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【Objective】 To evaluate the efficacy and safety of 3-dimensional laparoscopic pyeloplasty and ultrasound-guided flexible ureteroscopy lithotripsy (3DLP-UGFURL) in the treatment of ureteropelvic junction obstruction (UPJO) and renal calculi. 【Methods】 The clinical data of 29 patients of UPJO complicated with renal calculi treated with 3DLP-UGFURL during Dec.2017 and Jul.2022 were retrospectively analyzed. There were 23 males and 6 females with average age of (35.3±13.6) years. The lesions were on the left side in 20 cases, on the right side in 9 cases, and all were unilateral. One case was complicated with horseshoe kidney. The body mass index (BMI) was 23.6±3.9. Multiple calculi of renal pelvis or calyces occurred in 16 cases, and the rest were single calculi. The maximum diameter of calculi was (1.2±0.6)cm. There were 2 cases of mild hydronephrosis, 19 cases of moderate hydronephrosis and 8 cases of severe hydronephrosis. 【Results】 All operations were successful. The operation time of 3DLP was (84.2±15.4)min. Operation time of UGFURL was (42.8±15.7)min. Estimated blood loss was (36.9±13.6)mL. Indwelling time of drainage tube was (3.6±1.6)d. Indwelling time of urinary catheter and postoperative hospital stay was (6.8±1.2)d. One month after operation, the stone removal rate was 97.4%. The retention time of ureteral stent was 2.7 months. During the follow-up of (24.5±10.0)months, there were 45 Clavien Dindo grade 1 complications. 【Conclusion】 3DLP-UGFURL is safe and effective in the treatment of UPJO complicated with renal calculi, but it still needs long-term follow-up data.
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Based on the status and development of the majors and degrees at home and abroad, the relationship between health management sciences and their close secondary disciplines, course setting, and the demand for health management talents in society, this study elaborates the foundations of setting health management disciplines and the prospects of the discipline, and demonstrates the importance of the discipline construction of health management.
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Objective@#To investigate the motivation for weight self-management and analyze its influencing factors among pregnant women in a tertiary hospital in Hohhot City, Inner Mongolia Autonomous Region, so as to provide insights into body weight management during pregnancy. @*Methods@#Pregnant women at ages of 18 years and older that underwent prenatal examinations in a tertiary hospital in Hohhot City from January to March, 2022 were sampled using a convenience sampling method. Subjects' age, height, weight, occupation, residence, monthly household income, history of gestation and childbirth and gestational period were collected, and the motivation for weight self-management was evaluated among pregnant women using a pregnancy weight management protein motivation scale. The factors affecting the motivation for weight self-management were identified among pregnant women using a multivariable linear regression model. @*Results@#Totally 969 pregnant women were recruited, including 841 women at ages of <35 years (86.79%), 780 women with an educational level of diploma and above (80.50%), 794 women living in urban areas (81.94%), 729 primiparas (75.23%), 421 women in the third trimester of gestation (43.45%) and 758 women with pre-pregnancy body mass index (BMI) of <25 kg/m2 (78.22%). The mean score of motivation for weight self-management was 127.53±14.60 among the pregnant women. Multivariable linear regression analysis showed that an educational level of high school and below (β′=-0.201), unemployed/self-employed individuals (β′=-0.077), living in rural areas (β′=-0.059), monthly household income of <10 000 yuan (<5 000 yuan, β′=-0.238; 5 000 to 10 000 yuan, β′=-0.169), in the third trimester of gestation (β′=-0.135), pre-pregnancy BMI of 25 kg/m2 and higher (β′=-0.214) and reduced the motivation for weight self-management among pregnant women.@*Conclusion@#The motivation for weight self-management correlates with gestational period, pre-pregnancy BMI, residence, occupation, educational level and monthly household income among pregnant women.
