Objective To evaluate the safety and efficacy of QUILLTM self-retaining suture (QUILLTMSRS) in laparoscopie partial nephrectomy.Methods Sixty-three patients (39 males,24 females) with renal tumor accepted laparoscopic partial nephrectomy in Peking Union Medical Hospital from February 2012 to January 2013.The ages ranged from 38 to 75 years.The tumor sizes varied from 1.5 cm to 4.5 cm.According to the device of renorrhaphy,they were divided into 2 groups.Vicryl suture was used for renorrhaphy in 32 patients (Group 1),and QUILLTMSRS was used in 31 patients (Group 2).Renorrhaphy was performed in two layers for both groups,with a closure of deep vessels and the collecting system with 4-0 absorbable suture,followed by a running closure of the renal parenchyma and renal capsule.Demographical and perioperative parameters including age,body mass index,tumor size,R.E.N.A.L score,estimated blood loss,warm ischemic time,length of hospital stay were recorded and compared between the 2 groups.Results Renorrhaphy was successfully performed in all the 63 cases without conversion to open procedure or nephrectomy.The estimated blood loss and length of postoperative hospital stay were not significantly different between the 2 groups (P＞0.05).But warm ischemic time was significantly shorter in QUILLTM SRS group than that in Vicryl group (22.2 vs 26.7 min,P＜0.001).Conclusions QUILLTMSRS could be safe and effective for renorrhaphy in laparoscopic partial nephrectomy.It could make laparoscopic renorrhaphy easier and reduce warm ischemic time significantly.

Objective To investigate the safety and efficacy of flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal stones in patients with a solitary kidney.Methods Between May 2014 and June 2016,Clinical records of 17 cases of stones in a solitary kidney who underwent flexible ureteroscopy and holmium laser lithotripsy were reviewed.10 of these cases were male and the others female;mean age of these cases was 45.8 (32-67) years.9 were on the left side while 8 were on the right.6 cases were with functional solitary kidney (with the GFR of the contralateral kidney less than 10ml/min),while 11 others were with anatomical solitary kidney (6 due to tumor,2 due to tuberculosis,3 being congenital).All cases underwent BUS,KUB as well as CTU to confirm diagnosis before surgery,with 8 diagnosed with renal pelvis calculi,5 were with upper or middle calyx calculi,and 4 were with subrenal calyx calculi.The mean ± SD size of the stones was 1.2 ± 0.3 cm.Clinical m anifestations were asymptomatic in 10cases,backache in 5 cases and fever in 2 cases.All patients underwent exams of CBC,urinalysis,liver and kidney function,coagulation function,ECG,chest X-ray as well as cleaning midstream urine cultivation after admission.Results Mean ± SD operation time among all cases was (74.2 ± 23.6) min,the amount of bleeding during surgery was 5-15 (mean:8) ml,duration of hospitalization was 3-12 (mean:4.5)days,ureteral stents are kept for an average time of 4 weeks after surgery.3 patients developed fever after operation,1 developed urosepsis;all these patients recovered after active anti-infection treatment.No post-operative complications such as fever,renal colic,hematuresis,ureteral perforation,active bleeding as well as sepsis were found among the other patients.The preoperative and postoperative serum creatinine had statistical difference (P ＜0.05).14 patients were proved to be stone-free by KUB or CTU.The stone-free rate after a single operation was 82.3％ (14/17).Residual stone were found in the 3 patients,who subsequently underwent a second flexible ureteroscopy and holmium laser lithotripsy.The stone-free rate after a second operation was 94.1％.Conclusions Flexible ureteroscopy and holmium laser lithotripsy is a safe and effective method for the treatment of nephrolithiasis in patients with a solitary kidney with a lower procedure-related injury rate,smaller amount of bleeding,a lower complication rate and a shorter time required to recover after surgery.

