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INTRODUCTION: Knee osteoarthritis (KOA) is one of the most common osteoarthritis, imposing substantial economic and medical burdens on both individuals and society. In China, Tuina has been selected as a complementary and alternative therapy to relieve knee pain and dysfunction symptoms. However, the current evidence is insufficient to support the efficacy of Tuina therapy in addressing knee pain and improving physical function. The trial aims to compare the effectiveness of Tuina with celecoxib, which is considered as the standard treatment, and to assess its potential as an alternative therapy through changes in outcome measures. METHODS AND ANALYSIS: A total of 360 KOA patients aged between 40 and 70 years and classified as Kellgren and Lawrence grades I-II will be recruited from eight subcentral hospitals. The participants will be randomly assigned to either the treatment group (Tuina, Biw) or the control group (celecoxib, Qd), with both groups undergoing a 4-week intervention phase followed by an 8-week follow-up phase. The primary outcome is the change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale at week 4 compared with baseline. Secondary outcomes including WOMAC stiffness and function subscales, WOMAC total score, 36-item Short-Form Health Survey, Timed Up and Go test, Short Physical Performance Battery, gait analysis parameters and pain medication records will be assessed at weeks 4, 8 and 12. Any adverse events that occur during the trial will be promptly recorded. ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of Shanghai Municipal Hospital of Traditional Chinese Medicine (2023SHL-KY-16-01, 2023SHL-KY-16-02). Written informed consent will be obtained from all participants. Study results will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: ChiCTR2300069416.
Subject(s)
Osteoarthritis, Knee , Humans , Osteoarthritis, Knee/physiopathology , Osteoarthritis, Knee/therapy , China , Middle Aged , Aged , Randomized Controlled Trials as Topic , Male , Pain Measurement , Female , Celecoxib/therapeutic use , Multicenter Studies as Topic , Adult , Treatment Outcome , Arthralgia/drug therapyABSTRACT
INDRODUCTION: Primary dysmenorrhea (PD) is a very common issue in young women that reduces the quality of women's lives. Both Western medicine and traditional Chinese medicine (TCM) provide several ways to treat PD; however, TCM treatment exhibits fewer side effects for the patient. Tuina massage and Chinese herbal compresses are considered forms of external TCM therapy that have been widely used to treat PD, especially in China. Therefore, to provide the most effective and safe treatment for PD, we combined Tuina and Chinese herbal compresses together in this observational study. METHODS: A randomized controlled trial (RCT) consisting of 114 participants from the Shanghai University of Traditional Chinese Medicine who meet inclusion criteria will be divided into two groups in a 1:1 allocation ratio. The intervention group will receive Tuina combined with Chinese herbal compress therapy, while the control group will only receive Chinese herbal compress therapy. The treatment will be given 3 days before menstruation (once per day, 3 times per menstrual cycle). The primary outcome will be measured with the Visual Analog Scale (VAS). The secondary outcomes will be measured by the Dysmenorrhea Symptom Score, the Chinese Medical Dysmenorrhea Symptom Score, the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), and the pain threshold at Guanyuan (CV4). CONCLUSION: This study will be the first RCT that will entail the combination of Tuina and Chinese herbal compresses to treat PD in the category of cold coagulation and blood stasis syndrome. If the results demonstrate that Tuina combined with a Chinese herbal compress is effective, we posit that this study will provide evidence-based references for a potential alternative treatment to treat PD in the future.
