Clinical studies of minimally invasive percutaneous nephrolithotomy in treatment of kidney stones / 中国现代医生

Objective To compare and analyze the effect of minimally invasive percutaneous nephrolithotomy compare with traditional open surgical in treatment of kidney stones outcome. Methods Selected 120 patients with kidney stones from January 2009 to January 2014 in our hospital, all patients had complete clinical data, included 60 cases of renal sinus traditional lines pelvis lithotomy, established as the control group, and the remaining 60 routine minimally inva-sive percutaneous nephrolithotomy surgery, set up minimally invasive group, the operative time, blood loss, postoperative fistula time and hospital stay and complications were compared between two groups. Results 60 patients with invasive group homogeneity of puncture success and smooth gravel, stone successful in 58 cases, the success rate was 96.7%(58/60). Intraoperative complications pneumothorax, colon injury does not appear, one-time stone clearance rate was 80.0%(48/60). Stable vital signs after surgery, no nephrectomy, severe complications wound fistula, pneumothorax oc-curred. 4 cases of postoperative urinary tract infection sustained high fever, anti-infection cure. 1 case duodenal injury control group intraoperative peritoneal injury in 2 cases, 2 cases of postoperative fever, intestinal fistula, urinary tract infection in 8 cases. Operative time, blood loss, postoperative fistula compare the time and duration of hospitalization, of observation group improved significant than the control group, the difference was statistically significant (P<0.05 or P<0.01). Conclusion Minimally invasive percutaneous nephrolithotomy in the treatment of kidney stones with less trau-ma, less bleeding, fewer complications, shorter hospital stays and can be worthy of promotion and application.

Efficacy comparison of combined intracoronary administration of high-dose adenosine and tirofiban versus intracoronary tirofiban during primary percutaneous coronary intervention in patients with acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the efficacy of intracoronary administration of combined high-dose adenosine and tirofiban versus intracoronary tirofiban during primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction.</p><p><b>METHODS</b>Consecutive 258 patients with acute ST-segment elevation myocardial infarction (STEMI) underwent primary PCI, treated with thrombus aspiration and then intracoronary tirofiban, were randomly divided into adenosine group (n = 130) and control group (n = 128). Adenosine group received 2 times intracoronary adenosine (2 mg) after thrombus aspiration and after stenting of the infarct-related artery through the aspiration catheter. Control group received placebo. The primary end point was myocardial blush grade (MBG) after PCI. Secondary end points were thrombolysis in myocardial infarction (TIMI) flow grade and corrected TIMI frame count (CTFC) after PCI, ST-segment elevation resolution (STR), and major adverse cardiac events (MACE) at 30 days and 12 months.</p><p><b>RESULTS</b>TIMI flow grade post PCI did not differ between the 2 groups, while CTFC favored the adenosine-treated patients [(21.6 ± 6.5) frames] compared with the placebo-treated patients [(25.1 ± 7.8) frames, P = 0.001]. MBG 3 was more frequently observed in the adenosine compared to the control group [45.1% (55/122) vs.32.0% (39/122), P = 0.035]. Patients in the adenosine group had a trend of higher rate of compete STR after the procedure compared patients in the control group [53.6% (67/125) vs. 41.9% (52/124), P = 0.065]. The incidence of MACE was comparable between patients randomized to adenosine and placebo at 30 days [12.3% (16/130) vs. 17.2% (22/128), P = 0.295] and at 12 months [12.3% (16/130) vs. 18.0% (23/128), P = 0.227].</p><p><b>CONCLUSION</b>Intracoronary administration of high-dose adenosine combined with tirofiban provides further improvement on myocardial perfusion after primary PCI but does not affect the clinical outcomes in patients with STEMI.</p>

