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Objective To analyze the correlation between internal iliac artery calcification and delayed graft function (DGF) and short-term prognosis of kidney transplant recipients. Methods Clinical data of 222 kidney transplant recipients were retrospectively analyzed. According to the recovery of renal function, all recipients were divided into the DGF group (n=50) and immediate graft function (IGF) group (n=172). According to whether the recipients were complicated with severe internal iliac artery calcification, DGF and IGF groups were further divided into the high-risk DGF (n=22), low-risk DGF (n=28), high-risk IGF (n=41) and low-risk IGF(n=131) subgroups, respectively. Clinical data of donors and recipients were statistically compared between two groups. The incidences of postoperative DGF and internal iliac artery calcification were recorded. The risk factors of DGF after kidney transplantation, and the correlation between internal iliac artery calcification and clinical parameters were analyzed. Short-term prognosis of recipients with DGF complicated with severe internal iliac artery calcification was evaluated. Results The incidence of DGF was 22.5% (50/222). Among all recipients, 28.4% (63/222) were complicated with severe internal iliac artery calcification. In the DGF group, 44% (22/50) of the recipients were complicated with severe internal iliac artery calcification, higher than 23.8% (41/172) in the IGF group (P < 0.05). Univariate analysis showed that high serum creatinine (Scr) level of donors, male donor, high triglyceride level and severe internal iliac artery calcification of recipients were the risk factors for DGF after kidney transplantation (all P < 0.05). Multivariate logistic regression analysis revealed that Scr≥143 μmol/L of donors and severe internal iliac artery calcification of recipients were the independent risk factors for DGF after kidney transplantation (both P < 0.05). Correlation analysis indicated that internal iliac artery calcification was weakly correlated with the age of recipients and renal artery anastomosis (both P < 0.05). In the DGF group, the Scr level at postoperative 1 month was significantly higher, whereas the estimated glomerular filtration rate (eGFR) was significantly lower than those in the IGF group (both P < 0.05). The eGFR at postoperative 12 months in the high-risk DGF subgroup was significantly lower than those in the low-risk DGF, high-risk IGF and low-risk IGF subgroups (all P < 0.05). Conclusions Internal iliac artery calcification is not only a risk factor for recovery of renal allograft function, but also negatively affects short-term prognosis of renal allograft function.
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【Objective】 To explore the effects of early application of erythropoietin (EPO) in patients with anemia after renal transplantation. 【Methods】 Patients who underwent renal transplantation in the First Affiliated Hospital of Soochow University were retrospectively analyzed. According to whether EPO was applied after operation, the patients were divided into EPO group and routine group. Patients with delayed renal function recovery were excluded, and the remaining patients were further analyzed. The general, laboratory and follow-up data of the two groups were compared, and adverse drug reactions were observed. 【Results】 The hemoglobin (P=0.026), red blood cell count (P=0.038) and hematocrit (P=0.011) in EPO group were higher than those in the routine group 2 weeks after operation, while the postoperative serum creatinine level was lower (P=0.001). Since the first week after operation, the reticulocyte count in EPO group was significantly higher than that in routine group (P<0.01). There was a negative correlation between hemoglobin and serum creatinine in EPO group at week 1 (r=-0.375, P=0.010) and week 2 (r=-0.386, P=0.008). During the treatment, 6 patients showed transient elevation of serum potassium, which returned to normal after symptomatic treatment, and no obvious adverse drug reactions were observed. 【Conclusion】 Continuous application of erythropoietin in the early stage after renal transplantation can significantly improve anemia in renal transplant patients and promote the recovery of renal function.
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Objective:To explore independent risk factors and risk stratification for diagnosis of clinically significant prostate cancer (CsPCa) in biopsy-naive patients with nonsuspicious multiparametric magnetic resonance imaging (mpMRI).Methods:The data of 549 patients who underwent initial systematic biopsy (SB) in the First Affiliated Hospital of Soochow University, the Second Affiliated Hospital of Soochow University and Traditional Chinese Medicine Hospital of Kunshan between October 2015 and January 2021 were retrospectively reviewed. Nonsuspicious mpMRI was defined as Prostate Imaging-Reporting and Data System (PI-RADS)≤2. All patients received systematic 12 core prostate biopsy, 278 of them by transperineal and 271 by transrectal biopsies. The median age of the patients was 67 (62, 73) years, the median prostate specific antigen (PSA) was 9.01 (6.15, 13.64) ng/ml, the median prostate volume was 48.41 (35.85, 64.28) ml, and 54 patients were positive in digital rectal examination (DRE). Taking CsPCa as