Analysis on prognosis of pulmonary infection after renal transplantation by Cox risk model / 器官移植

Objective To analyze the relevant factors affecting prognosis of pulmonary infection after renal transplantation.Methods The clinical data of 40 patients who suffered from pulmonary infection after renal transplantation at the First Affiliated Hospital of Jinan University from January 2000 to December 2010 were analyzed retrospectively.By Cox risk model,single and multi-analysis were performed on 20 possible factors,including age,gender,time of infection,type of infection,white blood cell count,neutrophil ratio, hemoglobin,blood glucose,serum creatinine (Scr),pulmonary infection complicated with acute respiratory distress syndrome or acute pulmonary injury,rejection,blood transfusion,infusion of albumin,infusion of immune globulin,use of ventilator,way of offering oxygen,immunosuppressive regimen,dosage change of immunosuppressant,anti-infection therapeutic regimen and length of stay.Results and Conclusions Triple immunosuppressive therapy without mycophenolate mofetil (MMF ) and increase of neutrophil ratio were independent risk factors for pulmonary infection after renal transplantation.Triple immunosuppressive therapy with MMF combined with early anti-infection therapeutic regimen may improve patient and graft survival of patients with pulmonary infection after renal transplantation.

Effects of ethane 1,2-dimethanesulfonate preconditioning on renal ische-mia/reperfusion injury in male rats / 中国病理生理杂志

AIM:To investigate the effects of ethane 1,2-dimethanesulfonate (EDS) preconditioning on renal ischemia/reperfusion (I/R) injury in male Sprague-Dawley (SD) rats.METHODS: Male SD rats (n=48) were ran-domly assigned to 6 groups:blank, sham, I/R, EDS+I/R, EDS+testosterone (TST) +I/R, and castration (Cast)+I/R.The renal pedicles were bilaterally occluded with a microvascular clamp for 45 min to establish renal I/R-induced in-jury model.Bilateral orchiectomy was conducted 2 weeks before surgery .EDS (75 mg/kg) was intraperitoneally injected 5 d before operation .Blood samples were collected 24 h after reperfusion from the vena orbitalis posterior plexus .Luteinizing hormone (LH), TST, serum creatinine (SCr), blood urea nitrogen (BUN), and kidney injury molecule-1 (KIM-1) were detected.The renal tissues were harvested to measure the level of TNF-αand the expression of Fas mRNA and caspase-3 protein.RESULTS:Serum TST levels in EDS +I/R group and Cast +I/R group were below the minimum detectable threshold.Compared with other groups , the rats in EDS+I/R group and Cast +I/R group had higher levels of SCr , BUN and KIM-1 (P0.05), but KIM-1 level in EDS+I/R group was lower than that in Cast +I/R group (P<0.05).After reper-fusion for 24 h, the levels of TST and LH in EDS +I/R group, Cast+I/R group and EDS+TST+I/R group were lower than those 1 h before operation (P<0.05).Compared with Cast+I/R and I/R group, the TNF-αlevel and expression of Fas mRNA and caspase-3 protein were significantly decreased in EDS +I/R group ( P<0.05 ) .CONCLUSION: EDS preconditioning substantially reduces the serum TST level , thus attenuating I/R-induced acute renal injury .TNF-α-induced Fas/FasL pathway may be involved in this process .

The therapeutic effects of cystectasia with Sodium Hyaluronate solution on ketamine related cystitis / 中华泌尿外科杂志