Subject(s)
Dysmenorrhea , Pain Threshold , Female , Humans , Dysmenorrhea/drug therapy , China , Randomized Controlled Trials as Topic , Observational Studies as TopicABSTRACT
INTRODUCTION: Bladder cancer (BLCA) affects millions of people worldwide, with high rates of incidence and mortality. Ferroptosis proves to be a novel form of cell death process that is triggered by oxidative stress. METHODS: We procured a total of 25 single nuclear RNA-seq (snRNA-seq) samples from GSE169379 in GEO database. We obtained different cohorts of BLCA patients from the TCGA and GEO databases for model training and validation. A total of 369 ferroptosis-related genes (FRGs) were selected from the FerrDb database. AUCell analysis was performed to assign ferroptosis scores to all the cell types. Weighted Gene Co-Expression Network Analysis (WGCNA), COX, and LASSO regression analysis were conducted to retain and finalize the genes of prognostic values. Various bioinformatic approaches were utilized to depict immune infiltration profile. We conducted a series of colony formation analysis, flow cytometry and western blot (WB) analysis to determine the role of SKAP1 in BLCA. RESULTS: We divided the cells into high ferroptosis group and low ferroptosis group according to ferroptosis activity score, and then screened 2150 genes most associated with ferroptosis by differential expression analysis, which are related to UV-induced DNA damage, male hormone response, fatty acid metabolism and hypoxia. Subsequently, WGCNA algorithm further screened 741 ferroptosis related genes from the 2150 genes for the construction of prognostic model. Lasso-Cox regression analysis was used to construct the prognostic model, and the prognostic model consisting of 6 genes was obtained, namely JUN, SYT1, MAP3K8, GALNT14, TCIRG1, and SKAP1. Next, we constructed a nomogram model that integrated clinical factors to improving the accuracy. In addition, we performed drug sensitivity analyses in different subgroups and found that Staurosporine, Rapamycin, Gemcitabine, and BI-2536 may be candidates for the drugs treatment in high-risk populations. The ESTIMATE results showed higher stromal scores, immune scores, and ESTIMATE scores in the low-risk group, indicating a higher overall immunity level and immunogenicity of tumor microenvironment (TME) in this group, and tumor immune dysfunction and exclusion (TIDE) analysis confirmed a better response to immunotherapy in the low-risk group. Finally, we selected the oncogene SKAP1 in the prognostic gene for in vitro validation, and found that SKAP1 directly regulated BLCA cell proliferation and apoptosis. CONCLUSION: We identified a set of six genes, JUN, SYT1, MAP3K8, GALNT14, TCIRG1, and SKAP1, that exhibited significant potential in stratification of BLCA patients with varying prognosis. In addition, we uncovered the direct regulatory effect of SKAP1 on BLCA cell proliferation and apoptosis, shedding some light on the role of FRGs in pathogenesis of BLCA.
Subject(s)
Ferroptosis , Urinary Bladder Neoplasms , Vacuolar Proton-Translocating ATPases , Humans , Male , Multiomics , Ferroptosis/genetics , Urinary Bladder Neoplasms/genetics , Urinary Bladder Neoplasms/therapy , Oncogenes , Lipid Metabolism , Tumor MicroenvironmentABSTRACT
BACKGROUND: Chronic insomnia (CI) is a mind-body disease that is commonly defined as a state of having disturbed daytime activities due to poor nighttime sleep quality. Baduanjin qigong (BDJQG) is widely used for CI in China. However, there is little scientific evidence to evaluate its effects on the hyperarousal state, which is closely associated with improved sleep quality. OBJECTIVE: The objective of the trial is to assess the therapeutic effects of BDJQG on sleep quality in patients with CI. METHODS: A randomized controlled trial will be conducted on 86 patients, who will be divided into a BDJQG group and a cognitive behavioral therapy for insomnia group at a ratio of 1:1. Interventions in both groups will be given to the participants 7 times a week for 8 weeks, and the participants will be followed up for 4 weeks. The primary outcome is the change in the Pittsburgh Sleep Quality Index from baseline to week 8. The secondary outcomes are the changes in the Hyperarousal Scale, Insomnia Severity Index, Fatigue Scale-14, wrist actigraphy, salivary cortisol level, and functional magnetic resonance imaging from baseline to week 8. All main analyses will be carried out on the basis of the intention-to-treat principle. RESULTS: This study was funded from January 2023. As of the submission of the manuscript, there were 86 participants. Data collection began in April 2023 and will end in January 2024. Data analysis is expected to begin in January 2024, with the publication of results expected in February 2024. CONCLUSIONS: This study will present data concerning the clinical effects of BDJQG on CI. The results will help to demonstrate whether BDJQG is an effective therapy for improving sleep quality in association with a decreased hyperarousal level as a possible underlying mechanism. This study will provide much-needed knowledge for complementary and alternative therapy for patients with CI. TRIAL REGISTRATION: China Clinical Registration Agency ChiCTR2300069241; https://chictr.org.cn/bin/project/ChiCTR2300069241. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/53501.
