A meta-analysis of traditional and functional end-to-side anastomosis in radiocephalic fistula for dialysis access.

OBJECTIVE: Functional vein end to arterial side (ETS) anastomosis uses vein side to arterial side (STS) anastomosis with distal vein ligation, which can achieve similar effects as those of ETS after STS anastomosis. The purpose of the study was to provide a meta-analysis to compare the clinical outcomes between traditional and functional ETS anastomosis in radiocephalic fistula for dialysis access. METHODS: Databases including PubMed, EMbase, the Cochrane Library, CNKI, Wanfang database were searched from the inception to February 6, 2020. Eligible studies comparing traditional and functional ETS anastomosis in radiocephalic fistula were included. Data were analyzed using Review Manager Version 5.3. RESULTS: Seven studies were included in the meta-analysis. Five randomized controlled trials and two cohort studies involving 841 patients were identified. Compared with traditional ETS anastomosis, functional ETS anastomosis had shorter anastomosis time (MD - 9.54, 95% CI - 17.96 to - 1.12, P = 0.03), higher surgical success rate (OR 3.80, 95% CI 1.76-8.22, P < 0.01), fewer complications(OR 0.18, 95% CI 0.08-0.39, P < 0.01), higher patency rate after 3 months (OR 4.91, 95% CI 1.19-20.33, P = 0.03), higher patency rate after 6 months (OR 1.90, 95%CI 1.09-3.31, P = 0.02), higher patency rate after 12 months (OR 1.70, 95% CI 1.09-2.66, P = 0.02). There was no difference after the two arteriovenous (AVF) anastomosisl methods concerning AVF maturation time (SMD - 0.48, 95% CI - 1.30-0.34, P = 0.25) and patency rate after 1 month (OR 1.77, 95% CI 0.65-4.80, P = 0.26). CONCLUSION: Functional ETS anastomosis had advantages of easy operation, high surgical success rate, few complications, high patency rate of 3 months and long-term, but did not have obvious advantage in the early stages concerning AVF maturation time and 1-month patency rate.

Evaluation the clinical value of S.O.L.V.E.nephrolithometry scoring system for predicting the stone-free rate of flexible ureteroscopy / 中华泌尿外科杂志

Objective To establish S.O.L.V.E.nephrolithometry scoring system,and to evaluate value of S.O.L.V.E.scoring system for predicting the stone-free rate (SFR) of flexible ureteroscopy (FURS).Methods Five reproducible variables were included in S.O.L.V.E.scoring system,such as stone surface area (S),obstruction (O),length of calyces funnel (L),visible number of calyces (V) and essence of stone (E).Variables were measured based on preoperative non-contrast computed tomography of urography.Clinical data of 392 patients who underwent FURS for upper urinary tract stones in our department from January,2017 to Jnne,2018 were retrospectively analyzed.The total study population consisted of 258 male and 134 female patients.The mean age was (49.5 ± 12.6) years old,ranged from 15 to 85 years.There were 292 patients in stone-fiee group,including 197 male and 95 female patients.The average age was (49.2 ± 12.8) years old.37 patients had previous history of renal stone surgery.Median body mass index was 24.7 kg/m2 (18.1-29.0 kg/m2) and median value of preoperative serum creatinine was 72.5 μmol/L (48.9-84.8 μmol/L).The number of patients,whose stone located in the left side and right side were 155 and 137,respectively.The number of patients,whose stones located in ureter,renal pelvis,lower calyceal and non-lower calyceal were 19,16,87,170,respectively.There were 100 patients in non-stone free group,61 men and 39 women.The average age was (50.4 ± 12.0) years old.15 patients had previous history of renal stone surgery.Median body mass index was 25.0 kg/m2 (18.5-28.8 kg/m2) and median value of preoperative serum creatinine was 73.8 μmol/L (46.5-92.5 μnol/L).The number of patients,whose stone located in the left side and right side were 51 and 49,respectively.The number of patients,whose stones located in ureter,renal pelvis,lower calyceal and non-lower calyceal were 7,4,27,62,respectively.The correlation of S.O.L.V.E.scoring system and stone-free rate,postoperative hospital stay,surgical complications,operation time were analyzed.Receiver operating characteristic curves were drawn to detect predictive value of S.O.L.V.E.scoring system for SFR of FURS.Results All cases FURS were performed successfully and the SFR was 74.5％ (292/392).Among the variables of the S.O.L.V.E.scoring system in the stone-free group and the non-stone free group,item S were (82.6 ± 69.8) mm2 and (172.6±133.7)mm2,respectively.The item L were (12.7 ± 15.8) mm and (23.9 ± 15.3)mm,respectively.The item V were (0.6 ± 0.7) and (1.3 ± 0.8),respectively.The item E were (817.1 ± 285.5) HU and (902.4 ± 256.1) HU,respectively.The difference was statistically significant (P ＜ 0.01).The item O was (17.7 ± 10.9) mm and (19.3 ± 13.1) mm,respectively,no statistical significance was found (P =0.242).The mean score was 6.3 (ranging 4-11) in this c ohort.The patients were divided into low score (4-5) group,moderate score (6-8) group and high score (9-11) group due to S.O.L.V.E.scoring system,and the stone-free rates were 93.5％ (130/139),70.5％ (153/217) and 37.5％ (9/36),respectively (P ＜0.01).The operation time of low,moderate,andi high score group were (31.6 ± 10.9),(42.3 ± 18.3),and (58.0 ± 19.2) min,respectively.Additionally,the score was correlated with the operation time(P ＜0.01),but not with postoperative hospital stay (P =0.133),intraoperative bleeding (P =0.185) and postoperative infectious fever (P =0.839).In logistic regression model analysis,the stone surface area,length of calyces funnel,number of involved calyces were significantly correlated with SFR (P ＜ 0.01).The obstruction degree and essence of stone were not associated with SFR (P ＞ 0.05).The area under receiver operating characteristic curve of S.O.L.V.E.score was 0.782,higher than that of each variable in S.O.L.V.E.scoring system(S,O,L,V,E were 0.738,0.535,0.698,0.735,0.593,respectively).Conclusions The stone surface area,length of calyces funnel,number of involved calyces were significantly correlated with SFR.The S.O.L.V.E.nephrolithometry scoring system can predict SFR after FURS accurately,and provide assistance for making clinical decisions.

