Objective: To evaluate the efficacy and safety of a long-term adding metformin to a basic treatment strategy in systemic lupus erythematosus (SLE), and analyze whether the beneficial effects of metformin add-on treatment during the open-label proof-of-concept trial persisted during a posttrial follow-up (the metabolic memory effect), as there is a paucity of systematically collected data concerning long-term metformin use in SLE. Methods: Subjects who had participated in the open-label proof-of-concept trial and gave informed consent to this study were enrolled, and the disease flares and long-term adverse effects between metformin group and control group were compared. In addition, whether the benefit regarding decreased disease flare persisted after metformin withdrawal during the post-trial follow-up was investigated. Results: Twenty-nine subjects in the former metformin add-on strategy group and 28 subjects in the former control group were enrolled. No adverse reactions of metformin occurred during the study. The risk of disease flare in the control group was higher than that in the continuous metformin group, but the difference was not statistically significant (P=0.326). After metformin withdrawal, the risk of disease flare in the metformin group gradually increased to the control group (P=0.998). There was no significant difference between the two continuous metformin use groups whose metformin using duration are 2.56 years and 5.00 years respectively (P=0.802). Conclusion: A long-term metformin add-on treatment is security, and can keep SLE patients in a lower risk of disease flare. The metabolic regulation of metformin in SLE immune disorder may present a time-dependent metabolic memory effect.

Objective: To explore the association of fat content with left ventricular hypertrophy (LVH) in peritoneal dialysis (PD) patients. Methods: Eligible PD patients in Renji Hospital, Shanghai Jiao Tong University School of Medicine from November 2016 to June 2017 were recruited. Demographic data of patients were collected and biochemical indicators were measured. Fat content was measured by bioelectrical impedance analysis, and LVH was accessed using echocardiography. The prevalence of LVH in PD patients was compared between groups with different fat contents. Logistic regression was used to analyze the associated risk factors of LVH. Results: A total of 163 PD patients with a mean age of 55.85±13.20 years and a median PD duration of 46.0 (20.0, 73.0) months were enrolled. Of them, 98 patients (60.1%) were male, 34 patients (20.9%) had diabetes mellitus, 19 patients (11.7%) combined with cardiovascular disease and 122 patients (74.8%) were hypertensive. There were 51 patients (31.3%) with LVH, including 31 patients (37.8%) in high fat tissue index (FTI) group (n=82) and 20 patients (24.7%) in low FTI group (n=81). Logistic regression analysis indicated that FTI (OR=1.133, 95% CI 1.003-1.280, P=0.044), overhydration (OR=1.651, 95% CI 1.257-2.169, P=0.000) and hemoglobin (OR=0.972, 95% CI 0.948-0.997, P=0.028) were independently associated with LVH in PD patients. Conclusion: LVH is common in PD patients, especially in high fat content patients. Higher fat content, higher overhydration and lower levels of hemoglobin are risk factors for LVH in PD patients.

Objective    To report a simple and safe method for in situ fenestration of left subclavian artery in thoracic endovascular aortic repair (TEVAR). Methods    Twenty-eight patients received in situ fenestration of left subclavian artery in TEVAR from June 2018 to May 2019 in our center, including 23 males and 5 females at an average age of 57.7±9.6 years. Among them, 12 patients used adjustable sheath or guiding catheter (a group A) and 16 patients used "J. D" technique (a group B). The clinical efficacy of the two groups was compared. Results    In the group A, 1 patient failed to receive fenestration and was transferred to the chimney technique. In the group B, 1 patient due to the traction system shift during operation, was completed by traditional adjustable sheath puncture. The group B had shorter alignment-perforation time and trigger time and less complications. There was no significant difference in endoleak during short-term follow-up between the two groups. Conclusion    The "J. D" technique is simple, safe and easy to obtain materials. It effectively reduces the risk caused by difficult sheath alignment during the in situ fenestration of the left subclavian artery. Although the results of recent follow-up are not significantly different from traditional methods, it still needs to accumulate the cases to observe the possible risks and difficulties.

