Objective To evaluate the efficacy of transurethral pneumatic ballistic lithotripsy via outer sheath of ureterorenoscope for bladder calculi. Methods From March 2003 to May 2007, 32 patients with bladder calculi were treated by transurethral pneumatic ballistic lithotripsy via outer sheath of ureterorenoscope. Results The operation was completed in all the patients without conversion to open surgery. Transurethral prostatectomy (TURP) was carried out on 22 patients who were complicated with benign prostatic hyperplasia (BPH). Four patients received cystotrachelotomy because of bladder-neck contracture, and 4 underwent dilation of the urethra owning to urethral stenosis. Simple pneumatic ballistic lithotripsy was performed on two patients. The operation time was 25 to 90 minutes with a mean of (45?25) minutes. No patient had residual stones or perforation of bladder. One patient developed urethral stenosis after the operation. Conclusions Transurethral pneumatic ballistic lithotripsy via outer sheath of ureterorenoscope is a safe, less traumatic treatment for patients with bladder calculi with few complications. The method is especially suitable for patients with BPH.

Objective To evaluate modified retroperitoneal laparoscopic resection of renal cyst. Method Thirty-six patients with renal cyst were treated by modified retroperitoneal laparoscopic resection of renal cyst,summarized the clinic data and follow-up the effect. Results All 36 cases were operated suc-cessfuUy without changing to opening operation,average operation time (50 ± 35)min,no complications oc-curred and no recurrence was found. Conclusions The modified retroperitoneal laparoscopic resection of renal cyst with two 5 mm-trocars and one 10 mm-trocar has less trauma than classic laparoscopic operation. It is one of mini-trauma operation method which is worth to be popularized in clinic.

Objective To investigate the prevalence of children dental fluorosis in drinking-water-borne endemic fluorosis areas in Liaoning province and to evaluate the disease prevention effects of water improvement measures.Methods Haicheng city,Linghai city,Faku county,Fumeng county,Liaoyang county and Jianping county six endemic fluorosis diseased counties (cities) of Liaoning province were included in the study in September 2011.In each county,3 water improvement villages were selected as survey points.In each surveyed village,children aged 8-12 were generally surveyed the prevalence of dental fluorosis.One tap water sample was collected in each surveyed village for determination of water fluorine.level.Results A total of 786 children aged 8-12 were examined; 110 of them were found with dental fluorosis; detection rate of dental fluorosis was 14.0％ ; no defect case of dental fluorosis was found,and dental fluorosis index was 0.27.Among the cases,very mild were 76 cases,and the detection rate was 9.7％; mild 33 cases,the detection rate was 4.2％; moderate 1 case,the detection rate was 0.1％; and no severe case.Four cases were in the eight-year-old group,accounting for 3.6％ of the total number of cases; 20 in the 9-year-old group,accounting for 18.2％ ; 26 in the 10-year-old group,accounting for 23.6％; 32 in the 11-year-old group,accounting for 29.1％; and 28 in the 12-year-old group,accounting for 25.5％.The differences of detection rates of dental fluorosis of children in each age groups were statistically significant (x2 =13.57,P ＜ 0.05).Water fluoride of the 18 water samples ranged from 0.34 to 2.03 mg/L; 77.8％ (14/18) of the water improvement areas reached the control standard for endemic fluorosis areas.Conclusion The prevalence of dental fluorosis in the areas with high fluoride in drinking water remains high,the measures of water improvement should be strengthened.

