BACKGROUND: How to lessen neuronal necrosis to promote recovery of nerve function after ischemic cerebral injury? Cerebral ischemic preconditioning (IP) alleviates ischemic cerebral injury caused by re-ischemia to certain extent. It has been verified that sodium ferulate can lessen the incidence of neuron apoptosis after cerebral ischemia. Whether does sodium ferulate enhance the nerve protection of IP brain to not?OBJECTIVE: To explore the protection of sodium ferulate allied with IP in cerebral ischemic-reperfusion injury.DESIGN: Randomized controlled animal experiment was designed.SETTING: Neurological Surgery Department of 2nd Affiliated Hospital of Jiangxi Medical College, Department of Physiology of Jiangxi Medical College, Institute of Urinary Surgery of Jiangxi Medical College.MATERIALS: The experiment was perforned in Laboratory Room of Neurological Surgery Department of 2nd affiliated Hospital of Jiangxi Medical College from May 2001 to April 2002, in which, 85 Wistar male rats were employed, mass weighted varied from 250-300 g.METHODS: The rats were randomized into 4 groups: ① The control without ischemia (10 rats): Vertebral artery was ligatured bilaterally and common carotid artery was not clipped bilaterally. ② The control with ischemia (25 rats): Vertebral artery was ligatured bilaterally for 48 hours and common carotid artery was clipped for 10 minutes. ③ IP group (25rats): Vertebral artery was ligatured bilaterally for 48 hours and common carotid artery was clipped for 2 minutes, and 24 hours later, the common carotid artery was clipped again for another 10 minutes. ④ Sodium ferulate allied with IP group (Allied group) (24 rats): After IP, the common carotid artery was clipped again for 30 minutes and sodium ferulate (200 mg/kg)was injected intravenously from tail. The control without ischemia was subdivided into two groups of 2 days and 7 days after reperfusion respectively (5 rats for each one). The control with ischemia, IP group and allied group were subdivided into 5 groups of 6 bours, 12 hours, 24 hours,2 days and 7 days after reperfusion successively (5 rats for each one).The rats were sacrificed to collect brains at phase spots in each group.Coronary brain slice was collected 2.2 mm posterior to the optic chiasm and the effects of allied with was observed on neuron count and apoptotic cell count in cortex and hippocampal CA1 in cerebral ischemia reperfusion.MAIN OUTCOME MEASURES: Neuron count and apoptotic cell count in cortex and hippocampal CA1.RESULTS: Totally 85 experimental rats all entered result analysis. ①Neuron count in cerebral cortex and hippocampal CA1: On the 7th day after ischemia, the counts in IP group and allied group were higher than ischemia control (268±8.5, 244±12.5, 135±5.6, P ＜ 0.01). ② Count of TUNEL positive cell in cerebral cortex and hippocampal CA1: The count in allied group was lower than that in IP group and ischemia control (12 hours:1.2±0.8, 15.5±2.1, 39.8±3.9; 24 hours: 1.8±1.6, 39.3±11.8, 191.3±19.1;2 days: 2.8±1.2, 68.3±13.6, 328.4±24.0, P ＜ 0.01), and that in IP group was lower than ischemic control (P ＜ 0.01).CONCLUSION: IP lessens apoptotic neuron count in ischemic region.Sodium ferulate allied with IP further intensifies such effect and provides the protection of ischemic reperfusion injury of brain.

Objective To evaluate the value of cerebral CT and MRI in prediction of the recovery of comatose patients after severe traumatic brain injury.Methods Cerebral CT and MRI were performed in 98 comatose patients after severe traumatic brain injury. CT and MRI were reviewed by three neuroradiologists for the number, sizes, and location of brain lesions. Three neurologists assessed the patients at admission and 1 month after injury. The correlation among the neuroimaging finding, clinical examination index and the prognosis of the patients was analyzed.Results Clinical characteristics, such as initial score on the Glasgow Coma Scale, age, and pupillary abnormalities failed to predict recovery. Cerebral CT did not predict future recovery from post-traumatic coma. The patients in persistent vegetative state(PVS) revealed a significantly higher frequency of corpus callosum, corona radiate, and dorsolateral brainstem injuries than did patients who recovered within 1 month.Conclusion Cerebral CT findings in the acute stage after head injury can not predict the outcome of the post-traumatic PVS. There is a significant association between MRI findings and PVS: patients in coma with lesions in the corpus callosum, corona radiata or dorsolateral brainstem.

