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Objective:The aim of this study was to evaluate the safety and efficacy of prostatistic urethral lift (PUL) in treating benign prostate hyperplasia(BPH) through systematic review and Meta-analysis.Methods:A systematic literature search on CNKI, Wanfang, VIP, PubMed, Web of Science, Cochrane Library and Chinese Clinical Trial Registry to identify the relevant studies and data before September 2021. Information was extracted from each eligible article. All statistical analyses of this Meta-analyses were performed with Review Manager 5.3 and Stata 15.0 software to conduct a Meta-analysis of the symptom improvement of BPH patients before and 3 months and 12 months after PUL. The main evaluation indicators included: International Prostate Symptom Score (IPSS), maximum urinary flow rate (Q max), post-void residual (PVR), and Quality of Life Scale (QOL), Sexual Health Inventory for Men (SHIM). The complication rate of PUL was systematically evaluated. Results:A total of 12 clinical studies were included, and 850 patients accepted the PUL. The results showed that IPSS decreased significantly at both 3 and 24 months after PUL surgery ( MD = -11.77, 95% CI -12.47—-11.07, P<0.05; MD = -9.71, 95% CI-10.76—-8.66, P<0.05), Q max (ml/s) increased to a certain degree ( MD = 3.87, 95% CI 3.37—4.37, P<0.05; MD = 3.68, 95% CI 2.97—4.40, P<0.05), QOL decreased significantly ( MD=-2.57, 95% CI -2.76—-2.38, P<0.05; MD = -2.14, 95% CI -2.38—-2.91, P<0.05), SHIM score was unaffected ( P>0.05), compared with preoperative baseline data. PUL could be performed under local anesthesia, the main perioperative complications reported in the included studies were dysuria (17%±6%), hematuria (14%±5%) and pelvic pain (8%±6%), all of which were transient. Conclusions:PUL in the treatment of BPH has significant short-term and long-term efficacy with low surgical risk and complication rate, and can preserve normal ejaculation function. It is a safe and effective minimally invasive surgery, which can be used for BPH patients with intolerance to general anesthesia surgery or normal sexual function demand.
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This study explored the usefulness of two-dimensional shear wave elastography (2D-SWE) in the early assessment of corpora cavernosa fibrosis (CCF). New Zealand male rabbits were randomly assigned to an experimental group or a control group. Recombinant human transforming growth factor beta 1 (TGF-β1) was injected into the dorsal penis tissue of rabbits in the experimental group. Conventional ultrasound and 2D-SWE examinations were performed before and 20 days after injection. Penile histological analysis was performed by hematoxylin-eosin staining, sirius red staining, and immunohistochemistry. Measurement of 2D-SWE examination results was performed using shear wave elastography quantitative measurement (SWQ). Histological analysis outcomes were the proportion of smooth muscle cells (SMCs), collagen fibers (CFs), collagen type I (Col I), and collagen type III (Col III), as well as the SMCs/CFs ratio, measured by sirius red staining. Other histological analysis outcomes were the positive area proportion (PAP) of TGF-β1 (PAPT), fibronectin (PAPF), and Col III (PAPC), measured by immunohistochemistry. After recombinant human TGF-β1 injection, SWQ was higher in the experimental group than that in the control group (P < 0.001); however, there were no differences in conventional ultrasound results. There were significant differences in histological outcomes between the two groups (all P < 0.05). These results indicated that 2D-SWE was superior for identifying early histological changes in CCF.
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Animals , Male , Rabbits , Elasticity Imaging Techniques/methods , Fibrosis , Penis/pathology , Transforming Growth Factor beta1/metabolismABSTRACT
Objective:To investigate the role and mechanism of chemokine receptor type 4 (CXCR4) in renal injury and fibrosis caused by calcium oxalate crystals in mice.Methods:In June 2021, Fifteen male C57/BL6 mice were divided into control group (5 mice), model group (5 mice), and AMD3100 intervention group (5 mice) by random number table method. In model group and AMD3100 intervention group, glyoxylate (100 mg/kg) was injected intraperitoneal for 7 consecutive days for modeling. Meanwhile, the AMD3100 intervention group was also given intraperitoneal injection of AMD3100 (1 mg/kg) for 7 days. The control group was continuously injected with equal volume saline intraperitoneally. After 7 days, peripheral blood was collected from each group to determine the levels of serum urea nitrogen (BUN) and creatinine (Scr) to assess the renal function; HE, Von-Kossa, Picrosirius Red staining was also taken from the left kidney to observe the pathological changes of renal tissue. CXCR4, transforming growth factor β1 (TGF-β1) were detected by immunohistochemistry and western blot. The expression levels of PI3K/AKT pathway-related proteins were detected by western blot.Results:The results of biochemical indexes showed that the serum Scr [(108.03±13.56) μmol/L vs. (39.50±4.48)μmol/L, P<0.01)] and BUN[(5.66±0.48)mmol/L vs. (0.77±0.10)mmol/L, P<0.01) levels were significantly increased in model group compared with the control group. The AMD3100 intervention group was significantly lower than the model group in terms of Scr [(65.77±3.27)μmol/L vs. (108.03±13.56)μmol/L, P<0.05) and BUN [(2.97±0.44)mmol/L vs. (5.66±0.48)mmol/L, P<0.05) levels. The results of kidney