Objective To investigate the effects of cystectasia with sodium hyaluronate solution on ketamine related cystitis.Methods From June 2008 to October 2012,29 patients with ketamine related cystitis were analyzed,among which 27 were males and 2 were females.Their age ranged from 18 to 36 years old with a mean age of 25.All of them had frequency,urgency,urodynia and suprapubic pain.Voiding volume ranged from 10 to 160 ml and the interval duration ranged from 10 to 60 min.The test of ketamine in urine was positive.Patients were divided into four groups according to the treatment modality,namely the surgical treatment group (group A,n =11),surgery followed by addiction relapse group (group B,n =7),drug treatment group (group C,n =6) and non-drug treatment group (group D,n =5).Patients in group A and B underwent cystectasia with sodium hyaluronate solution under combined spinal-epidural anesthesia,and patients in group B were reported of addiction relapse within 2 weeks after cystectasia treatment.Patients in group C were free of the addiction to ketamine,while those in group D still rely on the ketamine.The average urine volume,OABSS and PUF scores were recorded 2 weeks and 4 weeks after the treatment.Results Two weeks after cystectasia,the average urine volums in group A and B were (107.7±39.6) ml and (95.0±35.5) ml respectively,which was larger than that in group D (42.0±13.5) ml,plus the volume in group A was larger than that in group C (63.3± 16.3) ml.The aforementioned differences were considered statistically significant (P＜0.05).As for OABSS and PUF scores,scores in group A [(6.0±2.6),(14.8± 4.2)] were lower than those in group C [(9.5±2.4),(22.5±2.2)].Furthermore,scores in group B [(9.0±2.4),(19.57±2.7)] were lower than those in group D [(12.2±1.9),(26.4±3.5)] (P＜0.05).Four weeks later,the average urine volume,OABSS and PUF scores in group A [(106.4±37.5) ml,(5.6± 2.5),(13.5±4.0)] and group C[(113.3±27.3) ml,(6.3±2.2),(14.5±2.7)] were significantly different from those in group B [(52.1±21.6) ml,(11.1±1.3),(26.4±2.8)] and group D [(40.0±13.7)ml,(12.0±1.6),(26.6±3.6)] (P＜0.05).While,no obvious distinction was observed between group A and group C,group B and group D in terms of average urine volume,OABSS and PUF scores at 4 weeks postoperatively (P＞0.05).Conclusions Cystectasia can efficiently alleviate lower urinary tract syndromes in patients with ketamine related cystitis.

The protective effects on the renal allografts from brain dead donor rats pretreated with bone marrow mesenchymal stem cells / 中华器官移植杂志

Objective To investigate the protective effects on the renal allografts from brain dead (BD) donor rats pretreated with bone marrow mesenchymal stem cells (MSCs).Method Three groups [normal transplant group (G1).BD transplant group (G2),and MSCs pretreated + BD transplant group (G3)] were set up.Male F344 rats served as donors and male Lewis rats as recipients.In G1,kidneys from F344 donor rats were implanted into Lewis recipients.In G2,kidneys from F344 BD donor rats were engrafted into Lewis recipients.In G3,after BD was established in F344 rats,MSCs were given intravenously to the rats.The kidneys harvested 6 h later were transplanted to Lewis recipients.Cyclosporine was intromuscularly given daily to the recipient rats for 10 days.Right kidneys were resected from recipients on day 10.Creatinine level was examined on day 14,21,28,and 35.Renal allografts harvested on day 35 were pathologically detected.The irnmunochemistry expression of interleukin (IL)-1β and tumor necrotic factor (TNF)-α in renal allograft tissue was tested.Result Serum creatinine levels in G2 were remarkably higher than those in G1 and G3 (P＜0.01) on day 14,21,28,and 35 postoperatively.The creatinine levels on the above mentioned time points had no statistically significant difference between G3 and G1 except on day 21.Postoperative pathological changes in G2 of both pronounced infiltration of mononuclear cells and tubular epithelia[inflammation were notably increased in renal allografts as compared with those in G1 and G3.There was no obvious difference between G1 and G3 in infiltrated mononuclear cells and tubular epithelial inflammation.Positive expression levels of both IL-1β and TNF-α in glomerular,tubular and interstitial epithelial cells were statistically enhanced in G2 as compared with those in G1 and G3 (H =7.210,P =0.027),while there was no statistically significant difference in the expression of both IL-1[β and TNF-α between G1 and G3.Conclusion Brain dead donor rats pretreated with bone marrow MSCs might reduce renal allograft injury via decreasing both inflammatory cell infiltration and IL-1β and TNF-α expression.

