Objective To investigate the effect of pneumoperitoneum pressure during robotic-assisted kidney transplantation (RAKT) on the function of the transplant kidney. Methods The data of 243 kidney transplant recipients were retrospectively analyzed and divided into open kidney transplantation (OKT) group (n=105) and RAKT group (n=138). The RAKT group was further divided into 13 mmHg group (n=67) and 7 mmHg group (n=71) based on pneumoperitoneum pressure. The donor information, recipient's preoperative general data, intraoperative data, and postoperative recovery of the three groups were compared. In the RAKT group, the renal artery, segmental artery, interlobar artery, and venous flow velocity of the transplant kidney were measured using laparoscopic ultrasound. Results There was a statistically significant difference in donor types among the groups (P<0.05), while other donor information and recipient's preoperative general data showed no statistically significant differences (all P>0.05). There were no statistically significant differences in serum creatinine and complications at 30 days and 1 year postoperatively among the groups (all P>0.05). The OKT group and 7 mmHg group had more intraoperative urine output than the 13 mmHg group. Both RAKT groups had less intraoperative blood loss and shorter hospital stays than the OKT group, and longer operation times than the OKT group (all P<0.05). There were no statistically significant differences in operation time, intraoperative blood loss, and hospital stay between the two RAKT groups (all P>0.05). The vascular flow velocity of the transplant kidney decreased at 13 mmHg compared to 7 mmHg pneumoperitoneum pressure, but the differences were not statistically significant (all P>0.05). Conclusions Controllable pneumoperitoneum pressure has a limited impact on the vascular flow velocity of the transplanted kidney. RAKT is a safe and effective surgical method under appropriate pneumoperitoneum pressure, and choosing a lower pneumoperitoneum pressure is more conducive to the early recovery of renal function postoperatively.

Mitochondria serve as multifunctional powerhouses within cells, coordinating essential biological activities that are critical for cell viability, including material metabolism, signal transduction, and the maintenance of homeostasis. They support cells in adapting to complex and fluctuating environments. Oocytes, being the largest cells in multicellular organisms, contain a high number of mitochondria with unique structural characteristics. Mitochondria play active roles in the development and maturation of oocytes. A decline in mitochondrial function negatively affects both the quality and quantity of oocytes, thereby contributing to ovarian aging. However, the specific mechanisms through which mitochondrial dysfunction influences the progression of ovarian aging and impacts reproductive longevity remain unclear. Furthermore, medical strategies aimed at rejuvenating mitochondria to restore ovarian reserve and improve female reproductive potential may open new avenues for clinical treatment. In this review, we summarize the current understanding and key evidence regarding the role of mitochondrial dysfunction in ovarian aging and present emerging medical approaches targeting mitochondria to alleviate premature ovarian aging and enhance reproductive performance.
Humans ; Female ; Mitochondria/physiology* ; Ovary/physiology* ; Aging/physiology* ; Animals ; Oocytes/metabolism*

ObjectiveTo observe the clinical effectiveness of point ligation therapy combined with catgut embedment in acupoint for patients with refractory facial paralysis， and to explore the possible mechanisms from the perspective of neurotrophic factors. MethodsTotally 168 patients with intractable facial paralysis were randomly divided into point ligation plus catgut embedment group and electroacupuncture group， with 84 cases in each group. Both groups took methylcobalamin tablets orally， on the basis of which the point ligation plus catgut embedment group gave point ligation therapy at Quanliao （SI 18）， Dicang （ST 4）， Jiache （ST 6）， and catgut embedment in the local acupoints on the affected side combined with the distal acupoints， and the point ligation therapy combined with catgut embedment in acupoint was performed once every 30 days for three treatments； the electroacupuncture group took the same acupoints and gave electroacupuncture， with sparse and dense waves， once every other day. Both groups were treated for 90 days. Before treatment and after 30， 60， 90 and 120 days （follow-up）， patients of both groups were observed for House-Brackmann Facial Nerve Grading （HB） and modified Portmann score； facial nerve electromyography was performed before treatment and after 90 days of treatment to record the wave amplitude and latency of facial nerve motor conduction， and serum brain-derived nerve growth factor （BDNF）， nerve growth factor （NGF）， fibroblast growth factor （FGF2） levels were determined. The clinical effectiveness of both groups after 90 days of treatment was compared， and the adverse events occurred in the course of treatment in all patients were recorded. ResultsAt 30 days， 60 days， 90 days and follow-up visits， the HB grading of patients in both groups improved compared with that before treatment （P＜0.05）； the distribution of the number of patients with HB grading in the point ligation plus catgut embedment group was superior to that in the electroacupuncture group after 60 days and 90 days of treatment and at follow-up visits （P＜0.05）. The maximal amplitude of the facial nerve electromyography in both groups after 90 days of treatment was large， and the latency was shorter when compared with those before treatment （P＜0.05）， and the maximum wave amplitude of the point ligation plus catgut embedment group was higher than that of the electro-acupuncture group， and the latency period was shorter than that of the electro-acupuncture group （P＜0.05）. The modified Portmann scores of the both groups of patients after 30， 60 and 90 days of treatment and follow-up were higher than those before treatment， and the scores of the point ligation plus catgut embedment group were higher than those of the electroacupuncture group （P＜0.05）. Serum BDNF， NGF and FGF2 levels in both groups after 90 days of treatment were higher than before， and the point ligation plus catgut embedment group was significantly higher than the electroacupuncture group （P＜0.05）. The total clinical effective rate of the point ligation plus catgut embedment group （92.68%） was higher than that of the electroacupuncture group （81.01%， P＜0.05）. Adverse reactions occurred in both groups， mainly including local haematoma or subcutaneous bleeding， allergic reaction， severe pain， and needle fainting， all of which disappeared after symptomatic treatment. ConclusionThe point ligation therapy combined with catgut embedment in acupoint for patients with refractory facial paralysis are effective. The therapy improve the facial nerve function， and its mechanism of action may be related to increasing the level of serum neurotrophic factor and thus promoting facial nerve repairment.

