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Objective To explore the feasibility and clinical significance of individualized formular administration of tacrolimus after renal transplantation based on the CYP3A5 and MDR1 gene polymorphism.Methods Total 129 renal transplantation recipients from Oct.1,2015 to July 30,2016 were included in this study and divided into 2 groups.In experimental group,tacrolimus was administrated by the individualized formula based on CYP3A5 and MDR1 gene polymorphism;in control group,tacrolimus was administrated by doctors' experience based on patient's body weight.The blood trough level of tacrolimus was determined 3 days after administration.The first blood trough level of tacrolimus,plasma creatinine level,acute rejection rate,and necessity for dialysis were compared between two groups.Results The first blood trough levels of tacrolimus in experimental and control groups were 9.24 ± 2.32 and 9.39 ± 3.47μg/L respectively (P＞0.05).The tacrolimus levels of 7 cases in experimental group and 18 cases in control group were not in normal range (P＜0.05).The plasma creatinine level at day 7 after surgery was 157.36 ± 110.55 μg/L in experimental group,and 174.01 ± 130.68μg/L in control group (P＞0.05).Acute rejection was found in both two groups:2 in experimental group and 5 in control group (P ＞ 0.05).There was significant difference in necessity for dialysis between two groups:4 in experimental group and 10 in control group (P＜0.05).Conclusion The individualized formular administration of tacrolimus based on the CYP3A5 and MDR1 gene polymorphism is more feasible and reasonable than experimental administration,which is more easier to come to an appropriate blood level and would benefit the early recovery of renal function.
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Objective To evaluate the application of inguinal incision in retroperitoneal laparoscopic nephroureterectomy(LNU)in the treatment of upper urinary urothelial carcinoma(UUUC).Methods From Mar.2007 to Jan.2012,186 retroperitoneal LNU procedures on 115 males and 71 females for the treatment of UUUC were performed in our institute.All cases were grouped as inguinal incision group(n =112)and lumbar incision group(n =74)according to specimen retrieval incision.Operative time,estimated blood loss,postoperative analgesia,hospital stay,incision complications,cosmetic satisfaction and tumor recurrence were compared between the 2 groups.Results All the 186 cases of operation were successfully accomplished.There were no differences in tumor stage,tumor grade,mean operative time,blood loss between the 2 groups.In inguinal incision group,the incidence of incision fat liquefaction,incision hernia,incision bulging,lumboabdominal unsymmetry and postoperative analgesia was less than that of lumbar incision group.In inguinal incision group,the mean hospital stay was shorter,cosmetic satisfaction(Ⅰ/Ⅱ/Ⅲ)was better(7/24/81 versus 22/18/34,P ＜ 0.01).Recurrence rate of UUUC in middle and inferior segment of ureter was fewer than that of lumbar incision group(5.3％ versus 35.0％,P ＜0.01).Conclusion Retroperitoneal LNU for UUUC combined with inguinal incision offers advantage of less trauma,less complications,higher cosmetic satisfaction and lower tumor recurrence.
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ObjectiveTo investigate the clinical outcome of laparoscopic nephroureterectomy (LUNT) for native upper tract urothelial carcinoma (UC) in renal transplant (RT) recipients.Methods We conducted a retrospective analysis on 1130 RT recipients,and 9 patients (0.8％,9/1130) with native upper tract UC were identified. UC was confirmed pathologically in the 9 patients,including 3 cases of unilateral ureter tumor (2 on the right,and 1 on the left),4 cases of unilateral renal pelvis tumor (2 on the right,2 on the left),1 case of bilateral ureter tumor and 1 case of tumor in the right ureter and left kidney.Females predominated (8/9) in the 9 patients with upper tract UC.The patients with left upper urinary tract cancer underwent LUNT using a retroperitoneal approach with a technique of transurethral circumcision of the ureteral orifice.The patients with right upper urinary tract cancer were subjected to nephroureterctomy with ureterectomy and bladder cuff excision by complete laparascopy through a transperitoneal approach. Immunosuppressive protocol conversion from calcineurin inhibitors to sirolimus was performed on all cases. Results In the 9 patients,11 LUNTs were performed successfully without conversion to open surgery.The follow-up period was from 6 to 48 months. One patient died of lung metastasis at 8th month after tumor excision,and 1 patient displayed ductal cancer of the left breast at 7th month after LNUT.Another seven patients showed no evidence of disease during the follow-up period with normal renal function.ConclusionOur present clinical experience suggested that LNUT for the native upper tract cancer in renal transplant recipients is feasible,safe,and effective.
