Objective To investigate the classification of cerebral arteriovenous malformation (AVM) associated with hemodynamics correlative aneurysms and its efficiency treated by endovascular treatment.Methods The clinical data of 17 patients of AVM associated with hemodynamics correlative aneurysms undergoing endovascular treatment were analyzed retrospectively.Results Eleven cases of aneurysms with great divergence between the aneurysm and arteriovenous malformation were embolized,6 cases of aneurysms without a great divergence between the aneurysm and arteriovenous malformation,1 case of aneurysm was treated with stent,other 5 cases of aneurysms were not treated.Eleven cases of arteriovenous malformations were embolized completely,4 cases were embolized 71％-90％ and 2 cases were embolized 50％-70％.Six cases with residual were given radiotherapy.Follow-up 3 months to 3 years,there were no cases of cerebral hemorrhage or death.Unhandled 5 cases of aneurysm and 1 case of stent implantation with the follow-up by using digital subtraction angiography,laneurysm with a stent was closed.Three aneurysms were disappeared and 2 aneurysms were reduced significantly among the 5 cases of aneurysms without treatment.One case of aneurysm occlusion in patients with stent implantation.Conclusions Classification based on a great divergence artery or not between the aneurysm and arteriovenous malformation is more instructive for clinical treatmen of cerebral arteriovenous malformation associated with hemodynamics correlative aneurysm.If it has not a great divergence artery between aneurysm and arteriovenous malformation,arteriovenous malformation after a thorough treatment,aneurysms need not be treated.The endovascular treatment for cerebral arteriovenous malformation associated with hemodynamics correlative aneurysms has a good efficiency and can be treated as a priority.

Objective The aim of this study was to explore the effect of androgen deficiency on serum hormone levels, visceral fat accumulation and inflammatory gene expression in miniature pigs fed a high-fat diet ( HFD) . Methods Sexually mature male Chinese Wuzhishan miniature pigs were divided into three groups ( animals/group) as follows:intact male pigs ( SHAM) , castrated male pigs ( CAS) and castrated male pigs plus testosterone treatment ( CAS+T) . The pigs were fed a HFD diet for 12 weeks. Serum levels of testosterone and leptin were measured and visceral fat were dissected and weighted. qRT?PCR was performed to determine the mRNA expression levels of lipogenic, lipolysis and inflammation relat?ed genes. Results (1) Serum testosterone levels were significantly decreased but serum leptin levels were significantly in?creased in the castrated pigs. These effects were recovered after testosterone treatment. ( 2 ) Visceral fat percentage was significantly increased in the castrated pigs, and testosterone treatment reduced the increased visceral fat in the castrated pigs. (3) Castration and testosterone treatment had no significant effects on the expression levels of lipogenic genes (FAS and ACC) and lipolysis genes (HSL and ATGL) in pigs fed a HFD. (5) Castration significantly induced the expressions of inflammatory genes including Leptin, CD68, CCL16, CCL23 and SAA, and testosterone treatment recovered the expres?sions of the above genes in the castrated pigs. Conclusions Castration?induced testosterone deficiency promotes visceral fat accumulation and upregulates the expression levels of inflammatory genes in miniature pigs fed a HFD. Moreover, tes?tosterone treatment ameliorates castration?induced visceral fat accumulation and inflammatory response in HFD?fed pigs.

