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Objective:To discover the efficacy of the combination of preoperative/2 hours postoperative blood WBC count ratio and qSOFA to predict the urosepsis after flexible ureteroscopic lithotripsy.Methods:Retrospectively analyze the patients’ information from September 2015 to July 2018. In total, 2 364 patients who underwent the flexible ureteroscopic lithotripsy procedure were enrolled in the study. Patients gender (male: 1463, female: 751), age (54.9±14.0)years, BMI (23.9±2.8)kg/m 2, stone size(10.8±6.2)mm, side (left: 1 305, right: 1 018, both sides: 41), preoperative body temperature(36.8±0.4)℃, blood glucose level(5.7±1.5)mmol/L, WBC(7.4±4.6)×10 9/L, neutrophil percentage 0.62±0.11, C reactive protein(20.1±59.3)mg/L, procalcitonin(1.6±11.8)μg/L, interleukin-6(11.3±32.9)pg/ml. Results:The operative time was (39.3±23.0) min. The 2 hours postoperative WBC count was (6.7±2.9) ×10 9/L, neutrophil percentage was 0.70±0.12. qSOFA was positive for 69 cases and negative for 2 295 cases. 15 (0.6%) patients developed urosepsis. qSOFA positive patients were 15 in urosepsis group and 54 in normal group. The preoperative/2 hours postoperative blood WBC count ratio was 2.5±1.6 for urosepsis group and 0.7±0.2 for normal group. Univariate analysis showed that female patients(χ 2=16.20, P<0.001), large size of stones( t=2.14, P=0.050), high preoperative blood WBC( t=2.51, P=0.025), neutrophil percentage( t=2.90, P=0.012), C reactive protein( t=2.58, P=0.028), procalcitonin( t=16.09, P<0.001)and interleukin-6( t=7.88, P=0.032), positive preoperative mid-stream sample of urine culture(χ 2=21.10, P<0.001), preoperative/2 hours postoperative blood WBC count ratio >1( t=4.51, P=0.001)and qSOFA positive(χ 2=502.10, P<0.001) were recognized as statistically significant. Patients whose qSOFA was positive as well as preoperative/2 hours postoperative blood WBC count ratio >1 were diagnosed high-risk urosepsis patients. The efficacy of the combining of qSOFA and preoperative/2 hours postoperative blood WBC ratio >1 were higher than using separately. When using qSOFA alone, the area under the receiver operating characteristic curve was 0.98 but the positive prediction value was 21.7%. When using preoperative/2 hours postoperative blood WBC ratio alone, AUROC was 0.98, specificity was 60.0% and positive prediction value is 38.5%. Both indicate that the false positive rates were high. And for combining model, the area under the receiver operating characteristic curve was 1.00, specificity was 98.3% and the positive prediction value was 93.8%. It had a much higher efficacy which was a 2-hour-quick, sufficient and reliable indicator for diagnosing urosepsis. Conclusions:The combination of qSOFA positive and preoperative/2 hours postoperative blood WBC count ratio>1 could quickly and accurately predict the urosepsis after flexible ureteroscopic lithotripsy.
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Objective To investigate the effect of early continuous renal replacement therapy on the prognosis of urinary sepsis after surgery for upper urinary tract calculi.Methods The clinical data of 59 patients with urinary sepsis after surgery for upper urinary tract calculi were retrospectively analyzed.In 59 patients with urinary sepsis,9 patients with early persistent renal replacement therapy were selected as the experimental group and 50 patients without early continuous renal replacement therapy as the control group. The age,sex ratio,diabetes,hypertension,the average operation time were no significant difference(P>0.05).Preoperative urinary tract infection,the experimental group preoperative urinary tract infection was significantly higher than the control group(77.8% vs.32.0%,P<0.05).In the results of preoperative urine culture positive ratio,the experimental group was also significantly higher than the control group,the difference was statistically significant(P<0.05).The changes of prognostic factors in patients with or without continuous renal replacement therapy were analyzed.Results In terms of the changes of postoperative laboratory results,the decrease of procalcitonin(PCT),C-reactive protein,white blood cell count and neutrophil ratio in the experimental group was significantly larger than that in the control group, and the difference was statistically significant;on the increase of hemoglobin,platelet count,fibrinogen,the standard bicarbonate level from blood gas analysis in the experimental group increased significantly more than the control group,the difference between the two groups were statistically significant.Conclusions Early renal replacement therapy in patients with urinary sepsis after upper urinary tract calculi surgeries can improve the prognosis of patients.