Association of chronic obstructive pulmonary disease with coronary artery disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The relationship between chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) remains largely unknown. This study aimed to explore the association of COPD with CAD, especially with multi-vessel disease (VD).</p><p><b>METHODS</b>The data of 354 patients who underwent multi-detector computed tomography (MDCT) for suspected CAD were analyzed. Luminal narrowing was defined as at least one lesion 50% or greater stenosis. The analysis of serum biochemistry profile and spirometry were performed on all eligible patients, and the diagnosis of COPD was defined as the criteria of Global Initiative for Chronic Obstructive Lung Disease.</p><p><b>RESULTS</b>Patients with CAD had a significantly higher complication of COPD than those without CAD (11.8% vs. 3.7%, P < 0.001). Comparing with patients without COPD, those with COPD were more likely to have multi-VD, proportion of smoking and high C-reactive protein (CRP) (P < 0.001). Multivariate Logistic regression analysis revealed that the multi-VD was significantly correlated with COPD (P=0.012) and CRP (P=0.015).</p><p><b>CONCLUSIONS</b>There was a high complication of COPD in patients with CAD, and COPD may be a critical risk factor for CAD, especially for multi-VD. CAD and COPD were closely associated and the interplay of systemic inflammation might in part explain the relationship between them.</p>

Relationship between 6-minute walk test and pulmonary function test in stable chronic obstructive pulmonary disease with different severities / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The relationship between the 6-minute walk test (6MWT) and pulmonary function test in stable chronic obstructive pulmonary disease (COPD) remains unclear. We evaluate the correlation of 6MWT and spirometric parameters in stable COPD with different severities. 6MWT data assessed included three variables: the 6-minute walk distance (6MWD), 6-minute walk work (6MWORK), and pulse oxygen desaturation rate (SPO(2)%).</p><p><b>METHODS</b>6MWT and pulmonary function test were assessed for 150 stable COPD patients with different severities. Means and standard deviations were calculated for the variables of interest. Analysis of variance was performed to compare means. Correlation coefficients were calculated for 6MWT data with the spirometric parameters and dyspnea Borg scale. Multiple stepwise regression analysis was used to screen pulmonary function-related predictors of 6MWT data.</p><p><b>RESULTS</b>The three variables of 6MWT all varied as the severities of the disease. The 6MWD and 6MWORK both correlated with some spirometric parameters (positive or negative correlation; the absolute value of r ranging from 0.34 to 0.67; P < 0.05) in severe and very severe patients, and the SPO2% correlated with the dyspnea Borg scale in four severities (r = -0.33, -0.34, -0.39, -0.53 respectively; P < 0.05). The 6MWD was correlated with the 6MWORK in four severities (r = 0.56, 0.57, 0.72, 0.81 respectively, P < 0.05), and neither of them correlated with the SPO(2)%. The percent of predicted forced expiratory volume in 1 second (FEV(1)% predicted) and residual volume to total lung capacity ratio (RV/TLC) were predictors of the 6MWD, and the maximum voluntary ventilation (MVV) was the predictor of the 6MWORK.</p><p><b>CONCLUSIONS</b>6MWT correlated with the spirometric parameters in severe and very severe COPD patients. 6MWT may be used to monitor changes of pulmonary function in these patients.</p>

Immature CD4⁺ dendritic cells conditioned with donor kidney antigen prolong renal allograft survival in rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Allogeneic transplant rejection is currently a major problem encountered during organ transplantation. The dendritic cell (DC) is the most effective powerful known professional antigen-presenting cell, and recent studies have found that DCs can also induce immune tolerance, and avoid or reduce the degree of transplant rejection. The aim of this study was to evaluate the effect of transfused immature CD4(+) DCs on renal allografts in the rat model.</p><p><b>METHODS</b>In this study, we induced CD4(+) immature DCs from rat bone marrow cells by a cytokine cocktail. The immature CD4(+) DCs were identified by morphological analysis and then the suppressive activity of these cells conditioned with donor kidney antigen was evaluated in vitro and in vivo.</p><p><b>RESULTS</b>Immature CD4(+) DCs conditioned with donor kidney antigen possessed immunosuppressive activity in vitro and they were able to prolong renal transplant survival in an allograft rat model in vivo.</p><p><b>CONCLUSIONS</b>Our study provides new information on efficacious renal transplantation, which might be useful for understanding the function of immature CD4(+) DCs in modulating renal transplant rejection and improving clinical outcome in future studies.</p>

