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Objective:To investigate the ureteral stricture after ureteroscopic holmium laser lithotripsy in patients with ureteral calculi and its effect on prognosis.Methods:The clinical data of 406 patients who underwent ureteroscopic holmium laser lithotripsy in Nanjing Tongren Hospital from January 2018 to August 2019 were analyzed retrospectively, according to postoperative ureteral stricture, the patients were divided into stricture group ( n=28) and non-stricture group ( n=378). The independent risk factors of postoperative ureteral stricture in patients with ureteral calculi were evaluated by univariate and multivariate Logistic regression analysis, and the postoperative recurrence rate and prognosis of the two groups were compared.The nomogram model was constructed according to independent risk factors, and the accuracy of the model was verified by receiver operating characteristic (ROC) curve, GiViTI calibration band and clinical decision curve. Measurement data were expressed as mean±standard deviation ( ± s), comparison between groups used t-test, and comparison of count data between groups used Chi-square. Results:Univariate analysis showed that there were significant differences in course of ureteral calculi, stone diameter, polyp wrapping, degree of hydronephrosis, incarcerated stone, ureteral injury and operation time between non-stricture group and stricture group ( P<0.05). Multivariate Logistic regression analysis showed that the course of ureteral calculi, stone diameter, polyp wrapping, degree of hydronephrosis, incarcerated stone and ureteral injury were independent risk factors for postoperative ureteral stricture in patients with ureteral calculi ( P<0.05). The patients with ureteral calculi were followed up for 1 year by telephone, outpatient reexamination and medical record inquiry. During the follow-up period, 106 cases of ureteral calculi recurred. The recurrence rate of 1 year (21.43% vs 8.99%) and 2 years (35.71% vs 14.81%) in the stricture group was significantly higher than that in the non-stricture group, the differences were statistically significant ( χ2=4.54, 8.36, P<0.05). Compared with the non-stricture group, the physiological function score [(79.28±8.17) vs (65.22±10.53)], physiological function score [(78.54±9.33) vs (69.23±7.86)] and overall health score [(81.03±10.54) vs (70.43±7.38)] in the stricture group were significantly lower, the differences were statistically significant ( t=7.70, 5.29, 5.43, P<0.05). The area under curve of the constructed nomogram model ROC curve was 0.882 (95% CI: 0.774-0.928). In the 80%-90% confidence interval area of the GiViTI calibration curve belt, it does not pass through the 45° angle bisector ( P=0.176). The clinical decision curve indicates that the net benefit rate was high. Conclusions:The course of ureteral calculi, stone diameter, polyp wrapping, degree of hydronephrosis, incarcerated stone and ureteral injury are independent risk factors for postoperative ureteral stricture in patients with ureteral calculi. Clinicians should actively take intervention measures to reduce the incidence of postoperative ureteral stenosis, improve the prognosis and improve the quality of life of patients.
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As a novel transdermal drug delivery technology of minimally invasive, safe and efficient, microneedles have received increasing attention. The microchannels formation by microneedles onto the skin is a prerequisite and key for microneedles to deliver drugs. However, there is still a lack of systematic evaluation in skin microchannels. This review summarized influencing factors and evaluation methods in microchannels formation and healing by microneedles, including geometric parameters, materials for preparation, drugs, penetration parameters, differences among the skin of subjects, and presence or absence of occlusion. This review provides reference for other scholars to further study the effectiveness and security of microneedle applications.
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In this paper, the effects of the blend of nanoparticles and microneedle matrix materials on the mechanical properties of dissolving microneedles were studied mainly, so as to construct microneedles with excellent mechanical properties. Different kinds of nanoparticles (calcium carbonate, hydroxyapatite, silica), particle sizes (20, 60, 100 nm) and the proportion of prescription (2%, 6%, 10%) were blended with the matrix material [polyvinyl pyrrolidone (PVP), poly(1-vinylpyrrolidone-co-vinyl acetate)(PVP/VA)] to form dissolving microneedles. The effects of nanoparticles on the elastic modulus and hardness of the microneedles were investigated using a nanoindenter. The results showed that the elastic modulus and hardness of PVP microneedles were significantly improved by nano-calcium carbonate (P < 0.001), and the elastic modulus and hardness of PVP/VA microneedles were significantly improved by nano-hydroxyapatite (P < 0.001). When the particle size of hydroxyapatite was 20 nm, the elastic modulus of PVP/VA microneedles was (10.6 ± 1.0) GPa, and the hardness was (0.47 ± 0.06) GPa. As the size of the nanoparticles increases, the mechanical performance of the microneedles decreases. When the mass proportion of nano-hydroxyapatite increased from 2% to 6%, the elastic modulus and hardness of the microneedles were significantly improved (P < 0.001), but the effect of continue increasing the proportion of nanoparticles on the microneedles was not significant. The nano-enhanced PVP/VA dissolving microneedles has no irritant effect on intact skin and has a slight irritation to damaged skin, but they disappear completely after 72 h. Animal experiments have been approved by the Laboratory Animal Welfare and Ethics Committee of Zhejiang University of Technology. Therefore, the nano-enhanced dissolving microneedles has good biological safety. To sum up, it is necessary to select the appropriate kind of nanoparticle, particle size, and prescription ratio when microneedles constructing with a given matrix material, so as to effectively improve its mechanical performance.
