Investigation of patients’preferences regarding therapeutic drug monitoring of mycophenolic acid in solid organ transplantation / 中国药房

OBJECTIVE To investigate the preferences of patients who underwent solid organ transplantation regarding therapeutic drug monitoring （TDM） of mycophenolic acid （MPA） and explore the factors influencing patients’ decision-making process， so as to provide support for the development of individualized medication guidelines for MPA and improvement of clinical decision-making. METHODS The cross-sectional study was used to design the questionnaire on the patients’ preferences to accept MPA TDM， and involved patients who underwent solid organ transplantation and received MPA treatment at two tertiary hospitals in Beijing from April 14， 2022， to June 27， 2022. The Likert 5-level scoring method was used to score the patients’ preferences to accept MPA TDM， the influencing factors and their correlation of the patients’ preferences to accept MPA TDM were analyzed by Pearson correlation analysis and binary Logistic regression analysis， and the nonparametric test and chi-square test were used to rank and analyze the consistency of the factors affecting patients’ preference decision. RESULTS A total of 140 questionnaires were collected， and the effective recovery rate was 77.35%. The average preference score of 140 patients to receive MPA TDM was （4.01±0.65）， and the overall preference value was high. There were 116 （82.86%） patients agreed or strongly agreed with MPA TDM. Significant differences were observed in preference scores between patients who had previously undergone MPA TDM and those who had never undergone it （[ 4.30±0.53） scores vs. （3.80±0.65） scores， P＜0.001]. Additionally， patients’ preference scores were significantly influenced by their understanding level and attention level （P＜0.001）. The ranking of factors contributing to decision-making exhibited consistency （P＜0.001）. The factors were ranked in descending order of clinical efficacy， safety， comfortability， economy and time cost. CONCLUSIONS The patients who underwent solid organ transplantation hold high preferences towards MPA TDM. The primary factors influencing their decisions are their prior experience， understanding level， and attention level.

Application of minimally invasive technique in kidney transplantation / 器官移植

Since the 21st century, minimally invasive technique has become a main development direction of surgery, which has been widely applied in all branches of surgery. In the field of kidney transplantation, minimally invasive technique has been mainly applied in the procurement of living donor kidney, kidney transplantation and the management of complications after kidney transplantation. It not only increases the resource of donor kidney, but also reduces the incidence of postoperative complications and enhances the quality of life of the recipients. The application of minimally invasive technique has become one of the research hot spots in the field of kidney transplantation. In this article, research progresses on the application of minimally invasive technique in the procurement of living donor kidney, kidney transplantation and management of complications after kidney transplantation were reviewed, aiming to provide reference for increasing the resource of donor kidney, enhancing the success rate of kidney transplantation and improving clinical prognosis of kidney transplant recipients, thereby promoting the development of minimally invasive technique in surgery.

Posterior approach laminectomy combined with localized resection of ossified posterior longitudinal ligament and dekyphosis for multilevel ossification of the posterior longitudinal ligament in the thoracic spine / 中华骨科杂志

Objective To investigate the safety and effectiveness of posterior approach laminectomy combined with localized resection of ossified posterior longitudinal ligament and dekyphosis for multilevel ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine.Methods Thirty-one cases of thoracic multilevel OPLL was treated with this new technique between August of 2012 and August of 2016.Twenty-nine among the 31 cases were successfully followed up more than two years.Among these 29 cases,9 were male and the other 20 were female,with an average age of 48.5±7.1 years.The average segment number of OPLLwas 6.5±2.2 (range,3-11).The average segment number of laminectomy was 7.9±2.5 (range,4-13).There were 26 cases combined with ossification of the ligamentum flavum (OLF).Posterior approach laminectomy combined with localized resection of OPLL and dekyphosis for multilevel OPLL in the thoracic spine was applied to all cases.Firstly,en-bloc laminectomy was performed to all the segments of OPLL.Then the nearest segment of ossification to the kyphotic apex and the most stenotie level was selected and limitedly resected.Finally,wedge-shaped osteotomy was conducted to decrease the kyphosis.The outcomes including recovery rate of myelopathy and the radiological changes were recorded during the post-operative follow-up.Single group pre and post analysis was conducted by using paired t-test.Results Twenty-seven cases underwent one-level circumferential decompression,and the other two case underwent two-level localized resection of the ossified posterior longitudinal ligament.The average operation time was 245.2±75.1 min (range,131-423 min).The average blood loss was 1 307.9±1 457.7 ml(range,300-6 000 ml).The average follow-up time was 40.2± 14.9 months (range,25-69 months).The kyphotic angle of the stenotic segments decreased 11.4°±3.5° averagely after the surgery,from pre-operative 28.7°±9.6° to post-operative 17.3°±8.6°.The decreased kyphotic angle was 7.4°±3.1 ° at the final follow-up with an average kyphotic angel of 22.3°± 10.3°.The average length of the resected ossified posterior longitudinal ligament was 11.3±3.9 mm,and the average shortening length of the spinal column was 5.0±3.0 mm (range,0.4-13.8 mm).The pre-operative Japanese Orthopedic Association (JOA) score was 4.3±2.2 averagely (range,1-9),and the final JOA score increased to 9.3±2.3 (rang,3-11).The average recover rate was 85.7％ (range,-100％ to 100％),and the rate of excellent or good was 89.7％.Among the 29 cases,6 cases occurred post-operative transient deterioration and regained a satisfactory recovery eventually;one case occurred post-operative paraplegia and never recovered;19 cases occurred post-operative cerebrospinal fluid leakage and healed under conservative treatment.Conclusion For the thoracic multilevel OPLL,one-stage posterior approach laminectomy combined with localized resection of the ossified posterior longitudinal ligament and dekyphosis can significantly improve the outcomes of the myelopathy with low rate of post-operative paraplegia.Therefore,this new surgery technique is a safe and effective treatment for multilevel OPLL in thoracic spine.

