Two new compounds Ⅰ and Ⅱ were isolated from Sparganium stoloniferum Buch. -Ham.. On the basis of chemical evidences and spectral analysis (UV,IR, 1H and 13CNMR,FAB-MS),the structure of l was elucidated as 5-ene-methyl-cholate-3-O-?-D-glucuronopyranosyl- (1→4 )-?-L-rhamnopyranoside,Ⅱ was 5-enemethyl-cholate- 3-O-?-D-glucopyranoside

Objective To observe the B- ultrasonic (B-US) renal changes of chronic aristolochic acid nephropathy (CAAN) patients and to determine its value in disease diagnosis. Methods The renal B-US data of 124 CAAN patients were retrospectively studied. The relationship between the B-US characteristics and the renal function was tested. Clinicopathological data of 19 CAAN patients underwent renal biopsy were compared with those of 18 patients with chronic tubulointerstitial nephropathy due to none-aristolochic acid causes (non-AAN-CTIN). Results The characteristics of renal B-US changes in CAAN patients included diminished parenchyma thickness (90.3%), atrophy of the kidney (62.90%) and asymmetrically shrinked kidneys (17.74%). The renal B-US markers, including the longitude, the volume and the parenchyma thickness, were closely associated with the level of Scr, eGFR and the function of renal tubules (P

Objective To investigate the clinical effect and the prospect of Infliximab in treatment of intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) patients.Methods Clinical features,inflammatory markers and coronary changes were observed in 2 cases of IVIG-resistant KD patients hospitalized in Peking University First Hospital,who were treated effectively by Infliximab.Relevant researches on the mechanism and progress of the Infliximab treatment for IVIG-resistant KD in the last 10 years were reviewed at the same time.Results Two KD patients hospitalized in Peking University First Hospital had been treated with 2 g/kg IVIG for 2 times and followed by methylprednisolone treatment.However,fever and other clinical manifestations occurred again after 2 days and 6 days when temperature returned normal.They both defervesced and all the symptoms were improved after 1 dose of Infliximab (5 mg/kg) by laboratory examinations.Four published literatures of the basic research and 9 retrospective or prospective clinical researches of Infliximab treatment of KD showed that Infliximab alleviated the inflammatory level in the KD patients significantly.Complete remission was up to 72.73％-92.11％.Those KD patients defervesced within 12 h,with dramatic improvement of symptoms and signs.Arthralgia also disappeared in the patients with arthritis.Only 1 case was complicated with hepatitis in the acute phase and cholecystitis in recovery time.A phase 3 randomised,double-blinded,placebo-controlled trial had been done to assess the addition of Infliximab to the standard therapy.Conclusions Infliximab is a feasible choice for IVIG-resistant KD patients.Efficacy and safety of Infliximab for KD treatment have been proved in the literature.However,Infliximab for KD treatment has not been indicated in the drug instruction,so the informed consent from the guardians and Ethics Committee is needed.

Objective To analyze hepatitis B virus ( HBV)-specific T lymphocyte responses dur-ing different stages of HBV infection.Methods Eighty-four patients with HBV infection were recruited in this study.They were divided into four groups including acute HBV infection group (8 cases), chronic HBV infection group (39 cases), hepatocirrhosis group (17 cases) and hepatocellular carcinoma group (20 ca-ses) .HBV-specific T cell responses were detected by using ELISPOT assay in combination with magnetic beads sorting assay.Results (1)The magnitudes of HBV-specific T cell responses in patients with acute HBV infection ,chronic HBV infection , hepatocirrhosis and hepatocellular carcinoma were respectively (2067.00±1029.00) SFU/106 PBMCs, (288.50±57.69) SFU/106 PBMCs, (96.25±31.06) SFU/106 PBMCs and (71.47±14.26) SFU/106 PBMCs.The differences with the magnitudes of HBV-specific T cell responses among patients from the four groups were significant (P<0.01).(2)HBV Core (HBV C) protein induced the strongest T cell responses[ (323.90±130.30) SFU/106 PBMCs] in patients with acute HBV infection in comparison with HBV-surface ( HBV S ) protein, HBV P protein and HBV X protein ( P=0.0037).The strongest T cell responses in patients with chronic HBV infection were induced by using HBV P protein [(127.20±54.42) SFU/106 PBMCs], followed by using HBV S protein, HBV C protein and HBV X protein (P=0.0159).(3)The magnitudes of IFN-γreleasing induced by HBV X protein, HBV P protein, HBV S protein and HBV C protein showed no significant differences in patients with either hepato-cirrhosis or hepatocellular carcinoma, but were lower than those induced in patients with chronic HBV infec-tion.Conclusion HBV-specific T cell responses were gradually reduced along the progression of HBV in-fection from acute HBV infection to chronic HBV infection, liver cirrhosis and hepatocellular carcinoma.The HBV-specific T cell responses induced by viral proteins might play different roles in different stages of HBV infection.

