Objective To analyze the different approaches and their indications in the laparo-scopic treatment of upper urinary tract transitional cell carcinoma. Methods 94 patients with upper urinary tract transitional cell carcinoma were divided to two groups. Group A (63 cases) with renal pelvic and ugper ureteral carcinoma were treated with retroperitoneal approach laparoscopic surgery and transurethral reseetoscope surgery. Group B (31 cases) with middle ureteral carcinoma including 6 cases with ureteral local infiltration were treated through 70° recumbent position transperitoneal ap-proach laparoscopic surgery combined with bladder cuff resection. The operative time, blood loss, the intestinal functional recovery time and post-operative complications were recorded. Results All 94 procedures were successfully completed, with no complication during the surgery. The mean operation time of A and B group was 156.5 and 160.8 min;the mean blood loss was 80 and 86 ml; the mean hos-pital stay was 8 and 8. 5 d; the time of bowel functional recovery of group A and group B was 24-48 and 24-72 h, respectively. 84 cases were followed-up with mean follow-up time of 23 months. Three eases and 5 cases were found having bladder tumor in the group A and group B. The incision and port metastasis was not found. Conclusions It is safe and feasible to treat the upper urinary tract transi-tional cell carcinoma laparoscopically. The selection of operating approach is mainly based on the loca-tion and local infiltration status of the tumor.

This article reviews the training model of orthopedic residents in the world's top orthopedic hospitals, such as Hospital for Special Surgery Affiliated to Cornell University and The Affiliated Hospital of Harvard University Medical School, and it is found that there are differences between China and the US in the training of orthopedic residents in the aspects of the admittance system of physicians, the setting of training contents , and the training model of orthopedic residents . The training of orthopedic residents in the US adheres to the concept of elite education and pays attention to the construction of tutors and learning atmosphere. The enlightenment to the training of orthopedic residents in China includes further clarification of the training objectives of orthopedic residents , improvement of the stage-based training system , integration of excellent medical teaching resources , and improvement of teaching methods and assessment systems.

Objective To evaluate the efficacy and safety of basiliximab (BAS) and antithymocyte globulin (ATG) in immune induction therapy in kidney transplantation by systematic review and Meta-analysis. Methods Prospective randomized controlled clinical trials screening and comparing BAS and ATG in immune induction therapy in kidney transplantation were systematically searched from global databases, screened and compared. The quality of clinical trials was evaluated by Jadad scoring system and data extraction was performed. The effects of BAS and ATG on the incidence of acute rejection, survival rate of kidney allografts, survival rate of recipients, incidence of delayed graft function, infection, cytomegalovirus infection, malignant tumor, leukopenia and thrombocytopenia at 1 year after kidney transplantation were analyzed. Results A total of 10 clinical trials in English consisting of 1 721 kidney transplant recipients were searched, including 883 cases in the ATG group and 838 cases in the BAS group. No significant differences were observed in the incidence of acute rejection, survival rate of kidney allografts, survival rate of recipients, incidence of delayed graft function, infection, cytomegalovirus infection and thrombocytopenia at postoperative 1 year between the ATG and BAS groups (all P > 0.05). The incidence of malignant tumor and leukopenia at postoperative 1 year in the ATG group were significantly higher than those in the BAS group (both P < 0.05). Conclusions The use of ATG and BAS for immune induction therapy in kidney transplantation yield equivalent efficacy at postoperative 1 year, but BAS is safer than ATG. Clinical trials related to stratified analyses of immune risk are urgently required to achieve individualized precision treatment.

Background With the rapid industrialization, cadmium has become a primary heavy metal pollutant in cultivated land soil in China, which seriously affects human health. Previous studies have found that cadmium exposure associates with cognitive dysfunction in individuals, but there is a lack of research on the mechanism of cadmium exposure associated cognitive impairment in offspring in early life which is more vulnerable to various toxins and crucial for development of the neuro. Objective To explore the potential mechanism of brain-derived neurotrophic factor/tyrosine kinase receptor B (BDNF-TrkB) signaling pathway in cognitive dysfunction in mice after cadmium exposure in early-life. Methods Twelve 8-week-old C57BL/6 pregnant mice were randomly divided into 2 groups, namely control group and cadmium exposure group, with 6 mice in each group. The exposure period was from pregnancy day 4.5 to lactation day 21 (E4.5-P21), during which distilled water or cadmium chloride solution (2.5 mg·kg⁻¹·d⁻¹) was given. After lactation, the offspring of the control group and the cadmium exposure group were given distilled water until 8 weeks of age. Then the toxicity effects of cadmium exposure on mice were evaluated by body weight and selected biochemical indicators. The cadmium content in brain was detected and the learning and memory ability was tested by Y maze and Morris water maze to evaluate cognitive function of offspring mice. Histopathological changes of the hippocampus were observed after Nissl staining and Golgi staining. The mRNA and protein expression levels of the BDNF-TrkB pathway and synapse were detected by real-time quantitative PCR (qPCR) and Western blot. Results Compared with the control group, no significant change was found in body weight, liver or kidney function in the cadmium exposure group (P> 0.05). However, compared with the control group, the cadmium content in brain was increased in the cadmium exposure group (P<0.001). The behavioral changes associated with cognitive dysfunction were positive in the cadmium exposure group (all P<0.05). The histopathological observation after Nissl staining showed abnormal tissue structure, decreased number of neurons and increased karyopyknosis in the cadmium exposure group (P<0.01).The spine density of Golgi staining was decreased in the cadmium exposure group (P<0.001). The BDNF-TrkB pathway-related mRNA and the synapse-related mRNA in the hippocampus were reduced in the cadmium exposure group (all P<0.05). The expression levels of BDNF-TrkB pathway-related proteins and synapse-related proteins in the hippocampus were also reduced in the cadmium exposure group (P<0.05). Conclusion Early-life cadmium exposure may induce synaptic dysplasia and lead to cognitive dysfunction by down-regulating the BDNF-TrkB signaling pathway in mice.