Kwv yees Glomerular filtration Rate poob ntawm 1 Xyoo Tom Qab Tsawg Tshaj Plaws Ib Nrab Nephrectomy: Kev Sib Piv Ntau Yam Ntawm Cov Kws Ua Ntej
Jul 12, 2023
Abstract
1. Keeb kwm
Lub raum ua haujlwm ntev tom qab ib nrab nephrectomy (PN) yog qhov nyuaj rau kwv yees vim nws cuam tshuam los ntawm ntau qhov hloov pauv thiab tsis hloov pauv, feem ntau cuam tshuam hauv kev sib raug zoo.
2. Lub hom phiaj
Txhawm rau txheeb xyuas qhov sib txawv uas cuam tshuam rau lub raum ua haujlwm ntev tom qab PN thiab ntsuas lawv qhov hnyav.
3. Tsim, teeb tsa, thiab koom nrog
Tag nrho ntawm 457 tus neeg mob uas tau txais kev kho neeg hlau (n=412) lossis laparoscopic PN (n=45) tau txheeb xyuas los ntawm ntau qhov chaw thoob ntiaj teb database.
4. Kev ntsuas cov txiaj ntsig thiab kev txheeb xyuas kev txheeb xyuas
Qhov 1-yr kwv yees glomerular filtration rate (eGFR) feem pua poob (1YPL), txhais tau tias yog qhov feem pua eGFR hloov pauv los ntawm qhov pib ntawm 1 xyoo tom qab kev phais, yog qhov kawg ntawm qhov tshwm sim. Cov kws tshuaj ntsuam xyuas suav nrog cov ntaub ntawv pej xeem, cov tsos mob qog noj ntshav, thiab kev ua haujlwm thiab kev hloov pauv tom qab. Bayesian multimodel tsom xam ntawm covariance tau siv los tsim txhua tus qauv ua tau thiab sib piv qhov haum ntawm txhua tus qauv rau cov ntaub ntawv ntawm tus qauv Bayes yam. Bayesian qauv nruab nrab yog siv los ntsuas qhov kev txhawb nqa rau txhua tus kwv yees los ntawm kev suav nrog Bayes yam (BFincl). High-dimensional undirected graph kwv yees tau siv rau kev tsom xam network ntawm kev ywj pheej ntawm kev kwv yees.
5. Cov txiaj ntsig thiab kev txwv
Ntau tus qauv tau pom tias ua tau rau qhov kev kwv yees ntawm 1YPL. Tus qauv zoo tshaj plaws, suav nrog postoperative eGFR feem pua poob (PPL), kev sib deev, cov txheej txheem ischemia, thiab preoperative eGFR, yog 207 npaug ntau dua li tag nrho lwm cov qauv hais txog kev kwv yees kwv yees kev ua tau zoo. Nws cov khoom yog ib feem ntawm 44 tus qauv saum toj kawg nkaus thiab yog cov kws tshaj lij nrog BFincl siab tshaj plaws. Lub luag haujlwm ntawm tus mob khaub thuas ischemia, lub raum nyob ib leeg, kev ua haujlwm ntawm tus kws phais, thiab hom renography tsis raug ntsuas.
6. Cov lus xaus
Preoperative eGFR, poj niam txiv neej, cov txheej txheem ischemia, thiab PPL yog qhov kev kwv yees zoo tshaj plaws ntawm eGFR feem pua poob ntawm 1 xyoo tom qab PN tsawg kawg nkaus. Lwm qhov kev kwv yees zoo li tsis muaj feem cuam tshuam, vim tias lawv qhov kev cuam tshuam tsis tseem ceeb lossis twb tau ze rau qhov cuam tshuam ntawm plaub qhov kev txwv no.
7. Cov ntsiab lus ntawm tus neeg mob
Lub raum ua haujlwm 1 xyoos tom qab tshem tawm ib feem ntawm lub raum yog nyob ntawm kev sib deev, cov txheej txheem siv los txwv cov ntshav ntws mus rau lub raum thaum lub sijhawm phais, thiab lub raum ua haujlwm ntawm lub hauv paus thiab thaum ntxov postoperative lub sijhawm.
