Hautmann R.E.,University of Ulm |
Abol-Enein H.,Mansoura University |
Davidsson T.,University of Bergen |
Gudjonsson S.,Skåne University Hospital |
And 16 more authors.
European Urology | Year: 2013
Context: A summary of the 2nd International Consultation on Bladder Cancer recommendations on the reconstructive options after radical cystectomy (RC), their outcomes, and their complications. Objective: To review the literature regarding indications, surgical details, postoperative care, complications, functional outcomes, as well as quality-of-life measures of patients with different forms of urinary diversion (UD). Evidence acquisition: An English-language literature review of data published between 1970 and 2012 on patients with UD following RC for bladder cancer was undertaken. No randomized controlled studies comparing conduit diversion with neobladder or continent cutaneous diversion have been performed. Consequently, almost all studies used in this report are of level 3 evidence. Therefore, the recommendations given here are grade C only, meaning expert opinion delivered without a formal analysis. Evidence synthesis: Indications and patient selection criteria have significantly changed over the past 2 decades. Renal function impairment is primarily caused by obstruction. Complications such as stone formation, urine outflow, and obstruction at any level must be recognized early and treated. In patients with orthotopic bladder substitution, daytime and nocturnal continence is achieved in 85-90% and 60-80%, respectively. Continence is inferior in elderly patients with orthotopic reconstruction. Urinary retention remains significant in female patients, ranging from 7% to 50%. Conclusions: RC and subsequent UD have been assessed as the most difficult surgical procedure in urology. Significant disparity on how the surgical complications were reported makes it impossible to compare postoperative morbidity results. Complications rates overall following RC and UD are significant, and when strict reporting criteria are incorporated, they are much higher than previously published. Fortunately, most complications are minor (Clavien grade 1 or 2). Complications can occur up to 20 yr after surgery, emphasizing the need for lifelong monitoring. Evidence suggests an association between surgical volume and outcome in RC; the challenge of optimum care for elderly patients with comorbidities is best mastered at high-volume hospitals by high-volume surgeons. Preoperative patient information, patient selection, surgical techniques, and careful postoperative follow-up are the cornerstones to achieve good long-term results. © 2012 European Association of Urology.
PubMed | Zhujiang Hospital
Type: | Journal: Journal of gastroenterology and hepatology | Year: 2016
Virological cure becomes available for most patients with chronic hepatitis C (CHC), but residual fibrosis can be an independent risk factor for liver-related complications. We aimed to characterize fibrosis change in CHC patients achieved virological cure.We did a systematic literature search for studies that had pre- and post-treatment evaluation of histologic fibrosis in CHC patients with sustained virological response (SVR). We identified the association of SVR with the incidence, extent, and velocity of fibrosis change.Overall 3,243 patients were included. Interferon-based regimens were used for all the patients, achieving a median SVR prevalence of 36.2%. Biopsy interval ranged from 1 to 10years. Mean baseline fibrosis score (METAVIR) was 2.3 points. Compared with Non-SVR patients, SVR patients could have higher incidence of fibrosis regression (35.1% vs. 17.0%; OR: 3.3; P<0.001), regardless of baseline fibrosis severity, way of biopsy evaluation, treatment regimen or study design, and could have more extent of reduction (-0.31 points vs. -0.00 points; P=0.004). Baseline advanced fibrosis (F>2) was associated with more rapid regression in both SVR and Non-SVR patients (P<0.05 for both). SVR patients could have lower incidence of fibrosis progression and maintenance than Non-SVR patients by 4.8% vs. 23.1% (OR: 0.20; P=0.008) and 42.9% vs. 55.2% (OR: 0.53; P<0.001), respectively.There could be a favorable characteristic of fibrosis regression in SVR patients. However, residential fibrosis may remain an issue due to a non-ignorable prevalence of fibrosis maintenance among these patients.
PubMed | Nanfang Hospital, Nanfang Hospital and, Southern Medical University, State Key Laboratory of Organ Failure Research and 3 more.
Type: Journal Article | Journal: Blood | Year: 2016
Aging is associated with an increased incidence of venous thromboembolism (VTE), resulting in significant morbidity and mortality in the elderly. Platelet hyperactivation is linked to aging-related VTE. However, the mechanisms through which aging enhances platelet activation and susceptibility to VTE are poorly understood. In this study, we demonstrated that mechanistic target of rapamycin complex 1 (mTORC1) signaling is essential for aging-related platelet hyperactivation and VTE. mTORC1 was hyperactivated in platelets and megakaryocytes (MKs) from aged mice, accompanied by elevated mean platelet volume (MPV) and platelet activation. Inhibition of mTORC1 with rapamycin led to a significant reduction in susceptibility to experimental deep vein thrombosis (DVT) in aged mice (P < .01). To ascertain the specific role of platelet mTORC1 activation in DVT, we generated mice with conditional ablation of the mTORC1-specific component gene Raptor in MKs and platelets (Raptor knockout). These mice developed markedly smaller and lighter thrombi, compared with wild-type littermates (P < .01) in experimental DVT. Mechanistically, increased reactive oxygen species (ROS) production with aging induced activation of mTORC1 in MKs and platelets, which, in turn, enhanced bone marrow MK size, MPV, and platelet activation to promote aging-related VTE. ROS scavenger administration induced a significant decrease (P < .05) in MK size, MPV, and platelet activation in aged mice. Our findings collectively demonstrate that mTORC1 contributes to enhanced venous thrombotic susceptibility in aged mice via elevation of platelet size and activation.
