Objective:To explore the factors affecting the operative time and postoperative complications of retroperitoneal laparoscopic adrenalectomy, and to establish a predicting model.Methods:A total of 298 patients who underwent retroperitoneal laparoscopic adrenalectomy at Beijing Friendship Hospital, Capital Medical University from October 2017 to July 2022 were retrospectively analyzed.Observe and record the patient′s operative time, postoperative complications, and record the possible influencing factors, including gender, age, body mass index (BMI), tumor size, Mayo adhesive probability (MAP) score, and distance from the lower pole of the adrenal tumor to the upper pole of the kidney (DAK), distance from the lower pole of the adrenal tumor to the renal pedicle (DARP), distance between the skin and Gerota′s fascia (S-GF), perinephric fat distance (PNF), posterior adiposity index (PAI), thickness of waist fat, thickness of subcutaneous fat, etc. Univariate analysis was performed on the above influencing factors with the operative time as the dependent variable, and all variables with statistical significance were included in the linear regression analysis, and get the regression equation. Then take the occurrence of postoperative complications as the dependent variable, and the above-mentioned influencing factors as independent variables, and incorporate univariate and multivariate Logistic analysis to obtain the relevant influencing factors of postoperative complications, and use R software to establish a risk prediction nomogram model for postoperative complications.Results:Male patients ( P<0.001) with high BMI ( P=0.001), thick waist fat ( P=0.013), high MAP score ( P<0.001), and high PNF ( P<0.001) were expected to require longer operative time, and get the linear regression equation: operative time=75.892+ 4.672×MAP score+ 13.574 (if male)+ 0.023×BMI+ 0.792×PNF+ 1.968×thickness of waist fat ( P<0.001); according to multivariate Logistic regression, short DARP ( P=0.003), high PAI ( P=0.002), and long operative time ( P=0.023) increase the risk of postoperative complications, and get a risk prediction nomogram model for postoperative complications. At the same time, postoperative complications were more likely to occur when the expected operative time was longer than 77.5 minutes. Conclusions:The prediction models of operative time and postoperative complications of retroperitoneal laparoscopic adrenalectomy established in this study provide an objective and reliable assessment. When the estimated operative time is longer than 77.5 minutes, the operation is more difficult and postoperative complications risk is higher and should be performed by more experienced doctors.

Objective:To summarize the experience and skills of ex-vivo ureteroscopy that performed on deceased donor kidneys with gifted lithiasis on bench prior to transplantation.Methods:From January 2018 to December 2019, a total of 7 death donors in Capital Medical University Beijing Friendship Hospital were found to have donor gifted lithiasis during pre-donation evaluation, and all of them underwent ureteroscope laser lithotripsy on bench before transplantation. We retrospectively analysied the demographic information of donors, stone size, location, operative complications and stone clearance rate of the total 7 donor kidneys. The mean age of donors was (49.6±6.8) years. The 7 gifted lithiasis consisted of 6 cases of simple pyelolithiasis and 1 case of upper ureteral calculi.Results:The mean diameter of the stones was (1.2±0.5)cm (0.4~2.1 cm). The 5 cases of pyelolithiasis and 1 case of ureteral calculi were examined with semi-rigid ureteroscopy and then underwent holmium laser lithotripsy. The other 1 case had not found the stone during the bench operation. The mean lithotripsy time was (23.0±6.1)min, and all donor kidneys underwent hypothermic machine perfusion after lithotripsy. The initial resistance index (RI) of donor kidney with gifted lithiasis was higher than the other side of the same donor ( P<0.05), but there was no statistical difference in end-point RI between the both sides. None of the 7 recipients had severe hematuria after operation and their renal function recovered well. CT scan at 1 month after the operation showed the clearance of stone was satisfied in all 7 recipients. Conclusions:Bench surgery is a minimally invasive method for donor gifted lithiasis management, and it is relatively safe and effective. For most cases, the semi-rigid ureteroscopy can handle it well, but the long-term effect still needs to be further evaluated.

