【Objective】 To explore the safety and efficacy of a novel endoscopic two-wire guided dilation in the creation of channels in percutaneous nephrolithotomy (PCNL). 【Methods】 Clinical records of 180 patients undergoing PCNL during Oct.2020 and Oct.2022 were retrospectively analyzed. The patients were divided into three groups, 60 in AMD group (fascial amplatz dilation), 60 in OSD group (one shot dilation) and 60 in END group (endoscopic dilation). Time to establish channels, operating time, failure of access, stone clearance rate, drop in hemoglobin, embolization rate, fever rate, blood transfusion rate and postoperative hospitalization were compared among the three groups. 【Results】 There were no significant differences in the general data among the three groups (P>0.05). Compared with AMD and OSD groups, END group needed significantly reduced time to establish the first channel [(5.6±0.8) min vs. (4.9±1.4) min vs. (4.2±0.5) min, (P<0.05)] . Compared with OSD group, END and AMD groups had significantly more hemoglobin drop [(14.0±17.6) g/L vs. (19.4±12.6) g/L vs. (10.2±6.8) g/L, (P<0.05)] . There were no significant differences in terms of failure of establishing channels, operating time, stone clearance rate, embolization rate, fever rate, blood transfusion rate and postoperative hospitality. Four patients needed selective renal artery embolization (1 case in AMD group and 3 in OSD group). No serious complications such as organ injuries, septic shock or death occurred. 【Conclusion】 Endoscopic two-wire guided dilation is simple, with few complications and good application value.

Objective:To explore the clinical value of laparoscopic abdominoperineal resection(LAPR) with pelvic peritoneum closure for patients with low rectal cancer.Methods:The clinicopathological data of 90 patients with low rectal cancer who underwent laparoscopic abdominoperineal resection from Mar 2014 to Jan 2019 at the Subei People's Hospital of Jiangsu Province were retrospectively analyzed. These patients were divided into closed pelvic floor peritoneum group (study group, n=42) and without pelvic floor peritoneum group (control group, n=48) . Results:The postoperative hospital stay of the study group was shorter than that of the control group[(10.8±3.0) d vs. (12.4±3.1) d, t=2.569, P=0.013]. There was no statistically significant difference in the operation time , intraoperative blood loss , time to first flatus ,first time of getting out of bed between the two groups. Perineal incision infection and perineal incision dehiscence occurred in 2 cases and 1 case in the study group, and 10 cases and 9 cases in the control group respectively (χ 2= 5.007, P=0.025; χ 2=6.077, P=0.033). In the study group, there were 0 cases of perineal hernia, 1 case of pelvic floor peritoneal hernia and 2 cases of adhesive intestinal obstruction, while those in the control group were 7 cases, 8 cases and 9 cases, respectively (χ 2=6.642, P=0.013; χ 2=5.079, P=0.033; χ 2=4.085, P=0.043). Conclusion:Laparoscopic abdominoperineal resection with pelvic peritoneum closure significantly reduces the incidence of postoperative perineal-related complications and shorten postoperative hospital stay.

Objective:To evaluate the safety and feasibility of laparoscopic selective lateral lymph node dissection (LLND) for radical resection of rectal cancer.Methods:From Dec 2018 to Jul 2020, at the Department of Gastrointestinal Surgery of Northern Jiangsu People's Hospital laparoscopic radical resection of rectal cancer was performed in 32 cases and radical resection plus selective LLND in 26 cases.Results:The operation time in the LLND group was significantly longer than that in the simple radical resection group [247(179-405) min vs. 146(118-258) min, Z=-5.169, P<0.001], but there was no significant difference in intraoperative bleeding [68(45-500) ml vs. 56(25-500) ml, Z=-1.598, P=0.110], postoperative ventilation time [2.5(1-6) d vs. 3.0(1-6) d, Z=-0.120, P=0.905], postoperative hospital stay [9.0(7-17) d vs. 9.5(6-14) d, Z=-1.050, P=0.294] and hospitalization costs [(49 000±3 000) RMB vs. (48 000±3 000) RMB, t=-1.072, P=0.289] between the two groups. The incidence of postoperative complications in the two groups was 19% and 27% respectively (χ 2=0.551, P=0.458). The number of lateral lymph node dissection in LLND group was 8(6-16), 5 of 26 patients had lateral lymph node metastasis, with a metastasis rate of 19%. Conclusion:Laparoscopic radical resectim plus selective LLND for rectal cancer harvests more lateral lymph node metastasis without causing higher complications .