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Objective:To evaluate the advantages of cortical perichondrium retention of costal cartilage in tip plasty.Methods:A total of 618 female cases were retrospectively analyzed from July 2017 to July 2018 in Zhengzhou Meilai Medical Beauty Hospital that underwent comprehensive line of rib cartilage rhinoplasty for beauty, aged 18-52 years with mean 27±6 years. According to different modification graft used in plasty, the cases were divided into reserve costal perichondrium cortex group (experimental group) and simple rib cartilage cortex group (control group). Statistical analyses were carried out 1 month and 12 months after operation. The tip displacement visualization was compared between the two groups and the advantages and disadvantages were evaluated in both.Results:After the surgery of the 618 patients, the rate of displacement in the experimental group was 3.6%, and that in the control group was 7.9% (χ 2=4.95, P<0.05). The rate of the implant exposure in the experimental group was 4.7%, and that in the control group was 9.1% (χ 2=4.38, P<0.05). The reserve costal perichondrium cortex used in the nasoplasty kept the prominent and stable nasal tip after the operation, and longterm follow-up showed there were no displacement and deformation occured in the patients. Conclusions:The application of costal cartilaginous cortex retaining costal perichondrium in tip plasty can obtain good nasal tip protrusion and stable rotation. It is an ideal nasal tip shaping material and worthy of clinical application.
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This study introduces the training of the subspecialties of obstetrics and gynecology in University of Chicago Medical Center, and details the enrollment scope, technical requirements and scientific research requirements of the subspecialty of reproductive endocrinology and infertility (REI), the subspecialty of gynecologic oncology, the subspecialty of maternal and fetal medicine, and the subspecialty of gynecological urology and pelvic floor reconstruction. The subspecialty training system for obstetrics and gynecology and the specific training direction for physicians have reference significance for the training of specialists in obstetrics and gynecology in China.
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Objective:To investigate the clinical and pathological features and immunophenotyping of keloidal cutaneous fibrous histiocytoma (FH) and dermatofibrosarcoma protuberans (DFSP) to provide evidence for clinical diagnosis and treatment.Methods:The clinical data were colleceted from March 2015 to March 2019 and retrospectively analyzed, including 12 cases of FH, 5 males and 7 females, aged 14-76 years, with average age (37.67±17.71) years and 9 cases of DFSP, 5 males and 4 females, aged 19-64 years, with average age (42.56±13.82) years. The clinical manifestations, histopathological features and immunophenotyping of FH and DFSP were compared.Results:The clinical manifestations of all cases were keloid-like lesions. All patients underwent surgical treatment. 12 cases of FH were diagnosed in the postoperation routine pathological examination and immunohistochemical staining, CD68 was positive in 10 cases, 9 cases of SMA were positive and all of S-100 were negative. 9 cases of DFSP were diagnosed and 2 cases were fibrosarcomatous DFSP among them. For the 7 cases of DFSP, CD34 were all positive, 5 cases of CD68 were negative, 6 cases of SMA were negative. For 2 cases of fibrosarcomatous DFSP, CD34, CD68 and SMA were all negative. During the follow-up period from 6 months to 4 years, there was no recurrence of FH cases, and 3 cases of DFSP recurred, 2 cases were fibrosarcomatous DFSP among them, and 1 case of fibrosarcomatous DFSP presented distant metastasis.Conclusions:The clinical manifestations and pathological features of some FH and DFSP are similar to keloids in a certain extent, and there is a little difficulty for clinical differential diagnosis. Early diagnosis and standardized treatment are crucial for prognosis.
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Objective To investigate the duration of indwelling ureteral stent after the ureteroscopic lithotripsy.Methods 300 cases of patients were retrospectively analyzed from June 2015 to June 2017,including 168 with renal calculi and 132 with non-incarcerated upper ureteral calculi.The size of stone is ＜2 cm in diameter.According to the length of time for indwelling ureteral stent,all patients were divided into two groups-150 cases in 14-day group (Group A) and 150 in the 28-day group (Group B) for comparing the complication and outcome,and then received modular flexible ureteroscopic lithotripsy combined with holmium laser.Lastly,6F ureteral stent was indwelling postoperatively.Results Complications happened in both two groups after stenting.There were 140 cases (93.3％) complained of bladder irritation symptoms (LUTS) in Group A,while 107 (71.3％) in Group B;85 cases (56.7％) suffered from flank or abdominal pain in Group A and 36 (24％) in Group B;gross hematuria happened in 133 cases (88.7％) of Group A and 60 cases (40％) of Group B.As the duration of indwelling ureteral stent extended,the incidence of complications increased,significantly (P ＜ 0.05).CT scan showed there was no statistical difference in stone-free rate (diameter ＜ 3 mm) of two groups [A group:91.3 ％ (137/150) vs.B group:89.3 ％ (134/150),respectively].Conclusion With high stone-free rate and low complication incidence,2-week indwelling ureteral stent is safe for patients suffered from renal calculi or non-incarcerated upper ureteral calculi (diameter ＜ 2 cm).
