Subject(s)
Renal Veins , Solitary Kidney , Humans , Kidney Neoplasms/surgery , Kidney Neoplasms/pathology , Prognosis , Nephrectomy/methods , Dissection/methodsABSTRACT
BACKGROUND: Renal function after left renal vein (LRV) ligation following en bloc resection of segmental inferior vena cava (IVC) and right kidney is understudied. We assessed the impact of LRV ligation on postoperative renal function following en bloc resection of segmental IVC and right kidney. METHODS: We retrospectively reviewed 28 patients who underwent LRV ligation during en bloc resection of segmental IVC and right kidney. Patient demographics, tumor characteristics, intraoperative factors, complications, length of hospital and intensive care unit (ICU) stay, and patient survival were collected. Pre- and postoperative renal function was retrospectively analyzed. RESULTS: Twenty patients underwent robot-assisted surgery and eight patients underwent open surgery. The median operative time was 162 min and estimated blood loss was 350 mL. Ten patients had normal renal function and 12 patients had an initial increase in creatinine but improved gradually. Six patients developed acute renal failure; five patients gradually recovered in 5-32 days after temporary hemodialysis. Renal replacement therapy significantly correlated with maximal anterior-posterior diameter of the LRV (p = 0.001). Complications were observed in 11 cases, four of which were Clavien-Dindo grades I-II. Thirteen patients were alive with no recurrence, nine patients were alive with metastasis, and six cases died during the follow-up period. CONCLUSIONS: LRV ligation following en bloc resection of segmental IVC and right kidney is feasible, with no significant long-term impact on renal function. The maximum anterior-posterior diameter of the LRV is a reliable method for predicting renal replacement therapy in the absence of collateral circulation.
Subject(s)
Kidney Neoplasms , Renal Veins , Vena Cava, Inferior , Humans , Vena Cava, Inferior/surgery , Vena Cava, Inferior/pathology , Male , Female , Renal Veins/surgery , Retrospective Studies , Middle Aged , Ligation , Kidney Neoplasms/surgery , Kidney Neoplasms/pathology , Aged , Follow-Up Studies , Adult , Survival Rate , Nephrectomy/methods , Postoperative Complications , Prognosis , Kidney/surgery , Robotic Surgical Procedures/methods , Kidney Function Tests , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/pathologyABSTRACT
Introduction: Robotic surgery using da Vinci surgical system has gained prominence in urology; emerging robotic platforms are expanding its applications and increasing affordability. We assess the feasibility and safety of a novel system, the Toumai® robotic system in various urological surgeries. Methods: This prospective study was conducted at the first affiliated hospital of Zhengzhou university. Twenty consecutive patients underwent renal and prostatic surgery with the Toumai. The study assessed technical feasibility (conversion rate) and safety (perioperative complications) of the procedures as primary outcomes. Secondary endpoints included key surgical perioperative outcomes: functional and oncologic results. The Endoscopic Surgical System operates within a master-slave protocol, comprising a Surgeon Console, Patient Platform, and Vision Platform. Results: Seventeen patients underwent various nephrectomy procedures and three underwent radical prostatectomy (RP). There was no conversion to alternative surgical approach; a single (Clavien-Dindo grade ≥3b) complication occurred, and no readmission was recorded within 30 days. The median operative time was 120, 140, and 210 minutes for partial nephrectomy (PN), radical nephrectomy, and RP, respectively. Off-clamp PN was performed in one case, and the warm ischemia time in the remaining two case was 18 minutes. The median docking time was 22 minutes for nephrectomy and 20 minutes for RP; no major robotic malfunction was encountered. At 3-month follow-up, no tumor recurrence was recorded, renal function was well preserved, and the continence status was satisfactory. Conclusions: We present the initial clinical utilization of an innovative robotic platform. Complex urological surgeries were successfully completed without conversions and with minimal complications. Further investigations are warranted to confirm these initial findings.
