Lidocaine-containing Euro-Collins solution prevents renal injury in the isolated perfused canine kidney exposed to prolonged cold ischemia

Previous studies have reported a decreased incidence of delayed graft function after cadaveric transplantation with the use of lidocaine pretreatment of the donor. We evaluated the effects of lidocaine on prolonged cold ischemia and reperfusion injury in a canine model of isolated kidney perfusion (IPK). The purpose of this study was to evaluate the renal function of isolated perfused canine kidneys after 48 h of cold storage with Euro-Collins (EC) solution or EC solution plus lidocaine. Isolated perfused canine kidneys were randomized into four groups which contained six kidneys: I) cold flush with EC solution and immediately reperfused, II) cold flush with EC solution plus lidocaine and immediately reperfused, III) 48 h of cold storage with EC and reperfusion, IV) 48 h of cold storage with EC solution plus lidocaine and reperfusion. The measured renal functions were glomerular filtration rate, urine production, perfusate flow, urinary lactic dehydrogenase (ULDH), Na reabsorptive capacity, and tissue MDA levels. Histological examination was performed after reperfusion. The tubular functions of kidneys preserved with EC solution containing lidocaine were better when compared with the kidneys preserved with EC alone. Tubular injury marker levels (ULDH) in group IV were significantly lower than in group III and lidocaine also reduced lipid peroxidation during reperfusion. This is in agreement with the histological results. The results of the present study can be taken as evidence of the cytoprotective effect of lidocaine, which may therefore be accepted as a useful agent for kidney preservation.     

Reduced expression of inflammatory genes in deceased donor kidneys undergoing pulsatile pump preservation

Background

The use of expanded criteria donor kidneys (ECD) had been associated with worse outcomes. Whole gene expression of pre-implantation allograft biopsies from deceased donor kidneys (DDKs) was evaluated to compare the effect of pulsatile pump preservation (PPP) vs. cold storage preservation (CSP) on standard and ECD kidneys.

Methodology/Principal Findings

99 pre-implantation DDK biopsies were studied using gene expression with GeneChips. Kidneys transplant recipients were followed post transplantation for 35.8 months (range = 24–62). The PPP group included 60 biopsies (cold ischemia time (CIT)  = 1,367+/−509 minutes) and the CSP group included 39 biopsies (CIT = 1,022+/−485 minutes) (P<0.001). Donor age (42.0±14.6 vs. 34.1±14.2 years, P = 0.009) and the percentage of ECD kidneys (PPP = 35% vs. CSP = 12.8%, P = 0.012) were significantly different between groups. A two-sample t-test was performed, and probe sets having a P<0.001 were considered significant. Probe set level linear models were fit using cold ischemia time and CSP/PPP as independent variables to determine significant probe sets (P<0.001) between groups after adjusting for cold ischemia time. Thus, 43 significant genes were identified (P<0.001). Over-expression of genes associated with inflammation (CD86, CD209, CLEC4, EGFR2, TFF3, among others) was observed in the CSP group. Cell-to-cell signaling and interaction, and antigen presentation were the most important pathways with genes significantly over-expressed in CSP kidneys. When the analysis was restricted to ECD kidneys, genes involved in inflammation were also differentially up-regulated in ECD kidneys undergoing CSP. However, graft survival at the end of the study was similar between groups (P = 0.2). Moreover, the incidence of delayed graft function was not significant between groups.

Conclusions/Significance

Inflammation was the most important up-regulated pattern associated with pre-implantation biopsies undergoing CSP even when the PPP group has a larger number of ECD kidneys. No significant difference was observed in delayed graft function incidence and graft function post-transplantation. These findings support the use of PPP in ECD donor kidneys.     

Renal preservation by hypothermic perfusion. I. The importance of pressure-control

Rabbit kidneys were preserved by hypothermic perfusion at 5 °C using a perfusate containing an extracellular balance of ions, dextran and bovine serum albumin. Two groups were studied: in one, the pressure was kept constant at 40 mm Hg, while in the other the flow was maintained at 13 ml/min. The mean flows in the two groups were similar but the resistance of the kidneys perfused under constant-flow conditions was lower and more stable: the vascular resistance in the constant-pressure group showed considerable fluctuations throughout the 24 hr perfusion period. The function of the kidneys was assessed by autotransplantation with immediate contralateral nephrectomy. The constant-pressure group functioned better in all respects: the proportion of animals surviving was higher, the postoperative blood urea and creatinine levels were lower, and histological examination of the kidneys revealed less damage. It is concluded that constantpressure perfusion should be preferred to constant-flow perfusion. These experiments confirmed that there is a correlation between potassium release into the perfusate and subsequent function, and an unexpected inverse correlation was observed between the perfusate glucose level and subsequent function. Possible reasons for this are discussed.     

