Objective To investigate the long?term effect of nerve?spring radical hysterectomy( NSRH) on anorectal function after radical hysterectomy. Methods Fifty?six cases of uterine cervical carcinoma patients who met the criteria were selected for the study and were randomly divided into RH group and NSRH group. Defecation functional and anorectal manometry were compared at 1 year after surgery. Results There were 2 patients were excluded both in the two groups, and 26 cases were included in the follow up of each group. Compared with RH group, NSRH group had a lower constipation and chronic diarrhea incidence ( 2 (7. 7%),8(30. 8%);1(3. 8%),6(23. 1%);χ2=4. 457,4. 127P<0. 05),a better self?evaluation bowel func?tion(no significant change:10(38. 5%),5(19. 2%);poor:7(26. 9%),3(11. 5%);very poor:9(34. 6%),18 (69. 2%);χ2=6. 267,P=0. 044;P<0. 05),a higher level of maximal anal squeeze pressure((132. 7±43. 6) mmHg,(119. 5±45. 3) mmHg;t=2. 116,P<0. 05),a lower level of threshold perception of distension((38. 6 ±10. 5) mmHg,(45. 8±12. 4) mmHg;t=2. 326,P<0. 05) and threshold perception of evacuative stimulus ((78. 3±33. 2) mmHg,(90. 6±40. 9) mmHg;t=2. 208,P<0. 05). Conclusion RH may cause more serious long?term anorectal dysfunction,while NSRH help to protect defecation function.

Objective To provide evidence for clinical diagnosis and treatment of staphylococcus peritonitis through retrospective analysis of peritoneal dialysis related clinical characters. Methods Patients who experienced staphylococcus peritonitis were observed as peritonitis group.Patients did not experience peritonitis were observed as one-to-one control group in order to investigate predictors of staphylococcus peritonitis,bacteria spectrum,antimicrobial resistance and clinical outcomes. Results There were 74 patients enrolled in either group.For patients in peritonitis group,Kt/V(1.74±0.03 vs 2.61±0.48,P＜0.01),CrCL[(55.82±2.22) ml/min vs (76.13±17.42) ml/min,P＜0.01],GFR [(1.32±0.55) ml/min vs (3.08±0.75) ml/min,P＜0.01],nutrition index,hemoglobin[(91.70±25.43) g/L vs (111.50±19.59) g/L,P＜0.01],potassium[(3.43±0.70) mmol/L vs (3.78±0.73) mmol/L,P=0.002],sodium [(137.09±5.06) mmol/L vs (140.57±3.55)mmol/L,P＜0.01],chloride [(98.31±6.14) mmol/L vs (101.52±4.58) mmol/L,P=0.001] and calcium [(2.23±0.24) mmol/L vs (2.31±0.22) mmol/L,P=0.04] in serum were significantly lower than those in control group.The morbidity of staphylococcus peritonitis was 0.030 episode per year in recent five yearn.The major strains were Staphylococcus epidermidis,followed by Staphylococcus aureus.Staphylococci were all sensitive to vancomycin,teicoplanin and linezolid.The cure rate was 89.19％,and mortality was 4.05％.Relapse rate of Staphylococcus epidermidis peritonitis was higher (40％) than other strains. Conclusions Poor nutrition,insufficient dialysis,longer followup interval,anemia,electrolytic imbalance are the risk factors of Staphylococcus peritonitis.The morbidity and mortality are lower than before.Staphylococcus epidermidis peritonitis has higher relapse rate and requires more attention to prevention and treatment.

AIM: To investigate the effect of 4.25%peritoneal dialysis solution (PDS) on CD40 expression in rat peritoneal mesothelial cells so as to reveal the potential mechanisms by which CD40-CD40 ligand (CD40L) interaction may be involved in the inflammation of peritoneal membrane. METHODS: Rat peritoneal mesothelial cells (MC) were harvested from the peritoneal cavity and maintained under defined in vitro conditions. Expression of CD40 on MC under normal culture or stimulation with 4.25%PDS or 4.25%PDS+IFN-? was detected by RT-PCR and FACS analyses. After activation of CD40 on MC with CD40 mAb, the expression of intercellular adhesion molecule-1 (ICAM-1) on MC was analyzed by FCAS. RESULTS: MC cultured in vitro expressed CD40 constitutively. 4.25%PDS markedly up-regulated the expression of CD40 mRNA and its protein. The expression of CD40 mRNA and its protein following stimulation with 4.25%PDS+IFN-? was significantly higher than 4.25%PDS alone. The expression of ICAM-1 on MC was significantly increased after activation of CD40 with CD40mAb.CONCLUSIONS: MC functionally express CD40. The up-regulated CD40 expression on MC following stimulation with 4.25%PDS may play an important role in local peritoneal defense mechanisms and may be involved in the chronic inflammatory process of the peritoneum.