the outcome index, receiver operating characteristic (ROC) analysis was performed on age, tPSA, f/tPSA and PSA density (PSAD) to obtain the optimal cut-off value, and logistics regression was used to explore the independent risk factor of CsPCa in mpMRI negative patients. The optimal cut-off value when the negative predictive value (NPV) of mpMRI diagnosis of CsPCa was 100%, was taken as the protective factor, and the risk stratification model was finally proposed.Results:Of all 549 cases, 44 were CsPCa, 35 were clinically insignificant prostate cancer and 470 were non-prostate cancer. There were significant differences in age (71 vs. 67 years old), tPSA (11.95 vs. 8.75 ng/ml), PSAD [0.31 vs. 0.18 ng/(ml·cm 3)], f/tPSA (0.12 vs. 0.16) and DRE positive rate (38.6% vs. 7.3%) between CsPCa group and non-CsPCa group ( P<0.01). Cut-off values were taken in ROC analysis when the Youden index was at its maximum. The optimal cut-off values of each continuous variable were: age=65 years, tPSA=10ng/ml, f/tPSA=0.2 and PSAD=0.15 ng/(ml·cm 3). Multivariate analysis showed that ages over 65 years ( OR=3.43, 95% CI 1.55-7.58, P=0.002), f/t PSA ratio<0.2 ( OR=3.84, 95% CI 1.28-11.56, P=0.016), PSAD>0.15 ng/(ml·cm 3) ( OR=3.60, 95% CI 1.13-11.51, P=0.03) and positive DRE ( OR=5.20, 95% CI 2.39-11.32, P<0.001) were independent risk factors of CsPCa. When NPV was 100%, the cut-off values were taken as the protective factors: age≤55 years, f/tPSA≥0.3, PSAD≤0.1 ng/(ml·cm 3). Combined with independent risk factors, preliminary risk stratification was conducted: those with ≥2 high risk factors were considered as high risk group, those with ≥2 protective factors were considered as low risk group, and the middle region was considered as medium risk group. Conclusions:Patients with age>65 years, f/tPSA<0.2, PSAD > 0.15 ng/(ml·cm 3) and DRE positive are independent risk factors of CsPCa in mpMRI negative patients. Patients in the high-risk group were recommended to undergo prostate biopsy, while patients in the low-risk group could be considered to avoid biopsy.
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Objective:To evaluate the predictive value of the quick sequential organ failure assessment(qSOFA) score in septic shock after percutaneous nephrolithotomy(PCNL).Methods:309 patients who underwent PCNL at the First Affiliated Hospital of Soochow University between May 2018 and October 2019 were retrospectively reviewed. Among them, there were 192 men and 117 women, whose mean age was (51.4±12.8)years (range from 20 to 79 years). There were 82 cases(26.5%) of hypertension and 23 cases(7.4%) of diabetes. There were 88 patients(28.5%) with positive preoperative urine culture.102 patients(33.0%) were diagnosed with staghorn calculi by abdominal CT and urinary tract abdominal plain film(KUB).78 patients(25.2%) had a history of urinary surgery. The qSOFA and SIRS were evaluated to all patients within 24 h after PCNL and the best diagnostic criteria was considered as qSOFA≥2 and SIRS≥2. Receiver operating characteristic(ROC) curves were constructed and the areas under the curve(AUC) were calculated to compare the discriminatory ability of qSOFA and SIRS with the post-PCNL septic shock. A univariate logistic regression analysis was used to identify the covariates associated with post-PCNL sepsis. Then adjusted multivariate analysis was used to identify the predictive value of positive qSOFA and SIRS for the postoperative clinical outcomes including postoperative hospitalization days, postoperative blood transfusion, postoperative re-intervention, residual stone, planned readmission within 30 days and unplanned readmission within 30 days.Results:Among the 309 patients who underwent PCNL, 23 patients(7.4%) met the positive qSOFA criterion while 84 patients(27.2%) developed to SIRS. 7 patients(2.3%) were admitted to ICU after operation and were eventually diagnosed as septic shock, among which 6 patients met the criteria of qSOFA and SIRS. 8 patients(2.6%) underwent multi-channel operation. The median operative time of 309 patients was 85(56, 115) min. Postoperative calculus composition analysis showed that 64 patients(20.7%) were infectious calculi. Postoperative KUB showed residual calculi in 179 patients (57.9%). The median postoperative hospital stay was 7(6, 9) days. 10 patients(3.2%) received blood transfusion. 9 patients(2.9%) received re-intervention after surgery. There were 41 patients (13.3%) of planned readmissions and 16 cases (5.2%) of unplanned readmissions within 30 days. The AUC of qSOFA and SIRS was 0.900 and 0.799 respectively. The qSOFA had a higher specificity, positive likelihood ratio and positive predictive value(94.4%, 15.23, 26.1%)than that of SIRS(74.2%, 3.32, 7.1%)for septic shock. In univariate logistic regression analysis significant associations were observed between positive urine culture, stone size, staghorn stones, struvite stones, surgery history, operation time and sepsis after PCNL. Multivariate logistic regression analysis revealed that postoperative length of stay( OR=1.237, 95% CI 1.048-1.459, P=0.012) and postoperative transfusion( OR=8.265, 95% CI 1.409-48.481, P=0.019) were closely associated with qSOFA after adjusting for covariates shown to be related to post-PCNL sepsis mentioned above. Conclusions:The qSOFA could be superior to SIRS in predicting septic shock after PCNL.
