ABSTRACT Purpose The predictors of trifecta achievement in partial nephrectomy (PN) were poorly inquired and remained a controversial area of discovery. To evaluate predictive factors of trifecta achievement in patients undergoing PN. Materials and Methods A systematic literature search was performed to identify relevant articles. Only studies focusing on postoperative trifecta achievement and exploring its predictor with multivariable analyses were included. The trifecta achievement was defined as negative surgical margins, warm ischemia time <25 minutes, and no complications. Merged odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the predictive effect. Results Thirteen studies with 7066 patients meeting the inclusion criteria were included. The rate of trifecta achievement ranged from 43.3% to 78.6%. Merged results showed that preoperative eGFR (OR: 1.01, 95% CI: 1.00, 1.02, P=0.02), operative time (OR: 0.99, 95% CI: 0.99, 1.00, P=0.02), estimated blood loss (OR: 1.00, 95% CI: 1.00, 1.00, P <0.001), tumor size (OR: 0.70, 95% CI: 0.58, 0.84, P <0.001), medium (OR: 0.39, 95% CI: 0.18, 0.84, P=0.02) and high PADUA score (OR: 0.23, 95% CI: 0.08, 0.64, P=0.005) were independently associated with trifecta achievement. A publication bias was identified for tumor size. Sensitivity analysis confirmed the stability of result for tumor size. Conclusions Larger tumor size, medium and high PADUA score are associated with decreased probability of trifecta achievement. After verifying by further high-quality studies, these variables can be incorporated into tools to predict probability of trifecta achievement during clinical practice.

Abstract Objective: To assess the effectiveness and safety of fast-track cardiac anesthesia using the short-acting opioid sufentanil in children undergoing intraoperative device closure of ventricular septal defect (VSD). Methods: This retrospective clinical study included 65 children who underwent intraoperative device closure of VSD between January 2017 and June 2017. Patients were diagnosed with isolated perimembranous VSD by transthoracic echocardiography. Then, they were divided into two groups, group F (n=30), whose patients were given sufentanil-based fast-track cardiac anesthesia, and group C (n=35), whose patients were given conventional cardiac anesthesia. Perioperative clinical data were analyzed. Results: No significant differences were found between the preoperative clinical parameters and intraoperative hemodynamic indices between the two groups. In group C, compared with group F, the postoperative duration of mechanical ventilation, the length of stay in the intensive care unit, the length of hospital stay, and the hospital costs were significantly increased. Conclusion: In this retrospective study at a single center, sufentanil-based fast-track cardiac anesthesia was shown to be a safe and effective technique for minimally-invasive intraoperative device closure of VSD in children, which was performed with reduced in-hospital costs.

Abstract Objective: To compare the results of surgical repair via median sternotomy, right submammary thoracotomy, and right vertical infra-axillary thoracotomy for atrial septal defect (ASD). Methods: This is a retrospective analysis of the relative perioperative and postoperative data of 136 patients who underwent surgical repair for ASD with the abovementioned three different treatments in our hospital from June 2014 to December 2017. Results: The results of the surgeries were all satisfactory in the three groups. No statistically significant difference was found in operative time, duration of cardiopulmonary bypass, blood transfusion amount, postoperative mechanical ventilation time, duration of intensive care unit, length of hospital stay, and hospital costs. However, the median sternotomy group had the longest incision. Meanwhile, there was no significant difference in postoperative complications. Conclusion: All three types of surgical incisions can be safely and effectively used to repair ASD. The treatments via right submammary thoracotomy and right vertical infra-axillary thoracotomy have advantages over the treatment via median sternotomy in cosmetic results and should be the recommended options.

OBJECTIVES: The purpose of this study was to evaluate the relationship between the serum levels of calcitonin gene-related peptide (CGRP) and the prognosis of pediatric patients with severe pneumonia. METHODS: Children diagnosed with severe pneumonia (n=76) were stratified into the survival (n=58) and non-survival groups (n=18) according to their 28-day survival status and into the non-risk (n=51), risk (n=17) and high-risk (n=8) categories based on the pediatric critical illness score (PCIS). Demographic data and laboratory results were collected. Serum CGRP levels were determined by enzyme-linked immunosorbent assay (ELISA). A receiver operating characteristic (ROC) curve was generated to determine the cutoff score for high CGRP levels. RESULTS: Serum CGRP levels were significantly higher in the survival group than in the non-survival group and were significantly higher in the non-risk group than in the risk and high-risk groups. The ROC curve for the prognostic potential of CGRP yielded a significant area under the curve (AUC) value with considerable sensitivity and specificity. CONCLUSION: Our findings show that CGRP downregulation might be a diagnostic marker that predicts the prognosis and survival of children with severe pneumonia.