Objective To retrospectively analyze the clinical data of 3 middle-aged and elderly cases with inflammatory myofibroblastic tumor (IMT) of the kidney,in order to improve its diagnosis and treatment.Methods The records of 3 patients who were diagnosed as IMT of the kidney by pathology in our hospital from Jan 2005 to Jun 2014 were reviewed to identify the characteristics including age,gender,clinical manifestation,tumor imaging and pathological features,treatment and prognosis.Results The mean age of the patients was 60 years.One patient underwent partial nephrectorny,1 patient underwent radical nephrectomy,and another patient received nephroureterectomy with bladder cuff excision.Patients were followed up for 8 months to 10 years,and no tumor recurrence was found.Conclusions IMT of the kidney is the tumor of low malignant potential with a good prognosis.Surgery is the first choice for the diagnosis and treatment.

Objective To objectively evaluate the endpoint ot transcatheter arterial chemoembolization (TACE) using two dimensional color-coded digital subtraction angiography (2D-ccDSA).Methods Retrospective analysis of twenty-four patients diagnosed with hepatocellular carcinoma (HCC),treated by TACE and evaluated by post-processed 2D-ccDSA.All patients were examined by DSA before and after TACE procedure,all these DSA series were converted into color-code images,the time density curve (TDC) was derived from the 2D-ccDSA imaging.Time-to-peak (TTP) was measured for the ostia of the catheter,the origin of the tumor feeding artery (TFA) and the embolized site of the TFA; maximal TDC enhancement was measured for selected spots of the tumor parenchyma.The tumor blood supply time (TBST) for pre and post-TACE was calculated accordingly.Data were interpreted with paired t test using SPSS.Results The TTP of the ostia of the catheter and the origin of the tumor feeding artery (TFA) before TACE were (3.47 ± 0.96) and (4.09 ± 1.09) s,after the TACE were (3.49 ± 1.02) and (3.78 ± 1.05) s,respectively.There was no statistical difference between the pre-and post-procedural TTP of the two landmarks (t values were 0.10 and 1.15,P values were 0.92 and 0.26).TTP at the embolized site of the main TFA were [(4.62± 1.16) and (5.59± 1.57)s]for pre and post-TACE,the tumor blood supply time (TBST) was greatly delayed compared with that after the TACE procedure [(1.82± 1.10)s and (0.52±0.41)s].The mean maximal TDC enhancements of the tumor parenchyma areas were (3.03±0.88)units before TACE and (1.10±0.67)units after TACE.The differences were all statistically significant (t values were 3.32,6.04 and 8.93,respectively,P＜0.01) Conclusion It is feasible to use 2D-ccDSA to objectively assess the endpoint of TACE procedures.

Objective To compare the clinical efficacy of laparoscopic radical nephrectomy for large renal cell carcinoma (＞7 cm) between retroperitoneal approach and transperitoneal approach.Methods From Jan 2008 to Dec 2013,the data of 68 patients who underwent laparoscopic radical nephrectomy for large renal tumor(＞7 cm) in our hospital were reviewed.There were 41 male patients and 27 female patients,whose age ranged from 43 to 73 (mean 58.4t6.9) years old.The size of tumor was between 7.0 to 12.5 cm (mean 8.9± 1.1 cm).Left renal tumor was found in 37 patients and right renal tumor in 31 patients.Clinical stages of the tumors were T2 to T3.All patients were undergone the laparoscopic radical nephrectomy,including retroperitoneal approach in 42 cases (observation group)and transperitoneal approach in 26 cases (control group).The exclusive criteria included inferior vena cava tumor thrombus,lymphatic or distant metastasis,previous operation history in the same region,multiple tumors.There were no significant differences in the age,gender,tumor size and location within two groups (P＞0.05).The perioperative indexes and oncological outcomes,such as operation time,blood loss,incidence of blood transfusion,incidence of SIRS,postoperative hospital stay,complications and follow-up results,were collected and compared between two groups.Results Conversion occurred in two cases from observation group and one case from control group.Operative time in observation group was significantly shorter than that in control group (114.9±24.4 min vs.131.2±29.9 min,P＜0.05).Bowel function recovered more rapidly in observation group than in control group (1.7±0.6 d vs.2.2±0.6 d,P＜0.05).However,the estimated blood loss,the incidence of blood transfusion,the postoperative hospital stay,the incidence of SIRS and perioperative complications showed similar results in the 2 groups (P＞0.05).The histopathological examination confirmed renal cell carcinoma in all cases.Observation group included 35 pT2 stage and 7 pT3a stage cases,while control group consisted of 21 pT2 stageand 5 pT3a stage cases.The follow-up duration ranged from 4 to 38 months (mean 17 months).Mean overall survival were 17.1 months in observation group and 18.7 months in control group.Progression free survival time was 15.7 months in observation group and 17.1 months in control group.Cox survival analysis showed that only pre-operative stage of the tumor were independent risk factor for the survival time (P=0.018) and progression free survival time (P=0.020),while the operative approach was not the independent risk factor (P=0.298,0.314).Conclusions For large renal tumors (＞7 cm),laparoscopic radical nephrectomy was safe and feasible.Compared to the transperitoneal approach,retroperitoneal approach cost less operative time and faster bowel recovery.But the operation approach is not an independent risk factor for the survival time and progression free survival time.

