During kidney transplant, the non-specific inflammatory response induced by ischemia-reperfusion injury (IRI) will lead to decreased survival ability of transplanted kidney. However, the effect of IRI on long-term survival rate of allograft is not sure. Here we illuminated the relationship between early IRI and decreased long-term survival ability of allograft by retrospectively analyzing the clinical evidences and laboratory investigations. Previous studies showed that early IRI resulted in the graft loss through reduction of renal functional mass, vascular injury, chronic hypoxia and subsequent fibrosis. IRI was also one of the main factors to induce dysfunction of transplanted kidney and acute rejection reaction, and to decrease the allograft survival. Therefore, it’s better to substitute traditional methods with novel measures during kidney transplant which may relieve the renal IRI much better.
Objective To systematically review the effectiveness and safety of flexible ureteroscope lithtripsy (fURL) and percutaneous nephrolithotomy (PCNL) in treating renal calculus. Methods Such databases as MEDLINE, EMbase, The Cochrane Library, CNKI, CBM, VIP, and WanFang Data from January, 1990 to August, 2012 were searched to comprehensively collect the clinical trials that compared fURL and PCNL in treating renal calculus. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.1 software. Results Eight non-randomized controlled trials involving 536 patients were included. The results of meta-analysis showed that, PCNL was better than fURL in stone clearance (OR=0.26, 95%CI 0.15 to 0.46), but fURL was better than PCNL in postoperative pyrexia (OR=0.1, 95%CI 0.42 to 3.35), the incidence of blood transfusion (OR=0.17, 95%CI 0.03 to 1.00), and the duration of hospitalization (P=0.45, I2=0%). Conclusion Current evidence has proved that PCNL is better than fURL in decreasing stone clearance, fURL is better than PCNL in complication, the duration of hospitalization, and medical costs.
Objective To review and evaluate the global clinical research literatures about the surgical management for prostatic abscess in the past decade, so as to provide useful information for clinical practice. Methods Based on the principles of evidence-based medicine, and the methods of bibliometrics, the PubMed database was searched from January 1st 2000 to April 10th 2011. The literatures about prostatic abscess were screened according to the predefined inclusion and exclusion criteria, the quality was assessed, the valid data were extracted and then systematical evaluation was performed after the establishment of the database with OpenOffice.org 3.8 Calc. Results a) A total of 205 articles were found initially and 81 were finally included with the total 388 cases involved (on average, 4.79 cases per paper). The patients’ ages ranged from 10 days to 83 years old. Two studies were diagnostic tests, and all the other 79 were surgical intervention studies; b) There was no controlled clinical trail. A total of 16 studies involving more than 5 cases for each and 311 cases in all which were retrospective case analyses, all the other 65 were individual case reports; c) American scholars published 13 papers (16.5%), ranked as the first. American and European scientists published 36 papers (44.44%). Chinese scholars published quite fewer studies, of which only 2 were in English; d) The incidence increased in younger patients gradually. The pathogens included fungi and bacteria. Most bacteria were gram-positive cocci (such as Staphylococci), followed by gram-negative bacillus (such as Klebsiella). There were also some minority pathogens. The pathogens were complex and quite diverse in different districts. The predisposing factors included both regional and systematic conditions, with diabetes mellitus, hepatocirrhosis, manipulations of lower urinary tract and urinary tract infections as the common; e) The diagnostic procedures included evaluation on symptoms and signs, physical examination, identification of pathogens, and medical imaging examinations (TRUS, CT, MRI). The therapeutic options included routine managements, conservative antibiotic therapies and surgical drainages. The surgical routes were transcutaneous, transperineal, transrectal, and transurethral. The fine needle aspiration, indwelling catheter drainage, or incision and drainage were performed under the guidance of TRUS, EUS or CT through transperineal or transrectal routes. The TUR, TURP or TUIP drainages were performed through transurethral route. The failed cases of fine needle aspiration were then treated by transurethral or transperineal incision and drainages, and some patients were also treated by urinary diversion; f) The best surgical method could not be concluded for lack of controlled data; and g) Few cases died from severe complications, and the outcomes of the majority cases were good. Conclusion a) The literatures about prostatic abscess are abundant but of low quality, with all retrospective studies or individual case reports, and most are published by American and European scholars; b) The prostatic abscess affects all ages but tends to increase in the young. Most pathogens are the gram-positive cocci (such as Staphylococci) ranked as the top and followed by gram-negative bacillus (such as Klebsiella), and the pathogens are obviously diverse in different districts; c) The predisposing factors are commonly seen as diabetes mellitus, hepatocirrhosis, manipulations of lower urinary tract and urinary tract infections; ......
