Immune environment modulation in pneumonia patients caused by coronavirus: SARS-CoV, MERS-CoV and SARS-CoV-2.

Currently, we are on a global pandemic of Coronavirus disease-2019 (COVID-19) which causes fever, dry cough, fatigue and acute respiratory distress syndrome (ARDS) that may ultimately lead to the death of the infected. Current researches on COVID-19 continue to highlight the necessity for further understanding the virus-host synergies. In this study, we have highlighted the key cytokines induced by coronavirus infections. We have demonstrated that genes coding interleukins (Il-1α, Il-1ß, Il-6, Il-10), chemokine (Ccl2, Ccl3, Ccl5, Ccl10), and interferon (Ifn-α2, Ifn-ß1, Ifn2) upsurge significantly which in line with the elevated infiltration of T cells, NK cells and monocytes in SARS-Cov treated group at 24 hours. Also, interleukins (IL-6, IL-23α, IL-10, IL-7, IL-1α, IL-1ß) and interferon (IFN-α2, IFN2, IFN-γ) have increased dramatically in MERS-Cov at 24 hours. A similar cytokine profile showed the cytokine storm served a critical role in the infection process. Subsequent investigation of 463 patients with COVID-19 disease revealed the decreased amount of total lymphocytes, CD3+, CD4+, and CD8+ T lymphocytes in the severe type patients which indicated COVID-19 can impose hard blows on human lymphocyte resulting in lethal pneumonia. Thus, taking control of changes in immune factors could be critical in the treatment of COVID-19.

The Prediction for Development of COVID-19 in Global Major Epidemic Areas Through Empirical Trends in China by Utilizing State Transition Matrix Model

BackgroundSince pneumonia caused by coronavirus disease 2019 (COVID-19) broke out in Wuhan, Hubei province, China, tremendous infected cases has risen all over the world attributed to high transmissibility. We managed to mathematically forecast the inflection point (IFP) of new cases in South Korea, Italy, and Iran, utilizing the transcendental model from Hubei and non-Hubei in China. MethodsWe extracted data from reports released by the National Health Commission of the Peoples Republic of China (Dec 31, 2019 to Mar 5, 2020) and the World Health Organization (Jan 20, 2020 to Mar 5, 2020) as the training set to deduce the arrival of the IFP of new cases in Hubei and non-Hubei on subsequent days and the data from Mar 6 to Mar 9 as validation set. New close contacts, newly confirmed cases, cumulative confirmed cases, non-severe cases, severe cases, critical cases, cured cases, and death data were collected and analyzed. Using this state transition matrix model, the horizon of the IFP of time (the rate of new increment reaches zero) could be predicted in South Korean, Italy, and Iran. Also, through this model, the global trend of the epidemic will be decoded to allocate international medical resources better and instruct the strategy for quarantine. Resultsthe optimistic scenario (non-Hubei model, daily increment rate of -3.87%), the relative pessimistic scenario (Hubei model, daily increment rate of -2.20%), and the relatively pessimistic scenario (adjustment, daily increment rate of -1.50%) were inferred and modeling from data in China. Matching and fitting with these scenarios, the IFP of time in South Korea would be Mar 6-Mar 12, Italy Mar 10-Mar 24, and Iran is Mar 10-Mar 24. The numbers of cumulative confirmed patients will reach approximately 20k in South Korea, 209k in Italy, and 226k in Iran under fitting scenarios, respectively. There should be room for improvement if these metrics continue to improve. In that case, the IFP will arrive earlier than our estimation. However, with the adoption of different diagnosis criteria, the variation of new cases could impose various influences in the predictive model. If that happens, the IFP of increment will be higher than predicted above. ConclusionWe can affirm that the end of the burst of the epidemic is still inapproachable, and the number of confirmed cases is still escalating. With the augment of data, the world epidemic trend could be further predicted, and it is imperative to consummate the assignment of global medical resources to manipulate the development of COVID-19.

Heart injury signs are associated with higher and earlier mortality in coronavirus disease 2019 (COVID-19)

