Objective:To investigate the selection of treatment methods for renal tumors in pilots as well as the clinical significance of robot-assisted surgery by summarizing the process of robot-assisted surgery in the treatment of renal cell carcinoma in a pilot.Methods:The diagnosis, robot-assisted surgery and aeromedical assessment of a pilot with renal cell carcinoma were reported, and the related literature was reviewed.Results:The patient was a 44-year-old male transporter pilot, who was diagnosed with a left renal mass in the middle-lower pole of the kidney during a routine abdominal CT scan. After detailed preoperative evaluation that ruled out the possibility of distant metastasis and other surgical contraindications, the patient underwent robot-assisted laparoscopic partial nephrectomy in August 2022. The postoperative recovery went well, and renal function remained within normal limits at follow-ups. In March 2023, the pilot was concluded as qualified for flight after aeromedical assessment.Conclusions:Robot-assisted partial nephrectomy can significantly reduce surgical trauma, lower the risk of complications, and maximally preserve renal function. It is a good approach to renal tumors in pilots who can recover quickly.

Objective:To investigate the selection of treatment methods for renal tumors in pilots as well as the clinical significance of robot-assisted surgery by summarizing the process of robot-assisted surgery in the treatment of renal cell carcinoma in a pilot.Methods:The diagnosis, robot-assisted surgery and aeromedical assessment of a pilot with renal cell carcinoma were reported, and the related literature was reviewed.Results:The patient was a 44-year-old male transporter pilot, who was diagnosed with a left renal mass in the middle-lower pole of the kidney during a routine abdominal CT scan. After detailed preoperative evaluation that ruled out the possibility of distant metastasis and other surgical contraindications, the patient underwent robot-assisted laparoscopic partial nephrectomy in August 2022. The postoperative recovery went well, and renal function remained within normal limits at follow-ups. In March 2023, the pilot was concluded as qualified for flight after aeromedical assessment.Conclusions:Robot-assisted partial nephrectomy can significantly reduce surgical trauma, lower the risk of complications, and maximally preserve renal function. It is a good approach to renal tumors in pilots who can recover quickly.

Objective To study the application effect of quality control circle(QCC)in reducing the dissatisfaction rate of physical examination clients in health management center.Methods To establish QCC,selected the health check-up popula-tion in our hospital in September-2019 and March-2020,through the questionnaire investigation and analysis,compare the dis-satisfaction of the clients before and after the quality control circle.Results After carrying out QCC activities,the dissatisfaction of physical examination clients was significantly lower than that before QCC,and the difference was statistically significant(P＜0.05).Conclusion The activities of QCC in the health management center can effectively improve the quality of the physical examination work and reduce the dissatisfaction of the customers in the physical examination.It is of great significance to the health management.

OBJECTIVE: To explore the clinical features and genomic abnorm ality of a fetus enlarged multicystic dysplastic kidneys with oligohydramnios caused by NPHP3 gene mutation. METHODS: The fetuse was found to have multicystic dysplastic kidneys with oligohydramnios upon ultrasonography during the second trimester. Following induced abortion, fetal tissue was collected for the extraction of DNA, chromosomal microarray analysis (CMA) and whole exome sequencing (WES). Sanger sequencing was used to verify the suspected variants in the family. RESULTS: Antenatal ultrasound examination at 19 weeks showed "polycystic" kidneys with Oligohydramnios. Delivery was by induced labour because of the critically low amniotic fluid volume. Testing of CMA was normal. WES showed a compound heterozygous mutation of c.1817G>A, p.W606X; c.432dupA, p.E145Rfs*18 mutations are novel mutations in this study. CONCLUSION The research may further expand the NPHP3 gene mutation spectrum. Enlarged multicystic dysplastic kidneys with oligohydramnios caused by NPHP3 gene mutation at least include one or two splice site mutation, frameshift mutation or nonsense mutation foetal poor prognosis.
Amniotic Fluid ; Female ; Humans ; Kidney Diseases, Cystic ; Multicystic Dysplastic Kidney/genetics* ; Mutation ; Oligohydramnios/genetics* ; Polycystic Kidney Diseases ; Pregnancy ; Ultrasonography, Prenatal