The differences in colonic mucosal microbiota between normal individual and colon cancer patients by polymerase chain reaction-denaturing gradient gel electrophoresis.

OBJECTIVE: The aim of this study was to analyze the differences in the intestinal composition between normal individuals and colon cancer patients. METHODS: To establish the criteria for screening a normal individual for colon cancer, human colonic biopsies were obtained at routine colonoscopy. For patients with colon cancer, samples were obtained from cancerous regions. For normal individuals, colonic biopsies were taken from 3 sites of large intestine (descending, transverse, and ascending colon). Thereafter, a comparison of the microbiota structure by polymerase chain reaction-denaturing gradient gel electrophoresis (PCR-DGGE) was carried out. At last, bacterial species were identified by sequencing special bands from DGGE gels and comparing data with sequence databases. RESULT: With PCR-DGGE, we have discovered that the diversity and richness of the bacterial community from colon cancer patient's colonic mucosa were lower than that of the normal individual's sample. Then, a special DGGE band was found in the colon cancer patients. After sequencing, we confirmed that it had a high level of similarity with bacteroides. CONCLUSIONS: Colon cancers are closely related with the alteration of intestinal flora such as the reduction of biodiversity and richness of the bacterial community. Furthermore, the increase in proportion of bacteroides may be directly associated with colon cancer.

Investigation of injury causes,ages and injury spectrum of traumatic inpatient / 中华急诊医学杂志

Objective To discuss the change of injury causes,ages and injury spectrum of traumatic inpatient recent years.Methods Clinical data of traumatic inpatient from 2000 to 2004 were analyzed.A total of 2 319 cases with trauma were divided into four groups:adolescent group (＜13 years old),youth group (13～44 years old),middle age group (45～64 years old) and elderly group (≥65 years old).Traumatic condition was evaluated by abridged injury score-injury severity score (AIS-ISS) Results From 2000 to 2004,the number of traumatic inpatient increased every year.In all cases,youth and middle age accounted for 87%.Traffic accident was the leading cause of injury,and injury by fall from height acted as the secondary injury cause in youth group and middle age group,as well as slip fall injury in adolescent group and elderly group.Of all cases,there were slight trauma (AIS＜3 or ISS＜16) in 1 335 cases,severe trauma (AIS≥3 or ISS≥16) in 984 case.Operation was performed in 1 249 cases and nonoperation was performed in 1070 cases.In all groups,73 patients were died.The overall mortality rate was 3.14%.Conclusion With the development of society,the occurrence rate of trauma increases accordingly.The youth and middle age were high risk groups.It was necessary and urgent to strengthen the traffic administration and carry out education on safety so as to decreas the incidence of trauma caused by all kinds of factors.