Objeetive To investigate the changes of kidney cortex hemoperfusion before and after extracorporeal shock wave lithotripsy (ESWL) with contrast-enhanced ultrasonography (CEUS) and time-intensity curve.Methods Thirty patients of renal calculi were treated with ESWL and examined with CEUS before and after ESWL.Renal cortex blood perfusion parameters of the lithotriptic areas,including the contrast agent arrival time (AT) ,time to peak (TTP) .peak intensity (PI) and velocity parameters (β) were quantitatively measured with ACQ software.Results The value of AT,TTP and β were not significantly different before and after ESWL (P＞0.05) .PI value after ESWL was lower than that before ESWL (P＜0.05) . Conclusion CEUS can quantitatively evaluate the changes of kidney cortex hemoperfusion after ESWL,and reflect the minor renal damage resulted from ESWL.CEUS can be used as a new method of observing and evaluating the renal damage caused by ESWL.

To study the traditional Chinese medicine (TCM) syndrome distribution in patients with hepatitis B virus (HBV) infection in Qidong region of Jiangsu Province, China.

Objective:To compare the effectiveness and safety of laparoscopic hepatectomy (LH) versus radiofrequency ablation (RFA) in treatment of hepatocellular carcinoma (HCC).Methods:The medical literatures on LH and RFA for HCC were searched in PubMed, Web of Science, Embase, VIP, Wanfang, CNKI and other electronic databases. The retrieval date was from database construction to June 7, 2021. According to the inclusion and exclusion criteria, studies were extracted by two authors, and Revman 5.3 software was used to conduct a meta-analysis to compare differences in operation time, blood loss, length of hospital stay, total complications, overall survival and disease-free survival outcomes between the LH group and the RFA group.Results:Of 3 690 patients who were included in 32 studies, there were 1 708 patients in the LH group and 1982 patients in the RFA group. Meta-analysis showed that compared with the LH group, the RFA group had significantly shorter surgical duration ( MD=-86.41, 95% CI: -116.21--56.60), less blood loss ( MD=-213.22, 95% CI: -273.43--153.00), shorter hospital stay ( MD=-3.23, 95% CI: -4.13--2.32), and lower incidence of complications ( OR=0.33, 95% CI: 0.26-0.43). However, local recurrence rate was significantly higher ( OR=1.83, 95% CI: 1.38-2.41). (All P<0.05). The 5-year survival rate of the LH group was significantly better than the RFA group ( OR=0.68, 95% CI: 0.51-0.90, P=0.008). Conclusion:LH provided better overall survival outcomes and lower local recurrence rates than RFA in HCC patients.

Objective:To clarify the anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava during laparoscopic surgery.Methods:In December 2018, two frozen and two fresh adult cadavers were dissected. The chest of the frozen cadavers was opened along the bilateral midline of the clavicle, the anterior pericardial wall was opened, and the superior vena cava and the inferior vena cava was dissected. The abdominal cavity was opened along the midline of the abdomen, the left and right hepatic lobes were turned over, the inferior vena cava and the second hilum of the posterior segment of the liver were exposed, and the hiatus of the inferior vena cava was opened and entered the pericardium.The anatomical characteristics and adjacent relationship of the superior segment of the inferior vena cava were observed, and the length of the superior segment of the inferior vena cava was measured. The fresh frozen cadaver patients underwent laparoscopic surgery.Five 12 mm trocars were placed at the side of umbilicus, right rectus abdominis about 4 cm from umbilicus, midline of abdomen about 6 cm above umbilicus, right axillary front about 2 cm below inferior edge of liver, left midline of clavicle about 2 cm below inferior edge of liver. Laparoscopic-assisted turning of the left and right hepatic lobes, exposing the posterior inferior vena cava and the second hilum of the liver, opening of the vena cava hiatus into the pericardium.The anatomical characteristics and adjacent relationship of the upper diaphragmatic segment of the inferior vena cava were observed.Results:In two autopsies, the inferior vena cava entered the chest through the cava sulcus of the liver and the phrenic foramen cava, and then through the fibrous pericardium into the right atrium. The length from the diaphragm of inferior vena cava to the right atrium was 1.67 cm, 2.57 cm. In laparoscopic operation, the diaphragm entrance of the posterior segment of the liver inferior vena cava, the second hepatic portal and the inferior vena cava could be well exposed.The diaphragm could be opened along the hole of the vena cava with a relatively non vascular anatomical layer of adipose tissue.There was a large anatomical gap between the pericardium and the right atrium, and the inferior vena cava, the superior vena cava and the right atrium could be well exposed, and the whole diaphragm could be completely and continuously exposed from the bottom to the inferior vena cava at the entrance segment of the right atrium.Conclusions:There was a relatively avascular anatomical layer beside the inferior vena cava. During laparoscopic operation, opening the diaphragm through the abdominal cavity could safely enter the pericardium and expose the inferior vena cava, the superior vena cava and the right atrium, which provides a possibility for the removal of Mayo Ⅳ grade inferior vena cava tumor thrombus through this approach.