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Objective To evaluate the clinical value and effect of biofeedback training therapy for functional constipation in elderly patients.Methods A total of 78 elderly patients with functional constipation were treated at the People's Hospital of Pudong New Area,and were divided randomly into two groups.The control group (n =39) received routine treatment plus oral polyethylene glycol,while the experimental group (n=39) received biofeedback training treatment in addition to what was offered to the control group.After treatment,constipation symptom scores,anorectal dynamic parameters and clinical effects were compared between the two groups.Results The scores on excrement characteristics,defecation difficulty,and time and frequency of defecation were better in the experimental group than those in the control group (t=5.670,4.740,4.170,5.530;P=0.016,0.034,0.039,0.022,respectively).The overall effectiveness rate was 94.9 ％ (37/39) in the experimental group,which was higher than that (71.8 ％,2 8/3 9) in the control group (x2 =4.493,P=0.030).Meanwhile,the levels of 3 SC and 10 SC in the two groups were higher than those before treatment,but the level of 10SR was lower than that before treatment (all P＜0.05).Moreover,improvement in 3SC,10SC and 10SR were more significant in the experiment group than in the control group (all P＜ 0.05).Conclusions Biofeedback training therapy is safe and effective for elderly patients with constipation to relieve constipation symptoms,enhance control of defecation and promote defecation.
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Objective To study the effect and safety of conversion from calcineurin inhibitors to rapamycin in kidney transplantation recipients with chronic allograft nephropathy.Methods In 82 kidney transplant recipients enrolled in this study,72 cases were diagnosed as having chronic allograft nephropathy by biopsy.Recipients (SRL group) were administered with rapamycin after withdrawal of calcineurin inhibitors.The doses of CNI in other recipients (non-SRL group) were not changed.Renal function,proteinuria,blood pressure,blood fat,hepatic function and hemogram were observed for 24 months in each group.Results During the follow-up period,serum creatinine level was dropped significantly in SRL group (P＜0.05),but it was increased in non-SRL group (P＜0.05).SRL group showed increased proteinuria,serum cholesterol and triglycerides (P＜0.05),and reduced Plt (P＜0.05).According to the renal function before conversion,the recipients who were administered rapamycin divided into four groups.In group A (Scr ＜ 120 μmol/L),there was no significant difference in diverse variables before and after conversion.In group B (Scr 120-200 μmol/L and Banff Ⅰ-Ⅱ),renal function was improved,and proteinuria alleviated.In group C (Scr 120-200 μmol/L and Banff ＞ Ⅱ),and group D (Scr ＞200 μmol/L),renal function was damaged to varying degrees and proteinuria was deteriorated.Conclusion It is safe and effective for patients with chronic allograft nephropathy to convert from calcineurin inhibitors to rapamycin.
