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Due to its high incidence and mortality rate， acute myocardial infarction poses a serious threat to public health. Reperfusion therapy is the preferred treatment strategy for acute myocardial infarction， which can quickly restore blood circulation to the ischemic myocardium， rescue dying myocardial cells， reduce infarct size， and lower the mortality rate. However， reperfusion may lead to additional heart damage， known as myocardial ischemia-reperfusion injury （MIRI）. Therefore， how to alleviate MIRI has become one of the urgent issues in cardiovascular therapy. Traditional Chinese medicine （TCM） has the advantage of multiple components， multiple pathways， and multiple targets in the treatment of MIRI， providing new ideas for reducing MIRI. Adenosine 5'-monophosphate （AMP）-activated protein kinase （AMPK） is closely related to MIRI， and it plays an important role in alleviating MIRI by regulating inflammation， oxidative stress， autophagy， apoptosis， and ferroptosis. This article reviewed the basic structure of the AMPK signaling pathway and its role in MIRI， as well as the research progress of TCM in the treatment of MIRI by regulating the AMPK pathway， aiming to provide a theoretical basis for the prevention and treatment of MIRI.
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Chronic heart failure （CHF）， the end stage of heart disease due to a variety of causes， features high disability rate and mortality， which has become a hot spot in cardiovascular field. As recorded in Treatise on Cold Damage（《伤寒论》）， Zhenwutang is composed of Radix Aconiti Lateralis Preparata， Poria Cocos， Rhizoma Atractylodis Macrocephalae， Paeoniae Radix Alba， and Rhizoma Zingiberis Recens. With the functions of warming Yang and excreting water， it is a classical prescription for the treatment of CHF in clinical settings. By searching China National Knowledge Infrastructure （CNKI）， PubMed， Wanfang Data， and VIP， we find Zhenwutang exerts therapeutic effect on CHF through multiple targets and multiple pathways. Experiments show that it alleviates CHF by antagonizing the overactivation of neuroendocrine system， inhibiting immune-inflammatory response， suppressing cardiac remodeling， restricting apoptosis， regulating autophagy， improving myocardial energy metabolism， inhibiting oxidative stress injury， protecting endothelial function， and decreasing volume load. Clinical research shows that Zhenwutang can significantly alleviate the clinical symptoms of CHF patients in a safe manner with little adverse reactions. This paper systematically summarizes the mechanisms of and clinical research on Zhenwutang in the treatment of CHF in recent years， so as to provide theoretical and experimental data for the further research and development of Zhenwutang.
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Objeetive To discuss risk factors for postoperative complications after Mini-percutaneous nephrolithotomy (mPNL) using modified Clavien classification of surgical complications.Methods From September 1999 to December 2010,4533 patients having complications after mPNL were analyzed with five related clinical factors using the modified Clavien classification of surgical complications in the Second Affiliated Hospital of Kunming Medical University.Results Among 88 cases having complications (1.94％),69 had hemorrhage (0.24％),5 had colon injury (0.11％),3 had septic shock (0.06％),5 had liquid absorption syndrome (0.11％),6 had pleural effusion (0.13％).According to the modified Clavien classification,11 cases were clustered into Class Ⅰ (0.24％),71 cases into Class Ⅱ (1.56％),6 cases into Class Ⅲa (0.13％) and no cases was classified in Class Ⅲ b,Ⅳ a,Ⅳ b and Ⅴ.For patients having complications of Class Ⅱ and Ⅲ,the average hospital stay was significantly longer than those having either Class Ⅰ or no complications.Multiple logistic regression analysis showed that five factors were associated with postoperative complications,including operation time (OR=1.46),ASA score (0 =2.49),having cardiovascular disease or diabetes at the same time (0R=1.67),stone load (0R=1.34) and positive urine culture (0R=0.97).Conclusion Using modified Clavien classification of surgical complications in the analysis of mPNL was standard,objective,applicable and recommended.