Subject(s)
Feasibility Studies , Robotic Surgical Procedures , Urologic Surgical Procedures , Humans , Robotic Surgical Procedures/methods , Robotic Surgical Procedures/instrumentation , Male , Middle Aged , Aged , Urologic Surgical Procedures/methods , Urologic Surgical Procedures/instrumentation , Urologic Surgical Procedures/adverse effects , Female , Prostatectomy/methods , Prostatectomy/adverse effects , Prostatectomy/instrumentation , Prospective Studies , Nephrectomy/methods , Nephrectomy/instrumentation , Adult , Treatment OutcomeABSTRACT
Maelstrom (MAEL), a novel cancer/testis-associated gene, may facilitate the initiation and progression of human malignancies, warranting comprehensive investigations. Single-cell and tissue-bulk transcriptomic data demonstrated higher MAEL expression in testis (spermatogonia/spermatocyte), kidney (proximal tubular cell), and brain (neuron/astrocyte), and corresponding cancers, including testicular germ cell tumor, glioma, papillary renal cell carcinoma, and clear cell renal cell carcinoma (ccRCC). Of these cancers, only in ccRCC did MAEL expression exhibit associations with both recurrence-free survival and overall survival. High MAEL expression was associated with an anti-inflammatory tumor immune microenvironment and VEGFR/mTOR activation in ccRCC tissues and high sensitivities to VEGFR/PI3K-AKT-mTOR inhibitors in ccRCC cell lines. Consistent with these, low rather than high MAEL expression indicated remarkable progression-free survival benefits from immune checkpoint inhibitor (ICI)-based immunotherapies over VEGFR/mTOR inhibitors in two large phase III trials (JAVELIN Renal 101 and CheckMate-025). MAEL is a biologically and clinically significant determinant with potential for prognostication after nephrectomy and patient selection for VEGFR/mTOR inhibitors and immunotherapy-based treatments.
Subject(s)
Carcinoma, Renal Cell , Kidney Neoplasms , Humans , Male , Carcinoma, Renal Cell/drug therapy , Carcinoma, Renal Cell/genetics , Immunotherapy , Kidney Neoplasms/therapy , Kidney Neoplasms/drug therapy , MTOR Inhibitors , Phosphatidylinositol 3-Kinases , Prognosis , Tumor MicroenvironmentABSTRACT
OBJECTIVES: We aimed to assess the feasibility and efficacy of laparoscopic extravascular stent in treatment of nutcracker syndrome by transperitoneal or retroperitoneal approach. METHODS: Seventy-six patients with nutcracker syndrome were retrospectively enrolled from a tertiary referral center, and underwent transperitoneal (63 patients) or retroperitoneal (13 patients) laparoscopic extravascular stent from March 2011 to December 2020. Surgical parameters, complications, imaging and clinical outcomes were collected and analyzed. RESULTS: All procedures were successfully carried out without open conversion. The median operation time, estimated blood loss, and postoperative hospital day were 120 (interquartile range [IQR]: 90-144) min, 20 (IQR: 10-30) ml, and 7 (IQR: 6-9) days. At a median follow-up of 52 (range: 9-127) months, 60 (79%) patients had complete symptom resolution, 14 (18%) patients had significant symptom improvement, and 2 (3%) patients reported no symptom improvement. Ninety-four percent (50/53) of hematuria, 91% (30/33) of proteinuria, and 89% (25/28) of flank/abdominal pain resolved after extravascular LRV stenting. No significant differences were detected in surgery parameters and recovery rates of clinical symptoms between two approaches (each p > 0.05). However, patients with transperitoneal approach need longer to achieve complete recovery compared with retroperitoneal approach (8.7 vs. 1.5 months, p = 0.016). CONCLUSIONS: Laparoscopic extravascular stent performed either transperitoneally or retroperitoneally is a feasible and effective option in treatment of nutcracker syndrome. Retroperitoneal laparoscopic extravascular stent required shorter time to achieve complete recovery, which should be considered whenever possible in surgical decision-making.