Objective:This study aimed to compare the clinical outcomes of laparoscopic pancreaticoduodenectomy (LPD) versus open pancreaticoduodenectomy (OPD).Methods:The clinical data of 386 patients who successfully underwent pancreaticoduodenectomy at the People's Hospital of Zhengzhou University from June 2017 to December 2019 were retrospectively analyzed. According to the different surgical methods, patients were divided into the LPD group ( n=122) and the OPD group ( n=264). The differences in operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications, postoperative oncology survival outcomes and prognosis between groups were compared. Results:Of 386 patients in this study, there were 232 males and 154 females, aged (57.8±11.0) years. The operation time of the LPD group was (330.69±80.55) min which was significantly longer than that of the OPD group (241.13±77.24) min. The intraoperative blood loss 300.00(200.00, 400.00) ml was also significantly less than the OPD group 400.00(262.50, 500.00) ml, and the length of postoperative stay in the LPD group (12.21±5.24) d was significantly less than the OPD group (16.61±6.63) d, (all P<0.05). There were 36 patients (29.51%) in the LPD group and 81 patients (30.68%) in the OPD group who developed postoperative complications, with no significant difference between groups ( P>0.05). Postoperative oncology outcomes showed that the number of lymph nodes dissected in the LPD group was significantly more than that in the OPD group [(12.65±5.03) vs (10.07±5.09)], ( P<0.05). There were no significant differences between the two groups in tumor pathology type, size, degree of differentiation and R 0 resection rates (all P>0.05). All patients were followed up for 6-36 months, with a median follow-up of 20 months. The survival rates of patients with malignant tumors after following-up for more than 1 year in the LPD group was 84.72%(61/72), that in the OPD group was 85.81%(133/155), with no significant difference between groups ( P>0.05). Conclusion:LPD was safe and feasible with its advantages of minimally invasiveness.

Objective To investigate the effect of targeted silencing Notch1 on proliferation and apoptosis of human non-small cell lung cancer stem cells.Methods Lung cancer A549 cells and SPC-A-1 cells were selected and divided into control group,Nc-shRNA group and Notch1-shRNA group.The Nc-shRNA group was a negative control RNAi lentivirus group,and the Notch1-shRNA group was a Notch1 inhibitory RNAi lentivirus group.The lentiviral-mediated shRNA interference technology was used to target the silencing of Notch1.The silencing effect of Notch1 gene was verified by quantitative real time polymerase chain reaction (qRT-PCR) and Western blotting.Cell proliferation was detected by methyl thiazolyl tetrazolium (MTT) and sarcosphere formation assay.Apoptosis was detected by Annexin V/7-AAD double staining.Western blotting was used to detect the expression of proliferating cell nuclear antigen (PCNA),B-cell lymphoma-2 (Bcl-2) and Notch1 downstream gene Hes-1.Results The results of qRT-PCR showed that the relative expression levels of Notch1 in control group,Nc-shRNA group and Notch1-shRNA group in A549 cells and SPC-A-1 cells were 1.000 ± 0.000,0.937 ± 0.025,0.490 ± 0.036 and 1.000 ± 0.000,1.077 ± 0.070,0.373± 0.038,with statistically significant differences (F =359.707,P ＜0.001;F =210.455,P ＜0.001),further paired comparison,the relative expression of Notch1 in Notch1-shRNA group was significantly lower than that in Nc-shRNA group (all P ＜ 0.05).Western blotting showed that the expressions of Notch1 protein in A549 cells and SPC-A-1 cells were consistent with the mRNA results.MTT assay showed that the 24 h A values of A549 cells in control group,Nc-shRNA group and Notch1-shRNA group were 0.209 ± 0.005,0.219 ± 0.009,0.159 ±0.006,48 h A values were 0.293 ± 0.004,0.302 ± 0.004,0.205 ± 0.005,72 h A values were 0.450 ± 0.003,0.430 ± 0.012,0.348 ± 0.017,with statistically significant differences (F =79.487,P＜0.001;F =508.664,P ＜0.001;F =57.156,P ＜0.001),further paired comparison,the proliferation ability of Notch1-shRNA group was significantly lower than that of Nc-shRNA group at 24,48,72 h (all P ＜ 0.05).The 48 h A values of SPC-A-1 cells in control group,Nc-shRNA group and Notch1-shRNA group were 0.438 ±0.022,0.412 ± 0.015,0.364 ± 0.010,72h A values were 0.540 ± 0.016,0.519 ± 0.009,0.438 ± 0.019,with statistically significant differences (F =15.667,P =0.004;F =37.299,P ＜ 0.001),further paired comparison,the proliferation ability of Notch1-shRNA group was significantly lower than that of Nc-shRNA group at 48 h and 72 h (all P ＜ 0.05).The sphere sizes of control group,Nc-shRNA group and Notch1-shRNA group in A549 cells were (149.667 ± 6.506) &mu;m,(136.667 ± 7.095) &mu;m,(86.676 ± 7.638) &mu;m,with statistically significant difference (F =65.940,P ＜ 0.001).The sphere sizes of the three groups in SPC-A-1 cells were (118.667 ± 6.658) &mu;m,(128.000 ± 7.000) &mu;m,(60.675 ± 4.509) &mu;m,with statistically significant difference (F =105.372,P ＜0.001).Further paired comparison,the sphere size of Notch1shRNA group was significandy smaller than that of Nc-shRNA group in the two kinds of cells (all P ＜ 0.05).The apoptosis rates of control group,Nc-shRNA group and Notch1-shRNA group in A549 cells and SPC-A-1cells were (0.489 ± 0.014)％,(0.633 ± 0.021)％,(1.683 ± 0.221)％ and (1.323 ± 0.194)％,(1.690 ± 0.188) ％,(3.017 ± 0.356) ％,with statistically significant differences (F =77.660,P ＜ 0.001;F=32.200,P =0.001),further paired comparison,the apoptosis rate of Notch1-shRNA group was significantly higher than that of Nc-shRNA group in the two kinds of cells (all P ＜ 0.05).Western blotting showed that the expressions of PCNA,Bcl-2 and Hes-1 in control group,Nc-shRNA group and Notch1-shRNA group in A549 cells were statistically significant (F =155.343,P ＜ 0.001;F =22.576,P =0.002;F =70.108,P＜0.001),and the expressions of PCNA,Bcl-2 and Hes-1 in the three groups in SPC-A-1 cells were statistically significant (F =49.419,P ＜0.001;F =28.090,P =0.001;F =12.040,P =0.007).Further paired comparison,the expressions of PCNA,Bcl-2 and Hes-1 in Notch1-shRNA group were significantly lower than those in Nc-shRNA group in the two kinds of cells,and the differences were statistically significant (all P ＜0.05).Conclusion Targeted silencing of Notch1 can reduce the proliferation activity of lung cancer stem cells and promote apoptosis,which may be related to the down-regulation of its downstream gene Hes-1.

