Objective To access the efficacy of the arterial based complexity (ABC) scoring system in predicting complexity of LPN.Methods A total of 70 patients underwent laparoscopic partial nephrectomy from January 2013 to November 2015 were enrolled in the retrospective analysis.Among those patients,53 (75.7％) were males and 17 (24.3％) were females.Their mean age was 52 years,ranged from 44 to 61 years.The average BMI was 28 kg/m2,ranged from 25 to 32 kg/m2.Before operation,the average creatinine was 70.5 μmol/L,ranged from 60.5 to 81.0 μmol/L.43 patients accepted the procedure via retro-peritoneal approach and 27 patients accepted the procedure via peritoneal approach.38 tumor located in the left kidney and 32 tumor located in the right kidney.By using ABC scoring system,four readers independently scored contrast-enhanced computed tomography images of 70 patients who underwent laparoscopic partial nephrectomy.Interobserver variability was assessed with kappa values and percentage of exact matches between each pairwise combination of readers.Logistics regression was used to evaluate the association between reference scores and ischemia time,estimated blood loss,operation time.Results The operative duration ranged from 100 to 180 min,mean 147 min.The mean ischemic time ranged from 15 to 37 min,mean 24 min.The average blood loss was 210 ml (ranging 50-380 ml).The mean hospitalization was 16 days (ranging 11-21 days).The urine leakage was noticed in 2 patients after the operation.The size of tumor ranged from 1.8 to 3.0 cm,mean 2.5 cm.The pathological classification included renal cell carcinoma in 65 cases,renal cell carcinoma with cystic changing in 2 cases,renal chromophobe cell carcinoma in 2 cases,right renal solitary fibroma in 1 case.Based on the ABC scorirng system,15 cases were in 1 degree,29 cases were in 2 degree,17 cases were in 3S degree and 9 cases were in 3H degree.Pairwise comparisons of readers' score assignments were significantly correlated;average kappa =0.492,across all reader pairs.The average proportion of exact matches was 65％,the average proportion that differ between a level or less than a level was 98.6％.Logistics regression between the complexity score system and surgical outcomes showed significant associations between reference category assignments and warm ischemia time and estimated blood loss (P ＜ 0.05),but showed no significant associations with operation time (P ＞ 0.05).Conclusions The ABC scoring system for LPN demonstrated good correlation with perioperative morbidity.This system is a novel anatomy-reproducible tool developed to help patients and doctors understand the complexity of renal masses and predict the outcomes of kidney surgery.

OBJECTIVE: To observe the safety of donor NK cell infusions in the settings of hematopoietic stem cell transplantation and after consolidation chemotherapy in elderly patients with acute myeloid leukemia (AML). METHODS: Forty patients with AML were included, in which 21 patients aged over 60 years were at the stage of complete remission (CR) and 19 patients that received allogeneic hematopoietic stem cell transplantation (allo-HSCT). Mononucleated cells were isolated from peripheral blood from the donors (for allo-HSCT) or healthy immediate family members (elderly AML). The cells were seeded into the flasks pre-coated with NK cell specific activators, and expanded in media containing recombinant human IL-15 and IL-2 for 14 days. The cells were transfused intravenously after the identification of quality control. Trypan blue exclusion test was used for the determination of cell viability and counting. Flow cytometry analysis was performed to assess the surface antigenic profile. Seventy-eight infusions of the cell products were received by the elderly patients with AML after consolidation chemotherapy, 11 infusions were received by the patients during allo-HSCT and 32 infusions 3 moths after transplantation. The safety of cell therapy, body temperature, blood pressure and other indexes were observe during and 48 hours after cell transfusion. Meanwhile, the occurrence and severity of acute graft-versus-host disease (GVHD) were documented. RESULTS: Flow cytometry analysis showed that the proportion of NK cells (CD3^-CD56⁺) in the mononucleated cells before culture was (14.10±4.22)% (n=121), and the proportion increased dramatically up to (87.29±8.75)% (n=121) after culture for 14 days, the number of NK cells increased to 753.47±140.13 times (n=121). The doses of the infused NK cells was (7.58±2.50)×10⁷/kg per infusion. Moderate fever occurred in three cases after multiple infusions, and the temperature restored to normal on the same day after treatment. Fever was observed in one patient after every infusion of four times in total. The temperature reached to 38.5-39.0 ℃ and returned to normal within 1-2 hours after adequate antipyretic treatment, and then there was no discomfort. No GVHD was observed in the elderly AML patients, while 6 cases that received allo-HSCT developed moderate acute GVHD, among them grade I in 5 cases and grade II in 1 case. No other severe toxicities were observed. CONCLUSION NK cell products with a high-purity could be obtained by ex vivo expansion with this protocol. The transfusion of these expanded cells is generally safe in the elderly patients with AML that have received chemotherapy or patients that received hematopoietic stem cell transplantation.
Aged ; Graft vs Host Disease/prevention & control* ; Hematopoietic Stem Cell Transplantation ; Humans ; Killer Cells, Natural ; Leukemia, Myeloid, Acute/therapy* ; Middle Aged ; Recurrence