Objective To evaluate the therapeutic effects of low tension,anti-reflux Roux-y sigmoid neobladder. Methods Using modified ureterocolostomy and colorectostomy,low tension Roux-y sigmoid neobladders were formed on 12 cases of bladder cancer and 1 case of vesicovaginal fistula.The surgical procedures involved making an “inversive valve” into the bowel lumen about 1.5 cm above the Roux-y anastomotic stoma and anastomosing the ureter and colon by Leadbetter method;then the reservoir was made by detubularization of sigmoid.Postoperatively,blood electrolytes and acid-base balance, and urination were monitored. Results During the follow-up of 0.5~5 years,only 2 cases had occasional fever;no hydronephrosis, no disorder of acid-base balance occurred.The blood electrolytes were within the normal range.And no one had incontinence. Conclusions The low tension,anti-reflux Roux-y sigmoid neobladder is a surgical technique of less trauma and with less complications.

Objective To observe the effect of FTY720 on the expressions of Bel-2 and Bax protein and explore the neuroproteetive effect of FTY720 on neuron after acute spinal cord injury in the rats.Methods A total of 75 SD rats were divided randomly into three groups,ie,the test group(treated with FTY720),the injury group(treated with normal saline)and the control group.The test and injury groups were impacted to create T10 spinal cord injury(SCI)by Allen's method.Both the mRNA and protein expressions of Bcl-2 and Bax in the injured spinal cord section were studied respectively with hematoxylin and eosin(HE)staining,immunohistochemical examination and reverse transcription polymerase chain reaction(RT-PCR)technique at different time points(at6 h,12 h,24 h,3 d and 7 d). Results The expressions of Bcl-2 and Bax in the test group and the injury group were higher than that in the control group at all time points.Meanwhile,at 12 h,24 h,3 d and 7 d,the mRNA and protein expressions of Bcl-2 in the test group were significantly higher than that in the injury group(P<0.05),while the mRNA and protein expressions of Bax in the test group were obviously lower than that in the injury group (P<0.05). Condusion Early administration of FTY720(0.5 mg/kg)after spinal cord injmy Canincrease the mRNA and protein expressions of Bcl-2,decrease the expression of Bax and inhibit neuron apoptosis in the injured spinal cord.

Objective To investigate the effect of combined Metformin and esomeprazole therapy on plasma levels of gastrin,blood glucose,glycosylated hemoglobin(HbA1c) and insulin in elderly patients with type 2 diabetes.Methods A randomized,double-blind,placebo-controlled study of 41 elderly patients with type 2 diabetes was conducted.Patients were randomly assigned into treatment group(combination therapy with Metformin 0.5 g,bid or tid and Esomeprazole 20 mg,qd,for 12 weeks)and placebo group(Metformin monotherapy 0.5 g,bid or tid,for 12 weeks).Fasting blood samples were taken from vein before and after treatment.Fasting serum levels of gastrin,glucose,HbA1c,insulin,lipids,liver and renal functions were compared between the two groups.The homeostasis model of assessment for insulin resistance index(HOMA-IR) and insulin secretion index (HOMA-β)were calculated,and complications were recorded.Results There were no significant differences in body mass index and waist circumference between the two groups.Serum gastrin level was slightly increased in the treatment group 12 weeks after treatment,but without statistically significance [(127.20±9.21)ng/L vs.(131.53±7.84)ng/L,P＞0.05],and serum gastrin level had no significant differences in the placebo group before and after treatment [(128.42±4.58)ng/L vs.(127.51±3.47)ng/L,P＞0.05].However,there were no significant differences in the changes of blood glucose,HbA1c,insulin,HOMA-β and HOMA-IR before versus after therapy,and between the two group(all P＞0.05).Conclusions Combined Metformin and insulin therapy cannot increase serum gastrin and insulin levels and has no significant effect on reducing blood glucose and HbA1c levels in elderly patients with type 2 diabetes.

Objective:To evaluate the clinical value and the prognostic factors of postoperative radiotherapy in type B3 thymoma pa-tients. Methods:A total of 159 patients with thymoma were treated by surgery and postoperative radiotherapy. According to Masaoka staging system, 12, 33, 62, and 52 patients had stageⅠ,Ⅱ,Ⅲ, andⅣlesions, respectively. Myasthenia gravis existed in 38 patients. Altogether 58 patients underwent chemotherapy. Overall survival, disease-free survival, and local control rates were calculated by Ka-plan-Meier method. Prognostic factors were analyzed by Cox regression model. Results:With a median follow-up of 52 months (8-125 months), the overall 5-year survival rate was 81.6%. The 5-year progression-free survival rate was 76.2%. The 5-year local control rate was 82.6%. The recurrence rate was 32.6%, and the metastatic rate was 9.3%. In the univariate analysis, tumor size, Masaoka stage, re-section margin, radiotherapy, and chemotherapy were significantly associated with 5-year overall survival and progression-free surviv-al (P<0.05). In the multivariate analysis, Masaoka stage, resection margin, and radiotherapy were independent prognostic factors of 5-year progression-free survival (P<0.05). Radiotherapy could improve the regional control rate and the overall survival of patients in Ma-saoka stagesⅢ-Ⅳ. Conclusion:The major failure mode for type B3 thymoma is the recurrence of pleure. Radiotherapy can improve the regional control rate and the overall survival of patients in advanced stages. Masaoka staging, surgical margin, and radiotherapy are the independent prognostic factors for type B3 thymoma treated by postoperative radiotherapy.

