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Objective:To evaluate left ventricular structural and functional abnormalities and vascular calcification in kidney transplant (KT) recipients, explore their influencing factors and examine the effects of mineral and bone disorders.Methods:From January 2017 to December 2019, retrospective analysis was performed for 292 KT recipients. Biochemical markers of bone metabolism, bone mineral density (BMD), left ventricular hypertrophy (LVH), left ventricular ejection fraction (LVEF), left ventricular diastolic function, coronary artery calcification (CAC) score and thoracic aortic calcification (TAC) score were assessed. Linear regression and binary Logistic regression analyses were employed for evaluating the influencing factors of cardiovascular parameters and the influence of abnormal mineral and bone metabolism.Results:Postoperative abnormalities in mineral and bone disorders were manifested mostly as hypercalcemia (8.9%, 26/292), hypophosphatemia (27.1%, 79/292), low 25-hydroxyvitamin D (25(OH)vitD) (67.0%, 196/292), hyperparathyroidismhigh parathyroid hormone (PTH) (50.6%, 148/292), elevated bone turnover markers and bone loss rate of 25%-30%. The prevalence of LVH, LVEF<50%, left ventricular diastolic dysfunction, high CAC score and high TAC score were 39.9%(116/292), 0%, 13.1%(38/292), 17.3%(50/292) and 39.9%(116/292) respectively. The results of multivariate analysis indicated that LVH was correlated positively with hypertension and serum calcium (Ca) (95% CI: 1.242-28.080, P=0.026; 95% CI: 1.714-277.584, P=0.018); LVEF was correlated positively with lumbar vertebrae BMD (95% CI: 0.000 1-0.005 5, P=0.041); Left ventricular diastolic dysfunction was correlated positively with age, diabetes and parathyroid hyperplasia/nodules (95% CI: 1.050-1.176, P<0.001; 95% CI: 2.118-43.813, P=0.003 and 95% CI: 1.419-9.103, P=0.007); High CAC score was correlated positively with recipient age and dialysis time (95% CI: 1.036-1.160, P=0.001; 95% CI: 1.009-1.041, P=0.002); High TAC score was correlated positively with age (95% CI: 1.095-1.215, P<0.001). Correlation analysis indicated that TAC was correlated positively with serum Ca ( r=0.233, P=0.003), bone-specific alkaline phosphatase (BALP)( r=0.325, P<0.001) and type Ⅰ collagen cross-linked N-terminal peptide (NTX)( r=0.204, P=0.011) and negatively with femoral neck BMD ( r=0.194, P=0.017). Conclusions:There is a high prevalence of left ventricular structural and functional abnormalities and vascular calcification. It is closely correlated with mineral and bone disorders.
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Objective:To observe the efficacy and safety of quadruple low-dose immunosuppressant maintenance therapy of sirolimus(SRL), calcineurin inhibitors(CNIs), mycophenolate mofetil(MMF)and glucocorticoid in recipients switched within three months after renal transplantation.Methods:This retrospective study recruited 61 recipients on quadruple immunosuppressive therapy within three months after renal transplantation from 2013 to 2018. The changes of serum creatinine(SCr), blood urea nitrogen(BUN), hemoglobin(HGB), white blood cell(WBC), platelet(PLT), liver function, fasting blood-glucose(FBG), serum lipid, electrolyte and urine protein before and after using this protocol were recorded.Results:No significant difference existed between before and after protocol switching in WBC or serum sodium. But after protocol switching, significant differences could be observed in SCr, BUN, serum calcium, serum potassium, aspartate transaminase(AST), PLT, alanine transaminase(ALT), HGB, FBG, triglycerides(TG)and cholesterol(TC, P<0.05). Urine protein negative rate was 44.26 % before switching. However, it was 81.97 % after protocol switching. After switching during a 1-year follow-up period, the incidence of pulmonary infection rate was 24.59 %, the incidence of BKV infection rate 4.92 %, the incidence of transplant renal artery stenosis 3.28 % and the incidence of acute rejection 6.56 %. Conclusions:Quadruple low-dose immunosuppression maintenance therapy of SRL, CNIs, MMF and glucocorticoid switched within 3 months after renal transplantation may be an effective and safe protocol of improving renal allograft function and enhancing recipient prognosis.
