Fibroblasts ; Heart ; Humans

Objective To investigate the influential factors of brachial-ankle artery pulse wave velocity (baPWV) in healthy individuals.Methods Total 716 healthy subjects including 503 males and 213 females,who underwent health check up in 2010,were enrolled in the study Bilateral baPWV was examined in all subjects and multiple factor linear regression was applied to evaluate the correlations of baPWV with sex,age,body mass index,arterial blood pressure,ankle-brachial index and biochemical variables.Results The mean baPWV of 716 healthy subjecs was ( 1224 ± 162) cm/s,and there was significant difference between men and women [ ( 1257 ± 159) cm/s vs.( 1144 ± 143) cm/s].There was a significant linear correlation of baPWV with sex,age,mean arterial blood pressure and plasma homocysteine concentration ; and the linear regression equation was:mean PWV =6.635 × age + 7.285 × mean arterial blood pressure + 2.682 × homocysteine concentration - 64.334 × sex + 347.500 ( sex:man =0,woman =1 ).Conclusion Age,sex,mean arterial blood pressure and plasma homocysteine concentration are independent influential factors of baPWV.

Objective To evaluate the effect of airway pressure release ventilation (APRV) in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS), to evaluate the extent of ventilator-induced lung injury (VILI), and to explore its possible mechanism. Methods A prospective study was conducted in the Department of Critical Care Medicine of the First Hospital of Hebei Medical University from December 2010 to February 2012. The patients with ALI/ARDS were enrolled. They were randomly divided into two groups. The patients in APRV group were given APRV pattern, while those in control group were given lung protection ventilation, synchronized intermittent mandatory ventilation with positive end-expiratory pressure (SIMV+PEEP). All patients were treated with AVEA ventilator. The parameters such as airway peak pressure (Ppeak), mean airway pressure (Pmean), pulse oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), arterial blood gas, urine output (UO), the usage of sedation and muscle relaxation drugs were recorded. AVEA ventilator turning point (Pflex) operation was used to describe the quasi-static pressure volume curve (P-V curve). High and low inflection point (UIP, LIP) and triangular Pflex volume (Vdelta) were automatically measured and calculated. The ventilation parameters were set, and the 24-hour P-V curve was recorded again in order to be compared with subsequent results. Venous blood was collected before treatment, 24 hours and 48 hours after ventilation to measure lung surfactant protein D (SP-D) and large molecular mucus in saliva (KL-6) by enzyme linked immunosorbent assay (ELISA), and the correlation between the above two parameters and prognosis on 28 days was analyzed by multinomial logistic regression. Results Twenty-six patients with ALI/ARDS were enrolled, and 22 of them completed the test with 10 in APRV group and 12 in control group. The basic parameters and P-V curves between two groups were similar before the test. After 24 hours and 48 hours, mechanical ventilation was given in both groups. The patients' oxygenation was improved significantly, though there were no significant changes in hemodynamic parameters. The Pmean (cmH2O, 1 cmH2O = 0.098 kPa) in APRV group was significantly higher than that in control group (24 hours: 24.20±4.59 vs. 17.50±3.48, P < 0.01; 48 hours: 18.10±4.30 vs. 15.00±2.59, P < 0.05). After ventilation for 24 hours, the ratio of patients with increased Vdelta in APRV group was higher than that in control group (90% vs. 75%), but without statistical difference (P > 0.05). The SP-D level (μg/L) in serum in APRV group showed a tendency of increase (increased from 19.70±7.34 to 27.61±10.21, P < 0.05), in contrast there was a tendency of decrease in control group (decreased from 21.83±7.31 to 16.58±2.90, P > 0.05), the difference between the two groups was statistically significant (P < 0.05). After 48-hour ventilation, SP-D in APRV group was decreased, but no change was found in control group, and no significant difference was found as compared with that of the control group (16.45±8.17 vs. 17.20±4.59, P > 0.05). There was no significant difference in serum KL-6 between the two groups before and after ventilation. The SP-D and KL-6 levels in serum were unrelated with 28-day survival rate of the patients. The odds ratio (OR) of SP-D were 0.900 [95% confidence interval (95%CI) = 0.719-1.125], 1.054 (95%CI = 0.878-1.266), 1.143 (95%CI = 0.957-1.365), and the OR of KL-6 were 1.356 (95%CI = 0.668-2.754), 0.658 (95%CI = 0.161-2.685), 0.915 (95%CI = 0.350-2.394) before the test, 24 hours and 48 hours after ventilation (all P > 0.05). Conclusions APRV was similar to lung protective ventilation strategy in oxygenation and improvements in the lung mechanics parameters. APRV with a higher Pmean can recruit alveolar more effectively, and it had no impact on hemo-dynamics, but might exacerbate VILI.