Objective:To examine the risk of long-term cognitive impairment in elderly prostate cancer patients aged 75 years and older undergoing androgen deprivation therapy(DAT), and to analyze the correlation between DAT and cognitive impairment.Methods:This was a retrospective cohort study.Elderly prostate cancer patients aged 75 years and older in the National Cancer Database(SEER)from 1996-2003 were included.According to whether ADT was received, patients were divided into the ADT group(n=82 514)and the control group(n=121 856). Baseline clinical data were compared between the two groups. Kaplan- Meier survival analysis and the Log- rank test were used to compare the incidence of cognitive impairment(dementia and Alzheimer's disease)between the two groups. Cox risk ratio regression analysis was used to assess the relationship between ADT and cognitive impairment. Results:A total of 204 370 patients were enrolled in this study.The mean age of patients was(79.2±4.6)years.Compared with the control group, the ADT group was older and had higher prostate specific antigen levels, higher proportions of poorly differentiated tumors, more complications and a higher proportion of patients receiving radiotherapy( P<0.05). During the follow-up of(12.1±3.3)years, a total of 41 661 cases of dementia were diagnosed, including 13 634 in the ADT group and 28 027 in the control group, and 28 945 cases of Alzheimer's disease were diagnosed, including 9 372 in the ADT group and 19 573 in the control group.Kaplan-Meier survival analysis and the log-rank test showed that the incidence of dementia in the ADT group was higher than that in the control group( χ2=8.10, P=0.004), and the incidence of Alzheimer's disease was also higher in the ADT group than in the control group( χ2=5.06, P=0.024). Cox regression analysis results showed that ADT significantly increased the risk of dementia( HR=1.71, 95% CI: 1.14-2.57, P=0.01)and Alzheimer's disease( HR=1.63, 95% CI: 1.08-2.46, P=0.02), compared with treatment that did not include ADT. Conclusions:The risk of dementia and Alzheimer's disease is increased in elderly prostate cancer patients aged 75 years and older after ADT.

Objective To observe the way of vascularization of acellular nerves and evaluate the enhanced vascularization of using COMP-Ang-1 into acellular nerve on bridging sciatic nerve gaps by radiography.Methods From March,2013 to June,2014,acellular nerves were harvested by chemical extraction.Thirty-six female rats weighing 200-250 g were randomly divided into 2 groups:18 animals with 1 cm long sciatic nerve lesions were repaired by nerve grafting (control group),18 animals with 1 cm long sciatic nerve lesions were repaired by nerve grafting and COMP-Ang-1 were administrated after surgery.Grafts were harvested after perfusion of lead oxide (carotid artery) on day 7,day 14 and day 21 postoperatively.Radiography was performed to capture the two dimensional image.The rules of vascularization of acellular nerve and the enhanced effects of COMP-Ang-1 on vascularization were evaluated.Results The density of vessels in COMP-Ang-1 group were higher than control group after 7 days (2701.60 ± 318.93 vs.925.40 ± 106.22,P =0.030),14 days (3309.21 ± 381.31 vs.2832.70 ± 189.23,P =0.210) and 21 days (4787.33 ± 251.09 vs.3469.36 ± 232.10,P =0.030) postoperatively; the area of vessels in COMP-Ang-1 group were higher than control group after 7 days (9231.03 ± 581.91 μm2 vs.4839.01 ± 101.01 μm2,P =0.043) and 14 days (15561.13 ± 697.73 vs.6811.07 ± 250.05,P =0.049) postoperatively.Conclusion COMP-Ang-1 can enhance the vascularization of acellular nerves fairly.

Objective Comparison of induction time on the proliferation of induced adipose-derived stem cells (ADSC) to differentiate into Schwann-like cells (iSC).Methods From March,2017 to October,2018,ADSCs were isolated from inguinal adipose tissue of healthy adult female SD rats.Flow cytometry was performed to detect ADSC positive markers CD29,CD90 and negative marker CD45.iSC induction medium was used to culture ADSC.S-100 and GFAP were detected by immunofluorescence staining to confirm that ADSC had differentiated into iSC.Morphological changes of cells were observed by inverted microscope on day 1st,4th,7th,10th,13rd,16th and 19th after induction.MTS assay was used to evaluate cell proliferation ability.Tunel staining was applied to assess cell apoptosis.Results Both S100 and GFAP were expressed in iSC.On day 7th,the cell proliferation rate was significantly slower than that before induction (A value was 0.330±0.020 vs.0.400±0.004,P＜0.05).It was negatively correlated with induction time.On day 19th,the proliferation rate of iSC was lower than 50％ of the proliferation rate before induction (A value was 0.016±0.003 vs.0.400±0.004,P＜0.05).Apoptosis of iSC was more obvious than ADSC at the same time point.Conclusion The proliferation ability of ADSC-induced iSC is optimal within 7 days after induction.

