A survey and cause analysis of community resilience in a Chinese city from the perspective of nursing.

BACKGROUND: Community resilience, which fully reflects the ability of communities to resist, absorb, recover or adapt to disasters, has attracted international attention. Nurses are an important force in disaster prevention, relief and postdisaster reconstruction. This study aims to test the current level of community resilience in Dujiangyan city, which was seriously damaged by the Wenchuan earthquake, and analyze the causes. METHODS: Community data from 952 residents, 574 families, 5 health care institutions and 12 communities in Dujiangyan city were collected by using stratified, cluster, map and systematic sampling methods. A new community resilience evaluation system from the perspective of nursing was used to test individual, family, health care and environmental resilience. RESULTS: In Dujiangyan city, average scores were obtained for community resilience (3.93 ± 0.12), individual resilience (4.07 ± 0.64), family resilience (4.07 ± 0.6), health care resilience (3.84 ± 0.33) and community environment resilience (3.69 ± 0.46). CONCLUSIONS: The urban communities in Dujiangyan city had acceptable resilience, with good family and individual resilience and medium health care and community environment resilience, but environmental resilience had the lowest score. Because conditions and resilience levels varied among the communities, targeted measures should be taken to improve resilience based on population characteristics, management, professional organizations, hardware and software facilities.

[Research progress on early warning model of influenza].

Influenza is an acute respiratory infectious disease caused by influenza virus. It usually exhibits seasonal transmission, but the novel influenza strain can lead to a pandemic with severe human health and socioeconomic consequences. Early warning of influenza epidemic is an important strategy and means for influenza prevention and control. On the basis of reviewing the main influenza surveillance and early warning systems, this study summarizes the principles, applications, advantages and disadvantages, and development prospects of common influenza early warning models, in order to provide reference for research and application of early warning technology for influenza and other acute respiratory infectious diseases.

[Management protocol and outcome assessment of ruptured intracranial aneurysm emergency surgery during coronavirus disease 2019 pandemic].

Objective: To explore the improvement of emergency admission screening and perioperative management protocols in the scenario of the coronavirus disease 2019 (COVID-19) pandemic and its regular prevention and control for patients with ruptured intracranial aneurysms, which are the most common emergency cases with the most urgent needs for emergent surgery. Methods: The response protocol of the emergency surgical management of ruptured intracranial aneurysm during the epidemic period (from January to March, 2020) at Beijing Tiantan Hospital, Capital Medical University was reviewed. The prognosis of emergent aneurysm surgery under different levels of protection or during the same period of 2019 and 2020 was further compared to describe the operation and prognosis under the new management protocol. Results: A total of 127 emergency cases with aneurysmal subarachnoid hemorrhage were referred to Beijing Tiantan Hospital, Capital Medical University from January 20 to March 25, 2020, and 42 cases(33.1%) underwent emergent aneurysm clipping after multi-desciplinary consultation. Admissions of emergency cases required epidemiological, laboratory, and imaging screenings for COVID-19, with additional throat swab virus nucleic acid screening afterwards. During the same period, 9 cases of COVID-19 were confirmed in the emergency screening, and no false negative cases were found. Compared with the same period in 2019, the interval between emergency visits and emergency craniotomy did not increase significantly due to the preoperative screening ((37±17) hours during the epidemic period versus (29±12) hours at the same period in 2019, P=0.058). There was no significant difference in the incidence of perioperative adverse events and postoperative neurological dysfunction (P=0.779). According to the screening results, the corresponding operative and postoperative management protocol and protection standards were adopted. There was no significant difference in the prognosis of emergent surgery between patients with a negative initial screening and those who were to be excluded or suspected in the initial screening (P=0.678). Although viral nucleic acid screening tended to prolong the time interval before surgical intervention ((36±15) hours before nucleic acid screening versus (40±20) hours after nucleic acid screening, P=0.453), there was no statistically significant difference in the preoperative adverse events and postoperative neurological function (P=0.653). Conclusion: The current protocol of COVID-19 screening and stratified emergent surgery management based on screening results can effectively identify suspected and confirmed COVID-19 cases, thereby ensuring timely, safe and effective emergent surgery and prohibiting nosocomial spread.

