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Global Cancer Statistics for 2020 show that urinary system tumors account for approximately 13% of the total number of cancers. At present, the diagnostic methods of urinary system tumors are imaging, endoscopy, and pathological examination. As the gold standard of tumor diagnosis, pathological examination has problems such as lack of pathologists and long operation time. Artificial intelligence (AI), with a strong ability for pathology image recognition and feature analysis, can be used as an auxiliary diagnosis. It has realized automatic diagnosis, typing, staging, grading, and prognosis prediction in several urinary system tumors. However, AI still has many shortcomings, which limit its clinical application. This article will review the progress of AI and its application in the pathological study of urinary system tumors.
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The incidence of bladder cancer is increasing annually, and the gold standard for its diagnosis relies on histopathological biopsy. Whole-slide digitization technology can produce thousands of high-resolution captured pathological images and has greatly promoted the development of digital pathology. Deep learning, as a new method of artificial intelligence, has achieved remarkable results in the analysis of pathological images for tumor diagnosis, molecular typing, and prediction of prognosis and recurrence of bladder cancer. Traditional pathology relies heavily on the professional level and experience of pathologists; as such, it is highly subjective and has poor reproducibility. Deep learning can automatically extract image features. It can also improve diagnostic efficiency and repeatability and reduce missed and misdiagnosed rates when used to assist pathologists in making decisions. This technology cannot only alleviate the pressure of the current shortage of skilled workforce and uneven medical resources but also promote the development of precision medicine. This article reviews the latest research progress and prospects of deep learning in pathological image analysis of bladder cancer.
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Objective:To summarize the institutional experiences of treating vascular complications caused by donor-derived infection(DDI)after kidney transplantation(KT).Methods:From January 1, 2015 to December 31, 2020, clinical data were retrospectively reviewed for 6 cases of vascular complications caused by DDI.Age, gender, surgical approaches, immunity induction therapy, immune suppression therapy, infection prevention, onset time of complication, type of complications, infection pathogens, therapeutic protocols and prognoses were summarized.Results:Six patients developed vascular complications caused by DDI in 997 KT recipients with an overall morbidity rate of 0.6%.In 3 cases, carbapenem resistant Klebsiella pneumoniae were positive in culture of secretion and blood samples.And Candida albicans was detected by blood cultures and pathological examinations.One case of antibiotic resistant Staphylococcus aureus was detected by blood culture.Among 3 cases of transplant kidney artery pseudoaneurysm on interventional therapy, there were curing(1 case)and immediate recurrent infection(2 cases). The latter two eventually died by cardiac complications.In 2 cases of arterial hemorrhage, graft nephrectomy was followed by hemodialysis.One case of transplanted renal artery stenosis was successfully cured by artery stenting and survived with normal graft function so far.Conclusions:Interventional endovascular therapy and open surgery are indicated for vascular complications caused by DDI post-KT.Interventional therapy may boost the odds of rescuing transplant kidney.However, clinicians should watch out for the risk of recurrent infection.Open surgery is an effective tool of eliminating infected focus.Preserving transplant kidney or nephrectomy may be adopted on the basis of specific conditions.
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The clinical data of 1 patient with long-term survival metastatic prostate cancer were analyzed retrospectively, and the related literature was reviewed and discussed. The patient, male, 70 years old, was admitted to the hospital in 2009 due to dysuria with lower abdominal pain for one month.Blood PSA>1 000 ng/ml. The pathology of prostate biopsy was prostatic adenocarcinoma, Gleason score was 8 points (4+ 4), and was diagnosed as prostate cancer (T 4N 0M 1b) with bone metastasis. The patient underwent combined androgen-blocked treatment(castration and bicalutamide 50mg) for four years, then progressed to mCRPC. The initial treatment was continued in the fifth year due to the absence of novel therapeutic agents, and then symptoms progressed. The regimens were adjusted successively to increased anti-androgen (castration and bicalutamide 150 mg) from Jan 2015, then switch to another anti-androgen (Flutamide 250 mg) from Aug 2015, and then withdraw the anti-androgens from Feb 2016. All these treatments showed limited benefit for a relatively short time. The t-PSA increased steadily to over 1 000 ng/ml with persistent symptoms. In April 2017, he started the treatment with the original abiraterone acetate and underwent a PSA flare-up in the following month.tPSA decreased sharply since May 2017, less than 0.02ng/ml in Aug 2017. Meanwhile, the regimen relieved the ostealgia. He could take care of himself in daily life. raditional CAB therapy can maintain PSA-free progression and symptom-free progression for several years for some metastatic prostate cancer patients. After disease progression, the increased dosage of anti-androgens, the substitution of anti-androgen, and the withdrawal of anti-androgens showed limited benefit within a short time. However, the novel hormone therapy is still effective in relieving clinical symptoms and prolonging patients' survival time.