Effect of pre-transplantation hemoglobin concentration on prognosis of renal transplant recipients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>For the renal transplant recipients, anemia is one of the common complications and becomes a major medical issue before transplantation. Haemoglobin (Hb) is used as a prognostic indicator, although the optimal pre-transplantation Hb concentration associated with positive prognosis is still controversial. The aim of this study was to detect the optimal Hb concentration on predicting the graft survival and function.</p><p><b>METHODS</b>A retrospective cohort study was conducted by reviewing the medical records of the patients who received renal transplantations at our center from January 2004 to June 2008. Patients were divided into two groups: high Hb group (≥ 100 g/L, n = 79) and low Hb group (< 100 g/L, n = 63). There was no significant difference between the two groups regarding sex, age, blood type and tissue types. Renal function among the two groups was measured and compared. Panel reacting antigens (PRA) of all the recipients were negative. The effect of preoperative hemoglobin concentration on the postoperative renal function recovery in both groups was further analyzed.</p><p><b>RESULTS</b>A total of 14 acute rejection episodes occurred, including 5 patients in the high Hb group (7.9%) and 9 in the low Hb group (11.4%, P > 0.05). The serum creatinine level at one-year post-transplantation of the low Hb group was significantly higher than that of the high Hb group ((117.8 ± 36.3) µmol/L vs. (103.1 ± 35.5) µmol/L, P < 0.05). For one-year actuarial patient and graft survival, incidence of delayed graft function (DGF), serum creatinine concentrations at 1, 3, 6 months post-transplantation, the incidence of cytomegalovirus (CMV) infection, post-transplantation anemia (PTA) and post-transplantation diabetes mellitus (PTDM) of both groups, there were no statistically significant differences.</p><p><b>CONCLUSION</b>Pre-transplantation Hb concentration has significant effect on one-year creatinine concentration, but can not significantly affect acute rejection episodes, DGF, PTA, CMV infection and PTDM.</p>

Long-term non-invasive positive pressure ventilation in severe stable chronic obstructive pulmonary disease: a meta-analysis / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The evidence for non-invasive positive pressure ventilation (NIPPV) used in patients with severe stable chronic obstructive pulmonary disease (COPD) is insufficient. The aim of the meta-analysis was to assess the treatment effects of long-term NIPPV on gas change, lung function, health-related quality of life (HRQL), survival and mortality in severe stable COPD patients.</p><p><b>METHODS</b>Randomized controlled trials (RCTs) and crossover studies comparing the treatment effects of NIPPV with conventional therapy were identified from electronic databases and reference lists from January 1995 to August 2010. Two reviewers independently assessed study quality. Data were combined using Review Manager 5.0. Both pooled effects and 95% confidence intervals were calculated.</p><p><b>RESULTS</b>Five RCTs and one randomized crossover study with a total of 383 severe stable COPD patients were included. NIPPV improved gas change significantly when using a higher inspiratory positive airway pressures. The weighted mean difference (WMD) for the partial pressure of carbon dioxide in artery (PaCO2) was -3.52 (-5.26, -1.77) mmHg and for the partial pressure of oxygen in artery (PaO2) 2.84 (0.23, 5.44) mmHg. There were significant improvements in dyspnea and sleep quality, but gained no benefits on lung function. The standardized mean difference (SMD) for the forced expiratory volume in 1 second (FEV(1)) was 0.00 (0.29, 0.29). And the benefits for exercise tolerance, mood, survival and mortality remained unclear.</p><p><b>CONCLUSIONS</b>Patients with severe stable COPD can gain some substantial treatment benefits when using NIPPV, especially improvements in gas change, dyspnea and sleep quality. Studies of high methodological quality with large population, especially those based on a higher inspiratory positive airway pressures are required to provide more evidences.</p>

Risk Factors for Development of Posttransplantation Anemia Following Kidney Transplantation / 中山大学学报(医学科学版)