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INTRODUCTION: Chronic fatigue syndrome (CFS) is a physical and mental disorder in which long-term fatigue is the main symptom. CFS patients are often accompanied by functional gastrointestinal diseases (FGIDs), which lead to decreased quality of life and increased fatigue. Prolong-life-with-nine-turn-method (PLWNT) is a kind of physical and mental exercise. Its operation includes adjusting the mind, breathing and cooperating with eight self-rubbing methods and one upper body rocking method. PLWNT was used to improve the digestive function in ancient China and to treat FGIDs such as functional dyspepsia and irritable bowel syndrome in modern times. Previous studies have shown that PLWNT can reduce fatigue in patients with CFS. But it is unclear whether the effect of PLWNT on CFS fatigue is related to gastrointestinal function. The aim of this study was to explore the relationship between PLWNT and fatigue and gastrointestinal function in patients with CFS. METHODS: This study is a non-inferiority randomized controlled trial (RCT). The whole study period is 38 weeks, including 2 weeks of baseline evaluation, 12 weeks of intervention and 6 months of follow-up. Ninety-six CFS patients will be stratified random assigned to the intervention group (PLWNT) and the control group (cognitive behavior treatment) in the ratio of 1:1 through the random number table generated by SPSS. In the evaluation of results, Multidimensional Fatigue Inventory-20 (MFI-20), Gastrointestinal Symptom Rating Scale (GSRS), Bristol Stool Form Scale (BSFS), and Short Form 36 item health survey (SF-36) will be evaluated at week 0 (baseline), week 6 (midterm), week 12 (endpoint) and month 9 (follow up). The intestinal flora will be evaluated at week 0 (baseline) and week 12 (endpoint). The data results will be processed by statistical experts. The data analysis will be based on the intention to treat principle and per-protocol analysis. In the efficacy evaluation, repeated measurement analysis of variance will be used for data conforming to normal distribution or approximate normal distribution. The data which do not conform to the analysis of repeated measurement variance will be analyzed by the generalized estimation equation Linear discriminant analysis will be used to clarify the difference species of intestinal flora. The significance level sets as 5%. The safety of interventions will be evaluated after each treatment session. DISCUSSION: This trial will provide evidence to PLWNT exerting positive effects on fatigue and gastrointestinal function of CFS. It will further explore whether the improvement of PLWNT on CFS fatigue is related to gastrointestinal function. TRIAL REGISTRATION: The trial was registered at Chinese Clinical Trial Registry http://www.chictr.org.cn/showproj.aspx?proj=151456 (Registration No.: ChiCTR2200056530). Date: 2022-02-07.
Subject(s)
Fatigue Syndrome, Chronic , Qigong , Humans , Fatigue Syndrome, Chronic/diagnosis , Quality of Life , Exercise , Patients , Treatment Outcome , Randomized Controlled Trials as TopicABSTRACT
The kinesin-14 motor proteins play important roles in tumor development and drug resistance and have been reported as potential biomarkers or therapeutic targets for tumor treatment. However, kinesin family member C2 (KIFC2), one of the kinesin-14 motor family members, remains largely unknown in prostate cancer (PCa) progression. Here, we used the GEO and The Cancer Genome Atlas datasets, Western blotting, and immunohistochemistry analyses to detect KIFC2 expression in PCa tissues. Additionally, a series of in vivo and in vitro experiments were utilized to demonstrate the roles of KIFC2 in PCa cells. We found that KIFC2 was highly expressed and positively correlated with the clinicopathological characteristics in PCa. Functional experiments indicated that KIFC2 could promote PCa progression. Furthermore, we performed an analysis of the KEGG and GSEA databases, subcellular fractionation, and immunofluorescence to investigate the potential mechanisms of KIFC2 in PCa. We confirmed that KIFC2 could regulate the NF-κB pathway via mediating NF-κB p65 protein expression and nuclear translocation thereby promoting PCa progression and chemotherapeutic resistance. Together, our results suggest that KIFC2 is overexpressed in PCa. By regulating the NF-κB pathway, KIFC2 may play a crucial role in PCa.
Subject(s)
Kinesins , Prostatic Neoplasms , Transcription Factor RelA , Humans , Male , Cell Line, Tumor , Kinesins/genetics , Kinesins/metabolism , NF-kappa B/metabolism , Prostatic Neoplasms/metabolism , Transcription Factor RelA/metabolismABSTRACT
BACKGROUND: Pressure injuries (PIs) continue to present significant challenges. In recent years, the number of patients with present-on-admission pressure injury (POA-PI) has increased, but researchers have devoted little attention to it, and little is known about its clinical outcome. AIMS: To compare the clinical outcomes of POA-PI and hospital-acquired pressure injury (HAPI) patients. METHODS: In this study, hospitalized patients with pressure injuries were divided into two groups based on whether they acquired the injury in the hospital or already present at the time of their admission. The disease prognosis, duration of stay, and healthcare costs of patients with HAPI and POA-PI were evaluated using propensity score matching analysis (PSM), t-tests, and Mann-Whitney U tests. RESULTS: The information on 1871 patients was retrieved from the electronic case system retroactively. A total of 305 pairs of patients were effectively matched between the two groups using propensity score matching (HAPI group = 305, POA-PI group = 305). There was no statistically significant difference at characteristics between the two groups (P > 0.05). The percentage of POA-PI group patients who were discharged from the hospital was greater than that of the HAPI group (P < 0.05). Conversely, the percentage of POA-PI group patients who died, ceased receiving treatment, or transferred to the hospital was lower than that of the HAPI group. Patients in the POA-PI group had shorter hospital stays than those in the HAPI group (P < 0.05). Patients in the POA-PI group had lower healthcare costs than those in the HAPI group (P < 0.05). CONCLUSIONS: Patients with POA-PI have superior clinical outcomes than patients with HAPI, but make up the overwhelming majority of hospitalized patients. It is imperative that future research focuses on the reduction of POA-PI and HAPI incidence and the identification of therapies that will enhance patient prevention for these conditions.