OBJECTIVE:To systematically review the efficacy and safety of Kanglaite injection combined with radiothreapy in the treatment of the non-small cell lung cancer (NSCLC),and provide evidence-based reference for clinical treatment. METH-ODS:Retrieved from PubMed,Cochrane Library,EMBase,VIP,CJFD,Wanfang database and CBM,randomized controlled tri-als(RCT)about the efficacy and safety of Kanglaite injection combined with radiothreapy in the treatment of NSCLC were collect-ed. Meta-analysis was performed by using Rev Man 5.3 software after data extraction and quality evaluation with modified Jadad scale. RESULTS:Totally 9 RCTs were included,involving 561 patients. Results of Meta-analysis showed,Kanglaite injection com-bined with radiothreapy can significantly improve the effective rate [OR=2.99,95%CI(2.07,4.31),P<0.001] and improvement rate of life quality [OR=3.74,95%CI(2.36,5.92),P<0.001],and reduce the incidence of radiation pneumonitis [OR=0.23,95%CI (0.12,0.47),P<0.001] and radiation esophagitis [OR=0.10,95%CI(0.05,0.21),P<0.001] of NSCLC patients,the differences were statistically significant. CONCLUSIONS:Both the efficacy and safety of Kanglaite injection combined with radiothreapy in the treatment of NSCLC are superior to radiothreapy alone.

Objective:To evaluate the risk factors of systemic inflammatory response syndrome (SIRS) in the patients with type 2 diabetes diagnosed with kidney stone after percutaneous nephrolithotomy (PCNL).Methods:In this study,461 patients with type 2 diabetes who received PCNL in Peking Uni-versity People’s Hospital from June 2006 to December 2015 were reviewed.There were 281 males and 180 females with an average age of 57 years were included,of whom,137 were diagnosed with SIRS after PCNL.The demographic data,clinical features,and test results were compared between the patients with SIRS and without SIRS,trying to identify the correlation between their clinical characters and the occur-rence of SIRS.Results:The SIRS was significantly correlated with the patients’preoperative white blood cell counting (×109 /L)[7.76 (4.00 -17.96)vs.6.31 (2.00 -17.40),P <0.001 ],preopera-tional blood glucose level (mmol /L)[7.30 (3.08 -19.90)vs.6.40 (3.42 -16.78),P <0.001], operative time (min)[75 (20 -270)vs.60 (20 -200),P <0.001 ],length of stay (d)[12 (2 -46)vs.11 (3 -29),P =0.019],staghorn stones [38.8% (33 /85)vs.27.7% (104 /376),P =0.042],and preoperational urinary tract infection [36.8% (50 /136)vs.26.6% (81 /304),P =0.032].There was no significant correlation between the SIRS and the patients’age,body mass index, preoperative hemoglobin level,preoperative serum creatinine,and transfusion.In multivariate analysis, abnormal preoperative white blood cell counting (OR =3.194,95% CI:1.531 -6.666,P =0.002), operative time longer than 60 min (OR =1.635,95% CI:1.088 -2.456,P =0.018),and preopera-tional blood glucose level higher than normal 7.1 mmol /L were significantly correlated with the presence of SIRS.Conclusion:The high level of preoperational blood glucose,abnormal preoperative white blood cell counting,and long operative time were significantly correlated with the presence of SIRS in patients with type 2 diabetes after PCNL.

