Classification management of HIV reactive blood donors based on test results / 中国输血杂志

【Objective】 To explore the viability of classification management of HIV reactive blood donors based on test results in blood screening laboratory. 【Methods】 According to the HIV test results of blood donors (including twice ELISA and once NAT), the HIV reactive blood donors were divided into three groups. Group 1 was all-test reactive (both ELISA and NAT were reactive), group 2 serological reactive (only ELISA was reactive), and group 3 NAT reactive (only NAT was reactive). The HIV test results of 191 628 blood donors from May to December 2017 were analyzed. Samples with positive RIBA results and / or the repeated reactive NAT results were determined as HIV true positive. The yielding rates of HIV true positivity in each group were analyzed. Receiver operating characteristic curve (ROC curve) was used to elevate the S/CO limit under 99% specificity as the blood donor deferral limit for ELISA. 【Results】 A total of 180 HIV reactive samples were detected out of 191 628 blood donors, including 77 positive cases in group 1, 100 in group 2 and 3 in group 3. 1) The HIV reactive results were diverse. Among the 82 true positive blood donors, 4 were early HIV infection (3 HIV antibody+ antigen window period yield, 1 HIV antibody window period yield), 2 were suspected elite controllers, and 76 cases were both serology and NAT reactive. 2) The overall yielding rate of HIV was 47.67%, with group 1 (100%) = group 3 (100%) > group 2 (2.17%), showing statistically significant (P0.05). All true positive blood donors in group 1 and group 2 could be accurately screened by using the blood donor deferral limit for ELISA1 and ELISA2 simultaneously. 【Conclusion】 The composition of HIV results among blood donors is diverse and complex. It is necessary to continuously improve the awareness of HIV prevention and control. The classification of HIV reactive blood donors is conducive to conduct fine and scientific management. The blood donors in group 1 and group 3 should be permanently deferral, and the suspected HIV elite controllers in group 2 should be paid attention to and permanently deferral.

Study on blood donor deferral strategy by analyzing anti-TP test results / 中国输血杂志

【Objective】 To discuss the reliability and applicability of the current blood deferral strategy concerning anti-TPreactive blood donors (by ELISA). 【Methods】 TPPA confirmatory test was performed on the samples routinely detected by two different anti-TP ELISA reagents(reagent 1 and reagent 2), and the test data of dual reagent reactive and one reagent reactive blood donors were analyzed to determine the possibility of true positivity. 【Results】 1 624 anti-TP reactive samples(by ELISA) were collected, among which 1 467 were dual reagent reactive, 77 were reagent 1 reactive, and 80 were reagent 2 reactive. TPPA results showed that the positive predictive value (PPV) of dual reactive samples was 85.48%. Samples with high S/CO value (reagent 1≥13 and/or reagent 2 >17) were more likely to be true positive, with the PPV at 98.56% (reagent 1) and 99.13% (reagent 2), respectively, which were significantly higher than that when the S/CO value was≥1. Among the samples reactive to one reagent, 2 were confirmed positive in reagent 1 and 3 in reagent 2, with the PPV at 2.60% and 3.75% respectively, and had no correlation with high S/CO value. 【Conclusion】 Dual-reagent reactive donors with high S/CO value showed high possibility of true positivity, therefore should be deferred. TPPA test is helpful to identify true positivity in one-reagent reactive donors. Confirmatory test and follow-up should be a supplement to the current blood donor deferral strategy to ensure blood safety.