BACKGROUND: Bone marrow cell transplantation is a simple and effective treatment to promote angiogenesis. The neovascularization and reestablishment of blood circulation is crucial to the repair of injured but still living neurons as well as to the survival and differentiation of the implanted tissues and cells. However,it is not clearly known whether autologous bone marrow cells implantation could promote neovascularization and facilitate reestablishment of circulation in ischemic regions of the brain.OBJECTIVE: To investigate the effect of autologous bone marrow cell transplantation via the carotid artery on angiogenesis in the ischemic regions of the brain.DESIGN: A randomized controlled experiment based on experimental animals.SETTING: Department of neurosurgery and institute of urinary surgery in a university hospital.MATERIALS: The experiment was conducted in the Laboratory of the Department of Neurosurgery,Second Affiliated Hospital,and the Institute of Urinary Surgery,Jiangxi Medical College during the period from September 2002 to April 2003,using 10 specific pathogen-free male SD rats weighing 250 - 300 g.INTERVENTIONS: Rat models of focal cerebral ischemia model were established and randomized equally into two groups. The rats in the transplantation group were injected with autologous bone marrow cells via the carotid artery and those in the control group normal saline injection. The angiogenesis in the ischemic regions of the brain was observed with immunohistochemical staining for microvessel counting.MAIN OUTCOME MEASURES: The density of microvessels. Immunohistochemical staining for F8.RESULTS: Greater density of the microvessels was found in the ischemic regions after bone marrow cell transplantation than in the control group[(159. 15 ±40.4)/mm2 vs(81.70 ± 32. 18)/mm2,P ＜ 0. 05] . Numerous endothelial cells were found scattered in the ischemic cortex of the transplantation group,but scarcely in the control group.CONCLUSION: Autologous bone marrow cell transplantation via the carotid artery can promote angiogenesis in the ischemic regions of the brain.

Objective To evaluate the efficacy of preoperative aspects and dimensions used for an anatomical (PADUA) scores in determining the surgical approach for T1 stage renal masses.Methods From Jan 2010 to Dec 2012,clinical data of 122 cases (76 males and 46 females),who underwent surgery for T1 stage renal masses,were collected retrospectively.The mean age was 51 years(range 21-81) and mean body mass index was (22.8±3.9) kg/m2.Sixty-three tumors were found in left kidney and 59 in right kidney.Among them,78 patients were diagnosed as T1a stage and 44 patients were T1b stage.In patients with T1a stage,56 received nephron sparing surgery (NSS) and 22 received radical nephrectomy (RN).In patients with T1b stage,21 received NSS and 23 received RN.The PADUA nephrometry score was analyzed to evaluate their relationships to surgical type and the approach of NSS.Results According to the PADUA nephrometry score,the number of low risk,middle risk and high risk patients were 24,62,26,respectively.Inlow risk group,middle risk group and high risk group,the proportion of RN and NSS was 8.3％/ 91.7％,30.6％/69.4％,66.7％/33.3％.In 77 patients received NSS,the unmber of laparoscopic NSS and open NSS was 18 ∶ 4,25 ∶ 18,2 ∶ 10,respectively.The PADUA nephrometry score was significantly associated with the type of surgery (x2 =23.16,P＜0.01),and the NSS approach (x2 =13.57,P＜0.01).Tumor size (HR =2.79 ; 95％ CI,1.29-6.02 ; P＜ 0.01),percentage of tumor deepening into the kidney (HR =3.82; 95％CI,1.77-8.09; P＜0.01),longitudinal (HR=4.00;95％CI,1.83-8.72; P＜0.01),tumor relationships with renal sinus(HR=103.13; 95％CI,21.85-486.81 ; P＜0.01),tumor relationships with urinary collecting system (HR =15.11 ; 95％ CI,5.95-38.35 ; P＜ 0.01),rim tumor location (HR =3.50 ; 95％ CI,1.61-7.59; P＜0.01) were closely related with surgery approach.The correlation coefficients of relationship with renal sinus was highest (r=0.70).Conclusions The PADUA nephrometry score provides a simple,useful and stable system to character the salient renal anatomy and guide the surgery.Low risk group should consider the NSS as the first line therapy.NSS could also be chosen in the middle risk group.However,the renal anatomy in those patients should be referred.RN should be chosen in high risk group.

