Objective To evaluate the efficacy of preoperative aspects and dimensions used for an anatomical (PADUA) scores in determining the surgical approach for T1 stage renal masses.Methods From Jan 2010 to Dec 2012,clinical data of 122 cases (76 males and 46 females),who underwent surgery for T1 stage renal masses,were collected retrospectively.The mean age was 51 years(range 21-81) and mean body mass index was (22.8±3.9) kg/m2.Sixty-three tumors were found in left kidney and 59 in right kidney.Among them,78 patients were diagnosed as T1a stage and 44 patients were T1b stage.In patients with T1a stage,56 received nephron sparing surgery (NSS) and 22 received radical nephrectomy (RN).In patients with T1b stage,21 received NSS and 23 received RN.The PADUA nephrometry score was analyzed to evaluate their relationships to surgical type and the approach of NSS.Results According to the PADUA nephrometry score,the number of low risk,middle risk and high risk patients were 24,62,26,respectively.Inlow risk group,middle risk group and high risk group,the proportion of RN and NSS was 8.3％/ 91.7％,30.6％/69.4％,66.7％/33.3％.In 77 patients received NSS,the unmber of laparoscopic NSS and open NSS was 18 ∶ 4,25 ∶ 18,2 ∶ 10,respectively.The PADUA nephrometry score was significantly associated with the type of surgery (x2 =23.16,P＜0.01),and the NSS approach (x2 =13.57,P＜0.01).Tumor size (HR =2.79 ; 95％ CI,1.29-6.02 ; P＜ 0.01),percentage of tumor deepening into the kidney (HR =3.82; 95％CI,1.77-8.09; P＜0.01),longitudinal (HR=4.00;95％CI,1.83-8.72; P＜0.01),tumor relationships with renal sinus(HR=103.13; 95％CI,21.85-486.81 ; P＜0.01),tumor relationships with urinary collecting system (HR =15.11 ; 95％ CI,5.95-38.35 ; P＜ 0.01),rim tumor location (HR =3.50 ; 95％ CI,1.61-7.59; P＜0.01) were closely related with surgery approach.The correlation coefficients of relationship with renal sinus was highest (r=0.70).Conclusions The PADUA nephrometry score provides a simple,useful and stable system to character the salient renal anatomy and guide the surgery.Low risk group should consider the NSS as the first line therapy.NSS could also be chosen in the middle risk group.However,the renal anatomy in those patients should be referred.RN should be chosen in high risk group.

To explore the status of cancer pain management among hospitalized elderly patients.Pain intensity,use of analgesic drugs and incidence of adverse reactions were surveyed for 620 cancer pain patients.And 218 of them were aged over 65 years.The proportions of mild,moderate and severe pain were 29.8％,36.2％ and 34.0％ respectively.And the corresponding rates in young and middle-aged patients were 28.4％,34.8％ and 36.8％ respectively (P ＞ 0.05).In elders with cancer pain,28％ used no analgesic.For severe pain patients,only 71.6％ received potent opioids and 5.4％ nonsteroidal antiinflammatory drugs.And the corresponding rates in young and middle-aged patients were 26.1％,73.0％ and 4.7％ respectively (P ＞ 0.05).The rates of constipation,dysuria and delirium in elderly patient group were higher than young and middle-aged patient group (P ＜ 0.05).Pain management is unsatisfactory and rational uses of analgesic drugs should be strengthened for preventing the relevant adverse reactions.

Objective To analyze the clinical characteristics of urinary tract infection after kidney transplantation and to analyze the distribution of pathogenic virulence factors.Methods From January 2014 to June 2016,a total of 255 cases were subjected to DCD renal transplantation in our center,and 45 cases of urinary tract infection occurred after operation.Among them,urinary tract E.coli infection occurred in 32 cases.The virulence factors gene aer,hly,irp2 and iucD in the 32 strains of E.coli isolated from urine were tested using PCR and multiple PCR.Results Thirty-two cases (71.1％) of urinary tract infection after renal transplantation was caused by E.coli,and divided into 9 cases of nosocomial infection group,and 23 cases of community-acquired group.The positive rate for aer,hly,irp2 and iucD in Nosocomial infection group was 66.7％,33.3％,88.9％ and 77.8％,and that in community-acquired group was 30.4％,8.70％,39.1％ and 34.7％,respectively.There were statistically significant differences among four kinds of virulence factors between two groups (P＜0.05).The positive rate of virulence factors was significantly higher in nosocomial infection group than in community-acquired groups.The total resistance rate was 84.38％,and there was significarit difference in multi-drug resistance rate between two groups (P＜0.01).Conclusion E.coli is the main pathogenic bacteria of urinary tract infection after renal transplantation,especially nosocomial infections.The detection rate of virulence factor is high,and the multiple drug resistance is outstanding,so the attention should be paid clinically.

