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1.

Background

Irreversible electroporation (IRE) has the potential to overcome limitations of thermal ablation, enabling small renal mass (SRM) ablation near vital structures.

Purpose

To assess feasibility and safety of percutaneous IRE for the treatment of SRMs.

Materials and methods

This prospective study is a phase 2 trial (NCT02828709) of IRE for patients with SRMs. Primary endpoints are feasibility and safety. Device- and procedural-adverse events were assessed by Clavien-Dindo and Common Terminology Criteria for Adverse Events version 4.0 grading systems. Technical feasibility was assessed by recording the technical success of the procedures. Technical success was evaluated by performing a CT immediately after ablation where complete tumor coverage and nonenhancement were evaluated. Tumor charcateristics and patient characteristics, procedural and anesthesia details, postprocedural events, and perioperative complications were recorded.

Results

Ten SRMs were included with a mean tumor size of 2.2 cm (range 1.1–3.9 cm) were treated with IRE. Renal mass biopsies revealed 7 clear cell and 1 papillary renal cell carcinoma. Two renal mass biopsies were nondiagnostic. The median follow-up was 6 months (range 3–12 months). Technical success was achieved in 9 out of 10 cases. One patient had a grade 3 Clavien-Dindo complication (1/10, 95% Confidence interval (CI) 0.0179–0.4041). Mean anesthesia time was 3.7 hours (range 3–5 hours), mean procedural time was 2.1 hours (range 1 hour 45 minutes–2 hours 30 minutes) and mean ablation time was 50 minutes (range 20 minutes–1 hour 45 minutes). The creatinine preoperative and postoperative (1 week, 3 months, 6 months, and 12 months) did not significantly differ. In total, 8 out of 10 cases did not experience postoperative pain.

Conclusion

IRE in SRMs is safe and feasible. Renal function is not affected by IRE and postoperative pain is rare. Anesthesia time and procedural time are a potential concern.  相似文献   
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This study was conducted to determine clinical parameters predicting future major adverse cardiovascular events (MACEs) in patients without significant stenosis on coronary computed tomographic angiography (CCTA). A total of 625 patients with suspected coronary artery disease (CAD) who underwent CCTA that revealed insignificant (< 50%) CAD was reviewed in three cardiac centers. The MACEs including cardiac death, non-fatal myocardial infarction (MI), unstable angina and late (> 90 days after CCTA) revascularization were assessed. During the mean follow-up period of 819 ± 529 days (median 837 days), there were 28 cases of MACEs (4.5%). In multivariable Cox regression analysis, independent predictors for MACEs were male sex (hazard ratio [HR], 2.40; 95% confidence interval [CI], 1.01-5.69; P = 0.046) and low estimated creatinine clearance (eCCr) (< 60 mL/min/1.73 m2) (HR, 3.07; 95% CI, 1.22-7.74; P = 0.017). Low eCCr was the only independent predictor for hard events including cardiac death and MI (HR, 17.6, 95% CI, 1.44-215.7; P = 0.025). In conclusion, renal function is an independent predictor for cardiovascular events among patients without significant CAD by CCTA. Careful monitoring and preventive strategy are warranted in patients with impaired renal function even without significant CAD.

