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At present, mammalian target of rapamycin (mTOR) inhibitors are commonly-used immunosuppressive drugs after organ transplantation, including sirolimus (rapamycin) and everolimus. mTOR inhibitors not only exert an immunosuppressive effect by inhibiting T cell proliferation, but also possess multiple potential functions, such as antiaging, anti-tumor and anti-virus infection, etc. Virus infection is one of the most common complications after organ transplantation. Current anti-viral treatments are limited and yield poor efficacy. In this article, the role of mTOR pathway in virus infection, the mechanism of common mTOR inhibitors and the role of mTOR inhibitors in different types of virus infections were reviewed, aiming to provide reference for clinical application and subsequent research of mTOR inhibitors in organ transplant recipients.
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Laparoscopy technology is widely used in urology. The mastery of laparoscopic surgery by urologists is very important to improve the quality of surgery and improve the prognosis of patients. However, there is no evaluation system for the maturity of laparoscopic technology of urologists. Based on this situation, in recent years, some evaluation criteria or evaluation elements have emerged to try to evaluate the laparoscopic skills of urologists. This article mainly summarizes the common evaluation tools, application scenarios, and limitations of laparoscopic technology in urology, and made an idea to establish a laparoscopic technology evaluation system in urology, providing a certain reference for the application and development of training and evaluation tools of laparoscopic technologyin urology.
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Objective:To evaluate the effects of preoperative transversus abdominis plane block (TAPB) and intraoperative deep wound local anesthesia on improving postoperative pain in kidney transplant recipients.Methods:A retrospective study was conducted on 62 recipients who underwent allogeneic kidney transplantation at Beijing Friendship Hospital, Capital Medical University from January 2020 to June 2023. The recipients were divided into three groups according to the different methods of postoperative analgesia: group A ( n=11), group B ( n=28) and group C ( n=23). Group A received preoperative TAPB anesthesia, group B received intraoperative deep wound local anesthesia, and group C received conventional anesthesia. Demographic characteristics, intraoperative parameters, postoperative pain visual analog scale (VAS) scores at 0, 2, 12 and 24 hours, postoperative analgesic medication requirement, time to postoperative oral intake, and incidence of complications were compared among the three groups. The normality of measurement data was tested by Shapiro-Wilk method. Measurement data conforming to normal distribution were expressed as mean ± standard deviation ( ± s). ANOVA was used for comparison between groups, and S-N-K method was used for pairwise comparison between groups with differences. Measurement data that did not conform to the normal distribution were expressed as the median (interquartile distance) [ M( Q1, Q3)], Kruskal-Wallis H test was used for comparison between groups, and Bonferroni was used for pairwise comparison after the fact if there were differences between groups. The Chi-square test or Fisher exact probability method was used for comparison between data groups. Results:There were no significant differences in demographic characteristics and intraoperative parameters among the three groups ( P>0.05). The pain VAS scores at 0, 2, 12 and 24 h after surgery in group A and group B were significantly lower than those in group C ( P<0.001), and the pain VSA scores at 0 and 24 h were no difference between group A and group B, while the pain VAS scores at 2 and 12 h were lower in group A than those in group B. The postoperative analgesic medication requirement was also significantly lower in group A and group B than those in group C, the requirement rate of nonsteroidal antiinflammatory drug in group A was lower than that in group B. Moreover, the time to postoperative oral intake was significantly shorter in group A and group B compared to group C. These differences were statistically significant ( P< 0.05). There were no statistically significant differences in postoperative nausea and vomiting or major complications among the three groups ( P> 0.05). Conclusions:Preoperative TAPB and intraoperative deep wound local anesthesia can effectively alleviate postoperative pain in kidney transplant recipients, reduce the use of analgesic medication, promote early recovery of gastrointestinal function in donors, and do not increase the incidence of postoperative complications. The analgesic effect of deep wound local anesthesia was similar to preoperative TAPB.