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Objective To investigate the clinical significance of ultrasonography combined with scrological detection in the screening of trisomy 21.Methods The clinical data of 2 281 pregnant women who have received prenatal ultrasound examination,scrological detection and prenatal diagnosis in our hospital from January 2014 to March 2016 were retrospectively analyzed.All the fetuses had ultrasound abnormal or/and 21-trisomy syndrome high risk with scrological detection.The detection rate of trisomy 21 was observed when ultrasonography combined with scrological detection.The detection rate was compared between the two methods respectively.Results Among 2 281 pregnant women who received prenatal diagnosis,68 fetuses with trisomy 21 were diagnosed by fetal karyotype,the detection rate was 2.98％ (68/2 281);There were 879 cases of merely ultrasound abnormal,27 of them were trisomy 21,the detection rate was 3.07％ (27/879);1 336 cases were merely high risk of 21-trisomy syndrome,34 of them were trisomy 21,the detection rate was 2.54％ (34/1 336);There were 66 cases of both ultrasound abnormal and 21-trisomy syndrome high risk,7 of them were trisomy 21,the detection rate was 10.61％ (7/66).The method of joint use is higher than the independent method,with statistically significant difference (P ＜ 0.05).Conclusions Ultrasonography combined with scrological detection have good application value in the screening of trisomy 21 syndrome.
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Objective To analyze the clinical features of candida arthritis and to conduct literature review to improve diagnosis and treatment.Methods From January 2008 to June 2018,eighteen patients (5 females and 13 males) with candida arthritis were admitted to two hospitals.The mean age at diagnosis was 59±8 (range 48-71 years).The diagnosis was determined based on joint fluid aspirate in all cases and on intra-operative samples in 1 patients.Seventeen patients received MR examination,and on epatient who underwent total knee arthroplasty underwent knee X-ray examination.The clinical features,risk factors,clinical manifestations,etiology,treatment and prognosis are recorded.Results Knee joints were involved in all patients as infection sites.Seventeen patients had risk factors for candida infection,including diabetes mellitus in 2 patients,artificial joint replacement in 1,and glucocorticoid injection in the joint cavity in 16.Swelling and pain were presented in all cases.Peripheral blood leukocytes were increased or normal,while C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were increased.Magnetic resonance showed joint effusion and slip membrane hyperplasia.Joint turbidity and synovial hyperplasia were presented by arthroscopy.X-ray demonstrated swelling of soft tissue around the prosthesis and bone absorption around the prosthesis.The most frequent species was non-candida albicans.Susceptibility to antifungals was tested in all cases.Thirteen patients underwent surgery combined with antifungal therapy,while 4 patients only received antifungal therapy and 1 patient refused to treat.The duration of antifungal therapy was from 6 weeks to 52 weeks (median,12 weeks).Twelve cases were treated with fluconazole and 1 with voriconazole,1 with voriconazole and fluconazole,1 with fluconazole combined with lipid formulation amphotericin B,1 with terbinatine and fluconazole,1 with flucytosine combined with tluconazole.Seventeen cases were followed up for 3 to 72 months.At final follow-up,twelve patients were healed,while 1 case was amputated and 4 patients relapsed and refused further treatment.Conclusion As a rare disease,candida arthritis is usually happened after artificial joint replacement and in high-risk patients with diabetes and immunosuppressant applications.In immunoeompetent patients without surgery,infection may be related to multiple injections into the joim cavity with glucocorticoids.The infection may be difficult to be diagnosed and with poor prognosis.Surgery with long-term antifungal therapy is required.
