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Background: For selected patients, endoscopic thyroidectomy via the oral-vestibular approach (ETOVA) can be used to achieve a very good esthetic effect. This study aimed to assess the learning curve for ETOVA and identify improvements., Patients and Methods: This retrospective study evaluated the outcomes of 101 patients who underwent ETOVA by surgeons A and B. The patients were classified according to whether they had undergone surgery during the primary or advanced stage of the learning curve, respectively. Proficiency with the procedure in various types of cases and the operation time, operative blood loss, hospital stay length, and postoperative complications were analyzed., Results: In total, 56 and 45 patients were treated by surgeons A and B, respectively. For both surgeons, the operation times decreased considerably after 20 cases. Statistically significant differences with respect to stage were observed in terms of operation time (P<0.05) and drainage tube reservation (P<0.05). By contrast, significant differences were not observed between stages in terms of operative blood loss (P>0.05) or postoperative hospital stay length (P>0.05). The total postoperative complication rate was low and comparable with that of open surgery., Conclusions: The specific learning curve identified for ETOVA suggests that surgeons with sufficient endoscopic surgery experience could achieve a stable proficiency after ∼20 cases. A standardized training program and exposure to more cases would reduce the learning curve.

Background: An analysis of some special factors was performed to further evaluate and discuss whether endoscopic surgery and traditional open surgery have similar therapeutic outcomes for differentiated thyroid cancer (DTC)., Methods: A retrospective study was performed on 76 patients undergoing surgery to treat DTC. Forty patients were treated by endoscopic thyroidectomy via the chest-breast approach (endoscopic group) and thirty-six patients were treated by open surgery (open group). Serum thyroglobulin (sTg), radioactive iodine uptake (RAIU), radioactive technetium uptake (RATU), radionuclide imaging of the thyroid residual area (RITRA), radionuclide imaging of suspicious lymph nodes metastasis (RISLNM), and other general indexes were analyzed and compared between the two groups., Results: All surgeries were successfully completed in both groups. There were no significant differences between the two groups regarding gender (P = 0.120), postoperative hospital stay (P = 0.766), operation time (P = 0.065), intra-operative blood loss (P = 0.064), tumor diameter (P = 0.059), and overall complications (P = 0.828). Among these complications, there was no significant difference between the two approaches in transient hypoparathryoidism (P = 0.771), transient recurrent laryngeal injury (P = 0.474) and serious neck skin traction sensation (2.5 vs. 0%, P = 1.000). Age and body mass index were lower in the endoscopic group than the open group (P < 0.05). No significant difference was found in special factors between two groups concerning surgical range (P = 0.872), RAIU-2 h/24 h (P = 0.660/P = 0.955), RATU (P = 0.116), number of dissected lymph nodes (P = 0.157), sTg before radioiodine therapy (P = 0.188), sTg after radioiodine therapy (P = 0.159), RITRA at different time points ( 99m Tc 15 min: P = 0.144; 131 I 24 h: P = 0.243; 131 I 72 h: P = 0.624) and RISLNM (none: P = 0.805; central: P = 0.744; lateral: P = 1.000; central + lateral: P = 0.958)., Conclusion: Endoscopic total thyroidectomy and central lymph nodes dissection via a chest-breast approach are safe and effective. Through the detection of the postoperative special factors, a well-trained surgeon can achieve similar therapeutic results for selected patients with DTC, compared with open surgery.

