Successful resection of a huge retroperitoneal venous hemangioma:A case report

BACKGROUND Venous hemangioma is a benign and non-invasive type of tumor,which is rarely identified due to the absence of clinical manifestations.A retroperitoneal benign tumor is comparatively rare,and hemangioma is exceptional.Because of the different types and locations of hemangioma,presentations are varied;thus,establishing an accurate diagnosis before surgery is challenging.CASE SUMMARY A 45-year-old female patient visited our hospital with the complaint of a retroperitoneal mass without symptoms discovered during a medical examination.An abdominal and pelvic computed tomography(CT)revealed a giant hypodense mass that extended from the lower edge of the liver down to the right groin and showed no marked enhancement in the arterial phase of the enhanced CT.On magnetic resonance imaging,the retroperitoneal mass was hyperintense on the T2-weighted image and hypointense on the T1-weighted image.The mass was completely resected and confirmed as a venous hemangioma by pathology.CONCLUSION Venous hemangioma is rare in adults,and an accurate diagnosis before surgery is challenging.Surgery is the curative treatment for venous hemangioma,and the definitive diagnosis relies on pathology.

Application of fluorescence in situ hybridization in the detection of bladder transitional-cell carcinoma: A multi-center clinical study based on Chinese population

Objective:To evaluate the diagnostic value of fluorescence in situ hybridization(FISH)in bladder cancer.Methods:We enrolled healthy volunteers and patients who were clinically suspected to have bladder cancer and conducted FISH tests and cytology examinations from August 2007 to December 2008.Receiver operating characteristic(ROC)curve analysis was performed and the area under curve(AUC)values were calculated for both the FISH and urine cytology tests.Results:A cohort of 988 healthy volunteers was enrolled to establish a reference range for the normal population.A total of 4807 patients with hematuria were prospectively,randomly enrolled for the simultaneous analysis of urine cytology,FISH testing,and a final diagnosis as determined by the pathologic findings of a biopsy or a surgically-excised specimen.Overall,the sensitivity of FISH in detecting transitional-cell carcinoma was 82.7%,while that of cytology was 33.4%(p<0.001).The sensitivity values of FISH for non-muscle invasive and muscle invasive bladder transitional-cell carcinoma were 81.7%and 89.6%,respectively(p=0.004).The sensitivity values of FISH for low and high grade bladder cancer were 82.6%and 90.1%,respectively(p=0.002).Conclusion:FISH is significantly more sensitive than voided urine cytology for detecting bladder cancer in patients evaluated for gross hematuria at all cancer grades and stages.Higher sensitivity using FISH was obtained in high grade and muscle invasive tumors.

A multicenter uroflowmetry study of healthy women in China

Uroflowmetry is an uroflow measurement technique used to record the voided volume(VV)and flow rate,which can help clinicians objectively evaluate lower urinary tract function.Currently,few uroflowmetry studies have focused on the female population,[1]especially on the uroflow curve standard analysis.Hence,we sought to establish dependable uroflow reference values and nomograms for Chinese women and to evaluate the relationship between uroflow patterns and demographic data.

Role of ferroptosis in fibrosis:From mechanism to potential therapy

Fibrosis,which is a manifestation of the physiological response to injury characterized by excessive accumulation of extracellular matrix components,is a ubiquitous outcome of the repair process.However,in cases of repetitive or severe injury,fibrosis may become dysregulated,leading to a pathological state and organ failure.In recent years,a novel form of regulated cell death,referred to as ferroptosis,has been identified as a possible contributor to fibrosis;it is characterized by iron-mediated lipid peroxidation.It has garnered attention due to the growing body of evidence linking ferroptosis and fibrogenesis,which is believed to be driven by underlying inflammation and immune responses.Despite the increasing interest in the relationship between ferroptosis and fibrosis,a comprehensive understanding of the precise role that ferroptosis plays in the formation of fibrotic tissue remains limited.This review seeks to synthesize previous research related to the topic.We categorized the different direct and indirect mechanisms by which ferroptosis may contribute to fibrosis into three categories:(1)iron overload toxicity;(2)ferroptosis-evoked necroinflammation,with a focus on ferroptosis and macrophage interplay;and(3)ferroptosis-associated pro-fibrotic factors and pathways.Furthermore,the review considers the potential implications of these findings and highlights the utilization of ferroptosis-targeted therapies as a promising strategy for mitigating the progression of fibrosis.In conclusion,novel anti-fibrotic treatments targeting ferroptosis could be an effective treatment for fibrosis.

