Objective:To compare the outcomes of robot-assisted laparoscopic partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) in the treatment of tumors in isolated kidney, and analyze the factors influencing postoperative renal function and long-term survival in patients.Methods:A retrospective analysis was conducted on clinical data of 67 patients with tumors in isolated kidney who underwent surgery at the Chinese PLA General Hospital from November 2010 to January 2022. There were 48 males and 19 females, with an average age of (58.6±10.1) years old. The patients were divided into RAPN group (43 cases) and LPN group (24 cases) based on the surgical approach. The RAPN group had a higher R.E.N.A.L. score than the LPN group [(8.7±1.5) vs. (7.9±1.7), P=0.042]. There were no statistically significant differences between the two groups in terms of age [(57.4±10.2) years old vs. (60.9±9.8) years old, P=0.185], body mass index (BMI) [(25.7±3.5) kg/m 2 vs. (25.1±3.6) kg/m 2, P=0.518], and preoperative serum creatinine [(102.9±31.6) μmol/L vs. (102.3±22.4) μmol/L, P=0.930]. Twelve cases underwent hypothermic treatment during surgery, with 9 cases(20.9%) in the RAPN group and 3 cases(12.5%) in the LPN group( P=0.596). Surgical time, intraoperative warm ischemia time, intraoperative blood loss, postoperative fasting time, perioperative complication rate, postoperative serum creatinine, and other indicators were compared between the two groups. Multiple linear regression analysis was used to identify factors affecting postoperative serum creatinine. Kaplan-Meier curves were employed to analyze patient prognosis, and log-rank tests were performed to compare the differences between the two groups. Multiple Cox regression analysis was used to identify factors influencing patient prognosis. Results:All surgeries were completed successfully with negative pathological margins. There were no statistically significant differences between the RAPN and LPN groups in terms of surgical time [(136.6±47.6) min vs. (125.3±34.4) min, P=0.311], intraoperative ischemia time [23.0 (16.0, 30.0) min vs. 19.0 (13.5, 27.5) min, P =0.260], intraoperative blood loss [50.0 (50.0, 100.0) ml vs. 50.0 (22.5, 100.0) ml, P=0.247], postoperative hospital stay [(6.6±3.5) days vs. (7.7±4.2) days, P=0.244], time to drain removal [4(3, 5) days vs. 5(3, 6) days, P =0.175], postoperative fasting time [(2.1±0.7) days vs. (2.2±1.0) days, P=0.729], perioperative complication rate [18.6% (8/43) vs. 16.7% (4/24), P=1.000], postoperative serum creatinine [145.2 (128.3, 191.3) μmol/L vs. 157.8 (136.2, 196.3) μmol/L, P =0.229], and pathological staging [T 1a/T 1b/T 2a/T 3a/T 4 stage: 32/7/1/3/0 case vs. 17/5/0/1/1 case, P=0.804]. Kaplan-Meier survival curves showed that the total survival rates at 1, 3, and 5 years after surgery were 94.7%, 84.9%, and 84.9% for the RAPN group, and 100.0%, 95.5%, and 95.5% for the LPN group, with no statistically significant difference in the log-rank test ( P=0.116). Excluding 10 patients with preoperative tumor metastasis (7 in the RAPN group and 3 in the LPN group), the progression-free survival rates at 1, 3, and 5 years after surgery were 84.8%, 81.1%, and 81.1% for the RAPN group, and 100.0%, 95.0%, and 90.0% for the LPN group, with no statistically significant difference in the log-rank test ( P =0.142). Multiple linear regression analysis showed that the use of hypothermic treatment during surgery significantly reduced postoperative serum creatinine ( B=-72.191, P=0.048). Multiple Cox regression analysis revealed that BMI ( HR=0.743, P=0.044), pathological T stage ( HR=4.235, P=0.018), and preoperative metastasis ( HR=18.829, P=0.035) were independent factors affecting patient overall survival time. A smaller BMI, higher pathological stage, and preoperative metastasis were associated with poorer prognosis. Conclusions:Despite the higher R. E.N.A.L. score and greater surgical difficulty in the RAPN group, RAPN achieved similar perioperative and prognostic results as the LPN, indicating RAPN advantages in treating tumors in isolated kidney. Appropriate intraoperative hypothermic treatment can better protect postoperative renal function. BMI, pathological T stage, and preoperative metastasis are independent factors affecting overall survival time.