Zhu X.-Y.,Shenyang Northern Hospital |
Qin Y.-W.,Changhai Hospital |
Han Y.-L.,Shenyang Northern Hospital |
Zhang D.-Z.,Shenyang Northern Hospital |
And 7 more authors.
EuroIntervention | Year: 2013
Aims: To assess the immediate and long-term outcomes of transcatheter closure of ventricular septal defect (VSD) in combination with percutaneous coronary intervention (PCI) in patients with VSD complicating acute myocardial infarction (AMI). Methods and results: Data were prospectively collected from 35 AMI patients who underwent attempted transcatheter VSD closure and PCI therapy in five high-volume heart centres. All the patients who survived the procedures were followed up by chest x-ray, electrocardiogram and echocardiography. Thirteen patients underwent urgent VSD closure in the acute phase (within two weeks from VSD) while the others underwent elective closure at a median of 23 days from VSD occurrence. The percentage of VSD closure device success was 92.3% (36/39) and procedure success was 91.4% (32/35). The incidence of in-hospital mortality was 14.3% (5/35). At a median of 53 months follow-up, only two patients died at 38 and 41 months, respectively, and other patients' cardiac function tested by echocardiography improved significantly compared to that evaluated before discharge. Conclusion: The combination of transcatheter VSD closure and PCI for treating VSD complicating AMI is safe and feasible and is a promising alternative to surgery in patients with anatomically suitable VSD and coronary lesion.
Wu X.,Zhujiang Hospital |
Zhou S.,Zhujiang Hospital |
Zhu N.,Third Peoples Hospital of Nanhai District |
Wang X.,Zhujiang Hospital |
And 3 more authors.
Molecular Medicine Reports | Year: 2014
Resveratrol is able to protect myocardial cells from ischemia/reperfusion-induced injury. However, the mechanism has yet to be fully elucidated. In the present study, it is reported that resveratrol has a critical role in the control of Ca2+overload, which is the primary underlying cause of ischemia/reperfusion injury. Hypoxia/reoxygenation (H/R) treatment decreased the cell viability and increased the apoptosis of H9c2 cells, whereas the caspase-3 and intracellular Ca2+levels were greatly elevated compared with the control group. Treatment of H9c2 cells with resveratrol (5, 15 and 30 μM) reduced caspase-3 expression and cardiomyocyte apoptosis in a dose-dependent manner, and the intracellular Ca2+overload was also significantly decreased. Furthermore, Frizzled-2 and Wnt5a belong to the non-canonical Wnt/Ca2+pathway, which have been demonstrated to be responsible for Ca2+overload, and were thus detected in the present study. The results indicated that both the mRNA and protein expression levels of Frizzled-2 and Wnt5a in H/R-induced H9c2 cells were markedly increased compared with the levels found in normal cells, and treatment with resveratrol (5, 15 and 30 μM) significantly reduced the expression of Frizzled-2 and Wnt5a compared with the H/R group. The results indicated that resveratrol protected myocardial cells from H/R injury by inhibiting the Ca2+overload through suppression of the Wnt5a/Frizzled-2 pathway.
Liu X.,Zhujiang Hospital |
Dong C.,East China Normal University |
Jiang Z.,Zhujiang Hospital |
Wu W.K.K.,Chinese University of Hong Kong |
And 5 more authors.
Experimental Cell Research | Year: 2015
Kidney transplantation is the major therapeutic option for end-stage kidney diseases. However, acute rejection could cause allograft loss in some of these patients. Emerging evidence supports that microRNA (miRNA) dysregulation is implicated in acute allograft rejection. In this study, we used next-generation sequencing to profile miRNA expression in normal and acutely rejected kidney allografts. Among 75 identified dysregulated miRNAs, miR-10b was the most significantly downregulated miRNAs in rejected allografts. Transfecting miR-10b inhibitor into human renal glomerular endothelial cells recapitulated key features of acute allograft rejection, including endothelial cell apoptosis, release of pro-inflammatory cytokines (interleukin-6, tumor necrosis factor α, interferon-γ, and chemokine (C-C motif) ligand 2) and chemotaxis of macrophages whereas transfection of miR-10b mimics had opposite effects. Downregulation of miR-10b directly derepressed the expression of BCL2L11 (an apoptosis inducer) as revealed by luciferase reporter assay. Taken together, miR-10b downregulation mediates many aspects of disease pathogenicity of acute kidney allograft rejection. Restoring miR-10b expression in glomerular endothelial cells could be a novel therapeutic approach to reduce acute renal allograft loss. © 2015.