Nyem qhov no kom paub seb qhov cuam tshuam ntawm Cistanche ntawm raum yog dab tsi
Taw qhia
Ib nrab nephrectomy (PN) yog tus qauv kho rau T1 lub raum loj [1]. Hauv kev sib piv rau radical nephrectomy, PN yog txuam nrog qis qis ntawm cov kab mob hauv lub raum (CKD) thaum tswj xyuas cov txiaj ntsig zoo xws li oncologic thiab kev nyab xeeb [2]. Kev khaws cia ntawm lub raum ua haujlwm yog qhov tseem ceeb hauv cov neeg mob uas muaj qhov tshwm sim ua ntej, mob raum tsis zoo, lossis mob qog noj ntshav ob sab, vim nws tuaj yeem cuam tshuam rau kev pheej hmoo ntawm kev tuag los ntawm lwm yam ua rau [3].
Tam sim ntawd thiab mus sij hawm ntev lub raum ua haujlwm tom qab PN cuam tshuam los ntawm ntau qhov hloov pauv thiab tsis hloov pauv, suav nrog cov pej xeem, cov kab mob ntsig txog, kev ua haujlwm tsis zoo, thiab kev ua haujlwm tom qab, feem ntau cuam tshuam hauv kev sib raug zoo [4].
Nyob rau hauv txoj kev tshawb no, peb nrhiav kev txheeb xyuas cov kev hloov pauv uas cuam tshuam rau lub raum ua haujlwm ntev thiab ntsuas lawv cov txheeb ze qhov hnyav hauv kev txiav txim siab qhov feem pua ntawm cov kev hloov pauv hauv kwv yees glomerular filtration rate (eGFR) ntawm 1 xyoo tom qab PN tsawg tsawg.
Kev sib piv ntawm Bayesian multimodel tau siv los sib piv qhov kev kwv yees ua tau zoo ntawm txhua qhov kev sib txuas ua ke ntawm cov neeg twv ua ntej thaum ntsuas qhov kev kwv yees yuam kev thiab qhov txaus ntshai txaus ntshai. Siv Bayesian qauv nruab nrab, nws muaj peev xwm ua kom hnyav txhua tus kwv yees thoob plaws txhua tus qauv thiab muab cov ntaub ntawv ntawm nws qhov kev kwv yees tag nrho thiab kev ua tau zoo.
Cov neeg mob thiab cov txheej txheem
1. Cov neeg mob
Kev tshawb fawb thoob ntiaj teb, ntau lub chaw, pawg thawj coj saib xyuas-pom zoo, kev tshawb fawb rov qab suav nrog cov neeg mob uas tau laparoscopic lossis neeg hlau pab PN ntawm tsib lub tsev kawm ntawv (peb los ntawm Tebchaws Europe thiab ob lub tebchaws Asmeskas) ntawm 2013 thiab 2019 tau ua. Cov txheej txheem suav nrog yog (1) cov neeg laus uas tau kuaj pom muaj lub raum qog hauv zos (T1 lossis T2); (2) tab tom raug neeg hlau lossis laparoscopic PN; thiab (3) nrog rau cov lus piav qhia tag nrho ntawm cov yam ntxwv ua ntej thiab tom qab kev phais, suav nrog mus txog rau 1-yr cov ntaub ntawv rov qab. Cov txheej txheem cais tawm hauv qab no tau siv: (1) cov neeg mob uas tau txais radical nephrectomy lossis kev kho tsis yog phais; (2) cov neeg mob menyuam yaus; thiab (3) cov neeg mob uas hloov lub raum los yog keeb kwm ntawm ntau PNs ntawm tib lub raum.
2. Cov ntaub ntawv khaws tseg Cov ntaub ntawv pej xeem thiab cov yam ntxwv ntawm lub hauv paus suav nrog hnub nyoog, poj niam txiv neej, haiv neeg, kub siab, ntshav qab zib mellitus xwm txheej, lub cev qhov hnyav, American Society of Anesthesiologists qhab nia, tib lub raum, thiab hemoglobin ua ntej. eGFR tau suav nrog CKD-Epidemiology Collaboration equation. Ntshav siab yog txhais tau tias yog ntshav siab systolic siab dua lossis sib npaug li 140 mm Hg lossis diastolic ntshav siab ntawmNtau dua lossis sib npaug90 mm Hg los yog noj tshuaj antihypertensive. Cov ntaub ntawv ntawm cov qog thiab cov ntsiab lus ntawm kev ua haujlwm suav nrog cov qog nqaij hlav loj, Radius, Endophytic, Ze rau kev sau cov kab ke, Sab Nrauv / posterior, Qhov Chaw (RENAL) cov qhab nia, txoj kev phais, cov txheej txheem clamping, lub sijhawm sov ischemia (WIT), lub sijhawm ua haujlwm, kwv yees cov ntshav poob ( EBL), thiab cov teeb meem intraoperative. Cov ntaub ntawv postoperative suav nrog eGFR ntawm kev tso tawm, qhov ntev ntawm kev nyob, thiab cov teeb meem tom qab phais. eGFR postoperative feem pua poob (PPL) raug xam raws li qhov feem pua ntawm qhov sib txawv ntawm lub hauv paus eGFR thiab eGFR thaum tso tawm: (preoperative eGFR -postoperative eGFR) * 100 / preoperative eGFR.