pathology in mice showed that renal tubules were significantly dilated with inflammatory cell infiltration in the model group compared with the control group, and a large number of calcium oxalate crystals and collagen fibers were deposited. The extent of kidney damage, calcium oxalate crystals and collagen fibers deposition were significantly reduced in the AMD3100 intervention group compared with the model group. The results of western blotting showed that the relative expression of CXCR4(0.639±0.019 vs. 0.158±0.012, P<0.01) and TGF-β1(0.698+ 0.018 vs. 0.314+ 0.015, P<0.05) was significantly increased in the model group compared with the control group. The relative expression of CXCR4(0.322±0.231) in the AMD3100 intervention group compared with the model group (0.322±0.231 vs. 0.639±0.019, P<0.05) and TGF-β1(0.445+ 0.017 vs. 0.698+ 0.018, P<0.05) were significantly decreased. The results of immunohistochemical staining showed the trend of CXCR4 and TGF-β1 expression in each group consistent with the results of protein blotting assay. Western blotting results showed that the expression of p-PI3K (0.613±0.016 vs. 0.213±0.011, P<0.01) and p-AKT(0.149±0.013 vs. 0.047±0.014, P<0.01) was significantly increased in the model group compared with the control group. The expression of p-PI3K in the AMD3100 intervention group compared with the model group (0.292±0.020 vs. 0.613±0.016, P<0.05) and p-AKT (0.098±0.021 vs. 0.149±0.013, P<0.05)was significantly decreased. Conclusion:CXCR4 inhibits calcium oxalate crystal-induced kidney injury and interstitial fibrosis in mice by targeting the PI3K/AKT pathway.
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Objective:To investigate the typing and clinical value of posterior group renal calyces.Methods:From April 2020 to June 2021, 640 patients (320 men and 320 women) who underwent CTU examination in our hospital with kidneys on both sides and normal or only mild hydronephrosis in the collecting system were analyzed. A total of 1 280 renal CTU three-dimensional reconstructed images were counted.The patients aged 52.4±11.9 years. The patients' CTU images were reconstructed in three dimensions using the spine as a marker to rotate the collecting system images in stereoscopic space to simulate a prone position. A two-person review was taken to observe the imaging morphology of the renal calyces in the prone position, and the 640 renal calyces in the posterior group of the left and right sides were counted for staging. Based on the morphology of the renal calyces and the influence on the establishment of surgical access, the posterior group of renal calyces was divided into 3 major types. Pot-belly type: the renal pelvis is shaped like a pot-belly, and the renal pelvis is directly connected to the cup-shaped minor calyces without a distinct major renal calyces. Classically branched: 2 or more major renal calyces are branched and converge to form the renal pelvis. Elongated branched: the major calyces are branched, with at least one major calyces having an axis length ≥0.9cm and a neck width ≤0.3cm.The classic branching type is divided into three types, a, b, and c, including seven subtypes, based on the relationship of the posterior group of the minor calyces to the major calyces. Type a is derived from group 1 major calyces only, type b is derived from group 2 major calyces at the same time, and type c is derived from the upper, middle and lower groups of major calyces at the same time. Type a contains 3 subtypes.Type a1 is derived from the upper group of major calyces only, type a2 is derived from the middle group of major calyces only, and type a3 is derived from the lower group of major calyces only. Type b is also divided into 3 subtypes. Type b1 is derived from the upper and middle groups of major calyces at the same time, type b2 is derived from the middle and lower groups of major calyces at the same time, and type b3 for the upper and lower renal major calyces. Type c had no corresponding subtype.Results:Statistical findings revealed that all kidneys had posterior group calyces. The morphological typing of the posterior group of calyces was 8.83% (113/1 280) for the pot-bellied type, which had the highest occurrence of 2 minor calyces (5.63%, 72/1 280). 71.25% (912/1 280) had the classically branched type, which had the highest occurrence of 3 minor calyces (31.17%, 399/1 280). 19.92% (255/1 280) had the elongated branched type, with the highest percentage of 3 occurring in the calyces (9.92%, 127/1 280). The anatomical typing of the classical branching type occurred in 20.50% (187/912) for type a, 66.45% (606/912) for type b, and 13.05% (119 /912) for type c. The percentage of occurrence of type a1/a2/a3 was 4.06% (37/ 912), 6.14% (56/ 912), and 10.31% (94/912). b1/b2/b3 types occurred in 2.03% (21/912), 7.46% (68/912), and 56.69% (517/912), respectively.Conclusions:The posterior group of calyces is structurally complex and extremely variable. In this study, the posterior group calyces were found to be present in all patients, and the posterior group calyces were morphologically divided into 3 types, with the highest percentage of occurrence of the classical branching type and the highest percentage of 3 posterior group minor calyces. The classical branching anatomical typing was highest in type b with the highest percentage of type b3, which combined with stone distribution, made it easy to choose the puncture location. The typing of the posterior group of calyces can provide an anatomical basis for PCNL puncture from the posterior group.
