Objective To investigate the management and prevention of the complications of sigmoid rectal pouch for urinary division after radical cystectomy. Methods The clinical data of 34 patients who underwent a sigmoid rectal pouch procedure were analyzed retrospectively, and the clinical experience was summarized in the management and prevention of the complications of sigmoid rectal pouch for diversion. Results Twenty-six patients were followed up for 2 months to 11 years, and 10 patients lost in follow-up. The early follow-up results were as follows:3 patients had postoperative high fever with unilateral the kidney water, 1 patient had retropubic bleeding and need to stop bleeding, 3 patients suffered from wound split open and were performed relaxation suture, and 1 patient had sigmoid colon rectum bladder fistula 10d after operation. The late follow-up results were as follows:1 patient had urethral neoplasms recurrence, 5 patients developed distance metastases, and 5 patients developed nocturnal incontinence and worn safety pad. There were no hyperchloremic acidosis requiring clinical treatment, hydronephrosis as well as retrograde pelvis infection. Conclusions The operation of sigmoid rectal pouch for urinary division is fairly simple, with no serious complication. It is a better alternative diversion procedure, and should be accepted gradually by patients and surgeons.

Objective To measure the pressure-volume changes and uroflow rate,and assess the function of upper urinary tract in sigmoidorcctal pouch patients.Methods Between 2007 and 2011,a to-tal of 10 patients who had a radical cystectomy because of muscle-invasive bladder tumor underwent a Mainz pouch Ⅱ procedure were evaluated.The ureters were implanted into the post walls of the detubularized sigmoid segment at least 30 cm in length.In all cases,sigmoidoscopy was done and the anal pressure was measured preoperatively,and video urodynamic study of sigmoidorectal pouch as well as the intravenous pyelography was conducted after 3 to 6 months postoperatively.Results Video urodynamic study of sigmoidorectal pouch revealed that no reflux up to an average volume of 360 ml (270-532 ml) of the descending colon.The sigmoidal colon pressure was 26 cm H2O during the 3 to 6 months post-operative follow-up.The anal sphincter pressure was 90 cm H2O on average preoperatively and did not change postoperatively.The renal function and upper urinary tract were preserved well.The Qmax was 30 ml/s and the average uroflow rate was 8 ml/s under abdominal strain.All the patients suffered slight incontinence in the first two months and became continent since the 3 month postoperatively with nocturnal voiding one to four times.Conclusions The sigmoidorectal pouch provides a reservoir with a higher capacity,lower pressure without reflux to the upper urinary tract and descending colon and lower metabolic acidosis problem.It is also a good alternative diversion procedure that would preserve upper urinary tract and good quality of life.

OBJECTIVE To establish the estimation model for the exposure of mycophenolic acid （MPA） in early renal transplant recipients [calculated by the area under the plasma concentration-time curve with 12 h （AUC0－12 h）]. METHODS Twenty kidney transplant recipients， who received triple immunosuppressive therapy of mycophenolate mofetil （MMF）+tacrolimus+ methylprednisolone， were selected and given MMF dispersible tablets （750 mg， q12 h） on the 15th day after the operation； the blood samples were collected from the patients before and 0.5， 1.0， 1.5， 2.0， 3.0， 4.0， 6.0， 8.0， 12.0 hours after the administration， respectively. The blood concentration of MPA was determined， and the pharmacokinetic parameters of MPA were calculated. The multivariate linear stepwise regression analysis method was used to fit an estimation formula for the finite sampling method suitable for MPA-AUC0－12 h of the recipients. Bland-Altman analysis was used to evaluate the agreement between the estimation formula and the classical pharmacokinetic method. RESULTS The main pharmacokinetic parameters of MPA in 20 renal transplant recipients： c0 was （1.53±0.84） μg/mL， cmax was （12.07±5.97） μg/mL， t1/2 was （5.41±3.67） h， tmax was （1.58±0.75） h， and the average AUC0－12 h calculated by the classical pharmacokinetic method was （33.95±13.40） μg·h/mL. MPA-AUC0－12 h was estimated with sampling points of “4.0， 8.0， 12.0 h”； the simplified calculation formula was AUC0－12 h＝12.058+2.819c4.0+7.045c8.0+ 3.879c12.0 （R 2＝0.934）. The predicted value had a good correlation and consistency with the measured value， and 95.0% of predicted values did not exceed the x±1.96SD （standard deviation） range. CONCLUSIONS The estimation model is established successfully for the exposure of MPA in early renal transplant recipients； the model has better prediction accuracy and fewer sampling points.

OBJECTIVE To explore and establish an analysis method for sulfamethoxazole blood concentration in patients with heart transplantation to guide clinical rational drug use. METHODS A new two-dimensional liquid chromatograph (2D-LC-UV) based on column switching technology was used. The on-line solid-phase extraction of sulfamethoxazole in serum was performed using a one-dimensional column Aston SC2(3.5 mm×25 mm, 5 μm), then it was intercepted and retained through the middle column Aston SBR(3.5 mm×10 mm, 5 μm), and the target analytes were completely separated and detected by transfer to the second-dimension column Aston SNX4(4.6 mm×130 mm, 5 μm). The chromatographic conditions were obtained by optimization. The one-dimensional mobile phase was acetonitrile-methanol-H2O(10:10:70), the flow rate was 0.8 mL·min-1; the two-dimensional mobile phase ratio was BPI-1 basic mobile phase-API-3 acidic mobile phase-methanol(20:40:40) the flow rate was 1.2 mL·min-1. The UV detection wavelength was 240 nm. RESULTS The correlation coefficient between the concentration of sulfamethoxazole and peak area was in the range of 9.96‒200.04 μg·mL-1 with R2=0.999 6, it showed a good linear relationship. The intra-day and inter-day precisions(RSD) at low, medium and high concentrations were <15%, and the relative recoveries were between 85%‒115%. The blood concentration of 56 patients in the hospital was measured, and only 30 patients(53.57%) had the blood sample sulfamethoxazole concentration of 100‒150 μg·mL-1, and the rest were not comfortable about the concentration treatment window; there were 0 cases of grade III-IV adverse reactions in the urinary system/blood system/liver, etc. CONCLUSION This method has a simple pre-treatment, high automation, can be sampled in large volumes, and has high accuracy and sensitivity. It can meet the requirements of clinical applications. The research results can provide a methodological reference for clinical therapeutic drug monitoring..