Objective To discuss prevention and treatment of the late complications of deteniaceacal-colon continent urinary reservoir. Methods 105 patients who underwent detenia ceacal-colon con-tinent urinary reservoir were followed up for 9 -82 months(mean 40.5 months).Clinical data of these wereretrospectively analyzed. Results Late complications occurred in 25.7%(27/105) of the cases and 9were treated with operations,including difficulty with catheterization in 4 cases(3.8%),3 treated with dila-tion and 1 with efferent limb reconstruction with ileal,urinary pouch stones in 5(4.8%),4 treated with li-thotomy,urinary pouch perfotation in 1 (0.95%),treated with repair,urinary pouch superdistention in 1(0.95%),treated with reduction, single or double lateral hydronephrosis in 8(7.6%),caused by strictureof single or double lateral lower ureters in 4 (2 treated with excision lesion and anastomosis ) and by refluxin 1,1 case suffering from azotemia preoperatively worsened to uraemia treated with regular haemodialysis,hyperchloremia in 7 (6.7%),only 1 needed drugs treatment,repeated urinary infection in 11,amomg them,10 were complicated by the other complications,all treated with sensitive antibiotic. Conclusions Most ofpatients underwent detenia ceacal-colon continent urinary reservoir had good curative effects. Late complica-tions afflicting these patients mostly had immediate or mediate relations with symptomatic urinary infection.Prevention and treatment of symptomatic urinary infection can reduce the occurrence of late complications ofthis operative method,regular and adequant pouch washing and catheterization is efficient to prevention oflate complications of this operative method.

Background Recent studies have demonstrated that epicardial flow in nonculprit arteries,which has been assumed to be normal,was slowed in the setting of ST-elevation myocardial infarction (STEMI).However,the impact of primary percutaneous coronary intervention (PCI) on blood perfusion in nonculprit arteries in patients with STEMI has not been clarified.The purpose of this study was to investigate the impact of primary PCI on blood perfusion in nonculprit arteries in patients with STEMI and correlated clinical factors.Methods A total of 117 patients with anterior wall STEMI,the culprit artery being the left anterior descending artery (LAD),undergoing primary PCI (the study group) and 100 patients with normal coronary angiography (the control group) were enrolled.To observe the differences of corrected TIMI frame count (cTFC) and myocardial blush grade (MBG) before and after primary PCI in both culprit and nonculprit arteries,the left circumflex coronary artery (LCX),cTFC and MBG in the LAD and LCX were measured in the study group and control group.The study group was divided into three groups; reflow in the culprit artery group (the R group),no reflow in culprit artery group (the NR group),and no reflow in both the culprit artery and nonculprit artery group (the NRB group) according to MBG grade.The level of serum C-reactive protein (CRP),catecholamine,and fibroblast growth factor-21 (FGF21) were assayed.The clinical and angiographic characteristics were also analyzed.Results cTFC (28.1±24.3 vs.20.3±19.3,P ＜0.05) and MBG in the LCX were different in the study group compared to the control group before primary PCI.cTFC (25.2±22.3 vs.28.1±24.3,P ＜0.05) and the MBG level in the LCX were improved after successful primary PCI,but were not recovered to the normal level.Patients with no reflow in the culprit artery had a higher incidence of no-reflow in the nonculprit artery (78％ vs.19％,P ＜0.0001),and the levels of CRP ((3.29±1.31) mg/dl vs.(2.51±1.14) mg/dl vs.(2.93±1.07) mg/dl,P ＜0.05,respectively),catecholamine ((epinephrine (693.48±89.78) pg/ml vs.(398.12±93.28) pg/ml vs.(562.54±96.22) pg/ml,P ＜0.0001,respectively),and norepinephrine ((7012.43±932.47) pg/ml vs.(4012.34±814.16) pg/ml vs.(5549.03±912.65) pg/ml,P ＜0.0001,respectively)) in the NRB group were higher than those in the R group and NR group.The level of FGF21 ((0.299±0.093) ng/ml vs.(0.612±0.071)ng/ml vs.(0.428±0.074) ng/ml,P ＜0.0001 respectively) in the NRB group was lower than that in the R group and NR group.Conclusions The blood perfusion in the nonculprit artery may be impaired in patients with STEMI.Although nonculprit artery perfusion may be improved after successful primary PCI,it is still lower than that in the control group,and may be involved in inflammation and spasms.

OBJECTIVETo evaluate the factors affecting the efficacy of extracorporeal shock wave lithotripsy (ESWL) for renal calculi.

METHODSBetween January, 2004 and January, 2007, 316 patients (212 men and 104 women) with renal stone underwent ESWL. The correlations of the patients' age, gender, body mass index (BMI), disease course, pain, hematuria, stone size, location, side, number and hydronephrosis to the outcome of the treatment was analyzed. The treatment success was defined as complete clearance of the stones or residual stone fragments <0.4 cm, and ESWL was considered unsuccessful with residual stones>0.4 cm.