Objective:To compare laparoscopic-assisted distal gastrectomy (LADG) and laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) for early gastric cancer (EGC). Methods:Firty-two EGC patients from Sep 2018 to Aug 2020 in Northern Jiangsu People's Hospital were divided into LAPPG group ( n=21) and LADG group ( n=31). Results:The average operation time in the LAPPG and LADG groups was (173±30) min and (144±31)min, respectively ( t=3.34, P=0.002). The average levels of Hb and albumin (ALB) in the LAPPG group were (128.7±16.0) g/L and (41.2±4.8) g/L respectively 3 months after gastrectomy, ( t=2.482, P=0.016 and t=2.097, P=0.041) compared to LADG group at (118.2±14.1) g/L, (38.4±4.7) g/L. According to the Clavien-Dindo classification, the incidence of complications above grade Ⅱ was 19.0% in LAPPG group and 22.6% in LADG group, and the difference was not statistically significant ( χ2=0.007, P=0.934). The PGSAS-45 questionnaire scoring results show that LAPPG scores were lower in the dumping syndrome and life dissatisfaction subscales ( t=-2.706, P=0.008 and t=-2.893, P=0.004) Conclusion:LAPPG procedure for the treatment of EGC patients is safe and feasible, promoting early postoperative nutritional recovery. In adition to less dumping syndrome and better postoperative quality of life .

Objective To prospectively survey the well-known experts of critical care and endocrine secretion to summarize their experience in treating diabetes mellitus complicated by sepsis for the purpose of providing guidance of theory and practice in making treatment schemes of traditional Chinese medicine for such disease.Methods The questionnaires were designed and submitted to the experts.The statistic analysis was undertook to investigate the rules.Results A total of 30 questionnaires were released and 28 were retrieved.The experts generally believed that eight-principle syndrome differentiation was the most useful method in the syndrome differentiation and treatment of this disease.The heat,stasis and toxin were usually acted as the main pathogenic factors while damp and phlegm commonly act as secondary pathogenic factors.They thought that weak body resistance under the invading of evil was the key mechanisms in the deterioration of the disease and they chose clearing heat,activating blood and detoxication as 3 core treatment principles.Conclusions The summarized opinions from the experts should be act as important reference in treating this disease,but its effectiveness and possibility for further generalization need to be validated in the clinical practice.

