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Objective:To summarize the clinical characteristics、diagnosis and treatment experience of children with reobstruction after pyeloplasty.Methods:A retrospective analysis was conducted on patients admitted to the Department of Urology, Beijing Children's Hospital from January 2015 to April 2022. Due to the unrelieved hydronephroplasty after the primary pyeloplasty, the anterior and posterior diameter of the pelvis was larger than that before the primary operation. Intravenous pyelography and diuretic renal radionuclide scanning confirmed the diagnosis of ureteropelvic reobstruction. Or underwent reoperation after undergoing puncture angiography for reobstruction. Fifty-four children were included in the study, 47 males (87.03%) and 7 females (12.96%), with a median age of 51.67(21.30, 117.24)month, and, 38 cases (70.37%) on the left side and 16 cases (29.63%) on the right side. The primary operation was open pyeloplasty (POP) in 20 cases and laparoscopic pyeloplasty (PLP) in 34 cases. 45 patients underwent primary operation in our hospital, and 9 patients were referred from other hospitals after primary operation. The interval between reoperation and initial operation was 7.25(6.15, 15.40)month. There were 28 cases with clinical symptoms before operation, and 26 cases without symptoms but reobstruction on imaging. 21 cases presented with recurrent abdominal pain, nausea and vomiting, and 7 cases presented with recurrent fever and urinary tract infection. All 54 patients underwent re-pyeloplasty after definite diagnosis of re-obstruction. In order to further study the feasibility of RLP, patients in the two groups were divided into RLP and ROP groups according to different surgical procedures. In the RLP group, there were 8 males (72.72%) and 3 females (27.28%). The median age was 82.21(49.83, 114.05) months, and obstruction was located on the left side in 8 cases (72.72%) and the right side in 3 cases (27.28%). There were 3 cases (27.28%) with POP and 8 cases (72.72%) with PLP. The time between the second operation and the primary operation was 12.83 (6.34, 16.86) months. APD before operation was 5.18 (4.25, 6.14) cm. There were 43 cases in the ROP group, including 38 males (88.37%) and 5 females (12.63%). The median age was 52.32 (26.62, 77.35) months; Obstruction was located on the left side in 31 cases (72.09%) and the right side in 12 cases (27.91%). The primary operation was performed in 19 cases (44.19%) with POP and 24 cases (55.81%) with PLP. The time between the second operation and the primary operation was 10.02 (8.03, 15.51) months. Preoperative APD was 5.42 (5.14, 5.90) cm. The causes of obstruction were found in the second operation: there were 28 causes (51.85%) of scar hyperplastic anastomotic stenosis, 7 cases (12.96%) of residual ectopic vascular compression, 8 cases (14.81%) of high ureteral anastomosis, 7 cases (12.96%) of ureteral adhesion distortion, and 4 cases (7.41%) of other causes (1 case of medical glue shell compression, 1 case of luminal polypoid hyperplasia, and 2 cases of complete luminal occlusion). Operation time, postoperative complications, APD, APD improvement rate (PI-APD), renal parenchyma thickness (PT), anteroposterior pelvis diameter/renal parenchyma thickness (APD/PT) at 3 and 6 months after operation were compared between RLP and ROP groups.Results:In this study, 54 patients were followed up with an average follow-up time of (34.41±20.20)month. APD of 3 months after pyeloplasty was 3.29(3.03, 3.52) cm, which was statistically significant compared with 5.45(5.13, 5.77)cm before pyeloplasty ( P=0.02). APD/PT changed from preoperative 21.71(21.08, 31.77)to 5.40(4.79, 6.79)3 months after surgery, and the difference was statistically significant ( P=0.03). The APD improvement rate was 37%(33%, 42%) 3 months after surgery and 49%(44%, 54%) 6 months after surgery. Among the 54 patients, 3 had lumbago and fever after clamping the nephrostomy tube, and 3(5.55%) had sinus angiography indicating that obstruction still existed and required reoperation. Therefore, the success rate of repyeloplasty in this group was 94.45%. Comparing RLP group and ROP group, operation time in RLP group was longer than that in ROP group [169.13(113.45, 210.66)]min vs. 106.83(103.14, 155.32)min, P=0.02]. The length of hospitalization in RLP group was shorter than that in ROP group [7.45(5.62, 9.28)d vs.11.64(10.45, 15.66)d, P=0.03], and the difference was statistically significant. The improvement rate of APD 3 months after surgery was compared between the two groups [30.48%(19.81%, 41.16%) vs.39.96%(35.16%, 47.76%), P=0.15], and the improvement rate of APD 6 months after surgery was compared between the two groups [48.00%(27.19%, 48.81%) vs.52.27%(46.95%, 56.76%), P=0.05], there was no significant difference in the success rate of operation between the two groups (90.90% vs. 95.34%, P=0.63). Conclusions:The common cause of reobstruction after pyeloplasty is cicatricial adhesion stenosis. The operation is challenging, but repyeloplasty can effectively relieve the obstruction and the overall success rate is 94.45%. RLP is a safe and effective surgical method for the treatment of reobstruction, which can achieve comparable surgical results with ROP.
