Objective To evaluate the technique and effect of laparoscopic live donor nephrectomy via retroperitoneal approach. Methods Thirty-two donors (15 males and 17 females) underwent laparoscopic donor nephrectomy at our institution. Twenty-nine left and 3 right procedures were performed. Under general anesthesia, all donors were placed in lateral decubitus. Three transretroperitoneal trocars were used through different ports. The first 12 mm port was placed 2 cm inferior to the edge of rib and 1 cm lateral to the edge of sarcospinous muscle. The second 10 mm port was about 8 to 10 cm anterior to the first, or on the anterior axillary line and 2 cm inferior to the edge of rib. The third 5 mm port was also on the anterior axillary line but 2 cm superior to the iliac crest. The surgeon created the retroperitoneal working space with a constructed catheter balloon device, and made the donor kidney and ureter dissociated. Renal arteries and veins were cut with endoscopic articulating linear stapler for the first 6 patients and then with Hemo-Lok, a plastic clip with a lock, for the others. Finally, the dissected donor kidney and ureter were taken out through an incision extended from the first trocar port. Results All the 32 donor grafts were dissected successfully. The duration of procedure was ranged from 60 to 180 min, and the volume of blood loss was from 20 to 200 ml. The range of warm ischemia time was 3 to 8 min, and 25 to 50 min of cold ischemia time. Short renal veins were found in 3 cases, 1 cm, 1.5 cm and 2 cm respectively. And one case of renal endoarterial injury occurred. On the day after transplantation, the urine volume of recipients was from 2800 to 10 100 ml. There was no delayed graft function found in recipients. Conclusion Laparoscopic donor nephrectomy via retroperitoneal approach is available and safe to renal transplantation with minimal invasion to donors. It can help to obtain donor grafts with higher quality, though skillful laparoscopic technique is demanded.

Objective To explore the techniques and efficacy of retroperitoneal laparoscopic operations in the treatment of renal cyst. Methods A total of 35 patients were operated on under general anesthesia. A water-filled balloon was used to dilate the retroperitoneal cavity. The renal cyst was exposed by identifying the psoas major muscle, peritoneal reflection, pillar of diaphragm and so on. All cyst walls were unroofed with ultrasonic scalpel 3～5 mm from the edge of renal parenchyma. Results With renal cysts removed, the operations were successfully accomplished in all the 35 patients. The operation time was 15～60 min (mean, 32 min). The intraoperative blood loss was 5～60 ml (mean, 35 ml). The postoperative hospital stay was 3～6 days. Pathological examinations reported benign lesions in 34 patients and suspected cystadenocarcinoma in 1 patient. All the 35 patients were followed for 1～22 months. No recurrence was found with exception of 1 case of remaining renal cyst 1.5 cm in diameter under B-ultrasonography at the first postoperative month. The patient with suspected adenocarcinoma had been followed for 1 year and no evidences of neoplasm or metastasis were detected on the chest roentgenogram and B-ultrasonography of the liver and the kidneys. Conclusions Retroperitoneal laparoscopic unroofing is a safe and effective procedure for renal cyst.

Objective To evaluate the feasibility and curative effects of retroperitoneal laparoscopic surgery for adrenal pheochromocytoma. Methods Clinical records of 9 cases of retroperitoneal laparoscopic adrenalectomy of pheochromocytoma from October 2002 to November 2004 were reviewed. Results The operations were successfully completed in all 9 cases without severe complications. A sudden rise of blood pressure with an amplitude over 30 mmHg appeared in 3 cases during the operation, which took a favorable turn after adjusting the surgical performance and blocking the central vein. The operation time was 90~210 min (mean, 150 min). The intraoperative blood loss was 30~150 ml (mean, 50 ml). Blood transfusion was required in no cases. The postoperative length of hospitalization was 4~9 days (mean, 5 days). Pathological examination revealed benign adrenal pheochromocytoma in all cases. Follow-up for 3~24 months (mean,11 months)in the 9 cases found symptom free and no recurrence by B-ultrasonography or CT scans. Conclusions Retroperitoneal laparoscopic surgery for adrenal pheochromocytoma is a feasible procedure which offers advantages of minimal invasion, short operation time, less blood loss, quick postoperative recovery, fewer complications and good curative effects, having a promising future.