Objective:To evaluate the effect of intraoperative incision combined with local anesthesia in improving postoperative pain after retroperitoneal laparoscopic living donor nephrectomy.Methods:Using retrospective research methods, 28 donors who underwent hand-assisted retroperitoneal laparoscopic living donor nephrectomy at the Beijing Friendship Hospital, Capital Medical University from January 2018 to December 2020 were selected as the research group. Before the wound was sutured during the operation use 0.2% ropivacaine 20 mL+ 5 mg dexamethasone to block the transverse abdominis fascia and subcutaneously for infiltration anesthesia. The other 1∶1 matched 28 donors who had the same operation method but used on-demand systemic opioid analgesia after the operation as the control group. The demographic indicators (age, gender, body mass index, length of donor kidney), intraoperative conditions (intraoperative blood loss, operation time, warm ischemia time), 2, 12, 24, and 48 hours pain visual analogue scales(VAS) after operation were compared between the two groups of patients, postoperative systemic opioid demand rate, postoperative exhaust time, time to return to the ground, complication rate (postoperative bleeding, lung infection, lymphatic fistula, wound infection, intestinal obstruction), postoperative length of hospitalization and other information. Measurement data were expressed as mean±standard deviation ( Mean± SD), and independent sample t-test was used for comparison between groups; Chi-square test or Fisher exact probability method was used for comparison of count data between groups. Results:The pain VAS of the donors in the research group were significantly lower than those in the control group at 2 h, 12 h, 24 h, and 48 h after surgery (2 h: 1.6±1.0 vs 3.9±1.1; 12 h: 1.9±0.7 vs 3.1±1.0; 24 h: 1.6±0.5 vs 2.9±0.8; 48 h: 1.2±0.5 vs 2.3±0.8; P<0.05). The donors in the research group postoperative morphine requirement rate was also significantly lower than that of the control group (0 vs 21.4%), and the postoperative recovery time was significantly earlier than that of the control group [(25.7±4.5) h vs (30.6±6.6) h], the difference was statistically significant ( P<0.05). Lymphatic fistula was the main postoperative complication. There was no statistically significant difference between the research group and the control group (14.3% vs 25.0%) ( P>0.05). Conclusion:Intraoperative incision transversus abdominis fascia and subcutaneous combined local block anesthesia can effectively reduce the pain after laparoscopic donor nephrectomy, reduce the use of opioids, promote early postoperative activities of the donor, and will not increase postoperative complications incidence rate.

In recent years, living kidney donors is getting valuable with the increasingly needs of kidney transplantation. However, living kidney donors can receive no benefits but greater incidence and severity of pain compared to other kinds of renal surgeries. Thus, it is getting popular on how to relief the postoperative pain during perioperative period for living kidney donors. As multidisciplinary cooperation developing, preoperative predictive nursing, changed analgesia mode, modified pneumoperitoneum, and postoperative application of different kinds of analgesic drugs can further relief the postoperative pain of living kindney donors. This paper sums up different modalities of pain relief in patients undergoing live donor nephrectomy to provide reference to clinical decision of living kidney transplantation.

Objective:To explore whether prophylactic resection of orthotopic polycystic kidney before allogeneic kidney transplantation can reduce the incidence and severity of perioperative complications in patients with end-stage renal disease due to autosomal dominant polycystic kidney disease (ADPKD), and reduce the difficulty of surgery.Methods:A retrospective case-control study method was used to recruit a total of 27 patients who were diagnosed with ADPKD and underwent allogeneic kidney transplantation in Beijing Friendship Hospital, Capital Medical University from January 2013 to January 2021, they were divided into prophylactic resection group ( n=19) and non-prophylactic resection group ( n=8) according to whether orthotopic polycystic kidney disease was prophylactic resection before transplantation. Patients in prophylactic resection group underwent orthotopic polycystic kidney resection before transplantation, while patients in non-prophylactic resection group didn′t. The indexes such as hemoglobin, platelet, albumin, left ventricular wall thickness, left ventricular ejection fraction, difficulty of kidney transplantation, average postoperative hospital stay, pain, and complication rate before kidney transplantation were analyzed and compared between the two groups. Measurement data were expressed as mean ± standard deviation ( ± s), and independent sample t-test was used for comparison between groups; Chi-square test was used for comparison of enumeration data between groups. Results:There was no significant difference in the general status of hemoglobin, platelets, albumin, left ventricular wall thickness, and left ventricular ejection fraction between the two groups before kidney transplantation ( P>0.05). However, the polycystic kidney volume [(2 409.8±1 899.8) cm 3] in the prophylactic resection group was greater than that in the non-prophylactic resection group [(1 340.2±290.6) cm 3], and the difference was statistically significant ( P=0.027). In terms of postoperative complications, 9 patients in the prophylactic resection group and 5 patients in the non-prophylactic resection group developed long-term low back pain or hematuria after transplantation, which were considered to be related to the unresected polycystic kidney disease, but the difference was not statistically significant ( P=0.678). Meanwhile, in both two groups, 3 patients underwent orthotopic polycystic nephrectomy after transplantation due to severe polycystic kidney complications. Although the incidence of complications in the prophylactic resection group (15.8%) was lower than that in the non-prophylactic resection group (37.5%), the difference was not statistically significant ( P=0.319). Conclusion:Prophylactic resection of orthotopic polycystic kidney before kidney transplantation can reduce the incidence and severity of polycystic kidney-related complications after transplantation, but has little effect on the operation time and intraoperative blood loss of kidney transplantation.

