Objective To explore the diagnosis and treatment features of tuberous sclerosis complex associated renal cell carcinoma.Methods A 22-year-old boy with a childhood history of epilepsy and mental retardation presented with a complaint of intermittent painless gross hematuria for the past 2 years.After superselective left renal artery embolization was done twice in the past year, painless gross hematuria was still repeated with 6- 10 months intervals.Physical examination showed retarded face, obesity, visible facial angiofibroma and a ditch fibroma.CT scan showed irregular lesions.The largest cross-section 14.2 cm × 9.0 cm in the left kidney was inhomogeneous enhanced from 45 - 54 HU in the plain phase to 60 - 78 HU in the contrast phase.Filling defect in the left renal vein and multiple fat-density lesions (CT value of -25 - -38 HU) with the largest cross-section 7.2 cm× 5.7 cm in the right kidney were also found in contrast CT scan.The PUBMED and CBM database were reviewed.Results Open retroperitoneal radical left nephrectomy was performed.Pathology showed renal clear cell carcinoma and renal vein thrombosis.There was no tumor recurrence or distant metastasis at 4-month follow-up.Conclusions Tuberous sclerosis complex associated renal cell carcinoma is rarely reported.Timely nephron-sparing surgery is necessary when the diagnosis is established, or radical nephrectomy is also necessary if nephron-sparing surgery is impossible.

A total of 105 patients with ketosis-onset diabetes were divided into four groups (A+B-,A + B +,A - B -,A - B +) based on the results of islet-associated autoantibodies (A +,A - ) and β-cell function (B +,B - ).Nearly 94％ patients in the A -B + group and 1/10 patients in the A - B - group were non-insulin dependent.While in the A + B - and A + B + groups,the detection rates of subsequent non-insulin dependency were 20％ and 58％,respectively.Among the four groups,patients in the A - B + groups had a lower level of IL-6 and a higher level of TNF-α. Patients in the A + B - and A + B + groups had a higher level of IL-18.Our study indicates that patients with ketosis-onset diabetes may present different clinical characteristics. Evaluate the islet-associated autoantibodies and pancreatic β-cell function may be helpful to the clinical diagnostic and therapeutic strategies in diabetes.

AIM: To investigate the change of myopic choroidal neovascularization treated by ranibizumab and evaluate their value in monitoring the effect of anti-vascular endothelial growth factor ( VEGF) therapy. ·METHODS: The study enrolled 30 patients ( 30 eyes ) diagnosed with myopic choroidal neovascularization. All affected eyes were treated with intravitreal ranibizumab 0. 05mL ( 10mg/mL ). Best corrected visual acuity ( BCVA ) , non-contact tonometer, ophthalmoscope, fundus fluorescein angiograph ( FFA ) and OCTA were evaluated monthly until 6mo. The changes of BCVA and central macular thickness ( CMT) were compared at 1, 3 and 6mo after treatment. ·RESULTS:All patients received an average of 1. 70±0. 65 injections. BCVA was 0. 96 ± 0. 17 ( LogMAR ) before therapy, and BCVA 1, 3 and 6mo after treatment respectively improved by 0. 23 ± 0. 09, 0. 34 ± 0. 07, 0. 38 ± 0. 11. The differences were significant ( t=5. 461, 8. 191, 8. 894; P<0. 05 ). Mean CMT decreased form 281. 07 ± 13. 72μm to 261. 33 ± 13. 13μm, 243. 47 ± 16. 65μm, 234. 73 ± 17. 52μm respectively 1, 3 and 6mo after treatment, showing significant differences (t=12. 007, 13. 360, 9. 531;P<0. 05). OCTA revealed a progressively smaller vascular lesion and reduction in capillary density. · CONCLUSION: Intravitreal ranibizumab for CNV secondary to pathologic myopia is effective and safe;OCTA is a noninvasive and time-saving new technology, and it also is a promising tool for clinicians to make preliminary diagnosis and assess treatment efficacy in the follow-up visits.

Objective To investigate the multiple risk factors for lower extremity lymphedema in patients following treatment of common gynecologic cancers by meta-analysis for systematic analysis and comprehensive quantitative study.Methods Clinical trials published up until August 2016 were retrieved from PubMed, Embase, and the Cochrane Library.The quality of the included studies was assessed by the Newcastle-Ottawa Scale, and data analysis was performed using Stata 14.0 and RevMan 5.3.The strength of the associations between risk factors and gynecologic cancer-related lower extremity lymphedema was described as odds ratio (OR) and 95% confidence intervals (CI).Results Eighteen studies were included in the meta-analysis, and 8 relevant factors were identified.The risk factors for lower extremity lymphedema after treatment of gynecologic cancer mainly included radiotherapy (OR=2.45, 95%CI:2.05-2.95, P=0.000), FIGO stage (OR=2.29, 95%CI:1.66-3.14, P=0.000), and pelvic lymph node dissection (OR=2.00, 95%CI:1.02-3.91, P=0.040).Conclusions Radiotherapy, FIGO stage, and pelvic lymph node dissection are the main risk factors for lower extremity lymphedema after treatment of gynecologic cancers.