Endoscopic ultrasonography(EUS)can not only directly observe the morphology of the lumens of the digestive tract through the endoscope,but also perform real-time dynamic ultrasound scanning to obtain the layers of the lumen and the structure of surrounding organs.With the wide application and technical improvement of EUS,we gradually realize that it plays an important role in the diagnosis and treatment of cholangiocarcinoma.This article reviews the application of EUS in the diagnosis and treatment of cholangiocarcinoma.

Telesurgery, which utilizes remote communication technology and surgical robots for operations, is an emerging method that breaks the constraints of space on surgical procedures and is an important development direction for future surgery. With a vast territory, telesurgery has the potential to become a candidate method to improve the uneven distribution of regional medical resources. In recent years, with the development and maturity of China′s domestic surgical robot technology and communication technology, China has made rapid progress in the field of telesurgery, but is still in the primary stage of development, facing many challenges and also taking advantage of opportunities. The next 20 years will be a golden opportunity for the development of telesurgery worldwide, and it is a hopeful view that Chinese surgeons will seize the opportunity and face the challenges to lead the development of telesurgery.

Telesurgery, which utilizes remote communication technology and surgical robots for operations, is an emerging method that breaks the constraints of space on surgical procedures and is an important development direction for future surgery. With a vast territory, telesurgery has the potential to become a candidate method to improve the uneven distribution of regional medical resources. In recent years, with the development and maturity of China′s domestic surgical robot technology and communication technology, China has made rapid progress in the field of telesurgery, but is still in the primary stage of development, facing many challenges and also taking advantage of opportunities. The next 20 years will be a golden opportunity for the development of telesurgery worldwide, and it is a hopeful view that Chinese surgeons will seize the opportunity and face the challenges to lead the development of telesurgery.

Objective To observe the value of chocolate balloon(controlled dilatation technique)for vascular preparation of endovascular treatments for lower extremity arteriosclerosis obliterans(ASO).Methods Data of 110 patients with lower extremity ASO who underwent vascular preparation with chocolate balloon were retrospectively analyzed.The type of ASO,with calcification or not and so on were recorded,and the success rate of vascular preparation with chocolate balloon and the therapeutic effect of endovascular treatments for ASO were evaluated.Results Among 110 patients,unilateral lower extremity ASO were found in 100 cases,while bilateral lower extremities ASO were noticed in 10 cases,including 100(100/120,83.33%)chronic occlusive lesions,8(8/120,6.67%)stenotic lesions and 12(12/120,10.00%)thrombotic lesions.Calcification with grade 3-4 were observed in 50 lesions(50/120,41.67%).The technical success rate of vascular preparation with chocolate balloon was 92.50%(111/120),while 7(7/120,5.83%)lesions developed flow-limiting dissection after chocolate balloon dilatation and 2(2/120,1.67%)lesions had significant residual stenosis that did not meet the technical success criteria,which underwent stent implantation without drug-coated balloon(DCB).Besides,flow-limiting dissection were noticed in 15 lesions after DCB,hence salvage stents were implanted.The success rate of endovascular treatments of ASO was 100%.Conclusion Chocolate balloon(controlled dilation technique)was valuable for vascular preparation of endovascular treatments for lower extremity ASO.

Interarterial subtype of coronary artery with anomalous aortic origin is a rare and congenital cardiovascular malformation,manifested by chest pain and syncope after exertion or activity,which can lead to decreased cardiac contractility,myocardial infarction,and even sudden death.Here we report a case of an adolescent patient,who presented with chest pain during activity accompanied by syncope and lost consciousness.Initially diagnosed with acute myocardial infarction,the patient was subsequently diagnosed as interarterial subtype of a coronary artery originating from anomalous aorta after echocardiography,coronary angiography,coronary CT angiography examinations.After anomalous coronary artery correction and coronary angioplasty,the paitent recovered well.