Long-term kidney transplant outcomes in Chinese patients with primary glomerulonephritis:A multicenter study in China

To the Editor:The primary cause of end-stage kidney disease(ESKD)in China is chronic glomerulonephritis(GN),which accounts for 45%of ESKD patients.[1]There is currently no nationwide large-scale study on the longterm prognosis of kidney transplantation in patients with chronic GN in China.Over the past decade,however,few landmark studies from populations in Europe[2,3]and the United States[4]have provided important reference data for this issue.Therefore,we propose to conduct a nationwide multicenter retrospective study,which was launched by the National Clinical Research Center of Kidney Diseases,Jinling Hospital,Nanjing University School of Medicine,from 2017 to 2020.

Effects of tacrolimus and cyclosporine treatment on metabolic syndrome and cardiovascular risk factors after renal transplantation：a meta-analysis

Background The therapeutic success of renal transplantation has been largely attributable to the development of effective and balanced immunosuppressive treatment regimens.This study provides a meta-analysis of a series of randomized controlled trials that compared the effects of tacrolimus and cyclosporine on metabolic syndrome （MetS） and cardiovascular risk factors after renal transplantation.Methods We searched various electronic databases and bibliographies,including MEDLINE,the Cochrane Central Register of Controlled Trials,and EMBASE,for relevant studies published prior to October 2012.Results Our meta-analysis included five randomized controlled trials that examined a total of 923 patients.The tacrolimus group and the cyclosporine group exhibited no significant differences in MetS incidence after renal transplantation; risk ratio （RR）：1.06,95％ confidence interval （C/）：0.73-1.55,P=0.76.Cyclosporine treatment was associated with a higher incidence of hyperlipidemia （RR：0.50,95％ CI：0.39-0.64,P ＜0.01）.Although there were no statistically significant differences,cyclosporine treatment was associated with a higher incidence of hypertension （RR：0.91,95％ CI：0.83-1.00,P=0.06） after renal transplantation compared to tacrolimus treatment,and tacrolimus treatment was associated with a higher incidence of diabetes after renal transplantation （RR：1.79,95％ CI：0.98-3.27,P=0.06） compared to cyclosporine treatment.Conclusions Compared to tacrolimus treatment,cyclosporine treatment was associated with a higher incidence of hyperlipidemia.Future large-scale studies are expected to be conducted to further confirm our findings.

Attitudes toward organ donation in China

Background Organ transplantation represents an important advance in modern medical science,and it has benefited many patients with organ failure; however,the severe deficiency of organ sources has been a bottleneck that has limited the benefits -this technology can bring.The aim of this study was to show the results of a survey on Chinese people＇s awareness and attitudes toward organ donation.Methods We designed a questionnaire regarding organ donation consisting of 20 short questions,which were distributed to 10 groups.Most of the questions were multiple-choice; the core question related to people＇s attitudes to organ donation and the development of organ donation.The survey was held in the outpatient hall of Beijing Chao-Yang Hospital,a commercial district,and four professional colleges.Participants were randomly selected,and answered questions about gender,age,educational background,profession,and study major.Results In all,2930 valid responses were received.Male：female ratio was nearly 1：1.2 （mean age 38 years）.Over 90.0% of participants knew about organ transplantation and which organs could be transplanted; more than 95.0% knew about organ donation,but the time they had been aware of it varied.Nearly 90.0% of the participants approved of deceased organ donation; 73.0% indicated they would like to donate their organs post mortem.Participants who knew more about organ failure and organ transplantation were more likely to support organ donation.College students were very positive about organ donation,though as they gain professional knowledge their attitudes may change.Altogether,65.3% of participants approved of living organ donation,which was obviously lower than the figure for deceased organ donation （P 〈0.05）.In all,85.7% of participants approved of compensation to the deceased donor＇s family.To promote organ donation in China,62.9% of participants indicated that the public＇s knowledge about organ donation should be increased via the media and various kinds of education.Only 20.0% of the participants believed that legislation was required.Conclusions We conclude that at present the Chinese public has a basic understanding about organ transplantation and donation.The majority respondents were in favor of deceased organ donation and were willing to donate their own organs after death.

