Objective:To evaluate the impact of metastatic site on the prognosis in patients with metastatic renal cell carcinoma (mRCC), and it′s value for modifying the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria.Methods:The data of 218 patients pathologically diagnosed with mRCC were analyzed retrospectively in West China Hospital from Jan. 2009 to Dec. 2019. Among all patients, 71.6%(156/218) were male, and 89.0% (194/218) underwent nephrectomy. Most of the patients were pathologically diagnosed with renal clear cell carcinoma (176 patients, 80.7%). Lung (137/218, 62.8%) was the most observed metastatic site, following by bone (47/218, 26.1%), lymph node (37/218, 17.0%) and liver (23/218, 10.6%). All patients were classified into favorable (26 patients, 11.9%), intermediate (126 patients, 57.8%) or poor (37 patients, 17.0%) risk group according to IMDC criteria. Endpoints of this study were progression-free survival (PFS), overall survival (OS) and tumor response. The impact of metastatic sites on patients’ prognosis was analyzed, and those that had significant relationship with prognosis were then added into IMDC criteria and a modifying IMDC model was established. Predictive value of this model was further evaluated by calculating concordance index (C-index).Results:In the whole cohort, median PFS and OS were 13.0 and 33.0 months. Survival analysis suggested that patients with bone ( P=0.004), brain ( P=0.042) and liver ( P=0.046) had significantly shorter OS. Thus, patients were divided into two groups: patients with bone/brain/liver metastasis (82 patients, 37.6%) and patients with other metastatic sites (136 patients, 62.4%). Compared with patients with other metastatic sites, those who with bone/brain/liver metastasis had inferior tumor response by TKIs treatment (disease control rate: 51.2% vs. 73.5%, P=0.004). Multivariate analysis suggested that bone/brain/liver metastasis had negative impact on OS (25.0 vs. 47.0 mo, P=0.039). Furthermore, bone/brain/liver metastasis also showed significant relationship with shorter OS in IMDC low (30.0 vs. 62.0 months, P=0.036), intermediate (31.0 vs. 48.0 months, P=0.048) or high (7.0 vs. 18.0 months, P=0.037) risk group, indicating that metastatic site had predictive value for prognosis of mRCC patients. Based on that, bone/brain/liver metastasis were added into the IMDC criteria, and weighting each parameter was weighted according to its coefficient to patients’ OS. Finally, a modified IMDC scoring system were established. C-index of this modified model was 0.669 (0.599 for current IMDC criteria). Conclusions:Bone/brain/liver metastasis in mRCC patients indicated a shorter OS duration. When adding bone/brain/liver metastasis as a predictive parameter for prognosis of mRCC patients into IMDC criteria, the modified IMDC criteria could offer more accurate prediction for patients’ survival.

Objective To analyze the hemodynamic parameters of anomalous origin of the right coronary artery from the left coronary artery sinus (AORL) based on computational fluid dynamics (CFD), so as to make an evaluation of the disease. Methods A normal right coronary artery (RCA) case and an AORL case were selected. Two models were reconstructed in Mimics software and imported into ANSYS CFX software for hemodynamics simulation. The hemodynamics of normal RCA model and AORL model were compared. Results AORL model had a smaller volume flow (9.35 cm3/s), which might lead to insufficient blood supply downstream of the RCA; the pressure at the acute corner of AORL model (13.78 kPa) was lower than normal RCA model (14.9 kPa); the wall shear stress (WSS) of AORL model (12.83 Pa) was larger than that of normal RCA model (9.74 Pa); the total deformation of AORL model was relatively large. Conclusions The entrance velocity and pressure of AORL were lower than those of normal RCA, which might lead to ischemic symptoms. The research findings are of theoretical significance for the effective evaluation of ischemia and other diseases in clinic.