Objective To investigate relation of IL-18 and collagen fibre(CF) with plaque stability in aorta atherosclerotic lesion.Methods Morphology and content of CF in rupture of aorta atherosclerotic group(A group),non-rupture of aorta atherosclerotic group(B group) and normal aorta group(C group) were examined by Massion's staining.Expression of IL-18 by was measured immunohistochemical staining among three groups.Results Increasing and arranging turbulence of the CF was found in tunica intima,middle layer and tunica adventitia in A and B groups.Around necrosis of atheromatous plaque,CF significantly increased and arranged turbulence,but the CF decreased or disappeared in necrosis area of atheromatous plaque in A group.The CF significantly increased,arranged turbulence and extended to SMCs in necrosis of atheromatous plaque in B group.Arranging orderliness and absence of disruption of the CF was recorded in C group.Percent age of CF content was significantly different among three groups(P

Objectives To explore the effects of aging on midgastric transverse band(MTB)and gastric emptying.Methods In our prospective study,57 healthy volunteer were divided into young, middle and old-age groups.After taking test meal labeled by 99mTc-iethylenetriaminepentaacetic acid(99mTc-DTPA), the pictures were collected using double probe single photon emission computed tomography(SPECT).Stomach in each frame of the pictures was divided into proximal, midgastric transverse band(MTB)and distal parts.And half gastric emptying time,gastric remnant rate at 90 min, areas of different gastric parts were tested and calculated respectively.Results Half gastric emptying time of whole stomach was(43.24± 11.87)min,(42.07 ± + 9.31)min and(45.81 ± 10.73)min in young,middle and old-age groups, respectively, with P＞0.05.Among young, middle and oldage groups, half gastric emptying time was(38.09 ± 10.26)min,(37.33 ± 9.28)min and(26.74 ± 12.07)min in proximal stomach, and it was(38.35 ± 12.96)min,(37.73 ± 7.46)min and(46.41 ± 10.74)min in distal stomach,respectively.The half gastric emptying time was significantly reduced in proximal stomach and increased in distal stomach in old-age group(both P＜0.05).The gastric nuclide remnant rate at 90min in total stomach was(30.38 ± 19.32)％,(29.03 ± 10.36)％ and(31.92 ± 13.47)％ ,in young, middle and old-age groups, respectively, with P＞0.05.This rate in proximal stomach was(25.01 ± 12.35)％,(26.36± 15.29)％ and(19.54±8.47)％ among three group, respectively.The rate in proximal stomach was(42.25 ± 12.36)％,(41.56 ±± 9.33)％ and(56.05 ± 11.72)％ among three group,respectively.The gastric remnant rate at 90min was reduced in proximal stomach and was increased in distal stomach significantly in old-age group(both P＜0.05).Compared with young and middle-age group,the old-age group showed no difference in areas of total stomach in all the time, while the areas were reduced in proximal stomach and increased in distal stomach significantly from 30 min to 90 min(all P＜0.05).Total stomach versus proximal and distal stomach showed no difference in count/pixel ratio in all time,while a count/pixel ratio was reduced in proximal stomach and increased in distal stomach significantly from 30 min to 90 min(both P＜ 0.05).Both areas and count/pixel ratio of MTB at 60 min and 90 min were significantly increased in old-age group(both P＜0.05).Conclusions The total gastric emptying is not delayed along with aging, while the gastric emptying is increased in proximal stomach and reduced in distal stomach in the elderly.This abnormity of intragastric distribution of food might be related with larger area of midgastric transverse band.

Objective:To confirm the safety and feasibility of totally thoracoscopic repair with leaflet folding, multiple artificial chordae implantation and ring annuloplasty for mitral regurgitation(MR) in Barlow disease.Methods:From June 2018 to December 2019, 10 consecutive Barlow’s disease patients underwent totally thoracoscopic repair with leaflet folding, multiple artificial chordae implantation and ring annuloplasty. The safety and feasibility of this technique was evaluated by its early clinical outcomes.Results:8 males and 2 females. The mean age was(33.5±11.0) years.There was no operative death and related complications. The mean cardiopulmonary bypass(CPB) time was(142±26)(112-194)min, and the aortic clamping time was(96±18)(78-128) min. The average number of artificial chordae implantation was(3.4±0.7)(2-4) pairs/case. Intraoperative transesophageal echocardiography(TEE) showed the mean mitral valve coaptation length and transvalvular pressure gradient was(1.2±0.2)(0.8-1.5) cm and(1.2±0.4) mmHg(1 mmHg=0.133 kPa), respectively, without MR or systolic anterior motion(SAM). During a follow-up of 1-18 months, there were 7 cases with no MR and 3 with trace MR, with a mean transvalvular pressure gradient of( 1.5±0.6 )mmHg.Conclusion:Totally thoracoscopic repair with leaflet folding, multiple artificial chordae implantation and ring annuloplasty was a safe and effective procedure with satisfied early clinical outcomes for MR in Barlow’s disease. However, further randomized and long-term follow-up studies were warranted to determine its clinical effects.