Atrial fibrillation (AF) is the most common arrhythmia reported in clinical practice. Connexin 43 (Cx43) is a member of the connexin protein family, which serves important roles in signal transduction in vivo. The aim of the present study was to investigate the role of Cx43 in the induction and maintenance of atrial fibrillation by using an animal model of sympathomimetic atrial fibrillation. Cx43 was successfully knocked down in the myocardium with gene‑specific small interfering (si)RNA via lentiviral infection. A total of 25 dogs were randomly and evenly divided into five groups: Normal (N), rapid atrial pacing (RAP), isoproterenol (ISO) + RAP, RAP + Cx43 siRNA and ISO + RAP + Cx43 siRNA. The mRNA and protein levels, as well as the distribution of Cx43 on the cell membrane, were gradually decreased in each group compared with the N group following treatment (P<0.05). The induction rate of the atrial effective refractory period was not significantly affected in the RAP and RAP + Cx43 siRNA groups, whereas it was significantly reduced in the ISO + RAP and ISO + RAP + Cx43 siRNA groups compared with the N group (P<0.05). The induction rate of AF was gradually increased in the RAP + Cx43 siRNA, ISO + RAP and ISO + RAP + Cx43 siRNA groups compared with the N group (P<0.05). The expression of nerve growth factor (NGF) and tyrosine hydroxylase (TH) was gradually increased in the ISO + RAP and ISO + RAP + Cx43 siRNA groups compared with their respective controls (RAP and RAP + Cx43 siRNA groups, respectively). However, no significant difference in the levels of NGF and TH was observed between the RAP, RAP + Cx43 siRNA, ISO + RAP and ISO + RAP + Cx43 siRNA groups. The mitochondrial morphology in each group was notably altered compared with the N group. The mitochondrial reactive oxygen species production and apoptotic index were gradually increased in each group compared with the N group (P<0.05). The results of the present study suggest that Cx43 reduces susceptibility to AF. Downregulation of Cx43 mediates the induction and maintenance of sympathetic AF.

Objective: Open surgery is the most common treatment of thyroglossal duct cyst (TGDC), but it leaves obvious neck scarring. This study aimed to explore the feasibility and strategy of total endoscopic procedure by breast approach to avoid such scarring on the neck., Materials and Methods: This study reviewed 13 patients who underwent endoscopic resection of TGDC and 15 patients who underwent open resection of TGDC. We compared and analyzed factors including operative time, estimated blood loss, postoperative hospitalization, complications, and cosmetic effect., Results: The surgery by the endoscopic approach was successfully completed in 13 cases and no one was converted to an open procedure. Another 15 cases were successfully performed by an open procedure. There were no significant differences between the 2 procedures in the mean cyst size, drainage time, intraoperative blood loss, and postoperative hospital stay. The cosmetic effect was better and the operative time was longer in the endoscopic approach. Two cases had swallowing discomfort after surgery in the endoscopic approach, whereas one case developed this complication in the open approach. On patient treated with each approach developed infection. One patient developed skin bruise and one patient developed subcutaneous hydros in the endoscopic approach, whereas no complications developed in the open approach. There were no incidences of uncontrolled bleeding, tracheal injury, dysphagia, salivary fistula, or asphyxia/dyspnea in both approaches, nor were there any deaths or recurrences of TGDC during the follow-up period., Conclusion: With strict indications, the total endoscopic breast procedure is feasible and effective for selected patients. This procedure can be another choice for patients who wish to avoid neck scarring when undergoing treatment for TGDC.

Parkinson's disease is one of the most common diseases in the elderly population, and the substantia nigra is generally involved in the disease process; however, the signaling pathways and related genes underlying Parkinson's disease remain unclear. This study integrated three cohorts of profile datasets to elucidate the potential key candidate genes and pathways in Parkinson's disease. The expression profiles of GSE8397, GSE20186 and GSE49036 were included 55 available substantia nigra tissue samples from individuals diagnosed with Parkinson's disease and 33 substantia nigra tissue samples from healthy controls. These samples were integrated and thoroughly analyzed. Differentially expressed genes (DEGs) were sorted, and candidate genes and pathway enrichments were analyzed. A DEG-associated protein-protein interaction network analysis was performed. 27 shared downregulated DEGs were identified from the three GSE datasets. The DEGs were clustered based on function and signaling pathway with significant enrichment analysis. 52 edges were identified from the DEG protein-protein interaction network complex, which included dopamine metabolism, nerve conduction, reduced neuronal toxicity and proliferation pathways. Using integrated bioinformatic analysis, we identified candidate genes and pathways in Parkinson's disease that could improve our understanding of underlying molecular events, which could be potential therapeutic targets for Parkinson's disease.

