Objective To detect sputum quantitative bacterial culture and sputum cell counts in stable chro -nic obstructive pulmonary disease (SCOPD) patients, and explore the correlation between lower airway bacterial colo-nization(LABC) and airway inflammation.Methods 47 patients with SCOPD were chosen ,all patients induced spu-tum specimens to sputum quantitative bacterial culture and sputum cell counts ,sputum and serum IL-8 levels were al-so detected.Results There were 13 patients whose bacterial colonization of the lower respiratory tract in patients was higher than 107CFU/mL.Serum IL-8 levels of 13 patients was ( 70.65 ±19.89 ) pg/mL, sputum IL-8 levels was (364.65 ±74.19)pg/mL,all significantly higher than those whose bacterial colonization of the lower respiratory tract lower than 107CFU/mL,(15.87 ±3.01)pg/mL and (146.65 ±28.11)pg/mL,there were statistically significant difference(t=13.43,9.76,all P<0.05).After 1-year follow-up,FEV1 decline(0.071 ±0.016)L in patients whose bacterial colonization of the lower respiratory tract≥107CFU/mL,it was significantly higher than those whose bacterial colonization of the lower respiratory tract <107CFU/mL;the frequency of acute exacerbation was (2.93 ±1.07) times,significantly more than those whose bacterial colonization of the lower respiratory tract <107CFU/mL,the differ-ences were statistically significant (t=5.43,6.54,all P<0.05).Conclusion Lower respiratory tract bacterial colo-nization in patients with SCOPD can aggravate the inflammatory response and increase degree of airflow limitation .

Objective To assess the value of procalcitonin (PCT) levels compared to C-reactive protein (CRP) levels and blood white cell count in early detection of sepsis following percutaneous nephrolithotomy.Methods This prospective observational study included 91 patients,including 59 male patients and 32 female patients,undergoing percutaneous nephrolithotomy between April 2014 and October 2015.Their mean age was (54 ± 15)years old,ranging 15 to 88 years old.The average size of stone was (20.9 7.0) am.Those patients were classified into two groups,based on whether the postoperative sepsis existed.In this group,51 cases were concluded in the sepsis group and 40 in the non-sepsis group.A statistically significant difference between patients with and without sepsis was found in the hydronephrosis (44 vs.25,P =0.009),urine white cell count [(402 ± 970) / μ1 vs.(70 ± 171) / μ1,P ＜ 0.01],positive urine culture(36 vs.20,P ＜ 0.05),positive pelvic urine culture (22 vs.5,P =0.001).There was not any significant difference in sex,age,size of calculi and blood culture between patients with and without sepsis (P ＞ 0.05).Blood white blood cell count,CRP,and PCT were measured in patients with an acute onset of sepsis.Diagnostic accuracy of PCT values was analyzed by the receiver operating characteristics (ROC) curve.Results A statistically significant difference between patients with and without sepsis was found in the PCT [(7.43 ± 10.15)μg/L vs.(0.14 ± 0.10)μg/L,P ＜ 0.01] and blood white cell count [(14.18 ± 6.47) × 109/L vs.(11.22±4.22) × 109/L,P ＜0.05].There was not any significant difference in CRP [(64.93 ± 68.60) mg/ml vs.(70.76 ± 53.36) mg/ml,P ＞ 0.05] between patients with and without sepsis.ROC curve analysis showed that blood white cell count and PCT concentrations had similar predictive values for the development of sepsis (area under the curve,0.78 and 0.90,respectively) with the best cut-off values of blood white cell count for 12 × 109/L (sensitivity 50％,specify 88％) and 0.5 μg/L (sensitivity 64％,specify 100％)for PCT.54 cases were performed blood culture,which showed positive in 12 cases and negative in 42 cases.The significant difference of PCT level could be noticed in two groups [(16.99 ± 11.64) μg/ L vs.(3.77 ± 7.23) μg/ L,P ＜ 0.05)].No significant difference was found in CRP,Blood white cells count among those groups (P ＜ 0.05).ROC curve analysis showed that PCT concentrations had predictive values for the positive blood culture (area under the curve,0.80) with the best cut-off values of 8 μg/L (sensitivity 71％,specify 88％) for PCT.Conclusions PCT was a useful marker for the diagnosis of the sepsis after percutaneous nephrolithotomy as compared with WBC and CRP.

