Objective Flexible ureteroscopic holmium laser lithotripsy for the treatment of calculi in caliceal diverticulum complicated with perirenal hematoma has a low incidence.This paper discusses the clinical features and preventive strategies of the disease. Case Presentation The patient was a 58-year-old male, admitted due to repeated left lower back pain for two months. CT scan indicated left calyceal diverticulum stones. Transurethral flexible ureteroscopic holmium laser lithotripsy was performed. A follow-up CT scan revealed a left perirenal hematoma and the stones had shifted to the perirenal area. Percutaneous nephrolithotripsy was then performed. Four weeks after surgery, CT scan showed that the left perirenal hematoma had absorbed well. Conclusion The risk of perirenal hematoma and stone displacement may occur during ureteroscopic holmium laser lithotripsy for calyceal diverticulum stones. The risk can be effectively reduced by negative suction sheath, reduction of intraoperative perfusion pressure, reasonable use of holmium laser, and control of related factors.

Objective:To evaluate the efficacy and safety of eculizumab in treating acute attacks of aquaporin-4 antibody(AQP4-IgG)positive neuromyelitis optica spectrum disorder(NMOSD).Methods:Six patients with AQP4-IgG-positive NMOSD treated with eculizumab at the Affiliated Hospital of Qingdao University from August 2023 to April 2024 were included.The patients' clinical characteristics, changes in scores of neurological function, pain and spasm before and after eculizumab treatment, and adverse drug reactions during the treatment period were described, and the data were subjected to Friedman test using SPSS 25.0.Results:The median score of expanded disability status scale in the six patients decreased from 3.25 before treatment to 1.25 after treatment, and the difference was statistically significant ( F=44.77, P<0.01).The functional status score showed noticeable improvement as early as week 1, demonstrating greater sensitivity to treatment response.Three patients experienced moderate to severe pain before treatment, with a mean pain score of 6, which reduced to 4.67 and 1.33 at week 2 and 6, respectively( F=29.17, P<0.05).Two patients reported spasms before treatment, with a mean score of 3.00, which decreased to 2.00, 1.50, and 1.00 at week 2, 3, and 6 after treatment, respectively( F=18.00, P>0.05).No serious adverse reactions were reported during the treatment. Conclusion:Eculizumab can effectively improve the neurological function and alleviate pain in patients with AQP4-IgG-positive NMOSD during acute attacks, and demonstrate good safety.

Objective:To evaluate the efficacy and safety of eculizumab in treating acute attacks of aquaporin-4 antibody(AQP4-IgG)positive neuromyelitis optica spectrum disorder(NMOSD).Methods:Six patients with AQP4-IgG-positive NMOSD treated with eculizumab at the Affiliated Hospital of Qingdao University from August 2023 to April 2024 were included.The patients' clinical characteristics, changes in scores of neurological function, pain and spasm before and after eculizumab treatment, and adverse drug reactions during the treatment period were described, and the data were subjected to Friedman test using SPSS 25.0.Results:The median score of expanded disability status scale in the six patients decreased from 3.25 before treatment to 1.25 after treatment, and the difference was statistically significant ( F=44.77, P<0.01).The functional status score showed noticeable improvement as early as week 1, demonstrating greater sensitivity to treatment response.Three patients experienced moderate to severe pain before treatment, with a mean pain score of 6, which reduced to 4.67 and 1.33 at week 2 and 6, respectively( F=29.17, P<0.05).Two patients reported spasms before treatment, with a mean score of 3.00, which decreased to 2.00, 1.50, and 1.00 at week 2, 3, and 6 after treatment, respectively( F=18.00, P>0.05).No serious adverse reactions were reported during the treatment. Conclusion:Eculizumab can effectively improve the neurological function and alleviate pain in patients with AQP4-IgG-positive NMOSD during acute attacks, and demonstrate good safety.

Objective:To investigate the clinical efficacy and safety of rituximab combined with chemotherapy in the treatment of small B-cell lymphoma.Methods:A retrospective series study was conducted. The clinical data of 44 small B-cell lymphoma patients with complete follow-up data who received rituximab combined with chemotherapy in Zaozhuang Municipal Hospital from January 2017 to August 2022 were retrospectively analyzed. The clinicopathological characteristics and prognosis of patients were also analyzed.Results:All the 44 patients with small B-cell lymphoma included 28 males and 16 females; the age was (62±13) years. Among the 44 patients, there were 27 cases of chronic lymphocytic leukemia, 7 cases of follicular lymphoma, 2 cases of lymphoplasmacytic lymphoma/Waldenstr?m macroglobulinemia, 3 cases of splenic marginal zone lymphoma, 1 case of lymph node marginal zone lymphoma and 1 case of hair-cell leukemia, 3 cases of unclassified B-cell chronic lymphocyte proliferative disease. Follow-up time [ M ( Q1, Q3)] was 35.5 months (18.5 months, 52.0 months). The complete remission (CR) rate, partial remission rate and the objective remission rate was 61.36% (27/44), 29.55% (13/44) and 90.91% (40/44), respectively. There were statistically significant differences in CR rates in patients with different expression levels of β 2-microglobulin, lactate dehydrogenase and ZAP-70 (all P < 0.05), while the differences in CR rates among patients with different age, gender and bone marrow infiltration were not statistically significant (all P >0.05). Until the last follow-up, the median overall survival (OS) time was not reached, the median progression-free survival (PFS) time was 65 months. The incidence of hematological adverse reactions was 27.27% (12/44), which was well tolerated. No serious non-hematological adverse reactions were observed. Conclusions:Rituximab combined with chemotherapy could improve the therapeutic effect, prolong PFS and OS time of patients with small B-cell lymphoma. The adverse reactions can be tolerated.