Objective: Atrial fibrillation (AF) is the most common rapid cardiac arrhythmia associated with high morbidity and mortality. Stimulation of the sympathetic nerve is involved in AF occurrence. The gap junction protein connexin 43 (Cx43) plays a key role in electrical conduction velocity in cardiac tissues, and under expression of Cx43 was linked with AF. The aim of this study was to investigate whether Cx43 was involved in sympathetic AF., Methods: Fifteen dogs were randomly divided into 3 groups (5 in each group). Sympathetic AF was induced in dogs and isolated canine atrial myocytes by isoproterenol (ISO) perfusion and rapid atrium pacing (RAP). The expression levels of nerve growth factor (NGF) and tyrosine hydroxylase (TH) in the atrial tissues were detected using immunohistochemical staining. The transcription and protein expression of Cx43 in the AF cell model was measured. Subsequently, Cx43 was blocked by short interfering (si) RNA in atrial myocytes and the gap junctional intercellular communication was detected using the scrape-loading and dye transfer assay., Results: Sympathetic AF was successfully induced by a combination of ISO perfusion and RAP. The expression levels of NGF and TH were increased in the RAP group, and further increased in the RAP + ISO group. Tissue samples from the AF dogs had a lower Cx43 level than those of the control group (p<0.05). The expressions of mRNA and protein of Cx43 in sympathetic AF cell model decreased by 26% and 28%, respectively, when compared with the control group, with p<0.05. Silencing Cx43 in cells by siRNA could also efficiently reduce Cx43 expression. The relative levels of Cx45 mRNA were decreased by 73% compared with unaffected cells. The scrape-loading and dye transfer assay showed that gap junctional intercellular communication was hampered in the sympathetic AF cell model and silencing Cx43 could impede channel conduction., Conclusion: The results suggested that low expression of Cx43 was involved in sympathetic AF by influencing intercellular channel conduction. Intervention of Cx43 expression might be an appealing therapy to sympathetic AF.

Prostate cancer (PCa) remains the second-leading cause of cancer-related deaths in American men with an estimated mortality of more than 26,000 in 2016 alone. Aggressive and metastatic tumors are treated with androgen deprivation therapies (ADT); however, the tumors acquire resistance and develop into lethal castration resistant prostate cancer (CRPC). With the advent of better therapeutics, the incidences of a more aggressive neuroendocrine prostate cancer (NEPC) variant continue to emerge. Although de novo occurrences of NEPC are rare, more than 25% of the therapy-resistant patients on highly potent new-generation anti-androgen therapies end up with NEPC. This, along with previous observations of an increase in the number of such NE cells in aggressive tumors, has been suggested as a mechanism of resistance development during prostate cancer progression. Dovitinib (TKI-258/CHIR-258) is a pan receptor tyrosine kinase (RTK) inhibitor that targets VEGFR, FGFR, PDGFR, and KIT. It has shown efficacy in mouse-model of PCa bone metastasis, and is presently in clinical trials for several cancers. We observed that both androgen receptor (AR) positive and AR-negative PCa cells differentiate into a NE phenotype upon treatment with Dovitinib. The NE differentiation was also observed when mice harboring PC3-xenografted tumors were systemically treated with Dovitinib. The mechanistic underpinnings of this differentiation are unclear, but seem to be supported through MAPK-, PI3K-, and Wnt-signaling pathways. Further elucidation of the differentiation process will enable the identification of alternative salvage or combination therapies to overcome the potential resistance development., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

