Objective To explore the surgical skills and clinical value of transperitoneal laparoscopic radical nephrectomy.Methods Laparoscopic radical nephrectomy was performed on 70 patients with renal cancers through the transperitoneal approach. After the lateral peritoneum was dissected, the vessels in the renal pedicle was controlled and the nephrectomy was carried out. Results The transperitoneal laparoscopic radical nephrectomy was completed in all the 70 patients without conversion to open surgery. The operation time was 90-230 min with a mean of 130 min. No patient received blood transfusion intra- and postoperation. No severe complications occurred in this series. The hospital stay was 4-8 d with a mean of 6.2 d. The patients were followed up for 2-78 months (mean, 47); no recurrence of renal tumor was found during this period. Conclusions Transperitoneal laparoscopic radical nephrectomy shows high clinical value owing to its advantages in minimal injury, safety, feasibility, and quick postoperative recovery.

Objective To discuss the surgical treatment of contracted bladder caused by ketamine abuse. Methods Twenty-five ketamine male abusers were included in this study.The ages were from 19 to 28 years old and mean age was 24 years old.AIl of them had abused ketamine history for 0.7 tO 4.0 years,and presented with severe lower urinary tract symptoms.including severe frequency,urgency,urge incontinence,and painful haematuria.Urine cultures were negative.Hepatic function and renal function were normal.B ultrasound examination of 23 cases demonstrated the presence of bilateral hydronephrosis,the separation of renal pelvic was(1.8±0.7)cm.B ultrasound examination of 22 cases demonstrated residual urine was 45-1 50 ml,mean 80 m1.Twenty-three IVU investigations demonstrated the presence of bilateral hydronephrosis with calyces renales minores cycloidal expansion and bladder contraction.All the patients took the urodynamies with bladder capacity was (89±34)ml,end filling detrusor pressure was(48±26)cm H2O,Qmax was(7.8±2.3)ml/s,residual urine volume was(82±47)m1.All patients had cystoscopies and random biopsies performed showed ulcerative cystitis only.All patients were required to withdraw the narcotics and the experimental medicines were given without symptoms alleviated.Sigmoid cystoplasty was performed in all the 25 patients. Results The mean follow up was 18 months(rang 6 to 36).Compared with that before operation, bladder capacity increased to (375 ±53)ml, end filling detrusor pressure reduced to( 13 ±9)cm H2O, Qmax increased to(17.6±5.8)ml/s, residual urine volume reduced to(20±10)ml.Compared with the preoperative, there were statistically significant differences.There was no complained of urinary incontinence, enuresis, frequency, urgency.Urine routine examination was normal.IVU showed the vesicoureteral reflux disappeared in all patients, and calyces renales no expansion or calyces renales minores light degree expansion.B ultrasound examination that the separation of renal collecting was(1.0 ±0.5)cm. Conclusions Sigmoidcystoplasty could increase bladder capacity and compliance, lower the intravesieal pressure.It could improve the patients' quality of life.

Objective To evaluate endoscopic ultrasonography (EUS) for diagnosis and treatment of ectopic pancreas in upper gastrointestinal tract.Methods Data of 52 patients with ectopic pancreas diagnosed by EUS and confirmed by pathological examination were reviewed.The feature of EUS image and diagnostic accuracy were retrospectively analyzed.Results Out of 52 patients, 41 (78.85% ) were pathologically diagnosed as having ectopic pancreas, 6 were stromal tumors, 4 were leiomyoma and 1 was nerve sheath tumor.All ectopic pancreases presented as protruding lesions, in which 37 were located at gastric antrum, 2 in duodenum, 1 in gastric body and 1 in gastric fundus.Under EUS, 1 case appeared as hyperechoic, 10 as isoechoic, 18 as hypoechoic and 12 as mixed echoic.The lesion involved mucosa in 2 cases, muscularis mu-cosae in 8, submucosa in 30 and muscularis propria in 1, in which 15 cases from submucosa underwent endoscopic resection.Bleeding occurred in 2 cases and no other complications occurred.There was one relapse during the 6 months of followed-up.Conclusion EUS is valuable and safe for the diagnosis of ectopic pancreas in upper gastrointestinal tract.Depth of lesions revealed by EUS can help further treatment.

