Objective To discuss the safety and efficacy of retroperitoneal laparoscopic partial nephrectomy in the treatment of unilateral multifocal renal tumors.Methods The data of 12 patients with unilateral multifocal renal tumors managed with retroperitoneal laparoscopic partial nephrectomy between 2009 and 2012 were reviewed retrospectively.The 12 patients had a mean age of 42 years (28 to 62) and body mass index of 23.5 kg/m2 (18.6 to 29.3),including 4 males and 8 females.Four cases were in the left side,7 cases were in the right side,and 1 case had bilateral renal tumors.The diameter of renal tumors ranged from 0.5 cm to 4.7 cm,and all tumors were projected on the surface of kidney.Nine cases were diagnosed as renal cell carcinoma,and 3 cases were diagnosed as angiomyolipoma before operation.All patients underwent retroperitoneal laparoscopic partial nephrectomy under general anesthesia,while 1 patient with bilateral renal tumors experienced radical nephrectomy of the contralateral renal tumor 3 months after the first operation.Results All the oprations were successful without conversion to open surgery.The mean renal artery cut off time,operative time,estimated blood loss and hospital stay were 36 min (26-60),126 min (75-184),142 ml (50-300) and 5 d (3-9),respectively.No complication occurred and 1-week postoperative serum creatinine was (78.1 ±8.1)μmol/L.Histopathological study revealed 9 cases of renal cell carcinomaand 3 cases of angiomyolipoma.During the follow-up for 33 months (13-51),1 patient with yon Hippel-Lindau syndrome was operated with ipsilateral radical nephrectomy for a local recurrence while the remains had no local recurrence or metastasis.Conclusions For localized and exogenous unilateral multifocal renal tumors,retroperitoneal laparoscopic partial nephrectomy is feasible and safe.Those who have hereditary and/or malignant renal tumors should be monitored closely.

Objective To compare the safety and efficiency of retroperitoneal laparoscopic and transperitoneal laparoscopic radical nephrectomy by meta-analysis.Methods A systematic review of the literature about laparoscopic radical nephrectomy was performed,searching Medline,Embase,Cochrane library,CBM,CNKI,VIP and Wan Fang database from January 2000 to October 2012.The key words were transperitoneal,retroperitoneal,laparoscopy,radical nephrectomy.Two researchers evaluated the quality of included studies.A meta-analysis was conducted using Review Manager 5.0 software.Results Nine controlled clinical studies were concluded,including 1 306 patients (520 in retroperitoneal group and 786 in transperitoneal group).The extracted data were comparable.Meta-analysis results showed that significant difference existed in operative time and complication rate (OR =16.23,95％ CI 1.62,30.84; OR =2.44,95％CI 1.35,4.41) (P＜0.05).It seemed that the retroperitioneal laparoscopic radical nephrectomy was prior to the transperitoneal laparoscopic radical nephrectomy in those items.There was no significant difference between transperitoneal and retroperitioneal laparoscopic radical nephrectomy in incision length,estimated blood loss,stay-in hospital,conversion rate,5-year disease-free survival and 5-year overall survival (P＞ 0.05).Conclusions Retroperitoneal laparoscopic radical nephrectomy demonstrated significant lower operative time and complication rate than those in transperitoneal laparoscopic radical nephrectomy.However,there is no significant difference in efficacy.Each center can choose a modality according to their convention.

