Objective To compare the safety and efficacy of flexible ureteroscopic lithotripsy (F-URS) and mini-percutaneous nephrolithotomy(MPCNL) for treating upper ureteral calculi by the randomized controlled clinical trial .Methods 120 cases of up-per ureteral calculi treated in this hospital from May to September 2013 were randomized into the F-URS group and the MPCNL group with 60 cases in each group .The postoperative clinical curative effects were compared between the two groups .Results The initial stone clearance rates of the F-URS group and the MPCNL group were 68 .33% and 95 .00% respectively ,and the difference was statistically significant (P< 0 .05) .The clearance rate of the two groups after postoperative 3 months were 96 .67% and 98 .33% respectively ,and the difference between the two groups had no statistical significance (P>0 .05) .The operating time of the F-URS group and the MPCNL group was (35 .33 ± 11 .57)min and (53 .75 ± 17 .31)min respectively ,the average hospital stay after operation was(3 .05 ± 0 .62)d and (5 .43 ± 1 .84)d respectively ,and the average visual analogue scale(VAS) score on first postoper-ative day was 1 .70 ± 1 .37 and 3 .68 ± 1 .57 respectively .These indicators had statistically significant differences between the two groups(P<0 .05) .The average dropped amount of hemoglobin and the occurrence rate of complications after operation had no sta-tistically significant differences between the F-URS group and the MPCNL group(P>0 .05) .Conclusion For upper ureteral calculi with surgical indication ,the effect of F-URS is equivalence to MPCNL in the aspect of the stone clearance rate ,but F-URS has high-er security and shorter postoperative hospital stay .In the department with the condition to conduct F-URS ,F-URS should be ranked as the preferred treatment method for upper ureteral calculi .

Objective To investigate the analgesic effect of oxysophoridine(OSR)and the influence of verapamil(Ver)on the antinociception of OSR when two drugs were co-administrated in mice.Methods The number of writhing within 15 min after ip different doses of OSR was observed in painful mouse mo- dels caused by acetic acid.The hot plate method was used to assess nociceptive sensitivity of CaCl_2 and Ver before ip OSR.Nitric oxide(NO)in serum was measured by spectrophotometry.Results The number of writhing was decreased and the latency of licking the hind paws was prolonged in a dose-dependent manner after ip OSR.The antinociception of OSR could be antagonized by CaCl_2 and enhanced by Ver.No inter- ference was detected in serum volume of NO.Conclusion These results suggest that OSR can antagonize the acute pain caused by acetic acid and hot plate in a dose-dependent manner in mice.Calcium channel blocker could enhance the effect of OSR.

Objective To evaluate the feasibility,safety and efficacy of tubeless percutaneous nephrolithotomy ( PCNL).Methods Patients who underwent PCNL were randomized into 2 groups by extracting a random number generated from random number table,tubeless PCNL group and traditional PCNL group when the stones were cleared.Each patient in tubeless PCNL group was treated with insertion of a F5 ureteral double pigtail stent without placement of nephrostomy tube,while both double pigtail stent and F16 nephrostomy tube were placed in patients in traditional PCNL group.Exclusion criteria were severe bleeding requiring blood transfusion,stone residual requring a second PCNL,severe hydronephrosis with the thickness of renal parenchyma less than 5 mm,pyonephrosis,stricture of ureter or ureteropelvic junction,and severe perforation of the collecting system.A total of 50 patients were enrolled in this study.Tubeless PCNL and traditional PNCL were performed in 25 patients,including 27 kidney units,respectively.The two groups had comparable demographic data.All the operations were performed by the same surgeon.Evaluation factors included postoperative pain,decreased hemoglobin,blood transfusion rate,incidence of fever and perirenal hematoma,and duration of hospitalization.Results The average visual analogue scale (VAS) score on postoperative day 1 in tubeless PCNL group was 2.24 compared with 5.04 in traditional PCNL group (P ＜ 0.01 ).The average hospital stay in tubeless PC NL group (3.04 d) was significantly shorter than that in traditioal PCNL group (6.88 d) (P ＜0.01 ).The differences in average hemoglobin drop and stone clearance in the 2 groups were not significant.The differences between the 2 groups in blood transfusion ( 1/25 in tubeless PCNL group vs 3/25 in traditional PCNL group,P ＞0.05),renal hematomas rate (6/27 in tubeless PCNL group vs 7/27 in traditional PCNL group,P ＞ 0.05) and fever rate (3/25 in tubeless PCNL group vs 4/25 in traditional PCNL group,P ＞0.05 ) were not significant.There was no incidence of urinary leakage from the nephrostomy site in the 2 groups.Conclusions Tubeless PCNL can significantly decrease postoperative pain and discomfort and shorten the duration of hospitalization without increase of complications.Tubeless PCNL is safe,effective and performable,but the contraindications such as massive haemorrhage,pyonephrosis,ureteral obstruction,severe perforation of the collecting system,residual stone requring a second PCNL,should be kept in mind.