Recurrent laryngeal nerve (RLN) injury can result in unilateral or bilateral vocal cords paralysis, thereby causing a series of complications, such as hoarseness and dyspnea. However, the repair of RLN remains a great challenge in current medicine. This study aimed to develop human umbilical mesenchymal stem cells (HuMSCs) and nerve growth factor (NGF)-loaded heparinized collagen scaffolds (HuMSCs/NGF HC-scaffolds) and evaluate their potential in the repair of RLN injury. HuMSCs/NGF HC-scaffolds were prepared through incorporating HuMSCs and NGF into heparinized collagen scaffolds that were prefabricated by freeze-drying in a template. The resulting scaffolds were characterized by FTIR, SEM, porosity, degradation in vitro , NGF release in vitro and bioactivity. A rabbit RLN injury model was constructed to appraise the performance of HuMSCs/NGF HC-scaffolds for nerve injury repair. Electrophysiology, histomorphology and diagnostic proteins expression for treated nerves were checked after application of various scaffolds. The results showed that the composite scaffolds with HuMSCs and NGF were rather helpful for the repair of broken RLN. The RLN treated with HuMSCs/NGF HC-scaffolds for 8 weeks produced a relatively normal electromyogram, and the levels of calcium-binding protein S100, neurofilament and AchE pertinent to nerve were found to be close to the normal ones but higher than those resulted from other scaffolds. Taken together, HuMSCs/NGF HC-scaffolds exhibited a high score on the nerve injury repair and may be valuable for the remedy of RLN injury., Competing Interests: The authors declare that there are no any conflicts of interest.All animal experiments were conducted according to the Guidelines on the Care and Use of Animals for Scientific Purposes (2004, Singapore). The animal experiment protocol was reviewed and approved by the Experimental Animal Ethical Committee of Jinan University (Approval No: SCXK 2011-0015) (Guangzhou, China).

Background: Despite experience with the use of endoscopic surgical technology, there is controversy over the role of endoscopic thyroidectomy (ET) for Graves' disease (GD). This study aimed to conduct a meta-analysis to evaluate the cosmetic and safety outcomes of ET versus conventional open thyroidectomy (OT) for GD with respect to short-term consequences., Methods: We searched the following English language databases (Ovid MEDLINE, ISI Web of Science, and the Cochrane Library), and Chinese language databases (CNKI, CBMdisc, and SinoMed) between January 1996 and November 2015. The quality of the included studies was determined by the Newcastle-Ottawa Scale. A meta-analysis was conducted using RevMan 5.3 software. Pooled mean differences (MD) or odds ratios(OR) with I 2 were calculated using either fixed or random-effect models., Results: Six trials including 846 total cases were ultimately selected for meta-analysis. ET was associated with reduced blood loss (MD = -32.02; 95%CI: -36.92 to -27.12; P < 0.00001) and better cosmetic satisfaction (OR = 38.92; 95%CI: 17.40-87.06; P < 0.00001) than OT. However, OT was associated with reduced operation time (MD = 19.70; 95%CI: 2.04-37.35; P = 0.03) and lower hospital costs (MD = 303.21; 95%CI: 123.07, 483.36; P = 0.0010). Furthermore, ET and OT were not significantly different in terms of drainage volume, and they had an equivalent complication rate, including for transient recurrent laryngeal nerve palsy, transient hypocalcemia, postoperative hypothyroidism, and recurrent-hyperthyroidism., Conclusions: ET appeared to provide better cosmetic satisfaction and a reduction in blood loss, whereas OT had a shorter operation time and lower hospital costs. Randomized clinical trials with large samples that include long-term follow-up data are necessary to confirm our findings., (Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: The treatment of burn patients is very challenging because burn injuries are one of the most severe traumas that can be experienced. The effect of music therapy on burn patients has been widely reported, but the results have been inconsistent. Thus, we performed a systematic review and meta-analysis of randomized controlled trials in burn patients to determine the effect of music during treatments., Methods: We searched a variety of electronic databases, including MEDLINE (via PubMed), EMBASE, Cochrane Library, Psychinfo, VIP Database for Chinese Technical Periodicals (VIP) and China National Knowledge Infrastructure (CNKI) for relevant trials on the basis of predetermined eligibility criteria. from their first available date through February 2016. Our search focused on two key concepts: music interventions (including music, music therapy and music medicine) and physical activity outcomes (including pain, anxiety, burn characteristics, dressing changes, wound care, debridement and rehabilitation). Two reviewers independently screened records and extracted data from all eligible studies. Statistical heterogeneity was determined using Q-test and the I 2 statistic. The endpoints included standardized mean differences (SMDs) and 95% confidence intervals (CIs). Publication bias was tested by Begg's funnel plot and Egger's test., Results: A total of 17 studies met the inclusion criteria, for a total of 804 patients. A statistically significant difference in pain relief was demonstrated between music and non-music interventions (SMD = -1.26, 95% CI [-1.83, -0.68]), indicating that music intervention has a positive effect on pain alleviation for burn patients. The results indicated that music interventions markedly reduced anxiety in individuals compared to non-music interventions (SMD = -1.22, 95% CI [-1.75, -0.69]). Correspondingly, heart rate decreases were found after treatments that included music interventions (SMD = -0.60, 95% CI [-0.84, -0.36])., Conclusion: In summary, a positive correlation was found between treatments including music interventions and pain alleviation, anxiety relief, and heart rate reduction in burn patients. However, additional high-quality studies with carefully considered music interventions for burn patients are still needed.

