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Objective:To investigate the prognostic value and related factors of heart-type fatty acid binding protein (H-FABP) in patients with heart failure.Methods:A total of 877 consecutive patients who were admitted to heart failure care unit of Fuwai hospital and diagnosed as heart failure from July 2015 to July 2017 were enrolled in this study. Baseline serum H-FABP concentration was measured by fluorescence lateral flow immunoassay. According to serum H-FABP levels, patients were divided into three groups: low H-FABP group (H-FABP≤4.04 ng/ml, n=292), middle H-FABP group (H-FABP 4.04-7.02 ng/ml, n=292) and high H-FABP group (H-FABP≥7.02 ng/ml, n=293). The general clinical characteristics were collected and compared among the three groups. According to whether heart failure was caused by coronary artery disease or not, patients with heart failure were divided into ischemic heart failure and non-ischemic heart failure. Multivariate linear regression analysis was performed to explore the independent risk factors of H-FABP. The primary endpoint events were the composite of all-cause death or heart transplantation. Multivariate Cox regression analyses, receiver operating characteristic (ROC) curves, risk prediction tests with multivariate Cox regression model and Kaplan-Meier analyses were conducted to investigate the relationship between H-FABP and the prognosis of heart failure. Results:Multivariate linear regression analysis showed that age, coronary artery disease, alanine aminotransferase, uric acid and N-terminal pro-B type natriuretic peptide (NT-proBNP) were positively associated with H-FABP (β=0.012, 0.238, 0.001, 0.345 and 0.063 respectively,all P<0.05), while female, hemoglobin, albumin, sodium, and estimated glomerular filtration rate (eGFR) were negatively associated with H-FABP (β=-0.184, -0.006, -0.016, -0.034 and -0.006 respectively, all P<0.05). One hundred and nineteen patients (13.6%) lost to follow-up, and 246 patients (32.5%) suffered from all-cause death or heart transplantation during the median follow-up duration of 931 (412-1 185) days. Multivariate Cox regression analysis showed that baseline H-FABP (log 2H-FABP) level was the independent predictor of all-cause death or heart transplantation in patients with heart failure ( HR=1.39, P<0.001). ROC curves showed that baseline H-FABP was a predictor of all-cause death or heart transplantation in patients with heart failure within 3 months, 1 year and 2 years (areas under the curves were 0.69, 0.69 and 0.71 respectively), and the best cut-off values were 5.85 ng/ml, 6.54 ng/ml and 6.54 ng/ml respectively. Risk prediction test with multivariate Cox regression model showed that baseline H-FABP could provide additional prognostic value in predicting all-cause death or heart transplantation for patients with heart failure on top of basic model and baseline NT-proBNP ( P<0.001). Taking 6.54 ng/ml and trisected levels of H-FABP as cut-off values respectively, Kaplan-Meier analyses showed that the survival rates were significantly different among the two or three groups ( P<0.001). Subgroup analyses showed that baseline H-FABP (log 2H-FABP) level was an independent predictor of all-cause death or heart transplantation in patients with ischemic heart failure ( HR=1.74, P<0.001), as well as in patients with non-ischemic heart failure ( HR=1.28, P=0.027). Conclusions:Age, sex, coronary artery disease, hemoglobin, albumin, alanine aminotransferase, sodium, eGFR, uric acid and NT-proBNP are associated with H-FABP level. Baseline H-FABP level is an independent predictor of all-cause death or heart transplantation in patients with heart failure. On top of basic model and baseline NT-proBNP, baseline H-FABP could provide additional prognostic value in predicting adverse events for patients with heart failure.
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Chitosan and its derivatives with good characteristics such as non-toxicity,good biocompatibility and degradability,mu-cosal adhesion and permeability promotion etc,have been widely researched and applied in the field of drug carriers. Based on the re-cently published papers at home and abroad,the application and action mechanism of chitosan and its derivatives as drug carriers were analyzed and discussed,and the application and research progress of chitosan and its derivatives as anti-tumor drug targeting carriers, sustained-release and controlled-release drug carriers,ophthalmic drug carriers,gene carriers and gel bases were reviewed.
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Objective To evaluate the efficacy and safety of retroperitoneal laparoscopic pyelolithotomy ( RLP) combined with holmium laser lithotripsy under flexible cystoscopy in the treatment of complicated nephrolithiasis. Methods The retrospective analysis was made on the clinical data of 37 patients who underwent RLP and holmium laser lithotripsy under flexible cystoscopy for complicated nephrolithiasis from January 2013 to January 2014. The clinic parameters involved basic data of patients,operational time,blood loss,post-operative hospital stay,the status of stone-free,perioperative complications,and the follow-up data of patients were observed. Results No patient was converted to open surgery. The mean stone size was (2. 8 ± 0. 9) cm in diameter,operational time was (89 ± 24) min,blood loss was (21. 3 ± 7. 7) mL,post-operative hospital stay was (6. 8 ± 1. 7) d,the stone removal rate in one session was 94. 6%. One case occurred urinary leakage,1 case occurred fever after operation,who were all recovered through conservative treatment. All cases were followed up at the sixth months after operation. Conclusion RLP combined with holmium laser lithotripsy under flexible cystoscopy is effective and safe for the treatment of com-plicated nephrolithiasis.
