Contrast-zero ultrasound-guided transcatheter aortic valve replacement: A case report / 中国胸心血管外科临床杂志

@#Conventional transcatheter aortic valve replacement is normally recommended with transthoracic echocardiography, and contrast agent mediated fluoroscopy under anesthesia to guide a better implantation of the transcatheter valve. However, iodine-containing contrast agent possibly damages the patient’s kidney, and even induces the acute kidney injury. We reported a 75-year-old patient diagnosed with severe aortic valve stenosis, moderate regurgitation, and chronic renal failure. We performed the aortic valve replacement under the guidance of fluoroscopy and transesophageal ultrasound without contrast agent. Seven days after surgery, the patient recovered well and discharged with alleviated aortic stenosis and fixed transcatheter aortic valve.

A novel technique of pure transperitoneal laparoscopic nephroureterectomy at a single position for native upper tract urothelial carcinoma in ipsilateral renal transplant recipients / 中华器官移植杂志

Objective:To explore the techniques and outcomes of pure laparoscopic native nephroureterectomy (LNUT) with ipsilateral allograft at a single position for upper tract urothelial carcinoma (UTUC) in renal transplant (RT) recipients.Methods:Clinical data were retrospectively reviewed for 12 renal transplant children undergoing native UTUC with ipsilateral allograft from January 2016 to December 2021.There were 4 boys and 8 girls.Complete LNUT was performed with bladder cuff resection at a single position via a transperitoneal approach.The interval between UTUC and RT was 12-146 months.There were 6 pelvic UCs and 6 ureter UCs.Results:All laparoscopic procedures were successfully completed without any serious perioperative complication.Postoperative pathological examination confirmed the diagnosis of urothelial carcinoma.And all surgical margins were negative.One patient experienced an elevation of creatinine after one cycle chemotherapy and normalized after withdrawing chemotherapy.The median follow-up period was (4-65) month.Two cases of contralateral native transitional cell carcinoma had radical nephroureterectomy two years later and another two cases underwent transurethral resection of bladder tumor one year later.One case died from tumor metastasis.The remainders had no tumor recurrence or metastasis during follow-ups.Conclusions:Complete single-position LNUT for UTUC with ipsilateral allograft is a safe and effective mini-invasive technique.Effectively avoiding the injury of allograft, it also offers the advantages of standard operation, minimal trauma, simple handling and enhanced recovery after surgery (ERAS).

Primary practice of transcatheter edge-to-edge repair for mitral regurgitation: Early results of MitraClip in multiple centers / 中国胸心血管外科临床杂志

@#Objective    To investigate the early clinical results of MitraClip system in domestic patients. Methods     We retrospectively analyzed the clinical data of 36 patients who underwent transcatheter edge-to-edge repair procedure using MitraClip system in Beijing Fuwai Hospital, Shenzhen Fuwai Hospital and Fuwai Yunnan Cardiovascular Hospital between January and June 2021. There were 24 males and 12 females, with a median age of 70 (47-86) years. Ten (27.8%) patients had 3+ mitral regurgitation (MR) and 26 (72.2%) patients had 4+ MR preoperatively. Results    All procedures were successfully performed. The reduction in MR was 2+ at least immediately after surgery, and 91.7% of patients had MR≤2+ at 3 days postoperatively. There was no statistical difference in left ventricular ejection fraction change postoperatively. Forward velocity and peak gradient of mitral valve were increased after the procedure. Mean gradient of mitral valve were increased at 3 days postoperatively than immediately after surgery (P<0.001). Two patients had acute pericardial effusion intraoperatively, and received pericardial puncture and drainage immediately. Conclusion    MitraClip system has been applied well in domestic patients and can significantly improve MR. This sutdy has a good consistency with foreign studies, and the early results are satisfactory.

Clinical characteristics of influenza A virus-induced pneumonia in renal transplantation recipients / 中华器官移植杂志