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To investigate the influence factors and effects of metal or dissolving microneedles on the formation and healing of skin microchannels, the pencil-shaped or conical stainless steel microneedles with different lengths, tip to tip space and base area, and the pencil-shaped dissolving microneedles with different tip to tip space were used. The microneedles were applied to the skin of epilatory mice and rats, and the effects of various microneedle parameters, application parameters, and animals on the microchannels were explored by the transepidermal water loss (TEWL) and methylene blue staining. Visually observe the skin local irritation caused by the microneedles. The animal experiments were approved by the Animal Experiments Welfare and Ethical Committee of Zhejiang University of Technology. The application time of the microneedle should be maintained at 30 s or more. When the insertion forces were 2, 4, 8 N, and the TEWL initial values of the formed microchannels were 12.9, 33.0, 40.4 g·m-2·h-1, respectively. When the length of metal microneedle were 400, 600, 800 μm, and the TEWL initial values of the formed microchannels were 37.1, 40.4, 49.5 g·m-2·h-1, respectively. When the tip to tip space of metal microneedle were 400, 600, 800 μm, and the TEWL initial values of the formed microchannels were 33.2, 40.4, 55.8 g·m-2·h-1, respectively. When the base area of metal microneedle were 0.16, 0.35, 0.62 cm2, and the TEWL initial values of the formed microchannels were 35.1, 40.4, 67.1 g·m-2·h-1, respectively. The effects of conical and pencil-shaped microneedles are similar. When the tip to tip space of pencil shaped dissolving microneedle were 400, 600, 800 μm, and the TEWL initial values of the formed microchannels were 49.8, 60.5, 70.5 g·m-2·h-1, respectively. The TEWL baseline values of animal skins of different genders and series are different, but the tendency of microchannels formation and closure is similar. Visual inspection revealed that the slight erythema caused by the microneedles subsided within 24 h. Microneedles of different parameters have different effects on microchannels. The microchannels closed within 24 or 48 h, and the skin local irritation caused by microneedle was mild.
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Microneedles is an efficient, safe and novel transdermal drug delivery technology that has attracted much attention in recent decades. Microneedles could break through the skin's stratum corneum barrier and have an especially significant effect on the transdermal delivery of water-soluble small molecules and biological macromolecules. In this paper, a rapid onset local anesthetic preparation of lidocaine hydrochloride was prepared based on dissolving microneedles, and related quality evaluations were carried out. The key quality indicators of prepared lidocaine hydrochloride dissolving microneedles such as drug loading amount, appearance morphology, mechanical properties, skin penetration performance, in vitro dissolution performance and local anesthetic efficacy were investigated with HPLC, SEM, texture analyzer, organic staining, histological section, in vitro dissolution test and pharmacodynamics experiments respectively. The drug loading of the dissolving microneedles array reached 68.19 ±1.55 mg, and the needle tip contained 3.57 ±0.21 mg. The microneedles has good needle shape and sufficient mechanical strength to penetrate into the skin, which is a prerequisite for the successful administration of the preparation. The in vitro dissolution time was 28.28 ±1.12 s. When applied to guinea pig back acupuncture model which was modified by guinea pig intradermal papules model, although the efficacy maintenance time was shorter than that of compound lidocaine cream, dissolving microneedles can be activated within 1 min, which was much faster than compound lidocaine cream. It is possible to increase the duration of drug efficacy by increasing the density of microneedles and preparing microneedles for sustained and controlled release in future studies. Lidocaine hydrochloride dissolving microneedles and its evaluation methods for local anesthesia were established systematically here for the first time. The rapid effect of anesthesia with lidocaine hydrochloride dissolving microneedles on the skin was worthy of further investigation.