Video-urodynamics study on female patients with bladder neck obstruction

Background Pressure-flow study combined with cystourethroscopy were used as the major method to define female bladder neck obstruction in China. However, the definition of urodynamics for female bladder outlet obstruction （BOO） is not clear so far. Video-urodynamic study （VUDS） would provide more information to define the female BOO, but it is not used commonly due to the limitation of video-urodynamic equipment in China. We attempted to find a better way for diagnosis of female BOO by performing VUDS. Methods VUDS and cystourethroscopy were performed in 38 women with signs and symptoms of difficult voiding from March 2008 to April 2010 in Beijing Chao-Yang Hospital. Bladder neck obstruction was defined by radiological evidence of narrowing bladder neck, voiding pressure greater than 20 cmH2O and maximum flow rate （Qmax） less than 12 ml/s. Transurethral incision of bladder neck was then performed on those patients. Follow-up examination （Qmax and residual urine） was recorded 3 months after operation. Results The mean time from its onset to diagnosis was （18.1±9.1） months in 38 patients. Average patient age was 36.1 years （range from 19 to 79 years）. The mean Qrnax was （10.6±4.7） ml/s and residual urine was （81.5±42.4） ml. Three out of 38 patients had obvious distal urethral stricture, eight of them suffered from definitely bladder neck contracture and the remaining 27 patients did not show obvious abnormalities measured by cystourethroscopy examination. For the 35 patients without urethral stricture, the most frequent findings of VUDS were high-voiding pressure plus low-flow rate and narrow bladder neck during voiding on simultaneous fluoroscopy examination. With video-urodynamics definition, 32 patients were diagnosed as bladder neck obstruction with mean Qmax of （10.8±3.7） ml/s, residual urine of （76.9±32.7） ml and detrusor pressure at maximum flow （Pdet Qmax） of （50.7±19.1） cmH20. Other three patients were suffered from detrusor hypocontractility. All 32 patients including eight with definitely bladder neck contracture and 24 with primary bladder neck obstruction received transurethral bladder neck incision. The symptom of difficult voiding was relieved. The postoperative follow-up showed that Qrnax was （21.7±7.6） ml/s （P 〈0.01） and the residual urine was （23.2±17.6） ml （P 〈0.01）. Conclusions The real cause of the obstruction for female patient with difficult voiding might be various. A full VUDS would give us valuable information for correct diagnosis in female patients with bladder neck obstruction.

Pharmacokinetics of enteric-coated mycophenolate sodium in Chinese renal transplantation recipients

