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.

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 efficacy of Gateway balloon dilation in the treatment of symptomatic severe stenosis of middle cerebral artery.Methods The clinical data and imaging materials of 98 patients with severe symptomatic stenosis of the middle cerebral artery,who were admitted to the Second Affiliated Hospital of Nanchang University of China from May 2019 to August 2022 to receive Gateway balloon dilation,were retrospectively analyzed.The diameter of the narrowed artery before and after Gateway balloon dilation treatment,peak systolic blood flow velocity(PSV),end-diastolic blood flow velocity(EDV),Mori classification of stenosis lesion,operation-related complications,imaging manifestations and clinical follow-up results were analyzed.Results Of the 98 patients,Mori type A was seen in 83(84.69％)and Mori type Bin 15(15.31％).Successful Gateway balloon dilation procedure was accomplished in all patients.After surgery,the symptoms were improved or stabilized to varying degrees.The mean residual lumen diameter of the stenosis lesion was significantly increased from preoperative(2.01±0.13)mm to postoperative(2.33±0.25)mm,the stenosis ratio was remarkably decreased from preoperative(81.28±15.17)％to postoperative(50.24±12.83)％,the PSV and EDV were strikingly decreased from preoperative(251.01±60.13)cm/s and(104.28±32.25)cm/s to postoperative(155.33±53.28)cm/s and(70.24±36.33)cm/s respectively,the differences were statistically significant(all P＜0.05).Seven patients developed surgical complications,which were improved in short time.The patients were followed up for 10 months,modified Rankin Scale(mRS)score of ≤2 points was obtained in 88 patients(89.79％),indicating that the patients had a good quality of life as well as a good functional recovery.Conclusion For the treatment of symptomatic severe stenosis of middle cerebral artery,Gateway balloon dilation carries a significant long-term therapeutic effect with fewer surgical complications.Therefore,Gateway balloon dilation is an effective treatment for this type of disease.

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.

Objective:To observe and study the therapeutic effect of hyperbaric oxygen (HBO) on acute encephalopathy and myocardial damage secondary to carbon monoxide (CO) poisoning.Methods:A total of 451 cases of CO poisoning admitted to the Department of Hyperbaric Oxygen of Central Hospital of Zibo Mining Group Co., Ltd. were retrospectively analyzed, including 105 cases of acute encephalopathy with secondary myocardial damage of different degrees. After dehydration, nerve nutrition, circulation improvement, waking up, organ protection, anti-infection, and other supportive symptomatic treatments, HBO was given for 2-3 courses. The myocardial enzyme levels of carboxyhemoglobin (COHb), cardiac troponin (cTnI), creatine kinase (CK), creatine kinase myocardial isoenzyme (CK-MB), and lactate dehydrogenase (LDH) were measured in all patients before and after treatment; the dynamic abnormal changes were monitored by 12-lead electrocardiograph (EKG); and the cerebrospinal fluid pressure was measured by lumbar puncture.Results:The blood biochemical test results after CO poisoning in 105 patients were as follows: the level of COHb was 40.3%~54.7%, with an average of (44.5±7.9)%; myocardial enzymes such as cTnI, CK, CK-MB, and LDH were significantly increased with 5-10 times of the normal values. The EKG of 105 patients showed significant abnormalities. The intracranial pressure was from 185 to 230 cmH 2O, with an average of (210.6±22.9) cmH 2O. After 2-3 courses of combined treatment, the level of COHb in 105 patients was 1.3%~4.7%, with an average of (3.2±0.6)%; the myocardial enzymes such as cTnI, CK, CK-MB and LDH returned to normal values. The intracranial pressure ranged from 160 to 178 cmH 2O, with an average of (166.4±11.9) cmH 2O. After treatment, 95 (90.5%) patients’ EKG gradually returned to normal; among the 10 patients (9.5%) with abnormal EKG, 5 patients had insufficient myocardial blood supply, 3 patients had atrial premature beat, and 2 patients had ventricular premature beat. There were significant differences in these indicators before and after treatment ( P<0.05, or P<0.01). Conclusion:CO poisoning is prone to secondary acute encephalopathy and myocardial damage. HBO combined therapy is highly effective for treating secondary acute encephalopathy and myocardial damage caused by CO poisoning, therefore it can provide a reference for clinical treatment.

