Objective To evaluate the efficacy and safety of the flexible ureteroscopy (FURS) with holmium laser lithotripsy in the management of stones in ectopic pelvic kidney (PK).Methods We retrospectively reviewed the records of 11 patients,ranged from 37-52 years old,who were underwent FURS with holmium laser for PK stones from January 2007 to April 2012.Three cases had solitary stones in renal pelvis,3 cases had solitary stones at lower calyx and multiple stones were found in 5 cases.Mean size of stone was 2.3 cm (ranged 1.8-3.7 cm).One case had history of ESWL and PCNL before surgery with unsatisfied result and 7 cases were underwent ESWL with poor outcome.The double J stent was placed into the ureter two weeks before the operation.Under the general anesthesia,the ureteral access sheath was placed firstly during operation.Then,flexible ureteroscopy was inserted into the renal pelvis through ureteral access sheath.Holmium laser was used to perform the procedure with the power less than 20 W (0.6-1.0 J/10-20 Hz).The stone fragments were taken out by stone baskets and double-J stent was set at the end of the procedure for additional two weeks.Results The successive rate of the ureteroscopic insertion was 100％.The average operation time was 62 min (ranged 31-87 min).No severe complications such as heavy bleeding,perforation or ureteral avulsion occurred.Small stone fragments were found in 3 cases.All of them located in the lower calyx.Since no one complained about the upper urinary obstruction or related symptoms,conservative observation was considered.All patients discharged the day after the operation.Within three months follow-up,no sign of urinary obstruction was found.Conclusions FURS with holmium laser is a safe,effective and minimally invasive technique.It could be the best option in the management of renal calculi in ectopic pelvic kidney.

Objective To investigate the effect of anti-epileptic soup on the levds of interleukin-2 (IL-2) and interleukin-6 (IL-6) in pentylenetetrazol-induced rats and its mechanism.Methods Healthy adult male SD rats were injected intraperitoneally with pentylenetetrazol kindling 35.0mg/kg to induce a rat epilepsy model.After successful construction of the epilepsy model,the rats were divided into four the groups:blank group,model group,anti -epileptic soup group and sodium valproate (VPA) group.All of the treatments were performed three times a day continuously for 28 days.The rats in the anti-epileptic soup group were given 6ml of anti-epileptic soup.The rats in the VPA group were given 400mg/kg of sodium valproate by garage.The rats in blank group and model group received 6ml of normal saline.After treatment,the seizures level was recorded by using the Diehl six point grading scale,and the expression of serum IL-2 and IL-6 were detected by the enzyme linked immunoassay (ELISA).Results The seizure level of the model group was (4.23 ± 0.43),while that of the anti-epileptic group was (3.47 ± 0.39),indicated that the anti-epileptic soup can reduce the seizures level.The expressions of IL-2 (4.18 ± 0.41)pg/mL and IL-6 (350.0 ± 82.5) pg/mL of the model group were higher than those of the blank group [IL-2 (3.20 ± 0.36) pg/mL,IL-6 (260.2 ± 69.0) pg/mL,P ＜ 0.01],while the expressions of IL-2 (3.48 ± 0.44) pg/mL and IL-6 (287.5 ±74.6) pg/mL of the anti-epileptic group were lower compared with the control group (P ＜0.01).No significant difference was found between the anti-epileptic group and VPA group IL-2 (3.35 ± 0.56) pg/mL and IL-6 (253.8 ± 59.8) pg/mL(P ＞ 0.05).Conclusion The anti-epileptic soup is effective for treating epilepsy in rats,the possible mechanism may be related with downregulating the expression of IL-2 and IL-6.

Objective To evaluate the therapeutic effect of flexible ureterorenoscopy (F-URS) with holmium laser lithotripsy in managing symptomatic caliceal diverticular calculi. Methods The records of 23 patients by flexible ureterorenoscopy (F-URS) with holmium laser lithotripsy in managing symptomatic caliceal diverticular calculi from January 2008 to December 2010 were retrospectively reviewed.The 23 cases included 15 males and 8 females,aged from 23 to 68 years.All patients had unilateral calyceal diverticulum stone,with 11,9,and 3 cases had a caliceal diverticular stone in the upper pole,midkidney,and lower pole,respectively.Sand-like stones were observed in most caliceal diverticular.The diameter of the largest stone was 18.9 mm.The presenting symptoms were flank pain,recurrent urinary tract infections,and hematuria.One week before operations,all patients was placed Double-J stent and underwent intravenous urography and renal computed tomography (CT).The ureteral access sheath was placed firstly during operation,and then ureterorenoscope was inserted into the renal pelvis.The diverticular neck was incised with holmium laser if needed,and a 200um holmium laser fiber was used to crush diverticular stone. Results Flexible ureterorenoscopes were successfully placed in all patients.Postoperatively,15 (65.3％patients were rendered stone free (SF),5 patients had clinically insigni? cant residual fragmentsless than 4 mm )( CIRF),and a residual fragment (RF) was found in three patients.The success rate ( SF ± CIRF) was 87.0％.All patients were symptom free after operation.The average operative time and hospital stay were 60 minutes and 3.5 days,respectively.No severe complications occured.A follow-up of 6 -12 months showed no recurrence. Conclusions F-URS using a holmium laser lithotripsy is a safe and effective,and may be offered as a first line therapy for symptomatic caliceal diverticula calculi.