Experience of diagnosis and treatment for renal multiple malignant tumors / 中华泌尿外科杂志

Objective To investigate the diagnosis and treatment of ipsilateral multiple renal malignant tumors.Methods 4 patients with multiple renal malignant tumors were retrospectively reviewed from May 2013 to November 2017.All cases were males,with average age of 64 years old (ranging 54-82 years old).Two cases were found thai tumor located in right side.The duration of disease ranged from 7 days to 6 months,with an average of 2 months.One case was found the tumor due to the complaining of lumbar discomfort,and other 3 cases were found by physical examination.The number of tumors was 2 in 1 case,and 3 in 3 cases.The sonographic features of the tumors were iso-echoic nodules.CT showed irregular soft tissue shadow,partially prominent outside the kidney,and heterogeneous enhanced after enhancement.3 cases were undergone laparoscopic radical nephrectomy and 1 case which was solitary kidney,was undergone laparoseopic partial nephrectomy.Results All operations were performed successfully.3 cases were undergone laparoscopic radical nephrectomy,which the operative time was 189-271 min (average,230 min),and blood loss was 50-100 ml (mean 83 ml).Postoperative hospitalization time was 5-14 days,average 9.7 days.1 case occurred intestinal obstruction after surgery,which was improved after treatment.1 case was found the close distance of 3 tumors during the laparoscopic surgery.In order to short the ischemic duration,open surgery conversion was performed in this case.The total operation time was 207min.The ischemic time was 15min and blood loss was 50 ml.The postoperative hospital stay was 6 days.Pathological reported that 3 cases were clear cell carcinoma,another 1 case was clear cell carcinoma with papillary carcinoma.All patients were followed up for 2-55 months (mean 38 months).No recurrence sign was recorded in all cases.Conclusion Ipsilateral multiple renal malignant tumors are rare,laparoscopic radical nephrectomy is effectie.Meanwhile,partial nephrectomy can also be chosen in some optimal cases.

Factors associated with open surgery in the management of patients with renal carcinoma and inferior vena cava tumor thrombus in the laparoscope time / 中华泌尿外科杂志

Objective To analyze clinical factors influencing the choice of open radical nephrectomy and inferior vena cava thrombus excision surgery.Methods 47 patients who received open radical nephrectomy and inferior vena cava thrombus excision were enrolled between January,2015 to March,2017 retrospectively.Among the 47 patients,37 were nale,10 were female.The average age was 61 years (29-84 years),with 33 patients younger than 65-year old,14 above this age.The tumor located in left in 10 patients,right in 37 patients.The average maximum diameter of tumor was 9.1 cm (3.6-23.0 cm),with ≥10 cm in 17 patients,less than 10 cm in 30 patients.The enhanced abdominal CT showed 5 patients with suspected of extra-organ invasiveness.Pre-surgery images showed 29 patients were suspected of enlarged lymph nodes.13,21,9 and 4 patients have Ⅰ,Ⅱ,Ⅲl or Ⅳ grade tumor thrombus respectively.The average major axis of tumor thrombus was 6.2 cm(1.0-20.0 cm),＞7.0 cm in 17 patients,≤7.0 cm in 30 patients.Results There were 31 patients underwent open surgery,and the other 16 underwent laparoscopic surgery.Multivariate analysis showed Ⅲ or Ⅳ grade of tumor was associated with the choice of open surgery (OR-13.476,95 ％ CI 1.044-173.882,P =0.046),but age ＞ 65 years (P =0.679),maximum diameter of tumor ≥ 10 cm (P =0.330),the side of tumor (P =0.220),suspected of enlarged lymph nodes (P =0.308) and suspected of extra-organ invasiveness (P =0.255) were not significantly associated with the choice of open surgery.Conclusions Ⅲ or Ⅳ grade of tumor was the major factor affecting the choice of open surgery,while age ＞ 65 years,maximum diameter of tumor ≥ 10 cm,the side of tumor were not the trigger for open sugcry.Suspected of enlarged lymph nodes and suspected of extra-organ invasiveness remained to be studied.