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s:Objective Discuss the application of CTA for renal vascular control in laparoscopic renal transplantation of relative renal donors. Methods 83 cases of relative renal transplantation donors which are completed in our department during March 2007 to Junuary 2012 were divided into 3 Groups. There were 35 cases in group A ( laparoscopic nephrectomy with preoperative CTA examination) , 15 cases in group B ( laparoscopic nephrectomy without preoperative CTA examination) , and 33 cases group C ( conventional nephrectomy) . In group A, the location and quantity of renal arteries and veins were observed with preoperative CTA to make plan for vascular control. And the oper-ation time, amount of bleeding, vascular injury cases, the renal warm ischemia time in the graft, mean time of postoperative hospitalization were compared with those of group B and group C. Results 5 cases of renal vascular anomalies were observed in Group A, including 2 cases of single accessory renal artery, 2 cases of early branch of renal artery and 1 case of double renal veins. And all of them were intraoperatively comfirmed. 3 cases of renal vascular anomalies were observed in group B, including 1 case of renal arteriovenous ectopic, 1 case of injury in the accessory renal artery with diameter of 0. 6 cm, and it were given artery elongation with inferior epigastric artery postoperatively, and 1 case of renal vein injure during blocking lumbar vein with Hemolock which were repaired postoperatively. 5 cases of renal vascular anomalies were observed in group C, including 1 case of single accessory renal artery, 3 cases of early branch of renal artery, and 1 case of accessory renal artery with the diameter of 0. 1cm in the right renal was injured during surgery. The operation time, amount of bleeding, cases with vascular injury , renal warm ischemia time of donor , and the mean time of postoperative hospitalization in group A were superior to those in group B and group C. Conclusion CTA is a simple noninvasive imaging method, which can provide the details of the renal vascular preop-eratively to ensure the safety of patients during surgery and improve survival quality of donor renal, and it is of great advance in laparoscopic renal transplantation of living-related renal donors.
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This article describes a novel Multifunctional and Transparent Urinary System Model (MTUSM), which can be applied to anatomy teaching, operational training of clinical skills as well as simulated experiments in vitro. This model covers kidneys, ureters, bladder, prostate, male and female urethra, bracket and pedestal, etc. Based on human anatomy structure and parameters, MTUSM consists of two transparent layers i. e. transparent organic glass external layer, which constraints the internal layer and maintains shape of the model, and transparent silica gel internal layer, which possesses perfect elasticity and deformability. It is obvious that this model is preferable in simulating the structure of human urinary system by applying hierarchical fabrication. Meanwhile, the transparent design, which makes the inner structure, internal operations and experiments visual, facilitates teaching instruction and understanding. With the advantages of simple making, high-findelity, unique structure and multiple functions, this model will have a broad application prospect and great practical value.
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Feminino , Humanos , Masculino , Rim , Modelos Anatômicos , Modelos Biológicos , Próstata , Ureter , Uretra , Bexiga Urinária , Sistema UrogenitalRESUMO
ObjectiveTo explore the feasibility of mediating recipient lymphocyte reaction with donor dendritic cells (DCs) in renal allograft recipients to guide individualized inmunosuppressive therapy. Methods From Jan. 2008 to Jan. 2010, 30 recipients received living related kidney transplantation were successively and divided into 2 groups according to the strategies of the correction of the dosage of immunosuppressant, 15 in each group. The strategy of immunosuppressive therapy in both groups was Tac + MMF + Pred. The correction of the dosage of immunosuppressant in experimental group was conducted by recipient lymphocyte reaction with donor DC (LR) combined with Tac and MPA blood concentration monitoring. Only blood concentration monitoring of drugs was applied in control group. Examinations of liver and renal function, blood and urine routine as well as blood sugar were done monthly for 1 year. ResultsDuring the follow-up period, the rate of acute rejection in experimental group and control group was 13. 3 ％ and 46. 7 ％ respectively (P＜0. 05) ;the rate of infection in experimental group and control group was 6. 7％ and 40. 0％ (P＜0. 05)respectively; the adverse reaction rate in experimental group and control group was 13. 3％ and 46. 7％(P＜0. 05). There was no significant difference in the serum creatinine level between the two groups at each observation point. ConclusionThe application of combined recipient LR with donor DC and blood concentration monitoring of drugs in individualized irnmunosuppressive therapy is more comprehensive and accurate.