Objective:To explore the clinical characteristics, outcomes and influencing factors of influenza A virus-induced pneumonia in renal allograft recipients.Methods:During the 2015-2019 influenza season, 21 patients with influenza A virus-induced pneumonia after renal transplantation(RT)were prospectively recruited with 42 matched non-immunocompromised inpatients with influenza A virus-induced pneumonia.Clinical data, outcomes and follow-up observations after discharge were collected for analyzing the clinical characteristics of influenza A virus-induced pneumonia after RT.Continuous variables were compared by t-test or Mann-Whitney U test.And categorical variables were compared by Chi-Square test.Results:The median time after RT was 5(0.88, 10.50)years for RT recipients.In RT group, none received seasonal influenza vaccination with a vaccination rate of zero.The influenza vaccination rate of non-immunocompromised patients in current season was 42.86%(18/42)and inter-group difference was statistically significant( P<0.001). The levels of hemoglobin, aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase in RT recipients were(108.47±22.39)g/L, 21.00(16.00, 46.50)U/L, 15.00(12.00, 21.00)U/L and 314.00(207.25, 374.00)U/L.And the values were lower than those of non-immunocompromised patients[(130.24±21.74)g/L, 48.50(36.00, 79.50)U/L, 32.00(20.00, 52.25)U/L and 466.00(227.00, 781.75)U/L]. The differences were statistically significant( P=0.001, P<0.001, P<0.001, P=0.005). The levels of blood urea nitrogen and serum creatinine were 8.27(6.69, 12.48)mmol/L and 130.30(94.15, 204.70)mmol/L versus 5.42(3.37, 7.65)mmol/L and 65.90(48.98, 82.13)mmol/L in non-immunocompromised patients.The differences were statistically significant(all P< 0.001). No significant differences existed in the levels of C-reactive protein and procalcitonin between RT recipients and non-immunocompromised patients( P=0.774 and 0.821). The level of ESR and oxygenation index at admission were 39.00(13.00, 53.00)mm/h and(306.95±90.97)in renal recipients and 18.00(11.50, 23.00)mm/h and(200.17±116.35)in non-immunocompromised patients.The differences were statistically significant( P=0.045 and 0.001). Imaging studies indicated that multiple lobar involvement was a major imaging feature in both renal recipients and non-immunocompromised patients.The probability of pulmonary consolidation was 33.33%(7/21)in renal recipients and it was lower than that in non-immunocompromised patients.And the probability of pleural effusion was 42.86%(9/21)and it was higher than control.The inter-group differences were statistically significant( P=0.020 & 0.024). Rate of mechanical ventilation, CRRT and mortality were 42.86%(9/21), 23.81%(5/21)and 28.57%(6/21). All of them were higher than non-immunocompromised patients[21.43%(9/42), 9.52%(4/42)and 9.52%(4/42)]. However, there was no significant inter-group difference( P=0.076, 0.252 & 0.113). The median score of CURB-65 was 1(0.5, 1). Conclusions:Renal damage is prominent in hospitalized patients with influenza A virus-induced pneumonia after RT.There are a high rate of mechanical ventilation and CRRT during hospitalization and a high mortality.The prognosis remains poor for hospitalized patients with influenza A virus-induced pneumonia after RT.No matter how serious their conditions are at admission, they need to be closely monitored and aggressively treated.

Clinicopathological characteristics and prognosis of subsequent upper tract urothelial carcinoma in non-muscle invasive bladder cancer patients after renal transplantation / 中华泌尿外科杂志

Objective:We aim to investigate the clinical characteristics and prognosis of upper tract urothelial carcinoma (UTUC) in patients with non-muscle invasive bladder cancer (NMIBC) after renal transplantation.Methods:We retrospectively analyzed the clinical and follow-up information of 13 kidney recipients with NMIBC admitted to our hospital from January 2014 to June 2022 who subsequently underwent complete transperitoneal laparoscopic nephroureterectomy. There were 8 males and 5 females, aged (56.1±11.5), 3 cases with history of smoking and 10 cases without history of smoking, 4 cases with history of Aristolochic acids and 9 cases with no history of Aristolochic acids. Six and seven cases were treated with transurethral resection of bladder tumor for hematuria and bladder tumors detected by ultrasound or imaging respectively. Single and multiple bladder tumors were 9 and 4 cases; bladder tumor size ≤ 3 cm, >3 cm were 9 and 4 cases respectively; low-and high-grade bladder tumors were 3 and 10 cases separately, with; T a and T 1 of 3 and 10 cases respectively; recurrent bladder cancer and non-recurrent bladder cancer were 5 and 8 cases respectively. Follow-up after transurethral resection of bladder tumor showed that 6 cases with imaging evidence of UTUC for 6-52 months after transurethral resection of bladder tumor were treated with ipsilateral laparoscopic nephroureterectomy, including 2 cases of hydronephrosis, 1 case of renal pelvis mass, and 3 cases of ureteral mass, and 7 cases without imaging evidence of UTUC were performed with bilaterally prophylactic laparoscopic nephroureterectomy. The Kaplan-Meier curve and log-rank test were used for survival analysis to evaluate the prognostic effect of UTUC in kidney recipients with NMIBC. Results:Six of 13 patients named UTUC group were diagnosed with UTUC and 7 of 13 patients named no-UTUC group were not detected with UTUC. There was no statistical difference between these two groups in terms of clinical characteristics, including age( P=0.10), sex( P=0.10), smoking( P=0.19), history of Aristolochic acids( P=0.99), number( P=0.56), grade( P=0.19), stage ( P=0.19)and recurrence of bladder tumor number( P=0.10), and radiological findings of UTUC ( P=0.29). However, patients with larger-sized bladder tumors (larger than 3cm) had a higher rate of UTUC compared to patients with equal or smaller than 3 cm ( P=0.29). In addition, two patients with negative radiological findings developed UTUC following the detection of a large bladder tumor size (larger than 3 cm). The median survival of overall survival time and cancer specific survival time after laparoscopic nephroureterectomy were 42(17, 65) months. Two patients died from any cause during follow-up in patients with UTUC, whereas no significant difference between UTUC group and non-UTUC group in overall survival time and cancer specific survival time, as evaluated by the Kaplan-Meier curves and log-rank tests. ( P=0.29). Conclusions:After kidney transplantation, the diameter of the bladder tumor in NMIBC patients with UTUC was significantly larger than that in patients without UTUC, and no significant difference was observed in the remaining clinical features. Considering the non-functioning kidney after kidney transplantation, prophylactic laparoscopic nephroureterectomy can be considered for NMIBC patients with bladder tumor size >3 cm. Survival analysis showed no significant difference between UTUC group and non-UTUC group.

