Liver function recovery of COVID-19 patients after discharge, a follow-up study.

Objective: The aim of this study was to observe the liver function recovery of COVID-19 patients after discharge. Patients and Methods: A total of 253 discharged COVID-19 patients in Shenzhen city, China were selected. The clinical characteristics of these patients were assessed. A 2-month follow-up and laboratory hematology test were performed to examine the status of patients' liver function. Results: Patients combined with liver diseases, especially fatty liver, are more likely to progress to severe condition (P<0.05). Patients in severe condition and those with liver diseases have higher rates of liver injuries during hospitalization, characterized by a significant increase in alanine aminotransferase (ALT) and aspartate aminotransferase (AST, P<0.01). The ALT, AST/ALT, gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), total protein (TP), albumin (ALB), and A/G levels showed significant differences in comparison with the control group (P<0.05, and P<0.001); and the outlier ratio of A/G, ALT, GGT and ALP of patients remained abnormal higher within 14 days after discharge (P<0.001). Liver injuries of COVID-19 patients may be related to the epidemiological characteristics, clinical indexes, basic diseases, symptoms, drug treatment during hospitalization and the complications. Indicators of liver function were correlated with cardiac function, renal function, thyroid function, lipid metabolism, glucose metabolism, immune index, leukocyte, erythrocyte, hemoglobin and platelet related indexes. The outlier ratio of TP, ALB and GLB remained extremely low throughout the follow-up period; the outlier ratio of ALT, AST and GGT decreased below 10% from a high level at 40 days after discharged. However, the outlier ratio of A/G, AST/ALT and ALP remained high during the follow-up period. Conclusions: Abnormal liver function might indicate worse recovery of COVID-19 patients. Changes in liver function should be emphasized during long-term follow-up of COVID-19 patients after hospital discharge; the necessity of employing appropriate interventions for liver function repair should be emphasized.

Clinical characteristics and follow-up analysis of 324 discharged COVID-19 patients in Shenzhen during the recovery period.

Objectives: Research on recovering COVID-19 patients could be helpful for containing the pandemic and developing vaccines, but we still do not know much about the clinical features, recovery process, and antibody reactions during the recovery period. Methods: We retrospectively analysed the epidemiological information, discharge summaries, and laboratory results of 324 patients. Results: In all, 15 (8.62%) patients experienced chest distress/breath shortness, where 8 of the 15 were severely ill. This means severely ill patients need an extended amount of time to recover after discharge; next, 20 (11.49%) patients experienced anxiety and 21 (12.07%) had headache/insomnia and a small fraction of them complained of anosmia/ageusia, indicating that these patients need treatment for mental and psychological health issues. Regarding the re-positive patients, their CT and laboratory test results showed no obvious evidence of illness progress or infectivity but a high anti-SARS-CoV-2 antibody expression. Conclusion: Recovered COVID-19 patients need psychological and physiological care and treatment, re-positivity can occur in any person, but juveniles, females, and patients with mild/moderate existing symptoms have higher rates of re-positivity, While there is no evidence that turning re-positive has an impact on their infectivity, but it still alerted us that we need differentiate them in the following managements.

[Risk Factors for Acute Renal Failure after Thoracoabdominal Aortic Aneurysm Surgery].

Objective To investigate the risk factors associated with acute renal failure (ARF) after thoracoabdominal aortic aneurysm (TAAA) surgery. Methods A total of 156 patients underwent TAAA repair between January 2009 and December 2017. Renal failure was defined based on the Kidney Disease Improving Global Outcomes criteria. The patients were divided into ARF group and non-ARF group based on the presence/absence of postoperative ARF. The risk factors of ARF were analyzed by univariate analysis and multivariate logistic analysis. Results The subjects included 111 males and 45 females aged (40.4±10.9) years (range:19-65 years). The surgical reasons included aortic dissection (n=130,83.3%),aneurysm (n=22,14.1%),and pseudoaneurysm (n=4,2.6%). The degrees of repair included Crawford extent I in 6 patients (3.8%),extent Ⅱ in 128 patients (82.1%),extent Ⅲ in 20 patients (12.8%),and extent Ⅳ in 2 patients(1.3%). There were 3 patients presented with aortic rupture and 6 patients received emergent operations. Nine patients (5.8%) died within 30 days after surgery,and 8 patients (5.1%) suffered from permanent paraplegia. Thirty-six patients (23.1%) had ARF after surgery,and 18 of them needed dialysis. Multivariate logistic analysis showed that smoking (OR =2.637,95%CI=1.113-6.250,P=0.028),packed red blood cell usage in operation (≥6 U) (OR =5.508,95%CI=2.144-11.930,P=0.000),reoperation for bleeding (OR=3.529,95%CI=1.298-9.590,P=0.013) were independent risk factors for ARF after TAAA repair. Conclusion Smoking,packed red blood cell usage in operation (≥6 U),reoperation for bleeding are the independent risk factors of ARF after TAAA surgery.