[Clinical effect of metatarsal diaphysis Z-shaped rotating osteotomy in moderate and severe hallux valgus with metatarsophalangeal joint incongruency].

Objective: To evaluate the clinical effect of Z-shaped rotating osteotomy of metatarsal diaphysis in patients with moderate and severe hallux valgus with metatarsophalangeal joint incongruency. Methods: We selected 36 patients (38 feet) with moderate and severe hallux valgus with metatarsophalangeal joint incongruency who underwent Z-shaped rotating osteotomy of metatarsal diaphysis in the First Affiliated Hospital of Army Medical University of Chinese PLA from September 2010 to January 2019. There were 2 males and 34 females with an average age of (49±18) years (18-77 years). Hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), congruency index, length of first metatarsal, and functional scores were evaluated before and 6 weeks after surgery and at the last follow-up. The data were compared by one-way ANONA or t test. Results: The congruency index was significantly improved from 0.75±0.11 before surgery to 0.95±0.07 at the last follow-up (t=11.728, P<0.01). HVA and IMA improved significantly at 6 weeks after surgery, however, HVA at the last follow-up showed an increased trend compared with that at 6 weeks after the operation, while no significant improvement in IMA. Although DMAA increased slightly 6 weeks after surgery when compared with that before surgery, there was no significant difference in it between the last follow-up and the 6 weeks after surgery, and no significant difference in the length of the first metatarsal at different time points (F=0.991, P>0.05). In terms of functional scores, American Orthopaedic Foot & Ankle Society (AOFAS) score increased from 50±9 before surgery to 80±17 at the last follow-up, while visual analogue scale (VAS) decreased from 5.8±1.1 to 2.7±1.5, Manchester-Oxford Foot Questionnaire (MOXFQ) score decreased from 70±13 to 25±19 (t=12.024, 13.439, 16.880, all P<0.05). Conclusions: The treatment of moderate and severe hallux valgus with metatarsophalangeal joint incongruency by Z-shaped rotating osteotomy of metatarsal diaphysis can significantly increase the congruency index of metatarsophalangeal joint and improve the metatarsophalangeal joint matching relations. It will not significantly increase the DMAA. A certain degree of radiographic recurrence occurs during a longtime follow-up, but it doesn't influence the symptoms and function.

[Impact of portal vein thrombosis on the efficacy of endoscopic treatment in preventing re-bleeding from ruptured gastroesophageal varices in hepatitis B-related liver cirrhosis].

Objective: To explore whether portal vein thrombosis affects the efficacy of endoscopic treatment in preventing re-bleeding from ruptured gastroesophageal varices in hepatitis B-related liver cirrhosis. Methods: Hospitalized patients who received endoscopic therapy to prevent re-bleeding from ruptured gastroesophageal varices due to hepatitis B-related liver cirrhosis during 2013 to 2017 were selected, and followed up for 1 year after treatment for re-bleeding and survival status. Patients were divided into thrombotic and non-thrombotic group according to whether they were combined with portal vein thrombosis at the time of initial admission. The baseline data characteristics of the two groups were analyzed. The 1-year re-bleeding rate and survival rate of the two groups were compared by Kaplan-Meier survival analysis. The other risk factors for re-bleeding after endoscopic variceal therapy were evaluated by univariate and multivariate regression. Results: A total of 124 cases with re-bleeding from ruptured gastroesophageal varices due to hepatitis B-related liver cirrhosis were included. The average age was 50.7 years old. 81.5% (101 cases) were male, and 24.2% (30 cases) were combined with portal vein thrombosis. There were no statistically significant differences between the thrombotic and the non-thrombotic group in the average age, gender, liver function classification, transjugular portal pressure gradient, antiviral treatment, and non-selective ß-blockers. Kaplan-Meier analysis of the re-bleeding rate after endoscopic treatment indicated that the incidence of non-bleeding in patients with thrombotic group at 60 days, 180 days and 1 year was significantly lower than that in the non-thrombotic group [86.7%, 80.0%, 56.7% vs. 95.7%, 93.6%, 87.2% (P = 0.000 1)]. Analysis of the location of portal vein thrombosis showed that the bleeding rate in the main portal trunk, left and right branches and superior mesenteric vein had increased significantly after endoscopic treatment, while the splenic vein had no effect on the bleeding after endoscopic treatment. Univariate and multivariate regression analysis indicated that age (HR 1.05, 95% CI: 1.01-1.09, P = 0.02) and thrombosis in the main portal trunk, left and right branches (HR 4.95, 95% CI: 2.05-11.95, P < 0.01) were independent risk factors for re-bleeding at 1 year after endoscopic treatment. Conclusion: Portal vein thrombosis is an independent risk factor that affects the efficacy of endoscopic treatment in preventing re-bleeding from ruptured gastroesophageal varices in hepatitis B-related liver cirrhosis and the risk of re-bleeding increases significantly after endoscopic treatment in patients with thrombosis.