Efficacy and safety of laparoscopic nipple-inserted ureteral bladder reimplantation for the treatment of ureteral stricture in kidney recipients / 中华泌尿外科杂志

Objective:To evaluate the safety and efficacy of laparoscopic nipple-inserted ureteral bladder reimplantation in the treatment of ureteral stricture in kidney recipients.Methods:Two patients with ureteral stenosis after kidney transplantation who underwent laparoscopic nipple-inserted ureteral bladder reimplantation in our hospital in November 2020 and May 2021 were retrospectively analyzed. Case 1, Female, 54 years old, the patient found mild hydronephrosis in the transplanted kidney 2 years before the operation. Ultrasound showed aggravated hydronephrosis 1 week before the operation, and the width of the renal pelvis was 2.9 cm. Nephrostomy was performed before the operation, and antegrade radiography showed that the ureteral anastomosis was narrow, about 2 cm in length, and the grade of ureteral stenosis in the transplanted kidney was grade 3. Case 2, Male, 56 years old, the patient was previously diagnosed with transplanted kidney hydronephrosis, ureterolithiasis and ureteral stricture, and had undergone percutaneous nephrolithotripsy for transplanted kidney and balloon dilatation for ureteral stricture. However, the hydronephrosis and calculus of the transplanted kidney recurred. One month before the operation, due to sudden anuria, a nephrostomy was performed in our hospital. Ultrasound indicated that the transplanted renal pelvis was dilated, and the width of the renal pelvis was 3.1 cm. The grade of ureteral stricture of the transplanted kidney was grade 3. Both patients underwent transabdominal laparoscopy to dissociate and disconnect the ureter, and performed ureteral papillaplasty outside the abdominal cavity to complete ureteral reimplantation. Data on operation time, intraoperative blood loss, intraoperative and postoperative complications, and postoperative follow-up data were collected.Results:Both operations were successfully completed. The operation time was 145 and 180 minutes respectively. The intraoperative blood loss was 30 ml and 50 ml, respectively. The patient had no postoperative complications, and the renal function recovered compared with before. The double J tube was removed 12 weeks after the operation, and ultrasound showed that the width of the renal pelvis recovered to 0.8 cm and 1.1 cm respectively. The two patients were followed up for 18 and 12 months, respectively, and no recurrence of hydronephrosis was found.Conclusions:Laparoscopic nipple-inserted ureteral bladder reimplantation is a safe and effective method for the treatment of allograft ureteral stenosis, which has the advantages of minimally invasive, faster recovery, and fewer complications.

The effect and mechanism of short-chain fatty acid regulate tacrolimus-related hyperglycemia in mice / 中华泌尿外科杂志

