OBJECTIVE：To stu dy the improvement effects o f Trillium tschonos kii total sapo nins（TTM）on adjuvant-induced arthritis model rats and its mechanism. METHODS ：SD rats were randomly divided into model group （n＝44）and blank group （n＝6）. Model group was given Complete Freund ’s adjuvant to induce the adjuvant-induced arthritis model ；blank group was given constant volume of normal saline with same method. Model group were divided into model group ，Tripterygium wilfordii polyglycoside tablets group （40 mg/kg），TTM low-dose ，medium-dose and high-dose groups （50，100，200 mg/kg），with 6 rats in each group. Administration groups were given relevant medicine intragastrically ；blank group and model group were given normal saline intragastrically ，once a day ，for consecutive 9 days. After last intragastric administration ，the body weight and foot swelling degree （bilateral）were detected ，and arthritis score was performed. The contents of tumor necrosis fator α（TNF-α）， interleukin 1β（IL-1β）and IL- 6 were detected ；the pathomorphological changes of rat ankle were observed ；protein expression of NOD-like receptor protein 3 （NLRP3），apoptosis associated spot-like protein （ASC），caspase-1 were detected ；the protein expression of NLRP 3 in synovial tissue of ankle joint were also determined. RESULTS ：Compared with blank group ，foot swelling degree，serum contents of TNF-α，IL-1β and IL-6，the protein expression of NLRP 3，ASC and caspase- 1 in knee tissue as well as the protein expression of NLRP 3 in synovial tissue of ankle joint were increased significantly in model group （P＜0.05 or P＜ 0.01），while the body weight was decreased significantly （P＜0.05）. The obvious proliferation of synovial cells ，the congestion and inflammatory cell infiltration of synovial tissue were all observed. Compared with model group ，most of the above indexes were all reversed significantly in TTM groups （P＜0.05 or P＜0.01）；the pathological changes such as synovial cell proliferation ， congestion of synovial tissue and chondrocyte destruction were all relieved ，and inflammatory cell infiltration was alleviated.CONCLUSIONS：TTM can improve rheumatoid arthritis of rats， the mechanism of which may be associated with 用。E-mail：yulingling@ctgu.edu.cn inhibiting the activity of NLRP 3/caspase-1 signaling pathway and decreasing the expression of inflammatory factors TNF-α，IL-1β，IL-6.

Objective:To evaluate the clinical efficacy and safety of ultrasound negative pressure suction with percutaneous nephroscope in the treatment of perirenal abscess.Methods:The clinical data of 11 patients with perirenal abscess admitted to Zhejiang Provincial People's Hospital from January 2013 to February 2021 were retrospectively analyzed. There were 4 males and 7 females. The average age was 59(51-76) years. The abscess was located on the left side in 4 cases and on the right side in 7 cases. The average diameter of abscess was 11.2(8.1-19.2) cm. All patients had fever, low back pain and abdominal mass, accompanied by bladder irritation in 6 cases, gross hematuria in 5 cases, abdominal distension, nausea and anorexia in 3 cases. There were 7 cases with type 2 diabetes, 2 cases with rheumatoid arthritis and 6 cases with ipsilateral kidney and ureter stone. Among the 11 patients, 6 had a history of urinary tract infection, 1 had a history of upper respiratory tract infection, 1 had secondary infection of perirenal hematoma after traumatic renal rupture, and 3 had secondary infection of perirenal hematoma after percutaneous nephroscopy. All patients were treated with ultrasound negative pressure suction with percutaneous nephroscope under local anesthesia by single operator. The operation time, intraoperative blood loss, drainage volume, drainage tube indwelling time, postoperative body temperature returned to normal time, postoperative hospital stay, therapeutic effect and complications were analyzed.Results:All operation procedures of 11 patients were successfully completed, including 8 cases of single channel, 2 cases of double channels and 1 case of three channels. The average operation time was 44(20-74)min, the average amount of blood loss was 15(10-20)ml, the average amount of pus was 325(200-500)ml, the average indwelling time of drainage tube was 8(6-12)d, the average time of body temperature returned to normal was 0.9(0.5-2.0)d, and the average hospitalization time was 9.6(7.0-14.0)d. Before discharge, CT reexamination showed that the perirenal abscess disappeared. There were no serious complications during and after operation. The average follow-up time was 4.4(3-8) months. There was no recurrence in all patients.Conclusions:Ultrasound negative pressure suction with percutaneous nephroscope is one of the safe and effective surgical methods for the treatment of perirenal abscess. It has the advantages of small trauma, quick recovery, complete drainage, exact effect and fewer complications.