Subject(s)
Pressure Ulcer , Humans , Pressure Ulcer/prevention & control , Propensity Score , Hospitalization , Length of Stay , HospitalsABSTRACT
BACKGROUND: Knee osteoarthritis (KOA) is a common public health problem and a leading cause of long-term pain, decreased muscle strength, and even disability. Tai Chi has been proved effective and highly recommended for KOA management worldwide. However, little is known about its benefits on quadriceps strength which is closely associated with relieving knee pain. This trial is designed to evaluate the efficacy and safety of Tai Chi on knee pain and muscle strength in middle-aged and older adults with KOA. METHODS: A total of 100 participants will be randomly divided into a Tai Chi group (TC group) (1x/week for 12 weeks) and a control group with a health education and stretching program (1x/week for 12 weeks) with a follow-up period of 6 weeks. The primary outcome is the change of Western Ontario and McMaster Universities (WOMAC) pain subscale at week 12 compared with baseline. Secondary outcomes include WOMAC stiffness and function subscales, data from isokinetic dynamometry, gait analysis with electromyography (EMG), and a 36-item short form health survey (SF-36). The daily dose of pain-relieving medication will also be recorded. All adverse effects will be assessed by the Treatment Emergent Symptom Scale (TESS). DISCUSSION: We expect this randomized trial to evaluate the effectiveness of Tai Chi on relieving pain and increasing quadriceps strength in KOA patients. This protocol, if proven effective, will contribute to providing a promising alternative intervention for middle-aged and older adults with KOA. TRIALS REGISTRATION NUMBER: This trial has been registered in the China Clinical Trials Registry (registration number: ChiCTR2300069339).
Subject(s)
Osteoarthritis, Knee , Tai Ji , Middle Aged , Humans , Aged , Osteoarthritis, Knee/therapy , Treatment Outcome , Pain , Muscle Strength , Randomized Controlled Trials as TopicABSTRACT
OBJECTIVE: To observe the effect of acupoint catgut embedding (CE) on Nod-like receptor protein 3 (NLRP3)/Caspase-1 signaling pathway in "deficiency-stasis" syndrome type ulcerative colitis (UC) rats, so as to explore its mechanisms underlying improvement of UC. METHODS: A total of 58 male SD rats were randomly divided into control group (10 rats) and model group (48 rats). The "deficiency-stasis" type UC model was established by gavage of adenine and folium sennae solution for 4 weeks, followed by clycter of mixture solution of 5% trinitro-benzene-sulfonic acid and 50% ethanol. A total of 44 UC rats were randomized into model, salicylazosulfapyridine (SASP), non-acupoint CE, and acupoint CE groups (11 rats in each group). The catgut embedment was applied to bilateral "Zusanli"(ST36), "Shenshu"(BL23), "Pishu"(BL20), "Dachangshu"(BL25), "Geshu" (BL17) and "Tianshu"(ST25), or non-acupoints (the fat muscles of the buttocks), separately, once every two weeks, 3 times altogether. Rats of the SASP group received gavage of SASP solution, and those of the other groups received gavage of same amount of normal saline, once daily for 42 days. The rat's general conditions and the colon length were recorded, the disease activity index (DAI, 0 to 4 points) and colonic mucosal damage index (CMDI, 0 to 5 points) were calculated. Histopathological changes of the colonic mucosa tissue were observed after HE staining, and the tissue damage index (TDI, 0 to 6 points) was given. The levels of serum NLRP3, interleukin (IL)-1ß and IL-18 were measured by ELISA, and the expression levels of NLRP3, Caspase-1, apoptosis-associated speck-like protein (ASC), IL-1ß and IL-18 mRNAs were measured by fluorescence quantitative PCR. The expression levels of NLRP3 and Caspase-1 proteins in the colon tissues were measured by Western blot, and the immunoactivity of colonic ASC was detected by immunohistochemistry. RESULTS: Compared with the control group, the rats' body mass and colonic length were significantly decreased (P<0.01), and DAI score, CMDI score, TDI score, contents of serum NLRP3, IL-1ß and IL-18, expression levels of colonic NLRP3, ASC, Caspase-1, IL-1ß and IL-18 mRNAs, and NLRP3 and Caspase -1 proteins as well as colonic ASC immunoactivity were significantly up-regulated in the model group (P<0.01). Compared with the model group, both SASP and acupoint CE groups had a significant increase in body mass and colonic length (P<0.01), and a marked decrease in DAI score, CMDI score, TDI score, contents of serum NLRP3, IL-1ß and IL-18, expression levels of NLRP3, ASC, Caspase-1, IL-1ß and IL-18 mRNAs and NLRP3 and Caspase-1 proteins and ASC immunoactivity (P<0.01). The above indexes were improved in the acupoint CE group in relevant to those of the non-acupoint CE group (P<0.01). HE staining of colonic mucosal tissue showed obvious ulcerative surface, destroyed recess, disordered arrangement of glands, mucosal edema and congestion, infiltration of a large number of inflammatory cells in the model group, which was obviously milder in both SASP and acupoint CE groups. CONCLUSION: Acupoint embedding can alleviate colonic injury and inhibit inflammatory reaction in rats with "deficiency-stasis" type UC by down-regulating colonic NLRP3/Caspase-1 signaling.