Objective:To investigate the effect and mechanism of short-chain fatty acids (SCFAs) on the side-effect of tacrolimus on blood glucose.Methods:The C57BL/6 mice were treated with tacrolimus orally (10 mg/kg, tacrolimus group), tacrolimus plus 150 mmol/L sodium butyrate and isovalerate mixed solution (SCFAs group), broad-spectrum antibiotics (antibiotic group), and tacrolimus plus broad-spectrum antibiotics (tac&abx group). After 8 weeks intervention, the fasting blood glucose (FBG), oral glucose tolerance test (OGTT), hemoglobin A1C (HbA1c) were tested as indicators of glucose metabolism, and the gut microbiota, SCFAs concentration in the ileocecal, serum glucagon-like peptide-1 (GLP-1), fasting serum insulin, and GLP-1 expression in intestinal mucosa were performed for intestinal-glucose metabolism mechanism.Results:The FBG and HbA1c were significantly increased in tacrolimus group[(7.31±0.97)mmol/L, (8.34±1.12)%] than control group [(5.23±0.30)mmol/L, (4.32±0.80)%, all P<0.05], which remained normal in antibiotic group [(4.92±0.31)mmol/L, (5.61±0.98)%)], tac&abx group[(5.95±0.37)mmol/L, (4.56±0.26)%] and SCFAs groups [(5.87±0.68)mmol/L, (5.07±1.79)%]. The OGTT in the tacrolimus group showed glucose tolerance impairment, while other groups remained normal. The ileocecal butyric acid and isovaleric acid concentrations in the tacrolimus group were (722.3±262.2) μg/g and (10.0±5.1)μg/g, lower than the control group[ (1 321.3±165.5) μg/g, (19.7±3.6)μg/g, P<0.05]. The above acids in the SCFAs group remained normal as in the control group [(1 375.7±451.6) μg/g, (24.5±11.5)μg/g)]. The fasting serum insulin in the tacrolimus group decreased significantly to (3.2 ± 0.6)mIU/L, compared with control[ (4.4±0.9) mIU/L]and SCFAs groups [(7.0±1.1) mIU/L]. The GLP-1 test indicated a significant decrease in the tacrolimus group[ (4.7±2.9)pg/ml, P<0.05] compared with the SCFAs group and control group [(42.5±19.9) pg/ml, (33.1±9.1) pg/ml]. Conclusions:Tacrolimus affects glucose metabolism through the SCFAs-associated GLP-1 pathway in the intestine, and oral supplementation with mixed SCFAs provides a new insight for the prevention and treatment of tacrolimus-induced hyperglycemia in transplant recipients.

Research progress on desensitization therapy for highly sensitized kidney transplant recipients / 器官移植

Human leukocyte antigen (HLA) sensitization has been previously considered as a contraindication for kidney transplantation. In the past 30 years, with the development of desensitization therapy strategies and immunosuppressants, more and more highly sensitized patients have been eligible for kidney transplantation. However, highly sensitized patients still face a high incidence of hyperacute rejection and antibody-mediated rejection following kidney transplantation, which restricts the success of kidney transplantation and long-term graft survival. At present, exploring effective desensitization regimen is a hot spot in the research of organ transplantation. In this article, the current desensitization therapy strategies, new preparations for desensitization therapy, and the benefits and risks of desensitization therapy were reviewed, and the current status and future direction of desensitization therapies were investigated, aiming to provide reference for resolving the immune barrier, improving the success rate of kidney transplantation and enhancing the quality of life of highly sensitized recipients.

Outcomes after Surgical Repair of Thoracoabdominal Aortic Aneurysm with Distal Aortic Dissection:DeBakey Type Ⅰ versus Type Ⅲ / 中国医学科学院学报

To evaluate the early and mid-term results after surgical repair of thoracoabdominal aortic aneurysm(TAAA)in patients with DeBakey typeⅠor Ⅲ aortic dissection. The clinical data of 130 patients who underwent TAAA repair for chronic DeBakey typeⅠ(groupⅠ, =47)or type Ⅲ(group Ⅲ, =83)aortic dissections in our center between January 2009 and December 2017 were retrospectively analyzed.Early postoperative results,midterm survival,and re-interventions were compared between these two groups. The 30-day mortality rate was 6.9%(=9)in the overall cohort,with no statistic difference between groupⅠand group Ⅲ(10.6% 4.8%;=0.803, =0.370).The incidence of major adverse events(38.3% 51.8%;=2.199, =0.138),5-year actuarial survival rate [(81.7±5.9)% (87.2±4.2)%;=0.483, =0.487],and 5-year actuarial freedom from all reinterventions [(84.5±6.7)% (85.5±4.8)%;=0.010, =0.920] showed no significant differences between these two groups. The early and mid-term outcomes after surgical repair of TAAA are similar for DeBakey typeⅠ and type Ⅲ patients.However,studies with larger sample sizes are still required.