Objective:To explore the factors related to the difficulty of adult allogeneic renal transplantation.Methods:Used retrospective study method, a total of 183 patients who were diagnosed with end-stage renal disease and underwent allogeneic kidney transplantation in Beijing Friendship Hospital, Capital Medical University from January 2020 to December 2021 were included in this study. With kidney transplant operation time as the evaluation criteria of operation difficulty, relevant clinical indicators that may affect the difficulty of surgery were collected, including recipient age, body mass index, pretransplant dialysis mode, blood lipid level, subcutaneous fat thickness, vascular anastomosis mode, donor kidney length, donor kidney volume, etc. Pearson, Spearman correlation test were used to analyze the correlation between the above indexes and surgical difficulty.Results:In terms of recipients, higher body mass index ( P=0.006), peritoneal dialysis before transplantation ( P=0.035), higher serum cholesterol ( P=0.016) and triglyceride ( P<0.001), thicker subcutaneous fat ( P=0.032) and calcification of the vessels ( P<0.001) all lead to increase the difficulty of kidney transplantation, and also prolong the operation time; in terms of kidney donors, the longer and larger of transplanted kidney length ( P<0.001) and volume ( P<0.001), the longer operation time will be cost. Meanwhile, the anastomosis of complex multi-vessel between kidney transplantation and recipient was more difficult than single internal iliac artery and single external iliac artery anastomosis ( P=0.005), and the operation time was also longer. Conclusions:The degree of obesity before transplantation, dialysis mode, blood lipid level, donor kidney size and vascular anastomosis mode were all factors affecting the difficulty of kidney transplantation. For patients with those above risk factors, the operation may be difficult and the surgical time can be much longer. Physicians with more experience in kidney transplantation can be selected to shorten the operation time, even reduce complications after operation.

Objective:To evaluate the feasibility and perioperative safety of retroperitoneal laparoscopic nephrectomy for autosomal dominant polycystic kidney disease (ADPKD) before kidney transplantation.Methods:A total of 22 patients with ADPKD who underwent laparoscopic polycystic nephrectomy before kidney transplantation in Beijing Friendship Hospital, Capital Medical University from January 2013 to December 2020 were enrolled in this retrospective study. Preoperative epidemiological data, operation time, intraoperative blood loss, perioperative blood transfusion, conversion rate, postoperative gastrointestinal function recovery time, drainage tube placement time, postoperative hospital stay, incidence and severity of complications were collected.Results:The mean age of all patients in this study was (50.95±9.28) years old, and the mean preoperative polycystic kidney diameter was (18.83±2.38) cm. In all patients, 20 patients were scheduled for polycystic nephrectomy due to transplantation and 2 patients were done for polycystic renal cyst rupture and hemorrhage. The mean operation time of all patients was (191.14±70.46) min, and the median intraoperative blood loss was 100 mL. Among them, 5 patients had large intraoperative blood loss, and were given intraoperative blood transfusion. Two of all patients were converted to open due to severe intraoperative adhesions. In terms of postoperative recovery, the mean recovery time of gastrointestinal function was (2.09±0.61) d, the mean time of abdominal drainage tube placement was (5.32±2.08) d, the mean postoperative hospital stay was (7.55±2.34) d. In terms of postoperative complications, 4 patients developed postoperative incision pain, bleeding or other complications, but all improved after symptomatic treatment.Conclusions:For patients with ADPKD, original polycystic kidney can be effectively resected by retroperitoneoscopy before transplantation. At the same time, the operation time is short, and patients have quick postoperative recovery, even the incidence and severity of postoperative complications are low. Therefore, retroperitoneal laparoscopic nephrectomy can be used as the first choice for the removal of original polycystic kidney before renal transplantation in ADPKD patients.