Abstract Objective: To analyze and summarize the clinical safety and feasibility of minimally invasive video-assisted mitral valve replacement via a right thoracic minimal incision in patients aged over 65 years. Methods: The clinical data of 45 patients over 65 years old who had mitral valve disease were analyzed retrospectively from January 2014 to January 2017 at Union Hospital, Fujian Medical University. The patients were divided into two groups; 20 patients in group A, who underwent minimally invasive video-assisted mitral valve replacement via a right thoracic minimal incision, and 25 patients in group B, who underwent conventional mitral valve replacement. We collected and analyzed their relevant clinical data. Results: The operation was completed successfully in both groups. Compared with group B, group A was clearly superior for postoperative analgesia time, postoperative hospital length of stay, thoracic drainage liquid, blood transfusion, and length of incision. There were no differences between the two groups in postoperative severe complications and mortality. More patients in group B had pulmonary infections and poor incision healing, while more patients in group A had postoperative pneumothorax and subcutaneous emphysema. Conclusion: In patients aged over 65 years, minimally invasive video-assisted mitral valve replacement with a small incision in the right chest had the same clinical safety and efficacy as the conventional method.

Abstract Objectives: To compare the advantages and disadvantages of perventricular and percutaneous procedures for treating isolated ventricular septal defect (VSD). Methods: A total of 572 patients with isolated VSD were selected in our hospital between January 2015 and December 2016. The patients’ median age and weight were five years (1-26 years) and 29 kg (9-55 kg), respectively. The median diameter of VSD was 6.0 mm (5-10 mm). Patients were divided into two groups. In group A, perventricular device closure was performed in 427 patients; in group B, 145 patients underwent percutaneous device closure. Results: Four hundred twelve patients in group A and 135 patients in group B underwent successful closure. The total occlusion rate was 98.5% (immediately) and 99.5% (3-month follow-up) in group A, which were not significantly different from those in group B (97.7% and 100%, respectively). Patients in group A had longer intensive care unit (ICU) stay than those in group B, but patients in group B experienced significantly longer operative times than those in group A. The follow-up period ranged from 8 months to 1.5 year (median, 1 year). During the follow-up period, late-onset complete atrioventricular block occurred in two patients. No other serious complications were noted in the remaining patients. Conclusion: Both procedures are safe and effective treatments for isolated VSD. The percutaneous procedure has obvious advantages of shorter ICU stay and less trauma than the perventricular procedure. However, the perventricular procedure is simpler to execute, results in a shorter operative time, and avoids X-ray exposure.

Abstract Purpose: To investigate the prognostic value of 17 platelet-based prognostic scores in patients with malignant hepatic tumors after TACE therapy. Methods: In total, 92 patients were divided into death group and survival group according to long-term follow-up results. The AUC was calculated to determine the optimal cut-off values for predicting prognosis. To determine better prognostic models, platelet-based models were analyzed separately after being showed as binary according to cut-off values. Cumulative survival rates of malignant hepatic tumors were calculated using Kaplan-Meier curves and differences were analyzed by the log-rank test. Univariate and multivariate analyses were performed to identify platelet-based prognostic scores associated with overall survival. Results: Univariate analysis showed that APGA, APRI, FIB-4, FibroQ, GUCI, King's score, Lok index, PAPAS, cirrhosis, number of tumors, vascular cancer embolus, AFP, ALP and APTT were significantly related to prognosis. A multivariate analysis showed that the APGA, number of tumors, ALP and APTT were independently associated with overall survival. Conclusion: This study showed that the APGA, a platelet-based prognostic score, was an independent marker of prognosis in patients with malignant hepatic tumors after TACE and was superior to the other platelet-based prognostic scores in terms of prognostic ability.

