Objective To assess clinical efficacy of the combined laparoscopic technique for superficial bladder neoplasms involved uretetic orifice. Methods A totsl of 12 patients with bladder neoplasms involved ureteric orifice were treated and reviewed.The clinieal tumor stage was Tis in 6,T1 in 6.During the procedure,the transurethral resection of bladder neoplasms was performed firstlythe extent including 0.5-1.0 cm formal bladder tissue around ureteric orifice,deep to superficial muscle of bladder,then ureteroneocystostomy was done with transperitoneal laparoscopic technique.Results The operations were successfully in all 12 cases.The average procedure time was 2.2 h.The average volume of hemorrhage was 25 ml.The double J stents were removed 3 months postoperatively.Six months after surgery intravenous pyelography(IVU)and cystography showed no ureter obstruction in all cases,Ⅰ-Ⅱ degree vesicle-ureteral reflux in 2 cases.One year after surgery custography showed Ⅰ-Ⅱdegree vesicle-ureteral reflux in 4 cases,Ⅱdegree relux in 3 cases.During 324 months' follow-up,B type ultrasound and IVU showed moderate hydronephrosis in 1 case,mild in 5. Conclusion The treatment of combining laparoscopic technique for superficial bladder neoplasms involved ureterie orifice might be an effective and safe method.

0.25. Conclusions Modified Stamey bladder neck suspension is an effective treatment for type Ⅰ female stsees urinary incontinence.

Objective To explore the feasibility of the three-port laparoscopic surgery through single umbilical incision with urological desease. Methods Thirty-two patients (10 males and 22 females) were taken the laparoscopic surgery using three ports through single incision. Including varicocele 7 cases, simple kidney cyst 12 cases, double kidney cyst 1 case, polycystic kidney 1 case, left adrenal tumor 3 cases, right adrenal tumor 1 cases, left upper ureteral calculi 1 cases, giant hydronephrosis 1 case and atrophic kidney 4 cases. The surgery procedures were including make a 1.0-3.0 cm long incision in the navel, followed by inserting three 10 mm or 5 mm trocars in the incision for observation and operation. Conventional laparoscopic techniques were used to complete the urological surgery. Results The operation time of varicoeele ligation was 10--20 rain, mean 15 min, no intraoperative bleeding. The operation time of renal cysts was 30-53 min, mean 40 rain, no intraoperative bleeding. The operation time of resection of adrenal tumor was 57--120 min, mean 68 rain, intraoperative bleeding was 20-60 ml, mean 30 ml. The operation time of ureterolithotomy was 86 min, intraoperative bleeding was 50 ml. The operation time of nephrectomy was 45-135 min, mean 65 min, intraoperative bleeding was 90-150 ml, mean 110 ml. Length of stay 3-8 days, average 5.5 days.With average follow-up time 2 months, all cases were fully recovered without complication and no visible scar in the abdominal region. Conclusion The laparoscopic surgery using three ports through single incision is safe and effective in selected urological surgery.

Objective:To investigate the effects of Orexin peptides on feeding and energy metabolism in mice.Methods:The mice were divided into two groups:feeding group and metabolic group.The feeding group were injected with different doses (1,3 and 10 nmol) of orexin-A and orexin-B to observe their effects on feeding and the activity of tyrosine hydroxylase in liver.We used the metabolic cages and observed the changes of respiration rate and respiration rate of mice were under light condition,dark condition and fasting condition.Results:Compared with the control group,1 nmol and 10 nmol orexin-A significantly stimulated mice to feed (P ＜0.05) within 4 hours after injection,and the effect of 3 nmol orexin-A on feeding was not obvious,but increase the activity of tyrosine hydroxylase.Any dose of orexin-B did not show a stimulating effect on mice feeding.(P ＞0.05).In the light cycle,orexin-A could significantly reduce the respiration rate (RQ),the metabolic rate was significantly increased (P ＜0.05);In the dark cycle,orexin-A had no effect on RQ,but the metabolic rate was significantly rised (P ＜0.05);But the injection of orexin-A in fasting mice induced a brief increase in RQ and a significant increase in metabolic rate (P ＜0.05).Conclusion:Orexins may play an important role in regulating feeding and energy metabolism in mice.

