Objective We summarized the clinical experience of modified ileal ureter substitution for treating long segment ureteral defection.Methods We retrospectively analyze the clinical data of 2 patients with long segment ureteral defect who treated with Yang-Monti ileal ureter substitution between March 2015 and November 2015.One 75 years old male patient was diagnosed as upper ureteral malignance and solitary kidney.The length of defection from renal pelvis to bladder was 22 em.His serum creatinine was 100 μmol/L,blood urea nitrogen was 5.7 mmol/L,serum chloride was 98 mmol/L.Another one 41 years old female patient was diagnosed as middle and lower ureteral iatrogenic injury.The traumatic length was 15 cm.Her serum creatinine was 70 μmol/L,blood urea nitrogen was 5.1 mmol/L,serum chloride was 100 mmol/L.they were both treated by Yang-Monti ileal ureter substitution.The ileal intestinal segment was used for the ureteral replacement,which were more than 15 cm to the ilealcecum.The length of intestine was 10.0 cm and 7.5 cm,respectively.The ileal mesentery was preserved.After closing the mesangial hiatus,the ileal segment was pull into the retroperitoneal space and pulling out via descending colonic mesangial window.The ileal segment was divided into three parts,which was 2.5 to 3.0 cm in each part.Each part was opened via long axis and then rotated 90 degree.The 4-0 absorable suture was used to suture the edge of each intestinal part continuously.The sutured intestine was re-tubularized,using 4-0 absorable suture and the F16 catheter was used as the tube model.The length of reconstructed ureter was 22 cm and 18 cm,respectively.The neo-ureter was re-anastomosed with renal pelvis and bladder wall.Two F6 double J stents were placed in the neo-ureter.Results The operative time was 160 min and blood loss was 200 ml in the first case.In the second case,the operative time was 180 min and blood loss was 220 ml.No significant complications were noticed intra-operation and post-operation.Six months after operation,the male patient's serum creatinine was 112 pmol/L,blood urea nitrogen was 6.1 mmol/L,serum chloride was 106.0 mmol/L and electrolytes were normal.In another patient,serum creatinine was 79 μmol/L,blood urea nitrogen was 5.9 mmol/L and serum chloride was 103.0 mmol/L.The GFR was 24.9 ml/min and 22.1 m]/min 3 and 6 months after operation,respectively.Ureteral obstruction wasn't detected on IVU images 3 months after operation.Conclusions For patient with long ureteral defect,which cannot be replaced by other urinary tissue,YangMonti ileal ureter substitution is one of the optional modalities.As a new technique of ureteral substitution,Yang-Monti ileal ureter substitution is simple and fewer complications and can improve the quality of life in patient compared with traditional ureteral substitution.

Objective To investigate the effect of endoscope assisted microincision cholelithotomy(EMC) in the treatment of gallstone. Methods The clinical data of 86 patients with gallbladder stone treated by EMC were analyzed retrospectively.Of them, 63 cases were follwed-up and studied. Results All eighty-six patients were successfully operated on and discharged, no operative complications occurred. Among 63 patient being followed up for 1～3 years,the recurrence rate of gallbladder stones was 3.2%(2/63). No recurrence was noted in 46 patients with single gallstone. In the other seventeen patients with multiple stones, gallstone recurrence was found in 2 patients, the recurrence rate was 11.8%(2/17). Conclusions If selection of the operation idications are strict, endoscope assisted microincision cholelithotomy for treatment of gallstone is simple, safe, effective and less trauma, and can preserves the function of gallbladder, but it can not replace the cholecystectomy.

Objective To restore the incisal angle defect of anterior upper teeth with partial cov-erage porcelain veneer, and evaluate the clinical performance of the restoration. Methods A total of 12 patients were included, and 14 anterior upper teeth with small incisal angle defect were involved in this study, after tooth reduction of 2 mm wider than the defect of every teeth, 14 partial coverage IPS-Empress Ⅱ veneers were made and binded with Variolink Ⅱ adhesive system. During the observation period of 36-48 months after insertion, prosthodontic results were evaluated, using the CDA quality e-valuation system, and marginal integrity, anatomic form, surface and color of the veneers, and sec-ondary caries were examined. Results During the period of 36-48 observation, all of the 14 restora-tions were rated satisfactory. Conclusions With strict control of indications, the partial coverage porcelain veneer could function satisfactorily as an alternative restoration for small incisal defect of an-terior upper teeth.