Qhov kev ua haujlwm tau zoo kawg yog qhov 1-yr eGFR feem pua poob (1YPL), txhais tau tias yog qhov feem pua eGFR hloov pauv los ntawm qhov pib ntawm 1 xyoo tom qab kev phais: (eGFR ntawm 1 xyoo - preoperative eGFR) * 100 / preoperative eGFR.
Cistanche extract
3. Kev txheeb cais
Txhawm rau kwv yees 1YPL, kev tshuaj xyuas ntawm cov sib txawv (ANCOVA) nrog ntau qhov sib txawv thiab sib txawv tau ua tiav. Txhawm rau txhawm rau txheeb xyuas cov qauv uas sib npaug ntawm qhov kev kwv yees yuam kev thiab kev pheej hmoo txaus ntshai, Bayesian multimodel sib piv tau siv. Nyob rau hauv Bayesian cov txheeb cais, cov kev ntseeg ua ntej (kev faib ua ntej ntawm tus qauv thiab qhov tshwm sim ntawm qhov tshwm sim) tau hloov kho nrog kev suav nrog cov ntaub ntawv yuav tshwm sim hauv kev ntseeg tom qab (tom qab kev faib tawm). Qhov tshwm sim ntawm cov ntaub ntawv yog kev txhawb nqa los ntawm cov ntaub ntawv rau lwm qhov kev xav thiab suav nrog siv Bayes yam (BFs). Nrog Bayesian multimodel ANCOVA, nws muaj peev xwm kov yeej qhov tsis paub tseeb los ntawm kev siv tib tus qauv los ntawm kev sib piv qhov kev ua tau zoo ntawm txhua qhov kev sib txuas ntawm cov neeg twv thiab suav cov txheeb ze plausibility ntawm txhua tus qauv txheeb ze rau lwm tus. Tsis tas li ntawd, Bayesian qauv nruab nrab tuaj yeem siv los ntsuas qhov ntsuas txhua qhov kev kwv yees thoob plaws txhua tus qauv thiab muab cov ntaub ntawv ntawm nws qhov kev kwv yees tag nrho kev ua tau zoo thiab plausibility [5]. Hauv thawj kauj ruam, peb tau ua qhov kev sib piv ntawm tus qauv Bayesian thiab suav cov qauv tom qab qhov tshwm sim P(M|cov ntaub ntawv) los ntsuas qhov txheeb ze ntawm txhua tus qauv thoob plaws tag nrho cov qauv qhov chaw; peb siv tus qauv BF (BFM) raws li qhov taw qhia ntawm cov qauv kev kwv yees ua tau zoo, lossis cov qauv yuav ua tau, uas ntsuas pes tsawg zaus cov ntaub ntawv muaj feem ntau tshwm sim raws li tus qauv tshwj xeeb tshaj li txhua qhov nruab nrab ntawm qhov chaw. BF01 tau siv los sawv cev rau qhov kev kwv yees kwv yees ua tau zoo (zoo li) ntawm tus qauv zoo tshaj plaws txog tus qauv txiav txim siab [6]. Rau tus qauv ua ntej qhov yuav tshwm sim P(M), peb xaiv tus qauv zoo ua ntej thiab yuam kom txhua tus qauv sib npaug ua ntej pom cov ntaub ntawv [7]. Hauv kauj ruam thib ob, peb siv tus qauv Bayesian qhov nruab nrab txoj hauv kev los xaiv qhov sib txawv uas muaj txiaj ntsig zoo hauv kev kwv yees 1YPL thiab ntsuas qhov kev txhawb nqa rau txhua tus neeg twv ua ntej raws li nws qhov muaj feem cuam tshuam tom qab P (nrog rau cov ntaub ntawv), uas yog qhov tshwm sim ntawm suav nrog hauv tus qauv. tom qab soj ntsuam cov ntaub ntawv. P (incl|data) yog qhov suav ntawm P(M|data) rau cov qauv nrog rau qhov sib txawv. Peb muab piv rau qhov kev ua tau zoo ntawm cov neeg twv twv ua ntej hauv cov ntsiab lus ntawm BExcl, uas yog qhov sib piv ntawm qhov yuav ua rau cov qauv tsis suav nrog tus kwv yees thiab cov qauv nrog rau nws. Nyob rau hauv txoj kev no, cov ntaub ntawv yog FBexcl lub sij hawm ntau dua yuav tshwm sim nyob rau hauv cov qauv uas tsis suav nrog tus kwv yees li cov qauv uas suav nrog. BFincl sawv cev rau qhov sib txuam ntawm BBexcl. Qhov feem pua yuav raug siv los txheeb xyuas qhov kev ua yuam kev feem cuam tshuam nrog kev kwv yees BF thiab qhia txog qhov feem pua qhov tseeb hauv kev kwv