Objective To evaluate the gastroesophageal reflux symptom in patients who underwent continuous ambulatory peritoneal dialysis (CAPD) and the efficacy of proton pump inhibitor (PPI) in treating gastroesophageal reflux. Methods Fifty-eight CAPD patients with good clinical and complete dialyzed eondition,who was admitted to the hospital between Jan. 2008 and July 2008, were inquired about their gastroesophageal reflux symptoms using reflux disease questionnaire (RDQ). The patients who had RDQ≥6 and <12 were received esomeprazole 20 mg daily, while those with RDQ≥12 were received esomeparzole 20 mg twice daily. RDQ score was reevaluated 4 weeks after treatment.Results The common symptom was regurgitation (64.70%), followed by acid reflux (52.9 %), non-cardic chest pain (47.1. %) and heart burn (17. 6%). After 4-week treatment, the RDQ was significantly decreased (P< 0. 05). But there was no difference in outcome of treatment between patients with RDQ≥ 12 and RDQ< 12 (P=0. 059). Conclusion The gastroesophageal reflux symptom in CAPD patients can be relieved by PPI administration, but a larger clinical trial is needed to evaluate the course and efficacy of treatment.

[Objective] To study the effect of electroacupuncture on NO, NOS and ET - 1 levels in rats with focal cerebral ischemia (FCI). [Methods] Rat models with FCI were established by occlusion of unilateral middle cerebral artery. Twenty - two rats were allocated to three groups: Group A (mimic operation group), Group B (model group) and Group C (model rats treated with electroacupuncture). NO, NOS and ET - 1 levels in brain homogenate were measured by spectrophotometry and radioimmunoassay method respectively. [Results] Sixty minutes after modeling, NO, NOS and ET- 1 levels were increased and then decreased 10 minutes after acupuncturing Baihui (GV20) and Dazhui (GV14). [Conclusion] Electroacupuncture of Baihui (GV20) and Dazhui (GV14) can protect neuron from ischemic injury by decreasing the levels of NO and ET - 1 and inhibiting the activity of NOS.

Objective To find the mutation of disease-causing genes of sudden unexplained death syn-drome (SU D S ) in the young by whole exome sequencing in one case. Methods O ne SU D S case was found no obvious fatal pathological changes after conventional autopsy and pathological examination. The whole exome sequencing was performed with the Ion Torrent PGMTM Systemwith hg19 as reference se-quence for sequencing data. The functions of mutations were analyzed by PhyloP, PolyPhen2 and SIFT. A three-step bioinformatics filtering procedure was carried out to identify possible significative single nu-cleotide variation (SN V ), which was missense mutation with allele frequency <1% of myocardial cell. Results Four rare suspicious pathogenic SN V were identified. C ombined with the analysis of convention-al autopsy and pathological examination, the mutation MYOM 2 (8_2054058_G/A ) was assessed as high-risk deleterious mutation by PolyPhen2 and SIFT, respectively. Conclusion Based on the second genera-tion sequencing technology, analysis of whole exome sequencing can be a newmethod for the death cause investigation of SU D S. The gene MYOM2 is a newcandidate SU D S pathogenic gene for mecha-nismresearch.

Objective To determine if activation of AMP-activated protein kinase (AMPK) is involved in ropivacaine-induced reactive oxygen species (ROS) production and apoptosis in human neuroblastoma cell line SHSY5Y.Methods SH-SY5Y cell line was purchased from cell center of Shanghai life Science Research Institute,Chinese Academy of Sciences and cultured in DMEM/F12 liquid culture medium containing 15 % bovine calf serum at 37 ℃ in incubator filled with 5% CO2 . Plasmids pGPU6/GFP/Neo-shRNA AMPKα2 and pEGFP-N1-AMPKα2were transfected into the SH-SY5Y cell line. The expression of AMPKα2 was determined by Western blot analysis.The SH-SY5Y cells transfected with recombinant plasmids were exposed to 3 mol/L ropivacaine. Intracellular ROS was detected by flow cytometry. Cell viability was quantitatively determined by MTT colorimetry assay. Apoptosis was assessed by flow cytometry and Hoechst33258 staining. Results The plasmid pEGFP-N1-AMPKα2 upregulated while pGPU6/GFP/Neo-shRNA AMPKα2 down-regulated the expression of AMPKα2 ( P < 0.01). Down-regulation of AMPKα2 expression attenuated while up-regulation of. AMPKα2 expression promoted intracellular ROS production and cell apoptosis induced by ropivacaine ( P < 0.01) . Conclusion AMPK probably mediates ROS production and cell apoptosis induced by ropivacaine.