Adolescent ; Child ; Child, Preschool ; Humans ; Hypospadias/surgery* ; Male ; Mouth Mucosa/transplantation* ; Plastic Surgery Procedures/methods* ; Reoperation/methods* ; Urethra/surgery* ; Young Adult

【Objective】 To explore the timing of surgical drainage for ureteral calculi with upper urinary tract infection. 【Methods】 Clinical data of 117 cases of ureteral calculi with upper urinary tract infection treated in our hospital during Jan.2018 and Jan.2020 were retrospectively analyzed. According to different treatment methods, the patients were divided into surgical drainage group and non-surgical drainage group. The patients’ age, gender, side of calculi, peak body temperature, time of onset, white blood cell (WBC) count, C-reactive protein (CRP) and other clinical indicators were compared between the two groups. The cutoff value of surgical drainage was determined with receiver operator characteristic (ROC) curve. 【Results】 The patients’ age, peak body temperature, WBC count and CRP level were the influencing factors of surgical drainage (P<0.05). Regression analysis showed that CRP (P<0.001), age (P=0.003) and WBC count (P=0.014) were independent risk factors for surgical drainage. The area under the ROC curve (AUC) of CRP, age, and WBC count were 0.923, 0.601, and 0.796, respectively. The cutoff value of CRP was 29.87 mg/L (sensitivity 79.4%, specificity 90.0%). Logistic regression model showed CRP was a significant clinical predictor. 【Conclusion】 Ureteral calculi with upper urinary tract infection need to be diagnosed and treated in time. Positive anti-infection should be performed during emergency treatment, and surgical drainage could be selected according to the value of CRP.

OBJECTIVETo explore the clinicopathological features, treatment and prognosis of renal mucinous tubular and spindle cell carcinoma (MTSCC).

METHODSThe clinicopathological data of eleven patients of pathologically confirmed renal MTSCC were reviewed retrospectively. Among the 11 patients, there were 4 males and 7 females with a mean age of 51.6 years (range, 24 to 81 years). Two patients presented with hematuria, one presented with lumbago and others were asymptomatic.

RESULTSThe renal MTSCC was of hypovascular tumor in enhanced CT scan. Seven cases were treated with radical nephrectomy, and the other four with partial nephrectomy. The mean diameter of tumors was 4.4 cm. The TNM stages were as follows: pT1aN0M0 in 6, pT1bN0M0 in 3, pT2N0M0 in 2 cases. Histological examination of the tumors showed that they consisted of spindle cells arranged in tubular and trabecular patterns embedded in a myxoid stroma. No recurrence or metastasis was observed during the follow-up (median 41 months).

CONCLUSIONSMTSCC is a rare low-grade renal epithelial carcinoma with a relatively good prognosis. Preoperative CT scan is partly helpful for diagnosis and guiding decision making. Nephron-sparing surgery is recommended in most cases, especially in patients with small tumors.

Adenocarcinoma, Mucinous ; Carcinoma ; Carcinoma, Renal Cell ; diagnosis ; Female ; Humans ; Kidney ; Kidney Neoplasms ; diagnosis ; Male ; Neoplasm Recurrence, Local ; Nephrectomy ; Prognosis ; Retrospective Studies ; Tomography, X-Ray Computed

BACKGROUNDThe induction of immune tolerance and suppression of allograft rejection has become the focus in the study of liver transplantation. The effect of immune therapy with anti-CD40L mAb alone or in combination with cyclosporine A (CsA) on the recipient survival and Th1/Th2 cytokine profile was studied to elucidate its immunological mechanism and role in rat orthotopic liver transplantation.