Objective To explore the operative approach, method,indication,and clinical feasibility of laparoscopic or retroperitoneoscopic treatment of ploycystic kidney.Methods The renal cyst unroofing(bilateral,9 cases;unilateral,4 cases) was performed under laparoscope(2 cases) or retroperitoneoscope(11 cases).The renal adipose capsule was dissected with a harmonic scalpel to fully visualize the whole kidney.According to preoperative positioning results,the cysts at all sizes were exposed.Then all visible cysts were unroofed or fenestrated with a margin 0.5 cm from the renal parenchyma.The cystic fluid was drawn out as much as possible.Results The operations were completed smoothly in the 13 cases.Pneumatothorax developed on the day of laparoscopic operation in 1 case,and then was cured by closed thoracic drainage.The operation time was 50～240 min(mean,139 min),and the blood loss was 10～200 ml(mean,58 ml).Patients began out-of-bed activities in 1～2 days after operation and were discharged from hospital at 3～10 days.The pathological findings were in accordance with changes of ploycystic kidney.Follow-up examinations were carried out for 1～30 months(mean,14.3 months).Back pain was relived in 8 out of 11 cases.In 3 patients with a high blood pressure,the systolic pressure was decreased by 16～19 mm Hg at 9 months after operation.Ten patients presented normal hepatic and renal functions,while the remaining 3 patients with preoperative increased creatinine levels of 194～301 ?mol/L had a drop by 20～40 ?mol/L.Conclusions Treatment of cyst unroofing under laparoscope or retroperitoneoscope is a safe and effective method in the treatment of ploycystic kidney,being worthy of clinical recommendation.

Objective To evaluate the safety and effectiveness of the Hem-o-lok in retroperitoneal laparoscopic nephrectomy.Methods A total of 178 patients underwent retroperitoneal laparoscopic nephrectomy from November 2003 to November 2006.The operation was performed through 3 lumbar ports.The renal artery and veins were blocked with the Hem-o-lok and then severed.The ureter was cut at the site near the iliac blood vessel.For living donor nephrectomy,the kidney was taken out and infused with 4℃ kidney preserving fluid immediately.Results The operation was successfully completed in all the 178 cases and there was no conversion to open surgery.No Hem-o-lok ligating clips became dislodged.The mean operation time was 100 min(60-200 min),and the mean blood loss was 95 ml(20-200 ml).Complications included renal vein injury in 1 patient and pancreatic tail injury in 1 patient.The mean length of postoperative hospital stay was 5 days(4-8 days).Pathological results showed renal clear cell carcinoma in 65 patients,renal cystadenocarcinoma in 3 patients,renal leiomyosarcoma in 1 patient,renal lymphoma in 1 patient,renal oncocytoma in 2 patients,renal hamartoma in 2 patients,ureteral transitional cell carcinoma in 12 patients,ureteral squamous cell carcinoma in 2 patients,renal pelvis transitional cell carcinoma in 31 patients,renal pelvis xanthogranuloma in 1 patient,renal tuberculosis in 4 patients,accessory kidney in 1 patient,renal calculus in 4 patients,nephrohydrosis in 4 patients,and renal abscess in 1 patient.A total of 136 patients were followed for 1-36 months(mean,25 months),involving 64 patients followed for

Objective To evaluate the outcomes of laparoscopic live donor nephrectomy via retroperitoneal approach. Methods From December 2003 to June 2004,6 patients underwent laparoscopic live donor nephrectomy (younger brother to elder sister in 1 case,elder brother to younger brother in 1, younger sister to elder brother in 1,elder sister to younger brother in 1,father to son in 1,mother to son in 1).For tissue matching,1 case was mismatched of 0 locus,2,of 2 loci and 3,of 3 loci.The results of PRA and lymphocytotoxicity test were negative.The patient was placed in the lateral decubitus.With 3 trocars, the left kidney was dissected via retroperitoneal approach.The arteries and veins were cut off by endoscopic articulating linear cutter. The donor's left kidney was taken out through a 6-7 cm long incision between 2 trocars.Staplers on renal arteries and veins were cut off,and the donor kidney was perfused with liquid,and then was implanted at the right iliac fossa of the recipients.Triple immunosuppressant therapy was used to prevent rejection. Results Laparoscopic donor nephrectomy was successfully performed on all the 6 cases by retroperitoneal approach.The kidney transplantations using the donor live kidneys were also successful.Postoperatively,the mean urine volume was 5036 ml(range,3500-6500 ml) on the first day;the mean serum creatinine level was 598 ?mol/L on the first day and 129 ?mol/L at 1 month.Follow-up of 3-9 months showed that the renal function was normal and no rejection occurred. Conclusions Laparoscopic donor nephrectomy via retroperitoneal approach is safe,feasible,and less invasive to the donor; however,this technique needs skilled surgeons of laparoscopy and renal transplantation.