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Objective:To evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on sleep quality in patients with post-stroke sleep disorder (PSSD).Methods:The clinical randomized controlled trials involving PSSD patients who received rTMS were retrieved from nine medical databases. After excluding duplicated references, screening for independent references and risk evaluation, the remaining references were input into RevMan5.4 software for meta-analysis.Results:Twelve eligible literatures were included in the final analysis. Meta-analysis results revealed that after rTMS intervention, there were significant differences in the following terms between the treatment and control groups (all P < 0.05): Pittsburgh sleep quality index score [MD = -2.60, 95% CI (-3.03, -2.17), P < 0.000 01]; sleep latency [MD = -9.69, 95% CI (- 16.87, - 2.50), P < 0.01], sleep efficiency [MD = 8.90, 95% CI (5.41, 12.39), P < 0.01], number of awakenings [MD = -1.15, 95% CI (- 2.26, - 0.04), P = 0.04], awakening duration [MD = -10.95, 95% CI (- 13.30, -8.61), P < 0.01], and rapid eye movement [MD = 4.54, 95% CI (2.24, 6.85), P < 0.01] in polysomnography; brain-derived neurotrophic factor score [MD = 5.29, 95% CI (2.47, 8.11), P = 0.0002]; clinical curative rate [ OR = 4.46, 95% CI (2.75, 7.23), P < 0.000 01]. Conclusion:rTMS can improve the sleep quality in patients with PSSD, which is worthy of clinical promotion.
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Objective:To introduce some rare clinical features of the variant Guillain-barre syndrome (GBS) and to explore its possible pathogenesis for the early diagnosis.Methods:The clinical data, laboratory data and treatment outcomes of four patients, who admitted to Shenzhen People′s Hospital from October 2017 to June 2018 and diagnosed with variant GBS were analyzed and summarized.Results:All the four patients presented limb weakness as a first manifestation. However, they all had clinical features that were inconsistent with typical GBS, and the clinical features were shown differently in each patient. One patient showed asymmetrical limb paralysis. The first manifestation of one patient was severe and persistent back pain accompanied by paraplegia. One patient was accompanied by obvious headache and positive meningeal irritation. One patients had the plane of sensory obstacles, paraplegia, and positive pathological sign. Cerebrospinal fluid examination showed protein cell dissociation in four patients. Electromyogram was consistent with peripheral neurogenic damage. Magnetic resonance imaging (MRI) of the brain and the spinal cord showed no obvious abnormalities. The four patients with obvious improvement in symptoms were treated with gamma globulin and glucocorticoid.Conclusions:Variant GBS is rare and clinical symptoms are various. Patients with atypical clinical symptoms should still be diagnosed by relevant auxiliary examinations to avoid delayed illness.
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Objective:To compare the injury of renal blood vessels using different puncture pathways and access sizes.Methods:Between April 2018 and June 2019, eighty fresh pig kidneys were selected to perform percutaneous puncture and dilation, which was used to compare the injury of renal blood vessels with different puncture pathways and access sizes. The puncture pathway included the centerline of the normal renal pyramid (A), centreline of one side pyramid of the fused renal pyramid (FRP) (B), midline of the entire FRP (C) and midline of the renal column (D). The access size included F8, F12, F16, F20, F24 and F30. Histopathological methods were used to analyze the injury of renal blood vessels.Results:The puncture through paths A and B mainly caused injury to the grade Ⅴ and Ⅵ arteries in renal cortex. The puncture often directly injures the grade Ⅳ artery in path C. The puncture often simultaneously injures the grade Ⅲ-Ⅵ arteries in path D. Grade Ⅲ artery injury began to occur when paths A, B, C, and D were dilated to F30, F24, F16, and F12, respectively. The degree of arterial injury among the four different puncture pathways was significantly different in F8, F12, F16, F20, F24 and F30 ( P<0.05). Statistical differences were found between paths A and D in F12, F16, F20, F24 and F30 ( P<0.05), and between paths A and C in F16, F20 and F24 ( P<0.05). No significant difference was found between paths A and B in all access sizes ( P>0.05). Compared with F8, the degree of arterial injury of the F30 in path A and the F24 and F30 in path B were increased significantly ( P<0.05). Conclusions:Vascular injury in path D was the most serious followed by that in path C. Relatively little vascular injury can be achieved in paths A and B. The vascular injury increased when the path B was dilated to F24, while the path A needed to be dilated to F30.
