BACKGROUND: Considerable debate exists which factors influence the outcomes of the vitrified frozen-thawed embryo transfer because lack of clinical applications.OBJECTIVE: To explore the factors influencing the outcomes of the vitrified frozen-thawed embryo transfer in assisted reproductive technology.METHODS: A retrospective statistical analysis was performed in Reproductive Medicine Center, Renmin Hospital of Wuhan University of 142 patients, 154 thawing cycles. The patients were grouped according to the age of patients, embryonic development, fertilization methods, endometrial preparation programs, the endometrial thickness, the process of transplantation and the survival cell ratio of embryo recovery, the implantation rate and clinical pregnancy rate were compared between various groups.RESULTS AND CONCLUSION: Among the groups of the different age, fertilization methods, endometrial preparation programs, endometrial thickness and the process of embryo transfer embryo implantation rate and clinical pregnancy rate were no significant difference (P > 0.05); between the two groups of the second day fertilized embryos (D2) and the third day (D3)fertilized embryos, the clinical pregnancy rate was not significant (P> 0.05), but the embryo implantation rate of D3 group was significantly higher than D2 group. The survival cell ratio of embryo recovery has a significant effect on implantation rate and clinical pregnancy rate (P < 0.05). Ln the frozen-thawed embryo transfer cycles, embryo quality plays a major role in pregnancy rate, and preparation for appropriate endometrial thickness can improve the clinical pregnancy rate.

BACKGROUND: Whether overweight and obesity have impact on the outcome of in vitro fertilization and embryo transfer (IVF-ET) treatment remains poorly understood.OBJECTIVE: To investigate the effect of women's body mass index (BMI) on the outcome of IVF-ET treatment. METHODS: A total of 184 cases were divided into 3 groups according to BMI: lankness group (BMI < 18.5 kg/m2), normal group (18.5kg/m2 ≤ BMI < 24 kg/m2), overweight and obesity group (BMI≥ 24 kg/m2). Treatments of ovulation induction and IVF-ET were regularly performed in the Reproductive Medical Center, Renmin Hospital of Wuhan University. The duration and dose of gonadotrophic hormone (GTH) treatment, estradiol level at the day of human chorionic gonadotropin (hCG) injection, and the differences of retrieved oocytes numbers, fertility rate, embryo quality, implantation rate, pregnancy rate and abortion rate were compared.RESULTS AND CONCLUSION: The dose of GTH used was in the overweight and obesity group was greater than that of the other groups (P< 0.05), and the dose was increased with BMI increasing. There was no significant difference in other aspects such as estradiol level, retrieved oocytes numbers, fertility rate, embryo quality, implantation rate, pregnancy rate and abortion rate at the day of hCG injection among the three groups (P> 0.05). All results demonstrated that overweight and obese patients require a higher hCG dose to achieve follicular maturation than normal weight patients. However, overweight and obesity does not affect negatively results of IVF-ET.

BACKGROUND: Pancreas-kidney transplantation is an effective treatment for diabetes combined with final stage renal disease. However, as the patients suffer diabetes for a long period of time, and cardiovascular system disease is complex, pre- and post-transplantation treatment is very important for successful pancreas-kidney transplantation.OBJECTIVE: To discuss immunosuppressant, coagulant, perioperative and postoperative treatment during pancreas-kidney transplantation to provide some clinical experience for pancreas-kidney transplantation.METHODS: Clinical data of 5 cases undergoing simultaneous pancreas-kidney transplantation in Department of Urinary Surgery, the 309 Hospital of Chinese PLA General Hospital between 2003 and 2008 were retrospectively analyzed to summarize the application of immunosuppressants and anticoagulant drugs and perioperative clinical monitoring focus. RESULTS AND CONCLUSION: There were 5 male patients with an average age of 43 years, and suffered type I diabetes mellitus complicated with final stage renal disease. The preoperative insulin dosage was 1.5-2.4 U/(kg·d). One case had diabetic retinopathy and fundus oculi hemorrhage for many times; two cases showed apparent coronary atherosclerotic heart disease with preoperative cardiac ejection fraction of 52% and 50%. Exocrine of transplanted pancreas had been considered by the intestinal fluid drainage. A total of 3 cases were complete rehabilitation. Of them, 1 case developed acute rejection in the first seven days after operation, but renal function restored with the hormones impact; 1 case had postoperative acute rejection of transplanted duodenum as well as intestinal fistula, eventually, transplanted pancreas was ectomized, but transplanted kidney was preserved; two cases succeeded in restoring and no complications occurred; 1 had postoperative gastrointestinal bleeding and died from multiple organ failure. Simultaneous pancreas-kidney transplantation is the most effective way to treat the diabetes mellitus with terminal nephropathy. Because of complications in the transplanted exocrine pancreas with bladder drainage, it has been replaced by the enteric drainage. Recovery of the transplanted kidney function is important for successful transplantation. After operation, oral FK should be taken when the serum creatinine returned to 300 umol/L. The application of clotting drug is one of the important factors for recovery of transplanted pancreatic function. Jejunostomy is an important therapeutic measure to prevent the reflux of intestinal juice to the transplanted pancreas in perioperative period. In the follow-up period cathartic drugs are recommended to prevent constipation and reduce the occurrence of acute pancreatitis caused by intestinal fluid reflux.