Discriminatory positive rate of individual donor-nucleic acid test mode of blood station laboratories in the Beijing-Tianjin-Hebei Region / 中国输血杂志

【Objective】 To analyze the discriminatory positive rate(DPR)of individual donor-nucleic acid test (ID-NAT)mode of blood screening laboratories in the Beijing-Tianjin-Hebei Region, explore the possible reasons for DPR differences among blood station laboratories and the measures to lesson the differences, in order to lay a foundation for realizing the homogenization of detection quality of blood screening laboratories in Beijing-Tianjin-Hebei Region. 【Methods】 The number of triplex-positive samples and discriminatory -positive samples of A, B, C, and D blood station laboratories, which submitted to ID-NAT system, in Beijing-Tianjin-Hebei Region from January to December 2018 were collected by a questionnaire of Quality Supervise Index of Blood Station Laboratories in Beijing-Tianjin-Hebei Region. The triplex-positive samples were divided into solo-positive samples(NAT+ ELISA-) and dual-positive samples(NAT+ ELISA+ ). The changes of total DPR of A, B and C blood screening laboratories in different months was analyzed and compared respectively. The differences of total DPR of ID-NAT, DPR of NAT+ ELISA+ samples, and DPR between NAT+ ELISA-samples and NAT+ ELISA+ samples of A, B, and C blood screening laboratories during January 2018 to December 2018 was analyzed and compared. The difference of DPR of NAT+ ELISA-samples among A, B, C, and D blood station laboratories was also compared. 【Results】 Significant difference in total DPR was noticed in different months of A, B, and C blood station laboratories from January to December 2018(P<0.05), with the highest DPRs of A, B and C laboratory at 91.67%, 72.73%. and 80.39%, the lowest DPRs at 65.88%, 21.05%, and 7.69%, respectively. Significant statistical differences in the total DPR and the DPR of NAT+ ELISA+ samples were found among A, B, and C blood station laboratories(P<0.05). Significant statistical differences in the DPR of NAT+ ELISA- samples were found among A, B, C, and D laboratories(P<0.05). The DPR of NAT+ ELISA+ samples of A and B blood station laboratories (95.97% and 85.25%) were significantly higher than those of NAT+ ELISA-samples (36.36% and 30.71%)(P<0.05). However, the DPR of NAT+ ELISA+ samples of C blood station laboratory (32.63%) was significantly lower than that of NAT+ ELISA-samples (44.39%)(P <0.05). 【Conclusion】 There were significant differences in the total DPR, the DPR of NAT+ ELISA-samples and NAT+ ELISA+ samples that were detected by ID-NAT system in 2018 among blood station laboratories in the Beijing-Tianjin-Hebei Region, and the total discriminatory positive rate in different months was also different for the same blood station. It is necessary to explore the reasons leading to the differences and seek solutions in order to achieve the homogenization of detection quality of blood screening laboratories in Beijing-Tianjin-Hebei Region.

Analysis of reactive HCV results detected by current blood screening strategy / 中国输血杂志

【Objective】 To assess the status of HCV infection by analyzing the results of anti-HCV reactive blood samples detected by the current blood testing strategy, and discuss the viability of classified management of reactive blood donors. 【Methods】 The anti-HCV reactive samples (dual ELISA and once NAT), from May 2017 to October 2018, were divided into three groups: samples both anti-HCV and HCV RNA reactive, sole HCV RNA reactive, and sole anti-HCV reactive, and all of them were confirmed by recombinant immunoblot assay (RIBA). The positive predictive value (PPV) between groups were compared. The sensitivity, specificity and PPV for each reagent under different screening threshold (screening threshold for routine detection, optimal screening threshold, and corresponding screening threshold of the highest PPV) were analyzed. The group with low PPV were stratified by ELISA S/CO values, and PPV by different screening threshold was compared. 【Results】 There were 939 reactive samples (0.49%, 937/191 627). Confirmed by RIBA, the positive rate of anti-HCV reactive samples was 10.67%(100/937). Two samples were sole HCV RNA reactive (0.001%). Both anti-HCV+ HCV RNA reactive samples were 6.71%(63/939), with the PPV of 96.83%(61/63). Sole anti-HCV reactive samples were 93.08(874/939), with the PPV of 4.46%(39/874), among which PPV by dual and one ELISA reagent were 18.72% and 0.15%, respectively, showing statistically significant difference (P<0.05). The PPV between different S/CO values was statistically significant (P<0.05). The optimal screening thresholds of anti-HCV reagent were 9.29 and 3.97, according to the ROC curve, with significant difference noticed in PPV by different screening threshold (P<0.05). PPV in the sole anti-HCV reactive group increased from 4.46% (the routine screening threshold) to 49.35%(the optimal screening threshold), and the difference was statistically significant (P<0.05). 【Conclusion】 The blood donors with both anti-HCV and HCV RNA reactive can be determined as HCV infection and need to be permanently deferred. The S/CO value of sole anti-HCV reactive samples was positively correlated with RIBA confirmation results, and the higher the S/CO value, the greater the chances of positive confirmation are. With the current blood screening strategy, the HCV infection status of sole anti-HCV reactive blood donors can be determined by establishing a screening threshold with high PPV or adding confirmatory test.