Radical nephrectomy and thrombectomy for Mayo clinic stage Ⅲ tumor thrombus:a surgical technique and clinical experience / 北京大学学报(医学版)

Objective: To evaluate the effectiveness and safety of radical nephrectomy and inferior vena cava thrombectomy in the treatment of patients with Mayo Ⅲ tumor thrombus, and to introduce our experience and surgical technique.Methods: The clinical data of 8 patients with Mayo Ⅲ tumor thrombus from October 2014 to September 2016 were analyzed retrospectively.Of the 8 patients, 3 were male and 5 were female.The average age was (50.8±18.7) years (18 to 77 years).The average body mass index (BMI) was (22.7±4.4) kg/m2 (15.2 to 30.8 kg/m2).Imaging suggested the right renal tumor in all the 8 cases.The average tumor size was (7.9±2.5) cm.Open radical nephrectomy and inferior vena cava thrombectomy was conducted in 5 cases and laparoscopic surgery in 3 cases, and 1 case was converted to open surgery.Results: All the 8 surgeries were completed successfully with no death case.The average surgery time was (370.3±101.6) min, ranging from 272-567 min.The average vena cava blocked time was (41.0±12.1) min, ranging from 17-55 min.The blood loss volume was (1 181.3±915.7) mL, ranging from 200-3 000 mL.During the operation, 5 cases were infused with suspended red blood cells, the amount of blood transfusion was 800-2 000 mL.3 cases were infused of plasma with 400-1 000 mL.The average hospital stay was 9-23 d, with an average of (14.1±4.0) d.In the 8 patients, 4 cases underwent inferior vena cava wall resection because of invasion by tumor thrombus.Preoperative serum creatinine was 60-101 μmol/L, with an average of (76.4±15.3) μmol/L.Serum creatinine 1 week after the operation was 74-127 μmol/L, with an average of (100.8±21.1) μmol/L.Pathological diagnosis showed 6 cases of clear cell carcinoma, 1 case of papillary carcinoma type Ⅱ, and 1 case of Ewing''s sarcoma.Among the 8 patients, early postoperative complications occurred in 5 cases.Postoperative complications were graded as level Ⅱ, according to the Clavien classifications.The 8 cases were followed up for 2 to 24 months with an average of 11.3 months.There was 1 patient who suffered from lung metastasis.Conclusion: Our initial clinical results show that radical nephrectomy and inferior vena cava thrombectomy is safe and effective for patients with Mayo Ⅲ tumor thrombus.The wide extension of grade Ⅲ vein tumor thrombus leads to the difficulty of operation technique.Sufficient preoperative preparation, rich operative experience and skills can improve the safety of operation.

Clinical experience of Mayo 0-Ⅳ tumor thrombus treated with radical nephrectomy and inferior vena cava thrombectomy / 中华泌尿外科杂志

Objective To investigate the safety and feasibility of radical nephrectomy and Mayo 0-Ⅳ venous thrombectomy.Methods The clinical data of 52 patients with Mayo 0-Ⅳ tumor thrombus from February 2015 to January 2017 were analyzed retrospectively.Of the 52 patients,42 were male and 10 were female.The average age was (59.8 ± 13.6) years old (2.5 to 84.0 years).The renal vein tumor thrombus or inferior vena cava tumor thrombus was found in all patients,including type 0 thrombus in 12 cases,type Ⅰ thrombus in 11 cases,type Ⅱ thrombus in 15 cases,type Ⅲ thrombus in 9 cases,type Ⅳ thrombus in 5 cases (Mayo Medical Center classification).Imaging suggested the right renal tumor in 36 cases and left tumor in 16 cases.The average tumor size was (8.5 ±2.0) cm(2.0-21.1 cm).There were 2 cases of ASA Ⅰ,40 cases of ASA Ⅱ and 10 cases of ASA Ⅲ according to the American Society of Anesthesiologists (ASA).In laparoscopic radical nephrectomy and Mayo 0 venous thrombectomy,we clamped the vena cava vessel wall nearby the renal vein entrance.The vena cava blood flow was blocked partially.Then we cut the vessel wall arcuately.Mayo Ⅰ tumor thrombus requires the use of a non traumatic auricle clamp to control blood flow by the block of vena cava above thrombus,vena cava below the renal vein level,and the contralateral renal vein.Right kidney tumors with Mayo Ⅱ could be completed by retroperitoneal surgery.At the time of vascular occlusion,the distal inferior vena cava,the left renal vein and the proximal inferior vena cava were interrupted sequentially.For left renal tumors with Mayo Ⅱ,the retroperitoneal approach combined with transperitoneal approach was used.The technique of "milking" can shrink the tumor thrombus and reduced the difficulty of the operation.For Mayo Ⅲ tumor thrombus just at the hepatic vein level,we cut off 3-5 hepatic short veins,and separated inferior vena cava long enough to provide surgical field.For Mayo Ⅲ tumor thrombus much higher than the hepatic vein level,we used open surgeries to free the liver and porta hepatis.We first blocked the distal inferior vena cava,followed by the left renal vein,the hepatic artery and portal vein,at last the proximal inferior vena cava.Mayo Ⅳ tumor thrombus often required a median incision to open the chest and establish an extracorporeal circulation.Results All the 52 surgeries were completed successfully without intraoperative and perioperative mortality.Open radical nephrectomy and inferior vena cava thrombectomy was underwent in 22 cases.Pure laparoscopic surgery was under went in 30 case.Two cases were converted to open surgery.The average surgery time was(333.7 ±80.1)min(136-694 min).The average blood loss volume was (1339.0 ± 508.1) ml(20-10 000ml).During the operation,the amount of suspended red blood cells transfusion was(761.5 ± 394.8)ml(0-10 400ml).28 cases underwent regional lymph node dissection,and postoperative pathological diagnosis showed lymph metastasis in 4 cases.24 cases underwent ipsilateral adrenalectomy,and 2 cases showed tumor invasion of adrenal gland.7 cases with right tumors underwent inferior vena cava wall resection because of invasion by tumor thrombus.The average postoperative hospitalization of all 52 cases was (9.7 ± 4.7) d.Among 27 patients,early postoperative complications occurred in 18 cases (34.6％).There were 1 case of Clavien Ⅰ,12 cases of Clavien Ⅱ,1 case of Clavien Ⅲ a,2 cases of Clavien Ⅳ a and 2 cases of Clavien Ⅴ according to modified Clavien classifications.44 cases (84.6％) were followed up for 1 to 22 months with a median of 8 months.Postoperative recurrence occurred in 3 cases,and distant metastasis occurred in 9 cases.9 cases (20.5％) had tumor specific death.Conclusions Our initial clinical results show that radical nephrectomy and inferior vena cava thrombectomy is safe and effective for patients with Mayo 0-Ⅳ tumor thrombus,but the wide extension of vein tumor thrombus leads to the difficulty of operation technique.Sufficient preoperative preparation,rich operative experience and skills can improve the safety of operation.