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Objective To compare the safety and short-term efficacy of thulium laser resection of the prostate (TMLRP) and bipolar transurethral plasmakinetic prostatectomy (TUPKP) for the treatment of benign prostatic hyperplasia (BPH) patients.Methods A total of 100 patients diagnosed with BPH were randomly divided into 2 groups:TMLRP group (50 cases) and TUPKP group (50 cases).There was no significant difference of preoperative variables such as age,prostate volume,PSA,IPSS,Qmax and PVR between the two groups (P＞0.05).The perioperative parameters and therapeutic effects were recorded and compared between the two groups.Results Comparison between TMLRP group and TUPKP group included:operating time ((61.2±24.2) min versus (30.1±15.9) min),catheterization time ((1.8±0.4) d versus (3.2±0.6) d)and postoperative hospital stay ((3.3±0.8) d versus (4.1±1.3) d).Significant differences in these parameters were found between the two groups(P＜0.05).Compared with TUPKP group,the blood loss and postoperative bladder irrigation were significantly less in TMLRP group.One month postoperatively,there were 4 cases of urethral stricture in TUPKP group.Three months postoperatively,IPSS,QOL,Qmax and PVR were significantly improved in both groups (P＜0.01),but no significant difference detected between the 2 groups (P＜0.05).Conclusions TMLRP is superior to TUPKP in term of safety and tolerability (decreased blood loss,complication rate and short recovery time),and as efficacious as TUPKP in efficacy.Compared with TUPKP,operating time were significantly longer in TMLRP group
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Objective To evaluate the value of sonourethrography in the diagnosis of dysuria after bipolar transurethral plasmakinetic prostatectomy. Methods Sixty male patients with dysuria after bipolar transurethral plasmakinetic prostatectomy underwent sonourethrography and re-operation.The clinical data of these patients were reviewed. Results The sonourethrographic findings were similar with the operative findings in 57 cases.In the 60 cases,there were 11 cases with bladder neck closure,10 cases with bladder neck stricture,30 cases with urethral stricture (16 located at membranous urethra,12 located at pars cavernosa urethra and 2 in external orifice of urethra),5 cases with prostate remnant,1 case with calculi in prostatic urethra,2 cases with dysfunction of detrusor of bladder and 1 case with flap of internal urethral orifice,Conclusions Sonourethrography could be a reliable diagnostic method for dysuria after bipolar transurethral plasmakinetic prostatectomy.It may be helpful for clinical treatment.
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Objective To analyze the cause of puncturing failure in ultrasonography guided minimal-invasive percutaneous nephrolithotomy (MPCNL). Methods A retrospective analysis involved total 612 patients with upper urinary tract lithialisis treated with MPCNL from May 2005 to May 2010.382 cases were acupunctured by traditional G18 puncturing instrument (group A),and the other 230 cases were performed by the improved ARROW Raulerson blue syringe (group B).The average renal pelvis range was 24 mm vs.21 mm before operation,and largest diameter of renal calculi was 3.7 cm vs.3.8 cm (P ＞ 0.05).Success rate and time cost as well as therapeutic effect were compared between the 2 groups. Results There were 29 cases of puncturing failure in group A (totally 382 cases) while only 2 in group B (totally 230 cases).The successful rate of establishment of working channel was significantly higher in group B (P ＜ 0.05).Average time of puncture procedure was 5.1 min and 4.8 min respectively (P ＞ 0.05).There was no puncturing-related severe complication in any group.The unsuccessful cases in the group A and related causes were:5 cases for obesity,13 cases for puncture needle slipping,9 cases for channel dropout,and 2 cases for needle route dropout.However,only 2 cases failed in group B,the accurate position of calculi was at upper and lower calyx.One case was over-weighted,another was because of pathway-loss during the calculi elimination processs.And the one-off puncture successful rate of A and B group was 92.4％ vs.99.1％,and the one-off puncture successful rate was significantly higher in group B. Conclusions Overobesity of patients is an important cause of puncturing failure for sonographically MPCNL.The establishment of working-channel with ARROW Raulerson blue syringe could be feasible and the success rate was significantly higher.
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Objective To report the experience and results in comparing laparoscopic radical nephrectomy (LRN) and open radical nephrectomy (ORN) in the treatment of clinical T_2 stage renal cell carcinomas. Methods Between Feb. 2004 and Jul. 2007, 30 patients (12 females and 18 males with average age of 58.0±8.5 years, range 42-68 years) received LRN and 36 patients (16 females and 20 males with average age of 60.0±9. 0 years, range 52-70 years) received ORN. The average tumor sizes in the LRN and ORN groups were (8. 5±2.2)cm (range 7-12 cm) and (8. 8±2.1)cm (range 7-14 cm) respectively. Renal cell carcinoma was histopatologically confirmed in all the patients of these 2 groups after surgery. Results The operative time in the ORN group (130±27 min) was significantly shorter than that in the LRN group (176±23 min), P<0. 01. The estimated blood loss in the LRN group (200±80 ml) was also significantly less than that in the ORN group (380±185 ml) , P<0. 01. Patients in LRN group experienced significantly earlier bowel function recovery (P<0. 01) and shorter duration of drainage (P<0. 01) than those in the ORN group after operation. No severe perioperative complications occurred in all patients. The follow-up range was 6-27 months (average 15±2 months). During the follow-up, 2 patients in the LRN group developed lung metastasis. In the ORN group, 2 patients developed liver metastasis and 1 developed lung metastasis. Conclusion LRN has the advantages of minimal invasiveness and rapid postoperative recovery comparable to those of ORN, and it might be an alternative treatment option for the clinical T_2 stage renal cell carcinomas.
