Objective To modify and improve the technique of continent outlet and to find an optional method of simpler construction and easier catheterization. Methods 47 patients underwent continent cecal-ascending colon urinary reservoir were followed up,among whom 37 were detenial and 10 were detubularized. All reservoirs used incisive terminal ileum being overlapped and sutured again as efferent tube. The limb was fixed between the back surface of the rectus and the pouch wall. The internal orifice of the overlapped ileum was ileocecal valve reinforced with few sutures.Its external orifice was anastomosed to the umbilicus.Urodynamic studies of the pouch and efferent limb were carried out more than 6 months postoperatively. Results All the tubes were easily catheterized with 16 F catheter.45/47 patients were completely continent during the day and 44/47 patients completely continent at night. Urodynamic study of the efferent tubes showed that the maximum close pressure with the pouch full was significantly higher than with the pouch empty( P

Objective To analyze the clinical characteristics of single renal transplantation from infant kidney donation after death (DCD) and summarize the nursing measures for nursing the infants. Method The clinical data of 36 cases of single kidney transplantation from 18 infant donors from January 2014 to June 2016 in our centre were reviewed and summarize the nursing experience. Results Pulmonary infection occurred in 3 cases, incision infection occurred in 2 cases and graft vascular complication occurred in 2 cases. Urinary fistula occurred in 2 cases, ureteral obstruction occurred in 1 case, delayed graft function (DGF) occurred in 16. Postoperative follow-ups for 1 to 20 months showed all the grafted kidneys survived and 34 of them were well recovery in view of renal function of grafted kidney and the rest two had the grafted kidneys resected because of arterial and venous thrombus in them. Conclusions The renal transplantation from infant DCD is difficult. The nurses should handle postoperative care to the patients, paying attention to the complications. On the other hand, intra-and post-operative monitoring of blood pressure, control of input and output and early observation of complications and treatment is of value for the improvement of survival rate of grafted kidneys, reduction of complication incidence and propelled recovery of the patients.

[Objective]To develop an ideal method for extracting type I collagen from cortical bone and to prepare a collagen-gelatin scaffold.[Method]The cortical bone was disintegrated into bone matrix powder in a high speed mill and was subsequently dehydrated in alcohol,decalcificated in hydrochloric acid and defatted in chloroform:methanol(1:1,v/v).The osscins were extracted using improved pepsin digestion method after the bone matrix powder was dissolved,centrifuged,dialyzed and lyophilized.Type I collagen was then characterized by SDS-PAGE and amino-acid composition analysis.The biomaterial was made of type I collagen and gelatin using freeze-drying method,and the alignment regularities of microscopic channels and their course directions were observed under the scanning electronic microscope.The size of the micropores and the factor of porosity were also measured.[Result] The collagen extracted was confirmed to be type I collagen by SDS-PAGE and amino-acid composition analysis.All the scaffolds looked like circular cylinder,the microscopic channels were arranged in parallel manners,and the pore sizes of the channels were uniform.[Conclusion]Ossein extracted from cortical bone is a real type I collagen that can be applied in the construction of collagen products.

Objective To investigate the surgical managements and effects of congenital islated penile curvature. Methods The degloving of penile shaft,penile dorsal tunical plication,urethral division and urethroplasty were performed in 23 patients with this entity including 2 cases of type Ⅰ,11 cases of type Ⅱ,6 cases of type Ⅲ,4 cases of type Ⅳ,mean age 7 years (age 1 to 21 years). Results Of all 23 patients 17 cases of type Ⅱ and Ⅲ were succesfully repaired by degloving of penile shaft;1 case of type Ⅰ,by degloving of penile shaft and dorsal tunical plication;1 case of type Ⅰ and 2 cases of type Ⅳ,by degloving of penile shaft,dorsal tunical plication and urethral division;2 case of type Ⅰ and Ⅳ,by urethroplasty.One case was complicated with urethrocutaneous fistula after urethroplasty,which was succesfully repaired 8 month later;16 cases were followed up average 24 months (range 7 months to 57 months),15 cases showed complete straight penis beside one case with mild curvature less than 15 degree. Conclusions The abnormalities of skin,dartos and Buck's fasciae are main causes of congenital islated penile curvature.Penile degloving,dorsal plication are main surgical methods with minimal complications.

