RESUMEN
Objective:To explore the efficacy of different unipolar electrocoagulation power on pathological injury of porcine kidney suffering suture-free partial nephrectomy (SFPN).Methods:From April 2018 to July 2018, nine Guizhou pigs were selected, with an average age of 3 years and an average weight of 48 kg. According to different hemostatic power of unipolar electrocoagulation during open partial nephrectomy, they were divided into three groups(60W group, 80W group, and 100W group), with 3 in each group. The left kidney was exposed with a surgical incision, parallel to the lumbosacral muscle.The left renal artery was clamped and about 2 cm renal tissue was excised at the middle pole of the left kidney. 60W, 80W and 100W were used by unipolar electrocoagulation for hemostasis until no bleeding occurred after the artery clamp was released. The total ischemia time was controlled within 20 min. Temperature was measured by a multi-channel thermometer probe which was inserted into the healthy kidney tissue at a distance of 2 mm, 5 mm, and 10 mm away from the unipolar electrocoagulation hook, and the upper pole of the kidney far away from the operation area. The time of operation, the volume of renal bleeding, the time of hemostasis and the temperature were recorded. On the 7th day after operation, the left kidneys were taken and the pathological changes were observed by toluidine blue staining.Results:All operations were completed safely and successfully. The operation time in 60W group, 80W group, and 100W group was (41.2±5.5)min, (35.1±3.7)min, (31.3±2.2)min , respectively. There was no significant difference of operation time among those group ( P>0.05). The blood loss of renal was (35.3±4.1)ml, (21.4±4.7)ml, (15.3±4.1)ml, respectively. The blood loss in the 100W group and 80W group was less than that in the 60W group ( P<0.05). And the blood loss in the 100W group was less than that in the 80W group ( P<0.05). The hemostasis time was (15.2±1.9)min, (10.1±1.4)min, (6.4±0.8)min. The hemostasis time in the 100W and 80W groups was less than that in the 60W group ( P<0.05). And the hemostasis time in the 100W group was less than that in the 80W group ( P<0.05). At the place of 10 mm away from the electrocoagulation hook, the temperature in the three groups were (33.1±1.1)℃, (34.0±1.0)℃, (34.3±0.6)℃, which was not significantly different from that of the respective upper poles. And there was no significant difference between the three groups( P>0.05). At the place of 5 mm and 2 mm away from the electrocoagulation hook, the temperature in the 100W group (41.7±1.3)℃, (61.4±6.4)℃ and the 80W group (38.6±2.4)℃, (50.3±6.0)℃ was higher than that in the 60W group (36.9±4.1)℃, (42.0±4.7)℃, and the temperature in 100W group is higher than that in 80W group ( P<0.05). When the power was 60W, 80W or 100W, the temperature in the place 10 mm away from the electrocoagulation hook was less than that in the place 5 mm away from the electrocoagulation hook ( P<0.05), and the temperature of the place 5 mm away from the electrocoagulation hook was lower than that of the place 2 mm away from the electrocoagulation hook ( P<0.05). The total pathological injury depth of wounds in 60W, 80W, 100W group was (7 323±50)μm, (8 119±100)μm, (8 896±40)μm, respectively. The depth in 100W group and 80W group was deeper than that in 60W group ( P<0.05), and the depth in 100W group was deeper than that in 80W group ( P<0.05). Conclusions:In SFPN, the hemostatic effect of three different monopolar electrocoagulation output power is satisfactory. With the increase of power, the hemostasis speed is faster. However, the temperature of surrounding healthy renal tissue would be higher, and the total pathological injury depth would be deeper.
