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Objective:To explore the techniques and outcomes of pure laparoscopic native nephroureterectomy (LNUT) with ipsilateral allograft at a single position for upper tract urothelial carcinoma (UTUC) in renal transplant (RT) recipients.Methods:Clinical data were retrospectively reviewed for 12 renal transplant children undergoing native UTUC with ipsilateral allograft from January 2016 to December 2021.There were 4 boys and 8 girls.Complete LNUT was performed with bladder cuff resection at a single position via a transperitoneal approach.The interval between UTUC and RT was 12-146 months.There were 6 pelvic UCs and 6 ureter UCs.Results:All laparoscopic procedures were successfully completed without any serious perioperative complication.Postoperative pathological examination confirmed the diagnosis of urothelial carcinoma.And all surgical margins were negative.One patient experienced an elevation of creatinine after one cycle chemotherapy and normalized after withdrawing chemotherapy.The median follow-up period was (4-65) month.Two cases of contralateral native transitional cell carcinoma had radical nephroureterectomy two years later and another two cases underwent transurethral resection of bladder tumor one year later.One case died from tumor metastasis.The remainders had no tumor recurrence or metastasis during follow-ups.Conclusions:Complete single-position LNUT for UTUC with ipsilateral allograft is a safe and effective mini-invasive technique.Effectively avoiding the injury of allograft, it also offers the advantages of standard operation, minimal trauma, simple handling and enhanced recovery after surgery (ERAS).
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Objective:To investigate the clinical efficacy of induced membrane technique in the staged treatment of adult chronic hematogenous osteomyelitis (CHOM) of long bone.Methods:The clinical data were retrospectively analyzed of the 22 adult patients with CHOM of long bone who had been admitted to the 920th Hospital, Joint Logistics Support Force of PLA from January 2016 to December 2019. There were 18 males and 4 females, aged from 16 to 56 years (average, 31.81 years). Their disease duration ranged from 0.6 to 42.0 years, averaging 18.4 years. By the Cierny-Mader anatomical classification, 4 cases were type Ⅰ, 6 cases Type Ⅲ, and 12 cases type Ⅳ. In the first stage, the bone defects were filled with antibiotic bone cement after thorough debridement. In the second stage when the infection had been controlled, the bone defects were repaired with bone grafts after removal of the bone cement. Bone healing time and complications were followed up. The treatment effects were evaluated by comparisons of the infection control indexes [including clinical manifestations like local redness, swelling, pus, and pain, and blood white blood cell count, C-Reactive protein (CRP), and erythrocyte sedimentation rate (ESR) as well] before the primary surgery, before the secondary surgery and at the last follow-up.Results:The volumes of the bone defects after stage-one debridement ranged from 54 cm 3 to 176 cm 3 (mean, 90.9 cm 3). All patients were followed up for 20 to 51 months (mean, 30.1 months) after surgery. All bone defects healed after 4 to 11 months (mean, 6.6 months). Postoperatively, infection developed at the bone extraction site of the posterior superior iliac spine in 3 cases and pain was observed at the donor site in one case, but the conditions were relieved after symptomatic treatment. Fracture and plate breakage occurred at the bone defect site in one case who had fallen down 7 months after operation, but responded to reoperation. The last follow-up revealed such symptoms as redness, swelling and pus discharge in none of the patients. The white blood cell count [(5.70 ± 1.57) × 10 9/L and (5.65 ± 1.58) × 10 9/L], CRP [(7.56 ± 2.57) mg/L and (7.25 ± 3.83) mg/L] and ESR [(9.64 ± 2.90) mm/h and (10.55 ± 5.23) mm/h] before the secondary surgery and at the last follow-up were significantly lower than those before the primary surgery [(8.24 ± 2.18) × 10 9/L, (49.54 ± 19.56) mg/L, and (42.68 ± 13.77) mm/h] (all P < 0.05). However, there were no significant differences between the indexes before the secondary surgery and at the last follow-up ( P > 0.05). Conclusion:In the staged treatment of adult CHOM of long bone, the induced membrane technique can effectively control infection, achieve repair of bone defects, and reduce complications.