Objective To report our experience of retroperitoneal laparoscopic extravascular stent placement for nutcracker syndrome.Methods The clinical data of 12 nutcracker syndrome patients (10 males and 2 females;mean age 26 years) who underwent retroperitoneal laparoscopic extravascular stent placement from March 2014 to Febuary 2016 were retrospectively reviewed.The main symptoms were gross hematuria in 8 patients(one with proteinuria)and flank pain was noted in 1 patient.Three male patients had left-sided secondary varicoceles.Ultrasonography and computed tomography showed the left renal vein clamped by the superior mesenteric artery and the aorta.The anteroposterior diameter of the left renal vein in the renal hilum was three-fold than the aortomesenteric area,and the peak velocity ratio of the aortomesenteric area was much faster than the renal hilum.Twelve patients underwent laparoscopic extravascular stent placement under general anesthesia.The preaortic fibrous tissue between the aorta and the superior mesenteric artery was released intraoperatively.Renal vein became fiat when the superior mesenteric artery was elevated.The 6-8 cm extravascular stent was set on the surface of the renal vein to prevent the compression.Results Stenting was successfully accomplished in all 12 patients.Mean operative time was 62 min (50-125 min),estimated blood loss was 35 ml(20-100 ml),and the hospital stay after operation was 8 days (6-12 days).Three patients had a transient orthostatic intolerance,and they were cured by conservative treatment.With a mean follow up of 14 months (5-30 months),symptoms of hematuria and flank pain resolved in 7/8 and 1/1,respectively.Varicoceles were cured in all three patients.One case got partial relief because of recurrent hematuria due to excessive exercise.Ultrasonography showed that extravascular stent was in the right place,and the angle between abdominal aorta and superior mesenteric artery became normal.The inner diameter of left renal vein was decreased,and the narrow segment was diminished in diameter meanwhile the blood outflow was smooth.Conclusions Retroperitoneal laparoscopic extravascular stent placement in the renal vein is a safe and effective approach for nutcracker syndrome.

Objective To evaluate the safety and short‐term efficacy of delta‐shaped anastomosis in the Billroth‐I reconstruc‐tion of totally laparoscopic distal gastric cancer radical operation (TLDG) .Methods The clinical data in 35 patients with TLDG Delta anastomosis(TLDG group) and 35 patients with laparoscopic assisted distal gastric cancer radical operation (LADG) extraper‐itoneal anastomosis (LADG group) in the gastroenterology department of our hospital from January to December 2014 were ana‐lyzed retrospectively .The intraoperative bleeding volume ,operative time ,gastroenterological function recovery time ,hospitalization duration ,postoperative pathological examination results and hospitalization total cost were compared between the two groups .Re‐sults Seventy cases successfully completed the operation without the cases of conversion to laparotomy and death .The TLDG group had no anastomotic leakage ,bleeding and stenosis after operation ;while the LADG group had 1 case of gastroparesis ,1 case of anastomotic bleeding and 2 cases of anastomotic leakage .The introperative bleeding volume ,tumor size ,number of lymph nodes dissection and distant and proximal incisal margin distance had no statistically significant differences between the two groups (P>0 .05);the operation time ,digestive tract reconstruction time ,first exhaustion time ,time taking liquid diet and postoperative hospital stay time in the TLDG group were significantly shorter than those in LADG group (P< 0 .05) ,but the hospitalization cost was higher than that in the LADG group ,the differences were statistically significant (P<0 .05) .Conclusion The delta‐shaped anasto‐mosis technique is safe and feasible for using in LADG ,moreover has better short‐term effect .

Parathyroid adenoma is the main cause of primary hyperparathyroidism and often associated with thyroid nodular goiter.Thyrothymic thyroid rest belong to the ectopic thyroids which are classified into 4 grades according to the state of their connection with the proper neck thyroid gland.Thyrothymic thyroid remnant can also develop into nodular goiter and may be difficult to be distinguished from parathyroid adenoma.We present herewith the diagnosis and treatment of a rare case of parathyroid adenoma accompanied by thyrothymic thyroid remnant nodular goiter in order to remind clinicians of the attention to the thyrothymic thyroid remnant disease.