Objective To evaluate the myocardial protective effects of thoracic epidural anesthesia (TEA) with 0 5% ropivacaine during acute myocardial ischemia reperfusion Methods Eighteen healthy hybrid dogs were randomly divided into three groups: ropivacaine group (group Ⅰ), bupivacaine group (group Ⅱa) and normal saline group (group Ⅱb) Anesthesia was induced and maintained with intravenous anesthesia and ventilation was mechanically controlled Epidural catheter was placed at T 6 7 and 0 5% ropivacaine, 0 5% bupivacaine or normal saline 12ml was administered epidurally 15min after epidural administration of local anesthetics or normal saline, the anterior descending branch of left coronary artery was temporarilly occluded for 45min Blood samples were taken from right atrium and assayed for cardiac troponin T (cTnT) before epidural administration and 6h after reperfusion Myocardial tissues of left ventricular infarction area were examined by electron microscopy Results Plasma cTnT levels were comparable (P

Objectives:To observe the characteristics of rocuronium bromide in cirrhotic patients. Methods:Six healthy patients and six patients with hepatic cirrhosis undergoing intraabdominal operation were studied. Rocuronium 0.6 mg/kg was given to all of the patients,and the twitch high of adductor pollicis muscle was recorded using NMT mechanosensor (Datex Ohmeda). The time of onset, T 1 Maximum depression, the clinical duration of initial dose, the clinical duration of repeated maintenance doses and the spontanous recovery index were observed. Results:The time of onset was markedly prolonged in the cirrhotic compared with the healthy group( P

ObjectiveTo compare the clinical effectiveness and adverse effects following low doses versus traditional doses of amphotericin B liposome (L-AmB) in the treatment of patients with invasive pulmonary fungal infections (IPFI) after renal transplantation.MethodsA total of 26 postrenal transplantation patients with IPFI between Jan. 2005 and Mar. 2011in Zhujiang hospital received L-AmB treatment identified low doses group (0.2-0.5 mg·kg-1·d-1,n =19) or traditional doses group (1-5 mg· kg-1,d-1,n =7) were reviewed.ResultsThe treatment duration in low doses group and traditional doses group was 20.3 +12.7 and19.3 ±13.2 days respectively (P＞0.05).The effective rate in low doses group and traditional doses group was 84.2％ and 57.1％ respectively (P＞0.05).The overall dosage was significantly less in the low doses group (414.7 ± 241.7 mg) than in the traditional doses group (1158.8 ± 928.0 mg) (P＜0.05).The incidence of adverse effect was significantly lower in the low doses group than in the traditional doses group (21.1％ vs.85.7％,P＜0.05).ConclusionThe effectiveness of low doses of L-AmB protocol in the treatment of IPFI postrenal transplantation patients was similar to that of traditional doses of L-AmB protocol,but the incidence of adverse effects in low doses of L-AmB protocol was significantly lower.

BACKGROUND: Recent studies have suggested that conversion from cyclosporine A (CsA) to tacrolimus (FK 506)-based regimen can improve renal allograft function and survival rate. But little is known about whether the conversion from CsA to tacrolimus(FK 506) plus mycophenolate mofetil (MMF)-based regimen exhibits the same or similar clinical efficacy. OBJECTIVE: To investigate the clinical efficacy and safety of converting CsA to FK506 plus MMF in treatment of different types of chronic allograft nephropathy (CAN). DESIGN, TIME AND SETTING: An observational and controlled trial was performed at the Center for Organ Transplantation, Zhujiang Hospital, Southern Medical University from January 2005 to October 2007. PARTICIPANTS: Fifteen-nine enrolled patients received CsA-based regimen after renal allografting. Following pathological confirm and typing, all patients were assigned to two groups: CAN with chronic rejection (CR, n = 31) and CAN without chronic rejection (non-CR, n = 28). FK 56 was purchased from Fujisawa Pharmaceutical Company, Ltd., Japan. MMF was sourced from Shanghai Roche Pharmaceutical Co., Ltd., China. METHODS: When patients were diagnosed CAN, the CsA regimen was conversed to FK506 plus MMF regimen. FK506 initiated at a dose of 0.08 mg/kg per day and then was adjusted to achieve steady-state whole blood trough levels of approximately 5-8 μg/L. MMF was used at a fixed dosage, 1.0 g/d, twice a day, only if relative adverse events occurred. All patients were followed up at least 6 months. MAIN OUTCOME MEASURES: Serum creatinine(Scr), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), 24-h proteinuria, glomerular filtration rate (GFR), and complications. RESULTS: All initial 59 patients were included in the final analysis. At 6 months after regimen conversion, the levels of Scr, TC, TG, LDL, and 24-hour proteinuria were significantly reduced in non-CR, in particular CR, groups, compared with prior to conversion (P< 0.05). GFR was markedly increased in both the CR and non-CR groups (P< 0.05). In the CR group, 20 patients obtained improved results, 7 got stable results, and 4 showed ineffective results. The effective rate of regimen conversion was 64.5% and 32.1% in the CR and non-CR groups, respectively, and significant difference existed between the two groups (P < 0.05). Compared with prior to conversion, the incidence of hypertension and hyperlipemia was significantly decreased after regimen conversion (P< 0.05). There was no significant difference in diabetes mellitus, opportunistic infection, and malignancy between prior to and after regimen conversion. CONCLUSION: FK506 plus MMF-based regimen can markedly improve the function of renal graft of CAN, in particular CR, patients.