Abstract The pyrolysis kinetics of hulless barley straw at different heating rates of 5，10, 15, 20 and 30 ºC/min were investigated via thermogravimetry, and the activation energy distribution E and pre-exponential factor k0 were calculated using the Distributed Activation Energy Model (DAEM) from thermogravimetric analysis (TGA) curves, and characterizations of pyrolysis product of biochar were analyzed by techniques of scanning electron microscopy (SEM) and X-ray diffraction (XRD). The pyrolysis process consisted mainly of the dehydration stage (50-150 ºC), the active pyrolysis stage (200-400 ºC) and the passive pyrolysis stage (400-800 ºC). The E ranged from 73.45 to 214.11 kJ/mol within the conversion rate range of 0.10-0.55, and changed from 214.11 to 141.55 kJ/mol within the conversion rate range of 0.55-0.90, and the average value of E was 172.23 kJ/mol. The values of k0 changed greatly with E values at different mass conversion. The wide E and k0 distributions obtained from the kinetic analysis are attributed to the complex chemical reactions of pyrolysis. The structure of biochar was degraded or ruptured due to the increase in temperature. The XRD analysis confirmed that the biochar was amorphous, dominated by disordered graphitic crystallites.

ABSTRACT DNA vaccines have been shown to be an effective approach to induce antigen-specific cellular and humoral immunity. However, the inability of DNA vaccines to elicit strong immune responses in clinical trials limits the application of DNA vaccines. Here, we developed a new DNA vaccine based on MUC1, which has been suggested as a potential target for lung cancer therapy, and we enhanced the potency of the DNA vaccine by including granulocyte-macrophage colony-stimulating factor (GM-CSF) as an adjuvant. A series of DNA plasmids encoding MUC1, human GM-CSF and their conjugates were constructed and injected into female mice intramuscularly (i.m.). This action was followed by an electric pulse. The humoral and cellular immune responses after immunization were examined by ELISA and ELISPOT, respectively. To evaluate the therapeutic efficacy of the plasmids, a mouse model with a MUC1-expressing tumor was designed. Mice vaccinated with the MUC1-GM-CSF plasmid generated the strongest MUC1-specific humoral and cellular immune responses. Furthermore, these vaccinations inhibited the growth of MUC1-expressing tumors and prolonged mouse survival. These observations emphasize the potential of GM-CSF as an adjuvant for DNA vaccines and of vaccines based on MUC1 and GM-CSF as a promising treatment for lung cancer.

Indica and japonica are two main subspecies of Asian cultivated rice (Oryza sativa L.) that differ clearly in morphological and agronomic traits, in physiological and biochemical characteristics and in their genomic structure. However, the proteins and genes responsible for these differences remain poorly characterized. In this study, proteomic tools, including two-dimensional electrophoresis and mass spectrometry, were used to globally identify proteins that differed between two sequenced rice varieties (93-11 and Nipponbare). In all, 47 proteins that differed significantly between 93-11 and Nipponbare were identified using mass spectrometry and database searches. Interestingly, seven proteins were expressed only in Nipponbare and one protein was expressed specifically in 93-11; these differences were confirmed by quantitative real-time PCR and proteomic analysis of other indica and japonica rice varieties. This is the first report to successfully demonstrate differences in the protein composition of indica and japonica rice varieties and to identify candidate proteins and genes for future investigation of their roles in the differentiation of indica and japonica rice.

ABSTRACT Introduction: Laser is a technology of wide applications is in industry, investigation and biology, that transforms large quantities of energy into electro-magnetic radiation that is then emitted as a light beam, which produces a photothermal or photoacustic effect. In the case of the Holmiun Laser whose wide wave-length (2120 nm) enables diverse procedures to be carried out, such as tissue ablation and cutting, lithotripsy, and tis-sue vaporization. Objective: To present different minimally invasive treatments with Holmium laser (New Star®, 18W model) in various urologic procedures done in the Country to the date. Material and methods: to present the first 10 cases of endourological surgery with Holmiun laser performed between July 2011 and December 2012 in Adventist Hospital of Asunción, such as PCNL, proximal and distal ureterolithotripsy, retrograde intrarenallithotripsy with flexible ureteroscope, internal urethrotomy, bladder neck restructuring for postoperative sclerosis, cystolithotripsy, all employing 18 Watt Holmium laser. Results: 1 patient underwent PCNL, 2 patient underwent intrarenal lithotripsy through flexible ureteroscopy, 6 cases of distal ureterolithotripsy, 1 case of cystolithotripsy. Among the patients who underwent uretrolithotripsy 2 of them required urethotomy and 1 cevicotomy with the same laser. Only in one case of distal ureteral stone, the laser lithotripsy had to be repeated. Treatment effectiveness was verified according to studies of choice for each pathology. In the patients that underwent lithotripsy plain abdominal x-rays were taken the patients that had urethral stricture and urethovesical stricture managed with laser urethrotomy , were followed up postope-ratively with urethrograph and urethral calibration. All studies showed anatomic improvements. Conclusions: The Holmium laser has an excellent safety profi-le and efficacy. It can be employed in the entire urinary tract, and its generalized application during recent years for the management of obstructive urinary tract pathology and stone disease, in which it has be-come the gold standard. Endourology is a fundamental area of general urology, and the skillful use of laser tech-nology is one of the greatest challenges in the professional training of the urologist which has allowed the use of flexible endoscope to reach the entire urinary tract. Key words: Laser, endourology, enucleation of the pros-tate, Holmium, laser endopyelotomy, cystolithotripsy, urethrotomy.

