Study of clinical practical model of urinary system injury / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>In order to improve the clinical treatment level of urinary system injury, it is necessary to build up an animal model of urinary system wound, which is not only analogous to real clinical practice, but also simple and practical.</p><p><b>METHODS</b>We have developed the third generation of firearm fragment wound generator based on the first and the second producer. The best explosive charge of the blank cartridge was selected by gradient powder loading experiments. The firearm fragment injuries were made to the bulbous urethra of 10 New Zealand male rabbits. One week preoperatively and 2, 4 and 8 weeks postoperatively, all the animals underwent urethroscopy and urethrography. At 2, 4 and 8 weeks postoperatively, two animals were randomly selected and killed, and the urethra was cut off for pathological examination.</p><p><b>RESULTS</b>The shooting distance of the third generation of firearm fragment wound generator is 2 cm. The best explosive charge of the blank cartridge is 1 g of nitrocotton. All rabbits survived the procedures and stayed alive until they were killed. Injuries were limited to bulbous urethra and distal urethra. Round damaged areas, 1-1.5 cm in length, on the ventral wall were observed. Ureteroscopy results showed that canal diameter gradually shrank by over 50% in 9 rabbits. The rate of success was 90%. Urethrography result noted that a 1-1.3 cm stricture was formed at the bulbous urethra. Histology results of injured stricture urethra showed that fibrous connective tissue hyperplasia and hyaline degeneration caused further stricture in the canal.</p><p><b>CONCLUSIONS</b>The third generation of firearm fragment wound generator imitates the bullet firing process and is more accurate and repeatable. The corresponding rabbit model of traumatic complex urethral stricture simulates the real complex clinical conditions. This animal model provides a standardized platform for clinical researches on treating traumatic injuries to the urinary system.</p>

The regulatory impact of immune inhibitors on T cells of SD rats

OBJECTIVE@#To observe the regulatory impact of immune inhibitors on T cells in rats.@*METHOD@#Forty SD rats were selected and randomly divided into experimental group and control group, Rapamycin (SRL) 0.4 mg/d to fill the stomach of the former one, saline lavage was used with the latter one for two weeks. Using flow cytometry to detect the two groups of rats with spleen and thymus level of CD4+ CD25+ T cells; and the spleen cells FoxP3 mRNA expression; Using ELISA method to detect TGF-β, IL-10 levels.@*RESULTS@#The peripheral blood, spleen and thymus of CD4+ CD25+ T cells accounted for the proportion of mononuclear cells were significantly higher than that of control group (P<0.05); FoxP3 mRNA expression quantity also significantly higher than the control group (P<0.05); Experimental TGF-β in rats, IL-10 levels are significantly higher than control group (P<0.05).@*CONCLUSIONS@#Immune inhibitors can regulatory CD4+ CD25+ foxp3+ T cells in rats, a single nuclear cell proportion increase, shows that it can induce rat CD4+ CD25+ foxp3+ regulatory T cells proliferation.