[Early and Midterm Results of Thoracoabdominal Aortic Aneurysm Repair in Patients with Marfan Syndrome].

Objective To evaluate the early and midterm results of surgical repair of thoracoabdominal aortic aneurysm(TAAA)in patients with Marfan syndrome(MFS). Methods The clinical data of patients with MFS undergoing TAAA repair in Fuwai Hospital between January 2009 and December 2017 were retrospectively analyzed.These patients were divided into two groups:MFS group(n=58)and non-MFS group(n=98).The baseline data,early postoperative results,and midterm follow-up outcomes were compared between these two groups. Results MFS patients were significantly younger(32 years old vs. 45 years old,t=9.603,P=0.000)and more frequently had a history of aortic aneurysm or dissection(19% vs. 0,χ 2=19.996,P=0.000)than non-MFS patients.However,the proportions of males and smokers were significantly lower when compared with non-MFS patients(55.2% vs. 80.6%,χ 2=11.489,P=0.001;13.8% vs. 46.9%,χ 2=17.686,P=0.001).There was no significant difference in proportion of emergency operation,prophylactic cerebrospinal fluid drainage,operation time,intra-operative circulation management,and intra-operative blood transfusion(all P>0.05).The 30-day mortality rate was significantly lower in MFS group than in non-MFS group(0 vs. 9.2%, [Formula: see text]=5.034,P=0.025). Conclusions For patients with MFS,TAAA repair provides lower 30-day mortality and comparative middle-term survival.However,the re-intervention rate is higher among MFS patients,highlighting the importance of close follow-up.

Unique Proton Dynamics in an Efficient MOF-Based Proton Conductor.

Recently, research on metal-organic frameworks (MOFs) serving as a new type of proton conductive material has resulted in many exciting achievements. However, direct observation of a well-established proton-transfer mechanism still remains challenging in MOFs and other crystalline compounds, let alone other conductive materials. Herein we report the solvothermal synthesis of a new proton-conducting MOF, (Me2NH2)[Eu(L)] (H4L = 5-(phosphonomethyl)isophthalic acid). The compound consists of a layered anionic framework [Eu(L)]- and interlayer-embedded counter cations (Me2NH2)+, which interact with adjacent uncoordinated O atoms of phosphonate groups to form strongly (N-H···O) hydrogen-bonded chains aligned parallel to the c-axis. Facile proton transfer along these chains endows the compound with single-crystal anhydrous conductivity of 1.25 × 10-3 S·cm-1 at 150 °C, and water-assisted proton conductivity for a compacted pellet of microcrystalline crystals attains 3.76 × 10-3 S·cm-1 at 100 °C and 98% relative humidity (RH). Proton dynamics (vibrating and transfer) within N-H···O chains of the compound are directly observed using a combination of anisotropic conductivity measurements and control experiments using large single-crystals and pelletized samples, in situ variable-temperature characterization techniques including powder X-ray diffraction (PXRD), single-crystal X-ray diffraction (SCXRD), diffuse reflectance infrared Fourier transform spectrum (DRIFTS), and variable-temperature photoluminescence. In particular, a scarce single-crystal to single-crystal (SCSC) transformation accompanied by proton transfer between an anionic structure (Me2NH2)[Eu(L)] and an identical neutral framework [Eu(HL)] has been identified.

Observation of Double-Dome Superconductivity in Potassium-Doped FeSe Thin Films.