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Objective To explore the value of DWI (diffusion weighted imaging,DWI) in diagnosis of bladder cancer in clinical T stage by comparing DWI and CT.Methods Seventy-five patients with bladder cancer underwent MRI plain scan,enhanced diffusion-weighted imaging and CT scan,to make a diagnosis preoperative clinical T stage according to their image.Then we compared the diffusion-weighted imaging and CT results with pathological staging results to assess the value of DWI in bladder tumor staging.Results For clinical T staging bladder cancer,the diagnostic accuracy rate was 83.5％ and 72％ for DWI and CT,resectively,statistical analysis showed a significant difference (P ＜0.05).Conclusion Magnetic resonance diffusion weighted imaging can accurately diagose the clinical T stage of bladder cancer,and has a higher value than CT.
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Objective To analyze the efficacy and safety of same-session bilateral and staged unilateral flexible ureteroscopic lithotripsy ( FURL) with holmium laser for the treatment of upper urinary system stones . Methods Clinical data of 29 patients who underwent same-session bilateral FURL ( same-session group ) and 20 patients who received staged unilateral FURL ( staged group ) from September 2012 to May 2015 at this hospital were analyzed retrospectively .The overall operation time ,overall hospital stay , stone free rate (SFR) and overall complication rate were compared between the two groups . Results The operations were successfully completed in both groups.The overall operative time was significantly longer for staged unilateral FURL than bilateral FURL [(71.0 ± 19.0) min vs.(112.6 ±26.8) min, t=-6.366, P=0.000].The overall hospital stay was slightly longer for staged unilateral FURL than bilateral FURL [(6.9 ±3.6) d vs.(8.4 ±2.1 ) d, t=-1.674, P=0.101].The four-week postoperative SFR for bilateral FURL and staged unilateral FURL were 79.3%(23/29) and 80.0%(16/20), respectively (χ2 =0.000, P=1.000).The overall complication rate was slightly higher for bilateral FURL [20.7% (6/29) vs.15.0% (3/20), χ2 =0.017, P=0.896]. Conclusion Same-session bilateral flexible ureteroscopic holmium laser lithotripsy is a safe and effective treatment for bilateral upper urinary system stones in select patients .
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Objective To evaluate the efficacy and safety of application of F 16 single-tract minimally invasive percutaneous nephrolithotomy ( MPCNL) combined with flexible ureteroscopy for the treatment of complex renal staghorn calculi . Methods From May 2009 to September 2012, 35 patients with complex renal staghorn calculi were treated by F 16 single-tract MPCNL combined with flexible ureteroscopy in this hospital .All the patients underwent MPCNL at the first-stage, and 5-7 days afterwards a second-stage operation was performed by using flexible ureteroscopy .The fragments of stones were removed from the MPCNL tract .For patients diagnosed as having residual stones , a third-stage reoperation of MPCNL combined with flexible ureteroscopy was given . Results Twenty-one patients were stone-free after the second-stage operation , 12 patients were stone-free after the third-stage operation , and the remaining 2 patients with residual stones were given drug administration for stone removal and were clarified as stone -free within 1 month of follow-up.No serious intraoperative or postoperative complications such as hemorrhage or infectious shock occurred .Follow-up reviews for 3 -6 months in the 35 patients found no residual stones or recurrence . Conclusion F16 single-tract MPCNL combined with flexible ureteroscopy is an effect and safe procedure for complex renal staghorn calculi .
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Objective To observe the effects of different concertrations of calcifying nanoparticles (CNP) on growth and proliferation of human renal tubular epithelial cells (HK-2),and to explore the effects of autophagy of human renal tubular epithelial cells induced by CNP. MethodsNormal growth HK-2 cells were cultured in vitro and the culture medium was changed to serum-free medium after cell growth to confluence,CNP with different concentrations were then added and the cell proliferation inhibition was measured by MTT assay after 12,24,48 and 72 h co-incubation.EGFP-LC3 express plasmid was transfected into HK-2 cells,CNP with certain concentration was then added after 24h incubation.The formation of autophagosomes and their adherence to cells were observed by electron microscopy,and EGFP-LC3 staining was used to detect the formation of autophagosome by flourescence microscopy after 3,6,24 and 48 h co-incubation. ResultsCNP presented a concentration-dependent cell proliferation inhibition on HK-2 cells,the inhibitory ratio in cell proliferation was 14.5 ％ after 48 h co-incubation when CNP density was 0.05 mg/ml,and the inhibitory ratio was 21.5％ after 72 h co-incubation when CNP density was 0.1 mg/ml.Autophagosome formation and CNP adherence to cell surface could be observed by electron microscopy 6 h after CNP was added to the DMEM medium.The LC3-positive dots were observed in HK-2 cells incubated with CNP.Conclusions Autophagy of HK-2 could be activated by co-incubation with CNP,which may play an important role in the formation of nephrolithiasis.