RESUMEN
Objective To evaluate the effect of selective segmental renal artery clamping ( SSRAC) on the solitary-kidney, providing a foundamental basis for the using of SSRAC in partial nephrectomy. Methods A total of 18 pigs were randomized equally into 2 groups according to the method of renal artery clamping such as main renal artery clamping ( MRAC) group or SSRAC group.Each case underwent right radical nephrectomy and either MRAC or SSRAC for 60 minutes on the left kidney.Serum creatinine ( SCr) and blood urea nitrogen (BUN) were measured before surgery and at 6 time points thereafter (the 1st, 7th, 14th, 21st, 28th, 90th day).Magnetic resonance imaging was performed before surgery and at 4 time points thereafter (the 1st, 7th, 28th, 90th day) and T2 relaxation time and apparent diffusion coefficient (ADC) were determined.Inflammatory cell infiltration and interstitial fibrosis were detected using renal histology on the 1st and 90th day after operation.Results SCr and BUN of the two groups increased to peak value on the 1st day, and then decreased gradually to normal on the 90th day after the operation.On the 1st day, SCr [(266.43 ±31.12)umol/l] and BUN [(13.63 ±2.54)mmol/l)] of SSRAC group were significantly lower than that of MRAC [(386.37 ±40.40)umol/l,(26.83 ±5.96)mmol/l] (P0.05) on the 7th, 14th, 21st, 28th, 90th day.In the MRAC group, the T2 relaxation time of upper, middle and lower pole of the left kidney increased and the ADC decreased on the 1st day after operation.It arrived to the peak value on the 7th day, and decreased or increased respectively from then on to normal level on the 90th day.In the SSRAC group, there were no significant changes of T2 relaxation time and ADC in the upper and middle pole of left kidney (P>0.05), but it was similar to that in the MRAC group for lower pole.On the 1st, 7th, 28th day after operation, the T2 relaxation time of upper and middle pole of the left kidney in the MRAC group [(45.50 ±1.87),(51.82 ±2.27), and(40.37 ±1.93)ms ) ] were significantly higher than those in the SSRAC group [(36.67 ± 1.33),(35.15 ±1.27), and(37.48 ±1.37)ms](P0.05).On the 1st, 7th, 28th day after operation, the ADC of upper and middle pole of the left kidney in the MRAC group [(2.29 ±0.08) ×10 -3 mm2/s, (2.10 ±0.08) ×10 -3 mm2/s, (2.41 ±0.09) ×10 -3 mm2/s] were significantly lower than that of the SSRAC group [(2.69 ± 0.08) ×10 -3 mm2/s, ( 2.63 ±0.06 ) ×10 -3 mm2/s, ( 2.68 ±0.05 ) ×10 -3 mm2/s ] ( P <0.05 ) . However, on the 1st,7th, 28th, 90th day after operation, the ADC of lower pole of the left kidney in the SSRAC group [(1.93 ±0.08) ×10 -3mm2/s,(1.91 ±0.09) ×10-3mm2/s,(2.33 ±0.07) ×10 -3mm2/s, and (2.43 ±0.07) ×10 -3 mm2/s] were significantly lower than those of the MRAC group [ (2.37 ±0.05) ×10 -3 mm2/s, (2.06 ±0.07) ×10 -3 mm2/s, (2.46 ±0.09) ×10 -3 mm2/s, (2.61 ±0.08) ×10 -3 mm2/s](P<0.05).The whole left kidney in MRAC group experienced extensive tubular hydropic degeneration and limited inflammatory cell infiltration on the 1st day after operation.Moreover, renal tubular hydropic degeneration alleviated and no glomerular changes, fibrous tissue hyperplasia or inflammatory cell infiltration was found on the 90th day after operation.In SSRAC group, no changes were found in upper and middle pole of left kidney at the two time points, while the pathological injury of the lower pole of left kidney was more severe.Conclusions SSRAC has obvious protective effect on renal function in the early stage. However, compared with MRAC, the renal tissue injury in the ischemic area was more serious.Therefore, to protect renal function in partial nephrectomy, the ischemic renal area should be reduced as much as possible, even to zero-ischemic, when adopting SSRAC.
