ABSTRACT
Objective:Primary biliary cholangitis (PBC) and Primary Sj?gren′s syndrome (pSS) are autoimmune epithelial inflammatory diseases that share many common clinical symptoms. The aim of this study was to investigate the differences and diagnostic value of Autotaxin (ATX) in PBC and SS.Methods:The clinical data of 237 cases diagnosed with PBC, PBC secondary to SS, pSS and healthy individuals(HC) between September 2020 and September 2021 were retrospectively analyzed. The levels of ATX in each group were measured by enzyme-linked immunosorbent assay (ELISA), and the corresponding sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve ( AUC), etc were analyzed. Normally distributed data were expressed as mean ±SD and non-normally distributed as median (IQR). The differences and correlations between ATX and the biochemical tests in each group were assessed by applying the Mann-Whitney U test, Spearman correlation analysis, etc. P<0.05 was considered statistically significant difference. Results:The results showed that ATX was positive in 33.9%, 33.3% and 53.3% for PBC, PBC secondary SS, and pSS, respectively, with the specificities of 93.1%, 100% and 93.2%, respectively. The highest accuracy was achieved in pSS and the sensitivity and specificity were 86.5% and 93.2%, which were higher than those in PBC group(56.8%, 93.1%), respectively. Compared with HC [32.6(21.8, 60.5)ng/ml], ATX levels in PBC[59.3(48.6, 86.3)ng/ml, U=1 750.50, P<0.001], PBC-SS [73.6 (53.3,102.4)ng/ml; U=199.00, P<0.001], and pSS [152.6 (97.4,192.1)ng/ml, U=264.00, P<0.001] were elevated with significant difference ( P<0.05). ATX levels showed a decreasing trend from the pSS group to the HC group. ATX in PBC group[AUC(95% CI)= 0.73(0.651,0.812), P<0.001], PBC secondary SS group [AUC(95% CI)=0.82(0.730, 0.912), P<0.001], and pSS group [AUC(95% CI)=0.94(0.898, 0.984), P<0.001] had prediction accuracy. ATX was associated with total protein ( r=-0.31, P=0.041) level and glutaminase (r=-0.26, P=0.024) level. Conclusion:ATX has diagnostic value in both PBC and SS, and with higher sensitivity and specificity for the latter.
ABSTRACT
Objective:To observe the changes of macular morphology and blood flow after minimally invasive vitrectomy (PPV) in patients with severe non-proliferative diabetic retinopathy (sNPDR).Methods:A prospective clinical study. From January 2020 to April 2021, 17 consecutive sNPDR patients with 17 eyes who were diagnosed and received PPV treatment at the Zhongshan Ophthalmic Center of Sun Yat-sen University were included in the study. There were 12 males with 12 eyes and 5 females with 5 eyes; the average age was 55 years old; the average duration of diabetes was 11 years; the average glycosylated hemoglobin was 7.9%. Before the operation and 1, 3, and 6 months after the operation, all the affected eyes underwent best corrected visual acuity (BCVA), standard 7-field fundus color photography, and optical coherence tomography angiography (OCTA). An OCTA instrument was used to scan the macular area of the affected eye with in the range of 3 mm×3 mm to measure the central subfoveal thickness (CST), the thickness of the ganglion cell complex (GCC) in the macular area, the thickness of the retinal nerve fiber layer (RNFL), and the superficial capillary plexus (SCP) vessel density and perfusion density in the macular area, macular avascular zone (FAZ) area, a-circularity index (AI). Before the operation and 6 months after the operation, the least significant difference test was used for the pairwise comparison.Results:Before the operation, 1, 3, and 6 months after the operation, the FAZ area of the macular area were 0.34±0.14, 0.35±0.10, 0.37±0.10, 0.36±0.13 mm 2, respectively; AI were 0.52±0.13, 0.54±0.11, 0.57±0.10, 0.60±0.11; CST was 282.6±66.7, 290.4±70.9, 287.2±67.5, 273.2± 49.6 μm; GCC thickness were 77.1±15.5, 74.3±13.9, 72.6±16.2, 78.5±18.3 μm; the thickness of RNFL was 97.9±13.8, 101.3±14.6, 97.7±12.0, 96.1±11.4 μm, respectively. The overall blood flow density of SCP in the macula were (16.79±1.43)%, (16.71±1.82)%, (17.30±2.25)%, (17.35±1.22)%; the overall perfusion density were 0.32±0.02, 0.32±0.03, 0.33±0.03, 0.33±0.02, respectively. After the