yees tus nqi ntawm txhua BF. Peb kuj tau tshaj tawm cov qauv-qhov nruab nrab qhov loj me rau txhua qhov ntsuas (regression coefficient b) los ntsuas qhov hnyav ntawm txhua tus kwv yees hauv kev kwv yees 1YPL. Qhov nruab nrab b raug xam los ntawm qhov nruab nrab ntawm qhov b qhov tseem ceeb rau tus kwv yees thoob plaws txhua tus qauv thiab hnyav los ntawm P (M|- cov ntaub ntawv). Kev sib txawv ntawm tus qauv (SD) thiab 95 feem pua ntawm kev ntseeg siab rau kev kwv yees kuj tau tshaj tawm. Peb xaiv Jeffrey-Zellner-Siow faib rau qhov ua ntej qhov tshwm sim. Txhawm rau piav qhia txog kev sib koom ua ke ntawm qhov sib txawv, peb tau ua ib qho kev soj ntsuam hauv lub network ntawm kev ywj pheej raws li kev cia siab ntawm cov neeg twv ua ntej uas siv cov qauv ntsuas ntsuas qhov ntsuas qhov ntsuas siab tsis zoo; nyob rau hauv lub resulting acyclic graph, variables yog qhia raws li nodes thiab conditional dependencies raws li ntug [8]. Txhua qhov kev txheeb xyuas txheeb xyuas tau ua tiav siv JASP (version 0.14; JASP Software Ltd., Warrington, UK).
Cistanche hmoov
Kev sib tham
Txoj kev tshawb no qhia tau hais tias ntau tus qauv yog qhov ua tau rau kev kwv yees lub raum poob ntawm 1 xyoo tom qab muaj kev cuam tshuam tsawg kawg nkaus PN. Peb pom tias tus qauv zoo tshaj plaws suav nrog kev sib deev, ua ntej eGFR, txheej txheem ischemia, thiab PPL. Tag nrho cov qauv uas muaj plaub qhov sib txawv no tau nthuav tawm qhov muaj peev xwm nce ntxiv tom qab pom cov ntaub ntawv thiab pom tias muaj kev kwv yees ntau dua li cov qauv suav nrog tag nrho lossis qee qhov kev hloov pauv ntxiv. Tus qauv nruab nrab thiab kev txheeb xyuas lub network ntawm kev ywj pheej muaj cai tau lees paub cov txiaj ntsig no. Ob peb lub ntsiab lus hais txog qhov kev tshawb pom no tsim nyog xav txog kom ntxaws ntxiv.
Unlike most studies in the literature, we chose percentage eGFR loss to evaluate functional loss after minimally invasive PN. Several previous models used the ultimate eGFR or progression to stage III CKD as the endpoint [9–12]. Choice of a similar criterion might lead to deceptive results because the dependent variable is directly calculated from the same variables (ie, age, sex, or serum creatinine) that it is tested against. This always results in the identification of those variables as important predictors of the outcome. Other studies evaluated predictors of significant eGFR loss, defined as a reduction of >25 feem pua ntawm cov hauv paus eGFR [13–15]. Qhov kawg no tau daws qhov kev txwv saum toj no, vim nws tsis tas yuav cuam tshuam los ntawm kev hloov pauv siv hauv eGFR cov qauv. Txawm li cas los xij, cov kev tshawb fawb no tau xaiv tsuas yog ib pawg ntawm cov neeg twv ua ntej los tsim cov qauv uas muaj covariates suav tias muaj feem cuam tshuam. Yog li ntawd, inference nyob rau hauv tag nrho cov kev tshawb fawb yav dhau los tau ua tsis tau mus rau hauv tus account lub uncertainty los ntawm kev siv ntawm ib tug qauv ntawm tag nrho cov ua qauv; Tsis tas li ntawd, qhov hnyav ntawm txhua tus kwv yees tau tshwj xeeb rau ib qho qauv thiab tsis tuaj yeem muab cov ntaub ntawv ntawm nws qhov kev kwv yees tag nrho (zoo li) muab los ntawm cov ntaub ntawv [5]. Cov txheej txheem no tuaj yeem ua rau muaj kev kwv yees ntau dhau ntawm cov qauv precision thiab tuaj yeem muab kev kwv yees tsis sib xws.