Background An ethylnitrosourea(ENU)-induced mutant strain C57BL/6 mouse model has been established by our research group.This model is proved to have the spontaneous phenotype of corneal opacity and the typical pathological process similar to human keratitis.Therefore,this model is expected to be a good animal model in the research of the mechanism,hereditary property,and development of drugs for corneal infectious diseases.Objective The present study is to investigate the biological features of opportunistic pathogens using a mouse Staphylococcus-infected corneal model(C57BL/6 mouse) induced by N-ethyl-N-nitrosourea(ENU),and offers an evidence of stability in this animal model.Methods Ten-week-old male C57BL/6 mice were treated with ENU at 150mg/kg by intraperitoneal injection,and then mated with female mice after 60 days.Corneal opacity mutant mice in the F1 generation were selected to backcross with C57BL/6 mice.The bacteria were isolated from the eyeballs of the mutants and cultivated,purified and identified.Drug sensitivity assay was carried out to screen for effective antibiotics for clinic medical care.Results The staphylococcus-infected corneal mouse model(B6-Co) was established successfully,and the Staphylococcus sciuri strain was separated and purified,and then the sensitive antibiotics were distinguished from resistant ones.The sensitive drugs for Staphylococcus sciuri included azithromycin,clindamycin,chloramphenicol,gentamicin,rifampicin,tetracycline,amikacin,sulfamethoxazole compound sinomin,minocycline,levofloxacin,cephalothin,cefotaxime,and furazolidone;whereas this Staphylococcal strain was resistant to cefoxitin,penicillin,ampicillin,novobiocin.Nitrofurantoin showed an intermediate sensitivity.Conclusion The C57BL/6 mouse model is a spontaneous-derived animal model that is infected by coagulase-negative staphylococci,among which the most abundant strain is Staphylococcus sciuri.

QRS-waves integral can reflect the activities of ventricular depolarization. In this paper are analyzed the nonlinear characters in QRS-waves integral: reconstructing state space with these integral signals after nonlinear noise reduction, calculating its attractor dimension and the largest Lyapunov exponents. With the results based on MIT-BIH database we proposed that QRS-waves integral is of chaos nature. When compased with HRV nonlinear analysis, QRS-waves integral analysis was found to be of more advantages in some cases such as premature ventricular contraction. This QRS-waves integral nonlinear analysis may be of use in evaluating clinical cardiac function.
Electrocardiography ; Humans ; Nonlinear Dynamics ; Signal Processing, Computer-Assisted

Objective To explore the causes,management and prevention of major blood vessel injury during urological laparoscopic surgery.Methods Six cases of major blood vessel injuries happened in 1700 laparoscopic surgeries from January 2007 to July 2011.All of the cases were males.Patient age was (53 ± 14) years.There were 4 extraperitoneal and 2 transperitoneal procedures including 3 adrenalectomies,1 radical cystectomy,1 radical prostatectomy and 1 radical nephrectomy.There were lacerations in 3 cases of vena cava,2 cases of external iliac vein and one case of renal vein.The length of laceration was (0.68 ±0.29) cm and blood lost was (114 ++ 79) ml.Results Five of the patients were managed with laparoscopic techniques by suction compressing bleeding sites,dissecting related vessels,adding extra trocar and repairing laceration by suturing in four cases and clipping bleeding site in one case.The bleeding control management lasted (21.0 ± 5.6) min.One laparoscopic adrenalectomty for the treatment of pheochromocytoma converted to open surgery because of increasing blood pressure.All the patients were followed up for (4 ± 2) months.No more related complication occurred.Conclusions Lymph node dissection,local adhesion and energy source are the main causes for blood vascular injuries.This kind of injuries may occur at any stages during a laparoscopic surgery and laparoscopic repairing is safe and feasible.

In order to improve the clinical skills of medical students,the First Clinical School of Tongji Medical College,Huazhong University of Science and Technology strengthened the construction of teaching base,teaching materials,teaching team,curriculum and assessment methods,and established a comprehensive experimental teaching system of clinical skills.