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Objective: To explore the clinicopathological features and the diagnostic value of the CT scan in multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) and cystic nephroma (CN). Methods: The clinical data of 12 patients with CN and 20 patients with MCRNLMP, confirmed by pathology at the Renmin Hospital of Wuhan University and Jingzhou Central Hospital from Janu-ary 2000 to March 2019, were retrospectively analyzed. The receiver operating characteristic (ROC) curves were used to analyze the feature of contrast-enhanced CT images of the tumors, and the immunophenotypes of the tumors were observed by immunohisto-chemistry. Results: There were statistically significant differences between MCRNLMP and CN in terms of thickness of the cyst wall and partition, number of soft-tissue enhancing masses, peak intensity of enhancement, and the Bosniak classification (P<0.05). Based on ROC curve analyses, when the thickness of the capsule wall and partition was greater than 2.25mm, the number of enhanced high-density lesions was greater than 1, and the peaking intensity of fortification was above the moderate level in the diagnosis of CRNLMP. The areas under the curve of the three indexes were 0.879, 0.800 and 0.838, which can be used as the best diagnostic criterion for MCRNLMP. Immunophenotyping revealed that MCRNLMP characteristically expressed the renal cell carcinoma (RCC) marker, and CN characteristically expressed the estrogen receptor(ER) and progesterone receptor(PR). Conclusions: The cyst wall and septal thickness, number of soft-tissue enhancing masses, and peak intensity of enhancement show a higher diagnostic value in differentiating MCRN-LMP and CN. The precise diagnosis relies on the pathological and immunohistochemical examination.
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Objective To investigate the effect of apigenin and the change of expression of Fas/FasL after renal ischemia/reperfusion injury in rats.Methods Establishing Renal ischemia/reperfusion injury rat model was established.Sixty rats were randomly divided into 5 Groups.Blood samples were collected for the detection of serum creatinine and urea nitrogen levels.The level of SOD,MDA and GSH-Px were detected.Histologic examinations were evaluated.The expression of Fas,FasL,Caspase-3 and Bcl-2 were performed by immunohistochemistry and Western blot.Results Compared with the sham group,the Cr and BUN levels in the I/R groups of were significantly increased,the level of SOD and GSH-Px reduced,the level of MDA improved.Histopathological damage of renal tubular aggravated.The immunohistochemical expression of FasL and Caspase-3 as shown in enhanced and Bcl-2 reduced.Western blot showed that Fas and FasL expression increased and Bcl-2 reduced significantly,and the difference was statistically significant (P ＜ 0.05).Compared with I/R group,apigenin significantly enhanced renal function,and alleviated renal tubular epithelial cell injury and decreased Fas,FasL and Caspase-3 expression,improved Bcl-2 expression,difference were statistically significant (P ＜ 0.05).Conclusion Apigenin can protect the rats subjected to ischemia/reperfusion injury.Its protective mechanism may be related to the inhibition in expression of Fas/FasL and the increase in expression of Bcl-2.