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<p><b>BACKGROUND</b>The difference between renal oncocytomas (RO) and renal clear cell carcinomas (RCCs) presents the greatest diagnostic challenge. The aim of this study was to retrospectively determine if RO and RCCs could be differentiated on computed tomography (CT) images on the basis of their enhancement patterns with a new enhancement correcting method.</p><p><b>METHODS</b>Forty-six patients with a solitary renal mass who underwent total or partial nephrectomy were included in this study. Fourteen of those were RO and 32 were RCCs. All patients were examined with contrast-enhanced CT. The pattern and degree of enhancement were evaluated. We selected the area that demonstrated the greatest degree of enhancement of the renal lesion in the corticomedullary nephrographic and excretory phase images. Regions of interest (ROI) were also placed in adjacent normal renal cortex for normalization. We used the values of the normal renal cortex that were measured at the same time as divisors. The ratios of lesion-to-renal cortex enhancement were calculated for all three phases. The Student's t-test and Pearson's Chi-square test were used for statistical analyses.</p><p><b>RESULTS</b>All RCCs masses showed contrast that appeared to be better enhanced than RO on all contrast-enhanced phases of CT imaging, but there was no significant difference in absolute attenuation values between these two diseases (P > 0.05). The ratio of lesion-to-cortex attenuation in the corticomedullary phase showed significantly different values between RO and RCCs. The degree of contrast enhancement in RCCs was equal to or greater than that of the normal renal cortex, but it was less than that of the normal cortex in RO in the corticomedullary phase. The ratio of lesion-to-cortex attenuation in the corticomedullary phase was higher than the cut off value of 1.0 in most RCCs (84%, 27/32) and lower than 1.0 in most RO (93%, 13/14) (P < 0.05). In the nephrographic phase, the ratio of lesion-to-cortex attenuation was higher than that in the corticomedullary phase in most RO (71%, 10/14), showing a prolonged enhancement pattern; and was lower than that in most RCCs (97%, 31/32), showing an early washout pattern (P < 0.05). In the differentiation of RO from RCCs, the sensitivity was 93%, specificity 84%, positive predictive value 72%, negative predictive value 84%, and accuracy for RO was 87, if the ratio of lesion-to-cortex attenuation in a cortex phase was lower than the cutoff value of 1.0. The sensitivity was 71%, specificity was 97%, positive predictive value was 91%, negative predictive value was 91%, and accuracy for RO was 89%, if the ratio of lesion-to-cortex attenuation in nephrographic phase was higher than that in the corticomedullary phase.</p><p><b>CONCLUSIONS</b>The ratios of renal lesion-to-cortex attenuation ratios may be helpful in differentiating RO from RCCs.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Adenoma, Oxyphilic , Diagnosis , Diagnostic Imaging , Carcinoma, Renal Cell , Diagnosis , Diagnostic Imaging , Kidney Neoplasms , Diagnosis , Diagnostic Imaging , Tomography, X-Ray ComputedABSTRACT
Nine female patients underwent resection of the middle and distal urethra and the urethra was reconstructed with labia majora fasciocutaneous flap.During the operation the bilateral inner side partial flap of labia majora was taken,and penetrated through the tunnel under the labia minora to the urethral incision,then the flap was sutured as tube-shaped and anastomosed with the urethral incision to reconstruct the urethra.Patients were followed-up for up to 11 years,all patients had normal urination,except 1 patient with adenocarcinoma who developed urinary incontinence 1 month after operation and recovered by pelvic floor muscle training.The application of labia majora fasciocutaneous flap is a safe and effective procedure with less trauma and fewer complications in reconstruction of female middle and distal urethra.
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To evaluate the regional left ventricular function (LVF) and to establish the reference data of LVF parameters in the normal people with retrospective ECG gating 64-detector row CT, ten time phases in the cardiac cycle were reconstructed. Scanning was performed on 42 normal adult, and short axis images of the left ventricular were acquired. Endo-cardium and epi-cardium were delineated along with function parameters based on the cardiac analysis software. End-systolic thickness (EST) was thicker than end-diastolic thickness (EDT) (P<0.05). EDT and EST increased, but thickness decreased from apical, mid-ventricular to basal segments. Statistically significant difference was noted between mid-ventricular and basal segments (P<0.05). EDT, EST, thickness and motion of anterior, lateral and inferior segments were greater than those of septal segments in the same ventricular slices (P<0.05). 64-detector row CT could depict the regional LVF accurately. The LVF parameters of normal adults might be useful in diagnosing abnormal left ventricular function.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Heart Ventricles , Diagnostic Imaging , Image Processing, Computer-Assisted , Myocardial Contraction , Physiology , Radiographic Image Interpretation, Computer-Assisted , Methods , Tomography, Spiral Computed , Methods , Ventricular Function, Left , PhysiologyABSTRACT
We report here on a 64-year-old woman with extramedullary plasmacytoma involving the bilateral adrenal glands. Primary adrenal extramedullary plasmacytoma is extremely rare and only three cases of extramedullary plasmacytoma in the unilateral adrenal gland have currently been reported on. This case is of interest in that the bilateral adrenals were involved. In this article, we present the MRI findings and we briefly review the relevant literature.