Objective:To investigate the effect of visceral fat thickness before operation on the operative difficulty and postoperative complications in renal transplantation recipients.Methods:A total of 179 patients diagnosed with end-stage renal disease who underwent kidney transplantation in Beijing Friendship Hospital, Capital Medical University from January 2020 to January 2022 were retrospectively included. According to the visceral fat thickness measured by CT before transplantation (distance from anterior wall of abdominal aorta to parietal peritoneum at 1 cm above umbilicus), patients were divided into two groups, with 103 patients in thin visceral fat group with visceral fat thickness ≤7.5 cm and 76 patients in thick visceral fat group with visceral fat thickness>7.5 cm. The epidemiological data before renal transplantation, operative time, intraoperative blood loss, postoperative complications, renal function after transplantation and patients′ recovery state were analyzed and compared between the two groups. Measurement data were expressed as mean±standard deviation ( ± s), and independent sample t-test was used for comparison between groups. The Chi-square test was used to compare the count data. Results:The mean age and body mass index of patients in thin visceral fat group [(38.70±11.50) years and (21.28±2.93) kg/m 2] were lower than those in thick visceral fat group [(43.14±11.42) years and (24.78±3.37) kg/m 2], and the differences were statistically significant ( P< 0.05). There was no significant difference in other preoperative epidemiological data between the two groups ( P>0.05). In terms of operation difficulty, the mean operation time of thin visceral fat group was (117.16±34.33) min, which was significantly shorter than that of thick visceral fat group (137.11±20.02) min. The mean intraoperative blood loss in the thin visceral fat group was (89.12±45.95) mL, which was lower than that in the thick visceral fat group (125.39±54.88) mL, the differences were statistically significant ( P<0.001). In terms of postoperative complications, 41 patients in the thin visceral fat group had postoperative infection, incision pain and intraoperative effusion, and the incidence was 39.8% (41/103), which was significantly lower than that in the thick visceral fat group (78.9%, 60/76), the difference was statistically significant ( P<0.001); However, there was no significant difference in the incidence of Clavien-Dindo grade 3 or higher complications between the two groups ( P> 0.05). There was no significant difference in serum creatinine levels at 3, 5, 7 days and 1, 2 months after surgery among patients with different visceral fat thickness ( P> 0.05). However, the mean serum creatinine level in the thin visceral fat group was (116.06±36.45) μmol/L, which was lower than that in the thick visceral fat group (133.35±72.26) μmol/L, and the difference was statistically significant ( P=0.038). There was no significant difference in the incidence of delayed renal function recovery between the two groups ( P> 0.05). At the same time, there was no significant difference in postoperative drainage tube indwelling time and hospital stay between the two groups ( P> 0.05). Conclusions:The thicker visceral fat in end-stage renal disease patients before transplantation, the higher the incidence of general postoperative complications, but the severity of complications, patients′ recovery after transplantation and the short-term function of the transplanted kidney are not significantly related to the thickness of visceral fat in the recipients. Meanwhile, although the visceral fat thickness of the recipients in this study was correlated with serum creatinine levels at 3 months after transplantation, its correlation with long-term graft renal function and graft survival time remains to be further studied.