operation, the CST increased first and then decreased; the thickness of RNFL increased 1 month after the operation, and then gradually decreased. Comparison of the parameters before and 6 months after the operation showed that the AI improved, and the difference was statistically significant ( P=0.049); the difference in FAZ area and the thickness of CST, GCC, and RNFL was not statistically significant ( P=0.600, 0.694, 0.802, 0.712); There was no statistically significant difference in the retina SCP blood flow density and perfusion density in the macular area ( P=0.347, 0.361). Conclusion:Compared with before surgery, there is no significant change in macular structure and blood flow density in sNPDR patients within 6 months after minimally invasive PPV.
ABSTRACT
Objective:To observe the long-term efficacy and safety of macular buckling (MB) in the treatment of high myopia traction maculopathy.Methods:A retrospective clinical study. From January 2014 to December 2017, 57 eyes of 57 patients with high myopia traction maculopathy who underwent MB treatment at Zhongshan Ophthalmic Center of Sun Yat-sen University were included in the study. Among them, there were 15 males with 15 eyes, average age was 51.80±10.72 years; there were 42 females with 42 eyes, average age was 59.14±11.51 years. There were 21 eyes of 21 cases with highly myopic macular hole with macular detachment (MHMD), and 36 eyes in 36 cases with highly myopic foveoschisis with macular detachment (FSMD), and they were grouped accordingly. All patients underwent best corrected visual acuity (BCVA), optical coherence tomography (OCT), and axial length (AL) measurements. The standard logarithmic visual acuity chart was used for BCVA examination, which was converted into logarithm of the minimum angle of resolution (logMAR) visual acuity during statistics. All patients underwent MB, either on its own or combined with vitrectomy. Patients with significant vitreous macular traction on OCT were treated with combined surgery. One, 3, 6 months and 1, 2, 3, and 4 years after the operation, the same equipment and methods before the operation were used to conduct related examinations, and the long-term efficacy and safety of the two groups of eyes were observed.Results:Before surgery, the logMAR BCVA of eyes in MHMD group and FSMD group were 1.35±0.47 and 1.17±0.59, respectively; 4 years after surgery, they were 1.02±0.49 and 0.73±0.55, respectively. The BCVA improved significantly at postoperative 4 years than preoperative in both groups ( P=0.039, 0.001). In the eyes with MHMD, the BCVA was found to be significant improved 3 years after surgery ( P=0.042). Whereas, in the eyes with FSMD, the BCVA was found to be significantly improved 3 months after surgery ( P=0.013). Macular reattachment was achieved in 100% of cases, while macular hole closure rate was achieved in 66.7% in the MHMD group. In the FSMD group, either macular reattachment rate or the foveoschisis resolution rate was 97.2%. After surgery, choroidal neovascularization was observed in 2 eyes, and 3 eyes with intraretinal cyst. Conclusion:MB may represent a safe and effective surgical option for the treatment of high myopia maculopathy.
ABSTRACT
Pathological myopia, characterized by progressive elongation of the axial length and formation of posterior staphyloma, is accompanied by chorioretinal irreversible degeneration. It is also the focus and biggest challenge of myopia control and blindness prevention. For managing progressive early-onset pathologic myopia and myopic traction maculopathy, episcleral pressurization of macula is a practical option. It can be divided into posterior scleral reinforcement surgery and macular buckling surgery according to the presence or absence of operative top pressure ridge after surgery, both of which are different in terms of implanted materials, procedures and indications. The implanted materials, procedures and indications are different between the two. Under the background of soaring prevalence of myopia, it is necessary to modify and cautiously popularize the techniques of episcleral pressurization of macula to provide high level clinical evidence for management of pathological myopia.