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Objective To investigate the relationship between body mass index (BMI) and homocysteine,pregnancy outcomes in patients with gestational diabetes mellitus.Methods From Jan,2013 to Oct,2015,120 patients with gestational diabetes mellitus were prospectively enrolled in this study.According to BMI level,all patients were divided into obese group (BMI≥25 kg/m2) and the control group (BMI ＜ 25kg/m2).The main outcome measures included homocysteine and pregnancy outcomes of the both groups.Results When compared with the control group,patients in the obese group got a significantly higher level of homocysteine (11.09 ± 1.91 vs 8.92 ± 1.57μmol/L,P =0.000);and BMI was positively associated with homocysteine (r =0.410,P =0.000).When compared with the control group,patients in the obesity group got a significantly higher rate of cesarean section (30.00％ vs 15 ％,P =0.049);a higher rate of macrosomia (20.00％ vs 5.00％,P =0.027);and a higher level of neonatal weight (3672.15 ± 475.45 vs 3220.93 ± 461.36g,P =0.000).There was no significantly difference between the two groups in weeks of gestation,postpartum hemorrhage,cephalopelvic said,abnormal fetal position,uterine atony,premature rupture of fetal membranes and neonatal asphyxia rate (P ＞ 0.05).Conclusion BMI in patients with gestational diabetes mellitus is positively correlated with homocysteine,cesarean section,macrosomia and neonatal weight.
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Objective: To investigate the effects of adipose-derived stem cells (ADSCs) and endothelial cells (ECs) on the survival and neovascularization of fat tissue transplants. Methods: The ADSCs were isolated by collagenase digestion from the adipose tissues voluntarily donated by the patients undergoing mastectomy, and subcultured. The passage 3 ADSCs were used for subsequent experiments. The residual fat tissues were used to prepare fat particles (FPs). The human umbilical vein endothelial cells (HUVECs) were used as ECs for subsequent experiments. Eighty healthy male nude mice, aged 4-6 weeks, were randomly divided into 4 groups ( n=20). The mice were received subcutaneous injection at the dorsum of 1 mL FPs+0.3 mL normal saline (NS) in control group, 1 mL FPs+2×10 6 ECs+0.3 mL NS in ECs group, 1 mL FPs+2×10 6 ADSCs+0.3 mL NS in ADSCs group, and 1 mL FPs+1×10 6 ECs+1×10 6 ADSCs+0.3 NS in ADSCs+ECs group. General observations of the injection sites were performed, and the survival of the mice was recorded. At 2, 4, 8, and 12 weeks after injection, grafted fat tissues were firstly assessed by ultrasonography, then they were collected for volume measurement (water displacement method) and histology observation (HE staining and immunofluorescence staining). Results: All mice survived until the end of experiment. At each time point, no significant difference was noted between groups in ultrasonography assay. There was no significant blood flow signal in the grafted fat tissues, or cysts, calcification, solid occupying in recipient area. Generally, the volume of grafted fat tissues decreased with time in all groups. Specifically, the volumes of grafted fat tissues were larger in ADSCs group and ADSCs+ECs group than that in control group and ECs group ( P<0.05) at each time point, and in ADSCs group than in ADSCs+ECs group ( P<0.05) at 8 and 12 weeks. HE staining showed that all groups had similar tendencies in general histology changes, and remodeling in ADSCs group was the fastest than in the other groups. By immunofluorescence staining for neovascularization, the new vessels in all groups were increasing with time. The vessel densities were higher in ECs group, ADSCs group, and ADSCs+ECs group than in control group ( P<0.05) at each time point, in ADSCs group than in ECs group and ADSCs+ECs group ( P<0.05) at 4 weeks, in ADSCs group and ADSCs+ECs group than in ECs group ( P<0.05) at 8 and 12 weeks. Conclusion: ADSCs can significantly increase the survival of transplanted fat tissue, which may be related to promoting the neovascularization.
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OBJECTIVE:To study the hemostatic effect of porcine fibrin sealant patch (DBT) on bleeding wound of liver in rats and gluteus maximus in heparinized rabbits. METHODS:48 rats and 24 rabbits were randomly divided into sham operation group,operation control group (gauze hemostasis),medical collagen sponge group and DBT group. Except for sham operation group,animals in other groups were reduced for rat model with liver bleeding or heparinized rabbit model with gluteus maximus bleeding. The hemostatic time was recorded,bleeding amount was calculated;DBT degradation and wound adhesion in liver after 3,13 weeks were observed;re-bleeding rate of heparinized rabbits in medical collagen sponge group and DBT group were investi-gated. RESULTS:Compared with sham operation group,the hemostatic time and bleeding amount of animals in operation control group were significantly increased(P<0.01). Compared with operation control group,the hemostatic time and bleeding amount of animals in DBT group and medical collagen sponge group were significantly reduced (P<0.01). After 3,13 weeks,different de-gree of adhesion appeared in the wound of rats in each group,while the adhesion scores had no statistical significances(P>0.05). After 13 weeks,liver margin of rats in administration groups was slightly blunt,but it basically had been restored to preoperative state,with good healing. DBT can be degraded and absorbed completely. The re-bleeding rate of rabbits in DBT group were33.3%,66.7% in medical collagen sponge group. CONCLU-SIONS:DBT has good hemostatic effect on fragile organs and the body with blood coagulation dysfunction,and can be de-graded and absorbed. Its effect is equivalent to medical colla-gen,while the adhesive strength is slightly better than the latter.