ImportanceHeart injury can be easily induced by viral infection such as adenovirus and enterovirus. However, whether coronavirus disease 2019 (COVID-19) causes heart injury and hereby impacts mortality has not yet been fully evaluated. ObjectiveTo explore whether heart injury occurs in COVID-19 on admission and hereby aggravates mortality later. Design, Setting, and ParticipantsA single-center retrospective cohort study including 188 COVID-19 patients admitted from December 25, 2019 to January 27, 2020 in Wuhan Jinyintan Hospital, China; follow up was completed on February 11, 2020. ExposuresHigh levels of heart injury indicators on admission (hs-TNI; CK; CK-MB; LDH; -HBDH). Main Outcomes and MeasuresMortality in hospital and days from admission to mortality (survival days). ResultsOf 188 patients with COVID-19, the mean age was 51.9 years (standard deviation: 14.26; range: 21[~]83 years) and 119 (63.3%) were male. Increased hs-TnI levels on admission tended to occur in older patients and patients with comorbidity (especially hypertension). High hs-TnI on admission ([≥] 6.126 pg/mL), even within the clinical normal range (0[~]28 pg/mL), already can be associated with higher mortality. High hs-TnI was associated with increased inflammatory levels (neutrophils, IL-6, CRP, and PCT) and decreased immune levels (lymphocytes, monocytes, and CD4+ and CD8+ T cells). CK was not associated with mortality. Increased CK-MB levels tended to occur in male patients and patients with current smoking. High CK-MB on admission was associated with higher mortality. High CK-MB was associated with increased inflammatory levels and decreased lymphocytes. Increased LDH and -HBDH levels tended to occur in older patients and patients with hypertension. Both high LDH and -HBDH on admission were associated with higher mortality. Both high LDH and -HBDH were associated with increased inflammatory levels and decreased immune levels. hs-TNI level on admission was negatively correlated with survival days (r= -0.42, 95% CI= -0.64[~]-0.12, P=0.005). LDH level on admission was negatively correlated with survival days (r= -0.35, 95% CI= -0.59[~]-0.05, P=0.022). Conclusions and RelevanceHeart injury signs arise in COVID-19, especially in older patients, patients with hypertension and male patients with current smoking. COVID-19 virus might attack heart via inducing inflammatory storm. High levels of heart injury indicators on admission are associated with higher mortality and shorter survival days. COVID-19 patients with signs of heart injury on admission must be early identified and carefully managed by cardiologists, because COVID-19 is never just confined to respiratory injury. Key pointsO_ST_ABSQuestionC_ST_ABSDoes coronavirus disease 2019 (COVID-19) cause heart injury and hereby impact mortality? FindingsIn this retrospective cohort study including 188 patients with COVID-19, patients with high levels of high-sensitivity cardiac troponin I (hs-TNI) on admission had significantly higher mortality (50.0%) than patients with moderate or low levels of hs-TNI (10.0% or 9.1%). hs-TNI level on admission was significantly negatively correlated with survival days (r= -0.42, 95% CI= -0.64[~]-0.12, P=0.005). MeaningCOVID-19 patients with signs of heart injury on admission must be early identified and carefully managed by cardiologists, in order to maximally prevent or rescue heart injury-related mortality in COVID-19.

Utilize State Transition Matrix Model to Predict the Novel Corona Virus Infection Peak and Patient Distribution

BackgroundSince December 2019, a pneumonia caused by the 2019 novel coronavirus (2019-nCoV) has broken out in Wuhan, Hubei province, China. The continuous rising of infected cases has imposed overwhelming pressure on public health decision and medical resource allocation in China. We managed to forecast the infection peak time in Hubei province and the severe and critical case distribution. MethodsWe used data resource according to cases reported by the National Health Commission of the Peoples Republic of China (Jan 25, 2019, to Feb 28, 2020) as the training set to deduce the arrival of the peak infection time and the number of severe and critical cases in Wuhan on subsequent days. Medical observation, discharge, infected, non-Severe, infected and severe, cure and death data were collected and analyzed. Using this state transition matrix model, we will be able predict when the inflection peak time (the maximum open infection cases) in Hubei Province will occur. Also, we can use this model to predict the patient distribution (severe, non-severe) to better allocate medical resource. Under relative pessimistic scenario, the inflection peak time is April 6-April 14. The numbers of critically ill and critically ill patients will lie between 8300-9800 and 2200-2700, respectively. ResultsIn very optimistic scenarios (daily NCC decay rate of -10%), the peak time of open inflection cases will arrive around February 23-February 26. At the same time, there will be a peak in the numbers of severely ill and critically ill patients, between 6800-7200 and 1800-2000, respectively. In a relative optimistic scenario (daily NCC decay rate of -5%), the inflection case peak time will arrive around February 28-March 2. The numbers of critically ill and critically ill patients will lie between 7100-7800 and 1900-2200, respectively. In a relatively pessimistic scenario (daily NCC decay rate of -1%), the inflection peak time does not arrive around the end of March. Estimated time is April 6-April 14. The numbers of critically ill and critically ill patients will lie between 8300-9800 and 2200-2700, respectively. We are using the diagnosis rate, mortality rate, cure rate as the 2/8 data. There should be room for improvement, if these metrics continue to improve. In that case, the peak time will arrive earlier than our estimation. Also, the severe and critical case ratios are likely to decline as the virus becomes less toxic and medical conditions improve. If that happens, the peak numbers will be lower than predicted above. ConclusionWe can infer that we are still not close to the end of this outbreak and the number of critically ill patients is still climbing. Assisting critical care resources in Hubei province requires the government to consider further tilt, and it is vital to make reasonable management of doctors and medical assistance systems to curb the transmission trend.