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Objective To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi.Methods The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed.There were 424 males and 216 females.The awerage age was (46.2 ± 12.8) years old,ranging 18 to 76 years old.The maximum diameter of the stone is (1.4 ±0.7) cm,ranging 0.6-3.2 cm.There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi.There were 196 cases with unilateral ureteral calculi,118 unilateral ureteral calculi cases with renal calculi,236 cases with unilateral renal stones,and 90 cases with double kidney stones.104 cases were placed with double J tube before operation and 496 cases were not placed before operation.There were 8 cases of horseshoe kidney,30 cases of isolated kidney with renal insufficiency,4 cases of pelvic ectopic kidney with dysplasia,6 cases of congenital ureteral malformation and 2 cases of sponge kidney.Preoperative average hemoglobin was (133.2 + 5.6) g/L,ranging 126-188 g/L.And average serum creatinine was (84.4 + 12.2) μmol/L,ranging 74-242μmol/L before operation.All patients were treated with general anesthesia under the lithotomy position.The ureteroscopy combined with holmium laser lithotripsy was performed.The 200tμm fiber was used,which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz).The stone baskets were used to take stones according to actual conditions.The operation was performed by doctors of the same qualifications.Results All patients underwent successful operation.The mean operation time was (45.6 + 14.6) min.The average postoperative hospitalization was (4.8 ± 1.5) d.The postoperative serious complication rate was 0.9％,including(2 cases of sepsis and 1 case of subcapsular hematoma.Of the 640 patients,596 were admitted to the hospital for a double J tube and 44 were lost of follow-up.552 patients met the stone removal criteria,44 patients did not meet the stone removal criteria for other treatments,such as extracorporeal shock wave lithotripsy,ureteroscopy or observed regularly.The stone-free rate (SFR) was 92.6％ (552/596) after 1-3 months.On the first postoperative day,serum creatinine was (76.0 ±10.6) (58-156) μmol/L,and postoperative hemoglobin was (126.4 ±9.6) (120-176) g/L.There was no significant difference in preoperative and postoperative hemoglobin (t =2.02,P =0.064).Preoperative and postoperative creatinine (t =64.76,P ＜ 0.05) was statistically significant.Meanwhile,the stone size (x2 =29.569,P ＜ 0.05) and position (x2 =44.949,P ＜ 0.05) versus SFR the impact was statistically significant.Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P =0.639).The stone position was an independent risk factor for stone clearance (P =0.013).Conclusions RIRS is a reliable treatment for small and medium calculi patients of the upper urinary tract.The curative effect of stone removal is clear,the complications are few,the safety is high.However,there are certain limitations to the efficacy in the treatment of large stones and lower calculi.Lower calculi is the independent risk factor for the treatment of efficacy.
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Objective@#To evaluate efficacy and safety of retrograde intrarenal stone surgery for treatment of upper urinary calculi.@*Methods@#The clinical data of 640 patients with upper urinary tract calculi treated by retrograde intrarenal stone surgery (RIRS) in Renmin Hospital of Wuhan University from April 2016 to January 2019 were retrospectively analyzed. There were 424 males and 216 females. The awerage age was (46.2±12.8) years old, ranging 18 to 76 years old. The maximum diameter of the stone is (1.4±0.7) cm, ranging 0.6-3.2 cm. There were 126 cases with inferior calculi and 514 cases with non-lurgical calculi. There were 196 cases with unilateral ureteral calculi, 118 unilateral ureteral calculi cases with renal calculi, 236 cases with unilateral renal stones, and 90 cases with double kidney stones. 104 cases were placed with double J tube before operation and 496 cases were not placed before operation. There were 8 cases of horseshoe kidney, 30 cases of isolated kidney with renal insufficiency, 4 cases of pelvic ectopic kidney with dysplasia, 6 cases of congenital ureteral malformation and 2 cases of sponge kidney. Preoperative average hemoglobin was (133.2±5.6)g/L, ranging 126-188 g/L.And average serum creatinine was (84.4±12.2)μmol/L, ranging 74-242μmol/L before operation. All patients were treated with general anesthesia under the lithotomy position. The ureteroscopy combined with holmium laser lithotripsy was performed.The 200μm fiber was used, which the parameters were set as 12-45 W(0.5-1.5 J/10-30 Hz). The stone baskets were used to take stones according to actual conditions. The operation was performed by doctors of the same qualifications.@*Results@#All patients underwent successful operation. The mean operation time was (45.6±14.6)min. The average postoperative hospitalization was (4.8±1.5)d. The postoperative serious complication rate was 0.9%, including(2 cases of sepsis and 1 case of subcapsular hematoma. Of the 640 patients, 596 were admitted to the hospital for a double J tube and 44 were lost of follow-up. 552 patients met the stone removal criteria, 44 patients did not meet the stone removal criteria for other treatments, such as extracorporeal shock wave lithotripsy, ureteroscopy or observed regularly. The stone-free rate (SFR) was 92.6% (552/596) after 1-3 months. On the first postoperative day, serum creatinine was (76.0±10.6)(58-156) μmol/L, and postoperative hemoglobin was (126.4±9. 6)(120-176) g/L. There was no significant difference in preoperative and postoperative hemoglobin (t=2.02, P=0.064). Preoperative and postoperative creatinine (t=64.76, P<0.05) was statistically significant. Meanwhile, the stone size (χ2=29.569, P<0.05) and position (χ2=44.949, P<0.05) versus SFR the impact was statistically significant. Multivariate regression analysis showed that stone size was not an independent risk factor for stone clearance (P=0.639). The stone position was an independent risk factor for stone clearance (P=0.013).@*Conclusions@#RIRS is a reliable treatment for small and medium calculi patients of the upper urinary tract. The curative effect of stone removal is clear, the complications are few, the safety is high. However, there are certain limitations to the efficacy in the treatment of large stones and lower calculi. Lower calculi is the independent risk factor for the treatment of efficacy.