Objective To determine the dose-response relationship of sufentanil blunting responses to double-lumen endotracheal intubation when combined with propofol given by target-controlled infusion (TCI) in patients with pulmonary tuberculosis.Methods One hundred patients of both sexes with pulmonary tuberculosis,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,aged 24-58 yr,with body mass index ＜30 kg/m2,with Mallampati grade Ⅰ or Ⅱ,undergoing thoracic surgery under general anesthesia,were divided into Ⅰ-Ⅴ groups (n =20 each) using a random number table.Anesthesia was induced with iv sufentanil 0.35 μg/kg (group Ⅰ),0.40 μg/kg (group Ⅱ),0.45 μg/kg (group Ⅲ),0.50 μg/kg (group Ⅳ) and 0.55 μg/kg (group Ⅴ),and propofol TCI (target plasma concentration 3.5 μg/ml) and iv vecuronium 0.15 mg/kg.The patients were endotracheally intubated and mechanically ventilated.The response to double-lumen endotracheal intubation was defined as positive when mean arterial pressure increased by＞ 20％ of the baseline value and/or heart rate ＞ 90 bpm within 5 min after intubation.The median effective dose (ED50),ED95 and 95％ confidence interval (95％ CI) of sufentanil blunting the responses to double-lumen endotracheal intubation were calculated by Probit analysis.Results The ED50 (95％ CI) and ED95 (95％ CI) of sufentanil blunting the responses to intubation were 0.411 (0.370-0.441) μg/kg and 0.635 (0.556-0.888) μg/kg,respectively,when combined with propofol given by TCI.Conclusion When combined with propofol given by TCI (target plasma concentration 3.5 μg/ml),the ED50 and ED95 of sufentanil blunting the responses to double-lumen endotracheal intubation are 0.411 and 0.635 μg/kg,respectively,in patients with pulmonary tuberculosis.

Objective To evaluate the effect of mild hypothermia on the expression of phosphorylated eukaryotic translation initiation factor 2α (p-eIf2αt) in the hippocampus in a mouse model of cerebral ischemia-reperfusion (I/R).Methods Sixty pathogen-free healthy male C57BL6 mice,aged 8-12 weeks,weighing 20-30 g,were divided into 3 groups (n =20 each) using a random number table:sham operation group (group S),group I/R and mild hypothermia group (group H).Cerebral I/R was induced by 15-min occlusion of bilateral common carotid arteries followed by reperfusion in chloral hydrate-anesthetized mice.Surface cooling was started immediately after reperfusion to maintain the rectal temperature at 32-34 ℃ for 3 h in group H.The neurologic deficit score was evaluated at 24 h of reperfusion.The mice were then sacrificed,brains were immediately removed,and hippocampi were isolated for examination of pathologic changes of hippocampal CA1 region and for determination of neuroapoptosis (by TUNEL) and expression of peIf2α (by Western blot).The apoptosis rate was calculated.Results Compared with group S,the neurologic deficit scores at 24 h of reperfusion and apoptosis rate of hippocampal neurons were significantly increased,and the expression of p-eIf2α was up-regulated in I/R and H groups (P＜0.05).Compared with group I/R,the neurologic deficit scores at 24 h of reperfusion and apoptosis rate of hippocampal neurons were significantly decreased,and the expression of p-eIf2α was down-regulated in group H (P＜ 0.05).Conclusion Mild hypothermia reduces endoplasmic reticulum stress and inhibits neuroapoptosis through inhibiting the expression of p-eIf2α in the hippocampus in a mouse model of cerebral I/R.