Objective To understand the zoonotic trematode species identified in domestic animals from Huainan area,An-hui Province,so as to supply the evidence for the prevention of zoonoses. Methods The livestock/definitive hosts were commer-cially available on category basis,and sacrificed for obtaining the parasitic samples via dissecting the viscera. The specimens were microscopically identified,with reference to the descriptions in the previous literature. Results By identification,sorting and classification,41 species of internal trematodes were found so far in the domestic animals fed in Huainan areas,in which 23 spe-cies were zoonotic trematodes and 18 were internally parasitic in livestock,belonging to 4 orders,12 families and 21 genera,and occurred in 9 definitive hosts including chicken,ducks,geese,pigs,cattle,buffaloes,sheep,goats and dogs,respectively. Con-clusion The findings suggest that the zoonotic trematodes belong to many kinds and prevalent in the domestic animals in Huainan areas,and such prevalence should call for high attention since it is urgent risk factors for zoonoses in this geographic area.

Objective To investigate the difference of apparent diffusion coefficients (ADCs) changes in three major salivary glands after gustatory stimulation using two different stimuli. Methods Thirty healthy volunteers were examined with a 1.5 T MR unit. A diffusion-weighted MR imaging (MR DWI) sequence was performed once at rest and continuously repeated 13 times after gustatory stimulation using a commercially available lemon juice and vitamin C tablets in the same volunteer by using self-controlled method. The subsequence of two stimuli was random. In addition, the salivary flow rates at rest and after stimulation were measured. Characteristics and differences in ADCs curves of three salivary glands before and after stimulation between two stimuli were analyzed. Comparison of maximum ADCs, maximum ADCs increase rates (IRs) and times to maximum ADCs(Tmax) between two stimuli was performed by using independent-samples t test. Correlation analysis between rest salivary flow rates and rest ADCs, the maximum salivary flow rates and ADCs after stimulation, the maximum salivary flow IRs and ADC IRs after stimulation were performed by using Pearson correlation test. Results In lemon juice stimulation group, the mean ADCs mostly showed a steady increase to peak values during the first DW MRI scan after stimulation in all glands, followed by a gradually decrease fluctuating slightly around the baseline values. In vitamin C stimulation group, the mean ADCs were significantly increased in all glands during the first DW MRI scan after stimulation, followed by a gradual upward trend till peak values. In lemon juice stimulation group, the mean Tmax of submandibular and sublingual glands[(184±122)s, (345±232)s, respectively] were significantly earlier than those[(454 ± 301)s, (528 ± 297)s, respectively] in vitamin C stimulation group (t=-3.517 and-2.548 respectively, P<0.01 for all). The mean maximum ADCs of three glands in lemon juice stimulation group[(1.05 ± 0.12) × 10-3 mm2/s, (1.22 ± 0.10) × 10-3 mm2/s and (1.26 ± 0.21) × 10-3 mm2/s, respectively] were all lower than those in vitamin C stimulation group[(1.13±0.13) ×10-3 mm2/s, (1.32±0.25) × 10-3 mm2/s and (1.57 ± 0.36) × 10-3 mm2/s, respectively], and the differences in parotid and sublingual glands between two groups were significant(t=-2.894 and-3.681 respectively, P<0.01 for all). The mean maximum ADC IRs of three glands in lemon juice stimulation group[(11.35±4.07)%, (8.81±5.40)%, (34.08±21.66)%, respectively] were significantly lower than those[(17.80 ± 12.72)%, (18.16 ± 18.93)%, (67.49 ± 46.04)% , respectively] in vitamin C stimulation group (t=-2.252,-2.330 and-3.432 respectively, P<0.05 for all) . In two groups, the mean maximum ADC IRs of parotid and submandibular gland were all significantly lower than sublingual gland (t=-5.994 and-6.443 respectively, P<0.01 for all). No correlation was observed between ADCs and salivary flow rates, ADC IRs and salivary flow rate IRs in two groups (P>0.05). Conclusion MR DWI with transient stimulation using lemon juice is more stable for evaluating the physiologic changes of salivary glands in vivo.

sing guidewire through temporary catheter is an alternative strategy, because of avoiding this avoids vein re-puncturation and doesn't increase catheter related complication.