Objective:To compare improved microbial assay (IMA) and electrochemiluminescence (ECL) for measuring serum folate, and to investigate the linear or non-linear correlation between the results of the two methods.Methods:This comparative study was conducted in National Health Commission Key Laboratory of Reproductive Health from October 2020 to February 2021, in which the folate concentration of 251 serum samples were measured by IMA and ECL. According to the serum folate concentration, the folate status was divided into sufficient (≥13.5 nmol/L), marginal deficiency (6.8≤serum folate<13.5 nmol/L), and deficiency (<6.8 nmol/L). Pearson correlation analysis and multivariate fractional polynomial (MFP) model were used to evaluate the correlation between the results measured by the two methods. The sensitivity of ECL for detecting folate status were calculated based on the IMA results as the golden standard.Results:The average folate concentrations in serum samples measured by ECL and IMA were (19.8±8.2) nmol/L and (23.0±9.7) nmol/L, respectively ( P<0.001). The Pearson correlation coefficient ( r) of the two methods was 0.894 ( P<0.001), yet the MFP model demonstrated non-linear correlation between the two methods. When the IMA results were≤9.1 nmol/L, the r was 0.070 ( P>0.05); when the IMA results were>9.1 nmol/L, the r was 0.867 ( P<0.001); for non-hemolytic serum samples ( n=221), the r was 0.902 ( P<0.001). Additionally, the sensitivity of ECL detecting folate deficiency was 27.78%, and the sensitivity of ECL detecting folate insufficiency (deficiency and marginal deficiency) was 93.33%. Conclusion:When folate concentrations was>9.1 nmol/L), the results of ECL and IMA were highly correlated; yet the correlation between the two methods was weak at lower folate concentrations, indicating that ECL was not applicable for serum folate measurement among folate insufficiency population.

Objective:Currently,patients with pre-exsiting donor-specific antibody(DSA)are prone to antibody-mediated rejection(AMR)after surgery and are at a relatively high risk of postoperative complications and graft failure.The risk of postoperative complications and graft failure is relatively high.This study aims to discuss the clinical outcome of DSA-positive kidney transplantation and analyze the role and safety of preoperative pretreatment in DSA-positive kidney transplantation,providing single-center treatment experience for DSA-positive kidney transplantation. Methods:We retrospectively analyzed the clinical data of 15 DSA-positive kidney transplants in the Department of Renal Transplantation of First Affiliated Hospital of Zhengzhou University from August 2017 to July 2022.Eight cases were organ donation after citizen's death(DCD)kidney transplant recipients,of which 3 cases in the early stage were not treated with preoperative desensitisation therapy(DCD untreated group,n=3),and 5 recipients were treated with preoperative rituximab desensitisation(DCD preprocessing group,n=5).The remaining 7 cases were living related donors recipients(LRD)who received preoperative desensitisation treatment with rituximab and plasma exchange(LRD preprocessing group,n=7).We observed and recorded the incidence of complications with changes in renal function and DSA levels in the recipients and the survival of the recipients and transplanted kidneys at 1,3 and 5 years,and to compare the differences in recovery and postoperative complications between 3 groups. Results:All 15 recipients were positive for preoperative panel reactive antibody(PRA)and DSA and were treated with methylprednisolone+rabbit anti-human thymocyte immunoglobulin induction before kidney transplantation.DCD untreated group all suffered from DSA level rebound,delayed renal graft function(DGF)and rejection reaction after surgery.After the combined treatment,DSA level was reduced and the graft renal function returned to normal.The DCD preprocessing group were all without antibody rebound,1 recipient developed DGF and the renal function returned to normal after plasmapheresis,and the remaining 4 recipients recovered their renal function to normal within 2 weeks after the operation.In the LRD preprocessing group,2 cases had antibody rebound and 1 case had rejection,but all of them recovered to normal after treatment,and DSA was maintained at a low level or even disappeared.The incidence of DGF and rejection in the DCD untreated group were significantly higher than that in the DCD preprocessing group and the LRD preprocessing group;and there were no significant difference in the incidence of postoperative haematuria,proteinuria,bacterial and fungal infections,and BK virus infection between the 3 groups(all P>0.05).A total of 11 of the 15 recipients were followed up for more than 1 year,6 for more than 3 years,and 1 for more than 5 years,and the survival rates of both the recipients and the transplanted kidneys were 100%. Conclusion:Effective preoperative pretreatment with desensitization therapy can effectively prevent antibody rebound in DSA-positive kidney transplantation and reduce perioperative complications.

