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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 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 investigate the safety and feasibility of robot assisted laparoscopic precise enucleation for complex central located renal hilum tumors.Methods From July 2017 to October 2018,a single surgeon completed seven robot assisted laparoscopic precise enucleations for complex central located renal hilum tumors.There were five males and two females with an average age of 56.5 years (45-68 years),an average body mass index of 25.1 kg/m2 (19.8-29.2 kg/m2),four cases on the left side and three cases on the right side.The average tumor diameter was 3.5 cm,ranging(2.2-4.5 cm).The R.E.N.A.L.score was 9.7 (9-11).The average preoperative GFR was 44.5 ml/min (36.5-51.7 ml/min).The surgery was completed step by step as follow:the renal hilum was fully dissociated.The arteries,veins and collective system were completely freed.After blocking the renal artery,the renal hilum was completely dissected again.The tumor was enucleated precisely,and the wound was given a point-to-point suture.Results All operation were completed safely and successfully without conversion to nephrectomy and open surgery.The average operative duration was 175.0 min (133-224 min).The average warm ischemia time was 27.3 min (22-38 min) and the intraoperative blood loss was 155.7 ml (50-250 ml).One patient had gross hematuria after surgery.Postoperative pathology showed clear cell carcinoma and the margins were negative.After three months,the average GFR was 29.3 ml/min (23.9-33.2 ml/min).There was no tumor recurrence and metastasis.Conclusions Robot assisted laparoscopic precise enucleation is a safe and feasible surgery for complex central located renal hilum tumors,and it is worth further promotion.
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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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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 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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Objective To investigate the value of B7-H3 in expressed prostatic secretions (EPS) in differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone (4-10 ng/ml). Methods One hundred and sixteen patients from the ages of 19 to 80 years (mean, 40 years) were stu-died. In the group there were 91 chronic prostatitis (CP) patients (mean age 31 years, 19-49 years), including 11 chronic bacterial prostatitis (type II) patients, 26 inflammatory nonbacterial prostatitis (IIIA) patients and 54 noninflammatory nonbacterial prostatitis (IIIB) patients. Transrectal ultrsound guided prostate biopsy was performed on 25 patients (mean age 71 years, 62-80 years) with t-PSA in gray zone (7.21±2.60 ng/ml). Five had positive results, Gleason score was 6 in two cases, 7 in two cases and 8 in one case. Twenty patients had negative results, of whom 11 patients had inflammatory cell infiltration. EPS was collected by transrectal massage, and Enzyme-linked immunosorbent assays (ELISA) were performed for B7-H3 detection. In addition, 11 normal male controls with a mean age of 30 years (24-46 years) were recruited into the study. Volunteers were excluded if they had a history of genitourinary symptoms or surgery.Results The EPS B7-H3 levels of controls, II, IIIA, IIIB groups were 49.81±11.54, 19.33±13.90, 17.67±15.76, 25.14±13.44 ng/ml, respectively. The levels of EPS B7-H3 in positive biopsy, noninflammatory negative biopsy and inflammatory negative biopsy groups were 26.30±16.32, 30.23±18.42, 10.11±5.42 ng/ml, respectively. The highest levels were found in the control group (P0.05). The EPS B7-H3 levels in the inflammatory negative biopsy group were statistically lower than in positive biopsy and noninflammatory biopsy groups (P0.05). Receiver operating curve (AUC=0.883, P=0.001) utilizing EPS B7-H3 levels≤16.24 ng/ml identified patients with inflammatory elevation of PSA with a sensitivity of 78.6% and a specificity of 81.8% from patients with t-PSA in gray zone. Conclusion The EPS B7-H3 detection provides a new way for differential diagnosis of patients with inflammatory elevation of PSA in t-PSA gray zone resulting in a reduction of unnecessary prostate biopsy.