Objective:To explore the effect of different tidal volumes (VT) on the hemodynamics of right heart in acute respiratory distress syndrome (ARDS) rats induced by oleic acid (OA).Methods:Sixty adult male Sprague-Dawley (SD) rats were divided into control group ( n = 20), ARDS model group ( n = 20), low VT (LVT) group ( n = 10) and high VT (HVT) group ( n = 10) by random number table. ARDS model was reproduced by injecting OA 0.15 mL/kg through a jugular vein. The control group was given the same amount of normal saline. The success of modeling was judged by the oxygenation index (PaO 2/FiO 2) 2 hours after modeling, at the same time, the lung tissues were collected, the wet/dry weight (W/D) ratio was determined, and the lung histopathological changes were measured by lung injury score. The rats in the LVT group and HVT group were given mechanical ventilation with VT of 6 mL/kg or 20 mL/kg for 4 hours, respectively at 2 hours after modeling. The rats in the control group and the ARDS model group maintained spontaneous breathing. After mechanical ventilation for 4 hours, the heart rate (HR), right ventricular systolic pressure (RVSP), the maximum rate of rising of right ventricular pressure (dp/dt max), and the blood pressure (BP) were measured. Meanwhile, arterial blood samples were collected for blood gas analysis, including pH value, arterial partial pressure of oxygen (PaO 2), arterial partial pressure of carbon dioxide (PaCO 2) and PaO 2/FiO 2. Results:The rats in the ARDS model group showed symptoms of respiratory distress 1 hour after modeling, and the lung tissue samples showed obvious patchy bleeding 2 hours after modeling, while the control group showed no such changes. The PaO 2/FiO 2 in the ARDS model group was significantly lower than that in the control group [mmHg (1 mmHg = 0.133 kPa): 294.3±5.9 vs. 459.0±4.4, P < 0.01], and the lung W/D ratio and lung injury score were significantly higher (lung W/D ratio: 8.24±0.25 vs. 4.48±0.13, lung injury score: 0.60±0.03 vs. 0.12±0.02, both P < 0.01). It indicated that ARDS model was successfully reproduced. The arterial blood gas analysis and hemodynamic parameters of the ARDS model group were significantly worse than those of the control group. After 4-hour mechanical ventilation, the blood gas parameters of the LVT group were better than those of the ARDS model group and the HVT group [pH value: 7.36±0.02 vs. 7.24±0.02, 7.13±0.01; PaO 2 (mmHg): 92.4±2.1 vs. 61.8±2.3, 76.6±2.2; PaCO 2 (mmHg): 49.6±1.7 vs. 61.8±1.8, 33.6±1.3; PaO 2/FiO 2 (mmHg): 440.0±10.2 vs. 274.3±21.4, 364.7±10.5; all P < 0.05]. HR, BP and dp/dt max in the LVT group were significantly higher than those in the ARDS model group and the HVT group [HR (bpm): 346.9±5.4 vs. 302.3±10.1, 265.5±12.2; BP (mmHg): 125.4±2.2 vs. 110.0±2.5, 89.2±2.8; dp/dt max (mmHg/s): 1 393.3±30.3 vs. 1 236.4±20.5, 896.1±19.5; all P < 0.05], and RVSP was significantly lower than that in the ARDS model group and the HVT group (mmHg: 31.3±0.4 vs. 34.0±1.0, 38.8±0.9, both P < 0.05). Conclusion:Mechanical ventilation with low VT can improve the hemodynamic parameters of the right ventricle and protect the function of the right heart in ARDS rats.

OBJECTIVETo assess the predictive value of Neuropad test on occurrence of diabetic foot ulceration (DFU) among type 2 diabetic patients.

METHODSWe divided 725 cases of type 2 diabetic patients into the high-risk and the non-high-risk groups of DFU based on the results of vibration perception thresholds(VPT) examination, which was widely used as a criteria for predicting DFU. Receiver operating characteristic (ROC) analysis was used to compare the effectiveness of Neuropad with 10 g Semmes-Weinstein monofilament (10 g SWMF) testing in predicting the risk of DFU.