Objective To investigate the correlation between myocardial fibrosis evaluated by cardiac magnetic resonance (CMR)T1 mapping and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in elderly patients with ischemic cardiomyopathy (ICM).Methods The 56 hospitalized patients with ICM(ICM group)and 20 healthy volunteers(control group)were recruited in cardiology department of Henan Provincial People's Hospital from April 2014 to June 2017.Clinical data,serum NT-proBNP detection,CMR T1 mapping and contrast-enhanced scan were determined,retrospectively collected and compared between two groups.The differences in myocardial extracellular volume fraction(ECVF)and NT-proBNP levels were compared among the control group,the ICM group and the ICM subgroups with different degree of cardiac dysfunction.The correlation between ECVF and NT-proBNP level was analyzed.Results The levels of ECVF and NT-proBNP were significantly higher in ICM group than in control group[(35.1t6.2)％ vs.(25.3±2.2)％ for ECVF,and(3 902.7± 1 670.3)ng/L vs.(280.5± 140.5)ng/L for NT-proBNP,t =6.917 and 9.645 respectively,both P＜0.01].Along with NYHA Functional Class upgrade of Ⅱ to Ⅲ] to Ⅳ of the ICM subgroups,the levels of ECVF and NT-proBNP were significantly increased (F =18.372 for ECVF,61.82 for NT-proBNP,all P＜0.01).There was a positive correlation between ECVF and NT-proBNP level in ICM patients (r =0.666,P ＜ 0.05).Conclusions Serum NT-proBNP level is correlated with the degree of myocardial fibrosis,which might be used as an indicator of myocardial fibrosis in ICM patients.

Objective To evaluate the short-term effect of Pipeline embolization device (PED)for the treatment of unruptured wide-necked intracranial aneurysms. Methods From October 2015 to September 2016,15 consecutive patients with unruptured wide-necked intracranial aneurysm (aneurysm neck and aneurysm body ratio ≥0. 5)treated with PED at the Department of Neurosurgery,the Second Affiliated Hospital of Nanchang University were enrolled retrospectively. Their clinical and imaging data were analyzed. Kamran scale was used to evaluate the embolization rate of aneurysms and the changes of the parent arteries. DSA examination was performed again at 6 -12 months after operation. Results Fifteen PED were implanted in 15 patients with unruptured wide-necked intracranial aneurysms,including 13ophthalmic artery aneurysms,1 posterior communicating artery aneurysm,and 1 cavernous sinus aneurysm. The technical success rate was 100% . Immediately after PED implantation,Karman rating of 15 cases were aneurysm grade 2 embolization,parent artery grade A (grade 2a). DSA examination was performed again at 6 - 12 months after operation showed that 14 patients were aneurysm grade 4,parent artery was grade A (grade 4a). One patient (ophthalmic artery aneurysm)underwent the second DSA examinations at 6 and 12 months after operation showed that the residual development of aneurysms. The aneurysm embolization was grade 3, and the parent artery was grade A (grade 3a). No branch artery occlusion was observed. Non of them had neurological deficit. The modified Rankin scale score was 0 in all 15 patients. Conclusion The use of PED in the treatment of unruptured wide-necked intracranial aneurysms has a higher occlusion rate. Its long-term effect still needs further follow-up.

Objective:To summarize the preliminary experiences of utilizing complete peritoneal externalization for donation after cardiac death (DCD) robot-assisted kidney transplantation (RAKT) and observe the effect of RAKT versus open kidney transplantation (KT) under the same donor kidney during the same period.Methods:From February 2019 to July 2020, 40 patients scheduled for kidney transplantation were divided into two groups of robot ( n=20) and open surgery ( n=20). Donor for DCD had the same blood type. Preoperative data, intraoperative findings and postoperative outcomes were analyzed. Results:No significant inter-group difference existed in age, body mass index (BMI) or dialysis time. Both groups completed operations successfully. As compared with open group, operative duration, blocking time, venous anastomotic time and ureteral anastomosis time were longer in robot group. And the incidences of lymphatic fistula/cyst was higher in robot group than that in open group. Robot group was superior to open group in terms of hospitalization time, ventilation time, pain disappearance time and time to ambulate. No statistically significant inter-group difference existed in iliac vascular separation time, arterial anastomotic time, volume of blood loss and postoperative recovery of renal transplant function.Conclusions:RAKT is both safe and feasible at advanced surgical centers. Early evidence indicates that RAKT can accelerate the recovery of patients and achieve the same renal function recovery as open surgery. As surgeons become more proficient in RAKT technology, operative duration will be gradually shortened.

