantly increased in model group [(3.21 ± 0.15)vs.(1.82 ± 0.10)mg/g,t =17.02,P ＜ 0.01].HE staining of myocardium showed that cardiomyocyte hypertrophy,abnormal nuclear morphology and significantly enlarged nuclear,and hyperplasia of myocardial interstitial fibrous connective tissue could be seen in model group.The mRNA expression of TRPC4 and TRPC5 was significantly increased in the model group as compared to those of the control group (1.51 ± 0.48 vs.1.22 ± 0.25,1.65 ± 0.35 vs.1.27-± 0.87,t =3.55,4.65,all P ＜ 0.05).The protein expression of TRPC4 and TRPC5 was significantly increased in the model group as compared to those of the control group (1.00 ± 0.54 vs.1.45 ± 0.68,1.00 ± 0.65 vs.1.58 ±0.93,t =5.51,7.10,all P ＜ 0.05).The protein expression of TRPC4 and TPRC5 were associated with cardiac hypertrophy index (r =0.728,0.681,all P ＜ 0.05).Conclusion Expression of TRPC4 and TRPC5 is increased in rats with cardiac hypertrophy.

Objective:The time-dependent changes of hypoxia-inducible factor-1? (HIF-1?) expression induced by CoCl_(2 ) treatment and the effects of genistein on the level of HIF-1? expression in human retinal pigment epithelium cells were studied. Methods:Using a confocal scanning laser microscope coupled to a computer, HIF-1? expression was determined. Results:CoCl_(2 ) treatment could significantly elevate the level of HIF-1? expression. At 0.5 hour after CoCl_(2 ) treatment, the highest level was observed. Genistein 50 ?mol/L, 100 ?mol/L, 200 ?mol/L could suppress HIF-1? expression in a concentration-dependent manner. Conclusions:These results suggested that genistein could inhibit HIF-1? expression induced by CoCl_(2).

BACKGROUND:Orthotopic liver transplantation is the most effective therapy for the treatment of end-stage liver diseases, but the lack of donor source, immune rejection, and repeated infections limit its application. Stem celltransplantation technology provides a new idea for the treatment of end-stage liver diseases. A variety of methods have been confirmed to successful y induce umbilical cord blood mesenchymal stem cells converted into liver cells in vitro.
OBJECTIVE:To explore the clinical efficacy and feasibility of human umbilical cord blood mononuclear cells transplantation in the treatment of decompensated cirrhosis.
METHODS:Twenty-three patients with decompensated cirrhosis received al ogeneic human umbilical cord blood mononuclear celltransplantation. Serum alanine aminotransferase, albumin, cholinesterase, total bilirubin and prothrombin time were detected at post-transplantation weeks 2, 4, 8 and 24. Improvement in clinical signs and symptoms as wel as adverse reactions was observed.
RESULTS AND CONCLUSION:Liver function had no changes at 2 weeks after human umbilical cord blood mononuclear celltransplantation (P>0.05). At 4 weeks after celltransplantation, serum alanine aminotransferase was improved significantly (P<0.05), but the other indexes stil had no changes. Until 12 weeks after celltransplantation, there were significant improvements in al the liver function indicators (P<0.05) and the liver stiffness (P<0.05). By the end of 24 weeks, al the test results were improved significantly (P<0.01). Clinical symptoms were al eviated, including fatigue improvement in 20 cases (87%), improved appetite in 21 cases (91%), and relieved ascites in 19 cases (83%). No severe adverse reactions were found during the transplantation and 24-week fol ow-up. These findings suggest that human umbilical cord blood mononuclear cells transplantation is effective and safe for the treatment of decompensated cirrhosis, which can be considered as a clinical therapy for patients with advanced cirrhosis.