RESULTSThe overall success rate was 75.3% (238/316) in these patients. Significant difference in stone clearance rates was observed in patients with stone size of 0.5-1.0 cm (90.3%, 167/185), 1.0-2.0 cma(69.6%, 55/79), and >2.0 cm (30.8%, 16/52) (P<0.05). The success rates differed significantly between cases of pelvic stones (83.1%, 118/142) and those of caliceal stones (69.0%, 120/174) (P<0.05). But in cases of caliceal stones, the success rates were comparable between cases with stones at the upper calyx (71.7%, 43/60), middle calyx (68.9%, 31/45), and lower calix (66.7%, 46/69) (P>0.05). Patients with single stones had significantly higher success rate (82.9%,170/205) than those with multiple stones (61.3%, 68/111) (P<0.05). The patients' gender, age, disease course, pain, hematuria, stone side and hydronephrosis did not produce significant impact on the outcome of the treatment (P>0.05).

CONCLUSIONStone size, location and quantity are significant independent factors affecting the outcome of ESWL for renal stones.

Adolescent ; Adult ; Aged ; Female ; Humans ; Kidney Calculi ; therapy ; Lithotripsy ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the clinical efficacy of extracorporeal shockwave lithotripsy (ESWL) for bilateral ureteral stones with renal colic in emergency.

METHODSWe retrospectively analyzed the clinical data of 86 patients suffered with sudden renal colic due to bilateral ureteral stones and treated with ESWL between January 2005 and January 2009.

RESULTSThe success rate was 74.4% after a single ESWL session, and the overall success rate was 82.6%. Significant difference in stone length was observed between successful group and failed group (P<0.01). The stone position did not produce significant impact on the outcome of the treatment (P>0.05).

CONCLUSIONESWL is an effective treatment modality in emergency for small-length and short-term obstruction bilateral ureteral stones with remal colic.

Adolescent ; Adult ; Emergencies ; Female ; Humans ; Lithotripsy ; Male ; Middle Aged ; Renal Colic ; etiology ; therapy ; Ureteral Calculi ; complications ; therapy ; Young Adult

OBJECTIVETo summarize the experience in the application of circumcision anastomat in the treatment of phimosis and redundant prepuce in children.

METHODSA total of 551 children with phimosis or redundant prepuce were treated by circumcision from 2008 to 2010, 342 with circumcision anastomat and the other 209 by traditional circumcision. Their clinical data were retrospectively analyzed.

RESULTSCompared with traditional circumcision, circumcision with the anastomat showed the advantages of less operation time (P < 0.05), fewer complications, no need for dressing, and better cosmetic appearance, but it also exhibited the disadvantages of longer healing time (P < 0.05) and more obvious postoperative pain (P < 0.05).

CONCLUSIONCircumcision with the anastomat and traditional circumcision for the treatment of phimosis and redundant prepuce in children each have their own advantages and disadvantages, but the former is more advantageous and more feasible clinically.

Adolescent ; Anastomosis, Surgical ; Child ; Circumcision, Male ; instrumentation ; methods ; Humans ; Male ; Phimosis ; surgery ; Treatment Outcome

OBJECTIVETo investigate the expression of cyclin-dependent kinase inhibitor p27kip1 in renal cell carcinoma and its clinical significance.

METHODSThe expressions of p27kip1 mRNA and protein were evaluated using reverse transcription polymerase chain reaction (RT-PCR), Western blotting and immunohistochemistry with tissue chip technique in renal cell carcinoma (RCC) tissues, adjacent tissues and 786-0 cell line. The relationship between the expression of p27kip1 and the tumor size, the clinical stage, pathological type and stage were evaluated, and the results by the 3 methods were analyzed to evaluate the relationship between the mRNA and protein of p27kip1.

RESULTSThe expression of p27kip1 protein (detected by immunohistochemistry and Western blotting) in RCC tissue was significantly lower than that in the adjacent normal tissues (P<0.05). The expression of p27kip1 mRNA (by RT-PCR) showed no significant difference between the two groups. p27kip1 protein expression was found to be inversely correlated to the tumor grade and clinical stage (P<0.05). Western blotting and immunohistochemistry showed a high coincidence rate in the detection of P27kip1 protein expression in RCC samples (P<0.001, K=0.828).

CONCLUSIONp27kip1 mRNA expression shows no difference between RCC and normal tissues, while the protein expression is significantly lower in the cancer tissues, suggesting a regulatory mechanism of p27kip1 expression at the transcriptional level. Low expression of p27kip1 protein may promote the development and progression of RCC. p27kip1 protein may serve as a diagnostic and prognostic marker of RCC.

Blotting, Western ; Carcinoma, Renal Cell ; genetics ; metabolism ; pathology ; Cell Line, Tumor ; Cyclin-Dependent Kinase Inhibitor p27 ; genetics ; metabolism ; Female ; Humans ; Immunohistochemistry ; Kidney Neoplasms ; genetics ; metabolism ; pathology ; Reverse Transcriptase Polymerase Chain Reaction

OBJECTIVETo evaluate the feasibility of oral cytokine gene therapy against tumor using live attenuated Salmonella as a vector.