ObjectiveTo investigate the effects of over expression of miR-34a on cellular proliferation and migration in bladder cancer cell line J82 by targeting Notchl.MethodsmiR-34a was predicted as a putative gene which can target Notchl through bioinformatics analysis,qRT-PCR and Western blot were performed to measure the expression levels of Notchl and miR-34a in invasive transitional cell carcinoma of bladder (TCCB) tissues and J82 cells transfected with miR-34a.Luciferase assay was employed to determine if miR-34a could target Notchl through binding to the 3'-untranslated region (3'UTR) of Notchl mRNA.J82 cells were transfected with pcDNA3.0-miR-34a or pcDNA3.0 control plasmid.MTS colorimetry was used to evaluate the effect of miR-34a on cell proliferation.The effect of miR-34a on cell migration was assessed by transwell migration assay.ResultsThe expression level of miR-34 in invasive TCCB tissues was lower than in adjacent bladder tissues (0.016(0.018) vs 0.042 (0.059),N =16; P =0.0006).On the contrary,the average levels of Notchl mRNA and protein were higher in tumors than in adjacent bladder tissues (2.765(2.156) vs 2.312(1.365),N =16; P =0.0025 and 0.857 ±0.197 vs 0.648 ±0.171 ;P ＜0.0001 ).After the transfection of miR-34a,the expressive level of miR-34a in J82 was highly induced ( (2.408 ±0.789) × 10-4 vs(0.153 ±0.029) × 10-4; P =0.0026).However,the expressive levels of Notchl mRNA and protein were obviously decreased (3.001 ± 0.106 vs 4.998 ± 1.053 ; P =0.0308 and 0.747 ± 0.050 vs 0.988 ± 0.102 ; P =0.0215 ).The results of luciferase assay showed that firefly activity was highly dimished (0.422 ± 0.028 vs 2.392 ± 0.148 ; P ＜ 0.0001 ).Cellular proliferation was inhibited after the transfection of miR-34a in J82 (P ＜ 0.0001 ).Moreover,number of migration cells of J82 was significantly reduced after the ectopic expression of miR-34a ( 179.3 ± 21.02 vs 269.7 ± 23.71 ; P =0.0078 ).ConclusionsmiR-34a inhibits the cellular proliferation and migration of bladder cancer cell line J82 via binding to the 3UTR of Notchl mRNA.

Objective:To analyze the effects of seasonal autoregressive integrated moving average model (SARIMA), generalized additive model (GAM), and long-short term memory model (LSTM) in fitting and predicting the incidence of hemorrhagic fever with renal syndrome (HFRS), so as to provide references for optimizing the HFRS prediction model.Methods:The monthly incidence data of HFRS from 2004 to 2017 of the whole country and the top 9 provinces with the highest incidence of HFRS (Heilongjiang, Shaanxi, Jilin, Liaoning, Shandong, Hebei, Jiangxi, Zhejiang and Hunan) were collected in the Public Health Science Data Center (https://www.phsciencedata.cn/), of which the data from 2004 to 2016 were used as training data, and the data from January to December 2017 were used as test data. The SARIMA, GAM, and LSTM of HFRS incidence in the whole country and 9 provinces were fitted with the training data; the fitted model was used to predict the incidence of HFRS from January to December 2017, and compared with the test data. The mean absolute percentage error ( MAPE) was used to evaluate the model fitting and prediction accuracy. When MAPE < 20%, the model fitting or prediction effect was good, 20%-50% was acceptable, and > 50% was poor. Results:From the perspective of overall fitting and prediction effect, the optimal model for the whole country and Heilongjiang, Shaanxi, Jilin, Liaoning and Jiangxi was SARIMA ( MAPE was 19.68%, 20.48%, 44.25%, 19.59%, 23.82% and 35.29%, respectively), among which the fitting and prediction effects of the whole country and Jilin were good, and the rest were acceptable. The optimal model for Shandong and Zhejiang was GAM ( MAPE was 18.29% and 21.25%, respectively), the fitting and prediction effect of Shandong was good, and Zhejiang was acceptable. The optimal model for Hebei and Hunan was LSTM ( MAPE was 26.52% and 22.69%, respectively), and the fitting and prediction effects were acceptable. From the perspective of fitting effect, GAM had the highest fitting accuracy in the whole country data, with MAPE = 10.44%. From the perspective of prediction effect, LSTM had the highest prediction accuracy in the whole country data, with MAPE = 12.23%. Conclusions:SARIMA, GAM, and LSTM can all be used as the optimal models for fitting the incidence of HFRS, but the optimal models fitted in different regions show great differences. In the future, in the establishment of HFRS prediction models, as many alternative models as possible should be included for screening to ensure higher fitting and prediction accuracy.