[Low power seven-step two-lobe holmium laser enucleation of the prostate technique for surgical treatment of benign prostatic hyperplasia].

OBJECTIVE: To evaluate the safety and efficacy of the seven-step two-lobe holmium laser enucleation of the prostate (HoLEP) technique with low power laser device, and to introduce the detailed operating procedures, key points, short-term outcomes of this modified HoLEP technique. METHODS: From March 2016 to November 2017, 90 patients underwent HoLEP in Peking University Third Hospital. The patients were divided into two groups: high-power group (32 patients) were performed with traditional Gilling's three-lobe enucleation using high power (90 W) laser; Low-power group (58 patients) were performed with seven-step two-lobe enucleation using low power (40 W) laser. The main steps of the low power seven-step two-lobe HoLEP phase included: (1) The identification of the correct plane between adenoma and capsule at 5 and 7 o'clock laterally to the veru montanum; (2) The connection of the bilateral plane by making a adenoma incision at the proximal point of veru montanum; (3) The extension of the dorsal plane under the whole three lobes between adenoma and capsule towards the bladder neck; (4) The separation of the middle lobe from two lateral lobes by making two retrograde incisions separately from apex 5 and 7 o'clock towards the bladder neck; (5) The enucleation of the middle lobe adenoma by extending the dorsal plane through into the bladder; (6) The prevention of the apex mucosa by making a circle incision at the apex of the prostate; (7) The en-bloc enucleation of the two lateral lobe adenomas by extending the lateral and ventral plane between adenoma and capsule from 5 and 7 o'clock to 12 o'clock conjunction and through into the bladder. RESULTS: The mean patient age was (66.25±5.37) years vs. (68.00±5.18) years; The mean body mass indexes were (24.13±4.06) kg/m2 vs. (24.57±3.50) kg/m2; The mean prostate specific antigen values were (3.23±2.47) µg/L vs. (6.00±6.09) µg/L; The average prostatic volumes evaluated by ultrasound was (49.03±20.63) mL vs. (67.55±36.97) mL. There was no significant difference between the two groups. Furthermore, there were no significant differences in terms of perioperative and follow up data, including operative time; enucleation efficiencies; hemoglobin decrease; blood sodium and potassiumthe change postoperatively; catheterization duration and hospital stay; the international prostate symptom scores and quality of life scores pre- and post-operatively. There was 1 transurethral resection of the prostate (TURP) conversion in high-power group and 1 transfusion in low-power group during the operations. The follow-up one month after operation showed no severe stress incontinence in both the groups, whereas 3 cases ejaculatory dysfunctions in high-power group versus 1 case in low-power group were observed; Other surgeryrelated complications included: 2 cases postoperative hemorrhage (Clavien II and Clavien IIIb) in high-power group, 2 cases postoperative temperature more than 38 °C (Clavien I) and 1 case dysuria following catheter removal (Clavien I) in low-power group. CONCLUSION: Low power laser device can be applied safe and effectively for HoLEP procedure using the seven-step two-lobe HoLEP technique. The outcomes comparable with high power laser HoLEP can be achieved.