To construct an HSV-1 vector vaccine carrying HIV-1 antigens, HIV-1 gp160, gag, protease and the expression elements were chained together, and then inserted into the internal inverted repeat sequence region of HSV-1 by bacterial artificial chromosome technology. Firstly, HIV-1 gp160 (including type B and C), gag and protease genes were cloned into pcDNA3 in series to generate the pcDNA/gBgp and pcDNA/gCgp, then the recombinant plasmids were transfected into 293FT cells, and HIV-1 antigen was detected from transfected cells by Western blotting. Then the expression cassettes from pcDNA/gBgp and pcDNA/gCgp, comprising HIV-1 antigen genes and expression elements, were cloned into pKO5/BN to generate the shuttle plasmids pKO5/BN/gBgp and pKO5/BN/gCgp. The shuttle plasmids were electroporated into E. coli cells that harbor an HSV-BAC, the recombinant bacteria were screened, and the recombinant DNA was extracted and transfected into Vero cells. The recombinant virus was purified through picking plaques, the virus' DNAs were identified by Southern blotting; HIV-1 antigen was detected from the recombinant HSV-1 infected cells by Western blotting, and the virus' replication competent was analyzed. As the results, gp160 and gag proteins were detected from 293FT cells transfected with pcDNA/gBgp and pcDNA/gCgp by Western blotting. The recombinant bacteria were generated from the E. coli electroporated with pKO5/BN/gBgp or pKO5/BN/gCgp. The recombinant HSV was purified from the Vero cells transfected with the recombinant DNA, the unique DNA fragment was detected from the genome of recombination HSV by Southern blotting; gp120 and gp41 were detected from the infected cells by Western blotting, and the recombinant HSV retained replication competent in mammalian cells. The results indicate that the recombinant HSV carrying HIV-1 gp160, gag and protease genes was generated, the virus retains replication competent in mammalian cells, and could be used as a replicated viral vector vaccine.
Animals ; Cercopithecus aethiops ; Chromosomes, Artificial, Bacterial ; DNA, Recombinant ; genetics ; DNA, Viral ; genetics ; Escherichia coli ; HIV Antigens ; genetics ; immunology ; HIV Envelope Protein gp160 ; genetics ; immunology ; HIV Protease ; genetics ; immunology ; Herpes Simplex Virus Vaccines ; immunology ; Herpesvirus 1, Human ; physiology ; Plasmids ; Transfection ; Vero Cells ; Virus Replication ; gag Gene Products, Human Immunodeficiency Virus ; genetics ; immunology

Objective To evaluate the recovery rate of erectile function (EF) and identify various factors predicting the recovery of EF in men undergoing laparoscopic radical prostatectomy (LRP) in our center.Methods From January 2011 to December 2012,a total of 106 men with localized prostate cancer underwent LRP in our center by one surgeon were included,and we gathered the preoperative EF condition and perioperative factors,such as patients' age,comorbidity and surgical procedure,et al.We followed up all the patients by telephone in August 2013 to collect the EF recovery data of these paticnts after LRP,with the mean follow-up of 18 (8-31) months.We analyzed the perioperative factors in order to predict the EF recovery after LRP.Results A total of 60 patients with preoperative sexual activity were included,and there was no difference in baseline data compared with other cases.Recovery of potency was defined as postoperative penile erection.The recovery rate of EF was 46.7％ (28/60) without the use of any drugs or devices for erection assistance.In our study,the recovery rate of EF in age ≤60 years was 90.0％ (9/10),and it was better than other two older groups (P =0.001).In patients whose preoperative IIEF-5 score was 22-25,the recovery rate of EF was 66.7％ (8/12),and it was better than those with IIEF-5＜22 (P=0.006).The recovery rate of EF in patients with preserved neurovascular bundle was 53.1％ (26/49) and it was 83.3％ (5/6) in patients with preserved accessory pudendal artery,which was better than those without preservation (P=0.036 and P =0.023).Conclusions In our study,age and preoperative EF were the significant factors to predict potency recovery,and preservation of neurovascular bundle and accessory pudendal artery during LRP were the positive predictor factors.

