ABSTRACT
Objective To investigate the distribution and drug resistance characteristics of pathogens in donors and recipients undergoing simultaneous pancreas-kidney transplantation (SPK). Methods Clinical data of 231 pairs of donors and recipients undergoing SPK were analyzed retrospectively. The pathogens of samples from donors and recipients were identified by VITEK-2 analyzer, and drug sensitivity test was performed by K-B method. The source distribution and composition ratio of pathogens in donor and recipient samples, distribution characteristics of multi-drug resistant organism, infection of recipients and drug resistance characteristics of pathogens were analyzed. Results A total of 395 strains of pathogens were cultured from 1 294 donor samples, and the detection rate was 30.53%. Gram-negative bacteria mainly consisted of klebsiella pneumoniae, Gram-positive bacteria mainly comprised staphylococcus aureus, and fungi primarily included candida albicans, respectively. In total, 2 690 strains of pathogens were cultured from 10 507 recipient samples, and the detection rate was 25.60%. Gram-negative bacteria mainly consisted of pseudomonas maltophilia, Gram-positive bacteria primarily comprised enterococcus faecalis, and fungi mainly included candida albicans, respectively. Among 395 pathogens of donors, 15 strains of methicillin-resistant staphylococcus aureus (MRSA), 16 strains of extended-spectrum β-lactamase (ESBL) positive drug-resistant bacteria, 8 strains of carbapenem-resistant pseudomonas aeruginosa (CR-PA), 21 strains of carbapenem-resistant acinetobacter baumannii (CR-AB), 2 strains of carbapenem-resistant enterobacteriaceae (CRE) and 1 strain of multiple-drug/pan-drug resistant pseudomonas aeruginosa (MDR/PDR-PA) were identified. Among 2 690 strains of recipient pathogens, 73 strains of ESBL positive drug-resistant bacteria, 44 strains of CR-PA, 31 strains of CR-AB and 3 strains of MDR/PDR-PA were detected. One recipient developed donor-derived infection, 69 cases of pneumonia, 52 cases of urinary tract infection, 35 cases of abdominal infection and 2 cases of hematogenous infection were reported within postoperative 1 year. Gram-negative bacteria were resistant to certain antibiotics. Gram-positive bacteria were sensitive to vancomycin. Fungi were sensitive to amphotericin B. Conclusions Gram-negative bacteria are the main pathogens of SPK recipients, which are resistant to certain antibiotics. Empirical use of antibiotics can be delivered before culture results are obtained. Subsequently, sensitive antibiotics should be chosen according to the culture results to improve the survival rate of SPK recipients.
ABSTRACT
ObjectiveTo compare the therapeutic effects of oral Chinese medicines （including Chinese patent medicines） on coronary artery disease （CAD） by the Bayesian network Meta-analysis. MethodThe randomized controlled trials of treating CAD with oral Chinese medicines were retrieved from the China National Knowledge Infrastructure （CNKI）， Wanfang Data， VIP， PubMed， Web of Science， Embase， and Cochrane Library from the inception to December 1， 2022. The Cochrane risk of bias assessment tool was used to evaluate the quality of the included articles. The direct meta-analysis was performed to compare the performance of oral Chinese medicines alone and in combination with Western medicine in the treatment of CAD in terms of intima-media thickness （IMT）， vascular endothelial function， plaque score， hypersensitive C-reactive protein （hs-CRP）， total cholesterol （TC）， triglyceride （TG）， high-density lipoprotein cholesterol （HDL-C）， low-density lipoprotein cholesterol （LDL-C）， and total response rate. Furthermore， the Bayesian network Meta-analysis was performed to compare the therapeutic effects of different Chinese medicines. ResultA total of 41 articles were included. The direct meta-analysis results showed that Chinese medicines combined with Western medicine outperformed Western medicine alone in recovering all the indicators of CAD. The Bayesian network meta-analysis yielded the following results. In terms of the total response rate， modified Huangqi Guizhi Wuwutang and Sanqi Huayu pills had obvious advantages over other Chinese medicines. In terms of IMT and plaque score， Xiaoban Huazhuo decoction， Yiqi Tongluo formula， Ruangan Jiangzhi capsules， and Guanxin Shutong capsules had obvious advantages over other Chinese medicines. In terms of blood lipid indicators， Shenqi Roumai mixture， Ruangan Jiangzhi capsules， Xiaoban Huazhuo decoction， Qiwei Sanxiong decoction， and Sanqi Huayu pills were superior to other Chinese medicines. The Chinese medicines above mainly had the functions of activating blood， resolving stasis， resolving phlegm， and dredging vessels. ConclusionThe combination of oral Chinese medicines and Western medicine is effective in treating CAD. Clinicians can use the drugs targeting abnormal indicators according to the results of this Bayesian network meta-analysis combined with the actual situation of patients to achieve better therapeutic effects.