Objective:To observe and study the therapeutic effect of hyperbaric oxygen (HBO) on acute encephalopathy and myocardial damage secondary to carbon monoxide (CO) poisoning.Methods:A total of 451 cases of CO poisoning admitted to the Department of Hyperbaric Oxygen of Central Hospital of Zibo Mining Group Co., Ltd. were retrospectively analyzed, including 105 cases of acute encephalopathy with secondary myocardial damage of different degrees. After dehydration, nerve nutrition, circulation improvement, waking up, organ protection, anti-infection, and other supportive symptomatic treatments, HBO was given for 2-3 courses. The myocardial enzyme levels of carboxyhemoglobin (COHb), cardiac troponin (cTnI), creatine kinase (CK), creatine kinase myocardial isoenzyme (CK-MB), and lactate dehydrogenase (LDH) were measured in all patients before and after treatment; the dynamic abnormal changes were monitored by 12-lead electrocardiograph (EKG); and the cerebrospinal fluid pressure was measured by lumbar puncture.Results:The blood biochemical test results after CO poisoning in 105 patients were as follows: the level of COHb was 40.3%~54.7%, with an average of (44.5±7.9)%; myocardial enzymes such as cTnI, CK, CK-MB, and LDH were significantly increased with 5-10 times of the normal values. The EKG of 105 patients showed significant abnormalities. The intracranial pressure was from 185 to 230 cmH 2O, with an average of (210.6±22.9) cmH 2O. After 2-3 courses of combined treatment, the level of COHb in 105 patients was 1.3%~4.7%, with an average of (3.2±0.6)%; the myocardial enzymes such as cTnI, CK, CK-MB and LDH returned to normal values. The intracranial pressure ranged from 160 to 178 cmH 2O, with an average of (166.4±11.9) cmH 2O. After treatment, 95 (90.5%) patients’ EKG gradually returned to normal; among the 10 patients (9.5%) with abnormal EKG, 5 patients had insufficient myocardial blood supply, 3 patients had atrial premature beat, and 2 patients had ventricular premature beat. There were significant differences in these indicators before and after treatment ( P<0.05, or P<0.01). Conclusion:CO poisoning is prone to secondary acute encephalopathy and myocardial damage. HBO combined therapy is highly effective for treating secondary acute encephalopathy and myocardial damage caused by CO poisoning, therefore it can provide a reference for clinical treatment.

Objective To investigate the correlation between myocardial fibrosis evaluated by cardiac magnetic resonance (CMR)T1 mapping and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in elderly patients with ischemic cardiomyopathy (ICM).Methods The 56 hospitalized patients with ICM(ICM group)and 20 healthy volunteers(control group)were recruited in cardiology department of Henan Provincial People's Hospital from April 2014 to June 2017.Clinical data,serum NT-proBNP detection,CMR T1 mapping and contrast-enhanced scan were determined,retrospectively collected and compared between two groups.The differences in myocardial extracellular volume fraction(ECVF)and NT-proBNP levels were compared among the control group,the ICM group and the ICM subgroups with different degree of cardiac dysfunction.The correlation between ECVF and NT-proBNP level was analyzed.Results The levels of ECVF and NT-proBNP were significantly higher in ICM group than in control group[(35.1t6.2)％ vs.(25.3±2.2)％ for ECVF,and(3 902.7± 1 670.3)ng/L vs.(280.5± 140.5)ng/L for NT-proBNP,t =6.917 and 9.645 respectively,both P＜0.01].Along with NYHA Functional Class upgrade of Ⅱ to Ⅲ] to Ⅳ of the ICM subgroups,the levels of ECVF and NT-proBNP were significantly increased (F =18.372 for ECVF,61.82 for NT-proBNP,all P＜0.01).There was a positive correlation between ECVF and NT-proBNP level in ICM patients (r =0.666,P ＜ 0.05).Conclusions Serum NT-proBNP level is correlated with the degree of myocardial fibrosis,which might be used as an indicator of myocardial fibrosis in ICM patients.