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Objective:To describe the clinical features and analyze the prognostic factors of blastemaltype Wilms tumor. To explore the clinical risk factors affecting the prognosis of blastoma.Methods:Clinical data of 75 patients admitted to the surgery department of Beijing Children's Hospital from January 2008 to June 2020 who were confirmed to be blastemal-type Wilms tumor by postoperative pathology without preoperative chemotherapy. The patients' general information, clinical characteristics, inspection data, surgical methods and follow-up results were collected. The related factors which influences its prognosis were analyzed. Among the 75 patients, 45 cases (60.0%) were male and 30 cases (40.0%) were female. The diagnosis age was 6-144 m, mean age was 39.1 m. Left side: 38 cases (50.7%), right side: 37 cases (49.3%). The clinical manifestations were abdominal mass in 35 cases (46.7%), hematuria in 24 cases (32.0%), abdominal pain in 7 cases (9.3%) and physical examination in 9 cases (12.0%). There were Stage Ⅰ 30 cases, Stage Ⅱ 28 cases, Stage Ⅲ 15 cases, Stage Ⅳ 2 cases. There were preoperative tumor rupture in 5 cases, intraoperative tumor rupture in 2 cases. Clinical stage Ⅰ and Ⅱ were classified as early, while stage Ⅲ, Ⅳ were classified as late. According to COG protocol, stage Ⅰ and Ⅱ patients received EE4A, stage Ⅲ and Ⅳ patients received DD4A protocol and radiotherapy. The number of lymph nodes sampled during operation was more than 7 in 10 patients.Results:7 cases were tested for 1p16q. One case(stage Ⅱ) was absent at 1p/16q LOH, and chemotherapy was upgraded from EE4A to DD4A. After the recurrence of 1 case in clinical stage Ⅰ, the 1p/16q heterozygotic deletion test was performed, which was changed to M regimen chemotherapy. Only 1p lost in one case, and 1p/16q was negative in 4 cases, so the original chemotherapy regimen was maintained. A total of 67 patients were recruited to the study. The median follow-up time was 57 months. The 5-year relapse-free survival(RFS) rate was74.7%, and the 5-year overall survival(OS) rate was 88.0%. Cox multivariate regression analysis showed that: advanced clinical stage ( HR=4.9, 95% CI 1.2-19.6, P=0.025), tumor volume ( HR=1.7, 95% CI 0.4-6.9, P=0.048), and tumor rupture ( HR=20.1, 95% CI 4.7-85.5, P<0.001) were independent risk factors for prognosis of blastoma. Gender, age, side profile, clinical manifestations, tumor embolism, and number of lymph nodes sampled had no significant influence on the survival rate of blastoma ( P>0.05). Conclusion:Advanced stage (Ⅲ-Ⅳ), tumor volume≥1 000 ml, tumor weight and tumor rupture were independent risk factors for relapse. Insufficient lymph node sampling and incomplete 1p16q, may be the reasons for the increased risk of local recurrence in low-stage patients due to the underestimated risk classification and insufficient treatment intensity.