Background Mycophenolic acid （MPA） as an anti-proliferative immune-suppressive agent is used in the majority of immunosuppressive regimens in solid organ transplantation. This study aimed to investigate the pharmacokinetic （PK） characteristics of enteric-coated mycophenolate sodium （EC-MPS） and area under the curve （AUC） from 0 to 12 hours with limited sampling strategies （LSSs） in Chinese renal transplant recipients. Methods This study was conducted in 10 Chinese renal transplant patients receiving living donor and treated with EC-MPS, cyclosporine, and corticosteroids. MPA concentrations were measured by enzyme multiplied immunoassay technique （EMIT）. Whole 12-hour PK profiles were obtained on Day 4 after operation. LSSs with jackknife technique, multiple stepwise regression analysis, and Bland-Altman analysis were developed to estimate MPAAUC. Results The mean maximum plasma concentration, the mean time for it to reach peak （Tmax）, and the mean MPA AUC were （11.38±2.49） mg/L, （4.85±3.32） hours, and （63.19±13.54） mg.h.L1, respectively. Among the 10 profiles, MPA AUC of four patients was significantly higher than that of the other six patients, and the corresponding Tmax was significantly longer than that of the other six patients. No patient exhibited a second peak caused by enterohepatic recirculation. The best models were as follows： 27.46＋0.94C3＋3.24C8＋2.81C10 （f2=0.972）, which was used to predict AUC of fast metabolizer with a mean prediction error （MPE） of -0.21% and a mean absolute prediction error （MAE） of 2.59%; 36.65＋3.08Ce＋5.30C10-4.04C12 （r2=0.992）, which was used to predict AUC of slow metabolizer with a MPE of 0.58% and a MAE of 1.95%. Conclusions The PKs of EC-MPS had a high variability among Chinese renal transplant recipients. The preliminary PK data indicated the existence of slow and fast metabolizer. These findings may be associated with the enterohepatic rec.irculation.

A Retrospective Study Comparing Surgical and Early Oncological Outcomes between Intracorporeal and Extracorporeal Ileal Conduit after Laparoscopic Radical Cystectomy from a Single Center

Background： Robot-assisted/laparoscopic intracorporeal ileal conduit （ICIC） has been reported in many experienced centers. Whether laparoscopic ICIC is superior to extracorporeal ileal conduit （ECIC） and whether laparoscopic ICIC should be promoted is still controversial. The aim of the study was to compare surgical and early oncological outcomes between patients undergoing laparoscopic radical cystectomy （LRC） with ICIC and ECIC. Methods： From January 2011 to June 2016, a total of 45 patients with bladder cancer underwent LRC with ileal conduit at our department, of whom 20 patients underwent LRC with ECIC and 25 patients underwent LRC with ICIC. Data of each patient＇s characteristics, surgical outcomes, and short-term oncological outcomes were collected and analyzed. Results： LRC with ileal conduit was performed successfully on all 45 patients. There were no significant differences in patients＇ characteristics, mean total operative time, and mean estimated blood loss between the ICIC and ECIC groups. Median time of flatus and oral intake was shorter in the ICIC group compared with the ECIC group （3 vs. 5 days, P = 0.035; 4 vs. 5 days, P = 0.002）. The complications rates did not show significant difference between the two groups within the first 90 days postoperatively （P = 0.538）. Cancer staging showed 45% of patients in the ECIC group and 36% in the ICIC group had a pathologic stage of T3 or T4, and 50% of patients in the ECIC group and 44% in the ICIC group had a pathologic stage of N1 or N1＋. Kaplan-Meier analysis showed no significant difference in overall survival at 24 months （60% vs. 62%, P = 0.857） between the ECIC and ICIC groups. Conclusions： ICIC after LRC may be successful with the benefits of faster recovery time. No significant difference was found in complications and oncological outcomes between ICIC and ECIC. However, larger series with longer follow-up are needed to validate this procedure.

A retrospective comparison of the efficacy and safety in kidney transplant recipients with basiliximab and anti-thymocyte globulin