BACKGROUND: Graft selection and histological fate for anterior cruciate ligament reconstruction is a hot topic in the fields of reconstruction and repair of anterior cruciate ligament.OBJECTIVE: To review structure of anterior cruciate ligament and graft selection.METHODS: Articles were retrieved from Medline database with the key words of "Anterior cruciate ligament, implant,reconstruction" between January 1980 and January 2010. inclusion criteria: ① Reconstructive surgery of anterior cruciate ligament injury; ② graft selection of anterior cruciate ligament. Exclusion criteria: ① the old literatures; ② repetitive studies. A total of articles related to reconstruction of anterior cruciate ligament were retrieved, but 33 ones were included in the final analysis. The old, duplicated, and similar studies were excluded.RESULTS AND CONCLUSION: At present, the major therapy for anterior cruciate ligament injury includes arthroscopy and arthroscopy-assisted reconstruction. For clincal application, there are a lot of grafts, including autogenous grafts, allografts,heterologous allograft, biological materials, artificial materials and tissue engineering grafts. Autogenous semitendinosus tendon and gracilis tendon or autogenous bone-patellar tendon (middle 1/3)-bone (BPTB) are mainly used for anterior cruciate ligament reconstruction at home and abroad.

BACKGROUND: Ischemic preconditioning (IPC) can induce endogenous protection mechanism, which effectively prevent ischemia/reperfusion injury following organ transplantation. Cold and warm ischemia may induce ischemia/reperfusion injury of pancreas transplantation, and apoptosis of pancreatic acinar cells is one of the important reasons of pancreas graft functional defect after transplantation. Mitochondrial DNA has repair system, and its balance with mitochondrial DNA injury influences disease occurrence and outcome.OBJECTIVE: To observe the effect of IPC on apoptosis of transplanted pancreatic acinar cells, and the possible role of reactive oxygen (ROS) and mitochondrial DNA repair enzyme.METHODS: A total of 50 health, male, Sprague-Dawley rats were randomly divided into three groups: sham operated (n = 10), donors (n = 20) and recipients (n = 20). The recipients were randomly divided into ischemia/reperfusion group (IR, n = 10) and IPC group (n = 10). The sham operated group was subjected to abdominal open and close operation. IR group and IPC group received establishment of diabetic model by streptozotocin injection. IR rats received whole pancreatic-duodenal transplantation alone. IPC rats received whole pancreatic-duodenal transplantation exposed ischemic preconditioning with 5 minutes ischemia and 5 minutes reperfusion twice. All grafts were keep with warm ischemia time 15 minutes and cold ischemia (in 4 ℃ UW preservation solution) time 180 minutes. Twelve hours after reperfusion, serum amylase, blood glucose, Caspase-3, -9 activity were detected. Pancreatic acinar cell apoptosis was measured by flow cytometry. Mitochondrial cross-membrane potential (Δψ) was measured by monitoring the fluorescence spectrum of rhodamine 123. Mitochondrial H2O2 generation was determined using dichlorofluorescein as a probe. 8-oxodG in mitochondrial DNA (mtDNA) was measured with HPLC system. Release of cytochrome C, phosphorylation of Akt and mitochondrial OGG1 protein expression were determined by Western-blotting. RESULTS AND CONCLUSION: The ischemia preconditioning can relieve the pancreatic acinar cell apoptosis in pancreas graft and relieve IR injury by decreasing mitochondrial oxidative stress, mtDNA injury, and increasing phosphorylation of Akt and mitochondrial OGG1 expression.

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.

BACKGROUND: Urological complication is one of common surgical complications following transplantation and severely threatens renal function, even patient's lives. Urological complications following renal transplantation mainly contain urinary fistula,ureteral obstruction and ureter backflow.OBJECTIVE: To retrospectively analyze the incidence and management of urological complications following kidney transplantation.METHODS: A total of 1 223 patient times following kidney transplants were selected at the Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University of Chinese PLA from December 1993 to April 2007.According to ureter of donor kidney and the urinary tract of recipients, ureteroneocystostomy was used for urinary tract reconstitution in 948 patient times, and end-to-end ureteroureterostomy in 275 patient times. Urological complications such as urinary fistula, ureteral obstruction and vesicoureteral reflux (VUR) were treated by the different methods on the basis of the different causes, mainly by surgical procedures. Reason of urological complications, surgical management of urologicalcomplications and its clinical outcome, the 3-year survival rate of grafted kidney were measured.RESULTS AND CONCLUSION: In a total of 1 223 patients, urological complications were encountered in 92 cases (7.5%), including 43 cases of urinary fistula (3.5%), 35 ureteral obstruction (2.9%), 14 VUR (1.1%). 35 cases of urinary fistula, 29 ureteral obstruction, 6 VUR were cured by surgical procedures including ureteroureterostomy in 35 patients (50%), revision of ureteroneocystostomy in 18 (25.7%), endourology in 11 (15.7%) and other operation in 6 (9.6%). All recipients with urological complications regained normal graft function except one undoing transplanted nephrectomy due to the pelvis and urteral necrosis. There was no grafted kidney and recipient loss secondary to these complications in the present series. The 3-year survival rate of graft with urological complications and without urological complications did not show significant difference (P > 0.05). These indicated that most of urological complications following kidney transplantation request surgical management, and ureteroureterostomy are frequently used. The long-term graft survival is not affected by a correctly treated urological complication.