Objective To evaluate the safety aod efficacy of device closure of ventricular septal defect (VSD) through parasternal approach,and to compare the advantages and disadvantages of three approaches.Methods Between Jan 2012 and Jul 2015,209 cases(Group A) underwent per-ventricular device closure of VSD through a left parasternal approach,and 36 cases(Group B) underwent per-atrial device closure of VSD through a fight parasternal approach,and 49 cases(Group C) underwent per-ventricular device closure of VSD through a median sternotomy approach.In group A,a 1.0 to 2.0 cm left parasternal iucision was made in the fourth or third intercostal space.Press the right ventricular(RV) free wall to select the puncture point.After securing double purse-string suture around the optimal puncture site,the occluder was introduced via a sheath inserted directly into the RV and navigation and positioning of the device guided by transesophageal echocardiography(TEE).In group B,a 1.0 to 2.0 cm right parasternal incision was made in the fourth or third intercostal space.After securing double purse-string suture at the right atrium near the atrioventricular groove,a specially designed hollow probe was inserted into the right atrium and was passed through the tricuspid valve into the right ventricle.The tip of the probe was manipulated to aim at or cross VSD,and a spring guide-wire was inserted into the left veotricle(LV) through the channel of the probe under TEE guidance.Then the delivery sheath was positioned into LV passing over the wire,and the device was pushed into the sheath and was deployed to finish closure.In group C,after a 1.5 to 3.0 cm median sternal incision was made,the closure of VSD was finished as the same procedure as in group A.Results There was no significant differences at the age and weight between 3 groups,as well as the size of VSD and devices.But the position of VSD varied between 3 groups.The rate of successful closure in group A (98.1％,205/209) and B (97.2％,35/36) was similar to group C (97.9％,48/49).The mean intracardiac manipulating time was shorter in group A(10 ± 6) min and group C (7 ± 5) min than in group B(19 ± 11) min.The mean time of skin cut to suture was shorter in group A(40 ± 15) min and group B(43 ± 17) min than in group C(55 ±21) min.And the average hospitalization time in group A (5.9 ± 2.2) days and group B (5.5 ± 2.7) days was shorter than in group C (8.3 ± 3.6) days.During the follow-up period of 1 to 40 months,no obvious residual leakage,arrhythmia or valvular inadequacy were found in all cases,and no device dropped out.Conclusion Minimally invasive technique of device closure of VSD through parasternal approach appears to be safe and effective,further reducing trauma and recovering faster than median sternal approach.Accurate and all-round TEE evaluation is very important to case selection of VSD.Individually procedure approach should be performed according to the size,position,and path and flow direction of VSD.

BACKGROUND:It has been demonstrated to be effective for the improvement of heart function after acute myocardial infarction with intravenous or intramyocardial administration of bone marrow mesenchymal stromal cels. However, little is known regarding the effect of the combination of intravenous and intramyocardial administration of mesenchymal stromal cels on the heart function of a chronic myocardial infarction model. OBJECTIVE:To study the effect of intravenous and intramyocardial administration of bone marrow mesenchymal stromal cels on the heart function of a rat chronic myocardial infarction model and the relevant mechanism. METHODS:Bone marrow mesenchymal stromal cels isolated from Lewis rats were expandedex vivo. BrdU-labeled bone marrow mesenchymal stromal cels (3×106) were administeredvia the femoral vein and the myocardial surface respectively into rat models of chronic myocardial infarction in cel transplantation group. The equal volume of PBS was injected into the same place in control group. Four weeks after injection, echocardiography was performed to evaluate the heart function, and then the heart tissues were harvested for immunohistochemistry examination. The total blood vessel density in the scar area was evaluated. RESULTS AND CONCLUSION:At 4 weeks after cel implantation, the left ventricular function was not improved in the two groups. The immunohistochemistry staining showed that (1) the mesenchymal stromal cels in the myocardium did not differentiate to myocardial cels; (2) there was no significant difference in the total blood vessel density in the scar area between the cel transplantation and control groups. Taken together, the combined intravenous and intramyocardial administration of bone marrow mesenchymal stromal cels cannot improve heart function in a rat chronic myocardial infarction model.