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Objective:To evaluate the application of multiparametric MRI (mpMRI)-transrectal ultrasound (TRUS) fusion guided biopsy in the diagnosis of clinical significant prostate cancer (PCa).Methods:A prospective analysis was performed in 168 patients with suspected PCa from September 2015 to June 2017 in the First Affiliated Hospital of Soochow University. Suspicious areas on mpMRl were defined and graded using prostate imaging reporting and data system version 2 (PI-RADS V2) score. All the patients had the TRUS-guided systematic biopsy, 108 patients with PI-RAD V2 scores ≥ 3 had additional MRI-TRUS targeted biopsies. Taking pathologic results as golden standard, the detection rates were compared between the 2 methods using χ 2 test. Results:Initially, all of the 168 patients underwent TRUS biopsy. PCa was detected in 86 (101 niduses) of 168 patients (51.19%, 86/168), 82 (91 niduses) (48.81%, 82/168) were not prostate cancer. Seventy eight (46.43%, 78/168) cases of PCa were detected by TRUS biopsy, and 63 (58.33%, 63/168) cases of PCa were detected by MRI-TRUS fusion guided biopsy, the difference was statistically significant between TRUS biopsy and MRI-TRUS fusion guided biopsy (χ 2=3.73, P=0.035). The 168 patients were biopsied with a total of 2 300 cores, including TRUS biopsy 2 016 cores and MRI-TRUS fusion targeted biopsy 284 cores. Additionally, the detection rate for per cores for MRI-TRUS fusion targeted biopsy (51.76%, 147/284) was significantly higher than that for TRUS biopsy cores (19.64%, 396/2 016) (χ 2=142.38, P<0.05). Among patients with a positive biopsy for PCa, the biopsy cores for conventional TRUS biopsy was 1 032 comparing to 214 cores for MRI-TRUS biopsy. The suspicious MRI-TRUS fusion targeted biopsy (68.69%, 147/214) detected more PCa compared with TRUS biopsy (38.37%, 396/1 032) (χ 2=66.27, P<0.05). Among patients with a positive biopsy for PCa, MRI-TRUS fusion targeted biopsy [69.74% (106/152)] detected more significant cancer cores than TRUS biopsy [54.50% (351/644) ] (χ 2=11.67, P<0.05). Conclusion:MRI-TRUS fusion biopsy combined with PI-RADS V2 increases positive rate markedly and improves the detection rate of clinical significant PCa.
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Objective@#To evaluate the diagnostic value of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) parameters in diagnosing prostate cancer(PCa) in transition zone (TZ) and stratifying pathologic Gleason grade of prostate cancer.@*Methods@#A total of 55 patients who were undergoing preoperative muti-parameters MRI of T2WI, DWI, IVIM and DKI model for the exploration of prostate cancer (January 2015 to June 2017) with pathologically confirmed by MRI-transrectal ultrasound (TRUS) targeted fusion biopsy were retrospectively included. Parameters were postprocessed by IVIM models including quantitation of perfusion fraction (f), diffusivity (D) and pseudo-diffusivity (D*) and DKI models including the mean diffusivity (MD), mean kurtosis (MK) and fractional anisotropy (FA) by outlining the 3D VOI. Independent sample t-test was used to compare the differences in lesion parameters between prostate cancer and BPH, low-risk (BPH+Gleason score 6 points) and medium-high-risk lesions (Gleason score ≥7 points). Correlation between ADC values, IVIM and DKI parameters and Gleason scores were assessed with Spearman analysis. Receiver operating characteristic curve analysis was used to evaluate the efficacy of various parameters in the differential diagnosis of prostate cancer and BPH with low-risk or high-risk.@*Results@#27 (36 focus) cases of PCa and 28 (40 focus) cases of benign prostatic hyperplasia (BPH) in PZ were included, meanwhile, the cases of GS ≥7 and and BPH+(GS=6) were 33,43,respectively. There were significant differences in ADC, D, MD, MK, and FA between patients in PCa-BHP group and high-low risk group in TZ (P<0.05), D* and f had no significant differences (P>0.05). ADC and MD showed relatively higher negativity correlations (r were -0.585 and -0.489, P<0.05) with GS of PCa in TZ. ADC exhibited a higher area under the curve (AUC 0.864) compared with D with area under the curve (AUC 0.853), however, the difference is not significant (P>0.05). Of model DKI in diagnose of PCa and BPH, the highest classification accuracy was MD(AUC 0.796). The AUC derived from multiple model parameters in different combination of ADC+D value, ADC+MD value, and ADC+MD+D value were 0.892, 0.884, and 0.897, respectively. ADC and D of IVIM model showed a significance difference between GS ≥7 and BPH+(GS=6) with a higher AUC of 0.826 and 0.743. The AUC was 0.851 of the combination of mean ADC and D, 0.846 of combination of mean ADC and MD, the AUC (0.856) of the combination of ADC, D and MD significant higher than any two combined parameters (P>0.05).@*Conclusions@#IVIM and DKI models may help to discriminate prostate cancer from BPH, and predict mid-higher GS PCa in TZ. But there is no significant advantage compared with ADC values. It is feasible to stratify the pathological grade of prostate cancer in TZ by mean ADC and MD.
