Objective To summarize the complications of retroperitoneal laparoscopic nephrectomy.Methods From November 2002 to May 2006,122 patients with renal carcinoma underwent retroperitoneal laparoscopic nephrectomy.Complications occurred in 7 patients,and the morbidity was 5.7%.One case of injury to vena spermatica converted to open surgery,the blood loss was 1000 ml with blood transfusion 800 ml.One postoperation hemorrhage of accessory renal artery which was cut off only by harmonic scalpel,leading to blood pressure decrease to 90/60 mm Hg,and a reoperation was performed and the blood loss was 600 ml with blood transfusion 400 ml.Injury of inferior vena cava by linear cutter stapler in one case,and there was no blood loss.Hemorrhage of renal artery stump after linear cutter stapler in one case and it was controlled by titanium clip.Injury of renal vein occurred in two cases and all were controlled by Hem-o-lok or titanium clip.Injury of tail of pancreas in one case and a drainage tube was placed.Results A patient with vena cava injury was followed for 30 months and no abnormality was noted.A patient with pancreas injury was followed for 1 year and nothing remarkable was noted.The other 5 cases was followed for 20-40 months,and they remained in good health.Conclusion The major complication for retroperitoneal laparoscopic surgery is injury to large blood vessels,the principle of treatment is to elevate the pressure of pneumoperitoneum up to 18-20 mm Hg and clip the blutpunkte or convert to open surgery promptly.A good drainage is necessary for the treatment of injury of pancreas.

Objective To evaluate the curative effects of retroperitoneoscopic nephroureterectomy for the treatment of carcinoma of the renal pelvis. Methods We performed retroperitoneoscopic nephroureterectomy in 22 cases of carcinoma of the renal pelvis between December 2002 and November 2005.Transurethral vesection of the ureteral orifice with bladder cuff was performed and the affected kidney was retroperitoneoscopically dissected en bloc.The dissected kidney and ureter were removed intact through a hypogastric incision.Results The operation was successfully completed in all the 22 cases.The operation time was 2~5 h(mean,4.3 h),the blood loss was 50~600 ml(mean,187 ml),and the postoperative drainage volume,50~200 ml/d(mean,120 ml/d).The drainage tube was removed at 24~48 postoperative hours. The duration of hospitalization ranged 8~13 d(mean,10 d).Pathological findings after operation showed transitional cell carcinoma in all the cases.Followup observations in the 22 cases for 1~24 months(mean,14 months) found no recurrence.Conclusions Retroperitoneoscopic nephroureterectomy in the treatment of carcinoma of the renal pelvis is feasible,effective and micro-invasive.

Objective To evaluate the feasibility of minimally invasive therapy for peripelvic renal cysts by retroperitoneal laparoscopy.Methods Clinical data of 10 cases of peripelvic renal cysts treated by retroperitoneal laparoscopic fenestration in this hospital from October 2003 to March 2005 were retrospectively reviewed.Results All the 10 cases of operation were successfully completed.The operation time ranged 40~60 min(mean,55 min).Follow-up observations in the 10 cases for 3~24 months(mean,12.8 months) showed no recurrence.Conclusions Retroperitoneal laparoscopy is a safe and feasible alternative for the management of peripelvic renal cysts.

Objective:To evaluate the effect of miR-133b on the apoptosis and radiosensitivity of colon cancer cell line (SW620 cells), and to explore its mechanism.Methods:SW620 cells were transfected with miR-con (miR-con group), miR-133b mimics (miR-133b group), si-con (si-con group) and si-HER-2(si-HER-2 group) by the liposome method, and then irradiated with 0, 2, 4, 6, 8 Gy. The miR-133b protein expression, HER-2 protein expression, apoptosis, cell survival fraction and cytofluoroactivity in each group were evaluated by qRT-PCR, Western blot, flow cytometry, colony formation assay and dual luciferase reporter gene assay, respectively.Results:Compared with the pre-irradiation group, the expression level of miR-133b was significantly down-regulated ( P<0.05), whereas that of HER-2 was significantly up-regulated in SW620 cells after irradiation ( P<0.05). Overexpression of miR-133b and knockdown of HER-2 remarkably reduced the survival fraction (both P<0.05), and significantly promoted the apoptosis of SW620 cells ( P<0.05). miR-133b could considerably inhibit the fluorescent activity of wild-type HER-2 cells ( P<0.05) and negatively regulate the expression of HER-2 protein. Conclusion:miR-133b can inhibit the survival of colon cancer cells, promote the apoptosis and enhance the sensitivity of radiotherapy probably via the mechanism of targeting HER-2.

