BACKGROUND:The selective immunosuppression on transplanted organ was realized by local drug delivery system,which is one of efficient ways to avoid many kinds of side reactions induced by systemic drug delivery.By using the characteristics that adrenal gland can secret glucocorticoid,the adrenal gland or adrenal implant as the way of local drug delivery of glucocorticoid for transplanted organ is hopeful to avoid the complications induced by systemic and amount of use of glucocoticoid.OBJECTIVE:To establish a model of adrenal gland self-implantation in greater omentum,and to observe the protection of the adrenal gland implant on transplanted liver.DESIGN,TIME AND SETTING:This randomized controlled animal experiment was performed in the Experimental Animal Center of Guizhou Provincial People's Hospital from May 2007 to October 2008.MATERIALS:Fifty male Sprague Dawley rats were assigned as donors,and fifty male inbred strain Wistar rats were assigned as recipients.METHODS:After feeding one week,the recipient rats were randomly divided into two groups with 25 rats in each group.In liver transplantation after adrenal gland self-implantation in greater omentum group,allogenic liver transplantation was performed after successful model establishment of adrenal gland self-implantation in greater omentum.In simple liver transplantation group,only allogenic liver transplantation was performed.No immunosuppressant was used after transplantation in both of the two groups.MAIN OUTCOME MEASURES:The survival time of rats was observed.The morphology of the transplanted livers and the adrenal implants was observed at different time points.The activities of serum aspartate aminotransferase(AST),as well as the concentration of serum corticosteroid and total bilirubin were detected at different time points.RESULTS:The recipient adrenal implants recovered their endocrinal function at 7 weeks after adrenal gland self-implantation in greater omentum.After liver transplantation,histological examination showed that the adrenal implants survived well.The median survival time of rats in the liver transplantation after adrenal gland self-implantation in greater omentum group was more than 30 days,which is obviously longer than that(12 days) in the simple liver transplantation group.There was no significant difference in concentration of serum corticosteroid between the two groups.At 7 days after transplantation,activities of serum AST and concentration of total bilirubin of rats in the simple liver transplantation group were significantly higher than those in the liver transplantation after adrenal gland self-implantation in greater omentum group(P ≤ 0.05).In the liver transplantation after adrenal gland self-implantation in greater omentum group,pathological changes of transplanted livers showed as grade 0 according to Williams standard.In the simple liver transplantation group,a mild rejection appeared at 3 days after transplantation,and the pathological changes turned to severe and reached grade 3 according to Williams standard at 7 days.CONCLUSION:Adrenal implant which survives and recovers its endocrinal function after self-implantation in greater omentum has protection on the transplanted liver in early stage.

Objective To investigate the molecular mechanisms of glial cell derived neurotrophic factor in promoting proliferation of spermatogonial stem cell.Methods RNAi expression vectors,targeted at GDNF,were constructed and transfected into SSCs from 5 to 7 days old mice.The SSCs with highest effectiveness of GDNF interfere was set as study group.And the SSCs without GDNF interfere was considered as control group.The ELISA method was used to compare the proliferative rate between study group and control group.Flow cytometry,RT-PCR were used to detect the expression of GDNF,RTKs,Fyn and FAK's mRNA,and the apoptosis of SSCs.Results From 1 to 4 days after transinfection,the absorbable A value in study group was 0.45 ± 0.02,0.68 ± 0.03,1.12 ± 0.03,2.24 ± 0.04,respectively.Meanwhile,the same item in control group was 0.46 ± 0.03、0.73 ± 0.02、1.32 ± 0.05、1.15 ± 0.06,respectively (P ＜ 0.05).There were significant different between experiment groups (25.43 ± 1.91) ％ and control group (5.61 ± 0.16)％ in the apoptosis rates of SSCs (P ＜ 0.05).Significant differences were noted between experimental group and control group(P ＜ 0.05).The mRNA expression rates of GDNF was (12.32 ± 1.22) ％ in study group and (54.25 ± 1.34)％ in control group (P ＜0.01).The mRNA expression rates of RTKs and Fyn and FAK in study group and control group were (16.24 ± 1.35)％ vs (45.35 ± 1.37)％,(18.32 ±1.34)％ vs (38.37 ± 1.55)％,(20.04 ± 1.65)％ vs (43.27 ± 1.28)％,respectively (P ＜0.05).Conclusions The glial cell line derived neurotrophic factor was important in course of SSCs' proliferation,which may up-regulating the expression of RTKs,Fyn and FAK.