Ice Storage versus Perfusion for Preservation of Kidneys before Transplantation

The results of simple ice storage and prolonged perfusion storage of kidneys were compared in two series, each of 100 cadaver kidney transplants. There was a similar warm ischaemia time for both groups, but the average total storage time was 17 hours for the perfused kidneys as compared to three and a half hours for those stored in ice. The results of transplantation (as shown by transplant function at three and 12 months) were the same for both groups. There was no evidence of damage due to prolonged perfusion. The extra time, however, enabled a more convenient operation time to be chosen and more extensive tissue matching to be undertaken.     

兔肾积水模型的建立及SPECT和CT灌注成像

目的探索建立肾盂输尿管连接部梗阻所致肾积水的动物模型的可行性;探讨CT灌注成像对积水肾脏肾功能的评估价值。方法10周龄雄性新西兰兔50只随机分组,假手术组20只,分离左侧输尿管后直接关腹。模型组30只,选用腰大肌包埋输尿管造成左侧肾盂输尿管连接部梗阻。术前两组进行单光子发射计算机体层成像（SPECT）比较左肾功能,检验无差异后在术后3月分别行左肾SPECT、CT灌注,以病理检查为佐证,观察两组参数变化,进行CT灌注各项参数和GFR的统计学相关性分析。结果模型组建模成功达70%,呈慢性肾积水病理表现,左肾皮髓质CT灌注参数BF、BV、PS均下降,与相应GFR呈高度正相关。结论腰大肌包埋输尿管的模型制作方法具有可行性。CT灌注参数可作为肾功能状态的评定指标,具有一定的临床指导意义。     

SPECT 对症状性颅内动脉狭窄支架成形术的疗效评价

目的:通过SPECT脑血流灌注显像,对症状性颅内动脉粥样硬化性狭窄行颅内支架成形术,进行血流动力学的疗效评价。方法:对42例症状性颅内动脉粥样硬化性狭窄(狭窄程度>50%)患者,术前通过SPECT,分为低灌注组和正常灌注组。术后3月复查SPECT,做出血流动力学的疗效评价。通过术前及术后1年mRS评分,比较两组的远期疗效。结果:低灌注组发病症状一般为缺血性卒中,正常灌注组一般为TIA(P<0.01)。低灌注组术后血流灌注较术前改善明显(P<0.01)。正常灌注组复发性TIA的发生率较低灌注组高(P<0.05)。低灌注组术前术后mRS评分有统计学差异(P<0.05)。结论:颅内支架成形术可以明确改善颅内低灌注区的血流灌注,对低灌注组术后缺血事件的预防效果好,并有改善神经功能作用。因此,存在颅内低灌注区的患者更具有颅内支架成形术的手术适应症。     

Preservation of Human Kidneys for Transplantation: Preliminary Results with a Gambro Perfusion Machine

Twenty-six human cadaveric kidneys have been preserved for up to 36 hours by continuous perfusion with 4·5% albumin solution on a Gambro machine. Of these, 20 kidneys were transplanted, and six were discarded owing to poor perfusion characteristics during storage. Immediate function was obtained with four kidneys, of which two had been preserved for over 30 hours.Satisfactory renal function has been obtained with 17 kidneys, and three kidneys were lost owing to rejection or technical complications. It is our experience that human kidneys can be successfully preserved for up to 36 hours by this technique.     

TURBT术后灌注不同剂量丝裂霉素对肿瘤复发的影响

目的:探讨经尿道膀胱肿瘤电切术(Transurethral resection of bladder tumor,TURBT)术后灌注不同剂量丝裂霉素对非肌层浸润性膀胱肿瘤(Non-muscularized invasive bladder tumor,NIMBC)复发率的影响。方法:选择三原县医院2013年1月至2016年12月收治的90例NIMBC患者,根据入院先后顺序分为A、B、C三组,A组TURBT后即刻给予20 mg丝裂霉素,B组给予30 mg丝裂霉素,C组给予40 mg丝裂霉素,对比三组患者术后不同时间点的复发率、平均复发时间、膀胱刺激综合征及其他不良反应。结果:三组术后不同时间点NIMBC复发率为A组B组C组。术后12个月、18个月、24个月时A组的复发率明显高于C组(P0.05),其余时间点组间对比无统计学意义(P0.05)。三组膀胱刺激综合征发生率C组B组A组,但组间对比无统计学意义(P0.05)。三组患者均完成丝裂霉素灌注治疗,未出现因严重膀胱刺激征无法耐受而中断膀胱治疗者。本研究所有患者灌注后未发现骨髓抑制、肝肾功能异常者。结论:TURBT术后即刻应用40 mg丝裂霉素,可显著降低患者的NIMBC复发率,通过术前、术后服用琥珀酸索利那新,可降低患者的膀胱刺激综合征,辅助患者完成TURBT术后丝裂霉素灌注化疗。     