METHODSThe model of rat orthotopic liver transplantation was established by modified Kamada's technique. Recipients were divided into group A (control group): SD-->SD; group B (group of rejection): SD-->Wistar without any treatment; group C: SD-->Wistar with CsA monotherapy from day 1 to day 5; and group D: SD-->Wistar with CsA from day 1 to day 5 and anti-CD40L mAb on day 0 and day 2. The survival of the recipients in all groups was observed and ELISA technique was used to detect the level of cytokines in peripheral blood on post-transplant day 7.

RESULTSThe survival period of recipients in groups A (> 60 days) and D (> 60 days) was significantly longer than that in group B (13.8 +/- 2.4 days). The serum levels of interleukin 2 (IL-2) and interferon gamma in group B were significantly higher than those in other groups; the level of tumor necrosis factor alpha was higher but not statistically significant. In contrast, the serum levels of IL-4 and IL-10 in group D were elevated more significantly than those in group B (P < 0.05).

CONCLUSIONSCombined immune therapy can prolong the survival of allografts. Increased expression of Th2 cytokines, which is closely related to the induction of tolerance and suppression of rejection, is beneficial to the long-term survival of recipients and allografts.

Animals ; Antibodies, Monoclonal ; therapeutic use ; CD40 Ligand ; antagonists & inhibitors ; Cyclosporine ; therapeutic use ; Cytokines ; blood ; Enzyme-Linked Immunosorbent Assay ; Graft Survival ; Immunosuppressive Agents ; therapeutic use ; Liver Transplantation ; Male ; Rats ; Rats, Sprague-Dawley ; Th1 Cells ; immunology ; Th2 Cells ; immunology

This study was aimed to develop the personalized finite element model (FEM) of spine of a scoliotic adolescent. We derived the data of spine of a scoliotic adolescent using spiral computed tomography. Then by using a series of computer aided design (CAD) software, the patient-specific 3D finite element model of spine of a scoliotic adolescent was developed. Results show the 3-D FEM of spine of AIS adolescent was established according to patient-specific geometric parameters. The model had an appearance similar an reality. We concluded that the way in this study is an exact and effective one to develop the FEM of spine of scoliotic adolescent. It is possible to analyze and research the biomechanical behavior of the scoliotic spine using the personalized FEM.
Adolescent ; Biomechanical Phenomena ; Finite Element Analysis ; Humans ; Image Processing, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; Male ; Models, Anatomic ; Scoliosis ; diagnostic imaging ; pathology ; Spine ; diagnostic imaging ; pathology ; Tomography, Spiral Computed

OBJECTIVETo investigate the role of single nucleotide polymorphisms of the gene of diacylglycerol kinase κ (DGKK) in hypospadias in Chinese children.

METHODSWe performed direct sequencing on 2 hypospadias-related candidate single nucleotide polymorphisms of the DGKK gene (rs1934179 and rs7063116, never previously reported in the Chinese population) from 300 children with sporadic hypospadias and 200 healthy controls, and compared the results between the two groups.

RESULTSThe mutation frequencies of rs1934179 and rs7063116 were 5.0% (15/300) and 5.67% (17/300) respectively in the hypospadias patients, significantly higher than 1.5% (3/200) and 2.0% (4/200) in the normal controls (P <0.05). The mutation frequencies of rs1934179 and rs7063116 in the cases of distal and middle hypospadias were also remarkably higher (6.5%, [13/200] and 7.5% [15/200], P <0.05), but those in the proximal cases (both 2.0% [2/100]) showed no statistically significant difference from the control (P >0.05).

CONCLUSIONThe polymorphisms of the DGKK gene may be associated with hypospadias, particularly distal and middle hypospadias, in Chinese children.

Asian Continental Ancestry Group ; Case-Control Studies ; Child ; China ; Diacylglycerol Kinase ; genetics ; Humans ; Hypospadias ; enzymology ; genetics ; Male ; Polymorphism, Single Nucleotide

Humans ; Liver Cirrhosis, Biliary ; Receptors, Cytoplasmic and Nuclear