Objective:To investigate the polymorphism of the (MTHFR) C677T and its correlation with the severity of hypertension in Shanxi Province.Methods:A total of 306 patients with essential hypertension from the Second Hospital of Shanxi Medical University from January 2017 to January 2018 were selected as subjects. The clinical data of these patients were extracted from the hospital information system. The biochemistry index, including homocysteine (Hcy) were collected from the hospital laboratory test system and the polymorphism of MTHFR C677T gene was analyzed by polymerase chain reaction (PCR). Logistic regression analysis was used to estimate the severity of hypertension.Results:The frequencies of CC, CT and TT genotypes in patients with essential hypertension in Shanxi were 22.22%, 47.06% and 30.72. The C677T genotype and allele frequency revealed no signifcant departures from Hardy-Weinberg equilibrium in the population from the Shanxi region. Compared with MTHFR 677CC, MTHFR 677CT and MTHFR 677TT genotypes could increase the severity of hypertension by 2.29-fold and 2.24-fold. Smoking, family history of hypertension , Hcy and TG were independent risk factors for increasing the severity of essential hypertension ( OR=2.04, 1.81, 1.04, 1.26). Conclusions:MTHFR C677T genotype, smoking, family history of hypertension, Hcy and triglycerides could be important genetic and high-risk factors for development of severe hypertension , which will help to identify populations at high-risk of hypertension and may facilitate the development of hypertension control strategies.

Objective To explore the feasibility and safety of cotransplantation of autologous bone marrow-derived mesenehymal stem cells (MSCs) and peripheral blood stem cells in hematological malignant diseases and to observe its effect on hematopoietic reconstruction after cotransplantation. Methods Adult human MSCs were isolated from the healthy bone marrow of the patient himself with Percoll (1. 073 g/ml) and cultured in Dulbecco's modified Eagle's medium with low glucose containing 10% AB type human serum. After conditioning regimen of high-dose chemotherapy and radiotherapy, cotransplantation of autologous bone marrow-derived MSCs and peripheral blood stem cells was done in five patients with hematological malignant diseases. Results The process of the infusion was safe and there were no adverse reactions or other toxicities related to the infustion of MSCs. The median time to achieve neutrophil counts greater than 0. 5 × 109/L was 9.4 days ( ranging from 8 to 11 days) after cotransplantation and platelet counts greater than 20 × 109/L 12. 2 days (ranging from 10 to 14 days). Conclusion Cotransplantation of autologous bone marrow-derived MSCs and peripheral blood stem cells in hematological malignant diseases is feasible and safe. The rapid hematopoietic reconstruction after cotransplantation shows that MSCs have an effect on hematopeiesis, but the mechanism is still to be investigated.

Objective To investigate the clinical and renal pathological features in the new rat model induced by anti-human podocyte-protein antibody. Methods The rat model was induced by once intravenous injection of rabbit anti-human podocyte-protein antiserum which was prepared at first. Male Sprague-Dawley rats (n=36) were randomly divided into six groups (6rats in each group): control group (CG), the time points of day 7 group (D7), day 14 group (D14),day 21 group (D21) and day 28 (D28) group after antiserum injection, and day 28 group after the normal rabbit serum injection (NRG). The level of 24 hour proteinuria, the clearance of creatinine,albumin, blood urea nitrogen, triglyceride, cholesterol and serum creatinine were measured. The renal morphology was detected under the light microscope, immunofluorescence microscope, and electron microscope. Results 24-hour proteinuria (mg) was gradually increased, and the level of proteinuria in D28 (48.56±13.80) was significantly higher than that in CG (5.34±2.77, P＜0.01)and NRG (11.32±4.90, P＜0.01). The clearance of creatinine (ml/min) and serum creatinine (μmol/L) in D28 (0.90±0.47, 33.48±9.94) were significantly different from CG (1.68±0.54, P＜0.05;26.03±2.67, P＜0.05), but showed no difference with NRG (1.34±0.87, P＞0.05; 27.40±4.73, P＞0.05). The level of albumin (g/L) was lower in D7, D14, D21, D28 (28.20±0.87, 27.80±1.97,27.42±1.66, 27.77±1.95) than CG (29.98±0.76, P＜0.05). But there was no difference in the level of albumin among the groups after antiserum injection and NRG (28.68±1.18, P＞0.05). The level of blood urea nitrogen, triglyceride, cholesterol showed no difference among the groups (P＞0.05). The renal morphology showed no obvious changes between CG and NRG. Among the groups after antiserum injection, the renal pathological changes under the light microscope were some spikes formation in D28. Immunostained for rabbit IgG in rat glomeruli progressively decreased over the 28 days, while rat IgG progressively increased. The renal section deposition for rat complement 3 reached a maximum at day 21 then decreased afterward. Under the electron microscope, there were immune complexes and foot process fusion at day 14. Conclusions The new rat model induced by anti-human podocyte-protein antibody showing typically clinical and pathological changes of the membranous nephropathy is successfully established.