We report on the emergence of two disconnected superconducting domes in alkali-metal potassium- (K-)doped FeSe ultrathin films grown on graphitized SiC(0001). The superconductivity exhibits hypersensitivity to K dosage in the lower-T_{c} dome, whereas in the heavily electron-doped higher-T_{c} dome it becomes spatially homogeneous and robust against disorder, supportive of a conventional Cooper-pairing mechanism. Furthermore, the heavily K-doped multilayer FeSe films all reveal a large superconducting gap of ∼14 meV, irrespective of film thickness, verifying the higher-T_{c} superconductivity only in the topmost FeSe layer. The unusual finding of a double-dome superconducting phase is a step towards the mechanistic understanding of superconductivity in FeSe-derived superconductors.

Structural basis for 18-ß-glycyrrhetinic acid as a novel non-GSH analog glyoxalase I inhibitor.

AIM: Glyoxalase I (GLOI), a glutathione (GSH)-dependent enzyme, is overexpressed in tumor cells and related to multi-drug resistance in chemotherapy, making GLOI inhibitors as potential anti-tumor agents. But the most studied GSH analogs exhibit poor pharmacokinetic properties. The aim of this study was to discover novel non-GSH analog GLOI inhibitors and analyze their binding mechanisms. METHODS: Mouse GLOI (mGLOI) was expressed in BL21 (DE3) pLysS after induction with isopropyl-ß-D-1-thiogalactopyranoside and purified using AKTA FPLC system. An in vitro mGLOI enzyme assay was used to screen a small pool of compounds containing carboxyl groups. Crystal structure of the mGLOI-inhibitor complex was determined at 2.3 Å resolution. Molecular docking study was performed using Discovery Studio 2.5 software package. RESULTS: A natural compound 18-ß-glycyrrhetinic acid (GA) and its derivative carbenoxolone were identified as potent competitive non-GSH analog mGLOI inhibitors with Ki values of 0.29 µmol/L and 0.93 µmol/L, respectively. Four pentacyclic triterpenes (ursolic acid, oleanolic acid, betulic acid and tripterine) showed weak activities (mGLOI inhibition ratio <25% at 10 µmol/L) and other three (maslinic acid, corosolic acid and madecassic acid) were inactive. The crystal structure of the mGLOI-GA complex showed that the carboxyl group of GA mimicked the γ-glutamyl residue of GSH by hydrogen bonding to the glutamyl sites (residues Arg38B, Asn104B and Arg123A) in the GSH binding site of mGLOI. The extensive van der Waals interactions between GA and the surrounding residues also contributed greatly to the binding of GA and mGLOI. CONCLUSION: This work demonstrates a carboxyl group to be an important functional feature of non-GSH analog GLOI inhibitors.

Alkaline earth metal (Mg, Sr, Ba)-organic frameworks based on 2,2',6,6'-tetracarboxybiphenyl for proton conduction.

Three new alkaline earth metal based metal-organic frameworks (MOFs), namely M-BPTC (M = Mg, Sr, Ba), have been synthesized by using BPTC (2,2',6,6'-tetracarboxybiphenyl) as ligand under hydrothermal conditions. These MOFs exhibit interesting structural diversity, variable chemical and thermal stability, as well as proton conductivity. Mg-BPTC with the formula {[Mg(BPTC)0.5(H2O)3]·5H2O}n consists of BPTC(4-) extended metal layers, and novel highly ordered infinite tape-like structures of cyclic water octamers reside interlayer. Three-dimensional porous {[Sr2(BPTC)(H2O)6]·H2O}n (Sr-BPTC) features inorganic Sr-O chains (I(1)O(2)) and open hydrophilic channels where water heptamers and carboxyl oxygen atoms conspire to form H-bond networks, whereas 3D {[Ba6(BPTC)3(H2O)6]·11H2O}n (Ba-BPTC) shows Ba-O inorganic layer (I(2)O(1)) and 1D channels incorporating large water 14-mers and 18-mers. M-BPTC (M = Mg, Sr) species exhibit excellent water stability and proton conductivity due to their respective appropriate pathways for proton transporting. M-BPTC (M = Sr, Ba) structures are highly thermally stable due to the presence of the inorganic connectivity. The present results suggest that M-BPTC (M = Mg, Sr) are promising materials for proton conduction and provide insight into the hydrogen bonding motif.