Objective To report a modified radical inguinal lymphadenectomy the aim of which is to reduce the incidence of the complication of skin necrosis.Methods One hundred and twenty-six modified radical inguinal dissections were performed in 63 patients with penile carcinoma from June 2002 to June 2010.A modified radical inguinal dissection characterized by an S-shaped incision and precisely separating layers using an anatomical mark was performed.The boundaries of dissection were the same as classic radical inguinal lymphadenectomy.The incidences of complications of skin flap necrosis were retrospectively analyzed.Results The follow-up time ranged from 12 to 93 months.A total of 37 complications occurred,including 7 minimal skin necroses (5.6％),3 wound infections (2.4％),19 lymphedemas (15.1％),2 seroma formations (1.6％),5 lymphocele (4.0％),and 1 deep venous thrombosis (0.8％).There were no complications in 106 dissections (84.1％ ),and 20 dissections had one or two minor complications ( 15.9％ ).Conclusions The complication of skin necrosis related to groin dissection in patients with penile carcinoma could be reduced by using this modified inguinal dissection technique,which characterized by an S-shaped incision and precisely separating layers with using an anatomical landmark.

Objective To investigate the techniques of laparoscopic retroperitoneal lymph node dissection(LRPLND)through extraperitoneal approach. Methods Seven non-seminomatous germ cell testicular tumor(NSGCT)patients of clinical stage Ⅰ underwent LRPLND through extraperitoneal approach.The average age was 31(27-39 years old),the average weight was 62 kg(weight 58-72 kg).Pathological examination revealed 2 testis mixed carcinoma(major of embryonal carclnoma and seminoma),2 yolk sac tumor,1 ehoriocarcinoma,2 teratoma with seminoma.Two of them were in right side,and 5 in left.All the chest X-ray,abdominal CT and bone scanning of them were normal before operation.All patients were general anesthetized.Three or 4 trocars were placed,from 2 of them two gasbags were used to expand the retroperitoneal space at volume of 800-900 ml.The retroperitoneal fat was cleared off from the surface of Gerota's fascia to iliac fossa and the plane spance betwwwn anterior rena fascia and posterior peritoneum was separated In the same way the Plane between dorsal renal and the surface of psoas major and quadratus lumborum unto iliae lossa was exposed.Abdominal aorta or vena cava was exposed,then divided and dissected free from surfaee of psoas maior.The conflux of renal vein and testicular vein at the deep face of renal artere(left)was exposed,then testicular vein was ligated and divided it at its end.Fat and lymph tissue between ureter and vessels was dissected to the crotch of abdominal aorta or inferior vena cava.The primary inguinal incision of testectomy was then excided.Normal antegrade ejaculation recovered in 1 month postoperatively. Results The initial 2 operations were converted to open way as the peritoneum were penetrated largely.The other 5 operations were successful.The average operating time was 285 min(245-350 min),intraoperative blood loss was 100-250 ml.Four patients'pathologic results accorded with clinical staging,and 2 positive lymph nodes were found in the other one.The average number of lymph node resected was 25.6 counts(22-31).Follow-up for 3-20 months,chest X-ray and abdominal CT revealed no evidence of recurrence or distant metastasis,and serum tumor markers were in normal range.Normal antegrade ejaculation recovered in 1 month postoperatively. Conclusions The technique through extraperitoneal approach could be applied for LRPLND.It might be an approach for diagnosis and treatment of stage Ⅰ NSGCT.

Objective To obtain DNA oligonucleotide aptamers which can specifically bind to MPT64 protein from Mycobacterium tuberculosis by SELEX(systematic evolution of ligands by exponential enrichment)technology. Methods A random ssDNA library with in vitro synthesized 78 nucleotides in length was subiected to 12 rounds of selection by SELEX method against MPT64 protein. The binding ability of the aptamers to the protein was examined by biotin-streptavidin-horseradish peroxidase system. Results The selective system used was as follows:in PCR amplification,annealing temperature was 65℃ and the concentration of Mg2+ was 1.5 mmol/L in optimizing library, and when preparation of ssDNA with asymmetrical PCR amplification, 0.75 mmol/L of Mg2+ was used. When using the plate for ELISA as the substrate for the selection, the pattern of electrophoretic band of PCR product after the tenth round selection became unitary and denser than that of the first round. The binding assay demonstrated that A value at 450 nm of the tenth round increased by 9.18 times as compared with that of the first round. The results showed that the affinities of the aptamers were different. The highest A value at 450 nm was 1.606, and the lowest 0.572. Conclusion A set of aptamers with considerable binding affinity to MPT64 protein are successfully picked out from the initial random DNA library.