ObjectiveTo observe the effect of acetylcholine (ACh) on lipopolysaccharide (LPS) induced inflammatory model of rat alveolar macrophages, and to observe the effect of the acetylcholinesterase inhibitor physostigmine (Phy) on the anti-inflammatory effect of ACh.Methods The rat alveolar macrophages NR8383 were cultured in vitro, which were divided into five groups: blank control group, LPS group (stimulated with 1 mg/L LPS for 12 hours), LPS+ ACh group (0.01, 0.1, 1, 10, 100μmol/L of ACh were added for 5 minutes before LPS stimulation), LPS+ Phy group (1 mmol/L Phy was added for 5 minutes before LPS stimulation), and LPS+ ACh+ Phy group (1 mmol/L Phy and 10μmol/L ACh were added for 5 minutes before LPS stimulation). The supernatants were collected in each group, the enzyme-linked immunosorbent assay (ELISA) was used to assay the contents of tumor necrosis factor-α (TNF-α), interleukins (IL-1β, and IL-6). The activity of acetylcholine esterase (AChE ) in the supernatant was also determined.Results① The contents of TNF-α (ng/L: 605.09±57.13 vs. 34.07±8.62), IL-1β (ng/L: 377.09±28.55 vs. 32.33±10.62) and IL-6 (ng/L: 558.04±77.45 vs. 42.62±11.21) in the LPS group were significantly higher than those in the blank control group (allP< 0.05). These results indicated that the inflammatory model of rat alveolar macrophages was constructed successfully.② ACh with the final concentrations of 0.01, 0.1, and 1μmol/L had less influence on the production of TNF-α, IL-1β and IL-6 in the culture supernatants of alveolar macrophages stimulated with LPS compared with LPS group (allP> 0.05). Nevertheless, 10μmol/L and 100μmol/L ACh notably reduced the production of TNF-α (ng/L: 451.19±30.67, 332.19±32.19 vs. 604.96±22.56), IL-1β(ng/L: 261.08±24.78, 143.98±28.39 vs. 367.06±10.44) and IL-6 (ng/L: 342.75±54.60, 235.48±29.75 vs. 562.69±63.34) in the culture supernatants compared with the LPS group (allP< 0.05).③ The activity of AChE in the LPS group was significantly higher than that in the blank control group (kU/L: 5.21±0.63 vs. 3.09±0.10,P< 0.05). The activity of AChE was successfully inhibited by 1 mmol/L acetylcholinesterase inhibitor Phy pretreatment compared with that in the LPS group (1.51±0.12 vs. 5.21±0.63,P< 0.05).④ The level of TNF-α (ng/L: 183.17±35.44 vs. 451.19±30.67), IL-1β (ng/L: 91.49±12.27 vs. 261.08±24.78) and IL-6 (ng/L: 108.17±22.82 vs. 342.75±54.60) in the culture supernatants of LPS+ ACh+ Phy group was significantly decreased as compared with LPS+ ACh group (allP< 0.05).Conclusions ACh with the final concentrations of 10μmol/L and 100μmol/L can inhibit the LPS induced inflammatory reaction in alveolar macrophages. The acetylcholinesterase inhibitor Phy can reinforce the ACh-mediated anti-inflammatory effect on alveolar macrophages inflammatory model.