Objective To explore the major risk factors of post transplantation diabetes mellitus (PTDM) and analyze the correlation between tacrolimus and PTDM after kidney transplantation. Methods Clinical data of 123 kidney transplant recipients were collected. All recipients were divided into the PTDM group (n=19) and non-PTDM group (n=104). Clinical data of all recipients in two groups were analyzed. The risk factors of PTDM were analyzed by binary logistic regression. Twenty-four mice were evenly divided into the control group (normal saline), low-dose tacrolimus (0.1 mg/kg), medium-dose tacrolimus (0.75 mg/kg) and high-dose tacrolimus groups (1.5 mg/kg). The solutions were given twice a day. The effect of tacrolimus on blood glucose metabolism in mice was evaluated. Results The incidence of PTDM was 15.4% (19/123) within 1 year after kidney transplantation. Age≥48 years old and the trough concentration of tacrolimus≥9 ng/mL within 3 months after kidney transplantation were the risk factors for PTDM after kidney transplantation (both P < 0.05). The fasting blood glucose levels of mice after administration in the low-, medium- and high-dose tacrolimus groups were significantly lower than those before administration (all P < 0.05) in a dose-independent manner (P=0.750). In the low-, medium- and high-dose tacrolimus groups, the postprandial blood glucose levels of mice after administration were significantly higher than those before administration (all P < 0.05) in a dose-dependent manner (P=0.012). Conclusions Tacrolimus is intimately correlated with the incidence of PTDM after kidney transplantation. Age≥48 years old and the trough concentration of tacrolimus ≥9 ng/mL within 3 months after kidney transplantation are the independent risk factors of PTDM. Tacrolimus affects the postprandial blood glucose levels of mice in a dose-dependent manner.

Objective:To characterize the longitudinal and dynamic high-density lipoprotein (HDL) trajectories in critically ill children and explore their correlation with clinical outcomes.Methods:Retrospective cohort study.All critically ill children admitted to the Pediatric Intensive Care Unit (PICU) of West China Hospital, Sichuan University from January 1, 2015 to October 1, 2020 were included in this retrospective study.Group-based trajectory modeling (GBTM) was applied to characterize the HDL trajectories in days 0-6 post-PICU admission and develop HDL trajectory groups.The in-hospital mortality rate was reported as frequency (%) and then compared by the Chi-square test or Fisher′s exact test between HDL trajectory groups.The length of stay (LOS) in the PICU was described by M( Q1, Q3), and its difference between HDL trajectory groups was evaluated by the Kruskal Wallis test.Logistic regression and multiple linear regression were used to determine the correlation between HDL trajectories and clinical outcomes.The primary outcome was in-hospital mortality rate, and the secondary outcome was LOS in the PICU. Results:A total of 4 384 critically ill children were ultimately enrolled in the study, and 6 HDL trajectory groups were developed based on GBTM analyses: group 1 (758 cases), the lowest HDL group; group 2 (1 413 cases), the low HDL group; group 3 (74 cases), the low-to-high HDL group; group 4 (621 cases), the medium HDL group; group 5 (1 371 cases), the high HDL group; and group 6 (147 cases), the highest HDL group.Logistic regression analysis showed that compared with critically ill children in group 1, those belonging to groups 2, 3, 4, 5, and 6 were at lower risks of in-hospital mortality with odds ratio ( OR): 0.475, 95%confidence interval ( CI): 0.352-0.641, P<0.001; OR: 0.093, 95% CI: 0.013-0.679, P=0.019; OR: 0.322, 95% CI: 0.208-0.479, P<0.001; OR: 0.263, 95% CI: 0.185-0.374, P<0.001, and OR: 0.142, 95% CI: 0.044-0.454, P=0.001, respectively.Multiple linear regression analysis revealed that compared with critically ill children in group 1, those belonging to groups 4, 5, and 6 had the trend of shorter LOS in PICU, and the β value and 95% CI were β: -4.332, 95% CI: -5.238- -3.426, P<0.001; β: -3.053, 95% CI: -3.809--2.297, P<0.001; β: -6.281, 95% CI: -7.842--4.721, P<0.001, respectively. Conclusions:The dynamic HDL trajectories during 0-6 days after PICU admission are associated with in-hospital mortality rate of critically ill children.The HDL trajectory at a persistently low level is associated with higher mortality, while the HDL trajectory at a persistently high level or with the trend from a low level rising to a high level shows a lower risk of mortality.It is suggested that the HDL trajectory model may become an indicator to predict the condition and prognosis of critically ill children.