Objective To assess the long-term outcome of unilateral adrenaletomy in patients with adrenocorticotropic hormone independent macronodular adrenal hyperplasia (AIMAH).Methods The data from 82 cases of AIMAH were reviewed and summarized including clinical manifestations, endocrinological data, imaging findings and postoperative follow-up.Fouty-nine males and thirty-three females with a mean age of fifty years composed our series.Among the 82 cases, 41 demonstrated Cushing syndrome (CS), 74 presented with hypertension, 38 manifested diabetes mellitus, 35 complicated of osteoporosis and 11 of them with bone fracture, 39 complained of edema.Laboratory tests showed low ACTH plasma levels (＜ 2.2 pmol/L) in 62 of 79 cases.High level of 24-hour urinay free cortisol excretion(＞ 284.2nmol/L) was found in 67 of 79 cases.Elevated serum cortisol with loss of the circadian rhythm was presented in 55 of 60 cases.Failed to suppress cortisol secretion was observed in 61 of 63 conducted with low-dose dexamethasone suppression tests and in 47 of 53 implemented with high-dose dexamethasone suppression tests.Bilateral massively enlarged multinodular adrenal glands were found in all cases with CT or MR imaging.Unilateral adrenalectomy was performed in the larger side of adrenal gland in all 82 cases.All adrenalectomies were carried out including 47 in right sides and 35 in left sides, with 77 by retroperitoneoscopic approach and 5 by open retroperitoneal approach.Results Histopathological examination confirmed nodular hyperplasia of the adrenal cortex for all specimens.After a mean duration of 48.5 months, 80 of 82 patients were available for follow-up.Most clinical symptoms resolved within 6 months after operation.Cushingoid features disappeared in 58.5％ (24/41)of patients who initially presented with typical signs of Cushing Syndrome.Weight loss was seen in 56.3％ (45/80).Improvement of hypertension and diabetes was observed in 63.5％ (47/74) and 76.3％ (29/38) respectively.All the eyelids swelling and edema of the limbs subsided within 3 months.In long-term follow-up (more than 6 months), 82.9％ (63/76) had clinical and biochemical recurrence within a mean time of 14.6 months and 46.0％ (29/63) received contralateral adrenal surgery.Two patients died, one died from heart attack and another one died from pulmonary infection, 2 years and 7 years after unilateral adrenalectomy, respectively.Conclusions Unilateral adrenalectomy just has transient efficiency for AIMAH.Most patients will experience clinical and biochemical recurrence for a long period,and have to receive another operation for the contralateral hyperplastic adrenal gland.