A recommended technique of renal vein anastomosis in rat kidney transplantation for trainee / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Various rat kidney transplantation models have been introduced over the decades and the study on the models seems to lack novelty and necessity. However, vascular anastomosis, especially renal vein, is still very difficult for trainees. The aim of this study was to provide the modified renal venous anastomosis of rat kidney transplantation to substitute the current method for trainees.</p><p><b>METHODS</b>Male Wistar rats were used as donors and recipients, respectively. Left orthotopic transplantation was performed with a modified technique of renal vein anastomosis, combining the end-to-end sutures with epidural catheter. Meanwhile, the survival rate, warm ischemia time, renal venous anastomosis time, and complications were recorded to evaluate the merits of the modified technique compared with the current recommended technique of rat renal vein. Two trainees took part in the learning of the models in two methods for performing 30 operations, respectively.</p><p><b>RESULTS</b>The difference in warm ischemia time (from (57.25 ± 7.30) minutes in the first 10 operations to (30.05 ± 1.85) minutes in the third 10 operations) and renal vein anastomosis time (from (32.80 ± 3.80) minutes in the first 10 operations to (19.30 ± 0.98) minutes in the third 10 operations) was significantly short (P < 0.01) and the survival rate was statistically high (from (25 ± 7)% in the first 10 operations to 70% in the third 10 operations) in equal number of operations (P < 0.01) by comparing with the current recommended method ((47.60 ± 7.19) minutes to (22.8 ± 1.85) minutes, (22.40 ± 3.10) minutes to (9.95 ± 1.50) minutes, 45%± 7% to 80%± 0, respectively). The intraoperative complications and postoperative complications of renal venous anastomosis were also significantly decreased (P < 0.01).</p><p><b>CONCLUSIONS</b>The technique with epidural catheter can shorten the learning curve of the trainee learning rat kidney transplantation. It may replace the currently recommended technique of rat renal vein for trainees.</p>

Clinical diagnosis and surgical management of ureteral obstruction after renal transplantation / 中华器官移植杂志

Objective To investigate the diagnosis and surgical management of ureteral obstruction after renal transplantation.Method A respective study was performed on 15 cases of ureteral obstruction who received renal allografts.All of the cases were confirmed,including 5 cases of stenosis of ureterovesical junction,4 cases of stenosis of distal ureter,2 cases of blood clot blockage,2 cases of edema due to perforation of distal ureter,1 case of ureteral calculi,and 1 case of extrinsic compression of hematoma.All 14 patients underwent open surgical management to reestablish ureter with D-J catheter as stent for 12-16 weeks.One patient was subjected to percutaneous nephrostomy followed by percutaneous ureteroscopy,the obstructed site was identified at ureterovesical junction and antegrade balloon dilation and D-J stent in ureter were performed subsequently.Result Fifteen patients were diagnosed as ureteral obstruction by colour Doppler ultrasound and MRU.All of the patients were resolved the obstructions after surgical managements and the renal function got improved.No reobstruction occured during one year follow-up period.Conclusion Colour Doppler ultrasound and MRU can definitely be used to diagnose ureteral obstruction after renal transplantation.Early diagnosis and surgical management are very important.Open surgical management of the obstructed ureter is an effective method.Antigrade balloon dilation is a therapeutic approach to treat ureteral obstruction.

Expression of Engrailed-2 and β-catenin in bladder urothelial carcinoma and their significance / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the expressions of Engrailed-2 (EN2) and β-catenin in bladder urothelial carcinoma and explore their significance.</p><p><b>METHODS</b>Sixty bladder urothelial carcinoma samples of different grades and stages and 10 normal bladder mucosal tissues were examined for expressions of EN2 and β-catenin proteins and mRNA using immunochemistry, Western blotting and RT-PCR. RESULTS Compared to normal bladder mucosa, bladder urothelial carcinoma tissues showed significantly increased expressions of EN2 and β-catenin proteins (P<0.05), and the high-grade carcinoma tissues exhibited significantly stronger expressions than the low-grade ones (P<0.05); the expressions of the proteins increased also significantly with advanced pathological stages of bladder urothelial carcinoma (P<0.05). The expressions of EN2 and β-catenin mRNAs showed a consistent pattern of changes with their protein expressions.</p><p><b>CONCLUSION</b>The expressions of EN2 and β-catenin are significantly increased in bladder urothelial carcinoma. EN2 may contribute to the development and progression of bladder urothelial carcinoma by activating Wnt/β-catenin signal pathway.</p>