Background Induction therapy are utilized to achieve an adequate immunosuppression at the time of transplantation. The use of basiliximab or anti-thymocyte globulin （ATG） for induction therapy has significantly reduced the incidence of acute rejection episodes post-transplantation. The purpose of this study was to compare the efficacy and safety of the basiliximab in patients with immuno-induction therapy after kidney transplantation with the ATG. Methods A retrospective analysis was carried out in kidney transplant recipients including 146 patients with the basiliximab and 116 cases with the ATG and the acute rejection, graft function, infective complications and 1-year and 5-year actuarial patient and graft survival after renal transplantation were compared between the two treatment groups. Results There were no statistically significant difference between groups regarding age, sex, cold ischemic time, warm ischemic time, human leukocyte antigen （HLA） matching type between the donor and recipient, lymphotoxin test and the use of immunosuppressive agents. There was no statistical significance regarding the incidence of the acute rejection （9.59% vs. 8.62%, P=0.481） and delayed graft function （10.27% vs. 9.48%, P=0.501） between groups. There were significantly lower lung infection incidence （5.48% vs. 12.93%, P=0.029） in the basiliximab-treated group in comparison with the ATG-treated group. One-year patient and graft survival rates were 98%, 97% for the basiliximab-treated group, and 95%, 73% for the ATG-treated group, respectively. Five-year patient and graft survival rates were 92%, 86% for the basiliximab-treated group and 93%, 72% for the ATG-treated group, respectively. Log rank test showed statistically significant difference with P=0.038 for patients and P=-0.033 for grafts, respectively. There were significantly lower the incidence of granulocytopenia （8.22% vs. 17.24%, P=0.022） and thrombocytopenia （4.11% vs. 19.83%, P=0.000） after transplantation in the basiliximab-treated group in comparison with the ATG-treated group. There was no statistical significance regarding the incidence of the heart dysfunction after transplantation between the two groups （6.16% vs. 6.90%, P=0.502）. Conclusion The immuno-induction therapy with the basiliximab in kidney transplant recipients is efficient and safe with less complication compared with the ATG.

Effects of Bailing capsules for renal transplant recipients： a retrospective clinical study

Background The administration of immunosuppressive agents is always an important factor affecting the long-term survival of organ transplantation recipients. The best therapeutic regimen which either decreases the side effects of immune inhibitors or enhances the immunosuppressive efficacy is the goal of transplantation surgeons continue to search. This study investigated the effects of Bailing （Cordyceps sinensis） capsules on renal function and other systems of the body after renal transplantation. Methods Clinical data of 80 renal transplant recipients who were administered Bailing capsules and 100 renal transplant recipients in the control group were retrospectively analyzed to compare the incidences of graft rejection and infection after transplantation. The results of routine blood and urine tests, liver and kidney functions, uric acid （UA）, 24-hour urine protein （24 h-Upro）, as well as 1- and 5-year patient renal allograft survival rates were compared between the two groups. Results The follow-up was 3-5 years. The two groups were not shown to have statistically significant differences in age, gender, cold ischemia time, donor-recipient human leukocyte antigen typing, panel reactive antibodies, lymphocytotoxicity tests, and the application of immunosuppressive agents at the baseline. The two groups were also not significantly different in the incidence of acute injection after transplantation, recovery of renal function, and blood glucose level. The Bailing group was significantly lower than the control in the incidence of infection, serum aspartate aminotransferase/ alanine aminotransferase, total bilirubin, UA, and 24-hour Upro, but significantly higher than the control group in peripheral red blood cell count and white blood cell count （P〈0.05）. One-year and 5-year patient survival rates were 98.7% and 98.0%, respectively in the Bailing group, 95.0% and 93.0%, respectively, in the control group. One-year and 5-year renal allograft survival rates were 97.5% and 95.0%, respectively, in the Bailing group, and 92.5% and 84.0%, respectively, in the control group. The comparison of patient and renal allograft survival rates between the two groups using Kaplan- Meier survival curves and log-rank test showed that only the differences in renal allograft survival rates were statistically significant （Log-rank： 5 years： patient survival P=0.420; renal allograft survival P=0.049）. Conclusion Bailing capsules were effective in preventing allograft rejection, protecting liver and kidney functions, stimulating hematopoiesis, and reducing the incidence of infection and thus are ideal immunoregulators.

