Expression and significance of Toll-like receptor 4 in renal tissue and peripheral blood of children with idiopathic nephrotic syndrome / 中华实用儿科临床杂志

Objective:To investigate the expression and significance of Toll-like receptor 4 (TLR4) in renal tissue and peripheral blood of children with idiopathic nephrotic syndrome(INS).Methods:The renal biopsy tissues of 78 children with INS diagnosed in the First Affiliated Hospital of Xinxiang Medical University from October 2015 to June 2018 and normal renal tissues of 21 children (control group 1) were collected, and the expressions of TLR4 in the renal tissue was detected by using immunohistochemical method.The expression of TLR4 in different renal pathological types and clinical types of INS was compared, and the correlation of TLR4 with 24-hour urinary protein and serum albumin was analyzed.The expression levels of TLR4 in peripheral blood of children with INS before and after treatment (active stage and remission stage) and 23 healthy children (control group 2) were detected by enzyme linked immunosorbent assay(ELISA). The serum expression levels of TLR4 in different renal pathological types and clinical types of INS were compared, and the correlation of TLR4 with 24-hour urinary protein and serum albumin was analyzed; The correlation between TLR4 expression in renal tubules and in the serum of children with INS was also analyzed.Results:(1)Compared with the expression of TLR4 in normal renal tissues[(0.93±0.26)%], the expression of TLR4 in glomeruli and interstitium of all pathological types of INS [mesangial proliferative glomerulonephritis (MsPGN): (0.93 ± 0.21)%, focal segmental glomerulosclerosis (FSGS): (1.02±0.25)%, membranous glomerulonephritis(MN): (1.03±0.09)%, minimal change disease(MCD): (1.02±0.27)%]was not significantly different ( F=0.741, P=0.562), but the expression of TLR4 in renal tubules[MCD: (82.94±4.62)%, MN: (63.54±1.98)%, MsPGN(42.32±2.97)%, FSGS: (22.60±2.07)%] was significantly increased ( F=1 929.842, P<0.01), Especially, the expression of TLR4 in renal tubules of MCD type INS was significantly higher than that of MN, MsPG N and FSGS [MCD: (82.94±4.62)%, MN: (63.54±1.98)%, MsPGN: (42.32±2.97)%, FSGS: (22.60±2.07)%], and the differences were statistically significant(all P<0.01). TLR4 expression in renal tubules was the highest in steroid-sensitive nephrotic syndrome (SSNS) type and the lowest in INS patients with steroid-resistant nephrotic syndrome (SRNS) type, and the differences were statistically significant( F=220.951, P<0.01). (2)The expression of serum TLR4 in INS children at the active stage [MsPNG: (143.36±12.99) ng/L, FSGS(75.94±7.29) ng/L, MN(210.22±14.66) ng/L, MCD(283.93±21.58) ng/L]was significantly higher than that in INS children at remission stage [MsPNG: (29.51±4.93) ng/L, FSGS(15.66±3.78) ng/L, MN(45.40±5.73) ng/L, MCD(62.29±7.90) ng/L]and control group 2[(0.69 ± 0.33) ng/L], and the differences were statistically significant(all P<0.01); the expression of serum TLR4 in INS children at remission stage was significantly higher than that in the control group 2 ( F=286.287, P<0.01). TLR4 had the highest expression level in serum of MCD type INS children at active and remission stages, followed by MN and FSGS successively.The expression of serum TLR4 was highest in SSNS and lowest in SRNS, and the differences were statistically significant ( F=147.438, P<0.01). (3)The expression of TLR4 in renal tubules of children with INS[(62.82 ±20.94)%]was positively correlated with the expression of TLR4 in serum[(213.26±73.33) ng/L] ( r=0.852, P< 0.05). The expression levels of TLR4 in renal tubules and serum of INS patients at active stage were positively correlated with 24-hour urinary protein level[(123.05±33.55) mg/kg] ( r=0.401, 0.427, all P<0.05), and negatively correlated with serum albumin level[(19.54±3.55)g/L] ( r=-0.602, -0.617, all P<0.05). Conclusions:The expression of TLR4 in renal tubules and serum of children with INS increases, and may be related to different renal pathological types and clinical types of children with INS, as well as disease activity.

Comparative study of 3D thoracoscopic esophagectomy versus 2D thoracoscopic esophagectomy for esophageal carcinoma / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and safety of 3D laparoscopic and thoracoscopic esophagectomy.</p><p><b>METHODS</b>From October 2013 to March 2014, 154 patients with esophageal cancer of clinical stage T3N1M0 undergoing 3D or 2D minimally invasive esophagectomy in lateral prone position in our department were enrolled prospectively, and randomly divided into 3D group (78 cases) and 2D group (76 cases). The esophagus was dissociated by 3D or 2D laparoscope and thoracoscope to the entry of thorax. Stomach was dissociated by same telescopes and cut linearly. After tube stomach shaping was completed, esophagogastric anastomosis was performed in the left neck. The operative safety and short-term efficacy were compared between the two groups.</p><p><b>RESULTS</b>The entire procedure was technically successful in 154 patients. The average total operative time in 3D group was shorter than that in 2D group [(176.0±27.7) min vs. (203.0±31.5) min, P<0.05]. No significant differences were observed in blood loss [(124.0±35.8) ml vs. (127.0±25.7) ml], number of harvested lymph node (17.0±8.6 vs. 18.0±3.3), postoperative hospital stay [(11.8±9.3) d vs. (12.6±8.8) d] (all P>0.05), and morbidity of postoperative complication [12.8% (10/78) vs. 14.5% (11/76)]. The median follow-up time was 5.6 (3-8) months and 5.2 (5-7) months in 3D and 2D groups respectively, and no death or relapse cases were found during the follow-up.</p><p><b>CONCLUSION</b>3D laparoscopic and thoracoscopic esophagectomy under lateral prone position is technically feasible and safe for esophageal carcinoma, as compared to 2D procedure.</p>

Clinical application of thoracoscopic surgery for esophageal neoplasms in lateral prone position / 中华全科医师杂志

Thirty-three patients with esophageal carcinoma (T3N1M0 or less) underwent thoracoscopic surgery in lateral prone position for esophagectomy from February 2010 to November 2012.Their postoperative outcomes and survivals were retrospectively analyzed.The results confirmed the feasibility and safety of this mini-invasive thoracoscopic procedure in lateral prone position for patients with esophageal carcinoma.A possible advantage of lateral prone technique is that in case of an emergency switch to open surgery,precious time may be saved in changing body position.

Video-assisted thoracoscopic surgery in the prone position for esophageal carcinoma / 中华全科医师杂志

Forty one patients with esophageal carcinoma (T3N1 M0 or less) underwent video-assisted thoracoscopic surgery (VATS) in prone position for esophagectomy from September 2006 to September 2010.The postoperative outcome and survival of patients were retrospectively analyzed.The results confirmed the feasibility and safety of this minimally invasive esophagectomy performed by thoracoscopy in the prone position for patients with esophageal carcinoma.