Peb coj tus account ntawm tus qauv qhov chaw tsis paub tseeb los ntawm kev siv Bayesian qauv nruab nrab, uas muaj ntau yam qauv pab rau kev kwv yees thiab kev kwv yees. Nyob rau hauv txoj kev no, cov ntsiab lus ntawm qhov tseem ceeb thiab sib xws ntawm txhua tus kwv yees tuaj yeem muab tau. Regression coefficients uas muaj tus nqi nruab nrab ze rau xoom yuav muaj kev txwv tsis pub muaj qhov tseem ceeb hauv kev kwv yees qhov sib txawv ntawm tus kheej; Tsis tas li ntawd, cov kev kwv yees nrog 95 feem pua txhim kho lub sijhawm uas suav nrog cov txiaj ntsig tsis zoo yuav cuam tshuam rau qhov tshwm sim tsis zoo, nyob ntawm tus qauv txiav txim siab, yog li ua pov thawj tias tsis sib haum. Tshwj xeeb, kev suav ntawm qhov nruab nrab ntawm qhov nruab nrab thiab 95 feem pua txhim kho lub sijhawm rau kev rov ua haujlwm coefficients pom tias PPL, preoperative eGFR, thiab poj niam txiv neej khaws lawv qhov kev kwv yees ua tau zoo thoob plaws hauv tag nrho cov qauv qhov chaw: qhov ua tau zoo rau lawv cov coefficients regression yog tag nrho saum toj no lossis qis dua qhov null effect (b=0). Interestingly, b qhov tseem ceeb ntawm kev sib deev muaj txij li 4 mus rau 0.4, qhia tau hais tias txiv neej pw ua ke yog ib qho kev tiv thaiv rau lub raum ua haujlwm vim tias nws txo qis ntawm 1YPL. Tag nrho lwm qhov sib txawv tau ua pov thawj tsis ntseeg, nrog rau 95 feem pua txhim kho lub sijhawm uas nws qhov tseem ceeb tshaj plaws yog cov cim qhia.
Previous studies tested the use of the acute kidney injury (AKI) categories of the Acute Dialysis Quality Initiative as predictors of long-term renal failure after PN. The Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria define AKI as an abrupt loss of kidney function resulting in a >25 feem pua txo hauv eGFR los ntawm lub hauv paus [16]. Nws tau pom tias AKI ua rau muaj kev pheej hmoo ntawm kev tuag thiab kev loj hlob ntawm CKD hauv cov neeg mob uas muaj mob hauv qab no [17,18] tab sis nws tsis tau xav tias yuav cuam tshuam rau cov txiaj ntsig no thaum tshwm sim hauv cov neeg mob PN [19,20]. Txawm li cas los xij, cov kev tshawb fawb tsis ntev los no tau pom tias ob qho tib si nyob thiab lub sijhawm ntawm AKI ua rau muaj kev pheej hmoo ntawm lub raum tsis ua haujlwm ntev hauv cov neeg mob no ib yam nkaus [14,21]. Txawm li cas los xij, cov txheej txheem RIFLE yuav tsis tsim nyog rau cov neeg mob uas tau phais lub raum; Hauv cov neeg mob no, qhov nce hauv eGFR tuaj yeem yog vim ob qho kev phais thiab kev puas tsuaj rau ischemic, nrog cov txheeb ze koom nrog uas nyuaj rau kev sib txawv ntawm kev kuaj mob thiab prognostically [18].