ABSTRACT
Objective@#To investigate the risk factors of urinary tract infection after flexible ureteroscopy combined with holmium laser lithotripsy for kidney calculi with human immunodeficiency virus infection.@*Methods@#A total 96 patients from June 2016 to June 2018 were analyzed retrospectively. It included 53 males and 43 females, aged 21 to 57(average 41) years old. All patients were diagnosed with kidney stones by KUB, IVU and CT examination. 19 cases of bilateral kidney stones and 37cases in left and 40 cases in right. 67 cases of single stones and 29 cases of multiple. There were 34 cases of renal pelvis calculi, 19 cases of meddle calyx, 17 cases of superior calyx and 26 cases of inferior calyx. Maximum diameter of calculus was 0.8-2.9 cm, average(1.6±0.8)cm, of which 49 cases size were over 2 cm. There is no obvious stenosis of the renal pelvis and ureter. There were 29 cases of CD4+ lymphocyte count ≤400/μl, and 26 cases of preoperative ureteral stents. Urine test and urine bacterial culture were confirmed no urinary tract infection before lithotripsy. 46 cases with abnormal white blood cells due to urinary test could not meet the diagnostic criteria for urinary tract infection, and prophylactic antibiotics, 51 cases without antibiotics. All 96 cases underwent lithotripsy and record postoperative conditions. Then single factor analysis and multi-factor logistic regression analysis were used to analyze the related factors of urinary tract infection after lithotripsy.@*Results@#All 96 cases were successfully completed, no open surgery, no complications. The operation time was 40-130 min (average 57 min), of which 34 cases were over 60 min. Postoperative retained catheter time was 2 to 11 days (average 3.5 days), of which 27 cases were over 7 days. Urinary tract infection occurred in 18 of all patients, with an incidence of 18.8%. The results of urinary bacterial culture in 18 cases were 13 cases of Escherichia coli infection, 3 cases of Proteobacteria infection, and 2 cases of fecal cocci infection. There were 14 cases of calculi size over 2 cm, 10 cases of CD4+ lymphocyte count≤400/μl, 11 cases of preoperative ureteral stents, 3 cases of prophylactic antibiotics, 11 cases of operation time over 60 min, and 10 cases of postoperative retained catheter over 7 days. Single factor analysis found that CD4+ lymphocyte count≤400/μl, preoperative ureteral stents, larger calculi size, longer operation time, postoperative retained catheter for a long time could increase the risk of urinary tract infection after operation (P<0.05), Preoperative prophylactic antibiotics could reduce the incidence of postoperative infection (P<0.05). Multivariate logistic regression analysis suggested that CD4+ lymphocyte count ≤400/μl, preoperative ureteral stents, calculi size over 2 cm, operation time more than 60 min, postoperative retained catheter more than 7 days, and no prophylactic antibiotics before surgery were risk factors for postoperative urinary tract infection(P<0.05).@*Conclusions@#CD4+ lymphocyte count ≤400/μl, preoperative ureteral stents, calculi size over 2 cm, operation time more than 60 min, postoperative retained catheter more than 7 d, and no preventive use of antibiotics before surgery are risk factors for urinary tract infection after flexible ureteroscopy combined with holmium laser lithotripsy with human immunodeficiency virus infection.