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Objective To investigate the influence of transurethral plasmakinetic resection of the prostate(PKRP)on sexual function. Methods From January 2007 to December 2007.165 patients received PKRP,who had sexual active and completed the follow-up data forms before and after surgery.The average age of this cohort was 71 years(from 55 to 79 years).The average history of disease was 5.5(3-15)years while the average prostate volume 57(33-82)g,IPSS(26.4±2.6),quality of lire score(5.54±0.50),the maximum flow rate(7.04±4.10)ml/s,the average residual 120(55～250)ml.45 cases were complicated with urinary retention,and bladder stones 45 cases.15 cases with prostate stones.Their sexual function was assessed by the international index of erectile function,ejaculation function and sexual satisfaction before and 6 months after surgery by questionnaires,and compared the respective scores using SPSS14.0 and χ2 test. Results All of 165 patients,the IIEF-5 improved from(23.4±4.7)point to(24.1±4.9)point 6 months after operation(P>0.05),there was not significant.The abnormal ejaculation rate increased from 18.8%(31/165 patients)to 75.2%(124/165 patients)(P<0.001)after PKRP,respectively.The retrograde ejaculation rate increased from 11.6% (19/165 patients) to 64.2%(106/165 patients) after PKRP, respectively.There was a significant difference.128 patients (77.6 % ) and 132 patients (80.0 % ) were satisfied with their sexual active before and after 6 months PKRP, respectively. Conclusions The results of this study confirmed that PKRP has no negative influence on the quality of erections measured by IIEF-5.The loss of ejaculatory function has no influence on patients sexual active.
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<p><b>OBJECTIVE</b>Gaultheria yunnanensis. are used widespreadly in the south of China to treat rheumatoid arthritis. The aim of this study was to provide an experimental basis for G. yunnanensis to therapy rheumatoid arthritis.</p><p><b>METHOD</b>We prepared water extracts, ethanol extracts, n-butanol extracts, ethyl acetate extracts and the rest of ethanol extracts from G. yunnanensis. Then, the n-butanol extracts were applied to macroporous resin and eluted with water, 30% ethanol, and 95% ethanol. Rheumatoid arthritis was induced by Freund's complete adjuvant injected into right postpedes in Wistar rats which was utilized to elucidate the anti-inflammatory effect of different extracted liquid of G. yunnanensis. Rats were intragastric injected (ig) with extracts as experimental group or normal saline as control group.</p><p><b>RESULT</b>Freund's complete adjuvant induced arthritis was successfully established: paw edema were increased after Freund's complete adjuvant injection, peaked at 2 or 3 day, then decreased, the paw edema were increased again at 7 or 8 day, and persisted 15 d. Water extracts, n-butanol extracts or ethyl acetate extracts could a significantlly decrease the paw edema as compared with the control group (P < 0.05, P < 0.01). The effect of n-butanol extracts was the most powerful. Further, n-butanol extracts eluant with water and 30% ethanol decreased the paw edema. The activity of extracts eluant with 30% ethanol was stronger than that of eluant with water.</p><p><b>CONCLUSION</b>G. yunnanensis displays considerable effects against Freund s complete adjuvant induced arthritis in rats, which is in concordance with clinical practice. n-Butanol extracts and both of the eluants with water and 30% ethanol produce a significant decrease in the paw edema. 30% ethanol eluants show a stronger activity than others. The effects against rheumatoid arthritis of different parts of G. yunnanensis differ in degree. It is deserved to explore the potential mechanisms of anti-inflammtion of the G. yunnanensis, especially the n-butanol extracts eluant with 30% ethanol.</p>