Objective The aim of this study was to explore the effect of testosterone deficiency on serum lipid levels and hepatic lipid accumulation in miniature pigs fed a high-fat diet (HFD).Methods Eighteen sexually mature male Chinese Wuzhishan miniature pigs (6~7 months old) were used in this study.The pigs were divided in three groups ( n =6 animals/group ) as follows: intact male pigs , castrated male pigs and castrated male pigs with testosterone replacement .They were fed a HFD diet for 12 weeks and body weights were recorded weekly .Serum levels of testosterone , total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) were measured.Hepatic TG and TC levels were also determined , and liver tissues were embedded in paraffin and stained with hematoxylin and eosin (H&E).Results (1) The body weights of pigs in each group were found to be linearly elevated over time .Though castrated pigs gained less weight than did pigs in the other groups , no significant differences were found between them .( 2 ) Castration caused a significant decrease in serum testosterone levels in pigs . This effect was recovered by testosterone treatment .(3) Serum levels of TC, LDL-C and TG were significantly increased in castrated pigs.However, castration had no significant effect on serum HDL-C levels.Testosterone treatment reduced the increased serum lipids in castrated pigs .(4) Hepatic TG and TC contents in castrated pigs were also significantly higher than those in other groups of pigs .Testosterone treatment reduced the increased hepatic lipids in castrated pigs .( 5 ) Compared with other groups of pigs , castrated pigs showed increased steatosis .However , testosterone treatment attenuated hepatic steatosis in castrated pigs .Conclusion Testosterone deficiency caused severe dyslipidemia , and increased hepatic lipid accumulation in miniature pigs fed a high-fat diet.

Objective:To analyze the correlation between preoperative parametres and positive surgical margin after robot-assisted laparoscopic radical prostatectomy.Method:From October 2014 to January 2019, the clinical data of 310 patients who underwent robot-assisted laparoscopic radical prostatectomy(RARP) by single surgeon were collected retrospectively. The median age, PSA, f/t PSA and PSAD was 68(62-72)years, 26(13-63) ng/ ml, 0.12 (0.07-0.18) and 0.36(0.20-0.75) ng/ml 2, respectively. There were 115 cases with clinical T 1, 100 with clinical T 2, 41 with clinical T 3, and 15 with clinical T 4. Based on the MRI or ultrasound examination, the median value for the transverse diameter, anteroposterior diameter, vertical diameter, and volume of the prostate is 44(35-50)mm, 45(40-51)mm, 41(36-50)mm, and 76(54-118)ml, respectively. In this study, 84(27%)cases were diagnosed pathologically by transurethral resection of the prostate, and 226(73%)cases by prostate biopsy. The biopsy technique was transrectal ultrasound-guided systematic 12-point biopsy, and additional 1-5 needles were performed in regions with abnormal ultrasound echoes. The median for total number of puncture needles, number and percentages of positive needles were 12(12-13), 9(4-12)and 85%(35%-100%), respectively. Of all the patients, there were 61 cases with Gleason score≤6, 95 with Gleason score=7 and 84 with Gleason score≥8. There were 237(76%)patients undergoing neoadjuvant endocrine therapy. The patients were divided into the negative surgical margin group and positive surgical margin group. The correlation between positive surgical margin and general clinical data, PSA derivates, prostate size (transversal diameter, anteroposterior diameter, vertical diameter, and prostate volume), percentage of positive biopsy cores, Gleason score, method of pathological diagnosis, and endocrine therapy were analyzed. Results:Of all the 310 enrolled patients, the overall positive surgical margin rate was 34.2%(106/310). Univariate analysis showed that tPSA(41.3 ng/ml vs.24.8ng/ml, P=0.029), f/tPSA(0.14 vs.0.10, P=0.004), transversal diameter of prostate(46 mm vs.38mm, P=0.049), percentage of positive biopsy cores(100% vs.58%, P=0.001), and biopsy Gleason score(Gleason score≤6, =7 and ≥8: 14, 31 and 32 cases vs. 47, 64 and 42 cases, P<0.05)exhibited significant correlation with postoperative positive surgical margin. Multivariate analysis showed that transversal diameter of prostate( P=0.026) and percentage of positive biopsy cores( P=0.048) were independent risk factors for positive surgical margin. Conclusions:Transversal diameter of prostate and percentage of positive biopsy cores were independent risk factors, which help to predict the occurrence of postoperative positive surgical margin.