Function of rabbit kidneys in vitro at normothermia following equilibration with 3.0 M Me2SO and removal by hypertonic washout at 10 degrees C

In the present study, rabbit kidneys were assayed for function on a 37 °C in vitro perfusion system after perfusion on a 10 °C perfusion system which permits the slow introduction and removal of cryoprotectant. The final concentration of 3.0 M Me₂SO was introduced slowly at two different rates. The washout was achieved by perfusion with Me₂SO-free solutions made hypertonic with mannitol. Two regimens of washout were used: 800, 700, 600, 500, and 400 mOsm/kg; and 600, 500, and 400 mOsm/kg.During perfusion at 37 °C, the glomerular filtration rate was similar in all groups and this increased significantly in all groups with time. Protein leakage was minimal. All three Me₂SO groups showed a depressed Na reabsorption capacity, but the 800 mOsm group was the most severely affected. This was also found with glucose reabsorption. We concluded that rabbit kidneys will function well with the cryoprotectant Me₂SO up to 3 M concentration when introduced slowly and washed out with hypertonic mannitol beginning at 600 mOsm/kg. When 800 mOsm is used at the initial step, the proximal tubular function is severely affected.     

微创后入路治疗肩胛骨骨折的临床研究

目的:探讨微创后入路手术治疗肩胛骨骨折的临床疗效。方法:选取2009年6月~2014年1月在我院接受后路内固定手术治疗的40例肩胛骨骨折,治疗组20例,行微创后入路内固定术,对照组20例,行Judet入路内固定术。比较两组间手术时间、术中出血量、切口总长度及术后肩关节功能Constant评分。结果:40例患者均获随访,随访时间12~36个月,平均16.5个月。治疗组手术时间、术中出血量、切口总长度均优于对照组(均P0.05),术后6个月肩关节功能:治疗组优15例,良3例,可1例,差1例,优良率90%,对照组优14例,良2例,可3例,差1例,优良率80%。两组优良率比较,差异有统计学意义(P0.05)。两组均无感染、骨折延迟愈合或不愈合。对照组1例发生肩胛上神经卡压。结论:微创后入路手术操作简单,创伤小,恢复快,是一种安全有效的肩胛骨骨折手术入路。     

手术时机的选择对股骨颈骨折患者术后髋关节功能的影响

目的：探讨手术时机的选择对股骨颈骨折患者行关节置换术后髋关节功能的影响,为临床骨科手术提供参考。方法：回顾性 分析117 例在我院接受关节置换术的股骨颈骨折患者的临床资料。根据手术时机不同,将患者分为急诊组和择期组,比较两组手 术效果,评价患者术后髋关节功能。结果：急诊组患者的手术时间、术中出血量及住院时间均优于择期手术的患者,差异有统计学 意义（P<0.01）;两组患者术后并发症的发生率无显著差异（P>0.05）;术后1 个月,急诊组患者的Harris 评分高于择期组,差异有统 计学意义（P<0.01）;术后3 个月,两组Harris评分无统计学差异（P>0.05）。结论：股骨颈骨折患者行急诊手术不但缩短手术时间、 降低术中出血量,而且术后对患者的髋关节功能影响较小,有利于恢复。     

Function and quality of kidneys after cold storage, machine perfusion, or retrograde oxygen persufflation: Results from a porcine autotransplantation model

Objectives

Especially for preservation of marginal donor organs, machine perfusion (MP) and retrograde oxygen persufflation (ROP) are alternatives to cold storage (CS). Using a porcine kidney autotransplantation model we compared metabolic and morphologic effects of CS, ROP, and MP on kidneys exposed to warm ischemia.

Methods

Kidneys of 21 pigs were exposed in situ to warm ischemia for 60 min. The kidneys were randomly allocated to three experimental groups, each receiving a 4-h treatment of either cold storage, machine perfusion, or retrograde oxygen persufflation. Tissue samples were examined for malondialdehyde and histological changes. Daily blood samples were examined for creatinine levels.