Objective To investigate the effects of mitogen-activated protein kinase p38(p38 MAPK)on CD3/CD28-stimulated T-cell proliferation and IL-2 expression which were enhanced by shockwaves.Methods Jurkat T cells or peripheral blood mononuclear cells(PBMC)were pretreated with the p38 MAPK-inhibitor(SB203580)(The Jurkat T cells or PBMC of the control groups were not pretreated with SB203580),then treated with shockwaves,and stimulated respectively with a suboptimal dose of anti-CD3 and anti-CD28 antibodies or PHA.Finally the IL-2 productions of Jurkat T cells or the proliferation of PBMC were respectively measured.The protein tyrosine phosphorylation of p38 MAPKin Jurkat T cells treated either with shockwaves or not was measured by Western blotting with anti-phosphotyrine antibodies(Thr180/Tyr182).The expressoins of p38 MAPK in Jurkat T cells treated either with shockwaves or not were determined by Western blotting with anti-p38 MAPK antibodies.Results Compared with negative control group without shockwave treatment,the 3H-TdR incorporation of the phytohemagglutinin-stimulated PBMC,which were treated with low dose shockwaves(LDSWs)of 100,150,200,250,300,330 impulses at(0.180?0.015)mJ?mm2,increased significantly(P

Objective To investigate the effect of follow-up frequency on the dialysis quality of patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods 298 CAPD pa-tients were selected for retrospective analysis from December 2005 to April 2007. All patients were di-vided into two groups according to different follow-up frequency: group A (shorter than 3 months),group B (longer than 3 months). The dialysis quality of the two groups was compared. Results The levels of hemoglobin, albumin and transferrin of group A were (112.19±20.62)mmol/L, (40.45±4.50) retool/L, (2.43±0.29) mmol/L,which were significantly higher than those of group B, (99.63±20.69) mmol/L, (38.01±5.02)mmol/L,(2.29±0.36) mmol/L (P＜0.05). In addition, edema level, life self-care,work capacity, median duration of dialysis, education level and address in group A were significantly different from those of group B (P ＜ 0.05). Conclusion Shortening follow-up frequency plays an im-portsnt role in improving the dialysis quality of CAPD patients.

As an important course in medical laboratory science, clinical immunology is composed of advanced immunological knowledge and advanced testing technology, which are closely related to many disciplines, such as basic medicine, clinical medicine and so on. Medical educators introduced case-based teaching into clinical immunology, selected the typical, enlightening and interesting clinical cases, designed some reasonable questions for students majoring in medical laboratory science and improved students' participation via pre-class discussion and answering their questions during class, so as to help them study actively. Case-based teaching has been proved through practice as one of the important ways to improve the learning efficiency of medical students and promote their overall development, and it is a successful method for teaching reform.

Objective To evaluate the short-term efficacy and safety of sevelamer hydrochloride in treating maintenance hemodialysis (MHD) patients with hyperphosphemia.Methods A multicenter,open-labeled,self-control study was performed.Phosphate binders were discontinued during a two-week washout period.Patients with more than 1.78 mmol/L serum phosphorus after two-week washout period were eligible for the trial.The dose was adjusted every two weeks as necessary to achieve serum phosphorus control. Sevelamer hydrochloride was administered to 138 MHD patients for 10 weeks and a second two-week washout period followed.Results A total of 111 from 138 patients fulfilled the whole 14-week study. Mean serum phosphorus and calcium-phosphate products starte to decline after two-week sevelamer hydrochloride treatment. By the end of 10-week sevelamer hydrochloride treatment, mean serum level of phosphorus [(1.85±0.50) vs (2.57±0.54) mmol/L,P＜0.01],calcium-phosphate product [(4.16± 1.72) vs (5.79 ± 1.50) mmol2/L2,P＜0.01 ] and low density lipoprotein [(1.64±0.76) vs (2.31 ±0.87) mmol/L,P＜0.01] were significantly decreased,while the adjusted serum level of calcium and serum intact parathyroid hormone kept steady.Both serum phosphorus and calcium-phosphrus product increased after the second washout period, but the levels were still lower as compared to pre-treatment [(2.26±0.71) vs (2.57±0.54) mmol/L; (5.12±1.63) vs (5.79±1.50) mmol2/L2,P＜0.01].Of the 138 patients involved,214 episodes in 106 patients and 121 episodes in 89 patients were reported as adverse events and adverse drug reaction respectively. Gastrointestinal symptoms,of which most were mild or moderate,happened to 68.1％ (94/138) patients. Conclusions Sevelamer hydrochloride can control serum phosphorus and reduce the levels of calcium-phosphorus product and cholesterol.Slight gastrointestinal symptoms like constipation are common during the treatment.