Background and objective China is a high-incidence area of lung cancer,and its morbidity and mortality were the highest in malignant tumors.At present,the popularization of low-dose computed tomography (CT) examination has significantly improved the detection rate of early lung cancer,anatomical segmentectomy is currently widely used early in non-small cell lung cancer (NSCLC) and those who cannot tolerate lobectomy in patients with lung cancer.However,the anatomical structure of segment and its surgical operation is relatively complex,lead to segmentectomy has a high risk and difficulty.We performed anatomical segmentectomy by use of combining three-dimensional computed tomography bronchography and angiography (3D-CTBA) and three-dimensional video-assisted thoracic surgery (3D-VATS) single-operationhole minimally invasive surgery in the treatment of NSCLC to investigate its clinical effect,and evaluate its clinical relevant feasibility and theoretical basis.Methods We carried out a retrospective review of the 57 cases by use of combining 3D-CTA in preoperative and 3D-VATS single-operation-hole anatomical segmentectomy in intraoperative in the treatment of NSCLC performed in Department of Thoracic Surgery,the First Affiliated Hospital of Soochow University from October 2015 to April 2017.Results The whole group was successfully performed by use of VATS without anyone conversion to thoracotomy.The mean operation time was (142.2±28.3) min,and the mean blood loss was (93.8±46.5) mL.The mean number of lymph node dissection was (9.1±2.2),and the mean postoperative thoracic drainage was (429.8±181.2) mL.The postoperative retention of chest tube time was (2.8±1.1) d.The mean hospitalization time was (5.2±1.3) d.The postoperative pathology showed 9 cases with benign lesions,accounting for 15.7％,48 cases with malignant lesions,accounting for 84.2％.Postoperative complications:pulmonary infection in 3 cases (5.2％),atelectasis in 1 case (1.9％),small amount of hemoptysis in 1 case (1.9％),lung leakage ＞3 d in 2 cases (3.5％).Arrhythmia in 4 cases (7.0％).The patients were followed up for 10 months.No complications occurred such as bronchial pleural fistula,chylothorax,encapsulated pleural effusion and those patients were followed up without recurrence and distant metastasis.Conclusion The use of combining 3D-CTBA and 3D-VATS single-operation-hole to anatomical segmentectomy is safe and effective in the treatment of NSCLC and is suitable for early non-small cell lung cancer,especially those can not tolerate lobectomy.

Objective To establish a chromogenic assay for blood-plasma collagenase Ⅳ in order to evaluation the reference range of collagenase Ⅳ in the plasma of healthy individuals.Methods The assay was based on measurement of terminal amino group with succinylated gelatin as substrates and TNBS as chromogenic reagent.The optical density of each reaction was determined at 405 nm using a Sunrise microplate reader.Chromatographic and detection conditions were optimized and performance of the methed was evaluated by recovery experiments and precision experiments.It was compared with ELISA.The levels of collagenase Ⅳ in 112 health persons'plasma were determined and the data were analyzed by SPSS statistical software.Results The whole determing time was within 1.5 h,the linear range of this method was 1.5-10.0 mg/L,and the minimum detection limit was 0.965 mg/L.They were well correlated with ELISA results (R~2=0.999 7,P＜0.01).The within-run CV was less than 3.16%and between-run CV was less than 9.81%.The 95%confidence interval of collagenase Ⅳ in healthy plasma was 33.38-49.80 mg/L.Conclusion This chromogenic assay for blood-plasma collagenase Ⅳ can be used for measurement of collagenase Ⅳ in blood-plasma and the reference range of collagenase Ⅳ in healthy plasma was established.

Objective A high-performance liquid chromatography(HPLC)method was modified and used to determine the inhibitory effects of GM6001 and inhibitor A on tumor necrosis factor-α converting enzyme(TACE).Methods TACE and polypeptides substrate were incubated for 15 min at 37°C.Ala-Dpa was added as internal standard of quantitative analysis.Then the solution was analyzed by HPLC.The 55% methanol aqueous solution was used as the mobile phase.The wavelength of detector was 353 nm.The ratio of the peak area of remaining substrate to that of internal standard was determined.And the amounts of inverted substrate could be obtained from calibration curve.The TACE activity could be calculated.Results The relative peak areas of substrate were linearly increased depending on the growth of substrate concentration.The correlation coefficient was 0.996 8 and linear range was from 10 to 400 μmol/L.Precision experiments indicated that the precision was improved obviously by using internal standard method in the determination of TACE activity by HPLC.The values of 50% inhibitory concentration IC50 of GM6001 and inhibitor A determined by the newly proposed method were 317.5 and 175.8 nmol/L,respectively.Conclusion The HPLC method assaying TACE activity with Ala-Dpa as internal standard is more accurate,and more practical for screening of TACE inhibitors.

The crystal structural data of TACE, MMP-1, MMP-2, MMP-3 and MMP-9 were obtained from PDB database, and then their catalytic domains' properties including conformation, molecular surface hydrophobicity and electrostatic potential were analyzed and compared by using Insight II molecular modeling software. It was found that the conformation and molecular surface hydrophobicity of catalytic domains of TACE and MMPs were not obviously different, but the molecular surface electrostatic potential of catalytic domain of TACE and MMPs had obvious differences. The findings are helpful in the Rational Drug Design of TACE selective inhibitor.