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Objective To study the ultrastructure of the renal papillary Randall's plaque in calclum oxalate stone formers. Methods The 14 biopsy samples of the Randall's plaque in 12 patients with calcium oxalate stone undergoing PCNL for stone removal were obtained using endoscopic biopsy technique,followed by staining with hematoxylin-eosin or fixing with osmium tetroxide,and then the ultrastructure of the Randall's plaque was observed under light microscope and transmission electron microscope. Results In all 12 patients,72 renal papillae were examined.All kidReys were found to have papillary plaque and 7 of the patients had attached stones.Sixty-three papillae(87.5%)contained plaque.Calcium deposition was seen in the 12 renal papilla tissue by light microscopy.Transmission electron microscopy images of the 2 Randall's plaque samples showed several cluster of sharp and large crystals lied closer to the surface of Randall's plaque.The typical crystals were acicular with light profile. Conclusions Randall's plaque is an interstitial medullary and papillary deposit of calcium oxalate.The appearance of the deposition of calcium oxalate crystals lies upon Randall's plaque,which might be an explanation for the mechanism of calcium oxalate stone formation.
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Objective To summarise the methods for a long segmental avulsed inj ury of ureter.Methods Ureteroscopies were performed on three male patients with upper ureteral calculi and one female patient with haematuria from upper urinary tract.Ureteral calculi caused small and middle hy-dronephrosis,obstruction wasn't seen on the upper urinary tract with haematuria.The kidney on the affected side showed normal founction on IVP.Four patients were suffered from a long segmental avulsed inj uries of full-thickness of ureter from ureteroscopy in a continuous epidural anesthesia.The injuries took place in UPJ and upper ureter.The length of avutsed ureters is 20-25 cm,mean length is 24 cm. Results The ureteroscopies were altered to open operations which were ileal ureteral substi-tutions on two patients,being anastomosed the avulsed ureter wrapped by caul on one patient and nc-phrectomy on one patient under general anesthesia in an emergercy.Two ileal ureteral substitutions had reached satisfied results that were no damaged renal functions,no metabolic acidosis,no repeatly U-rinary tract infections and no complains about micturition.One patient has maintained normal renal morphology and function after thirteen years followup,the other formed stricture in the anastomosis of the proximal piece of-ileum to the renal pelvis tWO years after operation,and then improved after ante-grade dilation.The patient with being replaced back and anastomosed the avulsed ureter had compli-cated with a renal atrophy on the affected side three months after the double-J was extracted.The kid-ney showed no function on isotop nephrogram and then was ablated.The last one with nephrectomy and the one before were followed up regularly,the renal functions and blood pressures remain normal.Conclusion Ileal ureteral substitution would be a good choice and has a stable curative effect and provide a good prognosis for treating long segmental avulsed injury of ureter suffered from ureterosco PY when no available urinary tract was utilized for reconstruction.