Objective To detect the expression of interleukin (IL)-18 of the peripheral blood cells and IL-18 receptor α chain(IL-18Rα) on the surface of CD_3~+ cells in patients newly diagnosed as immune thrombocytopenia (ITP) before medication and to explore the roles of IL-18 and IL-18Rα in the development of ITP. Methods Eighteen out-patients or inpatients with acute ITP accepting treatment in Qilu Hospital were enrolled in this study and 15 matching healthy subjects were taken as control. Plasma IL-18 level was detected with enzyme linked immunosorbent assay (ELISA), the expression of IL-18Rα on CD_3~+ lymphocytes and total lymphoeytes were measured with flow cytometry; T-bet and GATA-3 mRNA were measured with reverse transcriptase polymcrase chain reaction (RT-PCR). Results The expression of IL-18 in acute ITP plasma was (468. 57 ± 141.62) ng/L and IL-18Rα on the surface of CD_3~+ cells and lymphocytes were (8.50 ±3. 16)% and (9. 16±2.98)% respectively. The levels of IL-18 and IL-18Rα were increased in active ITP patients as compared with those in the controls (P <0. 05). The levels of IL-18 mRNA (0. 12 ±0. 02) and T-bet mRNA (0. 07 ±0. 02) were significantly increased in patients with active ITP as compared with those in the controls (P <0.05), while GATA-3 mRNA (0.0039±0.0014) were significantly decreased in patients with active ITP (P < 0. 05). The balance between T-bet and GATA-3 was significantly disturbed in ITP. Conclusions Through the variation of the levels of gene and protein, our study showed that IL-18 and IL-18Rα might upregulate the expression of Th1-cytokines in ITP patients. It is also suggested that IL-18 has potential association with the development of ITP. Especially, it may provide a new treatment method for ITP by regulating the ratio of T-bet and GATA-3 and resuming the balance of Th1/ Th2.

Objective To evaluate the feasibility of laparoscopic nephroureterectomy with bladder-cuff resection by TUR for upper urinary tract carcinoma. Methods Eighty-two patients with upper urinary tract transitional cell carcinoma(69 cases in renal pelvis and 13 in ureter)underwent retroperitoneal laparoscopic nephroureterectomy and bladder-cuff resection by TUR. This group of cases was retrospectively summarized including operative time, blood loss, drainage mounting days, catheterizing days, post-operative complications and hospital stays. Results All 82 operation procedures were successfully performed without severe complication. The mean operative time was 135 minutes.The mean length of hospital stay was 7 days postoperatively. The mean time with drainage and Foley catheter were 3 days and 6 days respectively. Follow-up time ranged from 6 to 76 months for 74 patients. The 3-year carcinoma recurrence was 10.6% (5/47). Only 1 patient was found incision tumor recurrence in 8 month after the procedure. Conclusion Retroperitoneoscopic nephroureterectomy with bladder cuff resection by TUR could be a feasible procedure to treat upper urinary tract transitional cell carcinoma.

Objective: To evaluate the acute effects of air pollutants (PM2.5,SO2 and NO2) on hospital visits for upper respiratory tract infection in children,and provide the reference for goverment to make effective interventional measures and to instruct prevention and protection of children’s health. Methods: Daily meteorological data, air pollutants levels and hospital visits for upper respiratory tract infection in children between 2016 and 2018 were collected for analysis. The generalized linear model (GLM) based on Quasi-Poisson regression was used for estimating the acute effects of each pollutant on hospital visits for upper respiratory tract infection in children. The confounding factors of seasonal trend, long-term trends, meteorological factors, week effect were controlled in the model. The lag pattern of lag days (lag0-lag5) and moving average effect (lag01-lag05) was conducted. The excessive risk (ER) of hospital visits for upper respiratory tract infection in children with 95% confidence interval (95%CI) was calculated with an increase of 10 μg/m3 of PM2.5，SO2 and NO2 respectively. Results: Seasonality was showed in the daily pollutants and hospital visits for upper respiratory tract infection in children from 2016 and 2018 in Xining. The average of annual PM2.5，SO2 and NO2 concentration were (47±28)(15+9)(35±17) μg/m3 respectively. The average number of hospital visits for upper respiratory tract infection in children was seventytwo persons. With an increase of 10 μg/m3 of PM2.5,SO2 and NO2 hospital visits for upper respiratory tract infection in children increased by 0.78% (95%C=0.39%-1.17%), 4.19% (95%CI=3.05%-5.34%) and 1.93% (95%CI=1.15%-2.71%) respectively. The three kinds of air pollutants all had certain lag effect. Conclusion The main air pollutants PM2.5，SO2 and NO2, have acute effects on hospital visits for upper respiratory tract infection in children in Xining district,thus,the work of preventing and controlling air pollution need to be furthur strengthened.

Humans ; Immune Tolerance ; Purpura, Thrombocytopenic, Idiopathic ; immunology ; T-Lymphocytes ; immunology