Preliminary results of multicenter studies on ABO-incompatible kidney transplantation / 中华器官移植杂志

Objective:To summarize the patient profiles and therapeutic efficacies of ABO-incompatible living-related kidney transplantations at 19 domestic transplant centers and provide rationales for clinical application of ABOi-KT.Methods:Clinical cases of ABO-incompatible/compatible kidney transplantation (ABOi-KT/ABOc-KT) from December 2006 to December 2009 were collected. Then, statistical analyses were conducted from the aspects of tissue matching, perioperative managements, complications and survival rates of renal allograft or recipients.Results:Clinical data of 342 ABOi-KT and 779 ABOc-KT indicated that (1) no inter-group differences existed in age, body mass index (BMI), donor-recipient relationship or waiting time of pre-operative dialysis; (2) ABO blood type: blood type O recipients had the longest waiting list and transplantations from blood type A to blood type O accounted for the largest proportion; (3) HLA matching: no statistical significance existed in mismatch rate or positive rate of PRA I/II between two types of surgery; (4) CD20 should be properly used on the basis of different phrases; (5) hemorrhage was a common complication during an early postoperative period and microthrombosis appeared later; (6) no difference existed in postoperative incidence of complications or survival rate of renal allograft and recipients at 1/3/5/10 years between ABOi-KT and ABOc-KT. The acute rejection rate and serum creatinine levels of ABOi-KT recipients were comparable to those of ABOc-KT recipients within 1 year.Conclusions:ABOi-KT is both safe and effective so that it may be applied at all transplant centers as needed.

One-stop hybrid technique to treat coronary atherosclerotic disease concomitant with penetrating atherosclerotic ulcers in 23 patients / 中华胸心血管外科杂志

Objective Retrospectively reviewed the early outcomes of one-stop hybrid technique to treat coronary atherosclerotic disease concomitant with penetrating atherosclerotic ulcers (PAU).Methods This study enrolled in 23 cases (male 21,female 2) of coronary atherosclerotic disease concomitant with penetrating atherosclerotic ulcers from Jan 2016 to Dec 2017 in our institute,with the mean age(67.5 ±7.5) years (51-79 years).Coronary artery bypass graft (CABG) surgery was performed by cardiopulmonary bypass (CPB),the procedure to treat aortic arch lesion included isolated CABG + thoracic endovascular stent graft in 2 patients,CABG + brachiocephalic arteries debranching + thoracic endovascular stent graft in 18 patients,CABG + hybrid total aortic arch replacement + thoracic endovascular stent graft in 3 patients.Results Mean CPB time was(94.3 ±25.7) min(55-145 min),mean aortic cross-clamp time was (61.4 ± 19.3) min(26-97 min),intraoperative blood loss was (654.8 ± 78.7) ml (510-900 ml),20 patients (87.0％) needed blood transfusion therapy . Median mechanical ventilation time was 18 hours(9-249 hours),with 1 patient (4.3 ％)exceeded 48 hours.Median intensive care unit stay time was 2.8 days(1-23 days),with 6 patients(26.1％) exceeded 4 days.There was no in-hospital mortality.The postoperative complications included:paresis in 2 patients (8.7％),re-exploration for bleeding in 1 patient (4.3％),pleural effusion in 1 patient (4.3％),pneumothorax in 1 patient (4.3％),paraplegia、pulmonary infection、acute renal insufficiency、respiratory failure、re-intubation in 1 patient (4.3 ％).Conclusion The one-stop hybrid technique for treating coronary atherosclerotic disease concomitant with PAU was effective and safe.The early clinical outcome was satisfactory.Mid and long-term result need further follow-up to study.

HIV-positive patient receiving living related renal transplantation : a report of one case and literature review / 中华器官移植杂志

Objective To summarize the outcomes and clinical experiences of renal transplantation in human immunodeficiency virus (HIV)-positive patients .Methods The clinical data were retrospectively analyzed for one HIV-positive case of renal transplantation .Diagnosed as chronic renal insufficiency 1 year ago ,he received hemodialysis .After a positive screen for HIV ,he received highly active antiretroviral therapy (HAART) and HIV RNA turned negative 3 months later .CD4 + T cell count was 331 cell/μl at pre-operation and there was no HIV-rated opportunistic infection or cancer . Her mother donated her kidney . Basiliximab and steroid pulse therapy were used preoperatively and immunosuppressants were used after transplantation , including tacrolimus , corticosteroids and mycophenolate mofetil .Results The kidney was transplanted successfully and serum creatinine declined to a normal level at day 4 after transplantation .Because of an interaction between efaverenz and tacrolimus ,the blood concentration of tacrolimus was extremely low and the dose of tacrolimus had to be raised to 0 .2 mg/(kg·d) .Antiroviral therapy remained unchanged .No rejection and other complications were observed .And HIV RNA remained negative .Conclusions Renal transplantation is optimal for HIV-positive patients whose HIV status is completely under control .However ,drug interactions needs to be considered during perioperative and postoperative periods .