Unqualified rate of anti-HIV detection in the laboratories from blood banks in Beijing-Tianjin-Hebei region / 中国输血杂志

【Objective】 To investigate the unqualified rate of anti-HIV detection of blood screening laboratories in Beijing-Tianjin-Hebei region, and explore the differences in anti-HIV detection ability and influencing factors in each laboratory. 【Methods】 Through filling questionnaires via e-mail, the anti-HIV ELISA unqualified rate and confirmed (WB) positive results (data) from January to December 2018 from 15 blood screening laboratories in Beijing-Tianjin-Hebei region were collected. Our laboratory was responsible for data collection and confirmation, and statistics software SPSS22.0 was used for analysis. 【Results】 1) There was a statistically significant difference among the unqualified rate of anti-HIV ELISA(6.77‱~35.71‱) and confirmed positive rate(0.60‱~3.56‱) in 15 blood screening laboratories in Beijing-Tianjin-Hebei region (P<0.05); 2) There were significant differencse among the ELISA unqualified rate and the confirmed positive rate of 8 reagents for anti-HIV detection(P<0.01), and the sensitivity of the 4th generation detection reagent and the imported reagent was higher than that of the 3rd generation reagent and the domestic reagent. The anti-HIV ELISA unqualified rate of R5 was the highest (19.08‱). 3)There were significant differences in the anti-HIV ELISA unqualified rate of R1, R2, R3, R5 and R7 reagents among different blood station laboratories(P<0.05), and there were no significant differences in the anti-HIV ELISA unqualified rate of R4, R6 and R8 reagents among different blood station laboratories(P>0.05). 4)The unqualified rate of anti-HIV ELISA of laboratories using different regents showed significant differences(P<0.05), except H, J, M. The unqualified rate of imported reagent was significantly higher than that of domestic reagents of laboratories using imported and domestic reagents combinations(P<0.05), except O. 62.5% (5/8) laboratories using domestic 3rd and 4th generation reagent combination showed significant differences in the unqualified rates among different reagents(P<0.05); 5) The positive rate of single-reagent(62.02%~95.45%)in 15 blood screening laboratories showed significant difference(P<0.001), and A was the lowest (62.02%). 【Conclusion】 The anti-HIV detection ability among 15 blood screening laboratories in Beijing-Tianjin-Hebei region is quite different. The application of different reagents is the main factor for the difference, and other factors such as personnel, instruments and test strategies also has a great impact on the detection of anti-HIV. It is still necessary to promote the process of homogenization of blood testing quality among blood screening laboratories in Beijing-Tianjin-Hebei region.

Differences and similarities of basic standards for blood banks between China and Russia / 中国输血杂志

【Objective】 To explore the basic situation and advantages of blood banks in Russia through analyzing the differences and similarities of basic standards for blood banks(referred to as standards) between China and Russia. 【Methods】 The main differences and similarities were analyzed by comparing the classification of blood banks and the requirements for staff and equipments. 【Results】 The macro contents such as the main functions and responsibilities of blood banks, the basic requirements for staff and equipments were both described in the standards in China and Russia, but such details as classification criteria of blood banks, the allocation criteria of staff and equipments were not the same. 【Conclusion】 The macro contents of the standards in China and Russia were basically the same, but some of the details of Russia standards were more clear and scientific than those of Chinese standards, and some contents were worth learning.