[Transurethral bipolar plasmakinetic prostatectomy for benign prostatic hyperplasia in high-risk and senior patients in China: a systematic review and meta-analysis].

Objective: To evaluate the effectiveness and safety of transurethral bipolar plasmakinetic prostatectomy in the treatment of benign prostatic hyperplasia in high-risk and senior patients in China. Methods: The PubMed, Cochrane Library, CBM, CNKI and WanFang databases were searched with computer for collecting relevant interventional case series from establishment dates to September 14, 2018. After quality evaluation and data extraction independently conducted by two authors, the Meta-analysis was performed using the Comprehensive Meta-analysis V2 software. Results: Eighteen studies involving 1 899 patients are included. Maximum flow rate increased to 12.28 ml/s (95%CI: 8.42-16.14), 12.88 ml/s (95%CI: 9.85-15.92) ,14.32 ml/s (95%CI: 10.47-18.18), 14.93 ml/s (95%CI: 10.19-19.67) and 20.00 ml/s (95%CI: 19.08-20.92) in 1, 3, 6, 12 and 24 months after surgery, respectively. International prostate symptom score decreased to -18.60 (95%CI: -23.20--14.00), -17.62 (95%CI: -20.21--15.03), -19.14 (95%CI: -20.70--17.59), -19.06 (95%CI: -21.53--16.60) and -22.90 (95%CI: -24.26--21.54), respectively. Quality of life decreased to -2.38 (95%CI: -4.26--0.50), -3.39 (95%CI: -4.57--2.21),-3.75 (95%CI: -4.14--3.36), -3.36(95%CI: -4.56--2.16), and -4.58(95%CI: -4.75--4.41). Post void residual decreased to -231.16 ml (95%CI: -288.30--174.01), -76.10 ml (95%CI: -116.71--35.50), -159.90 ml(95%CI: -207.21--112.59) and -87.70 ml (95%CI: -91.91--83.48). The event rate of postoperative adverse reactions all were not high. Conclusion: Transurethral bipolar plasmakinetic prostatectomy has better clinical efficacy and no obvious side effects in the treatment of benign prostatic hyperplasia in high-risk and senior patients in China.

[Epidemic characteristics and prophylaxis/control measures of infectious diseases caused by hydrological disasters].

Hydrological disasters are associated with infectious disease outbreaks and epidemics. Hydrological disasters will lead to water pollution, increased vulnerability to diseases, and increased density of vectors. These factors will facilitate the outbreaks of water-borne/food-borne diseases, vector-borne diseases, and air-borne/contagious diseases. Pre-event preparedness for disasters and post-event reconstruction of both disease surveillance system and water-supply system are key measures to prevent infectious disease outbreaks caused by hydrological disasters. This study reviews the domestic and overseas experiences of controlling infectious diseases after hydrologic disasters, outlines the spectrum of post-disaster infectious disease as well as their epidemiological characteristics, and provides practicable suggestions accordingly.

[A comparative study of the calcaneal closing-wedge calcaneal osteotomy versus posterior-superior prominence removal in both sides with Haglund syndrome].