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Objective To investigate the effects of metformin preconditioning on renal ischemia-reperfusion injury in rats and its possible mechanism.Methods A total of 30 rats which were healthy adult male SD rats weighing 220-250g were randomly divided into 3 groups randomly (n =10):sham operation group (Sham group),ischemia reperfusion group (I/R group) and metformin group (Metformin + I/R group).Group metformin + I/R was given intraperitoneal injection of metformin 0.125mg/(kg · d) before the establishment of I/R model,14days,while Sham group and I/R group were given equal amount of normal saline.After the end of administration,I/R group and metformin + I/R group used the mnethod of removing the right kidney,clamping the left renal artery and vein 45min after the recovery of perfusion to prepare the rat model of renal ischemia and reperfusion.In Sham group,resection of the right kidney was performod,without clamping the left renal artery and vein.Determination of serum creatinine in the blood from inferior vena cava at 24h after reperfusion (Cr) and urea nitrogen (BUN) concentration was performed.Then the rats were sacrificed.Renal tissue morphology,immunohistochemical expression of Bcl-2,Bax and caspase-3 were observed under light microscope.At the same time,Tunel staining were used to evaluate the degree of renal tubular epithelial cell apoptosis.Results Compared with sham group,BUN and Cr in the I/R group and metformin + I/R group were significantly higher than those in the sham group,while the BUN and Cr in the Metformin + I/R group were significantly lower than those in the I/R group,and the difference was statistically significant (P ＜ 0.05).Immunohistochemistry showed that,compared with Sham group,in I/R group and metformin + I/R group,the expression of Bcl-2,Bax and caspase-3 increased significantly.Compared with I/R group,in metformin + I/R group,caspase-3 and bax expression decreased significantly,while the expression of Bcl-2 was stronger than I/R group.Tunel results showed that compared with Sham group,I/R metformin + I/R group and the number of apoptosis of renal tubular epithelial cells was significantly increased in metformin + I/R group.At the same time,the apoptosis of renal tubular epithelial cells was significantly less than I/R group,and the difference was statistically significant.Conclusion Metformin pretreatment can improve renal damage in rats with renal ischemia-reperfusion injury,which may be related to the inhibition of renal tubular epithelial cell apoptosis.
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Objective To investigate the effects of metformin preconditioning on renal ischemia-reperfusion injury in rats and its possible mechanism.Methods A total of 30 rats which were healthy adult male SD rats weighing 220-250g were randomly divided into 3 groups randomly (n =10):sham operation group (Sham group),ischemia reperfusion group (I/R group) and metformin group (Metformin + I/R group).Group metformin + I/R was given intraperitoneal injection of metformin 0.125mg/(kg · d) before the establishment of I/R model,14days,while Sham group and I/R group were given equal amount of normal saline.After the end of administration,I/R group and metformin + I/R group used the mnethod of removing the right kidney,clamping the left renal artery and vein 45min after the recovery of perfusion to prepare the rat model of renal ischemia and reperfusion.In Sham group,resection of the right kidney was performod,without clamping the left renal artery and vein.Determination of serum creatinine in the blood from inferior vena cava at 24h after reperfusion (Cr) and urea nitrogen (BUN) concentration was performed.Then the rats were sacrificed.Renal tissue morphology,immunohistochemical expression of Bcl-2,Bax and caspase-3 were observed under light microscope.At the same time,Tunel staining were used to evaluate the degree of renal tubular epithelial cell apoptosis.Results Compared with sham group,BUN and Cr in the I/R group and metformin + I/R group were significantly higher than those in the sham group,while the BUN and Cr in the Metformin + I/R group were significantly lower than those in the I/R group,and the difference was statistically significant (P ＜ 0.05).Immunohistochemistry showed that,compared with Sham group,in I/R group and metformin + I/R group,the expression of Bcl-2,Bax and caspase-3 increased significantly.Compared with I/R group,in metformin + I/R group,caspase-3 and bax expression decreased significantly,while the expression of Bcl-2 was stronger than I/R group.Tunel results showed that compared with Sham group,I/R metformin + I/R group and the number of apoptosis of renal tubular epithelial cells was significantly increased in metformin + I/R group.At the same time,the apoptosis of renal tubular epithelial cells was significantly less than I/R group,and the difference was statistically significant.Conclusion Metformin pretreatment can improve renal damage in rats with renal ischemia-reperfusion injury,which may be related to the inhibition of renal tubular epithelial cell apoptosis.