METHODSA live attenuated AraA- autotrophic mutant of Salmonella typhimurium (SL3261) was used as carrier for eukaryotic expression vectors EGFPN1 and pCMVmIL-12 administered orally in BALB/c and C57BL/6 mice. After 6 weeks, the mice were challenged with 4T1 or Lewis tumor cells, respectively, and flow cytometry and confocal microscopy were used to detect the expression of green fluorescence protein (GFP) in the tissues. PCR and ELISA were performed to detect the integration and expression of mIL-12 gene, and the survival time of the mice was also recorded.

RESULTSGFP expression and mIL-12 gene integration could be detected in the liver, spleen, intestinal, kidney and tumor tissues of the mice. The serum level of mIFN-gamma, mIL-12 increased significantly in mice with oral mIL-12 administration (P<0.05), which resulted in the survival prolongation of the mice as compared with the control mice (P<0.05).

CONCLUSIONOral gene therapy using live attenuated Salmonella can be potentially a simple, effective and above all, safe means for tumor treatment.

Administration, Oral ; Animals ; Carcinoma, Lewis Lung ; therapy ; Flow Cytometry ; Genetic Therapy ; methods ; Genetic Vectors ; administration & dosage ; genetics ; metabolism ; Green Fluorescent Proteins ; genetics ; metabolism ; Interleukin-12 ; genetics ; metabolism ; Mammary Neoplasms, Animal ; therapy ; Mice ; Mice, Inbred BALB C ; Mice, Inbred C57BL ; Microscopy, Confocal ; Neoplasms, Experimental ; therapy ; Salmonella typhimurium ; genetics ; immunology ; metabolism ; Vaccines, Attenuated ; immunology

OBJECTIVETo investigate the expression of MN/CAIX in patients with renal cell carcinoma (RCC) and assess the value of MN/CAIX in the diagnosis of RCC.

METHODSRT-PCR was employed to detect MN/CAIX mRNA in the carcinoma tissue and peripheral blood of 62 patients with RCC, using normal renal tissue and peripheral blood sample from 32 patients without RCC as control. Immunohistochemistry was used to detect MN/CAIX protein in the tissue specimens of clear cell RCC (n=36), non-clear cell renal neoplasm (n=17) and normal kidney (n=16).

RESULTSThe positivity rate of MN/CAIX mRNA was 82.3% (51/62) in renal carcinoma tissues and 54.8% (34/62) in the peripheral blood from patients with RCC, significantly higher than the rates in the control cases (P<0.05). In cases of clear cell renal cell carcinoma, the positivity rate of MN/CAIX mRNA was 98% (49/50) in the carcinoma tissues and 66% (33/50) in the peripheral blood, significantly higher than the rates in cases of non-clear cell type of RCC (P<0.05). Immunohistochemistry showed a significantly higher positivity rate of MN/CAIX protein in clear cell RCC tissues [97.2% (35/36)] than in non-clear cell renal neoplasm and normal renal tissues (P<0.05).

CONCLUSIONMN/CAIX is specifically overexpressed in RCC, especially in clear cell RCC, suggesting its potential in the diagnosis and prognostic and therapeutic evaluation of RCC.

Adult ; Aged ; Antigens, Neoplasm ; genetics ; metabolism ; Biomarkers, Tumor ; Carbonic Anhydrase IX ; Carbonic Anhydrases ; genetics ; metabolism ; Carcinoma, Renal Cell ; diagnosis ; metabolism ; Female ; Humans ; Kidney Neoplasms ; diagnosis ; metabolism ; Male ; Middle Aged ; RNA, Messenger ; genetics ; metabolism ; Young Adult

Objective To explore the clinical outcome of improved technique of Gamma nail in the treatment of intertrochanteric hip fracture of the elderly patients. Methods From March 2002 to October 2006.39 patients with intertrochanteric hip fracture were operated by improved technique of Gam-ma nail.There were 18 males and 21 females at average age of75.7 years(67_98 years).There were 6 patients with type A1 fracture,24 with type A2 fracture and 9 with type A3 fracture according to AO/ASIF classification.Of all.36 patients(92.3%)had osteoporosis.The operation improvements included the following points:(1)The patients were placed at the lateral decubitus position with the fractured limb on the uppermost,with flexion of knee and hip of 60°.The normal hip and knee were flexed as possible.(2)One-off indirect traction reduction was used after general anesthesia. no requirement of continuous mechanical traction.(3)C-arm image intensifier was employed to obtain normal and lateral projections.Results Of all,35 patients were followed up for a mean period of3 years and 2 months, ranging from 6 months to 5 years and 2 months.Operation data showed incision length of(4.3±1.2)cm,mean opera-tion time of(46±10)minutes,intraoperative bleeding volume of(65±26)ml and intraoperative X-ray exposure of(3.0±2.1)times.Postoperative recovery data showed survival in one-year follow up,with ambulation time of(10.5±3.6)days and fracture union time of(10.9±2.1)weeks.Mean Parker's score wag(6.9±3.2)points 6 months after operation. Conclusions Improved technique of Gamma nail can shorten operation duration,reduce operative trauma and bleeding,reduce X-ray exposure and im-prove success rate of surgery.as facilitates early pest-operative recovery and reduces the perioperative mortality rate of the elderly.