Objectives To investigate the prevalence and its risk factors of restless legs syndrome (RLS) in maintenance peritoneal dialysis (PD) patients.Methods Patients who performed PD in the First Affiliated Hospital of Sun Yat-sen University were recruited by convenience sampling.International Restless Legs Syndrome Study Group diagnostic criteria and International Restless Leg Syndrome rating scale were used to diagnose and evaluate the RLS and its severity.Co-morbidities level,baseline demographic,clinical and biochemical data were collected to analyze the clinical characteristics of patients with RLS.Multivariate logistic regression analysis was used to assess the risk factors for RLS.Results A total of 421 PD patients were enrolled in this study.Their age was (46.3±12.8) years old,44.2％ were female and 17.3％ with diabetes.The median vintage of PD was 46.8(28.0,73.5) months.The prevalence of RLS was 14.0％,most of whom were affected with moderate or severe RLS.Logistic regression analysis showed that younger age,long-term dialysis duration,higher serum calcium and phosphorus were the risk factors associated with RLS in PD patients after adjustment for confounders (all P ＜ 0.05).Conclusions Prevalence of RLS in PD patients is 14.0％.Younger age,long-term dialysis duration,higher serum calcium and phosphorus were the risk factors associated with

Objective To investigate the association of low serum total bilirubin (TBIL) levelwith all?cause mortality and cardiovascular mortality in peritoneal dialysis patients. Methods As a single ? center, retrospective, cohort study, all the patients who underwent peritoneal dialysis catheterization in the Department of Nephrology, the First Affiliated Hospital of Sun Yat?sen University and started peritoneal dialysis for more than 3 months from January 1, 2006 to December 31, 2010 were included. Demographics, baseline clinical and laboratory test results were collected. All patients were followed up until December 31, 2012. Patients were divided into 4 groups according to their baseline serum TBIL levels (interquartile range). Kaplan?Meier method was used to compare the survival rate of each group. Cox regression model was used to analyze the association of TBIL with all?cause mortality and cardiovascular mortality. Logistic regression was used to analyze the influencing factors of low TBIL level. Results A total of 880 peritoneal dialysis patients with baseline TBIL data were enrolled in this study, with age of (48.0 ± 15.4) years old, among whom 59.0％ were male. Median TBIL was 4.5 μmol/L and interquartile range was 3.4?5.8 μmol/L. The comparison between TBIL quartile groups showed that the difference in proportion of diabetics, Charlson comorbidity index, hemoglobin, serum albumin, serum calcium, intact parathyroid hormone, urea nitrogen, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was statistically significant (all P<0.05), while the difference in body mass index (BMI), estimated glomerular filtration rate, serum creatinine, urea nitrogen, uric acid and phosphorus was not statistically significant. After a median follow?up of 31 months, 194 patients died, 104 of which were cardiovascular deaths. Kaplan?Meier curves showed higher all?cause mortality in patients with TBIL≤3.4 μmol/L (Q1 group) (P=0.032) and there was no statistical difference in the cardiovascular mortality among different groups. After adjusting for biochemical indicators such as demographics, comorbidities, and liver function, taking baseline TBIL Q2 level (3.4

Objective:To explore the correlation between serum 25-hydroxyvitamin D3 [25(OH)D3] level and peritoneal dialysis (PD) associated peritonitis, and provide a new idea for the prevention and treatment of peritonitis.Methods:In this single-center retrospective cohort study, patients who were≥18 years old and were treated with regular PD≥3 months in PD center from January 1, 2014 to September 30, 2018 were recruited, except those who had a history of malignant tumors or systemic infectious diseases, transferred from permanent hemodialysis (HD) or failed kidney transplantation. Baseline data including demographic characteristics as well as clinical and biochemical data were collected. All the patients were followed up until death, transfer to HD, kidney transplantation, transfer to other centers or the end of our study (December 31, 2018), and were divided into low tertile [serum 25(OH)D3 ≤12μg/L], middle tertile[12 μg/L17 μg/L] according to the baseline serum 25(OH)D3 level. Multivariate adjusted Poisson model was used to evaluate the association between serum 25(OH)D3 level and PD related peritonitis.Results:A total of 642 patients were enrolled in our study, of whom 341 were male (53.12%) , and the age was (47.58±14.10) years old. The serum 25(OH)D3 level was (13.83±6.41) μg/L. As for the primary disease, 67.19% were chronic glomerulonephritis. During a median 42(19, 59) months follow-up period, 232 peritonitis occurred in 139 patients. After adjusting for confounders, including gender, age, albumin, body mass index(BMI), calcium-phosphorus product, intact parathyroid hormone (iPTH), diabetes, charlson index and drug use, multivariate Poisson regression analysis showed that the risk of peritonitis in the middle tertile and the low tertile was 92% (95% CI 0.62-1.38, P= 0.690) and 1.74 times (95% CI 1.19-2.54, P=0.004) of the high tertile respectively. The difference between the low tertile and the high tertile was statistically significant. Conclusions:The level of serum 25(OH)D3 is closely related to the occurrence of PD associated peritonitis. Low level serum 25(OH)D3 is an independent risk factor for peritonitis in PD patients.