ABSTRACT
Objective:To investigate the effects of thoracic segment epidural anesthesia on inflammatory factors in patients undergoing lung cancer surgery.Methods:The clinical data of 136 patients who underwent lung cancer surgery in the Second People's Hospital of Liaocheng from June 2020 to May 2022 were retrospectively analyzed. According to anesthesia methods, these patients were divided into an observation group ( n = 89) and a control group ( n = 47). The observation group was given thoracic segment epidural anesthesia, while the control group was given remifentanil infusion anesthesia. The tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) levels in the epithelial lining fluid collected from the non-dependent lung, the plasma levels of TNF-α, IL-6, and malondialdehyde, arterial partial pressure of oxygen/inhaled oxygen fraction, the incidence of complications, the incidence of re-operations, numeric rating scale score, and the length of hospital stay were compared between the two groups. The effects of different anesthesia methods on lung cancer surgery were evaluated. Results:In each group, TNF-α, IL-6, and IL-10 levels in the epithelial lining fluid were significantly increased 30 minutes after termination of one-lung ventilation (T2) compared with those measured before one-lung ventilation (T1) ( t = 7.71, 77.10, 7.59, 3.41, 57.51, 5.74, all P < 0.05). In the observation group, TNF- α [(1.59 ± 0.53) ng/L, (1.89 ± 0.64) ng/L] measured at T1 and T2, IL-6 [(2.96 ± 0.82) ng/L] and IL-10 [(1.99 ± 0.53) ng/L] measured at T1 were significantly higher compared with those measured at the corresponding time points in the control group ( t = 10.45, 2.59, 2.00, 7.19, all P < 0.05). In the observation group, IL-6 measured at T2 [(38.91 ± 5.84) ng/L] was significantly lower than that in the control group ( t = 33.25, P < 0.001), and IL-10 measured at T2 [(2.51 ± 0.67) ng/L] was slightly, but not significantly higher than that in the control group ( P > 0.05). There was no significant difference in the plasma level of TNF- α measured at T1 and T2 between the two groups (both P > 0.05). Plasma levels of IL-6 in the two groups [(42.98 ± 5.29) ng/L, (27.93 ± 4.17) ng/L] measured at T2 were significantly increased compared with those measured at T1 ( t = 54.14, 61.06, both P < 0.001). In the observation group, TNF-α measured at T2 [(1.60 ± 0.56) ng/L] and IL-6 measured at T1 and T2 [(0.92 ± 0.16) ng/L, (27.93 ± 4.17) ng/L] were significantly lower compared with the control group ( t = 3.39, 6.96, 18.20, all P < 0.05). There were no significant differences in plasma level of malondialdehyde, arterial partial pressure of oxygen/inhaled oxygen fraction, numeric rating scale score, the incidence of complications, the incidence of re-operation, and the length of hospital stay between the two groups (all P > 0.05). Conclusion:Thoracic segment epidural anesthesia can reduce the local inflammatory response of the lung during lung cancer surgery.