Ex vivo ureteroscopy lithotripsy for stone in donated kidney from live-related donor / 中华泌尿外科杂志

Objective To propose ex vivo ureteroscopy (ExURS) and technical modification to render the donated kidney stone-free at live donor renal transplantation.Methods A suitable kidney donor with small unilateral nonobstructive calculi in the lower calyx of left kidney underwent laparoscopic live donor nephrectomy. After cold perfusion, ExURS was performed immediately in an iced saline solution. A F8.0/9.8 semirigid ureteroscope was accessed to collecting system via the ureteral stump. A 'Pull-up'skill was applied in order to facilitate the atraumatic access to the pelvis. The harvested kidney was rotated so as to facilitate the semirigid ureteroscope access to the lower calyx. The calculi was then completely endoscopic fragmented with holmium and removed. Results The warm ischemia time was 3 min and the cold ischemia time was 2.5 h. The procedure time was 18 min. There were no intra-operative or postoperative ureteral complications. The urine volume of recipient was 6260 ml in the postoperative day. the serum creatinine of 1 to 4 postoperative days were 402 μmol/L, 186 μmol/L, 136 μmol/L, 112 μmol/L, respectively, which was normal 4 days after operation. The serum creatinine maintain at 100 μmol/L approximately, in 6 months follow up.Conclusions ExURS is a technically feasible means of rendering a stone bearing donor kidney stone-free safely and efficiency.

Functional and oncologic outcomes after partial nephrectomy in anatomical solitary kidney / 中华泌尿外科杂志

Objective To investigate the effect of partial nephrectomy of anatomical solitary kidney on tumor control and renal function preservation.Methods 10 patients with anatomical solitary kidney underwent partial nephrectomy from December 2007 to May 2016,including 6 males and 4 females ranged from 38 to 71 years old with an average of 57 years old.The PADUA score ranged from 6-10,with an average of 7.6.The tumor diameter ranged from 1.0 to 7.4 cm,with an average of 3.2cm.Results 7 cases underwent laparoscopic surgery.3 cases underwent open surgery.Mean operation time was 168min (ranged 103-217min).Mean blood loss was 135ml (ranged 20-400ml).The renal arteries were blocked in all patients.The ischemia time ranged from 9 to 33min,with an average of 20.6min.The mean estimated glomerular filtration rate at one week after surgery [40.7ml/(main · 1.73 m2)] decreased 44.7％ compared with pre-operation [73.6 ml/(min · 1.73 m2)].Acute kidney injury developed in 2 patients.One required temporary dialysis.The other improved after conservative treatment.There were no other complications such as urinary fistula and hemorrhage.The pathology analysis confirmed that 2 cases were angiomyolipoma,one case was benign cyst,6 cases were renal clear cell carcinoma,and one case was multilocular cystic renal cell carcinoma.4 cases were stage pT1a,one case was stage pT1b,one case was stage pT2a,and one case was stage pT4.Positive margin was found in one case.The average follow-up period was 28.2 months(ranged 3-58months).Only one patient need long-term dialysis 20 months after surgery at the latest follow up.Another patient had local recurrence and ipsilateral adrenal metastasis.Conclusions Satisfactory effect of tumor control and renal function preservation can be achieved by partial nephrectomy in solitary kidney,which prevent or delay the occurrence of hemodialysis effectively.