Objective To identify the influencing factors of operation time of hand-assisted laparoscopic living donor nephrectomy, and to analyze the relationship between influencing factors and the severity of postoperative complications. Methods Clinical data of 91 donors who underwent hand-assisted laparoscopic nephrectomy were retrospectively analyzed. The correlation between preoperative baseline data of donors and operation time was analyzed. The relationship between operation time and postoperative complications was assessed and the threshold of operation time was determined. Results Multiple donor renal arteries, thick perirenal and posterior renal fat, metabolic syndrome, high Mayo adhesive probability (MAP) score and Clavien-Dindo score prolonged the operation time. By analyzing the receiver operating characteristic (ROC) curve, we found that when the operation time was ≥138 min, the incidence of postoperative complications of donors was significantly increased (P<0.05). Conclusions For donors with multiple renal arteries, thick perirenal and posterior renal fat, metabolic syndrome and high MAP score and Clavien-Dindo score, experienced surgeons should be selected to make adequate preoperative preparation and pay close attention after surgery, so as to timely detect postoperative complications and reduce the severity of complications, enhance clinical prognosis of the donors.

BACKGROUNDBu-Shen-Yi-Qi-Tang (BSYQT), which is prescribed on the basis of clinical experience, is commonly used in clinics of traditional Chinese medicine (TCM) for asthma treatment. The components of BSYQT include Radix Astragali (RA), Herba Epimedii (HE) and Radix Rehmanniae (RR). The aim of this study was to compare the effect of granules and herbs of BSYQT on airway inflammation in asthmatic mice.

METHODSSixty female BALB/c mice were randomly divided into the normal control (NC) group, asthmatic group (A), decoction of granules of BSYQT treatment group (GD), decoction of herbs of BSYQT treatment group (HD), and dexamethasone treatment group (DEX). The mouse asthmatic model was induced by ovalbumin (OVA) sensitization and challenge. GD and HD of BSYQT as well as DEX were prepared and administered by intragastric infusion. Airway hyperresponsiveness (AHR) to methacholine (Mch), lung histopathology analysis, inflammatory mediators in serum (IL-4, IL-5, IL-17A, IFN-γ, and eotaxin) and in lung (IL-4, IL-5, IFN-γ, and eotaxin) were selected for investigation and comparison.

RESULTSBoth GD and HD treatment could decrease airway resistance (RL) and increase dynamic compliance (Cdyn) to Mch compared with the A group (P < 0.05). HD treatment was more effective in RL reduction than Mch at doses of 3.125 and 6.25 mg/ml (P < 0.05) and in Cdyn increase at Mch doses of 6.25 and 12.5 mg/ml (P < 0.05). There were no marked differences in RL reduction and Cdyn improvement between mice in HD and DEX groups (P > 0.05). Both GD and HD treatment markedly attenuated lung inflammation (P < 0.05), and HD treatment demonstrated more significant therapeutic function in alleviating lung inflammation than that of GD and DEX treatment (P < 0.05). Both GD and HD treatment resulted in a significant reduction in IL-4 and IL-17A levels and an increase in the IFN-γ level in serum compared with the A group (P < 0.05). The effect of HD in lowering the IL-4 and IL-17A level was significantly greater than that of GD (P < 0.05), and was not significantly different from DEX (P > 0.05). HD treatment significantly reduced the serum level of IL-5 and eotaxin compared with the A group (P < 0.05), however, mice in the GD treatment group did not demonstrate this effect. GD and HD treatment significantly reduced IL-4 and eotaxin mRNA expression compared with the A group (P < 0.05). HD treatment significantly reduced IL-5 mRNA expression compared with the A group (P < 0.05). There was a significant difference between the GD and HD treatment groups in reducing IL-5 and eotaxin mRNA expression (P < 0.05). HD treatment was more effective in down-regulation of IL-5 in serum and eotaxin level both in serum and lung than DEX (P < 0.05). Compared with the A group, an obvious increase in mRNA expression of IFN-γ was observed in both the GD and HD treatment groups (P < 0.05). However, the effect of HD treatment on increase of IFN-γ mRNA expression was more apparent than GD and DEX treatment (P < 0.05).

CONCLUSIONSBoth GD and HD treatment could decrease AHR, attenuate lung inflammation, reduce IL-4, IL-5, IL-17A, and eotaxin levels and increase IFN-γ levels in asthmatic mice. HD treatment manifests more remarkable inhibitory effects on asthmatic inflammation than GD treatment, which could provide a guide for further research on the screening of the material basis of the best anti-inflammatory effect of BSYQT.

Animals ; Asthma ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Inflammation ; drug therapy ; Medicine, Chinese Traditional ; Mice ; Mice, Inbred BALB C