ABSTRACT
Objective To investigate the risk factors of urinary tract infection after flexible ureteroscopy combined with holmium laser lithotripsy for kidney calculi with human immunodeficiency virus infection.Methods A total 96 patients from June 2016 to June 2018 were analyzed retrospectively.It included 53 males and 43 females,aged 21 to 57(average 41) years old.All patients were diagnosed with kidney stones by KUB,IVU and CT examination.19 cases of bilateral kidney stones and 37cases in left and 40 cases in right.67 cases of single stones and 29 cases of multiple.There were 34 cases of renal pelvis calculi,19 cases of meddle calyx,17 cases of superior calyx and 26 cases of inferior calyx.Maximum diameter of calculus was 0.8-2.9 cm,average (1.6 ± 0.8) cm,of which 49 cases size were over 2 cm.There is no obvious stenosis of the renal pelvis and ureter.There were 29 cases of CD4 + lymphocyte count ≤400/μl,and 26 cases of preoperative ureteral stents.Urine test and urine bacterial culture were confirmed no urinary tract infection before lithotripsy.46 cases with abnormal white blood cells due to urinary test could not meet the diagnostic criteria for urinary tract infection,and prophylactic antibiotics,51 cases without antibiotics.All 96 cases underwent lithotripsy and record postoperative conditions.Then single factor analysis and multi-factor logistic regression analysis were used to analyze the related factors of urinary tract infection after lithotripsy.Results All 96 cases were successfully completed,no open surgery,no complications.The operation time was 40-130 min (average 57 min),of which 34 cases were over 60 min.Postoperative retained catheter time was 2 to 11 days (average 3.5 days),of which 27 cases were over 7 days.Urinary tract infection occurred in 18 of all patients,with an incidence of 18.8％.The results of urinary bacterial culture in 18 cases were 13 cases of Escherichia coli infection,3 cases of Proteobacteria infection,and 2 cases of fecal cocci infection.There were 14 cases of calculi size over 2 cm,10 cases of CD4+ lymphocyte count ≤ 400/μ l,11 cases of preoperative ureteral stents,3 cases of prophylactic antibiotics,11 cases of operation time over 60 min,and 10 cases of postoperative retained catheter over 7 days.Single factor analysis found that CD4 + lymphocyte count ≤400/μl,preoperative ureteral stents,larger calculi size,longer operation time,postoperative retained catheter for a long time could increase the risk of urinary tract infection after operation (P ＜ 0.05),Preoperative prophylactic antibiotics could reduce the incidence of postoperative infection (P ＜ 0.05).Multivariate logistic regression analysis suggested that CD4 + lymphocyte count ≤400/μl,preoperative ureteral stents,calculi size over 2 cm,operation time more than 60 min,postoperative retained catheter more than 7 days,and no prophylactic antibiotics before surgery were risk factors for postoperative urinary tract infection(P ＜ 0.05).Conclusions CD4 + lymphocyte count ≤ 400/μl,preoperative ureteral stents,calculi size over 2 cm,operation time more than 60 min,postoperative retained catheter more than 7 d,and no preventive use of antibiotics before surgery are risk factors for urinary tract infection after flexible ureteroscopy combined with holmium laser lithotripsy with human immunodeficiency virus infection.
ABSTRACT
Objective To discuss the efficacy of the flexible ureteroscopy combined with Holmium laser lithotripsy for kidney calculi with HIV positive patients.Methods From May 2015 to May 2016,47 cases of patients with renal calculi were treated by the flexible ureteroscopy combined with Holmium laser lithotripsy in our hospital.There were 29 cases male,18 cases female,aged from 22 to 56 years old,average 39 years.There were 38 cases with single stone,9 cases with multiple stones.There were 9 cases with stones on both sides.Flexible ureteroscopy channel sheath was used in surgery.Stones were fragmented by Holmium laser.During one-month follow-up after surgery,stone removal and stone free rate were recorded.Residual stones were re-treated with a secondary lithotripsy or ESWL.Results The flexible ureteroscopy channel sheath was indwelled successfully in all the cases.All stones were detected.The average operation time was 63min (range,42-141min) and the median postoperative stay was 4.5days (range,2-16 d).Among the 47 patients,41 patients underwent first-stage lithotripsy,6 patients underwent second-stage ESWL after lithotripsy,and 1 patient underwent third-stage lithotripsy.The one-month stone free rate was 87.2％ (41/47).The total stone free rate was 97.9％ (46/47) after second-stage lithotripsy.Postoperative fever occurred in 4 cases after lithotripsy.No blood transfusion,systemic infection,ureteral perforation,or ureteral avulsion occurred.The total complication rate was 8.5％ (4/47).The mean number of CD4 +T lymphocytes before lithotripsy was 402/μl,and was 410/μl 3 days after lithotripsy.There was no Statistical differences between them.Conclusions Flexible ureteroscopy combined Holmium laserlithotripsy could be a safe and effective treatment for kidney calculi patients with HIV/AIDS positive.