Objective To explore the technique of breast reconstruction after mastectomy. Methods 30 cases of patients with breast cancer who were not suitable for breast conservative surgery were sum-marized. Among them, immediate breast reconstruction with prosthetic implants after mastectomy was used in 16 patients, transverse rectus abdominis musculocutaneous flap (TRAM flap) in 10 patients, and latissimus dorsi musculocutaneous flap in 4 patients. There were 27 patients who underwent immediate breast reconstruction, while 3 patients underwent delayed breast construction. Results The appearance was good in 16 cases of breast reconstruction with prosthetic implants and no complications were found. Two out of the ten patients who had the transevarse rectus abdominis musculocutaneous flap (TRAM flap) breast reconstruction had partly necrosis of skin flap, and one lateral ventral syndrome. The appear-ance of the 7 cases after the TRAM flap breast reconstruction evaluated well, 2 cases moderate, and one case less satisfactory. The appearance of 4 patients who had breast reconstruction with latissimus dorsi musculocutaneous flap evaluated well. Conclusion Breast reconstruction is an important part of combined therapy for the breast cancer, especially for the patients who have strong desire to conserve breast, while incompetence for breast conserving surgery. In such a case breast reconstruction is a good choice. Imme-diate breast reconstruction is better than delayed breast construction. The appropriate method of breast reconstruction depends on each individual patient. Patients with locally advanced breast carcinoma can se-lectively choose immediate breast reconstruction.

OBJECTIVE: To evaluate the long-term efficacy and safety of ultrasound-guided percutaneous nephrolithotomy (PCNL) in the treatment of patients with solitary kidney stones. METHODS: The clinical data of 22 patients with solitary kidney stones treated with PCNL in Peking University People's Hospital from September 2008 to June 2014, with the follow-up data of more than 5 years were analyzed retrospectively. Perioperative indicators, postoperative stone free rate (SFR) and incidence of complications were recorded. Ultrasonography was used to evaluate the long-term stones recurrence rate. Serum creatinine and estimated glomerular filtration rate (eGFR) were used to assess the long-term renal function. RESULTS: In this group of 22 patients, the average age was (50.3±11.8) years, with 10 cases of anatomic solitary kidneys, 12 functional solitary kidneys, and the median stone diameter was 1.65 (1.1-3.9) cm. All the patients had multiple stones, including 7 cases of staghorn stones. The median pre-operative serum creatinine was 104.5 (60.0-460.0) μmol/L, and the mean eGFR was (60.3±29.4) mL/min, showing no statistically significant difference compared with that before surgery. The mean operative time was (88.2±42.0) min, and there were 11 cases of single-channel and double-channel PCNL. The median serum creatinine on the first day after surgery was 102.0 (63.0-364.0) μmol/L, and the mean eGFR was (58.0±25.1) mL/min. The mean postoperative hospital stay was (8.7±5.2) days. In this group, 5 patients (22.7%) presented short-term complications, among which 4 patients presented postoperative infection and massive hemorrhage at the same time, which improved after conservative treatment, and 1 patient presented pleural injury and improved after closed thoracic drainage. Two patients (9.1%) developed long-term complications, and ureteral stricture occurred 3 months after operation, which improved after balloon dilatation. The median follow-up time was 6.2 (4.7-11.1) years. The median serum creatinine at the last follow-up was 104.0 (72.4-377.0) μmol/L, and the mean eGFR was (60.1±23.7) mL/min, showing no statistically significant difference compared with that before surgery. Renal function decreased in 6 patients (27.3%). Initial and final SFR were 72.7% and 100%, respectively. During the 6.2-year follow-up, 9 patients (40.9%) experienced recurrence of kidney stone. After stone recurrence, 13 lithotomy surgeries were performed, and the SFR by the latest follow-up was 63.6%. CONCLUSION This study had the longest follow-up time for patients with solitary kidney stones after PCNL reported at home and abroad. Ultrasound-guided standard PCNL was safe and effective in the treatment of solitary kidney stones. Long-term follow-up results showed that the recurrence rate of kidney stones was still high, but the long-term renal function was stable after operation, and some patients showed mild renal function decline.
Adult ; Humans ; Kidney Calculi ; Middle Aged ; Nephrolithotomy, Percutaneous ; Retrospective Studies ; Solitary Kidney/surgery* ; Treatment Outcome