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Objective:To explore the application value of 3D-slicer software in measuring renal volume parameters of renal transplant donors in evaluating renal function.Methods:The data of 31 renal donors admitted to Beijing Friendship Hospital, Capital Medical University from October 2019 to September 2022 were retrospectively analyzed. Glomerular filtration rate (GFR) were measured by SPECT radioactive dynamic imaging, and renal cortex volume (RCV), renal parenchymal volume (RPV) were measured after 3D reconstruction of urinary enhanced CT based on 3D slicer software. The estimated GFR(eGFR) predicted by creatinine-based GFR estimation equations (C-G equation, modified and simplified MDRD equation) and volume-based GFR estimation equations (Herts equation, Choi equation). Different eGFR were calculated, and the correlation between kidney volume parameters, eGFR equations and measured GFR was analyzed. The deviation, accuracy and consistency between different equations eGFR and measured GFR were analyzed and compared. The measurement data of normal distribution were expressed as mean±standard deviation ( ± s), and t-test was used for inter-group comparison. Measurement data with non-normal distribution were represented by M( Q1, Q3), and non-parametric test was used for comparison between groups. Results:The correlation between different eGFR and measured GFR is poor, and the deviation is small, and with good accuracy and consistency. Except for the weak correlation between the Choi equation eGFR and measured GFR ( r=0.382, P=0.034), there was no significant correlation between eGFR by other equations and measured GFR ( P>0.05). Among them, the deviation between the Herts equation-eGFR and measured GFR was the smallest (0.30 mL·min -1·1.73 m -2), with a 10% coincidence rate (61.29%) and a 30% coincidence rate (96.77%), and the best consistency with measured GFR, with a consistency limit of -28.75 to 29.34 mL·min -1·1.73 m -2. Conclusion:Compared with the laboratory index formula method, the Herts equation has better prediction efficiency in estimating GFR, The measurement of renal volume parameters by 3D slicer software has a certain clinical value in evaluating the renal function of renal donors, which is worthy of further application.
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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.
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Objective:To investigate the application value of three-dimensional image reconstruction technology based on 3D-slicer software in urology.Methods:The data of 36 patients with urinary tract diseases admitted to Beijing Friendship Hospital, Capital Medical University from May 2019 to December 2021 were retrospectively analyzed, including 20 males and 16 females; the median age was 53.50(41.75, 66.25) years. There were 10 relative kidney transplant donors, 12 cases with renal tumors, 6 cases with hydronephrosis and 8 patients with urinary calculi. The CT urography data of 36 cases were reconstructed into three-dimensional image models based on 3D-slicer software, and the morphology of the target tissue was measured.Results:In the urinary system model of 10 relative kidney transplant donors constructed in this study, the type of donor renal artery was single artery in 7 cases and accessory renal artery in 3 cases; In the three-dimensional model of 12 tumor kidneys, 4 tumors were located at the upper part of the kidney (2 near ventral and 2 near dorsal), 5 tumors were located at the middle part of the kidney (2 near ventral and 3 near dorsal), and 3 tumors were located at the lower part of the kidney near ventral. The average maximum diameter of the tumors was (27.3 ± 9.63) mm, and the tumor volume was (15.89 ± 5.93) cm 2. The study also successfully constructed a three-dimensional image model of the urinary system in 6 patients with hydronephrosis and 8 patients with urinary calculi (without hydronephrosis). Three-dimensional model image reconstructed by 3D-slicer software clearly showed the spatial structure of renal parenchyma, blood vessels, renal pelvis, calyces and ureter. The diameter, position and direction of ureters and blood vessels can be observed clearly based on the three-dimensional reconstruction model, and clinicians could also evaluate the location, shape, size and adjacent relationship with surrounding tissues of renal cysts, tumors, stones or other masses. Conclusion:3D-slicer software platform can assist clinicians to reconstruct the three-dimensional model of urinary system, which is worthy of further clinical application.