The ferric metabolism of male regular plateletpheresis donors with plasma ferritin < 30 μg/L / 中国输血杂志

【Objective】 To investigate the variation of ferric metabolism indexes in male regular platetpheresis donors (MRPDs) with the low iron storage (plasma ferritin <30 μg/L). 【Methods】 The ferric metabolism indexes of 137 MRPDs with ferritin <30 μg/Lwere detected, including serum free iron (sFI), hemoglobin (Hb), unsaturated iron binding capacity (UIBC), total iron binding capacity (TIBC), transferrin (TRF) and prealbumin (PALB). The correlation between these indexes and the level of ferritin, the total number of platelet donation and the number of platelet donations in the previous year were analyzed. 【Results】 The UIBC of MRPDs with ferritin <30 μg/L showed a significant upward trendin comparison with the normal reference value, with the median level of UIBC at 55.1 μmol / L. The level of serum iron decreased significantly, with the median level at 10.9 μg / L. The level of ferritin was correlated with UIBC and Hb, and the indexes of iron metabolism were generally correlated to each other. The number of platelet donation in the previous year was correlated with TIBC, UIBC and TRF. The total number of platelet donation was correlated with TIBC and TRF. 【Conclusion】 MRPDs with ferritin <30 μg/L showed abnormalferric metabolism. It is necessary to detect both ferritin and ferric metabolism indexes to evaluate the iron deficiency in MRPDs.

Hemoglobin and ferritin status in frequent plateletpheresis donors / 中国输血杂志

【Objective】 To investigate and analyze the effect of frequent platelet donation on hemoglobin(Hb) and ferritin in blood donors. 【Methods】 73 male plateletpheresis donors, with an average donation interval of 15.26 days, in Beijing Red Cross Blood Center between March 2019 to June 2019 were enrolled into this study. These donors were classified into 3 groups according to the ferritin level during the 5 consecutive donations: 1st group (n=21, ferritin ≥30 μg/L), 2nd group (n=23, ferritin<30 μg/L) and 3rd group (n=29, ferritin fluctuated at 30 μg/L). Their Hb and ferritin during the 5 consecutive donation were detected and further analyzed. 【Results】 1) No significant difference was found in Hb during the 5 consecutive donations (P>0.05), and the ferritin decreased gradually(P<0.01). The incidence of low-value ferritin increased with the donations (35.62% - 63.01%). 2) The same change trend in Hb and ferritin was observed in 1st and 2nd group, except for Hb at 4th donation was significantly higher in 1st group than it in 2nd group. 3) Increasing Hb threshold for donation from 120g/L to 135 g/L can reduce the incidence of low-value ferritin from 23.23% to 18.00%, but also lead to a decrease of blood resources by 10.61%. 【Conclusion】 A progressive decline in iron reserve was observed in frequent platepheresis donors, with minimal impact of Hb on reducing the risk of iron deficiency. It is particularly necessary to carry out ferritin testing for frequent platepheresis donors.

Investigation and analysis of plasma ferritin levels in plateletpheresis donors / 中国输血杂志

【Objective】 We performed a prospective analysis of iron status in plateletpheresis donors, to provide data basis and support for optimizing the strategy of plateletpheresis donation and high quality service for donors. 【Methods】 Plasma ferritin levels were measured in samples from 3 444 plateletpheresis donors who donated in Beijing Red Cross Blood Center to evaluate iron status from the perspective of sex, age, donation status and number of donations in the past 12 months. 【Results】 1) The incidence of low ferritin level was 26.63% in 3 444 cases. There was significant difference in the incidence of low ferritin between sex, as 26.75% in males and 26.31% in females (P>0.05), respectively. There was no significant difference in the concentration of ferritin and the incidence of low ferritin between different age groups of first-time donors. The concentration of ferritin declined and the incidence of low ferritin in males and females increased along with accumulated donations during the past 12 months. 【Conclusions】 This is a large study of ferritin testing in Chinese plateletpheresis donors from multiple dimensions, which laid a foundation for further researches. Ferritin screening is necessary and helpful to reduce the risk of iron deficiency in plateletpheresis donors.