The experience of diagnosis and treatment for clear cell papillary renal cell carcinoma / 中华泌尿外科杂志

Objective To discuss the clinic characters of clear cell papillary renal cell carcinoma ( CCPRCC) and the efficacy of related laparoscopic surgery.Methods From October 2013 to December 2015, 4 cases were treated as CCPRCC including 3 male and 1 female.Their age ranged from 34 to 67 years old ( mean 53 years old) .The duration of illness ranged from 7 days to 3 months, which the average duration was 1.5 months.The location of tumor included left side in 2 cases and right side in other 2 cases.All tumors were found incidentally, without symptoms or positive sign.Ultrasound showed that 2 cases were solid, and the other 2 cases were cystic solid with low, high or mixed echo and rich blood flow signals.The tumors were enhanced in CT arterial phase, and calcification showed in one case.MRI showed heterogeneous signal.The mean size of tumor was 3.0 cm,ranging 2.3 to 4.5 cm.After preoperative examination, all cases underwent retroperitoneal laparoscopic partial nephrectomy.During the operation, 2 cases were confirmed as cystic solid tumors, and the other 2 cases were solid tumors.Renal artery and renal mass were dissociated , then the artery was blocked.The tumor was complete resected, and kidney was sutured. Results All surgery was performed successfully without conversion.The operation time was 137-191 min (average 157 min).The blood loss was 10-100 ml (average 45 ml) without blood transfusion.The warm ischemia time was 15-35 min ( mean 22 min) .The postoperative hospitalization time stay 6-8 d ( average 7 d).Pathologic report was CCPRCC, including 3 cases of WHO/ISUP grade 1, and 1 case of WHO/ISUP grade 2.2 cases were cystic solid tumor, and other 2 cases were solid tumor.Bland-appearing tubules and occasional small papillae, and uniform small nuclei are arranged in a linear manner away from the basal aspect of the tubules in microscope.Immunohistochemistry showed that CA IX, CK7, 34 E12 were positive, but CD10 , P504S and CD117 were negative.The mean duration of postoperative follow-up was 14 months, ranging 4 to 30 months.No recurrence was found in those patients.Patients were followed up for 4-30 months ( average 14 months) without recurrence or metastasis.Conclusions CCPRCC is a rare subtype of renal tumor, which mainly diagnosed by pathological diagnosis . Retroperitoneal laparoscopic partial nephrectomy is an effective method for the treatment with good prognosis.

Retroperitoneal laparoscopic nephrectomy with autotransplantation for severe iatro-genic ureteral injury / 北京大学学报(医学版)

Objective:To evaluate the safety and efficacy of retroperitoneal laparoscopic nephrectomy with autotransplantation in cases of severe iatrogenic proximal ureteral damage.Methods:From July 2011 to March 2015,two patients,aged 44 (female)and 54 years (male),underwent retroperitoneal laparoscopic nephrectomy and autotransplantation for treatment of severe iatrogenic proximal ureteral inju-ries.Both injuries were proximal ureteral avulsion during ureterolithotomy with the holmium laser for ure-teral calculi.computed tomography angiography (CTA)and computed tomography urography (CTU)was performed in both patients before operation.A 3-port retroperitoneal technique was used for the patients placed in a lateral decubitus position.A retroperitoneal laparoscopic nephrectomy with autotransplantation approach was used in both the patients,and the kidneys were removed to the right iliac fossa.Case 1’s kidney was removed through the right Gibson incision,while Case 2’s kidney was removed through the left lumbar incision.The renal artery and renal vein were ligated using the Hem-o-lok.The kidneys were taken out quickly from the patients and infused with 4 ℃ kidney preserving fluid immediately.Results:The retroperitoneal laparoscopic nephrectomy with autotransplantations was performed 4 hours in Case 1 and 2 years in Case 2 after atrogenic proximal ureteral injuries.Case 2 was associated with dense peri-nephric and perihilar fibrosis.The procedures were successful,with immediate return of renal function in both the patients.After ex vivo graft preparation,ureteral and vessel length and quality were adequate for transplantation in both the cases.A direct ureterovesical anastomosis was performed in both patients.In the 2 patients,the warm ischemia time was 3 and 5 minutes,the total operation time 185 and 246 mi-nutes,and the estimated blood loss 70 and 200 mL,respectively.No perioperative complications oc-curred.At the end of the follow-up,the transplanted kidneys were functional,and the patients had re-turned to their normal activity.Conclusion:Retroperitoneal laparoscopic nephrectomy with autotrans-plantation is an excellent alternative to nephrectomyor bowel interposition in patients with proximal urete-ral loss.This procedure is associated with acceptable morbidity and preserves the renal function.This re-port supports the safety and efficacy of retroperotoneal laparoscopic nephrectomy with autotransplantation in experienced hands.