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Objective To evaluate the clinical value of a new optic puncture needle designed by our department for renal calculi treatment. Methods There were 8 patients undergoing micro-PCNL with the new device from June 2016 to February 2017. Values of basic demographic data ,operation time ,pain score ,drop in hemoglobin and complications were recorded. Results The mean stone size,operation time,pain score,drop in hemoglobin,and in-hospital time was(21.9 ± 7.3)mm,(43.6 ± 13.6)min,2.8 ± 1.3,7.0 g/L[(133.2 ± 10.3 g/L vs.(123.2 ± 13.9)g/L,P>0.05]and(3.1 ± 1.0)d,respectively. No patient required blood transfusion. Stone-free rate at 1 and 3 months post-operation were 87.5%(7/8)and 100%(8/8),respectively. One suffered urinary tract infections( ClavienⅠ)and was treated with antibiotics. There were no major complications. Conclusion The new device for treatment of renal calculi is feasible and effective.
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OBJECTIVE:To study the hemostatic effect of porcine fibrin sealant patch (DBT) on bleeding wound of liver in rats and gluteus maximus in heparinized rabbits. METHODS:48 rats and 24 rabbits were randomly divided into sham operation group,operation control group (gauze hemostasis),medical collagen sponge group and DBT group. Except for sham operation group,animals in other groups were reduced for rat model with liver bleeding or heparinized rabbit model with gluteus maximus bleeding. The hemostatic time was recorded,bleeding amount was calculated;DBT degradation and wound adhesion in liver after 3,13 weeks were observed;re-bleeding rate of heparinized rabbits in medical collagen sponge group and DBT group were investi-gated. RESULTS:Compared with sham operation group,the hemostatic time and bleeding amount of animals in operation control group were significantly increased(P<0.01). Compared with operation control group,the hemostatic time and bleeding amount of animals in DBT group and medical collagen sponge group were significantly reduced (P<0.01). After 3,13 weeks,different de-gree of adhesion appeared in the wound of rats in each group,while the adhesion scores had no statistical significances(P>0.05). After 13 weeks,liver margin of rats in administration groups was slightly blunt,but it basically had been restored to preoperative state,with good healing. DBT can be degraded and absorbed completely. The re-bleeding rate of rabbits in DBT group were33.3%,66.7% in medical collagen sponge group. CONCLU-SIONS:DBT has good hemostatic effect on fragile organs and the body with blood coagulation dysfunction,and can be de-graded and absorbed. Its effect is equivalent to medical colla-gen,while the adhesive strength is slightly better than the latter.
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Objective To evaluate the clinical value of a new optic puncture needle designed by our department for renal calculi treatment. Methods There were 8 patients undergoing micro-PCNL with the new device from June 2016 to February 2017. Values of basic demographic data ,operation time ,pain score ,drop in hemoglobin and complications were recorded. Results The mean stone size,operation time,pain score,drop in hemoglobin,and in-hospital time was(21.9 ± 7.3)mm,(43.6 ± 13.6)min,2.8 ± 1.3,7.0 g/L[(133.2 ± 10.3 g/L vs.(123.2 ± 13.9)g/L,P>0.05]and(3.1 ± 1.0)d,respectively. No patient required blood transfusion. Stone-free rate at 1 and 3 months post-operation were 87.5%(7/8)and 100%(8/8),respectively. One suffered urinary tract infections( ClavienⅠ)and was treated with antibiotics. There were no major complications. Conclusion The new device for treatment of renal calculi is feasible and effective.