Objective To study the safety and clinical efficacy of transurethral 120 W 2 μm laser prostate vaporesection in the treatment of benign prostatic hyperplasia (BPH).Methods Forty-one BPH cases were treated with 2 μm continuous wave laser prostate vaporesection.Laser output power was 120 w.International prostate symptom scores (IPSS) were collected on all patients before and after surgery at one,six and 12 months for maximum urinary flow rate (Qmax) and post-voiding residual urine volume (PVR).Operative time,estimated bleeding loss,electrolyte changes,and the time of catheter removal were recorded and analyzed respectively.Results All procedures were successfully completed.The obstructive symptoms of lower urinary tract symptoms were relieved in varying degrees post-operatively.Preoperative and postoperative one,six and 12 months IPSS,Qmax and PVR showed statistical difference ( P ＜0.01 ).Operative time was 32.9 ± 10.7 min,decreased hemoglobin levels was 5.36 ± 2.78 g/L,no cases needed blood transfusion,and all patients were without electrolyte disturbance resulted in the safe perioperative period.The time of removal of the catheter was 2.5 ± 0.7 d.There was no secondary surgery,urinary incontinence,and complication such as bladder neck contracture at 12 months post-operative follow-up.Conclusions RevoLix 2 μm continuous wave laser prostate vaporesection as a treatment option for BPH is safe and effective over a short and long period of time.RevoLix 2 μm wave laser prostate vaporesection can significantly improve BPH patient symptoms of lower urinary tract obstruction.

Objective To assess the pubvaginal fascia sling cystourethropexy (PV sling) technique and outcomes of the treatment of female type Ⅲ stress urinary incontinence. Methods From October 2005 to January 2008, 9 women presenting with type Ⅲ stress urinary incontinence were treated with Pubvaginal fascia sling cystourethropexy. All the patients underwent 1 h pad test before discharge and were tested with maximum uroflow rate, volume of postal residual urine, maximum urethral close pressure (MUCP) and abdominal leak point pressure (ALPP) after 3 months. Results The operative time ranged from 60 to 90 min (mean, 75 min). Estimated blood loss ranged from 60 to 100 ml (mean, 76 ml). Intraoperative unilateral bladder perforation occurred in 2 cases. One patient with infection of abdominal incision was cured by changed dressings. The urinary catheter was removed 5 days post-operation. 4 patients had normal urination and 1 patient had urine retention. The recovery following intermittent catheterization was 3-12 days. 8 patients got 3-28 months' follow up. 7 patients were cured with 1 h pad test decreased from preoperative 58 g (45-75 g) to postoperative 1 g (0-2 g), mean residual urine was less 65 ml (0-80 ml). The values of Qmax (ml/s),MUCP (cm H2O) and ALPP (cm H2O) were 10. 5±2. 7, 15. 5±3. 4 and 40. 4±8.2 pre-opreative,and 26.5±3.9, 49.8±6.7 and 98.6± 12.2 3 months post-operative. There were significant differences of these parameters between pre-and post-operation (p＜0.01). Conclusions PV sling could be a safe and effective surgical procedure fortreatment of type Ⅲ female stress urinary incontinence.