Abstract: Objective　To investigate a poisoning incident caused by eating eight treasure congee, and establish liquid chromatography (LC)-mass spectrometry (MS)/MS screening method of 28 alkaloids to provide references for disposal of similar poisoning incidents. Methods　LC-MS/MS was used for screening 28 alkaloids in the urine, eight treasure congee and food raw material, and the detected alkaloids were quantified. Samples were extracted with 0.4% formic acid aqueous solution and separated by a Acquity UPLC BEH C18 column (1.7 μm, 100 × 2.1 mm). Acetonitrile-0.2% formic acid aqueous solution was used as the mobile phase and gradient elution was adopted. The ionization mode was electrospray positive ionization mode, and the detection method was multi-reaction monitoring (MRM). Analytes were quantified with the external standard method. Results　In the concentration range of 0-100 ng/mL, the linear correlation coefficient r were greater than 0.999 for 28 alkaloids. The recovery of 28 alkaloids in urine sample ranged from 63.0% to 105.0%, and the relative standard deviations (RSDs) were between 5.8% and 8.6%. The recovery of 28 alkaloids in eight treasure congee sample ranged from 72.0% to 109.0%, and the RSDs were between 6.3% and 9.7%. The recovery of 28 alkaloids in semen sesami nigrum sample ranged from 60.0% to 95.0%, and the RSDs were between 4.8% and 8.2%. Hyoscyamine (2 380.0 ng/mL), scopliamine (3.6 ng/mL) and rac-anisodamine (4.7 ng/mL) were detected in the patient's urine. Hyoscyamine (63.3 μg/g), scopliamine (5.7 μg/g) and rac-anisodamine (2.1 μg/g) were detected in eight treasure congee. Hyoscyamine (901.0 μg/g), scopliamine (80.0 μg/g) and rac-anisodamine (30.1 μg/g) were detected in the seed of Datura stramonium L. The ratio of scopliamine and hyoscyamine in the seed of D. stramonium was 1∶11, which complies with the characteristics of D. stramonium L. In urine sample, the proportion of scopliamine and rac-anisodamine was 0.15% and 0.20%, and hyoscyamine accounted for 99.65%. Conclusion　Seed morphology, the content range and proportion of three alkaloids are all in accord with the characteristics of D. stramonium. Combined with the clinical symptoms of atropine poisoning, it can be deduced that this incident is a family food poisoning caused by accidental consumption of seed of D. stramonium L. The method can provide technical support for the clinical diagnosis and treatment of alkaloid poisoning patients, and also provide a basis for emergency detection and disposal of alkaloid poisoning events.

Objective To investigate the association of the major histocompatibility complex class Ⅰ chain-related antigens A (MICA)-129 gene polymorphism and soluble MICA (sMICA) levels with ulcerative colitis (UC) in Hubei Han nationality. Methods The genetic polymorphism of MICA-129 was examined using a polymerase chain reaction-sequence based test (PCR-SBT) in 256 UC patients and 460 healthy controls. From the above subjects, 80 patients and 90 healthy individuals were randomly selected for determining serum sMICA concentrations by ELISA. Results The frequencies of variant allele (G) and genotype (GG) in MICA-129 gene were significantly higher in the UC patients than in the controls(76. 8%vs 72. 2%, P =0. 060; 55.9% vs 46. 3% ,P =0. 016). Serum sMICA levels were significantly elevated in the patients compared to the controls[(576. 47 ±279. 02) ng/L vs( 182. 17 ±73. 11 ) ng/L,P ＜0. 001]. In addition, the sMICA levels were higher in the patients carrying MICA-129 GG genotypes than in those carrying ( GA + AA) genotypes [( 638. 87 ± 347. 15 ) ng/L vs ( 507. 51 ± 152. 87 ) ng/L, P = 0. 035].Conclusions The genetic polymorphism of MICA-129 and sMICA levels are correlated with the UC patients in Hubei Han nationality. Our findings demonstrate that MICA-129 gene may contribute to the pathogenesis of UC.