[Synthesis and experimental study of a novel polymer/gene compound drug controlled release system for the treatment of erectile dysfunction].

OBJECTIVE: To overcome the deficiency in the current therapies for erectile dysfunction (ED), we designed and synthesized a novel high-efficiency polymer/gene compound drug controlled release system and discussed the feasibility of pH and temperature dually sensitive injectable hydrogel in ED gene therapy. METHODS: We synthesized optimal siRNA gene nanoparticles by characterizing the zeta potential of polylysine (PLL)/siRNA gene compounds, and established a pH and temperature dually sensitive injectable gene compound drug controlled release system via Schiffs reaction between glycol chitosan (GC) and benzaldehyde capped OHC-PEO-PPO-PEO-CHO. Then we demonstrated the sustained release of the system at different temperatures. RESULTS: When the mass ratio of PLL to siRNA was 20:1, the zeta potential of the PLL/siRNA gene compound reached the peak (+23.5 mV) and the siRNA was encapsulated by PLL in the maximal degree. GC and OHC-PEO-PPO-PEO-CHO was crosslinked via benzoicimine reaction when environmental pH was changed from 5.5 to 7.4. The reslease of the siRNA encapsulated in this system kept at a low rate at 37 degrees C, significantly enhanced with the increase of the temperature to 60 degrees C, rising to (122.5 +/- 5.3) microg at 1 000 minutes as compared with (23.8 +/- 6.0) microg at 37 degrees C (P < 0.05). CONCLUSION: The polymer/gene compound drug controlled release system was successfully synthesized, which improved the stability and capacity of gene carriers and achieved siRNA release at different temperatures, promising to be a new approach to the gene therapy of ED.

Successful resection of a huge retroperitoneal venous hemangioma: A case report.

BACKGROUND: Venous hemangioma is a benign and non-invasive type of tumor, which is rarely identified due to the absence of clinical manifestations. A retroperitoneal benign tumor is comparatively rare, and hemangioma is exceptional. Because of the different types and locations of hemangioma, presentations are varied; thus, establishing an accurate diagnosis before surgery is challenging. CASE SUMMARY: A 45-year-old female patient visited our hospital with the complaint of a retroperitoneal mass without symptoms discovered during a medical examination. An abdominal and pelvic computed tomography (CT) revealed a giant hypodense mass that extended from the lower edge of the liver down to the right groin and showed no marked enhancement in the arterial phase of the enhanced CT. On magnetic resonance imaging, the retroperitoneal mass was hyperintense on the T2-weighted image and hypointense on the T1-weighted image. The mass was completely resected and confirmed as a venous hemangioma by pathology. CONCLUSION: Venous hemangioma is rare in adults, and an accurate diagnosis before surgery is challenging. Surgery is the curative treatment for venous hemangioma, and the definitive diagnosis relies on pathology.

Direct observation of nodeless superconductivity and phonon modes in electron-doped copper oxide Sr1-xNdxCuO2.

The microscopic understanding of high-temperature superconductivity in cuprates has been hindered by the apparent complexity of crystal structures in these materials. We used scanning tunneling microscopy and spectroscopy to study the electron-doped copper oxide compound Sr1- x Nd x CuO2, which has only bare cations separating the CuO2 planes and thus the simplest infinite-layer structure of all cuprate superconductors. Tunneling conductance spectra of the major CuO2 planes in the superconducting state revealed direct evidence for a nodeless pairing gap, regardless of variation of its magnitude with the local doping of trivalent neodymium. Furthermore, three distinct bosonic modes are observed as multiple peak-dip-hump features outside the superconducting gaps and their respective energies depend little on the spatially varying gaps. As well as the bosonic modes, with energies identical to those of the external, bending and stretching phonons of copper oxides, our findings reveal the origin of the bosonic modes in lattice vibrations rather than spin excitations.

Advanced research on acteoside for chemistry and bioactivities.

Acteoside is one kind of phenylethanoid glycoside, which has shown a lot of biological activities. This article reviewed the study progress of acteoside, such as distribution, preparation, identification, and bioactivities.

Treatment of complex coarctation and coarctation with cardiac lesions using extra-anatomic aortic bypass.