RESUMEN
Objective To evaluated the clinical value of laparoscopic techniques in radical cystectomy surgery for the treatment of bladder cancer. Methods Clinical data of 49 patients underwent radical cystectomy with Bricker ileal conduit diversion were retrospectively analyzed from October 2009 to August 2014, which laparoscopic radical cystectomy with Bricker ileal conduit 20 cases (Group A), open radical cystectomy with Bricker ileal conduit 29 cas-es (Group B). The blood loss during operation, operating time, gastrointestinal function recovery after operation, hos-pital stay after operation and complications were observed between the two groups. Results The blood loss during operation was significantly lower in Group A (416.66 ± 232.73) ml than in Group B (964.16 ± 445.73) ml ( <0.05), and hospital stay after operation was significantly lower in Group A (14.93 ± 2.72) days than in Group B (19.50 ± 3.16) days ( < 0.05), complication after operation was significantly lower in Group A than in Group B ( < 0.05). The operating time and gastrointestinal function recovery has no significantly difference between the two groups. Conclusions Laparoscopic radical cystectomy have advantages of minimal invasion, less blood loss, rapid recovery and less postoperative complications. It is a safe and effective surgical method. Long term effect need evaluated by follow up.
RESUMEN
Objective To investigate the molecular mechanisms of glial cell derived neurotrophic factor in promoting proliferation of spermatogonial stem cell.Methods RNAi expression vectors,targeted at GDNF,were constructed and transfected into SSCs from 5 to 7 days old mice.The SSCs with highest effectiveness of GDNF interfere was set as study group.And the SSCs without GDNF interfere was considered as control group.The ELISA method was used to compare the proliferative rate between study group and control group.Flow cytometry,RT-PCR were used to detect the expression of GDNF,RTKs,Fyn and FAK's mRNA,and the apoptosis of SSCs.Results From 1 to 4 days after transinfection,the absorbable A value in study group was 0.45 ± 0.02,0.68 ± 0.03,1.12 ± 0.03,2.24 ± 0.04,respectively.Meanwhile,the same item in control group was 0.46 ± 0.03、0.73 ± 0.02、1.32 ± 0.05、1.15 ± 0.06,respectively (P ＜ 0.05).There were significant different between experiment groups (25.43 ± 1.91) ％ and control group (5.61 ± 0.16)％ in the apoptosis rates of SSCs (P ＜ 0.05).Significant differences were noted between experimental group and control group(P ＜ 0.05).The mRNA expression rates of GDNF was (12.32 ± 1.22) ％ in study group and (54.25 ± 1.34)％ in control group (P ＜0.01).The mRNA expression rates of RTKs and Fyn and FAK in study group and control group were (16.24 ± 1.35)％ vs (45.35 ± 1.37)％,(18.32 ±1.34)％ vs (38.37 ± 1.55)％,(20.04 ± 1.65)％ vs (43.27 ± 1.28)％,respectively (P ＜0.05).Conclusions The glial cell line derived neurotrophic factor was important in course of SSCs' proliferation,which may up-regulating the expression of RTKs,Fyn and FAK.
RESUMEN
Objective To explore the role and clinical significance of GSTM 3 ( glutathione S-trans-ferase mu 3) expression in prostate cancer (PCa). Methods We had used the two-dimensional fluores-cence difference gel electrophoresis ( 2D-DIGE) and mass spectral analysis to further verify the microarray data of mRNA expression profiling discovered .GSTM3 mRNA level was detected by Rael-time Quantitative PCR ( RT-QPCR) in 28 pairs of prostate cancer tissue and benign tissue .The relationship of GSTM 3 level with the serum PSA level and the clinical feature of PCa were analyzed . Results In 2D-DIGE study, we found that the expression of GSTM 3 protein in adjacent tissues was significantly higher than that in PCa tis-sues (P0.05) and prostate cancer clinical pathological parameters ( P>0.05). Conclusions GSTM3 expression is down-regulated in PCa tissues, and we may identify PCa by detecting the GSTM 3 expression .
RESUMEN
Objective To compare the safety and efficacy of the 2μm laser and the bipolar electrotome used in transurethral re-section of bladder tumor(TURBT)for treating non-muscle invasive bladder cancer(NMIBC).Methods The clinical data in the pa-tients with NMIBC treated by TURBT in our hospital from March 2009 to May 2013 were retrospectively analyzed.All patients were divided into the 2μum laser group(n=89)and the bipolar electrotome group(n=82).The operation time,complications,post-operative hospital stay and recurrence rate were compared between the two groups.Results There were no statistically significant differences in the operation time,postoperative hospital stay and recurrence rate between the two groups(P>0.05).Compared with the 2 μm laser group,the bipolar electrotome group showed significantly higher occurrence rate of the obturator nerve reflex (20.7%vs.0,P<0.05)and the bladder perforation(7.3% vs.0,P<0.05)and longer postoperative bladder irrigation time [(3.1±0.9)d vs.(2.2±1.0)d,P<0.05],the differences between the two groups had statistical significance.Conclusion Com-pared with bipolar electrotome,the 2μm laser used in TURBT is safe and effective with few complications for treating NMIBC.