Objective To evaluate the protective effect of aminophylline on myocardium in the patients undergoing prothetic valve replacement operation of heart.Mothods Thirty patients undergoing prothetic valve replacement operation of heart were randomized to be treated either with aminophylline(n=15)or without aminophylline treatment(n=15). Aminophylline(5mg/kg)was injected intravenously at 15 minutes after induction of anesthesia.Cardiac troponin I(cTnI), cyclic adenosine monophosphate(cAMP),myeloperoxidase(MPO),ratio of aortic blood neutrophil count to coronary vein sinus blood neutrophil count,hemodynamics,time of aortic cress-clamping and other clinical data were recorded during the operation.Results There were no differences between the two groups in the major perioperative variables.Plasm cTnI concentration in both groups increased after off-clamping than that before CPB,however,it was lower in aminophylline group than that in control group.Concentration of cAMP in both groups after off-clamping was lower than that before CPB, however cAMP concentration in aminophylline group after off-clamping was higher than that in control group.Myocardial MPO activity and neutrophil count ratio after aortic off-clamping in aminophylline group was significantly lower than that in control group.Conclusion These results suggest that aminophylline is helpful to unprotection of myocardial and decreases the sequestration of neutrophil in myocardium.The mechanism of the protection may be related to the cAMP increased in myocardium.

Objective To evaluate the response rate and survival rates of refractory or relapsed Hodgkin lymphoma (HL) and grey zone lymphoma patients treated with autologous peripheral blood stem cell transplantation (APBSCT).Methods From January 2004 to August 2012,30 HL and grey zone lymphoma patients were retrospectively analyzed.Statistical analysis was done to explore the long term outcome and prognostic factors of patients treated with APBSCT.Among all patients,the median age at transplantion was 30 (13-55) years old.Patients were major with nodular sclerosis HL and in stage Ⅲ/Ⅳ.Results Every patient had a successful collection.The median MNC cell dose infused was 6.8×108/kg [range (1.0-13.8)×108/kg] and median CD34+ cell dose infused was 6.3×106/kg [range (0.6-20.6)×106/kg].Median time to neutrophil engraftment was 9 days (range 8-12 days).28 patients were evaluable after transplantation with a median follow-up of 18.5 months (range 2.5-95.0 months).The overall response rate was 89.3 ％ [CR 64.3 ％ (18/28),PR 25.0 ％ (7/28)].The overall survival (OS) rate and progression free survival (PFS) rate at 5 year would be 78 ％ and 58 ％ for all patients.3 in 7 patients with no remission after salvage chemotherapy with rituximab plus chemotherapy before APBSCT got CR and 2 got PR.Univariate analysis showed that disease status and the number of replacement types of chemotherapy prior to transplantation affected OS,the history of radiotherapy prior to transplantation affected PFS.Conclusion APBSCT can increase CR rate,prolong survival time in patients with refractory or relapsed HL and grey zone lymphoma.Rituximab plus chemotherapy as a salvage therapy could raise CR rate before APBSCT.Chemosensitivity before transplantation affect outcome with APBSCT.Changing many types of chemotherapy is adverse for APBSCT.Salvage radiotherapy before APBSCT is not recommended.