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Objective To understand the background level of total radioactivity in drinking water around Tianwan Nuclear Power Plant. Methods According to the original plan of the National Health and Family Planning Commission of China, the monitoring of gross α and gross β radioactivity levels in drinking water during dry and rain periods around Tianwan Nuclear Power Plant, and water samples were collected including source water, factory water, peripheral water and reservoir water. Results A gross of 200 water samples were monitored at 35 sampling sites from 2016 to 2018.The gross α and gross β radioactivity levels in the dry period were (0.038 ± 0.033) Bq/L and (0.11 ± 0.03) Bq/L. The gross α and gross β radioactivity levels in the wet period were (0.038 ± 0.024) Bq/L and (0.11 ± 0.03) Bq/L. There were statistically significant differences in gross α and gross β radioactivity levels between the source water and the other water during the dry season (P < 0.05). There were statistically significant differences in gross α and gross β radioactivity levels in different years (P < 0.05). There were statistically significant differences in gross α and gross β radioactivity levels at different distances from the nuclear power plant (P < 0.05). Conclusion The gross α level and gross β level of radioactivity in drinking water around Tianwan Nuclear Power Plant are in line with the standard of drinking water, regular, fixed and continuous monitoring should be carried out, and radionuclide monitoring and radiological investigation should be carried out on this basis.In view of the density of personnel in the vicinity of nuclear power plants in China, nuclear emergency preparedness training should also be strengthened.
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Objective:To investigate the clinical effect of induced membrane technique combined with staged internal fixation for treatment of infected femoral nonunion.Methods:A retrospective case series study was conducted to analyze the clinical data of 21 patients with infected femoral nonunion treated from January 2016 to December 2018 in 920th Hospital of Joint Logistics Support Force of PLA. There were 13 males and 8 females, with the age of 18-57 years [(38.9±6.7)years]. The duration of nonunion was 7-78 months [(27.1±11.4)months]. All patients were treated by induced membrane technique in two stages. At stage I, the original internal fixation was removed and debrided thoroughly, then the antibiotic-loaded bone cement and locking compression plate (LCP) were placed. The length of bone defect following debridement was 5-15 cm[(7.4±1.9)cm]. At stage II, the bone defect was reconstructed with bone grafts and fixed with the intramedullary nail and/or LCP. The wound condition, white blood cell count, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were recorded after stage I surgery and at the last follow-up to measure infection control. The complications and bone healing time were recorded. The bone healing was evaluated by the Paley criteria and the functional recovery of the affected limb was evaluated by the range of motion of the knee at the last follow-up.Results:All patients were followed up for 23-43 months [(31.9±6.7)months]. The infection recurred in 4 patients after stage I surgery, and the wound healed after repeated debridement. There was no infection recurrence after stage II surgery. The white blood cell count, CRP and ESR were (6.1±1.8)×10 9/L, (10.1±3.1)mg/L, (10.2±3.4)mm/h at the last follow-up, significantly decreased from preoperative (15.0±4.8)×10 9/L, (69.8±14.8)mg/L, (66.2±13.2)mm/h ( P<0.05). The incidence of complications was 43%. Besides infection recurrence in 4 patients after stage I surgery, the donor site at the posterior superior iliac spine in 3 patients showed delayed healing, and the limb shortening occurred in 2 patients with the discrepancy of 3 cm and 4 cm. Bony union was observed in all patients within 6-16 months [(8.8±2.7)months]. The results were excellent in 19 patients and good in 2 patients according to the Paley criteria at the last follow-up. The knee range of motion was significantly improved from preoperative 30.0°(15.0°, 110.0°) to 90.0°(61.5°, 120.0°) at the last follow-up ( P<0.05). Conclusion:For infected femoral nonunion, the induced membrane technique combined with staged internal fixation can effectively control infection, achieve bony union, and promote functional recovery.