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Animals , Female , Male , Rats , Arthritis, Experimental , Drug Therapy , Disease Models, Animal , Drug Evaluation, Preclinical , Drugs, Chinese Herbal , Gaultheria , Chemistry , Random Allocation , Rats, WistarABSTRACT
Objective To investigate the influence of renal allograft donor cytokine and cytokine receptor gene polymorphisms on acute rejection after renal transplantation.Methods (1) 126 cases of cadaveric renal allograft recipients were divided into two groups according to the presence or absence of acute graft rejection.The distribution of 22 polymorphisms in 13 cytokine genes and production types of some cytokines were compared between donors of two groups as well as latent factors affecting acute rejection.(2) Based on the result of HLA-DR matching,all recipients were stratified into two conditions:0～1 locus HLA-DR mismatched and HLA-DR completely mismatched.Previous positive gene polymorphisms were compared between rejection group and no rejection group under two conditions.Results (1) Compared with no rejection group,the number of HLA-DR mismatched was significantly higher in rejection group.In the donors of rejection group,the genotype frequency of IL-1α-889 C/C,IL-1Rα msp I 11100 T/T,IL-4Rα+ 1902 A/A,TGF-β1 codon 10 C/C,IL-10-1082 A/A and lower production type frequency of IL-10 were significantly higher,whereas the genotype frequency of IL-12-1188 A/A,IL-2-330 G/G and IL-10 GCC/ATA was significantly lower.(2) With 0～1 locus HLA-DR mismatched,the genotype frequency of IL-1Rα msp I 11100 T/T,IL-4Raα+1902 A/A,IL-2-330 G/G,TGF-β1 codon 10 C/C and lower production type frequency of IL-10 showed significant difference between two groups,whereas with HLA-DR completely mismatched,the genotype frequency of IL-12-1188 A/A had significant difference.Conclusions This study verifies renal allograft donor genotype of IL-1α-889 C/C,IL-4Rα+ 1902 A/A,IL-1Ra msp I 11100 T/T,TGF-β1 codon 10 C/C,IL-10-1082 A/A and lower production type of IL-10 gene as the genetic safe factors for the development of acute allograft rejection and genotype of IL-12-1188 A/A and IL-2-330G/G as the major genetic risk factors for acute rejection after kidney transplantation Furthermore,the condition of HLA-DR mismatching might interfere with the action of these cytokine and cytokine receptor polymorphisms.
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Objective To study chitosan's improving proliferation effect to the bladder epithelial cells,thus providing experlimental foundation for the treatment of interstitial cystitis.Methods Bladder epithelial cells were harested by the enzymatic digestion of the epithelium exposed by the eversion of reseeted New-Zealand hare's bladder.The cells were cultured in different concentrations(0.3、0.6、1.2、2.4、4.8 g/L)of chitosan group and control group,after 72 h,observing their growth and proliferation with optical microscopy;The effects of chitosan on proliferation of rabbit bladder epithelial cells were studied by NAG assay.EGFR mRNA was measured by PT-PCR.Results The growth of cells in the sample added chitosan is much better than that of in the control group.Chitosan could promote the proliferation of bladder epithelial cells at higher than 0.3 g/L of concentration in a dose dependent way.The optimum concentration to increase proliferation of eonjunctival epithelial cells was 1.2 g/L.The proliferative effect of EGFR mRNA increased with the elevated chitosan concentration after 72 h.Conclusions Chitosan can promote the growth of the bladder epithelial eell,which can provides a valuable evidence for further studies of interstitial cystitis's treatment.This proliferation effect is perhaps related to chitosan's promoting EGFR combinating specificity with EGFR.