Objective To explore the application value of end-to-side closed in situ pancreaticojejunostomy in pancreaticoduodenectomy.Methods The clinical data of 22 patients with obstructive jaundice who were admitted to the Second Affiliated Hospital of Harbin Medical University from January to March 2014 were retrospectively analyzed.All the patients were explored whether tumors invaded inferior vena cava, superior mesenteric vein and portal vein after gallbladder decompression under general anesthesia by tracheal intubation.The standard or extended pancreaticoduodenectomy was applied according to the intraoperative results.The method of pancreaticojejunostomy was end-to-side closed in situ anastomosis of pancreatic duct and jejunal seromuscular layer.The operation time, intraoperative blood loss, postoperative gastrointestinal function recovery time, amylase concentration of drainage at postoperative day 1,3,5, postoperative complication, pathological classification and duration of hospital stay were observed.Patients were followed up by outpatient examination and telephone interview till May 2014.The out-patient follow-up included color Doppler ultrasound examination of effusion near the pancreatic stump, and the telephone interview included whether there were diarrhea of exocrine pancreatic insufficiency.Measurement data with normal distribution were presented as-x ± s (range) , and measurement data with skewed distribution as M(range).Results All the 22 patients underwent successfully the operation, including 17 undergoing standard pancreaticoduodenectomy and 5 undergoing extended pancreaticoduodenectomy, with end-to-side closed in situ anastomosis of pancreatic duct and jejuna seromuscular layer.The operation time of pancreaticoduodenectomy and end-to-side closed in situ pancreaticojejunostomy were (313 ± 37)minutes (range, 228-360 minutes) and(13 ± 4) minutes (7-22 minutes) , respectively.The intraoperative blood loss was (400 ± 207) mL (range, 100-800 mL).The mean tumor size was 3.69 cm2(range, 0.72-1.68 cm2).The recovery time of gastrointestinal function was (5 ±2)days (range, 4-7 days).The serum amylase at postoperative day 1, 3, 5 in the 21 patients was (145±30)U/L (range, 116-180 U/L), (136±40)U/L (range, 105-176 U/L), (147 ±38)U/L(range, 110-175 U/L), and the drainage amylase was (220 ±56)U/L (range, 172-289 U/L), (240 ±54)U/L (range, 192-300 U/L) , (245 ± 52) U/L (range, 190-298 U/L) , respectively.The serum amylase at postoperative day 1, 3, 5 in the patient with pancreatic fistula was 156 U/L, 178 U/L and 177 U/L, and the drainage fluid amylase was 500 U/L, 620 U/L and 605 U/L, respectively.There was 1 patient in the 22 patients with pancreatic duct stent and without death.Among the 4 patients with postoperative complications, 1 patient with grade A postoperative pancreatic fistula recovered after continuous external drainage, the other 3 including 1 case of infection,1 case of pneumonia and 1 of stress ulcer bleeding also recovered after symptomatic and supportive treatment.Postoperative pathological examinations of the 22 patients showed 12 cases of ductal adenoeareinoma, 2 of neuroendocine tumors, 1 of simple cyst, 1 of cystadenocarcinoma, 1 of squamous carcinoma, 1 of adenocarcinoma, 1 of ampullary carcinoma, 1 of tubular adenoma, 1 of leiomyoma and 1 of atypical intraductal hyperplasia.The average length of hospital stay was (11 ±3)days (range, 2-15 days).There were no effusion near the pancreatic stump showed in color Doppler ultrasound examination and diarrhea of exoerine pancreatic insufficiency.Conclusion End-to-side closed in situ pancreaticojejunostomy is safe and feasible, and can be applied to any pancreatic duct size and texture.

0.05).Compared to cultivation whose positive rate was 33.33%,the rates were obvious higher(P

Objective To evaluate the safety and efficacy of retroperitoneal laparoscopic resec-tion and reconstructive surgeries in urology. Methods Retroperitoneal laparoseopic resection and re-constructive surgeries were performed on 245 patients including 17 cases of adrenalectomies, 32 cases of radical nephrectomies, 12 cases of partial nephrectomies, 53 cases of nephrectomies, 5 cases of nephroureterectomies, 6 cases of unroofing of peripelvie renal cysts, 46 cases of unroofing of renal cysts, 4 cases of unroofing of polyeystic kidneys, 12 cases of pyeloplasties, 58 cases of ureterolithoto-roles. Results All 245 surgeries were successfully completed. The mean operation time was 59 (20-250) min and the estimated blood loss was 5-300 ml with no transfusion. There was no serious complication during perioperative period. Conclusion Retroperitoneal laparoscopic resection and re-conatruetive surgery in urology is safe and effective with the advantages of minimal invasion, quick re-covery and few complications.