Peb tsis tau siv tus nqi txiav tawm los txhais AKI hauv peb txoj kev kawm; Hloov chaw, peb tau ntsuas lub raum tsis ua haujlwm raws li PPL. Qhov kev xaiv no yuav muab qee cov txiaj ntsig, suav nrog kev zam kom tsis txhob muaj qhov tsis zoo ntawm dichotomization xws li poob ntawm cov txiaj ntsig loj thiab kev pheej hmoo ntawm kev faib tsis raug, tso cai rau kev sib piv nrog lwm cov kev sib txuas txuas ntxiv ntawm eGFR mus sij hawm ntev thiab ua rau muaj kev kwv yees ntau ntxiv ntawm kev ua haujlwm rov qab [22].
Peb tsis tsuas yog lees paub tias PPL muaj qhov cuam tshuam zoo rau kev ua haujlwm ntev, tab sis kuj pom tau tias PPL yog qhov tseem ceeb tshaj plaws cuam tshuam rau 1YPL. Tsis zoo li AKI, PPL zoo li muaj txiaj ntsig zoo rau kev kwv yees kev ua haujlwm ntev mus ntev txawm tias feem pua ntawm eGFR poob yog<25%; moreover, it is essential to precisely quantify the extent of PPL as a continuous variable, as it is linearly related to the outcome. An interesting difference between our study and the current literature is that PPL is a better predictor than all the other surgical variables tested, including WIT, tumor size, RENAL score, and EBL. In addition, all these variables showed little support from the data, because models that do not include them are more likely than models that use them as predictors. Finally, it should be considered that renal function decline related to postoperative acute injury could be influenced by consequent hypertrophy of the remnant healthy kidney parenchyma. Studies with longer follow-ups have shown that the impact of these modifiable parameters has a progressively lower influence on functional outcomes, while other comorbidities or de novo vascular diseases may have a significant impact on long-term outcomes [13,23].
Cistanche tubulosa
Ntau qhov kev tshawb fawb pom tias WIT yog qhov tseem ceeb hauv kev kwv yees eGFR hloov [24–27]. Lwm cov kev tshawb fawb tau txo qis nws lub luag haujlwm thiab xaus lus tias ntev npaum li WIT qis dua qhov chaw nyab xeeb (25-30 min) nws lub sijhawm tsis cuam tshuam rau eGFR mus sij hawm ntev [10,28–30].
Lub cev loj ntawm cov ntaub ntawv tau tsom mus rau feem pua ntawm parenchymal huab hwm coj khaws cia (PPMP) raws li qhov tseem ceeb ntawm kev txiav txim siab ntawm lub raum ua haujlwm, nrog WIT ua si tsuas yog lub luag haujlwm me [28,31]. Piv txwv li, ob qho tib si Simmons et al [10] thiab Ginzburg li al [15] pom tias PPMP thiab lub hauv paus eGFR, tab sis tsis yog WIT, nws tus kheej cuam tshuam nrog lub raum ua haujlwm ntev tom qab PN. Lwm tus kws sau ntawv pom tias kev suav nrog PPMP hauv ntau qhov sib txawv ntawm cov kab rov tav tau ua rau poob qhov tseem ceeb rau WIT hauv kev kwv yees eGFR ntawm 3 mo [31] lossis tom qab [32]. Nws yuav tsum tau muab sau tseg tias PPMP kev ntsuam xyuas tsis yog tam sim ntawd thiab yuav tsum muaj peb-dimensional rendering software los piv preoperative thiab postoperative lub raum xam tomography scans ua nrog intravenous contrast.