Objective To observe the contents of acid phosphatase (ACP) of Oncomelania snails infected with Schistosma japonicum.Methods Both the blood lymphocytes of positive and negative Oncomelania snails were dyed with the histochemistry staining method and their ACPs were observed under a microscope. Results The contents of ACP in the positive Oncomelania snails increased, being significantly higher than those in the negative snails. Conclusion The contents of ACP increase in Oncomelania snails infected with Schistosoma japonicum and ACP may have the defence function.

Objective To compare the effects of flexible ureterorenoscope holmium laser for treatment of different sizes lower pole caliceal stones. Methods 140 patients with lower pole caliceal stones from August 2011 to April 2015 were enrolled, 40 patients were divided into observation group which the largest stone diameter > 2.0 cm, 100 patients were divided into control group which the largest stone diameter ≤ 2.0 cm. All these patients received flexible ureterorenoscope holmium laser treatment. Then we observe and compare the prognosis. Results The postop﹣erative 3 d and 1 month of gravel success rates were 97.5 % and 80.0 % in observation group, while the control group were 98.0% and 95.0%. The postoperative 1 month of gravel success rates in observation group was signifi﹣cantly lower than that in control group (P< 0.05). The operative time and postoperative hospital stay in observation group were significantly higher than control group (P<0.05). The postoperative 1 month complications of lung infec﹣tion, hematuria, urinary extravasation and so on in observation group were significantly higher than that in control group (P<0.05). The postoperative 3 d creatinine contents in observation group were significantly higher than preop﹣erative (P< 0.05), and significantly higher than that in control group (P< 0.05). The creatinine contents compared between the two groups at other time points were not statistically significant (P> 0.05). Conclusion Compared with small lower pole caliceal stones, the success rate of flexible ureterorenoscope holmium laser treatment of large lower pole caliceal stones is declined, the patients also have some trauma, and the renal function is also fluctuate, postop﹣erative disease is relatively higher that clinically to be carefully chosen.

Objective:To study the clinicopathological features and differential diagnosis of metaneph-ric adenoma (MA).Methods:The clinicopathological data of 16 cases with MA diagnosed and treated in Peking University First Hospital from 2004 to 2016 were retrospectively analyzed,and the clinical characteristics,pathologic parameters,differential diagnosis,treatment options and prognosis of MA were analyzed with literature review.Results:The patients included 10 females and 6 males.The age of pa-tients ranged from 14 to 83 years (mean =33.7 years).The partial nephrectomy was carried out for most patients.All cases were located in renal codex with 3 growing into the renal sinus.Histologically,the tumor was composed of tubules,papillary or glomeruloid structures and psammoma bodies were focally seen.Immunohistochemical study showed that all the cases expressed vimentin,and 94% cases ex-pressed CD57,63% WT1,75% AE1 /AE3,19% cytokeratin 7 (CK7 )and 13%α-methylacyl-CoA racemase (AMACR),and negative expressions for MA included CD10,neuron-specific enolase (NSE) and CD56.Follow-up information from 1 to 125 months was available in all the patients;and none of the patients showed any evidence of recurrence and metastasis.Conclusion:The benign tumor characteris-tics of MA are not obvious for preoperative imaging diagnosis,and the diagnosis of MA should be based on the unique pathological features.Positive immunostain of CD57 is a useful indicator for MA diagnosis and differential diagnosis.The partial nephrectomy surgical treatment can achieve good clinical cure with good prognosis.