The combination of preoperative/2 hours postoperative blood WBC count ratio and qSOFA to predict the urosepsis after flexible ureteroscopic lithotripsy / 中华泌尿外科杂志

Objective:To discover the efficacy of the combination of preoperative/2 hours postoperative blood WBC count ratio and qSOFA to predict the urosepsis after flexible ureteroscopic lithotripsy.Methods:Retrospectively analyze the patients’ information from September 2015 to July 2018. In total, 2 364 patients who underwent the flexible ureteroscopic lithotripsy procedure were enrolled in the study. Patients gender (male: 1463, female: 751), age (54.9±14.0)years, BMI (23.9±2.8)kg/m 2, stone size(10.8±6.2)mm, side (left: 1 305, right: 1 018, both sides: 41), preoperative body temperature(36.8±0.4)℃, blood glucose level(5.7±1.5)mmol/L, WBC(7.4±4.6)×10 9/L, neutrophil percentage 0.62±0.11, C reactive protein(20.1±59.3)mg/L, procalcitonin(1.6±11.8)μg/L, interleukin-6(11.3±32.9)pg/ml. Results:The operative time was (39.3±23.0) min. The 2 hours postoperative WBC count was (6.7±2.9) ×10 9/L, neutrophil percentage was 0.70±0.12. qSOFA was positive for 69 cases and negative for 2 295 cases. 15 (0.6%) patients developed urosepsis. qSOFA positive patients were 15 in urosepsis group and 54 in normal group. The preoperative/2 hours postoperative blood WBC count ratio was 2.5±1.6 for urosepsis group and 0.7±0.2 for normal group. Univariate analysis showed that female patients(χ 2=16.20, P<0.001), large size of stones( t=2.14, P=0.050), high preoperative blood WBC( t=2.51, P=0.025), neutrophil percentage( t=2.90, P=0.012), C reactive protein( t=2.58, P=0.028), procalcitonin( t=16.09, P<0.001)and interleukin-6( t=7.88, P=0.032), positive preoperative mid-stream sample of urine culture(χ 2=21.10, P<0.001), preoperative/2 hours postoperative blood WBC count ratio >1( t=4.51, P=0.001)and qSOFA positive(χ 2=502.10, P<0.001) were recognized as statistically significant. Patients whose qSOFA was positive as well as preoperative/2 hours postoperative blood WBC count ratio >1 were diagnosed high-risk urosepsis patients. The efficacy of the combining of qSOFA and preoperative/2 hours postoperative blood WBC ratio >1 were higher than using separately. When using qSOFA alone, the area under the receiver operating characteristic curve was 0.98 but the positive prediction value was 21.7%. When using preoperative/2 hours postoperative blood WBC ratio alone, AUROC was 0.98, specificity was 60.0% and positive prediction value is 38.5%. Both indicate that the false positive rates were high. And for combining model, the area under the receiver operating characteristic curve was 1.00, specificity was 98.3% and the positive prediction value was 93.8%. It had a much higher efficacy which was a 2-hour-quick, sufficient and reliable indicator for diagnosing urosepsis. Conclusions:The combination of qSOFA positive and preoperative/2 hours postoperative blood WBC count ratio>1 could quickly and accurately predict the urosepsis after flexible ureteroscopic lithotripsy.

Effect of early continuous renal replacement therapy on the prognosis of urosepsis / 中华泌尿外科杂志

Objective To investigate the effect of early continuous renal replacement therapy on the prognosis of urinary sepsis after surgery for upper urinary tract calculi.Methods The clinical data of 59 patients with urinary sepsis after surgery for upper urinary tract calculi were retrospectively analyzed.In 59 patients with urinary sepsis,9 patients with early persistent renal replacement therapy were selected as the experimental group and 50 patients without early continuous renal replacement therapy as the control group. The age,sex ratio,diabetes,hypertension,the average operation time were no significant difference(P>0.05).Preoperative urinary tract infection,the experimental group preoperative urinary tract infection was significantly higher than the control group(77.8% vs.32.0%,P<0.05).In the results of preoperative urine culture positive ratio,the experimental group was also significantly higher than the control group,the difference was statistically significant(P<0.05).The changes of prognostic factors in patients with or without continuous renal replacement therapy were analyzed.Results In terms of the changes of postoperative laboratory results,the decrease of procalcitonin(PCT),C-reactive protein,white blood cell count and neutrophil ratio in the experimental group was significantly larger than that in the control group, and the difference was statistically significant;on the increase of hemoglobin,platelet count,fibrinogen,the standard bicarbonate level from blood gas analysis in the experimental group increased significantly more than the control group,the difference between the two groups were statistically significant.Conclusions Early renal replacement therapy in patients with urinary sepsis after upper urinary tract calculi surgeries can improve the prognosis of patients.