Subject(s)
Female , Humans , Middle Aged , Adrenal Gland Neoplasms/diagnosis , Back Pain/etiology , Kidney/pathology , Magnetic Resonance Imaging , Neoplasm Invasiveness , Plasmacytoma/diagnosis , Vena Cava, Inferior/pathologyABSTRACT
Objective To study the relationship between the choice of operation and the efficacy on hepa- tolithiasis.Methods From Januray of 1995 to December of 2006,89 patients with hepatolithiasis underwent surgical treatment were retrospectively analyzed.Of them 33 cases underwent hepaticoplasty,hepatolobectomy in 7 cases, cholangiojejunostomy in 22 cases,choledocholithotomy with T-tube drainage in 27 cases.Results Out of the 89 cas- es,follow-up was completed in 81 cases for 6 months to 12 years.The postoperative stone residual rate of the group which underwent hepaticoplasty was 15.15 %(5/33)and cholannitis recurrence rate was 12.50 %(4/32),hepa- tolobecromy was 14.29%(1/7)and 16.67%(1/6),cholangiojejunostomy was 18.18%(4/22)and 30%(6/20), choledocholithotomy with T-tube drainage was 33.33 %(9/27)and 29.17 %(7/24).Conclusion Hepaticoplasty and hepatolobecromy were superior to cholangiojejunostomy and choledocholithotomy with T-tube drainage for treat- ment of hepatolithiasis.
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Objective To evaluate the curative effect on chdecytolithiasis with Chinese traditional patent formulation Qingdanyin and ESWL. Methods From January 2000 to January 2003,332 patients with gallstones were treated with Qingdanyin and ESWL, compared with 141 patients with routine ESWL. Results The 2-week clean rate(36.14%),one month clean rate(58. 58%),3-month clean rate(68. 98%) ,6-month clean rate(86.75%) of gallstones in the Qingdanyin and ESWL group were much higher than those in routine ESWL patients(14. 92%, 21.02%,35.93%,47.11%,respectively)(P
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<p><b>OBJECTIVE</b>To study the dynamic change of the ingredients of Coptis chinensis and evaluate the quality of the crude drugs from main producing areas.</p><p><b>METHOD</b>The ingredients of samples from Shizhu and Wuxi counties in Chongqing, Hongya and Dayi counties in Sichuan, Zhenping county in Shanxi, Lichuan county in Hubei were analyzed for berberine, coptisine, jatrorrhizine, palmatine and the total alkaloids by HPLC and UV methods.</p><p><b>RESULT AND CONCLUSION</b>The contents of measured indexes were mostly highest in 5-years-old C. chinensis. Considering factors such as the yield, it is reasonable to harvest the 5-years-old C. chinensis. There are minor differences in condents of C. chinensis from different areas, all tested samples met the pharmacopoeial standards. It is concluded that the general quality of C. chinensis was good and acceptable.</p>
Subject(s)
Alkaloids , Berberine , Berberine Alkaloids , China , Chromatography, High Pressure Liquid , Coptis , Chemistry , Classification , Ecosystem , Plants, Medicinal , Chemistry , Quality Control , Spectrophotometry, UltravioletABSTRACT
<p><b>OBJECTIVE</b>To explore multi-drug resistance (MDR) of bladder cancer for the intravesical instillation.</p><p><b>METHODS</b>Using immunohistochemical staining, in 44-case human bladder cancer cells, the expressions of P-glycoprotein (P-gp), glutathione S-transferase (GST-pi) and topoisomerase (TOPO-II), were detected to find out the resistance to drugs.</p><p><b>RESULTS</b>P-gp had a higher expression in 54.5% cases. GST-pi had no or a lower expression in 65.9% cases. TOPO-II had a higher expression in 29.5% but a lower expression in 65.9% cases.</p><p><b>CONCLUSION</b>Detecting the factors of MDR in bladder cancer cells could help to choose drugs for intravesical chemotherapy.</p>