Objective To investigate the influences of gender,age,and body mass index (BMI)on the arterial stiffness in hypertensive patients.Methods A total of 1026 hypertensive patients were enrolled in this study from 6 community health centers in Baoshan District and Shanghai Third People's Hospital.The Related medical histories and carotid-femoral(C-F) pulse wave velocity (PWV) were recorded and PWV were re-tested in 672 patients after 1 year's follow-up.The C-F PWV was analyzed from different group of Gender,age and BMI at baseline and after follow up.Results (1)C-F PWV of the male hypertensive patients were higher than that of female's and the corresponding figures were (13.63 ±3.07)m/s and (12.59±2.85)m/s(P ＜0.01).After one year's follow up,C-F PWV was increased in both male and female with corresponding figures of (14.11 ± 3.58) m/s and (13.51 ± 3.56) m/s (P ＜ 0.05).(2) The C-F PWV was increased with age.The corresponding figures were [(11.11 ± 2.00) m/s for age group 30 ～ 50 years old,(12.73 ± 2.77) m/s for age group ＞ 50 ～ 70 years old,and (14.74 ± 3.29) m/s for age group ＞ 70 years old,all P ＜0.01].After one year's follow-up,C-F PWV of three age groups was increased and the corresponding figures were [(11.36±1.78)m/s(P ＞0.05),(13.39±3.33)m/s(P ＜0.01),and (15.68 ±3.94)m/s(P ＜0.05)].The increased range of C-F PWV (from high to low) was age group ＞ 70,age group ＞ 50 ～70 and age group 30 ～50.(3) C-F PWV of patients with BMI ≥ 24 kg/m2 was significantly lower than that of patients with BMI ＜24 kg/m2 and the corresponding figures were [(12.93 ±2.89)m/s and (13.39 ±3.18)m/s,P ＜0.05].After one year's follow up,C-F PWV was increased and the figures were [(13.54 ± 3.54) rn/s and (14.27±3.61) m/s,respectively(P ＜0.01)].Conclusions Except BMI,gender and age were the important influence factors on arterial stiffness.

Objective To evaluate the toxic effects of oxalic acid and calcium oxalate monohydrate crystals on human renal tubular epithelial cells (HK-2) as well as the influence on cell protein expression. Methods Normal HK-2 cells were cultured in vitro and the culture medium was changed to serum-free medium after cell growth to confluence. Oxalic acid with different concentration wasthen added and the formation of crystals and their adherence to cells were observed microscopically. A Fourier infrared spectrometer (FT-IR) was used to analyze the crystal composition. The toxic effects of 1, 2, 5 and 10 mmol/L oxalic acid on HK-2 cells after incubation for 4, 12 and 24 h were detected with a CCK-8 kit. Changes of protein express of HK-2 cells were determined using the Bradford method. Results Crystal formation and adherence to cell surface could be microscopically observed in a few minutes after oxalic acid was added to the DMED medium containing Caz+. The composition of the crystals was revealed to be calcium oxalate monohydrate by FT-IR. Oxalic acid and calcium oxalate monohydrate presented a concentration-dependent toxic effect on HK-2 cells which was, however, not merely increased with time lasting. The quantity of protein expressed by HK-2 cells incubated with 1,2, 5 mmol/L oxalic acid for 12 h and that of control was 358±51, 365±43, 328±52 and 329±60 mg/L, respectively (all P>0. 05), while the quantity of protein was significantly smaller than that of control after the incubation of 10 mmol/L oxalic acid for 12 h (264±76 vs 329±60 mg/L,P<0. 05).Conclusion Oxalic acid and calcium oxalate monohydrate crystals have toxic effects on normal human HK-2 cells and cause changes in protein expression,which may play an important role in the formation of renal calculi.

Objective To investigate the effects of fast-track surgery on postoperative rehabilitation of patients with liver cancer. Methods Forty-one patients with liver cancer who had been admitted to Zhongshan Hospital of Fudan University from 9 to 30 in July 2008 were randomly divided into fast-track surgery group (n =20) and routine treatment group (n =21) according to the random number table. Patients in fast-track surgery group were preoperatively educated in order to lessen their anxiety. Bowel preparation was not applied before operation, and they were orally administered with 1000 ml of enteral nutrition emulsion (1300 kcal), then they were fasted for 4 hours before operation. Urethral catheter and gastric tube were removed after operation. They were orally administered with 1000 ml of enteral nutrition emulsion on postoperative day 2, and were encouraged to partake in off-bed activity shortly after the operation. The off-bed time, anus exhaust time, postoperative complica-tions, hospitalization time, expense, nutritional and metabolic indexes on postoperative day 1, 3 and 5, hepatic and renal function, immune and stress indexes between the 2 groups were compared by t test and chi-square test. Results There were significant differences in off-bed time, anus exhaust time, patients' weight, expense, total bilirubin level on postoperative day 1, 3 and 5, and level of serum TNF-α on postoperative day 3 between the 2 groups (t =7.065, 5.483, 3.754, 2.291,2.289, 3.218, 3.192, 2.434, 2.089, P <0.05). Conclusions Fast-track surgery can accelerate the postoperative rehabilitation of patients with liver cancer.