OBJECTIVE: To find the mutation of disease-causing genes of sudden unexplained death syndrome (SUDS) in the young by whole exome sequencing in one case. METHODS: One SUDS case was found no obvious fatal pathological changes after conventional autopsy and pathological examination. The whole exome sequencing was performed with the Ion Torrent PGM™ System with hg19 as reference sequence for sequencing data. The functions of mutations were analyzed by PhyloP, PolyPhen2 and SIFT. A three-step bioinformatics filtering procedure was carried out to identify possible significative single nucleotide variation (SNV), which was missense mutation with allele frequency < 1% of myocardial cell. RESULTS: Four rare suspicious pathogenic SNV were identified. Combined with the analysis of conventional autopsy and pathological examination, the mutation MYOM2 (8_2054058_G/A) was assessed as high-risk deleterious mutation by PolyPhen2 and SIFT, respectively. CONCLUSION Based on the second generation sequencing technology, analysis of whole exome sequencing can be a new method for the death cause investigation of SUDS. The gene MYOM2 is a new candidate SUDS pathogenic gene for mechanism research.
Autopsy ; Brugada Syndrome/genetics* ; Cause of Death ; DNA Mutational Analysis/methods* ; Death, Sudden/etiology* ; Exome ; Gene Frequency ; Genetic Testing/methods* ; High-Throughput Nucleotide Sequencing/methods* ; Humans ; Molecular Biology ; Molecular Diagnostic Techniques/methods* ; Molecular Sequence Data ; Mutation

Neochemoradiotherapy has been implemented in the multidisciplinary therapy for advanced rectal cancer.The patients with complete response after neothemoradiation could avoid surgical resection and thereafter might be free of surgical complications,as well as functional impairment.However,the preoperative evaluated clinical complete response is not equally to the pathologic complete response after surgery.The accurate methods to evaluate the status of complete response remained controversy.Based on the digital rectal examination and endoscopic observation,rectal MRI and endorectal ultrasound could verify the integrity of mucosa and the structural changes in rectal wall.These preoperative staging methods,as well as PET-CT and needle biopsy,had been widely used,but with a low sensitivity.

OBJECTIVETo explore the cause, urgent management, further treatment, outcome and prevention of internal carotid artery (ICA) injury during transnasal endoscopic surgery.

METHODSFive ICA injury happened during transnasal endoscopic surgery of sphenoidal sinus and (or) sellar region, involving 1 case of traumatic optic neuropathy, 1 case of sphenoidal cyst, 1 case of fungal sphenoid sinusitis, 1 case of sellar adenoid cystic carcinoma and 1 case of pituitary tumor. These five cases were from three different hospitals in 1990 - 2009, and the clinical data were collected and retrospectively reviewed.

RESULTSInjury of ICA was related with improper anatomic localization and operative procedures. The locations of injury were in cavernous segment in 3 cases, lacerum segment in 1 case, and clinic segment in 1 case, respectively. The types of injury included 3 cases of bleeding of laceration, 1 case of carotid cavernous fistula and 1 case of pseudoaneurysm. Salvage sphenoid sinus packing with vaseline strip and subsequent intravascular stent graft implantation (2 cases) and endovascular embolization (2 cases) effectively controlled bleeding. Four cases were successfully treated without craniocerebral or ocular complications, only 1 case died of massive blood loss. Among 4 survival cases, 1 patient abandoned further therapy, the other 3 patients were cured of primary disease by reoperation or subsequent treatment.

CONCLUSIONPreoperatively, reading carefully the imaging data, intraoperatively, identifying anatomical positions accurately, performing proper operation, and stopping bleeding decidedly, postoperatively, seeking interdisciplinary cooperation to repair vascular damages, all these procedures can effectively reduce the surgical risk of ICA injury.

Adolescent ; Aged ; Carotid Artery Injuries ; etiology ; prevention & control ; surgery ; Carotid Artery, Internal ; Endoscopy ; adverse effects ; methods ; Female ; Humans ; Male ; Middle Aged ; Nose ; surgery ; Retrospective Studies

Objective To analyze the related pathogenicity gene mutations in a sudden death of hypertrophic cardiomyopathy (HCM) on whole exome level.Methods Whole exome sequencing (WES) was been performed on a sudden death case sample with pathological features of HCM by Illumina(R) Hiseq 2500 platform.Using hgl9 as the reference sequences,the sequencing data were analyzed.Suspicious single nucleotide variants (SNV) were screened,and the conservatism and function were analyzed by the software such as PhyloP,PolyPhen-2,SIFT,etc.Results After screening,a heterozygous mutation C719R was finally identified in the gene MYBPC3 of this case.Conclusion The molecular anatomy on whole exome level by second generation sequencing technology can help to define the molecular mechanism of HCM and provide a new mothed and thought for analysis of death cause.