BACKGROUND: Coarctation of the aorta with cardiac lesions or complex coarctation is a formidable challenge for cardiac surgeons. Extra-anatomic bypass allows simultaneous intracardiac repair or an alternative approach for patients with complex coarctation. METHODS: Between July 1997 and March 2008, 43 patients with coarctation of the aorta underwent extra-anatomic bypass grafting, including 10 ascending-to-descending aorta bypasses and 33 ascending aorta-to-infrarenal abdominal aorta bypasses. Forty patients had additional cardiovascular disorders and concomitant procedures performed including aortic valve replacement, mitral valve replacement, coronary artery bypass grafting, closure of ventricular septal defect and patent ductus arteriosus, ascending aorta repair, and the Bentall procedure. The other three patients had complex coarctation of the aorta, including a long-segment coarctation in two cases, and descending aortic aneurysm in one. RESULTS: Two patients died perioperatively: one due to air embolism during the cardiopulmonary bypass; one due to septic shock. There were no late deaths. Complications included laparotomy for mechanical ileus in one and re-exploration for bleeding in one case. There were no strokes or paraplegia and no grafted-related complication during follow-up period. Systolic blood pressure dropped from 160 +/- 27 mm Hg before surgery to 114 +/- 16 mm Hg postoperatively. Only two patients with mild hypertension postoperatively needed oral medicine. CONCLUSIONS: Extra-anatomic aortic bypass via median sternotomy or median sternotomy-laparotomy can be performed with low morbidity and mortality. It is a preferable single-stage approach for patients with concomitant complex coarctation and cardiovascular disorders.

Reduction and fixation of the avulsion fracture of the tibial eminence using mini-open technique.

The purpose of this prospective study is to present and evaluate a new technique using suture anchors for the treatment of the avulsion fractures of the tibial eminence. Twenty-three consecutive patients with the displaced avulsion fracture of the tibial attachment of anterior cruciate ligament were treated using mini-open technique with suture anchors between 2005 and 2008. According to the classification of Meyers and McKeever, there were 5 type II, 13 type III, and 5 type IV fractures. The median follow-up period was 18 months (range, 12-32 months). The patient assessment included Lysholm score, Tegner score, IKDC score, and radiographic evaluation. The median Lysholm score improved from 32 (range, 28-48) preoperatively to 98 (range, 85-100) postoperatively. The median preoperative Tegner score was 3 (range, 2-5), and the median postoperative Tegner score was 7 (range, 5-9). The global IKDC objective score was normal (A) in 21 knees and nearly normal (B) in 2 knees. At final follow-up, the Lachman test and anterior drawer test were negative. The results showed that mini-open reduction and fixation of avulsion fracture of the tibial eminence with suture anchors have achieved satisfactory results. We suggest the use of this technique for treating avulsion fractures of the tibial eminence.

[Early diagnosis and treatment of invasive pulmonary aspergillosis following kidney transplantation].

OBJECTIVE: To investigate the early diagnosis and treatment of invasive pulmonary aspergillosis (IPA) infection following kidney transplantation. METHODS: A retrospective analysis was carried out in 16 IPA patients after kidney transplantation from January 2002 to March 2008. There were 7 males and 9 females with a mean age of 42.9 years old. The prevalence of IPA was 2.21%. The induction therapy was given to 12 patients, 5 with CD25 monoclonal antibody and 7 with anti-thymocyte globulin (ATG). All 6 with acute pre-infection rejection were given the methylprednisolone sodium or ATG therapy. RESULTS: The intervals between transplantation and diagnosis were largely within 3 months. Persistent or intermittent fever was the main post-operative symptom. High resolution computed tomography (HRCT) of thorax and bronchoalveolar lavage fluid (BALF) for culture were the main evidence of clinical diagnosis. Amphotericin B (0.15 - 0.5 mg * kg(-1) * d(-1)) might be the major treatment for IPA because of its satisfactory initial therapeutic effect. The mortality rate was 7/16 (43.75%). Of the 9 surviving patients, 8 were treated before the test results were available. CONCLUSIONS: The clinical symptoms of IPA following kidney transplantation are atypical in the early stage so that it is easy to misdiagnoses and a high mortality rate ensues. Major risk factors for IPA include administration of ATG, CD25 monoclonal antibody and steroid boluses for prevention or treatment of allograft rejection; prolonged broad-spectrum antibiotic use after transplantation and environmental factors. Early diagnosis and empirical use of antifungal agents while waiting for a definitive diagnosis are imperative in achieving a favorable outcome.