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Objective:To evaluate the values of bone mineral density(BMD)of renal transplant recipients and analyze the influencing factors so as to provide rationales for preventing and treating osteoporosis after renal transplantation.Methods:A retrospective study was conducted for clinical data of 254 renal transplant recipients hospitalized from January 2017 to May 2019. The values of BMD of right femoral neck and lumbar vertebrae were detected by dual-energy X-ray absorptiometry(DEXA)and their relationships with other clinical parameters analyzed.Results:The average age was(40.5±9.8)years. Males accounted for 66.1 %, and menopausal women 5.9 %. The prevalence of osteopenia/osteoporosis of right femoral neck bone mass and lumbar vertebrae was 20.1 %, 2.8 % and 26.1 %, 3.6 % respectively. Chi-square test showed that recipients with lower BMD of femoral neck and lumbar spine were elders, menopausal women and those with longer postoperative time( P<0.05). Multivariate linear regression analysis indicated that BMD of right femoral neck was positively correlated with BMI and negatively correlated with acute rejection( P<0.05). The BMD of lumbar vertebrae was positively correlated with BMI and negatively correlated with PTH level ( P<0.05). Conclusions:There is a high prevalence of bone loss in kidney transplant recipients. Regular monitoring of BMD, active control of hyperparathyroidism, maintaining an excellent nutritional status, tapering of glucocorticoid dose and using immunosuppressants with less effect on bone metabolism may prevent osteoporosis.
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Objective:To observe the efficacy and safety of Iguratimod in reducing the level of panel reactive antibodies in renal transplant recipients.Methods:The clinical data of 35 patients with PRA-positive renal transplant recipients were retrospectively analyzed. All recipients were treated with Iguratimod for PRA-positive. The changes in PRA levels before and after treatment and the adverse events were observed.Results:Of the 35 recipients, 4 of them were discontinued due to pulmonary infection, and 2 patients were discontinued during the observation period. 3 patients were lost to follow-up. A total of 26 recipients were included. When Iguratimod was taken to 9 months, the PRA was reviewed. 71.5 % of the 207 sites showed a downward trend, 69.9 % of the 107 class I sites and 75.9 % of the 41 class II site showed a downward trend, and there was no difference in renal function before and after treatment. There were no significant changes in blood routine, liver function, blood lipids, and blood glucose. There were no other adverse events.Conclusions:Iguratimod can effectively reduce the level of PRA in renal transplant recipients with less adverse events.
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Objective To discuss the risk factors on short-term prognosis after kidney transplantation from donors after cardiac death (DCD). Methods We retrospectively analyzed the information of donors and recipients who performed DCD donor kidney transplantation in our center between January 2011 and August 2015, including 64 donors and 95 recipients. Also, we analyzed the potential relationship among donors' clinical characteristics and the early recovery of graft function, including the incidence of delayed graft function(DGF)and the serum creatinine (SCr) on the 90th day, and infection rate after kidney transplantation.Results We found that when donors had the factors of WIT>10 min, urine volume<100 ml/h, SBP≤100 mmHg or a history of CPR, the incidence of recipients' DGF were 55.6%,73.3%,62.5%,77.8% respectively with a significant difference. Recipients would have more chance to be infected if donors have the following characteristics: male, older than 50 years, died of cerebral hemorrhage which was caused by cardiovascular diseases, WIT>30 min, treated in ICU for more than 10 days or infection. Conclusions Nowadays, DCD has become the main graft source in Chinese kidney transplantation. This research indicates that the donors' factors may affect the recovery of graft function and the incidence of infection after kidney transplantation to some extent.By evaluating rigorously and preserving quality of renal grafts carefully, DCD would become more safe and valid.