Objective:To study the safety and efficacy of endoscopic combined intrarenal scopic surgery for complicated upper urinary calculi.Methods:The clinical data of 117 patients with complicated upper urinary calculi treated by simultaneous percutaneous nephroscopy combined with flexible ureteroscopy from March 2013 to February 2020 were retrospectively analyzed, including 71 males and 46 females, aged 31-73 years, with an average age of 45 years old. There were 29 cases of multiple kidney and ureteral stones, 22 cases of staghorn stones, 19 cases of postoperative residual stones, 18 cases secondary to urinary diversion, 13 cases of ureteral stricture with stones after kidney transplantation/ureteroplasty/endoscopic lithotripsy, 10 cases of isolated kidney, and 6 cases of caliceal diverticular stones. The maximum diameters of calculi were 13-45 mm, with an average of 27 mm.Results:All operative procedures of 117 patients were successful by one session. The mean operation time was (91.6±10.2) min. All cases were treated with single-channel lithotripsy combined antegrade percutaneous nephroscopy with retrograde flexibl eureteroscopy. An abdominal X-ray (KUB) or non-contrast CT was taken 3 to 7 days after the operation. There was no serious bleeding or infection after the operation, and the first-stage stone-free rate was 87.2% (102/117).Conclusions:The strategy of simultaneous antero-retrograde endoscopic combined intrarenal surgery for complicated upper urinary calculi can improve the success rate and first-stage stone-free rate, and reduce the number of percutaneous renal channel leading to the increasing safety of operation. It is an effective means of endourological management of urolithiasis.

Objective To evaluate the clinical efficacy and safety of robotic-assisted laparoscopic Boari flap ureteroplasty for ureteral strictures after kidney transplantation.Methods The clinical data of 2 patients with ureteral stricture after kidney transplantation in our department from May 2017 to September 2017 were retrospectively analyzed.All 2 cases were male.Case 1 was 73 years old and the transplanted kidney was located in the left iliac fossa.The patient was hospitalized due to still recurrent fever with longterm retention of nephrostomy tube because of hydronephrosis with repeated urinary tract infection after calculi surgery.Case 2 was 62 years old and the transplanted kidney was located in the right iliac fossa.The patient was hospitalized due to hydronephrosis and ureteral calculi after calculi surgery.All 2 cases were treated by robotic-assisted laparoscopic Boari flap ureteroplasty.The operative and postoperative complications were recorded and the postoperative examination data were collected.Results The operation time of the 2 cases were 165min and 189min,and the bleeding amount were 50ml and 100ml respectively.No urinary leakage,renal colic,high fever and other complications occurred.In case 1,nephrostomy tube was removed 8d after operation.The urinary catheters were removed 14d after operation in the 2 cases.The postoperative hospital day was 9d and 6d respectively.CT examination was performed 3 months after surgery.Compared with preoperative,case 1 had no significant change in hydronephrosis and the hydronephrosis of case 2 obviously relieved.In case 1,double J tube was removed in 3 months after operation.In case 2,double J tube was replaced in 3 months after operation and was removed after 3 months.2 patients were followed up to 18 months and 14 months after operation,respectively.Nohydronephrosis aggravated.Conclusions Robotic-assisted laparoscopic Boari flap ureteroplasty is a safe and effective treatment for ureteral strictures after kidney transplantation.It has the advantages of small trauma,quick recovery,exact effect and few complications.

Objective To evaluate the clinical efficacy and safety of dual shockwave lithotripter in treating urinary calculi.Methods Data of 371 cases treated with Direx-Magna dual shockwave lithotripter was retrospectively collected from July 2016 to June 2017,including 263 male and 108 female.Their age ranged from 15 to 66 years old (mean 36.5 ± 11.0).There was 117 patients with kidney stone,183 patients with upper ureteral and 71 patients with middle or lower stone.The average diameter of stones was (11.3 ± 1.5)mm (ranging 6.9-16.3 mm).The lithotripter was set at 60 times/min/head.Comparative analysis was made between 106 cases in dual mode and 265 cases in single mode.Comparative items included shock frequency,treating time,treating energy,pain scale,stone clear successive rate and complication.Patients were followed by KUB or NCCT at 1 and 2 weeks after the procedure.Stone clear successfully was defined as stone free or with fragment ＜4 mm.Results The overall success rate was 87.3％ (324/371).Among the patients who failed in first session,21 cases were successful with a second session,7 cases were treated with retrograde intrarenal surgery.There were 19 cases lost.Clavien grade Ⅲ complication rate was 0.8％ and no server grade complications.The average treating time was (25.2 ± 8.4) minutes and the average shock was (1419 ±440)times.The dual shockwave subgroup achieved higher success rate [93.4％ (99/106) vs.84.9％ (225/265),P ＜ 0.05] with less treating time [(15.7 ± 3.8) min vs.(29.0 ± 6.5) min],lower energy [(8.9 ± 2.0) kV vs.(10.7 ± 2.8) kV] and fewer shocks (833 ± 149 vs.1 654 ± 261),compared with that of the single shockwave subgroup (P ＜ 0.01).Also,pain scales and other complications were less than those of single shockwave subgroup (P ＜ 0.01).Conclusions Our study shows the new dual shockwave lithotripsy is safe and effective in both dual and single shock wave mode.Dual mode has higher success rate and fewer complications.