Objective To explore the clinical differences between patients with early-onset myasthenia gravis (EOMG)and those with late-onset myasthenia gravis(LOMG).Methods This was a retrospective study enrolling 157 MG patients.Based on the age of onset,patients were divided into the EOMG group(n=85)and the LOMG group(n =72).The groups were compared on clinical characteristics,including clinical manifestations,MG classification,electrophysiological findings on repetitive nerve stimulation(RNS),single fiber electromyography(SFEMG),levels of antibody against acetylcholine receptors(Ach-R Ab),antibody to muscle-specific kinase(MuSK Ab),titin antibody(Titin Ab),ryanodine receptor antibody(RyR Ab),thyroid function,thymectomy,thymus pathology and responses to treatment.Results The mean ages of onset were markedly different [(40.9 ± 9.7) years vs.(62.0 ± 12.2) years,P＜ 0.05] between the EOMG and LOMG groups.The LOMG group was associated with a significantly higher rate of the ocular form(50.0 ％,n=36 vs.32.9％,n=28,P＜0.05),a lower rate of the general form(50.0％,n=36 vs.67.1％,n=57,P＜0.05),and an increased risk of bulbar involvement(41.7％ n=30 vs.23.5％,n=20,P＜0.05)than those in the EOMG group.There was no significant difference in positive rates of RNAS and SFEMG,and levels of AChR Ab,MuSK Ab and double serum negative(DSN)MG between the groups (P＞0.05).Moreover,patients in the EOMG group were more likely to have abnormal thyroid function and higher percentages of receiving steroids,tacrolimus,plasma exchange therapy,and thymectomy (P＜ 0.05).Conclusions The clinical profiles of LOMG are different from those of EOMG in clinical manifestations,thyroid function,thymectomy frequency,striational antibody levels and disease-modifying drug options.

AIM: To investigate the protective effect of microRNA-218 (miR-218) silencing on kidney tissue of streptozotocin (STZ)-induced diabetic nephropathy rats and the potential mechanism.METHODS: The diabetic rat model was established by a single intraperitoneal injection of STZ (50 mg/kg).Meanwhile, the miR-218 short hairpin RNA (shRNA) lentiviral vector was constructed.The Sprague-Dawley rats were randomly divided into 4 groups: healthy control group, diabetes group, empty vector group and miR-218-shRNA group.The blood glucose, 24 h urinary protein, serum creatinine (SCr) and blood urea nitrogen (BUN) in the rats at different time points (4, 8 and 12 weeks) were measured by an automated analyzer.The expression of miR-218 was detected by RT-qPCR, while the expression of heme oxygenase-1 (HO-1), nephrin and p38 mitogen-activated protein kinase (p38 MAPK) at mRNA and protein levels in the kidney tissues was determined by RT-qPCR and Western blot.The caspase-3 activity was detected by caspase-3 activity assay kit, and the cell apoptosis of the kidney tissues was analyzed by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL).RESULTS: Compared with healthy control group, the expression of miR-218 was significantly increased in STZ-treated rats.Meanwhile, the concentrations of blood glucose, 24 h urinary protein, SCr and BUN were significantly increased in STZ-treated rats (P<0.05).The mRNA and protein expression of HO-1 and nephrin was significantly decreased, while the level of phosphorylated p38 MAPK was significantly increased in STZ-treated rats.In addition, the activity of caspase-3 was also significantly increased in STZ-treated rats.When the model rats were infected with miR-218-shRNA, the expression of miR-218 was significantly decreased and the above effects were markedly reversed.Furthermore, TUNEL results showed that compared with diabetic group and empty vector group, miR-218 silencing significantly attenuated the cell apoptosis in the kidney tissues in miR-218-shRNA group.CONCLUSION: miR-218 is involved in the kidney injury in diabetic rats, and silencing of miR-218 by lentiviral vector-mediated miR-218-shRNA transfection effectively inhibits kidney cell apoptosis, suggesting that miR-218 is a potential target for the treatment of diabetic nephropathy.