Ferritin in whole blood donors: an investigation in Beijing / 中国输血杂志

【Objective】 To detect the ferritin of whole blood donors in Beijing, and to analyze the influencing factors related to low level of ferritin, so as to provide scientific basis for iron supplementation of blood donors. 【Methods】 Ferritin was detected among 27 071 blood donors in Beijing area from March to June 2018. Related information of blood donors with low ferritin level was analyzed using Logistic regression analysis to determine the type of blood donors most likely to present low ferritin level. 【Results】 The rate of low ferritin value in whole blood donors in Beijing was 8.54%. The abnormal low ferritin was affected by gender, repeat donation behavior and the number of blood donations within one year, and not by age.The gender and the number of blood donations within one year presented great impact, with OR value at 8.258(CI7.463~9.137)and 2.148(CI1.856~2.485), respectively. 【Conclusion】 The iron storage status of whole blood donors in Beijing area under the current blood policy is better than that in other developed countries, revealed by a large-scale population survey, yet more attention should be paid to the ferritin status of repeat blood donors.

Detection of occult HBV infection and probably window period infection among single NAT reactive blood donors / 国际检验医学杂志

Objective To analyze hepatitis B virus(HBV) infection stage in single nucleic acid test(NAT)reactive blood donors.Methods Blood donor samples were screened routinely for HBV DNA by using transcription-mediated amplification(TMA) NAT and quantitative polymerase chain reaction(PCR).Then serum markers of HBV were also detected.The HBV infection stage was analyzed.Results Among the 225 single NAT reactive samples,78(34.67%) were identified to be reactive for HBV DNA by TMA NAT discrimination test and/or PCR test,of which 63(82.89%) were occult HBV infection(OBI),13(17.11%) were probably window period infection(pWP),and 2 cases could not be classified for infection stage.Among the OBI samples,49 samples(77.78%) were with HBV DNA concentration less than 20 IU/mL,whereas,there were only 4 samples(30.77%) in pWP samples.The 225 samples were classified into three groups according to the S/CO of NAT, including 1-<6 group,6-<10 group and 10-17 group, the confirmed HBV DNA positive rates of which were 13.11%,13.64% and 47.18%,and the positive rate of 10-17 group was higher than 1-<6 group and 6-<10 group(P<0.05).In all 63 OBI samples,there were 8(12.70%),3(4.76%) and 52(82.54%) samples were classified into S/CO 1-<6,6-<10 and 10-17,respectively.All of the 13 pWP samples were with NAT S/CO of 10-17.Conclusion Part of single NAT reactive blood donors could be with HBV infection,of which OBI might be popular than pWP, with very low concentration of HBV DNA.Deferral of single NAT reactive blood donors could reduce transfusion-transmitted HBV infection.

Endovascular aortic repair for the treatment of isolated iliac artery aneurysm: a report of 23 cases / 中华普通外科杂志

