Objective: Retro-laparoscopic partial nephrectomy is a challenge for ventro-renal tumors, especially hilar tumors.The tumors are partial or entirely out of operative field and there is blind space for operation.To solve this problem, a set of techniques including renal pedicle rotation is developed.Methods: A set of techniques including renal pedicle rotation, double-layer suture, early artery unclamping for retro-laparoscopic nephrectomy for ventro-renal tumors, especially hilar tumors were developed.Hilar tumors were located anteriorly to the angle of the renal and renal arteries and in contact with the anterior surface of the renal artery.The evaluation of the outcomes included the operation time, warm ischemia time, estimated haemorrhage, surgical margin, renal function after operation, and complications.This study reviewed the data of 28 patients with ventro-renal tumor, including 15 patients with complex hilar tumors.Results: The average tumor size was (3.8±0.5) cm.The average R.E.N.A.L score was 8 (ranging from 7 to 9).The average warm ischemia time was (23.8±4.7) min, and suture time was (26.2±6.5) min, and operation time was (124.1±12.1) min.The median hospital stay was 4 days and the average estimated haemorrhage was (139.1±54.0) mL.All the surgeries were operated under laparoscope and no surgery switched to open surgery.Seven patients developed Clavien Dindo Ⅰ-Ⅱ complications after operation.Three patients (10.7%) developed collective system damage and received repair of collective system in time and three patients (10.7%) developed slightly gross hematuria (Clavien-DindoⅠ).Two patients developed wound infection (Clavien-DindⅡ).Three patients (10.7%) got renal vein clamped because of capillary hemorrhage from basilar part of tumors.There were 14 patients received early unclamping of renal artery, and no obvious renal vessel damage was found.There were statistically significant differences between the serum creatinine levels (P<0.05) and the estimated glomerular filtration rates (P=0.02) before and after surgery.All the patients'' serum creatinine levels were in normal range and no patient needed regular dialysis.There was no positive surgical margin and the median follow-up was 7 months without local recurrence or distant metastasis.Conclusion: It is safe and effective to apply renal pedicle rotation technique in retro-laparoscopic partial nephrectomy for ventro-renal tumors.The short-term follow-up results are optimistic, but long follow-up is required.

Objective:To summarize our clinical experience in the treatment of aortic root aneurysm by aortic valve sparing root replacement.Methods:From May 2017 to October 2019, a total of 20 patients with aortic root aneurysm underwent aortic valve sparing root replacement by reimplantation method. There were 17 males and 3 females, with an average age of(35.6±15.8) years(12-63 years). There were 11 cases of Marfan syndrome, 5 cases of bicuspid aortic valve, and 1 case of redo operation. The preoperative diameter of ascending aorta was(40.6±9.7)mm, the diameter of aortic sinus was(52.2±9.2)mm, and the diameter of aortic valve ring was(27.1±3.6)mm. There were 10 cases of no or mild regurgitation, 5 cases of moderate regurgitation and 5 cases of severe regurgitation. In the whole group of patients, the root replacement of aortic valve was retained by reimplantation, and the artificial graft were selected as: 26, 28 and 30mm straight vessels, 1, 3 and 6 cases, respectively, 26 and 28mm artificial graft with valsalva sinus, 4 and 6 cases, respectively. During the operation, aortic valve cusp repair was performed in 6 cases, such as plication of the free margin( 4 cases), decalcification(1 case) and raphe release(1 case).Results:None of the patients died in hospital or underwent rethoracotomy for hemostasis. During the operation, the duration of CPB time was(171.0±25.6) minutes and the duration of cross-clamp time was(134.0±23.2) minutes. There were 12 cases of aortic valve regurgitation and 8 cases of mild regurgitation. The mean follow-up was(15.1±9.8) months(4-33 months). During the follow-up period, there were 2 cases with moderate aortic regurgitation no need reoperation, while the rest of the patients had no or mild regurgitation. There are no patients undergoing reoperation. During the follow-up, 1 patient suffered coronary artery embolism in left circumflex artery and recovered after medicine treatment.Conclusion:Reimplantation with aortic valve sparing root replacement is safe and effective in the treatment of aortic root aneurysm, and the early and mid-term follow-up results are satisfactory, which can avoid anticoagulation-related complications and is suitable for young patients.