Objective To establish a calculation method for the voiding work parameters by using the detrusor power curve and to evaluate its clinic efficacy.Methods From January 2001 to January 2011,132 male patients with benign prostate hyperplasia who underwent urodynamic tests were retrospectively reviewed.The patients' age ranged from 45 to 84 years old (mean 57 years old).All patients had no previous history of neurological disease and no positive findings in neurological examinations.The voiding work of bladder,the voiding power of bladder and voiding energy consumption were calculated by using the detrusor power curve method and the linearized passive urethral resistance relation analysis was conducted.According to the detrusor status,all patients were divided into the decreased detrusor pressure group,the normal detrusor pressure group and the increased detrusor pressure group.Meanwhile,normal urethral resistance group and the increased urethral resistance group were classified according to the urethral resistance status.The detrusor pressure at maximal flow rate (PdetQmax),the maximal flow rate (Qmax),the projected isovolumetric pressure (PIP),the voiding work,the voiding power and the voiding energy consumption were compared among the different groups.Results There were 56 cases,58 cases,18 cases in the decreased,normal and the increased detrusor pressure group respectively.The voiding work were (1.1 ± 0.5)J,(1.7± 0.7)J,(2.1±1.2)J; the voiding power were (15.3±7.3)mW,(31.9±12.6)mW,(42.5±21.1)mW; and the voiding energy consumption were (3.9± 1.2) J/L,(5.2± 1.9) J/L,(6.2±3.2) J/L in those three groups,respectively.With the increasing of detrusor pressure,PdetQ Q PIP,the voiding work,the voiding power and the voiding energy consumption all increased among three groups with significant difference (P＜ 0.05).There were 51 cases,81 cases in the normal and the increased urethral resistance group.The voiding work were (1.5±0.7)J and (1.5±0.8)J;the voiding power were (32.3±13.2)mW and (22.6±16.3)mW and the voiding energy consumption were (3.8±0.7) J/L and (5.4±2.4) J/L in two groups.The increased urethral resistance group had higher PdetQmax and voiding energy consumption (P＜0.05) and lower Qmax and voiding power (P＜0.05) than those in the normal urethral resistance group.However,the differences of PIP (P =0.438) and the voiding work (P =0.546) between the two groups were not determined.Conclusions The detrusor power curve method can be used to calculate the work parameters of voiding.This method can be applied to evaluate the compensatory state of bladder and is conductive to urodynamic analysis in low detrusor pressure status.Both detrusor pressure and urethral resistance had significant impact on the work capacity of bladder.

Objective To present our experience of dealing with complete penile amputation.Methods Two cases of penile complete amputation were reported.The first case was a 34-year-old man,suffered amputation of the penis approximately 2.5 cm distal from the pubic area with a sharp knife.3.5hours later,the patient was transferred to our hospital.The urethra mucosa and corpus spongiosum were anastomosed.The cavernous body of the penis was reattached by suturing the tunics albuginea of each corpus cavernosum to the corresponding proximal segment.One dorssl artery,two dorsal veins,and dorsal nerve were anastomosed under a 10 × microscope with interrupted 9-0 nylon nonabsorbable sutures.The second case was a 25-year-old man,presented to the emergency room 15 hours after distal penile amputation,which had 2 wounds as a result of self-mutilation caused by psychiatric problems.The urethra mucosa and corpus spongiosum were anastomosed.The cavernous body of the penis was reattached by suturing the tunics albuginea of each corpus cavemosum to the corresponding proximal segment using 4-0 polyglactic acid sutures.Results In the first case,the tourniquet was released after replantation,and the distal penis appeared to revascularize,as noted by the gradual increase in redness and size.An arterial pulse was detected,and the superficial penile veins displayed normal turgor,and no bleeding was found.On postoperative day 3,the penile skin started to necrotize.On day 12,the necrotic skin was superficially debrided,and a fistula was observed in the corresponding urethral segment.Two weeks later,the fistula was sutured with 4-0 interrupted synthetic absorbable suture,and a transposition flap to embed the whole injured penis shaft was created from the proximal scrotal skin.The glans was exposed.Two months after the second operation,the embedded penis was released from the scrotum.After follow-up of two years,the patient had glans re-epithelialization with normal voiding,sensation,and erections.In the second case,the glans was still pink,but the penile skin started to necrotize on postoperative day 3.On day 14,serious infections were noted,the necrotic skin was superficially debrided,and the amputated penis was relieved.Conclusions Prompt diagnosis and early treatment are essential to avoid the potential complications of ischemic necrosis and autoamputation.Venous outflow is a critical factor for success of replantation.Microsurgical reanastomosing of the dorsal penile vein,penile arteries,and dorsal nerves can be identified as the standard method for penile replantation.The bipedicled scrotal flap can provide adequate skin cover for penis defects.