WIT thiab PPMP muaj kev sib raug zoo thiab nyuaj rau decouple [33]. Cov qog loj thiab nyuaj feem ntau cuam tshuam nrog kev txiav tawm ntawm parenchymal zoo, kev puas tsuaj loj, thiab kev puas tsuaj rau theem nrab vim kev tsim kho [9,34,35]. Tag nrho cov xwm txheej no cuam tshuam nrog ntev WIT thiab me PPMP, uas nyob rau hauv lem muaj kev cuam tshuam nrog PPL [35–37], yog li ua rau muaj ntau yam sib txawv ntawm txhua qhov sib txawv. Qhov no yog qhia meej meej los ntawm kev tsom xam ntawm cov qauv network rau kev hloov pauv hloov pauv. Tshwj xeeb, txhua qhov ntawm lub network teeb sawv cev rau ib qho kev sib txawv thiab txhua tus ntug sawv cev rau qhov kev cia siab ntawm ob qhov sib txawv tau muab rau lwm tus. Ob qhov sib txawv thaum pib pom tias muaj kev sib raug zoo (piv txwv li, marginally dependent) tuaj yeem ua rau muaj kev ywj pheej (tsis muaj ntug ncaj nraim ntawm ob lub nodes) thaum lawv qhov kev sib raug zoo tau piav qhia los ntawm qhov sib txawv thib peb uas muaj feem cuam tshuam rau ob qho tib si. Piv txwv li, tom qab qhia PPL rau hauv tus qauv, WIT thiab 1YPL ua raws li kev ywj pheej, vim WIT cuam tshuam cov txiaj ntsig ntawm PPL. Tsis tas li ntawd, thaum cov kev kwv yees muaj kev ywj pheej ntxiv rau cov qauv uas twb muaj cov kev hloov pauv raws li kev cia siab, lawv tsis zoo li yuav ua rau cov qauv kev kwv yees nce ntxiv. Hauv peb qhov kev tshuaj xyuas, cov qauv uas muaj WIT thiab PPL ua tau zoo dua li cov qauv uas muaj PPL nkaus xwb vim tias qhov cuam tshuam ntawm WIT ntawm 1YPL twb nyob ze rau hauv cov nyhuv PPL.
Peb cov ntaub ntawv tsis muaj cov ntaub ntawv tiav rau PPMP, yog li peb tsis tau ntsuas qhov sib txawv no. Txawm li cas los xij, PPMP yuav tsum tsis txhob ntxiv cov txiaj ntsig rau peb cov qauv; thaum ntau qhov sib txawv ntawm PPMP, suav nrog qhov loj me me, RENAL tus qhab nia, thiab qog theem [35], tau ntxiv rau tus qauv uas muaj PPL, cov qauv muab los tsis muaj qhov zoo dua. Hauv lwm lo lus, cov kev hloov pauv no cuam tshuam nrog PPMP tsis tuaj yeem piav qhia txog qhov sib txawv ntawm qhov seem, ua tiav qhov kev ua tau zoo tag nrho ntawm kev kwv yees. Qhov no tsis tau txhais hais tias WIT thiab PPMP tsis tseem ceeb hauv kev txiav txim siab lub raum ua haujlwm ntev, tab sis feem ntau ntawm lawv cov txiaj ntsig yog kho los ntawm PPL, uas sawv cev rau qhov zoo tshaj plaws kwv yees ntawm eGFR ntawm 1 xyoo tom qab kev phais.
Hnub nyoog, kub siab, lub cev qhov hnyav, thiab ntshav qab zib mellitus tau raug txheeb xyuas raws li qhov muaj feem cuam tshuam rau CKD qhov pib thiab tseem tuaj yeem cuam tshuam rau kev ua haujlwm ntev dua [9,11,31]. Cov txiaj ntsig sib txawv tau pom rau lub luag haujlwm ntawm kev sib deev [11,31,38]. Peb ntseeg tias cov kev tshawb pom no tuaj yeem cuam tshuam los ntawm kev tshawb fawb tsim thiab kev xaiv ntawm qhov kawg, vim tias lawv txhua tus cuam tshuam nrog qis hauv lub raum ua haujlwm. Peb tau soj ntsuam lub luag haujlwm ntawm cov tshuaj kho mob xws li hnub nyoog, ntshav qab zib, rog rog, ntshav siab, thiab ua ntej hemoglobin hauv kev txiav txim siab 1YPL. Cov qauv ntsuas nruab nrab pom tau tias tsuas yog hnub nyoog muaj feem cuam tshuam rau 1YPL; nws cov txiaj ntsig yog kev sib kho los ntawm PPL thiab nws khaws cov txiaj ntsig zoo yog tias nws ntxiv los ua tus kws tshaj lij ywj pheej.
Qee cov kev tshawb fawb qhia tias kev xaiv clamping ntawm cov hlab ntsha [39] lossis zero-ischemia mus kom ze [40] ua rau muaj feem ntau dua ntawm parenchymal sparing piv rau hilar clamping. Peb cov txiaj ntsig tau qhia tias cov txheej txheem ischemia yog qhov muaj txiaj ntsig kwv yees ntawm 1YPL raws li qhia los ntawm nws cov BFincl ntawm 29.4, uas txhais tau hais tias nws cov kev suav nrog nce qhov kev kwv yees ua tau zoo ntawm cov qauv ze li 30-fold.
