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.

The production of high-quality oocytes requires precisely orchestrated intercellular communication. Extracellular vesicles (EVs) are cell-derived nanoparticles that play a vital role in the transfer of bioactive molecules, which has gained much attention in the field of diagnosis and treatment. Over the past ten years, the participation of EVs in the reproductive processes of oocytes has been broadly studied and has shown great potential for elucidating the intricacies of female reproductive health. This review provides an extensive discussion of the influence of EVs on oocytes, emphasizing their involvement in normal physiology and altered cargo under pathological conditions. In addition, the positive impact of therapeutic EVs on oocyte quality and their role in alleviating ovarian pathological conditions are summarized.
Humans ; Extracellular Vesicles/physiology* ; Oocytes/cytology* ; Female ; Animals ; Cell Communication/physiology*

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.

ObjectiveTo explore the potential suitable distribution area and spatial production area of high-quality medicinal materials of Miao medicine Laportea bulbifera. MethodBased on 200 distribution spots of L. bulbifera and 120 ecological factors, the maximum entropy model（MaxEnt） and ArcGIS software were applied to predict the potential suitable areas. The content of rutin, kaempferol-3-O-rutinoside, and quercitrin from 33 batches of L. bulbifera in Guizhou province was determined by high-performance liquid chromatography (HPLC). Combined with the previous content data of total polysaccharides and total flavonoids, the correlation between the main pharmacodynamic components of L. bulbifera and ecological factors was analyzed. Eventually, the quality regionalization of L. bulbifera was exhibited by the collocated Cokriging in ArcGIS. ResultThe optimum distribution areas of L. bulbifera were Yunnan, Guizhou, Sichuan, Hunan, and Hubei provinces in China, and the high and medium suitable areas accounted for 59.48% of the total distribution areas. October precipitation, slope, min temperature of the coldest month, altitude, solar radiation intensity in June, and April precipitation were the main ecological factors affecting the growth and distribution of L. bulbifera. Temperature, radiation intensity, precipitation, and soil composition and properties had great effects on the accumulation of secondary metabolites in L. bulbifera. The results showed that the high-quality areas of L. bulbifera mainly included Leishan county, Kaili city, Qingzhen city, Pingba district, Huishui county, Longli county, Kaiyang county, and Jiangkou county in Guizhou province. ConclusionL. bulbifera is widely distributed in China， but the suitable distribution areas are mainly concentrated in southwest China and part of central China. The planting bases of L. bulbifera can be selected in parts of cities and counties in southeast and central Guizhou province. In this study， the potential suitable growing areas and the optimum planting areas of L. bulbifera in Guizhou were predicted， which could provide scientific references for the cultivation and the site selection of large-scale planting for L. bulbifera.

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 investigate the relationship between the coagulation system status and the pulmonary hemorrhage in children with severe hand,foot and mouth disease(HFMD)and approach the clinical significance of early detection of coagulation function. Methods By prospective case design method,89 cases with HFMD admitted to Department of Critical Care Medicine of Hebei Provincial Children Hospital from July 2010 to July 2012 were enrolled. The children were divided into severe group(46 cases)and critical group(43 cases)according to the severity of disease,and the children in critical group were subdivided into survivor group(26 cases)and non-survivor group (17 cases). Forty-four healthy children with the same age and in the same period were served as healthy control group. The blood of children was collected immediately after admission for determination of blood routine, prothrombin time(PT),thrombin time(TT),activated partial thrombin time(APTT),fibrinogen(Fg),and D-dimer (DD). Results There were no significant differences in PT,TT,APTT and Fg among severe group,critical group and health control group(all P>0.05). The blood platelets count(PLT)in severe group and critical group was significantly lower than that in health control group(×109/L:245±130,237±156 vs. 389±120),while the DD was significantly higher than that in healthy control group(mg/L:0.34±0.67,0.41±0.08 vs. 0.24±0.13),and the DD in critical group was obviously higher than that in severe group(all P<0.05). The mortality rate in critical group was 39.5%,and there were no significant differences in PT,APTT,Fg,TT and PLT between survivor group and non-survivor group(all P>0.05),but the DD in non-survivor group was significantly lower than that in survivor group(mg/L:0.60±0.09 vs. 0.12±0.09,P<0.05). Conclusions In children with severe or critical HFMD, the coagulation factor and blood platelet were in a state of mobilization,mild consumption state with the existence of fibrinolytic inhibition,but without systemic bleeding tendency,therefore it is in a compensatory stage of disseminated intravascular coagulation(DIC),not the mechanism of pulmonary hemorrhage. The monitor of DD has its clinical significance in evaluations of the disease situation and its prognosis.