Detection of methyl mercaptan (CH₃SH) is essential for environmental atmosphere assessment and exhaled-breath analysis. This paper presents a sensitive CH₃SH sensor based on wavelength modulation spectroscopy (WMS) with a mid-infrared distributed feedback interband cascade laser (DFB-ICL). Multicomponent spectral fitting was used not only to enhance the sensitivity of the sensor but also to determine the concentration of interferents (atmospheric water and methane). The results showed that the uncertainties in the measurement of CH₃SH, H₂O, and CH₄ were less than 1.2%, 1.7% and 2.0%, respectively, with an integration time of 10 s. The CH₃SH detection limit was as low as 7.1 ppb with an integration time of 295 s. Overall, the reported sensor, boasting the merits of high sensitivity, can be used for atmospheric methyl mercaptan detection, as well as multiple components detection of methyl mercaptan, water, and methane, simultaneously.

Molecularly imprinted polymers (MIPs) for erythromycin (ERY) were prepared by precipitation polymerization, using ERY as template molecule, methacrylic acid (MAA) as functional monomer, ethylene glycol dimethacrylate (EGDMA) as cross-linker and methanol/acetonitrile (1:4, v/v) as porogens. The characterization of the prepared MIPs and non-imprinted polymers (NIPs) were evaluated by scanning electron microscope (SEM) and equilibrium adsorption experiment. The results showed that the MIPs possessed the specific adsorptivity toward ERY. Scatchard analysis revealed that the apparent maximum binding capacity (Qmax) and the dissociation content (Kd) to ERY were as follows: Qmax1 = 45.24 mg/g, Kd1 = 0.028 g/L; Qmax2 = 87.53 mg/g, Kd2 = 0.20 g/L. Using the prepared MIPs as selective adsorbent, the proposed molecularly imprinted solid phase extraction (MISPE) coupled with high performance liquid chromatography (HPLC) was successfully applied to determine ERY residue in pork samples. A linear correlation was obtained over a range of 0.5-50 mg/L (r2 = 0.999 4), and the limit of detection was 0.2 mg/kg (S/N = 3). The spiked recoveries of ERY were 95.2%-104.2% with the relative standard deviations (RSDs) of less than 5%. The proposed method is selective, sensitive and reliable for the analysis of ERY residue in pork samples.

Environmental and genetic aspects are reflected in the development of prostate cancer. In this context, there is growing evidence that chronic inflammation is involved in the regulation of cellular events in prostate carcinogenesis, including disruption of the immune response and regulation of the tumour microenvironment. One of the best surrogates of chronic inflammation in prostate cancer is interleukin 6 (IL-6). Serum IL-6 levels are elevated in patients with untreated metastatic or castration-resistant prostate cancer (CRPC) and correlate negatively with tumour survival and response to chemotherapy. Via multiple signal pathways including the Janus tyrosine family kinase (JAK)-signal transducer and activator of transcription (STAT) pathway, the extracellular signal-regulated kinase 1 and 2 (ERK1/2)-mitogen activated protein kinase (MAPK) pathway, and the phosphoinositide 3-kinase (PI3-K) pathway, IL-6 is able to promote prostate cancer cell proliferation and inhibit apoptosis in vitro and in vivo. IL-6 is associated with aggressive prostate cancer phenotype and may be involved in the metastatic process through regulation of epithelial-mesenchymal transition (EMT) and homing of cancer cells to the bone. A substantial body of evidence suggests that IL-6 plays a major role in the transition from hormone-dependent to CRPC, most notably through accessory activation of the androgen receptor. Collectively, these data have stimulated the development of agents targeting IL-6 signalling pathways. A chimeric anti-IL-6 monoclonal antibody has been tested in clinical trials, with mixed results., (© 2013 The Authors. BJU International © 2013 BJU International.)