Subject(s)
Colitis, Ulcerative , Rats , Male , Animals , Colitis, Ulcerative/genetics , Colitis, Ulcerative/therapy , Rats, Sprague-Dawley , Interleukin-18/genetics , NLR Family, Pyrin Domain-Containing 3 Protein/genetics , Catgut , Caspases , Signal Transduction , Sulfasalazine , Caspase 1/geneticsABSTRACT
Background: Ureteropelvic junction obstruction (UPJO) caused by crossing vessels is a common upper urinary tract abnormal development in which the vessels compress the upper segment of the ureter leading to different grades of hydronephrosis. Compared with routine computed tomography (CT) examination, three-dimensional visualization technology (3DVT) can help surgeons better understand the anatomical structure of the target surgical area. The aim of this study was to investigate the clinical value of 3DVT for the diagnosis, preoperative surgical planning, perioperative outcomes, and patient education of UPJO caused by crossing vessels. Methods: In this study, we retrospectively analyzed the clinical data of 28 patients who were admitted to the Department of Urology in Xiangya Hospital between January 2016 and December 2021 presenting with UPJO caused by crossing vessel compression. Among the 28 patients included, 13 patients underwent preoperative 3DVT and 15 patients underwent routine computed tomography (CT) scans. After the initial evaluation, all patients received standardized dismembered LP. The 2 groups of patients were compared in terms of demographic parameters, intraoperative data, and perioperative results. After surgery, all patients were asked to complete a Likert scale questionnaire to gain insight into their understanding of the disease and surgery, as well as their satisfaction with the use of different imaging techniques. Results: There were no statistically significant differences in age, gender, body mass index (BMI), side of obstruction, blood vessel compressing the ureteropelvic junction (UPJ), mean duration of hospitalization, and surgical efficacy between the 2 groups. However, the 3DVT group experienced a significant reduction in operation duration (120.8±7.0 versus 144.0±7.9 min, P=0.039), time required for dismemberment of the UPJ (14.8±1.7 versus 24.0±2.2 min, P=0.004), and the amount of intraoperative blood loss (60.8±10.5 versus 95.3±11.9 mL, P=0.041). The 3DVT group was also notably superior to the conventional CT group in terms of the overall levels of patient satisfaction and understanding of the disease and surgery. Conclusions: 3DVT is a helpful preoperative examination tool which can clearly show the anatomical relationship between crossing vessels and the UPJ. In addition, 3DVT can also help patients better understand their conditions and surgical plans, thereby improving patient satisfaction.
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This study explored the marketisation process of top-tier Chinese universities by scrutinising their self-promotional strategies over the past two decades. Drawing on Martin and White's (2005) Appraisal framework, we identified all attitudinal markers in the About Us texts posted by 35 top-tier Chinese universities on their official websites at two time-points: the turn of the century and the year of 2021. The 35 universities were drawn from China's "Double First Class" Initiative that prioritises the development of a select group of elite universities in China. Close textual analyses focussing on the attitudinal markers with reference to their contexts were conducted to identify the themes evaluated in the About Us texts; Wilcoxon signed-rank tests were run to quantitatively compare the relative frequencies of the attitudinal markers between the two phases, which was then supplemented by diachronic qualitative comparisons on the fine-grained linguistic features surrounding the markers. The study identified seven major themes positively appraised by the universities at both time-points. It also revealed diachronic differences in the use of attitudinal markers, reflecting a mediated change of promotional strategies over the past 20 years or so in the Chinese higher education context. These findings point to the influence of market, government, and tradition on Chinese top-tier universities' promoting strategies and the role of social cognition in shaping student choice. They also suggest the emergence of a higher education system with Chinese characteristics that features a reconciliation of market and government forces.