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Objective To evaluate the safety and efficacy of flexible ureteroscopy lithotripsy (FURL) for the treatment of renal stone in solitary kidney patients.Methods The clinical data of 46 patients of solitary kidney,who were treated with FURL from March 2015 to May 2018 in our hospital,were analyzed retrospectively.There were 34 males and 12 females,aged (48.6 ± 9.6) years.Maximum diameter of stone was (15.3 ±4.8) mm,and 29 cases in left kidney and 17 cases in right.34 cases were non-renal calcaneal calculi,12 cases were subrenal calyceal stones.There were 3 cases of congenital solitary kidney,31 cases of functional solitary kidney (contralateral kidney GFR ＜ 10 ml/min) and 12 cases of acquired solitary kidney (7 cases of renal calculi,4 cases of tumor,1 case of tuberculosis).The mean reoperative serum creatinine was (116.38 ± 25.77)μmol/L.All patients were treated with general anesthesia,lithotomy,soft ureteroscopy combined with holmium laser lithotripsy,and assisted lithotripsy.All operations were performed by the same surgeon.The data of operation time,hospital stay,blood loss,renal function before and after operation,postoperative complications and stone clearance rate were recorded.Results In this study,46 cases of the operation were successfully completed.The mean operation time was (58.6 ±16.4) min,the average hospitalization time was (5.6 ± 1.4) days.The mean hemoglobin was decreased (1.4 ± 0.9) g/L.The mean operative time was (58.6 ± 16.4) min.The average postoperative hospitalization time was (5.6 ± 1.4) days.The Postoperative hematuria occurred in 32 cases,low back pain in 3 cases and fever in I case.Stone-free reached in 39 of 46 patients,the stone-free rate(SFR)of primary operation was 84.8％ (39/46).There were 7 cases of residual calculi,five patients were treated with secondary FURL,2 patients were required conservative treatment.The SFR was 95.7％ (44/46) after the second stage operation.The mean serum creatinine was (112.29 ± 20.62) μ mol/L on the first day after operation,which was not different statistically with that before operation (P =0.177).The mean serum creatinine was (81.54 ± 10.75) μmol/L one month after operation,which was significantly lower than preoperative and 1 day postoperative (P ＜ 0.05).Conclusions FURL could be a safe and effective treatment for renal stone in solitary kidney patients.It has a definite stone-free effect,low incidence of complications.
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Objective To analyze the anatomical structure and distribution of the fused renal pyramid (FRP) in cadaveric kidney,and discuss its appearances by CT and ultrasonic examinations.Methods From June 2018 to September 2018,108 cadaveric kidneys were proceeded for regional anatomy.The distribution and anatomical manifestations of FRP was recorded.The renal pyramid was sliced and HE stained to explore the vascular distribution in FRP.From October 2018 to January 2019,ultrasound imaging data of 112 patients with 224 kidneys were collected,including 60 males and 52 females,age (39.0 ± 15.1),ranging from 16 to 73 years old.The renal imaging data of 89 patients and 178 patients with enhanced renal CT were collected,including 48 males and 41 females.Age (45.4 ± 13.6),ranging from 23 to 69 years old.The imaging findings of FRP in ultrasound and enhanced CT was summarized.Results In cadaver kidneys,the proportion of FRP in upper and lower calyces was 68.6％ (74/108) and 64.8％ (70/108),respectively,higher than that in middle calyces 34.3％ (37/108).In the middle group,the incidence of mild fusion was 39.0％ (16/41) and severe fusion was 48.8％ (20/41).The incidence of fusion of two renal pyramidal structures was 90.2％ (37/41).HE staining showed that the boundary between the artery in FRP and the surrounding renal pyramidal was unclear,and the protection of connective tissue was lacking.In Ultrasound,the FRP presented as a large trapezoidal hypo-echoic area with red and blue color signals in doppler mode.In ultrasound,the incidence of FRP was 18.8％ (42/224).In enhanced CT,the FRP presented as enhanced cord-like high density shade in large low density area in cortex phase.In enhanced CT,the incidence of FRP 27.5％ (49/178).Conclusions The FRP is a common structure in human kidney.The arteries localize within the FRP and are absence of sufficient connective tissue protection which are different from normal arteries.Ultrasound and enhanced CT have recognition ability for FRP.
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Objective@#To analyze the anatomical structure and distribution of the fused renal pyramid (FRP) in cadaveric kidney, and discuss its appearances by CT and ultrasonic examinations.@*Methods@#From June 2018 to September 2018, 108 cadaveric kidneys were proceeded for regional anatomy. The distribution and anatomical manifestations of FRP was recorded. The renal pyramid was sliced and HE stained to explore the vascular distribution in FRP. From October 2018 to January 2019, ultrasound imaging data of 112 patients with 224 kidneys were collected, including 60 males and 52 females, age (39.0±15.1), ranging from 16 to 73 years old. The renal imaging data of 89 patients and 178 patients with enhanced renal CT were collected, including 48 males and 41 females. Age (45.4±13.6), ranging from 23 to 69 years old. The imaging findings of FRP in ultrasound and enhanced CT was summarized.@*Results@#In cadaver kidneys, the proportion of FRP in upper and lower calyces was 68.6% (74/108) and 64.8% (70/108), respectively, higher than that in middle calyces 34.3% (37/108). In the middle group, the incidence of mild fusion was 39.0% (16/41) and severe fusion was 48.8% (20/41). The incidence of fusion of two renal pyramidal structures was 90.2% (37/41). HE staining showed that the boundary between the artery in FRP and the surrounding renal pyramidal was unclear, and the protection of connective tissue was lacking. In Ultrasound, the FRP presented as a large trapezoidal hypo-echoic area with red and blue color signals in doppler mode. In ultrasound, the incidence of FRP was 18.8% (42/224). In enhanced CT, the FRP presented as enhanced cord-like high density shade in large low density area in cortex phase. In enhanced CT, the incidence of FRP 27.5%(49/178).@*Conclusions@#The FRP is a common structure in human kidney. The arteries localize within the FRP and are absence of sufficient connective tissue protection which are different from normal arteries. Ultrasound and enhanced CT have recognition ability for FRP.