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Objective:To evaluate Masquelet technique plus flap transfer in repair of tibial infected defects complicated with extensive soft tissue defects in the lower leg.Methods:A retrospective analysis was performed in the 23 patients who had been treated by Masquelet technique plus flap transfer at Institute of Orthopedics and Trauma, 920 Hospital for tibial infected defects complicated with extensive soft tissue defects in the lower leg from March 2016 to June 2019. They were 15 males and 8 females, aged from 18 to 59 years (average, 38.4 years). The duration of disease ranged from 6 to 312 months (average, 23.6 months). All patients underwent surgery by 2 stages:1) debridement, locking compression plate fixation, formation of induced membrane by antibiotic-loaded bone cement, and repair of soft tissue defects with lower leg flaps; 2) removal of bone cement and fixation 6 to 8 weeks after infection control, fixation of broken ends after rinse, followed by grafting of cancellous bone particles in the induced membrane. The area of wound soft tissue defects after debridement ranged from 4.0 cm × 3.5 cm to 18.0 cm × 6.0 cm, and the length of bone defects from 6 to 12 cm (average, 8.4 cm). Locally grafted were pedicled fasciocutaneous flap in 4 cases, sural nerve nutrition skin flap in 9 cases (including 4 anterograde and 5 retrograde ones), saphenous nerve nutrition vascular flap in 7 cases (including 2 anterograde and 5 retrograde ones), retrograde superficial peroneal nerve nutrient vessel flap in one and free flap in 2 cases. The curative efficacy was evaluated according to the Paley fracture healing scores.Results:All the 23 patients were followed up for 9 to 46 months (average, 15.6 months). Flaps healed by the first stage in 18 cases and after skin grafting in 3 cases; skin flap transfer was conducted again in 2 cases. Infection was controlled in 21 cases but recurred in 2 cases at 9 and 14 months respectively after secondary surgery. The time for bone reunion ranged from 4 to 11 months (average, 6.2 months). According to the Paley criteria for fracture healing, 21 cases were excellent, one was good and one poor.Conclusion:In the treatment of tibial infected defects complicated with extensive soft tissue defects, Masquelet technique plus transfer of a variety of lower leg flaps can result in reliable outcomes because it controls infection, promotes formation of complete induced membrane and accelerates the process of bone reconstruction along with repair of soft tissue defects.
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Objective@#To explore the long-term effects of radiation injury and to provide scientific basis for the evaluation of the effects of ionizing radiation injury by carrying out medical follow-up of patients involved in the " 5.7" radiative source accident in Nanjing in 2014.@*Methods@#Through interviewing and investigating, we inquired about the new disease history of the exposed patients from rehabilitation treatment to medical follow-up peroid. Physical and laboratory examinations were carried out. According to relevant standards, physiological and biochemical indexes such as hematopoietic system, immune system, endocrine system, ophthalmology, circulatory system, digestive system, urinary system and bone mineral density were systematically evaluated, with the long-term effects being evaluated.@*Results@#The patient′s vital signs were good without new diseases. The indexes of hematopoietic system, immune system and endocrine system tended to be normal, the circulatory system, digestive system and urinary system showed degenerative changes, the ophthalmic examination showed visual acuity continue to decline, and bone mineral density examination indicated low bone mass.@*Conclusions@#Physiological and biochemical indicators of the patients gradually returned to normal without obvious symptoms of radiation damage. Further medical follow-up observation still needs to continue.