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Benign prostatic hyperplasia (BPH) is a common disease in older men, and there is evidence that obesity is a causal factor. It is currently unclear whether the hormone leptin, which is positively correlated to obesity, is involved in BPH. The aim of this study was to determine the effect of leptin on testosterone-induced BPH in mice and to explore possible underlying mechanisms. Testosterone (3 mg/kg) was injected into wild-type and leptin-deï¬cient ob/ob male mice for 14 consecutive days, and prostate tissues were subjected to various analyses. Additionally, BPH epithelial-1 (BPH-1) cells were treated with leptin to further investigate the underlying mechanisms. Leptin deficiency attenuated testosterone-induced morphological and pathological changes of BPH in mice. Furthermore, leptin deficiency alleviated the process of epithelial-mesenchymal transition (EMT) and suppressed the downregulation of bone morphogenic protein and activin membrane-bound inhibitor (BAMBI) in testosterone-treated mice. The in vitro data revealed that leptin significantly increased the expression of the EMT-associated marker vimentin but decreased the expression of E-cadherin, and that upregulation of BAMBI mitigated the intensity of leptin-induced EMT responses. Our results suggest that leptin can promote EMT in BPH through downregulating BAMBI. Suppressing leptin might be a potential therapeutic approach in preventing BPH development and progression.
Subject(s)
Down-Regulation/drug effects , Epithelial-Mesenchymal Transition/drug effects , Leptin/pharmacology , Membrane Proteins/metabolism , Prostatic Hyperplasia/metabolism , Animals , Cadherins/metabolism , Cell Line , Disease Models, Animal , Humans , Male , Mice , Mice, Inbred C57BL , Prostate/drug effects , Prostate/metabolism , Signal Transduction/drug effects , Testosterone/metabolism , Up-Regulation/drug effects , Vimentin/metabolismABSTRACT
PURPOSE: To describe our technique and experience with retroperitoneoscopic upper pole nephroureterectomy in duplex kidney, focusing on the role of dilated upper ureter. MATERIALS AND METHODS: From November 2004 to August 2011, retroperitoneoscopic upper pole nephroureterectomy was performed in 31 patients with a duplex kidney by a single, experienced laparoscopic surgeon. We developed our own surgical technique to suit this technically challenging procedure. Follow-up studies were performed using renal ultrasonography, intravenous urography (IVU) and/or dimercaptosuccinic acid (DMSA) renal scan in all patients at 3 months postoperatively and annually thereafter. RESULTS: All procedures were completed laparoscopically without conversion to open surgery and blood transfusion. The mean operative time was 106 (90-157) min. The estimated blood loss was < 50 mL in all cases. The mean postoperative hospital stay was 4.2 (3-7) days. Perioperative complications were limited to 1 case of peritoneal tear during a procedure and 1 case of transient postoperative fever. No major intraoperative and postoperative complication occurred. With the mean follow-up period of 41 months (range 3 to 80), no case was observed to have functional loss of the remaining lower moiety on postoperative IVU or DMSA renal scan. CONCLUSION: Retroperitoneoscopic upper pole nephroureterectomy using our technique is safe and effective.
Subject(s)
Kidney/abnormalities , Kidney/surgery , Laparoscopy/methods , Ureter/surgery , Adolescent , Adult , Blood Loss, Surgical , Chelating Agents , Female , Follow-Up Studies , Humans , Kidney/diagnostic imaging , Laparoscopy/adverse effects , Length of Stay , Male , Middle Aged , Operative Time , Retroperitoneal Space/surgery , Succimer , Tomography, X-Ray Computed , Treatment Outcome , Ureter/diagnostic imaging , Young AdultABSTRACT
OBJECTIVE: To present our experience of combining transperitoneal mini-laparoscopic pyeloplasty (mini-LP) and concomitant ureteroscopy-assisted pyelolithotomy (U-P) for ureteropelvic junction obstruction (UPJO) complicated by renal caliceal stones in the same session. METHODS: Between May 2007 and December 2011, mini-LP and concomitant U-P was performed in nine patients with UPJO and ipsilateral renal caliceal stones. Stone location and burden were preoperatively assessed. After pyelotomy with appropriate length (about 4 mm), a 16-Fr catheter sheath replaced the uppermost or lowermost laparoscopic trocar and was introduced directly into the renal pelvis under the guidance of a guide wire and laparoscopic vision. A 7.5F rigid ureteroscopy passed through the catheter sheath into the plevis. Intracorporeal lithotripsy and/or pressure irrigation via a pump was used for caliceal stone removal. Subsequently, laparoscopic pyeloplasty was performed in a standard fashion. Postoperative imaging was assessed. RESULTS: The calculi sizes ranged from 2 to 11 mm (mean, 7.1 mm) and an average of 3 stones per patient was removed (range, 1 to 6 stones). Complete stone clearance confirmed by postoperative imaging was achieved in all patients. Mean operative time was 210 minutes, and estimated blood loss was 20 mL. Mean hospital stay was 5 days (4-7). Stent was removed after 4-8 weeks. No intraoperative or postoperative complications were noted during a mean follow-up of 18.5 months (range, 6 to 24 months). CONCLUSIONS: Mini-LP and concomitant U-P are simple and effective alternatives for the simultaneous management of UPJO complicated by coexisting ipsilateral renal caliceal stones.