Objective To study the culture results of renal graft cold storage solution and therapeutic strategies.Methods This study retrospectively studied the bacterial culture,drug sensitivity test and fungal culture results of donor kidney preservation fluid in 172 cases in our hospital from February 2016 to December 2017.The prevention and treatment strategies of our hospital,and relevant literatures retrieved were comprehensively analyzed.Results Positive culture results were found in 13.4％ (22/172) cases.Among them,17 cases were positive for bacteria,including 1 case positive for Stenotrophomonas maltophilia,2 for Enterococcus faecium,2 for Acinetobacter baumannii (1 case of extensive drug resistance),4 for Klebsiella pneumoniae (2 cases of extensive drug resistance),1 for Klebsiella oxytoca,3 for Escherichia coli (2 expressing extended-spectrum beta-lactamase),1 for Enterobacter cloacae,1 for Staphylococcus epidermidis,1 for both Enterococcus faecium and Klebsiella pneumoniae,1 for both Escherichia coli expressing extendedspectrum beta-lactamase and Klebsiella pneumoniae.Three cases were positive for fungi,including 2 for Canidia albicans and 1 for Candida krusei.Two cases were positive for both bacteria and fungi,including 1 for Candida tropical and Enterococcus faecium,1 for Candida glabrata and Klebsiella pneumoniae with extensive drug resistance.One recipient died of serious cardiac arrhythmia on the 32nd day after implantation with positive results of Stenotrophomonas maltophilia.One recipient positive for Candida tropicalis fecal faecium had graft nephrectomy because of rupture of renal artery at day 14 after implantation.The remaining 15 and all culture-negative cases had good graft outcome during 6 months of follow-up.Conclusion Culture of renal graft cold storage fluid as well as targeted prevention and treatment strategies based on positive results can effectively reduce the incidence of infectious vascular complications in recipients.

OBJECTIVETo evaluate the application value of R.E.N. A.L. nephrometry score for surgery type decisions of T1 stage renal tumor.

METHODSClinical data including image data, surgery type and prognosis etc were collected retrospectively for 122 cases from January 2010 to December 2012. There were 76 male and 46 female patients and they were 29-82 years (mean 51 years). The body mass index was (22.8 ± 3.9) kg/m(2). The patients were undergoing surgical excision with renal tumor of T1 stage. The R.E.N. A.L. nephrometry score was analyzed to evaluate their relationships to surgery type (RN or NSS) and the approach of NSS (ONSS or LNSS) using chi-square tests, Fisher's exact tests, and logistic regressions analysis.

RESULTSAll surgery had been completed. The surgery included RN of 45 patients, LNSS of 45 patients and ONSS of 32 patients. The R.E.N. A.L. nephrometry score was significantly associated with the type of surgery (χ(2) = 27.89, P < 0.05), and the NSS approach (χ(2) = 12.87, P < 0.05). When the scores less than 7 points, it is majorly treated by nephron sparing surgery (92.9%), and when the scores more than 9 points, it is majorly treated by radical nephrectomy (69.4%). Individual component scores were analyzed to evaluate that they were all related to surgery type (χ(2) = 7.00-14.57, P < 0.05), and the individual component N associated the surgery type mostly. Furthermore, individual component R,E,N and L were statistically significant predictors of the NSS approach (χ(2) = 4.92-15.07, P < 0.05).

CONCLUSIONThe R.E.N. A.L. nephrometry scoring system provides a simple, useful, and stable system to character the salient renal anatomy of T1 stage, and can provide the best surgery approach.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kidney ; pathology ; Kidney Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Nephrectomy ; Prognosis ; Retrospective Studies