Risk factors of positive surgical margin and biochemical recurrence of patients treated with radical prostatectomy： a single-center 10-year report

Background Many studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with prostate cancer appeared in recent 20 years in China, it is necessary to investigate the risk of positive surgical margin and biochemical recurrence, and their possible impact on the prognosis of patients treated with radical prostatectomy. In this study, we analyzed the characteristics of patients with prostate cancer who had undergone radical prostatectomy in Macao area and tried to find any risk factor of positive surgical margin and biochemical recurrence and their relationship with the proanosis of these oatients.

The organ donation in China

Obrgan transplantation is one of the greatest achievements in the history of medicine during the 20th century. It has changed the practice of traditional medicine wherein the treatment of diseases relies mainly on drugs. Organ transplantation has saved the lives and restored the health in many patients with fatal illness or end-stage organ failure. It has brought a revolutionary change in medical practice and reflects true human wisdom and knowledge. Due to the advances in the organ transplant technology and the basic research in transplant immunology as well as the development of a variety of immunosuppressive agents, organ transplantation has been an effective treatment for patients with organ failure.

Retroperitoneal laparoendoscopic single-site ureterolithotomy versus conventional laparoscopic ureterolithotomy

Background Laparoendoscopic single-site （LESS） surgery through the retroperitoneal approach has been seldom reported.We aimed to evaluate the outcomes of LESS and conventional laparoscopic surgery via the retroperitoneal approach in the management of large,impacted ureteral calculi.Methods Between November 2011 and July 2013,retroperitoneal LESS ureterolithotomy was performed in 12 patients using a homemade single-port device comprising a surgical glove and several strips of tape.Another 16 patients underwent conventional retroperitoneal laparoscopic ureterolithotomy.We compared the operative time,complications,and surgical outcomes,retrospectively.Results All patients were completed without conversion to conventional laparoscopic or open surgery.The operative time of the LESS group and of the conventional laparoscopic group were （125.3±12.8） minutes and （116.9±14.4）minutes,respectively （P=0.119）.The intraoperative blood loss was （42.9±8.9） and （43.4±14.7） ml,respectively （P=0.914）.Postoperative radiologic evaluation revealed that the stones had been removed completely.Cosmetic results were superior in the LESS group （P=0.001）.Conclusion Retroperitoneal LESS ureterolithotomy using a homemade single-port device can be considered a feasible and safe alternative to conventional laparoscopic ureterolithotomy.

Multidetector row-CT in evaluation of living renal donors

Background Multidetector-row CT （MDCT） has been evolving to the standard evaluating method of potential living donor in most centers, and can provide excellent details for selecting candidates and determining surgical technique.This study aimed to assess the value of MDCT in evaluation of the anatomy of living kidney donors and to reveal the prevalence of renal vascular variations in a Chinese population.Methods One hundred and four potential donors underwent MDCT and the data sets were post-processed for reformatted images with various techniques, such as maximum intensity projection （MIP）, a volume-rendering technique （VR）, and multiplanar reformation （MPR）. Donor nephrectomies were performed on 97 candidates after MDCT evaluation with the findings during surgery constituting the standard of reference. Resulting MDCT images were compared with actual anatomy found during surgery. Results The MDCT images accurately displayed the anatomic structure of the main renal arteries and veins as well as the upper ureters, except in one case with horseshoe kidney. The prevalence of accessory arteries revealed in images was 27.2% （28/103） and early branching was found in 12.6% （13/103）. Compared with findings during surgery, the detection of accessory arteries in MDCT images was 85.7% （6/7）, and the detection of larger accessory arteries （〉1.5 mm in diameter） was 100%. Detection of early branching was 100%.Conclusion MDCT helps accurately evaluate the renal anatomy of potential donors thus facilitating the planning of surgery.