Objective To explore the effects of intra-jugular vein dual lumen catheter lock heparin in different concentrations on the coagulation function,hemorrhagic tendency and catheter thrombosis risk in hemodialysis patients,and to investigate the reasonable lock heparin cuncentration. Method Ninety end stage renal disease (ESRD)patients receiving regular hemodialysis were enrolled and randomly assigned into 3 groups(n=30):Group A(pure heparin lock solution,6250 U/m1),GrouP B(medium heparin lock solution,1040 U/ml)and Group C(low hepafin lock solution,625 U/ml).The coagulation indexes were determined in short term.Complications such as bleeding,thrombosis,infection and thrombocytopenia were monitored.Results Prothrombin time(PT),actiwtted partial thromboplastin time(APTT)and thrombin time (TT)were significantly prolonged in Group A(P＜0.01);only APTT was signifieanlly prolonged in Group B:however,no significant changes were observed in Group C.Hemorrhage risk was much higher in Group A than that in Group B and C (26.7%vs 10%and 0.P＜0.05).Catheter thrombosis incidence was significantly higher in Group C than that in Group A and B(23.3%vs 0and 10%,P＜0.05).Only 1 suspected catheter related infection was found in Group C,and 2cases of moderated thrombocytopenia in Group A. Concltrsion Moderate concentration of lock heparin solution has the best balance of hemorrhagic and thrombotic risk,and should be recommended to most of regular hemodialysis patients.

To observe the effects of serum containing Xiaotan Sanjie Decoction, a compound traditional Chinese herbal medicine, on proliferation and apoptosis of human gastric cancer cell line MKN-45.

Objective To determine the relationship between serum testosterone level and lean body mass, body fat content, and bone mineral density (BMD) . Methods The study involved 185 healthy females in Changsha, aged 45 ～81. Fasting serum testosterone was measured by radioimmu-noassay. Hologic QDR 4500A fan beam X-ray bone densitometer was used to measure the BMD of anteroposterior lumber (AP, L_(1～4)) and total hip, to measure the bone mineral content, BMD, body fat content and muscle tissue weight of head, trunk, ribs, pelvis, spine, upper limbs, lower limbs and the total body. Body weight, lean body mass and body fat percentage were calculated. SPSS 11.0 software was used to conduct regression analysis. Results (1) Serum testosterone showed no correlation with lean body mass, body fat content, and body fat percentage. (2) Serum testosterone was positively related with the BMD of lumbar spine and hip, but showed no correlation with the BMD after adjustment of age and years since postmenopause. (3) Lean body mass showed significant positive correlation with the BMD of different sites. Total body fat content showed positive correlation with the BMD of total hip, while body fat percentage showed negative correlation with the BMD of the whole body. Conclusion Keeping lean body mass benefits postmenopausal women to maintain bone mineral content, and taking androgen should still be cautious.