Subject(s)
Kidney Calculi/surgery , Laparoscopy , Ureteral Obstruction/surgery , Adolescent , Adult , Catheters , Female , Humans , Kidney Calculi/complications , Kidney Calculi/physiopathology , Male , Postoperative Complications/physiopathology , Treatment Outcome , Ureteral Obstruction/complications , Ureteral Obstruction/physiopathology , Ureteroscopy , Young AdultABSTRACT
OBJECTIVE: To retrospectively review our experience with respect to evaluating the feasibility and safety of laparoendoscopic single-site (LESS) dismembered pyeloplasty for ureteropelvic junction obstruction (UPJO) through a retroperitoneal approach. PATIENTS AND METHODS: Between March 2011 and January 2012, 10 consecutive patients underwent LESS retroperitoneoscopic dismembered pyeloplasty performed by one experienced laparoscopic surgeon at our institution. A single-port access was inserted through a 2.5-cm transverse skin incision below the 12th rib along the midaxillary line. Standard steps of the multisite retroperitoneoscopic Anderson-Hynes dismembered pyeloplasty technique using conventional instruments or a combination of conventional and bent laparoscopic instruments were performed. Follow-up studies were conducted by intravenous urography (IVU), diuretic renal scan, and renal ultrasonography. RESULTS: LESS retroperitoneoscopic dismembered pyeloplasty was successful in 9 patients, whereas 1 required four-port retroperitoneoscopic conversion because of difficulties in remaining in the retroperitoneal space due to a peritoneal tear during the procedure. The mean operative time was 148.4 minutes (range, 103-210 minutes). The mean estimated blood loss was 31 mL (range, 10-70 mL), and the mean postoperative hospital stay was 5.7 days (range, 3-13 days). Intraoperative complications were limited to the one case of peritoneal tear. An aberrant crossing vessel was noted in 4 patients, and transposition was not required in these patients. Urine leakage occurred in 1 patient postoperatively and was successfully treated by conservative management. The mean follow-up period was 6.2 months (range, 5-10 months). Satisfactory drainage with decreased hydronephrosis on IVU, diuretic renal scan, and renal ultrasonography was observed in all cases at the 3-month imaging studies. CONCLUSIONS: In experienced hands, LESS retroperitoneoscopic dismembered pyeloplasty is a feasible and safe alternative for correcting UPJO, although it remains technically challenging. The long-term outcome awaits further studies.
Subject(s)
Kidney Pelvis/surgery , Laparoscopy/methods , Ureteral Obstruction/surgery , Adolescent , Adult , Child , Feasibility Studies , Female , Humans , Laparoscopes , Laparoscopy/adverse effects , Male , Retroperitoneal Space , Retrospective Studies , Urologic Surgical Procedures/adverse effects , Urologic Surgical Procedures/instrumentation , Urologic Surgical Procedures/methods , Young AdultABSTRACT
OBJECTIVE: We performed retroperitoneal laparoendoscopic single-site (LESS) adrenalectomy using a homemade multi-access platform to evaluate the feasibility and safety of this technique and to share our initial experiences. PATIENTS AND METHODS: Since March 2011, 40 patients underwent retroperitoneal LESS adrenalectomy. A single incision of 2.5-3 cm was made under the 12th rib on the midaxillary line on the affected side. Next, a homemade multi-access platform was inserted through that incision, and a combination of lengthened curved and conventional rigid instruments was used for handling. The procedure was performed mainly according to the procedure for conventional laparoscopic retroperitoneal adrenalectomy. RESULTS: For 1 patient with pheochromocytoma, one additional trocar was used because the peritoneum was damaged. Surgery was successfully completed in all other patients without conversion to conventional laparoscopic or open surgery. CONCLUSIONS: Retroperitoneal LESS adrenalectomy is feasible; although initial technical adjustments are inevitable, some useful techniques are effective in simplifying the procedure.
Subject(s)
Adrenalectomy/methods , Laparoscopy/methods , Adrenalectomy/instrumentation , Adult , Equipment Design , Feasibility Studies , Female , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Patient Safety , Retroperitoneal Space , Treatment OutcomeABSTRACT
A 53-year-old man presented with a 6-month history of intermittent right flank pain. Radiological imaging confirmed the diagnosis of retrocaval ureter (RCU) and ureteral calculus. Retroperitoneal laparoendoscopic single-site surgery (LESS) ureterolithotomy and ureteroureterostomy was successfully performed. The operative time was 185 min and the blood loss was approximately 20 ml. The patient's postoperative course was uneventful. Postoperative analgesia was not needed. The patient was discharged on the third postoperative day. The drain and double-J stent were respectively removed at 1 and 8 weeks postoperatively. At the 3-month follow-up, nuclear scan showed no evidence of obstruction of the right kidney and the patient also remained symptom free. It may be concluded that retroperitoneal LESS repair for RCU is a feasible and safe procedure, which can be considered as a option for the management of RCU even if it is complicated by the presence of a ureteral calculus.