Background: To date, no report has discussed endoscopic thyroidectomy using the oral vestibular approach (ETOVA). The objective of this study was to evaluate the feasibility, safety, efficacy, and cosmetic results of endoscopic thyroidectomy involving this surgical approach., Methods: Twenty-four patients with benign thyroid nodules were randomized into the ETOVA (n = 12) and the endoscopic thyroidectomy by areola approach (ETAA) groups (n = 12). Therapeutic effects were assessed at follow-up by physical examination. All patients were followed to evaluate thyroid function and scar formation from endoscopic treatment., Results: Complete resection of all the lesions was performed endoscopically, and no conversion to open surgery was needed. There was no difference between the 2 groups with respect to surgical time (60.4 vs 59.6 min), blood loss (10.8 vs 13.8 mL), postoperative hospital stay (4.9 vs 4.6 d), or cost of surgery (17.6 vs 17.4 thousand yuan). Patients who underwent the areola approach had 3 scars, 10 × 2 mm, 5 × 1 mm, and 5 × 1 mm in size, all of which were visible at the 6-month follow-up. Patients in the ETOVA group did not have any scars. Follow-up showed a significant difference (P = .019) in the satisfaction score between the ETOVA (2.33 ± 0.65) and the ETAA group (1.58 ± 0.79). Imaging showed that all patients had complete resection and no residual disease. Severe complications such as subcutaneous accumulation of blood and fluid, superior or recurrent laryngeal nerve injury, and parathyroid dysfunction were not observed., Conclusion: ETOVA was found to be safe and feasible and did not leave any scars; however, large-scale, randomized clinical trials are necessary for confirmation., (Copyright © 2014 Mosby, Inc. All rights reserved.)

Objective: To evaluate the clinical efficacy and safety of three-port transumbilical endoscopic cholecystectomy performed using conventional laparoscopic instruments., Methods: Thirty-two patients undergoing three-port transumbilical endoscopic cholecystectomy using conventional laparoscopic instruments (group A) with 3 ports around the umbilicus were compared with 96 patients (group B) receiving the conventional 4-port routine endoscopic cholecystectomy., Results: All the procedures were successfully completed without conversion to open laparotomy. In group A, the procedures were completed smoothly in 30 cases while 2 cases required another port (5 mm) punctured below the xyphoid due to severe adhesion around the cyst. The median operating time was 39.7∓5.2 min in group A, significantly longer than that in group B (25.3∓3.3 min, P<0.001), but the patients in group A obtained better cosmetic results (P<0.001); the median blood loss, recovery time of postoperative intestine function, length of postoperative hospital stay, and the rate of use of postoperative painkillers were comparable between the two groups. Bile leakage or other postoperative complications occurred in none of cases in the two groups., Conclusion: In cases without severe adhesion around the cyst, three-port transumbilical endoscopic cholecystectomy using conventional laparoscopic instruments is a safe and feasible alternative to routine endoscopic cholecystectomy with better cosmetic results.

In this study, the levels of soluble delta-like ligand 1 in cerebrospinal fluid and serum of 50 patients with tuberculous meningitis, 30 patients with viral meningitis, 20 patients with purulent meningitis and 40 subjects without central nervous system disease were determined using an enzyme-linked immunosorbent assay. The mean levels of soluble delta-like ligand 1 in both cerebrospinal fluid and serum from patients with tuberculous meningitis were significantly higher compared with those from patients with viral meningitis or purulent meningitis or from subjects without central nervous system disease. Meanwhile, the level of soluble delta-like ligand 1 gradually decreased as tuberculous meningitis patients recovered. If patients deteriorated after treatment, the level of soluble delta-like ligand 1 in cerebrospinal fluid gradually increased. There was no correlation between the level of soluble delta-like ligand 1 and the protein level/cell number in cerebrospinal fluid. Our findings indicate that the levels of soluble delta-like ligand 1 in cerebrospinal fluid and serum are reliable markers for the diagnosis of tuberculous meningitis and for monitoring treatment progress. At the same time, this index is not influenced by protein levels or cell numbers in cerebrospinal fluid.

