Primary retroperitoneal mucinous cystic tumour of borderline malignancy mimicking kidney duplicate: cases report and literature review.

BACKGROUND: Primary retroperitoneal mucinous cystic tumours with borderline malignancy (PRMC-BM) are rare and difficult to diagnose preoperatively. We are the first to report two cases of PRMC-BM which mimic a duplex kidney and evaluate the outcomes of different surgical procedures. CASE PRESENTATION: We describe two cases of retroperitoneal cystic tumours. Both were diagnosed with duplex kidney with hydronephrosis on computed tomography scan. The first patient underwent robot-assisted laparoscopic surgery and was found to have a retroperitoneal cystic tumour. The other patient underwent an ultrasound-guided puncture before surgery and was diagnosed with retroperitoneal lymphangioma. Retroperitoneal cystectomy was performed using an open transperitoneal procedure. The final pathologic diagnosis in both cases implies PRMC-BM. The open surgical approach was associated with a shorter operation time, less intraoperative blood loss, and protected cyst wall integrity by comparing the different surgical approaches. During follow-up, the patient in the first case had tumour recurrence six months post-surgery, and the other patient was healthy without recurrence or metastasis 12 months post-surgery. CONCLUSIONS: Primary retroperitoneal mucinous cystic tumours with borderline malignancy can be enclosed within the kidney and misdiagnosed as other cystic diseases of the urinary system. Thus, an open surgical approach may be more suitable for this type of tumour.

Duck CD40L as an adjuvant enhances systemic immune responses of avian flavivirus DNA vaccine.

Under the dual pressure of emerging zoonoses and the difficulty in eliminating conventional zoonoses, the strategic management of bird diseases through vaccination represents a highly efficacious approach to disrupting the transmission of zoonotic pathogens to humans. Immunization with a DNA vaccine yielded limited protection against avian pathogen infection. To improve its immunogenicity, the extracellular domain of duck-derived CD40L (designated as dusCD40L) was employed as a bio-adjuvant. Our findings unequivocally established the evolutionary conservation of dusCD40L across avian species. Notably, dusCD40L exhibited a compelling capacity to elicit robust immune responses from both B and T lymphocytes. Furthermore, when employed as an adjuvant, dusCD40L demonstrated a remarkable capacity to significantly augment the titers of neutralizing antibodies and the production of IFNγ elicited by a DNA vaccine encoding the prM-E region of an avian flavivirus, namely, the Tembusu virus (TMUV). Moreover, dusCD40L could strengthen virus clearance of the prM-E DNA vaccine in ducks post-TMUV challenge. This research study presents a highly effective adjuvant for advancing the development of DNA vaccines targeting TMUV in avian hosts. Additionally, it underscores the pivotal role of duCD40L as a potent adjuvant in the context of vaccines designed to combat zoonotic infections in avian species.

Cost analysis of supply chain management of Da Vinci surgical instruments: A retrospective study.

BACKGROUND: Da Vinci surgery is used extensively, but the high costs of the surgical instrument are a serious clinical and management problem. OBJECTIVE: To reduce the cost of the Da Vinci robotic surgical instrument supply chain. METHODS: Patients were selected from the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Control group patients underwent Da Vinci robot-assisted surgery between January 2019 and June 2019 (control group). Patients who were operated with the same robot from July 2019 to December 2019 were selected as the experimental group (SCM group). The cost analysis and comparison were carried out to integrate instrument sets, working hours, workforce expenditure, and direct and indirect expenses. RESULTS: Compared with the control group, the number of instrument packages was lower (4.5 ± 1.4 vs. 11.5 ± 1.6, P< 0.001) and the personnel's awareness of the instruments was higher (92.3 ± 4.2 vs. 83.4 ± 3.7, P< 0.001) in the SCM group. The SCM group showed lower processing time per device (8.1 ± 1.6 vs. 44.2 ± 5.6 min, P< 0.001) and lower costs per surgical instrument (RMB 11.5 ± 2.3 vs. 60.3 ± 10.2, P< 0.001). CONCLUSION: The application of the supply chain management can reduce the costs of robotic surgery, improve work efficiency and decrease the failure rate of instruments.