Promotion of calcium oxalate crystallization after human renal tubular epithelial cell injury / 中华泌尿外科杂志

Objective To investigate the injury caused by hydrogen peroxide (H2O2) on human renal tubular epithelial cell (HKC) and its effect on calcium oxalate (CaOxa) crystal crystallization time before and after the injury. Methods The injury degree of HKC by H2O2 was measured by detecting the cell survival rate and the concentration change of malonaldehyde (MDA). CaOxa crystallization was investigated by scanning electron microscopy (SEM). Results Control cells induced only a small amount of calcium oxalate dihydrate (COD) crystals, while the injured cells not only induced calcium oxalate monohydrate (COM) crystals, but also increased the number and aggregation of CaOxa crystals. After incubating with CaOxa supersaturated solution, the control group HKC cells could be injured as well. Conclusions H2O2 can cause oxidative damage on HKC. The injured HKC promotes the nucleation and aggregation of COM crystals. In the body environment, the long-term presence of crystals in urinary tract is a risk factor for stone formation.

Protective effect of hyperoxic fluid on rat liver transplantation / 中国组织工程研究

BACKGROUND: Organ for transplantation is insufficient, and primary transplant of nonfunction caused by perfusion cryopreservation occasionally occurs. It is clinically significant to reduce organ damage caused by perfusion preservation. OBJECTIVE: To explore the protective effect of hyperoxic perfusion fluid on liver transplantation in rats. METHODS: A total of 40 Wistar rats were randomly divided two groups (n = 20) and respectively poured with Ringer lactate solution or hyperoxic ringer lactate solution. Each group comprised equal number of donors and recipients to prepare liver, kidney, and pancreas transplantation models. Hyaluronic acid (HA), alanine aminotransferase (ALT) and CD8+CD28- T cells were compared between two groups at the end of perfusion, and 1st and 3rd days after liver transplantation. The acute rejection score of liver tissues were also compared after operation. RESULTS AND CONCLUSION: The HA, ALT and CD8+CD28-T cells were no significantly different between two groups before operation (P> 0.05). The HA and ALT of hyperoxic ringer lactate solution group was significantly Ringer lactate solution group after liver transplant (P < 0.05), but the CD8+CD28-T cells were greater (P < 0.05). The acute rejection scores for liver in hyperoxia liquid group were significantly less than the common liquid group (P< 0.05). Results show that hyperoxic solution can attenuate ischemia/reperfusion injury and protect rats undergoing liver transplantation.

Protective effect of pentoxifylline against renal ischemia-reperfusion injury in rabbits / 中国病理生理杂志

AIM:To study pentoxifylline(PTX) prevention against renal ischemia-reperfusion injury in rabbits. METHODS: 50 New Zealand rabbits were randomly divided into 5 groups: sham operation groups, ischemia-reperfusion injury group(I/R), I/R+hypothermia group, I/R+PTX group and I/R +PTX+hypothermia group. Except the sham operation group, the rabbit left renal arteriae were blocked with bulldog clamps for 60 min. The left kidney was removed after 24 h. The activity of SOD, the content of MDA of kidney tissue homogenate, BUN and SCr in the blood were detected, meanwhile the pathological structure were observed. RESULTS: In I/R group, the renal tubule showed hydropic degeneration, hemorrhage and necrosis. A large number of inflammatory cells were infiltrated in the hemorrhage and necrotic tissue. The mitochondria of the proximal convoluted tubule epithelium were shown to be swollen highly, and the crisallia extremely confused, vague, disappeared. The injury was reduced in I/R+PTX group and I/R+hypothermia group. It was normal in the I/R+PTX+hypothermia group and sham group. The BUN, SCr, MDA in I/R group rised obviously and the activity of SOD was reduced significantly 24 h after reperfusion( P 0.05). CONCLUSION: PTX has a protective effect against renal ischemia-reperfusion injury.