Objective To investigate the syndrome type distribution of hypertensive patients; To analyze the correlation of characteristics of HRV time domain parameters and its influence factors. Methods Totally 515 cases of hypertensive patients were included and were put under syndrome type distribution. Demographic information, laboratory test parameters, risk factors and clinical symptoms were collected for correlation analysis. HRV time domain parameters were recorded by using 24 h ambulatory electrocardiogram. The differences in SDNN, SDNN Index, HRV Index, PNN50, and RMSSD of different TCM syndrome types were compared. Results Among 515 patients: 160 cases with hyperactivity of yang due to yin deficiency syndrome, 136 cases with turbid phlegm and blood stasis syndrome, 83 cases with overabundant liver-fire syndrome, 69 cases with deficiency of kidney qi, and 67 cases with abundant phlegm-dampness syndrome. By comparing different TCM syndromes, the level of SDNN was significantly reduced in the hyperactivity of yang due to yin deficiency syndrome, overabundant liver-fire syndrome,deficiency of kidney qi syndrome compared with turbid phlegm and blood stasis syndrome, abundant phlegm-dampness syndrome (P<0.05); SDNN Index and HRV Index decreased significantly in the hyperactivity of yang due to yin deficiency and overabundant liver-fire syndrome compared with abundant phlegm-dampness syndrome (P<0.05). SDNN Index decreased significantly in the deficiency of kidney qi compared with abundant phlegm-dampness syndrome (P<0.05). The level of PNN50 was significantly reduced in the deficiency of kidney qi compared with hyperactivity of yang due to yin deficiency syndrome (P<0.05). RMSSD decreased significantly in the hyperactivity of yang due to yin deficiency syndrome, deficiency of kindney qi syndrome, overabundant liver-fire syndrome compared with turbid phlegm and blood stasis syndrome (P<0.05). Discriminant analysis showed that SBP, DBP, MBPS, SDNN, SDNN Index, HRV Index, PNN50, RMSSD were correlated with the diagnosis of five syndrome types. Logistic regression analysis showed that the factors including gender (female), insomnia, elevated systolic blood pressure, MBPS, decreased SDNN Index and PNN50 were positively correlated to hyperactivity of yang due to yin deficiency; other factors including gender (female), advanced age, elevated blood pressure, decreased SDNN, HRV Index and RMSSD were positively correlated with turbid phlegm and blood stasis syndrome. And the study also showed that advanced age, family history of hypertension, elevated blood pressure, decreased SDNN Index, HRV Index and PNN50 were positively correlated to abundant phlegm-dampness syndrome. Conclusion HRV time domain parameters can be significantly reduced in the hyperactivity of yang due to yin deficiency, overabundant liver-fire syndrome, and deficiency of kidney qi syndrome. The autonomic nerve function is damaged seriously. Hyperactivity of yang due to yin deficiency syndrome, abundant phlegm-dampness syndrome turbid phlegm and blood stasis syndrome are closely related to the influencing factors that lead to cardiovascular and cerebrovascular events.

OBJECTIVE:To observe the clinical efficacy and safety of Feijin zhitong capsule combined with methotrexate and tripterygium glycosides in the treatment of rheumatoid arthritis. METHODS:70 patients with rheumatoid arthritis were randomly di-vided into control group(34 cases)and observation group(36 cases). Control group received Methotrexate for injection by intrave-nous infusion,10 mg every times,once a week;and also Tripterygium glycosides tablet,10 mg every times,bid,po. Observa-tion group additionally received Feijin zhitong capsule,3 capsules every times,bid,po. The treatment course for both groups was 6 months. The clinical efficacy,symptoms and signs,erythrocyte sedimentation rate (ESR),rheumatoid factor (RF),C-reactive protein(CRP),interleukin(IL)-1,IL-6,IL-8 and TNF-α levels before and after treatment in 2 groups were observed,and the in-cidence of adverse reactions was recorded. RESULTS:The effective rate in observation group was 85.71%,which was significant-ly higher than control group(70.59%),the difference was statistically significant(P<0.05). After treatment,duration of morning stiffness,joint pain index,joint swelling index,joint tenderness index,ESR,RF,CRP,IL-1,IL-6,IL-8 and TNF-α in 2 groups were significantly lower than before,and observation group was lower than control group,the differences were statistically signifi-cant (P<0.05 or P<0.01). And there was no significant difference in the adverse reactions in 2 groups (P>0.05). CONCLU-SIONS:Feijin zhitong capsule combined with methotrexate and tripterygium glycosides has good efficacy and safety in the treat-ment of rheumatoid arthritis,it can reduce the inflammatory index level,improve symptom and sign.