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【Objective】 To investigate the genotype of anti-HCV reactive blood donors by one ELISA assay and provide scientific basis for the reentry of anti-HCV false positive blood donors. 【Methods】 The data of 453 blood donors reactive to antibody to HCV(anti-HCV) with one ELISA assay(third generation) were extracted via the blood donor information system of Shaoguan Central Blood Station from January 1, 2014 to December 31, 2018. The subjects were recalled to the station for the serological retest, using a 4th generation ELISA reagent, and PCR qualitative test. The PCR reactive samples were sent to the genetic testing laboratory for HCV genotyping, in order to guide diagnosis and treatment in the future. Meanwhile, those PCR negative blood donors returned to be eligible again based on the Guidelines for the Return of Reactive Blood Donors for Blood Screening. 【Results】 70.2% (318/453) of the previous anti-HCV-reactive blood donors, using a third-generation ELISA assay responded to the HCV genotyping, of which 83.0%(264/318) were negative, and 17%(54/318) positive. The profile of HCV subtypes in positive donors was HCV2a>1b>3a=6a. A little bit high false positive rate was presented by the third, and former, generation reagent than the four generation(0.41% vs 0.06%), which was confirmed by HCV RNA qualitative and HCV genotyping tests.After two rounds of reentry testing, 98 eligible blood donors returned to the blood donor team, with the return rate at 21.63% (98 / 453). 【Conclusion】 NAT or (and) HCV genotyping for anti-HCV reactive blood donors screened out by the third, and former, generation, should be carried out to permanently shield the true positive donors and reenter the negative ones.
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Objective@#To understand HIV/AIDS knowledge, attitude, and awareness of HIV/AIDS policies and regulations among vocational medical students in Sichuan, and to provide scientific basis for AIDS prevention and treatment in higher vocational medical colleges.@*Methods@#A total of 1 458 medical students in a vocational college in Sichuan Province were selected through stratified cluster random sampling and investigated with questionnaire on HIV/AIDS related knowledge, policies and regulations.@*Results@#The average score of AIDS knowledge was(6.63±1.31), and the awareness rate was 82.9%; The average score of attitude towards AIDS was(2.17±0.45), with the highest score being fear and avoidance(2.56±0.61), and the lowest score responsibility perception(1.66±0.58); The total score of HIV/AIDS related policies and regulations was(19.17±2.91). AIDS knowledge was positively correlated with attitude and understanding of policies and regulations(r=-0.24, 0.28, P<0.01) , the higher the knowledge score, the better the attitude and the higher the understanding of policies and regulations.@*Conclusion@#HIV/AIDS knowledge of higher vocational medical students has been improved, the fear and avoidance of AIDS is widespread. There are insufficient awareness in AIDS related policies and regulations. Higher vocational medical colleges should be more targeted AIDS health education.
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Objective To investigate the effects of protein expressions and the urea transport activity of aldosterone on urea transporter A1 (UT-A1) and urea transporter A3 (UT-A3) in HEK293 cells and Xenopus laevis oocytes.Methods (1) Western Blot was used to investigate the protein expressions of UT-A1 and UT-A3.(2) Cell surface biotinylation was used to investigate the protein expressions of UT-A1 and UT-A3 on the cell surface of Xenopus laevis oocytes.(3) 14C-urea transport experiment was conducted to investigate the transport activity of UT-A1 and UT-A3 in Xenopus laevis oocytes.Results (1) Compared with UT-A1 or UT-A3 high expression groups,the total protein levels of UT-A 1 and UT-A3 were all significantly reduced in aldosterone treatment groups (all P ＜ 0.01).(2) Compared with UT-A1 or UT-A3 high expression groups,the levels of protein expression on cell surface were all significantly reduced in aldosterone groups (all P ＜ 0.01).(3) Compared with UT-A1 or UT-A3 high expression groups,14C-urea transport experiment results showed that aldosterone treatment groups had significantly reduced the urea transporter activity of UT-A1 (1 min:94.32±9.044vs 40.68±4.274,P＜0.01,n=6;3 min:165.0±4.7 vs 80.3±0.6,P＜0.01,n=6),and UT-A3 (1 min:204.6± 3.1 vs 176.7± 9.1,P＜0.05,n=6;3 min:371.4 ± 14.9 vs 318.8 ± 12.0,P＜0.05,n=6).Conclusion Aldosterone can directly down-regulate the protein expressions of UT-A1 and UT-A3 in both total protein and cell surface level,which reduces their urea transport activity.
