Objective To investigate the expression of Notch4 protein and to analyze its correlation with the clinical parameters and the microvessel dentisty in renal cell carcinoma. Methods The expression of Notch4 was examined in 60 cases of renal cell carcinoma and the para-carcinoma tissue by SP immunohistochemical stain-ing ,and CD34 detection was used for counting microvessel density. Statistical analysis was performed to reveal the correlation with clinicopathological parameters ,microvessel density and prognosis. Results The positive rate of Notch4 protein expression was 75%(45/60)in para-carcinoma tissue,and was 43.3%(26/60)in renal cell car-cinoma,with significant difference on tumor grade and Lymph node metastasis(P<0.05). The microvessel densi-ty in Notch4 positive tissues was significant lower than that in the negative samples(P<0.05). The survival time of patients with Notch4 positive expression was significantly longer than that of patients with Notch4 negative expres-sion(P<0.05). Conclusion Notch4 protein plays an important role in the development of renal cell carcinoma. Notch4 expression might both attenuate the malignant biological characteristics and suppress the angiogenesis dur-ing tumor development.

Objective To investigate etiologies,treatment approaches and prophylaxis for delayed thoracostomach emptying in esophageal or gastric cardiac cancer patients treated with esophagogastrostomy.Methods We performed a retrospective review of the clinical data of 24 patients suffering delayed thoracostomach emptying among 1985 post-surgical patients with esophageal or gastric cardiac cancer from January 2000 to June 2011.Results Eighteen patients in the 24 patients were cured by conservative managements including endoscopic dilatation procedures.The remaining 6 patients were treated with surgery.Conclusion The main etiology of delayed thoracostomach emptying is gastroparesis,which can be treated with nonsurgical conservative approaches; whereas mechanical emptying disturbance requires surgery.Endoscopic examination appears to be the most important diagnostic approach in identifying and differentiating the etiologies of delayed thoracostomach emptying in post-surgical patients.Endoscopic dilatation procedure is proved to be effective for the treatment of delayed thoracostomach emptying in post-surgical patients in this study.

Objective To explore the diagnosis value of CT in subarachnoid hemorrhage(SAH) induced by aneurysm rupture.Methods The clinical and CT data of 119 patients with SAH induced by aneurysm rupture were analyzed respectively.Results The CT characteristic of SAH induced by aneurysm rupture was full of hyperderse in sulcus and schizenceplay,or accompaning intracerebral hematoma in the straight gyrus of frontal lobe and the hippocampal gyrus of parietal lobe.Conclusion The CT has important value for diagnosing SAH induced by aneurysm rupture in the location and the nature.But it is indispensable that the CTA or DSA must be done for ascertaining the artery of responsibility of rupturing aneurysm.

Objective To obtain reasonable treatment by urodynamic detection and analysis in patients with diabetic cystopathy (DCP) complicated with benign prostatic hyperplasia (BPH).Methods Sixty patients with DCP complicated with BPH were selected,among the total 32 patients (duration of diabetes ＞ 12 years,blood glucose control was not ideal) were recognized as experimental group,and 28 patients (duration of diabetes ≤ 8 years,blood glucose control was stable) were recognized as control group.Using the Laborie UDS-120XLT urodynamic detection instrument,the urodynamic was detected and the international prostate symptom score (IPSS) was evaluate,and the results were compared between the 2 groups.Results There was no statistical difference in residual urine volume between experimental group and control group [(146 ±71) ml vs.(160 ±64) ml,P ＞0.05].The maximum urinary flow-rate in experimental group was significantly lower than that in control group [(5.4 ± 2.0) ml/s vs.(8.0 ± 3.2) ml/s],the symptom total score of IPSS was significantly higher than that in control group [(25.8 ± 4.1) scores vs.(22.6 ±5.0) scores],there were statistical differences (P ＜0.01).The maximum bladder capacity,compliance,incipient micturition desire volume in experimental group were significantly lower than those in control group,there were statistical differences (P ＜ 0.01).Conclusions The influence of DCP on the function of the bladder in BPH patients is significant.Urodynamic detection can provide objective basis for the selection of therapeutic methods,suitable to be operated and forecast the postoperative effect.It has an important reference value in DCP complicated with BPH patients.

Objective To analyze the incidence and clinical features of urothelial tumors in renal allograft recipients.Methods A retrospective analysis of 1042 patients received renal allografts who had taken immunosuppression for at least six months between 2006 and 2011 in The First Centre Hospital of Tianjin was performed.Results Eleven cases of uroepithelial tumors were diagnosed in the 1042 cases of renal transplantation ( 1.06％ ),of whom 9 cases were noticed by hematuria ( 81.8 ％ ),2 cases ( 18.2％ ) by medical examination.Six patients were diagnosed with multifocal urothelial carcinomas.Surgery was performed on all the patients with renal tumors and followed by chemotherapy or radiotherapy.Conclusion Malignancies in urinary tract after renal transplantation should be bore in mind.Early diagnosis is very important.The treatment options include reducing immunosuppressive agents and removing tumor lesions completely.