BACKGROUND: The renal transplanted recipients were in poor immunosuppressive state. Compared to common person, the bladder transitional carcinoma in recipients was aggressive and easy to recurrence. Looking for a more effective therapy method to decrease the recurrence of recipients' bladder transitional carcinoma is the hot and difficult problem in clinical study.OBJECTIVE: To analyze the efficacy and safety of submucosal injection epirubicin following transurethral resection of bladder tumor (TUR-Bt) to treat the recurrence of bladder transitional cell carcinoma in renal transplantation recipients.METHODS: Totally 9 renal transplantation recipients with transitional cell carcinoma of bladder were retrospectively studied. The patients' periods without cancer, the frequency of recurrence within one year, the rates of side effect, the changes of tumor grading following recurrence and allograff function were recorded when the routine method and submucosal injection epirubicin following TUR-Bt were used in different period respectively.RESULTS AND CONCLUSION: Submucosal injection epirubicin following transurethral resection of bladder tumor was safe and effective to treat bladder transitional cell carcinoma recurrence in renal transplantation recipients. Compared to the routine perfusion, periods without cancer and the frequency of recurrence within 1 year were significantly decreased, which can elevate recipients life quality and long-term survival rates.

BACKGROUND: The number of living renal donation has increased in China and abroad, thus, it is important to guarantee the safety of donors. How to accurately diagnose potential renal disease and provide guidance plays an import role in protecting safety of living renal donors.OBJECTIVE: To establish an evaluation method for analyzing the correlation between histological abnormalities and clinical predonation parameters.METHODS: The related data on renal transplantation of Fuzhou general Hospital of Nanjing Military Area Command of Chinese PLA were retrospectively reviewed. Paracentesis were performed when the vessels of kidney were mutilated and perfusions were finished. Time-zero renal biopsy was evaluated for following pathological changes: interstitial fibrosis, tubularatrophy, arteriolar hyalinosis, mesangial proliferation, and glomerulosclerosis. Predonation data were demography, body weight, body mass index' systolic/diastolic blood pressure, serum creatinine, glomerular filtration rate, and proteinuria.RESULTS AND CONCLUSION: There were no signs of kidney disease in preoperative examination of all the 62 patients, time-zero renal biopsy found there were 28 donors with histological changes, interstitial fibrosis with age and serum creatinine, tubularatrophy with diastolic blood pressure and protein excretion rate, arteriolar hyalinosis with serum creatinine and glomerular filtration rate, mesangial proliferation only with body mass index, and finally the presence of glomerulosclerosis did not correlate with any variable.

BACKGROUND: Microwave had been widely used in medical field, which can lead to local coagulation necrosis and repair the necrosis with fibrous tissue. However, whether microwave coagulation can be used in stomatology is poorly understood.OBJECTIVE: To observe the functional and volumetric changes of skeletal muscles following microwave coagulation, and to explore the possibility of microwave coagulation for volumetric reduction of skeletal muscle.METHODS: Both sides of tibialis anterior muscle of 20 New Zealand rabbits were exposed; one side was coagulated by 2 450 MHz microwave therapeutic instrument at 70 W for 20 seconds. No treatment was performed at the other side. Rabbits were sacrificed at hours 24, 48, weeks 1 and 8 after microwave coagulation. The volumetric changes of the ablated tibialis anterior muscle were measured, and electricitic physiology observations were conducted on the ablated muscle at 8 weeks after microwave coagulation before being sacrificed.RESULTS AND CONCLUSION: The volume of ablated muscle increased at hours 24 and 48, which was (5.82±0.93) and (6.04±0.47) mL, especially greater at hour 48 after microwave coagulation. After 1 week, the muscle volume began to decrease to (4.90±0.80) mL, reduced to (4.27±0.67) mL at week 8, which was 23.6% volumetric loss. However, the electrophysiologic observation showed that the latent periods were (1.765+0.393) and (1.760±0.394) ms, and the wave width was (6.273±0.808)and (6.259±0.773) ms of the control group and experimental group, respectively, without apparent differences (P ＞ 0.05). The volume of the skeleton muscle increased at hour 48 after microwave coagulation, and then decreased, but the muscle function of the skeleton muscle can be preserved.