Results

Seven days after transplantation, the plasma creatinine levels in the CS and MP groups were still significantly elevated above the baseline values. In the ROP group, all animals exhibited nearly normal creatinine levels. Malondialdehyde, an indicator of lipidperoxidation, was dramatically increased in the machine perfused kidneys on day 7, whereas the malondialdehyde levels in the other two groups were near normal values. The MP kidneys exhibited the most striking histological changes.

Conclusion

Though MP has been well introduced in organ transplantation, in our opinion, it must still be optimized and standardized. It is necessary to clarify questions such as whether there is a need for oxygenation during perfusion, the length of perfusion, the impact of pressure, and the effects of additional scavengers. The results of the present study suggest the reconsideration of the ROP-technique for the preservation of predamaged donor grafts especially of NHBD and further studies, comparing MP and ROP upon long term preservation are strongly encouraged.     

持续静态牵伸技术在肘关节康复训练患者中的临床疗效观察

为了探讨肘关节骨折患者行骨折术后采用持续静态牵伸技术结合常规功能康复的应用效果,并揭示其对患者生活质量的影响,本研究选取我院手术治疗的84例肘关节骨折患者,收集时间为2015年1月至2016年12月,其中42例患者术后接受常规功能康复(常规组)、另外42例患者在常规功能康复基础上加用持续静态牵伸技术(研究组),观察两组患者术后3个月和6个月时的肘关节功能和生活质量的差异。研究显示,术后3个月和6个月,研究组的疼痛、功能、矢状面活动、肌肉力量、屈曲挛缩、旋前、旋后评分均显著高于常规组(p<0.05);术后6个月,研究组的FIynn肘关节功能评价(优78.57%,良16.67%,可4.76%)优于常规组(优57.14%,良30.95%,可11.90%),差异具有统计学意义(p<0.05);两组患者术前生活质量无差别。术后3个月,研究组患者躯体功能、肢体疼痛等生活质量得分高于常规组。本研究表明,肘关节骨折患者行骨折术后采用持续静态牵伸技术结合常规功能康复可显著改善患者术后的肘关节功能,值得临床推广应用。     

对侧皮质锁定螺钉与锁定螺钉治疗股骨远端骨折疗效比较

目的:比较对侧皮质锁定螺钉与锁定螺钉治疗股骨远端骨折的临床疗效。方法:回顾性分析自2013年5月至2016年8月诊治的52例股骨远端骨折患者,采用对侧皮质锁定螺钉+NCB接骨板内固定治疗26例(A组:对侧皮质锁定组),采用锁定螺钉+NCB接骨板内固定治疗26例(B组:锁定螺钉组)。记录两组手术出血量和手术时间、切口长度、内固定治疗后骨折愈合时间、内固定治疗后完全负重时间、内固定治疗后并发症发生率等,在每个随访节点对每位患者进行患肢的正侧位X线平片检查,末次随访时对患肢进行膝关节功能评分,采用美国特种外科医院膝关节评分标准评定患肢功能。骨折愈合的定义为活动时骨折处无痛且在骨折正侧位X线平片上可见到断端骨皮质骨痂连接。术后并发症包括:关节僵硬、内固定断裂、骨不连以及感染等。结果:本研究52例骨折均获得至少12个月的随访。两组在手术相关指标及切口愈合等方面均无明显差异(P均0.05)。在骨折愈合以及完全负重时间方面,A组均显著短于B组(P均0.05)。末次随访时52例患者患肢膝关节功能:A组:优18例,良5例,差4例,优良率88.5%;B组:优15例,良6例,中4例,差1例,优良率80.8%。两组对比A组优良率显著高于B组(P0.05)。两组并发症对比无明显差异:A组发生骨不连2例,骨折内固定断裂2例。B组发生骨不连3例,畸形愈合2例。结论:与传统锁定螺钉相比,对侧皮质锁定螺钉在骨折愈合时间、完全负重时间、术后患肢功能优良率方面具有优势,但在并发症发生率方面没有明显差异。对侧皮质锁定螺钉的治疗指征及自身强度还有待大样本、多中心的临床研究进一步明确。     