Zhang Y.,Nanfang Hospital |
Li L.,Zhujiang Hospital |
Wang J.,Nanfang Hospital |
Li Z.-H.,Nanfang Hospital |
Shi Z.-J.,Nanfang Hospital
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2013
Purpose: To undertake a meta-analysis of randomized controlled trials to determine whether routine use of a tourniquet is a better choice for knee arthroscopic procedures. Methods: Randomized controlled trials which evaluated the application of a tourniquet were selected, gathering information about arthroscopic visualization and operative time. The random-effects meta-analysis was performed using relative risk calculated from the raw data. Results: A total of five eligible studies were selected in this meta-analysis with 471 participants. There was no significant difference in visualization or operative time between the tourniquet and the non-tourniquet group. Conclusions: There is insufficient evidence to support the hypothesis that patients would benefit from routinely applying a tourniquet. The use of a tourniquet did not show any advantage to arthroscopic procedures. Level of evidence: Therapeutic randomized controlled trials, Level I. © 2012 Springer-Verlag.
Zhang Y.,Nanfang Hospital |
Li L.,Zhujiang Hospital |
Shi Z.-J.,Nanfang Hospital |
Wang J.,Nanfang Hospital |
Li Z.-H.,Nanfang Hospital
European Journal of Orthopaedic Surgery and Traumatology | Year: 2013
Background and purpose: Femoral head necrosis (FHN) is a debilitating disease which seriously affects the patients' quality of life, especially the young. The porous tantalum rod has the advantages of high volumetric porosity, low modulus of elasticity, and excellent osteoinduction, with exceptional biocompatibility and safety record in clinical application, which makes it an ideal choice for FHN patients. However, there has not been a systematic analysis for its efficacy and safety. Methods: This meta-analysis of six randomized controlled trials and controlled clinical trials with 256 participants was performed to investigate the efficacy and safety of porous tantalum rod, by means of comparing with vascularized or non-vascularized bone grafting. Results: Porous tantalum has its advantages in functional evaluation of Harris Hip Score, with a significant lower incidence of femoral head collapse. The surgical blood loss is low and the operative time is short with no increase in complication rate. Interpretation: Our preliminary analysis provided that the porous tantalum rod was a less invasive method and was effective and well tolerant for early-stage FHN patients. Further specially designed clinical trials for long-term follow-up and socioeconomic assessment are needed before a final determination. © 2012 Springer-Verlag.
Liu X.Y.,Zhujiang Hospital
Xi bao yu fen zi mian yi xue za zhi = Chinese journal of cellular and molecular immunology | Year: 2011
To explore the role of miR-223 in the acute rejection after kidney transplantation. 33 patients who received kidney transplantation in our hospital within a year were collected and 12 of them appeared acute rejection within 1 month after surgery. In all the patients, the peripheral blood miR-223 level was collected and detected by blind arrangements. Furthermore, PBMCs from healthy volunteers were also collected and stimulated by PHA and then miR-223 level was measured. In the peripheral blood cell, the miR-223 was increased 2 times after acute rejection, as well as 3. 76 times after PHA treatment.Furthermore, using miR-223 predicts AR had a specificity of 90% and sensitivity of 92%. The miR-223 may have significant role in the acute rejection of kidney transplantation.
Xu A.,Zhujiang Hospital |
Zou Y.,Zhujiang Hospital |
Li B.,Zhujiang Hospital |
Liu C.,Zhujiang Hospital |
And 6 more authors.
Journal of Endourology | Year: 2013
Purpose: We compared the safety and efficacy of diode laser enucleation of the prostate (DiLEP) with plasmakinetic enucleation and resection of the prostate (PKERP). Patients and Methods: A total of 80 patients with bladder outflow obstruction from benign prostatic hyperplasia (BPH) were randomly assigned to either DiLEP or PKERP prospecticny CHNely. All patients were assessed preoperaticny CHNely and followed up at 3, 6, and 12 months postoperaticny CHNely. Baseline characteristics of the patients, perioperaticny CHNe data, and postoperaticny CHNe outcomes were compared. The operaticny CHNe data and perioperaticny CHNe and postoperaticny CHNe complications were also recorded. Results: The preoperaticny CHNe data were comparable between the two groups. The DiLEP group had significantly shorter operaticny CHNe time, postoperaticny CHNe irrigation, time and catheterization time than the PKERP group (P=0.000, P=0.000 and P=0.000). The drop in hemoglobin lecny CHNel was statistically significantly less in the DiLEP group (P=0.002). There were no statistical differences in complications between the two groups except irritaticny CHNe symptoms (P=0.018). At the 3, 6, and 12-month follow-up, no statistically significant differences were obsercny CHNed between the two groups in International Prostate Symptom Score, maximum flow rate, quality of life, postcny CHNoid residual, prostate cny CHNolume, and prostate-specific antigen lecny CHNel (P>0.05). Conclusions: The efficacy of DiLEP and PKERP were similar for reliecny CHNing obstruction and low urinary tract symptoms. DiLEP procny CHNides less risk of hemorrhage, reduced bladder irrigation, and catheter times. The downward morcellation technique is more efficient than the resection technique. Future well designed randomized trials with extended follow-up and larger sample sizes may be needed to better cny CHNerify the adcny CHNantage of DiLEP in treating patients with symptomatic BPH. © Mary Ann Liebert, Inc.