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Objective To summarize the experience in retroperitoneal living donor nephrectomy under 3D laparoscopy and to investigate its clinical effect and safety. Methods The clinical data of 19 cases who underwent retroperitoneal living donor nephrectomy under 3D laparoscopy were collected.Operation duration,intraoperative blood loss, renal warm ischemia time,length of renal artery,renal vein and ureter,incision size and operative complications were recorded.Postoperative renal function of donors and recipients was observed. Results Nineteen cases of living donor nephrectomy were successfully completed under the 3D laparoscopy,and there were no conversion into conventional laparoscopy and open surgery.The operation duration of living donor nephrectomy under 3D laparoscopy was 80.5﹣125.2 (with an average of 102.3)min;intraoperative blood loss was 40.6﹣90.4 (60.8)ml;renal warm ischemia time was 100﹣230 (161)s.Length of renal artery,renal vein and ureter was 2.6﹣3.2 (2.9)cm,2.2﹣3.0 (2.6)cm and 8﹣13 (10)cm, respectively.The incision size was about 5﹣6 cm,and the wound healed.Urine volume of the donors at 24 h after operation was 2 000﹣2 500 ml.Serum creatinine increased slightly in 1 case at 3 d after operation,and returned to normal through reexamination after 7 d and 1 month.The donors stayed in the hospital 5﹣7 (6)d after operation.All transplant operations were performed successfully,and delayed graft function did not occurred. Conclusions Accuracy of operation can be improved effectively by 3D laparoscopic surgery system.It is safe and feasible to perform retroperitoneal living donor nephrectomy under 3D laparoscopy.
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Objective To investigate the effect and mechanism of pretreatment with allopurinol on renal ischemia-reperfusion injury (IRI)in rats.Methods Twenty four rats were randomly assigned into the sham operation (S), ischemia-reperfusion (IR)and allopurinol pretreatment (APC)groups (n =8 for each group).At preoperative 2 weeks, allopurinol at a dose of 50 mg/(kg·d)was administered via intraperitoneal injection in the APC group,and an equivalent quantity of physiological saline was given via intraperitoneal injection in the S and IR groups.After pretreatment,the right kidneys of rats in the S group were resected.In the IR and APC groups,the right kidneys were resected and the left kidneys were treated with 30 min ischemia-reperfusion.Blood sample was collected at 24 h after reperfusion and the kidney specimen was obtained at postoperative 2 weeks.The levels of blood urea nitrogen (BUN)and serum creatinine (Scr)were detected by automatic biochemistry analyzer.The activity of plasma malondialdehyde (MDA)and superoxide dismutase (SOD)was respectively assessed by detection kits.The expression levels of Bax,Bcl-2 and Caspase-3 of rat kidney were measured by western blot.Pathological changes in the rat kidney were observed under light microscope.Cell apoptosis of rat kidney was evaluated by TdT mediated-dUTP nick end labeling (TUNEL).Results Compared with the S group,the levels of BUN, Scr and plasma MDA in the IR and APC groups were significantly increased,whereas the activity of plasma SOD was significantly reduced (all in P <0.05).Compared with the IR group,the levels of BUN,Scr and plasma MDA in the APC group were significantly reduced,whereas the activity of plasma SOD was considerably elevated (all in P <0.05).Compared with the S group,the expression levels of Bax and Caspase-3 proteins were significantly up-regulated in the IR and APC groups,and the levels in the APC group were considerably lower than those in the IR group (all in P <0.05).Compared with the S group,the expression of Bcl-2 in rat kidney in the IR and APC groups was significantly down-regulated,and the value in the APC group was dramatically higher than that in the IR group (all in P <0.05).Under light microscope,the morphology of rat kidney was intact and normal in the S group.In the IR group,evident renal tubular ectasia,massive necrosis of renal tubular epithelial cells,evident stromal edema and a large quantity of lymph cellular infiltration were observed.In the APC group,mild renal tubular ectasia was observed,whereas no apparent kidney stromal edema was noted.A slight amount of lymph cellular infiltration was noted in the stroma.TUNEL staining revealed that the apoptosis rate of kidney cells in the S,IR and APC groups was (4.1 ±1 .7)%,(32.8 ±8.9)% and (1 2.6 ±3.4)% (all in P <0.05).Conclusions Allopurinol pretreatment could suppress cell apoptosis through anti-oxidation effect,thereby alleviating IRI of rat kidney and improving renal function.