OBJECTIVE: To evaluate the histological characteristics of xenogeneic graft-versus-host disease (GVHD), and to differentiate it from the allogeneic GVHD. METHODS: The original articles related to the characteristics of xenogeneic GVHD and the relationship between xenogeneic GVHD and allogeneic GVHD were widely reviewed in the past decade. RESULTS: Xenogeneic GVHD was different from allogeneic GVHD in the speed of development, position and features of pathological changes, due to the incompatibility of common simulative signals, adhesive molecules and difference of antigens. Xenogeneic spleen transplantation could induce xenogeneic GVHD. CONCLUSION: Xenogeneic GVHD can be used as a model to mimic rejection in xenotransplantation and to evaluate the compatibility of xenotransplantation.
Objective To compare and assess the efficacy of ventral/dorsal onlay graft urethroplasty in the treatment of urethral stricture. Methods We searched pertinent English literature via MEDLINE (1966 to 2007), EMBASE (1977 to 2007) and The Cochrane Library (Issue 4, 2007) for the use of ventral/dorsal graft urethroplasty in the reconstruction of urethral defect associated with urethral stricture. Data were extracted by two reviewers independently and analyzed by SPSS 13.0 software. Results A total of 50 studies involving 1 264 patients were included. Ventral onlay graft urethroplasty was used in 751 patients with a success rate of 82.6%, while dorsal onlay graft urethroplasty was used in 513 patients with a success rate of 86.9% (ventral vs. dorsal, χ2=4.432, P=0.035). Oral mucosa graft had the highest success rate (88.1%) of all grafts, and the success rate of free skin graft onlay urethroplasty was associated with the location of graft placement (ventral vs. dorsal, P=0.016). Concerning the location of stricture, urethroplasty for bulbar urethral stricture achieved the best results, with a success rate of 87.7%, which was also associated with the location of graft placement (ventral vs. dorsal, P=0.025). Conclusion Dorsal onlay graft urethroplasty is better than ventral onlay. It is better to place the free skin graft in the dorsal part of urethra. Bulbar urethral stricture is more suitable for graft onlay urethroplasty than penile urethral stricture.