Objective To investigate cerebrospinal fluid characteristics and clinical features in children with severe hand,foot and mouth disease (HFMD) induced by enterovirus 71 (EV71) infection.Methods A total of 114 children with severe HFMD,in whom EV71 was detected by reverse transcription polymerase chain reaction (RT-PCR),were admitted in Hangzhou Children's Hospital during May and August 2013.Seventy-eight children with severe HFMD induced by other enteroviruses admitted at the same period served as controls.The results of cerebrospinal fluids (CSF) routine examination and biochemical tests,and the clinical symptoms were compared between two groups.Differences in enumeration data were compared with x2 test,and measurement data were compared with Mann-Whitney U test.Results The incidences of vomiting and limb shaking in EV71 infection group were 35.1％ and 50.9％,which were higher than those in control group (x2 =7.864 and 19.682,P ＜ 0.05).The incidence of limb shaking in children with nucleated cells count ≥ 100 × 106/L in EV71 group was higher than that with nucleated cells count ＜ 100 × 106/L (72.3％ vs.35.8％,x2 =14.740,P =0.000).The nucleated cells count,protein quantity and their positive rates in EVT1 infected group were higher than those in control group (Z =-9.458 and-6.591,P=0.000; x2=105.421 and 10.932,P =0.000 and 0.001).Conclusion The symptoms of nervous system damage and abnormal CSF examination were more serious in HFMD induced by EV71 infection,and in EV71 infected patients the incidence of limb shaking is correlated with nucleated cell count in CSF.

Objective To discuss the technique of laparoscopie radical cystectomy with Studer orthotopic ileal neobladder. Methods Eight men with bladder cancer who were indicated for radical surgery underwent laparoscopic cysteetomy with Studer orthotopic ileal neobladder. The ages were be-tween 51 and 69 with the mean age was 57 years. Seven cases were transitional cell carcinoma and 1 case was adenocarcinoma. A 5-port approach was employed. The first step was the bilateral pevic lymphadenectomiy including obturator lymph nodes, internal and external iliac lymph nodes. Then ventral surface of the bladder was mobilized and the bilateral endopelvic fascia was incised. Next step included the stich of dorsal vein complex and dissection of both the vas deferens and seminal vesicles. Denonvillier's fascia was incised to develop the plane between the rectum and the prostate. The urethra located in the prostatic apex was divided and transected thereby completely separating the specimen. Then the specimen was placed in a packet. Finally, a 6-8 cm lower median abdominal incision was performed, through which the specimen was extracted. Construction of the Studer pouch. A portion of terminal ileum about 45cm long was isolated approximately 20cm proximal to the ileocecal valve. The ends of the isolated ileal segment were closed to restore the bowel continuity. The distal 40 cm segment of ileum was placed in a U shape and opened along the antimesenteric border. The two medial borders were then oversewn and the bottom was folded over to form a neobladder. The ureters were anastomosed to the nonineised 5 cm portion of ileum. Finally, the neobladder was put into the abdomi-nal cavity and the anastomosis between the neck of the neobladder and the end of the remaining ure-theral was performed with interrupted suture. Results All the procedures were successful. The time of the operation was 6-8 h with the mean estimated blood loss 420(200-800)ml. Complication included 1 case of right ureteral indigitation in neobladder. The postoperative histopathology revealed 7 cases of pT2 and 1 cases of pT3. No positive margin was found. The follow-up (3 - 12 months) showed no recurrence. Conclusions The technique of laparoseopic radical cystectomy is feasible with the advantages of smaller incision and less blood loss. Studer orthotopic ileal neobladder has the ad-vantages of simple skill, antireflux, better postoperative urination.

Objective The aim of the present study was to evaluate the clinical application of 2 μm thulium laser in pulmonary nodules resection under VATS.Methods 61 patients,undergoing thoracoscopic resection of pulmonary nodules in thoracic department of Xuanwu Hospital,were identified between January and December of 2016.Of those,30 underwent 2μm thulium laser dissection and 31 were treated with standard technique by using staplers.In terms of clinical characteristics,including gender,age and smoking history,there is no significant difference between the laser group and the stapler group,but the lesion size was slightly larger in the stapler group compared with the laser group.The lesions of the two groups were almost evenly distributed on the five lobes.Results All the procedures were performed successfully under VATS.The intraoperative evaluation of air leaks demonstrated that less than or equal to 2 grade air leaks were observed in 28 cases in the laser group and in 30 cases in the stapler group.Grade 3 air leaks requiring a rescue treatment were observed in 2 cases in the laser group and in 1 case in the stapler group.There were no significant differences in the postoperative hospital stay and total hospital stay between two groups.Chest tube duration was lower in the laser group compared with the stapler group even if it was not statistically significant (2.71 vs 3.55 days).Hospitalization costs was significantly lower for the laser group.Conclusion The use of 2um thulium laser to prevent intra-and postoperative air leaks and bleeding is effective and makes patients recover quickly,which allows a minimally invasive,accurate and safe application during thoracoscopic resection of pulmonary nodules.