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Objective To compare clinical efficacy and safety between standard double-and single-dose of basiliximab in renal transplantation.Methods A total of 121 patients undergoing allogeneic cadaveric renal transplantation in Department of Urology of Renmin Hopsital of Wuhan University from January 2008 to May 2011 were recruited as study subjects.Among them,53 patients were assigned into the double-dose of basiliximab group and they were intravenously administered with 20 mg of basiliximab before and 4 d after surgery according to product description.Sixty-eight cases were allocated in the single-dose of basiliximab group and they were given with 20 mg of basiliximab before renal transplantation.The changes of immune function in two groups during perioperative period were monitored.The incidence of adverse reactions including delayed graft function (DGF),acute rejection,pulmonary infection and the survival of patients and renal grafts were statistically compared between two groups.Results There was no significant difference in preoperative humoral immune and cellular immune function between two groups.Compared with preoperative period,cellular and humoral immune function in both groups were inhibited by varying degree at 5 d after surgery (both in P <0.05).Compared with patients in the single-dose group,cellular and humoral immune functions were evidently suppressed in the double-dose group (both in P <0.05).Compared with the parameters assessed at 5 d after surgery,cellular and humoral immune functions were restored to varying degree at 15 d after surgery,whereas still significantly lower than preoperative levels (CD3,CD4,IgM and IgA).Partial parameters (CD8 and IgG)were persistently inhibited and continued to decline compared with the levels at 5 d after surgery.The incidence of DGF was 8% in the double-dose group,and 7% in the single-dose group.During 1-year follow-up,the rejection rates in the double-and single-dose groups were 13% and 12%,and the incidence of pulmonary infection was 9% and 10%.No statistical significance was noted between two groups in terms of these parameters (all in P >0.05).The 1-year survival of patients in the double-and single-dose groups was 94% and 98%,93% and 96% for the survival of renal grafts.No statistical significance was found between two groups (both in P >0.05).Conclusions Both double-and single-dose of basiliximab are efficacious in renal transplantation and do not increase the incidence of adverse reaction.The 1-year survival rates of patients and renal grafts between two groups are almost equivalent.Detection of immune function during perioperative period effectively guides individualized immune induction therapy.
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ObjectiveTo investigate the protective effect of ozone oxidative preconditioning (OzoneOP) on apoptosis induced by acute renal ischemia/reperfusion (I/R) injury in rats.Methods The right kidneys of rats in control group were excised.A rat I/R model was established in I/R group.In OzoneOP group,the renal OzoneOP was induced by rectal insufflation of 5.0～5.5 ml oxygen plus ozone (ozone 50 mg/L,1 mg· kg- 1 · d- 1,once every day).The parameters (blood urea nitrogen and creatine )of renal function were determined by auto-biochemical analyzer. The concentrations of malondialdehyde (MDA) and superoxide dismutase (SOD) were measured by using chromometry.Cytochrome c (CytC) was examined by using immunohistochemistry and Western blotting.The mRNA expression levels of TNF-α,IL-1β and IL-6 in the renal tissue were detected by using RT-PCR.ResultsCompared with the control group,the blood urea nitrogen,creatine,MDA and the release of CytC were increased significantly in I/R group.After OzoneOP,the levels of blood urea nitrogen,creatine,MDA,CytC and the mRNA expression levels of TNF-α,IL-1-β and IL-6were significantly decreased and SOD levels were significantly increased.ConclusionOzoneOP could relieve renal I/R injury of rats by improving antioxidation capability,cutting down cytokines contents and inhibiting the release of CytC from mitochondria.