Objective To evaluate the short term results of endovascular laser for the treatment (ELVT) of great saphenous varicosity. Methods Twenty one cases (a total of 27 lower extremities) were enrolled. Treatment included EL combined with ligation and resection of communicating branches. One patient underwent high ligation and resection of the great saphenous vein for the purpose of pathology after ELVT treatment. Result Twenty patients were followed-up for a period of 2～6 months. Color Duplex ultrosonography was conducted 2 weeks,4 weeks,and 6 mos,respectively. Thrombotic obliteration was found in all cases. Pathology study showed perforation of the vein with intimal injury and thrombosis. Conclusion The short term efficacy of EL treatment is definite with insignificant side-effect,and quick patient recovery. The mechanism is related to direct thermal injury of laser to the venous intima resulting in thrombotic obliteration.

Objective To sum up our experience in the diagnosis and management of acute superior mesenteric venous thrombosis (SMVT). Methods We retrospectively reviewed 41 patients treated for acute SMVT admitted in our hospital from Jan 1978 to Aug 2003. Before 1995 (group Ⅰ), a surgery was preformed in patients with suspected acute SMVT. Since Jan 1995 (Group Ⅱ), aggressive medical therapy was immediately delivered, and the patients were subjected to laparatomy with suspected peritonity. Results There were 13 cases in group Ⅰ, and 28 in group Ⅱ. Mortality in group Ⅰ was 38.5%, and that in group Ⅱ was 10.7% (P

ObjectiveTo investigate the expression and significance of p38 mitogen-activated protei n kinase (MAPK) in autogenous vein graft. Methods Autogenous vein graft model was established by transplanting the right jugular vein to infr arenal abdominal aorta in 80 Wistar rats. Ten vein graft samples were harvested 6 hours, 24 hours, 3 days, 7 days, 2 weeks, 4 weeks, 6 weeks and 8 weeks after s urgery,respectively. Reverse transcription-PCR and in situ hybridization,Wester n blot and immunohistochemistry methods were used to detect the expression of pr otein and phosphorylation protein of p38 and p38mRNA. ResultsThe expression of p38 mRNA increased 6 hours after surgery and reached the peak on the second week after surgery (59%?26%),and significantly higher than that on 4,6,8 weeks( P

Objective To evaluate the effects of gender and age on median-effective target plasma concentration(EC50)of propofol administered by target controlled infusion(TCI)causing respiratory depression.Methods Eighty ASA Ⅰ or Ⅱ patients aged 40-79 yr,with body mass index 18-25 kg/m2.undergoing general anesthesia were divided into 4 groups(n=20 each):1 middle-aged male group(MA);Ⅱ middle-aged female group(FA);Ⅲold male group(MO) and Ⅳo ld female group(FO).No premedication was administered.Propofol Was administered by TCI for 15 min,using TCI system incorporating Marsh pharmacokinetic model.EC50 Was determined by up-end-down sequential trial.The target plasma concentration(Cr)was set at 3.1μg/ml in the first Patient in each group.Each time Cr increased/decreased by 10%in the next patient depending on whether or not the respiratory depression occurred.Respiratory depression was defined as RR<8 bpm,Vr≤5 ml/kg,end-tidal PCO2≥50 mm Hg,SaO2≤94%and/or apnea≥15s.Results The EC50 and 95%confidence interval of propofol TCI causing respiratory depression were 6.40(6.09-6.72)μg/ml in group MA,5.93(5.54-6.34)μg/ml group FA,4.58(4.32-4.91)μg/ml in group MO and 4.37(4.14-4.61)μg/ml in group FO.EC50 was significantly lower in group FO than in group FA and in group MO than in group MA,but there Was no significant difference in EC50 between group MA and group FA or between group MO and FO. Conclusion The potency of propofol given by TCI causing respiratory depression is increased in the old patients as compared with the middle-aged patients and is not related to sex.

Objective To assess apoptosis mediated by the cell death receptor Fas in peripheral T lymphocytes of patients with abdominal aortic aneurysm. Methods The apoptotic pathway was triggered by anti-Fas monoclonal antibody in cultured and activated peripheral T-cells from 20 AAA patients. Control groups consisted of 15 patients with aortic atherosclerotic occlusive disease(AOD)and 25 healthy individuals. Cell survival and death rate were assessed. Results Cross-linkage of Fas receptor exerted a strong apoptotic response on T cells from AOD patients and healthy controls, while the effect on T cells was very limited from that of AAA patients. The evaluation of cell Survival rate showed a significantly higher percentage in AAA group(98.9%±10.3%)than in the AOD subjects(58.9%±15.2%)or the healthy group(59.4%±12.9%;P＜0.001＝.Apoptosis assessment by annexin V and propidium iodide staining and flow cytometry showed similar results. The defect in AAA group was not due to decreased fas expressed at normal levels. Moreover,it specifically involved the Fas system because cell death was induced in the normal way by methylprednisolone. Conclusions Fas-induced apoptosis in activated T cell from AAA patients is impaired. This may disturb the normal down-regulation of the immune response and thus provide a new insight into possible mechanisms and routes in the pathogenesis of AAA.