Ureteral implantation in peritoneum. Exceptional complication in renal transplantation

Because of the extraperitoneal location, generally used for renal grafting, intraperitoneal urine leaks are a rare complication after transplantation. We report a patient on peritoneal dialysis who developed ascites, abdominal pain, anuria and shock suddenly after renal transplantation. The patient was immediately taken back to the operating room. An abnormal implantation of ureter into the peritoneum overlying the bladder when carrying out an unstented parallel incision extravesical ureterone-ocystostomy was identified. After correcting ureter implantation the patient had immediate diuresis, renal function rapidly improved, with no further complications. Contributing causes were poor exposure, thickened peritoneum secondary to recurrent peritonitis, and the presence of residual peritoneal dialysis fluid.     

Preliminary evidence of polymorphisms of cell cycle regulatory genes and their roles in urinary tract urothelial cancer susceptibility and prognosis in a Taiwan population

Objective

Our aims were to investigate the correlations between polymorphisms in the cell cycle regulatory genes (aurora kinase A [AURKA], survivin, p21, and p53) and UC risk and prognosis.

手术器械质量现状的调查分析

目的了解手术器械的质量现状,为保障手术顺利及患者安全提供参考。方法便利抽取706份手术器械,共计26 445件进行完整性和功能性检测。结果检测的26 445件手术器械中,其中完好器械占38.6%,表面损伤器械占6.7%,需要修理器械占13.2%,需要替换的器械占41.5%。结论手术器械总体质量较差,应进行定期检测,及时发现和解决存在的问题,对供应室人员进行专业培训,合理确定手术器械的份数及配置,促进手术顺利进行。     

脊髓型颈椎病患者颈椎动态MRI检查价值与安全性分析

目的 探究脊髓型颈椎病（CSM）患者颈椎动态MRI（DMRI）检查的价值与安全性。方法 2019年1月—2021年9月,87例CSM患者于苏州大学附属第二医院行颈椎DMRI检查。在矢状面前屈、后伸和中立位MRI T2加权像上观察是否存在脊髓隐匿性压迫。记录患者在DMRI检查前后的症状及体征、疼痛视觉模拟量表（VAS）评分。以DMRI检查后原有症状或体征加重或出现新的症状与体征考虑为短期内脊髓损伤加重。结果 87例患者中17例（19.5%）存在脊髓隐匿性压迫,其中2例在前屈位MRI检查中发现,15例在后伸位MRI检查中发现。DMRI检查后73例患者无明显不适,出现颈肩部不适5例,轻度头晕4例,呼吸不畅、轻度胸闷3例,恶心2例,DMRI检查后VAS评分无下降。85例患者无脊髓神经损伤加重,2例脊髓钳夹伴MRI T2加权像高信号改变患者检查后症状、体征加重。结论 颈椎DMRI是一种相对安全的补充检查,19.5%（17/87）的CSM患者在屈、伸位MRI检查中可发现脊髓隐匿压迫,脊髓钳夹损伤伴MRI T2加权像高信号改变的CSM患者应慎行DMRI检查。     

普通外科恶性肿瘤患者术后下肢深静脉血栓形成预测模型的构建

背景与目的：下肢深静脉血栓形成（LDVT）是普通外科恶性肿瘤患者术后常见的并发症之一,严重影响患者的术后康复。目前的评估工具无法对LDVT患者进行更加细致的风险分层。因此,本研究探讨普通外科恶性肿瘤患者术后发生LDVT的影响因素,并建立可靠的预测工具,从而为LDVT的诊断和防治提供帮助。方法：回顾性分析2021年1月1日—2022年10月31日中南大学湘雅医院普通外科手术治疗恶性肿瘤患者的临床资料,根据良好设计的纳入、排除标准对病例进行严格的质量控制。使用已经较明确的LDVT的影响因素和一些重要临床特征作为分析变量,单变量分析和多变量分析用以评估LDVT的影响因素以及筛选模型的预测因子。应用编程软件制作基于Logistic回归的列线图并通过受试者工作特征曲线（ROC）评估列线图的预测性能,校准曲线用以评估预测模型与数据的拟合程度。使用决策曲线分析（DCA）比较预测模型与其他单一指标临床应用价值的差异。结果：本研究共纳入342例患者,其中LDVT组167例,对照组175例。单变量分析显示,1个月内有手术创伤史、高血压史、吸烟史、饮酒史、放疗史、ICU住院时间、红细胞（RBC）、血红蛋白（...     