Effect of biofeedback therapy for functional constipation in elderly patients / 中华老年医学杂志

Objective To evaluate the clinical value and effect of biofeedback training therapy for functional constipation in elderly patients.Methods A total of 78 elderly patients with functional constipation were treated at the People's Hospital of Pudong New Area,and were divided randomly into two groups.The control group (n =39) received routine treatment plus oral polyethylene glycol,while the experimental group (n=39) received biofeedback training treatment in addition to what was offered to the control group.After treatment,constipation symptom scores,anorectal dynamic parameters and clinical effects were compared between the two groups.Results The scores on excrement characteristics,defecation difficulty,and time and frequency of defecation were better in the experimental group than those in the control group (t=5.670,4.740,4.170,5.530;P=0.016,0.034,0.039,0.022,respectively).The overall effectiveness rate was 94.9 ％ (37/39) in the experimental group,which was higher than that (71.8 ％,2 8/3 9) in the control group (x2 =4.493,P=0.030).Meanwhile,the levels of 3 SC and 10 SC in the two groups were higher than those before treatment,but the level of 10SR was lower than that before treatment (all P＜0.05).Moreover,improvement in 3SC,10SC and 10SR were more significant in the experiment group than in the control group (all P＜ 0.05).Conclusions Biofeedback training therapy is safe and effective for elderly patients with constipation to relieve constipation symptoms,enhance control of defecation and promote defecation.

Clinical effect of conversion to Rapamycin on chronic allograft nephropathy / 中华器官移植杂志

Objective To study the effect and safety of conversion from calcineurin inhibitors to rapamycin in kidney transplantation recipients with chronic allograft nephropathy.Methods In 82 kidney transplant recipients enrolled in this study,72 cases were diagnosed as having chronic allograft nephropathy by biopsy.Recipients (SRL group) were administered with rapamycin after withdrawal of calcineurin inhibitors.The doses of CNI in other recipients (non-SRL group) were not changed.Renal function,proteinuria,blood pressure,blood fat,hepatic function and hemogram were observed for 24 months in each group.Results During the follow-up period,serum creatinine level was dropped significantly in SRL group (P＜0.05),but it was increased in non-SRL group (P＜0.05).SRL group showed increased proteinuria,serum cholesterol and triglycerides (P＜0.05),and reduced Plt (P＜0.05).According to the renal function before conversion,the recipients who were administered rapamycin divided into four groups.In group A (Scr ＜ 120 μmol/L),there was no significant difference in diverse variables before and after conversion.In group B (Scr 120-200 μmol/L and Banff Ⅰ-Ⅱ),renal function was improved,and proteinuria alleviated.In group C (Scr 120-200 μmol/L and Banff ＞ Ⅱ),and group D (Scr ＞200 μmol/L),renal function was damaged to varying degrees and proteinuria was deteriorated.Conclusion It is safe and effective for patients with chronic allograft nephropathy to convert from calcineurin inhibitors to rapamycin.

A comparative study of thulium laser resection of the prostate and bipolar transurethral plasmakinetic prostatectomy for the treatment of benign prostatic hyperplasia / 中华泌尿外科杂志

Objective To compare the safety and short-term efficacy of thulium laser resection of the prostate (TMLRP) and bipolar transurethral plasmakinetic prostatectomy (TUPKP) for the treatment of benign prostatic hyperplasia (BPH) patients.Methods A total of 100 patients diagnosed with BPH were randomly divided into 2 groups:TMLRP group (50 cases) and TUPKP group (50 cases).There was no significant difference of preoperative variables such as age,prostate volume,PSA,IPSS,Qmax and PVR between the two groups (P＞0.05).The perioperative parameters and therapeutic effects were recorded and compared between the two groups.Results Comparison between TMLRP group and TUPKP group included:operating time ((61.2±24.2) min versus (30.1±15.9) min),catheterization time ((1.8±0.4) d versus (3.2±0.6) d)and postoperative hospital stay ((3.3±0.8) d versus (4.1±1.3) d).Significant differences in these parameters were found between the two groups(P＜0.05).Compared with TUPKP group,the blood loss and postoperative bladder irrigation were significantly less in TMLRP group.One month postoperatively,there were 4 cases of urethral stricture in TUPKP group.Three months postoperatively,IPSS,QOL,Qmax and PVR were significantly improved in both groups (P＜0.01),but no significant difference detected between the 2 groups (P＜0.05).Conclusions TMLRP is superior to TUPKP in term of safety and tolerability (decreased blood loss,complication rate and short recovery time),and as efficacious as TUPKP in efficacy.Compared with TUPKP,operating time were significantly longer in TMLRP group