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Objective To explore the clinical significance of fused renal pyramid (FRP) structure in the establishment of percutaneous renal access.Methods From May 2017 to April 2018,10 fresh porcine kidneys were selected to cast in blood vessels for grading the kidney artery.Then another 80 isolated porcine kidueys were used to simulate percutaneous renal pu ncture and dilatation to establish F24 operative access by the same surgeon.Under the endoscope and microscope,we compared the effects of four different puncture paths on the occurrence of renal vascular injury when respectively punctured through the normal renal pyramid (group A),the side of the FRP (group B),the centre of the FRP (group C) and the renal column (group D).Results The kidney arteries can be divided into six grades,there is grade Ⅳ branchinterlobar artery walking inside the FRP.The diameter of interlobar artery in the FRP was significantly smaller than that in the renal column (0.442 ±0.012) mm vs.(0.778 ±0.037) mm,(P ＜0.001).Endoscopic observation and pathological tissue section showed the following results.In group A,there was no injured blood vessel distributed along the access.There were six specimens with grade Ⅴ or Ⅵ arteries injury in the cortex.Owing to the small size of the renal pyramid and the inaccurate location of the puncture,there was also injury associated with a normal grade Ⅳ artery in the renal column.In group B,there was a certain distance between the tract and the grade Ⅳ artery that distributed in the FRP,injury was still noticed in four specimens.And six specimens have grade Ⅴ/Ⅵ arterial injury.As the distance between the tract and the renal column decreased,there was a case in which a simultaneously injury occurred to the extremity of a grade Ⅲ artery and a grade Ⅳ artery.In group C,there was a white thin strip of connective tissue exposed along the puncture tract.Ectopic grade Ⅳ artery injury occurred in fourteen specimens,and grade Ⅴ/Ⅵ artery injury occurred in seven specimens.In group D,there were grade Ⅲ to Ⅵ arteries distributed along the operational access,which was cowered with white fat and connective tissue.The number of arteryinjury in grades Ⅲ,Ⅳ,and Ⅴ/Ⅵ were4,19,and 5,respectively.The mean ranks of artery injury degree in groups A (17.0),B (30.1),C (33.5) and D (41.5) gradually increased,and the difference was significant (P =0.006).There was a significant difference between group A and C (P =0.018),while no significant difference between group A and B (P =0.122),groups C and D (P =0.072).The proportion of grade Ⅳ artery injury in group A,B,and C was 5％ (1/20),25％ (5/20),and 70％ (14/20),respectively.There was a significant difference between group A and C (P =0.029),while no significant difference between group A and B (P =0.316).There was no significant difference in the injury of grade Ⅴ and Ⅵ artery in four groups (P =0.827).Conclusions When establishing a percutaneous renal access,vascular injury caused bv puncturing through the FRP cannot be ignored.It is necessary to carefu lly identify and bypass the FRP when selecting the puncture path.If unavoidable,the puncture path shoull be on the centreline of one side pyramid of the FRP.
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Objective To evaluate the safety and efficacy of ultrasound-guided transperitoneal PCNL for treatment of renal calculi in pelvic ectopic kidney.Methods The clinical data of 4 cases of pelvic ectopic kidney treated in our hospital from June 2016 to August 2017 were retrospectively analyzed.The patient's age ranged from 30 to 67 years with an average of 47.25 years.There were two male and two female patients.2 cases suffered with left pelvic ectopic kidney stones.One case had right pelvic horseshoe ectopic kidney stones and one case had spinal deformity left pelvic ectopic kidney stones.Multiple stones were found in 2 cases.The mainly stones located in the renal pelvis in one case.Multiple stones in the lower calyx was found in another case.The remaining 2 cases had single stones in the renal pelvis.Stone size was 3.4 cm × 2.1 cm,3.0cm×2.1 cm,2.8 cm×2.4 cm and 2.1 cm×1.9 cm respectively.And 1 case with renal calculi in left pelvic ectopic kidney had a history of open surgerv 11 years ago because of the same situation with pelvic ectopic kidney calculi.In this study,all operation was performed under general anesthesia.The ultrasound-guided percutaneous nephrolithotomy combined with preoperative CTU and intraoperative color Doppler ultrasound was used to find the target renal calyx or renal pelvis.And a certain pressure was applied to the abdominal wall to make the intestinal canal deviate from the surface of the pelvic ectopic kidney as much as possible.Under ultrasound real-time detection,it was punctured into the target renal calyx or renal pelvis to find and break stones.And F6 double J tube and F18 nephrostomy tube were left.Operative and post-operative related details (stone free,bleeding,abdominal infection) were reviewed.Results Stone free rate were 100％ (4/4).The time of operation and hospital stay were 62,59,55,51 min and 6,6,5,5 days,respectively.None had significant intraoperative and postoperative complications,including haemorrhage,injury of mesenteric vessels,abdominal infection and hydrops.No one left residual stones during 1 month and 3 nonths of follow-up.Conclusions The ultrasound-guided transperitoneal PCNL is a safe and effective procedure for the treatment of patients with renal calculi in pelvic ectopic kidney.