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Objective To evaluate surgical treatment of chronic tibial osteomyelitis of Cierny-Mader type Ⅳ with Ilizarov technique and lesion osteotomy. Methods From January 2010 to May 2016, 39 patients with chronic tibial osteomyelitis of Cierny-Mader type Ⅳ were treated at our center. They were 33 males and 6 females, 8 to 54 years of age (average, 33.8 years). After debridement and lesion osteotomy, the tibia was fixated with Ilizarov external fixator. Bone was transported to the bone defect after corticotomy was performed on the proximal and/or distal tibial metaphyses simultaneously. Bifocal corticotomy was per-formed in 11 cases, proximal corticotomy in 21 cases, and distal corticotomy in 7 cases. The transport began 3 to 5 days after operation at a speed of 0.5 to 1.0 mm/d initially. The speed was lowered according to the bone healing and pain. Radiographic examination was done every 2 weeks to observe transporting deviation and osteogenesis in the transporting area. The transporting was adjusted whenever any abnormality was observed. The bone transporting lasted for 50 to 130 days (average, 62.4 days). Results The patients were fol-lowed up for 11 to 49 months (average, 21 months). All the soft tissue wounds healed uneventfully and there was no relapse of osteomyelitis. The bone defects in the 32 cases were reconstructed primarily. Nonunion of fracture ends happened in 5 cases and nonunion of the bone lengthening zone in 2 cases. The 7 cases of nonunion were healed after secondary bone grafting. Malalignment happened in 5 cases, 4 of which responded to timely adjustment of the external fixation and one of which had to receive secondary bone grafting after failure in adjustment of the external fixation. Ankle joint dysfunction occurred in 7 cases, 5 of which re-sponded to functional exercise and 2 of which accepted joint dysfunction because they refused surgery after unsatisfactory functional exercise. Pin tract infection of different severities occurred in 9 cases, one of which was treated by replacement of the K-wires under local anesthesia and the other 8 of which responded to rein-forced dressing change. Conclusions Chronic tibial osteomyelitis of Cierny-Mader typeⅣcan be treated by Ilizarov technique and lesion osteotomy. However, the Ilizarov technique should be improved because of the risks of multiple complications which can be reduced significantly by strengthening postoperative instruction, nursing, and regular follow-up.
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As arising incidence of thyroid cancer, the treatment for thyroid carcinoma is becoming increasingly standardized. But there are different opinions on the treatment for some types of thyroid cancers, including the determination of operative opportunity, surgical method, and follow-up observation plan. There are mainly two categories of patients, namely the patients diagnosed as familial thyroid cancer mutation carriers through family screening, including medullary thyroid carcinoma and familial nonmedullary thyroid carcinoma, and the patients with thyroid microcarcinoma that can be observed after diagnosed by fine needle biopsy cytology. We will discuss current situation for the diagnosis and treatment of these patients.
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Objective:To discuss the causes and effective measures of prevention and treatment of chylous fistula after central lymph node dissection (CLND) of thyroid cancer. Methods:A total of 6 127 patients who underwent CLND of thyroid cancer in the Tianjin Medical University Cancer Institute and Hospital between July 2013 and June 2015 were analyzed;of which, 14 patients acquired the complication of postoperative chylous fistula. The following conservative treatments were initially performed:systemic therapy, local pressure bandaging, normal pressure drainage, 50%glucose injection, or pingyangmycin injection through a drainage tube. Surgical op-eration was then conducted when the efficacy of the treatment was poor. Results:After the conservative treatment of the 14 patients, the drainage volume gradually decreased in 12 patients, and surgery was performed on the remaining two patients. Conclusion:The CLND of thyroid cancer must be carefully conducted to prevent postoperative chylous fistula. An active conservative treatment must be the first option when chylous fistula occurs. Surgery must only be performed if the treatment is invalid.
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Objective To analyze the causes of clinical misdiagnosis of solid pseudopapillary tumor of pancreas (SPTP),and recommend the countermeasures with a combination of pertinent literature.Methods The clinical data of 10 cases of SPTP with misdiagnosis were retrospectively analyzed.There were 9 women and 1 man,and the average age was 29.3 years old.The clinical symptoms were nonspecific.Results All patients received surgical treatment,and the correct diagnosis was made according to the pathology after surgery.All patients were followed up,and no recurrence or metastasis was found.Conclusions SPTP is a rare disease in clinic.Sufficient understanding in the clinical features and imaging characteristics can improve the rate of diagnosis before operation.