ABSTRACT
Because of the frequent occurrence of epidemics in Jiangnan since ancient times， the local medical schools have accumulated rich experience in epidemic prevention， among which Yushan medical school， Wumen medical school， and Qiantang medical school are famous. The physicians have inherited the theory in Treatise on Cold Damage Diseases and developed the therapies for febrile diseases. Adhering to the idea of integrating cold and febrile diseases， the physicians in Jiangnan flexibly adapt ZHANG Zhongjing's theory by combining regional climate， patient physique and other factors to explain the pathogenesis， which is of great significance for the prevention and treatment of epidemics. Therefore， traditional Chinese medicine （TCM） has demonstrated good curative effect on coronavirus disease-2019 （COVID-19） in China. However， the SARS-CoV-2 variants （Delta and Omicron） characterized by strong infectivity， pathogenicity， and immune escape capacity keep emerging， which bring great challenges to the global prevention and control of this pandemic. To this end， we studied the ways of Jiangnan medical school for the prevention and treatment of epidemics， reviewed the evolution of TCM treatment protocols for COVID-19， and summarized China's experience in fighting against the emerging SARS-CoV-2 variants. Further， we explored the measures of TCM in treating SARS-CoV-2 variants from prevention， treatment， and rehabilitation according to the theory for epidemic prevention of Jiangnan medical school. This paper provides reference for the prevention and treatment of emerging SARS-CoV-2 variant and facilitates the development of TCM epidemiology.
ABSTRACT
Objective:To explore the clinical efficacy of aspirin plus low molecule heparin for pancreatic thrombosis during simultaneous pancreas and kidney transplantation (SPK).Methods:A total of 129 patients aged 18 years or higher underwent SPK between September 2016 and March 2020.They were divided retrospectively into two groups of aspirin ( n=60) and heparin ( n=69) according to different anticoagulant regimens.The aspirin group received only aspirin 100 mg/d at Day 1 post-operation.The heparin group received subcutaneous injection of enoxaparin 2 000 AxaIU daily for 7 days and followed by aspirin and clopidogrel.Outcomes and complication rates were compared between two groups. Results:All operations were successful without any mortality.In aspirin group, there were 5 cases of pancreatic thrombosis and one patient underwent pancreatectomy.There was no pancreatic thrombosis in heparin group ( P=0.014). There were 8 cases of intestinal anastomotic bleeding in aspirin group and 19 cases in heparin group.Statistically significant inter-group difference existed ( P=0.048). However, no significant inter-group difference existed in delayed recovery or rejection. Conclusions:Heparin anticoagulation can significantly lower the incidence of pancreatic thrombosis after SPK.Despite a higher incidence of intestinal anastomotic bleeding, no serious complication occurs after conservative meaures.
ABSTRACT
Objective:To analyze the association of pre-transplant risk factors with diabetes mellitus after renal transplantation and examine the significance of preventing the occurrence in kidney transplantation recipients.Methods:A total of 290 kidney transplantation recipients were retrospectively reviewed at our transplantation center from August 2018 to May 2020.Diabetes mellitus after renal transplantation was employed as a primary outcome index.Multivariate Logistic regression model was utilized for constructing A (without adjusting for covariates)、B(covariates include: gender, dialysis mode, type of donation)and C(covariates include: gender, dialysis mode, type of donation, calcineurin inhibitor, antiproliferative drugs, primary disease, fasting blood glucose, 1 h postprandial blood glucose, fasting C peptide, 1 h and 2 h postprandial C peptide, fasting C-peptide index, 1 h postprandial C-peptide index, albumin, triglycerides, total cholesterol)to evaluate the relationship between diabetes mellitus after transplantation and age, body mass index, 2 h postprandial blood glucose(2 h-PG), HbA1c, and 2 h postprandial C-peptide index(2 h-CPI).Results:In model A, age [odds ratio(OR)1.1, 95% confidence interval( CI)1.0~1.1], BMI(OR 1.2, 95% CI 1.0~1.3), 2 h PG(OR 1.2, 95% CI 1.1~1.4), HbA1c(OR 2.7, 95% CI 1.5~4.9), 2 h-CPI(OR 0.7, 95% CI 0.5~1.0), model B/C had similar results with A. Age, BMI, 2 h PG and HbA1c were all risk factors for diabetes mellitus after transplantation while 2 h-CPI was a protective factor.Quartile stratification was analyzed by regression model.And trend test was significant( P<0.05). Conclusions:Age, BMI, 2 h PG, HbA1c and 2 h-CPI are correlated with diabetes mellitus after kidney transplantation.