Objective To explore the learning curve of robotic-assisted kidney transplantation(RAKT).Methods The clinical data of 96 consecutive RAKT patients performed by the same surgical team were retrospectively analyzed.The arterial anastomosis time,venous anastomosis time,ureteral anastomosis time,hospital stay,and blood loss were selected as evaluation indicators.The learning curve of RAKT was analyzed using the cumulative sum(CUSUM),and the curve was divided into the learning improvement stage and the proficient mastery stage according to the learning curve.The learning curve was verified by comparing the general data and surgical data of patients in different learning stages,and the clinical efficacy of each stage was analyzed.Results The optimal fitting equation of the learning curve reached its peak at the 33rd case,which was the minimum number of surgeries required to master RAKT.There was no statistically significant difference in age,gender,dialysis type,previous abdominal surgery history,number of donor renal arteries,and preoperative serum creatinine between the learning improvement group and the proficient mastery group(all P>0.05).Compared with the learning improvement stage,the body mass index(BMI)was higher,and the number of right donor kidney was increased compared to the left donor kidney in the proficient mastery stage(both P<0.05).There were no significant differences in arterial anastomosis time,ureteral anastomosis time,postoperative serum creatinine,and complications between the two groups(all P>0.05).The iliac vessel dissection time,warm ischemia time,venous anastomosis time,blood loss,and hospital stay in the proficient mastery stage were superior to those in the learning improvement stage,with statistically significant differences(all P<0.05).Conclusions RAKT requires at least 33 cases to cross the learning curve.There is no difference in complications and recovery of transplant renal function between the learning improvement stage and the proficient mastery stage.

Objective:To evaluate the mechanical performance of customized metal prosthesis with tibia stems of varying lengths for tibial bone defects reconstruction.Methods:Morphologically matched postoperative finite element models of bone defect revision were developed, with three gradients (15 mm, 30 mm, and 45 mm) according to the degree of bone defect and were reconstructed with 3D printed tantalum metal prosthesis using three tibial stem lengths (80 mm, 120 mm, and 150 mm), respectively. Conventional static and dynamic (walking gait) loading was performed to analyze the peak tibial stress distribution and accumulated sliding distance at the prosthetic interface, and to assess the effects of the three tibial stems of different lengths on the stability of the customized tibial defect restorations and the internal tibial stress state.Results:The peak accumulated sliding distance of the dynamically loaded morphologically matched restorations ranged from 17.94 to 21.31 mm with static loading, which were 68% to 84.3% higher than those of 10.26 to 11.69 mm with static loading. The peak tibial stresses in the dynamically loaded model were greater than those in the statically loaded model, with an increase of 28%-49.2%, including 132.94-143.88 MPa in the statically loaded model and 170.41-200.14 MPa in the dynamically loaded model. The overall accumulated sliding distance of the tibia prosthetic model gradually decreased from the tibial osteotomy surface, and the accumulated peak sliding distances ranged from 10.26 to 11.69 mm for static loading, and from 17.94 to 21.31 mm for dynamic loading. The bone tissue stresses in the anterolateral and medial-posterior tibia increased gradually from top to bottom, and the maximum stress value in each section was in the posterior medial tibia (the maximum value was 200.14 MPa). The highest bone tissue stress in the lateral tibia was affected by the tibial stem length, which resulted in a different location, and it was the area most affected by stress shielding (maximum value of 170.65 MPa).Conclusion:For stability assessment of morphologically matched tantalum customized prosthesis, physiological gait dynamic loading studies are more reliable than static loading; the choice of tibial stem length depends on a combination of accumulated peak sliding distances and tibial bone stress distribution factors.

Objective:To explore the genetic etiology of a child suspected for peroneal muscular atrophy.Methods:The child and his parents were analyzed by using next generation sequencing.Results:The child was found to harbor compound heterozygous variants of c. 52G>T (p.Glu18X) and c. 1390C>T (p.Arg464X) of the PRX gene, which were inherited from his father and mother, respectively. Among these, the c. 52G>T variant was previously unreported. Based on the standards and guidelines of the American College of Medical Genetics and Genomics, both variants were predicted to be pathogenic (PVS1+ PM2+ PM3, PVS1+ PM3-Strong+ PM2+ BS2). Conclusion:The compound heterozygous variants of the PRX gene probably underlay the Charcot-Marie-Tooth disease type 4F in this child. Above finding has enriched the mutational spectrum of the PRX gene.

