BACKGROUND:The selective immunosuppression on transplanted organ was realized by local drug delivery system,which is one of efficient ways to avoid many kinds of side reactions induced by systemic drug delivery.By using the characteristics that adrenal gland can secret glucocorticoid,the adrenal gland or adrenal implant as the way of local drug delivery of glucocorticoid for transplanted organ is hopeful to avoid the complications induced by systemic and amount of use of glucocoticoid.OBJECTIVE:To establish a model of adrenal gland self-implantation in greater omentum,and to observe the protection of the adrenal gland implant on transplanted liver.DESIGN,TIME AND SETTING:This randomized controlled animal experiment was performed in the Experimental Animal Center of Guizhou Provincial People's Hospital from May 2007 to October 2008.MATERIALS:Fifty male Sprague Dawley rats were assigned as donors,and fifty male inbred strain Wistar rats were assigned as recipients.METHODS:After feeding one week,the recipient rats were randomly divided into two groups with 25 rats in each group.In liver transplantation after adrenal gland self-implantation in greater omentum group,allogenic liver transplantation was performed after successful model establishment of adrenal gland self-implantation in greater omentum.In simple liver transplantation group,only allogenic liver transplantation was performed.No immunosuppressant was used after transplantation in both of the two groups.MAIN OUTCOME MEASURES:The survival time of rats was observed.The morphology of the transplanted livers and the adrenal implants was observed at different time points.The activities of serum aspartate aminotransferase(AST),as well as the concentration of serum corticosteroid and total bilirubin were detected at different time points.RESULTS:The recipient adrenal implants recovered their endocrinal function at 7 weeks after adrenal gland self-implantation in greater omentum.After liver transplantation,histological examination showed that the adrenal implants survived well.The median survival time of rats in the liver transplantation after adrenal gland self-implantation in greater omentum group was more than 30 days,which is obviously longer than that(12 days) in the simple liver transplantation group.There was no significant difference in concentration of serum corticosteroid between the two groups.At 7 days after transplantation,activities of serum AST and concentration of total bilirubin of rats in the simple liver transplantation group were significantly higher than those in the liver transplantation after adrenal gland self-implantation in greater omentum group(P ≤ 0.05).In the liver transplantation after adrenal gland self-implantation in greater omentum group,pathological changes of transplanted livers showed as grade 0 according to Williams standard.In the simple liver transplantation group,a mild rejection appeared at 3 days after transplantation,and the pathological changes turned to severe and reached grade 3 according to Williams standard at 7 days.CONCLUSION:Adrenal implant which survives and recovers its endocrinal function after self-implantation in greater omentum has protection on the transplanted liver in early stage.

Objective To compare the safety and efficacy of the 2μm laser and the bipolar electrotome used in transurethral re-section of bladder tumor(TURBT)for treating non-muscle invasive bladder cancer(NMIBC).Methods The clinical data in the pa-tients with NMIBC treated by TURBT in our hospital from March 2009 to May 2013 were retrospectively analyzed.All patients were divided into the 2μum laser group(n=89)and the bipolar electrotome group(n=82).The operation time,complications,post-operative hospital stay and recurrence rate were compared between the two groups.Results There were no statistically significant differences in the operation time,postoperative hospital stay and recurrence rate between the two groups(P>0.05).Compared with the 2 μm laser group,the bipolar electrotome group showed significantly higher occurrence rate of the obturator nerve reflex (20.7%vs.0,P<0.05)and the bladder perforation(7.3% vs.0,P<0.05)and longer postoperative bladder irrigation time [(3.1±0.9)d vs.(2.2±1.0)d,P<0.05],the differences between the two groups had statistical significance.Conclusion Com-pared with bipolar electrotome,the 2μm laser used in TURBT is safe and effective with few complications for treating NMIBC.

Objective To study the values of clinicopathological features and expression of thyroid transcription factor 1 (TTF-1) in predicting the mutation status of epidermal growth factor receptor (EGFR) gene in patients with non-small cell lung cancer (NSCLC). Methods Mutation status of exons 18, 19, 20 and 21 in EGFR, and expression of TTF-1 protein in 283 cases of NSCLC diagnosed in Shanxi Provincial Cancer Hospital from January 2013 to December 2014 were analyzed by using amplification refractory mutation system (ARMS) and immunohistochemical method. The correlation of EGFR mutations with the clinicopathological features and TTF-1 expression were studied to explore the values of them in the prediction of EGFR mutations. Results Among 283 cases of NSCLC, the rate of EGFR gene mutation was 30.0 ％(85/283), including 3 cases with double mutations(exon 18 and exon 20 double mutations in one case, exon 19 and exon 21 double mutations in one case, exon 20 and exon 21 double mutations in one case). The EGFR gene mutations were associated with gender, histological type, history of smoking, and expression of TTF-1 (all P<0.001), but not related to age and tumor location (P= 0.785, P= 0.138). The combination of factors with high mutation rates (women, adenocarcinoma, no smoking, and TTF-1 positive) made the positive predictive value of EGFR mutations up to 57.6 ％. And the combination of factors with low mutation rates (male, nonadenocarcinoma, smoking history, TTF-1 negative) made the EGFR negative predictive value up to 90.3％. Conclusion The combination of clinicopathological features and TTF-1 expression status in patients with NSCLC has a great predictive value for EGFR mutations, which can provide a useful reference for clinical treatment decision-making.