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Objective To investigate the expression of hepatocyte growth factor activator inhibitor- 1 (HAl-1) gene in the tissues of renal cell carcinoma (RCC) and the correlation with tumor angiogenesis.Methods The expression of HAI-1 gene was detected by semi-quantitative RT-PCR in the tissues of 56 cases of RCC,corresponding adjacent non-cancer tissues and 12 nomad renal tissues,the expression of CD34was detected by immunohistochemistry SP method in the above-mentioned organizations,and counted the microvessel density (MVD),analyzed the relationship between the expression of HAI-1 gene in RCC and clinicopathological parameters,MVD.Results The positive expression rate of HAI-1 gene in RCC tissues,the adjacent non-cancer tissues and normal renal tissues were 58.93％(33/56),76.79％(43/56) and 91.67％(11/12),respectively.The expression of HAI-1 gene was a negative correlation to the Fuhrman histological grade,Robson clinical stage (r ＝ -0.617,-0.432,P ＜ 0.01 or ＜ 0.05 ).The positive expression rate in lymph node metastasis was significantly lower than that in without lymph node metastasis [ 35.29％(6/17) vs.69.23％(27/39),P＜ 0.05 ].The MVD in RCC tissues was significantly higher than that in the adjacent noncancer tissues and normal renal tissues(P＜ 0.05).The expression of HAI-I gene in RCC tissues was negative correlated to the MVD (r ＝ -0.516,P ＜ 0.01 ).Conclusions There is a certain relationship between the missing expression of HAI-1 gene in RCC and the development,invasion and metastasis of RCC.The HAI-1 gene deletion can be used as an important molecular marker in the invasion and metastasis of RCC.
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Objective To investigate the influence of m4-1BBL on the anti-tumor effects induced by truncated human prostate specific membrane antigen (tPSMA) gene in mice. Methods A eukaryotic expression plasmid encoding tPSMA and m4-1BBL (pDC316-tPSMA-IRES-m4-1BBL), pDC316-tPSMA and pDC316 were constructed. C57BL/6 mice were vaccinated in the quadriceps femoris, respectively. The CTL activity of spleen cells from the immunized mice against prostate cancer RM-1-tPSMA was detected by CCK-8 kit in vitro. The tumor growth was then observed. Results The target cell specific cytotoxicity rate induced by pDC316-tPSMA-IRES-m4-1BBL was 42.6%, compared to 24.8% in the pDC316-tPSMA group and 10.8% in the pDC316 group. The difference was significant (P<0.05). The volume of tumor in the pDC316 group was 2657.4mm3 7 d after vaccination, compared to 1334.5 mm3 in the pDC316-tPSMA group, 9 d after vaccination. In the pDC316-tPSMA-IRES-m4-1BBL group, the tumor volume was 445.8 mm3, 12d after vaccination. The difference was significant (P<0.05). Conclusion Gene vaccines co-expressing tPSMA gene and m4-1BBL gene could significantly enhance anti-prostate cancer effects in mice.