Clinical value of sonourethrography in the diagnosis of dysuria after bipolar transurethral plasmakinetic prostatectomy / 中华泌尿外科杂志

Objective To evaluate the value of sonourethrography in the diagnosis of dysuria after bipolar transurethral plasmakinetic prostatectomy. Methods Sixty male patients with dysuria after bipolar transurethral plasmakinetic prostatectomy underwent sonourethrography and re-operation.The clinical data of these patients were reviewed. Results The sonourethrographic findings were similar with the operative findings in 57 cases.In the 60 cases,there were 11 cases with bladder neck closure,10 cases with bladder neck stricture,30 cases with urethral stricture (16 located at membranous urethra,12 located at pars cavernosa urethra and 2 in external orifice of urethra),5 cases with prostate remnant,1 case with calculi in prostatic urethra,2 cases with dysfunction of detrusor of bladder and 1 case with flap of internal urethral orifice,Conclusions Sonourethrography could be a reliable diagnostic method for dysuria after bipolar transurethral plasmakinetic prostatectomy.It may be helpful for clinical treatment.

Cause of puncturing failure in ultrasonography guided minimal-invasive percutaneous nephrolithotomy / 中华泌尿外科杂志

Objective To analyze the cause of puncturing failure in ultrasonography guided minimal-invasive percutaneous nephrolithotomy (MPCNL). Methods A retrospective analysis involved total 612 patients with upper urinary tract lithialisis treated with MPCNL from May 2005 to May 2010.382 cases were acupunctured by traditional G18 puncturing instrument (group A),and the other 230 cases were performed by the improved ARROW Raulerson blue syringe (group B).The average renal pelvis range was 24 mm vs.21 mm before operation,and largest diameter of renal calculi was 3.7 cm vs.3.8 cm (P ＞ 0.05).Success rate and time cost as well as therapeutic effect were compared between the 2 groups. Results There were 29 cases of puncturing failure in group A (totally 382 cases) while only 2 in group B (totally 230 cases).The successful rate of establishment of working channel was significantly higher in group B (P ＜ 0.05).Average time of puncture procedure was 5.1 min and 4.8 min respectively (P ＞ 0.05).There was no puncturing-related severe complication in any group.The unsuccessful cases in the group A and related causes were:5 cases for obesity,13 cases for puncture needle slipping,9 cases for channel dropout,and 2 cases for needle route dropout.However,only 2 cases failed in group B,the accurate position of calculi was at upper and lower calyx.One case was over-weighted,another was because of pathway-loss during the calculi elimination processs.And the one-off puncture successful rate of A and B group was 92.4％ vs.99.1％,and the one-off puncture successful rate was significantly higher in group B. Conclusions Overobesity of patients is an important cause of puncturing failure for sonographically MPCNL.The establishment of working-channel with ARROW Raulerson blue syringe could be feasible and the success rate was significantly higher.

Sexual function changes after transurethral plasmakinetic resection of the prostate / 中华泌尿外科杂志

Objective To investigate the influence of transurethral plasmakinetic resection of the prostate(PKRP)on sexual function. Methods From January 2007 to December 2007.165 patients received PKRP,who had sexual active and completed the follow-up data forms before and after surgery.The average age of this cohort was 71 years(from 55 to 79 years).The average history of disease was 5.5(3-15)years while the average prostate volume 57(33-82)g,IPSS(26.4±2.6),quality of lire score(5.54±0.50),the maximum flow rate(7.04±4.10)ml/s,the average residual 120(55～250)ml.45 cases were complicated with urinary retention,and bladder stones 45 cases.15 cases with prostate stones.Their sexual function was assessed by the international index of erectile function,ejaculation function and sexual satisfaction before and 6 months after surgery by questionnaires,and compared the respective scores using SPSS14.0 and χ2 test. Results All of 165 patients,the IIEF-5 improved from(23.4±4.7)point to(24.1±4.9)point 6 months after operation(P>0.05),there was not significant.The abnormal ejaculation rate increased from 18.8%(31/165 patients)to 75.2%(124/165 patients)(P<0.001)after PKRP,respectively.The retrograde ejaculation rate increased from 11.6% (19/165 patients) to 64.2%(106/165 patients) after PKRP, respectively.There was a significant difference.128 patients (77.6 % ) and 132 patients (80.0 % ) were satisfied with their sexual active before and after 6 months PKRP, respectively. Conclusions The results of this study confirmed that PKRP has no negative influence on the quality of erections measured by IIEF-5.The loss of ejaculatory function has no influence on patients sexual active.