Clinical analysis of pure laparoscopic surgery for renal cell carcinoma with inferior vena cava tumor thrombus / 中华泌尿外科杂志

Objective To assess the safety and feasibility of pure laparoscopic surgery for renal cell carcinoma with inferior vena cava tumor thrombus.Methods We retrospectively analyzed 6 cases of renal cell carcinoma with inferior vena cava tumor thrombus from December 2010 to October 2014.The patients were all male.Their age ranged from 50 to 69 years and the body mass index ranged from 21.6 to 30.9 kg/ m2.Clinical manifestations included painless hematuria in 4 cases,low back pain in 1 cases and physical examination noticing in 1 cases.Imaging suggested the right renal tumor in 4 cases and left renal tumor in 2 cases.The tumor size ranged from 4.0 to 10.6 cm.The inferior vena cava tumor thrombus was found in all patients,including type Ⅰ thrombus in 3 cases and type Ⅱ thrombus in 3 cases.The length of type Ⅱ tumor thrombus ranged from 4.0 to 4.2 cm.We completed pure laparoscopic nephrectomy and inferior vena cava tumor thrombectomy in all patients.We chose retroperitoneal laparoscopic surgery to treat right renal tumor with inferior vena cava thrombus and chose retroperitoneal combined with transperitoneal laparoscopic surgery to treat left renal tumor with inferior vena cava thrombus.Results All surgery were successful.Cancer embolus defluxion didn't occur during the opearation.The operation time was 224-873 min and the intraoperative blood loss was 200-5 000 ml.There were 4 patients get transfusion,which the transfusion volume ranged from 400 to 2 800 ml.For 1 case of left renal cell carcinoma with level Ⅱ inferior vena cava tumor,the operation time was 873 min,the blood loss was 5 000 ml,and the transfusion volume was 2 800 ml.Postoperative hospital stay was 7-14 days.And the pathological results were all renal clear cell carcinoma.In those patients,the Fuhrman grade classification was Ⅱ-Ⅲ.All patients were treated by targeted medicine to control tumor recurrence and metastasis.During the 6-48 months following up,no recurrence and metastasis were reported.Conclusions Pure laparoscopic surgery for right renal cell carcinoma with inferior vena cava tumor thrombus and left renal cell carcinoma with level Ⅰ inferior vena cava tumor thrombus is safe and feasible.However,long learning curve should be necessary for performing the left renal cell carcinoma with level Ⅱ inferior vena cava tumor thrombus.The effect of total laparoscopic surgery for renal cell carcinoma with inferior vena cava tumor thrombus is definite.

Application of plasmapheresis in treating the antibody-mediated acute rejection after kidney transplantation / 中华泌尿外科杂志

Objective To investigate the efficacy of plasmapheresis therapy for treating the antibody-mediated acute rejection (AMR) after kidney transplantation.Methods The study group consists of 2 male patients and 3 female patients,who suffered with AMR after receiving first-time allograft renal transplantation from January 2011 to September 2013 in our hospital.The age ranged from 41 to 52 years old,average 46 years old.The preoperative diagnosis in all patients was chronic renal insufficiency (uremia stage) and the regular hemodialysis was given to them.The 5 patients received basic immunosuppressive therapy,including cyclosporine A [5 mg/(kg · d)] or FKS06 [0.1 mg/(kg · d)],mycophenolate mofetil (MMF) (1.5 g/d) and steroids.All the antibody-mediated acute rejections were diagnosed by renal allograft biopsy and serum DSA determination within 2 weeks after transplantation.Seven cycles of plasmapheresis rescue therapy were given to those patients respectively after the failure therapy of high dose of corticosteroids (1 000 mg/d) and ALG (250 mg/d).4 cases with primary glomerulonephritis,whose preoperative serum creatinine level was (784± 154) μ mol/L,were given plasmapheresis therapy within 2 weeks after transplantation.One case with primary anti-glomerular basement membrane disease,whose preoperative serum creatinine level was 935 μmol/L,received plasmapheresis 35 d after transplantation.The serum DSA in all patients was positive before plasmapheresis.Results After 7 cycles of plasmapheresis rescue therapy,the AMR was reversed in four 4 cases,whose plasmapheresis was given within 2 weeks after transplantation.Within three months follow-up,their renal function recovered well,which the mean serum creatinine level was (113± 12) μmol/L.In the case,whose plasmapheresis was given 35 days after transplantation,rejection was not reversed.His serum creatinine was 524 μmol/L and the intermittent hemodialysis was given,subsequently.With a follow-up of 12 months,the ultrasound examination showed that the atrophy of transplanted kidney and a high level of serum creatinine (758 μmol/L).Low dose of FK506 (0.5 mg/d) was given based on those results.Conclusions Active application of plasmapheresis can effectively reverse antibodymediated acute rejection within two weeks after transplantation.