Objective To investigate the feasibility and safety of laparoscopic aortobifemoral bypass (LABF) for diffuse aortoiliac occlusive diseases.Methods Clinical data of 18 cases who underwent LABF were retrospectively analyzed.The intraoperative procedures and postoperative outcome were evaluated.Results LABF was performed successfully in 17 of 18 patients.The mean operation time was (280 ±57) minutes,with a mean aortic cross-clamp time of (117 ±32) minutes.Estimated blood loss was(524 ±45) ml.Mean ICU stay was ( 1.0 ± 1.2) days.The mean postoperative hospital stay was ( 10 ±5) days.Mean time to resume diet was (3 ± 3 ) days.Postoperative myocardial infarction developed in 1 case,lung infection in 2 cases.There was no perioperative mortality.Graft thrombosis developed in 1 case and embolectomy surgery was successfully performed.All patients were followed up from 3 to 27 months,with mean follow-up of (18 ± 8) months,grafts were all patent.Conclusions Laparoscopic aortic bypass is feasible and miniinvasive in patients with diffuse aortoiliac occlusive disease.Short-term outcomes are comparable to those with open conventional aortic bypass.

Objective:The aims of this study were to compare the efficacy between salvage liver transplantation (sLT) and rehepatectomy (RR) basing on the propensity score matching (PSM), and to explore the prognositc factors of patients with recurrent hepatocellular carcinoma (HCC).Methods:124 patients with intrahepatic recurrence after hepatectomy in our center from January 2012 to August 2018 were divided into sLT group( n=46) and RR group( n=78). 34 patients were selected for data analysis base on 1∶1 propensity score matching (PSM). The advantages and disadvantages of the two surgical methods and the prognostic factors of the patients were discussed by comparing the basic clinical data, OS and DFS of the two groups before and after matching. Results:Before matching, the pre-operative serum total bilirubin, the occurrence of multiple tumors, the proportion of preoperative TACE and the proportion of patients within Milan criteria of the sLT group were higher than those of the RR group, and the maximum tumor diameter of the sLT group was shorter than that of the RR group ( P<0.05); the time of operation, the amount of intra-operative blood loss, the positive of MVI and the proportion of postoperative Clavien grade Ⅲ and above of RR group were higher than those of RR group ( P<0.05). After matching, the operation time, intra-operative blood loss and the proportion of postoperative complications of sLT group were higher than those of RR group; there was nosignificant difference between 1-, 3- and 5- years OS of sLT group and RR group( P>0.05), the 1-, 3- and 5-years DFS of sLT group were better than those of RR group( P<0.05); AFP≥100 μg/L was the independent risk factor of OS, and the type of operation and AFP≥100 μg/L were independent risk factors of DFS. Conclusions:The pre-operative condition of sLT group was more severe, and the operation time, intra-operative blood loss and post-operative severe complication rate of sLT group were higher than those of RR group, and the DFS time of sLT group was longer than that of RR group, but there was no significant difference in OS between the two groups.

Objective To analyze clinical characteristics of premenopausal and postmenopausal female patients with kidney stones.Methods The clinical data of 1 194 female adults with kidney stones from December 2004 to December 2014 were analyzed retrospectively.The incidence of kidney stones in different age groups was analyzed firstly.The post-hysterectomy patients or those taking estrogen for breast cancer were excluded, and then 1 166 patients were enrolled.The patients were divided into premenopausal group (464 cases, 39.8％) and postmenopausal group (702 cases, 60.2％), and clinic features of different groups were evaluated.Results The peak age of female patients with kidney stones is between 50 and 59 years old.There were 105 (22.6％) patients in premenopausal group and 204 (29.1％) patients in postmenopausal group complicated with urinary infection.Fifty-eight (12.5％) patients had genitonrinary malformations such as horseshoe kidney, medullary sponge kidney, ectopic kidney, duplex kidney or pyeloplasty for ureteropelvic junction (UPJ) stricture in premenopausal group, as well as 36 (5.1％) in postmenopausal group.Twenty patients (4.3％) had renal insufficiency in premenopausal group, and 66 (9.4％) in postmenopausal group.These differences were statistically significant (P ＜ 0.05).The patients complicated with hydronephrosis (251 vs.346) and ureteral calculi (63 vs.110) of two groups were not significant different (P ＞ 0.05).Multiple factors Logistic analysis indicated that age and urinary infection were statistically significant factors in the occurrence of renal insufficiency (OR =1.037,1.772, P ＜ 0.05).Conclusions The occurrence of genitourinary malformations was higher among premenopausal female patients with kidney stones, while urinary infection and renal insufficiency were more common for postmenopausal patients.Age and urinary infection were the independent factors for the occurrence of renal insufficiency.