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<p><b>OBJECTIVE</b>To study the technique and clinical outcomes of laparoscopic radical prostatectomy for high risk prostate cancer.</p><p><b>METHODS</b>A total of 65 patients with high risk prostate cancer were treated with surgery in the First Affiliated Hospital of Nanjing Medical University from January 2011 to June 2013. The mean age was 67 years (range 45-75 years). The mean preoperative prostate specific antigen (PSA) level was 26.7 µg/L (range 11.2-65.5 µg/L). The transrectal biopsy revealed Gleason score of 3+3 in 4 patients, Gleason 3+4 in 27 patients, Gleason 4+3 in 11 patients, Gleason 4+4 in 21 patients and Gleason 4+5 in 2 patients. The bone metastasis was excluded by scintigraphy examination. The surgical procedures were performed through transperitoneal approach. Extended pelvic lymph nodes dissection was performed after the removal of the prostate. Adjuvant radiotherapy or hormonal therapy was administrated according to the pathological results. Serum PSA was detected every 1 to 2 month and urinary continence was evaluated every 3 month in the first year, and then serum PSA was detected every 2 to 3 month.</p><p><b>RESULTS</b>The mean operative time was (134±21) minutes and the median blood loss was (300±146) ml. Bladder neck reconstruction was performed in 15 cases. The drainage was removed on postoperative day 4 and the catheter was removed on day 7. Pathologic results demonstrated pT2 in 25 patients, pT3a in 28 patients, pT3b in 9 patients and pT4 in 3 patients. Positive surgical margin was presented in 15 patients. A median of 19 lymph nodes (range 11-24 nodes) were retrieved during lymphadenectomy and 11 patients had lymph nodes metastasis with a total of 19 positive nodes. Forty-three patients recovered continence after the removal of catheter. Eleven patients received adjuvant hormonal therapy and 19 patients received adjuvant radiation therapy. With the median of 20 months follow-up (range 12-30 months), 5 patients got biochemical recurrence.</p><p><b>CONCLUSIONS</b>Laparoscopic radical prostatectomy with extended lymph nodes dissection for high risk prostate cancer is safe and technical feasible. It provides accurate information on tumor stage and grade. It is an important component of multimodality for the treatment of high risk prostate cancer.</p>
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Aged , Humans , Male , Middle Aged , Biopsy , Laparoscopy , Lymph Node Excision , Lymph Nodes , Pathology , Lymphatic Metastasis , Neoplasm Grading , Postoperative Period , Prostate-Specific Antigen , Blood , Prostatectomy , Prostatic Neoplasms , Diagnosis , General SurgeryABSTRACT
<p><b>BACKGROUND</b>Over the past two decades, the clinical presentation of renal masses has evolved, where the rising incidence of small renal masses (SRMs) and concomitant minimal invasive treatments have led to noteworthy changes in paradigm of kidney cancer. This study was to perform a proportional meta-analysis of observational studies on perioperative complications and oncological outcomes of partial nephrectomy (PN) and radiofrequency ablation (RFA).</p><p><b>METHODS</b>The US National Library of Medicine's life science database (Medline) and the Web of Science were exhaustly searched before August 1, 2013. Clinical stage 1 SRMs that were treated with PN or RFA were included, and perioperative complications and oncological outcomes of a total of 9 565 patients were analyzed.</p><p><b>RESULTS</b>Patients who underwent RFA were significantly older (P < 0.001). In the subanalysis of stage T1 tumors, the major complication rate of PN was greater than that of RFA (laparoscopic partial nephrectomy (LPN)/robotic partial nephrectomy (RPN): 7.2%, open partial nephrectomy (OPN): 7.9%, RFA: 3.1%, both P < 0.001). Minor complications occurred more frequently after RFA (RFA: 13.8%, LPN/RPN: 7.5%, OPN: 9.5%, both P < 0.001). By multivariate analysis, the relative risks for minor complications of RFA, compared with LPN and OPN, were 1.7-fold and 1.5-fold greater (both P < 0.01), respectively. Patients treated with RFA had a greater local progression rate than those treated by PN (RFA: 4.6%, LPN/RPN: 1.2%, OPN: 1.9%, both P < 0.001). By multivariate analysis, the local tumor progression for RFA versus LPN/RPN and OPN were 4.5-fold and 3.1-fold greater, respectively (both P < 0.001).</p><p><b>CONCLUSIONS</b>The current data illustrate that both PN and RFA are viable strategies for the treatment of SRMs. Compared with PN, RFA showed a greater risk of local tumor progression but a lower major complication rate, which is considered better for poor candidates. PN is with no doubt the golden treatment for SRMs, and LPN has been widely accepted as the first option for nephron-sparing surgery by experienced urologists. RFA may be the best option for select patients with significant comorbidity.</p>
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Humans , Catheter Ablation , Methods , Kidney Neoplasms , General Surgery , Therapeutics , Nephrectomy , MethodsABSTRACT
Objective To evaluate the technique and clinical outcomes of modified transperitoneal laparoscopic radical prostatectomy. Methods A total of 285 patients received the operation with mean age of 67 years (50-76 years) from January 2008 to April 2012.Mean level of PSA was 15.7 μg/L (1.8 -50.0 μg/L),and mean prostatic volume was 44 ml (26 -74 ml). No lymph node or seminal vesicle involvement was found by CT or MR and radionuclide bone scan revealed no metastasis.271 cases were confirmed diagnosis by prostatic biopsy and 14 were detected through pathological studies of TURP specimens.Gleason score ranged from 6 to 8.14 cases were in clinical stage T1b,29 cases in T1c,214 cases in T2 and 28 cases in T3a.Transperitoneal approach and modified technique involving bladder neck dissection,nervesparing technique and vesicoureteral anastomosis were applied on patients. Results Mean operative time was 105 min (55 -150 min).Mean intraoperative estimated blood loss was 240 ml (50-800 ml).Rectal injures occurred in 2 cases and were repaired under laparoscopy.Drainage tube and urinary catheter were removed 48 -72 h and 5 -8 d postoperatively.Postoperative hospital stay was 7 d (5 - 11 d).Positive surgical margin was present in 58 patients.Mean follow-up time was 29 months (3 -50 months).Complete continence were found in 208 patients immediately after catheter removal.68 patient recovered continence within 3 months and 9 patients remained incontinence 3 months after surgery. Normal erection presented in 42 of the 57 cases with nerve-sparing. Conclusions Transperitoneal laparoscopic radical prostatectomy is safe and efficient.Higher efficiency and lower complication rate have been achieved through modified laparoscopic technique involving bladder neck dissection,nerve-sparing technique and vesicoureteral anastomosis.