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Objective To evaluate the clinical efficacy and safety of laparoscopic nephron sparing surgery in the treatment of T1 renal cell carcinoma. Methods Thirty-two patients (24 males and 8 females) were diagnosed with T1 N0 M0 renal cell carcinoma by ultrasound, CT or MRI and un derwent laparoscopic nephron sparing surgery. The mean age was (49±2)years old (from 31 to 72 years old). The mean tumor diameter was (2.8±0.8)cm. There were 21 tumors in left kidney, 11 in right kidney. Of them, 10 tumors were in upper pole, 13 in lower pole, 5 in kidney center, 4 close to renal hilum, 18 in dorsal side and 14 in ventral side of the kidney. Tumor masses were resected with the surgical margin of 0. 5 cm. Twenty-five cases were done through retroperitoneal approach and 7 cases was done through transperitoneal approach. The pathological results showed that there were clear cell renal carcinoma in 28 cases, granule cell renal carcinoma in 3 cases and oncocytoma in 1 case. Renal function was examined by ECT before and after the surgery. Results Thirty-one cases under went laparoscopic nephron sparing surgery successfully and only one case converted to open surgery due to excessive intra-operative bleeding. The mean renal pedicle blocking time was (24±4)min (from 19 to 52 min). There were 3 cases having blocking time longer than 30 min (38 min, 45 min and 52 min) and accepted secondary blockage during the procedure. The mean operative time was (105 ± 15) rain. The mean estimated blood loss was (120±22)ml. Only 6 cases accepted 400 ml blood transfusion. D-J stents were placed in 5 eases with the tumor in kidney center before operation. In 3 cases with intra-operative exposure of renal calyx, D-J stems were placed after operation. Urine leakage in 2 eases were noted at 2 and 3 days and recovered at 15 and 21 days after operation. The mean hospital stay was (9±2)days. There was no recurrence in a mean follow-up time of (23±5)months. There were 3 cases with local hematoma (1 case of 4 cm × 3 cm, 2 cases of 2 cm×3 cm) in the surgical site confirmed by ultrasound or CT scan 1 month after surgery and they disappeared 3 months after the operation. Serum creatinine and urea nitrogen were all in normal range after operation. Compared with renal blood flow of the operated kidney before operation, there were 9 cases decreased by 10 %- 15 and 3 cases decreased by 20% at 15 days, 7 cases decreased by 10%-15% at 1 month and 3 cases decreased by 10%- 15% at (23 ± 5) months after operation. Conclusion Laparoscopic nephron sparing surgery is one of feasible and safe options for the treatment of T1 renal cell carcinoma.
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Objective To investigate the expressions of Ki67,p53,CKL,EMA,S-lOO,NSE,CgA,Syn,CEA and nm23 in adrenal tumors and their clinical significance.Methods Clinical data from 157 cases of adre-nal tumor patients were retrospectively reviewed including the clinical informa-tion and pathology data.Expressions of Ki67,p53,CKL,EMA,S-100,NSE,CgA,Syn,CEA and nm23 proteins were studied by immunohistochemistry(SP method)using monoclonal antibodies,and the relationship of their expressions with histopathologic type and clinical imformation was analyzed with SAS v6.12 software.A P value of＜0.05 was considered statistically significant.Results A increase of the expression rate of CKL,S-100,NSE,CgA,Syn and nm23 in adrenal tumors was obsered(P＜0.05).For univariate analysis,the expression of S-100,CgA,Syn was in connection with histopathologie types(P＜0.05).The expression of S-100,CgA,Syn had positive correlation with each other.The expression of CKL,S-100,NSE,CgA,Syn,nm-23 was no difference between adrnalbenign tumors and malignant tumors(P＞0.05),but it was much higher than in normal adrenal tissues(P＜0.05).The expression of Syn in adrenal cortical adenomaa was higher than in adrenal cortical cancers(P＜0.05),the expression of Ki67 in adrenal cortical adenomas was much lower than in adrenal cortical cancers(P＜0.05).The expression of EMA、CKL in adrenal cortical tumors were higher than in adrenal medullary tumors(P＜0.05),the expression of S-100,Syn,NSE,CgA in adrenal cortical tumors were lower than in adrenal medullary tumors(P＜0.05).Conclusions CKL,S-100,NSE,CgA,Syn and nm23 were good markers for adrenal tumors,they could be use for the adrenal tumors diagnosis.Detect Syn and Ki67 simutaneously was helpful to the diagnosis of adrenal cortical tumors.Detect EMA,CKL,S-100,Syn,NSE and CgA simultaneously and combine with clinical data was helpful to diagnosis between adrenal cortical tumors and adrenal medullay tumors.In malignant tumors,blood pressure had positive correlation with the expression of CgA,the size of tumor had neg-ative correlation of blood pressure,no prognostic factor was found.
