Urodynamic analysis of extraperitoneal Studer orthotropic ileal neobladder following radical cystectomy / 中华泌尿外科杂志

Objective To evaluate changes of the urodynamics of extraperitoneal Studer orthotropic ileal neobladder after radical cystectomy.Methods Between July 2013 and October 2017,Retrospective analysis was performed on 58 bladder cancer patients.58 patients who underwent retrograde extraperitoneal approach of radical cystectomy and Studer orthotopic ileal neobladder.The patients were comprised of 56 male and 2 female patients with average age of 62 years.There were 9 cases of T1,26 cases of T2,20 cases of T3,and 3 cases of T4.All operations were completed by open suprapubic extraperitoneal approach,then entered the abdominal cavity.An ileal segment 50-55 cm long was isolated which was 25 cm proximal to the ileocecum.The 35-40 cm ileal segment was detubularized along its antimesenteric border.The anterior wall was folded forward with U-shaped and the edges were sutured to formed a neobladder.The proximal 15cm was reserved for the double isoperistaltic afferent limb.The lowest part of the neobladder was anastomosed with urethral stump,the peritoneum was closed at the mesentery,and the neobladder was completely placed extraperitoneal.Upper urinary tract function was examined by renal function test,enhanced CT,IVU or cystography.Uroflowmetry,urodynamic evaluation,diurnal and nocturnal continence were performed at 3,6,12,24 months following the surgery.Results After removed of the catheter,all patients were able to urinate through the urethra.The 3,6,12,24 month follow-up data of urodynamic were compared.The maximum neobladder capacity was[(378 ±66) vs.(381 ± 102)vs.(438 ± 75)vs.(472 ±96)] ml,the maximum flow rate [(10.2 ± 2.8) vs.(14.9 ± 4.3) vs.(16.4 ± 3.6) vs.(17.6 ± 2.1)] ml/s,maximum bladder pressure during filling was [(23.0 ± 4.6) vs.(21.7 ± 7.1) vs.(20.6 ± 6.4) vs.(18.8 ±6.3)] cmH2 O,the PVR was[(68.0 ± 33.2) vs.(36.2 ± 10.1) vs.(30.6 ± 11.9) vs.(14.0 t 9.6)] ml.There were significant differences between the 6-month and 12-month.There were no significant differences in the maximum bladder pressure during flowing [(38.6 ± 7.4) vs.(49.2 ± 6.8) vs.(58.4 ± 10.5) vs.(56.8 ± 7.4)] cmH2O.53 cases were followed up 12 months after surgery.Excellent daytime and nighttime continence was 98％ (52/53)and 83 ％ (44/53)in the first year.Mild unilateral hydronephrosis occurred in 2 cases 1 month after surgery.Blood electrolytes and renal function were within the normal range.1 case presented bilateral mild hydronephrosis 12 months after surgery,without bladder and ureter regurgitation.The blood electrolyte and renal function of the other patients were in normal range with no signs of ureteral stricture and upper urinary tract hydronephrosis.Conclusions Extraperitoneal Studer orthotopic ileal neobladder reduced the interference of postoperative intraperitoneal intestinal tract on neobladder function.Postoperative patients have a smooth urination,a safe pressure during the storage period.The urination period,and the function of day and night urinary control is close to normal physiological characteristics.

Experimental study on mechanical properties of the ventral and the dorsal tissues of porcine descending aorta / 生物医学工程学杂志