Background: A 59-year-old man was admitted to hospital for investigation of a 1-year history of intermittent hematuria. He had undergone ileal ureteral replacement for left renal stones 36 years earlier., Investigations: Renal ultrasonography, physical examination, abdominal plain radiography, intravenous urography, CT urography, measurement of serum levels of creatinine, urea and electrolytes, renal scintigraphy, urinalysis and urine culture., Diagnosis: Staghorn calculi in the left kidney, with a high-lying anastomosis between the renal pelvis and the proximal ileal segment., Management: The patient underwent percutaneous nephrolithotomy via a middle-calyx access for the large staghorn stones. After surgery, no residual calculi were found and the patient was discharged with an uneventful postoperative course. At 1 month, renal scintigraphy showed normal bilateral kidney function. The patient received potassium citrate supplementation and was followed up with 6-monthly imaging studies. At the last report, he had been stone-free for 7 months.

Current widespread application of laparoscopic techniques in Roux-en-Y gastric bypass (RYGBP) is making surgical safety an increasingly important issue. We report one case that resulted in death due to postoperative fulminant acute pancreatitis after laparoscopic RYGBP was performed when this procedure was still relatively new in China. The patient was a chronically obese 19-year-old male. Weight loss medications had been ineffective, and preoperative body mass index was 40.7. Preoperative examination revealed moderate steatohepatitis. Laparoscopic RYGBP (LRYGBP) was performed. Early manifestations of clinical shock appeared 13 h after the laparoscopic surgery. A second laparoscopic examination showed small-vessel hemorrhage at the posterior wall of the jejunojejunal anastomosis, with blood clot formation resulting in Roux limb and afferent loop obstruction. Fulminant acute pancreatitis developed in the patient 18 h after the second surgery. The patient died 15 days later from systemic multiorgan insufficiency. LRYGBP (postcolon) is a technically demanding procedure for surgeons who are not experienced in this operation. In addition, surgical tolerance is reduced in morbidly obese patients. Therefore, special care should be taken during surgery, and hemostasis must be achieved at all bleeding sites. Increased perioperative surveillance allows for early detection and management of severe complications.

We detected loss of heterozygosity (LOH) and microsatellite instabilities (MSI), as well as extron expression of the fragile histidine triad (FHIT) gene in gastric carcinoma (GC), in order to evaluate their association with clinicopathological processes in gastric carcinogenesis. LOH and MSI of the FHIT were detected by using PCR at 4 microsatellite loci: D3S 1300, D3S 4103, D3S 1481, D3S 1234 in cancer tissues from 50 patients with primary GC, with normal mucosa acting as matched controls. FHIT transcripts were detected by nested RT-PCR in 30 cases of GC and their products were sequenced. Results show that the average frequencies of LOH and MSI of the FHIT gene in GC were 32.4% and 26.4%, respectively. There was no correlation between LOH and MSI of the FHIT gene in GC and the histological characteristics of gastric carcinoma (Bormann's or Lauren's classification). LOH of the FHIT gene in GC was related to depth invasiveness, and its frequency in GC where serosa was penetrated was significantly higher than that in GC without serosa penetration (73.5% vs 37.5%, P < 0.05). The frequency of MSI in GC without lymph node metastasis was significantly higher than that in GC with lymph node metastasis (66.7% vs 34.3%, P < 0.05). Aberrant transcripts were found in 11/30 GC tissues. Sequencing analysis of the aberrant fragments found a RT-PCR product missing exons 5-7 in one case of GC, and another product missing exons 4-7. Four of 10 (40.0%) cases of primary GC showed absent or decreased expression of the FHIT protein as compared to their matched normal tissues. The findings in this study suggest that LOH and MSI of FHIT gene may induce aberrant extron expression, which might play a role in gastric carcinogenesis.