ABSTRACT
Background Mitomycin C (MMC) is still irreplaceable until now.While it's current administration method has proved less than effective in the treatment of refractory glaucoma.To construct a MMC sustained release system which can maintain effective concentration and reduce toxicity is important for postoperative scarring regulation after glaucoma filtration surgery.Objective To evaluate the postoperative effect of use PTMC-F127-PTMC thermosensitive hydrogel as a new drug delivery carrier to sustained release MMC in rabbit trabeculactory.Methods Sixty rabbits,aged 10 to 14 weeks,were divided into 5 trabeculectomy groups in accordance with the random number table,including surgery only group,blank PTMC-F127-PTMC group and three sustained groups with 0.1 ml PTMC-F127-PTMC loaded with 0.05,0.10,0.20 g/L MMC injected after surgery.The MMC concentration of anterior chamber aqueous in three sustained release group with 0.1 ml PTMC-F127-PTMC loaded with 0.05,0.1,0.2 g/L MMC injected after surgery were tested by Guangzhou Analysis and Testing Center using high performance liquid chromatograph-mass spectrometer (HPLC-MS).At 3,7 days postoperatively,0.1 ml aqueous humor from 2 random selected rabbits in each group was extracted using 1 ml syringe with 30G needles from corneal limbus.At postoperative 1,3,5,7,10,14,28 days,bleb width and depth were calculated with caliper measurements and height was graded semiquantitatively by slit-lamp examinations,intraocular pressure (IOP) was measured with Tonopen.And corneal endothelial cell densities were examined by corneal endothelial counting before and 28 days after surgery.Sequential sections of the operative region were prepared and stained with hematoxylin and eosin and proliferating cell nuclear antigen (PCNA) after taking off the eyeballs from dead rabbits at 28 days later.Results MMC could be sustained released from PTMC-F127-PTMC hydrogel for more than 20 days.The mean postoperative bleb survival time in trabeculectomy surgery only group,blank hydrogel group and three sustained release groups were (5.3 ± 0.4),(5.5 ± 0.4),(12.2 ± 1.0),(25.1 ± 0.9),(26.7 ± 0.7) days respectively,the difference between each group was significantly (F =123.200,P =0.000).0.05 g/L MMC sustained release group has a better bleb survival time than that of surgery only group and blank hydrogel group (P =0.000).Compared with other groups,0.10 g/L and 0.20 g/L MMC sustained group has the longest bleb survival time (P =0.000),and more obvious IOP downtrending (F=53 010.000,P＜0.01).But the difference between the two groups was not significant.There was no difference in cornea endothelia cells counts between each group and no MMC was detected in aqueous humors.Histopathology test shows that the inflammatory response and fibrosis were lighter in MMC sustained release group,with stronger proliferation inhibition.Conclusions PTMC-F127-PTMC thermosensitive hydrogel can be a new drug delivery carrier to sustained release MMC.Sustain release MMC can extent bleb survival time with low toxicity.
