ABSTRACT
Objective:To explore the safety and early prognosis of robot assisted living donor kidney transplantation(KT)and plot the learning curve of mastering the operation.Methods:From July 2020 to March 2021, 30 cases of living robot assisted KT were completed.The follow-up period was 3 months.Cumulative sum analysis was performed for plotting the learning curve.According to the learning curve, they were divided into two groups of practice period(the first 17 cases)and proficiency period(the last 13 cases). Time of each operative stage and early prognosis were compared.Kidney function and perioperative complications of two groups were compared for evaluating the safety and effectiveness of robot assisted KT.Results:The average operative duration was (221.4±36.1)min.No intestinal obstruction, delayed graft function, urinary leakage and incision infection occurred during perioperative period.The average anal exhaust time was(1.9±0.2)days.During follow-ups, both pulmonary infection(2 cases)and acute rejection(1 case)improved after treatment.According to the learning curve, venous anastomosis(10 cases), arterial anastomosis(12 cases), warm ischemic time(12 cases)and ureteral anastomosis(17 cases)should be performed for reaching a proficiency level.An average of 15 operations was required for achieving proficiency throughout operations.Significant inter-group differences existed in operative duration [(235.5±31.6)vs(203.0±34.3)min, P=0.012] and warm ischemic time [(63.7±24.9)vs(47.0±11.3)min, P=0.033]. At some postoperative timepoints, creatinine of proficiency group was lower than that of practice group, such as Day 7 post-operation [(192.7±135.2)vs(107.8±27.9)μmol/L, P=0.022] and Day 30 post-operation [(147.8±46.3)vs(112.3±28.0)μmol/L, P=0.021]. However, no significant difference existed in estimated glomerular filtration rate at Day 7 post-operation [(56.1±34.1)ml/(min·1.73m 2)vs(72.0±18.5)ml/(min·1.73m 2), P=0.14] and Day 30 post-operation [(56.2±18.9)ml/(min·1.73m 2)vs(68.7±15.3)ml/(min·1.73m 2), P=0.14]. Conclusions:Robot assisted KT is both safe and feasible.And the learning curve requires 17 cases for reaching a proficiency level.
ABSTRACT
Objective:To evaluate the clinical value of temporal pole and external capsule white matter hyperintensities (WMHs) on the diagnosie of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) by meta-analysis.Methods:PubMed, Cochrane, Embase, VIP database, China Biomedical Literature database, CNKI, Wanfang Data Service Platform were retrieved. The relevant literature of temporal pole and external capsule WMHs for the diagnosis of CADASIL was collected. The retrieval time limit was from the establishment of the databases to April 1, 2020. Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) was used to evaluate the quality of literature. Stata 15.1 software was used for statistical analysis. The fitted Summary Receiver Operating Characteristic (SROC) curve and combined diagnostic effect size were used to evaluate the diagnostic value of temporal pole and external capsule WMHs for CADASIL.Results:A total of 9 articles involving 10 studies were enrolled, including 880 patients. The combined sensitivities of temporal pole and external capsule WMHs for CADASIL were 0.67 (95% confidence interval [ CI] 0.54-0.78) and 0.84 (95% CI 0.72-0.91) respectively, the combined specificities were 0.64 (95% CI 0.47-0.78) and 0.44 (95% CI 0.36-0.53) respectively, the combined positive likelihood ratios were 1.9 (95% CI 1.4-2.6) and 1.5 (95% CI 1.2-1.8) respectively, the combined negative likelihood ratios were 0.51 (95% CI 0.42-0.63) and 0.37 (95% CI 0.20-0.69) respectively, the odds ratios of combined diagnosis were 4 (95% CI 3-5) and 4 (95% CI 2-9) respectively, and the area under the SROC curves were 0.71 (95% CI 0.66-0.74) and 0.62 (95% CI 0.58-0.66) respectively. Conclusions:The temporal pole and external capsule WMHs have limited diagnostic value for CADASIL, and other factors need to be comprehensively considered in the clinical diagnosis process.
ABSTRACT
Objective:To summarize the clinical and imaging features of five patients of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) with cysteine-sparing NOTCH3 gene missense mutations and explore potential pathogenicity of gene mutations.Methods:The clinical data from five patients who were admitted to the People′s Hospital of Zhengzhou University from March 2017 to November 2018 were collected. The patients were found to carry cysteine-sparing NOTCH3 gene mutations through genetic testing and diagnosed pathologically. They were probands confirmed from five unrelated family and all five patients were performed full exon detection and skin biopsy.Results:Genetic testing identified five patients with cysteine-sparing NOTCH3 gene missense mutations, a total of five different mutations, including p.R75Q, p.D80G, p.V237M, p.S1418L and p.R1761H. The first three mutations were found in the epidermal growth factor-like repeats (EGFr), the latter two mutations near the transmembrane domain. Granular osmiophilic material was identified in all cases examined with skin biopsy. The age at initial symptom onset of these five cases was ranged from 22 to 58 years and three cases presented cardiovascular risk factors. The primary clinical manifestations included migraine in one case, ischemic stroke in three cases, psychiatric disturbances in four cases, cognitive dysfunction in five cases, while gait disturbance, pseudobulbar palsy, and seizures accounted for only one case each. Magnetic resonance imaging of five patients all showed white matter hyperintensities (WMLs) and lacunar infarcts, and WMLs involved the anterior temporal pole and external capsules in three cases separately. According to the criteria proposed by Mui?o et al for evaluating the pathogenicity of cysteine-sparing NOTCH3 mutations, all five mutations are potentially pathogenic.Conclusions:Most characteristics of CADASIL patients with cysteine-sparing NOTCH3 gene mutations are similar to those of CADASIL patients with cysteine NOTCH3 gene mutations. Mutations not involving the EGFr may also have potential pathogenicity, and the specific mechanism still needs further study.