Objective To evaluate the short-term effect of Pipeline embolization device (PED)for the treatment of unruptured wide-necked intracranial aneurysms. Methods From October 2015 to September 2016,15 consecutive patients with unruptured wide-necked intracranial aneurysm (aneurysm neck and aneurysm body ratio ≥0. 5)treated with PED at the Department of Neurosurgery,the Second Affiliated Hospital of Nanchang University were enrolled retrospectively. Their clinical and imaging data were analyzed. Kamran scale was used to evaluate the embolization rate of aneurysms and the changes of the parent arteries. DSA examination was performed again at 6 -12 months after operation. Results Fifteen PED were implanted in 15 patients with unruptured wide-necked intracranial aneurysms,including 13ophthalmic artery aneurysms,1 posterior communicating artery aneurysm,and 1 cavernous sinus aneurysm. The technical success rate was 100% . Immediately after PED implantation,Karman rating of 15 cases were aneurysm grade 2 embolization,parent artery grade A (grade 2a). DSA examination was performed again at 6 - 12 months after operation showed that 14 patients were aneurysm grade 4,parent artery was grade A (grade 4a). One patient (ophthalmic artery aneurysm)underwent the second DSA examinations at 6 and 12 months after operation showed that the residual development of aneurysms. The aneurysm embolization was grade 3, and the parent artery was grade A (grade 3a). No branch artery occlusion was observed. Non of them had neurological deficit. The modified Rankin scale score was 0 in all 15 patients. Conclusion The use of PED in the treatment of unruptured wide-necked intracranial aneurysms has a higher occlusion rate. Its long-term effect still needs further follow-up.

Immobilization of enzymes is important and widely applied in biocatalysis. Streptomyces platensis gene gox, encoding an extracellular L-glutamate oxidase (Gox), was fused to cellulose binding domain (CBDcex) from Cellulomonas fimi and the recombinant protein Gox-CBD was expressed in Escherichia coli. The fusion protein (Gox-CBD) was immobilized onto microcrystalline cellulose. The preparation conditions, binding capacity, properties and stability of the immobilized enzyme were studied. Under the condition of 4 ℃, for 1 hour, the fusion protein Gox-CBD was able to bind microcrystalline cellulose at a ratio of 9.0 mg of protein per gram of microcrystalline cellulose. Enzymatic properties of free and immobilized L-glutamic oxidase (Gox-CBD) were compared. The specific activity of the immobilized enzyme decreased, but its thermal stability increased a lot compared with that of the free Gox-CBD. After incubation at 60 ℃ for 30 min, 70% of the total activity remained whereas the free recombinant Gox completely lost its activity. The immobilized protein was tightly bound to microcrystalline cellulose at pH below 10 or more than 5 mmol/L NaCl. The fusion protein of Gox-CBD can be specifically immobilized on the microcrystalline cellulose on a single step. Therefore, our findings can provide a novel strategy for protein purification and enzyme immobilization.

OBJECTIVETo evaluate the application value of R.E.N. A.L. nephrometry score for surgery type decisions of T1 stage renal tumor.

METHODSClinical data including image data, surgery type and prognosis etc were collected retrospectively for 122 cases from January 2010 to December 2012. There were 76 male and 46 female patients and they were 29-82 years (mean 51 years). The body mass index was (22.8 ± 3.9) kg/m(2). The patients were undergoing surgical excision with renal tumor of T1 stage. The R.E.N. A.L. nephrometry score was analyzed to evaluate their relationships to surgery type (RN or NSS) and the approach of NSS (ONSS or LNSS) using chi-square tests, Fisher's exact tests, and logistic regressions analysis.

RESULTSAll surgery had been completed. The surgery included RN of 45 patients, LNSS of 45 patients and ONSS of 32 patients. The R.E.N. A.L. nephrometry score was significantly associated with the type of surgery (χ(2) = 27.89, P < 0.05), and the NSS approach (χ(2) = 12.87, P < 0.05). When the scores less than 7 points, it is majorly treated by nephron sparing surgery (92.9%), and when the scores more than 9 points, it is majorly treated by radical nephrectomy (69.4%). Individual component scores were analyzed to evaluate that they were all related to surgery type (χ(2) = 7.00-14.57, P < 0.05), and the individual component N associated the surgery type mostly. Furthermore, individual component R,E,N and L were statistically significant predictors of the NSS approach (χ(2) = 4.92-15.07, P < 0.05).

CONCLUSIONThe R.E.N. A.L. nephrometry scoring system provides a simple, useful, and stable system to character the salient renal anatomy of T1 stage, and can provide the best surgery approach.

Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Kidney ; pathology ; Kidney Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Nephrectomy ; Prognosis ; Retrospective Studies