RESUMEN
Objective To investigate the timing of super-selective renal artery embolization (SRAE) for the treatment of renal hemorrhage after percutaneous nephrolithotomy (PCNL) .Methods From June 2005 to February 2013 ,a total of 2 165 patients with upper urinary tract calculi underwent PCNL (2 384 PCNL procedures) and 16 of them suffered severe bleeding (0 .74% ) .In the 16 cases ,SRAE was used .The medical records of all the 16 cases were retrospectively analyzed .Results In 16 patients ,15 patients were successful with the first SRAE ,but 2 of them underwent an additional pure renal artery angiography (1 patient before SRAE and 1 patient after SRAE);1 healed after the second SRAE .The mean blood loss and transfusion volume were 32 .9 g/L and 250 mL before the first angiography/SRAE ,and an additional 3 .2 g/L and 0 mL before the second try .Although 1 patient died ,the oth-ers were recovered without complications .Conclusion SRAE should be adopted early for the treatment of severe renal hemorrhage after PCNL .However ,a second try should be considered for the repeated bleeding patients after the negative results of first renal artery angiography or SRAE .
RESUMEN
BACKGROUND:The selective immunosuppression on transplanted organ was realized by local drug delivery system,which is one of efficient ways to avoid many kinds of side reactions induced by systemic drug delivery.By using the characteristics that adrenal gland can secret glucocorticoid,the adrenal gland or adrenal implant as the way of local drug delivery of glucocorticoid for transplanted organ is hopeful to avoid the complications induced by systemic and amount of use of glucocoticoid.OBJECTIVE:To establish a model of adrenal gland self-implantation in greater omentum,and to observe the protection of the adrenal gland implant on transplanted liver.DESIGN,TIME AND SETTING:This randomized controlled animal experiment was performed in the Experimental Animal Center of Guizhou Provincial People's Hospital from May 2007 to October 2008.MATERIALS:Fifty male Sprague Dawley rats were assigned as donors,and fifty male inbred strain Wistar rats were assigned as recipients.METHODS:After feeding one week,the recipient rats were randomly divided into two groups with 25 rats in each group.In liver transplantation after adrenal gland self-implantation in greater omentum group,allogenic liver transplantation was performed after successful model establishment of adrenal gland self-implantation in greater omentum.In simple liver transplantation group,only allogenic liver transplantation was performed.No immunosuppressant was used after transplantation in both of the two groups.MAIN OUTCOME MEASURES:The survival time of rats was observed.The morphology of the transplanted livers and the adrenal implants was observed at different time points.The activities of serum aspartate aminotransferase(AST),as well as the concentration of serum corticosteroid and total bilirubin were detected at different time points.RESULTS:The recipient adrenal implants recovered their endocrinal function at 7 weeks after adrenal gland self-implantation in greater omentum.After liver transplantation,histological examination showed that the adrenal implants survived well.The median survival time of rats in the liver transplantation after adrenal gland self-implantation in greater omentum group was more than 30 days,which is obviously longer than that(12 days) in the simple liver transplantation group.There was no significant difference in concentration of serum corticosteroid between the two groups.At 7 days after transplantation,activities of serum AST and concentration of total bilirubin of rats in the simple liver transplantation group were significantly higher than those in the liver transplantation after adrenal gland self-implantation in greater omentum group(P ≤ 0.05).In the liver transplantation after adrenal gland self-implantation in greater omentum group,pathological changes of transplanted livers showed as grade 0 according to Williams standard.In the simple liver transplantation group,a mild rejection appeared at 3 days after transplantation,and the pathological changes turned to severe and reached grade 3 according to Williams standard at 7 days.CONCLUSION:Adrenal implant which survives and recovers its endocrinal function after self-implantation in greater omentum has protection on the transplanted liver in early stage.