CXCR4抑制剂对大鼠肺型氧中毒肺损伤的干预作用

目的：研究趋化因子受体4（chemokine receptor 4,CXCR4）特异性拮抗剂AMD3100在大鼠肺型氧中毒（ pulmonary oxygen intoxication）肺组织损伤中的干预作用。方法40只雄性SD大鼠随机分为常压空气PBS组、常压空气抑制剂组、纯氧暴露PBS组及纯氧暴露抑制剂组,每组10只。纯氧暴露PBS组及纯氧暴露抑制剂组利用0．23 MPa纯氧加压暴露,出舱后通过HE染色切片观察大鼠肺组织病理改变,ELISA法测定炎症因子TNF-α及IL-1β含量变化,应用Western印迹方法研究大鼠肺组织caspase-3含量变化。结果纯氧暴露抑制剂组大鼠肺组织淤血、水肿、出血与纯氧暴露PBS组相比程度较轻。纯氧暴露抑制剂组TNF-α、IL-1β及活化的caspase-3含量均低于纯氧暴露PBS组。结论应用AMD3100阻断CXCR4来减轻肺型氧中毒肺损伤是有效的。     

Incidence of and Risk Factors for Screw Loosening after Iliosacral Screw Fixation for Posterior Pelvic Ring Injury

Purposes

Screw loosening is a common complication of iliosacral screw fixation, with subsequent loss of stability and fracture re-displacement. This study aimed to investigate the incidence of and risk factors for screw loosening after iliosacral screw fixation for posterior pelvic ring injury.

Methods

A total of 135 patients with posterior pelvic ring injuries who were treated with iliosacral screw fixation in our department between July 2015 and April 2021 were selected for this retrospective analysis. The possible risk factors for screw loosening were investigated using univariate and multivariate logistic regression analyses of patient demographics and trauma-related and iatrogenic variables, including age, sex, body mass index, Osteoporosis Self-Assessment Tool for Asians (OSTA) index, mechanism of injury, Young–Burgess classification, site of injury, type of injury, type of screw, mode of fixation, numbers of guidewire adjustments, accuracy of screw position, and quality of fracture reduction.

Results

The incidence of screw loosening was 15.6% (n = 21). The mean duration for screw loosening was 3.2 ± 1.5 months after operation. Univariate analysis results showed that the Young–Burgess classification, type of injury, site of injury, type of screw, mode of fixation, and OSTA index might be related to screw loosening (p < 0.05). According to the multivariate logistic regression, vertical shear injuries (Odds ratios [OR] 9.80, 95% Confidence intervals [CI] [1.96–73.28], p = 0.008), type of injury (OR 0.25, 95% CI [0.13–0.79], p = 0.027), common screws (OR 6.94, 95% CI [1.53–31.40], p = 0.012), screws insertion only at the level of the first sacral segment (S1) (OR 8.79, 95% CI [1.18–65.46], p = 0.034), injury site located in the medial sacral foramina (OR 6.28, 95% CI [1.16–34.06], p = 0.033), and lower OSTA index [OR 0.41, 95% CI [0.24–0.71], p = 0.001] were significantly related to screw loosening.

Conclusions

Vertical shear injuries, sacral fractures, injury site located in the medial sacral foramina, and lower OSTA index are significantly associated with the postoperative occurrence of screw loosening. Transiliac–transsacral screw fixation and screws insertion both at the level of the S1 and second sacral segment can prevent screw loosening.     

人单核细胞共刺激分子在异种免疫反应中的表达及其作用机制

目的 揭示人单核细胞共刺激分子在异种免疫反应中的表达及其作用机制.方法 从猪的主动脉分离血管内皮细胞(PEC)并培养扩增;从人单个核细胞(PBMC)中纯化CD4+T淋巴细胞和单核细胞.建立PEC和人PBMC混合培养体系,培养后收集细胞,然后加入荧光标记的单克隆抗体,通过流式细胞术检测CD14+单核细胞表面共刺激分子表达情况.为了检测淋巴细胞增殖反应以及阻断共刺激分子对PEC免疫反应的作用,在PEC和人PBMC混合培养体系中分别加入抗CD154、CD80和CD86单克隆抗体.在培养的最后24 h加入同位素,于培养结束后收集细胞并经同位素计数仪进行检测.纯化的单核细胞经PEC刺激后与CD4+T淋巴细胞共培养来研究这些单核细胞诱导CD4+T淋巴细胞的增殖以及阻断共刺激分子的作用.结果 PEC和人PBMC混合培养后可检测到PBMC对异种PEC的高度免疫增殖反应;流式细胞术检测到PBMC中的CD14+单核细胞表面无CD40和CD80的表达,但表达CD86,经PEC刺激后,CD14+单核细胞膜表面显著上调CD40和CD80蛋白分子的表达,CD86表达上调.与未经刺激的单核细胞相比较,经PEC刺激后的单核细胞和CD4+T淋巴细胞共培养后可诱导CD4+T淋巴细胞明显增殖,抗人CD154、CD80、CD86单克隆抗体可以阻断CD4+T淋巴细胞对PEC的增殖反应.结论 人CD14+单核细胞在异种免疫反应过程的间接抗原提呈和共刺激信号传导中发挥重要作用,通过上调其共刺激分子的表达与CD4+T淋巴细胞共刺激分子CD154和CD28相互作用形成第二信号,并诱导CD4+T淋巴细胞对PEC的增殖反应;阻断共刺激分子可抑制异种细胞免疫反应.