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Objective To evaluate the predictive value of urinary neutrophil gelatinase-associat-ed lipocalin (NGAL) and interleukin-18 (IL-18) for delayed graft function (DGF) in kidney transplan-tation. Methods Serial urine samples collected at 0, 12 and 24 h after operation from 86 kidney transplantation patients were analyzed by enzyme-linked immunosorbent assay for NGAL, IL-18 and RBP. Results Fifteen patients developed DGF. At 12 h after transplantation, the level of urine NGAL elevated significantly (1712.75±474.6 vs. 863.1±199.8 without DGF, P<0. 001). The in-creases of urine IL-18 (29. 2±4.1 vs. 28.7±4.2 without DGF, P>0. 05) was not significant. At 24 h, both urine NGAL(2905.0±1108.1 vs. 911.8±221.0 without DGF,P<0. 001) and IL-18(211.3± 34.0 vs. 86.9±22.8 without DGF, P<0. 001) increased significantly, whereas the changes of urine RBP and serum creatinine (SCr) were not significant. ROC analysis showed that the area under the curve of NGAL and IL-18 were 0. 90 and 0.76 respectively, the cut-off values were 996.5 ng/mg and 148.5 ng/mg, the diagnostic sensitivities in DGF were 90.2% and 76.3%, specificities were 82.6% and 66.4% respectively. Conclusions Both urine NGAL and IL-18 could potentially be early predic-tive marker of DGF. The level of NGAL elevated earlier than IL-18, which may be more effective in predicting DGF.
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Objective To investigate the effects of isehemic postconditioning (IPO) on the acute renal ischemia/reperfusion (I/R) injury in dogs. Methods Fifteen adult male mongrel dogs were randomly divided into three groups with 5 animals in each group. In sham operation group (S), after the dogs were anesthetized, the midline laparotomy was made and right nephrectomy was performed;In I/R group, animals were subjected to the similar surgical procedures, except that the left renal vessels were clamped; In IPO group, the IPO was induced by 6 cycles of reperfusion (30 s) and ischemia (30 s) after 60 min renal ischemia before reperfusion completely. Blood samples were obtained for determination of blood creatinine (Cr) and urea nitrogen (BUN) concentrations before operation and at 24, 48 and 72 h after operation. The dogs were killed at the thirdday after operation and left kidneys were removed for determination of SOD activity and MDA and MPO concentrations.The apoptosis in the nephridial tissue was assessed by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) and apoptotic index (AI) was calculated. The changes of renal tissue were examined by a microscope. Results Blood Cr and BUN concentrations in I/R group, IPO group and S group were decreased in turn after operation (P<0. 05). MDA and MPO concentrations were decreased significantly, SOD activity was significantly increased and AI was decreased significantly in IPO group as compared with I/R group at 72 h after operation (P<0. 05). Microscopic examination showed that there was no renal injury in S group and renal I/R resulted in tubular necrosis, medullary hemorrhage congestion and proteinaceous casts in I/R group. The renal I/R injury was significantly attenuated by IPO. In S group, IPO group and I/R group the renal AI was 2. 7 ±1.3, 28. 4 ± 6. 2 and 15.4±4. 1 respectively (P<0. 05). Conclusion IPO can attenuate renal damage induced by I/R by inhibiting oxidative stress and apoptosis and decreasing inflammation.
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Objective To observe the effects of Triptolide on the expression of toll-like receptor 4 (TLR4) in renal ischemia/reperfusion (I/R) injury in rats. Methods A renal I/R model was established. Rats were randomly separated into the following experimental groups. Group 1, shamoperated control (n = 15) : rats were subjected to surgical manipulation, without the induction of renal ischemia. Group 2, I/R (n = 18): rats were subjected to left renal ischemia for 45 min followed by reperfusion. Group 3, TRI + I/R (n = 18): Before the I/R procedure (as in group 2), rats were intraperitoneally injected with TRI (0.4 mg/kg), once every day, three times. Rats were killed at the 1st, 3rd, and 5th day after I/R injury. The parameters of renal function were determined by autobiochemical analyzer. The expression of TLR4 was detected by RT-PCR and Western blotting. Results As comparedwith the sham-operated control group, serum BUN and Cr levels were significantly increased in the rats undergoing I/R procedure at the 1st, 3rd, and 5th day (P＜0. 01). After the treatment with TRI, the levels of BUN and Cr and the expression of TLR4 in the renal tissues were significantly decreased (P＜0. 05). Conclusion TRI could relieve renal I/R injury in rats by inhibiting the TLR4 expression.