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Objective To investigate the preoperative magnetic resonance imaging (MRI)examination of the distribution of neurovascular bundles (NVB) around the prostatic capsule,and its clinical value in the nerve-sparing laparoscopic radical prostatectomy (NS-LRP).Methods The clinical data of 42 patients with clinically localized prostate cancer who were admitted from January 2008 to January 2017 were retrospectively analyzed.Age ranged from 58 to 74 years,with an average of 68 years.Preoperative serum PSA range from 0.94 to 12.28 ng/dl,with an average of 7.01 ng/dl.Preoperative Gleason score range from 6 to 8,with an average of 6.Clinical stage:T1-T2 37 cases,T3 5 cases.The average preoperative International Erectile Function Index questionnaire-5 (IIEF-5) 21,of which 23 cases had normal erectile function (IIEF-5 ＞ 22).All the 42 patients underwent MRI examination before operation.According to the distribution of NVB around the prostatic capsule,they were divided into 3 groups:17 cases in group A,and no NVB was evident in all cases.In group B,8 cases were visible but not obvious.In group C,17 cases were evident NVB.There was no significant difference in age,preoperative serum PSA and Gleason score between the three groups (P ＞ 0.05).The preoperative IIEF-5 in group A,B,and C were 19.5,22.8,and 21.5,respectively,with no statistically significant difference (P ＞ 0.05).All 42 cases received NS-LRP under general anesthesia.The differences in IIEF-5 before and after surgery were compared between the three groups.Results In this study,42 cases were successfully completed.42 patients were followed up for 12 to 36 months,with an average of 14.1 months.In group A,B,and C,postoperative IIEF-5 was 8.0,14.1,and 15.5,respectively,which was statistically significant compared with preoperative values (P ＜ 0.05).The decrease of IIEF-5 afteroperation in group A was significantly different from that of group Band C (P ＜0.05).Conclusions Compared with patients with visible NVB on MRI examination,patients have no visible NVB observed on MRI with erectile function-related nerves around the prostatic capsule may be walking on both sides of the prostatic capsule and spreading over the entire anterior ventral surface of the prostate.To maxium-preserve NVB and postoperative erectile function to the utmost,NS-LRP surgery should be more accurately dissected on both sides and ventral side of the prostatic capsule.
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Objective To investigate the distribution and antimicrobial resistance of pathogens isolated from blood specimen,and provide laboratory basis for clinical treatment of bloodstream infection. Methods Pathogens isolated from blood specimen in a hospital laboratory from January 1,2015 to December 31,2016 were identified and per-formed antimicrobial susceptibility testing.Results A total of 1 061 pathogenic strains were isolated from blood speci-men,of which gram-negative bacillus,gram-positive coccus,and fungus accounted for 53.35%(n= 566),36.10%(n=383),and 10.55%(n= 112)respectively,the major gram-negative bacillus,gram-positive coccus,and fungus were Escherichia coli(E.coli)and Klebsiella pneumoniae(K.pneumoniae),coagulase-negative Staphylococcus,and Candida parapsilosis respectively. Strains were mainly isolated from intensive care unit(ICU,n= 308,29.03%),followed by hematology department and pediatric internal medicine department. Resistance rates of E.coli and K. pneumoniae to imipenem were 2.65% and 40.12% respectively.Extended-spectrum beta-lactamase(ESBL)-produ-cing E.coli and K.pneumoniae accounted for 62.96% and 33.14% respectively. Linezolid- and vancomycmin-re-sistant Staphylococcusspp. Were not found,isolation rates of methicillin-resistant coagulase-negative Staphylococ-cus and methicillin-resistant Staphylococcus aureus were 83.61% and 45.45% respectively,one vancomycin-resis-tant Enterococcus faeciu m and one linezolid-resistant Enterococcus faecium were isolated respectively.Conclusion There are multiple species of pathogens isolated from blood specimen,distribution and antimicrobial resistance of pathogens casing bloodstream infection should be monitored regularly to guide the empiric antimicrobial therapy.
