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Objective:To study the characteristics and clinical significance of mitochondrial injury of T lymphocyte subsets in patients with autoimmune hepatitis (AIH).Methods:The clinical data of 57 patients with AIH (AIH group) from June to December 2021 in Hangzhou Xixi Hospital were retrospectively analyzed, while 60 healthy physical examiners were included as healthy group. The peripheral blood T lymphocyte subsets (CD 8+ T lymphocyte count and CD 4+ T lymphocyte count) were detected by flow cytometry, and matched mitochondrial staining value according to certain algorithm was used to determine the mitochondrial damage of helper T lymphocyte (Th cell) and suppressor T lymphocyte (Ts cell). The levels of IgG, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured using a Roche E170 automatic electrochemiluminescence immunoassay. Anti-nuclear antibody (ANA) titer was measured by immunofluorescence. Multivariate Logistic regression was used to analyze the independent risk factors of mitochondrial damage of Th cell and Ts cell in patients with AIH. Results:The ALT, AST, IgG, positive rate of ANA titer, CD 4+ T lymphocyte count, CD 8+ T lymphocyte count, rate of Th cell mitochondrial injury and rate of Ts cell mitochondrial injury in AIH group were significantly higher than those in healthy group: (118.90 ± 37.61) U/L vs. (30.96 ± 14.37) U/L, (102.40 ± 36.51) U/L vs. (31.12 ± 14.06) U/L, (18.40 ± 3.71) g/L vs. (13.89 ± 1.98) g/L, 96.49% (55/57) vs. 16.67% (10/60), 438 (323, 637) × 10 6/L vs. 398 (272, 469) × 10 6/L, 296 (211, 296) × 10 6/L vs. 270 (193, 322) × 10 6/L, 61.40% (35/57) vs. 8.33% (5/60) and 82.46% (47/57) vs. 11.67% (7/60), and there were statistical differences ( P<0.01 or <0.05). Multivariate Logistic regression analysis result showed that the AST elevated and CD 8+ T lymphocyte count reduced were the independent risk factors of Ts cell mitochondrial injury in patients with AIH ( OR = 1.06 and 0.99, 95% CI 1.01 to 1.10 and 0.99 to 1.00, P<0.05); the ALT elevated and IgG elevated were the independent risk factors of Th cell mitochondrial injury in patients with AIH ( OR = 1.08 and 1.66, 95% CI 1.02 to 1.14 and 1.11 to 2.48, P<0.05). Conclusions:It is of positive clinical significance to measure the T lymphocyte subtype mitochondrial injury in patients with AIH. The probability of mitochondrial injury of T lymphocyte subtype can be predicted by biochemical indexes such as ALT, AST and IgG, so as to indirectly evaluate the liver cell necrosis.
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Objective:To explore the efficacy and safety of five-step 180W XPS greenlight photoselective vaporization of prostate (PVP)for large volume (≥80ml) benign prostatic hyperplasia.Methods:A total of 240 BPH patients (PV≥ 80 ml), treated with five-step 180W XPS PVP from June 2017 to May 2019 in our center, were reviewed retrospectively. The average age was (70.18±7.71) years old, and 129 cases were over 70 years old. The average body mass index was (24.91±2.98 )kg/m 2. The median international prostate symptom score (IPSS) was 23 (20, 26) and the quality of life (QOL) score was 5 (4, 5) points. Besides, the preoperative median prostate volume (PV) was 98.29 (86.49, 116.32) ml, the median maximum urinary flow rate (Q max)was 6 (4, 8) ml/s and postvoid residual urine volume (PVR) was 120 (30, 200) ml. All patients underwent 180W XPS five-step method PVP operation according to the following method. The first step is vaporization of 1-2 o′clock (left lobe) and 10-11 o′clock (right lobe) in order to establish operating channel. The second step is vaporization of the lateral lobe layer by layer from the ventral side to the dorsal side. The third step is channel establishment of 5/7 o′clock mid lobe parasulcus. The forth step is ablation of the middle lobe laterally. The fifth step is vaporization of the apex of the prostate and trimming. The IPSS score, QOL score, Q max and PVR were evaluated 12 months later after the PVP operation. Results:All the 240 cases were treated by five-step 180W XPS PVP operation successfully. The median operation time and laser time were 83 (73, 98.75) min and 66 (60, 76) min. Capsular perforation was found in 3 cases, which occurred in the trimming stage. There were 9 cases treated with TURP to stop bleeding, and no cases suffered blood transfusion. Twenty-two patients underwent bladder irrigation for 6 to 24 hours after the operation, and the median catheter indwelling time and post-operative hospital stay were 3 (3, 4) days and 4 (3, 5) days respectively. Twenty-six patients suffered urinary incontinence, including 22 cases of urinary incontinence and 4 cases of stress urinary incontinence. In addition, there was no severe hematuria, severe bladder irritation or urinary retention among the patients. The postoperative IPSS score was 5(4, 7), QOL score 1(1, 2), Q max 18(15, 20)ml/s and PVR 10(0, 30)ml, which were all significantly improved compared with those before surgery ( P<0.01). None second PVP surgery was performed. Conclusions:The five-step 180W XPS PVP operation has the advantages of improving lower urinary tract symptoms, less blood loss and low incidence of perioperative adverse events. It is easy to use, which is a reliable minimally surgery.