[Objective] To investigate the incidence and risk factors for posttransplantation anemia (PTA) following kidney transplantation. [Methods] A retrospective cohort study reviewing the medical records of the patients who received a renal transplant at our center from January 2004 to June 2008 was performed. All possible risk factors for PTA were recorded. Outcomes among the patients with PTA were compared with those without PTA using t-test and chi-square analysis methods. Logistic regression analysis was done to rank the relative risk of potential variables and calculate the 95% CI. [Results] Prevalence of PTA in our center was 31.0% (hemoglobin <120 g/L or Hct< 0.38 for males, < 110 g/L or Hct < 0.35 for males). Univariate and Logistic regression analysis revealed that the risk factors for PTA after kidney transplantation were female (RR=8.738; 95%CI 2.558～29.853; P= 0.001), creatinine level (RR=1.035; 95%CI 1.018～1.052; P<0.001) and acute rejection (RR=19.827; 95%CI 2.056～191.19; P=0.01); [Conclusions] PTA is a frequent complication after kidney transplantation. Great attention should be paid to this complication considering its negative effect on graft function. Female, impaired renal function and acute rejection are risk factors of anemia in kidney transplantation recipients.

Nosocomial mortality and early assessment of patients with severe acute pancreatitis / 中华急诊医学杂志

Objective To analyze risk factors in order to predict the in-hospital mortality of patients with se-vere acute pancreatitis (SAP), especially the factor of total cholesterol. Method Factors for predicting in-hospi-tal mortality were evaluated retrospectively from the clinical data collected from 338 SAP patients of Tianjin Nankai Hospital between January 1999 and December 2008 according to the Guidelines for for clinical diagnosis and classi-fication of Acute Panereatitis set by the Society of Chinese Medical Association in 2003. The patients were treated with intensive care, blood routine examination, blood biochemical test and even computed tomography within 24 hours after admission. The patients were divided as per outcome into deceased and survivor group. All patients were admitted within 72 hours after the onset of symptoms. The Off-square test was used for univariate analysis and multivariate test was performed by logistic regression. Results Compared with TC≤3.67 mmol/L, when the TC was between 3.67 -4.37 mmol/L, OR was 0.664 (P = 0.412), while TC was between 4.37 mmol/L and 5.23 mmol/L, OR was 0.144 (P =0.021).The OR was 1.013 (P =0.018) when TC was ≥5.23 mmol/L. The variation of serum TC levels was accompanied with the changes of C-reactive protein (CRP). When the CRP was ≥170 mg/L, OR was 7.074 (P =0.031). When the serum ALB≤30 g/L, OR was 7.224 (P =0.029).Conclusions The CRP, ALB, TC can be used for early predicting the in-hospital mortality of SAP patients. TC is a protective factor when it was between 4.37 mmol/L and 5.23 mmol/L, while it is a risk factor when ≥5.23 mmol/L or≤3.67 mmol/L. CRP> 170 mg/L or ALB < 30 g/L increases the probability of fatal outcome. Low level of albumin is a stronger predictor than the high level of CRP. Moderate elevation of TC level seems to in-crease the resistance to inflammation and hence improving the survival rate of patients with SAP and reducing the in-hospital mortality.

Analysis on the relative factors of recurrence of severe pancreatitis / 中华胰腺病杂志

Infection rate and in-hospital treatment were two prognostic factors for SAP recurrence.

Risk factors of the onset of multiple organ dysfunction syndrome in patients with severe acute pancreatitis / 中华消化外科杂志

Objective To analyze the value of early evaluation in predicting the onset of multiple organ dysfunction syndrome (MODS) in patients with severe acute pancreatitis (SAP). Methods The clinical data of 338 patients with SAP who had been admitted to Tianjin Nankai Hospital from January 1998 to September 2008 were retrospectively analyzed. The patients were divided into MODS group (n = 163) and control group (n = 175) according to whether they did or did not have MODS. Risk factors causing MODS were analyzed by t test and Logistic regression analysis. Results The factors leading to the MODS included white blood cells count≥ 16 ×109/L, serum creatinine≥ 180 μmol/L, serum calcium≥2.5 mmol/L, c-reactive protein≥ 120 mg/L and pH value of blood≥7.35 (χ2 = 51.720, 21.421, 12.393, P < 0.05). The total cholesterol was a protective factor when it was 3.67-5.23 mmol/L. Conclusions Infection, renal insufficiency and hypercalcinemia are early predictive factors for MODS, and infection is the strongest predictive factor. Appropriate elevated total cholesterol can reduce the incidence of MODS.