Objective To assess the value of contrast-enhanced ultrasound (CEUS) in differential diagnosis of BI-RADS-US 4 breast lesions.Methods A total of 123 lesions underwent CEUS.The CEUS features of lesions were categorized into 5 malignant or benign indexes respectively,lesions displaying any two of the five features were diagnosed as malignant or benign.The diagnostic effect of CEUS for BI-RADS-US 4 lesion was analyzed according to the pathological results as the gold standard.Results CEUS of the 123 BI-RADS-US 4 breast lesions indicated that 75 lesions were malignant while 48 were benign.Pathological results confirmed that there were 72 malignant lesions and 51 benign.The proportions of malignant lesions in 4A category,4B category and 4C category were 16.2 ％,58.5 ％ and 93.3 ％ respectively.The accuracy,sensitivity,specificity,positive predictive value,and negative and positive predictive value of CEUS for the diagnosis of BI-RADS-US 4 lesions were calculated as 92.7％,95.8％,88.2％,92.0％ and 93.7 ％ respectively.Lesions showing false positive in CEUS mainly needed surgical treatment,such as fibroma with active growth mesen-chyme,intraductal papilloma and granulomatous mastitts.Conclusions Surgical treatment rather than aspiration biopsy are suggested for those diagnosed being malignant in CEUS of the BI-RADS-US-4 lesions,as they can be treated as BI-RADS5 lesions.Short-term visit or aspiration biopsy are suggested for BI-RADS-US-4 lesions diagnosed being benign in CEUS.

BACKGROUND: The treatment of multilevel cervical spondylotic myelopathy (MCSM) aims at sustaining the spinal cord compression and restoring the stability of the cervical vertebrae at most.OBJECTIVE: To analyze the clinical characters of anterior cervical discectomy with fusion and expansive open-door laminoplasty for MCSM.METHODS: Sixty-seven patients with MCSM were divided into two groups, and treated with anterior cervical discectomy with fusion (group A) or posterior cervical expansive open-door laminoplasty (group B). All the patients were followed up for 12 months, and the range of motion of cervical vertebrae, cervical curvature index were observed,as well as the Visual Analogue Scale and Japanese Orthopaedic Association scores were condueted. Moreover, the operation time, blood loss and adverse reactions were recorded.RESULTS AND CONCLUSION: (1) The loss of range of motion of the cervical vertebrae in the group B was significantly less than that in the group A (P < 0.05). (2) The cervical curvature index in the group A was significantly improved (P < 0.05), but the index had no significant change in the group B. (3) The axial systems were significantly improved in both groups, especially in the group A (P < 0.05). (4) The neurological function was significantly improved in both groups (P < 0.05), which showed no significant difference between two groups (P > 0.05). (5) The intraoperative blood loss in the group B was significantly more than that in the group A (P < 0.05). (6) The incidence of hoarseness and dysphagia in the group A was 19％. The incidence of wound infection, cerebrospinal fluid leakage and C5 nerve root palsy in the group B was 9％. (7) These results suggest that during choosing an appropriate method for MCSM,surgeons' skills and patients' situation should be considered.