Background and purpose:Radiotherapy is the main method to manage head and neck tumors.About half of the patients with malignant tumor in head and neck could obtain long term survival through radiotherapy or other therapy combined with radiotherapy.However,it is necessary to clinically detect whether carotid stenosis is a major sequela of head and neck irradiation,especially in long term survivors such as patients with nasopharyngeal carcinoma.We analyzed this injury and the degree of carotid stenosis,and its related factors to provide information to reduce and delay the incidence of this injury.Methods:We analyzed the degree of arterial stenosis of the nasopharyngeal carcinoma patients who received radiotherapy and had survived more than three years in Cancer Hospital Fudan University,compared with newly diagnosed as nasopharyngeal carcinoma before radiotherapy.The degree of carotid artery injury was observed and the clinical factors which affect its occurrence and development.All patients were low differentiated squamous cell carcinoma confirmed by pathology.All patients were examined with color doppler ultrasound to detect the carotid artery.The main end points were the diameter of carotid artery,the peak systolic and end diastolic velocities.Results:Arterial stenosis was more common in the reserch group than the control group(80% vs 20%,P＜0.001).The common and internal carotid arteries were most commonly involved(70% vs 20%,P＜0.001;6313% vs 10%,P＜0.001),followed by the external carotid artery(30% vs 3.3%,P=0.015).Significant stenosis was only found in the research group,common carotid arteries 36.7%,internal carotid arteries 23.3%,external carotid arteries10%.Conclusion:This study showed that radiation could cause significant carotid stenosis in nasopharyngeal carcinoma patients who had received radiotherapy more than 3 years previously.Carotid stenosis developed more frequently in the common carotid artery and intemal carotid artery on the side that had received radiotherapy.

Objective To investigate the effects of ulinastatin on renal expression of endothelin￣1 and nitric oxide (NO) in rats with toxic acute kidney injury(AKI). Methods Twenty￣four male SD rats were randomly divided into the normal control group,model control group and treatment groups, with 8 rats in each group. Except normal control group, rats were subcutaneously injected with gentamicin (300 mg.kg-1 .d-1 ) for 3 days to establish a model of toxic AKI.Rats in the treatment group were intraperitoneally injected with a 7￣day course of ulinastatin (30 000 U.kg-1 .d-1 ) from the fourth day.While the other two groups were injected with 0.9% sodium chloride injection (3 mL.kg-1 .d-1 ). The serum level of creatinine and cystatin￣C,urinary concentration of kidney injury molecule￣1(Kim￣1) and neutrophil gelatinase￣associated lipocalin (NGAL), level of endothelin￣1 and NO,expression of endothelin￣1 mRNA,endothelial nitric oxide synthase (eNOS),induced nitric oxide synthase (iNOS),eNOS mRNA and iNOS mRNA in homogenate of renal tissues in each group were detected on the eleventh day. Results Compared with the normal control group,serum level of creatinine and Cystatin￣C,urinary concentration of Kim￣1 and NGAL,level of endothelin￣1 and NO,expression of endothelin￣1 mRNA,iNOS and iNOS mRNA in homogenate of renal tissues were higher in model control group (P<0.01, respectively), while which were lower in treatment group than those in model control group ( P < 0. 01, respectively). And no statistical significant difference of eNOS and eNOS mRNA expression in homogenate of renal tissues existed among the three groups. Conclusion Ulinastatin possesses curative role against rat with toxic AKI via down￣regulating renal expression of endothelin￣1,NO and iNOS.

Objective To discuss the major complications of urologic laparoscopic surgery.Methods From January 2004 to May 2012,2 250 urologic laparoscopic surgical procedures were performed in our institute,including radical nephrectomies (690 cases),partial nephrectomies (285 cases),simple nephrectomies (126 cases),nephrouretectomies (270 cases),renal cyst operations (281 cases),adrenalectomies (310 cases),pyeloplasties (93 cases),ureterolithotomies (48 cases),radical prostatectomies (43 cases),radical cystectomies (49 cases),donor nephrectomies (50 cases) and retroperitoneal lymph node dissection (5 cases).Medical records of each procedure were retrospectively evaluated.Intraoperative and postoperative complications were graded according to the Satava and Clavien classifications,respectively.Major complications were defined as Satava grade Ⅱ or higher,and Clavien grade Ⅲ or higher.Results Among the 2 250 laparoscopic procedures,53 major complications occurred,resulting in a major complication rate of 2.36％.Major intraoperative and postoperative complication rates were 1.16％ (26 cases) and 1.20％ (27 cases),respectively.Vascular injuries were the most common intraoperative complications (58％) while the proportion of visceral injury was the second as 42％.The most common postoperative complication was bleeding (19 cases).Among them,3 cases died of multiple organ failure after second operations.Other major postoperative complications included wound infection (2 cases),urine leakage (1 case),adrenal crisis (1 case),ileus (2 cases) and incisional hernia (Ⅰ case) and 1 death caused by pulmonary embolism.Conclusion Major complications,including death,may occur at any stages during the urologic laparoscopic surgery.