Immobilization of enzymes is important and widely applied in biocatalysis. Streptomyces platensis gene gox, encoding an extracellular L-glutamate oxidase (Gox), was fused to cellulose binding domain (CBDcex) from Cellulomonas fimi and the recombinant protein Gox-CBD was expressed in Escherichia coli. The fusion protein (Gox-CBD) was immobilized onto microcrystalline cellulose. The preparation conditions, binding capacity, properties and stability of the immobilized enzyme were studied. Under the condition of 4 ℃, for 1 hour, the fusion protein Gox-CBD was able to bind microcrystalline cellulose at a ratio of 9.0 mg of protein per gram of microcrystalline cellulose. Enzymatic properties of free and immobilized L-glutamic oxidase (Gox-CBD) were compared. The specific activity of the immobilized enzyme decreased, but its thermal stability increased a lot compared with that of the free Gox-CBD. After incubation at 60 ℃ for 30 min, 70% of the total activity remained whereas the free recombinant Gox completely lost its activity. The immobilized protein was tightly bound to microcrystalline cellulose at pH below 10 or more than 5 mmol/L NaCl. The fusion protein of Gox-CBD can be specifically immobilized on the microcrystalline cellulose on a single step. Therefore, our findings can provide a novel strategy for protein purification and enzyme immobilization.

OBJECTIVETo evaluate the application value of R.E.N. A.L. nephrometry score for surgery type decisions of T1 stage renal tumor.

METHODSClinical data including image data, surgery type and prognosis etc were collected retrospectively for 122 cases from January 2010 to December 2012. There were 76 male and 46 female patients and they were 29-82 years (mean 51 years). The body mass index was (22.8 ± 3.9) kg/m(2). The patients were undergoing surgical excision with renal tumor of T1 stage. The R.E.N. A.L. nephrometry score was analyzed to evaluate their relationships to surgery type (RN or NSS) and the approach of NSS (ONSS or LNSS) using chi-square tests, Fisher's exact tests, and logistic regressions analysis.

RESULTSAll surgery had been completed. The surgery included RN of 45 patients, LNSS of 45 patients and ONSS of 32 patients. The R.E.N. A.L. nephrometry score was significantly associated with the type of surgery (χ(2) = 27.89, P < 0.05), and the NSS approach (χ(2) = 12.87, P < 0.05). When the scores less than 7 points, it is majorly treated by nephron sparing surgery (92.9%), and when the scores more than 9 points, it is majorly treated by radical nephrectomy (69.4%). Individual component scores were analyzed to evaluate that they were all related to surgery type (χ(2) = 7.00-14.57, P < 0.05), and the individual component N associated the surgery type mostly. Furthermore, individual component R,E,N and L were statistically significant predictors of the NSS approach (χ(2) = 4.92-15.07, P < 0.05).

CONCLUSIONThe R.E.N. A.L. nephrometry scoring system provides a simple, useful, and stable system to character the salient renal anatomy of T1 stage, and can provide the best surgery approach.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kidney ; pathology ; Kidney Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Nephrectomy ; Prognosis ; Retrospective Studies

Objective To explore the learning curve of robotic-assisted kidney transplantation (RAKT). Methods The clinical data of 96 consecutive RAKT patients performed by the same surgical team were retrospectively analyzed. The arterial anastomosis time, venous anastomosis time, ureteral anastomosis time, hospital stay, and blood loss were selected as evaluation indicators. The learning curve of RAKT was analyzed using the cumulative sum (CUSUM), and the curve was divided into the learning improvement stage and the proficient mastery stage according to the learning curve. The learning curve was verified by comparing the general data and surgical data of patients in different learning stages, and the clinical efficacy of each stage was analyzed. Results The optimal fitting equation of the learning curve reached its peak at the 33rd case, which was the minimum number of surgeries required to master RAKT. There was no statistically significant difference in age, gender, dialysis type, previous abdominal surgery history, number of donor renal arteries, and preoperative serum creatinine between the learning improvement group and the proficient mastery group (all P>0.05). Compared with the learning improvement stage, the body mass index (BMI) was higher, and the number of right donor kidney was increased compared to the left donor kidney in the proficient mastery stage (both P<0.05). There were no significant differences in arterial anastomosis time, ureteral anastomosis time, postoperative serum creatinine, and complications between the two groups (all P>0.05). The iliac vessel dissection time, warm ischemia time, venous anastomosis time, blood loss, and hospital stay in the proficient mastery stage were superior to those in the learning improvement stage, with statistically significant differences (all P<0.05). Conclusions RAKT requires at least 33 cases to cross the learning curve. There is no difference in complications and recovery of transplant renal function between the learning improvement stage and the proficient mastery stage.