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Objective To establish computer assisted virtual ureteroscopy (VU) through data from computerized tomography urography (CTU) of patients with renal stones and make validation of effectiveness.Methods From June of 2015 to January of 2016,23 cases of renal stones cases was selected by 5 experts in 3 different centers.There were 21 unbilateral cases and 2 bilateral cases.The age ranged from 31 to 79(54.7 ± 12.5).Mean stone burden was (19.0 ± 6.2) mm.Stone number ranged from 1 to 5 (2.7 ± 1.2).VU generation was accomplished by specialized software (Crusher) with incorporating CTU data.After patientspecific VUs were presented to the experts,and the FURS surgeries were all finished successfully,face and content validations about VU using modified Likert questionnaire ordinal 10-point rating scales were made.20 trainee were selected to do the flexible ureteroscopy lithotripsy with assistance of VU.After observation of CTU and VU,the numbers of renal calyces and stones found by the experts and trainees were recorded.The statistical analysis were made before and after observation of VU between the experts and trainees.Result Face and content validation of VU:overall usefulness 7.6 ± 0.5,graphics 7.6 ± 0.5,intrarenal collecting system 8.4 ± 0.5,stone details 8.4 ± 0.5,usefulness in surgical planning and training 8.0 ± 0.7.Significant improvement was found when the trainees doing the surgery with the help of VU.Compared with using CTU only,VU could help the trainees had better understanding of intrarenal structure and stone information [the number of calyces (16.7 ±3.7)vs.(24.6 ± 1.8),P ＜0.001;the number of stones (4.9 ± 1.4)vs.(8.2 ± 1.3),P ＜0.001].Before observation of VU,trainees found much fewer calyces and stones compared with experts (P =0.004 and P ＜ 0.001 respectively).However,this gap disappeared after VU observation (P =0.327 and 0.292 respectively).Conclusions Establishing computer assisted VU through CTU data from renal stone patients is feasible and rapid.VU can significantly improve trainee's view of intrarenal collecting system and stone information before practicing FURS.
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Objective To evaluate the effect of micropercutaneous nephrolithotomy(microperc) for treatment of renal calculi with self-made F 4.8 optic puncture needle combined with ureteral access sheath.Methods There were 23 patients undergoing microperc with the self-made device from June 2016 to April 2017,Male,12 cases,female,11 cases.The mean ±SD (range) patient age was (49 ±14) years(28-67 years),stone volume was (1.7 ± 0.6) cm (1.0-3.0 cm) and stone density was (934.5 ± 282.7) HU (357-1 500 HU).The self-made all-seeing system consists of a puncture needle (F4.85) and two 3-way connector allowing the insertion of a flexible microoptic system,laser fiber and attaching to irrigation system.Single tract with one puncture with ultrasound guide was fit to treat the calices containing calculi or calices at one stage operation.The course of puncture could be " all-see" on the display which was connected with flexible microoptic system.After stone fragmentation,the procedure was terminated in tubeless fashion.Ureteral double J stent was inserted in order to prevent postoperative complications.The factors analysed were demographic variables including age,sex,stone volume,stone density [Hounsfield units (HU)] and stone location,and intra-and peri-operative variables such as operating time,drop in haemoglobin level,stone clearance and complications.Results Conversion to PCNL was required in one patient because intraoperative bleeding obscured vision.The mean ± SD (range) operation duration was (46.2 ± 19.9) min (20-120 min),pain score was 2.8 ± 1.2(1-6),hemoglobin decrease was 6.6 g/L,and in hospital time was (2.9 ± 0.8) d (2-5 d),respectively.No patient required blood transfusion.Stone-free rate at 1 and 3 months postoperation was 90.9％ (20/22) and 100 ％ (22/22),respectively.Two who suffered hematuria (Clavien Ⅰ)underwent conservative treatment and recorered well.One suffered urinary tract infections (Clavien Ⅱ) and was treated with antibiotics.There were no major complications.Conclusions Mircoperc with the self-made device and ureteral access sheath in management of renal calculi is feasible and effective.