Objective To summarize the experiences of endovascular aortic repair (EVAR) for isolated iliac artery aneurysm (ⅡAA).Methods The clinical data of 23 patients with ⅡAA undergoing EVAR from Aug 2008 to Mar 2016 were retrospectively analyzed.There were 5 cases of internal iliac artey (internal iliac artery ⅡA) aneurysm,10 cases of unilateral common iliac artery(common iliac artery CIA) aneurysm,6 cases of bilateral CIA aneurysms.Unilateral ⅡA aneurysm was treated by coil embolization and covering the entrance;CIA aneurysm without involving ⅡA was treated by EVAR with covered stent,those involved unilateral ⅡAs or combined ⅡA aneurysms were treated by EVAR after ⅡA embolization.Those with bilateral ⅡA involvement were repaired by Sandwich technique;Bilateral ⅡA was treated in two phases.Results All endovascular procedures were successfully performed;No patients died during the perioperation period.Intraoperative endoleak found in 5 cases managed by balloon dilatation,or conservatively were cured.23 patients were followed-up for 2-60 months,one rebuilding ⅡA was occluded.One CIA anurysm complicated with endoleak was cured by coils embolization and stenting.Gluteal claudication and erectile dysfunction occured in 4 out of 15 cases with unilateral or bilateral ⅡAs occlusion.Conclusion EVAR is a safe and effective treatment for ⅡAA,after a proper management for ⅡA.

Establish and confirm of blood donor deferral criterion in HBsAg ELISA test / 国际检验医学杂志

Objective To establish and confirm the hepatitis B surface antigen(HBsAg) enzyme linked immunosorbent assay(ELISA) high specificity S/CO limit as blood donor deferral criterion.Methods A total of 783 HBsAg ELISA reactive and 588 non-reactive samples were collected, and confirmed by HBsAg electrochemiluminescence detection and neutralization test.Receiver operating characteristic curve (ROC curve) was used to evaluate the S/CO limit under 95% and 99% specificity.Another 124 HBsAg ELSIA reactive samples were tested for five kinds of hepatitis B virus(HBV) markers by using electrochemiluminescence detection to verify the blood donor deferral limit.The blood donor deferral limits of 3 laboratories, using the same reagents, were compared.Results The 95% specificity S/CO limit of two reagents were 0.24 and 0.65, the 99% specificity S/CO limit of two reagents were 3.89 and 3.62.The 99% specificity S/CO limit was set as the blood donor deferral criterion.Verify test indicated that the samples, with S/CO higher than the blood donor reentry limit of reagent 1 and 2, were all from HBV infected donor.The 99% specificity S/CO limits of reagent 1 in the other three laboratories were 3.77, 3.60 and 13.42 respectively.And the 99% specificity S/CO limits of reagent 2 in the other three laboratories were 27.73, 31.75 and 1.17.Conclusion The blood donor deferral limit of HBsAg ELISA could identify the true positive blood donor, and reduce the number of blood donor, entering the reentry process.It might not suit to adopt a unified donor deferral limit in different laboratories, even using the same reagents.

Stromal cell-derived factor-1 and endothelial progenitor cells improve neovascularization / 中国组织工程研究

BACKGROUND:The endothelial dysfunction is the pathogenesis of arteriosclerotic disease, the quantity and function of endothelial progenitor cells are decreased within the cycle, leading to a poor capacity of neovascularizatio, the efficacy of stem celltransplantation alone is unclear, the combination of cytokines and gene-modified stem cells is the hotspot. OBJECTIVE:To observe the effect of stromal cel-derived factor-1 on the neovascularization after endothelial progenitor cells transplantation. METHODS:Unilateral hindlimb ischemia model was established in 20 athymic nude mice, and the mice were randomly divided into four groups:combined group (intravenous endothelial progenitor cells+intramuscular stromal cel-derived factor-1), endothelial progenitor cells group (intravenous injection of endothelial progenitor cells), stromal cel-derived factor-1 group (intramuscular injection of stromal cel-derived factor-1), and blank control group (intramuscular M199). The skin temperature of ischemic hindlimbs and survival of animals after transplantation were observed. The ratio of capil ary/skeletal muscle fiber was counted. The expression of CD31 and endothelial nitric oxide synthase were detected. RESULTS AND CONCLUSION:The fluorescence-labeled endothelial cells were embedded in ischemic hindlimb muscles after celltransplantation. Of the 20 nude mice, two mice died. The rate of ischemic hindlimb reserving was respectively 80%, 75%, 20%and 0 in combined group, endothelial progenitor cells group, stromal cel-derived factor-1 group, and blank control group. The capil ary/muscle fiber ratio in combined group and endothelial progenitor cells group was higher than that of blank control group (P0.05). Endothelial progenitor cells can migrate to ischemic tissues, endothelial progenitor cells transplantation can promote neovascularization, and stromal cel-derived factor-1 augments the neovascularization after celltransplantation, in which endothelial nitric oxide synthase is involved.

