Zhang Xiaopeng

Treatment of Hyperhomocysteinemia and Endothelial Dysfunction in Renal Transplant Recipients With B Vitamins in the Chinese Population

PURPOSEnWe studied the efficacy of B vitamins as a treatment for hyperhomocysteinemia and endothelial dysfunction in renal transplant recipients in the Chinese population.nnnMATERIALS AND METHODSnA total of 36 stable renal transplant recipients with hyperhomocysteinemia were randomly assigned to folate treatment (5 mg folic acid per day, 50 mg vitamin B6 per day and 1,000 microg vitamin B12 per day) or to the control group (placebo only) for 6 months. All subjects underwent tests for creatinine, creatinine clearance rate, average blood pressure, total cholesterol, triglyceride and fasting homocysteine. Endothelial function was evaluated using high resolution vascular ultrasound.nnnRESULTSnHomocysteine significantly decreased in those with folate treatment after intervention compared with baseline (12.6 +/- 3.9 vs 20.1 +/- 5.4 micromol/l, t = 5.3, p <0.01), whereas no significant changes were observed in controls. In the folate treatment group endothelium dependent and independent vasodilatation responses significantly increased after intervention (12.2% +/- 4.6% vs 8.8% +/- 5.2%, t = 2.9, p <0.01 and 17.6% +/- 3.9% vs 12.2% +/- 4.7%, t = 3.4, p <0.01, respectively). However, no significant changes were observed in controls. Endothelium dependent and independent vasodilatation responses were significantly lower in controls compared to levels in the folate group after treatment (8.7% +/- 6.3%, t = 2.8, p <0.01 and 12.2% +/- 5.3%, t = 3.5, p <0.01, respectively).nnnCONCLUSIONSnBased on these data B vitamin supplementation may decrease blood homocysteine and improve endothelial function in renal transplant recipients with hyperhomocysteinemia.

Diagnostic factor of N staging in rectal carcinoma: A computered tomography study corelated with pathological finding

ObjectiveTo investigate the characteristic findings in CT images associated with N-staging of rectal carcinoma.MethodsFifty nine patients underwent radical resection for rectal carcinoma after preoperative CT examinations. pN0, pN1, and pN2 were classified based on the pathological examination of excised specimens according to the AJCC N-staging criterion. Images were reviewed by two radiologists using CT cine blindly, reaching a consensus on size, number and distribution of lymph nodes, serosa behavior and circumferential infiltration of rectal carcinoma. The relationship between lymph node metastases and CT findings was analyzed statistically with SAS using k-w test and x2 test.ResultsLymph nodes were depicted in all node-positive cases. The mean diameters of the largest nodes displayed in the groups of pN0, pN1, pN2 were 3.84 mm, 5.60 mm and 6.79 mm respectively; the diameters showed a statistically significant increase with N-stage developing (H=23.842, P<0.01). The mean numbers of lymph nodes in the groups of pN0, pN1 and pN2 were 3.0, 4.5 and 9.0 respectively, which also showed an increasing trend and significant differences from each other (H=21.834, P<0.01). The summation diameters of all depicted nodes also showed a significant difference in the N0, N1 and N2 groups (H=32.037, P<0.001). Positive nodes were seen in 25% (3/12) of cases with perirectally displayed nodes, in 58.6%(17/29) of cases with lymph nodes distributed both perirectally and along the superior rectal artery, and in 72.7%(8/11) of cases with nodes detected along iliac vessels combined with either one of the previous two distributions patterns. The distribution patterns of lymph nodes were significantly different in N0, N1 and N2 groups (x2 = 19.517, P<0.05). The disorder of serosa behavior and circumferential infiltration of rectal carcinoma were more likely to occur in node positive group than negative group with statistical significance (x2=8.979, P<0.01, x2=5.107, P<0.05).ConclusionComprehensively considering the size, number, distribution of depicted lymph node, as well as serosa disorder and circumferential infiltration of rectal carcinoma would be helpful for improving the N-staging of CT in patients with rectal carcinoma preoperatively.

Repair of a small and crooked vesicovaginal fistula using electrocauterization

Vesicovaginal fistula (VVF) is an abnormal opening between the urinary bladder and the vagina. The condition has an immense psychological effect on patients due to the continuous leakage of urine or watery vaginal discharge. The wet feeling and foul smell associated with leakage of urine cause social outcasting of the patients. This leads to immense emotional trauma and makes life miserable for the patient. The most common etiology for VVF in developing countries is obstructed labour [1], and in developed countries, it is abdominal hysterectomy [2]. VVF poses a challenging problem to the surgeon. The location and the size of the fistula determine the extent of the patients’ symptoms. The transvaginal and abdominal routes (open, laparoscopic, or robotic) are the two approaches currently in vogue for the repair of VVF. However, some surgical procedures for fistula repair may worsen the situation for these patients. The appropriate surgical procedure needs to be chosen based on the particular condition of the fistula. The two patients in our research study, who have a small and crooked VVF, showed a poor prognosis after a cystoscopic holmium laser ablation. Therefore, electrocauterization was tried on them. The objective of the present study is to describe the management of a small and crooked VVF using electrocauterization, with the specific aims of avoiding the disadvantages associated with using the abdominal route, thereby minimizing the surgical trauma andmaximizing the prognosis. Two women admitted to Peking University People’s Hospital with vesicovaginal fistula were recruited for this study. The demographic information of the patients was shown in Table 1. They had a history of multiple uterine fibroids and endometriosis and underwent a hysterectomy. The patients developed continuous dribbling of urine 1 month after the operation, which was associated with position change and an increase of abdominal pressure. Physical symptoms and any illness were assessed prior to surgery. A speculum examination of both patients did not