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Objective To evaluate the efficacy of ultrasound guided diverticular puncture combined with flexible ureteroscope to treat calyceal diverticulum calculi, which is difficult in finding the diverticular orifice during ureteroscopic surgery.Methods From November 2012 to July 2015, Twenty-four cases suffered caliceal diverticulum calculi were treated with PCNL or flexible ureterorenoscopic methods.Twelve cases were treated with PCNL in Group PCNL, and 12 cases in Group FURS were all not found orifice or wall under flexible ureteroscope. For Group FURS, ultrasound guided nephrostomy needle puncturing into diverticular calvity were performed, saline-diluted methylthioninium chloride was injected through needle sheaths.The diverticular opening could be recognized in six cases.Guidewires were inserted through needle sheaths for identifying the wall of diverticular cavity in another six cases that could not find the orifice.The stenotic infundibulum or diverticular wall was incised with 200 micron holmium laser fiber for fragment or extraction of diverticular calculi.Results The time of operation, stone free and fragment success cases in Group FURS and PCNL were ( 91.8 ±24.2 ) min vs.( 86.3 ±18.7 ) min, 9 cases vs.10 cases, and 10 cases vs.11 cases, respectively ( P all >0.05 ) .Residual calculi with clinical significance in Group FURS and PCNL disappeared after the second FURS surgery.The VAS score in Group FURS was marked lower than that in Group PCNL [ ( 3.1 ±1.2 ) vs.( 5.3 ±0.9 ) , P﹤0.05 ] .There was no significant difference complication rate between two groups ( 2 cases vs.3 cases, P>0.05 ) .Hospital stay in Group FURS was dramaticly shorter than Group PCNL(3.4 ±0.8) d vs.(5.4 ±1.0) d,P﹤0.05).Diverticula disappeared in 6 cases and became smaller in 6 cases in Group FURS, disappeared in 10 cases and became smaller in 2 cases in Group PCNL.Conclusion Flexible ureteroscope combining with the ultrasound guided puncture of diverticular calvity for management of caliceal diverticula maybe a safe and effective option.
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Objective To evaluate the clinical feasibility of grading of ureteral stricture in renal allograft.Methods The clinical data of 9 case of ureteral stricture after renal transplantion from February 2015 to September 2015 were retrospectively analyzed and relative articles were reviewed to evaluate the significance of ureteral stricture grading.The diagnosis of ureteral stenosis was made by serum creatinine elevation,ultrasound of allograft kidneys and presence of stricture on a pyelogram.Grade 1 ureteral stenosis was defined as graft function deterioration with presence of hydronephrosis on ultrasound,but no obvious stricture identified on a pyelogranm.Grade 2 was defined as serum creatinine elevation,presence of hydronephrosis on ultrasound,and a focal (＜1 cm) distal ureteral stricture at the ureteral anastomotic site on a pyelogram.Grade 3 was defined as serum creatinine elevation,hydronephrosis on ultrasound,and a long segment (＞1 cm) distal ureteral stricture extending to proximal ureter or pelvis on pyelogram.Results One case,6 cases and 2 cases were classified to grade 1,2 (stricture length ＜1 cm) and 3 (＞1 cm),respectively.One case of grade 1,6 cases of grade 2 and 1 case of grade 3 were successfully dilated by balloon dilation catheter and endoureterotomy.One case of grade 3 was converted to open reconstructive surgery.Surgery success rate of grade 1 and 2 was 100％ (7/7) and 100％ (6/6) 6 and 9 months after surgery,respectively.Ureteral stenosis did not recur in one case of grade 1 and 6 cases of grade 2 during a follow-up period of 12 months after surgery.However,one case of grade 3 reoccurred 6 months after surgery,and reoperation was performed and there was no recurrence up to now (10 months).Conclusion Wuzhi tablet acted as an effective agent that makes rifampicin containing anti-tuberculosis chemotherapy possible and safe by stabilizing blood concentration of tacrolimus in post-renal transplant tuberculosis patients,which also reduced the dosage of tacrolimus as well as the risk of acute rejection greatly.