Objective Stanford type A acute aortic dissection is a life-threatening medical condition with high rates of morbidity and mortality that requires surgical repair, on an emergency basis. The extent of aortic arch repair that should be carried out during emergency surgery of this type is controversial. This study was conducted to report clinical experience on aortic arch repair and determine surgical indication, optimal operative procedures and strategy for Stanford type A acute aortic dissection. Methods 210 consecutive patients with acute Stanford A aortic dissection who underwent aortic arch replacement combined with implantation of stented elephant trunk into the descending aorta between August 2005 and August 2010. Surgical procedures included hemi-aortic arch replacement in 92 patients, subtotal aortic arch replacement in 50 patients and total aortic arch replacement in 68 patients. All operations were performed with the aid of deep hypothermic circulatory arrest and selective antegrade cerebral perfusion (SACP). Enhanced computed tomography scanning was performed to evaluate the postoperative outcomes, particularly the fate of the false lumen remaining in the descending thoracic aorta by aortic arch replacement combined with implantation of stented elephant trunk during follow up. Results Average cardiopulmonary bypass time was (146 ±52) min. The average cross clamp time was(93 ±25)min and average selective cerebral perfusion and circulatory arrest time was(35 ±14)min. The overall in-hospital mortality was 4. 8% (10/210) and morbidity was 8. 6% ( 18/210). Postoperative complications included acute renal failure, stroke, mediastinitis and respiratory insufficiency. During the follow-up period [mean (27 ± 18) months, ranged 2 to 60 months], 1 patient underwent reoperation due to the descending thoracic and abdominal aortic aneurysm. There was no late death. Follow-up enhanced CT scanning showed about 74% false lumens obliterated at the level of the distal border of the stent graft post operation. Conclusion Open aortic arch replacement is an effective approach and provides acceptable outcomes for type A acute aortic dissection. Optimal treatment strategy is the key factor to success in emergency surgical intervention.

Objective To evaluate effectiveness of peripheral Mohs micrographic surgery for the treatment of extramammary Paget′s disease (EMPD). Methods A total of 28 patients with EMPD were treated with peripheral Mohs micrographic surgery. The depth and extent of tumor infiltration were evaluated before the surgery. One day before the surgery, 20% aminolevulinic acid hydrochloride was topically applied to determine and label surgical margins under a Wood′s lamp. After fluorescence-based localization, peritumoral skin tissues were resected and underwent frozen-section examination according to the protocol for Mohs micrographic surgery. Meanwhile, the tumor was resected. After surgery, patients were followed up every 3 - 6 months to detect local recurrence and metastasis. Results Of the 28 patients, 25 were male and 3 were female. Six patients each underwent 3 sessions of frozen-section examination, and 12 patients each received 2 sessions, with an average of 1.86 sessions for each patient. During the follow-up for 5 - 72 months, local recurrence occurred in 3 cases, and 1 patient died of tumor metastasis and uremia after 2 years of follow-up. Conclusion Peripheral Mohs micrographic surgery is a time-saving and effective treatment for EMPD.

Objective To observe the effect of Weipixiao, a compound recipe which has the actions of strengthening spleen, resolving stasis and removing toxins, on the histopathological changes of gastric mucosal tissue in rats with gastric precancerous lesions ( GPL) . Methods SD rats were randomly divided into normal group, model group, Vitacoenzyme group (0.2 g·kg-1·d-1), and high-, middle-, and low-dose Weipixiao groups ( in the dose of 15, 7.5, 3.75 g·kg-1·d-1, respectively) . Except for the normal control group, the rats in other groups received spontaneous intake of N-methyl-N’-nitro-nitrosoguanidine ( MNNG) solution combined with irregular diet and oral use of purgative herbs for 18 weeks to induce GPL. From the 9th week, the mediation groups were simultaneously given corresponding medicine for 10 weeks. At the end of the experiment, the histopathological changes of gastric mucosal tissue in all groups were observed. Results Pathological scores of intestinal metaplasia and epithelial dysplasia in rat gastric mucosa of the model group were significantly increased ( P<0.01 compared with those of the normal group) , but were decreased in three Weipixiao groups to various degrees, particularly in low-dose Weipixiao group ( P<0.05 or P<0.01) . Conclusion Weipixiao can block and reverse gastric intestinal metaplasia and dysplasia in GPL rats to certain degrees, and low-dose Weipixiao may have better long-term effect for the prevention and treatment of GPL.