Laparoscopic radical nephrectomy for clinical stage T_2 renal cell carcinoma patients / 中华泌尿外科杂志

Objective To report the experience and results in comparing laparoscopic radical nephrectomy (LRN) and open radical nephrectomy (ORN) in the treatment of clinical T_2 stage renal cell carcinomas. Methods Between Feb. 2004 and Jul. 2007, 30 patients (12 females and 18 males with average age of 58.0±8.5 years, range 42-68 years) received LRN and 36 patients (16 females and 20 males with average age of 60.0±9. 0 years, range 52-70 years) received ORN. The average tumor sizes in the LRN and ORN groups were (8. 5±2.2)cm (range 7-12 cm) and (8. 8±2.1)cm (range 7-14 cm) respectively. Renal cell carcinoma was histopatologically confirmed in all the patients of these 2 groups after surgery. Results The operative time in the ORN group (130±27 min) was significantly shorter than that in the LRN group (176±23 min), P<0. 01. The estimated blood loss in the LRN group (200±80 ml) was also significantly less than that in the ORN group (380±185 ml) , P<0. 01. Patients in LRN group experienced significantly earlier bowel function recovery (P<0. 01) and shorter duration of drainage (P<0. 01) than those in the ORN group after operation. No severe perioperative complications occurred in all patients. The follow-up range was 6-27 months (average 15±2 months). During the follow-up, 2 patients in the LRN group developed lung metastasis. In the ORN group, 2 patients developed liver metastasis and 1 developed lung metastasis. Conclusion LRN has the advantages of minimal invasiveness and rapid postoperative recovery comparable to those of ORN, and it might be an alternative treatment option for the clinical T_2 stage renal cell carcinomas.

Donor cytokine gene polymorphisms affect the development of acute rejection after kidney transplantation / 中华器官移植杂志

Objective To investigate the influence of renal allograft donor cytokine and cytokine receptor gene polymorphisms on acute rejection after renal transplantation.Methods (1) 126 cases of cadaveric renal allograft recipients were divided into two groups according to the presence or absence of acute graft rejection.The distribution of 22 polymorphisms in 13 cytokine genes and production types of some cytokines were compared between donors of two groups as well as latent factors affecting acute rejection.(2) Based on the result of HLA-DR matching,all recipients were stratified into two conditions:0～1 locus HLA-DR mismatched and HLA-DR completely mismatched.Previous positive gene polymorphisms were compared between rejection group and no rejection group under two conditions.Results (1) Compared with no rejection group,the number of HLA-DR mismatched was significantly higher in rejection group.In the donors of rejection group,the genotype frequency of IL-1α-889 C/C,IL-1Rα msp I 11100 T/T,IL-4Rα+ 1902 A/A,TGF-β1 codon 10 C/C,IL-10-1082 A/A and lower production type frequency of IL-10 were significantly higher,whereas the genotype frequency of IL-12-1188 A/A,IL-2-330 G/G and IL-10 GCC/ATA was significantly lower.(2) With 0～1 locus HLA-DR mismatched,the genotype frequency of IL-1Rα msp I 11100 T/T,IL-4Raα+1902 A/A,IL-2-330 G/G,TGF-β1 codon 10 C/C and lower production type frequency of IL-10 showed significant difference between two groups,whereas with HLA-DR completely mismatched,the genotype frequency of IL-12-1188 A/A had significant difference.Conclusions This study verifies renal allograft donor genotype of IL-1α-889 C/C,IL-4Rα+ 1902 A/A,IL-1Ra msp I 11100 T/T,TGF-β1 codon 10 C/C,IL-10-1082 A/A and lower production type of IL-10 gene as the genetic safe factors for the development of acute allograft rejection and genotype of IL-12-1188 A/A and IL-2-330G/G as the major genetic risk factors for acute rejection after kidney transplantation Furthermore,the condition of HLA-DR mismatching might interfere with the action of these cytokine and cytokine receptor polymorphisms.