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Objective To evaluate the diagnostic value of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) parameters in diagnosing prostate cancer(PCa) in transition zone (TZ) and stratifying pathologic Gleason grade of prostate cancer. Methods A total of 55 patients who were undergoing preoperative muti?parameters MRI of T2WI, DWI, IVIM and DKI model for the exploration of prostate cancer (January 2015 to June 2017) with pathologically confirmed by MRI?transrectal ultrasound (TRUS) targeted fusion biopsy were retrospectively included. Parameters were postprocessed by IVIM models including quantitation of perfusion fraction (f), diffusivity (D) and pseudo?diffusivity (D*) and DKI models including the mean diffusivity (MD), mean kurtosis (MK) and fractional anisotropy (FA) by outlining the 3D VOI. Independent sample t?test was used to compare the differences in lesion parameters between prostate cancer and BPH, low?risk (BPH+Gleason score 6 points) and medium?high?risk lesions (Gleason score ≥7 points). Correlation between ADC values, IVIM and DKI parameters and Gleason scores were assessed with Spearman analysis.Receiver operating characteristic curve analysis was used to evaluate the efficacy of various parameters in the differential diagnosis of prostate cancer and BPH with low?risk or high?risk. Results 27 (36 focus) cases of PCa and 28 (40 focus) cases of benign prostatic hyperplasia(BPH) in PZ were included, meanwhile, the cases of GS≥7 and and BPH+(GS=6) were 33,43,respectively. There were significant differences in ADC, D, MD, MK, and FA between patients in PCa?BHP group and high?low risk group in TZ (P<0.05), D*and f had no significant differences (P>0.05). ADC and MD showed relatively higher negativity correlations (r were－0.585 and－0.489, P<0.05) with GS of PCa in TZ. ADC exhibited a higher area under the curve (AUC 0.864) compared with D with area under the curve (AUC 0.853), however, the difference is not significant (P>0.05). Of model DKI in diagnose of PCa and BPH, the highest classification accuracy was MD(AUC 0.796). The AUC derived from multiple model parameters in different combination of ADC+D value, ADC+MD value, and ADC+MD+D value were 0.892, 0.884, and 0.897, respectively. ADC and D of IVIM model showed a significance difference between GS≥7 and BPH+(GS=6) with a higher AUC of 0.826 and 0.743. The AUC was 0.851 of the combination of mean ADC and D, 0.846 of combination of mean ADC and MD, the AUC (0.856) of the combination of ADC, D and MD significant higher than any two combined parameters (P>0.05). Conclusions IVIM and DKI models may help to discriminate prostate cancer from BPH, and predict mid?higher GS PCa in TZ. But there is no significant advantage compared with ADC values. It is feasible to stratify the pathological grade of prostate cancer in TZ by mean ADC and MD.
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Objective To investigate the relationship between uric acid stone formation and visceral fat area based on computed tomography.Methods As many as 247 patients admitted to our hospital were retrospectively reviewed from January 2017 to January 2018.There were 161 males (65.2％) and 86 females (34.8％).The average age was 51 (20-88 years).According to the results of stone analysis after surgery,the patients were divided into uric acid stone group and non-uric acid stone group.According to the abdominal CT scan,Image J software was used to measure the anthropometric measurements like waist circumference,total fat area (TFA),and visceral fat area (VFA),and subcutaneous fat area (SFA).The clinical characteristics of different stone components were compared.An univariate and multivariate logistic regression analysis was used to identify the independent factors associated with uric acid stone formation.Different anthropometric measurements were compared by using the area under receiver operating characteristic curve.Results The uric acid stones in high VFA group (28/110;25.5％) were obviously more frequent than that in the low VFA group (7/137;5.1％) (P ＜ 0.05).The results of the univariate logistic regression analysis showed that age,diabetes,hyperlipidemia,TFA,waist circumference,body mass index (BMI),VFA,uric acid,and urine pH were statistically significant (P ＜ 0.05).Multivariate logistic regression analysis revealed that diabetes (OR =3.408,95％ CI 1.123-10.340,P =0.030),VFA (OR =6.740,95％ CI 1.95 1-23.279,P =0.003),uric acid (OR =3.182,95 ％ CI 1.120-9.040,P =0.030) and urine pH (OR =4.052,95％ CI 1.095-14.989,P =0.036) were independent factors associated with uric acid stone formation.The area under the curve of TFA,waist circumference,BMI,VFA,and SFA were 0.659,0.665,0.632,0.723 and 0.544,respectively.Conclusions Diabetes,VFA,uric acid and urine pH are independent factors influencing the formation of uric acid stones.Compared with other anthropometric measurements such as TFA,waist circumference,BMI,and SFA,VFA can better assess abdominal obesity and predict the formation of uric acid stones.