Objective To express the recombinant caspid of genotype 4 hepatitis E virus(HEV) ORF2. Methods HEV recombinant capsid protein D66 was expressed in E. coli, using the ORF2 fragment (aa368-606, obtained from swine bile) of genotype 4 HEV. Results The recombinant capsid proteins D66 self-assemble to be particle with a radius of 13 nm through dimeric form in neutral solution. Coated particles reacted well with sera obtained from patients during acute or recovered phase of HEV infection. Immunofluorescence and immnoblot assay suggested that D66 bound and penetrated HepG2 cell lines, and the process of attachment was blocked by sera collected from patients during acute or recovered phase of HEV infection.Conclusion Recombinant D66 particles simulate the structure at the surface of genotype 4 HEV well and specifically adhere and penetrate the host cells, which lays the foundation for the investigation of the molecular mechanism of genotype 4 HEV infection.

Objective To investigate the expression of macrophage migration inhibition factor (MIF) and cell cycle regulating factor Cyclin D1 in hepatocellular carcinoma tissue and the interaction between MIF and Cyclin D1 in hepatocellular carcinoma cell cycle controlling. Methods Using quantitative real-time PCR and Western blotting to detect mRNA and protein expression of MIF and Cyelin DI in HCC tissues and tumor adjacent tissues. Specific small interfering RNA(siRNA) targeting MIF gene was transfccted at doses of 50 nmol/L and 100 nmoL/L into HCC cell lines of PLC and HepG2 with lipofeetamine 2000 methods to knockdown the expression of M1F gene and to investigare the the interaction between M1F and Cyclin D1. Results MIF and Cyclin D1 protein and mRNA were overexpressed in HCC tumor tissues. The relative expression of MIF,Cyclin D1 protein and mRNA were 0.825±0.13,0.843± 0.104 and 7.31±1.85 folds、4.27±1.05 folds, compared with the tumor adjacent tissues (FMIF= 15.5, P<0.01;FCyclin D1=87.5,P <0.01). In MIF siRNA treated PLC and HepG2 cells, MIF mRNA down regulation 71.2%±7.2%, 87.4%±2.9% ,74.3%±8.9% and 88.4%±4.6% respectively (FPLC = 315.5 ,P < 0.01 ; FHepG2= 201.2 P < 0.01). While MIF protein expression were significandy reduced to 0.33±0.03,0.11±0.02, 0.81±0.08 and 0.36±0.02 in a dose-dependent manner (FPLC= 43.9, P <0.01 ;FHepG2 = 133.4 P <0.01). Cyclin D1 mRNA was significantly down-regnlated in MIF siRNA treated PLC and HepG2 cell lines when compared with control group(P <0.01). In 50 nmol/L and 100 nmol/L groups, Cyclin DI mRNA levels were respectively decreased by 68.2%±3% and 78.1%±1.4% in PLC cell, 65.8%±4.7% and 77.3%±2.6% in HepG2 cell (FPLC= 1569, P < 0.01 ; FHepG2= 480.4, P <0.01). Compared with control groups, Cyclin D1 protein levels significantly reduced to 0.28±0.06、0.15±0.03 and 0.44 ±0.04、0.13±0.02 in the PLC and HepG2 after M IF siRNA treatment(FPLC= 35.5, P < 0.01 ; FHepG2 = 114.7, P < 0.01). Conclusions MIF and Cyclin D1 mRNA and protein were overexpressed in HCC tumor tissues and participated in tumor cell cycle regulation. MIF may up-regnlate the expression of Cyclin DI via ERK signalling and precipitate in carcinogenesis of hepatocellular carcinoma.

OBJECTIVETo study the clinical and pathological features of drug-induced liver injury (DILI).