Subject(s)
Laparoscopy , Renal Nutcracker Syndrome , Humans , Renal Veins/diagnostic imaging , Renal Veins/surgery , Retrospective Studies , Stents , Retroperitoneal Space/surgery , Laparoscopy/adverse effects , Laparoscopy/methods , Syndrome , Renal Nutcracker Syndrome/complications , Renal Nutcracker Syndrome/diagnostic imaging , Renal Nutcracker Syndrome/surgery , Treatment OutcomeABSTRACT
BACKGROUND: Machine learning has many attractive theoretic properties, specifically, the ability to handle non predefined relations. Additionally, studies have validated the clinical utility of mpMRI for the detection and localization of CSPCa (Gleason score ≥ 3 + 4). In this study, we sought to develop and compare machine-learning models incorporating mpMRI parameters with traditional logistic regression analysis for prediction of PCa (Gleason score ≥ 3 + 3) and CSPCa on initial biopsy. METHODS: A total of 688 patients with no prior prostate cancer diagnosis and tPSA ≤ 50 ng/ml, who underwent mpMRI and prostate biopsy were included between 2016 and 2020. We used four supervised machine-learning algorithms in a hypothesis-free manner to build models to predict PCa and CSPCa. The machine-learning models were compared to the logistic regression analysis using AUC, calibration plot, and decision curve analysis. RESULTS: The artificial neural network (ANN), support vector machine (SVM), and random forest (RF) yielded similar diagnostic accuracy with logistic regression, while classification and regression tree (CART, AUC = 0.834 and 0.867) had significantly lower diagnostic accuracy than logistic regression (AUC = 0.894 and 0.917) in prediction of PCa and CSPCa (all P < 0.05). However, the CART illustrated best calibration for PCa (SSR = 0.027) and CSPCa (SSR = 0.033). The ANN, SVM, RF, and LR for PCa had higher net benefit than CART across the threshold probabilities above 5%, and the five models for CSPCa displayed similar net benefit across the threshold probabilities below 40%. The RF (53% and 57%, respectively) and SVM (52% and 55%, respectively) for PCa and CSPCa spared more unnecessary biopsies than logistic regression (35% and 47%, respectively) at 95% sensitivity for detection of CSPCa. CONCLUSION: Machine-learning models (SVM and RF) yielded similar diagnostic accuracy and net benefit, while spared more biopsies at 95% sensitivity for detection of CSPCa, compared with logistic regression. However, no method achieved desired performance. All methods should continue to be explored and used in complementary ways.
Subject(s)
Machine Learning , Patient Selection , Prostate/pathology , Aged , Biopsy , Humans , Male , Middle Aged , Models, Theoretical , Multiparametric Magnetic Resonance Imaging , Prostate/diagnostic imaging , Retrospective StudiesABSTRACT
Air pollution has been suggested to cause genetic damage from investigations of many biological markers that measure cytogenetic damage in humans. Here, we evaluated the genotoxic effects of ambient air pollution by investigating the extent of cytogenetic damage in human blood lymphocytes from rural and industrial female residents of Shenyang city, China, using micronuclei assays and polymorphic analyses of metabolic enzyme and DNA repair genes. After adjustment for potential confounding factors including DNA polymorphisms, industrial female residents were found to have a higher micronuclei frequency. These results provide evidence that micronuclei assays are a sensitive indicator to air pollution-induced genotoxic effects in humans.
Subject(s)
Air Pollutants/toxicity , Carcinogens, Environmental/toxicity , Fluorenes/toxicity , Lymphocytes/drug effects , Micronuclei, Chromosome-Defective , Mutagens/toxicity , Occupational Exposure , Adult , Air Pollutants/analysis , Carcinogens, Environmental/analysis , China , Female , Fluorenes/analysis , Humans , Micronucleus Tests , Middle Aged , Mutagens/analysis , Polycyclic Aromatic Hydrocarbons/analysis , Urban HealthABSTRACT
To examine the effects of carbofuran on the testis of male rats. The activities of beta-glucuronidase (beta-G), glucose-6-phosphate dehydrogenase(G-6-PD) and lactate dehydrogenase isoenzyme-x (LDHx) in serum and testis homogenate were determined for the rats given carbofuran at the dises of 0.3, 1.5 and 3.0 mg/kg orally for 7, 35 and 77 days. The results showed that after 7 days, the activities of beta-G in serum in all exposed groups were lower than those in control (P < 0.05). The activities of beta-G in testis homogenate in 0.3 mg/kg and 3.0 mg/kg were higher or lower than those in control (P < 0.05), respectively. After 77 days, the activities of G-6-PD in serum both in 1.5 mg/kg and 3.0 mg/kg were lower than those in control (P < 0.05). The activities of LDHx in testis homogenate in 3.0 mg/kg were lower than those in control (P < 0.05). It suggested that exposure to carbofuran could testis damage.