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Objective To study the inhibitive effects of matrine on the formation of glaucoma filtration bleb scar.Methods A total of 40 New Zealand white rabbit were chosen and randomly divided into four groups(group A,B,C and D).Both eyes in four groups were treated with glaucoma filtration surgery.The cotton pieces under the sclera flap were made:1.0 g · L-1 matrine cotton piece in group A,0.4 g · L-1 matrine cotton piece in group B,0.2 mg · L-1 mitomycin cotton piece in group C and PBS cotton piece in group D.The intraocular pressure,filtering bleb,anterior chamber reaction and complications were observed at preoperative and postoperative 1 day,3 days,7 days,14 days,28 days in all groups.Two rabbits selected randomly from every group were killed at 1 day,3 days,7 days,14 days and 28 days after surgery.Tissue was harvested from the bleb area and made into pathological section,immunestaining and Masson trichromatic dyeing were used to observe the inflammatory cells,collagen,fibroblasts,the change of muscle fibroblasts and new collagen fibers under light microscope.The cornea was observed at 7 days under transmission electron microscope for drug toxic reaction,Results At postoperative 7 days,14 days,28 days,there were statistical difference in IOP between group A,B,C and group D group (P ＜ 0.05),and there were statistical difference between group A and group B (P ＜ 0.05).At postoperative 7 days,14 days,28 days,there were statistical difference in fibroblasts counting between group A,B,C and group D group (P ＜0.01),and there were statistical differences between group A and group B (P ＜ 0.05).Conclusion Matrine can inhibit fibroblasts hyperplasia,reduce the scar of filtration area and has no side effects on eye tissues.
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Objective To observe enhancing effect of nerve regeneration on peripheral nerve defect models bridged by a new PRGD/PDLLA/VPA composite conduit.Methods In this study from February,2012 to March,2014,PRGD/PDLLA/VPA nerve conduits were tested in the rat sciatic nerve transection model.At different periods after operation,its ability to promote nerve regeneration was evaluated by sciatic functional index(SFI),electrophysiology (CMAPs,NCVs) and histologic assessment.Forty rats were randomly divided into 4 groups (n =10),group A:PRGD/PDLLA/VPA,group B:PDLLA/VPA,group C:PRGD/VPA and group D:autograft.Results At 12 weeks after surgery,the SFI value of group A (-45 ± 3.19)and group D (-42 ± 3.01)were significantly higher than those of group B(-79 ± 3.06) and group C(-72 ± 2.07)(P ＜ 0.05);The CMAPs of group A (24.89 ± 5.01) and group D (25.39 ± 5.63) were significantly higher than those of group B(14.88 ± 3.11) and C(15.00 ± 5.54);the NCVs of group A (31.42 ± 2.43) and group D (31.50 ± 2.16) were significantly higher than those of group B (20.11 ± 2.39) and group C(21.00 ± 2.13)(P ＜ 0.05).At 12 weeks after surgery,the numbers of regenerated nerve in the tube of group A (258 ± 6.18) and D(259 ± 5.59) were significantly higher than those of group B (231 ± 5.00) and group C(230 ± 5.07)(P ＜ 0.05).There was no significant difference between groups A and D(P ＞ 0.05).Conclusion These results illustrated that this new PRGD/PDLLA/VPA conduit could significantly facilitate the regeneration of short nerve defect and recovery of motor nerve,which provides a new thought for treatment of peripheral nerve injury.
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Valproic acid [VPA] is used to be an effective anti-epileptic drug and mood stabilizer. It has recently been demonstrated that VPA could promote neurite outgrowth, activate the extracellular signal regulated kinase pathway, and increases bcl-2 and growth cone-associated protein 43 levels in spinal cord. In the present research we demonstrate the effect of VPA on peripheral nerve regeneration and recovery of motor function following sciatic nerve transaction in rats. The rats in VPA group and control group were administered with valproic acid [300mg/kg] and sodium chloride respectively after operation. Each animal was observed sciatic nerve index [SFI] at 2-week intervals and studied electrophysiology at 4-week intervals for 12 weeks. Histological and morphometrical analyses were performed 12 weeks after operation. Using the digital image-analysis system, thickness of the myelin sheath was measured, and total numbers of regenerated axons were counted. There was a significant difference in SFI, electrophysiological index [motor-nerve conduct velocity], and morphometrical results [regenerated axon number and thickness of myelin sheath] in nerve regeneration between the VPA group and controls [P<0.05]. The results demonstrated that VPA is able to enhance sciatic nerve regeneration in rats, suggesting the potential clinical application of VPA for the treatment of peripheral nerve injury in humans
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@#Objective To observe enhancing effect of nerve regeneration on peripheral nerve defect models bridged by silicone tube idled with valproic acid (VPA). Methods In present research we demon-strate the effect of VPA on peripheral nerve regeneration and recovery of motor function following sciatic nerve transaction in rats. An 8-mm sciatic nerve deficit was created in a rat mode land bridged by a 1-cm silicone tube.Then, 10 lad of 8% VPA were perfused into the silicone chamber in the VPA group. The same volume of normal saline was delivered in the control group. Results Each animal was observed sciatic nerve function index (SFI) at 2-week intervals and studied electrophysiology at 4-week intervals for 12 weeks. Histological and morphometrical analyses were performed at the end of the experiment, 12 weeks after operation. Using the digital image-analysis system, thickness of the myelin sheath was measured, and total numbers of regenerated axons were counted. There was a significant difference in SFI, electrophysiological index (motor-nerve conduct velocity, MCV), and morphometrical results (regenerated axon number and thickness of myelin sheath) in nerve regeneration between the VPA group and controls (P ＜ 0.05). Conclusion The results demonstrated that VPA is able to enhance sciatic nerve regeneration in rats, suggesting the potential clinical application of VPA for the treatment of peripheral nerve injury in humans.