Polymorphisms of FAS and FASL genes and susceptibility of silicosis / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To explore the relationship between polymorphisms of FAS and FASL genes and genetic susceptibility of silicosis.</p><p><b>METHODS</b>A case-control study was conducted. The case group was 183 male patients with silicosis and the control group was 111 male silica-exposed but without silicosis miners. Data on total dust concentrations was collected to estimate cumulative total dust exposure (CTE) of each subject and each person's characteristics and work history were obtained from questionnaire. Polymerase chain reaction re-strained fragment length polymorphism technique (PCR-RFLP) was applied to detect the single nucleotide polymorphisms (SNPs) of FAS-1377, FAS-670 and FASL-844. Associations between polymorphisms and risk of silicosis and stages, interactions between polymorphisms, between polymorphisms and CTE and smoking and haplotypes were analyzed.</p><p><b>RESULTS</b>There were no differences in the FAS-1377, FAS-670 and FASL-844 genotypes between the case group and the control group (P > 0.05). No association was observed between FAS-1377, FAS-670 and FASL-844 polymorphisms and silicosis and stages (P > 0.05). The frequencies of FAS-1377G/-670G haplotype in the cases (9.6%) were higher than those in the controls (3.6%) (P < 0.05). No interactions between the polymorphisms of different genes, the gene polymorphism and the total accumulative total dust, the gene polymorphism and smoking were observed (P > 0.05).</p><p><b>CONCLUSION</b>FAS-1377, FAS-670 and FASL-844 polymorphisms are not susceptible factors of silicosis. The FAS-1377G/-670G haplotype might be a susceptibility marker of silicosis.</p>

Effect of serum autoantibodies against the M2 muscarinic acetylcholine receptors from patients with heart failure on L-Type Ca2+ channel activity in guinea pig cardiac myocytes / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the effect of serum autoantibodies against the human M(2) muscarinic acetylcholine receptors (M(2)-receptors, Abs) from patients with congestive heart failure on L-Type Ca(2+) channel activity in guinea pig cardiac myocytes.</p><p><b>METHOD</b>Using whole cell patch-clamp technique, we quantitatively measured the ionic intensity and density of L-Type Ca(2+) channel (I(Ca-L)).</p><p><b>RESULTS</b>The M(2)-receptors agonist (carbachol) could decrease the I(Ca-L) peak intensity and density stimulated by isoprenaline from (2111.65 +/- 203.13) pA and (18.83 +/- 1.14) pA/pF to (1230.87 +/- 208.14) pA (P < 0.01) and (10.72 +/- 1.06) pA/pF (P < 0.01). The serum Abs could also decrease I(Ca-L) peak intensity and density [from (1995.21 +/- 195.13) pA and (18.13 +/- 1.03) pA/pF to (636.42 +/- 110.07) pA (P < 0.01) and (5.54 +/- 0.81) pA/pF, P < 0.01]. The M(2)-receptors antagonist, atropine was able to block these effects of carbachol and Abs.</p><p><b>CONCLUSIONS</b>The circulating serum autoantibodies against the M(2)-receptors has similar effect as M(2)-receptors agonist on decreasing the isoprenaline stimulated I(Ca-L) in guinea pig cardiac myocytes and possess negative inotropic effect. These results further suggest that serum autoantibodies against the human M(2) muscarinic acetylcholine receptors may participate in the pathophysiological processes in patients with heart failure.</p>