Objective To observe the individualized insertion choice in treatment of upper cervical injury with posterior atlantoaxial short-segmental pedicle screws or lateral mass screws and the relevant clinical outcome.Methods A total of 23 cases of upper cervical injuries received skull traction preoperatively.Individual surgery plan including internal fixation using pedicle screws or lateral mass screws as well as diameter,length,entry point,direction,and angle of screws was determined according to their atlantoaxial CT scan and three-dimensional reconstruction results.Results Six cases of Frankel grade C and eight of grade D were all recovered to grade E after operation.All cases presented rigid fixation and bony fusion in the follow-up of 6 to 36 months.Besides,screws were removed after bony fusion for three young cases and one case with left atlas pedicle screws emerged laterally out of cortex.Clinical outcome was all satisfactory.Conclusion Individualized posterior atlantoaxial fixation using pedicle screws or lateral mass screws is an effective way to treat upper cervical injury and gains advantages of stable threedimensional structures,short fixation segments,and few postoperative complications.

ObjectiveTo investigate the correlation of hippocampal synaptic plasticity with spatial learning and memory under normal and pathological condition,and provide experimental evidence for the coincidence of hippocampal late-phase long-term potentiation (L-LTP) and behavioral experiments.Methods 38 SD rats were randomly divided into two groups,control and AD model.First,Morris water maze was used to test the ability of spatial learning and memory of rats.The escape latencies for rats to search for an underwater platform in 5 days of navigation tests and the swimming time percentage in target qtuadrant on the 6th day after withdrawing the platform in probe trails were recorded.Then,in vivo hippocampus L-LTP of field excitatory postsynaptic potential (fEPSP)in CA1 region was recorded after delivering high frequency stimulation (HFS).ResultsBilateral intrahippocampal injection of 4 nmol amyloid β peptide ( Aβ 25-35 ) significantly impaired spatial learning and memory of rats in water maze tests,as well as in vivo hippocampal L-LTP.In control group,there was a significant negative correlation between the amplitude of fEPSP and the escape latency ( r =-0.8306,P ＜ 0.01 ) and a significant positive correlation between the amplitude of fEPSP and the swimming time percentage in target quadrant ( r=0.7709,P＜0.01 ).In AD model group,similar correlations were found,with a correlation coefficient of r =-0.7675 (P ＜0.01 ) and r =0.8049 (P ＜ 0.01 ),respectively.When putting all data from the two groups together,the hippocampal L-LTP was more correlated with escape latency ( r =-0.9124,P ＜ 0.01 ) and swimming time percentage ( r=0.9745,P＜0.01).ConclusionThere is very close correlation between the hippocampal L-LTP and the spatial learning and memory behavior in rats,suggesting that the hippocampal L-LTP may be involved in the electrophysiological mechanism of spatial learning and memory in rats,and the impairment of L-LTP could partly represent the deficits in cognitive function of animals.

Objective To investigate the efficacy of using three-dimensional (3D) printing technique on surgical planning and its function in enhancing the physician-patient rapport before surgery.Methods From June 2013 to January 2014,10 patients with T1 renal tumors,who were received laparoscopic partial nephrectomy,were selected in study.Left renal tumor was found in 3 cases and right renal tumor was found in 7 cases.The location of tumor included upper part of kidney in 5 cases,lower part of kidney in 3 cases and renal hilum in 2 cases,4 cases were diagnosed as T1a stage and 6 cases were diagnosed as T1b stage.64-slice enhanced CT scan was performed preoperatively.Data of DICOM format was sent for post processing.The final data was then output to 3 d printer for generating kidney models using thermoplastic plastics.After generating the model,different colors were put on the model,including pink in kidney,yellow in pelvis and ureter,red in renal artery and blue in renal vein.Plotted questionnaires were designed for medical professionals and patients,respectively.4 urological experts make the scores by this questionnaire in order to evaluate the efficacy and fidelity of the model.2 surgeons evaluated the efficacy of model after operation by comparing the actual tumor size with that measured on the models.Meanwhile,the model was used for conversation before operation.The questionnaires were also used for evaluating the effectiveness of conversion.Results 10 kidney models fabricated successfully with 3D-printing.The tumor size,position,renal vascular and collecting system could be clearly presented.Being evaluated by 4 experts and 2 performing urologists,and the mean scores was 7.8 ± 0.7.Intraoperative correlation was advocated by the performing urologists.The mean evaluation score was 7.5.The bias between real diameter of renal carcinoma and that of 3 d model was 3.4± 1.3 mm.Patients and family members preferred the demonstration of the disease and the procedure with a visual and tactilediseased organ.The scores of satisfactory were 9.0 ± 0.8.Conclusions The 3d printed model could exhibit the relationship between tumor and renal,clearly.It can help the urologists in making surgical plan,effectively.Patients' Understandings from patients and family members of the disease and the procedure to be used can be upgraded with this novel technology.