The value of diffusion tensor imaging in early diagnosis of chronic allograft nephropathy and monitoring graft fibrosis in rats / 中华放射学杂志

Objective To estimate the value of diffusion tensor imaging (DTI) in early diagnosis of chronic allograft nephropathy (CAN) and monitoring of graft fibrosis in rat models . Methods Thirty CAN rat models were established as experimental group by transplanting Fisher donor kidneys into Lewis recipients. Thirty Lewis rats that received Lewis kidneys served as control group. Serum creatinine (SCr) was monitored regularly every two weeks from 14 days after transplantation. Eight rats were randomly selected by random number table method and underwent DTI examination at 4, 12, 20 weeks after modeling. DTI scans were performed on the renal cortex and medulla to measure apparent diffusion coefficient (ADC) and fractional anisotropy (FA). From the remaining 22 rats in each group, 6 rats were randomly selected and underwent pathological analysis at 4, 12, 20 weeks after modeling. Histological changes in the kidney were evaluated by chronic allograft damage index (CADI) scores. The expression of alpha-smooth muscle actin (α-SMA) and Vimentin were quantitatively measured. The differences in creatinine, DTI parameters, CADI score, α-SMA, Vimentin expression level were analyzed by two independent samples t test in two groups, the differences among CADI score, α-SMA, Vimentin expression level of the experimental group were compared using ANOVA. The correlations among DTI parameters and CADI score, α-SMA and Vimentin expression level were analyzed using Pearson analysis. Results The creatinine in the experimental group increased continuously, and the creatinine in the control group showed no significant increase. The difference in creatinine between the two groups was statistically significant from 8th week after operation (P＜0.01). There was no obvious difference in the size and signal intensity of transplanted kidneys in control group at different time points. Compared with the control group, the graft kidney in the experimental group at the 4 weeks demonstrated increased signal intensity with mild increased volume of kidney, and the boundaries between cortex and medulla were not clear. The cortex and medulla showed gradually increased signal intensity, heterogeneous signal distribution and marginal haziness over time. The ADC and FA value of renal cortex and medulla in experimental group were significantly lower than those in control group at 4, 12, 20 weeks (P＜0.05). The ADC and FA values of the cortex and medulla gradually decreased in the experimental group over time, while the values of the parameters in the control group did not show a significant decrease. The ADC and FA values of the cortex and medulla were negatively correlated with the scores of CADI, and the expression level of α-SMA, Vimentin in the experimental group(r=－0.50 to －0.85, P＜0.01).Conclusion DTI can be an effective technique for early diagnosis of CAN and monitoring of graft fibrosis process.

Clinical characteristics and pathogens of recurrent urinary tract infection after renal transplantation / 中华器官移植杂志

Objective To investigate the clinical characteristics and the pathogens of recurrent urinary tract infection (RUTI) after renal transplantation.Methods The data of adult recipients with UTI from November 2011 to December 2016 were retrospectively analyzed.The recipients were divided into single UTI (SUTI) group and RUTI group.The clinical characteristics and pathogens were analyzed,and the independent risk factors of RUTI were analyzed using logistic regressionmodel.Results Fifty-three cases were selected,including 29 cases of SUTI and 24 cases of RUTI.The positive rate of blood culture (55％ vs.25％,P =0.042) and the concentration of FK506 in the peri-infection period (11.0 + 3.4 ng/mL vs.8.6 + 3.2 ng/mL,P =0.024) in the RUTI group were significantly higher than that those in the SUTI group at the first UTI.The increased concentration of FK506 in the peri-infection period at the first UTI was an independent risk factor for RUTI (β:0.282,95％ CI:1.026-1.713,P＜0.05).There were 86 infection events in 53 patients,and pathogenic microorganisms were cultured in blood culture and urine culture for 86 times.The positive frequency of culture in the RUTI group was higher than that in the SUTI group,but not significantly.The most common pathogenic microorganisms included Escherichia coli (17 times),pseudomonas aeruginosa (16 times),and Enterococcus (16 times).Conclusion Reduction of the FK506 concentration during the peri-infection period at the first UTI is the key to prevent RUTI after renal transplantation.The empirical antibiotics for RUTI should be sensitive for Escherichia coli (ESBL +)and pseudomonas aeruginosa.

Effect of processing time on the content of five active ingredients in vinegar frankincense / 中国基层医药

Objective To study the effect of processing time on the content of five active ingredients in vine-gar frankincense.Methods Acetic acid,3－acetyl－β－lactic acid,3－acetyl－α－lactic acid,11－carbonyl－β－lactic acid 5 kinds of active ingredients in vinegar frankincense were determined.Results The results showed that four kinds of lactic acid (α－boswellic acid,β－boswellic acid,3－acetyl－β－lactic acid and 3－acetyl－α－lactic acid)showed an increasing trend (from 16.88mg/g to 23.05mg/g,40.35mg/g to 61.05mg/g,11.02mg/g to 18.17mg/g,19.78mg/g to 25.08mg/g),11－carbonyl－β－lactic acid showed a decreasing trend (6.98mg/g to 5.86mg/g),with the increasing of processing time (5,10,15,20 and 30min).Conclusion 30 min was the best time to prepare the balsamic vinegar frankincense.

