Objective:To assess the evidence for relevant factors associated with mortality in COVID-19 kidney transplantation recipients(KTR) through Meta-analysis.Methods:A complete search of PubMed, Web of Science, Medline, Scopus, Cochrane Library, CNKI and Wanfang Database were performed to search for eligible studies on 18 August 2022.Results:twenty-nine studies involving 7 978 Cases were included in our Meta-analysis.Patients with mean age ≥60 years( OR=1.09, 95% CI: 1.06-1.13), Comorbidities including diabetes mellitus( OR=1.49, 95% CI: 1.26-1.76), cardiovascular disease( OR=1.88, 95% CI: 1.33-2.65), and acute kidney injury( OR=3.46, 95% CI: 1.35-8.89) significantly increased mortality risk.KTR with dyspnea ( OR=2.17, 95% CI: 1.38-3.42), higher Hemoglobin ( OR=1.09, 95% CI: 1.00-1.19), Use of mycophenolic ( OR=1.18, 95% CI: 1.02-1.37) and Antibiotics( OR=7.26, 95% CI: 2.11-25.07) at presentation were at higher mortality risk, while diarrhea( OR=0.57, 95% CI: 0.34-0.96) and higher eGFR( OR=0.95, 95% CI: 0.92-0.98) decreased the risk.Overall in-hospital mortality in COVID-19 KTR was 19%, 95% CI: 15%-23%. Conclusions:Our systematic review and -analysis results suggest that overall in-hospital mortality in COVID-19 KTR declined progressively over time.KTR with these risk factors should receive more intensive monitoring and early therapeutic interventions to optimize health outcomes.

Objective:To examine the location and the reparative impact of iatrogenic ureteral injury.Methods:Retrospectively analyzed the clinical data of 43 patients with iatrogenic ureteral injury admitted from May 2019 to May 2022. The median age of the patients was 39 years. The injuries were predominantly on the left side in 26 patients (60.5%), in addition, there were 16 patients (37.2%) on the right side, and 1 patient on(2.3%)bilateral sides. The types of injuries were upper ureteral (8 patients, 18.6%), middle ureteral (8 patients, 18.6%), and lower ureteral (27 patients, 62.8%). The average injury length was 5.9 cm with a standard deviation of 2.4.During intraoperative diagnosis, 7 cases were found to have damage, transection, or ligation of the ureteral luminal structure. Surgical areas displayed extensive exudation and the presence of adipose tissue was observed during ureteroscopy. There were 36 cases manifested symptoms such as lumbar and abdominal pain (13 cases), fever (12 cases), peritoneal irritation sign (9 cases), vaginal discharge (9 cases), or hematuria (5 cases). Among these cases, 10 showed contrast agent spillage on urinary enhanced CT or intravenous urography, while 27 exhibited hydronephrosis or ureteral dilatation. Additionally, one case presented a renal tumor on the affected side, and creatinine examination was performed on drainage fluid in 7 cases. Furthermore, a unilateral renal nonfunction was identified in 1 case through renal ECT examination.Results:Out of the 43 patients followed up for a median of 18 months (range 11-47), 41 patients had no urinary symptoms such as hematuria, urine extravasation, or hypochondriac pain. Their urine tests (routine, urea nitrogen, and serum creatinine) were normal. Thirteen patients showed mild hydronephrosis on urinary ultrasonography, which remained stable during the follow-up period. One patient experienced restenosis at the ureterovesical anastomosis after renal autograft transplantation, but symptoms improved after balloon dilatation. Another patient underwent nephrostomy puncture and was found to have a clamped left ureteral end and a fistula in the sigmoid colon. This patient successfully underwent bilateral ureteroneocystostomy with a bladder flap and had a positive postoperative outcome.Conclusions:Iatrogenic ureteral injuries occur at seven specific sites, with gynecological surgeries posing a higher risk of injury at the ureter and external iliac artery, pelvic infundibulum ligament, and uterine artery intersection or adjacent areas. Similarly, colorectal surgeries can result in injury at the parallel segment of the ureter and mesenteric vessels, colon adjacent region, and vas deferens intersection. Urological surgeries are more likely to cause injury at the intersection of the ureter and external iliac artery, as well as the ureteropelvic junction.When treating ureteral injuries, it is important to consider the cause, location, and length of the injury. For short and deep injuries, options such as ureteral anastomosis or ureterovesical anastomosis may be considered. In cases of longer injuries, alternatives like renal autograft transplantation, ureteral surgery involving other tissues, or techniques such as the Boari flap or buccal/oral mucosal transplantation can be explored. The primary focus during repair surgeries should be on achieving tension-free anastomosis while maintaining sufficient blood supply to the ureter and placing it in an area with better blood circulation.

【Objective】 To investigate the clinical features, treatment methods and prognosis of advanced renal cell carcinoma (RCC) patients in Xinjiang, especially the Han population. 【Methods】 Clinical data of 233 patients with advanced RCC treated in The First Affiliated Hospital and The Affiliated Cancer Hospital of Xinjiang Medical University were retrospectively analyzed, including 133 Han patients.The median age of patients was 52 years (range: 23 to 87), and the maximum tumor diameter was (7.73±4.04) cm.Survival curves were plotted using the Kaplan-Meier method.Multivariate and univariate Cox regression analysis were conducted for all patients, and further analysis was performed for the Han patients. 【Results】 Among the 233 patients, 131 died during the average follow-up of 27.6 months (range: 1 to 120), and the median survival time was 12 months.In this cohort, 110 patients had lymph node metastasis, and 200 had distant metastasis, among them, 21 (10.5%) patients had brain metastasis and 45 (22.5%) patients had adrenal metastasis.The 1-, 3-, and 5-year survival rate were 48.9%, 18.3% and 6.1%, respectively.Univariate analysis revealed that International mRCC Database Consortium (IMDC) score, pathological type, lymph node metastasis, distant metastasis, number of metastatic foci and treatment methods impacted the prognosis in Xinjian (P<0.05).Multivariate analysis indicated that IMDC score, pathological type and distant metastasis were significant factors influencing the prognosis, which were also the prognostic factors of the Han patients (P<0.05). 【Conclusion】 In Xinjiang, patients with advanced renal cell carcinoma have a 6.1% 5-year survival rate and a median survival time of 12 months.Brain and adrenal metastases are common.Prognostic factors include IMDC score, pathological type, and distant metastasis for all patients, including the Han patients.