[Immunoadsorption in highly sensitized renal transplant recipients].

OBJECTIVE: to investigate the efficacy and safety of protein A immunoadsorption (IA) therapy in the prevention of highly sensitized renal transplant recipients with acute rejection. METHODS: a retrospective analysis of preoperative clinical data was carried out in 12 renal transplant patients in our hospital from March 2008 to October 2009 with a high level of panel reactive antibody (PRA). Serum PRA and IgG, IgM, IgA were detected at pre and post-treatment. The acute rejection responses and adverse effects were observed. RESULTS: at post-treatment, PRA of both Class I and II antibody [14% (4%, 27%) vs 86% (73%, 98%), 6% (0, 23%) vs 68% (34%, 88%), P < 0.01] and serum total IgG levels significantly decreased [(550 ± 341) g/L vs (1301 ± 393) g/L, P < 0.01]. IgA and IgM were also lower than those at pre-treatment [(144 ± 78) g/L vs (185 ± 93) g/L, (103 ± 48) g/L vs (131 ± 66) g/L, P < 0.01]. Five cases had acute rejection reversible by anti-thymocyte globulin (ATG) or combined IA (n = 2). Within 6 months, 1 cases developed Aspergillus pneumonia, 2 cases of Pneumocystis carinii pneumonia were cured. CONCLUSION: IA therapy can reduce antibody levels in highly sensitized renal transplant recipients. When supplemented with induction therapy, it can effectively prevent and reduce rejection after renal transplantation.

Primary pulmonary artery sarcoma: surgical management and differential diagnosis with pulmonary embolism and pulmonary valve stenosis.

BACKGROUND AND AIM OF THE STUDY: Primary pulmonary artery sarcomas are rare and lethal tumors that are usually diagnosed during surgery or autopsy. We present six cases of primary pulmonary artery sarcomas and discuss clinical features, differential diagnosis, surgical treatment, and outcome of the tumors. METHODS: Between January 1994 and July 2008, six patients were identified with the disease during operation. Three patients were initially diagnosed with pulmonary valve stenosis, and two patients had a presumptive diagnosis of chronic pulmonary embolism. Two patients had simple or partial tumor resection. Four patients had radical tumor resection and homograft reconstruction of the pulmonary arteries. RESULTS: Histological examinations showed five malignant mesenchymomas and one fibrosarcoma. One patient died of refractory pulmonary hypertension during operation. Two patients died 4 months postoperatively because of brain metastases. Two patients were alive for 3 and 9 months, respectively after the operation with recurrent tumor. One patient is alive even 2 years after resection with no signs of recurrence or metastasis. CONCLUSIONS: Because of similar clinical features, pulmonary artery sarcomas are often confused with other pulmonary vascular obstructive diseases. Computed tomography scanning and gadolinium-enhanced magnetic resonance imaging could be useful methods for differential diagnosis. The prognosis is very poor. The survival time after resection varies from several months to several years depending on the presence of recurrence or metastasis. Early diagnosis and radical surgical resection presents the only opportunity for a potential cure.

[Extraanatomic aortic bypass grafting for the treatment of complex aortic coarctation].