Fumarate hydratasedeficient renal cell carcinoma(FH-RCC)is s a rare and highly aggressive and metastatic form of renal cell carcinoma. Clinical diagnosis is relatively challenging, and there is a lack of recognized systemic treatment options. Therefore, in clinical practice, it is necessary to have a deeper understanding of this disease and fully integrate family history, imaging findings, and pathological manifestations for clinical identification, and genetic testing shoule be conducted when necessary. Improved patient prognosis can be achieved through the selection of appropriate curative surgery or systemic treatment strategies.

Objective:To investigate the causal association between testosterone and nonalcoholic fatty liver disease(NAFLD) in men and women using a two-sample Mendelian randomization(MR) approach.Methods:Genetic variation in testosterone(total testosterone, bioavailable testosterone) and sex hormone-binding globulin(SHBG) in females and males was used as an instrumental variable using the genome-wide association study(GWAS) pooled data, and the inverse variance weighting method was applied. Inverse variance weighted(IVW) was used as the main analytical method, along with six univariate MR methods based on other modeling assumptions to assess the causal relationship between testosterone(total testosterone, bioavailable testosterone) as well as SHBG and NAFLD in women and men. In addition, NAFLD data from Finnish Biobank(FinnGen) were applied to validate the results of the exploratory analysis. Further, sensitivity analyses were performed to assess the level of heterogeneity, genetic pleiotropy, and stability of the instrumental variables using Cochran′ s Q test, MR-Egger regression, and leave-one-out methods. Results:The results of exploratory analysis of IVW model showed that bioavailable testosterone and SHBG were causally associated with NAFLD in women, for each unit increase in bioavailable testosterone levels, the risk of developing non-alcoholic fatty liver disease(NAFLD) rose by 24%( OR=1.24, 95% CI 1.07-1.43, P=0.004); and with each unit decrease in women′s SHBG, the NAFLD risk increased by 31%( OR=0.69, 95% CI 0.57-0.83, P<0.001). However, testosterone(total testosterone, bioavailable testosterone) as well as SHBG in men and female total testosterone did not show a causal relationship with NAFLD. The results of the other six MR methods were generally consistent with the IVW method. The results of the external validation data provided further evidence of a causal relationship between female bioavailable testosterone and SHBG and NAFLD. Conclusion:Elevated levels of bioavailable testosterone along lower levels of SHBG may increase the risk of developing NAFLD in women.

Acid-Base Equilibrium ; Adolescent ; Child ; Drinking Water ; Humans ; Kidney ; Mineral Waters ; Minerals ; Schools ; Surveys and Questionnaires ; Water Supply

Objective To explore the feasibility of robot-assisted laparoscopic inferior vena cava (IVC) thrombectomy in treating renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava thrombus.Methods From November 2014 to January 2017,5 cases of renal tumor with Mayo level Ⅲ-Ⅳ inferior vena cava tumor thrombus were treated with robot-assisted surgery.There were 4 males and 1 female with the median age of 59 years (range 54-71 years).Four cases had the renal tumor on the right side and one on the left side.The mean tumor size was 6.8 cm (range 5-9 cm) with 3 cases of T3b and 2 cases of T3c.There were 4 cases of level Ⅲ and 1 case of level Ⅳ inferior vena cava thrombus with the median length of 9 cm (range 7-11 cm).The surgical procedure for Mayo level Ⅲ inferior vena cava thrombus included mobilization of both left and right robes of liver,subsequently controlling the suprahepatic infradiaphramatic IVC and first porta hepatis simultaneously.The surgical procedure for Mayo level Ⅳ inferior vena cava thrombus included cardiopulmonary bypass by multi-disciplinary cooperation among urologists,hepatobiliary and cardiovascular surgeons.The procedures included live mobilization,control of the superior vena cava and first porta hepatis and remove thrombus in the atrium and IVC respectively.Results All operations were completed successfully.The median operative time was 440 min (320-630 min).The blood recovery device was used and the intraoperative estimated blood loss was 2 500 ml (500-6 000 ml) and all cases required intraoperative blood transfusion.The median time of intraoperative occlusion of IVC was 35 min (25-50 min).All patients were transferred to the intensive care unit for median of 4 days (2-8 days) after surgery.The median time to remove the postoperative drainage tube was 9 days (7-12 days).Postoperative pathological diagnosis revealed 5 cases of clear cell carcinoma.Postoperative renal dysfunction occurred in 3 patients and liver dysfunction occurred in 2 patients who improved after medical therapy.During median 19.6 months (12-48 months) of follow-up,1 patient died and 1 patient progressed.Conclusions Despite the high risk of surgery,robot-assisted laparoscopic IVC thrombectomy for renal tumor with Mayo level Ⅲ-Ⅳ thrombus is feasible for experienced surgeons in selected patients.However,the oncological outcomes need further investigation.