OBJECTIVE: To identify and analyze drug sensitivity of Corynebacterium glucuronolyticum iscolated from clinic, and to provide reference for clinical drug use. METHODS: Two strains isolated from the urine specimens of urolithiasis-induced urinary tract infection patients in our hospital were inoculated into Columbia blood plate and the MacConkey plate. The growth of strains was observed and counted. Protein mass spectrometry of strains was detected by MALDI-TOF-MS. DNA of strains was extracted, and PCR was used to amplify the 16S ribosome RNA (rRNA) sequence. Bi-directional sequencing of 1 500 bp target bands was conducted. Blast comparison between it and GenBank database was conducted to identify bacterial strain. Drug resistance of 2 strains was monitored by Etest assay. RESULTS: Two strains grew on the Columbia blood plate (with colony forming unit ＞105 CFU/mL) and did not grow on the MacConkey plate. Two strains were Gram-positive Corynebacterium and showed palisading or eight type arrangement. Two strains were C. glucuronolyticum by MALDI-TOF-MS identification, with reliability of 99. 9％. The characteristic peaks of m/z 2 431, 3 089, 3 364, 3 378, 4 200, 5 508, 6 302, 6 637, 6 730, 6 946, 12 603 appeared. Blast comparison showed that the sequence homology of 2 strains compared with C. glucuronolyticum strain known in GenBank were higher than 98 ％. Results of drug sensitivity test showed that strain 1 was resistant to ceftriaxone and ciprofloxacin, and sensitive to 14 other antibiotics as penicillin G; strain 2 was resistant to ceftriaxone, erythromycin, ciprofloxacin, tetracycline and clindamycin, moderately sensitive to cefotaxime, and sensitive to 10 other antibiotics. CONCLUSIONS: Two strains are C. glucuronolyticum, and drug resistance of them to commonly used antibiotics is different. The strains are rare pathogen of urinary tract and show multidrug resistance. Antibiotics should be selected according to the results of strain identification and drug sensitivity test.

BACKGROUND: Previous studies have demonstrated that the well combination of decellularized matrix and appropriate seeded cells could construct a tissue-engineered kidney.OBJECTIVE: To review advances in kidney tissue engineering and decellularized matrix.METHODS: The first author retrieved CNKI, Wanfang and PubMed databases for articles addressing kidney tissue engineering published from January 1996 to April 2016. The key words were decellularized matrix,extracellular matrix,tissue engineering, kidney, seeded cells in English and Chinese,respectively.RESULTS AND CONCLUSION: The decellularized matrix loses its immunogenicity due to the removal of cellular components, while it retains the important bioactive components of the extracellular matrix and the ultrastructure of the tissues and organs, making it more and more important in kidney tissue engineering. The decellularized matrix especially exerts an important role in the tissue-engineered construction of the entire kidney as driven by recently emerging all-organ acellular cell technology. Remarkable advances in kidney tissue engineering and decellularized matrix have been made in recent years, and realized the construction of a certain functional tissue-engineered kidney. However, there are still many challenges on the way to construct a completely functional tissue-engineered kidney.BACKGROUND: Previous studies have demonstrated that the well combination of decellularized matrix and appropriate seeded cells could construct a tissue-engineered kidney.OBJECTIVE: To review advances in kidney tissue engineering and decellularized matrix.METHODS: The first author retrieved CNKI, Wanfang and PubMed databases for articles addressing kidney tissue engineering published from January 1996 to April 2016. The key words were decellularized matrix,extracellular matrix,tissue engineering, kidney, seeded cells in English and Chinese,respectively.RESULTS AND CONCLUSION: The decellularized matrix loses its immunogenicity due to the removal of cellular components, while it retains the important bioactive components of the extracellular matrix and the ultrastructure of the tissues and organs, making it more and more important in kidney tissue engineering. The decellularized matrix especially exerts an important role in the tissue-engineered construction of the entire kidney as driven by recently emerging all-organ acellular cell technology. Remarkable advances in kidney tissue engineering and decellularized matrix have been made in recent years, and realized the construction of a certain functional tissue-engineered kidney. However, there are still many challenges on the way to construct a completely functional tissue-engineered kidney.