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BACKGROUND:Previous studies on immunosuppression and anti-rejection after organ transplantation mainly focused on effects of T lymphocytes-mediated immune response and immunosuppressive agents on T lymphocytes. Effects of dendritic cel s were unclear. The manifestation and mechanism of immunosuppressive agent effects on dendritic cel s are not identical. OBJECTIVE:To compare the effects of different immunosuppressive agents on expression and function of costimulatory molecules of dendritic cel s, and to explore the mechanism of action of immunosuppressive agents. METHODS:20μg/L rapamycin, 0.04 mg/L mycophenolate, 10μg/L tacrolimus and 1 mg/L cyclosporine A were separately added during bone marrow cel s of C57BL/6 mice were differentiated into dendritic cel s. RESULTS AND CONCLUSION:Flow cytometry results revealed that CD40 expression in each group:rapamycin0.05). One-way mixed lymphocyte reaction results displayed dendritic cel costimulatory T cel proliferation in each group:rapamycin
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ObjectiveTo investigate DNA loads and risk factors of BK virus infection in renal transplant recipients.MethodsWe developed a real-time PCR assay to quantitate BK virus loads in 80 patients receiving renal transplantation in our center,and correlation between the BK virus load and clinical course was analyzed.BK virus loads were measured in urine and plasma. Epidemiological features and risk factors of BK virus infection were analyzed.ResultsThe positive rate of BKV viruria and viremia in 80 renal recipients was 37.5％ (30/80) and 8.75％ (7/80),respectively.BKV loads were higher in renal allograft recipients whose age was more than 50 years old.BKV loads were observed in urine and plasma (compared with group whose age was less than 50 years,P=0.017 and 0.05,respectively).BKV DNA copies were higher in group Tac than that in group CSA (P＜0.05),and the peak of BKV load in serum appeared at14th and10th month after transplantation,respectively,but the peak in urine was ahead of that in serum,appeared at 2nd and 8th month,respectively.ConclusionSerial measurement of BKV viral loads by quantitative PCR is a useful tool in monitoring the course of BK virus infection.The ages of recipients (＞50 years) and using Tac + MPA can reactivate BK virus and then result in BKVAN in renal transplant recipients. Intensive BKV monitoring is necessary for these recipients.
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Objective To investigate the clinical features of bilateral native pelvic and ureteral transitional cell carcinoma (TCC) in renal transplant patients. Methods A retrospective analysis was carried out on 16 patients with bilateral native pelvic and ureteral TCC after kidney transplantation.The mean time between transplantation and diagnosis of upper urinary TCC was 56. 2 ± 33. 0 months.Two patients were suffered from bilateral upper urinary TCC at the same time. The mean interval between 2 upper urinary tract operations of the remaining 14 cases was 8. 6 ± 6. 7 months. Hematuria and hydronephrosis of native kidneys were the main symptoms and targets in checkup. Intravesical chemotherapy was postoperatively given. Results All operations were performed successfully. All specimens obtained from the operations were pathologically diagnosed as TCC. The TCC location involved pure native pelvis (n = 4), pure native ureter (n = 9), and pelvis combined with ureter (n = 19). Pelvic TCC pathological grades included grade 1 in 8 cases, grade 2 in 11 cases, and grade 3 in 4 cases; Ureteral TCC grades included grade 1 in 6 cases, grade 2 in 10 cases, and grade 3 in 12 cases.Patients were followed up for 26. 8 ± 25. 1 months. One patient died of lung metastasis. (One case of lumbar soft tissue transfer was given local excision. The remaining patients had no recurrence and metastasis. Conclusion Renal transplant patients with hematuria and native renal hydronephrosis should be highly vigilant of the occurrence of upper urinary tract TCC. TCC after renal transplantation is invasive. Prophylactic contralateral nephroureterectomy should be performed on the recipients having TCC at the bladder and one side of native upper urinary tract.