ABSTRACT
@#With the development and improved availability of low-dose computed tomography (LDCT), an increasing number of patients are clinically diagnosed with lung cancer manifesting as ground-glass nodules. Although radical surgery is currently the mainstay of treatment for patients with early-stage lung cancer, traditional anatomic lobectomy and mediastinal lymph node dissection (MLND) are not ideal for every patient. Clinically, it is critical to adopt an appropriate approach to pulmonary lobectomy, determine whether it is necessary to perform MLND, establish standard criteria to define the scope of lymph node dissection, and optimize the decision-making process. Thereby avoiding over- and under-treatment of lung cancer with surgical intervention and achieving optimal results from clinical diagnosis and treatment are important issues before us.
ABSTRACT
Objective To analyze the risk factors for the occurrence of post transplantation diabetes mellitus (PTDM) in renal transplant recipients, establish a prediction model for PTDM and evaluate its prediction value. Methods Clinical data of 915 renal transplant recipients were retrospectively analyzed. According to the occurrence of PTDM, all recipients were divided into the PTDM group (n=78) and non-PTDM group (n=837). The main indexes of recipients were collected. The risk factors for the occurrence of PTDM in renal transplant recipients were analyzed by univariate and multivariate analysis. The prediction model for PTDM was established and its prediction value was evaluated. Results Family history of diabetes mellitus, body mass index (BMI), preoperative 2 h postprandial blood glucose and preoperative glycosylated hemoglobin were the independent risk factors for the occurrence of PTDM in renal transplant recipients. The prediction model for PTDM was logit (P)=2.199×family history of diabetes (yes=1, no=0)+0.109×BMI+0.151×2 h postprandial blood glucose (mmol/L)+0.508×glycosylated hemoglobin (%)-9.123. The results of receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of these 4 predictors combined for predicting PTDM in renal transplant recipients was 0.830 [95% confidence interval (CI) 0.786-0.873], the cut-off value was 0.0608, the sensitivity was 0.821, the specificity was 0.700, and the Youden index was 0.521 (P < 0.05). Conclusions Family history of diabetes mellitus, BMI, preoperative 2 h postprandial blood glucose and preoperative glycosylated hemoglobin are the independent risk factors for the occurrence of PTDM in renal transplant recipients. The prediction model for PTDM combined with4 predictors yield relatively high prediction value for PTDM.
ABSTRACT
Since the appearance of urethral stent, it has become an alternative treatment for urethral stricture except for urethral reconstructive surgery, and can be used safely in some patients with poor efficacy of urethral reconstructive surgery or unable to receive reconstructive surgery. This article summarizes the urethral stent in the application of bladder neck, prostatic urethra, ball, membrane urethra, penile urethra stricture, and postoperative hypospadias. Most study revealed that urethral stent could significantly relieve symptoms, improve the maximum urinary flow rate, reduce the residual urine volume, improve patients' quality of life, but the long-term effect need more follow-up and research evidence.