Purpose To compare radiation dose and image quality of different scan modes for CT pulmonary angiography (CTPA) including high-pitch flash mode, dual energy CT (DECT) mode, 128-slice mode of dual source CT and 64-slice CT mode. Materials and Methods One hundred and sixty-seven patients with suspected pulmonary embolism were retrospectively studied. All the patients underwent CTPA. Twenty patients were selected randomly from the patients scanned by high-pitch flash mode. Patients who were scanned by the other three modes were selected with body mass index and age matched those in high-pitch flash mode, with 20 patients in each group. Two radiologists assessed signal-to-noise ratio (SNR) and image quality with 5-piont scale. Dose parameters of volume CT dose index (CTDIvol), dose length product (DLP), and effective dose (ED) were compared among the four groups. Results Mean CTDIvol, DLP and ED were (3.72±0.74) mGy, (137.5±28.7) mGy · cm, and (2.34±0.41) mSv for Flash mode;(5.31±1.21) mGy, (181.6±34.5) mGy· cm and (3.24±0.57) mSv for DECT mode;(5.66±1.47) mGy, (198.7±42.1) mGy·cm and (3.58±0.63) mSv for 128-CT mode;and (6.75±1.68) mGy, (231.5±54.2) mGy·cm and (4.21±0.89) mSv for 64-CT mode. There was no significant difference of SNR and image quality among the four modes (P>0.05). Conclusion There are no significant difference of image quality among the four groups. Flash mode allows for minimum radiation dose compared to other modes. DECT mode and 128-CT mode get higher radiation dose with no difference between them. 64-CT mode gets the highest radiation dose.

Objective To investigate the efficacy of plasmapheresis therapy for treating the antibody-mediated acute rejection (AMR) after kidney transplantation.Methods The study group consists of 2 male patients and 3 female patients,who suffered with AMR after receiving first-time allograft renal transplantation from January 2011 to September 2013 in our hospital.The age ranged from 41 to 52 years old,average 46 years old.The preoperative diagnosis in all patients was chronic renal insufficiency (uremia stage) and the regular hemodialysis was given to them.The 5 patients received basic immunosuppressive therapy,including cyclosporine A [5 mg/(kg · d)] or FKS06 [0.1 mg/(kg · d)],mycophenolate mofetil (MMF) (1.5 g/d) and steroids.All the antibody-mediated acute rejections were diagnosed by renal allograft biopsy and serum DSA determination within 2 weeks after transplantation.Seven cycles of plasmapheresis rescue therapy were given to those patients respectively after the failure therapy of high dose of corticosteroids (1 000 mg/d) and ALG (250 mg/d).4 cases with primary glomerulonephritis,whose preoperative serum creatinine level was (784± 154) μ mol/L,were given plasmapheresis therapy within 2 weeks after transplantation.One case with primary anti-glomerular basement membrane disease,whose preoperative serum creatinine level was 935 μmol/L,received plasmapheresis 35 d after transplantation.The serum DSA in all patients was positive before plasmapheresis.Results After 7 cycles of plasmapheresis rescue therapy,the AMR was reversed in four 4 cases,whose plasmapheresis was given within 2 weeks after transplantation.Within three months follow-up,their renal function recovered well,which the mean serum creatinine level was (113± 12) μmol/L.In the case,whose plasmapheresis was given 35 days after transplantation,rejection was not reversed.His serum creatinine was 524 μmol/L and the intermittent hemodialysis was given,subsequently.With a follow-up of 12 months,the ultrasound examination showed that the atrophy of transplanted kidney and a high level of serum creatinine (758 μmol/L).Low dose of FK506 (0.5 mg/d) was given based on those results.Conclusions Active application of plasmapheresis can effectively reverse antibodymediated acute rejection within two weeks after transplantation.