RESUMEN Introducción: El laser es una tecnología de amplias aplicaciones industriales, biológicas y de investigación que se logra con grandes cantidades de energía transformada en radiación electromagnéti-ca que emite finalmente haces de luz produciendo un efecto fototérmico o fotoacústico. En el caso del láser Holmiun debido a su amplia longitud de onda (2120nm) permite realizar distintos procedimien-tos como la ablación y corte de tejidos, litotripsia y vapori-zación tisular. Objetivo: Presentar los tratamientos mínima-mente invasivos mediante laser Holmium (New Star®, 18W), en distintos padecimientos urológicos realizados hasta la fecha en el país. Material y Métodos: Se presentan los 10 primeros casos de cirugías endourológicas con el laser Holmium realizadas entre julio de 2011 y diciembre de 2012 en el Sanatorio Adventista de Asunción, principalmente litotripcias como nefrolitotripsia percutánea, ureterolitotripcia distal y proximal, nefrolitotripcia vía retrograda mediante uso de ureteroscopio flexible, cistolitotripsia y la cervicotomía vesical y uretrotomía interna, todos ellos em-pleando un equipo de laser Holmium de 18W. Resultados: Se realizaron un caso de nefrolitotripsia percutánea, dos litotripsias caliciales vía retrograda, seis uretero-litotripsias distales y una cistolitotripsia. En tres casos de uretero-litotripsia se requirió de uretrotomía por estrechez uretral bulbar y de anastomosis uretrovesical. Un caso de ureterolitotripsia fue reintervenido por los fragmentos residuales. No hubo perforaciones de mucosas y las retropulsiones fueron mínimas. Se efectuó uretrografía retrógrada de control y calibraciones uretrales en los casos de uretrotomía y de la cervicotomía con láser. Se ejecutaron radiografías simples de las vías urinarias en cistolitotripsia, ureterolitotripsia y nefrolitotripsia percutánea y retrograda, todos ellos mostrando mejorías anatómicas. Conclusiones: El laser Holmium es una herramienta que posee un excelente perfil de eficacia y seguridad. Se destaca su generalización en los últimos años para el manejo de las patologías obstructivas del tracto urinario y de la enferme-dad litiásica, de la cual actualmente se constituye como el "estándar de oro". El campo de la endourología constituye un área primordial para el urólogo general, por lo cual el adiestramiento y empleo de la tecnología laser, constituye uno de los mayores retos en la forma-ción profesional del mismo ya que ha permitido incorporar el endoscopio flexible que abarca la totalidad del tracto urinario. Palabras clave: Laser, holmiun, litotripsia, endourología, cistolitotripsia, uretrototomía.

Snake liver has been implicated in the adaptation of snakes to a variety of habitats. However, to date, there has been no systematic analysis of snake liver proteins. In this study, we undertook a proteomic analysis of liver from the colubrid snake Elaphe taeniura using a combination of two-dimensional electrophoresis (2-DE) and matrix-assisted laser desorption/ionization time of flightmass spectrometry (MALDI-TOF MS). We also constructed a local protein sequence database based on transcriptome sequencing to facilitate protein identification. Of the 268 protein spots revealed by 2-DE 109 gave positive MS signals, 84 of which were identified by searching the NCBInr, Swiss-Prot and local databases. The other 25 protein spots could not be identified, possibly because their transcripts were not be stable enough to be detected by transcriptome sequencing. GO analysis showed that most proteins may be involved in binding, catalysis, cellular processes and metabolic processes. Forty-two of the liver proteins identified were found in other reptiles and in amphibians. The findings of this study provide a good reference map of snake liver proteins that will be useful in molecular investigations of snake physiology and adaptation.