OBJECTIVE: To review the experience of extraanatomic aortic bypass grafting for the treatment of complex aortic coarctation. METHODS: From July 1997 to July 2008, 48 consecutive patients (median age 30 years; range 10 to 58 years) with complex aortic coarctation underwent extraanatomic aortic bypass grafting. Indications include: (1) coarctation with intracardiac anomaly (n = 28); (2) coarctation with ascending aortic aneurysm (n = 1); (3) adult coarctation with calcification of local aortic wall (n = 7); (4) coarctation with hypoplasia aortic arch (n = 4); (5) long or multiple coarctation segment (n = 4); (6) coarctation with poststenotic aneurysm (n = 1); and (7) recurrent coarctation (n = 3). Routing of the grafts was:ascending-to-posterior pericardial descending aorta (n = 37); ascending-to-infrarenal abdominal aorta (n = 9); left subclavian artery-to-descending aorta(n = 2). Concomitant cardiac operations were performed in 31 patients (65%) using cardiopulmonary bypass; procedures included: aortic valve replacement in 16; mitral valve repair or replacement in 9; Bentall procedures in 6; patent ductus arteriosus closure in 5; ascending aortic replacement or plasty in 4; ventricular septal defect closure in 3 and coronary artery bypass surgery in 2. RESULTS: There was no operative death. One patient died of septic shock 39 days postoperatively. Two patients received laparotomy because of mechanical ileus shortly after the ascending-to-subrenal abdominal aortic bypass. Mean systolic blood pressure gradient between upper and lower extremities decreased from (65 +/- 27) mm Hg preoperatively to (14 +/- 11) mm Hg postoperatively (P < 0.05). During a mean follow-up of 28.9 months, there were no late deaths or graft-related complications. Residual mild hypertension were observed in five patients. CONCLUSION: Extraanatomic aortic bypass is an attractive treatment option for complex aortic coarctation in adults and adolescents. It can be performed with low morbidity and mortality. The midterm results is favorable.

[Clinical character of renal transplant recipients with bilateral native upper urinary transitional cell carcinoma].

OBJECTIVE: To analysis the clinical character of renal transplant (RTx) recipients with bilateral native upper urinary transitional cell carcinoma. METHODS: The clinical data of 7 cases of transitional cell carcinoma in 2236 RTx recipients who underwent non-synchronous native bilateral nephroureterectomy (BNU) for 14 case-times were retrospectively analyzed. RESULTS: The mean time between RTx and diagnosis of TCC was 49.7 months (24 - 96 months). The mean interval between 2 upper urinary tract operations was 14.0 months (2 - 36 months). All specimens obtained in the 14 operations were TCC-positive. The TCC location involved pure native pelvis (n = 2), pure native ureter (n = 4), and pelvis combined with ureter (n = 8). The TCC pathological grades include G(1)-G(2) (n = 7), G3 (n = 6), and cancer in situ (n = 1). The TCC stage status included pTIS (n = 1), pT(1) N(0)M(0) (n = 4), pT(2)N(0)M(0) (n = 6), pT(3)N(0)M(0) (n = 2), and pT(4)N(2)M(1) (n = 1). Five patients were observed to have TCC in bladder. Each patient underwent more then 2 times of transurethral resection of bladder tumor (TUR-Bt). The bladder TCC was at G(2)-G(3) with deep of superficial muscle involvement. Metastasis was found in skin, soft tissue, and costal bone of lumbar in one patient. The blood creatinine level of the 7 patients, representing the graft's function, was 120 micromol/L (97 - 161 micromol/L). The patients were followed up for 2 - 48 months, all patients survived. CONCLUSION: TCC after RTx has multiple sources and is invasive. Non-synchronous prophylactic native BNU with removal of bladder cuffs should be considered for those RTx recipients having multiple urinary tract malignancy in native upper urinary tract and bladder.

[Recovery characteristic of donor's and receptor's renal function from age over 55 years living donors donate kidneys].

OBJECTIVE: To observe and research clinical characteristics and curative effect and safety of renal transplantation from living elderly donors donating kidneys. METHODS: Retrospective study on the 19 living kidney donors who were over 55 years old and on the renal transplantation operations completed by our center for the past few years. Among the 19 donors, with an average age of 58 years old. Their mean creatinine clearance was 81.7 +/- 2.2 ml/min. Among the 19 acceptors, with an average age of 34 years old. All kidney before the open circulation transplant performed routine 0 point puncture and histological examination. RESULTS: All donors smoothly spent their perioperative period without any surgical complications. All the donors keep their blood Cr in a normal range one week after the operation. There was no significant difference between posttransplantation one week and six month and one year in blood Cr and Ccr. Blood pressure and blood sugar didn't not have significant changes, urine protein(-). All receptors' renal functions recovered in early stages without DGF. 7 receptors who had Ccr lower than 80 ml/min had their blood Cr decreased slowly. Among the 19 kidneys donated, 3 donors' glomerulosclerosises were higher than 10 percent. CONCLUSIONS: The kidney source shortage is the main factor that restricts the development of the renal transplantation currently, undoubtedly, the application of elderly donors will expand the kidney source and save more uremic patients. Renal transplantation is safe and feasible with the help of living elderly donors.