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Objective To compare the effect of the application of tracheal intubation with SEESHEEN video intubation endoscope (ENF-20) and direct laryngoscopy in patients with missing teeth.Methods 50 patients with missing teeth were selected,and they were randomly divided into two groups, respectively after induction of general anesthesia in tracheal intubation using ENF-20 (group E) and direct laryngoscopy (SHUCMAN laryngoscopy) (group S) intubation.The time of intubation, the times of intubation and the complication of intubation were recorded.Results The success rate of intubation in group E was 92%, which was significantly higher than 64% in group S (x2=5.711,P=0.017).The intubation time of group E was (27±12)s, which was significantly shorter than (36±13)s in group S (t=-2.620,P=0.012).The total intubation complications of group E was 12%, which was significantly lower than 48% of the group S (x2=6.095,P=0.014).Conclusion The successful rate of tracheal intubation in patients with missing teeth by using video tracheal intubation (ENF-20) is higher and with less complication.
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Objective To assess the efficacy and safety of smoking intervention by anesthesiol-ogists in surgical patients.Methods A total of 182 male patients,aged 18-79 years,ASA grade Ⅰ-Ⅲ,scheduled for elective noncardiovascular and nonthoracic surgery,were assessed preoperatively. Patients were randomized to either the control group or the intervention group,n =91 each.The con-trol group did not receive specific smoking cessation intervention.The intervention group received brief counseling by the anesthesiologist,leaflets on smoking cessation,including pictorial health warning labels,smoking cessation clinic’s smokers’hot line and WeChat public number.Anesthesia methods,operation time,treatment time in PACU,the rate of smoking cessation at 30 days postop-eratively,perioperative complications and smoking status at 30 days postoperatively were recorded. Results One hundred and sixty-six patients were included in the analysis finally.There was no signif-icant difference between two groups in 30 days of follow-up postoperatively.Self-reported smoking re-duction in the postoperative 30 days the intervention group was significantly lower than that in the control group (36.9% vs.22.0%,P <0.05).For smokers,there was a relationship between the lev-el of eCO and the smoking cessation rate,it was 83.3% in the intervention group and 40.0% in the control group (P <0.05).There was no significant difference of overall rate of combined intraopera-tive and immediate postoperative complications between two groups.Conclusion Smoking cessation intervention launched by anesthesiologists promotes 30 days of abstinence postoperatively.
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Inhaled nitric oxide has been identified as a potent method for curing acute respiratory distress syndrome,high brood pressure and some illnesses related to the lung,but the high cost limits its application.The present study investigates the reason of the high cost of inhaled nitric oxide in the current application,and gives some advices on solving them by using pulsed arc discharge in clean air,reducing the price of nitrogen oxides analyzer and being compatible with the present ventilators.The perspective of inhaled nitric oxide was viewed as well.
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OBJECTIVE:To analyze the constituents of volatile oil in Artemisia indica from different area of Guangxi, and to compared which with those in Artemisia argyi. METHODS: The volatile oil was extracted from Artemisia indica and Artemisia argyi respectively by steam distillation. The constituents of the volatile oil were identified by GC-MS technology. RESULTS: The yield of the collected volatile oil of Artemisia indica from different area of Guangxi was 0.32%～0.67%, and compared with Artemisia argyi, both were found to contain the following main constituents: eucalyptol, camphor, borneol, germacrene D, caryophyllene, caryophyllene oxide, terpineol, azulene etc. But the content of the same constituents in Artemisia indica varied with different producing area and there was also difference for a certain constituent of the volatile oil. CONCLUSION: The study results serve as a scientific basis for rational use of Artemisia indica from Guangxi.