METHODSLiver specimens were obtained through needle biopsies from 100 patients with DILI. The histological preparations of the specimens were stained with haematoxylin eosin, several histochemistry methods, and immunohistochemistry stains. The pathological changes of the livers were analyzed together with the patients's clinical data. The patients were divided into two groups, an acute DILI group (n=39) and a chronic DILI group (n=61), based on their clinical courses and histological changes in their livers. In the chronic DILI group, the clinical courses were longer than 6 months and/or fibrosis or cirrhosis occurred in their liver tissues.

RESULTSAmong our cases the leading cause of DILI was Chinese herb medicine, accounting for 21% of the 100 cases; steroids induced cases were 11% of the total. 78% of the patients presented elevated serum transaminases and/or jaundice. The degree of transaminases elevation and the frequency of jaundice happening in the acute group were significantly higher than those in the chronic group (P less than 0.05). The histopathological liver changes in these DILI cases included: (1) necrosis commonly occurred in acinar zone 3, (2) abundant neutrophil and/or eosinophil infiltrations, (3) hepatocytic and/or canalicular cholestasis with little or no inflammation, (4) microvesicular steatosis mixed with macrovesicular steatosis, and (5) presentation of epitheloid cell granuloma. There were no significant differences in liver histopathology between the acute and the chronic DILI groups, except that the fibrosis and the ductular proliferation were different.

CONCLUSIONDILI has become a notable liver disease in mainland China, and the use of Chinese herbal medicine must be improved, standardized and regulated more closely.

Adolescent ; Adult ; Aged ; Chemical and Drug Induced Liver Injury ; pathology ; Child ; Child, Preschool ; Female ; Humans ; Liver ; pathology ; Male ; Middle Aged ; Young Adult

OBJECTIVETo explore the effects of microcystin-LR (MCLR) on the expression of base excision repair genes and genes related to apoptosis.

METHODSThe BRL-3A cells were exposed to different concentrations of MCLR for various periods of time and the cell viability was measured by MTT. The mRNA expression was determined with the quantitative real-time polymerase chain reaction (QRT-PCR).

RESULTSThe viability of BRL-3A cells significantly reduced in a concentration- and time-dependent manner. In 30 µg/ml group, the mRNA expression level (1.327 ± 0.028) of p53 increased significantly at 24 h after exposure, as compared with the other groups (1.005 ± 0.117, 0.862 ± 0.154, 1.028 ± 0.056 and 1.015 ± 0.091) (P < 0.05). The mRNA expression levels (5.080 ± 0.729, 5.820 ± 0.373, 6.018 ± 0.359 and 6.183 ± 0.515) of Bax in all exposure groups were significantly higher than that (1.024 ± 0.277) in control group at 24 h after exposure. However, the Bax mRNA expression level (0.604 ± 0.146) in the 30 µg/ml group at 72 h after exposure was significantly lower than those (1.004 ± 0.107, 0.811 ± 0.142, 0.855 ± 0.101 and 0.814 ± 0.056) in other groups (P < 0.05). When compared with control group (1.006 ± 0.132) and 1 µg/ml group (1.034 ± 0.241), the mRNA expression level (0.488 ± 0.147) of PARP1 in 30 µg/ml group at 48 h after exposure decreased significantly (P < 0.05). Furthermore, the mRNA expression levels (0.594 ± 0.180, 0.491 ± 0.015 and 0.305 ± 0.091) of JWA, XRCC1 and PARP1 in 30 µg/ml group at 72 h after exposure decreased significantly, as compared with the other groups (P < 0.05).

CONCLUSIONThe induction of gene expression is a transient phenomenon that occurred at different times of exposure for different genes. Inhibition of MCLR on the base excision repair gene expression may play important role in the course of MCLR promoting liver tumor.

Animals ; Apoptosis ; Apoptosis Regulatory Proteins ; genetics ; Base Sequence ; Cell Line ; DNA Repair ; Gene Expression ; Microcystins ; toxicity ; RNA, Messenger ; genetics ; Rats