Subject(s)
Ureter/abnormalities , Ureteral Calculi/surgery , Humans , Laparoscopy , Male , Middle Aged , UreterostomyABSTRACT
PURPOSE: To present our early experience with retroperitoneal laparoendoscopic single-site (LESS) simple nephrectomy. PATIENTS AND METHODS: A total of 16 patients with benign nonfunctioning kidney underwent retroperitoneal LESS nephrectomy by one experienced laparoscopic surgeon. A single-port access was inserted through an approximately 3-cm lumbar incision made below the 12th rib along the midaxillary line. Standard steps of multisite retroperitoneoscopic nephrectomy technique with a combination of conventional and bent laparoscopic instruments were performed. RESULTS: Retroperitoneal LESS nephrectomy was performed in 15 cases successfully. The procedure of one patient (genitourinary tuberculosis) needed conversion to open surgery because of the severe adhesions surrounding the kidney, which resulted in failure to progress. Overall, the mean operative time was 85 (75-140) minutes, and estimated blood loss was 56 (20-110) mL. The mean time to resume oral diet was 1.5 days. The mean postoperative hospital stay was 4 (3-5) days. Perioperative complications were limited to one case of transient postoperative fever. No major intraoperative and postoperative complication occurred. CONCLUSIONS: Retroperitoneal LESS nephrectomy performed by an experienced laparoscopic surgeon is feasible and safe, offering improved cosmesis, although it remains technically challenging. Retroperitoneal LESS nephrectomy should be selectively used in terms of patients' specific conditions.
Subject(s)
Laparoscopy , Nephrectomy/methods , Retroperitoneal Space/surgery , Adult , Drainage , Female , Humans , Male , Middle Aged , Nephrectomy/standardsABSTRACT
OBJECTIVE: To investigate the clinical application of retroperitoneoscopic dismembered pyeloplasty for pediatric ureteropelvic junction obstruction (UPJO). METHODS: Of the 85 pediatric patients with UPJO, 56 were boys and 29 were girls. The age of the patients ranged from 2.5 to 11 years (mean = 4.6 years).B-ultrasonography showed hydronephrosis <15 mm (mild) in 15 patients,15-30 mm (moderate) in 59, <30 mm (severe) in the other 6. Intravenous urography (IVU) showed good imaging in 55 patients within 30 min, light imaging in 27 at 30-120 min, and no imaging in 3 after 120 min. The 85 patients underwent retroperitoneoscopic dismembered pyeloplasty. Conventional antegrade or modified antegrade double-J stenting was inserted in the 85 patients intraoperatively. RESULTS: The operation was successful in all, with no conversion to open surgery during the operation. The mean operation time was 146 min (125-240 min).The mean blood loss was 68 mL (55-112 mL).The mean postoperative hospitalization was 7 d (6-8 d ).Urine leakage occurred in 1 patient and with a good drainage, urine leakage disappeared in 1 week. Follow-up ranged 3-24 months (mean = 11 months).IVU showed on UPJ stricture, and good imaging in 75 patients within 30 min, light imaging in 10 at 30-120 min. Hydronephrosis was remitted:hydronephrosis resolution in 51 patients, mild in 6 and moderate in 3. CONCLUSION: Retroperitoneoscopic dismembered pyeloplasty is a safe, effective and mini-invasive procedure for pediatric ureteropelvic junction obstruction, with a rapid postoperative recovery. It will be the ideal treatment for UPJO in pediatric patients.
Subject(s)
Kidney Pelvis/surgery , Laparoscopy/methods , Ureteral Obstruction/surgery , Urologic Surgical Procedures/methods , Child , Child, Preschool , Female , Humans , Male , Retroperitoneal Space , Ureteral Obstruction/diagnosis , Ureteral Obstruction/etiologyABSTRACT
In this paper, two groups of Chinese herbs are investigated, one includes four species of rhubarb in which only one is used to treat against diseases and illnesses as Traditional Chinese Medicine, the other group is a common anemarrhena rhizome, it is found to mix with different materials in it. Both of them are directly identified by means of Fourier transform Raman spectroscopy for the first time. The tiny, delicate varied chemical components of different raw Chinese herbs lead to different characters in vibration frequency of Raman functional groups. It is found that the vibration frequency variance follows a certain specific regularity. The method is more precise and quick than traditional approaches. What is more, it will not damage samples.