Preliminary experience with transperitoneal laparoendoscopic single-site radical nephrectomy using a home-made single-port device in China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Laparoendoscopic single-site (LESS) surgery represents a technique to further reduce morbidity and scarring associated with surgery. We present our preliminary experience with transperitoneal LESS radical nephrectomy (RN) using a home-made single-port device in China.</p><p><b>METHODS</b>From July 2010 to November 2011, eleven patients with renal tumor not greater than T2 underwent LESS-RN by an experienced laparoscopic surgeon. A home-made single-port device was used through a 5-cm umbilical incision. A combination of standard and articulating laparoscopic instruments was used. The sequence of steps of LESS-RN was similar to transperitoneal laparoscopic RN. Patient characteristics, perioperative variables and postoperative outcomes were recorded and analyzed.</p><p><b>RESULTS</b>Except for two transperitoneal laparoscopic conversions and one hand-assisted laparoscopic conversion, the other procedures were completed successfully without conversion to open surgery. The mean operative time was 224.5 (155-297) minutes, estimated blood loss was 270.9 (50-900) ml, and hospital stay was 10.4 (5-15) days. The mean visual analog pain scale (VAPS) on the first postoperative day was 4.0/10. Final pathological analysis revealed renal cell carcinoma in all cases with a stage distribution of three T1a, five T1b, and three T2a tumors. With the mean follow-up period of 21.4 (12-28) months, all patients were alive without evidence of tumor recurrence or metastasis, and were satisfied with the appearance of the scars.</p><p><b>CONCLUSION</b>Transperitoneal LESS-RN using a home-made single-port device is technically feasible and safe in a selected group of patients (low body mass index and stage tumor) and has excellent cosmetic results. Although preliminary oncologic outcome is not compromised, the long-term evaluation of these patients is awaited.</p>

Determination Optimization of 15 Sun-screening Agents in Cosmetics / 中国药师

Objective:To improve and optimize the determination methods for 15 chemical sun-screening agents in cosmetics by HPLC described in Hygienic Standard for Cosmetics (2007 edition) to enhance the quality control of limited chemical sun-screening a-gents in cosmetics. Methods:The samples were extracted using the improved mixed liquor. The detection was performed on an Accur-asilC18(250mm×4.6mm,5um)analyticalcolumn,themobilephasewasmethanol-tetrahydrofuran-water(adjustingpHto2.60 with acetic acid) with gradient elution, the flow rate was 1. 0 ml·min-1 , the column temperature was 25℃,and the detection wave-length was 311nm. Results:The method showed good linear relationship and the correlation coefficient was above 0. 999 5, the detec-tion limit was 1. 9-18. 7 ng, and the average recovery was within the range of 97. 5%-113. 7% with RSD of 0. 85%-1. 56%(n=9). Conclusion:The improved method is reliable, which is the effective optimization and complement for the determination methods of chemical sun-screening agents in cosmetic described in Hygienic Standard for Cosmetics (2007 edition).

Severe hemolytic anemia caused by passenger lymphocyte syndrome after kidney transplantation: one case report / 中华器官移植杂志

Objective A kidney transplantation patient who was diagnosed with autoimmune hemolytic anemia (AIHA) caused by passenger lymphocyte syndrome (PLS) was reviewed.Method A male kidney transplantation patient aged 31 was admitted due to severe anemia.Direct antiglobulin test (DAT) was positive and reticulocyte was elevated significantly,and PLS was diagnosed.He was treated with blood transfusion,glucocorticoid and intravenous immunoglobulin,and recovered at last.Result PLS is a rare but important cause of AIHA after kidney transplantation,often occurs in blood type A patient who received a kidney from a blood type O donor.Final diagnosis depends on the detection of anti-erythrocyte antibody in recipient serum.Conclusion PLS should be considered when anemia with unknown reasons occurred in kidney transplantation patients.

Role of methylation of p21 gene in the proliferation of human vascular smooth muscle cells / 中国组织工程研究

BACKGROUND:Proliferation, migration and phenotypic changes of vascular smooth muscle cells is the core of the occurrence of atherosclerosis, and a series of related genes via methylation are involved in the process. OBJECTIVE:To investigate the effects of oxidized low density lipoprotein (ox-LDL) on DNA methylation in the promoter region of the p21 gene and its potential mechanism in the pathogenesis of atherosclerosis. METHODCultured human vascular smooth muscle cells were treated with different concentrations of ox-LDL (0, 10, 20, 40 mg/L) for 24 hours. The degree of DNA methylation was assayed by methylation-specific polymerase chain reaction, the expression of p21 mRNA was measured by reverse transcriptional polymerase chain reaction and the proliferative activity of vascular smooth muscle cells was determined by the MTT assay. RESULTS AND CONCLUSION:The ox-LDL treatment resulted in a promotion in the methylation in the promoter region of the p21 gene and a decrease in mRNA expression with a concentration-dependent manner;it also induced a dose-dependent promoting effect on vascular smooth muscle cellproliferation. The atherogenic mechanism of ox-LDL might promote vascular smooth muscle cellproliferation by the hypermethylation of the p21 gene that may lead to the occurrence and development of atherosclerosis.