OBJECTIVE To investigate the changes in serum HBV-DNA level in HBsAg positive patients before and after operation and their infectious risk in hospital.METHODS HBV markers(HBV-M) in serum was detected in 58 HBsAg positive patients by time-resolved fluoroimmunometric assay before operation.HBV-DNA level in serum of them before operation and at 3rd,and 7th day after operation was detected by real time fluorescent quantitative polymerase chain reaction.We also detected HBV-DNA in gastric drainage juice and abdominal drainage after operation.RESULTS HBV-DNA was detected in 27 of 58 HBsAg positive patients' serum,the positive rate was 46.1%.After operation,serum HBV-DNA was increased remarkably at 3rd and 7th day compared with before operation in these patients respectively(P

The DNA fragment sized 2 139bp, the same Sequence with AtKup1 gene from Arabidopsis thalianna was used as the templates for DNA family shuffling. The shuffeld AtKup1 gene library was expressed in the mutant of 5. cerevisae in which potassium transporter gene TRK1 and TRK2 were knocked out by homologous recombination. Then the screening was carried out in the low potassium media containing 5. 0 mmol/L KC1 and no histidine in it. it was found that both of diverse and wild AtKup1 gene can rescues the trk1△trk2△yeast mutant strain in low [ K + ] medium. The growth of 2 clones yeast containing diverse AtKup1 were beter than that of AtKup1 wild gene transformant. The sequencig results of the shuffeld AtKup1 showed that there were 2 nucleotide changed, which resulted in 2 amino acid variations in it compared with the original AtKup1. The potassium uptaking capacity of shuffled AtKup1 gene increased significantly when it was transformed into tobacco.

For medical image volume rendering, it is very difficult to simultaneously visualize interior and exterior structures while preserving clear shape cues. Highly transparent transfer functions produce cluttered images with many overlapping structures, while clipping techniques completely remove possibly important contextual information. To address this issue, A gradient adaptive shading based illumination model is proposed and implemented in CUDA architecture. The coefficients of ambient, diffuse and specular lighting are tuned adaptively according to gradient. The experiments show that our method is capable of preserving 3-D contextual information in medical image dataset while still show clear boundaries with real-time interactive speed.
Algorithms ; Artifacts ; Computer Graphics ; Computer Simulation ; Humans ; Image Enhancement ; methods ; Image Interpretation, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; Models, Theoretical ; Pattern Recognition, Automated ; methods

AIM: To explore the predisposing factors, population characteristics and clinical features of severe fungal keratitis.
METHODS:The data of 233 cases 233 eyes of severe fungal keratitis in my hospital from January, 2008 to November, 2013 was retrospectively reviewed. The predisposing factors, population characteristics and clinical features were analyzed.
RESULTS: In 233 cases of severe fungal keratitis, the number of male patients was 153 ( 65. 7%) and the number ratio of male to female was 1. 9:1. The average age of them was (52. 7±11. 3), and most of them were middle-aged and elderly people living in the rural area (78. 1%) and were farmers ( 66. 1%) with low literacy (59. 7%). In 233 cases, 188 cases (80. 7%) possessed a clear history of ocular trauma, mainly caused by plant-based trauma (60. 9%). 90 cases (57. 3%) were infected with Fusarium, and 47 cases ( 29. 9%) by Aspergillus. The main treatment of severe fungal keratitis was surgery (87. 9%). 83 cases ( 52. 9%) were treated with penetrating keratoplasty, and in Fusarium and Aspergillus infected patients with severe fungal keratitis, 58. 4% ( 80/137 ) were performed with penetrating keratoplasty. In addition, patients treated with eye enucleation or evisceration, 68. 4% (13/19) were infected with Fusarium species.
CONCLUSION: Patients with severe fungalkeratitis in our hospital are mainly elderly male farmers living in rural, because of low economic condition and poor diagnosis consciousness. The main pathogens are Fusarium and Aspergillus species, and the major treatment is penetrating keratoplasty. Most of patients with poor clinical outcomes are infected with Fusarium species.