Effects of Gaultheria yunnanensis on adjuvant arthritis in rats / 中国中药杂志

<p><b>OBJECTIVE</b>Gaultheria yunnanensis. are used widespreadly in the south of China to treat rheumatoid arthritis. The aim of this study was to provide an experimental basis for G. yunnanensis to therapy rheumatoid arthritis.</p><p><b>METHOD</b>We prepared water extracts, ethanol extracts, n-butanol extracts, ethyl acetate extracts and the rest of ethanol extracts from G. yunnanensis. Then, the n-butanol extracts were applied to macroporous resin and eluted with water, 30% ethanol, and 95% ethanol. Rheumatoid arthritis was induced by Freund's complete adjuvant injected into right postpedes in Wistar rats which was utilized to elucidate the anti-inflammatory effect of different extracted liquid of G. yunnanensis. Rats were intragastric injected (ig) with extracts as experimental group or normal saline as control group.</p><p><b>RESULT</b>Freund's complete adjuvant induced arthritis was successfully established: paw edema were increased after Freund's complete adjuvant injection, peaked at 2 or 3 day, then decreased, the paw edema were increased again at 7 or 8 day, and persisted 15 d. Water extracts, n-butanol extracts or ethyl acetate extracts could a significantlly decrease the paw edema as compared with the control group (P < 0.05, P < 0.01). The effect of n-butanol extracts was the most powerful. Further, n-butanol extracts eluant with water and 30% ethanol decreased the paw edema. The activity of extracts eluant with 30% ethanol was stronger than that of eluant with water.</p><p><b>CONCLUSION</b>G. yunnanensis displays considerable effects against Freund s complete adjuvant induced arthritis in rats, which is in concordance with clinical practice. n-Butanol extracts and both of the eluants with water and 30% ethanol produce a significant decrease in the paw edema. 30% ethanol eluants show a stronger activity than others. The effects against rheumatoid arthritis of different parts of G. yunnanensis differ in degree. It is deserved to explore the potential mechanisms of anti-inflammtion of the G. yunnanensis, especially the n-butanol extracts eluant with 30% ethanol.</p>

Clinical study of laporoscopic nephron sparing surgery for T1 renal cell carcinoma / 中华泌尿外科杂志

Objective To evaluate the clinical efficacy and safety of laparoscopic nephron sparing surgery in the treatment of T1 renal cell carcinoma. Methods Thirty-two patients (24 males and 8 females) were diagnosed with T1 N0 M0 renal cell carcinoma by ultrasound, CT or MRI and un derwent laparoscopic nephron sparing surgery. The mean age was (49±2)years old (from 31 to 72 years old). The mean tumor diameter was (2.8±0.8)cm. There were 21 tumors in left kidney, 11 in right kidney. Of them, 10 tumors were in upper pole, 13 in lower pole, 5 in kidney center, 4 close to renal hilum, 18 in dorsal side and 14 in ventral side of the kidney. Tumor masses were resected with the surgical margin of 0. 5 cm. Twenty-five cases were done through retroperitoneal approach and 7 cases was done through transperitoneal approach. The pathological results showed that there were clear cell renal carcinoma in 28 cases, granule cell renal carcinoma in 3 cases and oncocytoma in 1 case. Renal function was examined by ECT before and after the surgery. Results Thirty-one cases under went laparoscopic nephron sparing surgery successfully and only one case converted to open surgery due to excessive intra-operative bleeding. The mean renal pedicle blocking time was (24±4)min (from 19 to 52 min). There were 3 cases having blocking time longer than 30 min (38 min, 45 min and 52 min) and accepted secondary blockage during the procedure. The mean operative time was (105 ± 15) rain. The mean estimated blood loss was (120±22)ml. Only 6 cases accepted 400 ml blood transfusion. D-J stents were placed in 5 eases with the tumor in kidney center before operation. In 3 cases with intra-operative exposure of renal calyx, D-J stems were placed after operation. Urine leakage in 2 eases were noted at 2 and 3 days and recovered at 15 and 21 days after operation. The mean hospital stay was (9±2)days. There was no recurrence in a mean follow-up time of (23±5)months. There were 3 cases with local hematoma (1 case of 4 cm × 3 cm, 2 cases of 2 cm×3 cm) in the surgical site confirmed by ultrasound or CT scan 1 month after surgery and they disappeared 3 months after the operation. Serum creatinine and urea nitrogen were all in normal range after operation. Compared with renal blood flow of the operated kidney before operation, there were 9 cases decreased by 10 %- 15 and 3 cases decreased by 20% at 15 days, 7 cases decreased by 10%-15% at 1 month and 3 cases decreased by 10%- 15% at (23 ± 5) months after operation. Conclusion Laparoscopic nephron sparing surgery is one of feasible and safe options for the treatment of T1 renal cell carcinoma.

Expressions of multiple proteins in adrenal tumors and the clinical significance / 中华泌尿外科杂志