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Objective To report the modified liver mobilization technique in management of renal cell carcinoma with intrahepatic inferior vena cava thrombus. Methods 10 cases (7 men and 3 women at the average age of 49 years) of renal cell carcinoma with intrahepatic inferior vena cavs thrombus were reviewed.The operations were carried by using father clamp to control inferior vena cava,combined with hepatic portal blocking. Results There was no postoperative complication.The average blood loss was 800 ml.The mean hospital stay was 13 days.The time of follow-up ranged from 1 to 48 months. Conclusions The technique of using father clamp to control suprahepatic inferior vena cava combined with hepatic portal blocking is feasible for the treatment of the renal cell carcinoma with intrahepatic inferior vena cava thromhosis.
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Objective To evaluate the technique and efficacy of retroperitoneal laparoscopic partial nephrectomy. Methods From June 2002 to December 2009, 113 cases of renal tumor received retroperitoneal laparoscopic partial nephrectomy. The age ranged from 26 to 73 years. The tumor located in left side in 51 cases and right side in 62 cases with the mean diameter of 3.7 cm(1.2-6.3cm). During the procedure, the renal artery was separated and then clamped with bulldog. The renal parenchymal was incised with cold endoscissor and the tumor was totally removed. Pelvicalyceal repairing and parenchymal hemostasis were then performed. Renal defect closure was achieved with running suture or horizontal mattress suture. Results All the procedures were completed successfully.There was no open conversion. The mean operation time was 85 min(60- 125 min), the mean warm ischemic time was 24 min(19-43 min). The pathology studies revealed 87 cases of clear cell carcinoma, 9 cases of papillary renal cell carcinoma, 7 cases of chromophobe cell carcinoma, 6 cases of perivascular epithelioid renal cell tumor and 4 cases of renal oncocytoma. The surgical margin was negative in all cases. There was no complication of urine leakage. Gross hematuria occurred in 2 cases.During 3-41 months of following up, there was no recurrence. Conclusion Retroperitoneal laparo-scopic partial nephrectomy is safe and effective for the treatment of renal tumor, which becomes an alternative treatment to open procedure.
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Objective To observe the steps of vascular smooth muscle cells (VSMCs) calcification induced by high phosphate enviroment in vitro. Methods VSMCs were incubated with high phosphate (2.5 mmol/L or 3.5 mmool/L) medium for different times. Expression of core binding factor α1(Cbfα1), osteopontin(OP), collagen type Ⅰ(Col Ⅰ), osteocalcin(OC) and α-smooth muscle actin (α-SMA) was investigated by Western blot, immunofluorcscencc staining and real time PCR. Mineral deposition was assessed by von Kossa aad Alizarin red staining. Ultrastructure of VSMCs calcification was observed by electron microscopy (EM). Results Up-regulated expression of osteoblast-specific transcription factor Cbfα1 in the nuclei oceured at as early as 12 hours. The protein of Col Ⅰ and OP was up-regalated when VSMCs were incubated in high phosphate medium for 3 days, and content of OC increased at the time of 6 days. When cultured in 2.5 mmol/L phosphate medium for 15 days, VSMCs lost their lineage marker α-SMA, developed granular calcium deposits. Moreover, the results of real time PCR indicated mRNA level of OP and Col Ⅰ increased at day 1, OC increased at day 5 and α-SMA level decreased at day 10, respectively. Ultrastructural analysis also confirmed the presence of collagen and matrix vesicles in the cells. Conclusion VSMCs phenotype transformation induced by high phosphate enviroment is an orchestrated, highly regulated process.