Objective: To compare the clinical outcome of removal of calcaneal posterior-superior prominence and that of calcaneal closing-wedge osteotomy for Haglund syndrome. Methods: From February 2009 to July 2014, 36 patients with Haglund syndrome were included.They were divided into two groups, and each group included 18 patients and underwent removal of calcaneal posterior-superior prominence and calcaneal closing-wedge osteotomy respectively.They were evaluated preoperatively and after 6 , 12 months and 24 months postoperatively by American Orthopedic Foot & Ankle Society (AOFAS) score, VAS score, VISA-A questionnaire and Maryland Foot Score.Fowler-Philip angle and calcaneal posterior slope of the two groups were compared preoperatively and after 6 months.All data were analysis utilizing SPSS 18.0. Results: At six months of follow-up, the weight-bearing lateral X-rays reveals that removal of calcaneal posterior-superior prominence did not change Fowler-Philip angle and calcaneal posterior slope and calcaneal closing-wedge osteotomy decreased Fowler-Philip angle and calcaneal posterior slope significantly[from preoperation (56.5±5.4)°, (120.0±1.3)°to postoperation (48.4±4.6)°, (109.0±5.3)°]. At six months of follow-up, the AOFAS score, VAS score, VISA-A questionnaire and Maryland Foot Score were worse in the wedge calcaneal osteotomy group.At twelve months of follow-up, no significant difference (P>0.05)was found between the two groups in terms of VAS score, and Maryland Foot Score, while the AOFAS score, and VISA-A questionnaire in the wedge calcaneal osteotomy group were better than those of posterior-superior prominence removal group.At twenty-four months of follow-up, the AOFAS score, VAS score, VISA-A questionnaire and Maryland Foot Score were better in the wedge calcaneal osteotomy group (P<0.05). Conclusions: Both the two surgical methods are effective for Haglund syndrome.Calcaneal closing-wedge osteotomy decreased Fowler-Philip angle and calcaneal posterior slope of calcaneus and its clinical outcome appears better than that removal of calcaneal posterior-superior prominence.

Recombinant erythropoietin protective and related effects on brain injury in premature infants.

OBJECTIVE: The aim of this study was to investigate the protective effect of recombinant erythropoietin at different doses on brain injury in premature infants and the related effects on blood routine, liver function, intellectual development, mental development index (MDI), psychomotor development index (PDI), etc. PATIENTS AND METHODS: A total of 120 premature infants were divided into four groups, including experimental group A (n=30), experimental group B (n=30), experimental group C (n=30) and control group (n=30). The experimental group was treated with different doses of recombinant erythropoietin for brain injury protection of premature infants, while the control group with conventional methods. RESULTS: There was no statistical significance in all test indicators of the four groups of patients before the intervention. After the intervention experiment, the S-100B index was p<0.05, and the erythropoietin (EPO) index was p<0.05. In the comparison of IL-6 indicators, the indicators of the experimental group were reduced after the comparison experiment, and there were significant differences, p<0.05. In neonatal behavior evaluation, there was a statistical difference between groups A and B and the control group (p<0.05), and no statistical significance was shown between group C and the control group (p>0.05). In the intelligence test comparison, the F value of the experimental group was 3.113 three months after treatment. After six months, the F value was 3.654. After nine months, the F value was 3.392 with p<0.05. In the comparison of blood routine indicators, the p-values of four indicators between groups were more than 0.05. In the comparison of liver function indexes, the indexes of groups A, B, and C were significantly changed before and after treatment, and the data after treatment were significantly different from those before treatment, p<0.05. In the comparison of development, there were no significant differences observed in the p-values of the two indicators of vigorous exercise and language in the experimental group. CONCLUSIONS: Recombinant erythropoietin has a protective effect on infants with brain injury and can improve the intellectual development of premature infants, but has no significant effect on blood routine indicators. It can effectively improve the MDI, PDI, and related cytokines of premature infants, and has certain significance for the treatment of brain injury.

[Evaluation of demand of resources for laboratory testing and prevention and control of COVID-19 in the context of global pandemic].