Objective The expression of chemokine C-X-C motif ligand 13 (CXCL13) within liver in primary biliary cholangitis (PBC) patients is significantly increased, but its origin and mechanism is not clear yet.The study aimed to investigate the expression of CXCL13 in the liver of mice through establishing a mouse model of PBC.Methods C57BL/6 mice were randomly divided into experiment group (n=20) control group(n=10).The mice in the experimental group were intraperitoneally injected with polyriboinosinic polyribocytidylic acid (Poly I:C) while the mice in control group were injected with PBS of the same volume.The level of serum AMA was quantified by ELISA and intrahepatic inflammatory cells were assessed by HE staining.Kupffer cells, liver sinusoidal endothelial cells, and infiltrating lymphocytes in the liver of mice were collected by in situ perfusion enzyme digestion and magnetic bead separation methods.The transcriptional level of intrahepatic CXCL13 in liver tissues and cell subpopulations were detected by qPCR.Results The serum AMA titers of the mice in experiment group increased gradually with the prolonging of modeling time and the positive rates at the 4th, 8th, and 12th week after the first injection of Poly I:C were 5.9%, 52.9% and 76.5% respectively.While the serum AMA titers of the mice in control group were at a lower level through the modeling process, with only 2 mice presenting a little higher level above positive cutoff value at the 12th week.The results of HE staining in liver tissues of both groups showed that there were a great amount of intensely infiltrating inflammatory cells in the mice of experimental group while no inflammatory cell infiltration were found in the mice of control group.The separation purity of Kupffer cells and liver sinusoidal endothelial cells in the mice of experiment group tested by flow cytometry were 76%-80%, 68%-72% respectively.Compared with the CXCL13 mRNA level in Kupffer cells [2.34(0.22-8.64)], the expression levels in liver sinusoidal endothelial cells and infiltrating lymphocytes declined[0.27(0.03-1.64), 0.05(0-0.22), P<0.05].Conclusion The chemokine CXCL13 is predominantly produced by Kupffer cells in the liver of PBC mice established by Poly I:C injection.

Objective To design a complex hepatitis C vires(HCV)=E1 antigen,and to search its application in HCV vaccine and diagnosis test.Methods Through consulting the database and widely comparison of sequences from HCV E1 of different genotype,the representative immunodominant epitope sequences were selected from all the six genotypes.Their genes were deduced according to the preference codon in E.coli and three fragments were designed to contain the six epitopes.They were chemically synthesized and cloned into pBVIL1 vector separately.The cloned fragments were conjugated together profiting from pBVIL1's property,and then a doubled pan-DR helper T cell epitopes(PADRE)gene was inserted to form a complex expression plasmid.The transformed E.coli cells with this plasmid were cultured and induced to express recombinant protein and the antigenic activity of the product was tested.Results An expressing plasmid containing 8 epitopes from HCV genotype 1a,1b,2a,3a,4a,6a and a doubled PADRE sequences was constructed successfully and the engineering E.coli transformed with this plasmid highly expressed after inducing culture at 42℃ in an inclusion manner.The immunological activity of the purified recombinsnt multi-epitope antigen shows that:(1)It can react with a great part of sera from HCV positive patients by indirect ELISA.(2)It can induce notable specific humoral immunity in injected mice.Conclusion The novel constructed expressing plasmid and its product may be useful in study of a newly HCV vaccine as well as an antigen for HCV immunoassays.

Objective: To evaluate the impacts of the prognostic factors of T2N0M0 upper tract urothelial carcinoma (UTUC) for Chinese patients.Methods: A retrospective study was conducted including 235 patients who were diagnosed with T2N0M0 UTUC in our hospital and received radical nephroureterectomy (RNU) or partial ureterectomy during January 2000 and December 2013.The 3 and 5-year can-cer-specific survival rates and bladder recurrence-free survival rates of all the patients were valued using Kaplan-Meier method, and the survival curves with statistical significance between the two were compared using the Log-rank test.Variables with significant differences in the univariate analysis were subjected to the multivariate analysis by Cox regression model.Results: A total of 235 patients were included in this study, including 95 (40.4%) male patients and 140 (59.6%) female patients.The mean age was 66.73±10.49 years.The median follow-up time was 53 (rang: 3-142) months, and during the follow-up, 74 (31.5%) patients died of UTUC after a median of 35 months,and 96 (40.9%) patients developed intravesical recurrence after a median of 19.5 months.The 3 and 5-year cancer-specific survival rates of all the patients were 89.1% and 85.9%, respectively;the bladder recurrence-free survival rates were 85.5% and 80.2%, respectively.The independent prognostic factors of cancer-specific mortality were tumor age elder than 55 years (HR=3.138, 95%CI: 1.348-7.306, P=0.008) and diameter larger than 5 cm (HR=3.320, 95%CI: 1.882-5.857, P<0.001).The independent prognostic factors of bladder recurrence-free survival were ureter tumor (HR=1.757, 95%CI: 1.159-2.664, P=0.008) and lower tumor grade (HR=1.760, 95% CI: 1.151-2.692, P=0.009).Conclusion: T2N0M0 UTUC has a better cancer-specific survival.The intravesical recurrence was equivalent to non-muscle invasive UTUC but earlier.The tumor diameter larger than 5 cm and the patient age elder than 55 years were independently associated with cancer-specific mortality;the primary tumor located in ureter and lower tumor grade were more likely to develop intravesical recurrence.