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Objective:To explore the feasibility and safety of long-distance urological nephrotomy with the support of 5G communication technology by using the domestic robot.Methods:Clinical data of the patients with remote robot-assisted laparoscopic nephrectomy, which were completed from March to April 2021 by the Affiliated Hospital of Qingdao University (as the host hospital where the main operating system located) were retrospectively analyzed. There were 3 patients, including 2 males and 1 female.The average age was 61 (49-73) years, and the average body mass index was 23.73 (20.00-27.76) kg/m 2. One patient had a ASA classification of grade 2, and the other 2 patients had grade 3. All patients met the surgical criteria for non-functional nephrectomy. The chief surgeon who performing the telesurgery was located at the Affiliated Hospital of Qingdao University. The surgeon remotely controlled the bedside operating system (slave system) in 3 local hospitals located in other cities in Shandong Province (network communication distances of 82.5, 141 and 229 km, respectively) by manipulating the master system located in Qingdao. Images and operating instructions during surgery were transmitted using 5G wireless communication technology. Intraoperative network conditions, robot operation, and patient perioperative data were summarized. Results:All 3 tele-nephrectomies were successfully completed. The average network signal latency time was 27.3 (23-30) ms, with no packet loss, and the average total latency time was 177.3(173-180) ms. The mean resection time was 79.3 (52-111) min, and the average intraoperative blood loss was 31.1 (15.6-41.9) ml. There were no network related adverse events occurred during the operation, and the robot-related adverse events occured 3 times, all three of which were characterized by inconsistent master and slave movements of the manipulator arm and the bedside robotic arm. None of these adverse events affected the successful performance of the telesurgery. The mean postoperative exhaust time was 60.5 (38.5-78.0) h. The mean postoperative VAS score at 24 hours was 3.7 (3-4). The Clavien-Dindo classification were all grade I. No significant abnormality was found on the 30th day after surgery, and the patients recovered well at the follow-up until 6 months postoperatively.Conclusions:It is safe and feasible to perform remote robot-assisted laparoscopic nephrectomy based on 5G communication technology with no serious adverse events or surgical complications.However, the conclusion needs to be further verified by large sample and multi-center prospective study.
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Objective To analyze the mutations of SLC12A1 gene in nine Chinese families with Bartter syndrome type I (BS1),and analyze the relationship between genotype and phenotype.Methods The next generation sequencing was used to detect mutations in nine BS1 patients including eight with antenatal BS (aBS) and one with classical BS (cBS).Clinical characteristics and biochemical findings at the first admission as well as follow-up were reviewed.Results 15 different mutations of SLC12A1 gene were identified,including 11 novel ones.Among nine probands,seven were compound heterozygotes,two were homozygotes.All patients presented with polydipsia and polyuria,and eight with growth retardation.All patients had lower than-normal serum chloride concentration,metabolic alkalosis,and elevated basal renin activity and aldosterone,and seven had hypokalemia.Through treatment of indomethacin and/or potassium chloride,biochemical indicators could roughly restored normal.Conclusion These findings will enrich the human gene mutation database (HGMD) and provide valuable references to the genetic counseling and diagnosis for Chinese population.
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Purpose To explore the reason which resulted in the flow-empty area in carotid artery, establishing a logistic regression model of carotid artery by power Doppler ultrasound, screening the risk factors of the occurrence of this phenomenon and analyzing their reasons. Materials and Methods Clinical data of 172 male subjects who had undergone power Doppler ultrasound were analyzed retrospectively, whether there was flow-empty area at the edge of carotid artery lumen during diastole was observed, brachial artery systolic pressure, diastolic pressure and pressure difference, carotid artery intima media thickness, and the existence of atherosclerotic plaques was measured, the age, body mass index (BMI), blood glucose, blood lipid, history of smoking and cerebrovascular accident situation was collected to establish the logistic model to analyze the risk factors resulted in flow-empty area. Results Among the 172 patients, intima media thickened in 89 cases, systolic blood pressure increased in 97 cases, diastolic blood pressure increased in 7 cases, the pulse pressure increased in 90 cases, with the age of 65 years or older in 92 cases, atherosclerotic plaque formation in 84 cases, long smoking history in 63 cases, cerebral vascular accident history in 11 cases, diabetes mellitus in 79 cases, hyperlipidemia in 101 cases, and abnormal BMI in 13 cases. Doppler energy imaging showed flow-empty area wave type in 98 cases, no flow-empty area wave type in 74 cases. 5 statistically significant variables for the occurrence of flow-empty area in carotid artery lumen during diastole were selected using logistic regression, which were carotid artery intima media thickness, BASP, the pressure difference of brachial artery, existence of atherosclerotic plaque, and the age of patients (OR=50.643, 47.248, 29.426, 32.667 and 20.514, P<0.05). Conclusion The risk factors resulted in flow-empty area in carotid artery are increased IMT, systolic BP and pressure difference, existence of atherosclerotic plaque and the age of 65 years or older. The flow-empty area provides hemodynamic information for the diagnosis of atherosclerosis, and it also plays a helping role in evaluating the degree of arteriosclerosis.