Endovascular treatment of iliac vein compression syndrome:analysis of 33 cases / 中国医师进修杂志

Objective To evaluate the clinical effect of the endovascular treatment of iliac vein compression syndrome.Methods Thirty-three patients with iliac vein compression syndrome were treated with endovascular treatment.Of which,edema and varicose vein of the left lower extremity in 29 patients,complicated with acute deep vein thrombosis of left lower extremity in 3 patients,post deep venous thrombosis syndrome in 1 patient.Balloon dilatation and stent implantation were performed in all 33 patients.The diameter of balloon was 10-12 mm,diameter 12-14 mm Bard self expandable stent.Five patients with varicose vein and ulcer of left lower extremity were treated with two stage operation.Results The diagnosis was confirmed by left lower extremity deep veins angiography.There was no death patient,and no hematoma of hematoma locus.Follow-up for 3-30 months,the rate of follow-up was 100％(33/33).The edema of the lower extremity was markedly reduced or disappeared in 28 patients.Color Doppler ultrasound and left lower extremity angiography showed that the stent was unobstructed,no stent occlusion and new onset thrombosis cases.Conclusion Endovascular treatment is safe,effective with few complications,and is the first choice for the treatment of iliac vein compression syndrome.

Application of 3D-printing technology in surgical planning for renal tumor: a preliminary report / 中华泌尿外科杂志

Objective To investigate the efficacy of using three-dimensional (3D) printing technique on surgical planning and its function in enhancing the physician-patient rapport before surgery.Methods From June 2013 to January 2014,10 patients with T1 renal tumors,who were received laparoscopic partial nephrectomy,were selected in study.Left renal tumor was found in 3 cases and right renal tumor was found in 7 cases.The location of tumor included upper part of kidney in 5 cases,lower part of kidney in 3 cases and renal hilum in 2 cases,4 cases were diagnosed as T1a stage and 6 cases were diagnosed as T1b stage.64-slice enhanced CT scan was performed preoperatively.Data of DICOM format was sent for post processing.The final data was then output to 3 d printer for generating kidney models using thermoplastic plastics.After generating the model,different colors were put on the model,including pink in kidney,yellow in pelvis and ureter,red in renal artery and blue in renal vein.Plotted questionnaires were designed for medical professionals and patients,respectively.4 urological experts make the scores by this questionnaire in order to evaluate the efficacy and fidelity of the model.2 surgeons evaluated the efficacy of model after operation by comparing the actual tumor size with that measured on the models.Meanwhile,the model was used for conversation before operation.The questionnaires were also used for evaluating the effectiveness of conversion.Results 10 kidney models fabricated successfully with 3D-printing.The tumor size,position,renal vascular and collecting system could be clearly presented.Being evaluated by 4 experts and 2 performing urologists,and the mean scores was 7.8 ± 0.7.Intraoperative correlation was advocated by the performing urologists.The mean evaluation score was 7.5.The bias between real diameter of renal carcinoma and that of 3 d model was 3.4± 1.3 mm.Patients and family members preferred the demonstration of the disease and the procedure with a visual and tactilediseased organ.The scores of satisfactory were 9.0 ± 0.8.Conclusions The 3d printed model could exhibit the relationship between tumor and renal,clearly.It can help the urologists in making surgical plan,effectively.Patients' Understandings from patients and family members of the disease and the procedure to be used can be upgraded with this novel technology.