Analysis of the predicting factors for erectile function recovery after laparoscopic radical prostatectomy / 中华泌尿外科杂志

Objective To evaluate the recovery rate of erectile function (EF) and identify various factors predicting the recovery of EF in men undergoing laparoscopic radical prostatectomy (LRP) in our center.Methods From January 2011 to December 2012,a total of 106 men with localized prostate cancer underwent LRP in our center by one surgeon were included,and we gathered the preoperative EF condition and perioperative factors,such as patients' age,comorbidity and surgical procedure,et al.We followed up all the patients by telephone in August 2013 to collect the EF recovery data of these paticnts after LRP,with the mean follow-up of 18 (8-31) months.We analyzed the perioperative factors in order to predict the EF recovery after LRP.Results A total of 60 patients with preoperative sexual activity were included,and there was no difference in baseline data compared with other cases.Recovery of potency was defined as postoperative penile erection.The recovery rate of EF was 46.7％ (28/60) without the use of any drugs or devices for erection assistance.In our study,the recovery rate of EF in age ≤60 years was 90.0％ (9/10),and it was better than other two older groups (P =0.001).In patients whose preoperative IIEF-5 score was 22-25,the recovery rate of EF was 66.7％ (8/12),and it was better than those with IIEF-5＜22 (P=0.006).The recovery rate of EF in patients with preserved neurovascular bundle was 53.1％ (26/49) and it was 83.3％ (5/6) in patients with preserved accessory pudendal artery,which was better than those without preservation (P=0.036 and P =0.023).Conclusions In our study,age and preoperative EF were the significant factors to predict potency recovery,and preservation of neurovascular bundle and accessory pudendal artery during LRP were the positive predictor factors.

Laparoendoscopic single-site radical cystectomy and urinary diversion: initial experience using homemade single-port device / 中华泌尿外科杂志

Objective We report our initial experience with laparoendoscopic single-site surgery (LESS) for radical cystectomy and urinary diversion performed by a single surgeon using homemade singleport device.Methods From December 2010 and April 2011,7 LESS radical cystectomy were performed using a home-made single-port device composed of an inverted cone device of polycarbonate and a powderfree surgical glove.7 patients were all male,mean age was 66 (54-81) years and mean BMI (Body mass index) was 23.1 (20.9-25.3) kg/m2.The port was placed into a 5 cm periumbilical skin incision.The conventional laparoscope and laparoscopic instruments were inserted through the single-port.No additional ports were needed for radical cystectomy and bilateral standard pelvic lymphadenectomy.Cutaneous ureterostomy (3 cases) and ileal conduit urinary diversion (4 cases) were used for patients.Operative time,estimated blood loss,postoperative recovering time,oncologic data and complications were collected and analyzed.Results All the procedures were completed successfully.The mean operative time was 210.1 (155-280) minutes.The estimated blood loss was 300 (100-500) ml.The bowel recovering time 8 (4-12) days and postoperative hospital stay was 20 (13-34) days.One patient required a transfusion of 400 ml red blood cells.The pathologic evaluation revealed that there were one case of pT1N0M0,two of pT2aN0M0,two of pT2bN0M0 and two of pT3aN0M0.The high grade tumor in 4 cases and low grade in 3 cases.The surgical margins were negative in all the patients.All patients were node negative.After the operations,one case had a small bowel obstruction after three days and was treated by abrosia,fluid infusion and gastrointestinal decompression.Another patient died of cardiac disease at first day postoperative.Conclusions In our experience,LESS for radical cystectomy could be clinically feasible for selected patients,but it requires the learning curve.

Clinical manifestations of paraganglioma of the urinary bladder / 中华泌尿外科杂志

Objective To review the clinical characteristics of paraganglioma of the urinary bladder with 5 cases reprt.Methods The clinical data of 5 patients (2 males and 3 females,age 23-68 years)with paraganglioma of the urinary bladder were reported.Two cases were diagnosed by ultrasonography during health examination,1 case was found by hematuria,1 had difficulty of voiding,and 1 presented with palpitation,chest discomfort while urination.Two cases were clinical diagnosed as bladder paraganglioma,1case urachal carcinoma,and 2 cases bladder tumor.Cystoscopy showed a protruding tumor within the bladder or bladder had compressed changes.One case of tumor located in the triangle,1 in the posterior wall,1in the top,2 in the anterior wall.Three cases of biopsy were negative.Three cases of preoperative endocrine examinations showed norepinephrine significantly higher.Results Laparoscopic partial cystectomy was performed in 3 cases,open partial cystectomy in 1 case,and transurethral resection of bladder tumor (TURBT) in 1 case.One case had the complication of stress cardiomyopathy during TURBT,3 cases found intraoperative hypertensive crisis.The bleeding volume was 20-800 ml (average 126 ml),and I case received blood transfusion.During the follow-up period for 3-48 months,the blood pressure was normal,and no recurrence was found.Conclusions Bladder paraganglioma is uncommon and easily misdiagnosed.For the patients with bladder tumor,accompanied by changes in blood pressure,palpitations during urination should be highly suspicious of bladder paraganglioma.Partial cystectomy is the main treatment method.