BACKGROUND:Bone marrow mesenchymal stem cel s and al ogenic bones are commonly used as seed cel s and scaffolds, respectively, for constructing tissue-engineered cartilage through in vitro co-culture. The loose body of the knee joint can survive in the articular cavity for a long time, and maintain certain characteristics of cartilage tissues. Therefore, the articular cavity can provide a good environment for the growth and development of chondrocytes. OBJECTIVE:To investigate the effect of bone marrow mesenchymal stem cel s co-cultured with al ogenic bone in the articular cavity. METHODS:Bone marrow mesenchymal stem cel s were isolated from five newborn New Zealand white rabbits. One adult New Zealand rabbit was enrol ed to prepare al ogenic bone for co-culture with bone marrow mesenchymal stem cel s. Afterwards, bone marrow mesenchymal stem cel s and al ogenic bone composites were cultured in the articular cavity (intracavitary culture group) or in vitro as in vitro culture group, respectively;the normal cartilage tissues grew in the articular cavity as control group. Cel s were observed by hematoxylin-eosin staining and type II col agen immunohistochemistry staining at 4, 8 and12 weeks of culture. RESULTS AND CONCLUSION:At 12 weeks culture, hematoxylin-eosin staining showed:in the control group, chondrocytes arranged tightly and directional y with red stained cytoplasm and cartilage matrix as wel as blue nuclei;in the intracavitary culture group, the scaffold was mostly absorbed and chondrocytes grew into the scaffold in a certain direction with smaller shape, while cytoplasm and cartilage ma trix were red stained, blue nuclei appeared;in the in vitro culture group, abundant chondrocytes proliferated in a disordered arrangement. Immunohistochemistry staining showed:the absorbance ( A) values in the intracavitary culture group showed a continuous increase, but no obvious change was in the other two groups. Moreover, at 4, 8 and 12 weeks of culture, A values in the control group and intracavitary culture group were significantly higher than that in the in vitro culture group (P<0.05);at 4 and 8 weeks, A value in the intracavitary culture group was significantly lower than that in the control group (P<0.05), but at 12 weeks, there was no significant difference in A value between the two groups (P>0.05). These results suggest that the tissue-engineered cartilage can be constructed by bone marrow mesenchymal stem cells co-cultured with allogenic bone under in vitro and in vivo environment, especially in the articular cavity.

Objective To evaluate the clinical value and safety of hysteroscopy in diagnosis of abnormal uterine bleeding.Methods The clinical characters and histopathological data of 272 cases of abnormal uterine bleeding were retrospectively analyzed.They received hysteroscopy in our hospital from Jan.2010 to Jan.2015.Results Histopathological diagnosis showed 75 cases were with endometrial polyps,including 5 cases misdiagnosed as submucosal fibroids,and the correct diagnostic rate was 93.3％ (70/75).50 cases were with submucosal fibroids,and the diagnostic rate was 90.9％ (50/55).97 cases were endometrial hyperplasia,including 7 cases misdiagnosed as atypical hyperplasia or cancer by hysteroscopy,and the correct diagnostic rate was 92.8％ (90/97).19 cases were atypical hyperplasia or endometrial carcinoma,and the diagnostic rate was 73.1％(19/26).Atrophic endometrium were 23 cases.8 cases had intrauterine device remained.Conclusions Premenopausal women are more likely to present with endometrial hyperplasia,submucosal fibroids,endometrial polyps,while endometrial cancer and precancerous lesions are rare.But in postmenopausal women endometrial polyps,atrophic endometrium,cancer and precancerous lesions are mainly included.Hysteroscopic has a good diagnostic value in endometrial diseases which should be combined with histopathological examination.