ABSTRACT
Objective@#To investigate the incidence and risk factors contributing to post-transplant diabetes mellitus (PTDM) in kidney transplant recipients within one year post-transplantation.@*Methods@#A total of 293 non-diabetic kidney transplant recipients were retrospectively analyzed. Patients were divided into non-PTDM group and PTDM group according to the diagnostic criteria of diabetes mellitus. The incidence of PTDM was calculated and the potential risk factors of PTDM were analyzed by univariate and multivariate Logistic regression analysis.@*Results@#Among the 293 non-diabetic patients, 36 patients developed PTDM within 1 year, with an incidence of 12.3%. Multivariate Logistic analysis showed that age (OR 1.055, 95% CI 1.014-1.098, P=0.009) , body mass index [odd ratio (OR) 1.231, 95% confidence interval (CI) 1.084-1.398, P=0.001], polycystic kidney as the primary disease (OR 1.508, 95% CI 1.006-2.262, P=0.047) , 2-hour postprandial blood glucose (OR 1.186, 95% CI 1.04-1.53, P=0.011) , HbA1c (OR 1.732, 95% CI 1.075-3.428, P=0.015) and 1-hour postprandial blood C-peptide (OR 0.869, 95% CI 0.804-0.939, P=0.001) were independent risk factors for PTDM in kidney transplant recipients within 1-year post-transplantation.@*Conclusion@#Patients with older age, obesity, polycystic kidney as the primary disease, higher level of HbA1c and 2-hour postprandial blood glucose, and lower level of 1-hour postprandial blood C-peptide may have higher risk of developing PTDM.
ABSTRACT
Objective@#To observe the clinical effect of surgical resection after conversion therapy for patients with advanced gastric cancer.@*Methods@#The clinical data of 23 patients with advanced gastric cancer who were admitted to Shanxi Provincial Cancer Hospital from January 2015 to October 2017 were retrospectively analyzed. All patients underwent multi-disciplinary treatment(MDT)-directed conversion therapy, and D2 radical gastrectomy was performed after the disappearance of non-healing factors. The remission of patients after conversion therapy and the related intraoperative and postoperative indicators were analyzed.@*Results@#After the conversion therapy, there were 2 cases (8.7%) of complete remission, 13 cases (56.5%) of partial remission and 8 cases (34.8%) of stable disease. The remission rate of the conversion therapy was 65.2% (15/23). In all 23 cases, the surgical time was (135.5±32.1) min, the intraoperative blood loss was (356.7±101.3) ml, the number of lymph nodes resected was 35.5±10.3. The time of gastric tube indwelling was (70.5±29.6) h, the time to first liquid intake was (85.0±21.5) h, the time of drainage tube placement was (196.2±36.2) h and the postoperative hospital stay was (10.7±3.2) d. After surgery, two cases had grade ⅢA post-operative complications and 2 had gradeⅡ. All patients were followed up, the median progression-free survival time was 13.5 months and the median overall survival time was 21.9 months.@*Conclusion@#The survival time of patients with advanced gastric cancer can be prolonged by D2 radical gastrectomy after the MDT-guided conversion therapy.
ABSTRACT
Objective To investigate the safety of young recipients undergoing living donor renal transplantation from elderly relative donors through long-term follow-up of the pathological changes. Methods According to the age of donors, 28 young recipients were divided into the observation group (n=14, elderly donors) and control group (n=14, young and middle-aged donors). The 7-year survival after renal transplantation, the serum creatinine (Scr) levels at various postoperative time points were compared between two groups. The chronic pathological injury scores of renal allograft biopsy at time-zero, postoperative 6-month and 7-year were compared between two groups. The expression levels of renal interstitial fibrosis indicators connective tissue growth factor (CTGF), transforming growth factor (TGF)-β, laminin (LN), fibronectin (FN), cell senescence indicators intercellular connexin (Cx)-43 and mammalian target of rapamycin (mTOR) at postoperative 6-month and 7-year were compared between two groups. Results The 7-year survival rates in the observation and control groups were 78.5% and 92.8% with no statistical significance (P > 0.05). In the observation and control groups, the levels of Scr were 190 and 160 μmol/L at the postoperative 7 d, and 170 and 125 μmol/L at postoperative 1 month. At each postoperative time point, the levels of Scr in the observation group were significantly higher than those in the control group (all P > 0.05). The total chronic pathological injury scores of renal transplant biopsy at time-zero in the observation group was significantly higher than that in the control group (P > 0.05), whereas the total chronic pathological injury scores at postoperative 7-year did not significantly differ between two groups (P > 0.05). Within either group, the total chronic pathological injury scores at postoperative 7-year was remarkably higher than those at time-zero and postoperative 6-month (both P < 0.05). The expression levels of CTGF, TGF-β, LN, FN, mTOR, Cx43 of renal transplant tissue at postoperative 7-year did not significantly differ between two groups (all P > 0.05). Conclusions The long-term follow-up outcomes demonstrate that the pathological changes of young recipients undergoing renal transplantation from elderly donors are similar to those from young and middle-aged donors. It is safe and feasible for young recipients to undergo renal transplantation from elderly donors in the pathological perspective.