Effect of the positive sera of autoantibodies against the human beta1-adrenoceptor from patients with congestive heart failure on activity of L-type Ca2+ channel in guinea pig cardiac myocytes / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the effect of the positive sera of autoantibodies against the human beta1-adrenoceptor from patients with congestive heart failure on activity of L-Type Ca2+ channel in guinea pig cardiac myocytes.</p><p><b>METHOD</b>Using whole cell patch-clamp technique, we quantitatively researched the ionic intensity and density of L-type Ca2+ channel (ICa-L).</p><p><b>RESULTS</b>The beta-adrenocepter agonist isoprenaline increased the ICa-L peak intensity and density from (997.09 +/- 227.5) pA and (8.20 +/- 0.86) pA/pF to (2241.01 +/- 348.5) pA and (18.98 +/- 1.18) pA/pF, respectively (P < 0.01). The positive sera of autoantibodies against the beta1-adrenoceptor could also increase ICa-L peak intensity and density from (963.57 +/- 207.56) pA and (8.14 +/- 0.72) pA/pF to (1382.41 +/- 241.36) pA and (11.70 +/- 1.03) pA/pF (P < 0.01). Esmolol, a beta1-adrenoceptor antagonist blocked these effects of isoprenaline and autoantibodies.</p><p><b>CONCLUSIONS</b>Human cardiac positive sera of autoantibodies against the beta1-adrenoceptor has an isoproterenol-like effect on cardiac myocytes receptor. It may participate in the pathophysiologic process of cardiac myocytes.</p>

Study of autoantibodies against the G-protein-coupled beta 2- and alpha 1-adrenergic and AT1 receptors in patients with primary hypertension / 中国医学科学院学报

<p><b>OBJECTIVE</b>To determine whether autoantibodies against the cardiac G-protein-coupled beta 2- and alpha 1-adrenergic and AT1 receptors are related to patients with primary hypertension.</p><p><b>METHODS</b>Synthetic peptides corresponding to amino acid sequences of the second extracellular loops of the beta 2- and alpha 1-adrenergic and AT1 receptors were respectively used as antigens to screen sera from patients with hypertensive heart diseases (n = 50) as well as simple hypertension (n = 40) and healthy blood donors (n = 40) using ELISA test.</p><p><b>RESULTS</b>The positive ratio of autoantibodies against beta 2 and alpha 1 and AT1 receptors in patients with hypertensive heart diseases were significantly higher than patients with simple hypertension and healthy donors. The geometric mean titers of autoantibodies against beta 2- and alpha 1-adrenergic and AT1 receptors had no difference between the patients with hypertensive heart diseases and the patients with simple hypertension, but the geometric mean titers of two groups were higher than healthy donors. In the patients with hypertensive heart diseases, 81.0% of the patients with autoantibodies against beta 2-adrenergic receptor had autoantibodies against alpha 1-adrenergic receptor and 76.2% had autoantibodies against AT1 receptors. The percent of the autoantibodies against three receptors in patients with hypertensive heart diseases were 52.4%.</p><p><b>CONCLUSIONS</b>Autoantibodies against beta 2- and alpha 1-adrenergic and AT1 receptors play an important role in the pathophysiological changes of primary hypertension, and may participate myocardial and vessel remodeling.</p>

The causes for biliary duct reoperations: a report of 828 cases / 中国普通外科杂志

Objective To study the causes of reoperation after biliary duct operation, in order to decreasing the rate of biliary tract reoperation. Methods The clinical data of 828 patients who underwent reoperation of biliary duct diseases in Nankai hospital between 1990-1999 were evalated, and the causes of biliary duct reoperation were classified and analysed.Results The most common cause for reoperation was recurrent or retained bile stone(65.10% ), bile stone companied by stenosis of the sphincter of oddi (33.82%), simple stenosis of sphincter of Oddi ( 9.54%), traumatic stricture of bile duct and stricture of bilioenteric anastomosis( 10.39%), bile duct obstruction due to tumor (6.52%), and other less important factors. Conclusions Recurrent or retained bile duct stone was the main cause for biliary reoperation,and stenosis of the sphincter of Oddi was the next important factor for reoperations.Thoroughness of the initial operation and rationality of operative procedure are the chief factors to decrease bile duct reoperations.