Objective: To rapidly evaluate the level of healthcare resource demand for laboratory testing and prevention and control of corona virus disease 2019 (COVID-19) in different epidemic situation, and prepare for the capacity planning, stockpile distribution, and funding raising for infectious disease epidemic response. Methods: An susceptible, exposed, infectious, removed infectious disease dynamics model with confirmed asymptomatic infection cases and symptomatic hospitalized patients was introduced to simulate different COVID-19 epidemic situation and predict the numbers of hospitalized or isolated patients, and based on the current COVID-19 prevention and control measures in China, the demands of resources for laboratory testing and prevention and control of COVID-19 were evaluated. Results: When community or local transmission or outbreaks occur and total population nucleic acid testing is implemented, the need for human resources is 3.3-89.1 times higher than the reserved, and the current resources of medical personal protective equipment and instruments can meet the need. The surge in asymptomatic infections can also increase the human resource demand for laboratory testing and pose challenge to the prevention and control of the disease. When vaccine protection coverage reach ≥50%, appropriate adjustment of the prevention and control measures can reduce the need for laboratory and human resources. Conclusions: There is a great need in our country to reserve the human resources for laboratory testing and disease prevention and control for the response of the possible epidemic of COVID-19. Challenges to human resources resulted from total population nucleic acid testing and its necessity need to be considered. Conducting non-pharmaceutical interventions and encouraging more people to be vaccinated can mitigate the shock on healthcare resource demand in COVID-19 prevention and control.

Examination of preliminary behavioral and effective connectivity findings from treatment response to citalopram in cocaine use disorder: A dynamic causal modeling study.

We sought effective (directional) connectivity parameters associated with response to citalopram in cocaine use disorder (CUD) by conducting a functional magnetic resonance imaging (fMRI) experiment with participants diagnosed with CUD (n = 13) and matched healthy controls (HC; n = 17). CUD participants showed a positive correlation between bilateral DLPFC-to-putamen effective connectivity and treatment effectiveness score. These preliminary results support further investigation of prefrontal-striatal interactions in response to treatment in CUD.

Minimally invasive surgery for congenital diaphragmatic hernia: a meta-analysis.

OBJECTIVES: To compare the safety and efficacy of minimally invasive surgery (MIS) with traditional open surgical approach for congenital diaphragmatic hernia (CDH). METHODS: A literature search was performed using the PubMed database, Embase, and the Cochrane central register of controlled trials using a defined set of criteria. The outcomes, which include post-operative mortality, incidence of hernia recurrence, rates of patch use and complications, were analyzed. RESULTS: We investigated nine studies, which included 507 patients. All studies were non-randomized historical control trials. The MIS group had a significantly lower rate of post-operative death with a risk ratio of 0.26 [95% confidence interval (CI) 0.10-0.68; p = 0.006] but a greater incidence of hernia recurrence with a risk ratio of 3.42 (95% CI 1.98-5.88; p < 0.00001). Rates of prosthetic patch use were similar between the two groups. Fewer cases of surgical complications were found in the MIS group with a risk ratio of 0.66 (95% CI 0.47-0.94; p = 0.02). CONCLUSIONS: MIS for CDH repair is associated with lower post-operative mortality and morbidity compared with traditional open repair. Although rate of patch use appears to be comparable, the increased risk of CDH recurrence should not be ignored. The lack of well-controlled prospective trials still limits strong evaluations of the two surgical techniques.

In vivo activity of leflunomide: pharmacokinetic analyses and mechanism of immunosuppression.