Objective To investigate the pathogens and their antibiotic resistance in patients with peritoneal dialysis‐related peritonitis .Methods The clinical data including pathogens ,antibiotic resistance profile of 213 patients with peritoneal dialysis‐related peritonitis who were treated in our peritoneal dialysis center from January 2011 to December 2013 were analyzed retrospectively .Results Dialysate culture was positive for 132 (62 .0% ) of the 213 cases ,resulting in a total of 140 strains of microorganisms ,including 84 strains of gram positive cocci ,37 strains of gram‐negative bacilli ,10 strains of fungus and 9 strains of gram positive bacilli . Coagulase‐negative Staphylococcus was the most common gram positive bacteria while Escherichia coli was the most common gram negative bacteria isolated from the effluent .The prevalence of methicillin‐resistant S .aureus and methicillin‐resistant coagulase negative Staphylococcus was 14 .3% (1/7) and 43 .2% (19/44) ,respectively . About 44 .4% (8/18) of the E .coli and K . pneumoniae isolates produced extended spectrum beta‐lactamases .All the gram‐positive cocci were sensitive to vancomycin and linezolid and slightly resistant to chloramphenicol (6 .3% ) , moxifloxacin (8 .5% ) , and rifampicin (9 .5% ) , but highly resistant to cefazolin (90 .0% ) ,followed by ampicillin (76 .7% ) ,oxacillin (71 .2% ) and penicillin (69 .7% ) . Coagulase negative Staphylococcus isolates were sensitive to vancomycin , linezolid , tigecycline , quinupristin‐dalfopristin and daptomycin ,but all resistant to cefazolin and ampicillin ,and highly resistant to penicillin (91 .9% ) and oxacillin (82 .5% ) .All the gram‐negative bacilli were sensitive to meropenem ,ertapenem ,cefoperazone‐sulbactam and tigecycline .About 80 .6% and 65 .5% of the gram‐negative bacilli were resistant to ampicillin and peperacillin ,respectively .E .coli isolates were sensitive to meropenem ,ertapenem and piperacillin‐tazobactam but highly resistant to ampicillin (81 .3% ) and piperacillin (71 .4% ) . Conclusions Gram‐positive cocci especially Staphylococcus and gram negative bacteria E .coli are major pathogens in peritoneal dialysis‐related peritonitis .Adequate microbiological culture and suitable antimicrobial therapy are key to successful treatment of the peritonitis associated with peritoneal dialysis .

BACKGROUND:Calcitonin gene-related peptide has been confirmed to induce osteogenic differentiation, but whether it can induce the osteogenic differentiation of adipose-derived stem cells under three-dimensional culture to construct tissue-engineered bone is rarely reported.
OBJECTIVE:To investigate the feasibility of exogenous calcitonin gene-related peptide to induce osteogenic differentiation of adipose-derived stem cells combined with calcium alginate gel in three-dimensional condition.
METHODS:Adipose-derived stem cells were gained by col agenase I digestion of the subcutaneous adipose tissue of both inguinal regions of New Zealand rabbits. Passage 3 cells were mixed with sodium alginate to prepare calcium alginate gel, and then the cells were assigned into two groups and cultured in 24-wel plates. Adipose-derived stem cells in the control group were cultured in Dulbecco’s modified Eagle’s medium/Ham’s nutrient mixture F-12 supplemented with 10-2 mol/Lβ-glycerophosphate sodium, 10-7 mol/L dexamethasone, 50 mg/L ascorbic acid, 10%fetal bovine serum. While, adipose-derived stem cells in the experimental group were incubated with the same medium as above, but 1.5 μg/L calcitonin gene-related peptide was added. The cells proliferation and the mRNA expressions of col agen I and osteocalcin were detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and reverse transcription-PCR respectively, and alkaline phosphatase and calcium concentration were detected at different induction time.
RESULTS AND CONCLUSION:The cellproliferation curves were S shaped. The absorbance values of the experimental group were higher than those of the control group at1, 3, 5, 7, 14, 21 days after osteogenic induction (P<0.05). Alkaline phosphatase and alizarin red staining of adipose-derived stem cells was al positive, but golden round nodes became more and bigger in the experimental group compared with the control group after 2 weeks. At 7 and 14 days, col agen I and osteocalcin mRNA expressions were higher in the experimental group than in the control group. Alkaline phosphatase activity and calcium concentration of the experimental group were higher than those of the control group at 1, 2, 3, 4 weeks after osteogenic induction (P<0.05). Results showed that the calcitonin gene-related peptide can induce the osteogenic differentiation of adipose-derived stem cells combined with calcium alginate gel.

BACKGROUND: The inoculation of hybridoma cell strain onto mouse abdominal cavity may obtain ascites containing mass antibody. Previous method to purify monoclonal antibody in ascites is complex and difficult to operate.OBJECTIVE: To prepare, purify and label anti-human leukocyte antigen (HLA)-I class molecule light chain monoclonal antibody, and to detect the expression of tumor cell surface HLA-I class molecules. METHODS: Hybridoma cells were inoculated onto the mouse abdominal cavity. Ascites containing anti-human light chain beta2-microglobulin antibody were obtained and purified with the modified caprylic acid-ammonium sulfate method. The purified monoclonal antibody was labeled with fluorescein isothiocyanate to detect peripheral blood mononuclear cells, T2 cells expressing blank HLA-A2 molecule and K562 cells surface HLA-I class molecules. The expression of HLA-I class molecules was determined by using flow cytometry and fluorescent microscopy. RESULTS AND CONCLUSION: The purified anti-human light chain beta2-microglobulin-fluorescein isothiocyanate monoclonal antibodies accounted for 96% purity. Flow cytometry results showed that, the HLA-I class molecules were highly expressed in peripheral blood mononuclear cells surface, lowly expressed in T2 cells, and not expressed in K562 cells surface. It is a simple and convenient method to purify ascites with the modified caprylic acid-ammonium sulfate method, and according prepare anti-human light chain beta2-microglobulin-fluorescein isothiocyanate. This method is effective to distinguish the levels of HLA-I class molecules expressed in various cells.