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<p><b>OBJECTIVE</b>To study the expression of the inhibitor of apoptosis (IAP) gene XIAP in prostate cancer and the relationship between its expression and its clinical stage or Gleason grade.</p><p><b>METHODS</b>XIAP mRNA expression was detected by RT-PCR in three prostate cancer cell lines (PC-3, DU-145, LNCaP), neoplastic prostate tissues and normal prostate tissues. Immunohistochemical SP method was used to examine the expression of XIAP protein in 56 neoplastic prostate tissue specimens.</p><p><b>RESULTS</b>XIAP gene was not expressed in normal prostate tissues, but highly expressed in prostate cancer cell lines PC-3, DU-145, LNCaP. Thirty of the 56 (53.6%) tumor samples were positive XIAP protein, and only 12 (21.5%) paratumor samples were positive XIAP protein (P < 0.01), XIAP positivity not correlated with tumor stage or Gleason grade (P > 0.05).</p><p><b>CONCLUSION</b>XIAP may be involved in the development of prostate cancer and play an important role in human prostate carcinogenesis. It is likely to be used as a target of prostate cancer therapy.</p>
Subject(s)
Aged , Aged, 80 and over , Humans , Male , Cell Line, Tumor , Immunohistochemistry , Neoplasm Staging , Prostatic Neoplasms , Metabolism , Pathology , Reverse Transcriptase Polymerase Chain Reaction , X-Linked Inhibitor of Apoptosis Protein , GeneticsABSTRACT
By investigating the perspectives of medical scholars, experts, personnel and students, this paper makes an investigation on the present cognition of medical ethics education in the medical department. By studying and comparing the respective opinions of medical teachers and students on the current medical ethics education, analysis on the application of medical ethics in clinical practice and medical research, and cognitive characteristics of the ethical expectation on medical treatment from the general public have been carried out, pointing out some specific problems affecting the actual effect in current medical and ethics education on teachers' and students' sides, and bringing forward some suggestions.
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60?Gy is able to effect a good loco-regional control as well as a good result.
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Objective To investigate the pathogenesis ,d iagnosis and treatment of traumatic pseudoaneurysmal-ureteral fistula. Methods A 49-year-old male patient with traumatic iliac pseu doaneurysmal-ureteral fistula was reported.The patient presented with recurrent massive hematuria,and then was diagnosed by DSA and ureteroscopy.By reviewing t he published literature on arterio-ureteral fistula, we analyzed and discussed the patient’s clinical data. Results The patient was cu red by endovascular management.The procedure was as follows.First,the right exte rnal iliac artery was dilated with balloon;then the right internal iliac artery was embolized;finally,a covered stent was placed into the right external iliac a rtery.During 18-month follow-up,no hematuria recurred. Conclusions Traumatic pseudoaneurysmal -ureteral fistula is clinically rare.Th e main symptom is massive hematuria.DSA and ureteroscopy are important means for diagnosis of the disease.Endovascular therapy with covered stents is a safe,eff icacious method for the treatment of the disease.
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Objective To explore the distributions of C AG polymorphisms of androgen receptor gene in Chinese population and the relatio nship with prostate cancer (CaP). Methods The number of CAG repeats were measured in 105 cases with CaP and 190 matched case-control b y PCR、DHPLC and Sequencing analysis,and its association with the susceptibility to CaP. Results The average number of CAG repeats was 2 2.7 in CaP and 23.3 in control group ( P =0.22).Men with CAG repeats lengt h less than 22 may be in high risk of prostate cancer (odds ratio,2.39;95%CI 1.1 9～4.81, P =0.012),compared with men CAG repeats length of 22 or more. Conclusions A less CAG repeat length (
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Objective To investigate the influence of d iagnostic needle biopsy (prior to MRI) on the magnetic resonance imaging (MRI) s taging of prostate cancer. Methods Ten patients suspicio us of prostate cancer were enrolled in this study.MRI was performed both prior t o transrectal sextant biopsy and a week after biopsy.The MRI staging of prostate cancer before and after biopsy was compared. Results Al l the 10 patients were classified as stage B before biopsy,while 9 of the 10,wer e classified as stage C 6～8 days (mean,7 days) after biopsy.The post-biopsy MR I staging was higher than that of pre-biopsy because of bleeding due to biopsy. Conclusions When MRI examination was performed within o ne week after needle biopsy,the MRI staging of prostate cancer would be influenc ed because of bleeding due to biopsy.Our data suggested that MRI should be perfo rmed prior to needle biopsy in suspicious cases of prostate cancer.