The mechanical properties of the aorta tissue is not only important for maintaining the cardiovascular health, but also is closely related to the development of cardiovascular diseases. There are obvious differences between the ventral and dorsal tissues of the descending aorta. However, the cause of the difference is still unclear. In this study, a biaxial tensile approach was used to determine the parameters of porcine descending aorta by analyzing the stress-strain curves. The strain energy functions Gasser-Ogden-Holzapfel was adopted to characterize the orthotropic parameters of mechanical properties. Elastic Van Gieson (EVG) and Sirius red stain were used to observe the microarchitecture of elastic and collagen fibers, respectively. Our results showed that the tissue of descending aorta had more orthotropic and higher elastic modulus in the dorsal region compared to the ventral region in the circumferential direction. No significant difference was found in hyperelastic constitutive parameters between the dorsal and ventral regions, but the angle of collagen fiber was smaller than 0.785 rad (45°) in both dorsal and ventral regions. The arrangement of fiber was inclined to be circumferential. EVG and Sirius red stain showed that in outer-middle membrane of the descending aorta, the density of elastic fibrous layer of the ventral region was higher than that of the dorsal region; the amount of collagen fibers in dorsal region was more than that of the ventral region. The results suggested that the difference of mechanical properties between the dorsal and ventral tissues in the descending aorta was related to the microstructure of the outer membrane of the aorta. In the relatively small strain range, the difference in mechanical properties between the ventral and dorsal tissues of the descending aorta can be ignored; when the strain is higher, it needs to be treated differently. The results of this study provide data for the etiology of arterial disease (such as arterial dissection) and the design of artificial blood vessel.

A risk analysis of acute kidney injury after orthotropic liver transplantation for benign end-stage liver disease in adults / 临床麻醉学杂志

Objective To analyze the risk factors of acute kidney injury after orthotropic liver transplantation for adult benign end-stage liver disease.Methods A retrospective analysis was conducted in 30 recipients (18 males,12 females,aged 23-68 years,ASA grade Ⅲ or Ⅳ) who underwent orthotropic liver transplantation for benign end-stage liver disease at Tongji Hospital from May,2014 to December,2014.Both demographic characteristics and perioperative parameters were collected,including general condition,surgery and anesthesia factors and intraoperative salvage autotransfusion or not.Perioperative laboratory findings related to renal function including urine volume,serum creatinine (Scr) and urea nitrogen (BUN) were collected,too.All variables tested in the univariate analysis with a P<0.10 were included in a multiple logistic regression analysis.Results There were less intraoperative salvage autotransfusion,more platelet transfusion and a higher using rate of vasopressors in the AKI group after surgery than those did not.Patients who received intraoperative salvage autotransfusion had 0.058 time odds (95%CI 0.005-0.649) of AKI than those did not;patients who required platelet transfusion had 10.706 times higher odds (95%CI 1.212-94.963) of AKI than those did not.Conclusion It is likely that intraoperative salvage autotransfusion was able to decrease the morbidity of AKI,while platelet transfusion and vasopressor administration to maintain blood pressure could increase the possibility of AKI.

Establishment and assessment of orthotropic and heterotrophic valve implantation models in goat with minimally invasive methods / 中华胸心血管外科杂志

Objective To establish and evaluate 3 kinds of minimally-invasive valve implantation model in vivo.Methods A novel tissue engineered heart valve(TEHV) manufactured by branched polyethylene glycol cross-linked acellular porcine valve and a minimally-invasive valve implantation system according to the design of Corevalve revalving system were adopted.After anesthesia,18 adult male goats were randomly divided into 3 groups: the ulrasound-directed orthotropic group (group A,n =6),angiography-directed orthotropic group (group B,n =6) and direct-released heterotopic group (group C,n =6),and all received minimally-invasive valve implantation orthotropically or heterotopically.4 weeks later,the valvular function was evaluated by CTA and/or echocardiography.Results All 3 kinds of caprine model were successfully constructed.The operation success rate of each group was A: 66.7％,B: 50.0％ and C: 100.0％,respectively(multiple x2 analysis,group A and B P ＞0.05; group A and C,group B and C,P ＜0.05).The operation-time of each group was A: (79 ± 18) min,B:(61 ±23) min,C: (45 ± 15) min(one-way ANOVA,P ＜0.05).The survival rate at4 weeks was A: 100％,B: 100％ and C: 83.3％ (multiple x2 analysis,P ＞ 0.05).Echocardiography and CTA proved the short-term function of implanted TEHV was satisfactory.Conclusion All 3 kinds of caprine valve implantation model can be established without cardiopulmonary bypass and blood transfusion.The devices and equipments required in group A is relatively simple,but the procedure cost longer time for it is hard to determine the right position by ultrasound.The application of angiography made the positioning much easier in group B while the procedure had to be performed in specific operation room with angiographic apparatus.Group C did rely on neither special equipments nor complex operation,but the valve leaflets cannot work normally,so this model was only suitable for testing in vivo characteristics such as biocompatiblities.