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Objective: To discuss the procedure and clinical effect of retroperitoneal laparoscopic nephropexy (RLN).Methods: From August 2001 to June 2006, RLN was performed on 28 female patients aged 26-45 years old (mean, 34±2.5) with symptomatic nephroptosis, including 15 with the right kidney, 12 with the left, and 1 with both. The preoperative complaint of patients included subjective symptoms (constant and recurring pain in 28 patients) and objective symptoms (upper urinary infections in 16, hematuria in 12, and upper tract obstruction in 12). One patient underwent nephropexy via the transperitoneal approach and the others underwent nephropexy via the retroperitoneal approach. A retroperitoneoscopic procedure was performed after positioning the patients in the flank position. Digital preparation of the retroperitoneal space was made and standardized trocar was placed. The key step of the surgery was complete exposure of the kidney within Gerota' fascia, which was aimed to separate the potential adhesions between the colon and kidney or between the inferior blood vessels of the kidney. Nephropexy was performed between the fibrous capsule at the lower pole of the kidney and the dissected psoas muscle, using three sutures placed by intracorporeal technique or the percutaneous needle both for introduction and removal of the suture; the sutures were separately tied over the sacrospinalis fascia. Results: The mean operative time was (125±9) min (ranging 115-240 min); the mean postoperative hospital stay was (9±1.2) days, largely owing to the required 5-12 days' bed rest. During a mean follow-up of (24±4.2) months(ranging 3 to 70 months), 3 patients had paresthesia, 5 had constant and recurrent ache, 20 were completely free of pain, and 4 had micro-hematuria. One patient had further episodes of pyelonephritis and upper tract obstruction after operation. Intravenous pyelogram(IVP) revealed that the ptosis incorporated into more than one vertebral body in 2 patients. Postoperative renal function test showed an improvement in renal function. Conclusion: RLN is mini-invasive and has less complication. The procedure should be considered as one of the optimal therapy for nephroptosis.
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Objective:To separate chemical and active constituents from the stem bark of Albiza julibrissin . Methods:Chromatography and spectral methods were used. Results:3 O ? D xylopyranosyl (1→2) ? L arabinopyranosyl (1→6) ? D glucopyranosyl 21 O {(6 S) 2 trans 2 hydroxymethyl 6 methyl 6 O [3 O (6 S ) 2 trans 2 hydroxymethyl 6 methyl 6 hydroxy 2,7 octadienoyl) ? D xylopyranosyl] 2,7 octadienoyl} acacic acid 28 O ? D glucopyranosyl (1→3) [? L arabinofuranosyl (1→4)] ? L rhamnopyranosyl (1→2) ? D glucopyranosyl ester (1) was separated and identified. Conclusion: Compound 1 is a new saponin named as Julibroside J 24 .
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Objective To observe the expression of FcRIIa and FcRIIb on the surface of several immune cells.Methods The expression of FcRIIa and FcRIIb on the surface of several immune cells were detected by RT-PCR and Western blot before and after IVIG incubation. The difference of Fc?RIIb expression on U937 and human peripheral blood mononuclear cells (PBM) after IVIG induction. was also analyze by FACS.Results Under normal conditions Fc?RIIa was mainly detected in macrophages/monocytes and B lymphocyte cells, while Fc?RIIb could not be detected. After IVIG administration, the expression of FcRIIb on the surface of U937 cells was quickly up-regulated (RT-PCR). FACS analysis revealed that the Fc?RIIb expression on U937 and human peripheral blood mononuclear cells (PBM) after IVIG induction was also increased. Conclusion The effect of immunoregulation of IVIG was partly achieved by up-regulation of the expression of FcRIIb on the surface of some immune cells.