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Objective To investigate the diagnostic accuracy of magnetic resonance imaging and ultrasound (MRI/US) fusion targeted biopsy (TB) and systematic biopsy (SB) in the patients with prostate specific antigen (PSA) in grey area.Methods The patients who received MRI/US fusion TB and SB in the First Affiliated Hospital of Soochow University between October 2015 and March 2018 were retrospectively reviewed.Eligibility criteria included:tPSA ranged 4 to 10 ng/ml;prebiopsy MRI found at least 1 suspected lesion;no prostate-related treatment history;no prostate biopsy history.A total of 93 patients were invloved.The median age,tPSA and prostate volume were 66 (30-85) years,7.18 (4.11-9.95) ng/ml and 42.01 (14.93-119.15) ml,respectively.Prebiopsy MRI found 136 suspected lesions,with the median PI-RADS of 3 (3-5) and lesion size of 7 (3-20) mm.All patients underwent MRI/US fusion TB followed by SB.The comparison of two protocols in detecting any prostate cancer (PCa) as well as clinically significant prostate cancer (CsPCa) were analyzed.Results Cancer detection rates for PCa in TB [34.40％ (32/93)] was not different with SB [36.55％ (34/93),P =0.759].There was no significant difference in the detection rate of CsPCa between TB and SB [20.43％ (19/93) vs.24.73％ (23/93),P=0.483].A total of 1 374 biopsy cores were sampled,among which 266 were TB cores and additional 1108 were SB cores.The positive rate of TB cores [24.81％ (66/266)] was significantly higher than SB cores [9.84％ (109/1 108),P ＜0.001].Conclusions In the patients with PSA in grey area,MRI/US fusion TB achieved similar cancer detection rate compared with SB using only few biopsy cores.Therefore,TB was appropriate for patients with MRI suspicions.Moreover,combination of TB with SB can achieve the highest cancer detection rate.
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Objective To explore the role of B7-H3 in the Tie2 expressing monocytes (TEMs) mediated angiogenesis of clear cell renal cell carcinoma (ccRCC).Methods Level of B7-H3 expression on TEMs surface was detected by flow cytometry in ccRCC tissues and normal renal tissues,which were obtained from April 2016 to August 2016 from 20 patients.Microvessel density (MVD) labeled by CD34 in high B7-H3 + TEMs group and low B7-H3 + TEMs group was detected by immunohistochemical examination in ccRCC specimens.B7-H3 + TEMs and B7-H3-TEMs were co-cultured with the 786-O cell lines,and B7-H3 + TEMs and B7-H3-TEMs culture supernatants were collected as conditioned medium,then the effect of B7-H3 + TEMs on angiogenesis was tested by tubule formation assay and mouse aortic ring assay.Results Flow cytometry showed that the frequency of B7-H3 expression on TEMs in ccRCC was (45.10 ± 17.78)％,and the frequency of B7-H3 expression in normal kidney tissues was (10.28 ± 4.28) ％.The frequency of B7-H3 expression on TEMs was significantly higher than that in normal renal tissues (P ＜ 0.001).The MVD of high B7-H3 + TEMs group (103.81 ± 29.28) was higher than that of low B7-H3 + TEMs group (76.55 ± 20.80) (P =0.027).The results of tube formation assay showed that the number of tubule formation of HUVEC in B7-H3 +TEMs group(55.25 ± 11.48) was significantly greater than that of B7-H3-TEMs group (31.34 ± 8.45) and blank control group (25.00 ± 6.74) (P ＜ 0.001).The results of mouse aortic ring assay showed that the number of neovascularization in B7-H3 + TEMs group(77.35 ± 18.47) was significantly greater than that of B7-H3-TEMs group (39.42 ± 8.29) and blank control group (28.79 ± 7.63) (P ＜0.001).Conclusions B7-H3 + TEMs can promote angiogenesis in ccRCC,and might act as an effective target in anti-angiogenic therapy for ccRCC.
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Objective To investigate the relationship between the interleukin (IL)-35 and the recovery of renal graft function. Methods Clinical data of 45 recipients receiving renal transplantation from donation after cardiac death (DCD) were retrospectively analyzed. According to the presence of delayed graft function (DGF) after renal transplantation, all recipients were divided into the immediate graft function (IGF) group (n=32) and DGF group (n=13). The serum creatinine (Scr) level and estimated glomerular filtration rate (eGFR) in the recipients were statistically compared between two groups at 1, 2, 3, 7, 14, 28 d and 3, 6 and 12 months after renal transplantation. The IL-35 levels in the serum and urine samples of the recipients were statistically compared between two groups at 1, 2, 3, 7, 14, 28 d following renal transplantation. Results In the DGF group, the renal function was restored slowly. Compared with the IGF group, the Scr level was significantly higher, whereas the eGFR was considerably lower in the DGF group at postoperative 7 d (both P<0.05). At 1 year after surgery, there was no significant difference in the Scr level between two groups. Compared with the IGF group, the eGFR in the DGF group was significantly lower at postoperative 1 year (P<0.05). At 1, 2, 3, 7, 14 d after operation, the serum levels of IL-35 in the DGF group were evidently lower than those in the IGF group (all P<0.05). Compared with the IGF group, the serum level of IL-35 in the DGF group was significantly increased at postoperative 28 d (P<0.05). At postoperative 1, 2, 3, 7 d, the IL-35 levels in the urine samples in the DGF group were significantly lower than those in the IGF group (all P<0.05). At postoperative 14 and 28 d, the IL-35 levels in the urine samples did not significantly differ between two groups (both P>0.05). Conclusions The low levels of IL-35 in the serum and urine of recipients after renal transplantation are associated with the incidence of DGF to certain extent, prompting that excessively weak systemic and local anti-inflammatory responses early after renal transplantation and uncontrolled excessive inflammatory response are probably the pivotal causes of DGF.