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ObjectiveTo explore the treatment and economic burden of urine incontinence (UI) in the rural elderly,and provide evidences for preventive intervention.MethodsA cluster sampling was carried out in 743 people (aged 60 years and over) from 5 villages dominated by Yanliu and Dafengshang health centers,Jixian County,Tianjin from 2007 to 2008.The information about general state of health,treatment and economic burden of disease were analyzed. Results The prevalence of UI was 33.4％ (248 cases) among the 743 elderly people.Only 12 patients (4.8％) with UI ever visited community health-care service centers or hospitals for diagnosis and treatment,among whom only 1 case visited hospital within 1 year,8 cases during 1 to 5 years,and 3 cases over 5 years.And the method of treatment was all drug therapy.Among 248 cases with UI,there were 227 cases (91.5％) without any treatment,9 cases (3.6％) buying medicines by themselves.The direct cost for treatment of UI was 80-12000 yuan RMB,including 2 cases below 100 yuan RMB,2 cases 100-1000 yuan RMB,7 cases 1001-5000 yuan RMB and 1 case over 10000 yuan RMB. Conclusions Prevalence of UI is high while hospital-visiting rate is very low,and the financial burden of disease is serious,thus intervention measures for UI should be taken for the elderly people in rural areas of Jixian County,Tianjin.
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Objective To explore the relationship of chronic diseases and the history of gestation and delivery with urinary incontinence (UI) among elderly people of rural areas, so as to lay a scientific foundation for formulating strategies of prevention and treatment for UI. Methods A cross-sectional study was carried out in two towns of Jixian county, Tianjin. A total of 743 people aged 60 years and over were selected with cluster sampling, and all information were collected with a standardized structured questionnaire by face-to-face interview. The relationships of chronic diseases and the history of gestation and delivery with UI were analyzed with univariate analysis and multivariate Logistic regression method. Results Prevalence of UI was 33. 4% among the people aged 60 years and over in two towns of Jixian, and it was higher in females than in males (43. 2% vs. 22.8%, χ~2= 34.70, P<0.0001). Logistic regression analysis revealed that the chronic respiratory diseases, prostate disease, neurological diseases or motor system diseases were all associated with UI in men, and the elderly men who suffered from prostate disease and neurological diseases had the highest risk of UI (OR=11. 47, OR=11. 76). Constipation, chronic respiratory diseases, diabetes mellitus and motor system diseases were all associated with UI in women, and the elderly women with chronic respiratory diseases had the highest risk of UI (OR = 4. 84). Elderly women who had more gravidity (OR = 1. 03), more parity (OR= 1.02), perineal laceration (OR = 1.72) and wound infection (OR= 1. 65) during delivery had higher prevalence of UI. Conclusions Prevalence of UI is higher among the elderly people in rural areas of Jixian county, and several chronic diseases and gestation and delivery history in women are all associated with UI in the elderly. For the prevention of UI, the elderly should actively look for treating their chronic diseases and the medical workers should strengthen health education or health care for pregnant women.