ABSTRACT
Objective To investigate the distribution characteristics of pathogenic bacteria in infectious donors from organ donation after citizen's death and preventive strategies for renal transplant recipients. Methods Clinical data of 412 donors and 803 recipients from organ donation after citizen's death were retrospectively analyzed. All donors underwent culture of airway secretions, urine, blood and renal lavage fluid. The incidence rate of infection, distribution and composition ratio of pathogenic bacteria of donors from organ donation after citizen's death were observed. The scores of all donors were evaluated according to the length of intensive care unit (ICU) stay for donors, the situation of abdominal trauma and the results of body fluid culture, etc. According to the score, the recipients received different infection prevention regimes. The incidence rate of donor-derived infection (DDI) and clinical prognosis of the recipients were analyzed. Results A total of 243 donors were diagnosed with infection in 412 donors from organ donation after citizen's death with an infection rate of 59.0%. In total, 456 strains of pathogenic bacteria were isolated, mainly derived from the airway secretions (71.7%). Gram-negative bacteria dominantly consisted of Klebsiella pneumoniae and acinetobacter baumannii. Gram-positive bacteria mainly included staphylococcus aureus and fungus mainly included yeast-type fungus. Three recipients (kidneys from 2 donors respectively) developed DDI with an incidence rate of 0.4%. Conclusions The infection rate of donors from organ donation after citizen's death is relatively high. It is effective to prevent the incidence of DDI by grading the risk of infection of donors and adopting rational preventive plan according to the score.
ABSTRACT
Objective To explore the drug sensibility of Brucella from bovine and sheep in Xinjiang.Methods Using paper diffusion method,19 drugs of 8 kinds of antibiotics including aminoglycosides,macrolides,sulfonamides,tetracyclines,β-lactams,fluoroquinolones,chloramphenicols and rifamycins,were tested.Drug sensitivity test was conducted on 57 Brucella strains isolated from bovine and sheep in Xinjiang from 2010 to 2016.Results The 57 Brucella strains were highly sensitive to doxycycline,tetracycline,streptomycin,tobramycin,gentamicin,amikacin,amoxicillin,ofloxacin,fleroxacin,ciprofloxacin and chloramphenicol,with the sensitivity rates were all higher than 90％;and they were highly resistance to azithromycin,clarithromycin and bactrim,with the drug resistance rates were all higher than 80％.Conclusion Brucella from bovine and sheep in Xinjiang is sensitive to tetracyclines,aminoglycosides,β-1actams,fluoroquinolones and chloramphenicols.
ABSTRACT
Objective To identify molecular typing of Brucella abortus isolates in Xinjiang,and determine the identification ability of multiple locus variable-number tandem repeat analysis (MLVA).Methods The optimized Brucella AMOS-PCR was used for identification of Brucella (n =7) genus and species in Xinjiang from 2010-2015,and MLVA-16 was used to further identify the isolates.Results were compared with the data of the Brucella standard strain provided by the http://mlva.u-psud.fr database.Cluster analysis was carried out with Bionumerics 6.6.Results The results of AMOS-PCR and MLVA-16 were identical,all were Brucella abortus.Further classification results of the MLVA-16 showed that the strain in Xinjiang was type 3 of Brucella abortus,which was basically the same as that of the domestic Brucella.Conclusions The molecular typing of isolates separated in Xinjiang is type 3 of Brucella abortus.MLVA can identify Brucella at the level of species,and highly sensitive to Brucella biotype and isolates differences,which provides a basis for the traceability and evolution of brucellosis epidemic strains.