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Objective To estimate the value of transrectal ultrasound/magnetic resonance imaging (TRUS/MR) fusion targeted prostate biopsy(targeted biopsy,TB) in the biopsy naive patients.Methods Between September 2015 and September 2016,91 patients with PI-RADS ≥ 3 suspicious regions on the multiparametric magnetic resonance imaging (mpMRI) were retrospectively evaluated.The age of patients was 46-83 years (median 68).Serum PSA level before biopsy was 1.2-85 ng/ml (median 11.2 ng/ ml),in which 36 cases with PSA ＜ 10 ng/ml,30 cases 10-20 ng/ml,and 25 cases ＞ 20 ng/ml.Two-core TB using real-time virtual sonography (RVS) platform for mpMRI-suspicious lesions was followed by 12-core systematic biopsy (SB).The detection rates for any cancer (PCa) and clinically significant prostate cancer (CsPCa) were compared between TB and SB.Results The total detection rate for PCa was 57.1％,with a comparable positive rate between TB (44.0％) and SB (51.7％) groups which did not significantly differ (P =0.14).The proportion of CsPCa in TB group was higher than that in SB group (80.0％ vs.68.1％,P =0.21).In TB group,detection of PCa for grade 5 lesions was significantly higher than that for grade 3 lesions (77.1％ vs.10.3％,P ＜0.001).Detection of PCa was comparable between TB and SB groups in different regions of PSA ＜ 10 ng/ml,10 ～ 20ng/ml and ＞ 20ng/ml (27.8％ vs.36.1％,50％ vs.56.7％,60％ vs.68％,respectively).Conclusions This study revealed a similar rate of prostate cancer detection between 2-core targeted biopsy guided by TRUS/MR fusion and 12-core random biopsy in different PSA regions for no prior biopsy men.TB maybe tend to detect high proportion of CsPCa.PI-RADS is instructive to select appropriate patients for TB.
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Objective To evaluate the diagnostic value of prostate imaging reporting and data system version 1 (PI-RADS V1) and version 2 (PI-RADS V2) for detection of prostate cancer (PCa) in the transition zone (TZ).Methods Seventy-seven patients with suspicious lesions in TZ on mpMRI were scored according to the PI-RADS system (V1 and V2) before MR-TRUS fusion guided biopsy prospectively.In all of the patients with suspicious tumors,respectively at least one lesion with a PI-RADS V1 assessment category of ≥3,was selected for biopsy.Independent sample t test was used to compare scores of PI-RADS V1 and V2 between PCa and benign prostatic hyperplasia (BPH).The diagnostic performance of PI-RADS V 1 and V2 for detection of PCa in the transition zone was compared by analyzing ROC basing on the results of MR-TRUS fusion guided biopsy.Results A cohort of 77 patients was performed including 31 cases of PCa (32 cores) and 46 cases of BPH (51 cores).PCa (V1:1 1.50±2.79;V2:4.28±0.99) had significantly higher scores of both PI-RADS V1 and PI-RADS V2 than BPH(V1:7.51± 1.63;V2∶2.61 ±0.67) (P＜0.05).Using a PI-RADS V1 score cut-off ≥ 11,sensitivity and specificity in group PCa and BPH were calculated,which were 68.8％(22/32) and 96.1％(49/51) with a area under curve of 0.869;using a PI-RADS V2 score cut-off ≥4,which were 75.0％ (24/32) and 90.2％ (46/51) with a area under curve of 0.888,respectively.Conclusions PI-RADS system can indicate the likelihood of PCa of suspicious lesions in TZ on Mp-MRI.PI-RADS V2 perform better than V 1 for the assessment of prostate cancer in TZ.
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Objective To evaluate the feasibility and efficacy of intra-cavity contrast enhanced ultrasound (ICCE-US) in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis.Methods From March 2016 to March 2017,ICCE-US-guided PCNL was performed in 35,patients who had kidney stones with slight hydronephrosis in 11 and without hydronephrosis in 24.The sample comprised 20 males and 15 females,including 10 with renal pelvic calculi alone,17 with renal pelvic calculi combined with renal calyx calculi,and 8 with partial staghorn calculi.Mean age was 46.8 years (ranging,28-75 years).The size of calculi ranged from 2.5 cm to 5.0 cm [mean(3.6 ± 1.2) cm].In the prone position,the preferred calyces are the posterior ones,which were enhanced by sulfur hexafluoride microbubbles (SonoVue) retrogradely injected through ureteral catheter.An 18-gauge needle was inserted toward the desirable calyx.Successful renal entry was confirmed by administration of ultrasound contrast agents into the collecting system via the needle regardless of whether spontaneous urine drainage was observed.A guidewire was passed through the needle to renal collecting system.Subsequently,the needle was removed.And the renal tract was dilated to F18-F20 size with dilators.Finally,holmium laser lithotripsy was performed through nephroscopy.Results Posterior calyces and its fornix were revealed under contrast-enhanced ultrasound in all patients.The successive access rate was 100％.The average time for establishing the access was (8 ±2.6)min (ranging 5-10 min).The mean number of needle passes was (1.5 ± 0.3) times per kidney,ranged from 1 to 3 times.Hemoglobin level averagely reduced (11.3 ± 3.7) g/ L (ranging 6-15 g/L) within 24 hours postoperatively.No major complications,such as adjacent organs injuries or collecting system perforation were observed.No blood transfusion was needed.The mean hospital stay was (5.6 ± 1.2) days (ranging 5-7 days).The stone-free rate was 91.4％ (32/35).Conclusions ICCE-US can demonstrate clearly about the posterior calyces and its fornix as well as puncture needle site by contrast enhancement in the nephrolithiasis patients with slight or no hydronephrosis.It has the potential to improve the accuracy and successive rate of puncture resulting in a decrease in the puncture-related complications.