颈动脉支架置入术后患者认知功能的变化及CT灌注成像技术的疗效评估价值研究

目的:探讨颈动脉狭窄患者在行颈动脉支架置入术后认知功能的变化情况,并分析CT灌注成像(CTP)对手术疗效的评估价值。方法:选取2015年10月到2018年3月在济宁医学院附属日照市人民医院接受治疗的颈动脉狭窄患者80例,其中有症状性颈动脉狭窄患者49例作为有症状组,无症状性颈动脉狭窄患者31例作为无症状组。所有患者均接受颈动脉支架置入手术及CTP检查,采用蒙特利尔认知评估量表(MoCA)、简易智能精神状况量表(MMSE)、搭火柴测验(Stick Test)综合评价颈动脉狭窄患者的术前、术后1周、术后3个月、术后6个月认知功能的变化情况,比较有症状组和无症状组患者的CTP相对灌注参数。结果:术后1周,颈动脉狭窄患者的MoCA总分、视空间/执行能力、注意力、延迟回忆以及MMSE总分、Stick Test总分较术前有所降低(P0.05);术后3个月、术后6个月,颈动脉狭窄患者的MoCA总分、视空间/执行能力、注意力、延迟回忆以及MMSE总分、Stick Test总分较术前有所升高(P0.05)。术前,有症状组的相对血流达峰时间、相对平均通过时间长于无症状组,相对脑血流量低于无症状组(P0.05);术后1周,无症状组的相对血流达峰时间较术前有所缩短,且短于有症状组(P0.05);术后1周,有症状组的相对血流达峰时间、相对平均通过时间较术前有所缩短,相对脑血流量较术前有所升高(P0.05);两组术前、术后1周相对脑血容量比较均无统计学差异(P0.05)。结论:颈动脉支架置入术后患者会出现暂时的、可逆的认知功能恶化,但最终认知功能会得到明显的改善。CTP可发现异常的脑灌注情况,同时能够较好地评价颈动脉支架置入术治疗颈动脉狭窄患者的疗效。     

大鼠爬板实验装置的设计制作及其在脑损伤实验中的应用

目的设计制作一种大鼠爬板实验装置,以使科研工作者能轻松快捷地通过爬板实验检测大鼠脑损伤后神经功能的改变,并提高实验数据的准确性。方法将成年雄性SD大鼠随机分为Tβ4组、PBS组和sham组。分别采用新装置和原装置对3组大鼠进行爬板实验,检测记录术后1～7d的神经功能缺失评分,并进行统计分析。结果用新装置进行检测：Tβ4组和PBS组的神经功能缺失评分均在逐步平缓下降,5 d后,仍可检测到神经功能缺失;两组之间的差异（P〈0.05）在3 d后,均可检出。Tβ4组与sham组之间的差异（P〈0.05）,前3d均可检出。PBS组与sham组之间的差异（P〈0.05）,术后一直可以检出。用原装置进行检测：Tβ4组和PBS组的神经功能缺失评分呈跳跃式下降,5 d后,不再能检出神经功能缺失;两组之间的差异（P〈0.05）,只在第4天时检出。Tβ4组与sham组之间的差异（P〈0.05）,只在前2 d检出。PBS组与sham组之间的差异（P〈0.05）,只前在前4 d检出。结论新的实验装置制作简单,实验操作便利;可以提高实验数据的准确性,能更好地检测出因实验因素所造成的统计学差异。     

Renal preservation by hypothermic perfusion. IV. The use of gelatin polypeptides as the sole colloid

Rabbit kidneys were perfused with a solution of extracellular electrolyte composition, rendered hypertonic with glucose and containing 1.75% Haemaccel (Hoechst) as the sole colloid. Perfusions were carried out at 10 °C for 24 and 48 hr using perfusion pressures of 20 or 40 mm Hg. Function, was tested by autografting with immediate contralateral nephrectomy. All the kidneys perfused at 20 mm Hg for 24 hr showed excellent life-sustaining function and 7 of 10 survived in the 40 mm Hg group; the difference was not statistically significant. However, all the kidneys perfused for 48 hr failed to sustain life, and histological examination revealed extensive breakdown of the microcirculation. The 24 hr results were similar to those previously obtained with an albumin-based perfusate, but the 48-hr results were inferior: However, the obvious advantages of a well-standardised, cheap, and easily stored perfusate are such as to justify further study of gelatin-derived colloids for organ preservation.     

Ultrasonographic assessment of kidney dimensions in first six months of life

The kidney growth in children is not linear. The aim of this study was to define normal dimensions of kidneys in healthy infants during the first six months of life. A prospective ultrasonographic screening of 1870 kidneys in 935 healthy full-termed infants (476 males, 459 females) was done throughout a 5-year period. Measured kidneys were divided into six age groups according to gender and side. In the first three months of life males had both kidneys longer than same-age females (p < 0.05). In the next three-month-period the difference between sexes was not significant (p > 0.05). Left kidneys were longer than right kidneys in both sexes in the first six months of life (p < 0.01). Four nomograms with normal values of kidney lengths, according to age, sex and side were done in newborns and infants in the first 6-months of life.