Objective To explore the effects of NF-E2-related factor 2 (Nrf2) overexpression on mitochondrial biosynthesis and function in melanocytes.Methods An immortalized human vitiligo melanocyte cell line PIG3V was used in this study.An overexpression plasmid Nrf2-pEX-1 containing the full-length Nrf2 gene was constructed.PIG3V cells were divided into 3 groups:blank group receiving no treatment,control group transfected with the pEX-1 plasmid,overexpression group transfected with the Nrf2-pEX-1 plasmid.After transfection,real-time quantitative reverse transcription-PCR (RT-PCR) and Western blot were performed to determine the mRNA and protein levels of mitochondrial biosynthesis-related factors (including Nrf2,nuclear respiratory factor 1 (NRF1) and mitochondrial transcription factor A (TFAM)) respectively;RT-PCR was also conducted to measure the copy number of mitochondrial DNA (mtDNA),and flow cytometry to estimate mitochondial membrane potential (MMP);luciferase reporter system was used to estimate the intracellular adenosine triphosphate (ATP) level.Statistical analysis was carried out by using a two-sample t-test.Results After transfection,a significant increase was observed in the mRNA expression levels of Nrf2 and NRF1 at 24 hours (both P ＜ 0.001) and in those of Nrf2 and TFAM at 48 hours (both P ＜ 0.05),but no significant change was noted in the mRNA expression level of TFAM at 24 hours (P ＞ 0.05) or in that of NRF1 at 48 hours (P ＞0.05) in the overexpression group compared with the control group.In the case of Nrf2,NRF1 and TFAM protein levels,the overexpression group showed significant increases compared with the control group at 48 hours after transfection (all P ＜ 0.05),while no significant difference was noted between the two groups at 24 hours.Compared with the control group,MMP in the overexpression group increased by 2.313％ at 24 hours (t =5.546,P =0.005) and by 14.872％ at 48 hours (t =8.537,P =0.001) after transfection.Both the relative copy number of mtDNA and ATP level were similar between the overexpression group and control group at 24 hours after transfection (both P ＞ 0.05),but significantly higher in the overexpression group than in the control group at 48 hours (t =5.760,P =0.005;t =22.040,P =0.008).Conclusion Up-regulation of Nrf2 pathway can improve mitochondrial function and biosynthesis in PIG3V cells likely by promoting the expressions of mitochondrial biosynthesis-related genes and proteins.

Organ system based integrated teaching model has been adopted in several medical schools, and these schools face some challenges in this teaching process. In order to provide new sights for organ system based integrated teaching reform in eight-year medical education program, ex-ploration of setting up three-staged-dimensional integrated teaching models was conducted in urinary system by hematuria, and designing related teaching objectives, teaching programs and assessment form to optimize teaching quality in this teaching methods, according to characteristics of the urinary systemic diseases, cultivating objectives of eight-year medical education program and teaching experi-ence of Xiangya School of Medicine.

Objective To investigate the expression of E-cadherin and Snail proteins in rectal cancer and their significance. Methods The expression of Snail and E-cadherin proteins was detected using immunohistochemical SABC method in 101 cases of rectal cancer tissues. Results The positive rate of Snail in rectal cancer was 78.2% (79/101). The negative expression rate of E-cadherin in rectal cancer was 62.4% (63/101). The expression of Snail and E-cadherin were significantly related with the lymph node metastasis and Dukes' stage of rectal cancer (P ＜ 0.05). Conclusion The overexpression of Snail and the decreased expression of E-cadherin might be important biological markers for malignant transformation, invasion and metastasis of rectal carcinoma.