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Objective To evaluate the feasibility and efficacy of intra-cavity contrast enhanced ultrasound (ICCE-US) in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis.Methods From March 2016 to March 2017,ICCE-US-guided PCNL was performed in 35,patients who had kidney stones with slight hydronephrosis in 11 and without hydronephrosis in 24.The sample comprised 20 males and 15 females,including 10 with renal pelvic calculi alone,17 with renal pelvic calculi combined with renal calyx calculi,and 8 with partial staghorn calculi.Mean age was 46.8 years (ranging,28-75 years).The size of calculi ranged from 2.5 cm to 5.0 cm [mean(3.6 ± 1.2) cm].In the prone position,the preferred calyces are the posterior ones,which were enhanced by sulfur hexafluoride microbubbles (SonoVue) retrogradely injected through ureteral catheter.An 18-gauge needle was inserted toward the desirable calyx.Successful renal entry was confirmed by administration of ultrasound contrast agents into the collecting system via the needle regardless of whether spontaneous urine drainage was observed.A guidewire was passed through the needle to renal collecting system.Subsequently,the needle was removed.And the renal tract was dilated to F18-F20 size with dilators.Finally,holmium laser lithotripsy was performed through nephroscopy.Results Posterior calyces and its fornix were revealed under contrast-enhanced ultrasound in all patients.The successive access rate was 100％.The average time for establishing the access was (8 ±2.6)min (ranging 5-10 min).The mean number of needle passes was (1.5 ± 0.3) times per kidney,ranged from 1 to 3 times.Hemoglobin level averagely reduced (11.3 ± 3.7) g/ L (ranging 6-15 g/L) within 24 hours postoperatively.No major complications,such as adjacent organs injuries or collecting system perforation were observed.No blood transfusion was needed.The mean hospital stay was (5.6 ± 1.2) days (ranging 5-7 days).The stone-free rate was 91.4％ (32/35).Conclusions ICCE-US can demonstrate clearly about the posterior calyces and its fornix as well as puncture needle site by contrast enhancement in the nephrolithiasis patients with slight or no hydronephrosis.It has the potential to improve the accuracy and successive rate of puncture resulting in a decrease in the puncture-related complications.
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Objective To assess the clinical significance of red blood cell distribution width ( RDW) in patients undergone prostate biopsy.Methods A total of 793 consecutive patients were enrolled, with 359 cases of prostate cancer ( PCa) and 434 cases of benign prostate hyperplasia ( BPH) diagnosed by pathological examination.The difference of RDW level between PCa and BPH patients was analyzed by T-test.Logistic regression was used to evaluate the contributed factors such as RDW, PSA, HB, WBC, PLT, TG and age.Areas under operating characteristic curves ( AUC) were used to compare the predictive power of RDW for the presence of PCa among different PSA level groups.The difference of RDW level was also analyzed in different groups divided by PSA, Gleason score and clinical stage respectively.Simple linear regression analysis was performed to explore the association of RDW with PSA, Gleason score and clinical stage.Results The means of RDW were ( 13.38 ±1.11 )%in patients with PCa which were higher than those with BPH (12.75 ±0.62)%(P20 ng/ml, the highest in the PSA groups.The RDW was positively correlated with increasing risk evaluated by PSA, Gleason score or clinical stage (P20 ng/ml.Therefore, RDW can be used to evaluate the risk of prostate cancer.
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BACKGROUND:In recent years, with the use of new immunosuppressive agents, the survival rate of renal graft is greatly improved, but accompanied by lots of side effects and unchanged long-term graft survival. Mesenchymal stem cel s (MSCs) have aroused people’s great interest, while their efficacy in kidney transplantation remains controversial. OBJECTIVE:To evaluate the efficacy of MSCs transplantation on post-transplant renal graft function with a systematic review. METHODS:PubMed, EMBASE, the Cochrane Library database, the Cochrane Central Register of Control ed Trials, Wanfang database and China National Knowledge Infrastructure (CNKI) were searched until November 2015. Revman 5.3 was used for statistical analysis. RESULTS AND CONCLUSION:A total of 6 randomized control ed trials were included, including 1 166 patients. Meta-analysis results showed that at 1, 2 weeks and 1 month after kidney transplantation, the posttransplantation estimated glomerular filtration rates in the MSC-treated group were significantly higher than those in the control group (P0.05). To conclude, MSC-based immunosuppression regimen is superior to current standard immunotherapy in improving renal graft function in the early stage after kidney transplantation, but the clinical efficacy is diminished in the later period. Therefore, further investigation using large-scale randomized control ed trials is warranted.