Building of medical teams was a basic preparation for Beijing 2008 Olympic Games and Paralympic Games as well. In this consideration, the Beijing Organizing Committee for the Olympic Games (BOCOG) and Beijing Health Bureau developed a complete set of mechanism to integrate human resources, coveting standards development, selection, training and testing for members of medical teams. This ensures the success of medical services delivery and provides medical services delivery of subsequent Large-scale activities with valuable experiences as well

Objective To explore optimal methods and an opportunity of the management of scalp and facial burns caused by sulphuric acid,so as to prevent the development of facial hypertrophic scar and deformity. Methods Early zoning management were carried out in burn patients by sulphuric acid : ⑴Early (postburn 1～4 days) escharectomy and full or split thickness skin grafting were carried out in up-facial( forehead,temporal and up eyelid) ; ⑵Early(postburn 9～12 days) peeling of eschar and split thickness skin grafting were applied in cheek. ⑶Scalp expansion or skin grafting in granulation laterly in scalp wound according its shape and area.Results The wounds in 6 cases had healed comfortably ,hypertrophic scar and facial deformity were not occurred during the followed-up.3 cases of scalp burns scarring baldness were avoided.Conclusion Scalp and facial burns by sulphuric acid could be managed as early escharectomy and peeling of eschar and zoning skin grafting.As result,facial scar hypertrophy and deformity could be avoided.

Objective To evaluate the therapeutic effect of the jejunal interposition reconstruction type Ⅰ and Ⅱ after total gastrectomy in patients with gastric carcinoma.Methods 31 cases of gastric carcinoma operated were retrospectively analyzed, 16 patients after total gastrectomy were reconstructed to have a jejunal interposition type Ⅰ and 15 a jejunal interposition reconstruction type Ⅱ. The clinic data of the two types jejunal interposition reconstruction were assessed during 6 months ～5 years follow-up. Results 30- 60 minutes and 80-120 minutes barium agent emptying time of type I and II were 62.5%,66.7% and 37.5%,33.3% respectively;normal diet regimen(4～6 meals/d)was recovered,plasma total protein 56～75g/L accounted for 74 2%(23/31),46～56g/L accounted for 25 8%(8/31).Hemoglobin 110～160g/L accounted for 38 7%(12/31) 96～105g/L accounted for 61 3%(19/31).Mean body weight was decreased by 3～5kg in all groups.9 cases recovered eight physical strength labor.The visick scoring of the 87 7% patients with type I and the 86 7% patients with type II was I-II grades. Reflux oesophagitis of the patients with type I was 12 5%. Conclusions The jejunal interposition reconstruction type Ⅰ and Ⅱ is suitable reconstruction after total gastrectomy to improve quality of life and to reduce complications and to maintain the canal of the chyme through the duodenal tract.

Purpose: To evaluate the therapeutic effect of the jejunal interposition reconstruction SS and P type after total gastrectomy in patients with gastric carcinoma. Methods: 31 cases with gastric carcinoma operated on from June, 1990 - Octuber, 2000 were retrospectively analyzed. After total gastrectomy 16 patients were operated by jejunal interposition reconstruction SS type and 15 a jejunal interposition reconstruction P type. The clinic materials of the two types of jejunal interposition reconstruction were assessed by 6 months -5 years follow-up. Results: 30 -60 minutes and 80 - 120 minutes Ba emptying time of SS and P type were 62. 5%, 66. 7% and 37. 5%, 33. 3% respectively ; BLA were 73. 6 + 1. 1% and 74. 4 + 1. 3% , respectively; HB were 15 +1.3 and 15 +1.5; The Visick scoring of the 87. 7% patients with S type and the 86. 7% patients with P type was Ⅰ - Ⅱ grades. Reflux oesophagitis of the patients with S type was 12. 5%. Conclusions: The jejunal interposition reconstruction SS and P type after total gastrectomy are effective means to improve quality of life and to reduce complications after gastrectomy and to maintain the canal of the chyme through the duodenal tract.

AIM\ To observe the effect of methionine enkephalin(Met Enk) on proliferation and mechanism involved by opiate receptor of peripheral blood lymphocyte(PBL) from patients with systemic lupus erythematosus(SLE). METHODS\ Lymphocyte proliferation assay. RESULTS\ Naloxone (Nal,1?10 -6 mol?L -1 )could block the increasing effect of Met Enk(1?10 -8 ～1?10 -6 mol?L -1 )on the PBL proliferation of normal humans,but there was no direct effect on that. However,Nal could not only block the promotive action of Met Enk on PBL proliferation of SLE patients,but there was a direct decreasing effect on it. CONCLUSION\ Endogenous Met Enk may participate in the abnormal regulation with SLE PBL via opiate receptor.