OBJECTIVE: To explore new methods for laparoscopic repair of vesicovaginal fistula. METHODS: Five patients with vesicovaginal fistula in Xiangya Hospital, Central South University, were reviewed retrospectively from May 2013 to July 2014. All patients underwent laparoscopic repair surgery, and the surgical methods were analyzed. The operative time, intraoperative blood loss, and hospital stay time were recorded. The duration of follow-up was from 4 to 12 months. RESULTS: Th e surgical procedures for all 5 patients were successful. No open surgery was required. The operative time was 70~120 (mean: 97) min, the intraoperative blood loss was 40~70 (mean: 54) mL, the hospital stay time was 4~8 (mean: 5.8) days. During the follow up of 4~12 (mean: 7.6) months, no recurrence was observed. CONCLUSION Laparoscopic repair of vesicovaginal fistula is a feasible and safe and effective procedure with less blood loss and shorter recovery time, which can minimize surgery damage and improve successful rate.
Blood Loss, Surgical ; Female ; Humans ; Laparoscopy ; Length of Stay ; Recurrence ; Retrospective Studies ; Treatment Outcome ; Vesicovaginal Fistula ; surgery

Objective: To assess the effect of combined treatment using cell scaffold and human fibroblast growth factor for small soft tissue defects of digits caused by trauma. Methods: From May 2012 to September 2016, twenty cases of small soft tissue defect of digits were repaired with cell scaffold combined with recombinant human basic fibroblast growth factor. The average defect area was 2.5 cm². Wounds were debrided and repaired with artificial dermis. Every 2 or 3 days the dressings were changed and the wounds were treated externally with fibroblast growth factor until cell scaffolds have been removed 3-4 weeks after surgery. Results: The group of 20 cases was followed up for 2-24 months. Wounds were healed with satisfactory appearance and no recurrence of wound or obvious hypertrophic scar was observed. No obvious functional problem was found in interphalangeal motion. Conclusions The method of repairing wound with cell scaffold combined with human fibroblast growth factor is simple and it result in healing of wounds with high quality.It provides a new choice for repairing wound in digits.

Objective:To investigate the effects of laparoscopic surgery versus open surgery on acute appendicitis in children. Methods:We retrospectively analyzed the data of 50 children with acute appendicitis who underwent surgery in Zhoushan Women and Children Hospital from December 2016 to December 2019. They were randomly divided into observation ( n = 27) and control ( n = 23) groups. The observation group underwent three-port laparoscopy. The control group underwent open surgery. Operation-related indicators, postoperative recovery, parental satisfaction, and complications were compared between the two groups. Results:Operative time was significantly longer in the observation group than in the control group [(56.57 ± 5.35) minutes vs. (40.23 ± 6.31) minutes, t = 9.78, P < 0.001). Intraoperative blood loss was significantly less in the observation group than in the control group [(10.11 ± 2.36) mL vs. (18.36 ± 3.21) mL, t = 10.45, P < 0.001]. Duration of pain was significantly shorter in the observation group than in the control group [(1.23 ± 0.23) days vs. (2.98 ± 0.87) days, t = 10.06, P < 0.001). Time to postoperative exhaust was significantly shorter in the observation group than in the control group [(21.39 ± 4.35) minutes vs. (39.88 ±5.39) minutes, t = 13.35, P < 0.001]. Time to defection was significantly shorter in the observation group than in the control group [(50.12 ± 3.35) minutes vs. (61.23 ± 4.21) minutes, t = 10.33, P < 0.001]. Time to first diet was significantly shorter in the observation group than in the control group [(13.25 ± 2.56) hours vs. (19.96 ± 2.67) hours, t = 9.07, P < 0.001]. Length of hospital stay in the observation group was significantly shorter in the observation group than in the control group [(4.13 ± 1.12) days vs. (7.98 ± 1.96) days, t = 8.53, P < 0.001). Parental satisfaction was significantly higher in the observation group than in the control group [96.30% vs. 47.83%, χ2 = 13.360, P < 0.001]. The incidence of complications was significantly lower in the observation group than in the control group [7.41% vs. 52.17%, χ2 = 10.58, P < 0.001]. Conclusion:Laparoscopic surgery is superior and safer to open surgery in the treatment of acute appendicitis in children.