Objective To compare the safety and efficacy between flexible ureteroseope lithtripsy (FURS) and super-mini-percutaneous Nephrolithotomy (SMP) in the treatment of lower calyx calculus.Methods From Mar 2015 to Apr 2017,120 male and 75 female patients were accepted FURS (n =112)or SMP(n =83) in our hospital.Their average age was 45 years old,ranged from 19 to 68 years old.The cumulative stone diameter ranged from 15-24 mm (mean 20.3 ± 3.9 mm) in FURS group and ranged from 15-28 mm (mean 20.7 ± 3.2mm) in SMP group.There were no significant differences between the groups FURS and SMP in the stone size (P ＞ 0.05).Operative duration,postoperative hospital stay,complication rate,and stone-free rate(one day or one month after procedure) were recorded and compared.Results The operative time ranged from 28 to 62 min (mean 55.3 ± 7.3min) in FURS group and ranged from 15 to 55 min (mean 40.5 ± 6.8 min) in SMP group (P ＜ 0.05).One day after the operation,CRP was 7.4-29.1 (mean 17.2 ± 7.1) mg/L in group SMP,which was lower than that in group FURS 6.9-37.8 (mean 26.4 ± 6.4) mg/L (P ＜ 0.05).And the procalcitonin and peripheral leukocyte count was 0.1-1.2 (mean 0.6± 0.3)ng/ml and 6.3-18.1(mean 12.6± 3.2) × 109/L respectively,which was lower than that in group FURS O.2-1.4 (mean 0.9 ± 0.4) ng/ml and 9.5-21.7 (mean 14.8 ± 2.9) × 109/L respectively (P ＜ 0.05).One day after the operation,the stone free rate was 80.4％ (90/112) in group FURS,which was lower than that in group SMP 89.2％ (74/83) (P ＜ 0.05).And one month after the operation,the stone free rate was 85.7％ (96/112) in group FURS,which was lower than that in group SMP 96.4％ (80/83) (P ＜ 0.05).Postoperative hospitalization stay ranged from 2 to 5 days (mean 2.3 ± 1.2 days) and ranged from 3 to 6 days (3.7 ± 1.6 days) in FURS and SMP group,respectively (P ＜ 0.05).The scores of Visual Analogue Scale (VAS) ranged from 0 to 3 (mean 2.1 ± 0.4) and ranged from 0 to 3 (mean 1.9 ± 0.5) in FURS and SMP group,respectively (P ＜ 0.05).And the scores of Bruggrmann comfort scale (BCS) ranged from2to4 (mean 3.2 ±0.7) and ranged from 2 to4 (2.8 ±0.5) in FURS and SMP group,respectively(P ＜ 0.05).Conclusions Both SMP and FURS are efficacy and safe surgical alteration for patients with renal and renal lower calyx calculus of CSD about 2cm.The SMP could have some advantages such as the better stone free rate and acceptable complieation rate.

Objective To investigate whether the amount of blood transfusion affects the lengths of stay (LOS),costs,and outcomes of hospital patients or not,and to prepare for the execution of patient blood management.Methods The data of hospital patients,who had been administrated with blood in our hospital during 2016,were collected.And the influence of blood transfusion volume on LOS,costs and outcomes of patients was analyzed retrospectively.Results LOS,costs and outcomes of patients vary significantly with the amount of blood transfusion (P＜0.01).There were positive correlations between the total amount of blood transfusion and LOS,costs,and outcomes of patients.The Spearman correlation coefficient was 0.317,0.497,0.290,respectively (P＜0.01).Plasma preparation transfusion volume has a great influence on LOS,costs,and outcomes than red blood cell (P＜0.05).The transfusion volume of death patients was significantly higher than that of the survival (P＜0.01).In particular,the amount of transfused plasma and precipitation was distinctly higher than that in death patients(P＜0.01).Conclusion Blood transfusion volume affects LOS,costs and outcomes of hospital patients.The administration of plasma preparations should deserve more attention.