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Objective To explore the relationship between dyslipidemia and urinary stone formation.Methods The clinical data of 427 patients diagnosed with urolithiasis in our hospital during January 2015 to May 2016 were collected.Among them,272 men accounting for 63.7%,155 women account for 36.3%.The average age were 53 (43-63).218 cases were kidney stones,accounting for 35.6%;158 cases were ureteral calculi, accounting for 25.8%; 23 cases were kidney stones with ureteral calculi, accounting for 3.8%;28 cases were bladder calculi, accounting for 4.6%.At the same time,950 age and gender matched healthy controls were collected.Among them,570 men accounting for 60%, 380 women account for 40%.The average age were 53 ( 48-60 ).All of them had undergone renal ultrasound to excluded urolithiasis.The difference between lipid level and incidence of dyslipidemia in patients with urolithiasis were observed. The relationship between lipid level and serum UA, urine pH and stone composition was evaluated and analyzed with logistic regression.Results The average serum TC,TG,HDL-C levels of patients with urolithiasis were 4.34mmol/L, 1.38mmol/L, 1.25mmol/L, which levels were 4.32mmol/L,1.09mmol/L,1.40mmol/L in healthy controls.Significant difference were seen between the two groups ( P <0.05 ).The average serum LDL-C was 2.63mmol/L in patients with urolithiasis and 2.65mmol/L in healthy controls.No difference were seen between the two groups ( P=0.241).31.6% of patients with urolithiasis had different degree of dyslipidemia.The average serum UA levels,urine pH value of patients with dyslipidemia were 392μmol/L and 5,which were 339μmol/L and 6 in patients with normal lipid level.Significant difference were seen between the two groups ( P<0.05 ).Among 193 patients who had stone composition analysis, 130 cases had normal lipid level, accounting for 67.4%; 63 cases had dyslipidemia, accounting for 32.6%.In 63 patients with calculi who had dyslipidemia,31 cases had uric acid calculi,accounting for 49.2%.In 130 patients with calculi who had normal lipid level,40 cases had uric acid calculi, accounting for 30.8%.Significant difference were seen between the two groups ( P =0.013 ).Multivariate logistic regression showed TG was the independent risk factor of urinary stone formation ( P=0.001).Conclusion Dyslipidemia is closely related to urinary stone formation,especially concerning the for hypertriglyceridemia.
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Objective To investigate the relationship between body mass index (BMI), blood lipid level and cancer de?tection in prostate biopsy. Methods A total of 214 patients undergoing a prostate biopsy during 2013.2—2014.8 were re?viewed retrospectively. They were divided into prostate cancer and non-cancer groups by biopsy results. The differences of age, prostate-specific antigen (PSA) level, prostate volume (PV), blood lipid level and BMI were analyzed between two groups. Risk factors for cancer detection of biopsy were also analyzed. Results Compared with non-cancer patients, pros?tate cancer patients were older, had higher level of PSA and BMI, but smaller PV and lower level of HDL-C ( P<0.05). Lo?gistic regression analysis showed that older, higher level of PSA and BMI were risk factors for prostate biopsy positive, but larger PV and higher level of HDL-C were protective factors (P<0.05). Conclusion Comprehensive assessment of BMI and blood lipid levels can provide important reference for prostate cancer screening at early time and establishment of pros?tate biopsy scheme, which also provide significant evidence for the prevention, diagnosis and treatment of prostate cancer at early stage for high risk population.
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<p><b>BACKGROUND</b>Rat renal transplantation is an essential experimental model and requires greater microsurgical skills. Thus, training novices to perform quick and reliable microvascular anastomosis is of vital importance for rat renal transplantation. In this study, we developed and evaluated a staged microvascular anastomosis training program for novices, harvesting and transplanting both kidneys from one rat donor.</p><p><b>METHODS</b>Five trainees without any prior microsurgical experience underwent a training program in which the goals were staged according to difficulty. Each trainee had to achieve satisfactory results as evaluated by a mentor before entering the next stage. Rat renal transplantation was accomplished by end-to-end technique with a bladder patch. In the intensive rat renal transplantation stage, the trainees required an average of 20 independent attempts at isotransplantation as final training assessment.</p><p><b>RESULTS</b>After 2 months of intensive practice, all trainees had achieved stable and reproducible rat renal transplantation, with a satisfactory survival rate of 85.9% at postoperative Day 7. The total mean operative time was 78.0 minutes and the mean hot ischemia time was 26.2 minutes. With experience increasing, the operative time for each trainee showed a decreasing trend, from 90-100 minutes to 60-70 minutes. After 20 cases, the mean operative time of the trainees was not statistically significantly different from that of the mentor.</p><p><b>CONCLUSION</b>Harvesting and transplanting both kidneys from one rat donor after a staged microvascular anastomosis training program is feasible for novices without any prior microsurgical skills.</p>