Objective To assess the effects of hyperbaric oxygen(HBO) on indolent prostate cancer on a murine model. Methods Human prostate cancer cell line PC-3 ceils were injected into 40 severe combined-immunodeficient mice. They were randomized to undergo 20 sessions of either HBO or normobarie air in standardized conditions, and observed for 4 weeks before the histological assess-ment of any palpable tumors developed. The analysis parameters included tumour volume, microvessel density, apoptosis markers (p53, p27) and proliferative index (Ki-67). Results On the 28th day af-ter tumor vaccination, the tumor volume was (425.8±13.9)mm3 in HBO group and (433.6±12.8) mm3 in normobaric air group (P>0.05). Mierovessel density and Ki-67, p53, p27 protein expression were 69.7±9.5, (55. 2±6. 7)%, (31.9±5. 3)%, (80. 4±5. 7)% in HBO group;77. 1±8. 7, (50.6±7.3)%, (30.5±4. 7)%, (85.3±6.4)% in norrnobaric air group, respectively. There were no significant differences in both groups (P>0. 05). Conclusions HBO does not accelerate the growth of indolent prostate cancer in murine model. This result suggests that HBO does not increase the risk of residual prostate cancer reactivation when it is used to manage radiation-induced hemorrhag-ic cystitis in patients treated by pelvic radiotherapy for prostate cancer.

Objective To explore the relationship between stone formation and histopathological characters of renal papilla in patients with infectious renal calculi. Methods A total of 43 patients with infectious renal calculi undergoing percutaneous nephrolithotomy (PCNL) were included in this study. Renal papilla biopsy specimens were obtained under a nephroscope during the operation, fol-lowed by staining with hematoxylin-eosin or alizarin bordeaux for light microscopy and electron mi-croscopy. The extracted stones were analyzed and proved to be composed of magnesium ammonium phosphate or carbonate apatite with a transform-infrared spectrometer. Results Renal papilla calci-um plaques were found in 24 of the 43 patients (56 % ) during PCNL. Local calcium salt deposits could be found localized in the renal tubular basement membrane and spread to the interstitial tissue. Tiny stone adherence was observed in the renal papillae where calcium salts grew into the collection system. Conclusion Calcium salt deposits exist on the renal papilla in some patients with infectious renal calculi, which may be correlated with the formation of infectious stones.

Objective To investigate the diagnosis and treatment of hepatic metastasis from gastrointestinal stromal turnor(GIST).Methods The clinical data of 16 patients with GIST who had been admitted to our hospitalfrom December 1993 to May 2007 were retrospectively analyzed.Results Of all patients,14 underwent radical resection and 2 underwent palliative operation.Two patients with palliative operation and 3 with radical resection were administered with imatinib postoperatively. All patients were followed up for 3-161 months,and GIST metastasis and invasion was observed in 8 of the 14 patients who received radical resection.Of the 7 patients with hepatic metastasis.3 were treated with hepatic artery chemoembolization,1 was administered with imatinib,2 received reoperation and 1 did not receive any treatment. Reoperation was carried out on 1 patient who had abdominal wall metastasis.The 1-and 3-year survival rates of the 16 patients were 92%and 74%,respectively.Conclusions The recurrence rate of GIST after hepatectomy is high.Complete surgical resection is the best curative treatment for hepatic metastasis from GIST and GIST recurrence.The combination of surgical resection and imatinib administration may help to improve the prognosis of patients with hepatic metastasis from GIST.

Objective To evaluate the efficacy of percutaneous nephrolithotomy (PCNL) forupper ureterie calculi or renal calculi without keeping nephrostomy drainage. Methods A total of240 patients with upper ureteric calculi or renal calculi undergoing PCNL were selected and randomizedto receive no nephrostomy drainage (Group A,120 patients) or a standard (14 F) nephrostomy drain age (Group B,120 patients) after lithotripsy was finished. Inclusion criteria included no urinary infec tion history,one stage operation,single percutaneona tract,no operative bleeding and no need for see ond percutaneous operation. The pain score,the number of patients requiring postoperative analgesiaand the incidence of urine leakage as well as postoperative hospital stay time of the 2 groups were not ed and compared. Results Compared with Group B,patients in Group A got lower pain scores at6 h,1 d and 2 d after the operation (4.2±1.5,2.1±1.6 and 1.2±1.0 vs 5.5±2.4,3.9±1.5 and2.5±1.5,respectively,P<0.01),with fewer patients requiring postoperative analgesia (15.0% vs26.7%,P<0.05),lower incidence of urine leakage (2.5% vs 23.3%,P<0.01) and shorter postop erative hospital stay (1.7±0.6 dvs 3.1±1.1d,P<0.01). Conclusion For selected patients,takeaway nephrostomy drainage right after PCNL could be considered as an effective method to get lesspostoperative pain,lighter economic burden and shorter recovery time.