Objective To investigate the clinical outcomes derived from Ningmitai combined with tamsulosin to prevent double-J stent syndrome after laser lithotripsy with ureteroscope. Methods 117 patients underwent laser lithotripsy with ureteroscope and then placed a double-J stent for draining were collected from January 2010 to January 2013. Patients with double-J stent placement were divided into four groups determined by dosage regimen. Tamsulosin group (30 cases) was treated with tamsulosin (0.4 mg once daily) lonely, Ningmitai group (29 cases) was treated with Ningmitai (1.52 g, trice time a day) lonely, tamsulosin combined Ningmitai group (30 cases) was treated with tamsulosin and Ningmitai at the same time, operation control group (28 cases) was neither tamsulosin nor Ningmitai. The catheter was removed on the 3rd day post-lithotripsy and then remained double-J stent for 1 month. The scores of urinary tract, pain and the incidence of gross hematuria were assessed. Results The significant differences in the improvement of symptom score (χ2=22.038, P=0.000), pain score (χ2=9.876, P=0.020) and hematuria (χ2=8.000, P=0.046) were found among tamsulosin group, Ningmitai group, and tamsulosin combined Ningmitai group. The number of patients with symptomless, slight symptom in tamsulosin combined Ningmitai group were higher than those of tamsulosin group, Ningmitai group, operation control group (symptomeless:14 vs. 6, 3 and 2 cases;slight symptom:13 vs. 9, 5, 4 cases). The number of patients with>Ⅱpain score (7 vs. 9, 14, 17 cases) and incidence of hematuriag [26.6%(8/30) vs. 56.7%(17/30), 58.6% (17/29), 53.6% (15/28)] were lower in tamsulosin combined Ningmitai group than those of tamsulosin group, Ningmitai group, operation control group. The drug combination of Ningmitai with tamsulosin had the synergism to relived symptom and pain, and showed the more obviousthan lonely use. Conclusion The drug combination of Ningmitai with tamsulosin can be used in clinic for prophylactic purpose to prevent double-J syndrome.

Objective To explore the role and clinical significance of GSTM 3 ( glutathione S-trans-ferase mu 3) expression in prostate cancer (PCa). Methods We had used the two-dimensional fluores-cence difference gel electrophoresis ( 2D-DIGE) and mass spectral analysis to further verify the microarray data of mRNA expression profiling discovered .GSTM3 mRNA level was detected by Rael-time Quantitative PCR ( RT-QPCR) in 28 pairs of prostate cancer tissue and benign tissue .The relationship of GSTM 3 level with the serum PSA level and the clinical feature of PCa were analyzed . Results In 2D-DIGE study, we found that the expression of GSTM 3 protein in adjacent tissues was significantly higher than that in PCa tis-sues (P<0.05).RT-QPCR results showed that GSTM3 in adjacent tissues (8.12±0.51) was significantly higher than that in PCa tissues (7.18±0.54) (P<0.05).There was no significant difference of GSTM3 ex-pression in different serum PSA packets ( P>0.05) and prostate cancer clinical pathological parameters ( P>0.05). Conclusions GSTM3 expression is down-regulated in PCa tissues, and we may identify PCa by detecting the GSTM 3 expression .

Objective To compare the safety and efficacy of the 2μm laser and the bipolar electrotome used in transurethral re-section of bladder tumor(TURBT)for treating non-muscle invasive bladder cancer(NMIBC).Methods The clinical data in the pa-tients with NMIBC treated by TURBT in our hospital from March 2009 to May 2013 were retrospectively analyzed.All patients were divided into the 2μum laser group(n=89)and the bipolar electrotome group(n=82).The operation time,complications,post-operative hospital stay and recurrence rate were compared between the two groups.Results There were no statistically significant differences in the operation time,postoperative hospital stay and recurrence rate between the two groups(P>0.05).Compared with the 2 μm laser group,the bipolar electrotome group showed significantly higher occurrence rate of the obturator nerve reflex (20.7%vs.0,P<0.05)and the bladder perforation(7.3% vs.0,P<0.05)and longer postoperative bladder irrigation time [(3.1±0.9)d vs.(2.2±1.0)d,P<0.05],the differences between the two groups had statistical significance.Conclusion Com-pared with bipolar electrotome,the 2μm laser used in TURBT is safe and effective with few complications for treating NMIBC.