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<p><b>OBJECTIVE</b>To retrospectively analyze the risk factors and clinical manifestations of myocardial damage of patients with severe burn in order to provide evidence for its prevention and treatment.</p><p><b>METHODS</b>Two hundred and fifty-two patients with severe burn admitted to 5 burn centers from January 2010 to June 2015, conforming to the study criteria, were treated in accordance with the fluid resuscitation formula of the Third Military Medical University. According to the creatine kinase isoenzyme-MB (CK-MB) level before treatment on admission, patients were divided into non-myocardial damage group (n=118, CK-MB level less than 75 U/mL) and myocardial damage group (n=134, CK-MB level higher than or equal to 75 U/mL). Data of patients in two groups were collected and evaluated such as gender, age, body mass, number of patients with chemical burn, admission time after injury, total burn area, full-thickness burn area, number of patients with inhalation injury, levels of haemoglobin, hematocrit, and blood lactate on admission and at post injury hour (PIH) 24 and 48, volumes of urine output and fluid input at PIH 24 and 48, levels of creatinine, urea nitrogen, total bile acid, diamine oxidase on admission and at PIH 24 and 48, and mortality. Furthermore, patients were divided into three groups, i. e. less than 50% total body surface area (TBSA) group (n=110), larger than or equal to 50% TBSA and less than 80% TBSA group (n=83), and larger than or equal to 80% TBSA group (n=59) according to the total burn area, and the incidence rates of myocardial damage in patients of three groups were recorded. Data were processed with chi-square test, t test, Wilcoxon test, analysis of variance for repeated measurement, and the values of P were adjusted by Bonferroni. Basic data of 252 patients were processed with binary logistic regression analysis. Receiver operating characteristic curve of total burn area of 252 patients was drawn to predict myocardial damage.</p><p><b>RESULTS</b>(1) There were no statistically significant differences in age, body mass, number of patients with chemical burn, number of patients with inhalation injury, and full-thickness burn area between two groups (with t values respectively 0.20 and 0.31, χ(2) values respectively 0.49 and 4.10, Z=1.42, P values above 0.05). There were statistically significant differences in gender, admission time after injury, and total burn area of patients between two groups (χ(2)=5.00, with t values respectively 2.44 and 3.13, P<0.05 or P<0.01). (2) Gender, admission time after injury, and total burn area were independent risk factors related to myocardial damage in the patients (with odds ratios respectively 2.608, 3.620, and 1.030; 95% confidence intervals respectively 1.315-5.175, 1.916-6.839, and 1.011-1.049; P values below 0.01). (3) The incidence rates of myocardial damage of patients in less than 50% TBSA group, larger than or equal to 50% TBSA and less than 80% TBSA group, and larger than or equal to 80% TBSA group were 38.2% (42/110), 54.2% (45/83), and 61.0% (36/59) respectively, and there was statistically significant difference among them (χ(2)=9.46, P<0.05). (4) The total area under receiver operating characteristic curve of total burn area to predict myocardial damage of 252 patients was 0.706 (with 95% confidence interval 0.641-0.772, P<0.01), and 51.5% TBSA was chosen as the optimal threshold value, with sensitivity of 62.6% and specificity of 65.3%. (5) Compared with those in non-myocardial damage group, except the levels of haemoglobin and hematocrit at PIH 48 (with t values respectively -0.76 and -0.61, P values above 0.05), the levels of haemoglobin, hematocrit, and blood lactate of patients in myocardial damage group were significantly increased at each time point (with t values from -2.80 to -2.06, P<0.05 or P<0.01). Compared with those in non-myocardial damage group, the volume of urine output of patients was significantly declined (with t values respectively 2.05 and 3.68, P<0.05 or P<0.01), while the volume of fluid input of patients was not obviously changed in myocardial damage group at PIH 24 and 48 (with t values respectively 1.01 and 1.08, P values above 0.05). (6) Compared with those in non-myocardial damage group, the level of creatinine of patients was significantly increased on admission and at PIH 24 and 48 (with Z values from -2.91 to -1.99, P<0.05 or P<0.01), the level of urea nitrogen of patients was only significantly increased at PIH 24 and 48 (with t values respectively -4.75 and -5.24, P values below 0.01), the level of total bile acid of patients was not obviously changed on admission and at PIH 24 and 48 (with t values from -0.81 to -0.20, P values above 0.05), and the level of diamine oxidase of patients was only significantly increased on admission and PIH 24 in myocardial damage group (with t values respectively -3.97 and -2.02, P<0.05 or P<0.01). (7) Compared with that in myocardial damage group, the mortality of patients in non-myocardial damage group was significantly declined (χ(2)=5.81, P<0.05).</p><p><b>CONCLUSIONS</b>Patients with severe burn have high incidence of myocardial damage, which may be predicted by total burn area. Severely burned patients with myocardial damage are more likely to suffer from decline of effective circulating volume, tissue oxygenation disorders, and damage in other organs in shock stage.</p>