Sleep disorders and its related risk factors in patients undergoing chronic peritoneal dialysis

Background The prevalence of sleep disorders has been shown to be high in patients with chronic dialysis patients and may contribute to impaired quality of life and higher mortality in this population.However,there are few data on the relationship of sleep disorders and their risk factors in chronic dialysis patients.The aim of this study was to evaluate the relationship of sleep disorders and their risk factors in chronic dialysis patients.Methods A total of 42 continuous ambulatory peritoneal dialysis （CAPD） patients were involved in this cross-sectional study.Sleep quality was assessed by the Pittsburgh Sleep Quality Index （PSQI）.Restless legs syndrome （RLS） was diagnosed according to the criteria of the International Restless Legs Syndrome Study Group.And depression was assessed by Hamilton depression scale.General information and laboratory data were collected.Results The prevalence of sleep disorders was 47.6％ in the CAPD patients.According to the PSQI,the 42 CAPD patients were divided into sleep disturbance group and non-sleep disorders group.There were no significant differences in age,gender,dialysis duration,hemoglobin,serum creatinine,urea nitrogen,β2-microglobulin,parathyroid hormone,calcium,and phosphorus between CAPD patients with sleep disorders and those without sleep disorders.But the level of serum albumin （AIb） in CAPD patients with sleep disorders was significantly lower than that in CAPD patients without sleep disorders （31.3±1.4 vs.34.3±3.7,t=3.603,P=0.001）.And the prevalence of RLS and depression was significantly higher than that in CAPD patients without sleep disorders （RLS：11/22 vs.1/20,x2=10.395,P=0.001; depression：7/22 vs.1/20,x2=4.886,P=0.027）.In CAPD patients with RLS,the prevalence of sleep disorders was significantly higher than that in CAPD patients without RLS （11/22 vs.11/30,x2=10.395,P=0.001）.And in CAPD patients with depression,the prevalence of sleep disorders was significantly higher than that in CAPD patients without depression （7/8 vs.15/34,x2=4.886,P=0.027）.In CAPD patients,bivariate correlation analysis showed that sleep disorders was negatively correlated with serum AIb （r=-0.606,P=0.000） and positively correlated with RLS （r=0.497,P=0.001） and depression （r=0.341,P=0.029）.Multivariate regression analysis revealed that the odds ratio of RLS,depression,and low serum AIb was 22.900,42.209,and 0.597,respectively.Conclusions The prevalence of sleep disorders was relatively high in CAPD patients.RLS,depression,and low serum AIb were the risk factors for CAPD patients with sleep disorders.

Changes in biochemical parameters on the first day after kidney transplantation： risk factors for nosocomial infection？

Background Nosocomial infection in early post-transplantation period is a tough problem for kidney transplantation. Few reports have explored the relations between biochemical parameters and nosocomial infection in kidney transplantation. This retrospective study was carried out to describe the characteristics of nosocomial infection in the very early period of kidney transplantation and to determine the risk factors in biochemical parameters and their alterations. Methods Patients who underwent their first kidney transplantation from January 2001 to March 2009 in Beijing Chao-Yang Hospital were recruited and the nosocomial infectious episodes were collected for this study. Gender, age, donor type, delayed graft function （DGF） and biochemical parameters such as serum uric acid, lipids files and albumin on day 0 （before transplantation） and day 1 （24 hours after transplantation） and their changes were analyzed with Logistic regression models for nosocomial infection. Results A total of 405 patients （315 men and 90 women） were involved in this study. There were 80 patients experiencing 113 infection episodes and 105 strains of microorganism were indentified. In univariate analysis, there were significant differences in DGF, albumin on day 0, lipoprotein （a） （Lp（a）） on day 1, change in low density lipoprotein-cholesterol （LDL-C, day 1-day 0） and change in uric acid （day 1-day 0） between nosocomial infection patients and noninfectious patients （P 〈0.05）. In multivariate analysis, change in uric acid （day 1-day 0） （OR 5.139, 95% CI 1.176-22.465, P 〈0.05）, change in LDL-C （day 1-day 0） （OR4.179, 95% CI 1.375-12.703, P 〈0.05） and DGF （OR 14.409, 95% CI 1.603-129.522, P 〈0.05） were identified as independent risk factors for nosocomial infection in kidney transplantation. Conclusions Most nosocomial infections in early postoperative period of kidney transplantation are bacterial, especially with Gram-negative bacteria. The most common infection sites are respiratory tract, urinary tract and surgical site. DGF, decrease of LDL-C and increase of uric acid could increase the risk for nosocomial infections.