Ntau cov ntawv tshaj tawm pom tsis muaj qhov sib txawv tseem ceeb hauv kev txo qis hauv eGFR ntawm txoj kev phais [31,38,41]. Peb txoj kev tshawb fawb tau lees paub cov kev tshawb pom no los ntawm kev pom tias cov ntaub ntawv tsis tshua muaj tshwm sim nyob rau hauv pab pawg ntawm cov qauv nrog rau cov txheej txheem phais raws li kev kwv yees.
Peb txoj kev tshawb fawb no muaj ntau yam kev txwv. Nws yog ib qho kev tshawb nrhiav rov qab thiab yog li kev xaiv thiab kev txheeb xyuas qhov tsis ncaj ncees tsis tuaj yeem raug cais tawm. Peb cov pej xeem tuaj ntawm cov chaw ntim siab thiab tag nrho cov PNs tau ua los ntawm cov kws phais neeg muaj kev paub dhau los; yog li ntawd, peb qhov kev tshawb pom yuav tsis siv rau lwm qhov chaw kho mob. Hauv txoj kev tshawb no, cov ntaub ntawv rau 1359 tus neeg mob tau sau, nrog 896 tsis suav nrog vim cov ntaub ntawv tsis tiav. Qhov no feem ntau yog vim yog cov txheej txheem kev suav nrog nruj; feem ntau ntawm cov neeg mob no tsis muaj 1-yr cov ntaub ntawv rov qab thiab tsis muaj cov ntaub ntawv txheeb xyuas rau cov neeg mob no; Qhov no tuaj yeem qhia txog kev xaiv qhov tsis ncaj ncees thiab cuam tshuam rau qhov dav dav ntawm qhov kev tshawb pom. Peb tsis tuaj yeem txiav txim siab txog lub luag haujlwm ntawm tus mob khaub thuas ischemia, ib leeg lub raum, kev paub txog kev phais, lossis cov txheej txheem renography; qhov ua tau thiab qhov loj ntawm kev ua haujlwm mus sij hawm ntev yuav raug cuam tshuam los ntawm txhua qhov no.
Standardized Cistanche
Cov lus xaus
Ntau tus qauv muaj peev xwm ua tau rau kev kwv yees lub raum poob ntawm 1 xyoo tom qab kev cuam tshuam tsawg kawg nkaus PN. Peb qhov kev ntsuam xyuas qhia tias tus qauv zoo tshaj plaws yuav tsum muaj xws li kev sib deev, cov txheej txheem ischemia, preoperative eGFR, thiab PPL. Tag nrho cov qauv kev kwv yees uas muaj plaub qhov sib txawv no muaj qhov tshwm sim ntau dua thiab pom tias muaj kev kwv yees ntau dua li cov qauv suav nrog tag nrho lossis qee qhov kev hloov pauv ntxiv. Piv nrog rau lwm cov cuab yeej, cov kev kwv yees no yog tam sim thiab yooj yim muaj. PPL yog qhov muaj txiaj ntsig zoo rau kev kwv yees kev ua haujlwm ntev mus ntev txawm tias qhov feem pua tsawg poob qis dua 25 feem pua vim nws muaj feem cuam tshuam nrog 1YPL. Lwm qhov kev kwv yees zoo li tsis muaj feem cuam tshuam, vim tias lawv qhov kev cuam tshuam tsis tseem ceeb lossis twb tau ze rau qhov cuam tshuam ntawm plaub qhov kev txwv no.
Cov ntaub ntawv
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Fabio Crocerossa a,b, Cristian Fiori c, Umberto Capitanio d, Andrea Minervini e, Umberto Carbonara a,f, Savio D. Pandolfo a, Davide Loizzo a, Daniel D. Eun g, Alessandro Larcher d, Andrea Mario Andrea , Grosso e , Fabrizio Di Maida e , Lance J. Hampton a , Francesco Cantiello b , Rocco Damiano b , Francesco Porpiglia c , Riccardo Autorino a,
ib Division of Urology, VCU Health, Richmond, VA, USA;
b Department of Urology, Magna Graecia University, Catanzaro, Ltalis;
c Division of Urology, Tsev Kho Mob San Luigi, University of Turin, Orbassano, Ltalis;
d Unit of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Ltalis;
e Department of Experimental and Clinical Medicine, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, University of Florence, Florence, Ltalis;
f Department of Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Ltalis;
g Department of Urology, Lewis Katz Tsev Kawm Ntawv ntawm Tshuaj, Tuam Tsev University, Philadelphia, PA, USA