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ObjectiveTo understand the prevalence of urinary incontinence (UI) and its epidemiological characteristics in rural elderly people and to lay a scientific foundation for formulating the strategies oI prevention and treatment for UI. MethodsA cross-sectional study was carried out in two townships of Jixian County, Tianjin. People aged 60 years and over were selected with cluster sampling, and the prevalence of UI and its epidemiological characteristics were collected with a standardized structured questionnaire by face-to-face interview. ResultsPrevalence of UI was 33.4% among the people aged 60 years and over in two townships, and it was increased with ageing.The elderly women had a higher prevalence of UI than the elderly man (43.2% vs. 22.8%, P<0.0001). The prevalences of UI in groups of 60-, 65-, 70-, 75-, 80-, 85-95 years old were 28.6%,32.1%,34.1%,35.5%,47.8%and 30.0%, respectively, and increased with ageing (X2for trend=2.19,P=0.029). Mixed UI (MUI) was the most common in different types of UI, and the constitution ratios of stress UI (SUI), urge UI (UUI), MUI and other type of UI were 27.4%, 1.2%, 60.9%,10.5%, respectively. The prevalence of MUI was the highest among the four types of UI in each age group. In all age groups, the prevalences of SUI and UUI were the highest in 60～ age group, and the prevalence of MUI was the highest in 80 ～ 95 age group. ConclusionsPrevalence of UI is high among the elderly people in rural areas of Jixian County, Tianjin.
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Objective To compare the safety of laparoscopic live donor nephreetomy(LDN) and open live donor nephrectomy(ODN), evaluate the kidney function and blood pressure of living donors during 1 year follow-up. Methods Thirty cases of LDN and 30 eases of ODN were retrospectively reviewed. The operation time, warm ischemia time, operative blood loss, time to post-operative intake and time to ambulation of the 2 grouups were compared. According to the modified Clavien classifica-tion system procedure-related complications were described and compared. Serum creatinine(SCr) le-vels, blood pressure and 24-h urine protein excretion were measured before nephreetomy and 1 d, 7 d, 3 months, 6 and 12 months after nephrectomy. Glomerular filtration rate (GFR) were measured preo-pratively and at 6 and 12 months postoperatively. These data were statistically analyzed. Results The operation time was (98. 6+13. 6)rain and (96.3+19. 5)rain in the LDN and ODN groups, re- spectively. Warm ischemia time in the LDN group was (90.6±15.1)s, in the ODN group was (86.4±12.3)s. Operative blood loss was (105.2±634.8)ml and (206.3±126.4)ml in the LDN and ODN groups(P<0.01). For the time to post-operative intake and time to ambulation, LDN group was (28.5±2.9)h and (25.8±63.8)h, ODN group was (38.6±63.3)h and (36.5±65.3)h(P<0.01). Perioperative complications rates were 6.6%(2/30) and 23.3%(7/30) for LDN and ODN, respective-ly. SCr was (109.1±7.5), (105.4±69.5), (96.6±10.7), (89.4±11.5), (91.6±69.3)/zmol/L in the LDN group and (107.3±69.6), (103.3±68.4), (95.4±69.1), (90.5±13.6), (90.3±11.7)μmol/L in the ODN group 1 day, 7 days, 3 months, 6 months and 12 months after nephrectomy. The mean GFR of LDN and ODN was 64.7 and 65.8 ml/min at 6 months after nephrectomy, 65.9 and 67.5 ml/min at 12 months postoperatively, which were significantly different comparing with preoperative mean GFR in each group(P<0.05) but no significant difference was found between 6 months and 12 months after nephrectomy and between the 2 groups at the same time point respectively(P>0.05). Mean 24 h protein excretion was elevated after either LDN or ODN during 1 year followup, but was not significantly different either between predonation and 1 year after nephrectomy or between the 2 groups at the same period. Blood pressure increased or decreased slightly with the duration of follow-up,no significant blood presure changes were found before and after nephrectomy or between the two groups at the same period postoperatively. Conclusions LDN has the advantages of minimal trauma, less operative blood loss and quicker convalescence. It is safe and and has no adverse effects regarding kidney function and blood pressure during the first year after living kidney donation comparing to ODN.
