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Objective:To explore the clinical characteristics, causes, diagnosis and treatment of transplant renal artery stenosis after pediatric-to-adult kidney transplantation.Methods:Between July 2014 and March 2019, clinical data were retrospectively reviewed for 25 en-bloc and 27 single kidney transplant cases.Results:One en-bloc(4.0%)and two single kidney recipients(7.4%)were diagnosed as renal artery stenosis at Month 13-23 months post-transplantation.It was higher than the rate of stenosis in adult-to-adult transplant cases(1.1%)during the same period.As compared with recipients without stenosis, stenotic ones had younger pediatric donors( P<0.05)and yet similar body weight of donors as well as recipients( P>0.05). The inner diameters of stenonotic sites were(1.40-1.63)mm and predominant stenotic site was proximal renal artery rather than anastomotic site.The remaining parts of major renal arteries varied from 2.31 to 4.93 mm in diameter.It was normal in children with a corresponding age.All three cases responded well to percutaneous transluminal angioplasty and stenting. Conclusions:The cause of stenosis may be an undeveloped local artery diameter due to extensive tissue dissection around artery.Therefore cautious selections of infantile single renal graft for adult recipients and preserving surrounding tissue of renal artery assist in the prevention of graft arterial stenosis.
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Objective:To systematically review the efficacy and safety of electrostimulation of the posterior tibial nerve and antimuscarinic drugs in the treatment of overactive bladder.Methods:The literature search was conducted using the PubMed, The Cochrane Library, EMbase, Medline, CNKI, CQVIP, Wanfang databases.The retrieval period was from the establishment of the database to February 2021. Literature was screened and evaluated independently by two investigators to compare the safety and efficacy of electrostimulation of the posterior tibial nerve and antimuscarinic drugs in the treatment of overactive bladder. Meta-analysis was performed using Review Manager 5.4 software.Results:A total of 11 clinical trials, including 10 randomized controlled trials and 1 cross-over study were included, involving 605 patients, including 309 in the experimental group (nerve stimulation group) and 296 in the control group(antimuscarinic drugs group). The results of meta-analysis showed as follow. For patients with non-neurogenetic overactive bladder, there was no statistically significant differences between electrostimulation of the posterior tibial nerve therapy and antimuscarinic drugs in the improvement of 24h urination frequency( MD=-0.06, 95% CI -1.67-1.54, P>0.05), 24h urge incontinence frequency( MD=0.04, 95% CI -0.46-0.54, P>0.05), symptoms scores of OAB-q questionnaire( MD=0.37, 95% CI -0.02-0.76, P>0.05)and quality of life scores( SMD=0.32, 95% CI-0.06-0.69, P>0.05). However, compared with antimuscarinic drugs, posterior tibial nerve stimulation had better efficacy satisfaction rate ( OR=1.97, 95% CI 1.16-3.36, P<0.05) and lower side effect rate ( OR=0.24, 95% CI 0.12-0.48, P<0.0001). And the results have significant statistical differences. Conclusions:Electrostimulation of the posterior tibial nerve was almost as effective as antimuscarinic drugs in improving symptoms and quality of life in patients with non-neurogenic OAB. However, compared with antimuscarinic drugs, electrostimulation of the posterior tibial nerve had a higher efficacy satisfaction rate and a lower incidence of side effects. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
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Objective:To summarize the clinical experiences of pediatric en-bloc kidney transplantation (EBKT) at a single center and explore the measures of improving its efficacy.Methods:Clinical data and outcomes retrospectively analyzed for 38 EBKT children between September 2014 and November 2019 from Department of Urology Affiliated Union Hospital Tongji Medical College Huazhong University of Science & Technology. The pediatric donors were aged (63.6±5.7) days with a weight of (4.1±0.2) kg. And the transplant recipients were aged (28.1±1.4) years with a weight of (48.7±4.9) kg. Serum levels of creatinine and basic profiles of both donors and recipients were recorded at Day 0/7/30/90/80/360 post-EBKT. The postoperative occurrences of such complications such as thrombosis, urine leakage, delayed graft function (DGF), proteinuria and hematoma were measured.Results:The one-year graft survival rate was 76.3%(29/38) and the recipient survival rate 100.0%(38/38). Among 29 recipients with long-term graft survival, no dialysis was required at Week 2 post-EBKT and the serum level of creatinine dropped to normal at Year 1. Thrombosis was a major post-EBKT complication with an incidence of 18.4%(7/38). The other complications included urine leakage (20.7%, 6/29), hematoma (6.9%, 2/29) and primary non-functioning kidney (2.6%, 1/38).Conclusions:As an effective way of expanding the pool of donors, pediatric EBKT is clinically feasible.
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Organ transplantation is the most effective method to treat end-stage organ failure. As the increase of transmission risk of donor-derived diseases, the quality, safety and selection criteria of transplanted organs become more and more important. Chapter 7 of the European Union's Guide to the Quality and Safety of Organs for Transplantation (6th Edition) proposed basic requirements in terms of donor and organ quality assessment, selection criteria and procedures, which were worthy of study and practice in clinical practice.
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The microRNA let-7 family,functioning as a tumor suppressor,has emerged as a regulator of stem cell differentiation and tumor repression.The RNA-binding protein lin28 is a stem cell pluripotency factor,which contributes to the maintenance of stem cell characteristics and promoting cell malignant transformation.lin28 can block the maturity of let-7 by combining with the precursors of let-7 family miRNAs,which is itself able to repress lin28 by binding to the 3'-UTR of lin28 transcripts,thus forming a feedback loop.The double-negative feedback loop comprising lin28 and let-7 is involved in several biological processes such as differentiation of stem cell,tumorigenesis,invasion and metastasis,drug resistance and relapse,which couldbe a potential target for cancer therapy.