Objective To compare the early outcomes of laparoscopic and open resection and evaluate the safety and feasibility of laparoscopic surgery in patients with colorectal cancer aged ≥ 70 years.Methods A total of 91 consecutive patients with colorectal adenocarcinoma underwent surgery in Yizheng City People's Hospital between Jan.2009 and Dec.2015.In 91 patients included in this study,38 received laparoscopic surgery and 53 underwent open surgery.Main outcome measures were clinical data,postoperative recovery status and short-term outcomes.Results There were no significant differences between two groups with respect to demographic indicators,clinicopathological results and chronic comorbidities had no significant difference between two groups.No death cases occured in both groups.One patient in the laparoscopic group required conversion to open surgery due to ureteral injury.Laparoscopic surgery was associated with significantly longer operating time [(238 ± 71.3) minutes vs (175 ± 60.8) minutes,P ＜ 0.001],less estimated blood loss [(145 ± 58 ml) vs (186 ± 45) ml,P ＜ 0.001)],a shorter postoperative hospital stay [(11.9 ± 3.9) days vs (14.5 ± 3.7) days],lower overall postoperative complication rate (23.7％ vs 45.3％,P =0.035),wound-related complication rate (2.6％ vs 22.6％,P =0.017) when compared with open surgery.Quality of surgical specimen,lymph nodes harvested were not significantly different between two groups.Conclusion Laparoscopic colorectal cancer surgery is safe and feasible in elderly patients,associated with better short-term outcomes when compared with open surgery.

Objective To investigate the effects of the erythropoietin (EPO) on ischemia reperfusion injury (IRI) in rats with nephron-sparing surgery (NSS). Methods Fifty-four Sprague Dawley rats were divided into 3 groups randomly after right kidney nephrectomy: Sham group, NSS group (PBS+NSS) and EPO group (EPO+NSS). During NSS, renal artery was clamped for 40 min to induce IRI. Sham group just adopted exposure renal artery without vascular clamped. Rats in NSS group were injected intraperitoneally with PBS for 3 days before NSS. Rats in EPO group were injected intraperitoneally with EPO for 3 days before NSS. After 12 h, 24 h, 72 h, blood sample and renal tissues were collected. The serum creatinine (Scr) and urea nitrogen (BUN) were evaluated. The pathology injury was evaluated by HE staining. The CD24/CD133 double-positived renal progenitor cells (RPCs) were tested by flow cytometry. The CD133 and PCNA protein were quantified by immunohistochemical staining. The expressions of Wnt7b and β-catenin protein were detected by Western blotting. Results Rats in NSS group had more elevated Scr, BUN and pathology injury scores 12 h, 24 h and 72 h after operation than those in Sham group (all P<0.05). Compared with those in the NSS group, the Scr and BUN in the EPO group were significantly lower 24 h after the surgery (all P<0.05), and the pathology injury score also decreased (P<0.05). The proportion of RPCs, expressions of CD133 and PCNA, and expressions of Wnt7b and β-catenin protein were significantly higher after 24 h of the surgery in NSS group than those in the Sham group (all P<0.05). While compared with those in the NSS group, the proportion of RPCs and expressions of CD133, PCNA, Wnt7b and β-catenin increased at the EPO group (all P<0.05). Conclusions EPO can reduce the IRI after NSS, and its mechanism may be related to the mobilization of the RPCs by the Wnt7b/β-catenin signal pathway.

BACKGROUND:Orthopedic osteotomy at the apex of kyphosis is best for treatment of ankylosing spondylitis from a biomechanical aspect, but there is a high risk for intraoperative spinal cord injury.
OBJECTIVE:To explore the clinical efficacy of vertebral plate osteotomy+vertebra osteotomy+long-segment pedicle screw fixation in the treatment of ankylosing spondylitis with kyphotic deformity.
METHODS:Thirty-six patients with ankylosing spondylitis were subjected to pedicle subtraction osteotomy and Smith-Peterson osteotomy, and then fol owed up for 3 months to 2 years.
RESULTS AND CONCLUSION:After implantation, sagittal imbalance did not occur in 36 patients, and the improvement rate of sagittal imbalance was 64%. The improvement rates of thoracolumbar kyphosis and chin-brow vertical angle were 60%and 98%, respectively. The pain relief rate was 64%, and the Oswestry Disability Index was 95%. There were no pul ed nails, broken nails and broken robs after implantation. These findings indicate that the combination of selective osteotomy technique and long-segment internal fixation can achieve stable fixation effects, prevent sagittal imbalance, and avoid the occurrence of pul ing nails, breaking nails and breaking robs caused by osteoporosis.