Objective To investigate serum uric acid (UA) levels and related clinical characteristics of neuromyelitis optica (NMO). Methods The serum uric acid levels were measured in 65 patients with NMO, compared to control groups which were 76 cases with multiple sclerosis ( MS), 126 cases with cerebral vascular diseases (CVD) and 130 healthy controls(HC). The disability severity in NMO was assessed by the Expanded Disability Status Scale (EDSS). Magnetic resonance imaging ( MRI ) was performed to strengthen assessment the involved lesions. Serum AQP4 antibody was tested in a cell based immunofluorescence assay. Results In male groups, serum UA levels in NMO patients [ (298.90±74.14) μmol/L] were significantly lower than that in CVD [ (355.37 ±50. 30) μmol/L] and HC subjects [ (340.33 ± 58.23 ) μmol/L, P ＜ 0.05 ]. No difference was found between NMO and MS [ ( 292.36 ±92.95) μmol/L] groups. In female groups, serum UA levels in NMO patients [(198.21 ± 62.62)μmol/L] were significantly lower than that in CVD [(274.51 ± 70.66) μmol/L] and HC subjects [(243.26 ±60.65) μmol/L,P ＜0.05]. No difference was found between NMO and MS [(232.29 ±71.95 ) μmol/L ] groups. UA levels were significantly lower in females [ ( 198.21 ± 62. 62) μ mol/L] than in males [ (298.90 ±74.14) μmol/L]. UA levels were significantly lower in patients with EDSS≥5 [ ( 195.48 ± 83.70 )μmol/L] than EDSS ＜ 5 [ (241.00 ± 63.20)μmol/L] NMO patients. In our study UA levels were not correlated with longitude of spinal lesions, activity revealed by MRI and AQP4 antibody tires.Conclusion Lower serum UA levels were found in patients with NMO and related to more severe symptoms.

Objective To analyze the clinical characteristics of two patients with 3β-hydroxysteroid dehydrogenase deficiency and to explore their molecular genetic defects.Methods The clinical features and laboratory data of two patients were collected.The exons of HSD3B2 gene were amplified by PCR and sequenced by Sanger sequencing.Results Patient 1, aged 5 yrs old, was raised as a girl with 46, XY karyotype, presented with hyperpigmentation, female infant vulva, clitoral hypertrophy, and bilateral cryptorchidism;Patient 2, aged 11 yrs old, was raised as a girl at birth but as a boy after 1 yr old for known 46, XY karyotype, presented with hyperpigmentation, micropenis and severe hypospadias.Both patients had markedly elevated adrenocorticotropin and decreased cortisol.Two homozygous missense mutations in HSD3B2 gene were identified:conversions of codon Pro155 toLeu(p.P155L)inpatient1,andcodonAla82toThr(p.A82T)inpatient2,bothofwhichwerereportedforthe first time in China.Conclusion The patients with 3β-hydroxysteroid dehydrogenase deficiency in 46,XY karyotype mainly present with male pseudohermaphroditism and adrenocortical deficiency, and the diagnosis should rely on the steroids detection and HSD3B2 gene screening.

[Summary] Graves'ophthalmopathy ( GO) is the most common extrathyroidal manifestation of Graves disease ( GD) . It is an organ-specific autoimmune disorder. The estimated incidence of GO in the general population is 16 women and 3 men per 100,000 population every year. Approximately 3%-5% of patients with GO are exposed to the potential of losing their sight and requiring optimized medical intervention. For the clinicians it is helpful to assess the degree of activity and severity of GO;both are important in deciding whether a patient requires intervention and which type of intervention is indicated. These interventions include management of hyperthyroidism, measures to relieve local symptoms, immunosuppressive therapies for active moderate and severe GO, and finally rehabilitative surgery for inactive patients.

Objective To investigate the role of individual dental stent on taste protection in the patients with primary nasopharyngeal carcinoma.Methods Firstly,dosimetric evaluation of the tongue under the circumstance of 10 pairs of patient wearing dental stent or not was done.Secondly,a total of 61 patients were randomized into two arms:29 were in the trial arm and 32 in the control arm.The patients wore dental stent during radiotherapy in trial group,but not in control group.The endpoint was taste dysfunction before radiotherapy,every week during radiotherapy till the completion of radiotherapy,and followed up six months after radiotherapy.Results The mean dose of tip of tongue,body of tongue,base of tongue for patient with dental stent or not were (394.43±24.01) cGy,(986.35±77.15) cGy,(4 401.16±179.01) cGy and (677.03± 110.05) cGy,(2 418.19±414.18) cGy,(4 878.67±387.45) cGy (P value were 0.031,0.007 and 0.284,respectively) separately.By the completion of the radiotherapy,there were 9 (31.03 ％) patients suffering from a taste dysfunction in the trial group and 25 (78.13 ％) in the control group (P ＜ 0.001).Conclusions Individual dental stent has a potential tendency to relieve the taste impairment by reducing the irradiation dose of tongue.