Objective To investigate the expressions of Ki67,p53,CKL,EMA,S-lOO,NSE,CgA,Syn,CEA and nm23 in adrenal tumors and their clinical significance.Methods Clinical data from 157 cases of adre-nal tumor patients were retrospectively reviewed including the clinical informa-tion and pathology data.Expressions of Ki67,p53,CKL,EMA,S-100,NSE,CgA,Syn,CEA and nm23 proteins were studied by immunohistochemistry(SP method)using monoclonal antibodies,and the relationship of their expressions with histopathologic type and clinical imformation was analyzed with SAS v6.12 software.A P value of＜0.05 was considered statistically significant.Results A increase of the expression rate of CKL,S-100,NSE,CgA,Syn and nm23 in adrenal tumors was obsered(P＜0.05).For univariate analysis,the expression of S-100,CgA,Syn was in connection with histopathologie types(P＜0.05).The expression of S-100,CgA,Syn had positive correlation with each other.The expression of CKL,S-100,NSE,CgA,Syn,nm-23 was no difference between adrnalbenign tumors and malignant tumors(P＞0.05),but it was much higher than in normal adrenal tissues(P＜0.05).The expression of Syn in adrenal cortical adenomaa was higher than in adrenal cortical cancers(P＜0.05),the expression of Ki67 in adrenal cortical adenomas was much lower than in adrenal cortical cancers(P＜0.05).The expression of EMA、CKL in adrenal cortical tumors were higher than in adrenal medullary tumors(P＜0.05),the expression of S-100,Syn,NSE,CgA in adrenal cortical tumors were lower than in adrenal medullary tumors(P＜0.05).Conclusions CKL,S-100,NSE,CgA,Syn and nm23 were good markers for adrenal tumors,they could be use for the adrenal tumors diagnosis.Detect Syn and Ki67 simutaneously was helpful to the diagnosis of adrenal cortical tumors.Detect EMA,CKL,S-100,Syn,NSE and CgA simultaneously and combine with clinical data was helpful to diagnosis between adrenal cortical tumors and adrenal medullay tumors.In malignant tumors,blood pressure had positive correlation with the expression of CgA,the size of tumor had neg-ative correlation of blood pressure,no prognostic factor was found.

Experimental study of chitosan on proliferation of bladder epithelial cells in vitro in rabbit ZHENG / 中华泌尿外科杂志

Objective To study chitosan's improving proliferation effect to the bladder epithelial cells,thus providing experlimental foundation for the treatment of interstitial cystitis.Methods Bladder epithelial cells were harested by the enzymatic digestion of the epithelium exposed by the eversion of reseeted New-Zealand hare's bladder.The cells were cultured in different concentrations(0.3、0.6、1.2、2.4、4.8 g/L)of chitosan group and control group,after 72 h,observing their growth and proliferation with optical microscopy;The effects of chitosan on proliferation of rabbit bladder epithelial cells were studied by NAG assay.EGFR mRNA was measured by PT-PCR.Results The growth of cells in the sample added chitosan is much better than that of in the control group.Chitosan could promote the proliferation of bladder epithelial cells at higher than 0.3 g/L of concentration in a dose dependent way.The optimum concentration to increase proliferation of eonjunctival epithelial cells was 1.2 g/L.The proliferative effect of EGFR mRNA increased with the elevated chitosan concentration after 72 h.Conclusions Chitosan can promote the growth of the bladder epithelial eell,which can provides a valuable evidence for further studies of interstitial cystitis's treatment.This proliferation effect is perhaps related to chitosan's promoting EGFR combinating specificity with EGFR.

Retroperitoneal laparoscopic nephropexy: a report of 28 cases / 第二军医大学学报

Objective: To discuss the procedure and clinical effect of retroperitoneal laparoscopic nephropexy (RLN).Methods: From August 2001 to June 2006, RLN was performed on 28 female patients aged 26-45 years old (mean, 34±2.5) with symptomatic nephroptosis, including 15 with the right kidney, 12 with the left, and 1 with both. The preoperative complaint of patients included subjective symptoms (constant and recurring pain in 28 patients) and objective symptoms (upper urinary infections in 16, hematuria in 12, and upper tract obstruction in 12). One patient underwent nephropexy via the transperitoneal approach and the others underwent nephropexy via the retroperitoneal approach. A retroperitoneoscopic procedure was performed after positioning the patients in the flank position. Digital preparation of the retroperitoneal space was made and standardized trocar was placed. The key step of the surgery was complete exposure of the kidney within Gerota' fascia, which was aimed to separate the potential adhesions between the colon and kidney or between the inferior blood vessels of the kidney. Nephropexy was performed between the fibrous capsule at the lower pole of the kidney and the dissected psoas muscle, using three sutures placed by intracorporeal technique or the percutaneous needle both for introduction and removal of the suture; the sutures were separately tied over the sacrospinalis fascia. Results: The mean operative time was (125±9) min (ranging 115-240 min); the mean postoperative hospital stay was (9±1.2) days, largely owing to the required 5-12 days' bed rest. During a mean follow-up of (24±4.2) months(ranging 3 to 70 months), 3 patients had paresthesia, 5 had constant and recurrent ache, 20 were completely free of pain, and 4 had micro-hematuria. One patient had further episodes of pyelonephritis and upper tract obstruction after operation. Intravenous pyelogram(IVP) revealed that the ptosis incorporated into more than one vertebral body in 2 patients. Postoperative renal function test showed an improvement in renal function. Conclusion: RLN is mini-invasive and has less complication. The procedure should be considered as one of the optimal therapy for nephroptosis.