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Objective To investigate the signal transducer and activator of transcription 1(STAT1) and matrix metalloproteinase 3(MMP3)′s genetic expressions and their clinical significance on urothelial carcinoma after renal transplantation. Methods Fifty-one patients with urothelial carcinoma were recruited in this study. Sixteen of them who had renal transplant were in the experimental group and 35 of them without renal transplant were in the control group. All the cases had been proved postoperatively having transitional cell carcinoma by histopathological study. The human genome oligo arrays were used to analyze the gene expression spectrum of urothelial carcinoma after transplantation, aiming the STAT1 and MMP3's expression. Real time RT-PCR and immunohistochemical staining were used to compare the differences in the 2 groups. Results The experimental group showed that there were 35 genes up-regulated compared with the control group. Of them, 23had known gene function or partly known, and 12 had unknown gene function. There were 76 genes down-regulated. Of them, 46 had known gene function or partly known, and 30 had unknown gene function. After pathway analysis of the differentially expressed genes, there were 23 groups of pathways which had significant differences (P＜0.05), referring to the aspects of immunosuppressive and tumor growth. The levels of STAT1 and MMP3 expressions had significant differences between the 2groups(P＜0.05)as well. Conclusions The differential expression of urothelial tumor genes is obvious between patient who has had renal transplant and who has not. There are many aspects that are related to the tumor's growth like signaling pathways regulating proliferation, apoptosis of tumor cells, tumor angiogenesis and the tumor metastasis potential. STAT1 and MMP3 maybe become the targets of chemoprevention for post-transplantation urothelial carcinoma.
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Objective To explore the expression of anti-MICA antibodies and evaluate its influence on acute rejection and renal function in early period after renal transplantation. Methods A total of 29 sensitized subjects (PRA＞20 %) were enrolled in this study. All the patients underwent protein A immunoabsorption treatment and the expression of anti-MICA antibodies was detected before and after treatment. Triple immunosuppressive regimen consisting of tacrolimus, mycophenolate mofetil (MMF) and steroid was given to prevent graft rejection. The correlation between the expression of anti-MICA antibodies and acute rejection or serum creatinine (SCr) level was analyzed.Results The expression of anti-MICA antibodies was detected in 8 candidates (27. 6 % ,8/29) ,and 6 kinds of anti-MICA antibodies simultaneously expressed were found in one individual, 3 kinds in one case,and sole kind in 6 patients. There was no significant difference in acute rejection rate between positive anti-MICA antibodies group and negative group [37.5 % (3/8) vs 38. 1% (8/21), P＞0.05). The positive expression rate of anti-MICA antibodies in the recipients with PRA ≥40% was higher than that in those with PRA ＜40% [43. 8 % (7/16) vs 7. 7 % (1/13),P＜0.05]. The SCr level in patients positive for anti-MICA antibodies was markedly higher than that in those negative anti-MICA antibodies at the 1st week postoperatively ( 135.4 ± 21.4 vs 108. 6 -+ 31.6 μmol/L, P＜0.05). The SCr level in the patients with positive anti-MICA antibodies, however, was reduced to the normal range at the 2nd week after surgery (P＞0.05). The levels of anti-MICA antibodies were continuously decreased in the candidates undergoing protein A irnmunoadsorption treatment. Conclusion Higher expression of anti-MICA antibodies exists in sensitized recipients and possesses an influence on the recovery of renal function in early postoperative period. Protein A immunoadsorption can eliminate anti-MICA antibodies effectively in sensitized recipients.
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Objective To explore the clinico-biological characteristics, treatment and prognosis of salivary duct carcinoma. Methods This study included 12 cases of salivary duct carcinoma treated in our hospital. Clinical data were retrospectively analyzed for patients admitted between April 1995 and October 2006. The clinical characteristics, histological features, imaging, therapy methods and prognosis were analyzed. Results Of 12 salivary duct carcinoma, there were 10 males, 2 females. The age of onset ranged from 53 to 73 year old and the average was 56 year old. Physical examination revealed a firm and unboundary mass accompanied by nerve infiltrating symptom. The histological appearance was characterized by solid cell nests with ductal structures and central comedonecrosis. Extensive resection and radical neck dissection was performed in 11 patients, postoperation radiation done in 10 patients and chemotherapy in 3 patients. One year survival rate was 83. 33% , that of 3 years was 41. 67% , and of 5 years was 25. 00% , the median survival time was 36 months. Conclusion Salivary duct carcinoma is a rare malignant salivary tumor and most patients are men. Regional extensive resection and postoperative radiation or chemotherapy are the mainstay of therapy. Lymph node metastases in level Ⅰ ,Ⅱ , Ⅲ are a common finding in patients with SDC and the prognosis is poor.