目的 探讨不典型肾结核诊断与治疗。 方法 回顾性分析2003年1月－2010年7月12例肾结核住院患者的临床资料。患者尿常规异常9例（75%）；腰痛3例（25%）；尿频8例（66.7%）。尿沉渣检查抗酸杆菌9例中阳性2例（22.2%）；静脉尿路造影11例，患肾不显影7例（63.6%），提示肾结核2例(18.2%)；逆行尿路造影7例，提示肾结核1例（14. 3%）；CT确诊8例（66.7%）。确诊肾结核后，12例患者中7例行手术治疗，5例行药物治疗。药物治疗患者中3例采用异烟肼、利福平加盐酸乙胺丁醇治疗，疗程为9个月；2例加用吡嗪酰胺，疗程为1年。手术治疗7例患者于抗结核治疗2周后行肾切除术，术后行抗结核治疗1～1.5年。治疗结束后随访尿查结核分枝杆菌6个月。 结果 异烟肼、利福平加盐酸乙胺丁醇药物治疗组3例中1例在9个月后复查时患肾损伤严重，行肾切除，另2例患者以及加用比嗪酰胺2例药物抗结核治疗后，活动性病灶消失，连续半年尿中未找见结核分枝杆菌。行肾切除手术的7例患者术中2例肾萎缩，5例患肾体积增大，均伴有不同程度肾积脓；肾切除术后病理均确诊为肾结核，合并输尿管结核2例，输尿管慢性炎症4例。7例手术患者术后行抗结核治疗，治疗结束后尿中均未找见结核分枝杆菌，影像学检查也未发现新发病灶。 结论 临床症状不典型及起病隐匿是导致肾结核延误诊疗的重要原因。彩色多普勒超声、静脉肾盂造影、逆行尿路造影是主要的检查方法，CT对肾结核的诊断具有重要价值。手术治疗上多以患肾切除为主。
ObjectiveTo explore the relationship between the pressure level within the scope of promoting proliferation and cell injury of human bladder smooth muscle cells (HBSMCs). MethodHBSMCs in vitro were divided into the experimental group and control group. The cells in the experimental group were exposed to 40 cm H2O (1 cm H2O=0.098 kPa) pressure and those in the control group were cultured in normal condition for 24 hours. We investigated the cell morphology and cytoskeleton with indirect immunofluorescence staining for α-actin. Propidium iodide (PI) staining was applied to evaluate the level of cell apoptosis. ResultsThere was no significant difference in the cell morphology between the two groups. However, the expression of α-actin in the experimental group[(50.93±1.99)%] was significantly reduced comparing with that in the control group[(24.70±1.61)%] (t=32.404, P<0.001). The results of PI staining showed that compared with the control group[(3.50±2.12)%], the number of PI staining positive cells in the experimental group [(9.00±1.41)%] was significantly higher (t=6.110, P<0.001). ConclusionsPressure condition can promotes cell proliferation, but at the same time, it can also lead to cell injury of HBSMCs.
ObjectiveTo systematically review the effectiveness and safety of transurethral ureteroscopy lithotripsy in the treatment of upper ureteral calculi. MethodsWe electronically searched The Cochrane Library (Issue 3, 2013), PubMed (1966 to 2013.8), EMbase (1990 to 2013.8), CNKI (1949 to 2013.9), CBM (1978 to 2013.9), VIP (1989 to 2013.8) and WanFang Data (1990 to 2013.8) for the randomized controlled studies (RCTs) related to retroperitoneoscopy ureterolithotomy versus transurethral ureteroscopy lithotripsy for upper ureteral calculi. Two reviewers independently screened literature, extracted data, and evaluated methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. ResultsA total of 16 RCTs involving 1 410 patients (transurethral ureteroscopy lithotripsy:747 cases; etroperitoneal laparoscopic ureterolithotomy:663 cases) were included. The results of meta-analysis showed that, transurethral ureteroscopy lithotripsy was lower than retroperitoneoscopy ureterolithotomy in success rates of surgery (OR=0.26, 95%CI 0.14 to 0.51), 3-day stone clearance rates (OR=0.06, 95%CI 0.03 to 0.11), and 1-month stone clearance rates (OR=0.21, 95%CI 0.08 to 0.53), while it showed superiority in operation time (MD=-22.35, 95%CI-35.29 to-9.41) and postoperative hospital stay (MD=-1.84, 95%CI-3.44 to-0.24). ConclusionCurrent evidence shows that, in the treatment of upper ureteral calculi, transurethral ureteroscopy lithotripsy causes less operation time and postoperative hospital stay, but it had no advantage in success rates of surgery, 3-day stone clearance rates, and 1-month stone clearance rates.
Three dimensional (3D) bioprinting is a new biological tissue engineering technology in recent years. The development of 3D bioprinting is conducive to solving the current problems of clinical tissue and organ repairing. This article provides a review about the clinical and research status of 3D bioprinting and urinary system reconstruction. Furthermore, the feasibility and clinical value of 3D bioprinting in urinary system reconstruction will be also discussed.