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Objective:To explore the efficacy and safety of pretreating with oral immunosuppressants alone for ABO-incompatible (ABOi) renal transplant recipients with an initial isoagglutinin titer <1: 8.Methods:From September 2014 to October 2019, 16 cases of ABOi renal transplantation pretreated with oral immunosuppressants alone and 32 cases of ABO-compatible (ABOc) renal transplantation were recruited for comparing the inter-group incidence of graft function, acute rejection, infection and recipient and allograft survival.Results:The 16 ABOi renal transplantations were AB-to-A(n=4), AB-to-B(n=3), A-to-B(n=1), B-to-A(n=4), A-to-O(n=2) and B-to-O(n=2). The initial isoagglutinin titer (IgM & IgG) and that on the date of transplantation were both ≤1∶8. The median follow-up period was 495(90-1696) days. One patient in ABOi group underwent allograft nephrectomy due to hyperacute rejection. The graft survival rates were 93.75%(15/16) and 100%(32/32) in ABOi and ABOc groups respectively. No recipient died. No significant inter-group difference existed in postoperative renal function after 6 months (serum creatinine μmol/L: 114.30±28.13 vs. 106.08±23.80, P=0.38; eGFR ml/min/1.73 m 2: 64.93±19.60 vs. 82.34±22.58, P=0.13). In ABOi group, there were 3 episodes of postoperative infection, 2 episodes of acute rejection within 2 weeks (including 1 episode of hyperacute rejection) and 1 episode of acute rejection after 2 weeks; 5 episodes of postoperative infection, no acute rejection within 2 weeks and 5 episodes of acute rejection after 2 weeks in ABOc group. No significant inter-group difference existed in the incidence of infection or rejection ( P>0.05). Conclusions:Using oral immunosuppressant alone is both safe and feasible for ABOi renal transplantation recipients with an initial isoagglutinin titer ≤1∶8. It may greatly simplify the pretreatment scheme for those with a low initial isoagglutinin titer and lower the incidence of complications.
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Objective To investigate the protective effect of ADP-ribosylation factor 6 inhibitor on acute kidney injury induced by sepsis in mice.Methods In February 2018,thirty male BALB/c mice were divided into uninfected group (5 mice),fluconazole group (5 mice),ADP-ribosylation factor 6 inhibitor group (10 mice)(inhibitor group) and saline control group (10 mice)(control group) by random number table method.In fluconazole group,inhibitor group and control group,1 × 105 CFU of Candida albicans was injected via tail vein for modeling.The uninfected group was injected with equal volume of saline.After 3 hours,inhibitor group was injected with 1.032 mg ADP-ribosylation factor 6 inhibitor,and fluconazole group was injected with 51 μg fluconazole.The control group were injected with equal volume of saline as inhibitor group.After 24hours,serum creatinine,urea nitrogen were measured by kit method.The mice were clinically scored for sepsis severity according to signs and symptoms after treatment and histopathological changing of kidney tissue were observed and scored according to the damage area of renal cortical with hematoxylin-eosin staining.Results The clinical scores,serum creatinine,urea nitrogen and pathological scores of uninfected group were 0,(0.98 ± 0.38) μmol/L,(9.77 ± 0.36) mmol/L,(0.88 ± 0.30),respectively.The fluconazole group were (0.80 ± 0.84),(1.09 ± 0.51) μmol/L,(9.64 ± 0.17) mmol/L,(1.22 ± 0.270),respectively.The inhibitor group were (2.80 ± 1.32),(1.43 ± 0.50) μmol/L,(12.05 ± 1.20) mmol/L,(2.04 ± 0.55),respectively).The control group were (5.20 ± 1.87),(2.96 ± 1.55) μmol/L,(13.94 ± 1.94) mmoL/L,(2.67±0.55).The difference was statistically significant between inhibitor group and the control group both (P ＜ 0.05).Conclusions ADP-ribosylation factor 6 inhibitor reduce acute kidney injury induced by sepsis in mice.