Objective To explore if it is essential to excise ipsilateral adrenal gland in radical nephrectomy.Methods Two hundred and sixty-three patients underwent radical nephrectomy were analyzed retrospectively.The duration of operation,bleeding volumn,complications and survival rates were compared between the adrenalectomy and adrenal preserved groups.The clinical data of the patients with adrenal gland involvement were analyzed as well.Results There were 214 clinical localized(T_(1-2)N_0M_0 )renal cell carcinoma (RCC) patients,26 local advanced RCC(T_(3-4)N_(0-2)M_0 ) patients and 23 metastatic RCC(T_(1-4)N_(0-2)M_1) patients in this study.In the 263 patients,146 cases received ipsilateral adrenal gland excisions,while 117 cases had the ipsilateral adrenal glands preserved.The duration of operation,estimated blood loss and the complications did not differ significantly between these two groups.Only 8 patients had adrenal gland involvement.The mean size of the 8 tumors was 9.7 cm and 5 of them had a diameter ≥8 cm.In the 8 patients,6 had the tumor in the upper pole and 2 had the whole kidney involved.One hundred and twenty-nine clinical stage Ⅰ and Ⅱ patients had ipsilateral adrenal excised,while only 4 (3.1%) had adrenal gland involvement.Seventeen clinical stage Ⅲ and Ⅳ patients had ipsilateral adrenal excised,and 4 (23.5%) had adrenal gland involvements.The clinical stages of these 8 patients were stage Ⅲand Ⅳ.The patients were followed up for 28 months (3-102 months).There was no significant difference of 5-year survival rates between the ipsilateral adrenal gland excised and preserved patients categorized according to pathological stage.Conclusion For patients with renal cancer larger than or equal to 8 cm,localized in upper pole of kidney or with the whole kidney involve and with a clinical stage higher or equal to Ⅲ,it is essential to excise ipsilateral adrenal gland in radical nephrectomy,otherwise the ipsilateral adrenal can be preserved.

Objective To estimate the feasibility of QOL score in functional assessment of or-thotopic neobladder after radical cystectomy. Methods Questionnaire survey,QOL score sheet and urodynamic examination were done in 22 patients with orthotopic neobladder.Investigations were fo-CUS on the micturition interval during daytime and nighttime.Micturition time,degree of incontinence and their relationship with QOI.scores and urodynamic parameters wete also analyzed. ResuIts There were 3,6,7,1,2,3 and 0 cases which QOI.score were 0 to 6 accordingly.In the dav time,2 patients complained a light incontinence while 1 patient of moderate incontinence.In the nighttime.3 patients had the complaint of moderate incontinence while 4 patients of light incontinence.The average daytime mlcturltlon interval was 136 min(45-210 rain).The average maximum urinary flow rate,maximal urethral closure pressure and postvoid residual were 12.9 ml/s(2.7-22.1 ml/s),69.3 cm H2O(33-114 em H20)and 91.8 ml(5-300 m1)respectively.QOL scores had D.sitive correlation with the degree of incontinence during daytime and nighttime(daytime:r-0.510,P=0.015,night time:r=0.911,P<0.001).The QOL scores had negative correlation with daytime micturition inter-val(r=-0.749,P<0.001).The factors which influenced the QOL scores included the maximaI ure-thral closure pressure,postvoid residual and the maximum urinary flow rate. Conclusions QOL score reflects the patients"continent ability,subjective feelings on quality of life.It is correlated with the common urodynamic parameters.QOI.score might be used as a new index to estimate the function of orthotopic neobladder.

AIM: To investigate the dynamic variety of frequency and function of FoxP3~+ regulatory T cells in patients with acute hepatitis B (AHB). METHODS: Peripheral blood mononuclear cells (PBMCs) from 15 AHB patients at acute phase (week 1 of illness), convalescent phase (primary occurrence of both ALT level normalization and HBsAg negative conversion), resolved phase (at least 8 weeks after both ALT normalization and HBsAg seroconversion, and 15 health subjects were analyzed for FoxP3 (Forkhead/winged helix transcription factor) mRNA expression in MACS magnetic beads-purified CD4~+ T cells by real-time RT-PCR assay. The effects of Treg cells on the proliferation of CD4~+CD25~- T cells were examined by a ~3[H]-thymidine incorporation assay. RESULTS: AHB patients presented a significantly higher FoxP3 mRNA expression at convalescent phase than acute phase (t=-6.04, P<0.01) and resolved phase (t=4.45, P<0.01), and healthy controls (t=3.44, P<0.01). We also observed that the suppression efficiency of Treg cells on proliferation of CD4~+CD25~- T cells was lower at acute phase than convalescent phase (t=-5.30, P<0.01) and resolved phase (t=-3.20, P<0.05), but there was no significant difference between healthy controls and any phase of AHB. CONCLUSION: AHB patients presented lower circulating Treg frequency and suppression function at acute phase, and both of them are increased at convalescent phase, and then return to normal level along with disease resolved. This follow-up study furthers our understanding of Treg' s role in immunopathogenesis of hepatitis B.