ABSTRACT
<p><b>OBJECTIVE</b>To compare the clinical effectiveness and safety of alpha-blocker alone and combined tamsulosin with an anticholinergic drug for bladder outlet obstruction (BOO) with overactive bladder (OAB).</p><p><b>METHODS</b>Literature search was performed using PubMed, EMBASE, Ovid, Wanfang, and CNKI from inception to October 2013 for comparative studies assessing alpha-blocker alone and combined alpha-blocker with an anticholinergic drug for BOO+OAB. Data were extracted and evaluated by two reviewers independently according to the Cochrane Handbook for systematic reviews. Meta-analyses were conducted using RevMan 5.2.</p><p><b>RESULTS</b>A total of 7 studies involving 3 458 patients were included for the analysis. The values of total IPSS and storage IPSS reduced significantly after treatment in combination group (RR = -0.23, 95%CI: -0.44--0.02, P = 0.03; RR = -0.69, 95%CI: -0.88--0.51, P < 0.01). There were no significant differences between the two groups in voiding IPSS and Qmax (P = 0.86 and 0.89). The incidences of dry mouth (OR = 2.53), constipation (OR = 3.74), dizziness (OR = 0.73), and urinary retention (OR = 0.26) were higher in combination group than in alpha-blocker alone group (P < 0.05). But most adverse events were mild in degree.</p><p><b>CONCLUSION</b>Alpha-blocker combined with an anticholinergic drug in the treatment of BOO+OAB was better than that of alpha-blocker alone, and was safe and well tolerated.</p>
Subject(s)
Humans , Adrenergic alpha-Antagonists , Therapeutic Uses , Cholinergic Antagonists , Therapeutic Uses , Drug Therapy, Combination , Sulfonamides , Therapeutic Uses , Treatment Outcome , Urinary Bladder Neck Obstruction , Drug Therapy , Urinary Bladder, Overactive , Drug TherapyABSTRACT
ObjectiveTo investigate the role of p38 and ERK1/2 during rhesus monkeys mesenchymal stem cells differentiated into neuron-like cells.MethodsTo induce the neuronal phenotype,rhesus monkeys mesenchymal stem cells were maintained in sub-confluent cultures in serum-contain medium supplement with Sonic hedgehog.Western blot analysis the change of p38 and ERK1/2 during rhesus monkeys mesenchymal stem cells differentiated into neuron-like cells.Under transmission and scanning electron microscope,ultra-structure of the differentiated cell were observed.ResultsDuring BMSCs differentiated into neuron-like cells by SHH,Mitogen-activated protein kinases (MAPK) involved in their signal transduction,p38 was activated and ERK1/2 was inhibited.P38 inhibitor SB203580 increased induced differentiation time compared with normal induced cells,and inhibited neurite outgrowth.ConclusionActivation of p38 and inhibition of ERK was impacted on differentiation into neuron-like cells from rhesus monkeys mesenchymal stem cells induced by Sonic hedgehog,which may has potential application on neuroprotection of stem cells in Nervous system diseases
ABSTRACT
BACKGROUND:Bone marrow mesenchymal stem cells(BMSCs)differentiating into neural cells is an effective way of cell therapy of nervous system disease.However,the methods used nowadays still need to be improved.OBJECTIVE:To induce the differentiation of rhesus monkey BMSCs into neuron-like cells by using sonic hedgehog factor.METHODS:Rhesus monkey BMSCs differentiating into neuron-like cells was induced by typical retinoic acid and sonic hedgehog factor.Rhesus monkey BMSCs were isolated and cultured by density gradient centrifugation method.Cell growth was observed under an inverted phase contrast microscope and cell growth curve was determined using MTT assay.Flow cytometry was performed to characterize the phenotype of BMSCs,and immunohistochemistry was utilized to assess differentiated cells.Ultra-structure of the differentiated cells was observed by transmission and scanning electron microscopes.RESULTS AND CONCLUSION:Rhesus monkey BMSCs cultured in vitro were identified by flow cytometry,with high homogenicity.Following sonic hedgehog factor disposal for 7 days,differentiated cells were mainly positive for neurone specific enolase,neurofilament protein,Tau and glial fibrillary acidic protein(GFAP).Image statistical analysis found that in sonic hedgehog factor scheme,neural stem cells marker Neetin positive rate was significantly higher compared with the rstinoic acid scheme(P＜0.01).GFAP-positive rate was greater in the retinoic acid scheme than in the sonic hedgehog factor scheme(P＜0.05).Results indicated that sonic hedgehog factor scheme is an effective pathway of rhesus monkey BMSC differentiation into neuron-like cells.