ABSTRACT
Objective To preliminarily explore the clinical efficacy of ipsilateral simultaneous pancreas and kidney transplantation (SPK) .Methods Ipsilateral SPK was performed in 40 patients from September 2016 to August 2018 .During a follow-up period of 6 to 29 months ,we summarized the efficacy and complications of the technique .Results Up to now ,38 patients achieved an exceelent clinical efficacy with no major surgical complications .However ,two patients died of severe pneumonia .The postoperative serum levels of creatinine at 3 ,6 ,12 ,24 months were 107 ,102 ,107 ,110 umol/L ;creatinine clearance rate 64 ,67 ,64 ,63 ml/min;fasting glucose 4 .6 ,5 .1 ,4 .6 ,5 .2 mmol/L ;glycated hemoglobin 4 .8％ , 5 .4％ ,4 .9％ ,5 .2％ respectively .And 1/2-year pancrea and kidney graft survival rates both were 92％ . Complications included kidney graft rejection (n= 11) ,pancreas graft rejection (n= 12) ,simultaneous renal & pancreas graft rejection (n=6) ,renal graft DGF (n=1) ,pulmonary infection (n=14) ,urinary tract infections (n=18) ,gastrointestinal bleeding (n=10) diarrhea (n=6) ,splenic venous thrombosis (n=2) ,incomplete ureteric obstruction of renal allograft (n=3) ,urine leakage (n=1) and pancreas allograft dysfunction (n= 2) .There were no severe surgical complications .After aggressive interventions ,all postoperative complications were cured and none required excision of kidney or pancreas .Conclusions Ipsilateral SPK has definite therapeutic efficacy and it is worth wider popularization .
ABSTRACT
Objective To investigate the incidence and risk factors contributing to post-transplant dia-betes mellitus (PTDM) in kidney transplant recipients within one year post-transplantation. Methods A total of 293 non-diabetic kidney transplant recipients were retrospectively analyzed. Patients were divided into non-PTDM group and PTDM group according to the diagnostic criteria of diabetes mellitus. The incidence of PTDM was cal-culated and the potential risk factors of PTDM were analyzed by univariate and multivariate Logistic regression analysis. Results Among the 293 non-diabetic patients, 36 patients developed PTDM within 1 year, with an in cidence of 12.3％. Multivariate Logistic analysis showed that age (OR 1.055, 95％ CI 1.014-1.098, P=0.009), body mass index [odd ratio (OR) 1.231, 95％ confidence interval (CI) 1.084-1.398, P=0.001], polycystic kidney as the primary disease (OR 1.508, 95％ CI 1.006-2.262, P=0.047), 2-hour postprandial blood glucose (OR 1.186, 95％CI 1.04-1.53, P=0.011), HbA1c (OR 1.732, 95％ CI 1.075-3.428, P=0.015) and 1-hour postprandial blood C-pep-tide (OR 0.869, 95％ CI 0.804-0.939, P=0.001) were independent risk factors for PTDM in kidney transplant re-cipients within 1-year post-transplantation. Conclusion Patients with older age, obesity, polycystic kidney as the primary disease, higher level of HbA1c and 2-hour postprandial blood glucose, and lower level of 1-hour post-prandial blood C-peptide may have higher risk of developing PTDM.