Autogenous odontogenic materials are a new, highly biocompatible option for jaw restoration. The inorganic component of autogenous teeth acts as a scaffold to maintain the volume and enable donor cell attachment and proliferation; the organic component contains various growth factors that promote bone reconstruction and repair. The composition of dentin is similar to that of bone, which can be a rationale for promoting bone reconstruction. Recent advances have been made in the field of autogenous odontogenic materials, and studies have confirmed their safety and feasibility after successful clinical application. Autogenous odontogenic materials have unique characteristics compared with other bone-repair materials, such as the conventional autogenous, allogeneic, xenogeneic, and alloplastic bone substitutes. To encourage further research into odontogenic bone grafts, we compared the composition, osteogenesis, and development of autogenous odontogenic materials with those of other bone grafts. In conclusion, odontogenic bone grafts should be classified as a novel bone substitute.

Autogenous odontogenic materials are a new, highly biocompatible option for jaw restoration. The inorganic component of autogenous teeth acts as a scaffold to maintain the volume and enable donor cell attachment and proliferation; the organic component contains various growth factors that promote bone reconstruction and repair. The composition of dentin is similar to that of bone, which can be a rationale for promoting bone reconstruction. Recent advances have been made in the field of autogenous odontogenic materials, and studies have confirmed their safety and feasibility after successful clinical application. Autogenous odontogenic materials have unique characteristics compared with other bone-repair materials, such as the conventional autogenous, allogeneic, xenogeneic, and alloplastic bone substitutes. To encourage further research into odontogenic bone grafts, we compared the composition, osteogenesis, and development of autogenous odontogenic materials with those of other bone grafts. In conclusion, odontogenic bone grafts should be classified as a novel bone substitute.

Objective:To explore the value of radiomics based on 18F-fluorodeoxyglucose (FDG) PET/CT in predicting the Children′s Oncology Group (COG) risk stratification of neuroblastoma (NB). Methods:From March 2018 to November 2019, the 18F-FDG PET/CT images of 125 NB children (51 males, 74 females, age: 0.5-10.5 years) confirmed pathologically in Beijing Friendship Hospital were retrospectively analyzed. According to the COG classification, patients were divided into high-risk group and non-high-risk group (including low- and intermediate-risk). Imaging radiomics features were extracted from PET and CT images and screened. Logistic regression was used to build the first model based on radiomics features (R_model) and calculate radiomics score (Rad_score), then build the second model (RD_model) based on Rad_score and demographic features and at last build the third model (RDC_modle) based on Rad_score, demographic features and clinical features. The receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy of these models. Results:The training set contained 94 NB cases (63 high-risk cases, 31 non-high-risk cases), and the validation set contained 31 NB cases (21 high-risk cases, 10 non-high-risk cases). Four radiomics features were obtained by screening, of which two features were based on CT images and the other two features were based on PET images. The area under the curves (AUCs) of the R_model, RD_model and RDC_model in training or validation set were 0.91, 0.94, 0.98 or 0.86, 0.92, 0.95, respectively. The accuracies of the R_model, RD_model and RDC_model in training or validation set were 86%(81/94), 89%(84/94), 93%(87/94) or 84%(26/31), 84%(26/31), 87%(27/31), respectively.Conclusions:Radiomics based on 18F-FDG PET/CT can accurately predict the COG risk stratification of NB. Prediction model of radiomics features combined with demographic and clinical characteristics can further improve the accuracy of predicting NB COG risk stratification, which can help personalized and precise therapy protocol management in NB.

Objective:To summarize the preliminary experiences of utilizing complete peritoneal externalization for donation after cardiac death (DCD) robot-assisted kidney transplantation (RAKT) and observe the effect of RAKT versus open kidney transplantation (KT) under the same donor kidney during the same period.Methods:From February 2019 to July 2020, 40 patients scheduled for kidney transplantation were divided into two groups of robot ( n=20) and open surgery ( n=20). Donor for DCD had the same blood type. Preoperative data, intraoperative findings and postoperative outcomes were analyzed. Results:No significant inter-group difference existed in age, body mass index (BMI) or dialysis time. Both groups completed operations successfully. As compared with open group, operative duration, blocking time, venous anastomotic time and ureteral anastomosis time were longer in robot group. And the incidences of lymphatic fistula/cyst was higher in robot group than that in open group. Robot group was superior to open group in terms of hospitalization time, ventilation time, pain disappearance time and time to ambulate. No statistically significant inter-group difference existed in iliac vascular separation time, arterial anastomotic time, volume of blood loss and postoperative recovery of renal transplant function.Conclusions:RAKT is both safe and feasible at advanced surgical centers. Early evidence indicates that RAKT can accelerate the recovery of patients and achieve the same renal function recovery as open surgery. As surgeons become more proficient in RAKT technology, operative duration will be gradually shortened.