Objective　To report a 4-year cumulative series (209 cases) of laparoendoscopic singlesite surgery (LESS) in urology and assess its clinical utilization.　Methods　Consecutive LESS cases done between December 2008 and July 2012 at our institution were prospectively recorded and retrospective analyzed in this study.Demographic data,main perioperative outcomes,and information related to the surgical technique were collected and analyzed.There were 209 patients ( 121 males and 88 females) with a mean age of (52.8 ±14.5) years,a mean B MIof (23.5 ±3.12) kg/m2 and a mean ASA score of (2.0±0.3).20.1％ (42 cases) of patients had previous abdominal or pelvic surgeries.29.2％ (61 cases) and 12.9％(27 cases) of patients had diabetes mellitus and hypertension. Indications were renal tumors (70 cases,33.5％),adrenal tumors (42,20.1％),renal cyst (22 cases,10.5％),ureteral calculi (22 cases,10.5％),nonfunctional kidneys (19 cases,9.1％),BPH (10 cases,4.8％),and others (24 cases,11.5％ ).Surgical conversions were evaluated,as well as intraoperative and postoperative complications.Two periods were arbitrarily dcfined:the first was from December 2008 to Septcmber 2010 (22 mon) and the second.was from October 2010 to July 2012 (22 mon).A comparative analysis between these two periods was conducted.　Results　There were 209 LESS surgeries included in this study.Most common procedures ( 92.3％ ) were done on the upper urinary tract,with 55.5％ of the whole cohort being tumor-related indications and only 16.3％ being reconstructive procedures.The transperitoneal approaches were preferentially adopted in 80.9％　cases,and transvesical access in 5.3％ cases. The transumbilical access was used in 46.9％ of cases.The overall conversion rate was 8.1％,with 4.3％ of cases converted to reduced - port laparoscopy,1.9％ to conventional laparoscopy,and 1.9％ to open surgery.The intraoperative complication rate was 4.8％ ( 10/209 ) and postoperative complications,mostly low grade,were encountered in 11.5％(24/209) of cases.There was a significant increase in the number of LESS cases during the second study period; the rate of some procedures (ie,transumbilical LESS,renal cyst decortication and transvesical single-port enucleation of the prostate) was lower,whereas some other procedures were performed more frequently (ie,tumor-related LESS procedures,radical nephrectomy and adrenalectomy).　Conclusions　A broad range of urological procedures can be finished with LESS technique in the experienced hands of a laparoscopic surgeons.However,LESS is still in its infancy with a certain risk of surgical complication and conversion.Stringent patient selection criteria should be applied,especially during the learning curve.Complex reconstructive procedures or malignant tumor related indications are not appropriate as the start of this kind of procedure.We need always put patient's safety and treatment efficacy first.

Objective To summarize the clincical experience of transumbilical Laparoendoscopic Single-site (LESS) nephrectomy and to evaluate its safety and efficacy. Methods From December 2008 to August 2010, we have performed 20 cases of transumbilical LESS nephrectomy by Tri-Port system, of which 9 patients underwent LESS radical nephrectomy (left 8, right 1, stage T1 ), 1 patient underwent LESS radical resection of right ureteral carcinoma, 10 patients underwent LESS simple nephrectomy (left 5, right 5). The Tri-Port system was inserted transperitoneally through a 2 cm umbilical incision. A 5-mm 30° telescope was introduced through the port to visualize the operative field. Flexible equipment and standard laparoscopic equipment were used to perform the procedures.The incisions were extended to about 6cm in order to remove the specimens. Results Conversion to open surgery was necessary in one LESS radical resection of right ureteral carcinoma and one LESS simple nephrectomy, while the remaining 18 cases were successful (the addition of a single 5-mm port was necessary in 2 cases of LESS radical nephrectomy). The mean operative time was 197 min (85-510 min), mean estimated blood loss was 126 ml (50-400 ml), without blood transfusion in the perioperative period, mean postoperative hospital stay was 6.3 d (3-14 d), and mean duration of catheter drainage was 3.6 d (0- 14 d). Conclusions Transumbilical LESS nephrectomy is feasible, safe,minimally invasive and cosmetic. Long-term follow-up and a clinical control study are needed for evaluating clinical outcomes.