BACKGROUND: Leflunomide is an experimental drug with demonstrated ability to prevent and reverse acute allograft and xenograft rejection. The two biochemical activities reported for the active metabolite of leflunomide, A77 1726, are inhibition of tyrosine phosphorylation and inhibition of dihydroorotate dehydrogenase, an enzyme necessary for de novo pyrimidine synthesis. These activities can be distinctly separated in vitro by the use of uridine, which reverses the anti-proliferative effects of A77 1726 caused by inhibition of de novo pyrimidine synthesis. We report the effect of uridine on the in vivo immunosuppressive activities of leflunomide. METHODS: We first quantified the serum levels of A77 1726, the active metabolite of leflunomide, after a single treatment of leflunomide (5, 15, and 35 mg/kg). Additionally, we quantified the levels of serum uridine and of nucleotide triphosphates in the liver, spleen, and lymph nodes of Lewis rats after the administration of a single dose of uridine (500 mg/kg; i.p.). Lewis rats heterotopically transplanted with brown Norway or Golden Syrian hamster hearts were treated for 50 or 75 days with leflunomide (5, 15, and 35 mg/kg/day; gavage) alone or in combination with uridine (500 mg/ kg/day; i.p.). Hematocrits were determined and the levels of alloreactive or xenoreactive immunoglobulin (Ig)M and IgG were determined by flow cytometric analysis. The allograft and xenografts, small bowel, liver, kidney, and spleen were subjected to pathological examination. RESULTS: A linear relationship was observed between the serum A77 1726 concentrations in Lewis rats and the dose of leflunomide administered. Peak A77 1726 concentrations were 20.9, 71.8 and 129.3 mg/l (77.5, 266.1 and 478.8 microM) for the 5, 15, and 35 mg/kg doses of leflunomide, respectively. The concentration of uridine in the serum of normal Lewis rats is 6.5 microM; after i.p. administration of 500 mg/kg uridine, the serum uridine concentrations peaked at 384.1 microM in 15-30 min. The rapid elimination of uridine was not reflected in the lymphoid compartments, and the pharmacokinetics of pyrimidine nucleotides in the spleen resembled that of A77 1726. This dose of uridine, when administered daily (500 mg/kg/day, i.p.), weakly antagonized the immunosuppressive activities of leflunomide (5, 15, and 35 mg/kg/day) in the allotransplantation model. In contrast, in the xenotransplantation model, the same concentration of uridine completely antagonized the immunosuppressive activities of low-dose leflunomide (15 mg/kg/day) and partially antagonized the immunosuppressive activities of high-dose leflunomide (35 mg/kg/day). Toxicities associated with high-dose leflunomide (35 mg/kg/day) were anemia, diarrhea, and pathological changes in the small bowel and liver. These toxicities were significantly reduced by uridine co-administration. CONCLUSION: These studies reveal that the blood levels of A77 1726 in Lewis rats satisfy in vitro requirements for both inhibition of de novo pyrimidine synthesis and protein tyrosine kinase activity. Our data also illustrate that the in vivo mechanism of immunosuppression by leflunomide is complex and is affected by at least the following four factors: type and vigor of the immune response, availability of uridine for salvage by proliferating lymphocytes, species being investigated, and concentration of serum A77 1726.

Technical modifications of retroperitoneoscopic live donor nephrectomy: Chinese experience.

OBJECTIVE: The objective of this article is to report a single-center experience and technical modifications of retroperitoneoscopic live donor nephrectomy (RPLDN). MATERIALS AND METHODS: One hundred twenty-one 3-port RPLDNs were performed at our institution. No prisoners or organs from prisoners were used to collect the data for this study. The tributaries of renal artery and vein were transected using a harmonic scalpel after both ends of the tributary were coagulated intermittently until the color turned light yellow. Transection was made using shifting coagulation. A longitudinal 6-8-cm skin incision was extended inferiorly from the primary trocar with muscles intact. The renal artery was clipped using two Hem-o-Lok clips at the proximal end, and then sheared by scissors without any clips on the kidney side. The renal vein was controlled similarly. The graft was retrieved by insertion of a hand through the longitudinal lumbar incision. RESULTS: The mean operative time and warm ischemia time were 126.1 and 3.6 minutes, respectively. No blood transfusion or open conversion was required. None of the donors encountered a major complication, but 7 suffered minor complications. Preoperative and postoperative mean serum creatinine levels of the donors were 1.00 and 1.29 mg/dL, respectively. The mean serum creatinine levels of the recipients postoperatively at day 1 and month 1 were 5.48 and 1.60 mg/dL, respectively. CONCLUSIONS: The modified approach of RPLDN may be a useful alternative with flexible control of the renal vessels and tributaries and easy retrieval of the graft.