Video-urodynamics study on female patients with bladder neck obstruction / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pressure-flow study combined with cystourethroscopy were used as the major method to define female bladder neck obstruction in China. However, the definition of urodynamics for female bladder outlet obstruction (BOO) is not clear so far. Video-urodynamic study (VUDS) would provide more information to define the female BOO, but it is not used commonly due to the limitation of video-urodynamic equipment in China. We attempted to find a better way for diagnosis of female BOO by performing VUDS.</p><p><b>METHODS</b>VUDS and cystourethroscopy were performed in 38 women with signs and symptoms of difficult voiding from March 2008 to April 2010 in Beijing Chao-Yang Hospital. Bladder neck obstruction was defined by radiological evidence of narrowing bladder neck, voiding pressure greater than 20 cmH2O and maximum flow rate (Q(max)) less than 12 ml/s. Transurethral incision of bladder neck was then performed on those patients. Follow-up examination (Q(max) and residual urine) was recorded 3 months after operation.</p><p><b>RESULTS</b>The mean time from its onset to diagnosis was (18.1 ± 9.1) months in 38 patients. Average patient age was 36.1 years (range from 19 to 79 years). The mean Q(max) was (10.6 ± 4.7) ml/s and residual urine was (81.5 ± 42.4) ml. Three out of 38 patients had obvious distal urethral stricture, eight of them suffered from definitely bladder neck contracture and the remaining 27 patients did not show obvious abnormalities measured by cystourethroscopy examination. For the 35 patients without urethral stricture, the most frequent findings of VUDS were high-voiding pressure plus low-flow rate and narrow bladder neck during voiding on simultaneous fluoroscopy examination. With video-urodynamics definition, 32 patients were diagnosed as bladder neck obstruction with mean Q(max) of (10.8 ± 3.7) ml/s, residual urine of (76.9 ± 32.7) ml and detrusor pressure at maximum flow (P(det Q(max))) of (50.7 ± 19.1) cmH2O. Other three patients were suffered from detrusor hypocontractility. All 32 patients including eight with definitely bladder neck contracture and 24 with primary bladder neck obstruction received transurethral bladder neck incision. The symptom of difficult voiding was relieved. The postoperative follow-up showed that Q(max) was (21.7 ± 7.6) ml/s (P < 0.01) and the residual urine was (23.2 ± 17.6) ml (P < 0.01).</p><p><b>CONCLUSIONS</b>The real cause of the obstruction for female patient with difficult voiding might be various. A full VUDS would give us valuable information for correct diagnosis in female patients with bladder neck obstruction.</p>

Identification of lower urinary tract voiding dysfunction in females by using video-urodynamic study / 中华外科杂志

<p><b>OBJECTIVE</b>To assess the value of video-urodynamic study (VUD) in the identification of lower urinary tract voiding dysfunction in female.</p><p><b>METHODS</b>A total of 126 female patients with sign and symptoms of lower urinary tract voiding dysfunction underwent VUD from December 2008 to January 2011 in Beijing Chaoyang Hospital. The causes of voiding dysfunction were analyzed based on VUD findings.</p><p><b>RESULTS</b>Neurogenic voiding dysfunction was found in 30 patients (23.8%), non-neurogenic voiding dysfunction was found in 96 patients (76.2%). The 72 patients suffered from recurrent urinary tract infection (57.1%) and 23 patients suffered from hydronephrosis (18.3%). Based on special characteristics of video-urodynamic study, a total of 126 patients were classified as: (1) Bladder outlet obstruction (BOO) was found in 65 patients. Of them, bladder neck obstruction in 40 patients (61.5%), their VUD showed "high pressure-low flow" obstructive curve and synchronic image showed bladder neck did not open in a funnel shape and no contrast was found in urethra. Distal urethral stricture in 22 patients (33.8%), VUD showed "high pressure-low flow" obstructive curve and synchronic image showed bladder neck open in a funnel shape, proximal urethra dilated and no contrast was found in distal urethral. Urethral sphincter obstruction in 3 patients (including detrusor-sphincter dyssynergia in 1 and sphincterismus in 2 patients), VUD showed "high pressure-low flow" obstructive curve and synchronic image showed bladder neck open in a funnel shape, sphincteric urethra did not open, proximal urethra dilated and no contrast was found in distal urethral. (2) Detrusor areflexia (DA) was found in 39 patients (2 patients with hydronephrosis), the VUD finding was: no voluntary detrusor contraction in voiding phase, and abdominal pressure voiding pattern. (3) OAB was found in 3 patients, which VUD findings was frequent involuntary detrusor contraction at storage period with or without urine leakage. (4) Low compliance bladder was found in 17 patients (13.5%), 16 patients with hydronephrosis, the VUD showed that increased bladder storage pressure with significantly decreased bladder safe capacity and compliance, appearance of the bladder as "Christmas tree", with or without ureteral reflux. (5) And stress urinary incontinence (SUI) was in 2.</p><p><b>CONCLUSIONS</b>The main causes of female BOO may be non-neurogenic conditions or organic obstruction. VUD would offer valuable information for confirmed diagnosis of voiding dysfunction in female patients.</p>