Graphical Abstract

Open in a separate window  相似文献   
5.
目的:探讨原发性高血压肾损害患者血清胱抑素C( Cys-C)与肌酐变化及相关性。方法选取原发性高血压肾功能正常者为对照组,原发性高血压肾功能损害者为观察组,各80例,分别检测两组血清Cys-C与肌酐水平。结果观察组血清Cys-C与肌酐水平均高于对照组( P <0.01);肾功能储备功能下降期组血清Cys-C及肌酐水平均低于肾功能不全组( P <0.01);相关性分析结果显示,观察组血清Cys-C与肌酐水平呈正相关性( P <0.05)。结论原发性高血压患者随着肾损害程度加重血清Cys-C和肌酐水平随之升高,两者间呈正相关性,可作为原发性高血压肾损害的早期诊断指标。  相似文献   
6.
Background and aimsThe level of albuminuria is used to evaluate diabetic nephropathy (DN). However, to detect or predict the early stages of DN, better biomarkers are needed.MethodsThis study is a case-control observational study. 80 Egyptians participated in the study: 60 patients with type 2 diabetes mellitus (T2DM) were divided into three groups (20 patients each), and 20 healthy subjects with matched age and gender were used as controls. Demographic and laboratory data were analyzed. An enzyme-linked immunosorbent assay was used to determine the levels of four biomarkers of DN; urinary adiponectin (ADP), urinary transferrin, serum Zinc Alpha 2 Glycoprotein (ZAG), and urinary Retinol Binding Protein (RBP).ResultsThe levels of DN biomarkers urinary ADP, transferrin, RBP, and serum, ZAG were significantly higher in patients with T2DM than in controls. The ROC curve of the validity of the simultaneous use of all four biomarkers in predicting albuminuria indicates a sensitivity of 90% and a specificity of 90%. The Area Under the Curve (AUC) was 0.948, the 95% confidence interval was 0.998–0.897, and the p-value was 0.001.ConclusionsIn patients with T2DM, urine adiponectin, transferrin, RBP, and serum ZAG concentration may be useful biomarkers in the early diagnosis of DN. A further longitudinal prospective study is required to explore the potential utility of these biomarkers.  相似文献   
7.
目的:探讨各种毒蛇咬伤患者治疗前后肾功能的变化情况。方法选择近两年住院治疗、属于何种蛇伤诊断明确的毒蛇咬伤患者作为研究对象,这些患者在治疗前后各时段均进行5项肾功能指标检测,按蛇种、时段及病情对检测结果作出统计分析。结果与治疗前比较,各种毒蛇咬伤在治疗后1d除个别指标外其检测均值都有不同程度地升高趋势、特别是治疗后2d升高更明显,有些指标的升高具有显著性差异( P<0.05或P<0.01)。与治疗后2 d比较,治疗后4 d各项指标均有不同程度下降。治疗前后各时段除尿酸外,其它指标均值基本上是蝰蛇咬伤显著高于银环蛇咬伤、竹叶青蛇咬伤、眼镜蛇咬伤和眼镜王蛇咬伤(P<0.05或P<0.01)。结论5种毒蛇咬伤均可能导致肾功能损害,其损害程度以眼镜王蛇咬伤最轻,蝰蛇咬伤最重。  相似文献   
8.
目的:探讨血清胱仰素(Cysc)、尿微量蛋白/肌酐(mAlb/Cr)和Ⅳ型胶原(Ⅳ-C)检测在2型糖尿病肾病早期诊断中的应用.方法:将随机选取的60例2型糖尿病患者分为观察组A(微量尿蛋白排出)28例和观察组B(大量尿蛋白排出)32例,另选同期30例体检健康者作为对照组.测定各组间研究对象Cysc、mAlb/Cr及Ⅳ-C值,并进行比较,分析Cysc、mAlb/Cr及Ⅳ-C三者联合检测2型糖尿病肾病的准确性.结果:观察组A和观察组B Cysc、mAlb/Cr及Ⅳ-C水平均显著高于对照组(P<0.01);观察组B Cysc、mAlb/Cr及Ⅳ-C水平均显著高于观察组A(P<0.05);Cysc、mAlb/Cr及Ⅳ-C三者联合检测敏感性、特异性和诊断符合率分别达到93.31%、96.67%和95.35%,显著高于三者单独检测(P<0.05);而假阳性率和假阴性率仅为3.33%和6.69%,均显著低于三者单独检测的值(P<0.05).结论:2型糖尿病肾病Cysc、mAlb/Cr及Ⅳ-C三者联合检测结果显著优于单项检测,具有较高的准确性,可作为2型糖尿病肾功能损伤的早期诊断的重要指标之一.  相似文献   
9.
Background and objectiveThere is a growing body of evidence that the equations used to estimate the glomerular filtration rate (GFR) are not suitable in critically ill patients, a population whose GFR fluctuates continuously. Glomerular filtration is usually estimated by measuring urine creatinine clearance (CrCl) at various time points. The aim of our study was to evaluate the performance of the most widely used GFR calculators in the subpopulation of critically ill patients admitted for severe trauma, and to compare the results against determinations of CrCl in urine collected over a 4-hour period (4h-CrCl).Material and methodsObservational study in patients hospitalized for severe trauma. We measured the 4h-CrCl and estimated GFR using the Cockcroft-Gault, modified Jelliffe, MDRD, t-MDRD, and CKD-EPI equations, adjusting the results for body surface area (BSA) (ml/min/1.73m2). Data were analysed using R version 4.0.4.ResultsA total of 85 patients were included. Median age was 51 years, and 68 were men (78.82%). The mean BSA-adjusted 4h-CrCl (4h-ClCr/1.73 m2) was 84.5 ml/min/1.73 m2. We found that GFR estimated using the t-MDRD equation correlated significantly with 4h-CrCl/1.73 m2. The Cockcroft-Gault equation correlated significantly with 4h-CrCl/1.73 m2 when GFR was greater than 130 ml/min/m2.ConclusionsIn ICU patients, glomerular filtration can be reliably estimated by determining urine CrCl, but GFR calculators are not accurate in this population.  相似文献   
10.
林佳伟  肖映胜  杨熙鸿  林炘 《新医学》2021,52(5):343-346
目的 探讨继发性甲状旁腺功能亢进症(SHPT)患者术后发生低钙血症的相关因素。方法 回顾性分析62例接受了双侧甲状旁腺全切除术+前臂甲状旁腺自体移植术的SHPT患者的临床资料,包括性别、年龄、透析类型、透析时间、体质量、术前术后生化指标等。采用多因素Logistic回归分析模型分析术后发生低钙血症的独立危险因素。结果 所有患者术中切除甲状旁腺后15 min 甲状旁腺激素(PTH)水平均下降80%以上,术后24 h PTH水平降至20 ~ 30 pg/ml;血钙水平于术后24 h明显下降,48 h降至低值。多因素Logistic回归分析结果显示透析方式(OR = 0.173,P = 0.038)、术前PTH水平(OR = 1.003,P < 0.001)、术前肌酐水平(OR = 1.004,P = 0.001)是术后低钙血症的独立影响因素。结论 腹透透析方式、术前PTH水平偏高、术前肌酐水平偏低是甲状旁腺全切除术+前臂甲状旁腺自体移植术后出现低钙血症的独立危险因素。  相似文献   
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