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<p><b>OBJECTIVE</b>To review kidney transplantation in the center and analyze the risk factors affecting long-term allograft survival.</p><p><b>METHODS</b>Thirty-two relative variables were analyzed with SAS statistical software. Using Log-rank method, we investigated influence of these variables on short-and long-term survival of grafts. Kaplan-Meier analysis was used to estimate the 1-, 3-, 5-, 10-years graft survival rates and half-life. Proportional hazards regression analysis (Cox model) was used to assess and rank the relative risk of potential variables.</p><p><b>RESULTS</b>The 1-, 3-, 5-, 10-years graft survival rates were 83%, 75%, 66% and 48%. After excluding the patients died with functioning grafts, the 1-, 3-, 5-, 10 years grafts survival rate increased to 89%, 82%, 75% and 69%, respectively. The mean half-life was 8.78 +/- 0.14 and 14.09 +/- 0.20 years, respectively. By Log-rank analysis, factors affecting short- and long-term graft survival were identified as: renal function, duration of graft function became normal, cold-ischemia time, presence of acute rejection, delayed graft function, immunosuppressive regimen, complication, infection, anti-rejection therapy. Cox model multivariate analysis showed that there were 18 factors affecting graft survival.</p><p><b>CONCLUSIONS</b>New immunosuppressive agents not only significantly increase short-term graft survival, but also have the better long-term outcome tendency. Making assurance to get high quality donor organ and minimizing the death with graft function may be the most feasible way to prolong graft survival at present.</p>
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Adult , Female , Humans , Male , Cadaver , Graft Survival , Immunosuppressive Agents , Pharmacology , Kidney Transplantation , Multivariate Analysis , Transplantation, HomologousABSTRACT
Objective: To probe into the etiology of the sever e post-renal transplantation infection and its diagnosis and t reatment. Methods: A retrospective analysis was made on the seve re infected cases among 1 504 renal transplantation cases. Results: (1)The infected rate in the whole group was 23.74%,and 14.01% of the infecti on cases was severely involved. (2) About 86% of the severe infection occurred within 6 months after operation and as high as 82% of the patients were successf ully rescued by various etiological treatment. (3) The main etiological causes according to their frequency and type were: Bacteria(Mycobacterium tub erculosis, Pseudomonas, Aureus staphylococcus, Bacillus cloacae, etc.); Fungus (Candida albians, Candida tropicals, Penicillum patulum). Cytomegalo virus also often appeared. Conclusion: (1) Infection is one of t h e common complications after renal transplantation and severe infection is an im portant cause of death. (2) Correct diagnosis and combined therapy in time may improve its success rate. (3) Characterized germ spectrum exists in severe post -renal transplantation infection and its role is of great importance to clinica l management.
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Objective To evaluate the efficacy of retroperitoneoscopic radical nephrectomy.Methods From October 2001 to September 2006,a total of 108 patients underwent retroperitoneoscopic radical nephrectomy in our department.The tumors sized 1.0-8.0 cm in diameter with a mean of(4.3?2.9)cm.Before the operation,42 patients were in stage T1N0M0,54 in stage T2M0N0,and 12 in stage T3aN0M0.Results The operation time was 35-180 min with a mean of(63.5?30.3)min,and the blood loss was 20-1500 ml [mean,(75?23)ml].Totally 3 patients were converted to open surgery.The intra-and postoperative complications included hemorrhage caused by the injury of the inferior vena cava or renal artery(4 cases),wound infection(3 cases),and hypercapnia(8 cases).The patients were followed up for 6-36 months(over 12 months in 61 cases),during which 2 patients died of pulmonary metastasis one year after the surgery,1 patent died of liver metastasis 7 months after postoperation,the other 105 patients survived without tumor.The 1-year survival rate was 98.4%(60/61);and 3-year survival rate was 85.7%(18/21).Conclusions Retroperitoneoscopic radical nephrectomy is mini-invasive and effective for renal carcinoma.The patients recover quickly after the surgery.The procedure is worth being wildly used.