The role and mechanism of SDF-1/CXCR4 signaling pathway in rat model of chronic renal allograft rejection / 中华器官移植杂志

Objective To investigate the role and mechanism of SDF-1/CXCR4 in the development of chronic rejection (CR) in rat models.Methods CR rat models were established using Fisher 344 to Lewis rats.In the blank control group (n=10),Lewis rats getting isotransplantation were treated with Cyclosporine A.CR rat models were established in positive group (n=10) and the rats were treated with Cyclosporine A.CR rat models were also established in CXCR4 antagonism group (n=10) and the rats were treated with both Cyclosporine A and AMD3100 (1 mg/kg).The serum creatinine levels were monitored every week.Kidney grafts were harvested 12 weeks after transplantation for histological analysis.We evaluated graft injuries using chronic allograft damage index (CADI) scores.Q-PCR and Western blotting were used to measure CXCR4,TGF-β1/Smad3 signaling pathway and α-smooth muscle actin (α-SMA) expression in renal allograft tissues.Results The serum creatinine levels in blank control group and CXCR4 antagonism group were significantly lower than those in positive control group (P<0.05).The blank control group and CXCR4 antagonism group presented milder pathological manifestations of CR.The CADI score in CXCR4 antagonism group was 3.54,which was lower than that of positive control group (P<0.05).The expression of biological markers in TGF-β1/Smad3 signaling pathway and SDF-1/CXCR4 signaling pathway was significantly lower in blank control group and CXCR4 antagonism group than in positive control group (P<0.05).Conclusion SDF-1/CXCR4 signaling pathway may play a crucial role in the development of CR.The usage of SDF-1/CXCR4 antagonist can protect renal allograft by inhibiting the TGF-β1/Smad3 pathway.Therefore,antagonism of CXCR4 may provide a novel way to prevent the development of CR.

Pathology features of incidentally discovered prostatic cancer from radical cystectomy and its effects on the patients prognosis / 中华泌尿外科杂志

Objective To assess the incidence,clinic feature,pathological characteristics and prognosis of incidental prostate cancer from specimens via radical cystoprostatectomy (RCP) for muscleinvasive bladder cancer.The postoperative erectile function in patients with NVB operation are also to be evaluated.Methods Between Jan 2002 and Jan 2015,150 male patients with bladder cancer who underwent radical cystoprostatectomy in our center were included in this study.133 patients underwent open surgery and 17 cases underwent laparoscopic operation (13 patients underwent NVB operation).The average age of 150 patients was 63 years (ranging 41 to 83 years).The average tPSA was 3 ng/ml(ranging 0.2 to 7.8 ng/ml).The digital rectal examination was negative,CT results didnt exhibit the evident of abnormality in prostate.Results Overall,incidental prostate cancer was diagnosed in 11 male patients (7.3％).The pathological diagnosis are all prostatic adenocarcinoma.In those patients,the mean age was 65.5 years (ranging 42 to 82 years).The mean tPSA at the time of surgery was 2.6 ng/ml (0.3-4.0 ng/ml).There was no statistical significance of tPSA values in the incidental prostate cancer group and non risk group (2.6vs.3.2ng/ml)(P ＞ 0.05).The preoperative enhanced CT imaging showed normal prostate in 7 cases,prostate hyperplasia in 2 cases,prostate calcification in 1 cases and bladder cancer invasion into the prostate in 1 cases.9 cases of incidental prostate cancer are low risk grade (Gleason score ≤ 6,the clinical stage ≤T2).Among 11 cases,bladder cancer histologic type in 10 cases was transitional cell carcinoma and small cell carcinoma in 1 case.According to the TNM classification,4 cases were less than pT2 stage and 7 cases were more than pT3 stage.11 patients were followed up between 6 to 24 months (mean 10 months).All patient survived at the end of study without the treatment of castration.Among 13 cases accepted NVB operation,8 cases achieve the preoperative level of erectile function to achieve.Conclusions The rate of incidental prostate cancer from RCP specimens is low,Most patients have low risk level,and there was no statistical significance of tPSA values between the incidental prostate cancer group and non risk group.