Retroperitoneal Fibrosis： A Retrospective Clinical Data Analysis of 30 Patients in a 10-year Period

Background:Retroperitoneal fibrosis (RPF) is an uncommon disease that is characterized by development of fibrosclerotic tissues involving retroperitoneal structures.This study aimed to investigate the clinical features of 30 patients with RPF in a single center in Beijing in a 10-year period.Methods:We retrospectively analyzed clinical data on demographic characteristics,clinical manifestations,laboratory findings,radiological findings,modalities of treatments,outcomes and prognosis of 30 patients with RPF.Patients were treated in Beijing Chao-Yang Hospital between January 2003 and December 2013.Results:The mean age of patients with RPF was 56.7 ± 14.4 years.Twenty-three patients were men and seven patients were women.Acute phase reactants were elevated in most patients.Rheumatic factor was positive in 4/25 (16.0％) patients,and antinuclear antibody was positive in 6/22 (27.3％) patients.Elevation of IgG4 was observed in 9/22 (40.9％) patients.The most common type was I + Ⅲ (n =13),followed by Ⅰ + Ⅱ +Ⅲ (n =12).Five patients undertook an 18F-fluoro-deoxy-D-glucose positron emission tomography examination and increased uptake was detected in four patients.Eight patients received combination therapy with glucocorticoids and tamoxifen.Surgical intervention treatments included intraureteral double-J stent implantation (n =26),percutaneous nephrostomy (n =2),open ureterolysis and intraperitonealization of the ureters (n =5) and Iaparoscopic ureterolysis and intraperitonealization of the ureters (n =5).Three patients underwent hemodialysis because of renal failure.Conclusions:Clinical characteristics of RPF patients in our study are similar to those previously reported.Steroids and immunosuppressive therapy combined with ureterolysis could be a viable choice of treatment for RPF.More prospective,multi-center studies with a longer follow-up are warranted.

Role of R.E.N.A.L.Nephrometry Score in Laparoscopic Partial Nephrectomy

Background：Preoperative anatomical scoring system is conducive to comparison between treatment options and evaluation of postoperative outcomes in patients with small renal tumors.This study aimed to evaluate the clinical application efficacy of the R.E.N.A.L.nephrometry score （RNS） in predicting perioperative outcomes in patients with renal tumor who underwent laparoscopic partial nephrectomy （LPN）.Methods：The clinical data of 139 patients with renal tumors who underwent LPN between 2009 and 2015 were collected and analyzed.Patients were divided into three groups according to their RNS （low,moderate,and high）.Clinical characteristics including perioperative variables,complications,and RNS were compared to evaluate the differences between the three groups.Multivariable logistic regression analysis was used to analyze the risk factors of postoperative complications.Results：According to the RNS,there were 74,50,and 15 patients in the low,moderate,and high RNS groups,respectively.There were significant differences in estimated blood loss （EBL;χ^2 =7.285,P =0.026）,warm ischemia time （WIT;χ^2 =13.718,P =0.001）,operation time （OT;χ^2 =6.882,P =0.032）,perioperative creatinine clearance change （PCCC;χ^2 =6.206,P =0.045）,and number of patients with complications （NPC;P =0.002） among the three groups.The values for EBL,WIT,OT,PCCC,and NPC for patients in the high RNS group were higher than those for patients in the low RNS group.After adjustment for OT,WIT,and EBL,RNS was statistically significantly associated with the risk of postoperative complications in a multivariable logistic regression model （odds ratio =1.541,95% confidence interval：1.0592.242,P =0.024）.Conclusions：The RNS is a valuable tool for evaluating the complexity of renal tumor anatomy.It can aid surgeons in preoperative decision-making concerning management therapy.Future multicenter,large sample size studies are warranted for evaluating its predicting performance of perioperative outcomes.