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Objective To explore the feasibility of mediating recipient lymphocyte reaction with donor dendritic cells (DCs) in renal allograft recipients. Methods Donor bone marrow monocytes (BMMCs) were isolated and cryopreserved in liquid nitrogen before kidney transplantation. At 0 day, 1month,3 month, 6 month and 9 month post-operation, CD34+ cells which were isolated from frozen BMMCs and cultured into DCs as well as the peripheral blood lymphocytes (PBLs) of donors were used as the stimulating cells to the PBLs of recipients and healthy volunteers. The number of viable DCs from frozen- and room temperature-preserved BMMCs was counted and the reactions of recipients'and healthy volunteers' lymphocytes to DCs and donor PBLs were measured. Results 6. 8 × 107BMMCs were isolated from each 10 ml of donor bone marrow on average while (4. 10 ± 0. 58) × 105CD34+ cells were isolated by magnetic active cell sorting (MACS). There was no significant difference in the isolating rate of recovered CD34+ cells at each observation point postoperatively. The percentage of viable BMMCs and CD34+ was decreased significantly at 1 month after surgery, then, decreased slowly and progressively. The decreasing rate of BMMCs was higher than CD34+. The rate of viable DCs was maintained stable (93. 2%-94. 8% ) in each group. The reactions of recipients' and healthy volunteers' lymphocytes to DCs were stronger than those to donor PBLs (P＜0. 05). The reactions of healthy volunteers' lymphocytes to DCs were maintained stable while those of recipients' were fluctuating. Conclusion Bone marrow-derived DCs are superior to PBLs in mediating long-term lymphocyte reaction after kidney transplantation due to their stable viability and stimulating ability to lymphocytes. Only once collection of a small quality of bone marrow of donors is needed to meet the demand of immune monitoring at any time after transplantation.
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0.05) and the histopathological results of the test group did not show any inflammatory reaction in incisions of liver and kidney tissues.Muscular tissues allowed a little inflammatory cells infiltrate at two days,after four days,there was not inflammation or fibrous tissue envelope.CONCLUSION:The prepared PHS granules have good biocompatibility without any acute or chronic toxicity,reject reaction,immunological reaction and anaphylactic response in animals.
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OBJECTIVE:To investigate the effects of long-term use of calcium channel blocker-Diltiazem(Dil)on the dosage of ciclosporin A and renal function of renal graft recipients.METHODS:Dil was administed in67renal graft recipi?ents,meanwhile who were orally taking CsA with another59renal graft recipients served as controls.The dosages of ci?closporin A of2group were adjusted to the level within therapeutic window,then the dosage of CsA and serum creatinine change of the2groups36mo after drug administration were observed.RESULTS:12mo,24mo and36mo after operation,the synchronized cyclosporin A dosages in Dil group were lower than the control group respectively by14353mg,9656mg and7817mg.No significant differences were found in serum creatinine levels between the2groups within the first12mo after operation.Thereafter,the creatinine levels in the control group has a faster increase and the creatinine level in Dil group was significantly lower than that of the control group18mo～36mo after operation(P
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Objective To observe the protective effects of enalapril on the long-term functions of the allograft in renal transplant recipients. Methods Twenty renal transplant recipients with ~survival time over one year, normal renal functions of the allograft and urine TGF-?_1 levels being more than ~250.0 pg/mg.Cr took enalapril every day for at least one year. Twenty-three recipients under the same conditions who did not receive enalapril served as control group. Three years later renal ~dysfunction cases, loss of creatinine clearance rate (Ccr) and TGF-?_1 levels in blood and urine were compared between the two groups. The changes in the expression of TGF-?_1mRNA in renal biopsy specimens were compared before and one year after enalapril therapy. Side-effects of enalapril were ~investigated in all patients in enalapril-treated group. Results Three years later, the number of renal dysfunction cases was less, the loss of Ccr was less and the level of urine TGF-?_1 was lower in ~enalapril -reated group than those in control group with the differences being significant (P~0.05 ). One year after enalapril therapy TGF-?_1mRNA expression was significantly decreased in renal biopsy specimens (P
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Objective To observe the efficacy of local gene transfection in CD154 extracellular domain on the survival of renal allografts. Methods The kidneys of Brown Norway (BN) rats were transfected with CD154 extracellular domain gene recombined adenovirus. The transfected kidneys were transplanted to Lewis rats (transfection group). BN→Lewis kidney transplantation with non transplanted kidneys served as the controls. The allograft survival time and the allograft function between the two groups were compared. Results The allograft survival time of the transfection group was longer than that of the controls significantly [(28?7.3)d vs (8.6?1.2) d, P