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Objective To systematically review the efficacy and safety of mini-percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopic lithotripsy (FURL) in management of lower pole kidney stones.Methods PubMed, Embase, Scopus, Cochrane library, CNKI, VIP and Wanfang Data were searched from the beginning of database to September 2016 and clinical trials that compared the two above operation for treatment of lower pole stones were collected.Two researchers independently filtered literature,extracted data and evaluated the methodological quality of research papers.The meta-analysis was performed using the RevMan 5.3 software.Results One randomized and seven non-randomized studies were analyzed, which consists of 621 patients including MPCNL group 327 cases, FURL group 294 cases.The results of meta-analysis showed that MPCNL was better than FURL in stones clearance (OR =2.65,95％ CI 1.58-4.46,P ＜ 0.01) and operative time (WMD =-21.86,95％ CI-28.52--15.20, P ＜ 0.01).FURL was better in hospital stay time (WMD =2.28,95％ CI 0.29-4.28, P =0.02), decrease in haemoglobin levels (WMD =0.78,95 ％ CI 0.68-0.89, P ＜ 0.01), bleeding (OR =5.11,95 ％ CI 1.12-23.31,P =0.04), transfusion(OR =7.04,95％ CI 1.59-31.15, P =0.01).There was no significant difference in fever,urinary tract infection, hematuria (P ＞ 0.05).Conclusions Both MPCN and FURL are safe and effective for the treatment of lower pole stones, MPCNL can get higher stone clearance rates and shorter operation time.However, FURL can get shorter hospitalization time and lower complication rates.
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Objective To evlauate the clinical feasibility and efficacy of laparoscopic right hemicolectomy in the treatment of colon carcinoma .Methods 100 patients with rightcolon carcinoma were divided into 2 groups,50 ca-ses in each group .The control group received open surgery ,and the observation group was treated by laparoscopic right hemicolectomy .The clinical effect and side effect of the two groups were compared .Results The patients of the two groups were all successfully operated .The intraoperative blood loss ,postoperative anal exhaust time ,postoperative hos-pital stay,incidence rate of postoperative complications in the observation group were (75 ±42)mL,(24.8 ±1.3)h, (7.5 ±2.0)d,4.0%,respectively,which were significantly better than those of the control group [(100 ±50)mL, (64.9 ±1.8)h,(12.1 ±3.4)d,10.0%](χ2 =5.02,9.28,11.70,9.87,all P<0.05);Conclusion The laparo-scopic right hemicolectomy in the treatment of rightcolon carcinoma is safe and feasible ,and the curative efficacy is outstanding .It can obviously improve the prognosis of patients ,which should be popularized and applied in clinical .
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Objective To explore the causes and prevention methods of postoperative anastomotic leakage after colorectal cancer laparoscopic-assisted surgery.Methods 100 patients with colorectal cancer underwent laparoscopic-assisted surgery,the data was collected and retrospectively analyzed.Results All patients were successfully done,there were 5 cases with anastomotic leakage (5％).There were significant correlations of anastomotic leakage with too strong anastomotic tension,insufficiency anastomotic blood supply,tumor location,size,operation time,preoperative radiotherapy,gender,age,obesity,diabetes,hypoalbuminemia,and so on.Conclusion The laparoscopic-assisted surgery of colorectal cancer has a curative efficacy,with the continuous improvement of laparoscopic technique and operation,as long as the proper measures were taken,the occurrence of anastomotic leakage can be prevented and reduced.
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Objective To explore the feasibility and clinical effect of single-incision laparoscopic surgery(SILS) in the treatment of gastrointestinal stromal tumors (GIST).Methods Clinical data of 13 GIST patients who underwent SILS resection [tumor diameter (1.3 ± 0.5) cm] were retrospectively analyzed.Surgical method was summarized and the clinical outcome was evaluated.Results All patients were successfully implemented without open conversion.The incision length was (3.8 ± 0.6) cm.Operation time was (100.0 ± 34.6) min.Intraoperative blood was (70.0 ± 45.5) ml,hospitalization time was 1 ～ 4d.There were no intraoperative or postoperative complications,such as secondary haemorrhage,anastomotic leakage or obstruction.The patients were favorably healed.Conclusion Application of SILS in treatment of GIST is safe with small trauma,fast postoperative rehabilitation,and early curative effect is satisfactory.
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Objective To explore the clinical value of laparoscopic hepatectomy in liver tumor surgery.Methods The clinical data and follow-up results of 50 patients with liver tumors treated by laparoscopic hepatectomy were retrospectively analyzed.Results Laparoscopic liver resection was successful in 30 cases of primary liver cancer,10 cases of hepatic hemangioma,and 10 cases of other benign liver space occupying lesions (liver vascular smooth fatty tumor,focal nodular hyperplasia,hepatic abscess).Conclusion Laparoscopic hepatectomy as a minimally invasive treatment method is applicable to all parts of liver tumor surgery,and trauma is small,recovery is quick,and it is safe and feasible,and clinical effect is reliable.