Objective To investigate the clinical effects and influencing factors of remote ischemic post-conditioning RIPostC in the patients with post stroke fatigue(PSF).Methods Eighty patients with PSF were ran-domly divided into experimental group(n = 40)and control group(n = 40).Patients in both groups received routine drug therapy and rehabilitation training for stroke.The experimental group were additionally given RIPostC for four weeks.They were evaluated with National Institute of Health Stroke Scale(NIHSS),Barthel Index(BI),Mini-mental State Examination(MMSE),fatigue severity scale(FSS),Hamilton Anxiety Scale(HAMA),and Hamilton Depression Scale(HAMD).Results The score of NIHSS,FSS,HAMA and HAMD in the both groups were decreased,while the score of BI and MMSE were increased(P<0.01).The difference in the score of NIHSS,BI,MMSE,FSS,HAMA and HAMD between the two groups before and after treatment showed statistical significance(P<0.01)and the difference in the score was more significant in the experimental group.The risk factors of FSS were MMSE and HAMA.Conclusion RIPostC can effectively improve the neurological deficits,daily activity ability and cog-nitive function,alleviate fatigue,anxiety and depression in the patients of PSF.The influencing factors of PSF are cognitive function and anxiety.

It was a retrospective cohort study. Patients diagnosed with idiopathic membranous nephropathy (IMN) and received rituximab (RTX) alone for one course of treatment during hospitalization in the Department of Nephrology of the First Hospital of Jilin University from March 2020 to March 2022 were enrolled. The patients were divided into 1 g standard treatment group (once 1 g every 2 weeks for twice) and 375 mg/m 2 experimental treatment group (375 mg/m 2 once a week for 4 weeks) according to the different methods of drug administration, and the efficacy and safety of different doses of RTX in the treatment of IMN were compared between the two groups to provide a reference for optimizing the clinical treatment protocol. The patients were followed up regularly for more than 9 months after treatment and the data were complete. A total of 69 patients were included with age of (51.7±11.8) years old, and 46 males (66.7%). There were 31 patients in the 1 g standard treatment group and 38 patients in the 375 mg/m 2 experimental treatment group. The proportion of first-treatment patients in the 1 g standard treatment group was higher than that in the 375 mg/m 2 experimental treatment group (87.1% vs. 65.8%, χ2=4.174, P=0.041). There were no statistically significant differences in the general data, clinical characteristics and baseline laboratory parameters between the two groups (all P>0.05). At the end of 3 months of treatment, 22 patients (31.9%) experienced remission, including 9 patients (29.0%) in the 1 g standard treatment group and 13 patients (34.2%) in the 375 mg/m 2 experimental treatment group ( χ2=0.211, P=0.646). At 6 months, 30 patients (43.5%) experienced remission, including 12 patients (38.7%) in the 1 g standard treatment group and 18 patients (47.4%) in the 375 mg/m 2 experimental treatment group ( χ2=0.521, P=0.470). At 9 months, 38 patients (55.1%) achieved remission, including 18 patients (58.1%) in the 1 g standard treatment group and 20 patients (52.6%) in the 375 mg/m 2 experimental treatment group ( χ2=0.204, P=0.652). At 9 months, the 24 h urine protein of 1 g standard treatment group and 375 mg/m 2 experimental treatment group decreased by 7.93 (6.24, 8.46) g and 7.45 (5.66, 8.67) g (both P<0.05), respectively, and serum albumin increased by 16.4 (15.5, 17.5) g/L and 15.5 (9.0, 15.8) g/L (both P<0.05), respectively, from the baseline value. Kaplan-Meier survival analysis result showed that there was no significant difference in the time of phospholipase A2 receptor titer decreasing to <5 RU/ml between the two groups (Log-rank χ2=3.653, P=0.056). Twenty-three non-serious adverse events occurred in the 1 g standard treatment group, involving 16 patients, and 10 non-serious adverse events occurred in the 375 mg/m 2 experimental treatment group, involving 10 patients. There was better safety in the 375 mg/m 2 experimental treatment group than that in the 1 g standard treatment group ( Fisher value=8.593, P=0.015). Both 375 mg/m 2 regimen and 1 g regimen of RTX in IMN patients are effective in relieving proteinuria and elevating serum albumin. The 375 mg/m 2 regimen of RTX has a lower incidence of adverse events compared with the 1 g regimen.