ABSTRACT
BACKGROUND: Present studies have demonstrated that during neural development, differentiation of neural stem cells (NSCs) was affected by various regulatory factors from surrounding microenvironment. Sonic hedgehog (Shh) is a key induction signal during neural fetal development, and can be an effective inductor to regulate differentiation of neural cells. OBJECTIVE: To investigate the signal transduction pathway of SHH for differentiation of rhesus monkey bone marrow mesenchymal stem cells (BMSCs) into of neuron-like cells by sonic hedgehog factor. METHODS: Rhesus monkey BMSCs were isolated and cultured by conventional density gradient centrifugation. BMSCs in the induction group were treated with L-DMEM containing FGF2, B27 and fetal bovine serum for preinduction of 24 hours, and then with DMEM supplemented with 0.5 μmol/L retinoic acid or 400 μmol/L SHH for 8 days. Non-induced cells served as control group. Following labeling with neuron enolase, positive cells were screened by flow cytometry. RT-PCR and Western-blot were used to detect SHH- and retinoic acid-induced cell membrane receptor and intracellular signal protein changes. RESULTS AND CONCLUSION: SHH specific membrane receptor Ptc, retinoic acid specific receptor RARα, signal protein molecule ptch1 and Smad expressed in normal cells. Ptc expression upregulated in SHH-induced cells. High expression lasted for a long time with induction time, which was significantly stronger compared with the retinoic acid and control groups (P < 0.01). Intracellular ptch1 protein molecule expression showed similar tendency as this, but could not induce upregulation of RARα expression. During induction, retinoic acid-stimulated cells did not activate Ptc pathway. Four days following induction, RARα expression upregulated and lasted till 6 days, but there were no significant differences. No significant change in ptch1 expression was determined. SHH- and retinoic acid-induced cell Smad molecule expression upregulated, but no significant difference was determined. Results verified that SHH-induced scheme participated in cell induction and differentiation by persistently activating its specific receptors. However, there was no significant receptor pathway crossing between retinoic acid-induced and SHH-induced schemes.
ABSTRACT
Objective To assess the safety and efficacy of percutaneous nephrolithotripsy withpneumatic and ultrasonic power in pediatric renal calculi. Methods The clinical data of 44 patientstreated with combination of pneumatic and ultrasonic power during pereutaneous nephrolithotripsywere retrospectively analyzed. The 44 patients had 49 renal calculi. The patients were all under 14years old. The average age was 11 years (range 7-14 years). There were 39 unilateral and 5 bilateralcalculi. Among the 44 patients,metabolic disturbance occurred in 19 cases (43.2%),anatomical dys function occurred in 15 cases (34.1%),urinary tract infection occurred in 14 cases (31.8%). Ante grade percutaneous access was established under ultrasound guidance,a combination of pneumatic andultrasonic lithotripsy were used. The effect was evaluated by postoperative KUB and ultrasonic. Re suits The access was successfully established in all patients. Complete stone clearance was achievedin 36 kidneys in phase Ⅰ,stones from 9 kidneys were completely removed with second lithotripsy.Leftover stone in 2 kidneys were treated by ESWL. Open surgery was performed in 2 kidneys due toexcessive bleeding. The operative time ranged from 52 132 min,average time was 79 min. Two pa tients needed blood transfusion. No severe complications occurred in all patients. Thirty seven pa tients were followed up for 3 18 months. The renal function was not worsened and hydronephrosiswas not aggravated in these patients. Conclusion The percutaneous nephrolithotripsy with pneumatic and ultrasonic power is a safe,effective treatment for pediatric renal calculi.