Background Pluripotent stem cell-derived retinal pigment epithelial (RPE) cells holds great promise for the treatment of age-related macular degeneration (AMD) and retinitis pigmentosa (RP),but the poor induction efficiency and the according high cost of RPE differentiation hindere its clinical applications.Curcumin is proved to have a promoting effect on the induced differentiation of embryonic stem cells (ESCs).However,the mechanism of curcumin on differentiation of human ESCs into RPE-like cells remains unclear.Objective This study aimed to explore the underlying molecular mechanism of curcumin on directed differentiation of human ESCs into RPE-like cells.Methods Human ESCs strains were cultured in the Matrigel-coated 6-well plate with mTeSRTM 1 medium until over-confluence,and basic fibroblast growth factor was withdrawn there after to induce automatic differentiation.Curcumin at the final concentration 1 μmol/L was added in the first day of differentiation for 24 hours,and the cells without curcumin in the medium served as the control group.Total RNA and protein were extracted at 3 weeks and 5 weeks after induction.RT-PCR,Western blot and immunofluorescence were performed to examine the expressions of the biomarks of stem cells and RPE cells as well as Wnt/β-catenin signaling pathway components.The endocytosis of polystyrene microsphere by induced RPE (iRPE) cells was investigated to verify their function of phagocytosis which features RPE cells.Results Pigmented cells were found from 3 weeks through 5 weeks after induction in the curcumin group,but only less pigmented cells were seen in the fifth week after induction in the control group.In the third and fifth week after induction,the relative expression levels of NANOG mRNA in the iRPE cells were significantly lower than those in the control group (t =13.086,P =0.022;t =34.186,P =0.004),and the relative expression levels of Pax6,RX,CRALBP and RPE65 mRNA were higher in the curcumin group than those of the control group (all at P＜0.01).Western blot assay showed that the expressing bands for CRALBP,RPE65 and MITF enhanced in iRPE cells with a similar appearance in human RPE cells.However,these expressions were all absent in human ESCs.Immunofluorescence staining showed the positive expressions of Pax6,MITF and ZO-1 in cytoplasm of iRPE cells in the curcumin group with a purified efficacy 100％.The fluorescence dye-doped polystyrene microspheres in cytoplasm were obvious in the iRPE cells like positive controls,but the polystyrene microsphere was absent in the negative controls.From 3 weeks through 5 weeks after induced,the relative expression levels of Lef1,MYC and TCF7 mRNA (the dwnstream target genes of Wnt signaling pathway),FZD3 mRNA (Wnt receptor),Wnt2B mRNA (Wnt ligand) and Wnt7B mRNA were significantly reduced in the curcumin group compared with the control group (all at P＜0.01).Conclusions Curcumin promotes the differentiation of human ESCs into RPE-like cells by stimulating the activation of Wnt signaling pathway,and therefore accelerate the differentiation and mature of iRPE cells.

Objective To investigate the change of AQP1 and AQP2 before and after the release of obstruction and explore the relationship between reabsorption dysfunction of renal tubule and the change of AQPs. Methods The model of unilateral ureter obstruction (UUO) was established by surgery. Western blot and immunohistochemistry were used to study the expression of AQPs before and after obstruction. Results In UUO model, both AQPs began to down-regulate one day after obstruction, the expression of both AQPs became lower one day after the release of obstruction. And they started to up-regulate 7 day after the release of obstruction. AQP2 became normal since 14 days after the release of obstruction, and AQP1 became normal since 21 days after the release of obstruction. Conclusion The expression of AQP1 and AQP2 were descended in hydronephrosis. The dysfunction of renal tubule and the osmotic-dependent polyuria after the release of obstruction in UUO were caused by the down - regulation of AQPs.

Objective To observe the efficacy and safety of in-center nocturnal hemodialysis (INHD) in uremic patients. Methods Thirty-two maintenence hemodialysis (MHD) patients received INHD (3 times per week and 7.5 hours each session) for 6 months.Before and 1, 3 and 6 months after entering INHD, blood routine, hepatic and renal function,serum electrolyte, lipids, parathyroid hormone and β2-microglobulin(β2-MG) were assayed, Kt/V and URR were calculated. Blood pressure of each dialysis session 2 months before and 6 months after INHD was recorded. Cardiac ultrasound and SF-36 questionnaire before and after INHD were performed. Use of drugs was recorded. Results Compared with 2 months before INHD, predialysis BP decreased [(130.3/86.0) vs (139.3/88.6) mm Hg, P＜0.01], while post-dialysis BP raised significantly [(121.1/80.5) vs (115.0/77.8) mm Hg, P＜0.01] 6 months after INHD.Intradialysis hypertension (9.8%vs 24.0%) and hypotension (7.3% vs 14.9%) both reduced (all P＜0.01). Serum phosphorus [(1.37±0.27) vs (2.08±0.49) mmol/L, P＜0.01] and iPTH [(355.4±139.6) vs (632.3±750.0) ng/L, P＜0.01] decreased, while calcium increased [(2.64±0.25) vs (2.28±0.37) mmol/L, P＜0.01], HDL[(1.27±0.29) vs (0.75±0.08) mmol/L] increased, LDL [(2.04±0.52) vs (2.75±0.75) mmol/L] decreased (all P＜0.05). URR [(79.7±0.1)% vs (64.7±4.7)%] and Kt/V (1.40±0.44 vs 0.89±0.25, P＜0.01) increased. Serum β2-MG decreased [(17.3±3.9) vs (24.6±5.9) mg/L, P＜0.01]. LVMI decreased [(99.8±29.0) vs (114.8±72.7), P＜0.05]. Physical functioning, role-physical and role-emotional of SF-36 increased (all P＜0.01). The types of antihypertension drug, dosage of EPO, Vitamin D3 and phosphorus binder decreased (all P＜0.01).Patients of drug withdrawal increased (P＜0.05). Conclusion The hypertension, anemia,calcium-phosphorus metabolism, lipid disorder, cardiac malfunction and the quality of life are improved in INHD patients.