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Objective To investigate the safety and efficacy of photoselective green laser vaporization of bladder tumor (PVBT). Methods A total of 522 patients with bladder tumor were enrolled in present study from January 2010 to May 2015, including 405 cases of non muscle-invasive bladder cancer (NMIBC) and 117 cases of muscle-invasive bladder cancer (MIBC). All of patients were treated with PVBT and intravesical instillation of epirubicin. Patients with MIBC received intravenous chemotherapy (kisi-hama and cisplatin). Results The hospitalization time was (7.32±1.28) days, the operation time was (27.08±5.36) min, and the indwelling urinary catheter was (2.42±0.34) days for patients in NMIBC group. During the follow-up period (12-60 months), 38 cases (9.4％) relapsed, of which 3 cases underwent radical cystectomy, and other 35 cases underwent PVBT again. All 405 patients were alive at the end of follow-ups. The hospitalization time was(26.18 ± 1.92) days, the operation time was (38.32 ± 6.54) min, and the time of indwelling urinary catheter was (2.72 ± 0.85) days for patients of MIBC group. During the follow-up period (12-60 months), 19 cases (16.2％) relapsed. Among them, 4 patients underwent radical cystectomy, and other 15 cases underwent PVBT. Six patients died from distant organ metastasis (including 2 cases of pulmonary metastasis and 4 cases of bone metastasis), and other 111 patients survived. Conclusion PVBT is safe and effective in the clinical application, especially for NMIBC and MIBC patients who are unable or unwilling to undergo radical cystectomy.
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Objective To explore the safety and clinical efficacy of radical transurethral photoselective vaporization of bladder tumours (RPVBT) combined with chemotherapy in the treatment of muscle invasive bladder cancer.Methods Collected during Sept.2010 to Sept.2012,a total of 34 patients with muscle invasive bladder cancer who refuse or older,merge the heavier medical disease,difficult to tolerate radical cystectomy.Using RPVBT,vaporization resection to the bladder wall fat layer,postoperatively systemic chemotherapy of gemcitabine combined cisplatin and bladder perfusion chemotherapy of pharmorubicin.The operation time、the first recurrent time and recurrent rate,and the survival rate were measured.Results Operation are completed smoothly,operating time is 30.5-69.0 min and average 49.2 min,intraoperative rinses quantity is 5.9-10.7 L and average 8.3 L.Intraoperative no obvious bleeding,intraoperative no serioue complications,postoperative pathological diagnosis is invasive epithelial cell carcinoma of the urinary tract,pathology classification:low level 15cases,the high level 19 cases.Followup of 12 to 36 months,an average of 21 months,9 cases of recurrence,2 cases underwent radical cystectomy,7 cases again RPVBT,the first tumor recurrence time 3-20 months,11 months and the median time to relapse recurrence rate 26.5％ (9/34),3 cases of relapses diedof bladder cancer metastasis,31 cases of survival.Conclusion Treatment of RPVBT combination chemotherapy in patients with locally invasive bladder cancer,small trauma,less bleeding,high safety,have certain curative effect,It could be a effective treatment strategy for patients of high-risk elderly or unwilling to accept Radadical cystectomy.
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Violent trespass against medical right dangerously harms medical staffs' health,both physically and mentally.It disarranges normal infirmary system on medical diagnosis and treatment.The research carried out in 80 hospitals covering 10 provinces indicates that presently violent trespass against medical right occurs from time to time;moreover this shows an up-growing trend.Such phenomena take place in various medical colonies and medical organizations diverse themselves obviously.This passage analyzes the causes of violence from the aspects of society,hospital and physician-patient relationship.