To accurately analyze metabolites in industry-important photosynthetic microbes, LC-MS based metabolomics protocol needs to be optimized specifically for individual species. In this study, an LC-MS based metabolomics method was optimized for cyanobacterium Synechocystis sp. PCC 6803. With the optimized extraction, liquid chromatographic and mass spectral parameters, the method was capable of detecting 24 important metabolites related to central carbohydrate and energy metabolism in Synechocystis sp. PCC 6803. The study laid an important foundation for the metabolomics analysis of cyanobacteria.
Chromatography, Liquid ; Mass Spectrometry ; Metabolome ; Metabolomics ; Photosynthesis ; Synechocystis ; metabolism

Objective To analyze the related factors that influence the stone free rate ( SFR) in flexible ureteroscopic lithotripsy ( FURL ) and develop a stone free index ( SFI ) model to estimate and predict the outcome of FURL.Methods A total of 393 patients receiving FURL were included in this study from May 2013 to August 2014.All patients′and calculous characteristics were recorded.It was evaluated the correlation of one-stage SFR with body mass index, the degree of hydronephrosis, the sterile urine, the renal insufficiency, the stone location, the stone number, the cumulative stone diameter ( CSD) , the stone density, the average of CT values, the minimum angle of pelvis ureter long axis with lamp long axis, the average length of stone located calyx-neck, and the minimum ratio of stone located calyx-neck′width with calyx′width.Multivariate regression analysis was used to analyze the relationship between preoperative characteristics and the SFR.Results The one-stage postoperative SFR in our study was 92.4% ( 363/393).We found that the staghorn stone, bacteriuria, CSD, average of CT values, the average length of stone located calyx-neck, the minimum ratio of stone located calyx-neck′width with calyx′width were significantly correlated with the postoperative SFR ( P <0.05 ) .We used logistic regression analysis to determine statistical significant variables and to create predictable mathematical model.The SFI system was consist of four stone characteristics, including the staghorn stone, the cumulative stone diameter, the average length of stone located calyx-neck, and the minimum ratio of stone located calyx-neck′width with calyx′width.The SFI had a high ROC curve (AUC=0.867) for predicting the one-stage postoperative stone free outcome.SFI score >7.5 meant a relatively high SFR ( SFR>85%) of FURL.Conclusions A SFI model using preclinical data was developed to predict the postoperative outcome of FURL, as well as the one-stage SFR.This model needs further prospective studies in the future.

Objective To summarize and analyze the pathological data of 431 cases of renal biopsy from Quzhou, Zhe-jiang and to discuss the epidemiological characters via pathological distribution in Quzhou. Methods A total of 431 patients with kidney diseases hospitalized between January 2012 and December 2014 by our hospital were reviewed and their epidemiological characters and distribution of pathological patterns were analyzed. Results Among the 431 speci-mens, 181 cases were from males (42.0%), and 250 were females (58.0%, male/female=1:1.38). As to the clinical types of disease, the most common disease was nephrotic syndrome (NS, 178 cases, 41.3%), followed by chronic glomeru-lonephritis (CGN, 142 cases, 32.9%). As to the etiologic classification, a majority of 342 cases were primary glomeru-lonephritis (PGN, 79.3%), 77 cases were secondary glomerulonephritis (SGN, 17.9%), 11 cases were tubulo-interstitial disease(TID, 2.6%), and 1 case was renal transplantation disease(0.2%). Among the PGN patients, IgA nephropathy (IgAN) and membranous nephropathy(MN) were most commonly observed, accounting for 32.7%and 24.5%, respectively. Of the SGN patients, lupus nephritis(LN) was most common, accounting for 40.2%, which was followed by Henoch-Schonlein purpura nephritis (HSPGN, 18.2%) and hepatitis b virus-associated glomerulonephritis (HBVGN, 13.0%). Conclusion PGN is the most common etiological factor of kidney biopsy, with IgAN and MN at most. LN is the main type of SGN, followed by HSPGN and HBVGN. In Quzhou, Zhejiang, the incidence rate is higher in young adults, indi-cating that special attention should be paid on IgAN, MN and LN in prevention and treatment of kidney diseases.