Treatment of reoperation on blood vessel prosthesis occlusion after arterial bypass graft in lower limbs / 中国医师进修杂志

Objective To review reoperation on blood vessel prosthesis occlusion after arterial bypass graft in lower limbs. Method The treatment effect of 21 patients with reoperation on blood vessel prothesis occlusion after arterial bypass graft in lower limbs was analyzed retrospectively. Results All the cases were followed up 6-36 (12 ±3) months. The limb salvage rate was 71.4%(15/21) ,the amputation rate was 28.6% (6/21). All 9 limbs that underwent revascularization from deep femoral artery reserved. Conclusions Endomembrane hyperplasy, occlusion of the inflow and outflow tracts are the major reasons for the occlusion of blood vessel prosthesis after arterial bypass graft in lower limbs. Appropriate procedures should be based on careful consideration of the occlusion reasons. Profundaplasty is an effective therapy for those who are treated by reoperation on blood vessel prosthesis occlusion in lower limbs.

Effects of exercise training on microangiogenesis of rat ischemic lower limbs / 中国组织工程研究

BACKGROUND:Previous studies demonstrated that ischemia can be compensated by establishing collateral circulation and microangiogenesis,and exercise training can ameliorate blood supply of ischemic lower limb.However,whether exercise training accelerate establishment of collateral circulation remains poorly understood.OBJECTIVE:To explore the mechanism of exercise training on accelerating microangiogenesis of rat ischemic lower limb.METHODS:Sprague-Dawley rats were randomly divided into the exercise training,model and sham-surgery groups.All animals were established left lower limb ischemia models except those in the sham-surgery group.Rats in the exercise training group were forced running 30 minutes per day at 1 week after model preparation and those in other groups were performed daily activities.The adductor of ischemic lower limb was obtained for the examination of microvessel density and the expressions of vascular endothelial growth factor and basic fibroblast growth factor.Simultaneously,bone marrow-derived endothelial progenitor cells were harvested for detection of microangiogenesis.RESULTS AND CONCLUSION:Number of endothelial progenitor calls,expressions of vascular endothelial growth factor and basic fibroblast growth factor,as well as microvessel density of the exercise training group was obviously greater than those in the model and sham-surgery groups(P<0.01).Compared with the model and sham-surgery groups,in vitro vasculogenesisof bone marrow-derived endothelial progenitor cells in the exercise training group was increased(P<0.05).These findings demonstrated that lower limb ischemia increases microangiogenesis,and exercise training enhances this effect.

Thoracotomy and endovascular repair for traumatic aortic rupture / 中华创伤杂志

Objective To summarize experiences in treatment of traumatic aortic rupture. Methods Between July 2001 and December 2008, 17 patients with acute traumatic aortic rupture were treated in our department. One patient died of hemorrhagic shock one hour after admission before opera-tion. Nine patients underwent thoracotomy under general anesthesia with double lumen endotracheal tube and normothermic femoral-femoral partial cardiopulmonary bypass, with bypass time for 35-139 minutes and aortic clamping time for 25-87 minutes. Successful operation was performed in seven patients inclu-ding one treated with simple repair and the other six with partial replacement of thoracic aorta with artifi-cial vascular graft. The other seven patients underwent endovascular repair and received stent grafts at the site of thoracic injury via right lilac-femoral artery under general or local anesthesia. Results One pa-tient free from operation was died of hemorrhagic shock. Of nine patients treated with thoracotomy, two patients died of hemorrhagic shock during operation and the other seven survived, with operation time ran-ging from 100 to 180 minutes. Seven survivors were followed-up for 2-6 years, with no death during fol-low-up period. Seven patients in endovascular repair group recovered, wiht operation time ranging from 50 to 70 minutes. All these seven patients were followed up for 3-14 months, which showed no death. Reex-amined CT in six patients showed no mediastinal hematoma or leakage of contrast medium from the aorta isthmus at 2-5 months after operation. Conclusions Endovascular repair is simple, safe and effective for traumatic aortic rupture. The selection of thoracotomy and endovascular repair is based on following conditions: the combined injuries of patients, the equipments of hospital and the skills of operators.