全息影像技术在机器人辅助腹腔镜下肾部分切除术治疗肾门部肿瘤中的应用

目的评价全息影像技术引导机器人辅助腹腔镜下肾部分切除术(RAPN)治疗肾门部肿瘤的可行性与有效性。方法回顾性分析该院2019年6月-2019年10月收治的11例肾门部肿瘤患者的临床资料。其中,男3例,女8例;左侧4例,右侧7例;患者年龄32~75岁,平均62.6岁,体质指数19.45~28.12 kg/m^2,平均23.75 kg/m^2,肿瘤直径1.1~6.7 cm,平均2.76 cm,R.E.N.A.L.评分8~12分,平均10.7分,患肾肾小球滤过率(GFR)22~51 mL/min,平均35 mL/min。患者术前行全腹部增强CT,利用CT数据进行全息影像重建。术中应用该技术结合达芬奇机器人辅助系统,精准分离、剜除肿瘤,并记录手术持续时间、出血量、肾脏热缺血时间、有无并发症及切缘阳性率等。结果根据全息影像引导,11例患者均顺利剜除肿瘤,完成手术,无中转开放。手术时间60~130 min,平均90 min。术中出血量50~180 mL,平均100 mL,热缺血时间18~25 min,平均21 min,无术后发热、继发出血或漏尿等并发症。术后病理诊断肾透明细胞癌9例(FuhrmanⅠ和Ⅱ级),乳头状细胞癌1例,血管平滑肌脂肪瘤1例,无切缘阳性病例。术后随访3~7个月,平均4.3个月,患肾GFR 18~43 mL/min,平均31 mL/min。术后3个月复查肾脏CT平扫及增强,全部患者未出现复发。结论全息影像技术引导RAPN治疗肾门部肿瘤,围手术期并发症少,安全有效。

Robotic-assisted Laparoscopic Nephrectomy with Vein Thrombectomy:Initial Experience and Outcomes from a Single Surgeon

This study was designed to explore the safety and feasibility of robotic-assisted laparoscopic nephrectomy with vein thrombectomy (RAL-NVT) for the treatment of renal cell carcinoma (RCC)with venous tumor thrombus (VTT).Clinical data of 6 patients treated with RAL-NVT between July 2016 and November 2017 in our hospital were retrospectively collected and analyzed.There were 5 males and 1 female with their age ranging from 48 years to 68 years.Five renal tumors were right-sided and one left-sided. Three cases fell in level 0 VTT,one in level I and two in level Ⅱ.preoperative imaging revealed lymph node involvement in 1 case and distant metastasis in 2 cases.For RCC with level 0 VTT,the renal vein of the affected side was adequately and carefully dissected around the thrombus to the proximity of inferior vena cava (IVC)and was ligated with Hem-o-loks without cross-clamping the IVC.For level Ⅰ and Ⅱ VTT,the IVC was cross-clamped cephalically and caudally around the tumor thrombus and all tributaries were sequentially blocked to ensure the safe retrieval of VTT.All operations were successfully completed without conversion to open operation.The mean operative time was 150(115-230)min.Cross-clamping of the IVC happened in 3 cases,and the blocking time was 14, 19 and 20min,respectively.The mean estimated blood loss during the operation was 400 (200-580)mL.The peritoneal drainage tube was removed 5 to 9 days after the operation, and all patients were postoperatively discharged at 6 to 11 days.Postoperative pathological analysis confirmed that the RCCs were comprised of 4 clear cell RCCs,1 papillary cell RCC,and 1 medullary cell RCC;2 cases were Fuhrman grade Ⅱ,3 cases grade Ⅲ,and 1 case undefined grade.No recurrence or progression was observed during the follow-up of 4.2(3-6)months.We concluded that RAL-NVT is highly challenging but safe and feasible for the treatment of RCC with VTT.

Metabolic reprogramming drives homeostasis and specialization of regulatory T cells in cancer

Transcription factor forkhead box P3(Foxp3)+regulatory T(Treg)cells are receiving increasing attention because this unique subset of T cells is characterized by exerting negative regulatory function of cellular immune responses.The resultant suppression of anti-tumor immunity in the tumor microenvironment(TME)is regarded as a major obstacle to immunotherapies in a plethora of cancers.Thus,an integrated understanding of the intrinsic correlation between tumors and Treg cell biology is urgently required.This review focuses on the peculiar biochemical effects of tumor metabolic environments on Tregs and how Tregs orchestrate internal metabolic switches and altered metabolic pathways and molecules to survive and function after the remodeling of homeostasis and specialization,providing new directions for immunotherapies.

The O2-ZmGRAS11 transcriptional regulatory network orchestrates the coordination of endosperm cell expansion and grain filling in maize

Maize(Zea mays)endosperm filling is coordinated with cell expansion to enlarge the grain size,but the mechanism coupling the two processes is poorly understood.Starchy endosperm cells basically contain no visible vacuoles for cell expansion.During grain filling,efficient synthesis of storage compounds leads to reduced cytoplasm and thus lowered cell turgor pressure.Although bioactive gibberellins(GAs)are essential for cell expansion,they accumulate at a low level at this stage.In this study,we identified an endosperm-specific GRAS domain-containing protein(ZmGRAS11)that lacks the DELLA domain and promotes cell expansion in the filling endosperm.The zmgras11 loss-of-function mutants showed normal grain filling but delayed cell expansion,thereby resulting in reduced kernel size and weight.Overexpression of ZmGRAS11 led to larger endosperm cells and therefore increased kernel size and weight.Consistent with this,ZmGRAS11 positively regulates the expression of ZmEXPB12,which is essential for cell expansion,at the endosperm filling stage.Moreover,we found that Opaque2(O2),a central transcription factor that regulates endosperm filling,could directly bind to the promoter of ZmGRAS11 and activate its expression.Taken together,these results suggest that endosperm cell expansion is coupled with endosperm filling,which is orchestrated by the O2-ZmGRAS11-centered transcriptional regulatory network.Our findings also provide potential targets for maize yield improvement by increasing the storage capacity of endosperm cells.