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Percutaneous nephrostomy was applied in some other urologic diseases and the efficacy was evaluated. Percutaneous nephrostomy for percutaneous nephrolithotomy (PNL) was performed in patients with various renal, perinephric and bladder diseases (n=79). The tract establishment, operation duration and complications were observed and the efficacy was assessed. The results showed that the tracts were successfully established in 79 cases. The operation lasted 4-20 min. 12F-16F single tract was established in nephrohydrop patients and 16F-20F single or multiple tracts were established in patients with pyonephrosis, renal cortical abscess, renal cyst and perinephric abscess. During dilation, no leakage of liquor puris was noted. Establishment of 18F single tract was achieved in one urinoma patient. In two patients with foreign body in kidney, the foreign bodies were removed via established 14F single tract. 18F tracts were established in 2 patients with bladder contracture, which was followed by the placement of 16F balloon urethral catheter for drainage. No complications, such as massive bleeding, intestinal injury and spreading of infection took place in our series. All the patients were followed up for 2-12 months. No long-term complications such as dropping of drainage tube occurred. It is concluded that as a minimally invasive technique, percutaneous nephrostomy has the advantages of convenience, simplicity and causing less complications and can be used for various urologic diseases.
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To observe the efficacy and safety of mini-percutaneous nephrolithotomy with Neodymium: Yttrium Aluminum Garnet (Nd-YAG) laser in the treatment for upper urinary tract stones, from December 2005 to September 2006, 31 patients with renal stones, 15 patients with ureteral stones and 7 patients with renal and ureteral stones underwent mini-percutaneous nephrolithotomy with Nd-YAG laser by combination of rigid ureteroscope and flexible ureteroscope under B-ultrasound guidance. Clinical data including operation time, lithotripsy time, complications and stone-free rate were analyzed retrospectively. Our study showed that the percutaneous renal access (F14-F18) was successfully established under B-ultrasound guidance in all cases. Immediate phase: lithotripsy was performed in 47 cases through single tract, and in one case through two tracts. Delayed phase II lithotripsy was done in 5 cases of renal stones. Operation time ranged from 55 to 180 min with an average time of 100+/-15 min. Lithotripsy time was from 25 to 135 min and the average lithotripsy time was 65+/-11 min. No severe complications occurred in our series. Complex renal stones were cleared in 34 of 38 cases (89.5%). All ureteral stones were completely removed in 15 cases (100%). It was concluded that mini-percutaneous nephrolithotomy with Nd:YAG laser for the treatment of upper urinary tract stones by combination of rigid ureteroscope and flexible ureteroscope has the advantages of effectiveness, mini-invasion, shorter operative time and safety.
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To observe the efficacy and safety of mini-percutaneous nephrolithotomy with Neodymium:Yttrium Aluminum Garnet (Nd-YAG) laser in the treatment for upper urinary tract stones, from December 2005 to September 2006, 31 patients with renal stones, 15 patients with ureteral stones and 7 patients with renal and ureteral stones underwent mini-percutaneous nephrolithotomy with Nd-YAG laser by combination of rigid ureteroscope and flexible ureteroscope under B-ultrasound guidance. Clinical data including operation time, lithotripsy time, complications and stone-free rate were analyzed retrospectively. Our study showed that the percutaneous renal access (F14-F18) was successfully established under B-ultrasound guidance in all cases. Immediate phase Ⅰ lithotripsy was performed in 47 cases through single tract, and in one case through two tracts. Delayed phase Ⅱ lithotripsy was done in 5 cases of renal stones. Operation time ranged from 55 to 180 min with an average time of 100 ± 15 min. Lithotripsy time was from 25 to 135 min and the average lithotripsy time was 65 ± 11 min. No severe complications occurred in our series. Complex renal stones were cleared in 34 of 38 cases (89.5 %). All ureteral stones were completely removed in 15 cases (100 %). It was concluded that mini-percutaneous nephrolithotomy with Nd:YAG laser for the treatment of upper urinary tract stones by combination of rigid ureteroscope and flexible ureteroscope has the advantages of effectiveness, mini-invasion, shorter operative time and safety.