Objective To investigate the clinical results of free super-thin peroneal artery perforator flap containing neurovascular axis in reconstruction of hand or foot soft tissue defects.Methods A retrospective case series study was made on 23 cases of hand or foot soft tissue defects admitted from January 2006 to March 2013.There were 16 males and 7 females,with a mean age of 33 years (range,17-51 years).Wounds were located in dorsal hand (n =12),dorsal pedis or amputated forefoot (n =8),greater thenar (n =2) and index finger (n =1) respectively.Defects ranged in size from 5.0 cm × 3.5 cm to 11.5 cm × 7.5 cm.Flap elevating was performed underneath the deep fascia and the perforator supplying the flap was dissected thoroughly,ligated and cut at the location arose from the peroneal artery.Most of the deep fascia except stripe shaped areas along the main blood supply chains was moved sharply and the fat underlying thinned primarily to the subdermal vascular network.After transferred to the recipient site,the flaps were revascularized by anastomosis of the perforating artery and its venae comitantes to appropriate recipient vessels.A total of 15 cases received innervated flap reconstruction.Flap vascularity and cosmetic results were recorded.Hand function was evaluated with the standard set up by the hand surgery branch of Chinese Medical Association.For foot reconstruction,shoe wearing status,gait,pressure-sore,flap sensibility,donor site appearance and complications were evaluated.Results All flaps were transplanted successfully with satisfactory cosmetic results,except that one flap used to cover dorsal ring finger defect left slightly bulky appearance.Mean duration of follow-up was 19 months (range,11-26 months).For hand reconstruction,the functional results were excellent in 6 cases and good in 9 cases.Repairing of foot defects with the flaps caused no problem of shoe wearing and no sore occurred.Normal gait was acquired except two cases of partially amputated foot.If innervated,flap sensibility was restored at least to the degree of S3.Protective sensation and touchpressure sensation were restored in eight non-innervated cases,and two of them were recovered to the degree of S3.There was only suture or small grafting scars on the donor leg and partially sensibility loss of lateral foot without functional defects in 13 cases.Conclusion Free super-thin peroneal artery perforator flap containing neurovascular axis is an easy and reliable technique that can attain satisfactory results for accurate coverage of hand or foot soft tissue defects.

Objective To summarize our experience in the modified total cystectomy and neobladder in patients with invasive bladder cancer.Methods Twenty one male patients with invasive bladder cancer were treated with modified total cystectomy and neobladder.Reconstruction of the lower urinary tract using modifiled ileal neobladder(in 17 patients)and sigmoid neobladder(in 4 patients)were performed.The median age of the patients was 62 years.The patients were followed up for 1-4 years.Clinical outcomes of these patients was evaluated,including the function of the neobladder,urinary function,renal function,serum electrolytes and QOL.Results There was no surgical mortality.The operating time was 3.5-6.5 h(mean,4.5 h).Blood transfusion was required in 4 cases.Fifteen patients(97 ％ had voluntary control of urination at daytime and 6 at night.They were functional to control urination 3-6 months after operation.Hydronephrosis to certain extent occurred in 5 patients,but was recovered after 6-8 months.There were one case of intestinal obstruction and one case of metabolic acidosis.Residual urinary volume was 30 ml in 1 cases and 40 ml in another.Conclusions Modified total cystectomy and neobladder is an ideal technique to treat invasive bladder cancer with good clinical outcomes of tumor control,high life quality,few severe complications and good urination control.