Objective To summarize the surgical experience and primary follow-up results for robotic assisted radical cystectomy ( RARC ) , as well as to evaluate the safety and feasibility of this procedure.Methods From Jan 2013 to Oct 2015, we retrospectively analysis the perioperative data and primary follow-up data from 35 patients who underwent radical cystectomy with Da VinCi robotic laparoscopic in urological institution of Changhai Hospital.The median age was 65 (ranging from 46 to 78) years.The amount of male cases were 34, the female case were 1.There were three kinds of urinary diversion, ureterocutaneostomy, Bricker operation and orthotopic neobladder, were 2, 26 and 7 respectively.We collected the parameters including operating time, estimated blood loss, blood transfusion volume, time to flatus,length of hospital stay,perioperative complication,time of recurrence,time of death and the reason of death.Results All of the related operations had been accomplished successfully, none of which had been converted to the open procedure.The estimated operating time of ureterostomy was (315.0 ±106.1) min, Ideal conduit was ( 443.2 ±93.2 ) min, Orthotopic bladder was ( 488.3 ±80.6 ) min.The estimated intraoperative blood loss was 260.0 ±108.6(100 to 500 )ml.5 cases of all patients were transfused 400ml red cell suspension, the transfusion rate was 14.2%.The mean time to flatus was 3.1 ±1.6(1 to 7) d.The estimated time to remove the gastric tube and the drainage tube was 4.2 ±2.2d(2-10d),10.8 ±5.1d(4-25d),respectively.The length of hospital stay after surgery was 12.4 ±5.17(6 to 25) d.Overall,17,8, 10,31 and 4 of these patients had

Objective To study the biological behaviors and effects of immunoglobulin-like transcript-4 (ILT4) expression in mononuclear cells on the prognosis of sepsis.Methods ILT4 +/+ (WT) and ILT4-knockout mice (ILT4-/-) male BALB/c mice were used for sepsis modeling using cecal ligation puncture (CLP).Flow cytometry was used to measure the levels of expression of ILT4 and major histocompatihility complex class Ⅱ molecules (MHC-Ⅱ) in mononuclear cells of peripheral blood 24 h after CLP.ELISA was used to measure the concentrations of interleukin-6 (IL-6) and serum tumor necrosis factor-alpha (TNF-α) in different groups of mice at 0 h,6 h,12 h,and 24 h after CLP to monitor the survival and prognosis over the course of 168 h.Results ILT4 was highly expressed in mononuclear cells of the peripheral blood of septic mice 24 h after CLP in comparison with that before CLP (1292.00 ± 143.70) vs.(193.50 ± 52.54),P ＜ 0.05.MHC-Ⅱ expression in mononuclear cells of the peripheral blood in ILT4-/-mice was significantly higher than that in WT mice (49.38 ± 5.66)％ vs.(24.25 ± 6.76) ％,P ＜ 0.05).Serum IL-6 was significantly elevated 24 h after CLP compared with that before CLP (470.75 ± 88.03) vs.(54.25 ± 20.04),P ＜ 0.05.The serum IL-6 concentration was much lower in ILT4-/-mice thanthatin MT mice (241.25 ± 45.10)vs.(470.75 ± 88.03),P ＜ 0.05;whereas,there was no significant difference in TNF-α expression between two groups of mice (50.88 ± 6.38) vs.(53.13 ± 5.49),P ＞ 0.05.The survival rate of ILT4-/-mice was significantly higher after CLP compared with WT mice (P ＜ 0.05).Conclusion The high level of ILT4 expression in mononuclear cells were observed in peripheral blood during sepsis and it was found to be associated with high serum IL-6 levels and low MHC-Ⅱ expression in mononuclear cells,leading to increased mortality.

Objective To investigate the timing of super-selective renal artery embolization (SRAE) for the treatment of renal hemorrhage after percutaneous nephrolithotomy (PCNL) .Methods From June 2005 to February 2013 ,a total of 2 165 patients with upper urinary tract calculi underwent PCNL (2 384 PCNL procedures) and 16 of them suffered severe bleeding (0 .74% ) .In the 16 cases ,SRAE was used .The medical records of all the 16 cases were retrospectively analyzed .Results In 16 patients ,15 patients were successful with the first SRAE ,but 2 of them underwent an additional pure renal artery angiography (1 patient before SRAE and 1 patient after SRAE);1 healed after the second SRAE .The mean blood loss and transfusion volume were 32 .9 g/L and 250 mL before the first angiography/SRAE ,and an additional 3 .2 g/L and 0 mL before the second try .Although 1 patient died ,the oth-ers were recovered without complications .Conclusion SRAE should be adopted early for the treatment of severe renal hemorrhage after PCNL .However ,a second try should be considered for the repeated bleeding patients after the negative results of first renal artery angiography or SRAE .