ObjectiveTo evaluate the effect of increasing doses of tamsulosin in lower urinary tract symptom (LUTS) of benign prostatic hyperplasia (BPH).MethodsA prospective self-controlled clinical trail was performed.Two hundred and sixty-one patients who had LUTS of BPH were enrolled in this prospective 4 weeks study of tamsulosin.The patients were randomly divided into 2 groups:took tamsulosin 0.2 mg QN (n =126,group A) and 0.4 mg QN (n =135,group B) respectively.The IPSS score and maximum flow rate before and after treatment were compared between the 2 groups.ResultsThe IPSS score of group A decreased from 17.72 ± 2.50 to 10.21± 1.95,average decreased 7.59 ± 2.74 ； maximum flow rate was elevated from (8.78 ± 3.70) ml/s to ( 12.74 ± 2.99 ) ml/s,average increased (4.31 ± 3.01 )ml/s.The IPSS score of group B decreased from 19.24 ± 3.22 to 11.21 ± 3.02,average decreased 8.49 ±3.73； maximum flow rate was elevated from (7.74 ± 1.97) ml/s to ( 12.04 ± 2.46) ml/s,average increased (4.73 ± 2.97) ml/s.There was no significant difference of the changes of IPSS score between the 2 groups ( P ＞ 0.05 ),but there was a significant difference of the changes of maximum flow rate between the 2 groups ( P ＜ 0.05 ).The results was further analyzed by sub grouped ( by patient body weight,divided into ≤55.0 kg,55.1 -65.0 kg,65.1 -75.0 kg,＞75.0 kg group).There were significant differences of the changes of IPSS score and maximum flow rate between the 2 groups in 65.1 - 75.0 kg and ＞ 75.0 kg subgroups ( P ＜ 0.05 ).The incidence of side effects between the 2 groups was not significantly different (P ＞ 0.05).ConclusionsFor most patients,the use of high-dose tamsulosin in improving LUTS caused by BPH can not bring significant benefits.But if the patient's weight is more than 65.0 kg,increasing the dose of tamsulosin is suggested for consideration.

Objective To investigate the effect of C4d deposition in peritubular capillary (PTC)in chronic allograft nephropathy (CAN) on prognosis and intervention of renal transplantation recipients. Methods All the cases who received the renal graft biopsy due to diagnosis of CAN from January 2000 to August 2008, and had the 2-year follow-up data were included in the study. The clinical data were analyzed according to the C4d deposition in PTC. Results Among 86 cases 39 cases were C4d positive (C4d+ group) and the remaining 47 cases were negative (C4d group). There was no significant difference in sex, age, donor source, transplant times, time after biopsy, the panel reactive antibodies (PRA) level between two groups (P＞0. 05). Before intervention, there was no significant difference in serum creatinine (Scr) and 24 h urinary protein between two groups (P＞0. 05). At the end of 2-year followed-up period, graft loss rate and urinary protein levels in C4d+group were significantly higher than in C4d- group (P＜0. 05). Before intervention, the incidence of blood lipid disorder and hypertension was higher in C4d- group (P ＜ 0. 05 ), but no significant difference was found in uric acid and blood sugar levels (P＞0. 05). At the end of 2-year followed-up period, there was no significant difference in blood glucose, uric acid, blood pressure and lipid profile (eliminating renal lost cases) between two groups (P＞0. 05). Conclusion The patients with CAN and C4d+ means the involvement of chronic humoral rejection and have poor clinical results. Effective intervention against humoral immune response can improve renal allograft survival.