RESULTSAmong 725 patients of type 2 diabetes, 6.1% were at a high risk of DFU. Compared to non-high-risk group, patients in high-risk group had older age, longer diabetes duration, higher values of complete colour change time (CCC time) of Neuropad and higher abnormal rate of 10 g SWMF (P<0.01). CCC time of Neuropad was shown to be better in predicting the risk of DFU than 10 g SWMF, and the area under the ROC curve was about 0.8, and the best cut-off value was 22.25 min.

CONCLUSIONNeuropad is an effective means for predicting of the risk of DFU, and can be used to prevent diabetic foot ulceration.

Adult ; Aged ; Diabetic Foot ; diagnosis ; Female ; Humans ; Male ; Middle Aged ; Neurologic Examination ; methods ; Predictive Value of Tests ; Risk Assessment

OBJECTIVETo explore the distribution and antibiotic resistance of pathogens in lesions of diabetic foot osteomyelitis (DFO) and analyze the risk factors causing osteomyelitis.

METHODSA total of 372 patients with diabetic foot infections hospitalized between January 2011 and December 2014, including 203 with osteomyelitis (OM group) and 169 without osteomyelitis (non-OM group), were examined for the distribution and antibiotic resistance profile of the pathogens in the wounds. Logistic regression analysis was used to analyze the risk factors causing osteomyelitis.

RESULTSGram-negative bacteria were the predominant pathogens (53.7%) in the infected wounds in OM group, whereas Gram-positive bacteria were the most frequently found (56.7%) in non-OM group (P=0.001). Among the Gram-positive bacteria, Staphylococcus was the dominating flora (35.1%). The resistance rate to oxacillin and cefoxitin of the isolated bacteria in OM group (64.9% and 68.5%, respectively) was significantly higher than that in non-OM group (29.2% and 32.6%, respectively; P<0.05). Among the gram-negative bacteria, Enterobacteriaceae was the dominating flora (62.4%), with a higher resistance rate to Cefepime and Aztreonam in OM group (30.1% and 38.6%, respectively) than in non-OM group (15.1% and 22.2%, respectively; P<0.05). Logistic regression analysis indicated that the infection by multi-drug resistant bacteria and an wounds area >4 cm(2) were the risk factors for osteomyelitis in patients with diabetic foot infections (P<0.05).

CONCLUSIONIn addition to an empirical anti-infection therapy, clinicians should choose specific antibiotics against Gram-negative bacteria according to the microbial spectrum and antibiotic resistance of pathogens in patients with DFO; patients with diabetic foot infections by multi-drug resistant bacteria and those with a wound area exceeding 4 cm(2) are exposed to an increased risk of osteomyelitis.

Anti-Bacterial Agents ; Cephalosporins ; Diabetic Foot ; microbiology ; Drug Resistance, Multiple, Bacterial ; Gram-Negative Bacteria ; classification ; isolation & purification ; Gram-Positive Bacteria ; classification ; isolation & purification ; Humans ; Osteomyelitis ; microbiology ; Risk Factors ; Wound Infection ; microbiology

Cancer immunotherapy has veered the paradigm of cancer treatment. Despite recent advances in immunotherapy for improved antitumor efficacy, the complicated tumor microenvironment (TME) is highly immunosuppressive, yielding both astounding and unsatisfactory clinical successes. In this regard, clinical outcomes of currently available immunotherapy are confined to the varied immune systems owing in large part to the lack of understanding of the complexity and diversity of the immune context of the TME. Various advanced designs of nanomedicines could still not fully surmount the delivery barriers of the TME. The immunosuppressive TME may even dampen the efficacy of antitumor immunity. Recently, some nanotechnology-related strategies have been inaugurated to modulate the immunosuppressive cells within the tumor immune microenvironment (TIME) for robust immunotherapeutic responses. In this review, we will highlight the current understanding of the immunosuppressive TIME and identify disparate subclasses of TIME that possess an impact on immunotherapy, especially those unique classes associated with the immunosuppressive effect. The immunoregulatory cell types inside the immunosuppressive TIME will be delineated along with the existing and potential approaches for immunosuppressive cell modulation. After introducing the various strategies, we will ultimately outline both the novel therapeutic targets and the potential issues that affect the efficacy of TIME-based nanomedicines.