ABSTRACT
Objective To explore the technique and significance of intraoperative neuromonitoring (IONM) for scarless in the neck endoscopic thyroidectomy (SET) via breast approach.Methods From Apr.2015 to Oct.2015,101 consecutive patients undergoing SET with IONM were included.During the operation,patients received radical resection of the thyroid cancer by Wang's seven-step method.The lymph nodes in the central area were dissected and Wang's multi-functional separation forceps were implemented for recurrent laryngeal nerve (RLN) positioning,monitoring and protection.Also,time required for RLN positioning and exposure,postoperative transient and permanent RLN damage incidence were calculated to assess the feasibility of IONM under SET.Results Among 101 patients,130 RLNs in total were exposed.The average time required for RLN positioning under IONM was (3.26 ± 1.08)min,with round-nerve management time of (13.95 ± 4.58)min.Nerve signal change happened in 16.9％(22/130) patients.Positive predictive value was 13.6％ and negative predictive value was 100％.The overall accuracy rate was 85.4％.Conclusion IONM during SET is feasible,and can be helpful for the localization and functional protection of RLN and was useful to predict vocal cord paralysis.
ABSTRACT
Objective To investigate the quality of life and psychological status of donors and recipients of living-related donor kidney transplantation. Methods Selected the treatment of living donors in the hospital (n = 80)and recipients(n = 80)from January 2014 to January 2017 as the research objects,and 80 cases of hemodialysis patients at the same period as the control group. Using the SF-36,Zung Self-rating Anxiety Scale (SAS),and the Self-rating Depression Scale(SDS)to evaluate the psychological status of the two groups and com-pared.Results Scores of donors′physiological function,and general health compared with the norms were not sig-nificant(P>0.05),while the somatic pain scores were significantly lower than the norms(P<0.05).There was no difference between the donors group and the norms in scores of vitality,social function and emotional function (P>0.05).The scores of physical health and mental health of recipients were significantly higher than those of the control group(P < 0.05). The donors′ SAS and SDS anxiety and depression scores were significantly higher than the norms(P<0.05).Besides,SAS and SDS anxiety and depression scores of the recipients were also significantly higher than the norms(P < 0.05),but significantly lower than the control group(P < 0.05). Conclusion The living-related donor kidney transplantation does not affect the quality of life and psychological state of the donor, but can improve the quality of life and reduce the anxiety and depression of the recipient.
ABSTRACT
Objective:To evaluate the effect of preoperative panel reactive antibody(PRA)levels on long-term survival after kidney transplantation. Methods:Data on 1 162 patients underwent first kidney transplantation performed between January 2001 and June 2014 were included in our center. According to the preoperative PRA levels,the patients were divided into negative group( PRA≤10%) and positive group( PRA>10%) ,which were retrospectively analyzed. Results: The 1-,5-,10-year patient survival rates of the negative group calculated by Kaplan-Meier were 96. 8%,89. 4%,78. 6%,respectively,while the positive group were 93. 5%,81. 6%, 65. 4%. The 1-,5-,10 -year death-censored graft survival rates of the negative group were 95. 9%,84. 8%,63. 1%,respectively,while the positive group were 92. 3%,74. 1%,51. 9%. The log-rank test revealed that there was significant difference between the patient and graft survival curves (χ2 =9. 623/11. 019, P=0. 002/0. 001 ) . Cox multivariate analysis found that preoperative PRA levels were independent risk factors for reducing the patient or graft survival rates(P<0. 001). Logistic multivariate regression analysis confirmed the significant association between preoperative PRA levels and the risk of acute rejection ( OR=8. 25,95% CI=2. 86-5. 72, P<0. 001). The 5-,10-year creatinine values were significantly lower in the negative group compared to the positive group(all P<0. 05), while there was no difference in the 1-year. In addition, Logistic multivariate regression analysis confirmed the significant association between preoperative PRA levels and the production of donor specific antibody(DSA)(OR=6. 89,95% CI=4. 52-9. 17,P<0. 05). Conclusion: The detection of preoperative PRA is an important indictor predicting the sensitivity status of the recipients. The preoperative PRA positive recipients need careful monitoring and diagnosis of acute rejection and DSA after kidney transplantation.