Classification of ureteral stenosis after renal transplantation and evaluation of treatment in 9 cases / 中华器官移植杂志

Objective To evaluate the clinical feasibility of grading of ureteral stricture in renal allograft.Methods The clinical data of 9 case of ureteral stricture after renal transplantion from February 2015 to September 2015 were retrospectively analyzed and relative articles were reviewed to evaluate the significance of ureteral stricture grading.The diagnosis of ureteral stenosis was made by serum creatinine elevation,ultrasound of allograft kidneys and presence of stricture on a pyelogram.Grade 1 ureteral stenosis was defined as graft function deterioration with presence of hydronephrosis on ultrasound,but no obvious stricture identified on a pyelogranm.Grade 2 was defined as serum creatinine elevation,presence of hydronephrosis on ultrasound,and a focal (＜1 cm) distal ureteral stricture at the ureteral anastomotic site on a pyelogram.Grade 3 was defined as serum creatinine elevation,hydronephrosis on ultrasound,and a long segment (＞1 cm) distal ureteral stricture extending to proximal ureter or pelvis on pyelogram.Results One case,6 cases and 2 cases were classified to grade 1,2 (stricture length ＜1 cm) and 3 (＞1 cm),respectively.One case of grade 1,6 cases of grade 2 and 1 case of grade 3 were successfully dilated by balloon dilation catheter and endoureterotomy.One case of grade 3 was converted to open reconstructive surgery.Surgery success rate of grade 1 and 2 was 100％ (7/7) and 100％ (6/6) 6 and 9 months after surgery,respectively.Ureteral stenosis did not recur in one case of grade 1 and 6 cases of grade 2 during a follow-up period of 12 months after surgery.However,one case of grade 3 reoccurred 6 months after surgery,and reoperation was performed and there was no recurrence up to now (10 months).Conclusion Wuzhi tablet acted as an effective agent that makes rifampicin containing anti-tuberculosis chemotherapy possible and safe by stabilizing blood concentration of tacrolimus in post-renal transplant tuberculosis patients,which also reduced the dosage of tacrolimus as well as the risk of acute rejection greatly.

Dendritic cell costimulatory molecule expression and immunosuppressant intervention / 中国组织工程研究

BACKGROUND:Previous studies on immunosuppression and anti-rejection after organ transplantation mainly focused on effects of T lymphocytes-mediated immune response and immunosuppressive agents on T lymphocytes. Effects of dendritic cel s were unclear. The manifestation and mechanism of immunosuppressive agent effects on dendritic cel s are not identical. OBJECTIVE:To compare the effects of different immunosuppressive agents on expression and function of costimulatory molecules of dendritic cel s, and to explore the mechanism of action of immunosuppressive agents. METHODS:20μg/L rapamycin, 0.04 mg/L mycophenolate, 10μg/L tacrolimus and 1 mg/L cyclosporine A were separately added during bone marrow cel s of C57BL/6 mice were differentiated into dendritic cel s. RESULTS AND CONCLUSION:Flow cytometry results revealed that CD40 expression in each group:rapamycin0.05). One-way mixed lymphocyte reaction results displayed dendritic cel costimulatory T cel proliferation in each group:rapamycin

The treatment and prognosis of silent pulmonary embolism after off-pump coronary artery bypass graft surgery / 中华胸心血管外科杂志

Objective The purpose of this study was to assess the incidence,treatment and prognosis of silent pulmonary embolism (PE) after off-pump coronary artery bypass graft (CABG).Methods From December 2009 to September 2012,582 consecutive patients underwent off-pump CABG by a same surgeon.Their age ranged from 16 to 86 years with a mean age of (61.4 ± 9.3) years.Left internal mammary artery and saphenous vein were harvested routinely.A dose of 20 mg unfractionated heparin was given intravenously every 6 hours on the operative day after postoperative pleural fluid less than 50 ml per hour.All patients received aspirin 100 mg daily starting on postoperative day 1.The 64-slice coronary MDCT was performed to assess the graft patency on postoperative day 5 ～ 7.Results There were no in-hospital death.PE,which involved the lobar or more proximal arteries,was detected on the CT images of 10 patients (1.7％).In these 10 patients,there were no significant dyspnea or hypoxemia postoperatively ; echocardiography and ECG showed no specific signs of PE ; all bypass grafts were patent in CT images except a LIMA to LAD graft with LAD endarterectomy.PE involved both lungs in 6 patients,and only the right lung in 4 patients.All patients received anticoagulation with warfarin for 3 to 6 months except one.All patients were with good quality of life during 6 to 18 months of follow-up.Three to six months after discharge,8 patients received repeated MDCT,which showed diminish of PE.Conclusion Acute PE after off-pump CABG was an uncommon complication and was difficult to diagnose.MDCT played an important role in examining the patency of graft vessels and helped detect silent PE in CABG patients.The prognosis of acute PE after off-pump CABG was acceptable.PE diminished after 3 months of anticoagulation with warfarin.