Objective The study is to investigate the role of miR-328 in endothelial mesenchymal transition (EMT)induced by high glucose in human umbilical vein endothelial cells (HUVECs)and its signaling mechanism.Methods HUVECs were cultured in high glucose environment to induce EMT;The recombinant lentiviruses were created by miR-328 and antagomiR- 328 transfection of HUVECs.The experiment was divided into seven groups: normal glucose;mannitol group;high glucose;miR-328;miR-328 virus negative control;high glucose + U0126;miR-328 + U0126.Double immunofluorescent staining was used to determine expression of EMT markers;Changes in miR-328 expression is examined by RT-qPCR;The expressions of type Ⅰ/Ⅲ collagen,p-MEK1/2 and p-ERK1/2 are examined by Western blot.Results 1)HUVECs showed positive staining for CD31 and α-SMA in high glucose group.2)The expression of miR-328 was up-regulated(P<0.05)in HUVECs treated by high glucose or miR-328.Compared with high glucose group or miR-328 group,miR-328 expression was less pronounced aftertreatment with U0126.3)The expressions of type Ⅰ/Ⅲ collagen increased in HUVECs treated by high glucose or miR-328(P<0.05) Compared with high glucose group or miR-328 group,typeⅠ/Ⅲ collagen expressions were less pronounced after treatment with U0126.4)The expressions of p-MEK1/2 and p-ERK1/2 were increased in HUVECs treated by high glucose or miR-328 in comparison to the control group (P<0.05);a lower expression of p-MEK1/2 and p-ERK1/2 were observed in U0126 group than in high glucose group or miR-328 group.Conclusions The phenomenon of EMT in HUVECs is induced by high glucose with increased expression of miR-328;overexpression of miR-328 induced EMT in HUVECs;miR-328 induced EMT is related with MEK1/2-ERK1/2 signaling pathway.

Objective To discuss the effects of prophylactic chemotherapy on the outcomes and prognosis of invasive mole patients.Methods One hundred and fifteen invasive mole (IM) patients older than 40 years were registered in Peking Union Medical Collage Hospital.Eleven of them were treated with prophylactic chemotherapy before diagnosed as IM prophylactic chemotherapy group,while the other 104 cases received therapeutic chemotherapy after diagnosed as IM (non-prophylactic chemotherapy group).The general clinical data (including age,clinical stage,risk factor score),treatment,outcomes and relapse of patients were retrospectively compared between two groups.Results (1) The age of prophylactic chemotherapy group and non-prophylactic chemotherapy group were (47±5) versus (46±4) years old.Ratio of clinical stage Ⅰ-Ⅱ were 3/11 versus 29.8％ (31/104),clinical stage Ⅲ-Ⅳ were 8/11 versus 70.2％ (73/104).Ratio of risk factor score 0-6 were 11/11 versus 84.6％ (88/104),risk factor score ＞6 were 0 versus 15.4％(16/104).There were no significant statistical differences between two groups in age,clinical stage or risk factor score (all P＞0.05).(2) Treatment:the total chemotherapy courses between prophylactic chemotherapy group and non-prophylactic chemotherapy group (median 7 versus 5) were significantly different (Z=3.071,P=0.002).There were no significant statistical differences between two groups in the chemotherapy courses until negative conversion of β-hCG,consolidation chemotherapy courses,total therapeutic chemotherapy courses or ratio of hysterectomy (all P＞0.05).(3) Outcomes and relapse:between the prophylactic chemotherapy group and the non-prophylactic chemotherapy group,the complete remission rate were 11/11 versus 98.1％(102/104),the relapse rate were 0 versus 1.0％(1/102).There were no significant difference between the two groups in outcomes or relapse rate (P＞0.05).Conclusions Prophylactic chemotherapy does not substantially benefit the IM patients older than 40 years.Prophylactic chemotherapy may not significantly improve patients' prognosis,in which increased sample size is required in further study.

Objective To investigate the effects of different doses of alcohol on the synthesis of testosterone and the expression of androgen binding protein(ABP)mRNA in rat testis.Methods Forty male Wistar rats were randomly divided into 4 groups(10 rats each group)and received either distilled water(control group)or alcohol(alcohol-fed groups)for 5 months.Alcohol was administered by garage with a single daily dose : 5 g/kg(large dose group),2.5 g/kg(middle dose group)and 0.5 g/kg(small dose group).Testosterone content was measured by ELISA.mRNA levels of peripheral-type benzodiazepine receptors(PBR),PPARct and ABP were assayed by RT-PCR.Results Compared with control group:(1)ethanol feeding with daily doses of 5 g/kg,2.5 g/kg and 0.5 g/kg significantly decreased testosterone levels by 31.13%(P0.05)respectively,indicating that ethanol might impair testosterone synthesis;(2) mRNA levels of PBR were decreased in all three ethanol-treated groups(all P